Health and Social Care Bill

Earl of Clancarty Excerpts

Tuesday 11th October 2011 Lords Chamber

[The Earl of Clancarty]

My Lords, I rise, as others are doing, who do not usually speak in a health debate, to register my own concern about this Bill, with its potential far-reaching significance. If I have interests to declare, it is that my wife is a health journalist and my brother a surgeon who, like many, is devoted to the NHS as a public service.

Despite its faults, since its inception the NHS has been over decades a public service without equal. In my case, as someone with a chronic condition—asthma—I have benefited from the way it has been managed, indeed the way that the NHS still is able to handle long-term conditions. But I have also seen the NHS at its best in acute situations, such as when my own daughter was born nearly two months premature. Undoubtedly, her life was saved by the NHS.

The question I would then ask is: would these have been managed as well, and for free, under private care? I do not believe that they would, but more authoritative support for that belief lies in the huge number of briefings that we in this Chamber have all received from the healthcare experts themselves: from doctors, consultants, nurses, patients, academics, institutions, organisations, hundreds of people—indeed the tip of an iceberg of opinion, the overwhelming majority of whom are highly critical of this Bill, and critical in much the same vein, which is that the move towards greater commercialisation, a road that this Government are already proceeding down before this Bill is even passed, will be a huge disaster for the NHS.

This is an important question, because the main threat to the NHS lies in the introduction of the free competitive market, and indeed the noble Baroness, Lady Jay, has already given us today the example of Assura Medical being the preferred bidder for Surrey community health services over an award-winning social enterprise.

I believe that if an entity such as the NHS changes radically its internal workings, then the message and meaning of that entity must also change. This is why I share the fear many have that the NHS will simply become a kitemark, because what was previously the key aspect of that entity—healthcare that was universal, comprehensive and free—will simply not be compatible with the NHS’s new construction.

In the first instance, though, and what should be greatly disturbing to the public, is the discrepancy between on the one hand what the experts think and say, and on the other what the Government say they are doing and what they say the experts feel about this Bill.

If the term “privatisation of the NHS” had been used by any party in its manifesto, we all know that no voter would have gone near it. Andrew Lansley denied last week at the Conservative Party annual conference that that is what the Government are doing when he said,

“the NHS will never be fragmented, privatised or undermined”.

Yet in the—perhaps to his credit—more transparent words of the Minister at the Independent Healthcare Forum on 7 September, previously mentioned in this debate by the noble Lord, Lord Clinton-Davis, not only did he say that there will be,

“huge opportunities for high quality companies”—

but that—

“we want to create as level a playing field as possible”.

To me, that is as clear a signal of an intent to privatise the NHS as one could possibly give, whether such intent is acknowledged or not. It does not take a healthcare expert to understand, even with checks in place, but with a marked reduction in accountability for the Government, as this Bill would effect, that our National Health Service would become an industry where the public NHS is only one provider among a host of private ones; and one that may very likely eventually be squeezed out altogether.

This sense is supported by what the healthcare experts say. Organisations including the Royal College of General Practitioners, the BMA, the Royal College of Nursing, the Royal College of Midwives and many others directly contradicted David Cameron’s statement on 7 September at Commons Question Time of healthcare organisations’ support for the reforms.

The problem in recent weeks is that the Government have had the louder voice—what Andrew Lansley and David Cameron say gets coverage in the media. The healthcare experts, by and large, have not had that coverage. However, it is right that we should give a voice in this Chamber to these views. They are not being given enough of one, and, to be blunt, I know as a non-healthcare expert, whose views I would rather pay attention to.

For example, there can be no more damning indictment of this Bill than the letter published in the Daily Telegraph on 4 October from over 400 top healthcare professionals that stated:

“The Bill … ushers in a … degree of marketisation and commercialisation that will fragment patient care; aggravate risks to individual patient safety; erode medical ethics and trust within the health system; widen health inequalities; waste much money on attempts to regulate and manage competition; and undermine the ability of the health system to respond effectively and efficiently to communicable disease outbreaks and other public health emergencies”.

Dr Peter Carter, chief executive of the Royal College of Nursing, says:

“This fragmentation risks … preventing health providers from collaborating in the interests of patients. We must avoid a situation where existing NHS providers are left with expensive areas of care while private providers are able to ‘cherry pick’ the services which can be delivered easily”.

But of course that is exactly what will happen with a level playing field, and the head start, the necessary head start, that the public NHS as a provider has always had—which is also, perhaps I may remind your Lordships, our head start, as the NHS belongs to us not private individuals—will be lost, and that services such as acute care, which I understand private providers do not like, will suffer.

Yesterday, the Royal College of General Practitioners published a survey saying that more than 70 per cent of respondents strongly agree, or agree, with proposals by some organisations and clinicians that this Bill be withdrawn. Seventy per cent said they did not wish to be on the board of a clinical commissioning group and a mere 4 per cent thought the reforms would lead to better care. It is also expected that a significant number of GPs who do not have the expertise, inclination or time will employ private companies to do the work, creating distance and adding to the financial drain. This—despite what the Government would clearly like the public and us to believe—is the true picture of medical professional opinion. How many more, then, do we need?

A major reason why we find ourselves in this situation now is that the movement towards privatisation did not of course start with the present Government but has been proceeding by degrees over a long period of time; largely, it has to be said, unremarked upon by the public. In an article for the London Review of Books published on 22 September, James Meek says:

“The more closely one looks at what has happened over the last 25 years, the more clearly one can perceive a consistent programme for commercialising the NHS that is independent of party political platforms: a purposeful leviathan of ideas that powers on steadily beneath the surface bickering of the political cycle, never changing course”.

One contemporary challenge of the National Health Service is how a degree of patient choice can be accommodated within it without greater competition being understood as its necessary corollary. I say “degree” because I wonder how much patient choice as an ideal has in fact been overplayed. Yes, it is right that you should have the option of seeing a different doctor if you have a bad relationship with the one you have been seeing; yes, you should be able to have a second opinion; and yes, you should be able to visit a different hospital if you had a bad experience at the first. By and large, however, I believe that what a patient wants is appropriate care and the guidance to achieve that—something that can only happen, surely, in an NHS based on mutual trust and co-operation rather than competition. Indeed, the Coalition of Medical Specialty Societies says,

“For the overwhelming majority of our patients, having access to high quality and suitable care is more important than choice”.

Generally speaking, people do not want to travel across the country. A new article published in the Lancet by Alyson Pollock and others finds no evidence that patient choice saves lives. It noted that, given a multiple choice, patients choose the hospitals nearest to them.

When we had to rush our daughter to hospital with suspected meningitis a month after her early birth and just 48 hours after she had been allowed home, there was no choice involved. It was an instant snap judgment uninformed by outcomes, specialism or recommendations. We simply drove her to the nearest hospital, knowing instinctively that with acute care, time can be the most important factor in survival rate. However, if, through competition, the local hospital’s A&E department has been shut or the whole hospital closed, there is going to be no choice anyway.

To acknowledge the long-term creeping movement toward privatisation could make those who support a public NHS highly pessimistic, but because this is the biggest leap yet towards full-scale privatisation, we are nevertheless at a crossroads where this trend could still be stopped in its tracks and even reversed, where we still have a chance to say “enough is enough”. This is why I support first and foremost the amendment tabled by the noble Lord, Lord Rea. This is the NHS privatisation Bill. The public understand it as such and we should call it by that name and reject it.