Future of the NHS

Baroness Primarolo Excerpts

Monday 9th May 2011 Commons Chamber

[Tony Baldry (Banbury) (Con)]

The hon. Gentleman is a member of the Health Committee, so one would expect him to be well informed on these matters. I assume that he reads other reports of the House relating to health. I wonder what he would say about the report of the Public Accounts Committee that was recently published, under the chairmanship of one of his right hon. Friends, which says:

“The trend of falling NHS productivity will have to be reversed if the NHS is to deliver, by 2014-15, savings of up to £20 billion each year for reinvestment in healthcare.”

The PAC found that there were serious problems with productivity—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. Interventions, by their nature, must be brief, particularly when so many Members are waiting to speak.

[Grahame M. Morris]

I am grateful, Madam Deputy Speaker.

Indeed, that was the point that I wanted to make when the right hon. Member for Charnwood was speaking about the level of the challenge faced by the NHS. Sir David Nicholson rightly pointed out that major efficiency savings have to be made and he identified the figure. However, he did not advocate massive organisational change on top of the drive for efficiencies in the system.

During the 28 sittings of the Public Bill Committee, I raised countless issues and made numerous interventions against the health reforms. Unfortunately, the Secretary of State was unwilling to take them earlier in this debate. I have followed this matter very closely. The hon. Member for Banbury (Tony Baldry) asked if I had read the Bill. As a matter of fact, I have read it inside out and could probably give some lessons to a few Members who are in the Chamber. My conclusion is that the policy has remained basically the same, and that only the public relations strategy and the spin has changed.

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[Valerie Vaz]

I absolutely agree with my hon. Friend.

We were told by Sir David Nicolson that very little work has been done on what will happen in 2013-14. Just for the record, the UK had the second-lowest debt in the G7 in 2007-08, before the global financial crisis. Which Government are out of control with their spending?

Finally, there are many unanswered questions. I have tried to obtain the legal advice on whether EU competition law applies to the provisions of the Bill from the Secretary of State, but apparently, it is in the public interest not to disclose that to the public. However, in a recent article in the British Medical Journal, Rupert Dunbar-Rees, a GP, and Robert McGough, a solicitor, say that

“the technical argument reinforces the logical argument that the reforms further open up the NHS to EU competition law.”

Who will account for the training of doctors, and indeed health care professionals? That cannot be left at a local level. In A and E, an increased percentage of patients wait more than four hours, the maternity service in Maidstone has been closed despite GP opposition—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I am very sorry to interrupt the hon. Lady, but the clock is not correct. If she is following that, she will not know that she does not have that much time left—the clock stopped and did not start again. I would advise her to take about another minute and a half only.

[Valerie Vaz]

At Barts specialist regional cancer care unit, 20% of staff have been cut in two weeks.

An Ipsos MORI poll found that 71% agree that the NHS is the best in the world and that 72% express satisfaction with the NHS, but that was published by the Department only under pressure.

Finally, there have been 6,000 responses to the White Paper. The people of England have given their proposals, but they have not given their verdict on the Bill. They want the Prime Minister to keep his promise. If he does not do so, they will be ready to give their verdict at the next general election.

[Several hon. Members]

rose—

[Madam Deputy Speaker]

Order. May I apologise to the hon. Lady for the error with the timing? It was very gracious of her to ensure that she stayed within the time, which allows others to speak, but I think she will find that she got her time anyway.

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[Several hon. Members]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. A large number of Members still wish to speak, and we simply will not get everyone in unless I reduce the time limit further, so that is precisely what I am going to do. The time limit for contributions to the debate from Back-Bench Members is now five minutes.

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[Debbie Abrahams]

Does not the hon. Gentleman think that that is why we won the election in Wales?

The savings required are 4%, and if the Government get their way with the new economic regulator Monitor, they could go as high as 7% each year—far more than our NHS is capable of coping with.

My constituent, Peter, was refused a cataract operation, yet his vision was so poor that he was able to see the world only through a haze; as a precision engineer, furthermore, he was not able to do his job and faced the threat of redundancy. In other cases, non-compliance with NICE guidelines—on familial hypercholesterolaemia, for example—is leaving people at extreme risk of untreated cardiovascular disease.

Health professionals have almost without exception castigated the Bill for what it will do to the NHS in completely opening it up to the market, with competition law applying in full and allowing private health care providers to cherry-pick profitable services. A hospital medical director said last week that he did not know how his hospital could continue to provide care for unprofitable patients.

The unprofitable services for most hospitals are elderly care, mental health, paediatrics and maternity, which are essential services for all communities. Instead of service providers and commissioners working together to provide the best quality care they can for their patients, the trend is for hospital trusts to maximise income and compete against each other. We are already seeing that lack of co-operation when PCTs look at alternatives in commissioning. Trusts are reluctant to collaborate when they see that it might reduce their income, even if it improves the quality of patient care. Similarly, the Bill gives GPs a financial interest in restricting or refusing treatment in order to make savings and to get bonus payments from the NHS commissioning board.

Labour wants genuine savings that will enhance patient outcomes rather than produce the diminishing effect that we are currently seeing, and we believe that we can achieve that. We want hospital specialists and GPs to work together to deliver clinical care pathways that improve the quality of patient care and bring care closer to home. One local PCT is trying to introduce the use of drugs that are cheaper—and unlicensed—to treat age-related macular degeneration, but it is under severe pressure from the pharmaceutical industry. That is another way in which we could reduce costs.

There is no doubt in my mind that, unamended, the Bill threatens the founding principles and values of the NHS. It removes the duty to provide a comprehensive health service, and provides an opportunity for the new NHS commissioning board and GP consortia to charge for services. It involves a costly, ideologically driven reorganisation of the NHS that has no mandate from the British people, and no support from health professionals and that will mean the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health care; it reflects the values of our society on which this country set such store.

I know that there are many members on this side of the House—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. The hon. Lady’s time is up.

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[Tony Baldry]

No, I am not going to give way as I am conscious that many Members wish to speak, and Madam Deputy Speaker has already told me off this afternoon for taking too long.

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I was not telling the hon. Gentleman off; rather, I was reminding him of the convention.

[Tony Baldry]

I can recognise a chastisement when I see it!

GPs want to get on with things, and while it is important that we should pause and have a listening exercise, we also need to give GPs the confidence so that they continue to plan for GP-led commissioning.

The more I listen to the contributions in the debate, the clearer it becomes that each Member has their own agenda of changes that they wish to be made. Much has been made of the 98% vote against my right hon. Friend the Secretary of State by the Royal College of Nursing, but I listened to Peter Carter, chief executive and general secretary of the RCN, on “The World at One”, and I was so struck by what he said that I took down a transcript. Martha Kearney put it to him—

[Madam Deputy Speaker (Dawn Primarolo)]

Order.

[Tony Baldry]

Am I out of time, Madam Deputy Speaker?

[Madam Deputy Speaker]

Yes. Thank you.

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[Andrew George (St Ives) (LD)]

It is a pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson) and I was glad that his speech contained an element of recognition of the excellent contribution made by my hon. Friend the Member for Southport (John Pugh), who set out far more articulately than I could many of the concerns about the Bill that underpin this evening’s debate. These concerns have been raised by Liberal Democrat Members and I know for a fact that a number of Conservative colleagues feel the same way about aspects of the reform, although that has not been articulated this evening.

I wish to get one piece of rough and tumble out of the way before I commence with the substantive comments I wish to make in the short time available to me. I will not be supporting Labour’s motion this evening because to do so would be to endorse Labour’s history of having introduced the following: independent treatment centres, which wasted hundreds of millions of pounds of taxpayers’ money; alternative providers of medical services enforced through primary care trusts; and many other top-down reorganisations, which Labour Members now pretend they are against. It would also mean endorsing their approach to the whole concept of top-down reorganisations, the billions that Labour wasted on NHS IT systems and Labour’s failure to address the unfair funding formula, which set back my part of the country significantly and left it in significant debt, from which it is still trying to escape.

I set out my position in the Second Reading debate on the Health and Social Care Bill, on 31 January, when I refused to support the Government because of the criticisms and concerns that I raised then. I do not need to repeat them now, but I also made it clear then, as I do now, that I would vote against the Government on Third Reading if the Bill were to look in any way like the measure that we saw come out of the Committee and that will come through to the Report stage. I therefore look forward to the outcome of the listening exercise, and hope that it is a genuine listening exercise and that substantial changes will be made to the Bill. The changes that I wish to see are so substantial that they would take the guts out of the Bill.

To the concept of commissioning proposed in the Bill and the idea of handing all that power to one narrow group of clinicians—GPs—there is, despite what the hon. Member for Banbury (Tony Baldry) said about GPs in his area, at best a resigned reluctance and at worst outright hostility about what GPs are being asked to do. I do not go along with the hon. Gentleman’s view that they are keen to get on with it. They are responsible people and responsible professionals; they recognise when they are being asked to do something and they will get on with it, but I must say that they will not do so with any enthusiasm.

Secondly, the substantial elephant in the room is not the risk of privatisation of the NHS, as the hon. Member for Easington (Grahame M. Morris), who is no longer in his place, described it, but the marketisation of the NHS. My hon. Friend the Member for Southport (John Pugh) put it well: the cherries will be picked by the private sector. Any decisions on commissioning could easily be unscrambled by a process whereby decisions that were intended to try to integrate services could be challenged because they were structured uncompetitively. Those are two fundamental failings in the Bill.

This comes to the heart of what coalitions are about. No one gets their own way, as Labour knows from being in coalition in other places, and it is silly to be childish about that. In a coalition, the parties work together when they agree and seek a compromise where they fail to agree. I would argue that when they cannot come to any kind of agreement or compromise, they should allow Parliament to decide. What I do not like about what is happening is the fact that the Secretary of State is largely implementing this—

[Madam Deputy Speaker (Dawn Primarolo)]

Order.

[Owen Smith (Pontypridd) (Lab)]

I am delighted to follow the hon. Member for St Ives (Andrew George) and to hear him say that, were this a Third Reading debate and the Bill had remained as it is, he would vote against it. He should not hold his breath, because we have not heard any indication from those on the Treasury Bench that they propose to listen to the reasoned and substantive opposition that we heard in the Public Bill Committee, of which I was a member and where the Government rejected all 250 to 300 suggested amendments, or to that in the rest of the country, where doctors and all the medical professions are united in opposing the Bill.

Earlier, those of us on the Opposition Benches were admonished for the sound and fury coming from us. Mr Speaker was right to admonish us for shouting, but that sound and fury is not born of cynicism; it comes from three things. The first is our outrage at how the history of what the Labour Government did in office is being rewritten and at the suggestion that this Bill represents an evolution of what we did with the NHS. It is not an evolution, but a revolution.

The second is the shameless way in which the Government are misrepresenting that which sits at the heart of the Bill. They present it as trying to bring about patient focus and GP-led improvements to the NHS, but in truth it is about competition and the Government’s belief that competition in health care, like in telecoms or the energy market, is the best way to drive improvements in the efficient allocation of resources, allowing consumer-driven demand to drive efficiency. We fundamentally contest that. We do not think that it is true in many aspects of life, but it is certainly not true in the NHS, a body built on collectivism, co-operation and integration. Those fundamental ethics—the ethos of the NHS—will be undermined by the Bill.

Thirdly, the Bill is a completely unnecessary intervention. We did not need a top-down reorganisation of the NHS, because we got record patient satisfaction and increased productivity in all the ways that matter, as described earlier by my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). Crucially, we have a far more efficient and better-resourced system than previously. That prompts the question of why the Government are pursuing this change. They are doing so because they fundamentally believe that the way to drive the NHS forward is an unfettered market and greater deregulation.

That brings me to my substantive point. I want to rebut the notion which we have heard repeatedly from the Government that competition will not bite harder on the NHS as a result of the changes. The Government have told us repeatedly that nothing in the Bill says that competition will impact on the NHS to any great extent. As we all know, however, in 100 of the 300 clauses Monitor is established as an Office of Fair Trading-style competition overlord for the NHS, because as soon as the NHS is opened up to multiple entrants in the market and there are multiple providers of health care services in this country, we will no longer be able to argue that it is a state service that ought to be protected and therefore should not be subject to the vagaries of the market and EU competition law. As soon as we allow multiple health providers into the market, we will have to apply EU competition law, and European case law and arguments between lawyers will inevitably lead to the progressive fragmentation of the NHS.

There is one other point with which I want to take issue. Privatisation is a pretty difficult word to bandy about in politics, but I do not shy away from using it in this debate. We are going to see a progressive and creeping privatisation of the NHS. To argue about marketisation and privatisation is to argue about semantics. We will increasingly see many more aspects of the NHS either in the hands of or being delivered through the private sector. Earlier, the Secretary of State asked us to point out where in the Bill it showed that there would be an increased number of private providers in the NHS. My challenge to the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), who is now back in his place, is to point out to me where in the Bill it says that we will not see more private providers entering the marketplace. The Bill provides for that to happen and what will arise from that is the break-up, fragmentation and, eventually, privatisation of the NHS. Those on the Government Front Bench know that—

[Madam Deputy Speaker]

Order.

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[Clive Efford (Eltham) (Lab)]

I must confess to being somewhat confused about where we have got to with the Bill. I have been here for 14 years and I cannot recall a Bill being halted after it had been through Committee so that we could go back and consult the public. I will be corrected by Members who have been here longer than me, but I cannot remember anything like this extraordinary situation.

Yesterday, I listened to the Deputy Prime Minister on the “Andrew Marr Show”. He said:

“Let me stress this, it’s not a gimmick, it’s not a PR exercise. We will make changes, we’ll make significant and substantive changes to the legislation”.

We have not heard any of that tonight. No one has got up and said, “We are listening,” or, “We are pausing,” or “We are reflecting and we are going to see substantial changes to this Bill.” The Secretary of State is in his place: I would like him to intervene on me and tell me that in relation to GP commissioning, the full £80 billion will be transferred to GPs, as he has frequently stated it would; that they will be in charge of commissioning and that we will not see that altered in any significant way as a result of the interventions of the Prime Minister or the Deputy Prime Minister. Members of the Government are trying to say that they are listening and that they are not responsible for all this, but I have here the White Paper that was published back in January, the foreword of which was signed by the Prime Minister, the Deputy Prime Minister and the Secretary of State for Health. They all signed up to it, but all of a sudden we are back to pausing, reflecting and listening.

What or who are we listening to? We have heard from the Secretary of State tonight that there are no cuts in the NHS, but let me tell hon. Members the story of Mrs Bell, a constituent of mine who was referred by her GP to a consultant last spring about cataract operations. She received the first operation within 18 weeks, and when she went back for a second consultation about the other eye she was referred for another operation. After 18 weeks, she rang the local health care trust to say that she had been waiting for her cataract operation for 18 weeks, but she was told that that was no longer a deliverable target. She ended up waiting more than 26 weeks for that cataract operation, so no one can tell my constituents or anyone else that we are not seeing cuts to the NHS and longer waiting times for patients.

What is fundamentally wrong with the Bill is that it places the market at the head of commissioning and planning services. The coalition document said that the coalition was going to introduce some element of democracy into primary care trusts, but PCTs got demolished as part of the proposals. My local PCT has been absolutely decimated, because although the Bill has not gone through Parliament yet, people are acting on it: they are voting with their feet and they have all gone. Currently, my area has no one who is responsible for the oversight and planning of our local health care services. Moreover, no one who will ultimately be accountable to local people is responsible for planning local services. All of that has been frittered away; it has disappeared. What we need is some form of democratisation of the commissioning process so that local people can know quite clearly who is accountable and who is not.

Tonight’s vote presents the Liberal Democrats—after we have paused and listened and reflected and after all they have said over the weekend about changes to the legislation—with an opportunity to send a message to the Government. This morning, the hon. Member for North Norfolk (Norman Lamb), the Parliamentary Private Secretary to the Deputy Prime Minister, said on the “Today” programme that there will be significant changes to the Bill. If the Liberal Democrats want to send a message to the Government, they should join the Opposition in the Lobby tonight and send the message that the Bill has to be changed. But I will tell them what will happen when it comes to Third Reading. The Whips will get to them, they will be as spineless as ever and they will go through the Lobby defending the Bill’s Third Reading—

[Madam Deputy Speaker (Dawn Primarolo)]

Order.