National Health Service (Amended Duties and Powers) Bill

Andy Burnham Excerpts

Friday 21st November 2014 Commons Chamber

[Sir Tony Baldry]

My hon. Friend makes a good point. I think the Labour party will regret signing up to every 38 Degrees campaign, because if 38 Degrees starts drafting the Labour party manifesto rather than the Labour party, the Labour party will never sort out whether it is new Labour, old Labour or any other sort of Labour, which is why it did so incredibly badly yesterday in the Rochester by-election.

[Andy Burnham (Leigh) (Lab)]

The right hon. Gentleman has just made a comment that cannot go unchallenged. He claims that the relationship that this Government have with the private sector is the same as that of the previous Government. That is absolute rubbish. When his Government’s legislation went through, he said that doctors would decide. Doctors throughout the country are now saying that they are mandated to put services out to the open market under section 75 of the Health and Social Care Act 2012—his Government’s legislation. That was not the case under the previous Government. If this Government are just doing the same as the previous Government, why did they need a 300-page Bill to rewrite the legal basis of the national health service?

[Sir Tony Baldry]

May I remind the right hon. Gentleman of a document published on 31 October 2000, under the last Labour Government? The printout that I have is entitled, “A Concordat with the Private and Voluntary Health Care Provider Sector”. It is headed, “Socialist Health Association—Promoting health and well-being through the application of socialist principles”. It was a concordat introduced by the previous Government with the private and voluntary health care sector. It says:

“Introduction. There should be no organisational or ideological barriers to the delivery of high quality healthcare free at the point of delivery to those who need it, when they need it. The Government”—

the last Labour Government—

“has entered into this concordat with the Independent Healthcare Association to set out the parameters for a partnership between the NHS and private and voluntary health care providers. It describes a partnership approach that enables NHS patients in England to be treated free in the private and voluntary health care sector.

The key tests for any relationship between the NHS and private and voluntary health care providers is that it must represent good value for money for the tax payer and assure high standards of care for the patient. The involvement of private and voluntary health care providers in the planning of local health care services at an early stage will enable the NHS to use a wider range of health facilities within their locality. To achieve this Health Authorities in their strategic leadership role will be expected to ensure that local private and voluntary health care providers are involved in the processes designed to develop the local Health Improvement Programme as appropriate.”

And it carries on. The document is headed, by the last Labour Government, “Socialist Health Association…A Concordat with the Private and Voluntary Health Care…Sector”. Indeed, the last Labour Secretary of State for Health signed a concordat with the Independent Healthcare Association on 31 October 2000.

The decision to make greater use of private sector facilities for NHS patients did not require new legislation and it was possible to undertake it within the existing legislation on the NHS, but for the avoidance of doubt let me quote the Labour party manifesto from 2001. In the chapter on NHS reform, Labour promised to

“work with the private sector to use spare capacity, where it makes sense, for NHS patients”

and to

“create a new type of hospital—specially built surgical units, managed by the NHS or the private sector—to guarantee shorter waiting times”.

In my constituency, we have an independent orthopaedic treatment centre run by the private sector and introduced under the Labour Government. We have a Darzi walk-in centre run by private GPs, which was also introduced during the time of the Labour Government.

--- Later in debate ---

[Sir Tony Baldry]

The hon. Gentleman misunderstands my point. The Act did not introduce competition into the NHS because that competition had already been introduced by the previous Labour Government, who introduced greater private sector involvement in the NHS. Labour made binding rules to manage the competition, and the Act continued that approach with an expert health sector regulator working in the best interests of patients. Removing Monitor as the health sector regulator would merely leave commissioners facing actions through the courts under Labour’s own 2006 procurement regulations, which I do not think would be in the best interests of patients.

[Andy Burnham]

I am afraid that the right hon. Gentleman has undermined his entire speech with the ignorance he has displayed in response to my hon. Friend the Member for Eltham (Clive Efford). For the first time in the history of the NHS, the Act gave a role to the competition authorities, under the Enterprise Act 2002, in taking precisely the kind of action that my hon. Friend referred to. I am very surprised the right hon. Gentleman does not know that; may I suggest that he does not know what he is talking about?

[Sir Tony Baldry]

We heard that argument during the passage of the Act, and it is simply wrong. It is wrong to suggest that somehow the Act opened the door to competition.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

Tuesday 20 March 2012 was a black day for the NHS and for this Parliament. A Bill with no mandate from the British people was allowed to pass through this House and to place market forces at the heart of our health service. It allowed this democratic House to be bypassed when it comes to decisions affecting the country’s most valued institution. In other words, it was a crime against democracy and the national health service. Ever since that dark day, the damage has been mounting: NHS services worth billions of pounds—including blue light 999 ambulance services and cancer services—forced out to open tender; millions of pounds thrown at competition lawyers and consultants to run those tenders; and NHS hospitals, freed to earn up to 49% of their income from treating private patients, doing just that and letting NHS waiting lists get longer.

[Ian Lavery (Wansbeck) (Lab)]

Is my right hon. Friend aware of the unique deal between Northumbria Healthcare NHS Trust and the Labour-led Northumberland county council in which the council bought out the PFI deal, which means a better deal for the taxpayers in Northumberland and a much better deal for the NHS trust and the patients?

[Andy Burnham]

Yes, I am aware of the deal, and it is a great example of how a Labour council, working with the NHS, can take steps to improve funding for front-line patient care. It happened because of the deal that was struck in the latter stages of the previous Labour Government.

As a result of the Health and Social Care Act 2012, NHS hospitals can earn more money from treating private patients, while NHS waiting lists get longer. Those same hospitals have now been told by competition authorities that they cannot collaborate any more because it is “anti-competitive.” How did it come to this? That is not the health service that we have known for 66 years. Every day that this illegitimate legislation remains in force is a day closer to the demise of the national health service.

[Jonathan Edwards]

In response to an FOI request, I was told by my local health board that between December last year and July this year, 373 ophthalmology patients, 90 pain management patients, 165 neurology patients and 264 orthopaedic patients were transferred to private sector providers at a cost of nearly £600,000. What is the right hon. Gentleman’s message to his Labour colleague, the Health Minister for Wales?

[Andy Burnham]

I will give the hon. Gentleman my message now: the Labour Government in England and in Wales have taken steps to bring down NHS waiting lists. When we left office, they were at the lowest ever level. I make no apology to him for those improvements.

The 2012 Act has put the NHS in danger, which is why it has to go. Back on that March day in 2012, I pledged that the party that created the NHS would repeal that Bill at the first opportunity, and today we honour that promise. The Bill before us, presented by my hon. Friend the Member for Eltham (Clive Efford), restores the right values at the heart of the NHS: collaboration over competition; integration over fragmentation; people before profits.

[Angie Bray]

Will the right hon. Gentleman care to comment on the letter in The Daily Telegraph today, signed by a number of doctors and led by the chairman of NHS Alliance, asking people not to support this Bill, as it would be a backward step for patients?

[Andy Burnham]

I am sure that Tory central office has been ringing around for a few days trying to find some doctors who are still in favour of the 2012 legislation, and they found 11. Well, I think that is probably about the limit for the number of people prepared to put their name to it. I can tell the hon. Lady that thousands of doctors lined up with the Opposition and pleaded with her party to call off its reorganisation, and that included the British Medical Association and the royal colleges, but it would not listen. The Government ploughed on regardless, and the NHS has gone downhill ever since.

That is why my hon. Friend the Member for Eltham gave a stirring speech of the kind this House needs to hear more, full of conviction and passion, standing up for the national health service that he believes in. He has brought before the House a Bill that reaffirms the words of Nye Bevan’s original National Health Service Act 1946 on the democratic accountability of the NHS to the Secretary of State and, by extension, to this House. The Bill abolishes the compulsory tendering of NHS services and removes market forces. It reduces the private patient income cap back down to single figures. Once and for all, it fully exempts the NHS from EU procurement and competition law, as is our right under the Lisbon treaty. It sends the Government an uncompromising message that the NHS will never be touched by any TTIP treaty.

In particular, I commend my hon. Friend for saying that it is about time this House regained full sovereignty over the national health service. They gave it away—the Eurosceptics sitting there on the Government Back Benches—when they mandated open tendering of services. By doing that, they placed the NHS in the full glare of European competition law. [Interruption.] They do not like to hear it, but that is what they did.

[Sir Oliver Heald]

Is the right hon. Gentleman the same man who used to talk about an end to the polarising debate on private and public sector provision? Is he the same man who, when Secretary of State, privatised the services for an entire hospital at Hinchingbrooke? What is he doing today? It is buff and blow party politics.

[Andy Burnham]

I told the hon. and learned Gentleman earlier that that was incorrect and that he should withdraw the suggestion, because I did not do that. The contract for Hinchingbrooke was awarded under his Government. I will tell him who this man is. This is the man who, when Secretary of State, introduced the concept of NHS preferred provider, because I believe in the public NHS and what it represents, unlike him. I believe in an NHS that puts people before profit, unlike him. That is the man he is talking to, and that is what I will always stand up for.

[Dr Huppert]

The right hon. Gentleman correctly says that the contract for Hinchingbrooke was let under this Government, but does he not accept that it was he who, when Health Secretary, reduced the list of bidders to five, none of which were NHS bidders, and then to three, all of which were private companies? Does he accept that he could have left NHS bidders in the process, rather than only private bidders? Then he complains when one of the providers that he shortlisted got the contract.

[Andy Burnham]

I am afraid that the hon. Gentleman has to get his facts right, because they are wrong. When I was Health Secretary and Hinchingbrooke needed to find a new operator, I asked local NHS trusts in his area to come forward, and at the time none of them wanted to do that, so we had to find an operator—

[Sir Oliver Heald]

On a point of order, Madam Deputy Speaker. I may have inadvertently said that the contract was let, but I do not believe that I did. The true position is that it was the right hon. Gentleman who took the decision to privatise the services in that hospital, and it is wrong for him to seek to deny it. [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I appreciate that the hon. and learned Gentleman wishes to ensure that the record is set straight. He has attempted so to do, but it is not a point of order for me to deal with.

[Andy Burnham]

“Attempted” is the operative word, Madam Deputy Speaker. The hon. and learned Gentleman says that it was my decision, but it was the decision of his right hon. Friend the Member for South Cambridgeshire (Mr Lansley). He did it when their Government came in, and the hon. and learned Gentleman should have the good grace to withdraw what he said.

I was in the middle of answering the intervention from the hon. Member for Cambridge (Dr Huppert)—the hon. and learned Gentleman should listen to this, because he will get his answer. I said that the process should go forward under the NHS preferred provider principle, which I introduced—he seems not to understand that. To correct him, when the previous Government left office there were three bidders, one of which was an NHS provider, so he really needs to get his facts straight—

[Dr Huppert]

Will the right hon. Gentleman give way?

[Andy Burnham]

No. The hon. Gentleman needs to get his facts straight before he tries to shout the odds in my direction.

The Bill gives back to this House sovereignty over the national health service, which millions of people will welcome. The Bill means so much to so many people who are concerned about what is happening to the NHS right now under this Government.

[Barry Gardiner (Brent North) (Lab)]

My right hon. Friend says that the Bill will mean so much to so many people. He will recall that in 1997 the waiting lists at Northwick Park hospital were the highest in the country, with people having to wait for 21 hours on trolleys. He will also know that the people in Brent and Harrow who rely on that hospital today are now enduring the highest waiting lists in the country again. Waiting lists came down on his watch, but they are back up again. What message does that send to the people of Brent and Harrow?

[Andy Burnham]

My hon. Friend is right to remind the House that in 1997 people were spending years on NHS waiting lists, and even dying while still on them. As my hon. Friend the Member for Bolsover (Mr Skinner) said, we brought those waiting lists down, and by the time we left government in 2010 this country had the lowest ever NHS waiting lists and the highest ever level of public satisfaction in the NHS. That is Labour’s record, and we will not let the Government forget it.

What is happening now? NHS waiting lists are back at a six-year high. That is the result of the reorganisation that the Government ploughed through, which nobody wanted. The country did not want it. There are millions of people out there who are concerned about what the Government are doing. It will not have escaped their notice that scores of Government MPs have failed to turn up today to defend what was one of their flagship Bills. What a shower! There are people who kept a vigil outside the House last night, in cold temperatures, imploring Members to be here to pass this Bill because the issues it raises matter so much to them. Then we have the spineless MPs of a disintegrating Government, some loaded up to the eyeballs with links to private health care, who do not have the guts to come here today to argue for what they have done. Is it any wonder that people are losing faith in this place?

[Dr Huppert]

On a point of order, Madam Deputy Speaker. The right hon. Gentleman claimed earlier that one of the bidders at Hinchingbrooke was an NHS provider, but according to the National Audit Office there was Circle, Serco and Ramsay. Can he now either correct the record for the House, or let us know which of those three he believes is an NHS provider?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The hon. Gentleman makes a perfectly good point of debate, but it is not a point of order.

[Andy Burnham]

We have spineless Government MPs who will not come here today to argue for the Act.

I congratulate the hon. Member for Rochester and Strood (Mark Reckless) on his victory and on being here today, despite being up all night—I cannot imagine that he managed to get any sleep. His party leader has said that when the hon. Gentleman is tired he says things that he does not mean—I think that he just nodded there. Given that he has been up all night, I can only conclude that he does not actually believe what he said in the speech we just heard. In three days he has gone from being in favour of the repatriation of European citizens to being against the privatisation of the NHS. That is a pretty big political distance to cover in just three days.

[Mark Reckless]

I have only ever argued for European citizens to be able to stay; any other words came from others, not me. It is the right hon. Gentleman’s party that has reversed its position, having previously privatised the Darent Valley hospital and fragmented the Medway Foundation Trust, but it now seems to have a better policy, which I am happy to support.

[Andy Burnham]

The hon. Gentleman said that he could not understand Labour’s position, but surely he remembers 2012, when Opposition Members spoke with force against that legislation, which he then voted for in the Lobby. I know that it has been a long night, but he really should try to remember these things, because they are quite important.

[Mr Anderson]

Is it not also true that the hon. Gentleman went through the Lobby not once, but 18 times, despite being told time and again that what has now happened would happen? The people who had their finger on the pulse were telling us what would happen, but he ignored them.

[Andy Burnham]

It is a tiring business being an MP and it is possible to forget things, particularly when one drinks as many pints as UKIP Members do, but they should try to remember. Their party leader once said that he would give the NHS budget to insurance companies; apparently, he does not believe that now. The deputy leader, a Mr Nuttall, said that the right hon. Member for South Cambridgeshire was to be congratulated on bringing a whiff—just a whiff—of privatisation to the NHS, and the hon. Member for Clacton (Douglas Carswell), whom the Minister quoted earlier, described the Lansley reforms as “fairly modest”. He chided his Tory colleagues who were sniping against him at the time and said that the reforms must not be derailed. The party says it is anti-politics in the way things are done. This is sheer opportunism and dishonesty.

[Mark Reckless]

I recall much of what the right hon. Gentleman said from the Dispatch Box in 2012, and I would like to credit him because a lot of it has come to pass. He was perspicacious in much of what he said and many of the assurances that I was given from the Government Front Bench have been found wanting.

[Andy Burnham]

I appreciate what the hon. Gentleman says—it would be churlish for me to say otherwise—and I am grateful for the way he said it. The things Opposition Members were saying back then have happened, and we can see the effects of the Government’s reorganisation in the NHS. With the new figures that came out this morning, we see that A and E has missed the Government’s target for 70 weeks in a row. The A and E figures are the barometer of the health and care system. They are the best place to look if we want to see whether there are problems in the health and care system. The fact that the target has been missed for 70 weeks in a row tells us that severe storms are building over the NHS.

[Mr Jim Cunningham]

I am glad my right hon. Friend raised that. It takes us back to pre-1997, when people who could not get beds were lying on trolleys. I am sure he remembers that. I can remember a hospital in Coventry that was falling down. As a result of the Labour Government, we got a new hospital.

[Andy Burnham]

My hon. Friend is right. The Labour Government inherited a situation where almost three quarters of the NHS estate was built before 1948. We transformed that, as well as bringing those waiting lists down. He is right to remind us.

I cannot believe that Government Members have not had the guts to be here today to argue for their own policy on the NHS. Or is it that under the shambolic regime of their new Chief Whip, who is now inflicting the same chaos on the parliamentary Conservative party as he did on England’s schools, the Government did not think they could win the vote today, so they did not dare to bring their troops here to hold it? I do not know what the reason is, but they clearly do not believe in their own legislation and the catastrophic reorganisation that followed. An unnamed senior Cabinet Minister has been quoted in The Times as admitting that it was their single biggest mistake.

[Mr Ronnie Campbell]

Will my right hon. Friend touch on the fact that 71 coalition Members of Parliament are being paid by private companies involved with the national health service?

--- Later in debate ---

[Andy Burnham]

It is one of the biggest scandals of recent times that people in this House who have links to private health, and many more in the other place, put through legislation that did not have a mandate from the British people and from which they would benefit financially. The story of that will one day be told in full.

The reorganisation has dragged the NHS down and left it on the brink. A reorganisation that was meant to put GPs at the heart of the NHS has left patients waiting days or even weeks to get a GP appointment. This week, there was news that the NHS has missed its cancer standard for the third quarter, leaving thousands of cancer patients waiting more than two months for treatment to start. It is a reorganisation that has systematically run down the NHS and opened the door for it to be sold off.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

The reorganisation was unnecessary. My right hon. Friend is no doubt aware that in Staffordshire a £1 billion cancer contract has been put out to tender. The newly rebuilt local hospital is concerned that that will destabilise its finances. Does he agree that we should be very careful about going down that route without proper consideration?

[Andy Burnham]

The example that my hon. Friend quotes is the best example of the fact that the Government see no limit at all on the scale or extent of privatisation in the NHS, both in terms of the monetary value— £1 billion—and the fact that they are prepared to put cancer services out on the open market.

[Mark Durkan (Foyle) (SDLP)]

Does my right hon. Friend recall that some of us supported his opposition to the Health and Social Care Bill, which purported to be England-only legislation? By its marketisation and altering of the public service ethic for the health service, it was going to be predictive legislation with severe implications for devolved services. For similar reasons we support the Bill today, because it offers a bulwark against TTIP hazards for devolved health services.

[Andy Burnham]

The Bill before us deals comprehensively with that threat from any proposed TTIP treaty. I am glad to see the hon. Gentleman in his place today.

[Robert Flello]

Is my right hon. Friend aware that the companies on the list of preferred bidders to provide cancer care in north Staffordshire include CSC computer services, which was responsible for the £10 billion IT failure, the Lorenzo system, and Interserve Investments, which was fined £11 million by the Office of Fair Trading for anti-competitive bid rigging? These are the sort of firms that our cancer services might go to.

[Andy Burnham]

Those examples will alarm people. In Greater Manchester, a bus company has been running ambulance services. We had news this week that an arms manufacturer is bidding for a GP contract. These are the things that are beginning to happen to the NHS. Nobody’s constituents have ever given their permission for any of this to happen.

We heard speeches from the hon. Member for Bosworth (David Tredinnick) and the right hon. Member for Banbury (Sir Tony Baldry), who said that nothing had changed and what was happening in the NHS now was just a continuation of what the previous Government were doing. No, it is not. The right hon. Member for South Cambridgeshire said in a speech on 9 July 2005:

“The time has come for pro-competitive reforms in…health”

and he help up the example of utilities and rail. That was the specific inspiration for his reorganisation. He sold his Bill on the basis that doctors would decide, but doctors tell us that they have no choice but to put services out to the market. Section 75 says that commissioners may not run a tender if there is only one available provider. That is never the case, which is why CCG lawyers conclude that they have no choice but to put services out to tender.

That is why we see, according to figures from the NHS Support Federation, that 865 contracts for NHS services, worth £18.3 billion, have been offered to the market. Some 67% of the contracts awarded so far have gone outside the NHS. It is this decision to mandate the tendering of services which places the NHS in the full glare of EU procurement and competition law. Because Ministers have refused to exempt the NHS from the TTIP treaty, we could soon have private US health care providers ringing up CCGs to challenge them on their commissioning decisions.

This Bill legislates to remove that threat. It repeals section 75 and it really does let doctors and local commissioners decide. It restores the role of the Secretary of State and brings much needed ministerial accountability back to this House. No longer will Ministers be told to write to NHS England when they have concerns. Instead, there will be answers from the Government Dispatch Box about the service that matters most to their constituents. It removes the role of the competition authorities that the Government’s Act introduced. It stops the ludicrous situation where hospitals such as Bournemouth and Poole are not allowed to collaborate. Importantly, it stops hospitals devoting half their beds and half their facilities to the treatment of private patients.

[Mr Slaughter]

Since Hammersmith and Central Middlesex A and E departments closed two months ago, we have had people waiting in ambulances and waiting rooms with every seat taken. We have even had people waiting on floors. The Government’s answer to that is to close two more A and E departments, those at Charing Cross and Ealing in west London. Is that not just preparing the NHS for failure and for privatisation?

[Andy Burnham]

What is happening in west London should send a shiver down the spine of every community in the country. The NHS is being torn apart, which is damaging patient care and leading to the consequences that my hon. Friend outlines.

This is how the character of the NHS is changing under this Government and before our eyes. With every year that the Health and Social Care Act stays on the statute book, the private sector will be more embedded in the NHS and the public NHS weakened as a result. The Government have undermined the “N” in NHS. They are letting our hospitals become part-privatised and they must be stopped. If the Government continue on their current course, in the next Parliament the NHS will be overwhelmed by a toxic mix of cuts and privatisation.

If the Government stop this Bill receiving Royal Assent, it will form the basis of the repeal Bill that the next Labour Government will lay before the House in May next year. But it will do more than that: it will remove the competition role to allow the full integration of health and care to build and lay the foundations for a 21st-century NHS.

One final thing needs to be said. Before we vote, there is a simple truth that all Members in all parts of the House must confront: nobody here has permission from their constituents to put the NHS up for sale. Today is their last chance to put that right before they face their constituents in six months’ time. The people of this country value and trust a public NHS that puts people before profits. This Bill restores that. The party that created the NHS is proud to support it, and I urge all Members to vote for it.

--- Later in debate ---

[Dr Poulter]

Thank you, Madam Deputy Speaker. I think the tone of that point of order made my point for me better than I could have done.

As my right hon. Friend the Member for Banbury said in what was one of the best speeches on the NHS I have heard in this Parliament, the Health and Social Care Act 2012 did not introduce competition into our NHS. To say that it did is factually incorrect, scaremongering and distracts the NHS from addressing the key issues it faces. It was the creation of a mixed health economy, implemented by the previous Labour Government, that exposed our NHS to competition law, not the introduction of the Health and Social Care Act.

[Andy Burnham]

That is a very important point that goes to the heart of this debate and that really needs to be cleared up for those listening and watching. The Minister said that the Act did not introduce competition. Will he confirm that it gave, for the first time, a role to the competition authorities under the Enterprise Act 2002 and that since then they have intervened, for the first time ever in the history of the NHS, in Bournemouth and Poole?

[Dr Poulter]

What I will confirm is that it is factually correct, as my right hon. Friend the Member for Banbury made clear, to say that it was the previous Labour Government—Tony Blair’s Government—who introduced competition into our NHS. At the end of Labour’s time in office, I believe that £6 billion a year was going to NHS providers. The right hon. Member for Leigh was quite happy to pay private sector providers 11% more than NHS providers for providing the same service. That was Labour’s commitment to the private sector, which we have cleared up and put right in the 2012 Act.

Let us remember what the Labour party said in its last general election manifesto. I am sure Labour Members will remember it well—the right hon. Gentleman may well have written it. It said:

“All hospitals will become Foundation Trusts…Foundation Trusts will be given the freedom to expand their provision…and community care, and to increase their private services”.

That is from the manifesto that every Labour Member stood on at the last election. The facts are clear: competition in our NHS was introduced well before this Parliament and well before this Government came into power. It was introduced by policies made by Members who now sit on the Opposition Benches—the policies of the previous Labour Government.

As my right hon. Friend the Member for Banbury reminded us, it was Labour that introduced the use of independent treatment centres in 2003, the “any willing provider” policy and the advent of patient choice in 2006, and it was Labour’s policies when in government that brought NHS commissioning under the scope of European competition law through the Public Contract Regulations 2006.