NHS Commissioning Board

Andy Burnham Excerpts

Tuesday 5th March 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on comments by the deputy medical director of the NHS Commissioning Board on the regulations on procurement, patient choice and competition under section 75 of the Health and Social Care Act 2012.

[The Minister of State, Department of Health (Norman Lamb)]

I know that the right hon. Member for Leigh (Andy Burnham) and others have raised concerns about the effect of the regulations and I would like to address them in my response. First, however, I would like to make it absolutely clear that the regulations must be fully in line with the assurances given to the House during the passage of the Health and Social Care Bill. The former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), said to clinical commissioning groups in 2012 that

“commissioners, not the Secretary of State and not the regulators, should decide when and how competition should be used to serve…patients interests”.

That must be the case. I made it clear in Health questions last week that we would review the regulations to ensure that that was the case and that they were not open to any misinterpretation.

The right hon. Member for Leigh himself gave guidance to primary care trusts which made this clear in 2010:

“Where there is only one capable provider for a particular bundle of services or the objective of the procurement is to secure services to meet an immediate interim clinical need there will be a case for Single Tender Action (i.e. uncontested procurement). By definition, an immediate or urgent scenario will be exceptional and likely to only arise on clinical safety grounds or for example, where existing services have been suspended following intervention by the Care Quality Commission.”

The next bit is very important.

“A decision to procure through single tender should always take account of the potential to secure better value by investing in a competitive process, as long as this is justified by the scale and importance of the opportunity (i.e. it has to be worth it).”

[Interruption.] Those were the comments of the right hon. Member for Leigh.

In the Government’s response to the Future Forum report, we committed to ensuring that the regulations would simply continue that approach. However, I fully recognise that the wording of the regulations has inadvertently created confusion and generated significant concerns about their effect. I have therefore listened to people’s concerns and my Department is acting quickly to improve the drafting so that there can be no doubt that the regulations go no further than the set of principles and rules that we inherited from the previous Labour Government. Following our commitment in response to the Future Forum report, the co-operation and competition panel has been transferred to Monitor. That will ensure consistency in the application of the rules.

Concerns have been raised that commissioners would need to tender all services. That is not our intention and we will amend the regulations to remove any doubt and to clarify that the position remains the same as at present and as stated in my right hon. Friend the former Secretary of State’s letter of 2012.

Concerns have been raised that Monitor would use the regulations to force commissioners to tender competitively. However, I recognise that the wording of the regulations has created uncertainty, so we will amend them to put this beyond doubt. Concerns have also been raised that competition would be allowed to trump integration and co-operation. The Future Forum recognised that competition and integration are not mutually exclusive. Competition, as the Government made clear during the passage of the Bill, can only be a means to improve services for patients—not an end in itself. What is important is what is in patients’ best interests. Where there is co-operation and integration, there would be nothing in the regulations to prevent this. Integration is a key tool that commissioners are under a duty to use to improve services for patients. We will amend the regulations to make that point absolutely clear.

[Andy Burnham]

In less than four weeks’ time, new GP commissioners take control, yet today there is complete confusion about the job they are being asked to do. Following comments by the deputy medical director of the NHS Commissioning Board and the statement we have just heard, coalition policy on competition in the NHS is in utter chaos. It beggars belief that almost three years after the White Paper introduced by the right hon. Member for South Cambridgeshire (Mr Lansley) and after all the upheaval he inflicted on the NHS, there is still no clarity on policy today. They are in this mess because the “doctors will decide” mantra was always a fig leaf for their true ideological purpose of driving competition and privatisation into the heart of the NHS.

We notice that the Secretary of State is not here today, but perhaps the Minister will remind him of the statement his predecessor made to GPs:

“I know many of you may have read that you will be forced to fragment services, or to put services out to tender. This is absolutely not the case.”

I am tempted to ask: if the aim is to revert to the position we held, why on earth bring forward a 300 page Bill to rewrite the entire legal basis of the national health service? The truth is that they have been found out trying to sneak through the back door privatisation proposals that the Minister’s predecessors were forced to rule out to save their discredited Bill. In that light, does the Minister accept that it will not be good enough to bring these proposals back with a few cosmetic changes? Will he give a categorical assurance that there will now be a fundamental rewrite to reflect to the letter commitments given to the House and to the professions?

More broadly, we now need urgent clarification, in a full and detailed statement, of what Government policy on competition actually is. Will the Minister today send the clearest message to clinicians that they will control whether or not to use competitive tenders, and will he fulfil the pledge by his leader to protect the NHS from the full glare of EU competition law? If the Government still want to argue for more private providers in the NHS, is he confident that this will not restrict whistleblowing as it has in other outsourced public services?

Will they also respond today to the research of the Nuffield Trust, which shows that more competition in the NHS has resulted in falling productivity? A quarter of a million people who signed the 38 Degrees petition have forced the Government into yet another humiliating U-turn, but there will be lingering distrust at the fact that they had the audacity even to attempt this. The simple truth is this: the British public have never given them permission to put the NHS up for sale. Until they acknowledge that, we will never tire of reminding them.

[Norman Lamb]

I sense that the right hon. Gentleman’s speech was written before he heard what I had to say. If he had listened to it, he would know that we recognise concerns about the drafting and whether it absolutely meets the commitments already made. We want to be certain that the commitments made in this place during the passage of the Bill are met. Indeed, when the Secretary of State wrote to clinical commissioning groups in 2012, he made it absolutely clear that those groups would not be forced to go out to tender. We will make sure that that is met. [Interruption.] If Opposition Members had simply listened to what I said, they would have avoided coming up with a set of questions that completely ignored my points.

The right hon. Gentleman referred to the question of quality of care. From my point of view, poor care should be condemned wherever it happens, and he needs to remember that the scandal of Mid Staffordshire hospital happened under his and his party’s watch. The poor quality of care uncovered in that NHS hospital is completely unacceptable—just as unacceptable as poor quality care from any private provider at all. Let us be clear about that.

There will be no privatisation of the NHS under this Government. Furthermore, there will be no special favours for the private sector, which were provided under the right hon. Gentleman’s Government. It was his Government who gave £250 million to private providers of independent sector treatment centres—whether or not they delivered care. There will be no special favours under this Government’s new rules. No clinical commissioning group will be forced into competitive tender. The rules will be absolutely clear, and we shall publish the amended regulations shortly.