National Health Service (Amended Duties and Powers) Bill

Baroness Keeley Excerpts

Friday 21st November 2014 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I congratulate my hon. Friend the Member for Eltham (Clive Efford) on his excellent opening speech—I think it was one of the best speeches I have heard in the House—and on introducing his Bill so that we can review and reform some of the more pernicious effects of the Health and Social Care Act 2012. One of the worst was to force market tendering of services, meaning that millions of pounds are wasted on the process, money that should be spent on improving front-line patient care.

As a member of the Health Committee, I am very concerned about the increasing role that private companies are paying in providing NHS services. We recently looked at what is happening in Stoke and Staffordshire. There have been a few references to that in this debate and I will talk some more about it, but we looked at it under the label of the integrated care pioneers pilot. I want to talk more about that development as an example of just what can happen under this Government’s market framework—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. There are a lot of conversations and I am struggling to hear the hon. Lady. If we need to have the conversations, can we turn them down a little?

[Barbara Keeley]

Thank you, Mr Deputy Speaker.

The clinical commissioning groups involved plan to tender by summer 2015 a £1.2 billion contract to deliver cancer services and end-of-life care for 876,000 people across the area. The witnesses we heard from made it clear that commissioning on a disease-specific basis like this is risky. There are only a few small-scale examples of that being done anywhere, and nothing on the scale of this project. Despite the risk, we heard some worrying things about local people or local MPs not being listened to and about a lack of consultation with or involvement of hospital-based clinicians. The Minister has just referred a number of times to letting doctors get on with running the NHS, but the CCGs involved in driving this pilot are not even involving or listening to local clinicians. I and other colleagues on the Committee found that bodies such as Healthwatch England and Macmillan Cancer Support were cheerleaders for—and in Macmillan’s case, a funder of—development work on a project that could end up privatising cancer and end-of-life care for almost a million people. I for one found that disturbing. I felt, and I know that some of my colleagues did too, that there was a conflict of interest. Healthwatch England was meant to be the consumer champion of health and care.

By contrast with what Government Members have said, there was also a fair amount of concern among Committee members about the role of Macmillan Cancer Support in funding the development work when many believe that the money they give to Macmillan goes directly to cancer care. Indeed, the example I saw on the Macmillan website yesterday was that a donation would pay for a Macmillan nurse for a period to help people living with cancer and their families receive essential medical, practical and emotional support. It does not appear to be a selling point for that charity that funds would be used on a project to privatise end-of-life and cancer care in Staffordshire and Stoke.

[Jeremy Lefroy]

As I have already said, I have major concerns about the form of the contract. The hon. Member for Stoke-on-Trent Central (Tristram Hunt) wrote, and I say this in defence of Macmillan:

“This is the context for our new cancer contract and we should not pass knee-jerk judgments upon new ideas which aim for better outcomes and efficiency.”

That is what Macmillan is after.

[Barbara Keeley]

I thank the hon. Gentleman for that comment, but the point is that Macmillan Cancer Support is using money fundraised by the public in ways that I do not think the public would approve of. That was the key thing we explored. It is not at all clear, if we look at the Macmillan website, how it is using approaching £1 million of the public’s money, donated on that basis.

[Valerie Vaz]

My hon. Friend mentions conflicts of interest. Is she aware that one of the companies bidding for the privatisation of cancer services is UnitedHealth Group, which was advised by the chief executive of NHS England?

[Barbara Keeley]

Indeed. Now that the shortlist for bidding has been announced for end-of-life care, we find that five of the shortlisted bidders are private companies, with only two NHS trusts on the list. For cancer care, there are three private companies and two NHS trusts. Given the seemingly headlong drive for change we found in those commissioning this large and risky contract, a great number of questions were left unanswered. For instance, despite the key role that GPs play in end-of-life care for patients choosing to die at home, the prime provider of end-of-life care will not have control over the actions of the GPs involved in that care unless a specific contract is drawn up and GPs are paid for extra tasks.

The contracts for cancer and end-of-life care are to be placed in early summer 2015, and I invite anybody with an interest in this to review the evidence and, in particular, the unanswered questions in the session the Health Committee held on 14 October. I have yet to find assurances in the evidence I have heard that the profit motive of private providers can be squared with the objective of improving cancer care and end-of-life care for patients.

[Chris Ruane (Vale of Clwyd) (Lab)]

Cancer care for north Wales is provided by bodies in the north-west of England. MPs on the Government Benches are saying that I, as a Welsh MP, should not have a vote on this matter. What does my hon. Friend think about that? Should I be concerned about standards of care and the privatisation of the English health service? My constituents will suffer if it is hollowed out and privatised by the Government.

[Barbara Keeley]

My hon. Friend absolutely should be concerned and I know that he is.

One of the elements of cancer and end-of-life care given to us as an example of where improvement is needed in Staffordshire and Stoke was patient transport. However, we know in the north-west that going to new private providers does not tend to help. We have already had a negative experience since patient transport was contracted out to the bus company Arriva.

A number of my constituents have had problems with Arriva’s patient transport. One contacted me following a wait of more than three hours for ambulance transport to be arranged for her husband. He has terminal cancer and needed to be transported back to Salford Royal after oncology treatment at the Christie hospital. That was the second time in three weeks that this terminally ill patient had to wait two or three hours for transport. Staff at the Christie hospital told my constituent that such long waits were common, despite the fact that many oncology patients are very sick.

[Mr Slaughter]

I am very grateful to my hon. Friend for giving way, particularly because the Minister did not in the course of his very long speech. Of course, that might have been because the main emergency hospital in my constituency, Charing Cross, is being demolished, losing all but 24 of its 360 beds, losing the best stroke unit in the country and losing its A and E, which, according to board papers, is moving from the site. There will be no emergency consultancy services at all. Is not what is happening on the ground very different from the jargon-filled rubbish we heard from the Minister today?

[Barbara Keeley]

Absolutely, and I am saying what is happening on the ground to a terminally ill cancer patient.

In her letter to Arriva, my constituent told the company:

“Your company should not have this contract if it displays such a lack of concern for very ill patients causing distress to both them and their relatives”.

Not only was the delay unacceptable to a terminally ill patient, but the reply to my constituent’s complaint was one of the worst I have ever seen, as we are talking about gobbledegook. For instance, the explanation for the long wait included the following sentence:

“When an outpatient booking is made, the expected outbound blocking is automatically populated, using the throughput assumption.”

The jargon that starts at the top permeates down even to the complaint handling. It took a lot more letters to get an apology for such appalling service and such a poor reply.

Another constituent has told me of unsuitable transport and untrained staff—we have heard about this happening across the country—sent to the home of a patient who needed to use a wheelchair. That meant that the patient missed their appointment and an important investigation of their health was delayed by a number of weeks. I trust that the commissioners driving the privatisation of cancer services in Staffordshire and Stoke are aware of just how wrong transport services can go with a private transport provider.

This Government’s measures have put competition and privatisation above the needs of NHS patients. The Health and Social Care Act has put pressure on regulators to make clinical commissioning groups and NHS trusts adopt tendering processes that are not in the best interest of patients. That means wasted money, resources and time. This Bill would remove these damaging reforms, and patient care would be prioritised instead of unnecessary competition. The Bill would not prevent competition within the NHS, but it would prevent competition at the expense of patient care.

Our national health service is different from other sectors and needs a different approach. Integration to improve patient care needs collaboration rather than competition. It is a great pleasure to be in the Chamber today to speak and vote in support of the Bill.