Health and Social Care (Re-committed) Bill

Debate between Debbie Abrahams and Dan Poulter

Tuesday 6th September 2011 Commons Chamber

[Debbie Abrahams]

There are many unanswered questions about the Bill, which makes it particularly dangerous.

By opening up competition under the guise of increasing patient choice and clinician-led commissioning, the Government are trying to increase both demand and supply for these services, but the implication for a single-payer health system with a fixed budget, such as the NHS, is that this will inevitably lead to financial meltdown. The only way this can be avoided is by injecting extra capital into the system and the Bill achieves this in many ways. We need to look at not only this cluster of amendments but all the amendments and clauses in the Bill as a whole, because they are interrelated.

First, the Bill allows foundation trusts to borrow money from the City to invest. This is supported by the opening up of EU competition law. Foundation trusts are currently social enterprises and are exempt from part of EU competition, but this opening up will open the flood gates. It means that the trusts will have to compete for tenders with private health care companies. They will have to repay the money they have borrowed by treating more and more patients, including private patients, which will be aided by the abolition of the cap on income from private patients. However, many foundation trusts will still struggle, so the Bill introduces a new insolvency regime to enable private equity companies to buy NHS facilities and asset-strip them, which has direct parallels with the demise of Southern Cross.

Secondly, waiting lists will go up. We are already seeing that across the country, including in my constituency. We have seen that already because unrealistic efficiency measures mean that cash-strapped primary care trusts are rationing access to treatment such as cataract surgery and hip replacements.

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

Does the hon. Lady not accept that waiting lists have not gone up in England but have gone up in Wales, where Labour is in control of the NHS?

[Debbie Abrahams]

It is very interesting that the Government have changed how they measure waiting lists and now use an average, so those indicators are a movable feast.

As waiting lists go up, new health insurance products on the market are enticing people to believe that all their treatment and care can be met fully by the private sector. This will be complemented by new insurance markets set up for top-ups and co-payments. We know from the United States that people on low incomes will be less able to afford these products directly, which will impact on the existing health inequalities that the Secretary of State has stressed his commitment to reducing. Why are we doing this? It will increase and exacerbate the inequalities that already exist in accessing care.

Finally, the Bill allows both the national commissioning board and clinical commissioning groups to make charges. I foresee that in the next Parliament there will be more direct patient charges if this Government get in again. As the NHS budget is fixed, the drive for excess capacity will drain that budget rapidly. That will result in clinical commissioning consortia increasingly becoming rationing bodies. As waiting lists increase, they will attempt to manage the issue by reducing the number of core services. That will drive foundation trusts into further debt, forcing closures, mergers and private management takeovers, and we are already seeing that.

Future of the NHS

Debate between Debbie Abrahams and Dan Poulter

Monday 9th May 2011 Commons Chamber

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

I agreed with very little of what the hon. Member for Pontypridd (Owen Smith) said when we were on the Public Bill Committee together, and I am afraid that I will not change my view after hearing what he has said today. He touched, however, on the important issue of health economics. In a thoughtful speech, the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made some good points about health economics. Much as I would rather talk just about patient care, given my medical background, health economics are at the centre of the discussion about how we will reform and improve the NHS.

The comprehensive spending review announced that the NHS would see its funding rise by 0.4% in real terms over the next four years. Despite the current economic climate, the Government have stood by their commitment to increasing NHS funding over this Parliament—we are very proud of that—but, even so, it is the smallest increase in NHS funding for decades. Ever-increasing patient demand for health care coupled with Britain’s demographic time bomb means that over the next few years the NHS will have to achieve value for money for its patients on an unprecedented scale.

Our NHS needs to make efficiency savings just to stand still and to continue to deliver high-quality patient care. My right hon. Friend the Member for Charnwood (Mr Dorrell) hit the nail right on the head when he said that we need to think about not just the worried well but the 80% to 85% of patients who have serious medical co-morbidities or present as emergencies with acute medical problems in accident and emergency. That desire lies at the heart of the Government’s proposed reforms.

People are living longer, and as they do the number of people living with multiple medical co-morbidities also increases. The majority of people require their health care in the later stages of their lives and if we are to have an NHS that is truly responsive to the demographics of this country, we need to ensure better integration of health and social care. We must stop the silo working that often exists between local authorities and the NHS and ensure that we have a more locally responsive NHS. At the heart of the Bill is a desire to see better integration of adult social care and NHS care, which can only be a good thing in view of this country’s demographics and of the health economics of looking after people in the later years of their lives.

[Debbie Abrahams]

Does the hon. Gentleman share the concern that many councils that will be responsible for the delivery of public health are not ring-fencing the money and are using it to offset some of the cuts that they face?

[Dr Poulter]

I can only say that my Conservative-run, Suffolk council is doing exactly the opposite of what the hon. Lady describes. The Government have committed to putting almost £2 billion into adult social care, looking at the demographic time bomb and looking at better integrating health care with adult social care. I would be very concerned to see councils doing what she describes, because that is not what they are given that money for. If she has had a problem with that at her local authority, she needs to take it up with that authority.

The key to unlocking potential in the health sector lies in cutting the red tape and pointless form-filling that wastes the time of so many front-line staff. Of course, our NHS must have a level of regulation that ensures that products and services are thoroughly tested and that ensures patient safety. However, the over-excessive regulation introduced by the previous Government has been damaging not only to patient care but to staff morale. It has also diverted vital resources away from the front line and away from patients, who are, after all, what health care should be all about. This Government are rightly looking to take simple, obvious and positive steps in improving the overall efficiency of the NHS by scrapping the health quangos that waste £2 billion a year—money that could be much better spent on front-line patient care.

Another issue that I want to highlight in the time left to me is another area of wasteful spending in our NHS—management. Under the previous Government, the number of managers and unproductive non-medical staff increased in the past decade, with the number of managers and senior managers in the NHS almost doubling to 42,000. In many hospitals, more new managers than new nurses were recruited in that time. That cannot be right—it is bad for patients and money is being misspent. As I witnessed at first hand, NHS managers were rewarded at a better rate than front-line staff—at around 7%, compared with 1.8% pay rises for front-line medical staff. That is not a good thing.

The Opposition are very concerned about staff morale, but let me tell them why staff morale is so low: it is because the contributions of front-line staff were badly undervalued by the previous Government while the contribution of managers were over-valued. I believe that what we and the Government need to do is make sure that more money goes into front-line patient care and front-line staff rather than being wasted on management and bureaucracy.