European Union (Withdrawal) Bill

Debate between Caroline Lucas and Philippa Whitford

Committee: 7th sitting: House of Commons
Wednesday 13th December 2017 Commons Chamber

[Dr Whitford]

Thank you, Sir David. I hope, as my party’s Front-Bench representative, and perhaps as the only SNP Member who will get to speak, that that timing does not apply to me.

I also wish to speak to amendment 241, which stands in my name and those of my colleagues, and which would preserve reciprocal healthcare and social security rights under the social security co-ordination regulations 883/2004 and 987/200, and to amendments 270 and 271, which stand in the name of my right hon. Friend the Member for Ross, Skye and Lochaber (Ian Blackford) and which would prevent the Executive from using clauses 8 and 9 to reduce the rights of EU citizens in this country.

There was supposedly a breakthrough last week. The phase 1 agreement having been achieved, some level of agreement was meant to be fixed, but unfortunately it was then unpicked on “The Andrew Marr Show”. Moreover, we are still hearing the phrase, “No deal is better than a bad deal”, which completely undermines the agreement made last week. I make this plea: having reached a phase 1 agreement on citizens’ rights, this issue should now be taken out of the negotiations and a deal to give them security should be brought forward in the upcoming immigration Bill, and not left another year for the withdrawal agreement Bill.

It has been a year and a half already. Many Members know that my husband is German. There are many people here with EU spouses. We have friends who have been in extreme anxiety and uncertainty for a year and a half. This is not happening in March 2019; it is happening now. Ten thousand EU nationals have left the four NHSs because their children are being bullied and they feel insecure. They are going home “to be safe”. That is an appalling indictment of the current situation.

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

The hon. Lady is making an incredibly strong point, and one that gets lost in all this debate about article this and article that: these are real people’s lives. Does she share my anger at the way the Brexit Secretary has played fast and loose with people’s lives? He went on “The Andrew Marr Show” and completely ripped up an agreement that people thought on Friday was done and which would have a big impact on their lives.

[Dr Whitford]

The hon. Lady is absolutely right. Among other things, we are talking about preparing for a future deal, but the suffering and anxiety of EU nationals and EU national families in this country is already happening. They should have been given surety the morning after the vote, but instead we heard phrases such as “bargaining chips” and “playing cards” and were told they were key in the negotiations.

NHS Provision (Brighton and Hove)

Debate between Caroline Lucas and Philippa Whitford

Monday 24th October 2016 Commons Chamber

[Caroline Lucas]

I am grateful to the hon. Gentleman for his contribution and I entirely agree. When I have talked to staff of the CCG, they have acknowledged that they are using an off-the-peg contract that is not suitable for such a service, and that there have therefore been problems in the system as well as with the company, which is not providing the service that people in our city deserve.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I can see that in this case due diligence was not done in the contract, but is there not an underlying principle that when a piece of NHS service is outsourced the NHS version ceases to exist? Therefore, at some future date, if the service is not good enough or other circumstances change, it is not possible simply to take it back in-house.

[Caroline Lucas]

I thank the hon. Lady for her intervention—someone who knows a great deal about these issues. I absolutely agree. Once the service has been outsourced, the ability to do a convenient U-turn is taken away. That is failing patients in Brighton and Hove.

The Department has said that allegations of ambulances operating illegally warrant investigation by the CQC. I have written to the Department of Health to demand that that happens and I have written to the CQC as well. Will the Minister go further tonight than admitting the severity of the problem, and let us know what he thinks he can do about it? Specifically, will he provide assurances that the Department of Health is no longer content to leave patient safety in the hands of private companies such as Coperforma, and that it intends to step in, bring the service back in-house and at the very least check that the sub-contractors’ contracts meet the requirements?

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[Caroline Lucas]

I am going to make some progress, because I want to finish making my case about funding.

Last week the Prime Minister claimed that NHS funding was being increased by £10 billion. In doing so, she ignored a plea from the respected Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), for Ministers to stop using such a misleading figure, when the correct figure is less than half the amount claimed.

The chief economist of the Nuffield Trust argues that even that is overstating the case, highlighting King’s Fund research that found that NHS-specific inflation means that the real increase is about £1 billion—about a 10th of the figure that the Secretary of State and others repeatedly use. It is certainly not £350 million a week. I would be very surprised if any Ministers repeated that blatant lie again, but anyone who claims that the investment is £10 billion is playing hard and fast with the truth. Indeed, the NHS chief executive admitted to the Health Committee that the spending review settlement would actually deliver

“negative per person NHS funding growth”

in 2018-19, with “very modest” increases in the other years.

On top of that, Ministers expect the NHS to find £22 billion in efficiency savings by 2020-21. No one with expertise thinks that that is possible. In a scathing report in March, the Public Accounts Committee found that a significant number of acute hospital trusts are in

“serious and persistent financial distress”.

It said that there is a “spiralling” trend of increased deficits and that the current payment system is “not fit for purpose”. That is perhaps most starkly demonstrated by our beleaguered social care provision, the funding of which all three Care Quality Commission inspectorates agree is seriously affecting the NHS. The Committee goes on to warn that it must be funded sustainably as a priority.

Yes, we have the better care fund, intended to advance the integration of health and social care services, but the majority of that comes directly from the NHS budget, resulting in what the King’s Fund describes as

“a sharp and sudden reduction in hospital revenues.”

In other words, the Government are robbing Peter to pay Paul, while local authority social care budgets are slashed and people are having to sell their homes to pay for care or are not getting it.

Nor is the Government’s secretive sustainability and transformation programme the solution. Many constituents are worried that plans are being conducted behind closed doors and that vital NHS services could be cut as a result. We urgently need clarity on what STPs will mean in practice for both patients and staff. The Sussex and East Surrey STP area, which includes Brighton and Hove, faces a financial funding gap of literally hundreds of millions of pounds by 2021, and it is not at all clear how our STP will bridge that financial gap or whether acute services will be cut.

[Dr Philippa Whitford]

Does the hon. Lady agree that the principle of STPs going back to place-based planning could actually help reintegrate the NHS, but that, if it is done on the basis of budget-centred care instead of quality and patient-centred care, we will get the wrong answer?

[Caroline Lucas]

I am grateful to the hon. Lady for her intervention. I agree that place-based planning is potentially a very useful tool, but I fear that it is being used as a back-door way of making yet more cuts. I am also worried that that is happening in an untransparent way, which is giving rise to concerns among my constituents about exactly what is being set out. Winter is coming and the crisis already playing out in Brighton and Hove is likely only to get worse if the NHS continues down the path on which the Government have put it.

Specifically, we spend 2.5% less of our GDP on health than countries such as France and Germany. I am prepared to say what few others will say, which is that, if we want an NHS that meets our complex health and social care needs, we do not need privatisation and competition; we need those who can afford it to pay more in tax. This is something we can put a price on, whereas the cost of the worry, misery, pain and sheer uncertainty for many of my constituents is incalculable. Whole families have to live with the agonising wait for a loved one’s treatment. It often falls to them to act as carers during that time. The knock-on effect of NHS delays cannot and should not be dismissed. Concerns about delays and cancellations at our digestive diseases unit, for example, come up repeatedly. Operations are repeatedly cancelled, with patients in distress. There is the amazing mum fighting tooth and nail for adequate care and support for her severely disabled son. For her, the system is a battleground. She has to co-ordinate equipment in four different places and put up with repeated delays. She told me:

“It’s this that pushes people beyond despair and to breaking point.”

Breaking point is exactly where we are. A perfect storm caused by decades of chronic underfunding and privatisation has met the consequences of fragmentation and ramped-up marketisation. Terms and policies manifest themselves in grave and very real problems of the kind that I described when I opened this debate. Those problems are not unique to my constituency or city, but Brighton and Hove has an unusual demographic profile, with many younger people, as I have said, with complex needs, mental health problems, drugs and alcohol addiction, homelessness and long-term conditions. It also has some very elderly people.

That means that the array of services to support people using the NHS may need to become more complex, more tailored and more multi-agency, including police, voluntary agencies and so on. We need an ecosystem of healthcare, in which each part complements other parts as well as the whole, and which is achievable locally and nationally if we strip back the unnecessary, ineffective and damaging complexity that currently infects the NHS; if we reinstate the basic principle of a publicly funded and provided national health service that is free at the point of access; and if we give patients, staff and the public a voice from the outset and not just as part of a box-ticking exercise. I believe that is the way to bring us back from the brink.

I have raised a number of questions, and I will repeat them for the Minister before I give the floor to him for his response. Will the Department of Health step in to bring back accountability and stability to the non-emergency transport system in Brighton and Hove? Will it bring that service back into the public sector as a matter of urgency and pick up the Coperforma bill? Can the Minister promise that the STP plans will not mean cuts to services and closures? Will our hospital trust and mental health trust get the money that they need to address the staffing and other crises that they face without having to impose cuts dressed up as efficiency savings?

Will the Minister and other Ministers stop using inaccurate figures when they talk about investment in the NHS and use the autumn statement to announce a genuine step change when it comes to funding social care via local authorities and NHS services in the round, taking full account of NHS-specific inflation? Will he petition the Home Secretary to immediately guarantee EU workers the right to remain and protect the NHS from yet further instability and uncertainty? Finally, will he take a really honest look at the knock-on effects and inefficiencies of a healthcare model that is jeopardising accountability, transparency, standards and patient care?

National Health Service Bill

Debate between Caroline Lucas and Philippa Whitford

Friday 11th March 2016 Commons Chamber

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

I beg to move, That the Bill be now read a Second time.

It is an honour to have brought this Bill to Parliament today. It is the result of widespread consultation and has extensive backing from a raft of doctors and nurses delivering front-line care, as well as from local NHS campaign groups. Its backers include the British Medical Association council, the president of the Royal College of Paediatrics and Child Health and many local NHS staff and campaigners. I want to pay tribute to them all for their amazing work. I pay tribute, too, to Allyson Pollock, the professor of public health research and policy at Queen Mary University of London, and to Peter Roderick, a barrister and senior research fellow there, for their expertise and help.

The incredibly positive and wide-ranging popular support for the Bill reflects a strong belief in a publicly provided NHS. People are rightly worried because the NHS, consistently ranked one of the best in the world, is under threat like never before. It is under threat from underfunding dressed up as efficiency savings; under threat from cuts; under threat from the wasteful bidding of the internal market; under threat from increasing commercialisation and the steep increase in corporate sector contracts since the Health and Social Care Act 2012.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

A Select Committee on Health report in 2010 showed that the NHS’s running costs had more than doubled from 6% to 14%, based on the purchaser-provider split, and that was before the outsourcing and tendering of the Health and Social Care Act 2012.

[Caroline Lucas]

I am grateful to the hon. Lady, who speaks with great expertise in this area. She is absolutely right that the creeping privatisation and marketisation are, along with all the other problems they bring, incredibly inefficient.

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[Caroline Lucas]

I pay tribute to Labour colleagues who are here. Unfortunately, there were not enough to ensure that we could have had a closure motion earlier, about which I am sorry. However, the hon. Lady is absolutely right that we need to tackle reorganisation head-on. Some will argue that the NHS cannot face yet more reorganisation. I agree with that on one level, but the alternative of carrying on down the current route is absolutely impossible. The Bill is framed in such a way to ensure that reforms are implemented organically over time. Frankly, I do not think that we can do without it.

[Dr Philippa Whitford]

The NHS is being reorganised on a daily, weekly and monthly basis. Every time a service is outsourced, it is completely reorganised. By being taken over, people’s contracts are altered, and the shape of the service changes. In Scotland, we reversed the purchaser-provider split in 2004, and it was relatively painless. What we need is simply a decision not to outsource further and gradually to move back to geographical health planning instead of the fragmentation of clinical commissioning groups at a time when we need integration.

[Caroline Lucas]

That intervention is incredibly helpful, as it shows what is possible. The fact that it has been done in Scotland without major problem demonstrates that, if the political will is there, changes can be made.

--- Later in debate ---

[Dr Philippa Whitford]

I have asked on several occasions in the Chamber about the contribution of the Health and Social Care Act to the current financial state of the NHS in England. We constantly hear that it is all just due to agency nurses, yet when we look at the five years before the change, we see that the NHS managed, somehow, to balance its books. It then had a debt of £100 million, then £800 million, and now we are looking at a debt of £2.5 billion. That is because we are not looking after everyone. We are giving the private sector the cheap people and the NHS ends up with the expensive people.

[Caroline Lucas]

The hon. Lady puts her point well.

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[Caroline Lucas]

I thank the hon. Gentleman. I think that point will be explored in Committee. I cannot point him right now to the relevant clause, but it is a serious point. I would say that we will have a better chance of having such a managed and planned NHS, in which we can ensure that there are appropriate services in rural and urban areas, if we have a guiding mind back in charge of the NHS. That is exactly what was broken by the provider-purchaser split. The hon. Gentleman’s point is a good one, and I would love to see it debated further in Committee.

When it comes to the overall direction of travel and the duty to provide, it is shocking that the private hospital share of NHS-funded patients grew rapidly between 2006 and 2011. By 2010-11, private companies performed 17% of hip replacements and 17% of hernia repairs, and handled 8% of patients. First attendances for orthopaedics or trauma, such as broken limbs, also increased, yet it is the NHS that invests in training and picks up the pieces when things go wrong in the private sector, and it is the NHS that so often innovates.

Following the coalition’s Health and Social Care Act 2012, the NHS Support Federation has been charting the impact of Government policy on the use of outside providers to deliver and plan NHS care. Its report, which came out last month, charts the continuing steep escalation of creeping private sector involvement in the NHS. Its research shows that more than 400 NHS clinical contracts, worth £16 billion, have been awarded through the market since April 2013. Over that time the private sector has won nearly £5.5 billion of them, so let me give a few examples of the kind of corporate takeover that we are talking about.

In September 2015, Capita, despite its chequered record in the provision of public services, took control of a contract worth £1 billion to be the provider of primary care services in England. In October 2015, Virgin Care won a five-year, £64 million contract from Wiltshire clinical commissioning group, Wiltshire Council and NHS England to provide community child health services in Wiltshire. As of April 2016, services including children’s specialist community nursing, health visiting and speech and language therapy will all transfer to Virgin Care. In my constituency, the private company Optum, part of the giant American corporation UnitedHealth, last year won a £1.5 million contract from Brighton and Hove CCG for referral management services.

Such outsourcing goes on despite a trail of failed, terminated and collapsed contracts, such as the £235 million contract for provision of musculoskeletal services in West Sussex, which was awarded but never begun once it was determined just how much damage it would do to other NHS services in the region. Then there was the collapsed £800 million contract for Cambridgeshire and Peterborough older people’s services. There are estimates that the collapse of that contract has cost the local hospitals, GPs and community care providers about £20 million. There is a third example, of course—that of Circle, the private company running Hinchingbrooke hospital, which pulled out after just two years of a 10-year contract. That company’s announcement came just after the publication of a damning report on the hospital from the Care Quality Commission that raised serious concerns about care quality, management and the culture at the hospital.

[Dr Philippa Whitford]

One of the areas in which I have concerns relates to the case of Mid Staffordshire. A lot of the blame in the Francis report was on the drive for foundation status, which meant that senior management were totally fixated on that instead of on the quality of care to the patient. Consideration should be given to clinical governance, so that management are responsible for the clinical outcomes and not just the financial outcomes.