NHS Outsourcing and Privatisation

Alex Chalk Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Mr Hunt]

No, I do not think it acceptable at all, but I would ask the hon. Lady to bear it in mind that we have 2,000 more paramedics than we did in 2010 and that we have invested in a huge amount of capital equipment for the ambulance services. Of course we need to do more, but, when she talks about A&E, she should recognise the achievements of many hospitals, including her own. Every day across the NHS—even over this difficult winter—2,500 more people are seen within four hours than were in 2010.

Labour seems to think that quality problems in the NHS started in 2010. I should point out that because of what we have done to deal with the problems of Mid Staffs, which happened on Labour’s watch, including through the new Care Quality Commission regime, 2.1 million more patients every year benefit from good or outstanding hospitals than did five years ago. A couple of weeks ago for the first time the majority of hospitals in the NHS were good or outstanding, which is a huge step forward and a huge tribute to NHS staff. That might be just one reason the Commonwealth Fund last year said that the NHS was the best healthcare system in the world. When Labour was in office, it was not even the best in Europe.

There is another reason to oppose the motion. It has nothing to do with health policy, but is a much bigger point of principle. After more than five years in this role, the one thing I have learned is that good policy can be made only through frank and open discussion between Ministers and officials. It will not surprise the House to know that Ministers are human, we make multiple mistakes—not me of course—and it is critical that the Secretary of State in charge of the largest health system in the world can get honest, high-quality advice, but the motion would fundamentally undermine that.

This is not a party political point. Many Labour Members have benefitted from such advice, and all of us would want Ministers of any party in power to benefit from such advice, regardless of whether we support the Government, yet the motion asks us to release not just that written advice from officials, which would have an enormous chilling effect, but notes of confidential discussions between Ministers and officials. In short, as my right hon. Friend the Member for Aylesbury (Mr Lidington) said only last week, it would undermine the safe space within which Ministers and civil servants consider all the options and weigh up the best approach. Officials must be able to give advice to Ministers in confidence. The candour of all involved would be seriously affected if there were any fear of those discussions being disclosed.

No Government of any party have ever operated in an environment where advice is sought one week and made public the next. Let us look back to what Andy Burnham said in 2007 when he as a Minister was asked to release information. His words were:

“Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1191.]

Far from increasing the accountability of the Executive to the legislature, releasing such information would risk weakening it, as more and more discussions would end up taking place informally with no minutes taken at all.

[Alex Chalk (Cheltenham) (Con)]

Does my right hon. Friend agree that it would be completely inconsistent with the Freedom of Information Act—passed, by the way, by a Labour Government—which deliberately carved out an exemption for precisely these sorts of communications? It would be very odd—in fact, completely counterproductive—to turn that on its head.

[Mr Hunt]

My hon. Friend speaks extremely wisely. He is right: it would fundamentally weaken the ability of the Executive—which the Freedom of Information Act tried to protect—to make considered, thoughtful and wise decisions. Ultimately, that would put at risk the credibility of our democracy itself.

I think it fair to say that, despite my many faults as Health Secretary, I have pursued transparency in the NHS with greater vigour than has been the case previously. I passionately believe that in this House we must be accountable for the outcomes of all the decisions that we make, but all of us are mortal—all of us make mistakes—so if accountability is the watchword after a decision is made, thoughtfulness must be the watchword before it is made. Any measures that affect the honesty and frankness of the advice that Ministers receive would fundamentally reduce that thoughtfulness and reduce the effectiveness of our Government for the people whom they serve.

For those reasons—as well as because of all the ridiculous myths about the millions and privatisation—I have absolutely no hesitation in asking my right hon. and hon. Friends to vigorously and thoroughly oppose the motion.

--- Later in debate ---

[Alex Chalk (Cheltenham) (Con)]

The allegation of privatisation of the NHS is wholly misconceived. It is a reheated and debunked myth that irresponsible elements have been trotting out for decades, and repeating it does not make it any more true. NHS outsourcing to private providers is being weaponised in a way that involves dressing it up as a threat to the NHS’s guiding principle that treatment should be provided free at the point of use and regardless of ability to pay. That is what people understand when the expression “privatisation” is used, but the reality is that nothing could be further from the truth.

That principle is fundamental, inviolable and enduring. It is all those things because it reflects so much about the kind of country we are and want to continue to be. It is the principle that says that when a member of the public is rushed into hospital needing emergency care, we take pride in the fact that the ability to pay is irrelevant. NHS staff are interested in vital signs, not pound signs. There is no appetite in this country for the Americanisation of British healthcare. Even if there were, I could never support it, my colleagues could never support it and the Government could never support it. That is why it is so important that we make that position crystal clear.

On the issue of outsourcing, we must not rewrite history. As moderate members of the Opposition concede, certain services have been provided independently since the NHS’s inception 70 years ago. Most GP practices are private partnerships; the GPs are not NHS employees. The same goes for dentists and pharmacists. Equally, the NHS has long-established partnerships for the delivery of clinical services such as radiology and pathology, and for non-clinical services such as car parking and the management of buildings and the estate. To give an everyday example, the NHS sources some of its bandages from Elastoplast. That is common sense; it would be daft if public money was diverted from frontline patient care in order to research and reinvent something that was already widely available.

That is why certain members of the Labour party have slammed this kind of argument as scaremongering. Lord Darzi, a former Health Minister, has been highly critical. In 2017, the shadow Secretary of State said on the “Today” programme that there may well be examples

“where in order to increase capacity you need to use the private sector”,

so this argument is completely misconceived. In 2009, Andy Burnham admitted that the private sector could benefit the NHS. As Labour’s Health Secretary, he said:

“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 250WH.]

[Helen Whately]

My hon. Friend is making the point extremely well that there is complete inconsistency in Labour’s argument on this point. Which of the various parts of NHS services that are provided by independent sector providers is Labour against?

[Alex Chalk]

My hon. Friend is absolutely right. I shall give three brief examples from my own constituency. First, Cobalt is a Cheltenham-based medical charity that is leading the way in diagnostic imaging. It provides funding for research, assists with training for healthcare professionals and provided the UK’s first high-field open MRI scanner. Is the Labour party now suggesting that that should be ditched—that we should axe that fantastic facility in my constituency?

Secondly, the Sue Ryder hospice at Leckhampton Court is part-funded by the NHS and part-funded by charitable donations; again, is that for the axe under Labour? Thirdly, what about Macmillan and its nurses? It is a fantastic organisation, yet we have the extraordinary situation in which the Labour party says, “Macmillan is all right, but another provider is not.” What is the logic of the Labour position? What about Mencap? The list goes on and on.

Let me deal briefly with the second part of Labour’s motion, whereby it wants to ensure that all communications between Ministers and their officials are revealed. The reason why that is so bogus was explained clearly by the former senior Labour Secretary of State Jack Straw in a statement that was quoted with approval in the Chilcot committee’s report. He said that meetings in Cabinet

“must be fearless. Ministers must have the confidence to challenge each other in private. They must ensure that decisions have been properly thought through, sounding out all possibilities before committing themselves to a course of action…They must not be deflected from expressing dissent”.

What about advice given by officials in the form of memorandums and so on? What would Labour Members say to those officials about a motion that might result in the making public of the advice of professional civil servants—people who, of course, can never answer back themselves—that they thought was given to Ministers in confidence? As I have already indicated, it would also be completely inconsistent with the Freedom of Information Act 2000, which was introduced by a Labour Government. On both bases, the motion is misconceived, and I shall have no hesitation in voting against it.