Health and Social Care Bill

Alex Cunningham Excerpts

Tuesday 20th March 2012 Commons Chamber

[Dr Poulter]

I thank my right hon. Friend for that clarification. The Government are clearly committed to the value that lay members bring to commissioning groups, and, as my right hon. Friend has said, two is the minimum. I hope the hon. Lady will accept that it is very disingenuous to suggest that lay members who are appointed to boards of hospitals or primary care trusts, or indeed to commissioning boards, show a lack of genuine care for patients in the way in which they commission services.

Given that the Opposition have tabled a bad amendment, and given the renewed focus on a commitment to integrated care for the benefit of older patients and people with mental health problems, I believe that we should support the Government this evening.

[Alex Cunningham (Stockton North) (Lab)]

I support the amendment relating to Monitor and NHS foundation trusts. The Government seek to amend the Bill to allow—[Interruption.]

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I think the hon. Gentleman will find that he is referring to the wrong group of amendments. The group that we are discussing is headed “Secretary of State, NHS Commissioning Board and CCGs”. We will be discussing the amendment to which he referred later, and I presume that for that reason he will now resume his seat.

--- Later in debate ---

[Dr Poulter]

I hope I reassured my hon. Friend with my earlier answer. Yes, he is right that that has happened in the past. However, there is a presumption in the Bill—particularly for rural areas such as Cornwall and in Suffolk, which I represent—that the renewed focus on integrated care that we heard about earlier is the primary focus and purpose of commissioning, over and above the use of any willing provider or private sector providers. That has given me great reassurance regarding our ability to take on and deal with the big demographic challenges of looking after older people better.

I am reassured by what the Minister has said, and I urge Government Members to support the Government.

[Alex Cunningham]

I rise to support the amendment and to speak against anything that will allow 49% of the capacity of our local hospitals to be used for private patients.

Along with other measures in the Bill, the Government have accepted various amendments that will result in lengthening waiting lists for NHS patients. The Government’s relaxation of NHS waiting times targets means that hospitals are free to devote more theatre time to private patients, and they will have a clear incentive to do so in order to maximise income, given the move towards full financial independence and a “no bail-outs” culture whereby hospitals in financial trouble are allowed to go bust with no help from the Government.

The Health and Social Care (Community Health and Standards) Act 2003 placed a cap on the level of income that a foundation trust could earn from private patients. It was based on the level of a foundation trust’s private income in 2003—the year when foundation trusts first came into being—which was typically about 2%. The Bill in effect sets trusts free to deploy as much as 49% of that capacity to generate income from private patients who can afford the fees to jump the queues, which ordinary hard-working people, and the most vulnerable in our society, cannot do. This is not what patients want, not what the professionals want, and not what the NHS needs.

The Government amendments must be changed to ensure that any increase in the proportion of patient income has the approval of Monitor. Allowing individual trusts to make the decision alone means that there is no strategic overview, which Monitor would offer, and so in theory it would be possible for all the trusts in a locality to make that increase to 49% if their individual boards approved it. I wonder what that would mean on Teesside. We have two major hospitals, so half the capacity for NHS patients could go. Labour’s amendment would set a tougher cap on private patient income. Without the amendment, the NHS will take a huge step towards privatisation and we will fail to put in safeguards to ensure that the needs of the general public are met. Rather than the NHS being free at the point of delivery, more and more people will be pushed towards insurance schemes, thereby putting money in the pockets of the insurance industry and denying the exceptionally important right to have free, high-quality health care when it is needed.

[Simon Hughes]

I am absolutely clear that I was not sent to this place to force through the privatisation of the NHS, to force people from the public sector into the private sector, or to undermine great hospitals such as Guy’s, St Thomas’s and King’s College or the other hospitals in my constituency and my borough. Like colleagues from all parts of the House, I know what a fantastic service the NHS provides, not as a matter of policy but from personal experience. It saved the life of my younger brother and looked after my mother in her last days in the most fantastic way that anybody could wish for. I am clear about the commitment of the NHS.

I am therefore clear that we have to look at what the Bill says and what it will do. I have had an exchange about that with the shadow Secretary of State for Health. This is a really important issue outside this place. Clause 161 sets out the following principle:

“The principal purpose of an NHS foundation trust is the provision of goods and services for the purposes of the health service in England.”

That was not thought to be enough, so colleagues in the other place said, “Let’s for the first time ever make it clear that private activity can never be more than a minority activity.” That is why the 49% figure appeared.

However, that is not still enough—[Interruption.] Let me deal with this point. That is why Lords amendment 148 is before us. It states that if any foundation trust hospital in England proposes to increase its private income by 5% or more from its current level, which is usually about 2% or 3% of its income, the governors have to agree to the proposal by a majority. There will not be any great vote by the governors of Guy’s and St Thomas’s, King’s College or any other hospital, with the public participation in the debate that there would be, suddenly to increase their private sector activity. That is not the real world, because that is not what the British public want. There are one or two cases—