NHS (Private Sector)

Henry Smith Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

Just hang on and listen. Nothing has been done to the Bill to bring together the Prime Minister’s and Deputy Prime Minister’s promises that there would be no privatisation. There has been no substantial change since the pause.

Let me come directly to whether the Bill represents a privatisation of the kind that we saw in the 1980s. In doing so, I shall refer to a report from the King’s Fund, which I recommend to the hon. Lady. The Government have failed to introduce measures that they promised, months after the pause, so it is still considered appropriate for a body as respected as the King’s Fund to make a fairly shocking comparison that, indeed, the Bill is similar to the privatisations of the Thatcher Government. The report says:

“The Government’s proposals draw heavily on the regulatory framework developed in telecoms and utilities regulators …Interestingly, Secretary of State for Health Andrew Lansley’s own ideas for the reform of the NHS, developed while in opposition, were born out of his experience of the privatisation and regulation of utilities in the mid-1980s when he was Principal Private Secretary to Norman Tebbit.”

There we—[Interruption.] Okay, there we have it. That is the view of the King’s Fund—this is a privatisation along the lines of those we saw in the 1980s.

To back up that point, the King’s Fund quotes from a speech that the Secretary of State gave in 2005 to the NHS Confederation. He said this of the 1980s privatisations:

“The combination of the introduction of competition with a strong independent regulator delivered immense consumer value and economic benefits.”

There are two problems with that statement. First, there are real questions about whether gas, electricity, water and rail customers feel that they have had immense value. Secondly, it is troubling that the Secretary of State for Health, of all people, considers the delivery of health care directly comparable to telecoms and utilities.

[Henry Smith (Crawley) (Con)]

Does the right hon. Gentleman recall saying in 2007 that he celebrated the role of the private sector in the NHS?

[Andy Burnham]

This is getting a little tedious. May I refer the hon. Gentleman to the motion, which indeed does the very same thing? It recognises the fact that there is

“an important role for the private sector”

in the delivery of good NHS care and celebrates the role that it played in helping us to deliver the lowest ever NHS waiting times. Before intervening in future debates, he might like to read the motion that the House is considering.

Let me quote the Secretary of State’s interesting 2005 speech to the NHS Confederation, which set out the essential ingredients that we now see in his Health and Social Care Bill. His plan was to

“maximise competition, transfer risk to the private sector…appoint a strong, pro-competitive regulator…set out clearly the standards which have to be met and how operators will be held accountable for them…be clear about how and by whom universal service obligations are to be met…ensure high quality information for customers”

and have

“more customers rather than fewer.”

That is, do not have a few monopolistic health authority purchasers. The Secretary of State is nodding in assent that that is, essentially, his Health and Social Care Bill. This is, of course, the basic framework that the House of Lords is considering, despite the Deputy Prime Minister’s claim to have rejected

“the free market dogma that can fragment the NHS.”

A phrase leaps out of that 2005 speech that, in the light of recent events, needs to be challenged. It is

“transfer risk to the private sector”.

While acceptable in theory, I wonder whether recent experience with the private cosmetic surgery industry has led the Secretary of State to reconsider whether and how, in the health context, that can be delivered in practice. In an NHS based on commercial contracts, would there not always be arguments about legal liability when things went wrong? Would it not be much harder to control quality and costs in such a way, rather than through the current planned and managed NHS system that we have?

--- Later in debate ---

[Mr Lansley]

There will not be any transfer of responsibility for services from the NHS to the private sector; the NHS will continue to be responsible. The balance in the NHS—[Interruption.] No, I shall answer the right hon. Gentleman’s point. He is trying to interpret “privatisation” as every service currently provided by an NHS provider being provided by an NHS provider in the future, but whether services are provided by the NHS or by a private enterprise, a social enterprise or a charity will be determined by patients choosing who is the best-quality provider. So that is not privatisation; the service remains free, and it remains an NHS service. It is guaranteed to patients in exactly the same way, and there is no presumption in the legislation—in fact, it excludes any presumption—in favour of a private sector provider as against an NHS provider.

The right hon. Gentleman is in absolutely no position to make any criticism of that, because he served in a Government who introduced independent sector treatment centres. They went through the process of giving the private sector contracts that were not available to the NHS, with an 11% higher price on average and a guarantee that they would be paid even if they did not necessarily provide the treatment. The net result was £297 million spent on operations that never took place, and the private sector walked away with that money, so he is in absolutely no position to make any criticism, because we are going to exclude such practices. The contracts that the Labour party gave to the private sector when he was a Minister are exactly the contracts that our legislation will exclude.

[Henry Smith]

Will the Secretary of State confirm that, under the previous Administration, private sector involvement in the NHS went up by 78%?

[Mr Lansley]

Interestingly, under the so-called extended choice network that the Labour Government introduced, the number of elective operations conducted in the private sector went from, I think, 16,000 in 2005-06 to 208,000 in 2009-10—an enormous increase. From the right hon. Gentleman’s point of view, it was marginal capacity that did not really matter, but the point is that patients said that they thought it provided good quality care. In a Care Quality Commission survey, some 96% of NHS patients using independent facilities said that the elective surgery they received was “excellent” or “very good”. The figure for NHS facilities was 79%. On the NHS Choices website, nine of the top 20 highest-rated NHS-funded providers were run by the independent sector; there were no independent-sector hospitals in the bottom 20. The general proposition is that the private sector is worse in the NHS, but there is no evidence to support that.

The right hon. Gentleman will recall that the Royal College of Surgeons conducted a study of the quality of care, and its general conclusion was that the quality of clinical care offered to NHS patients by private sector providers was as good as the care offered by the NHS. So what is his point? He used the private sector, patients used the private sector and patients were happy. What is his point?

--- Later in debate ---

[Henry Smith (Crawley) (Con)]

I am grateful to be called, Mr Deputy Speaker. I had three reasons for writing to Mr Speaker requesting to take part in this debate. The first is that I genuinely wanted to hear, in this Opposition day debate on the NHS, what the Opposition’s plans really are for the future of our health service. The second reason is that I want to describe the experience that my constituents went through, over 13 years of a Labour Administration. Finally, I want to talk about how already, in anticipation of the Health and Social Care Bill becoming law, clinicians in Crawley are working to deliver a better national health service.

I do not mind telling the House that I am forgoing an invitation to a dinner this evening, so great was my desire to hear exactly the official Opposition’s view on the NHS. What I have heard this evening is incredible—or, so that I am not misunderstood, not credible. It is amazing that a party that massively increased the PFI programme during its tenure, spending billions of pounds of taxpayers’ money in an inefficient way through the national health service, should come to the House this evening and try to claim that what we are trying to achieve in the Health and Social Care Bill will somehow privatise the national health service. Let us be quite clear: this Government are committed to providing a national health service that is available regardless of the ability to pay. The difference, I contend, between Government Members and Opposition Members is that they are ruled by some sort of centralist dogma that says that if the Department of Health has not willed it, it cannot happen, whereas the Government are trying to introduce a pragmatic approach, in which outcomes are far more important than the strict processes that a dogmatic system for delivering health care should produce.

I said that I wanted briefly to mention the experience of the NHS during what we are often led to believe were the golden years of the health service, under the previous Government. Those years were not so golden for my constituents, because in 2001—a decade ago—we regrettably saw the downgrading of maternity services at Crawley hospital. Crawley is a growing town; indeed, its motto is, “I grow and I rejoice”. However, there was not much rejoicing when its maternity services were taken away and transferred almost 10 miles up the road to East Surrey hospital, where there is now increased pressure on maternity services, as it is having to cope with the increased number of people from not only east Surrey, but the north-east of West Sussex.

To add insult to injury, in 2005 Crawley hospital saw its accident and emergency department closed. Again, it was moved miles up the road to East Surrey hospital, even though there is little public transport between that hospital and Crawley—a growing and ageing town, with increasing health needs and major transportation links, not least the nation’s second biggest airport, London Gatwick—and single-carriageway roads. At best, that is inconvenient for patients and for families wishing to visit them in hospital; at worst, it is potentially fatal. That is my constituents’ experience.

[Barbara Keeley]

The hon. Gentleman is making a defence of A and E and maternity services, but does he not recognise that, despite the promises made by the current Secretary of State during the election campaign, many hospitals have, for clinical reasons, done the very same thing? They include Salford Royal, which has lost its maternity services, and others in the north-west, even though the Secretary of State promised that that would not happen to them. Does the hon. Gentleman not see that those things are going on now?

[Henry Smith]

The principal reason behind the closure of the accident and emergency unit at my local hospital was the European working time directive, which had a massive impact across the national health service. The NHS as an institution will of course evolve, the better to serve patients up and down the country. That is absolutely right.

That brings me to the third point that I wanted to make: the opportunity that the Health and Social Care Bill will provide for greater localisation in decision making on the future of health care services. I am delighted that the clinicians and GPs in Crawley have already come together to form a GP commissioning body, which is very ably chaired by Dr Amit Bhargava. It is brimming with ideas for innovative ways in which patients can be provided with much better services. For the first time in many years, decisions about the future of health care in Crawley are being made by Crawley clinicians, in conjunction with their patients and in the light of their patients’ needs. The group is working in conjunction with the local authorities—West Sussex county council and Crawley borough council—which, incidentally, will be providing oversight of some of the private sector contracts in the national health service, as envisaged in the Bill. The provision of that democratic oversight for the first time will achieve a localisation of services that is more relevant to the needs of the local communities, as well as a far greater degree of oversight.

I reject the motion before us, and I welcome the Health and Social Care Bill. It will be better for patients and better for democratic oversight. Ultimately, we should be talking about, and delivering, better outcomes for health care in this country, not remaining wedded to an outdated dogma which does not deliver services as efficiently as it could and should deliver them.