Health and Social Care Bill

David Anderson Excerpts

Monday 31st January 2011 Commons Chamber

[John Healey]

My hon. Friend is right—and the chief executive of the Patients Association, Katherine Murphy has said just that. Many patient groups are making the same arguments and issuing the same warnings.

My serious concern is that this Government have told only half the story from the start. The Health Secretary and the Prime Minister are happy to talk about GP commissioning and happy to talk about cutting management—the organisational changes—but they downplay or deny the deep ideological changes at the heart of these plans. The Health Secretary mentioned the new economic regulator, Monitor, in just one line in a speech lasting more than 40 minutes. The Prime Minister said last week in his speech on public services that these reforms

“are not about theory or ideology”.

The Prime Minister writes in The Times today, just as the Health Secretary did last week, both of them producing 700 words about their health plans, yet they made not a single mention of competition.

We will explain and expose the truth throughout this debate and the Bill’s passage through Parliament because these changes will break up the NHS; they will open up all areas of the NHS to price-cutting competition from private health companies; and they will take away from all parts of the NHS the requirement for proper openness, scrutiny and accountability to the public and to Parliament. These Government changes are driving free market political ideology into the heart of the NHS, and that is why doctors are now saying:

“As it stands, the UK Government’s new Bill spells the end of the NHS.”

[Mr David Anderson (Blaydon) (Lab)]

rose—

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

rose—

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[John Healey]

My hon. Friend may be right. I have not seen the regulations, but that is certainly in the impact assessment, so he is on to an important point.

Government Members and the Health Secretary have spent a long time talking about Labour’s plans, policies and record, but the debate at the heart of this Bill is not about whether competition, choice or the private sector has a part to play in the NHS—they have and they do. The debate at the heart of this Bill is about whether full-blown competition, based on price and ruled by competition law, is the right basis for our NHS. That is why Labour Members oppose this Bill. We want the NHS run on the basis of what is best for patients, not what is best for the market. We want the NHS to be driven by the ethos of public service, not by the economics of forced competition. We will defend to the end a health service that is there for all, fair for all and free to all who need it when they need it.

If the stated aims for the reform were all the Government wanted—we have heard the Health Secretary say that he wants a greater role for doctors in commissioning, more involvement of patients, less bureaucracy and greater priority put on to improving health outcomes—he should do what the GPs say: turn the primary care trust boards over to doctors and patients, so that they can run this and do the job. But there is no correlation between the aims that the Health Secretary sets out and the actions he is taking. There is no connection between his aims and his actions. He is pursuing his actions because his aims are not sufficient. His actions would not achieve the full-scale switch to forced market competition, which is the true purpose of the changes.

Meanwhile, the biggest challenges and changes for the NHS will be made harder, not easier, by the reorganisation. Such challenges include making £20 billion of efficiency savings and improving patient services; ensuring better integration of social care and health care, of primary care and hospital care, and of public health and community health; and providing more services in closer reach of patients in the community rather than in hospital. But the Government will not listen to the warnings from the NHS experts, the NHS professional bodies, patient groups or even the Select Committee on Health.

[Mr Anderson]

In a disparaging comment earlier, the Secretary of State said that the voices of concern were the voices of the trade unions. They are led by people who were health professionals and they represent 1.3 million professionals. Surely somebody in this place should listen to what they say and not to Government Members, who have a biased reason for doing this.

[John Healey]

My hon. Friend is right. The more that NHS staff see of the changes and the consequences of this Government’s handling of the NHS, the more concerned they are about the changes and the more they are starting to see the NHS go backwards. But the Government will not listen to these warnings that are coming from all sides. They are in denial about the risks: the risk that patients will see services get worse, not better; the risk that up to £3 billion will be wasted on internal reorganisation; the risk that innovation and improvements in care that come from greater collaboration will be blocked by the Office of Fair Trading, competition courts and the new market regulator; and the risk that the Bill will create the monster of a full-blown market in health care which GPs will not control and nor will Ministers or Parliament.

If patients have been sold a false prospectus, that is true of GPs too. GPs are being told that they will call the shots on deciding who provides care for their patients, but they are being set up by the Government. They are likely to find their hands tied by Monitor and the Office of Fair Trading and by the courts enforcing competition law. They are likely to find their decisions challenged by private companies if they do not accept “any willing provider”, especially one that offers to undercut on price. The chair of the Royal College of General Practitioners recently issued a warning to her colleagues. She said:

“I understood these reforms were about putting GPs at the centre of planning healthcare for their patients, not about making sweeping cuts, which will include shutting hospitals, making enormous redundancies, closing services”.

Because the reorganisation will force doctors to make rationing decisions as well as referral decisions for their patients, they will make treatment decisions with one eye on their patient and the other on their budget and their consortium’s bottom line.

The Government say they are devolving power to front-line services, putting clinicians in control, making the NHS more accountable and improving the integration and quality of services, but in the Bill they are making the forces of competition and centralisation far stronger than those of devolution, democratic accountability or the development of quality in patient services. We will explain and expose the gap between what Ministers are saying and what they are doing in every debate at every stage of this legislation.

Patients and staff are already seeing signs of strain in the NHS. They are starting to ask, “What on earth are the Government doing with the NHS? Why don’t they listen to the warnings? Why is the Prime Minister breaking the very personal promise he made to protect the NHS?” The Bill puts competition first and patients second. That is why we will oppose the Bill tonight and expose this truth in the months ahead. These are the wrong reforms for the wrong reasons at the wrong time.

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[Dan Byles (North Warwickshire) (Con)]

I am grateful for the opportunity to speak in this debate, and declare an interest in that my wife is a general practitioner.

It is an oft-stated fact that the NHS holds a special place in the hearts of British people. That is why it is so important that this vital institution is managed effectively and sustainably so that our children and grandchildren can continue to use and rely on it in the years to come. However, the problem with the cherished position that the NHS holds is that it makes it difficult to discuss and debate its future dispassionately. It is extremely important that we in this House are able to discuss NHS reform sensibly and without the hyperbole and hysteria shown by the shadow Secretary of State in his opening remarks and by the hon. Member for Eltham (Clive Efford), whose frankly disgusting remarks were not worthy of this Chamber.

The previous Government, who undertook considerable, frequent and, dare I say it, well-intentioned reorganisations of the NHS, found that each reorganisation was opposed by a variety of interests for a variety of reasons. Although they spent too much time reorganising the bureaucracy of the NHS, and generally adding to it on each occasion, I welcomed some of their reforms and am happy to say so, with the notable examples of foundation trusts and the greater involvement of private and other providers. In too many cases, however, previous reforms took the form of shuffling the management deck chairs. Strategic health authorities and primary care trusts were reorganised and reorganised again, often before the ink at the top of the old letterheads had dried, while the number of bureaucrats soared relentlessly.

The challenges faced by the NHS are considerable, and to deny the need for further change is dangerous. Cost pressures within the NHS are rising. This has, in part, been driven by the blunt way in which the previous Government pushed up health spending without insisting on robustly improving outcomes alongside that increased spending. As a result, we have seen productivity fall—a trend that must be reversed if the NHS spending model is to be sustainable. That health care inflation has also been driven by outside factors. Costly new drugs and treatments, coupled with an ageing population, have created serious challenges and will continue to do so.

A hard-headed analysis of these demographic changes has led the coalition Government, rightly, to commit to ring-fencing the NHS from Government spending cuts and guaranteeing real-terms increases in NHS spending—a commitment, I might add, not matched by Labour. With the privilege of a ring-fenced budget comes a responsibility on the side of the NHS to maximise productivity and efficiency to ensure the best possible clinical outcomes for patients within that budget settlement.

[Mr Anderson]

If it is a ring-fenced budget, why does the Royal College of Nursing believe that there will be 27,000 fewer nurses in a year’s time?

[Dan Byles]

The NHS budget is going up in real terms every year, as the hon. Gentleman can see by looking at the books. We are all aware that the system we inherited had ongoing problems because of the high management costs and other structural problems within the NHS. There will be no shortage of nurses as a result of any underfunding by the current Government—I can assure him of that.

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[Mr David Anderson (Blaydon) (Lab)]

I rise to speak not only as a former official of Unison, the biggest trade union in the health service, but as a former care worker. Like most other union officials who have been bad-mouthed as the voice of conservatism, I have actually worked in taking care of people. Perhaps once in a while the people who have delivered services to the vulnerable, the sick and those in need in this country might be listened to. The last time the Conservatives were in power, they did not listen to the voices of such people about the health service, which is why we saw the introduction of compulsory competitive tendering, which led to hygiene-related diseases. We saw massive waiting lists and people waiting on trolleys in corridors.

I do not want to put my views tonight, but the views of the people who work in the health service, such as my GP, who asked me this morning how, if we are to go through all these changes, he will be able to take the time off to learn business administration and how to use a computer properly so that he will be able to challenge the people who will run his service. The King’s Fund says that it questions

“the need to embark on a fundamental reorganisation when evidence shows health outcomes and public satisfaction have improved.”

The hon. Member for Totnes (Dr Wollaston) says that

“it does look like somebody has tossed a hand grenade at the PCTs”

and, even more importantly:

“If the expertise isn’t there…inevitably they’re going to be having to turn more to the private sector.”

Dr Hamish Meldrum, chairman of the British Medical Association, says:

“Ploughing ahead with these changes as they stand, at such speed, at a time of huge financial pressure…is a massive gamble.”

He also says:

“We will quickly see failed consortia bought up on the cheap by foreign companies and see bits of the NHS run from abroad.”

Sir Richard Thompson, president of the Royal College of Physicians, says:

“The fragmentation of services would have detrimental impacts on the various areas the reforms seek to improve”.

Dr Peter Carter from the Royal College of Nursing says:

“The RCN is also concerned that the fragmentation could result in unexplained variations in service, a reduction in collaboration and less sharing of good practice—all of which impact on quality care.”

He also says:

“We don’t think it’s been properly thought through… In May last year the average waiting time was nine weeks. Our concern at the moment is that short-sighted false economy will end up costing the public money and result in patient care going backwards.”

The head of Arthritis Care says that

“the Bill risks creating a ‘free-for-all’ situation where only those patients who shout the loudest will get the services they need.”

In a letter to The Times on 17 January, the leaders of six professional health service organisations said:

“The scale and ambitions of the cost-reform programme are extremely risky and potentially dangerous.”

Last Monday, in a letter to The Times, 190 nurses from one trust said that the

“figures from the Royal College of Nursing show 27,000 nursing posts are being cut. These proposed reforms will make matters much, much worse…The proposed reforms will be rapid, costly and staggering in scale: they presage nothing less than the complete reconstruction, if not privatisation, of the NHS”.

This morning, in the Newcastle Journal, 12 doctors representing people from Northumberland in the north to Yorkshire in the south said that

“enforced financial competition, creating a health ‘market’, risks damaging our health service. Forcing GP consortia to tender contracts out…runs the huge risk of seeing large commercial, profit-driven companies entering the market. They will pursue the most profitable contracts…and ignore aspects of healthcare which are not profitable, leaving behind ‘Cinderella’ services. There can be no doubt that the use of their size to undercut on price…could damage local services in the north-east.”

Those are not my words. They are the words of those we as a nation trust to take care of the people who send us here. To rubbish them, like Government Members have done tonight, as the voices of conservatism means just one thing: arrogance. It shows that they are not prepared to listen to those who take our people forward and look after them. [Interruption.] No, I am not going to sit down; other people want to speak. The truth is that the people of this country will never forget that, and they will not forget the human shields in the Liberal Democrats who are giving cover to that policy.