National Health Service (Amended Duties and Powers) Bill

David Nuttall Excerpts

Friday 21st November 2014 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

It is a pleasure to follow the right hon. Member for Banbury (Sir Tony Baldry). He made an attempt to make a serious speech, but his 30 minutes were based on one argument that is fundamentally wrong, which is that this Government have made no changes to the basis of the NHS in this country. These 457 pages of his Government’s legislation show that that is wrong. If he looks at sections 72, 73 and 80 of the Health and Social Care Act 2012, he will see that the Competition Act 1998, the Enterprise Act 2002 and the Office of Fair Trading are brought into play for the first time in our NHS.

So why no Tory apology to NHS staff, patients and the public? Why no Tory apology to NHS staff for forcing through the largest internal reorganisation in 65 years of NHS history and for forcing them to cope with increasing confusion, complex bureaucracy and wasted cost? Why no Tory apology to the public for an NHS that they now see has longer waiting lists and service cuts? Why no Tory apology to the public for breaking election promises and the terms of the coalition agreement to stop top-down reorganisations of the NHS, which have often got in the way of patient care? Finally, while we are at it, why no apology to this House for the way we were misled about the reorganisation and the legislation in 2010 and 2011, which became the 457-page Health and Social Care Act 2012?

[Mr David Nuttall (Bury North) (Con)]

I will tell the right hon. Gentleman why there has been no apology: because there is nothing to apologise for. That is the simple reason. We have a better health service now than we had before; that is why there has been no apology.

[John Healey]

Patients say exactly the opposite of what the hon. Gentleman has just argued. However, I understand that he feels he has nothing to apologise for. If he fundamentally believes that the NHS should be a system based on full-blown competition, delivered by the private sector, then of course he would want to legislate in that way.

--- Later in debate ---

[David Tredinnick]

I thank the hon. Lady for her intervention. The Government have made it possible for trusts to generate half their income from private sources, but it is not true to make out that we are in some way privatising the health service in a way that is detrimental to patients. We have made it possible for trusts to generate more income. In an ideal world, it would be wonderful if we could pay for all health care through general taxation. However, the Health Committee has examined the Nicholson challenge and seen the tremendous demand on resources. We have managed to maintain a flat-line budget in this Parliament, but demand is such that it is difficult to pay for everything through general taxation. One way to do it is by getting the private sector to contribute to the health service. The original arrangements were increased to this figure of nearly half. The thing to remember is that all the money generated from these sources is reinvested in patient care.

I had some freedom of information requests made, and wish to refer to the effect of these arrangements on four NHS foundation trusts in the midlands. They are not from Leicestershire, because those figures did not come through, but I do represent a midlands constituency. The Dudley Group NHS Foundation Trust received £68,000 in 2010-11, £50,000 in 2011-12 and another £80,000 in 2012-13 in funds that can go directly into patient care. The figures for the Heart of England NHS Foundation Trust are £559,000 in 2009-10, another half a million in 2010-11, a bit more in 2011-12 and nearly £532,000 in 2012-13, and there has been an increase to £628,000 in 2013-14.

My FOI request to the Shrewsbury and Telford Hospital NHS Trust elicited the following response—it is a short paragraph, so if I may, I will read it out:

“The Shrewsbury and Telford Hospital NHS Trust gains substantial income from Apley Ward and Clinic. Where private patient work is carried out in an NHS hospital, it is carried out in addition to and not in place of regular NHS treatment. Profits from this private facility make a considerable contribution to the running costs of the hospital for the benefit of all patients and staff.”

The hon. Member for Eltham made a passionate speech, but this point goes to the heart of the issue: privatisation is not about reducing resources, but increasing them. I gave notice to the hon. Member for Walsall South (Valerie Vaz) that I was going to mention the other figures I received, which are from the Walsall Healthcare NHS Trust and which show that over the past four years it has gained between £14,000 and £50,000 a year. The figures illustrate clearly that this approach is helping, and that is very welcome.

[Mr Nuttall]

The point my hon. Friend has just made is key in showing the dangers of this Bill. People have been writing to say that they are concerned about the risk of privatisation, but what is actually happening as a result of the 2012 Act process is that there is more money in our NHS, rather than less.

[David Tredinnick]

The Act is complicated. It is a big Act and it landed with a thump when the right hon. Member for Wentworth and Dearne (John Healey) dropped it on the Opposition Benches. I think he did so intentionally; and it was very theatrical and effective. It is true that there is more money there, and it is clear that the Government pledged at the last election to maintain the funding of the health service and have done so. We also have in place the Nicholson challenge, a phrase coined by my right hon. Friend the Member for Charnwood (Mr Dorrell)—formerly the Member for Loughborough—when he was Chair of the Health Committee, and we now face even greater challenges.

Let me set out to the hon. Member for Eltham what he could include in his Bill if it goes forward. He could examine the next stage of bringing together health and social care. On Tuesday, the Health Committee heard from Dame Kate Barker, the chair of the Commission on the Future of Health and Social Care in England. We were examining the transitional costs of bringing health and social care together, and looking ahead at the savings that can be made. The hon. Gentleman might apply his mind to the complications arising from the different streams of funding represented in health and social care, whereby health is funded by general taxation and some private support, which I have already discussed, whereas social care is the subject of means tests and other constraints. We are therefore talking about completely different funding stream. I do not know how the Health Committee will report this, but I was struck by Dame Kate Barker’s determination that there should be one person running health and social care. That is essential if we are going to bring those two things together.

The other point the hon. Gentleman should take on board as we look at the Bill is the high profile that the Secretary of State and his predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), have given to patient choice. The Government have said time and again that patient choice is at the heart of the health service, and we have already seen the benefits. The personal budgets now available for people who are seriously ill have had three benefits. First, they enable the patient to choose whatever treatment they want, be it tai chi, yoga or piano therapy—I believe that there have even been cases where tickets to a football match have been given. This is not something regulated by double-blind placebo controlled trials, as some of the other access arrangements for health care are. Secondly, the personal budgets enable the carers to go out into the world and get jobs, so freeing them up. Thirdly, when the personal budget money is given, it is spent responsibly by the patients. We have a whole new paradigm of health through personal budgets, and that should be examined through this Bill.

I have always felt that the 2012 Act and the reforms that were made produced something that put in place two legs on the stool, not three. The third leg comprises the vast and diverse multiplicity of support services that are not used in great depth in the health service now. Using them would considerably reduce costs and increase choice. The choice of these other support services will inevitably come to the fore as patients demand what they want, and we really have to bring this into the health service.

I have had many conversations about these things with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—the Minister on the Front-Bench today. He has entrusted me with being vice-chair of the herbal working group, which is trying to sort out herbal medicine regulation. When we examine the support services that are not now part of mainstream health care, we see that we have a fundamental problem relating to the insistence that we rely on evidence-based medicine. I do not know where that phrase came from—it has not been around for a long time. Various bodies protect the public, and all new drugs are carefully scrutinised, by the pharmacists and the Herbal Medicines Advisory Committee, which has put together a list of what are, in effect, poisons and bans the use of some herbs. The public are protected in that way, but it is very difficult to use normal measurements to assess the effectiveness of, for example, acupuncture, which the National Institute for Health and Care Excellence has approved for treating lower back pain. A lot of evidence shows that acupuncture can reduce the effects of lower back pain and save the NHS a lot of cost. With homeopathic medicine, which I have long supported and advocated, it is impossible to run trials on every dilution: some are so dilute that they do not show up.