Community Hospitals

Charlie Elphicke Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Charlie Elphicke (Dover) (Con)]

It is a pleasure to serve under your chairmanship, Mr Owen. I welcome the Under-Secretary of State for Business, Innovation and Skills, my hon. Friend the Member for Mid Norfolk (George Freeman), to the debate and congratulate him on his elevation in the reshuffle before the summer recess. It is a pleasure to speak in such a well attended debate, with so many parliamentary colleagues coming to share my concerns about the future of our community hospitals.

The purpose of this debate is to make the case for the Government’s putting the community back into community hospitals and for recognising that such hospitals should have a central role in coping with the issue of people living longer. Community hospitals are important providers of recovery beds that speed rehabilitation and recovery, which can also help older people in particular to continue to live independently.

I was inspired to seek this debate because people in my community care deeply about the local community hospitals in Dover and Deal. Years of centralisation have taken their toll. My constituents want more locally-based health services provided by their local hospitals.

Dover was deeply concerned to see services axed at its Buckland hospital; wards were closed one by one and a much-loved hospital was decimated over a decade. When I was elected in 2010, plans for a new hospital had been going nowhere for getting on for a decade and the new hospital project was set to be axed altogether. Meanwhile, in Deal, it was agreed in 2006 that out-patient services should be axed and residents were fearful that the hospital would be closed altogether. However, after much hard campaigning, the long-stalled new Dover hospital is being built. It will open in February or March next year and will have out-patient facilities, day surgery, diagnostics and a revamped urgent care centre. The number of journeys that will need to be taken to the big, far away hospitals will fall dramatically. It will make a massive difference.

In Deal, we campaigned hard to safeguard the future of the hospital. A massive survey and a packed public meeting ensured that NHS chiefs pledged not to close the hospital and they will now seek to expand its services. We now hope that out-patient services can be maintained for people who find it hard to travel: the elderly, the partially sighted and people with broken bones.

However, we have not achieved everything that we want. People in Dover want recovery beds to be located at the new hospital. Residents of Deal would like greater community and local general practitioner involvement in the hospital and its services. Both communities would like more locally-based services, to minimise the number of journeys to the large, far away acute hospitals for simple procedures and treatments. These concerns led me to move a ten-minute rule Bill earlier this year and I was delighted that so many parliamentary colleagues supported that.

The issue is not just for Dover and Deal; I have set out the local situation to provide context for the concerns of so many parliamentary colleagues. There are some 400 local and community hospitals throughout the land and there are similar stories to be told about many of them—stories of people battling to defend their hospitals and hospital services against the NHS leviathan and the forces of centralisation.

There is a sense that the tide has begun to turn. After all, a new hospital is being built at Dover, health chiefs have pledged to secure the future for Deal hospital, and there has been a move towards a fairer share of health care for rural and semi-rural communities far from acute hospitals. We have come a long way. Today, I am making the case for going further and asking what more we can do to embrace community hospitals and bring them closer to the heart of the NHS and, in particular, support the role that they play in providing recovery beds and more locally-based services, particularly for an ageing population. We need to put the community back into community hospitals.

We should note an important moment in the history of the NHS, marked by the comments of Simon Stevens, the new chief executive of NHS England, who recently made the case for patients to be treated more often in their own communities, saying that the NHS is currently too focused on

“a steady push towards centralisation”

and that Britain should learn from countries such as Sweden, the Netherlands and the United States, which have strengthened community care around small hospitals to meet the needs of local communities.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this debate. In Northern Ireland, of course, we do not have as many community hospitals as there are on the mainland. Ours tend to feed into a main hub and we have out-of-hours services more than community hospitals. However, Mr Stevens, whom the hon. Gentleman mentioned, also says that we should consider community hospitals developing as social enterprises. What is the hon. Gentleman’s view on that?

[Charlie Elphicke]

The hon. Gentleman anticipates the direction of my speech. I wholly support it; it is a great idea. Mr Stevens also said:

“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS”

and that

“Most of western Europe has hospitals which are able to serve their local communities, without everything having to be centralised”.

In a speech to the NHS Confederation annual conference in June 2014, he outlined his plans for reform of community health services, reiterating the problems of the ageing population and the increasing number of long-term conditions, such as obesity and dementia, as well as more expansive and expensive treatments and the need for more localised health services to tackle these problems.

Mr Stevens is right. Community hospitals have an important role to play and perform best in respect of intermediate, step-down and step-up recovery beds, particularly for people recovering from an operation who need round-the-clock care, and in respect of helping older people get better and continue to live independently, keeping them out of end-of-life or long-term nursing home care.

[Richard Drax (South Dorset) (Con)]

I, too, congratulate my hon. Friend on this excellent debate. Does it not surprise him that the acute hospitals are not clamouring to keep the community hospitals, which could free up their beds, allowing patients to go home to their local communities, where they are going to get better, not worse? That, of course, would cost the Government less in the long term.

[Charlie Elphicke]

I agree. I congratulate my hon. Friend on his hard campaigning in his constituency to secure the future of his own community hospitals. I understand that the campaign has met with great success, showing how fortunate his constituents are to have such a diligent, effective Member of Parliament. He is right; community care beds are more cost-effective and reduce the pressure of bed blocking on acute hospitals, meaning that acute hospitals can do more of what they are best at and that community hospitals can do more of what they, in turn, are best at.

Community hospitals are good at creating a friendly, personal and home-like environment, well suited to older people, particularly those who suffer from dementia yet live independently; such people have better health outcomes and a lower rate of readmission following rehabilitation and recovery. Community hospitals can be localised hubs for less complex health care and can have minor injury units, diagnostic provision, clinics for various specialities and even out-patient services and day surgery, and they are more cost-effective, when compared with acute hospitals, in respect of post-acute recovery. It is hard to see why we ever went down the route of centralisation, because it cost us more money and gave us less effective care. The move to putting the community hospital back at the heart of things will be more cost-effective and will give better care and better health outcomes.

I welcome Ministers’ comments in answers to oral and written questions, as well as the comments of Mr Stevens. Ministers have recognised that community hospitals are important in improving patients’ discharge from acute hospitals and in increasing access to treatment in the community. I welcome their acceptance that community hospitals are good bases for respite, palliative and intermediate care, and step-up and step-down care close to home. Community hospitals are also strong resources for people in rural areas, who have to travel long distances to reach general hospitals. Much of what I am saying is in line with the direction of travel of Ministers. I welcome that.

An important aspect of community hospitals is as providers of recovery beds. Study after study has shown that community hospital recovery beds are effective at getting people well, meaning they are less likely to be readmitted to hospital than if they recovered in an acute hospital. Older patients are more likely to enjoy continued independent living, and a friendly home life environment is preferred by patients.

I will cite a few studies and a bit of evidence in support of what I am saying. There was a study in Bradford in 2005, a study in the midlands and the north of England in 2007, research from 2009 into patient-reported experiences and research into intermediate care in Norway in 2007, so there is a significant evidence base. In addition, the NHS Confederation recently used Department of Health evidence to conclude that closer-to-home care produced a fall of 24% in elective admissions, a 14% reduction in bed days, a 21% drop in emergency admissions, a 45% reduction in mortality and a 15% fall in visits to accident and emergency. Those are encouraging figures. Community hospitals are more cost-effective, according to a 2006 research paper published in the British Medical Journal, so there is strong evidence to back up what I have set out.

The case is made in certain quarters that it is somehow easier and possibly cheaper to have intermediate beds in nursing homes. Nursing homes play an important role in long-term care and end-of-life care, but community hospitals are more suitable for recovery, rehabilitation and continued independent living. It is in their interest to get people out, but the nature of nursing homes is that people are not expected to leave very quickly. With an ageing population, community hospitals are particularly well suited to keeping older people healthier and more well. The clinical commissioning group covering Dover and Deal, ably led by the local GP, Darren Cocker, is building on that in creating an integrated care organisation. It sees the local hospitals in Dover and Deal as essential to the success of its vision.

Moving on, let us look at how we can put the community more into community hospitals. Many community hospitals were established and funded, as colleagues will know, through public subscription by locally based community trusts before the NHS came into existence. The trusts managed effectively and the move to nationalisation and centralisation saw those hospitals taken from communities and taken over by the NHS in Whitehall. Many communities want to be given the chance to have a greater say over what happens to their local hospitals. Allowing local communities to own, lease or manage their hospitals would be a clear way to accommodate the concerns many have and enable people to have the greater say they would like to have.

Reforging the strong link that GPs had with their local hospitals is important as well. My local GPs are up for that, and I want to encourage and support them in that move. Communities should also have greater influence over the provision of health care in their areas; that would allow them to give greater priority to the needs of their specific community. I hope that Ministers will take the opportunity to promote community ownership or management of community hospitals.

In conclusion, much progress has been made on community hospitals, but more can be done. They could be embraced and put more closely at the heart of Government health care policy, and I look forward to hearing from the Minister what steps he will take in four key areas. First, what steps will he take to enable communities to have a greater say in running their local community hospitals: to own, to lease, or to manage? How can we have stronger links among GPs, GP-led clinical commissioning groups and community hospitals, as used to happen many years ago and could happen again?

What about the potential for community hospitals to be hubs for the integration of social care and the policy support that might be given for that? Finally, we need to accept that it is not always best just to drop off people at home after acute hospital treatment and that intermediate recovery beds are often a key element in the path to recovery, distinct from nursing homes, which are better suited to longer-term and end-of-life care.

[Albert Owen (in the Chair)]

Before I call Mr Jim Shannon, I say to Members that I will call the Front Benchers at 10.40 am. Seven Members have indicated in writing that they want to speak in this debate, and a couple of others have also indicated that they might wish to speak. As would be expected, those who have written in will get priority. The maths is easy: we have 55 minutes and 10 Members wishing to speak.

Managing Risk in the NHS

Charlie Elphicke Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

This is all part of the spin in which Government Members have been engaging in recent days. [Interruption.] Okay, so let me answer and then the same test will apply to the Secretary of State as the hon. Lady is applying to me. She is referring to letters sent by members of the public to the Department of Health. I am sure that this has not changed with the change of Government; contrary to what she has just said, those letters do not come across Ministers’ desks. They are not formal warnings to Ministers, and it is very important to be precise with language here. This Secretary of State will have received many, many hundreds of letters about hospitals up and down the country that he will not have seen, and it is not right for the hon. Lady to come along, again, with slurs and half truths to try to muddy the waters.

[Charlie Elphicke (Dover) (Con)]

With respect, I do not think the right hon. Gentleman’s answer to my hon. Friend the Member for Portsmouth North (Penny Mordaunt) is good enough and convincing enough. We have heard too much about concern for hospitals and for hospital staff from the right hon. Gentleman, but not enough about concern for patients and for patient care.

[Andy Burnham]

If the hon. Gentleman was listening, I said just a few seconds ago that the Secretary of State will not improve care for patients if he continually blames nurses and doctors. It is not one or the other, although Government Members seem to think they can attack the health unions for somehow being the enemy of patients. Ordinary people do not see it that way. They know that the staff are there for them day in, day out. We support the staff to help the patients. If staff are rewarded properly and have good working conditions, they will provide better care to patients. These are not opposites; the two go together, and the Conservative party would do well to remember that.

--- Later in debate ---

[Charlotte Leslie]

That is very encouraging to hear post-event, but unfortunately it still leaves some questions as to why the Cure the NHS group was not able to go along and formally deliver the case studies of Bella Bailey at the Department of Health but instead had to go and see the former Secretary of State outside his constituency office—and for those who want to deny yet more evidence, that is on YouTube.

We have to ask why this review was not commissioned at the time if there were, through 81 requests, serious concerns raised. What did people have to hide? In 2009 the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) said fairly clearly that Mid Staffs was a one-off, but unfortunately we know from the Labour “lines to take”—which are in the inquiry so are in the public domain—that Labour knew there were 12 hospitals with equal or even worse mortality rates. That was denied, but, tellingly, that brief says Labour should try to avoid naming them. That stands in stark contrast to the approach taken in the Keogh report, which has been transparent in naming those trusts where there are problems. Unlike Labour, I do not think being honest about the situation prevents improvement; actually, I think it helps improvement.

[Charlie Elphicke]

I congratulate my hon. Friend on making such a powerful speech. Does she agree that we have got to put patients first? If we put institutions first, and if we worry about staff and staff morale and how they might feel about things, we will inevitably slide in the direction of having a culture of sweeping things under the carpet and—dare I say it—covering things up. Unless we put patients first, we will not ensure there is a proper, sensible culture in our health service.

[Charlotte Leslie]

I absolutely agree with my hon. Friend. I would draw a distinction, however, as I think many members of staff in the NHS want, and wanted, nothing more than to put patients first. I was slightly surprised that only two Opposition Members mentioned patients and patient safety in their contributions yesterday. That was very upsetting.

Immigrants (NHS Treatment)

Charlie Elphicke Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

I explained where the figure of £20 million came from, and why I believe that it is probably the tip of the iceberg. If the hon. Lady really wants to know the answer, we do not know the full extent of the abuse of NHS services because the previous Government left them in such an appalling mess.

[Charlie Elphicke (Dover) (Con)]

I understand that under the European health insurance card scheme the UK paid out about £1.7 billion for Brits abroad, but claimed only £125 million back. Is that also receiving attention?

[Mr Hunt]

Yes it is. We are always likely to pay out more than we receive under that scheme because we have a number of pensioners who decide to retire to slightly sunnier climes and there is a cost to the UK under EU treaty law with those decisions. My hon. Friend is right to point out that just as inadequate as our failure to charge people from outside the EU when we should is our failure to collect money from inside the EU when we are able to, and we must also look at that.

Social Care Funding

Charlie Elphicke Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

Absolutely. There was a time when the Labour party would have considered a package that will be worth £1 billion a year by the end of the next Parliament to be a significant investment, but after its free spending ways of a billion here and a billion there, we are now talking real money.

[Charlie Elphicke (Dover) (Con)]

May I congratulate my right hon. Friend on a meaningful step forward in the social care debate, with a proper settlement? The shadow Health Secretary made a spending commitment of a £35,000 cap; for the record, how much would that spending commitment cost the country?

[Mr Hunt]

What the shadow Secretary of State said this morning would have cost the country an extra £2.4 billion on top of the proposals that we are outlining today. Labour Members need to say whether they would pay for that by increasing taxes or by reducing spending, but perhaps they are thinking of adding to the deficit.

Oral Answers to Questions

Charlie Elphicke Excerpts

Tuesday 27th November 2012 Commons Chamber

[Anna Soubry]

Yes, of course I will meet my hon. Friend. I hold a ministerial surgery on Monday evenings and would be grateful if he came along to one, but I would be happy to meet him in any event. These are local decisions that will be made by local commissioners, but they should always commission in the interests and to the benefit of the people whom they serve.

[Charlie Elphicke (Dover) (Con)]

9. Whether he has recently reviewed how access to health care treatment can be made easier for vulnerable groups; and if he will make a statement. [Interruption.]

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am so sorry, Mr Speaker, I was getting carried away. It is my hon. Friend the Member for Dover (Charlie Elphicke) who has asked a question, is it not? [Interruption.] It does not help when the right hon. Member for Leigh (Andy Burnham) shouts at me. I am at a profound disadvantage, because I cannot shout back—not that I would ever want to raise my voice, of course. I do not seek sympathy, just parity. Opposition Members should listen with great care. This Government introduced in statute an absolute duty on the NHS to ensure that health inequalities, which, of course, rose under the previous Administration, are at last reduced.

[Charlie Elphicke]

My constituents in Deal are concerned that consultant out-patient services may be withdrawn from their much-loved hospital. Is it not right that GP commissioners should be particularly mindful of services to vulnerable people in rural areas who find it hard to travel?

[Anna Soubry]

Indeed it is. That is one of the great joys of the CCGs. As other Ministers have alluded to, we are putting commissioning decisions into the hands of the people who know best—the health professionals. When they exercise their commissioning responsibilities, we urge them to ensure, as I am sure they will, that they deliver the very best services for the people they serve.

Oral Answers to Questions

Charlie Elphicke Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

I would not necessarily expect the hon. Gentleman to follow announcements that are made at the Conservative party conference, but we did make the big announcement that access to radiotherapy will be transformed, making it available to everyone for whom it is clinically necessary and cost-effective. Improving mortality rates is extremely important. As I have set out, one of my key priorities is to transform the NHS so that we have the best mortality rates in Europe. I hope that that is welcome news for his constituents.

[Charlie Elphicke (Dover) (Con)]

Does my right hon. Friend agree that there will be less budget pressure on the NHS if we do better with long-term conditions, get better at integrated care and use data better to predict ill health? To that end, will he come and see the work of the Kent Health Commission on those issues?

[Mr Hunt]

I would be delighted to see the innovative things that are happening at the Kent Health Commission. Looking at how we deal with people with long-term conditions—that is 30% of the population, and the proportion is growing with the ageing population—will be a vital priority for the NHS over the coming years.

Health and Social Care Bill

Charlie Elphicke Excerpts

Tuesday 28th February 2012 Commons Chamber

[Mr Lansley]

My right hon. Friend and I are very clear that, as I explained—really quite carefully, I thought—it is customary in another place for some of the issues that have been debated to be reflected in amendments on Report, and that is what will happen.

[Charlie Elphicke (Dover) (Con)]

Can the Secretary of State confirm that the principles underpinning the Bill are that the NHS is and will remain free for all patients; that a person’s GP knows them and their needs best; and that although we are spending billions of pounds more than Labour would have done, every pound needs to work as hard as possible if the NHS is to be modern and provide care for the future?

[Mr Lansley]

My hon. Friend is right, not least on his point that the coalition Government are investing in the NHS, with real-terms increases each year. That contrasts with the Labour Government in Wales, who in the course of this Parliament intend to reduce spending on the NHS by more than 6% in real terms.

NHS Risk Register

Charlie Elphicke Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House calls on the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill in order to ensure that it informs public and parliamentary debate.

These are extraordinary times for the national health service and, indeed, for our democracy. A top-down reorganisation that nobody voted for, which was ruled out by the coalition agreement and which Parliament has yet to approve, is happening anyway. From the moment the White Paper was published 20 months ago, the NHS began to change in every constituency represented in the House. From that very moment, the Opposition consistently argued that the Prime Minister was making a catastrophic error of judgment in allowing that to happen.

[Charlie Elphicke (Dover) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

Not at the moment.

When the Government chose to combine the biggest ever financial challenge in the NHS with the biggest ever top-down reorganisation, they gave the NHS mission impossible. The £20 billion so-called Nicholson challenge was always going to be a mountain to climb—it is an all-consuming challenge on its own—but with this reorganisation the Government have effectively tied not one but two hands behind the NHS’s back and taken away the maps and safety equipment. The Health Secretary began to dismantle the existing structures of the national health service across England before he had permission from Parliament to put new ones in their place. The result has been a loss of grip and focus at local level in the NHS just when it was most needed.

--- Later in debate ---

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

rose—

[Charlie Elphicke]

rose—

[Mr Lansley]

I had better give way now, and then that will be the end of it.

--- Later in debate ---

[Charlie Elphicke]

I thank my right hon. Friend for giving way; he has been very generous with interventions today. I am proud of what this Government have been doing for the NHS. Indeed, we can see what happens when we protect NHS spending and when we have a cancer drugs fund. We do not need a risk register to see the difference that that makes; we can just look at Wales, where waiting times are rising and cancer patients are being denied access to life-saving drugs and having to wait longer. That is the benefit of the Conservative policies in England.

[Mr Lansley]

My hon. Friend is safely in Dover, a long way from Wales, when he says these things, but I go to Wales and he is absolutely right. It is staggering. The right hon. Member for Leigh and his colleagues can stand there and say, “Oh, well, you know, it’s only”—what is it?—“8% of patients who are not being seen within 18 weeks.” In Wales it is 32% of patients who are not being seen—

--- Later in debate ---

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

The last time we saw the Government circling the wagons like this, it was in defence of the poll tax. Those present at the time will remember the fanaticism of the Conservative Back Benchers supporting a policy that was ultimately doomed. It is impossible not to feel sorry for the Secretary of State for Health. Nobody has ever coveted the position of Health Secretary for so long and then failed in it so quickly. The publication of the transition risk register will, I am sure, make his position even more untenable, but I doubt whether it will change anybody’s mind about this Bill.

For Government Members, I am afraid that the die is cast. They have a millstone around their neck called the Health and Social Care Bill, and they have to decide whether to carry on with the millstone or to take the difficult decision of unburdening themselves of it. As my former right hon. Friend, Alan Milburn, said in possibly the best description of this Bill, it is

“a patchwork quilt of complexity, compromise and confusion”.

Conservative Members will, I am sure, have deep concerns about how this issue has been handled. Some of them might agree with the Tory matinee idol, Daniel Hannan, who said that the NHS was a 60-year mistake, but I doubt whether that is the view of the majority of them. Indeed, I think they would have signed up to the principles set out in the coalition agreement. There is not much wrong with those principles, including that of no further top-down reorganisations. Now, however, they are forced by the political incompetence of their Secretary of State to turn this argument into a touchstone issue—if someone is in favour of the Bill, they are in favour of reform in the NHS; if someone is against the Bill, they are against reform of the NHS. Nothing could be further from the truth. [Interruption.] I see the nodding dogs on the Parliamentary Private Secretary Bench agreeing with that proposition.

I do not oppose this Bill because it aids reform. I do not oppose it because it will make no difference. I oppose it because it will hamper the reforms that the NHS badly needs at this stage of its development, and I suspect that the risk register will reinforce that belief.

[Charlie Elphicke]

On 31 July 2008 and on 17 September 2008, the right hon. Gentleman decided not to release risk registers or risk assessments. Why was he right then and the Secretary of State wrong now?

[Alan Johnson]

I see that the Whips’ brief dragged up something I did in a previous life. [Interruption.] The risk register is, with respect, a second-order issue. I cannot understand why the Health Secretary does not publish it. He is in enough trouble already, and the Government are in enough trouble already without adding an issue of transparency that simply makes the situation worse.

NHS (Private Sector)

Charlie Elphicke Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

When the Bill was introduced, great claims were made that it would improve NHS efficiency. That was one of the reasons the Government gave for subjecting the NHS to a huge top-down reorganisation; they wanted to make the system more efficient, but they made a mistake that many people make over time. They claimed that the NHS is inherently inefficient when in fact international evidence shows the exact opposite: the NHS model is the most efficient health care system in the world. That is because control of the system is democratically accountable, and national standards can be set through bodies such as the National Institute for Health and Clinical Excellence and entitlements can be set at national level. If that control is removed, we will see the emergence of a much less efficient health care system, like the many market-based systems.

[Charlie Elphicke (Dover) (Con)]

The motion

“notes with concern the Government’s plans…increasing private sector involvement in…commissioning and provision of NHS services.”

In Dover, our hospital was run down over the 13 years until 2010 and is now a shell. Why should the GPs not be able to commission another provider if the foundation trust will not fulfil its long-standing pledge to build a hospital and provide proper services for my constituents?

[Andy Burnham]

My argument would be that if those decisions are to be made, the people who make them should be accountable to the hon. Gentleman and the House, whereas the Bill that his right hon. Friend the Secretary of State is introducing proposes to push those things away. There will be an independent commissioning board that GPs and clinical commissioning groups will not be able to overturn; it will make the decisions. That is a completely unacceptable state of affairs.

Before the last election, we proposed a modest loosening of the private patient cap in response to pressure in another place when we were debating the Health Act 2009, but compared with our modest reforms, the Government’s plans are off the scale. Instead of private sector activity at the margins, the Health and Social Care Bill places market forces at the heart of the system. The private sector will not support the NHS, but will replace large chunks of the service in commissioning and provision.

--- Later in debate ---

[Andy Burnham]

My hon. Friend makes an important point. If the Bill was really about clinical commissioning, as the Government said at the beginning, and putting GPs in control, that could have been done through existing NHS structures. They could simply put clinical teams in charge of existing PCT structures. It could be done without any hassle or cost, but no, they completely broke down and rethought the whole system, because it was an ideological reform. Doctors oppose the measure, because they saw through the Bill, and saw it for what it was: a privatisation plan for the NHS.

Let me give three examples that demonstrate why the Prime Minister has not lived up to his “no privatisation” claim. The first is a letter sent by the Department on 19 July last year to NHS and social care leaders entitled “Extending Choice of Provider”:

“The NHS is facing a period of significant transition and financial challenge. But this is not a reason to delay action to address patient demands for greater choice”.

It went on to require all PCT clusters and clinical commissioning groups to identify three community services by 31 October that would be subject to an “any qualified provider” tendering process. That is significant because it exposes the ideological agenda behind the Bill and explodes the myth that it is about putting doctors in charge. If that was the case, logic would demand that it should be for doctors to decide whether or not any underperforming services could benefit from open procurement. That mandating of compulsory competitive tendering, even before Parliament has given its consent to the Bill, reveals the real direction of the policy. We simply ask how that can possibly be consistent with the Prime Minister’s promise of no privatisation.

The second example is the Department's guidance document to CCGs entitled “Developing commissioning support: towards service excellence”. I shall quote from the beginning of the document, which gives a clear statement of intent:

“The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to freestanding enterprise.”

It could not be clearer, which is why members of the British Medical Association council called the document a “smoking gun”, confirming their fears of a stealth privatisation. The document confirmed that the Government envisaged large-scale privatisation of services to support commissioning—jobs that are currently carried out by public servants. It puts into practice the comments made by Lord Howe on 7 September 2011 at the Laing and Buisson independent healthcare forum:

“The opening up of the NHS creates genuine opportunities for those of you who can offer high quality, convenient services that compete favourably with current NHS care. If you can do that then you can do well. But you know that won’t be easy, the NHS isn’t a place to earn a fast buck...they will not give up their patients easily”.

On commissioning, he said:

“Commissioning support is an absolutely critical area for CCGs. Some of it will come from the PCT staff who will migrate over to the groups but there will need to be all sorts of support at various levels…There will be big opportunities for the private sector here.”

With reference to that second example, I ask the Secretary of State how on earth is that policy consistent with the promise made by the Prime Minister and the Deputy Prime Minister of no privatisation?

That brings me to the third example, which we have discussed tonight. Just before the Christmas recess, the plan, which threatens to change the very character of our hospitals, was sneaked into the House of Lords. I do not seek to argue that that provision would change the NHS overnight, but in the context of a competitive NHS, where there is an obligation to promote the autonomy of hospitals, I believe that it would completely change the character of our hospitals and the way they think and function over time. The effect of a cap at this scale—a staggering 49%—means that hospitals could give equal priority to private patients. It sets the NHS and private sector in direct comparison with each other, and creates the conditions for an explosion of private work in NHS hospitals.

It is such a liberal provision that the Government’s amendment will have virtually the same impact as abolishing the cap completely, and it is a world away from the current situation. It fails to protect the interests of NHS patients by giving equal priority to other patients. Indeed, it creates a conflict of interest, as trusts could even seek to push patients into their private beds.

[Charlie Elphicke]

I thank the right hon. Gentleman for giving way; he has been extraordinarily generous in accepting interventions. When he discusses privatisation of services, does that include services taken on by charities, social enterprises and mutuals?

[Andy Burnham]

I am not against services being taken on by charities, voluntary providers and, indeed, the private sector. I have never set my face completely against that, but I see clear limits on the involvement and the role of the private sector in the delivery of NHS services. I see the private sector supporting the NHS, working at the margins, providing innovation and support. The Health Secretary sees the private sector replacing large chunks of the NHS, set up in direct competition with it, which is a very different policy. I ask the hon. Gentleman whether he was elected to the House to support such a policy. Do not the constituents of Dover quite like the NHS that we have, and want it to continue as it has for its first 63 years?

I want briefly to mention the impact assessment. It gives this specific warning if hospitals loosen the private patient cap without creating additional capacity:

“there is a risk that private patients may be prioritised above NHS patients resulting in a growth in waiting lists and waiting times for NHS patients. This is the eventuality that the PPI cap was originally introduced to prevent.”

In other words, there would be a return to that traditional Tory choice in health care—wait longer or pay to go private.

That sums up the big difference between this Government’s approach to the private sector and that of the previous Government. In our system, the private sector was encouraged to throw its lot in with the delivery of the best possible NHS standards of care to NHS patients. By contrast, the world view of this Government sees private health care as a way out of the public NHS, trading on its failures as a means of boosting the private market.

The next question that I ask the right hon. Gentleman to answer is whether the 49% plan can possibly be consistent with the Prime Minister’s promise of no privatisation. We make a reasonable request this evening. We do not reject out of hand any change to the existing PPI cap on foundation trusts. Voting for the motion does not imply opposition to the entire Health and Social Care Bill. But we do reject a 49% cap, which is tantamount to abolition, and we call on the Government to revise it significantly downwards. Voting for the motion will send a signal from the House that the Government need to rethink.

In conclusion, I give notice that we will continue to oppose the Bill outright, and we will put everything we have got into that fight. Let me be clear. The Prime Minister should withdraw his “no privatisation” promise or he should withdraw his Bill. He cannot have it both ways. If the Bill is passed, I do not think there is any question but that it will lead to the privatisation of large chunks of commissioning and NHS provision. The truth is that this is an illegitimate Bill. Nobody voted for it, and it is a Bill that the Health Secretary has mis-sold to the public and professions. He claimed that it was about putting doctors in the lead, but doctors can see it now for what it is. From here on in, we on the Opposition Benches will call it what it is—a privatisation plan for the national health service.

We have called the debate tonight to bring these dangers home to a much wider audience. Time is running out for the NHS and I will give everything I have got to protect the NHS that I believe in. This is worth fighting for because the NHS stands for something different in a world where large parts of our national life have been taken over by profit and money. Recent events have shown the dangers of mixing medicine with the market. People see health as different from other areas and overwhelmingly support the NHS as it is. By and large they trust it and see it as one area of national life where the money motive has not taken over. They want it to stay that way and they look at social care as a warning, showing how a fragmented system can drag standards down. Nye Bevan said there would be an NHS for

“as long as there are folk left with the faith to fight for it”.

This is the moment of greatest threat to our health service and I tell the Health Secretary and the Government straight tonight to drop this illegitimate Bill or face the fight of their lives. I appeal to Members in all parts of the House who have worries about where the Government are going with the Bill to send a direct message to the Government and to vote as their constituents would want them to—for an NHS that will always put patient care before profits. I commend the motion to the House.

--- Later in debate ---

[Mr Lansley]

It is not. The right hon. Gentleman, having been Secretary of State, ought to understand the difference between compulsory competitive tendering and any qualified provider. Under compulsory competitive tendering, it is the primary care trust that gets to choose who provides the service, but under any qualified provider it is patients who get to choose. One example is access to wheelchair services. Voluntary sector organisations, such as Whizz-Kidz, are setting out to provide a better service. From its point of view, that is not competitive tendering. Wherever Whizz-Kidz provides the service, patients in that area—[Interruption.] If he wants to have a conversation with other Members, he may by all means do so, but I will sit down.

I answered the right hon. Gentleman’s point and I am afraid that it proceeds from a fundamental misunderstanding of the difference between competitive tendering processes, which have been the stuff of primary care trusts—in the past it was they that decided who should provide services—and giving patients access to choice so that they can drive quality. Unlike competitive tendering, which was generally price-based tendering decided on cost and volume, under any qualified provider it is not about price, but about quality.

[Charlie Elphicke]

My right hon. Friend mentioned the provision of wheelchair services, which we have been looking at in Kent when considering how commissioning can be taken forward. Whizz-Kidz offers really great and radical ideas. Is it not the case that the Labour party would have condemned disabled people to the same standard-issue NHS wheelchairs rather than allowing them real choice across the spectrum?

[Mr Lansley]

My hon. Friend is absolutely right. That is precisely why on that basis, using the any qualified provider approach, the chief executive of the NHS can set out the ambition that a child who needs a wheelchair should get it in a day. In the past they would have to wait and then would not necessarily get the wheelchair they wanted, or in any reasonable time scale. This is about driving improvement and quality. Many NHS providers will respond positively to that and deliver the quality, but if they do not we ought to be in a position to believe that what really matters in the NHS is the quality of the service provided to patients. That used to be what the Labour party believed in, which I suppose was why its last manifesto, written when the right hon. Gentleman was Secretary of State, stated:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”

That is a complete description of what we are setting out to do. It is a description of the any qualified provider policy and something that he has now completely abandoned, and he has abandoned patients in the process. It is absurd.

The objective of the Bill and of the Government is simple: continuously to improve care for patients and the health and well-being of people in this country, and that includes improving the health of the poorest fastest, and to ensure that everyone, regardless of who or where they are, enjoys health outcomes that are as good as the very best in the world. That is what we are setting out to do.

The motion states that the private sector already plays an important role in providing that care. Indeed, once upon a time the Labour party was in favour of it. The right hon. Gentleman said in May 2007:

“Now the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”

Like my hon. Friends, I do not understand where he is coming from. The motion tries to face both ways, stating that Labour agrees with the private sector but also wants to have less of it. It agrees that the private sector can make a valuable contribution, but wants to stop it doing so. What matters to patients is the quality of care they receive, the experience of their care and the dignity and respect with which they are treated. Whether the hospital or community provider is operated by the NHS, a charity, a private company or a social enterprise is not the issue from the patient’s point of view. From our point of view, we should not make that the issue. The reason it will not matter is that, whoever is the provider of care, the values of the NHS—universal health care, paid for through general taxation, free and based on need, not ability to pay—will remain unchanged. No NHS patient pays for their care today; no patient will pay for their care in future under this Government. On that basis, I can absolutely restate what the Prime Minister said: under this Government and on our watch the NHS will not be privatised.

Oral Answers to Questions

Charlie Elphicke Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Anne Milton]

My right hon. Friend is absolutely right. Conditions will be attached to the ring-fenced money to determine how it can be spent, but any expenditure will need to refer to promoting or protecting public health. I hesitate to use the word “shortly”, which the previous Government used on many occasions, but it will be published along with the outcomes framework. It is important that we get it right.

[Charlie Elphicke (Dover) (Con)]

Will the Minister join me in congratulating Kent county council and Dover district council on their enthusiasm for taking over public health responsibilities and on the fact that they are looking at how to expand the resources that are available by considering the co-commissioning of social services with local GPs? Finally, may I inject a note of caution about the new community health trusts?

[Anne Milton]

I am happy to join my hon. Friend in congratulating Kent county council. As he rightly points out, these moves have been welcomed by many local authorities, many of which already do much to improve the health and well-being of their populations. It is extremely important that councils are eager to start, as I know they are, and eager to get that money and see the public health outcomes framework so that they can build on some of the good work they have already done.