Future of the National Health Service

Hannah Bardell Excerpts

Wednesday 22nd September 2021 Westminster Hall

[Hannah Bardell (in the Chair)]

Before we begin, I encourage Members to wear masks when they are not speaking, which is in line with current Government guidance and that of the House of Commons Commission. Please also give each other and members of staff space when seated and when entering and leaving the room.

[Richard Burgon (Leeds East) (Lab)]

I beg to move,

That this House has considered the future of the National Health Service.

Against the backdrop of the deepest health crisis in decades, the Tories have launched a dangerous NHS Bill. The Bill is not an attempt to address the deep failings of the past decade, driven by austerity, cuts, privatisation and the disastrous 2012 reforms that marketised our NHS. It is about entrenching an even greater role for private companies in our NHS.

The new Health and Care Bill should really be called the NHS Americanisation Bill, because it is the latest stage in the corporate takeover of our NHS, one where private companies not only profit from people’s ill health but increasingly get to decide who gets what treatments and when. Those who believe, as we do, in the real principles of our NHS—free treatment, based on need, guaranteed as a right in a comprehensive system—should be deeply alarmed. Others will address their concerns about the Government’s latest plans. Here are just a few of my concerns.

The Bill will not end or reverse privatisation but will open the door to greater private involvement. It is a charter for corruption, with the dodgy allocation of contracts we have seen throughout covid becoming the norm. It will mean even more politically compliant cronies, as it gives the Secretary of State powers to decide the heads of the new local health boards—expect more Dido Hardings, and accountability to local communities to be reduced.

It will introduce strict caps on budgets, which could lead to serious rationing, with services cut to match funding, rather than funding matching health needs. We will have a postcode lottery for treatments. A new payment system would give providers, including private providers, a say in how much they should be paid for contracts won. It has the potential for staff to be paid according to local rates and conditions, creating a race to the bottom with the deregulation of the medical professions, potentially undermining the quality and the safety of care.

These reforms are part of a wider plan. That plan depends first on deliberately underfunding the NHS. Under the previous Labour Government, NHS funding increased by 7% a year; under the Tories, it increased by just 1.2% a year between 2009-10 and 2018-19, and by even less when the growing and ageing population is factored in. Although some new funding is planned through regressive taxes on working people, funding under this Government will still be well below the historic average that is needed. As Matthew Taylor of the NHS Confederation said:

“Extra funding is welcome. But the Government promised to give the NHS whatever it needed to deal with the pandemic, and while it makes a start on tackling backlogs, this announcement unfortunately hasn’t gone nearly far enough. Health and care leaders are now faced with an impossible set of choices about where and how to prioritise care for patients.”

That deliberate underfunding always goes hand in hand with greater privatisation. Waiting lists grow and people start to seek health provision elsewhere. As budgets are cut, that is used as the cover to bring the private sector into the NHS under the false arguments of efficiencies and savings, when the reality is that every pound spent bolstering the private companies is a pound less spent on people’s healthcare. Instead of more privatisation, the public overwhelmingly back the NHS being returned fully to being a public service.

The Bill is being spun as a way to address the huge failings of the Health and Social Care Act 2012, which placed markets at the heart of the NHS, but, in reality, it is simply a way to entrench privatisation in a different way. The Bill does not address the deepest failings of the 2012 reforms. For instance, while dropping the absurd competitive tendering process, the new Bill does not make it a requirement that the NHS is the default option for providing healthcare services.

The legal structure for the market remains. The profit-hungry vultures will still be circling and trying to pick a profit from human suffering. Foundation trusts will still be able to make from 49% of their income by treating private patients, and key outsourced services, including those provided by porters and cleaners, will not be brought back in-house.

As well as allowing private companies still to pocket public money, the Government’s plans also give private companies a chance to shape health policy directly. The Bill opens the door for private corporations to sit on the 42 local health boards—the so-called integrated care boards—that will make critical decisions about NHS spending. In a sign of what might be to come across the country, Virgin Care already has such a seat in Somerset. The Government are under political pressure on the issue, as we know, so we have seen some limited concessions, but they are not enough. The real solution must be that private companies have no role at all on these boards or in the running of our national health service.

The Bill also allows NHS local boards to award contracts to private healthcare providers with even less transparency than they do now. Contracts will be exempted from the public contracts regulations, which opens the door to yet more dodgy handouts to the Tories’ corporate mates, something that has become all too common during the pandemic—and the public know it.

What we have seen with test and trace over the past year is what the Tories want to do with the whole of our NHS. But this stealth privatisation does not end with test and trace. An unbelievable £100 billion has gone to non-NHS providers of healthcare over the last decade alone. Earlier this year, 500,000 patients had their GP services passed over to a US health insurance company, Centene, which is one of the biggest companies in the United States. Its UK subsidiary, Operose Health, now runs 58 GP practices and is thought to be the largest private supplier of GP services in the UK. It is no coincidence that Operose Health’s former chief executive officer, Samantha Jones, was appointed as an adviser to the Prime Minister. An adviser on what? An adviser on NHS transformation. Nothing to see here, of course.

The public have not consented to any of this. In fact, the Government have gone to great lengths to ensure that the public are not even aware that the process is happening, because a new poll by EveryDoctor showed that just one in four people know that up to 11% of the NHS budget goes to private companies.

Finally, when we consider the future of our NHS, we must tackle its staffing crisis. There are many tens of thousands of vacancies, including nearly 40,000 nursing vacancies alone. Yet NHS staff are set to get just a 3% pay increase this year, with most or even all of that increase being eroded by inflation. That will not only fail to tackle the shortages; it is a kick in the teeth, after everything—everything—that our NHS heroes have done over the past 18 months and after a decade of real-terms pay cuts. Nurses’ pay has fallen by around 12% since 2010, so the 15% pay increase that nurses are demanding would address that fall, even if it will not make up for the thousands of pounds in lost pay over the past decade. NHS staff have been balloted and they reject the current pay offer. I wish to place on the record that NHS staff have my full support in their campaign for 15%.

To conclude, instead of addressing the immediate crisis of 5 million people—and rising—on waiting lists, or the tens of thousands of staff vacancies, we are getting yet another top-down reorganisation, the aim of which is to accelerate the stealth Americanisation of our national health service. Of course, the Tories deny that their latest Bill is about privatisation and Americanisation, but I would argue that their response to the pandemic reveals their real ambitions.

[Hannah Bardell (in the Chair)]

Members will be aware that there will be a Division very shortly and the debate will be suspended. I would like to call winding-up speeches by 3.28 pm and I appeal to Members to speak for around five minutes.

[Chris Green (Bolton West) (Con)]

It is a pleasure to follow the hon. Member for Leeds East (Richard Burgon). He made a powerful speech, true to his beliefs and values, and he made some powerful points.

It reminded me of my more radical background when it comes to politics, especially in terms of health. I remember attending—not participating in—a demonstration and march in 2011 in Chorlton, shortly after the new Government came in. It was a reasonably left-leaning march and there were a few Soviet Union flags with the hammer and sickle. One of the most powerful contributions was from a trade union rep, who said, “We don’t need change. We don’t need innovation in the National Health Service. The only change you ever needed in the NHS was in 1948 when it was created. We don’t need any change from then.” That was the spirit, and it is the view that too many people have.

The NHS ought to be changing all the time, in different ways, to keep up with the way people work, and with technology and culture. There are so many ways in which the national health service ought to be changing all the time. We need legislation, led by my hon. Friend the Minister, to make sure that we keep up with changes in society. People would be outraged if we had not moved on culturally from 1948.

What does that lead to? Fundamentally, we ought to be focusing on the importance of patients’ values and needs, to make sure that they are at the centre of the national health service. It is not fundamentally about NHS structures, although those are incredibly important, or about maintaining structures as they are forever, but about ensuring that those structures reflect the needs of the national health service so that it is as effective as possible.

We hear discussions and talk about globalisation, which we know is a reality. Many parts of globalisation are a threat, as highlighted by the hon. Member for Leeds East, who talked about the threats and concerns. However, there are also significant opportunities. We want better access to drugs and medicines, especially innovative drugs and the latest drugs. If we look at figures from the European Medicines Agency about the adoption of drugs, we see that England is behind Germany, Denmark, Austria, Switzerland and Italy. We ought to be at the forefront of the adoption of new drugs and new ways to look after people’s lives.

What do we need to understand when we are thinking about this, especially when we consider treatments and support for people with rare conditions? The UK is often not big enough to provide the innovation for these new treatments, so we need international collaborations. The national health service and other UK bodies need to work with countries around the world, but there is a place for corporations, whether in America, Japan or other places.

We need to ensure that our research and development effort collaborates and works with countries around the world. That cannot be on a Government-to-Government or Government agency-to-Government agency basis only. It has to be right through the system. If we do not have that approach where we need clinical trials at scale to support people or to find new treatments for people with rare diseases, it will not happen. We need to participate in international trials as well.

I would expect these things and I hope my hon. Friend the Minister will articulate that they give more potential to the national health service, because we need more engagement. At the moment, the national health service does not function in the way that many people around the country believe it ought to function. It ought to be far more engaged in clinical trials. Talking to many people from the sector, my sense is that that is down to individual leadership in particular trusts.

Too many trusts do not lead and participate in innovation or the adoption of new drugs, once they have been approved. The system is too slow and it often takes far too long, so patients and patient groups know that their trust or clinical commissioning group does not have the life-enhancing or even life-saving treatment that is available. We need that reform of the system to ensure that it looks after the patients.

There is another aspect that needs changing, which is the way that the NHS is funded or operates. I have a strong sense that it is relatively straightforward for the NHS to adopt a new drug. However, it is far more challenging for the NHS to adopt a new medical device because of the up-front costs and the training needs at the beginning. It is more difficult to adopt a device than it is a drug, and we need to have parity in that. We need the NHS to have the ability to adopt these devices and adapt to them.

That naturally leads on to what devices do. A key part of devices is the generation of data. Data is important for understanding the performance and ability of new treatments to make a difference to people’s lives. The NHS does not operate, to any extent, as a system that works and engages properly and fully with data systems. We need reform of the NHS to do that.

[Hannah Bardell (in the Chair)]

Order. I hope the hon. Member will wind up his comments shortly.

[Chris Green]

I will. The integrated care systems ought to be part of this, with local leadership, and hopefully strong accountability, to ensure that leaders in those areas can drive that engagement with medical research technology charities, corporations, institutes and universities, to ensure that the NHS is innovative, adopts new technologies and ensures that patients have the best they can. That is a huge amount of reform, and it must start now.

[Rachael Maskell (York Central) (Lab/Co-op)]

It is a pleasure to serve with you in the chair, Ms Bardell. I thank my hon. Friend the Member for Leeds East (Richard Burgon) for opening the debate with so many facts that we need to reflect on. From before our first breath, to our very last, since 5 July 1948, the NHS has worked day and night to give us hope.

The principle was that, no matter who we were—duke or dustman, as Bevan said—we knew that, when the hands of the NHS reached out to us, it neither judged nor differentiated. It simply did everything it could to invest in our health. That equality was the way out of health inequality, which is, sadly, so stark today in constituencies like mine, where the most affluent can expect to live for 10 years more than the poorest.

Reading Michael Marmot’s report, there is something fundamentally missing from the NHS. This reorganisation will not address it. We must sew that into housing, air pollution, jobs—the things that really will bring about a fundamental change.

[Hannah Bardell (in the Chair)]

Order. I am sorry to interrupt the hon. Lady mid-flow.

--- Later in debate ---

On resuming—

[Hannah Bardell (in the Chair)]

Before I call the hon. Member for York Central again, I advise Members that the new end time for the debate will be 4.15 pm, and that I would like to call Ministers by 3.45 pm.

[Rachael Maskell]

Unless and until public health is the Government’s first priority, the demands will be ever-growing, but now, unlike before, it is uncertain whether those demands will be met. Just look at covid-19: the countries that put public health first had the lowest sickness and mortality rates, yet over 135,000 lives have been lost here. Whether it is covid or cancer, poverty is the greatest enemy of health, yet as we speak, the surge in poverty that this Government are imposing on our constituents through the changes they are bringing about—whether through national insurance contributions, or by taking away the £20 universal credit uplift and other benefits—is resulting in poorer mental and physical health. After a decade of austerity, poor workforce planning and a continued drive to profit off the sick have taken their toll on our NHS. In 2019-20, according to the King’s Fund, £9.7 billion was spent on private provision, up by £500 million on the previous year. According to the data provider Tussell, £37.9 billion-worth of covid contracts have been let.

The economic and health shock of covid should prompt us to hit the pause button on the NHS. Last Friday, I spent half a day with York Medical Group, with clinicians, managers, GP partners and support staff; I was there to listen. This Friday, I will be at York Hospital, which is also struggling. The GP practice has received 41,000 calls from a population of 44,000 patients on their books in a month; add to that the 5.6 million, rising to a possible 13 million, waiting for treatment in secondary care. The system is imploding, the staff are imploding, and the NHS is imploding. We cannot just keep feeding money into the NHS, and we cannot keep selling it off.

When I read the subject of the debate—“the future of the NHS”—I did not consider the Health and Care Bill to be that, nor did the staff who I met with. In fact, they see the Bill as a massive distraction from dealing with the current crisis that they are having to grapple with, and another assault is just one step too many. Staff are saying that to save their own mental and physical health, they are now having to walk. We therefore have a workforce crisis on top of a health crisis, and the NHS is now in a clinically dangerous place. Government Ministers who completely misunderstand how the NHS works cannot just keep interfering in the system. They need to pause. They misunderstand the professionalism, care, dedication and love of the people who give all that they have—day in, day out—to care for us. As Ministers introduce more complex systems and more private companies into the health service, the NHS itself is falling apart. The Health and Care Bill is not the solution; it cannot be the way forward.

On the integration of the health service and social care, if we do not put the money together, we cannot put the systems together. However, the reforms will create more barriers and more division, rather than solving the challenges before us. The World Health Organisation describes health as

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A future NHS must start here. Public health has been so underfunded over the last 10 years, and even under-utilised during the pandemic. It is absolutely vital that it is at the forefront of the future NHS. Regular population screening will start addressing severe health inequalities. Health counselling will ensure that people make the right choices about their future and will divert people who do not access the health service when they need it into early intervention and prevention. If we invest in clinicians in the community to undertake that dialogue and those discussions, and if we invest in social prescribing and other ways of improving people’s lifestyles, we have a real chance to turn this system around.

We cannot delay putting together an integrated public health agenda to drive forward our health service. If we continue as we are, our NHS will not be here. The pressures bearing down now are just indescribable. After listening to staff, all I can say is that the Health and Care Bill is just not the solution.