NHS (Private Sector)

Dan Poulter Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.

The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on 8 May, he promised that safeguards would be brought forward in the health Bill. He said:

“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”

He followed that up on 14 June with this promise:

“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”

Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.

Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.

Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the right hon. Gentleman accept that the cap was not clearly defined but was very variable according to the hospital, and will he now say that it was wrong for the previous Government to set the cap at over 30% for the Royal Marsden hospital, which is a centre of excellence?

[Andy Burnham]

I agree that the cap varied according to historical levels of private sector activity within the different trusts. The hon. Gentleman is absolutely right about that, but he must agree that it was clearly defined in respect of every individual NHS hospital. They had a clear number and local people were able to hold them to account for that number. Where hospitals had large numbers, the cap froze their level of activity at the level when the cap was introduced.

--- Later in debate ---

[Andy Burnham]

There are a lot of questions there. The Secretary of State discusses the safeguards, but he has introduced them precisely because he has made a major break with 63 years of NHS history. He needs them because he wants a different health care system in this country, in which much more work is done by private providers and in which the commissioning of services is largely handed over to the private sector. That is why he has had to introduce those safeguards. We had a health service that was planned, managed and publicly accountable, but he is throwing all of that away.

[Dr Poulter]

I thank the right hon. Gentleman for giving way; he is very generous. Does he not agree that the two hospitals with the highest patient cap—the Royal Marsden and the Royal Brompton—use the money that they make through private income very effectively, and put it back in to make them centres of excellence for all patients, particularly their NHS patients?

[Andy Burnham]

That was the policy of the previous Government, but the cap was clearly defined. It was a tight cap, and it reflected historical levels of work. What we are talking about is a liberalising measure to enable the private sector to double if not quadruple the amount of work that it is doing, which is why we are debating the motion.

I shall pose a question for the Health Secretary, who mentioned safeguards. If it is all fine to create a different NHS in which we have many more private contracts, might not the NHS risk register have something to say about the risks of creating such an NHS and the additional challenges of delivering health care through a system based on commercial contracts? Might it not lead to a diversion of spending on lawyers and consultants, away from patient care? Is there not a great irony, as we have heard the Health Secretary bemoan a lack of ability to intervene in the recent situation while, at the same time, here he is promoting a Bill that removes his ability to do so on a much wider basis? He wants to hand over his ability to intervene to the independent NHS Commissioning Board. The irony of his position will not be lost on many people listening to the debate.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is always a great pleasure to follow the right hon. Member for Holborn and St Pancras (Frank Dobson), but he was rather disingenuous about my right hon. Friend the Member for Charnwood (Mr Dorrell). My right hon. Friend said—I think we all agree about it—that where the private sector can add value for money and add value to patient care that always has to be a good thing, as well as something that I think Members on both sides of the House agree on.

My right hon. Friend made the point, which was also well made by the right hon. Member for Leigh (Andy Burnham), that this is not a debate about whether the private sector is a good thing or a bad thing in the NHS; it is a good thing, clearly, where it improves care for patients and offers high-quality patient care. The debate is about whether having a cap on the role of the private sector in foundation trusts is a good thing.

It appears that the private patient cap is set arbitrarily and varies from trust to trust. On the basis of what we know, it is difficult simply to argue that having the private sector heavily involved in the workings of a trust is necessarily a bad thing. We know that the 30% private sector activity at the Royal Marsden is hugely beneficial—not only to the private patients, but to those patients looked after by the Royal Marsden who are NHS patients. We see the same at the Royal Brompton, Moorfields and many other hospitals with a relatively high private patient cap. At those hospitals, the money raised from private activities and the private sector is pumped back into the hospital to improve research and to provide high-quality patient care for all NHS patients at those hospitals. Simply saying that having the private sector involved in a hospital to a larger extent is a bad thing because it compromises patient care is plainly not the case. Some of the best hospitals make the case that, in fact, a cap set at a high level is right. As my right hon. Friend the Secretary of State said, at hospitals such as the Marsden, even when they could set 30% private activity, they use only a proportion of that cap, because what they look at first is their primary duty to their NHS patients and their primary duty to provide high-quality care.

It is difficult to argue for a cap set at an arbitrary level, because what everyone in the NHS is interested in, and what we in Parliament are interested in, is producing high-quality patient care. In that respect, my right hon. Friend the Member for Charnwood was absolutely right. Tony Blair believed that, and it was at the heart of his health care reforms. In that respect, the Government are carrying forward the mantra of patients’ best interests.

I have discussed a little the fact that an arbitrary cap does not work, and is not in patients’ best interests. I have also discussed the benefits that involving the private sector in hospitals can bring to NHS patients. The good thing about those hospitals, particularly the Royal Brompton and the Royal Marsden, which are centres of excellence, is the fact that private sector involvement improves the quality and the output of medical research. That is another reason why those hospitals are pioneering examples of high-quality patient research, which benefits patients, particularly in the NHS. This is a good motion, as it endorses the role of the private sector, which can be a good thing as long as it is for the benefit of patients. However, it is a bad thing to impose arbitrary caps that do not benefit patients.