National Health Service (Amended Duties and Powers) Bill

Clive Efford Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford (Eltham) (Lab)]

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

Today we begin to restore the sovereignty of this House over our national health service. We begin to put patients at the heart of decision making. We will restore the responsibility of the Secretary of State to promote a comprehensive national health service. We will tear the heart out of the hated Health and Social Care Act 2012. We will remove the health service commissioners’ obligation to put services out to tender. We will replace the 49% private patient cap, and allow the Secretary of State to set limits. We will prevent competition authorities from interfering in mergers that are in the interests of NHS patients. We will stop the sale of assets that are in the long-term interests of patients and our national health service. We will restore the powers of the Secretary of State to direct health commissioners. We will create a framework for national health service contracts that will put the interests of patients before competition. We will protect the NHS from the imposition of competition rules by the transatlantic trade and investment partnership, and give sovereignty to this House.

Through this House, the Secretary of State will be accountable for promoting a comprehensive national health service. If any Government dare to impose competition on our national health service in the future, they will have to come before the House and repeal this Bill, if it becomes an Act. We, as Members of the House, will be accountable to our constituents for how we vote in that debate. There will be no hiding place.

Some have expressed the fear that the Bill opens the door to further privatisation. It does not. I accept that the last Labour Government unlocked the door to competition, albeit in a modest and measured way. I voted against the creation of hospital foundation trusts, which introduced legally binding contracts with NHS commissioners; in retrospect it was a mistake, because it brought procurement law into parts of the NHS.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I congratulate the hon. Gentleman on being so lucky in the draw. He has referred to competition. Does he not accept that Labour did much more than he is suggesting? The then Secretary of State, who is now the shadow Secretary of State, privatised an entire hospital in the east of England. That is privatisation. [Interruption.]

[Clive Efford]

It is not possible to compare what went on under the last Government with what has been introduced by the raw market mechanisms of the 2012 Act.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I, too, congratulate my hon. Friend. Is he aware that in north Staffordshire, cancer and end-of-life care is going into the private sector on a 10-year contract worth £1.2 billion?

[Clive Efford]

There are numerous examples of contracts that are going out to tender, and the cost to the national health service of lawyers and accountants is increasing. The Government have made so much of the issue of bureaucracy in the NHS, but when I asked the Secretary of State about the cost of those lawyers and accountants to oversee the tendering process, what was the response? It was, “We do not collect those figures centrally.” I wonder why that is.

[Dr Julian Huppert (Cambridge) (LD)]

rose—

[Clive Efford]

Ah! The hon. Gentleman is presumably getting to his feet to apologise for supporting the 2012 Act.

[Dr Huppert]

I have no need to apologise, because I voted against it. I was actually about to give the hon. Gentleman credit for introducing this Bill, which I look forward to supporting, and for his role in opposing some of the things that the Labour Government did. Does he welcome the fact that the £800 million tender for older people’s services in Cambridgeshire stayed within the NHS? Does he also accept the concerns that many of us had about the contract at Hinchingbrooke that was put out to private tender by the last Labour Government? I am sure he would agree that that was a problem.

[Clive Efford]

It is just not realistic to compare what went on under the previous Labour Government with what is going on now. Yes, the contract in Cambridgeshire, at Peterborough, was won by an NHS bidder, but what was the cost? How much money was diverted from patient care into running that tendering process? That is an increasing cost to the NHS that we cannot allow to continue. By the way, I unreservedly withdraw my accusation that the hon. Gentleman voted in favour of the 2012 Act, because that is a calumny I would not use against my worst enemy.

Through the House, the Secretary of State would be accountable—

[Philip Davies (Shipley) (Con)]

Will the hon. Gentleman give way?

[Clive Efford]

Yes, I will, because I have lost my place.

[Philip Davies]

I am delighted to help the hon. Gentleman out. Helpful as ever! He talks about stopping what he calls privatisation and about putting the Secretary of State in charge. At the moment, there is a cap on the amount of private income that a hospital trust can gain, but does he agree that clause 7 of his Bill would remove that cap, giving discretion to the Secretary of State? Does he acknowledge that the amount of private income a hospital could receive could actually go up under his Bill?

[Clive Efford]

There are a number of provisions relating to the Secretary of State which state that everything that is decided has to put patients first, rather than competition. That is the key difference in this Bill. The Secretary of State will have to be satisfied that every penny raised from private income serves the needs of patients. The Secretary of State will set the limit, which can be variable, but it will have to come down because this House will demand that.

[Mr Jim Cunningham (Coventry South) (Lab)]

Is it not true that, under this Government’s reorganisation, between £3 billion and £5 billion has been wasted as a result of tendering exercises?

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[Clive Efford]

My hon. Friend is absolutely right. There are too many examples of money being wasted on the tendering process.

Those who suggest that what the Labour Government did can be compared in any measure with what this coalition has inflicted on our national health service are completely misguided. When the Labour Government were elected in 1997, we spent 5.2% of our GDP on our health services. In 2010, we had increased that to 8.6%. We increased the number of doctors by 48,000. We increased the number of GPs by 5,000. We increased the number of training places for doctors, which had been cut by the previous Tory Government. We increased the number of nurses by 70,000. We had the biggest hospital building programme in the history of the national health service. We rebuilt or refurbished every accident and emergency department in the country. When Labour left office, the NHS had the highest satisfaction ratings from its patients that it had ever had in its history. The NHS was in crisis in 1997, and Labour saved it. It is in crisis again now.

[John Pugh (Southport) (LD)]

Does the hon. Gentleman accept that Labour also guaranteed the private sector a fixed slice of NHS income in a way that the Bill does not do?

[Clive Efford]

The hon. Gentleman was on the Bill Committee for the 2012 legislation, and I wonder how many amendments he tabled to put those issues right. And he has the cheek to come here and ask questions about my Bill, which seeks to put right what he did not attempt to put right when he was on that Committee.

[John Robertson (Glasgow North West) (Lab)]

I congratulate my hon. Friend on getting this Bill to its Second Reading debate. The Government have been throwing all these facts and figures at us about how the number of doctors is increasing all the time, but these things started under Labour. It takes seven years for a doctor to be a decent practitioner, and we are the ones who made a start on this, not the Government.

[Clive Efford]

My hon. Friend is absolutely right: the claim that this Government, whose top-down reorganisation has caused so much chaos in the national health service, are responsible for the standards of the NHS now is laughable. They claim to have turned the NHS around in a short space of time, but they are standing on the shoulders of the achievement of the previous Labour Government.

[Mr Dennis Skinner (Bolsover) (Lab)]

My hon. Friend is absolutely correct, and another way of putting it is as follows: we dragged the national health service, between 1997 and 2010, from the depths of degradation that the Tories left it in and hoisted it back to the pinnacles of achievement. I have got a united nations heart bypass to prove it—it was done by a Syrian cardiologist, a Malaysian surgeon, a Dutch doctor and a Nigerian registrar, and these two people on the Bench behind me talk about sending them back. If you did that in the hospitals in London, half of Londoners would be dead in six months. Those are the facts about the United Kingdom Independence party.

[Clive Efford]

My hon. Friend is absolutely right.

[Grahame M. Morris (Easington) (Lab)]

I congratulate my hon. Friend on introducing this Bill. Does he agree that the Liberal Democrats have got a brass neck in making criticisms, given that not only did they sit on their hands during that Bill Committee, but the right hon. Member for Sutton and Cheam (Paul Burstow) was the prime advocate who led the Bill during its passage through Parliament?

[Clive Efford]

And then led a campaign to stop his local accident and emergency department closing, having done that for the Government.

[Toby Perkins (Chesterfield) (Lab)]

I, too, congratulate my hon. Friend on his Bill. He also carries the congratulations of 1,924 people from across Chesterfield who have signed a petition asking me to be here to support it. He is not just speaking with people behind him here; people right across the country are saying, “Thank you very much for what you are doing.”

[Clive Efford]

I am grateful for my hon. Friend’s kind words and for the support of all the thousands of people, particularly health service staff, who have supported the Bill.

[Philip Davies]

Will the hon. Gentleman give way?

[Clive Efford]

I hope the hon. Gentleman does not mind, but I am going to make some progress.

Never before have we had market tendering of the health service as we have today, and it is breaking down our NHS. The Bill is not a solution to all the mistakes that this Government have made in their top-down restructuring of the NHS, but it is an important block on enforced privatisation. The argument can be simplified into two distinct sides. If people believe the NHS should be a pure market, open to competition regulations, where the interests of competition are put before those of patients, they belong on the side of the Government. If people believe the NHS is a public service that should be free of competition rules, where the interests of patients are put first, they should vote for the Bill today.

We know that No. 10 did not understand what was going on in 2012. The Chancellor was asleep at the wheel, and the Liberal Democrats, suffering from some form of terminal Stockholm syndrome, were led by the nose to turn the NHS from a public service into a free market. My Bill takes a scalpel to cut the heart out of the hated 2012 Act and put right the worst of the Government’s mistakes. It will remove the sections that require the tendering of NHS services for competition with the private sector, the result of which has been millions of pounds being diverted from patient care into the pockets of lawyers and accountants through the tendering process. NHS bodies are spending millions either bidding or managing bidding processes, and that is all money being diverted from patient care. That must stop, and this Bill will end it.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on securing the Bill’s progress today. Does he agree with my constituent Julian Corlett, who expresses real concern that further privatisation would mean the NHS may be reduced simply to a brand and nothing more?

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[Clive Efford]

Absolutely. It is the capacity of the NHS to continue to provide services in the future that is under threat. Eventually and inevitably, with continuing privatisation of all its services, the NHS will end up as just a patchwork of contracted-out services, and that will put us at the mercy of the private sector.

[Philip Davies]

The hon. Gentleman talks about money being diverted away from patient care and about extended privatisation, but will he comment on the private finance initiatives that the previous Labour Government imposed right across the NHS, bankrupting many of its institutions and taking money away from patient care?

[Clive Efford]

There are issues about PFI, which we need to sort out. I must say, though, that the hon. Gentleman has picked on the wrong Member of Parliament. I have one of the very first PFIs in my local hospital. When was it advertised in the European Journal? In March 1995. It was a Tory PFI and it is one of the most expensive in the national health service; it is costing millions of pounds for my local hospital. Both Governments have something to answer for when it comes to PFI. There are issues that need to be put right, but people must understand that that will not happen under a Tory Government.

[Mr David Anderson (Blaydon) (Lab)]

My hon. Friend is making a good case. Is it not the truth that the one constant over the past quarter of a decade is that both Governments—they are equally matched in this—did not listen to the people who really knew about the NHS? I am talking about the people who work in the service. To be honest, our Government, to their shame, ignored the working people and those in the NHS who said do not go into PFI or foundation hospitals. Exactly the same thing happened in 2012 when the Tory party ignored the same voices of the people who were saying, “Don’t go ahead with this Act.” We should start listening to the people who know what they are doing—the people we rely on to deliver NHS services.

[Clive Efford]

All Governments have lessons to learn. This party is not saying that it has nothing to learn, but it wants to end the privatisation of the national health service. We must understand one thing: next May is when we have to fight to save our national health service. If we continue under this Act to keep privatising our services, we will not have a national health service as we understand it.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Like me, is my hon. Friend amazed by the faux indignation of some Government Members? Those Members will be the ones who will benefit from the donations of some of the private sector companies that are winning the contracts in our NHS service.

[Clive Efford]

We have seen the names—64 of them. We will see how they vote today, and then let the public know what they are doing with our national health service.

[Several hon. Members]

rose—

[Clive Efford]

I should like to make some progress. The Bill is in four parts. Part 1 deals with the powers and duties of the Secretary of State. It reinstates the legal duty of the Secretary of State to promote a comprehensive national health service. It gives powers of direction to the Secretary of State over NHS England and local commissioners. It also requires the Secretary of State to put the needs of patients above those of the providers, or the market within which providers operate. It also provides that all contracts will be deemed to be “NHS contracts”. The significance of that is that they will not be subject to competition rules. All complaints will be dealt with within the framework of the NHS, with the Secretary of State having the final say—not lawyers or the courts.

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am grateful to my hon. Friend for giving way and for securing this private Member’s Bill. One urgent issue that we must address is that of the purchaser/provider split. Will he assure us that the proposals in this part of the Bill will mean that health services can be run purely on health grounds?

[Clive Efford]

The Bill does not attempt to rid the NHS of the purchaser/provider split. That would require a new top-down reorganisation of the national health service, which people in the NHS say they do not want. What I can say is that this Bill will create a framework in which NHS contracts are not open to competition rules. As long as the commissioners of services stay within the confines of the NHS contracts, they will not be open to competition. They will be compelled to do that by sheer cost, because if they step outside of NHS contracts they are then into European competition rules and will have to spend millions on lawyers and accountants to oversee the tendering process.

[Several hon. Members]

rose—

[Clive Efford]

I shall make some progress before giving way again.

Part 2 deals with the private patient income. It empowers the Secretary of State to set the cap and reduce it from 49%. It also ensures that any income derived from private care is in the interests of NHS patients.

Part 3 gets to the core of the issue. It repeals the sections of the 2012 Act that require health service commissioners to put services out to tender, particularly the hated section 75. Clause 9 provides that no legally enforceable procurement obligations shall be imposed on NHS commissioners in relation to any arrangement that is proposed to take effect or takes effect by way of an NHS contract. It further provides that commissioners who place NHS contracts shall not be within the scope of the Public Contracts Regulations 2006.

That provision ensures that article 168(7) of the treaty on the functioning of the European Union is given proper effect in UK domestic law. The article states:

“Union action shall respect the responsibility of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of resources assigned to them.”

This provision prevents the market from interfering in mergers of services and makes it clear that the disposal of assets will require the permission of the Secretary of State. The Secretary of State will exercise his duties in the interests of patients.

[Ian Murray (Edinburgh South) (Lab)]

My hon. Friend is making one of the best speeches we have heard in this Parliament about protecting our national health service. Does he agree that another way we could prevent private providers from competing in the national health service would be by persuading this Tory Government to exclude the national health service and other public services from the transatlantic trade and investment partnership negotiations?

[Clive Efford]

My hon. Friend has guessed the next part of my speech. Part 4 of the Bill deals with TTIP. I have heard some criticisms that the Bill does not protect the NHS from TTIP. Clause 14 reads:

“No ratification… of the proposed Transatlantic Trade and Investment Partnership Treaty shall cause any legally enforceable procurement or competition obligations to be imposed on any NHS body entering into any arrangement for the provision of health services in any part of the health service.”

There are differing legal views on whether the proposed TTIP will or will not impose legally enforceable procurement or competition obligations on the NHS. However, without this clause the question of which set of highly paid lawyers is right will be decided only after the treaty is signed and will be a decision for the courts, not the elected Government. I am sure that is music to the ears of Government Members.

[Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)]

My hon. Friend is making a tremendous speech. Will he confirm that clause 14 is absolutely crucial across the United Kingdom, including Scotland, given the potential impact of TTIP?

[Clive Efford]

My hon. Friend is absolutely right; TTIP is a UK treaty, negotiated by the UK Government, and it will affect England, Scotland, Wales and Northern Ireland.

[Sheila Gilmore (Edinburgh East) (Lab)]

My hon. Friend may be aware that in response to a question I asked him this Monday, the Prime Minister indicated that he thought the health service would not be affected. He seemed to be suggesting that he did not want it to be affected. If that is the case, surely his Government should be supporting this provision to ensure that does not happen.

[Clive Efford]

My hon. Friend is absolutely right. We know that the Prime Minister has accepted it was a mistake, so the Government’s position on the Bill is a bit curious.

[Albert Owen (Ynys Môn) (Lab)]

Will my hon. Friend give way?

[Clive Efford]

I will, but then I will have to make some progress.

[Albert Owen]

I congratulate my hon. Friend on securing this Second Reading debate. He made an important point about the provisions applying across the United Kingdom: Wales, where the policies are different from those operating across England, would still come under the TTIP agreement, so it is important that this clause is included.

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[Clive Efford]

Absolutely essential. The question for the House is whether that policy issue should be decided by Parliament or the courts. Clause 14 is either unnecessary or essential, depending which set of lawyers ends up being proved correct. We say it should be a decision for Parliament, not the courts. Clause 14 puts the matter beyond doubt.

The public must decide whom they trust with the NHS. Do they believe the Tories who say they will protect it? After all, the Tories said there would be no top-down reorganisation, they said there would be no closure of A and E departments, and they said there would be no closure of maternity units except where local people agreed.

[Mr Andy Slaughter (Hammersmith) (Lab)]

I am grateful to my hon. Friend for allowing me to intervene, in addition to my main function today, which is to provide a cordon sanitaire. [Laughter.] I am very pleased that my name appears on the Bill as one of its supporters because nowhere is it more apparent than in west London what the Tories mean for the NHS. Two A and E departments closed, and within weeks up to a third of patients were not seen within four hours at A and E. Does my hon. Friend agree that unless we get rid of all this Tory legislation, the NHS will not survive?

[Clive Efford]

My hon. Friend is right. Before the election the Tories said that they would seek the agreement of local people in decision making, but in south-east London in 2007 my local health managers published a document called “A Picture of Health”. It was drawn up by doctors, nurses and midwives. They held a conference and reviewed all our services. They came to politicians like me and said, “We want you to behave sensibly. This is about improving the quality of care for patients, but at A and E it is also about saving lives.” Just before a general election, it is quite a thing for people to say, “We’re going to close one of your A and Es.” I differed with the health managers over which A and E should close, but when clinicians come and say, “We can save lives and improve quality of care,” we have to listen.

That is what the Government said they would do. What happened? The then shadow Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley), came to the A and E proposed for closure in “A Picture of Health”, marched around the area and told local people, “We’re not going to close your A and E.” What happened then? The Tories got into Government and closed the A and E. In London they put nine out of 31 A and E departments under threat, then they attempted to force the closure of Lewisham A and E. When they were beaten off by local people, they took powers to themselves to close it over the heads of local people.

Now, my constituents who get in an ambulance are handed a leaflet that says, “If you come from SE9 or SE3, you can’t go to the local A and E at the Queen Elizabeth.” Where do they have to go? You guessed it: Lewisham. But Lewisham A and E would not have been there if the Government had had their way. On top of that, the Care Quality Commission has condemned A and Es in our area because of lack of resources and lack of capacity. At the same time the CQC commended the staff for their dedication in keeping the service running, yet the Government would have closed Lewisham A and E. So, what of their pre-election commitment not to do anything over the heads of local people or local health managers?

Do we believe the Tories when they say the NHS is safe in their hands? [Hon. Members: “No.”] To defend the NHS, one has to believe in the founding values that led to its creation. Our NHS treats everyone equally—from each according to their means, to each according to their needs. Are these the values of the party that gave us the poll tax or the bedroom tax, or the party that plunges thousands of disabled people into poverty by denying them benefits and forcing them through an unending cycle of appeals to get what they are entitled to?

Throughout history working-class people have had to fight to assert the undeniable truth that all men and women are created equal. From the very first poll tax rebellions, John Ball asked:

“When Adam delved and Eve span, who was then the gentleman?”

He educated common people that they were all created equal. It is a theme that working-class people have been forced to return to throughout the centuries, whether through Christianity or a political fight for social justice from the Levellers to the Diggers, from Thomas Paine and the Chartists to the trade union movement today. These are the people who fought for the values that created the national health service. There is nothing in our society today that embodies those values more than our national health service. It is these values that cannot be defended by a party that talks about fairness while it justifies the bedroom tax and measures people’s worth. That is not what our NHS does.

This Bill will not solve all the problems in our national health service—it will take a Labour Government to rescue it from a crisis—but it is an essential step in rebuilding our national health service.

Mr Speaker, I do not beg to move that this Bill be read; I demand it be read, on behalf of NHS patients, on behalf of the staff—the nurses, the doctors, the support staff, the carers, the volunteers. On behalf of everyone who holds our national health service dear, I move that this Bill be read a Second time.

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[Sir Tony Baldry]

Yes, but the first point I want to make is this. We need to be careful about what we say about the NHS in the run-up to general elections. The first general election campaign that I was seriously involved in was back in 1966. In every one since then, there has been a period when the Labour party has run around saying things along the lines of “24 hours to save the NHS.” That is very destabilising, as was evidenced today in a letter to a national newspaper by Dr Michael Dixon, the chairman of the NHS Alliance, and a number of other GPs, in which they say:

“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.

The Bill’s proponents claim it will remove competition from the NHS and guard against ‘privatisation’ by repealing key clauses of the 2012 Health and Social Care Act.

We believe this would be a backwards step for patient care, reorganising the NHS in a top-down way at a time when it needs to be looking ahead to the huge challenges of the future. These were set out in the NHS England Five Year Forward View, and we urge all politicians to support it rather than using the NHS as a political football.

Suggesting that GP commissioners have a ‘privatisation agenda’ is an ill-informed attack on the clinical leadership which improves services and helps patients.”

I agree. It is disappointing if politicians use the NHS as a political football.

The NHS is an enduring part of the post-war consensus on the welfare state. That consensus was agreed on by everyone who had gone through the deprivations of the second world war, had lived through the blitz, and were determined that there would be a better Britain. The NHS was supported by everyone, including Archbishop Temple, a brilliant Archbishop of Canterbury, who was the person who first coined the phrase “the welfare state”.

I have always been interested in the NHS, not least because both my parents became part of the NHS on its very first day. When it came into being in 1948, my father was a recently qualified registrar and my mother was a theatre sister, having served as a theatre nurse during the Coventry blitz. My parents spent the whole of their working lives in the NHS: my father went on to become the research secretary of the British Tuberculosis Association and a chest and heart specialist, and my mother went on to become a sister tutor.

The other reason I have always been extremely interested in the success of the NHS is that, in the nearly third of a century I have been fortunate to be the Member of Parliament for north Oxfordshire, the most important issue in my constituency has probably been the position of Horton general hospital and the retention of its services.

I have left instructions in my will that my body should go to the anatomy department of the university of Oxford, partly because there is quite a lot of it for them to work on, but also because I feel that the liver of anybody who has been an MP for nearly a third of a century must be worthy of some anatomical research. I am also determined that when they open me up, they will discover engraved on my heart, “Keep the Horton general.”

What we heard from the hon. Member for Eltham was a litany of gloom in the NHS, but Horton general hospital now has more consultants than at any time in its and the NHS’s history. The Oxford University Hospitals NHS Trust employs 11,598 staff, including 1,800 doctors and 3,600 nurses. It is important to make clear that, since 2010, the number of patients seen by the trust, including at Horton, has increased significantly. There has been a 19% increase in elected in-patient admissions, a 9% increase in emergency in-patient admissions, a 24% increase in day-care admissions and a 12% increase in out-patient attendances. Those are significant increases in just over four years, so the NHS continues to treat more out-patients and in-patients.

Over the past two years, the Oxford University Hospitals NHS Trust has managed completely to eliminate its financial deficit and increase the amount paid to the Oxfordshire clinical commissioning group, such that the group finished the year with a surplus. Most importantly, over the past couple of years the trust has managed to create 400 new jobs, almost all of them new doctors and new nursing posts. Sir Jonathan Michael and his team deserve considerable congratulations on managing to balance the finances of the trust and securing a large number of new medical and nursing posts.

[Clive Efford]

Does the right hon. Gentleman think that all those things would have been achievable had the level of funding for the NHS continued at the rate we inherited in 1997 and had Labour not almost tripled the amount of GDP put into our health services?

[Sir Tony Baldry]

Every Government have invested money in the NHS, and quite rightly so. This Government have invested real-terms increases in the NHS, as evidenced by the Commonwealth Fund, which compares health systems internationally. It found this year that, although the United States health care system is the most expensive in the world, it underperforms relative to other countries on most dimensions of performance. The fund studied 11 nations: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The United States ranks last, but who ranks first as the best health care system in the world? The United Kingdom. We should all, wherever we sit in this House, be proud that we have the best health care system in the world.

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[Sir Tony Baldry]

With respect, I think the hon. Gentleman is seeking to avoid the point, which is that the 2012 Act did not fundamentally change the situation in the NHS between the public and private sectors. I draw the House’s attention to a debate that took place in Westminster Hall in 2002 on the subject of the private sector in the NHS that was initiated by the then Chair of the Select Committee on Health, the then Member for Wakefield, David Hinchliffe. The Minister, John Hutton, made a speech in response that could easily have been made in identical terms by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). John Hutton said:

“I do not want to repeat arguments that have already been made about the future of our relationship with the private sector, but I shall deal with some more specific points. My hon. Friend the Member for Wakefield was concerned about whether reference costs provide a sufficient measure of value for money in the NHS. We accept that they do not, and we have tried to set out in our report several ways in which we can strengthen reference cost data.”

He went on to say:

“My hon. Friend also referred to the evidence that my right hon. Friend the Secretary of State gave to the Committee. He set out four essential tests that we apply to each prospective partnership in the NHS and private sector. Is it in the interests of patients? Is it consistent with the local and national strategies of the NHS? Is it value for money? Is it consistent with public sector values, including that treatment is determined by clinical need and staff are treated fairly? Those are the yardsticks by which we will judge and develop our relationship with the private sector. Provided that those tests are satisfied, we should use the private and voluntary sector where it has a track record of achievement or where it can offer clear potential gains.”—[Official Report, 11 July 2002; Vol. 388, c. 354WH.]

I have absolutely no doubt that those are views that my hon. Friend the Minister would endorse today. It is an entirely sensible approach to how the NHS and the private and independent sector should work. The National Health Service Bill passed during the Session of 2005-06 further enshrined the relationship between the national health service and the private sector in statute.

The Bill promoted by the hon. Member for Eltham misses the point. The Health and Social Care Act did not and does not introduce competition into the NHS, it does not change the rules on when to tender competitively and there is no requirement to tender all services. What it does do is manage the competition that has been introduced.

[Clive Efford]

If the Act did not introduce competition to the NHS, will the right hon. Gentleman explain the following? Bristol hospital wanted to restructure its head and neck cancer surgery service. Monitor considered the proposal and concluded that it was likely to improve the quality of service to patients, but that

“the merger removes important competitive constraints for elective head and neck, ENT, OMF, urology and symptomatic breast care services in the absence of other competitors”.

In effect, it said that the restructuring could have improved the quality of care, but that because it would have removed competition, it could not go ahead.

[Sir Tony Baldry]

The hon. Gentleman misunderstands my point. The Act did not introduce competition into the NHS because that competition had already been introduced by the previous Labour Government, who introduced greater private sector involvement in the NHS. Labour made binding rules to manage the competition, and the Act continued that approach with an expert health sector regulator working in the best interests of patients. Removing Monitor as the health sector regulator would merely leave commissioners facing actions through the courts under Labour’s own 2006 procurement regulations, which I do not think would be in the best interests of patients.

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[Mark Reckless]

And indeed on this side of the House.

It is a particular pleasure to speak on a Bill introduced by the hon. Member for Eltham (Clive Efford), because I have spent time in the past few weeks defending myself following allegations from the Conservative party that I grew up in his constituency, in SE9.

[Clive Efford]

You should be proud.

[Mark Reckless]

Indeed, I am proud, and many people in my constituency have moved down from Eltham and the surrounding areas, and I am delighted that they returned me to the House in the early hours of this morning.

I found the hon. Gentleman’s speech compelling. At half-past 4 this morning or thereabouts, I was extolling the virtues of the Levellers and the Chartists. I can only think that I had a premonition of the speech that the hon. Gentleman was to make in the House this morning.

The other reason for my presence here is that, in the by-election I have just fought, we had in Naushabah Khan a Labour candidate who made—quite eloquently, I thought —the case against fragmentation and privatisation of the NHS, and she and others in Medway Labour commended the Bill to me.

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[Mark Reckless]

I will continue, if I may.

The independence of such hospitals, the inability of the House or the Secretary of State to drive improvements, and the decision to allow a hospital to become a foundation trust although one in 10 more people were dying than should have been the case, constitute an indictment of the last Government’s policy. I was delighted to hear from the Labour candidate whom I have faced in recent weeks that Labour is now against fragmentation and privatisation of the NHS. I welcome the Bill, and I am pleased to be able to support it.

[Clive Efford]

I welcome support for my Bill from all quarters, but why should anyone believe what the hon. Gentleman says about the NHS? Does he accept that the Government were elected with no mandate to introduce the 2012 Act, and that he voted for it?

[Mark Reckless]

I think that that is probably correct. I may be guilty of having believed the undertakings I was given by those on the Government Front Bench.

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[Dr Poulter]

I am just a doctor who still works in the health service and I practise medicine for free. Of course, we could go into the fact that I am the only Front Bencher present who has front-line experience of looking after patients. Professional politicians on the Opposition Benches are outlining a case that is incoherent with their record in government. We could also talk about the huge union funding that goes towards many Labour policies, but time would forbid us from doing so and I am sure that the Deputy Speaker would not want me to digress from the subject of this debate.

Let us come on to what the Health and Social Care Act actually did. First, it stripped out an entire layer of management from what was at the time an overly bureaucratic NHS. This is an important point that hon. Members would do well to listen to. The reforms will save our NHS £5.5 billion in this Parliament alone, and £1.5 billion every following year. That money is being put back into front-line patient care. In addition, as I notified the House in an answer to a recent written question, spending on administration as a proportion of the total NHS budget has fallen under this Government from 4.3% in 2010-11 to 2.9% in 2013. More money is going into front-line patient care because we have stripped out bureaucracy and administration and freed up that money to look after patients.

Between 2010 and July 2014, the number of infrastructure and administration support staff in the NHS has reduced by 10.3%, which is about 21,000. That includes a 17.7% decrease in managers and senior managers combined. Savings from reducing bureaucracy in this manner are being ploughed back into front-line patient care. For instance, we now employ 8,000 more doctors and 5,600 more nurses on our wards than in May 2010, and our NHS can do nearly 1 million more operations every year.

[Clive Efford]

The hon. Gentleman is taking us through a very detailed list of bureaucratic costs. Obviously, the Government are paying close attention to that, but why is it that when I asked them about the cost of overseeing the tendering process—the cost of lawyers, accountants and other advisers—they said that they do not collect that information?

[Dr Poulter]

I will come on later to the costs that the hon. Gentleman’s Bill would directly create. The point is that we should be proud—the Labour party should be supporting the Government—that we are reducing administration and bureaucratic costs, because that money is now being spent on patients. Why cannot Labour for once accept that a good thing has happened and that more money is now going into front-line patient care?

The second effect of the 2012 Act is that it empowered local doctors and nurses, as those closest to and most able to determine the needs of their patients, to design and lead the delivery of services around the needs of those patients. Thirdly, the Act placed great importance on and sought to drive increased integration across our NHS, a point clearly articulated by my hon. Friend the Member for Bosworth (David Tredinnick). Commissioners had duties placed on them by the Act to consider how services could be provided in a more integrated way, and we have since built on the Act by supporting a number of integration pioneer sites, which will trail-blaze new ideas to bring care closer together, particularly for frail elderly people and people with complex care needs. They will be leaders of change—a change we have to see in the health system, if we want to offer the very best quality of care to patients.

We are also supporting the health and care system through the £5.3 billion better care fund, with commissioners working in partnership with local authorities to deliver more integrated person-centred care. Offering seven-day services and delivering care that is centred on patients’ needs will encourage organisations to act earlier to prevent people from reaching crisis point. That is the sort of clinical leadership that the Act has fostered. It will refocus the point of care towards more proactive community-based care, for the benefit of so many patients.

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[Dr Poulter]

I believe I have given the hon. Lady those reassurances.

[Clive Efford]

rose—

[Dr Poulter]

The Government’s health care reforms ensured that, as under the last Labour Government, day-to-day decisions of care delivery became the responsibility of clinically led NHS commissioners. It is for the local NHS to decide which providers, whether from the public, private or voluntary sectors, can best meet the needs of their patients and deliver high-quality care.

[Clive Efford]

rose—

[Dr Poulter]

I will give way one more time in a moment, and then that really will, I am afraid, be the lot, because I know that Mr Deputy Speaker would like me to come to a conclusion.

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[Dr Poulter]

Thank you, Mr Deputy Speaker.

I have mentioned the benefit to patients many times in my speech, because that is, after all, what I care about as a doctor and what I care about as a Health Minister, and what I hope all hon. Members care about; I know that the hon. Member for Huddersfield (Mr Sheerman) does so.

Additionally, and contrary to claims made by some, TTIP will not prevent any future Government from changing the legal framework for the provision of NHS services. Neither will it prevent the termination of the private provision of such a service in accordance with the law or contracts entered into, as is already the case today. The reassurances that we and the European Commission offered were sufficient for the right hon. Member for Wentworth and Dearne (John Healey), a previous shadow Health Secretary, when he stated:

“On the NHS....my direct discussions with the EU’s chief negotiator have helped produce an EU promise to fully protect our health service including, as the chief negotiator says in a letter to me, so that: ‘any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS.”

If it was good enough for the right hon. Gentleman—

[Clive Efford]

rose—

[John Healey]

rose—

[Dr Poulter]

I will give way to the hon. Member for Eltham and then I will conclude.

[Clive Efford]

That really will not wash. The Minister is saying that we must trust the Government and that they will not allow TTIP to apply to the national health service. The Bill says that this House will be sovereign; this House will decide whether TTIP applies to our national health service. Does he support that?

[Dr Poulter]

I was simply quoting the reassurances that his right hon. Friend had given to all hon. Members, which was that

“any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS”.

If TTIP is good enough for the right hon. Member for Wentworth and Dearne , it should be good enough for everyone in the Labour party.

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[Jeremy Lefroy (Stafford) (Con)]

I welcome the Bill and congratulate the hon. Member for Eltham (Clive Efford) on introducing it; I shall be supporting its Second Reading today.

My support derives mainly from my and my constituents’ experiences over several years of some of the workings of the Health Act 2006, introduced by the previous Government, and the 2012 Act, introduced by this Government. In particular, two matters have been, and continue to be, of great significance: first, the two Francis inquiries into cases of dreadful care in my constituency, and secondly, the reports that have had such a major influence on the entire NHS. Just yesterday, my wife was giving a lecture to medical students on aspects of the Francis reports. It is vital that these lessons, particularly on patient safety and zero avoidable harm, are not forgotten, which is why I introduced a Bill on the subject two weeks ago.

The second concerns a more recent matter referred to already today: the review, supported by Macmillan, of cancer and end-of-life services in north Staffordshire, Stoke-on-Trent, Stafford and Cannock, which has resulted in a tender of all these services to be managed through an integrator. Just to correct the record, it is not just private companies on the tender—NHS organisations are also on it—but I still have major concerns. I am looking at this through the eyes of patients everywhere. The NHS must not be about structures or be in thrall to political dogma of any kind; it must be about safety and quality of care for all patients. I hope the Government might see the Bill in that way and use it as an opportunity to make improvements to both the 2006 Act and the 2012 Act.

I welcome clause 1. During the trust special administrator process that we had to go through, the inability of providers and commissioners to speak to one another—in some cases because of so-called commercial confidentiality —was ridiculous and without doubt delayed the process. At certain points, the whole process cried out for someone, if necessary the Secretary of State, to put everyone in a room for a day with instructions not to leave until everything had been sorted out. However, everybody was walking on eggshells in case they did something that might result in a judicial review and a reversion to square one. That was not in the interests of patients. That is not to be critical of those involved: for the most part they tried very hard and we got a better result than at some points we feared.

I want to make a serious point about clause 1 and the desire for the Bill to place the running of the NHS firmly in the hands of the Secretary of State. It is vital that there should not be too much hands-on running of the NHS by the Secretary of State—the British Medical Association, which has some very positive comments about the Bill, says that as well.

I am short of time, so let me conclude by talking about cancer and end-of-life services, which have been raised today. The problem is the way in which the NHS is funded and the fact that the tender is for all services involved in those pathways. It would have been much more sensible for the tender to help the work of integration, which would have involved a much smaller amount, rather than the full amount of services.

[Clive Efford]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

The House proceeded to a Division.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

I ask the Serjeant at Arms to investigate the delay in the No Lobby.

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Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63.)

[Clive Efford]

On a point of order, Mr Deputy Speaker. I understand that, in order to go into Committee, this Bill requires a resolution from the Government. Given the overwhelming number of people who turned up on a Friday to support it, would it not be churlish of the Government not to pass that resolution and make sure that this Bill goes into Committee forthwith?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

As you pointed out, it is something for the Government, but not me, to take on board.