National Health Service

Eleanor Smith Excerpts

1st reading: House of Commons
Wednesday 11th July 2018 Commons Chamber

[Eleanor Smith (Wolverhampton South West) (Lab)]

I beg to move,

That leave be given to introduce a Bill to re-establish the Secretary of State’s legal duty as to the National Health Service in England and to make provision about the other duties of the Secretary of State in that regard; to make provision for establishing Integrated Health Boards and about the administration and accountability of the National Health Service in England; to make provision about ending private finance initiatives in the National Health Service in England; to exclude the National Health Service from international trade agreements; to repeal sections 38 and 39 of the Immigration Act 2014; and for connected purposes.

As we celebrate 70 years since the NHS was founded, it is a privilege to have the opportunity to present to the House this Bill on the reinstatement of the NHS. It was founded in 1948 by a Labour Government, who recognised that, as Nye Bevan said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

The Bill honours that founding vision of the national health service.

In short, the Bill proposes to fully restore the NHS in England as an accountable public service. It is intended to give back to the Secretary of State for Health and Social Care the duty to provide services, including hospitals, medical and nursing services, primary care, and mental health and community services. It would integrate health services under the Secretary of State, while allowing the delegation of public health services to local authorities. The intent behind the Bill is to take private profits out of the NHS by abolishing the purchaser-provider split and repealing the competition and marketisation provisions in the Health and Social Care Act 2012. It is intended to make sure that the NHS is properly funded and ready to deliver the comprehensive care that people need now and in future.

The Bill is about getting private, profit-making companies out of NHS service provision, ending contracting out and reversing nearly 30 years of marketisation. It would end private practice and pay beds in NHS hospitals, and end contracts for GP services with commercial companies. It would create truly accountable local NHS planning, re-establishing public bodies capable of providing integrated services and accountable to local communities. The Bill would abolish NHS England, clinical commissioning groups, NHS trusts and NHS foundation trusts. It would scrap private finance initiatives and ensure that NHS assets and land remain in public ownership for future generations. The Bill is intended to make sure that no part of our NHS is up for sale, and would protect it from any forthcoming global trade agreement designed to asset-strip its resources.

For decades, core NHS values have been undermined. I was a nurse for 40 years before entering Parliament and saw this first hand. I was also a member of Unison and fought against it. We might hear that there is no privatisation because the NHS remains free, but believe me, it is being privatised. The fact that services are free to patients does not mean that they are not run by private companies for profit. That profit does not go back into the NHS. The money that we pay through our taxes should be spent on patient care and not go to shareholders. These are our hospitals, paid for out of our taxes and run by our NHS staff; they are not the Government’s to give away.

The Government downplay the amount spent by the NHS in the private sector but, according to the NHS Support Federation, in the year to April 2017, some £7.1 billion-worth of NHS clinical contracts was awarded through an NHS tendering process. The 2012 Act forced NHS contracts out to competitive tender in the marketplace, allowing private companies to cherry-pick profitable NHS services. Since that Act came into force, spending on non-NHS providers has totalled around £25 billion. That undermines NHS services and affects staff pay and conditions. The Government line is that only a trivial 7.6% of NHS services are run privately. According to the NHS Support Federation, for-profit companies won £3.1 billion-worth of new contracts in 2016-17. That is 43% of the total value of those advertised. The number of contracts awarded to the private sector has increased sevenfold since the 2012 Act came into force.

Under current arrangements, clinical commissioning groups do not have to serve a particular geographic area and are not required to tend to all illnesses and conditions. This is not the NHS that I understand and love. In some areas, certain treatments—such as hip and knee replacements and cataract operations—are already being rationed. It is vital to reinstate the Secretary of State’s duty, to provide the Government accountability needed to maintain a comprehensive NHS. An integrated structure would also mean we would have an opportunity to change the way social care is addressed. The NHS is for everyone, including the elderly and those with complex needs. Integrated health services and social services would be a welcome return to how the NHS previously gave care to those in need.

The Bill addresses the impact of the 2012 Act’s raising of the amount of income hospitals were permitted to make from private sources. That has shot up from 2% to 49%, which means that an NHS hospital could choose to devote 49% of its resources to private patients. That could be 49% of its precious beds. Such a scenario is almost upon us. For example, the Royal Marsden, with beds used by both NHS and private patients, has seen its income from private patients rise by 105% to £91.1 million—nearly a third of its total funding. That cannot have happened without an impact on NHS patients.

NHS trusts are almost £l billion in deficit, and it does not take much imagination to believe that NHS trust managers will see further increases in private patient care as a solution to this dire situation. The impact on NHS patients is obvious: it is the very embodiment of a two-tier system. With this ideology directed at it, no wonder the NHS is in crisis. The road we are travelling on is leading to a much diminished service. It is leading to a US-style health insurance system. That is not what I signed up to in 1977 when I started my training; I signed up to provide love, support and care to patients and their families, treating them all equally, whether they had money or not.

The Bill would impose a duty on the Treasury to minimise—and, if possible, end—the expenditure of public money on private finance initiatives in the NHS. Government Members might come back at me and say that PFI was wholeheartedly embraced by the previous Labour Government; well, not by me, and not on my watch. I was with Unison, fighting PFI every step of the way. Ending expenditure on PFI would contribute to returning the NHS to its founding principle and signal a return to the public service ethos that the NHS is famous for and that drives everyone involved to deliver the highest standard of care.

As a former nurse who is immensely proud of the NHS, I thank and pay tribute to the many patients, nurses, doctors, trade unions and campaigners across the country who have worked tirelessly to combat its privatisation. I also pay tribute to my hon. Friends the Members for York Central (Rachael Maskell) and for Wirral West (Margaret Greenwood) and the hon. Member for Brighton, Pavilion (Caroline Lucas) for the work that they have done on this Bill. The Bill has been created with the Labour Front-Bench leadership team and we will continue to work together on its future development with campaigners, unions, professionals and stakeholders.

Although, apparently, Nye Bevan did not actually say these words, everything that he ever said and did suggests that he wholeheartedly believed in them:

“The NHS will last as long as there are folk left with faith to fight for it.”

I have that faith. I left nursing and entered politics to fight for the NHS and to help to save it.

Question put and agreed to.

Ordered,

That Eleanor Smith, Bambos Charalambous, Mr Jim Cunningham, Caroline Lucas, Luke Pollard, Jo Platt, Matt Western, Laura Smith, Stephen Timms, Thelma Walker, Mohammad Yasin and Dr Rupa Huq present the Bill.

Eleanor Smith accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 26 October and be printed (Bill 250).