Future of the National Health Service

Debate between Hannah Bardell and Richard Burgon

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.