Affordable Homes Bill

Debate between Andrew George and John Pugh

Friday 5th September 2014 Commons Chamber

[Andrew George]

I thank the hon. Lady. I am sure that the Minister will have heard those remarks.

[John Pugh (Southport) (LD)]

Is not the huge amount of discretionary money that the Government have had to throw at this scheme an indication that things are not working and that we need to move towards a more evidence-led policy?

[Andrew George]

I am grateful to my hon. Friend for making that point for me very articulately.

NHS (Private Sector)

Debate between Andrew George and John Pugh

Monday 16th January 2012 Commons Chamber

[John Pugh (Southport) (LD)]

Far be it from me to presume to criticise the wise counsel of other Members, but it is absolute nonsense to think that the NHS has always been a monolithic system of public provision. It is absolute nonsense to think that private health providers always think only of profit instead of providing a good service or that services delivered by a public body are necessarily less costly or always better than those delivered by a private provider. It is nonsense to think that choice and competition are never needed, that diversity is bad or that reform or improvement—I prefer that word—is not needed. Sensible, pragmatic, evidence-led arguments can be made for mixed provision, for improvement, for choice and competition, for the involvement of the private sector and for diversity. That is not the problem.

The problem is that pragmatism and evidence count for very little because for the past eight years health policy in this country has been in the grip of an unspoken ideology. Put very simply it goes like this: the Government have no real business in providing health services but should buy them from health providers in a market. Some will be private providers that will make a profit, some will be voluntary bodies or social enterprises and others will be the fragmented, dissected pieces of the old NHS—foundation hospitals, trusts and the like. All can be branded as NHS providers if we want and all can have the NHS logo. The differences between them all will become increasingly blurred and of no consequence. Some people believe it should not matter which of these bodies delivers health services so long as the taxpayer and not the patient pays and the Government keep out of the provider business. That idea is rather like what exists already in other countries, except that generally in those places it is insurance, not tax, that funds the system.

And it is not privatisation. Ministers can truthfully say, “We are not privatising the NHS.” It is marketisation. What is happening is that the Government are buying health in a market, either national or local—an external market. They are gradually giving up on providing health services and in my view clearly mean to do so. It is a beautifully clear, coherent ideology that is rarely explicitly set out, defended, discussed within parties or put to the electorate. Indeed, to do so might be electoral suicide.

Stage by stage over the past eight years that ideology has been progressed. If one assumes it and holds it in mind one can understand why hospitals have to become foundation hospitals independent of the state—that was a Blair idea—and why it was necessary to create a bigger private sector by offering it preferential terms, which was another Blair idea. One understands why services formerly run by primary care trusts, such as community nurses and the like, are being forced to become social enterprises and why it is suggested that NHS hospitals might do up to 49% private work and that private hospitals can do as much NHS work as they like. One also understands why the Health and Social Care Bill abolishes the Government power to start a new hospital, why there is such unseemly haste to extend “any willing provider” and why the Secretary of State, even at the cost of peace in the Lords, does not want the word “provide” back in the list of his powers. If anyone is unpersuaded regarding any of that, let them turn it the other way around and point to one—just one—recent policy initiative that clearly shows that that market solution is not the endgame and the ultimate goal.

I do not believe that ideology is in itself bad, and this ideology has the virtues of being clear, consistent and radical, but in my view it is basically wrong because a health market cannot ensure that health services integrate well—the Future Forum spotted that—or that scarce NHS funds are spent in the most efficient way, as previous Treasury reports have shown in abundance. It cannot ensure that people get the services to which they are entitled and it cannot ensure that health inequalities are properly addressed. It clearly cannot easily make the strategic planning decisions needed to sustain services, encourage training and organise research, which is precisely why these issues have been so problematic in the Bill and why we are going to find slimming down the financially challenged hospital sector so painful and so uncontrollable in its consequences.

I am not here to argue against this market ideology, because, frankly, few have the honesty to argue for it openly. It is not the official Labour policy or the official Liberal policy. I do not believe it is even the official Conservative policy. It was smuggled past all of us, including the general public, shrouded in vague pragmatic talk about choice, diversity, reform and independence, but we should have no doubt: it is ideology. How else can we possibly explain the headlong pursuit at pace of a set of reforms that complicate and make riskier the huge £20 billion efficiency programme? How else do we explain the overloading of bodies such as the Care Quality Commission and Monitor, whose inadequacies, if not apparent now, will soon become painfully apparent after the Mid Staffs inquiry reports?

[Andrew George]

Does my hon. Friend agree that it would be worth revisiting the issue of whether the NHS should be pre-eminent as first provider or in some other role before we finally make what may be a catastrophic error?

[John Pugh]

My fundamental point is that this is not evidence-led pragmatism. If we join up the policy dots, we see pure, simple, unalloyed faith in the market system to deliver health in this country. Time after time, in issue after issue, ideology trumps pragmatism and prudence.

The Labour motion is a potpourri of varied sentiments, some of which are true and some of which are confused, and some, given the history, that it is surprising the Opposition have the gall to table at all. However, we should be genuinely grateful to them because they have given us an opportunity—a platform—to name the beast, to define real choice and to cut to the quick.

Chris Mullin, in his excellent “Diaries”, describes a discussion with a fellow Member of this place, a Yorkshire MP, “a mild-mannered fellow”—I do not know who that would include—who in 2005, prophetically, said of the Labour party:

“We’re opening the door…Whatever safeguards we put in place, whatever assurances we give will be absolutely worthless once the Tories are in power…I think we will lose the next election. The Tories will come to some sort of understanding with the Lib Dems—”

NHS Reorganisation

Debate between Andrew George and John Pugh

Wednesday 16th March 2011 Commons Chamber

[Andrew George]

I am grateful to my right hon. Friend. Indeed, that is a very encouraging indication of the fact that the Secretary of State is prepared to listen. As far as I am concerned, however, he is not prepared to go far enough in reassuring me on those points, because taking the word “maximum” out of the clauses relating to price competition and the role of Monitor, the market regulator, is still insufficient. We have not got time to debate that today.

There are several issues, through which I shall canter in the few moments I have left, about the Bill’s objectives and what we want to achieve. First, we want to drive patient choice and innovation. I do not think that anyone would disagree with that, but we do not need to demolish the core—or at least the institutional architecture—of the NHS and PCTs, and alienate the majority of clinicians against achieving such innovation and patient choice.

Again, I think we all agree that giving power to communities and patients is highly desirable. However, although GPs will be given responsibility for commissioning services through the consortia, I do not think that they are particularly asking for that. Having spoken to many of them and listened to the national debate, I believe that they are reluctant, or at best resigned to taking on those roles, feeling that they have to follow that course.

If we want decentralisation, why will we end up with the ludicrous centralisation of commissioning NHS dentistry and dispensing? Indeed, every contract for a GP surgery will be centrally commissioned from an NHS commissioning board in Leeds. That is absurd. It does not even achieve what it is claimed that the Bill wants—decentralisation.

Many attempts have been made to argue that the Bill will cut bureaucracy and managers. I am not sure that that will happen. A big focus of today’s debate is the impact of competition, which will be unleashed. Once the private sector has its foot in the door, the genie will be out of the bottle. It is clear that everything, including designated services, in my view, will be open to contest. Although it is claimed that the Bill will result in fewer managers, I think that it is a dream come true for litigators, lawyers and management consultants.

[John Pugh]

Will my hon. Friend give way?

[Andrew George]

I am afraid that I do not have time.

The idea that the Bill will drive integration and social care is more wishful thinking because there will be less coterminosity between commissioning boards and local authorities under the Government’s proposals for an increased number of commissioning bodies than we have now.

Much rethinking needs to be done, and I hope that Government Front Benchers are listening.