Health and Social Care Bill

Caroline Lucas Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham]

Those factors demand service reform. I remind the hon. Gentleman that he stood at the election for a moratorium on such reform, which was a dishonest pledge that would have prevented the NHS from making the changes that it needs.

The NHS model that the hon. Gentleman and his colleagues seek to break with the Bill is judged to be the most efficient health care service in the world. The Secretary of State says today that that model is simply unsustainable in this century, with the ageing society and all the other pressures on it. I put it to the hon. Gentleman and the Secretary of State that that model is not the problem but the solution to the challenges of an ageing society, because it is proven to be the most fair and cost-effective way of delivering health care to the whole population.

We need to be honest with ourselves today. I mentioned the fact that it is just political pride and gut loyalty that are driving the Bill towards the statute book. Those motivations, however understandable and human they are and however familiar to politicians of every stripe, do not justify inflicting a sub-optimal legislative structure on our most cherished public service and making the already difficult job of health professionals even harder as they struggle to make sense of Parliament’s intentions.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the right hon. Gentleman agree that it is ideology, not evidence-based policy, that is driving ever greater competition in health care markets? Does he agree that the evidence suggests that that is the way to undermine our NHS, not to improve quality and equity?

[Andy Burnham]

I agree with the hon. Lady. It is that ideology that the NHS and health professionals are rejecting. They want to work in an essentially collaborative health service. They do not accept the vision that pits hospital against hospital and doctor against doctor.

Barely anybody has a good word to say about this busted flush of a Bill, which has lurched from one disaster to another. The unprecedented pause did not address the real concerns, but simply added bureaucracy and complexity. The 1,000-plus amendments are not a sign of improvement, but of confusion, complexity and contradiction. They have left a mess of a Bill that even the Health Secretary cannot recognise as his own. If that was not bad enough, an unfolding communications disaster has alienated the very people the Government are depending on to implement their Bill. A Downing street summit was called to discuss the implementation of a reform that is about clinical leadership, but doctors’ and nurses’ leaders were shut out of Downing street. It was hard to see how the situation could get any worse, but it just has.

First, on Friday, the Information Tribunal ruled against the Government and in favour of my right hon. Friend the Member for Wentworth and Dearne (John Healey). I pay tribute to the assiduous way in which he has pursued his principled case. The tribunal ruled against the publication of the strategic risk register, but in favour of the publication of the transition risk register, vindicating our position and dismissing the Prime Minister’s claims against my actions as Health Secretary.

Let us be clear about what that ruling represents. It is an incredible state of affairs for any Government to suffer such a serious legal reversal at this stage of a protracted parliamentary process. It is an indictment of the judgment, or lack of it, of the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) and others in the Department, in their handling of the Bill. Where is the Minister’s good grace in defeat? It is simple: my right hon. Friend the Member for Wentworth and Dearne won and the Government lost. What are they waiting for? They must publish the risk register today and give Parliament the courtesy of knowing all the relevant information on Ministers’ plans before they ask us to approve them. Instead, what do we get? Silence and playing for time. They are hoping to string it out until after 20 March. That is simply not good enough.

Health and Social Care Bill

Caroline Lucas Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

Yes, I have the benefit, as do many of my colleagues on the Government Benches, of talking to GPs across the country, individually and in clinical commissioning groups. The issue to address is not the distortion of legislation and its effects but realising benefits for patients. That is where we are. We want to achieve and improve quality for patients. That is where GPs are, where nurses are and where doctors and health professionals are. The legislation is part of the broader process of devolving responsibility to them and patients to allow that to happen.

[Caroline Lucas (Brighton, Pavilion) (Green)]

What is the Secretary of State most worried about: the frightening chaos of the billion pound commissioning underpinning the reforms that will benefit Circle health care, United Health, PricewaterhouseCoopers, KPMG, McKinsey and the rest at the expense of patients; or the personal embarrassment that he would feel if he did what he should do—if he listened to the professionals and the thousands of people who have signed the e-petition—and dropped the Bill?

[Mr Lansley]

I will tell the hon. Lady what most frightens me: it is that if we had carried on the inheritance from Labour, with waste and bureaucracy escalating and a year-on-year reduction in productivity in the NHS, in a financially challenged environment the quality of patient care would have suffered. At the moment, we have an NHS that is doing magnificently well at raising performance across the service while transforming itself to meet future challenges.

Alcohol Strategy

Caroline Lucas Excerpts

Tuesday 7th February 2012 Westminster Hall

[Caroline Lucas (Brighton, Pavilion) (Green)]

I congratulate the hon. Member for Totnes (Dr Wollaston) on securing this important debate, and I pay tribute to her for tenacious campaigning on the subject. I am also pleased to follow the hon. Member for Shipley (Philip Davies), because our views are about as divergent as they possibly could be, so there is an opportunity for some balance.

I want to talk about minimum pricing, because the sale of alcoholic drinks at pocket-money prices is costing not only the economy anything between £20 billion and £25 billion a year, if we look at the total costs, but many thousands of people’s lives. This is a fundamental public health issue: people are getting avoidable diseases and dying early. As others have said, those of us who are on the side of supporting minimum pricing do not want to stop people having fun and enjoying a drink; we want a strategy in place to ensure that as far as possible people drink as safely as possible.

The bottom line is that alcohol currently presents us with a massive public health problem in this country. With the British Medical Association, the Royal College of Physicians and the Royal College of Nursing, I believe that we need to act on minimum pricing. The hon. Member for Southport (John Pugh) was right to say that it is not a panacea and, on its own, minimum pricing will certainly not solve the problem, but it is an important tool in our armoury, so we should use it.

As mentioned already, the Government’s policy so far is that, instead of supporting minimum pricing, they will bar the selling of alcohol below the rate of duty and VAT. I welcome that as a step forward, with Ministers acknowledging price as a factor in how much people drink, but the policy does not go far enough, as evidenced by the drinks industry calling the approach “pragmatic”—in other words, the industry is not bothered by it. Health campaigners point out that one of the reasons why the industry is so relaxed is because the price floor is probably too low to have a real impact. That was supported by evidence from an investigation by The Guardian newspaper last year, which showed that of 4,000 price promotions, just one would be affected by the Government’s policy to bar selling alcohol at below the rate of duty and VAT. I am interested to hear the Minister’s response to that research. If the Government fail to act on the evidence, and if they refuse to stand up to the drinks industry, I fear that their alcohol strategy simply will not work. Resources and good intentions will be wasted because a successful strategy must be underpinned by measures to address the easy availability of alcohol.

Local communities are, rightly, worried and want action. For example, in Brighton and Hove, we have been trying to address the £100 million annual bill facing the city from the impact of over-consumption of alcohol. In October last year, the city started what it called “the big alcohol debate”, which closed last month. Its purpose was to hear what the residents of Brighton and Hove had to say about alcohol in the city. It is deeply worrying that 40% of the 1,300-plus respondents said that they avoid parts of the city because of the way in which drunken people behave. A clear message came through from Brighton’s debate that people are concerned about the too-easy availability of alcohol, and the effects of drunken behaviour in the city.

I am proud of the clear and radical action that city councillors have recently taken on licensing with an expanded cumulative impact area that allows councillors to take into account the impact of other licensed premises in the area when considering new applications. Councillors in the city are doing all they can to work closely with the police, the NHS and many other agencies that must pick up the pieces resulting from the lack of a clear alcohol strategy. The point of the debate is that there is only so much that can be done at local level without a clear lead from the Government on the key issues, which include minimum pricing. Price can and does regulate people’s consumption patterns, which seems to me why so much of the drinks industry is so worried about it.

By way of illustration, I shall say a few words about the continued sale of white cider. The issue concerns me greatly, and has been raised in Brighton and Hove as a significant problem connected with the level of street drinking and drunkenness in the city. It makes the case that minimum pricing has an important part to play. White cider is often sold at a cheaper price than bottled water. It is consumed for no other reason than instant intoxication for homeless and dependent street drinkers, as well as young at-risk drinkers. The charities that work with street drinkers report that white cider has a particularly damaging effect on the health and behaviour of the people consuming it. The harm it causes should help to convince the Government that minimum pricing is part of the answer.

I have contacted the supermarkets that continue to sell the product, albeit on their bottom shelves where they know that those who are ill enough and desperate enough to need it will be able to find it. I am encouraged that in response, those supermarkets have agreed to meet me to discuss the issue. However, whatever the outcome of that meeting, white cider will still be bought by many small retailers from cash and carry outlets.

Bigger retailers can and should take a lead, and stop selling this dangerous and damaging substance, but we need action from the Government if we are to eradicate it from our streets and from the lives of vulnerable drinkers. I shall illustrate what a difference a minimum price would make to the cost of white cider. Currently 2-litre bottles of Diamond White cider, consisting of 7.5% alcohol by volume, cost around £3.50 for around 15 units of alcohol. At a minimum price of 50p, the cost would be £7.50, and at 45p it would be £6.75. The point that a minimum price would not unduly penalise people who drink more moderately is underscored by the fact that an average bottle of wine—750 ml at 12%—would cost £4.50 with a 50p minimum price, or £4.05 if it were 45p.

[Eric Joyce]

The hon. Lady has switched from white cider to wine, the implication being that people who drink moderately drink wine. In fact, she is arguing that less well-off people should pay more and middle-class people should pay the same. That identifies that the problem is only with less well-off people.

[Caroline Lucas]

I reject what the hon. Gentleman says, because I am showing that price will have a big effect on people who consume vast amounts of alcohol, but not for most people who consume it more moderately. I could have given the same figures for cider. Clearly it will not put off moderate drinkers. The big red herring in this debate is that if the price of alcohol is increased, life will suddenly become enormously difficult for moderate drinkers. As the hon. Member for Totnes has said, with a 50p per unit minimum price a harmful drinker would spend an average of £163 a year extra if they continued with the habit, but a moderate drinker would spend an extra £12 a year. I do not want to inflict an extra £12 a year on anyone, but when that is set against the overall cost of alcohol misuse to society, it is far outweighed by an extra £12 for people who continue with their moderate drinking behaviour.

I am aware that Ministers are raising concerns that a minimum price per unit might contravene European competition laws and would be challenged in the courts. My understanding is that the European Commission has indicated that minimum pricing does indeed have the potential to target heavy drinkers. If minimum pricing is to satisfy the law, it must be shown that it is in proportion to the problems caused by alcohol without unduly affecting competition. There is a strong case for saying that action on pricing is proportionate to the problems caused, not least the chronic disease that we have heard about, thousands of deaths, and an estimated cost to the economy of between £20 billion and £25 billion.

In 2009, before the Scottish Government proposed introducing a minimum price policy, a written question on whether minimum alcohol retail prices violated EC law was answered by the European Commission. It clearly set out that treaty rules on the free movement of goods would not be contravened as long as price rules applied to all relevant traders operating within the national territory, and if they affected in the same manner in law and in fact the marketing of domestic and imported products. No one is suggesting that we treat imported and domestic products differently. We could make a strong case, if the political will were there to do so, for saying that such a response is proportionate.

[Katy Clark in the Chair]

A more recent ruling from the Commission in 2010 was even clearer. In answer to a question, the Commissioner for Health said that

“the Commission fully shares…the conviction that there are strong public health reasons for the EU to tackle alcohol-related harm including minimum pricing measures.”

We must lay to rest the ghost that suggests that the EU is saying that we cannot do this. It is saying that we can do it with certain conditions. Our role is to show that those conditions are met, and with all the evidence that has been cited here today and in many other places, we can make that case clearly. In this instance, the EU is saying not that we cannot act, but that we must be proportionate.

I hope that the Minister will accept that and that we need to make the political case for pursuing this measure. The Commission is telling us that if we do that, it is open to supporting that way forward. Let us have the debate on the issues, not on bugbears and myths about what the EU will or will not allow.

[Several hon. Members]

rose—

Health and Social Care (Re-committed) Bill

Caroline Lucas Excerpts

Wednesday 7th September 2011 Commons Chamber

[Andrew George]

On that basis, Madam Deputy Speaker, I will end that part of the conversation and move on, acknowledging that my hon. Friend has made a point that is worth considering.

Amendment 1224 would restore the duty to provide or secure provision of health services. Although that is seen as the headline proposal, it is consequential on new clauses 16 and 17, hence my intention to draw attention to the likelihood of my seeking to divide the House on those issues.

Amendments 1222 and 1223 seek to establish why the Bill has never provided for the Secretary of State to provide or secure a comprehensive health service rather than promote a comprehensive health service. This is an either/or situation, but I draw attention to the possibility that instead of pressing new clause 16, I may, in discussion with others, seek to divide the House on amendment 1222.

Amendment 1183 would beef up a duty of the Secretary of State—a theme that runs through a number of amendments. The purpose of amendments 1183 and 1194 is to address the conflict between having regard to reducing inequalities and placing above that duty the other duties that apply—for example, on choice. Amendment 1183 seeks to ensure that it is the duty of the Secretary of State, in reducing inequalities, to

“act with a view to”

rather than merely “have regard to”. Otherwise, the responsibility, and the duty, on the Secretary of State is rather weak. That applies to amendment 1194 in the same manner.

New clause 18 would impose a new duty on the CQC, the NHS Commissioning Board and clinical commissioning groups not to undermine existing NHS services in an unplanned way through the operation of competition. Rather than extending my description of this issue, it might be worth referring to the debate that we had yesterday about the regulations surrounding the functions and duties of Monitor, as the same question arises. We have to look at the impact that competition is likely to have on the provision of essential services such as major trauma and accident and emergency, where its existence may destabilise emergency services through the loss of, for example, important underpinning elective services provided by the hospital.

New clause 20 would ban the wholesale outsourcing of commissioning work with regard to clinical commissioning groups. That was demanded in a Liberal Democrat conference motion but has still not been delivered. The commissioning process is a public function, not a private function. The amendment therefore seeks to change schedule 2 in different ways to prevent private entities on clinical commissioning group committees and sub-committees from commissioning and making other decisions. This also applies to amendments 1224, 1245, 1244 and 1249.

The Minister said that the work of the Neurological Alliance is important to preserve. I hope he will recognise that new clause 20 talks only about commissioning work being

“predominantly retained as a function by staff directly employed by the clinical commissioning group.”

There is nothing in the Bill that prevents the bulk of the commissioning work—not the decision, but the work—of a clinical commissioning group from being done by a private company and thus, potentially, in secret. I hope he will accept that under the current wording of schedule 2, private entities will be able to sit on clinical commissioning committees and sub-committees and make commissioning decisions.

Amendments 1184 to 1188 and 1195 would demote choice to a subsidiary duty of commissioners to tackle fair access and inequality of outcomes. They relate to page 17 of the Bill. The priority of choice over inequity and inequality was introduced by the Government after the pause and the NHS Future Forum report as a way of promoting competition in ways other than through the role of Monitor. The amendments would reverse that priority for the NHS commissioning board.

Amendment 1211 provides that clinical commissioning groups should be more coterminous with local authorities than is the case under the Bill. The Minister said that there is no intention that clinical commissioning group boundaries will cross local authority boundaries. However, we all know that district councils do not cross local authority boundaries. In Cornwall, for example, we are likely to move from one PCT to three clinical commissioning groups, which will make the streamlining of the pathways between health and social care a lot more difficult. The purpose of amendment 1211 is to enforce that point.

I am aware of time and I hope that the House will appreciate that I will not explain every aspect of the many other amendments I have tabled. I am aware that there are significant issues that other people wish to raise. I simply emphasise that what the Minister said about health and wellbeing boards being able to refer matters to the Secretary of State is once again something that we have always argued for. Local authorities should of course be given a far greater say in commissioning decisions and in setting the strategy for health services in their area. As a back-stop, it is important that matters can be referred to the Secretary of State. My hon. Friend the Member for Cheltenham (Martin Horwood) has tabled some important amendments in respect of public health, some of which I have supported, and I hope that the Minister will consider them. I apologise for the amount of time I have taken, but I hope that the Minister will address the important issues advanced by the amendments.

[Caroline Lucas (Brighton, Pavilion) (Green)]

I apologise for not being present for the first half hour of this debate. I was in the Environmental Audit Committee, where I had specifically asked for certain witnesses to be invited, and I have not yet worked out how to be in two places at once, although it is on my list.

I will make a few general points about this part of the Bill before turning to a couple of the amendments that are in my name. I echo the many concerns that have been expressed around the Chamber this afternoon. Many of us argue that there is no legal duty on the Government to provide health services. The new hands-off clause limits the Government’s ability to intervene should health care provision be deemed inadequate, because it says that clinical commissioning groups, the new agents of health provision that can include private companies, must be free to exercise powers and duties without “unnecessary burdens”. I am equally concerned that the powers and duties of a commissioning group, including its ability to award contracts and charge for commercial activities, could be exercised by a private health care company. The Bill opens the way for private companies to determine much of English health care and takes away the Government’s duties and powers, which is why I believe it should be opposed.

--- Later in debate ---

[Andrew Percy]

The hon. Lady is making an interesting argument, and I would just ask her two things. First, how is she suggesting that we should pay for the idea? Secondly, is she seriously suggesting that we should return to millionaires being provided with dental treatment and eye care free of charge?

[Caroline Lucas]

It seems to me that if Wales and Northern Ireland have been able to abolish prescription charging altogether, it is certainly possible to do it. I would also argue that although everyone collectively having a stake in our public services may well mean that millionaires get a free eye test, under the type of regime that I would like to see they would be paying an awful lot more tax than they are under the Conservative party’s regime.

[Fiona O'Donnell]

I am aware that the hon. Lady sits close to Scottish National party Members, who may not have given an accurate picture of what has happened in Scotland. We have free prescriptions, but we also have 1,200 fewer nurses. People such as me are getting our prescriptions free, but that puts strain on other parts of the service.

[Caroline Lucas]

I thank the hon. Lady, but I do not agree that the two points that she makes are causally linked. Of course I do not want to see the abolition of nurses, but that does not mean that we should have to pay for our prescription charges. Either we want an NHS free at the point of delivery and with free eye tests and so forth or we do not. [Interruption.] Someone is speaking from a sedentary position, no doubt asking how we will pay for it. I will be very clear that there is massive potential in cracking down on tax evasion and avoidance, higher tax for the rich, higher corporate tax and so forth. We are essentially talking about political priorities. The priority that I represent—a great many more people are coming to this view—is that we should be willing to pay for the public services that we want.

Hon. Members may oppose amendment 48 on the basis that charging for prescription or for dental and eye care is an important way of raising revenue. In England, eligible patients pay a prescription charge of £7.20 an item. In Scotland the charge is £3 and Wales and Northern Ireland have abolished prescription charging altogether. England raised just £470 million through the charges in 2009-10, which was just 0.5% of the NHS resource budget.

Crucially, we should remember that income from charging in the NHS is not pure profit. There is a real cost to administering the plethora of exemptions and reduced charging rates for which different groups are eligible. For example, there are 11 different groups that are eligible for free dental care, 15 that are eligible for free sight tests and 12 that are eligible for free prescriptions. I hope that hon. Members will see the benefit of doing away with that convoluted and complex system, which provides little benefit in terms of income, and which goes directly against the NHS principles by significantly reducing people’s access to all forms of health care simply because of their inability to pay.

Much has been said by hon. Members on both sides of the House about the founding principles of the NHS, and it will continue to be said. However, I put it to hon. Members that amendment 48, more than any other, seeks to point out that much important NHS care and treatment is charged for, and that we need to go back to NHS services as they were envisaged by its architect, who has been referred to many times this afternoon. Hon. Members might recall that he resigned as Health Secretary as early as 1951, in protest at his Chancellor’s efforts to impose charges for prescriptions, dental treatment and eye care.

Amendment 1181 raises serious concerns about the way in which CCGs will be able to charge for services. Although the power to charge, under proposed new section 14Z3 to the National Health Service Act 2006, is intended to be of benefit to the health service, it is very disturbing. Its scope is unclear—I wrote to the Minister last week to ask for clarification—but the fact is that important limitations on how the Secretary of State can exercise that power would apparently not apply to CCGs. The measure could run a coach and horses through the principle of a free health service, and Parliament needs to be clear on its impact in practice.

It is extremely worrying that CCGs will be able to decide that certain specialist services—for example, for pregnant women or women who are breast feeding young children, or aftercare—are not appropriate as part of the health service. That would mean that the statutory guarantee that the NHS will be free will not apply, because CCGs can decide that certain services and facilities should not be provided as part of the NHS. If that happened, CCGs could use the charging power to decide to charge for supplying, for example, goods to pregnant women, or for instructing people how to use their rehabilitation equipment.

Amendment 1181 would ensure that that could not happen. Ministers might say, “CCGs are commissioners and not providers”. If so, why is a measure that allows CCGs to charge necessary in the first place? The amendment would make it absolutely clear that there is no way in which a CCG could charge for anything that is related to the basic core health service, such as hospitals, doctors, nurses or ambulances, whether they are acting under section 3 or proposed new section 3A of the 2006 Act. The amendment would also impose on CCGs the same limitation that is already imposed on the Secretary of State. Why was that omitted from the Bill?

It is right that raising funds under that power should not interfere with a CCG’s functions. However, the Bill says that raising funds should not interfere significantly, but what on earth does “significantly” mean in that context? How is it to be determined or measured? If companies such as UnitedHealth got hold of that power and reckoned they could make money out of it, they will be on to it in a flash. The very least that they should be required to do is demonstrate that dealing in land and supplying goods and the like will not take them away from fulfilling their commissioning role. I would prefer it if those giant profit-driven companies were nowhere near the health service, but while they are, we need far greater safeguards than currently exist.

Unfortunately, the previous Government gave overseas companies the legal route into the NHS, and this Government are seeking to smooth that route yet further. Hon. Members may recall that at Prime Minister’s questions on 18 May, the Prime Minister claimed that he had not heard of Mark Britnell, one of his health advisers, who was also a key adviser under Tony Blair, until he googled him the previous Sunday. The Prime Minister’s interest was stoked by a report of a speech that Britnell, global head of health care at KPMG, gave to a group of private health companies in New York last October. Dr Philip Hammond pointed out in Private Eye that according to a brochure summarising the conference, Britnell said:

“GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process…In future, the NHS will be a state insurance provider, not a state deliverer…The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”

That is a shocking thing to say, and no wonder the Prime Minister was keen to distance himself from it, at least in public.

My last point is about the final proposal in amendment 1181, which would mean that:

“Income raised by a clinical commissioning group as a result of the exercise of powers under this section shall be specified in its annual accounts, referred to in its annual report under section 14Z13, and paid annually to the Secretary of State.”

Without the amendment, it is completely unclear what CCGs will do with the money that they raise and how, if at all, it will affect their budget allocations. I think it would be madness for Parliament to give CCGs the right to charge for supplying goods, dealing in land and providing instruction for the purposes of raising more funds for the NHS, and then not to require them to account for it in any way, and not to ensure that the funds find their way back to the public rather than the private purse. This part of my amendment seeks to ensure that that is done.

Amendment 1234 refers to the fact that once they managed to get into the CCGs, multinational health companies such as UnitedHealth would be allowed to do the actual commissioning, thus creating a very unhealthy form of what is effectively in-house outsourcing. I understand that they will be able to charge for the supply of goods if the Government do not accept the amendment. Parliament cannot trust companies whose primary duty is to their shareholders to be in charge of so much taxpayers’ money, nor should such companies be given the right that the Secretary of State currently holds to charge for the supply of goods or for land deals. We should make it clear that CCGs cannot agree among themselves that their functions will be carried out by one of their private company members. Commissioning is a public function that should be exercised in the public interest, and private companies such as UnitedHealth should not be entitled to charge for any it.

[Nick de Bois (Enfield North) (Con)]

I refer Members to my entry in the Register of Members’ Financial Interests. I wish to speak to amendments 1172 and 1173, in my name, which require the Secretary of State to collect haematopoietic stem cells. The issue is, of course, that of the collection of umbilical cord blood and cord bank policy, which was first raised in the last Parliament.

I pay particular tribute to the work of the all-party parliamentary group on stem cell transplantation for its work under the leadership of the hon. Member for Alyn and Deeside (Mark Tami), and to the enormous contribution and determination of my hon. Friend the Member for Enfield, Southgate (Mr Burrowes). My previous lack of knowledge of the subject was probably no different from that of many other people, but after giving my hon. Friend and neighbour a lift home on several occasions I became a speedy convert. Quite simply, the collection of cord blood can be life-saving. I pay tribute to the work of the Anthony Nolan trust in that regard.

In 1974 the Secretary of State was not obliged to facilitate stem cell transplantation from unrelated donors. Because the Governments of the day took that position, advances made took longer to achieve, which undoubtedly cost lives. The situation is different now: both the Government and the Opposition support expansion of the practice, and in particular of the more modern use of umbilical cord blood for such purposes. However, it would be fitting for the Minister now to make it clear in the Bill that this issue is important, to lock in the bipartisan support while it is strong, and to send a message to future Governments and civil servants that for as long as the Bill remains on the statute book, the issue is not to be lightly disregarded or de-prioritised at a future date.

The amendments involve no financial or political cost, but they are not merely symbolic. They could be described as an insurance policy against the risk of thoughtlessness or distraction on the part of future Governments—a risk that would ultimately cost lives.

Health and Social Care (Re-committed) Bill

Caroline Lucas Excerpts

Tuesday 6th September 2011 Commons Chamber

[Debbie Abrahams]

I am grateful to my hon. Friend for drawing that to my attention. He is absolutely right.

The Secretary of State’s duty to secure and provide a comprehensive health service is a key issue and needs protecting in full. It should not be changed at all. Why are we changing it if is already acceptable? I am sure that we will revisit the matter tomorrow.

Although the Government have supposedly made concessions, recognising that attempting to privatise the NHS, just as the utilities were privatised in the 1980s would not be acceptable to the public, they have changed tack, not direction. Opening up the NHS to EU competition law may dramatically increase the amount of capital available to bring into our health service, but ultimately that capital will flow back to investors at a profit, at the expense of patients and the UK taxpayer. That will only increase income and health care inequalities even further—another way in which the Secretary of State’s duty will not be met. It is clear that the NHS cannot survive the Bill. The NHS needs appropriate reform and proper accountability, but definitely not an opening up of the market in this way.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the hon. Lady acknowledge that when her party introduced foundation trusts back in 2003, many of us warned that it would lead to precisely the kind of privatisation that is now being threatened? Does she now regret that?

[Debbie Abrahams]

Fortunately, I was not a Member of Parliament at that time. As I said earlier, I have no problem with the private sector’s being part of our health system when it adds capacity and value, but the Bill is a whole new ball game.

--- Later in debate ---

[Caroline Lucas]

New clauses 19 and 22 also have my name on them, and I should like to say a few more words in support of them as I have not been reassured by the Minister. I find it unacceptable that taxpayers’ money has ever been used to allow private patients to jump the queue and use NHS facilities. The history of the cap was all very interesting, but the bottom line is that it serves an important purpose, which is why it should stay. The Government argue that income from private patients is put back into the NHS and ultimately benefits the health service, but the reality is that when people become ill and need treatment, it is hard to justify asking them to wait longer because capacity in our NHS hospitals is being taken up by private patients. The bottom line is that an NHS hospital has to treat NHS patients, and I do not believe that we have adequate spare capacity sloshing about in the system to justify private queue-jumping.

Some Members will recall that foundation trusts were brought in after Alan Milburn visited the state-owned but privately run Fundación hospital in Madrid. The then Health Secretary was apparently impressed when he was told that the foundation hospital outperformed the Government-controlled hospitals. However, he ignored the argument put forward by the local unions that it was able to do so precisely because the more costly and difficult patients were sent to the fully public hospital nearby.

It is often argued that foundation trusts are about choice, but I would argue that such private treatment should be offered only when there is surplus provision in the system. It is one thing to talk about a choice of general goods and services, but it is enormously inefficient and massively costly to apply that mentality to the health service. Now, we see the present Government trying to use the model introduced by the previous one to allow foundation trusts to do as they please, and lifting the cap on the income that can be derived from private sources.

The hundreds of constituents who are contacting me about this do not want private queue-jumping; they want NHS services paid for from taxation. The future of the NHS should be about developing whole systems, not isolated institutions, and private health care in the NHS should be phased out. The NHS needs to be about building networks across professional and institutional boundaries, not about creating new barriers. It needs to be about IT and information sharing, not reducing connectivity, and about getting more people treated in the community and in primary care. The danger with this Bill is that it will do exactly the opposite and return us to the fragmentation of the time before the NHS.

[John Pugh]

I supported the amendment tabled by the hon. Member for Islington South and Finsbury (Emily Thornberry)—or, rather, I tabled it independently. I accepted at the time that it was not the most elegant way of dealing with the problem, but I recognise that there is a problem, as do foundation trusts. The cap as it stands has certain perverse consequences, and the NHS cannot fully profit from sources such as intellectual property. NHS profits help to subsidise public services. As the Minister has pointed out, there is no cap on non-foundation trusts, and the current format was to some extent a political compromise because Labour Members raised certain considerations during the passage of the legislation on foundation hospitals. That does not mean that their concerns were not valid at the time.

I am not concerned by the prospect of dramatic privatisation overnight; nor do I think that queue-jumping is the real danger. By abolishing the cap altogether, however, we run the risk that foundation trusts will run on the wrong side of state aid rules, and that their activity will be perceived as economic activity under EU competition law. The more they subsidise general NHS services, the more they will be perceived as engaging in economic activity.

I do not take a doctrinaire view on this issue. Very sensible people, such as Steve Field and the NHS Confederation, have raised the matter. The hon. Member for Leicester West (Liz Kendall) raised it, as did, if I recall correctly, the hon. Member for Islington South and Finsbury in a spirit of compromise in Committee, making the point—I think I am quoting her correctly—that the only alternative to a bad cap is not no cap at all.

There is a genuine fear, however, among people who are far more expert than most hon. Members in this field, which is caused by the blurring of the boundaries between public and private hospitals. We could end up theoretically with a private hospital that has 90% of its patients provided by the NHS. I know we cannot end up with an NHS hospital filled by 90% of private patients, but there is a threshold at which things could quite easily start to become complicated. This a critical issue, which will have to be dealt with in the House of Lords.