Regional Pay (NHS)

Jamie Reed Excerpts

Wednesday 7th November 2012 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

NHS staff are among the most valued and respected members of any work force, public or private. Like so many public sector workers—the police, firefighters, teachers, social workers, and many more—they make a crucial and often critical difference every day to the real lives of ordinary people in communities throughout our country, wherever they may be and whatever their wealth. In so many ways, these universal services and the values that they both represent and live by are our national values. They support us, they strengthen us, and they bind us as one nation.

The values of the national health service were celebrated as an article of faith in what it means to be British by Danny Boyle during the opening ceremony of the Olympics. When the eyes of the world were upon us, we showed the world that the NHS and the values that underpin it are part of what makes us British—not Cornish, not Cumbrian, not Lancastrian, but British. It is little wonder that the new Secretary of State tried to have that tribute removed from the ceremony. He knew what it meant then, he knows what it means now, and his support for regional pay in the NHS—revealed at the Dispatch Box today—shows that he is determined to fragment the service.

Since the Government came to power, NHS staff have been marginalised, trivialised and ignored. Reorganisation was imposed upon them with no mandate, no support and no warning. Since then more than 6,000 nursing posts have been lost, and billions of pounds have been taken away from the NHS front line to pay for redundancies and a reorganisation that nobody wanted—a reorganisation that was hidden from the electorate before the election.

Despite all that, these people still achieve remarkable results in the most trying of circumstances every single day. They continue to succeed, despite the incompetence of the Prime Minister and his Health Ministers. NHS workers can surely be forgiven for having had enough of the Government being on their backs; but, not content with being on their backs, the Government now want to be in their pockets as well.

Regional pay is demotivating, demoralising and wrong. It will harm the NHS in the parts of our country that are most in need, not only in the NHS and not only in local NHS services, but in the local economies where those NHS services are located. The London Evening Standard’s city editor, Russell Lynch, wrote last week that the regions

“still account for more than three-quarters of the economy. And if I were in Middlesbrough, Manchester or Leeds right now, I’d be more worried about the mugging that’s on the way from the Chancellor over regional pay in the public sector.”

Of course he was right, and the fear is palpable. That is why this is so important. That is why the Government must intervene, stop regional pay taking hold, and uphold the principle of national pay agreements within the NHS.

As we have heard, 60 academics recently wrote to The Times damning the Government’s regional pay proposals. Let us examine why. The public sector wage bill last year was £162.5 billion for the employment of approximately 6 million people. The aim of the Prime Minister, the Chancellor and, I assume, the Health Secretary is to remove what they claim is an 8% disparity between the wages in the public and private sectors. As usual, that is a heavily disputed figure with no real basis, but let us assume that it is correct. If the Government succeed in removing the difference that they imagine exists, 6 million people will have a cumulative £13 billion less to spend. That is almost 1% of our total economy.

In an age of austerity, when the parts of our country that already rely heavily on public spending are feeling the cuts most acutely, what madness it is to take even more money away from those economies, those homes and those families. Talk about killing demand in the regions! This will not just hurt the public sector and damage local economies; it will bludgeon local private enterprise—those who work in partnership with the public sector, who have contracts with the public sector, who trade with the public sector, and who sell their products to local people paid by and working in the public sector. The insidious desire to divide and rule ignores the fact that one nation has one economy.

Let us consider what regional pay in the NHS could mean for the future of NHS services. The Government have encouraged privatisation to run amok in the NHS, deliberately and ideologically. Whereas we used the private sector in a targeted, limited and structured manner, the Conservatives want to let it run riot like the Bullingdon Club in a china shop. It is no wonder that private health care provides so many funds for the Conservative party.

One of the more flimsy Treasury claims about regional pay is that it would stop private firms being crowded out by the public sector, but how is this applicable to the NHS? Is the real purpose of the NHS regional pay proposals to allow the Government to facilitate faster privatisation of NHS services by hollowing out NHS terms and conditions? Unless the Government intervene —as they should—to halt this development, it will appear that part of the agenda underpinning regional pay is, indeed, to enable the easier privatisation of NHS services. Instead of seeing NHS staff for what they are—the best partners any Government committed to improving the NHS could ever have—this Government see them as surplus to requirements in too many parts of the country, with terms and conditions that the Government see as acting as a roadblock to further privatisation.

[Sarah Newton]

Will the hon. Gentleman give way?

[Mr Reed]

I am afraid I do not have enough time.

Let us concentrate on the impact of regional pay proposals in the south-west. Because the Government have given their clear approval through their submission to the NHS Pay Review Body, 20 trusts across the south-west have already each committed £10,000 to form a consortium—a cartel—designed to reduce staff pay and to break away from the established NHS terms and conditions. That is money that should be spent on patient care. Is the Secretary of State satisfied with that state of affairs? Some £200,000 is being spent in an effort to reduce the pay and conditions of NHS staff in the south-west—one of the lowest paid areas in England—against the backdrop of almost 1,000 nursing posts being lost in the south-west since this Government came to office.

It is barely credible that this Government should use the south-west as a laboratory in which to experiment with regional pay. It is a Liberal Democrat stronghold. The Liberal Democrat leader has said that regional pay will not happen, yet it is happening. It may call itself a coalition, but this is a Conservative Government in all but name, and with NHS regional pay they are treating south-west England in the same way that the last Tory Government treated Scotland with the poll tax. I know Members from the south-west see that, and I hope that they will vote with us to stop this gruesome experiment in its tracks.

Regional NHS pay is not being introduced only in the south-west, however. It is also being proposed by a series of trusts across the north-east, which is another region that cannot afford to let this Government pick its pocket. NHS trusts in Oxford, Birmingham, Cheshire and Manchester are also threatening to break away from the national pay agreements established under “Agenda for Change”.

This Government have lost financial control of the NHS, unless it is to cut it. They are now refusing even to try to control the demoralisation of NHS staff as their terms and conditions are denigrated. That is shameful. Why is this happening?

All roads lead back to the Government’s hated Health and Social Care Act 2012, with a £3 billion reorganisation at a time of an already unprecedented financial savings challenge. As trusts are plunged into financial turmoil, they are forced to look at opting out of national pay structures. And that is not all. The Treasury’s own figures show that real-terms NHS spending has been reduced under this Prime Minister year on year, as broken promise follows broken promise.

Regional pay in the NHS is opposed by the Royal College of Nursing, the Royal College of Midwives, NHS Employers, the British Medical Association and more. More importantly—[Interruption.] All Members would do well to listen to this point. Surveys show that 2 in 3 voters across the political spectrum believe that regional pay should be dropped: over 70% of Labour and Liberal Democrat voters and just over 50% of Conservative voters believe that.

That opposition is mirrored across this House. The Deputy Prime Minister claims to be against it—we will see—but Liberal Democrat MPs for Manchester, Withington, for Southport, for Torbay, for St Austell and Newquay, for St Ives and for North Cornwall are against it, and Conservative MPs for areas such as Torridge and West Devon, Hexham, and Brigg and Goole have also spoken out against these ruinous proposals. I commend the argument put forward by the hon. Member for Hexham (Guy Opperman). He has said:

“Our current pay system, which sets a base pay rate, already allows for adjustments in high cost areas like London”,

and

“I do not believe reducing public sector pay will help stimulate private economic growth.”

He added:

“I am very concerned that regional pay would lead to a reduction in the pay packets of some public sector workers in the North East.”

I share that view entirely, and the same can be said for communities across England.

Let none of us forget the disproportionate effects of regional pay on women, because this is also a gender issue. Not for the first time, working women around the country will be asking themselves just what this Prime Minister has against them. Do they all have to lend him a horse before he offers them some protection? Women make up 65% of the public sector work force and they account for more than 80% of NHS staff covered by “Agenda for Change”. Regional pay will hit women disproportionately. That is not right or fair. It is being done knowingly, and the Prime Minister will pay a heavy price if these proposals are not stopped.

We again find ourselves in the midst of a slow-moving disaster that the NHS can do without. We find ourselves having to deal with a Government who command no trust on the NHS, whether from the public or from health professionals. It is a disaster of the Government’s own making. As usual, the areas that can least afford to, and, most importantly, NHS patients, will end up paying the price for this ineptitude. The Secretary of State knows that regional pay will damage the NHS, he knows that the country is opposed to it, and he knows that he should intervene to stop it. A refusal to do so will demonstrate a failure to understand the values, principles and purpose of a truly national health service, and will illustrate his desire to undermine those very values. I commend the motion to the House.

--- Later in debate ---

[Dr Poulter]

The right hon. Gentleman cannot rewrite history. He cannot stand at the Dispatch Box and say that he no longer agrees with the pay flexibilities he gave local NHS employers or with the “Agenda for Change” document that his Government put in place. That document recognises that in parts of this country premiums of up to 30% need to be paid to employees. It also recognises that the cost of living in London is much higher and gives a £6,000 premium to NHS workers who work in the centre of London.

In our amendment, the Government are pleased to support the comments made to the GMB by my right hon. Friend the Chief Secretary to the Treasury. That highlights the Government’s support for NHS and public sector staff and recognises implicitly that in some parts of the country—as the previous Government’s “Agenda for Change” makes clear—we need pay flexibility to recognise when the cost of living is greater.

Importantly, the Government have also made clear our intention to retain national pay frameworks and national collective bargaining while they remain fit for purpose. That is why we are encouraging NHS employers and the trade unions to come together at the NHS Staff Council to negotiate a settlement that remains fit for purpose so that we can continue to endorse national pay frameworks. That is the stated position of the Government and it is a shame that the Opposition are attempting to politicise an issue of their own making.

It is worth putting it on record that despite the financial challenge faced by the whole public sector, we have put an extra £12.5 billion into the NHS during the life of this Parliament. That is not to say, however, that there is no financial pressure, and the Opposition were right to highlight the Nicholson challenge and the need to cut away bureaucracy and waste in the NHS in order to put more money into the front line. We endorse that. The Government are meeting the Nicholson challenge, and the NHS reforms we have put in place will put the NHS in a much better place to do that in the future.

[Mr Reed]

Does the Minister agree that everyone in this House should pay close attention to the fact that another set of terms and conditions for public servants is being negotiated now, and that if Members of Parliament vote for regional pay in the national health service they should accept regional pay for Members of Parliament?

[Dr Poulter]

The hon. Gentleman needs to be brought back to reality for a second. His Government introduced regional pay in the NHS through “Agenda for Change”, so he cannot stand at the Dispatch Box and rewrite history, saying that he is desperately concerned for the workers. “Agenda for Change” needs to remain fit for purpose, and it is the Government who are standing up for NHS workers. We will protect not just patients but jobs and workers in the NHS by ensuring that we support NHS employers and the trade unions as they come together to protect jobs and ensure that “Agenda for Change” remains fit for purpose in the future.

In conclusion, it is clear that the Opposition want to rewrite history, but it is time to cut the propaganda and get real about the debate. We all want to see individual employers given autonomy based on agreed national frameworks, but we want to make sure that “Agenda for Change” stays fit for purpose. In the end we must deliver high quality care for patients, and we understand that that also means looking after staff. That is why it is so important that the national pay frameworks remain fit for purpose, and that on both sides of the House we encourage NHS employers and the trade unions to negotiate a settlement within those frameworks.

The Opposition must stop attempting to play politics. They must support the NHS staff, as we on the Government Benches are doing. The Government are standing up for the NHS, its staff and its patients. That is why I urge all hon. Members to support the amendment and reject the motion.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

My hon. Friend makes a good point and it is important that we support national pay bargaining where we can. There is an agreement in principle, endorsed by NHS employers, that national pay bargaining is supported throughout the NHS. It was supported throughout the NHS under the previous Government, who set up the “Agenda for Change”, and during their tenure, that agenda remained fit for purpose. Twenty changes during the previous Government’s tenure benefited employees in the NHS, and rightly so. The current Government believe that we must continue to ensure that the system is fit for purpose.

[Mr Jamie Reed (Copeland) (Lab)]

It is most unusual to find the ghost of Christmas past sitting next to the invisible man. The truth is that in May this year, the Deputy Prime Minister stated:

“There is going to be no regional pay system. That is not going to happen.”

Regional pay will strip millions from local NHS services; it will hit the poorest areas of the country hardest, damage front-line NHS care, and there can be no justification for it. Will the Minister categorically rule out continuing with these ruinous proposals—yes or no?

[Dr Poulter]

The arguments presented by the hon. Gentleman are fatuous, and the previous Government endorsed regional bandings for London workers. If today he is saying that he does not agree—[Interruption.] You might learn something if you listen. If he is saying that he does not agree with London weighting for London workers, which is a form of regional pay—[Interruption.]

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Burns]

As the hon. Lady will be aware from the debate we had last week, these proposals are subject to the consultation process and to consideration of the results. Commissioners fully recognise the need to minimise the impact the changes will have on neighbouring A and E departments and other services. The Trafford and South Manchester clinical commissioning groups are working on developing further integrated care services, and on developing community care services as an alternative to hospital care, as well as on ensuring that the final decisions meet the needs of the local health economy by providing first-class quality care for the people of that area.

[Mr Jamie Reed (Copeland) (Lab)]

Of course, it is not just Wythenshawe A and E that is facing difficulties. All Members throughout the House are grateful for the work our medical professionals do in extremely trying circumstances, but the truth is that the Government’s chaotic reorganisation has resulted in longer waits in accident and emergency. The Minister of State said last night that A and E departments were meeting the target, but figures published by his Department last week show that the Government have failed to meet the 95% target across major type 1 A and E units. If he cannot get his own figures right, he cannot expect to command the trust of patients or medical professionals. Will he now take this opportunity to show some respect for this House, for the public and for patients in general, and correct the record?

[Mr Speaker]

Order. May I just explain that the Minister did not widen the parameters of the exchange and therefore they should not be widened, so he is perfectly within his rights, if he wishes, to focus his reply on Wythenshawe. I hope he is not going to be too disappointed. We’ll give it a go.

NHS (Rationing of Care)

Jamie Reed Excerpts

Monday 16th July 2012 Commons Chamber

[Mrs Mary Glindon (North Tyneside) (Lab)]

This issue has already been raised today in the debate on a motion in the main business of the House, but I believe that the growing concern about rationing in the NHS justifies further debate tonight. For almost as long as the NHS has existed, rationing has been a matter of concern. Resources are finite, but in the past two years rationing has reached an unprecedented level; more than 125 previously free treatments have now been restricted or even stopped altogether, and they cover the full health care spectrum, from the cosmetic to the essential and all stages in between.

These findings were revealed in a survey, carried out by Labour’s shadow health team, of all NHS primary care trusts and shadow clinical commissioning groups in England. It is important to state the relevance of Labour’s new NHS check, which I will refer to in my speech, because as well as conducting surveys it gathers together the views of those working in the health service and takes into account the views of those receiving the service and their families. The submissions are considered alongside evidence from freedom of information requests to produce an accurate and relevant monthly report, such as the one on rationing.

Labour’s findings are backed by members of the British Medical Association who warn that creeping NHS rationing is making patients suffer unnecessarily, with people who need hip and knee replacements having to wait longer for operations while suffering in pain. GPs believe that the rationing is the result of the drive to make savings in the NHS of up to £20 billion by 2015. That is further borne out by the results of a poll conducted by the BBC in March, which found that more than four out of five GPs expect the rationing of NHS care to increase in response to financial pressure.

The concerns of the medical profession are echoed by other professions in the health service. Ahead of this debate I was contacted by the Chartered Society of Physiotherapy, which is very concerned about the rationing of NHS physiotherapy services and has a number of examples of patient care and outcomes suffering as a result. The CSP opposed the Health and Social Care Bill and the Government’s reforms to the NHS because of concerns about the negative impact on patient care resulting from rationing and the fragmentation of services. It is particularly concerned about the “any qualified provider” model and has found that patient choice is being adversely affected by the clear rationing of treatment and access in some of the “any qualified provider” service specifications, which it has systematically reviewed. For example, in Nottinghamshire the amount of treatment prescribed is limited without regard to patient need. In other areas, no re-referrals are allowed within a six or 12-month period, also regardless of patient need. This rationing is likely to lead to increased orthopaedic referrals and unnecessary surgical interventions.

The CSP has further concerns about the impact of the “any qualified provider” model, including a reduction in patient choice and the quality of care, the loss of clinically and cost-effective innovations such as self-referral to physiotherapy, the negative impact on the physiotherapy profession and the risk of conflicts of interest among private providers. Those are all legitimate concerns from a respected professional body, so I hope that the Minister will address them specifically with the society.

The Minister has denied the relevance of the shadow health team’s extensive survey, the NHS check, but perhaps he should reconsider his opinion of it, because the survey’s findings mirror those of GP magazine, which gathered evidence under the Freedom of Information Act, showing that 90% of primary care trusts were imposing restrictions. The magazine received responses from two thirds of England’s 151 trusts on the procedures that they considered to be non-urgent. The most common restriction was on tonsillectomies, but there was rationing in other areas, too.

[Mr Jamie Reed (Copeland) (Lab)]

Will my hon. Friend give way?

[Mrs Glindon]

I will.

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. You can make an intervention, Mr Reed, but not from the Opposition Front Bench. If you step up to another Bench, you may intervene from there.

[Mr Reed]

Thank you, Mr Deputy Speaker. I trust that this is in order.

Will my hon. Friend join me in asking the Minister, who has indicated that he will not take interventions from me this evening, whether he will undertake a nationwide investigation into the clear rationing that is occurring in the NHS, and whether the Government will publish a list of procedures in which the eligibility criteria for treatment are now being changed? Will she join me also in asking the Government to act where various NHS organisations are breaching NICE guidelines on treatments offered to patients?

[Mrs Glindon]

I certainly will, and my hon. Friend may find that at the end of my speech I reiterate some of what he has said.

There is rationing in other areas, too, with 66% of trusts limiting cataract surgery and more than half rationing weight-loss surgery and hip and knee operations. Dr Richard Vautrey of the British Medical Association describes the situation as a “cost-saving exercise”, saying quite rightly:

“Patients fully understand the NHS doesn’t have unlimited resources...but they don’t understand, or believe it’s fair, when services are provided in one area but not another.”

The Labour party’s survey provides evidence of random rationing throughout the NHS, and of an accelerating postcode lottery. A number of rationed or decommissioned treatments are common across several PCTs and clinical commissioning groups, while some are specific to individual PCTs and CCGs. That demonstrates the wide variation throughout the country.

The survey found that rationing of treatment varies from capping, as in NHS South West Essex and NHS South East Essex, where a cap has been placed on the community diabetes service, to restricting treatment based on age or clinical need, as in NHS Warwickshire, where new criteria require that a patient must complain of intense or severe symptomatology and have a BMI of less than 40 to be listed for a knee replacement.

Evidence also showed, alarmingly, that PCTs and CCGs are diverging from the NICE guidelines, as in NHS Bassetlaw, where needle fasciotomy for Dupuytren's contracture is considered only if the patient is aged over 45 and has a loss of extension in one or more joints exceeding 25°, or if the patient is under 45 years old and has a greater than 10° loss of extension in two or more joints. However, the NICE guidelines do not refer to degree of loss of extension or any specific age criteria, other than to say that the procedure would be more appropriate in older people.

Equally alarming are the findings that show that patients now have to pay for treatments that had been free. In a surgery in Yorkshire, patients needing treatments for cysts, skin lesions and in-growing toenails were told that they were no longer available on the NHS. But the practice had established a private company to offer those minor operations at a cost: £56.30 for the removal of a small cyst; £126 for larger cysts; £146.95 for the removal of an in-growing toenail; and £243 for the removal of a non-cancerous mole. In response to the GP magazine report, the Minister said:

“It is quite unacceptable if this is going on in all those cases. As you’ll appreciate, it is a complex issue. But the defining point is that people should be treated on clinical need, and not financial considerations.”

The findings of the BMA, the concerns of other health professionals, such as the Chartered Society of Physiotherapy, and the results of Labour’s in-depth survey all point to the fact that, because of increasing rationing, people are being treated on the basis not of clinical need, but of financial considerations.

Will the Minister respond positively to Labour’s call for an immediate review of rationing in the NHS and act immediately on the new evidence showing treatment restrictions on cost alone? How will he ensure that national guidelines can be implemented? Will he take action, pending the outcome of the review, to reverse immediately rationing decisions that leave patients in severe pain, restrict mobility, limit their ability to live independently or have a major psychological impact? Will the Government initiate a public debate on whether all other treatments should be provided by the NHS, rather than allowing them to be restricted in a random fashion?

[Mr Reed]

I am grateful to my hon. Friend for letting me intervene once more. Will she also join me in asking the Minister to publish whatever assessment must have been made into the claims forthcoming from the freedom of information requests shown to the Department of Health? Will she join me in asking the Government to publish that assessment of those claims?

[Mrs Glindon]

I certainly join my hon. Friend in asking the Government to publish the assessment.

In denying the findings of Labour’s survey of rationing and the supporting evidence from the BMA and other professional bodies working in the NHS, the Government are denying the people of this country the full NHS service that they deserve and have contributed towards.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the hon. Member for North Tyneside (Mrs Glindon) on securing this debate and the shadow Minister, the hon. Member for Copeland (Mr Reed), for more or less keeping a straight face during the course of it.

[Mr Reed]

For the Minister’s delectation, I should say that it is exceptionally hard to keep a straight face when he is in the Chamber.

[Mr Burns]

I am extremely grateful. I take that as a compliment, because I would hate to reduce the hon. Gentleman to tears.

As the hon. Lady and other hon. Members well know, cost-based rationing of the sort that she has described is not permitted and not condoned.

--- Later in debate ---

[Mr Burns]

Of course the Government take these allegations very seriously, which is why my officials rang NHS Hull to ask about wrist ganglia and were amazed to be told that there were no restrictions as described in the Labour party’s political leaflet. [Interruption.] If the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) will just hush for a minute, I will answer the question. I am always very pleasant to her, as she knows from experience.

I have personally made checks on two allegations about rationing, one in south-east Essex, south of my constituency, and one that I believe from memory was in Bedfordshire. My officials investigated both claims, which arose out of a meeting that I had with a clinician, and both claims were untrue. There had been a mistaken understanding of what was going on, and there was no rationing based on cost. The conditions in each trust were quite specific, and cases were determined on clinical grounds.

I also looked into one example after reading a story in my local newspaper about what was allegedly going on in the mid-Essex primary care trust, which is now part of the north Essex cluster. It was to do with the treatment of people suffering from overweight. Again, the story was inaccurate. There was no truth in the allegation that the trust was refusing to treat smokers or people who were overweight. They were treated, providing that it was clinically safe to do so. The three specific allegations that I have investigated, both myself and through my officials, have proved to be untrue.

As I said earlier, we have had officials look at the Labour party’s political document because, on the face of it, it raised serious allegations that merited investigation. I am afraid that the examples that I have given have not met the reality of the headline claims.

[Mr Reed]

I appreciate the confidence that the Minister is showing in refuting the evidence put to him based on freedom of information requests to the PCTs in question. He mentioned three cases out of 125. When will he assess the remaining 122, and will he publish that assessment?

[Mr Burns]

This debate is half an hour long, and I have been fortunate enough to have 15 minutes. We have investigated all the claims, but it would not be in the interests of the hon. Member for North Tyneside, or possible in the time allowed, for me to go through all of them. I have been assured that the evidence that Labour claimed to have in its party political document does not live up to the hyperbole of the hon. Member for Copeland or the shadow Secretary of State.

Appropriate, clinically based decisions about the setting of priorities will continue to be taken by commissioners in the NHS. However, by shifting decision making to local clinicians, we will ensure that those decisions are fair, transparent and based on the best clinical evidence. Treatment should never be restricted without clinical justification, and I say again that we will take action should any genuine evidence emerge that that is occurring. We regard it as unacceptable as Opposition Members do; the trouble is, the evidence that they have come up with so far does not live up to the claims that they make about it.

Question put and agreed to.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 12th June 2012 Commons Chamber

[Mr Lansley]

At the risk of repetition, let me say that in any part of the country NHS organisations, like organisations in other fields, should have the ability to set pay levels that reflect to a greater extent local labour market conditions and their need to recruit and retain staff. My hon. Friend will recall that a number of south-west trusts are looking at going down the path of setting their own pay arrangements. It was in fact the previous Administration who in 2004, under the “Agenda for Change” pay framework, gave trusts and foundation trusts precisely the freedoms that they are proposing to use, so I cannot understand how Labour Members can possibly object to those freedoms now.

[Mr Jamie Reed (Copeland) (Lab)]

The Secretary of State may wish to call this market-facing pay, but he has rather let the cat out of the bag with his previous answers. In fact, he has proposed lower pay for NHS staff in poor areas—a move that would create a deeply divided, two-tier NHS and undermine the NHS in the communities that need it most. We know that the Secretary of State does not take advice from medical professionals, but will he perhaps take some from one of his own Back-Bench colleagues, the hon. Member for Hexham (Guy Opperman), who said that

“someone working in the NHS in a deprived part of the North East probably deserves more pay, certainly not less, than a nurse in leafy Surrey”?

Will the Secretary of State commit today, yes or no, to withdraw these disastrous proposals?

[Mr Lansley]

If I may say so, I think that the hon. Gentleman wrote his question before he had listened to my earlier answer. I am not proposing to reduce anybody’s pay. It is very simple. The NHS Pay Review Body will have the opportunity to make recommendations. I gave evidence to it on the basis that we should retain a national framework for pay through the “Agenda for Change” framework. However, it is transparently the case that the “Agenda for Change” framework has not thus far enabled NHS organisations, as they say themselves, to adopt a pay structure locally which better reflects the market in which they are employing.

NHS (Foreign Nationals)

Jamie Reed Excerpts

Tuesday 22nd May 2012 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to contribute to a debate under your chairmanship for the first time, Mr Streeter. I congratulate the hon. Member for Kingswood (Chris Skidmore) on securing the debate. The use of the NHS by foreign nationals is a growing problem and it is important to take a moment to reflect on why we are discussing the issue today. It is a concern among hon. Members from all parties and, as my hon. Friend the Member for Ealing, Southall (Mr Sharma) said, among people representing all communities throughout the country. The issue is of paramount importance to a number of people.

As the previous Labour Government delivered the lowest ever waiting times and the highest ever level of patient satisfaction, along with 44,000 more doctors and 89,000 more nurses, the NHS became the envy of many other countries. The recent Commonwealth Fund comparative study of the state of the NHS makes that absolutely clear. However, a consequence of having one of the—if not the—best health services in the world was, and is, that it became increasingly attractive to foreign visitors. That has brought a number of issues that need to be addressed.

The commonly agreed figure that the hon. Member for Kingswood has mentioned is that the debt accrued by foreign nationals to the NHS is around £40 million. He is right to point that out. It is a lot of money—whether it is £40 million or £60 million—that would buy a lot of medicine and fund a lot of projects in a lot of communities. If the figure is £40 million, it is approximately 0.1% of the £3.5 billion that the Government are wasting on NHS reorganisation now. None the less, that figure is an awful lot of money.

The NHS is built on the principle that it should provide a comprehensive service based on clinical need, not ability to pay. However, at the same time, it is a national health service—not, as has been repeated on a number of occasions, an international health service. There must not and cannot ever be any doubt about that. Therefore, it is right that we impose charges for overseas visitors, who are defined in respect of NHS hospital treatment as people who are not ordinarily resident in the UK.

The previous Labour Government were committed to maintaining the existing system of charges, but they proposed a series of further safeguards, including amending the immigration rules so that anyone who accrued substantial medical debts would not be allowed back into the country if they left without settling their bill. I am genuinely pleased that the current Government have adopted so many of those recommendations. However, we need to look again at the ability to make and recover charges, and we would be happy to work with the Government on that issue. For example, the previous Government considered whether foreign nationals should be charged for NHS services outside the hospital. That issue warrants further close discussion.

We also need to learn from those hospitals that are more successful at recovering charges. The hon. Member for Kingswood referred to some of those. Hospitals have a legal duty to recover any charges made to overseas patients and, frankly, some hospitals need to be much better at that. Sometimes dealing with that problem can be as simple as improving the recording of contact details, so that the patient can be pursued for payment, but I accept that the rules and procedures could be demonstrably improved. The Government should ensure that that is done and, again, we will support them in their efforts to do so.

A relevant issue that has not been touched on today is the Olympics. It would be helpful if the Minister explained what plans are in place to ensure that the NHS can meet the rise in demand from overseas visitors during the games. Will she tell hon. Members what exemptions are in place for athletes and officials? “Newsnight” recently reported that Olympic VIPs could receive fast-track emergency care. With A and E waits already increasing, is there not a danger that taxpayers who are paying for the NHS and the Olympics will be pushed to the back of the queue?

[Chris Skidmore]

I would have raised the Olympics in my speech had it not been for the fact that I wanted this to be a cross-party debate. The criterion that Olympic officials and athletes should receive free treatment was part of the bid that was successful in 2005 under the previous Government. We would not have been awarded the Olympics if that had not been part of the 2005 bid.

[Mr Reed]

The hon. Gentleman makes a good point. He is obviously aware of the fact that although he, I and other hon. Members are privy to those details, the general public are not. There is a salient concern out there about the perceived emergence of a better standard of care being afforded to people who are involved in the Olympics. I visited Homerton hospital in Hackney, which is one—if not the—Olympic hospital in London. I saw some tremendously innovative professionals there who are developing innovative medical treatments and systems of working. They need to get the message across that local people who use that hospital on a daily basis will not be disadvantaged by the Olympics. We need a clear exposition of why that will not be the case.

Although I have considerable sympathy with the contributions I have heard this morning, all hon. Members must recognise that, under the UN convention on human rights, the UK has an international obligation to provide free NHS treatment to those seeking asylum here. All of the contributions I have heard today indicate that that will not be too hard to achieve, but hon. Members must guard against those Members who advocate that we should not fulfil that obligation, because the temptation will be too much for some. When we produce facts and figures used in support of the arguments, that must be acknowledged.

We must also guard against Members from all parties who advocate that the NHS should turn away pregnant mothers or patients in need of emergency care. Overall, this issue requires a diligent, careful approach. It is not the platform for a weird, xenophobic virility contest. I look forward to hearing what the Minister has to say. There may be little common ground between my party and the Government on the NHS, but we can agree that NHS care must always be based on clinical need, not ability to pay. At the same time, first and foremost, the NHS must serve the people of the United Kingdom—those whose taxes fund the NHS, those who believe in it passionately as the guarantor of a better society and those who expect it to be there for them when they need it. I hope that we can agree on that principle as we continue to debate the issue constructively and develop the fair and appropriate policy responses that the issue deserves.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

It is a pleasure to serve under your chairmanship this morning, Mr Streeter. I thank my hon. Friend the Member for Kingswood (Chris Skidmore) for securing the debate, which has provided a useful opportunity for hon. Members from all parties to come together and share their views. I express some disappointment at the fact that the shadow Minister, the hon. Member for Copeland (Mr Reed), was somewhat party political, but I commend the hon. Member for Ealing, Southall (Mr Sharma) for his generous comments. It is important to have that on the record: we all want clarity and fairness in the system.

I have met my hon. Friend the Member for Kingswood before to discuss the matter and, again, I commend his efforts in raising the subject, which has provided an opportunity to put some things on the record. Access to NHS care is very poorly understood—indeed, that is also the case for Members of Parliament. This is about foreign nationals using and potentially abusing the NHS. Like the health system of any country, the NHS provides for foreign nationals. Millions of people come to this country every year for various purposes and stay for different periods of time. Some become ill or have accidents, and have immediate health care needs that need to be met. We have a duty to treat them, just as other countries have a duty to treat British citizens who become ill abroad. I assure the shadow Minister that there is no question of anybody wanting to undermine that duty—nobody has raised that in the debate, it is not being discussed either and that will remain the case. However, we have a duty to taxpayers who pay for the system.

Questions were raised about who should be charged. To clarify the situation again regarding ordinary residence—settled, lawful residency in the UK—access to the NHS is not based on nationality, the payment of taxes or national insurance contributions. I accept that that is not widely understood. The service is paid for by taxpayers, so they have an interest in who has access to it. We exempt some categories of visitor from charges, such as those working or studying and those visiting from countries with which we have bilateral health care agreements. A few services are free to all—my hon. Friend the Member for Kingswood may have mentioned them—such as treatment in an A and E department, which I have mentioned, and treatment for certain infectious diseases, as there are wider public health reasons for ensuring that people receive prompt treatment.

Under the legislation, charges can only be made for hospital treatment. Charging is not in place for registering with or seeing a GP, although prescriptions are subject to the usual charges. GP registration or the holding of an NHS number does not trigger free hospital treatment. The hospital to which a non-resident has been referred should check separately for eligibility, but I know that that does not happen as it should. Current legislation allows only for charging overseas visitors for NHS hospital treatment. There are therefore no rules of entitlement governing overseas visitors’ access to GP services, and visitors are able to register.

GPs are self-employed and are contracted to provide primary medical services for the NHS. Under the terms of their contract, GPs have a measure of discretion in accepting patients on their list, but they can only turn down an applicant on reasonable, non-discriminatory grounds. My hon. Friend discussed that at length and made it quite clear what the guidance says. In practice, a GP’s discretion to refuse a patient is limited, and a GP cannot refuse to register a patient just because they cannot provide identification or proof of address—that is unlikely to be considered reasonable grounds.

The European economic area confuses the issue further, but our obligations are simple. Each country is responsible for the cost of providing treatment for their own citizens while they are in other EEA countries, unless they are working. Workers are entitled to the same access to health care as that country’s own residents, on the principle that the country to which an individual makes social security contributions is liable for that person’s health care needs. In practice, that means we pay other EEA countries for treating our state pensioners who have retired there, and for the emergency needs of our own citizens who need health care when visiting another country, using their European health insurance card. The same is also true in reverse—other countries must reimburse the UK for treatment provided to their citizens. EEA nationals who come here to work are entitled to free NHS provision.

Overall, we pay out more than we receive, simply because many more of our state pensioners choose to settle in Europe than vice versa. This is sometimes the subject of large tabloid headlines, but it is important to make that point. We may see that change in the coming months. I acknowledge, however, that we need to do more to recover income due to us from other EEA countries for providing health care to their visitors and pensioners. We have an extensive programme of work under way to address that.

As the shadow Minister said, unpaid debts are a small amount of the total spent on the NHS. However, as my hon. Friend pointed out, £30 million or £40 million pays for a lot of treatment, a lot of care and a lot of medicine. Although it is a small percentage of the total budget, for an individual it is significant. We need to recognise that in any system that charges, debts are sadly inevitable. Guidance is clear that hospitals should not provide non-urgent treatment until a chargeable patient has paid in full, but they have a legal duty to provide emergency care. When a patient is responsible for repaying a debt, if a debt is incurred, the NHS has a duty to the taxpayer to recover that debt. Audited NHS trust accounts and data from Monitor show that last year, £14 million was written off due to unpaid debts—a small but significant amount for taxpayers. We are determined to reduce that write-off without compromising the provision of urgent treatment. My hon. Friend related the terrible story of the American visitor for whom the hospital could not even provide any documentation for him to claim from his health care insurer. The statistic of a third of NHS trusts not even pursuing debts is shocking. On the other hand, we have the example of West Middlesex, which is clearly doing an excellent job.

The hon. Member for Ealing, Southall expressed his frustration with some immigration and Home Office issues, and he is absolutely right to discuss the UK Border Agency. My hon. Friend the Member for Kingswood discussed the fact that GPs do not want to be gatekeepers on immigration issues. We are therefore reliant on UKBA to ensure that people who are entitled to be here are here, and that people who are not entitled be here are not here. He also made a distinction regarding foreign nationals who come here specifically to access NHS care. I remind the shadow Minister, probably because I am significantly older than him, that this issue goes back a great deal further than the previous Labour Government. It probably goes back further than previous Conservative Governments, which have to be thanked for making the NHS such an attractive option that people came here as health-care tourists a long time before 1997.

I share the concern and frustration of the hon. Member for Ealing, Southall about immigration status. I have a university in my constituency. A lot of foreign students try to regularise their status in this country and fail to do so—their passports are left with the Home Office for goodness knows how many months and the situation becomes very confusing. I think that the people he is talking about are in the grey area in the middle. We need to address this matter and will continue to work with the Home Office. To repeat for the record, the recently amended immigration rules state that a person with a debt to the NHS of £1,000 or more can now be refused a new visa or extension stay. That should not only assist in recovering more debts, but act as a deterrent against failing to have health insurance when visiting the UK.

[Mr David Crausby in the Chair]

[Mr Reed]

Will the Minister help with a genuine question about the new NHS commissioning arrangements? If clinical commissioning groups procure services from hospitals where that is a particular problem, what advice will the Government give them?

[Anne Milton]

It will bring the focus closer to home. I would expect the shadow Minister to welcome this change, because GPs will now be much more acutely aware that registration with them should not automatically entitle people to NHS acute trust care. We are undertaking a review that I will mention in my concluding remarks. It is early days in respect of the UK Border Agency and the change in the immigration rules, so we do not have sufficient information adequately to evaluate how effective they are, but I think that we will see a significant impact. The shadow Minister asked specifically about the Olympics.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 27th March 2012 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

When I last asked the Minister from the Dispatch Box about the loss of 3,500 nursing posts, he told the House that that was “factually incorrect”. He was right, and I apologise: the actual figure, published last week, is 4,096. In what will surely be one of the Secretary of State’s final outings in his current post, before he is reshuffled to where he can do no further harm, will he tell the House how many of those nursing posts would have been secured by the £500 million spending cut he agreed with the Treasury in last week’s Budget?

[Paul Burstow]

Well, if the question is as put, the answer is none.

Health and Social Care Bill

Jamie Reed Excerpts

Tuesday 13th March 2012 Commons Chamber

[Priti Patel (Witham) (Con)]

As in the many other debates that we have had on this Bill, there is a strong sense of déjà vu here today. Opposition Members grind out the same old arguments over and over again to attack the Government. They spin the same misleading, scaremongering lines about privatisation. They proclaim the end of the NHS and talk down the medical professionals and patients who will be empowered by the Bill. They continue to support the bureaucracy that drains vital resources away from front-line care, certainly in my constituency. [Interruption.] As he did the last time we debated this, when I mentioned that my constituency had very little front-line local NHS care, the hon. Member for Copeland (Mr Reed) arrogantly sneers—

[Mr Jamie Reed (Copeland) (Lab)]

At you.

[Priti Patel]

No, at my constituents, actually. The Bill will bring much-needed front-line NHS resources to my constituency.

We have heard the shadow Secretary of State recycle the same speech from the Dispatch Box like a broken record stuck in the 1970s. The Opposition have nothing sincere to say and, as in every other debate on the Bill, my right hon. Friend the Secretary of State has rebutted all their opportunistic smears and given a robust account of the Bill and the benefits that it will bring. He has also ensured that the NHS budget is being increased.

Opposition Members would have done well to engage constructively on the Bill, instead of spending the past two years siding with the smear campaigns run by the left and its trade union paymasters that seek to misinform the public, play with their emotions and frighten them. In particular, we hear the Opposition complain about the involvement of the private sector in delivering health care, but it is this Government who are getting to grips with the spiralling private finance initiative costs that are crippling many NHS trusts in England, for which the Labour Government were entirely to blame.

I find it astonishing that the shadow Secretary of State can come to the Dispatch Box, week in and week out, and bleat on about the private sector without having the courtesy to accept that his Labour Government blew hundreds of millions of pounds of taxpayers’ cash on paying private providers for treatments that they failed to carry out. [Interruption.] Opposition Members should put away their synthetic anger for a moment and accept that, thanks to the Bill, expensive private sector pay-offs will be a thing of the past. When they were in government, they were enriching the private sector and creating an army of fat-cat NHS managers while failing to support patient care.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Burns]

If the hon. Gentleman is trying to tease out of me what is in the risk register, I am afraid he will be unsuccessful, but if it is of any reassurance I can tell him that for people living close to the border there have been arrangements between Wales and the English NHS and they will continue. Those people will benefit if treated in England, because waiting times are falling in this country, unlike Wales where they are increasing.

[Mr Jamie Reed (Copeland) (Lab)]

What a pleasure it is to see the Secretary of State here today; he managed to make his way in.

I am afraid I have to describe the Minister of State’s answer as codswallop. Let me give him an example of one risk to the NHS that we already know about. The number of NHS nurses has fallen by 3,500 since the general election, and that figure could be at least 6,000 by the end of this Parliament. The Bill is damaging front-line services in the NHS right now. Why does the Minister not put patients before his, the Secretary of State’s and the Prime Minister’s pride, drop this unwanted Bill, and use some of the money it would save to protect those 6,000 nursing posts?

[Mr Burns]

I have to say that, unfortunately, notwithstanding what the hon. Gentleman thought was a rather clever way of describing my answers, his figures are factually incorrect. As Jim Callaghan once said, an inaccuracy can be halfway round the world before truth gets its boots on. The facts are these: there are 896—[Interruption.] If the hon. Gentleman would listen to the answer he asked for, he might learn something and stop making misrepresentations. There are 86 more midwives working in the NHS—[Hon. Members: “86?”]—896, which is an increase of 4%. There are 4,175 more doctors working in the NHS: an increase of 4%. There are 15,104 fewer administrators working in the NHS—a decrease of 7.4%—and 5,833 fewer managers. There are more doctors. There are more midwives. There are fewer administrators.

NHS (Private Sector)

Jamie Reed Excerpts

Monday 16th January 2012 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

Private sector involvement in the NHS will always be an emotive and contentious subject. As members of the party that founded the NHS, we on the Labour Benches are clear that there are, have been and always will be times when the private sector can and should provide an important function in supporting the delivery of NHS care, but recognising that role is in no way comparable to opening up the NHS to full-blown privatisation, which is the clear intention of the Government’s shambolic Health and Social Care Bill, which is quickly acquiring the same level of popularity as the poll tax. There is a world of difference between using private providers to support the work of the NHS and privatising the NHS. This legislation and the Government’s desire to set free the ravages of the market on what we believe to be the country’s most treasured institution commands no public support and no democratic mandate.

The reality is that the NHS, as a publicly owned and publicly funded world-class health care service providing medical care free at the point of need, is one of the defining institutions of our society and one of the most important hallmarks of our national identity. Established in the aftermath of the greatest conflict our country has ever faced, the NHS was built by a tired nation and an exhausted people from the wreckage of the second world war. They knew that it would help to build a better country and that it could not be done by the private vested interests that so bitterly opposed its creation, and they were right. Every Member of Parliament must recognise that to the people we serve and to our country as a whole the NHS is more important than any of us, collectively or as individuals, and that it is much more important, more trusted and more respected than any one of the political parties represented in the House.

Politicians across the House must recognise that they damage the NHS at their peril. The public do not want the NHS to be opened up to the market, because they know where that leads: the wealthy customer will take priority over the patient in need. The Government know that the public would never have voted for any party with that objective at the heart of its health policies. For that reason, the privatisation of the NHS is being undertaken by stealth. It was a former Conservative Secretary of State, Michael Portillo, who told the BBC’s Andrew Neil last January that the Conservatives

“did not believe they could win an election if they told you what they were going to do because people are so wedded to the NHS.”

He was entirely right. The Prime Minister knows it, the Secretary of State—the architect of so many privatisations when he worked for Lord Tebbit—knows it, and the Liberal Democrats know it.

We in this Chamber are often too slow, too ungracious and, frankly, too partisan to pay tribute to those outside our own parties when tribute is deserved, so I now commend the four Liberal Democrat MPs who voted against the Bill on Second Reading. They did so not simply because it was not in the coalition agreement and has no democratic mandate, and not just because they recognise that the NHS is bigger and more important than any of us or the fortunes of any political party, but because they recognise that the Bill paves the way for the privatisation of the NHS. May I just say “Ahoy” to the Education Secretary, who has just entered the Chamber? To paraphrase the hon. Member for St Ives (Andrew George), for whom I have a great deal of respect, those Liberal Democrats at least did not want to become the architects of the NHS’s demise.

We have heard many promises from the Prime Minister on the NHS, none of which, sadly, is backed up by his or his Government’s actions. He promised real-terms increases for the NHS, but in his first year in office he delivered a real-terms cut. He promised no top-down reorganisation, yet he delivered the biggest and most unwanted reorganisation since the NHS’s creation. Most sickeningly of all, he played fast and loose with the trust of health campaigners across the country when he promised a bare-knuckle fight against hospital and ward closures. Now the Department of Health talks openly of nationwide hospital closure programmes, and wards and services are being lost all over the country.

It is essential to listen to health professionals on matters of health service reconfiguration, but it is deceitful to pretend to oppose those reconfigurations, to trade on the hopes and fears of ordinary patients and to say one thing in opposition and do another in government. But it is perhaps the Prime Minister’s assurance of “no privatisation” in the NHS, given in May last year, that illustrates that pattern of behaviour most clearly.

Last year, Mark Britnell, one of the Prime Minister’s hand-picked health advisers, told a conference of private health care providers:

“In future, the NHS will be a state insurance provider, not a state deliverer.”

He continued:

“The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years”—[Interruption.]

I advise those Government Front Benchers who are chuckling—perhaps the bars have closed early—to dwell upon the phrase “no mercy”.

With the shambles of a Bill plunged into crisis, the Prime Minister was forced to demonstrate that he was across the detail of the Bill, and in a speech at Ealing hospital he said:

“Let me make clear: there will be no privatisation… These are red lines we will not cross.”

Yet just before the Christmas period, perhaps ignorant of the Prime Minister’s guarantee or based on the fact that there is no mandate for the changes and the Government are not in the habit of ever doing what they say they will, the Secretary of State tabled amendments to his health care Bill that would allow NHS hospitals to devote 49% of their beds and theatre time to private patients, opening the door to an explosion of private work in NHS hospitals and inevitably resulting in longer waiting times for ordinary NHS patients and widening health inequalities not just between but within different communities throughout England.

I therefore call on the Government to answer this simple question: how can it be right to allow the wealthiest in our country to use publicly funded services, paid for by the taxes of those most in need, to jump the NHS waiting lists that are now growing under this Government?

That is a Mickey Mouse policy, and speaking of Mickey Mouse I should say that Members who have been to Disneyland or any other holiday park for that matter—perhaps on a Tory party policy seminar—will have seen fast-pass systems in operation. The fast-pass system works in exactly the same way as the Government hope 49% private sector involvement in the NHS will: everyone pays to get into the theme park, the queues are too long so the richest pay more to beat them, and eventually all but the poorest buy the fast pass and the queues become as long as they were in the first place. The only difference is that everyone ends up paying double for the same queues they were suffering at the beginning.

The Prime Minister may not want to admit to the privatisation of the health service, and he may not be able to acknowledge that his attempt to change his party, based on a cosmetic change of attitude to the NHS, was never real and was always hollow, but the inescapable reality is that his Government, through the Health and Social Care Bill, are taking a sledgehammer to Britain’s most valued public service by not simply allowing but encouraging, as a matter of principle, a private sector free-for-all in England’s health service.

That is why in a speech in November last year the Prime Minister stated that he wanted the NHS

“to be a fantastic business for Britain”—

a line strangely omitted from the official transcript of the speech—[Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), chunters from a sedentary position, but he himself told “Newsnight” in January last year that the Prime Minister’s Bill would turn the NHS into a “genuine market”.

Labour Members believe that the NHS is an unprecedented force for good in our society, the mainstay of so many of our communities and the guarantor of a fairer, better society. We believe it speaks to who we are and what kind of nation we aspire to be. It is not the Prime Minister’s to sell, and it is not for sale.

Only a few months after becoming a Health Minister, the hon. Member for Sutton and Cheam (Paul Burstow), representing the Liberal Democrats—he is not in his place—told reporters from The Daily Telegraph:

“I don’t want you to trust David Cameron…he has values that I don’t share.”

The Minister was right then, and if we listen the to the rank and file membership of the Liberal Democrats we find that that is what they believe now.

The inescapable reality is that the Liberal Democrats find themselves in a constitutionally and historically unique position. They can now determine the future of the NHS in England, as either a world-class public service treating people equally, providing medical care to those who need it and free at the point of use, or as a fragmented, US-style health system, that will see publicly owned hospitals, publicly funded services and health professionals employed by the public purse giving up 49% of hospital beds and theatre time not to those who need them but to those who are most able to pay for them. That is an enviable responsibility, and Liberal Democrats Members can stop that creeping, stealth privatisation of the NHS. The Minister was right to distrust his Prime Minister, and his party colleagues can stop this attempt to take a wrecking ball to the NHS as we know it.

After the gold rush, the NHS might never be the same again. That is why the editor of The Lancet, Richard Horton, told the “Today” programme last week:

“What we will see with private providers is a fragmentation of the NHS, with no accountability…we will see the diminution in the quality of care. And unfortunately what we are seeing with the breast implant scandal is the future of the NHS, it will be destroyed.”

Tonight, the Secretary of State has dissembled and fumbled his way through an attempted defence and explanation of the Bill, but he could not provide it. He does not know what he is for, what he is against, what he is replacing or what he is introducing. It is no wonder that the medical profession neither believes nor trusts him. He either does not know what his policy is or he is afraid to say. The country deserves better. This is now a bare-knuckle fight and the Government must think again.