NHS Reorganisation

Angela Smith Excerpts

Wednesday 16th March 2011 Commons Chamber

[Angela Smith (Penistone and Stocksbridge) (Lab)]

Thank you, Mr Speaker, for giving me the opportunity to take part in this important debate. Health is undoubtedly one of the most important areas of public policy, and one that the British people care about deeply. We on the Opposition Benches are very proud of our record on the NHS. It was Labour who created the NHS in 1947, and Labour who saved it from Tory destruction in 1997. Under the Labour Government there was significant real growth in the resources going into health care. NHS expenditure increased by more than two thirds over 13 years, with real-terms growth averaging around 5.5% per annum. Those high rates of investment led to improvements in hospital waiting times, life expectancy and health outcomes.

It is all too easy to forget what the NHS was like under the previous Tory Government. People waited for years for treatment such as hip replacements, and it was common for patients to spend hours in the cold corridors of old hospitals built in the 19th century while waiting for beds to become available. We changed that by building new hospitals and employing more doctors and nurses.

[Henry Smith]

Will the hon. Lady give way?

[Angela Smith]

I will give way once and no more, because I want other Members to have an opportunity to speak.

[Henry Smith]

I am interested to hear the tale of life in the NHS before the Labour Government and now, because under Labour my constituents lost hospital provision, including accident and emergency and maternity services. That was the Labour experience in Crawley.

[Angela Smith]

All I will say to the hon. Gentleman is that I worked in the NHS as one of the so-called bureaucrats in the Tory ’80s, and I remember having a patient crying to me over the phone, begging me to admit him so that he could have his eye taken out, because the Tory NHS was not providing the beds or the theatre space for such operations. We changed that by investing in the NHS so that life chances for many people could be improved. There is no doubt that there are people alive today who would not be so had that investment not been made.

Before the election, the Tories promised to protect the NHS with real-terms increases in spending. Let us get one thing straight: the 0.1% per annum increase that the coalition Government said they would provide does not equate to real increases in spending, because since then inflation rates have gone through the roof. There is no real-terms increase in spending, so one has to ask why the Government want to divert a further £2 billion from tight budgets into a top-down, ideologically driven reorganisation, especially when the coalition agreement specifically stated that the Government would not do that.

Furthermore, it is a reorganisation that no one wants—and that includes the Lib Dems, as we saw with last week’s vote in the great city of Sheffield. Just this week the BMA voted against the proposals, and many other health professionals think that they are dangerous and ill thought through. Without the support of anybody, it seems, the Government are intent on forcing through

“the biggest…upheaval in the health service, probably since its inception.”

Those are not my words but the words of Chris Ham, the chief executive of the King’s Fund.

I have a fundamental disagreement with the Secretary of State’s view that competition and free markets will drive innovation in the NHS, and that profit will motivate performance. I do agree, however, with my hon. Friend the Member for Kingston Upon Hull (East) (Karl Turner), when he says that the introduction of these reforms risks removing the N from NHS. No longer will we have a national service; instead, the system will be fragmented and the postcode lottery of service will become more and more prevalent.

The notion of “any willing provider” means that many NHS hospitals will be at a disadvantage compared with private providers, which will not have to provide a comprehensive service for complex problems. “Fine,” some might say, “if that brings costs down”—but what happens when hospitals and other treatment centres become insolvent and have to close down, leaving many areas of the country without adequate health care provision? Handing over £80 billion to GPs to commission services not only risks the important relationship between patient and doctor; it is extremely risky in itself, because of the lack of accountability.

If the plans are passed unaltered, GPs, through the quality premium bonus, will have a financial incentive to keep costs down and not to refer patients for diagnostic tests or treatment. As we found the last time the Tories tried to undertake such a scheme, they could also become unwilling to take on costly patients with chronic conditions. Those who need the most help could find it more and more difficult to get the treatment that they require.

Of deeper concern is the opaque nature of the consortiums. They will have to produce annual financial reports only for the national commissioning board, and they will not have to publish them. At the same time, every council in the country will have to publish every invoice over £500.

These health reforms have no mandate with the British people. They were in neither of the coalition parties’ manifestos, and even if NHS funding were not being cut, they would still run the clear risk of destabilising the service, because they hand over £80 billion of taxpayers’ money to private institutions, with insufficient safeguards in terms of accountability. The reforms are simply wrong. To allow any willing provider to deliver services risks the destruction of the NHS and a return to the dark days of the 1930s, when we had a two-tier system, with the state providing a minimum service and those who could afford to going private. That, too, would be plainly wrong, and something that the British people have consistently said they would not want.

It was pleasing to see the Lib Dem grass-roots vote against the policy last week, so I say to Lib Dem Members, “The ball is in your court. You can be on the right side of this argument, and your party can be on the right side of the British people, if you go through the Lobby tonight with us. The choice is yours. Flex your muscles and demonstrate that you are prepared to force the Government to revisit their plans by voting with Members on this side of the Chamber tonight.”

[Andrew George (St Ives) (LD)]

It is a pleasure to follow the hon. Member for Penistone and Stocksbridge (Angela Smith), who made a number of important points about the extent of the reorganisation, quoting Chris Ham of the King’s Fund. Indeed, a number of other authoritative sources point out that these reforms amount to the most significant reorganisation of the NHS since its inception 62 years ago. Therefore, we need to look with great care at the issues that arise as a result of this substantial change. We are talking about the public institution that the majority of people in this country hold most dear, so we have a great responsibility in this House to deal with these issues seriously.

I query the hon. Lady’s final point on the purpose of today’s debate. If the intention was to alienate those who broadly share her and the shadow Secretary of State’s analysis of the Bill, then adopting the device of today’s debate was probably the best way of doing so, so I congratulate them on that. Following the debate in our conference in Saturday, I would say that if Labour Members have a significant interest in the future of the NHS, the most appropriate thing to do would be to try to form a coalition of the people who share concerns about the Bill. Many of the institutions that she and others quoted—the King’s Fund, the BMA, the GMC, the royal colleges and many others—share concerns on the basis of a very objective and dispassionate point of view and could make a significant contribution. That is how we should be doing it, not by using—I am sorry to describe it thus—the playground politics of an Opposition day debate as a means of advancing the issue.

[Angela Smith]

Is the hon. Gentleman indicating that he would be prepared to talk to Labour Front Benchers on meaningful ways of taking this debate forward?

[Andrew George]

I am prepared to talk to anyone who wants to engage constructively in improving the Bill to ensure that it achieves its stated intentions, because I do not think that it will, given the nature of the reorganisation proposed in it. The reason I will not be joining the hon. Lady and her colleagues in the Lobby to support the motion is that it is tactically wrong at this stage to engage in such antics. This issue is a great deal too important to be turned into a party political playground game.

I am pleased that the Secretary of State said today that he is prepared to listen and engage. We need to explore every opportunity to engage in constructive dialogue with him, involving all the stakeholders I mentioned, and, indeed, those in the Labour party who want so to engage, to find a way through and to ensure that the genuine concerns about the impact of the Bill are properly scrutinised. Yes, they are being scrutinised in the Bill Committee, but before we get to Report stage in this House, it is important that we create a coalition of the bodies that share these concerns. Rather than inviting them to go out on to Parliament square and wave their placards and so on, it would make a lot of sense to encourage them to engage in greater constructive dialogue than we have succeeded in achieving so far.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

I start by thanking the right hon. Member for Wentworth and Dearne (John Healey) for attending the Liberal Democrat conference last Saturday. Unfortunately, no one knew who he was when he arrived. Had he been more clearly identified, I am sure he would have received a very warm welcome from delegates, because he was welcome, as was the registration fee he paid. He will know that I gave my Liberal Democrat colleagues a guarantee on Saturday that, along with other members of this Government, we will listen to every word that Liberal Democrats said at that event.

I agreed with my hon. Friend the Member for Southport (John Pugh) when he said that it was important that we should drop the rhetoric and listen. However, I am not absolutely certain—if I can say this gently to him—whether his contribution entirely measured up to his own statement. Dialogue, yes, but dialogue is not diatribe. Let me also tell him that had the amendment in the name of Conservative and Liberal Democrat Members been selected, I would have urged hon. Members to vote for it, because it sums up the Government’s approach. We are listening to concerns and seeking to strengthen and improve the Bill, and we will continue to do so.

However, that is not what Labour is about. Labour’s purpose is very clear indeed. Those on the Labour Front Bench let the cat out of the bag a few weeks ago when the hon. Member for Islington South and Finsbury (Emily Thornberry) said in Committee that

“many of our amendments seek to undermine the Bill entirely and in every way possible”.––[Official Report, Health and Social Care Public Bill Committee, 3 March 2011; c. 448.]

That is not about improving the Bill; that is about trashing it. Sometimes it seems like we are debating two entirely different Health and Social Care Bills. One is the Bill currently in Committee—the real Bill. The other is the phantom Bill that has been conjured up by Labour Members—a hall of mirrors constructed by the Labour party and the unions that bears no resemblance to the real Bill, and is a gross distortion of so many of its provisions. Let me deal with some of the myths that have been peddled in today’s debate.

First, let me address the charge of privatisation. I thought that the

“ideological battle over using private and third sector providers”

was “over,” and that

“What matters to the public is not who provides but how well a service is provided.”

That is not just my view; that is the view of the Labour Business Secretary from 2008, the former Member for Barrow and Furness. He was a long-standing Health Minister who took that view then and, I suspect, holds it today. My right hon. Friend the Member for Charnwood (Mr Dorrell) was absolutely right: the involvement of the private sector is not new to the NHS. Indeed, involving the private sector was certainly not new to the last Government. Labour imposed private sector treatment centres on the NHS, guaranteed the private sector higher prices and, through all that, institutionalised cherry-picking in the NHS. Indeed, it is a scandal that in none of the Opposition speeches was there any sense of an apology for the £250 million spent on the private sector for doing absolutely nothing.

Instead of loading the dice in favour of the private sector, which is what Labour did, we are correcting the balance, creating a fair playing field for the full range of providers—something that Labour said in its manifesto it would do, but which it is running away from in opposition. We have tabled amendments to the Health and Social Care Bill to put beyond doubt the fact that there will not be price competition, but there will be quality competition, to ensure that, unlike Labour, we will not see differential prices set on the grounds of ownership. Under our plans there will be less competition on price than there is now and more competition on quality.

[Angela Smith]

Shirley Williams described the level playing field to which the hon. Gentleman refers as “lousy”. How would he respond to that?

[Paul Burstow]

I am looking forward to further dialogue with my noble Friend to ensure that we deliver the important improvements to the NHS that will ensure that unlike Labour, which cherry-picked and set up contracts with the private sector that undermined the NHS, we deliver a level playing field that delivers good quality care, chosen by patients not politicians.

The debate has shown that we continue to share an enduring commitment across the House to the notion that the NHS must be based on need and free at the point of use. That is what the Bill entrenches and what it will secure. Our plans are all about offering more choice to patients, more accountability for the public and more autonomy for front-line professionals. It is easy for the Opposition to attempt to caricature and distort those policies, but they are based on our belief that we need an NHS that is not about looking up to Whitehall for its lead, but about looking out to its communities and ensuring that it delivers the quality services that make a difference to our constituents.

The purpose of the motion is very clear. It is nothing to do with listening; it is all about scaremongering, opportunism and grandstanding, and the House should throw it out. We will continue to listen and to improve the Bill, but we will not do it by listening to Labour Members, who have no interest in making the NHS better and who would have cut it, had they had the opportunity to do so in government.

Question put.

NHS Reorganisation

Angela Smith Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

If the right hon. Gentleman reads the official record, he will see I have just said that I will back plans to get the efficiency savings out of the NHS. They are needed and they have to happen, and I will back them as long as all the savings are reused for front-line services to patients.

Faced with the toughest test in its history, the least NHS patients and staff can expect is that the Government keep their funding promise. At this time of all times, the last thing the NHS needs is a big internal reorganisation. The Prime Minister ruled out such a reorganisation before the election, saying:

“With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS”.

The right hon. Gentleman, now the Secretary of State, ruled it out, saying that the NHS

“needs no more top-down reorganisations”.

The coalition agreement was clear and reassuring on this point. In it, the Prime Minister and the Deputy Prime Minister pledged:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care”.

That was before the Secretary of State’s White Paper plans, which the head of the King’s Fund has called

“the biggest organisational upheaval in the health service, probably since its inception”.

Promise made in May, broken in July. Promise made by the Prime Minister, broken by the Secretary of State.

There is a story doing the rounds in the media of a journalist being briefed by No. 10, early on the morning of the publication of the White Paper, and told

“there’s nothing much new in it.”

When did the Secretary of State tell the Prime Minister that he was breaking his promise? When did he tell the Prime Minister that he was not only breaking the Government’s promise but forcing the NHS through the biggest reorganisation in its history, with a £3 billion bill attached, at a time when all efforts should be dedicated to achieving sound efficiencies and improving care for patients? This is high cost and high risk; it is untested and unnecessary.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

The Public Accounts Committee has identified that improving integration and co-ordination of services for the 580,000 people who suffer from rheumatoid arthritis would deliver efficiency savings on the annual £560 million bill faced by the NHS each year for this care. The National Rheumatoid Arthritis Society believes, however, that the new commissioning responsibilities outlined in the White Paper

“risk increasing fragmentation in services”

and reducing savings overall. Does my right hon. Friend agree?

[John Healey]

In a way it does not matter whether I agree; it matters much more that the National Rheumatoid Arthritis Society and many other patients groups are deeply concerned about this.

It is not just patients groups but professional bodies and NHS experts who are worried. Even the GPs are not convinced, and they are meant to be the winners in all this. They are meant to be the ones planning, buying and managing the rest of the NHS’s services. A King’s Fund survey carried out last month found that fewer than one in four GPs believe that the plans will improve patient care, and only one in five believe that the NHS will be able to maintain the focus on efficiency at the same time.

Oral Answers to Questions

Angela Smith Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Burns]

May I pay tribute to my hon. Friend for her assiduous work in her constituency? She represents her constituents and looks after their interests regarding the provision of the highest quality health care. From conversations that I have had with her, I fully appreciate her concerns about the financial situation. I understand that South Central strategic health authority is working closely with the trust as it implements a cost-improvement programme to achieve financial balance.

[Angela Smith (Penistone and Stocksbridge) (Lab)]

16. How many diagnostic tests for cancer he expects to be carried out by the NHS in each of the next four years.

[The Minister of State, Department of Health (Mr Simon Burns)]

The Department collects waiting times and activity data on 15 key diagnostic tests, but these data do not include the reason for a diagnostic test, such as suspected cancer. The NHS carries out more than 40 million diagnostic tests per year. The cancer reform strategy review is looking at the scope to improve survival rates by increased use of some diagnostic tests.

[Angela Smith]

I thank the Minister for that answer, although it was not quite as precise as I would have liked. How will those numbers be impacted by the Government’s decision to abandon the one-week guarantee for cancer tests and their decision not to performance-manage the abandonment of the 18-week diagnostic target?

[Mr Burns]

I say in the politest way possible to the hon. Lady that we cannot abandon a target that has never been imposed in the first place. May I remind her that, as a sop to the Labour party conference more than a year ago, the former Prime Minister merely announced an aspiration? He never provided any funding or said where the funding should go, and he never provided any clinical evidence for the viability of the proposal. Saying that the Government have abandoned a target when it never existed is sheer poppycock.