National Health Service (Amended Duties and Powers) Bill

Jeremy Lefroy Excerpts

Friday 21st November 2014 Commons Chamber

[John Pugh]

If the right hon. Gentleman reminds me, I will endeavour to do so. What I am really hoping for, though, is a change in the conversation about the NHS so that we stop talking about the internal market—Labour Front Benchers have in a sense reneged on their involvement in that—and instead talk about how we should organise NHS services that will efficiently deliver the moral entitlements that people expect.

[Jeremy Lefroy (Stafford) (Con)]

I am grateful to my hon. Friend for giving way and to the hon. Member for Eltham (Clive Efford) for introducing this opportune Bill.

Does my hon. Friend agree that one problem with an internal market is the sheer complexity of tendering, which means that smaller organisations such as some in my constituency are simply not capable of matching up with the organisations that decide to tender for some of the contracts that are available?

[John Pugh]

My hon. Friend makes a good point. For those who are unsure about the benefits of the internal market, there is a way of addressing the problem, which is to allow individual health economies, in whatever area—Eltham or wherever—to opt out of the internal market if they can prove that there is a case for doing so. That could be put into legislation in a permissive form, so it would not be a top-down reorganisation, and it would allow people objectively and sensibly to test the benefits of the internal market against a more normal model of public service delivery, which I support, as I hope the hon. Member for Eltham does.

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[Dr Poulter]

I will come to TTIP shortly, and I think that I will be able to reassure the hon. Lady and the hon. Member for Angus (Mr Weir).

The Health and Social Care Act put in place an alternative route to the courts, through Monitor, to address abuses of the rules around procurement. The Bill would remove that alternative route, meaning that future complaints under the law would result in hugely costly legal processes for health care commissioners, and complaints would be considered by the courts, rather than by Monitor, a health expert regulator. That cannot be good for patients. The Bill would result in more money for the lawyers, and much less money for our NHS and the patients that it looks after.

Another important point is that by favouring NHS over non-NHS providers, the Bill would be a move against the voluntary and charity sector providers, such as Macmillan and Marie Curie, who have done so much to help care for patients for many years.

[Jeremy Lefroy]

I am glad that my hon. Friend has mentioned Macmillan. At the moment, Macmillan is in the middle of tendering for end-of-life and cancer care in Staffordshire, which hon. Members have mentioned. Although the integration that the tender requires is absolutely vital—I think that it is supported by all Members, including the hon. Member for Stoke-on-Trent Central (Tristram Hunt) in a recent article—one of the real problems involves the mechanism. The fact is that the integration seems to require the tender to be for the entire service, rather than for just a small contract, say, to help with integration. Will my hon. Friend comment on that, because this is one of the problems at the heart of the matter? We do not want large private companies to run our cancer and end-of-life services.

[Dr Poulter]

In a moment I will address in a little more detail a couple of the points that were raised. I reassure my hon. Friend that the section 75 regulations that underpin the 2012 Act, which are almost identical to regulations that the previous Government were involved with, outline very clearly, under regulation 10, that integrated service, or encouraging co-operation between providers in the interests of patients should not be seen as anti-competitive. Regulation 15 makes it clear that Monitor cannot direct a commissioner to hold a competitive tender. There is strong support throughout those regulations, as there is throughout the 2012 Act, for integrated service delivery in the best interests of patients, where that is appropriate.

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[Barbara Keeley]

Thank you, Mr Deputy Speaker.

The clinical commissioning groups involved plan to tender by summer 2015 a £1.2 billion contract to deliver cancer services and end-of-life care for 876,000 people across the area. The witnesses we heard from made it clear that commissioning on a disease-specific basis like this is risky. There are only a few small-scale examples of that being done anywhere, and nothing on the scale of this project. Despite the risk, we heard some worrying things about local people or local MPs not being listened to and about a lack of consultation with or involvement of hospital-based clinicians. The Minister has just referred a number of times to letting doctors get on with running the NHS, but the CCGs involved in driving this pilot are not even involving or listening to local clinicians. I and other colleagues on the Committee found that bodies such as Healthwatch England and Macmillan Cancer Support were cheerleaders for—and in Macmillan’s case, a funder of—development work on a project that could end up privatising cancer and end-of-life care for almost a million people. I for one found that disturbing. I felt, and I know that some of my colleagues did too, that there was a conflict of interest. Healthwatch England was meant to be the consumer champion of health and care.

By contrast with what Government Members have said, there was also a fair amount of concern among Committee members about the role of Macmillan Cancer Support in funding the development work when many believe that the money they give to Macmillan goes directly to cancer care. Indeed, the example I saw on the Macmillan website yesterday was that a donation would pay for a Macmillan nurse for a period to help people living with cancer and their families receive essential medical, practical and emotional support. It does not appear to be a selling point for that charity that funds would be used on a project to privatise end-of-life and cancer care in Staffordshire and Stoke.

[Jeremy Lefroy]

As I have already said, I have major concerns about the form of the contract. The hon. Member for Stoke-on-Trent Central (Tristram Hunt) wrote, and I say this in defence of Macmillan:

“This is the context for our new cancer contract and we should not pass knee-jerk judgments upon new ideas which aim for better outcomes and efficiency.”

That is what Macmillan is after.

[Barbara Keeley]

I thank the hon. Gentleman for that comment, but the point is that Macmillan Cancer Support is using money fundraised by the public in ways that I do not think the public would approve of. That was the key thing we explored. It is not at all clear, if we look at the Macmillan website, how it is using approaching £1 million of the public’s money, donated on that basis.

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[Jeremy Lefroy (Stafford) (Con)]

I welcome the Bill and congratulate the hon. Member for Eltham (Clive Efford) on introducing it; I shall be supporting its Second Reading today.

My support derives mainly from my and my constituents’ experiences over several years of some of the workings of the Health Act 2006, introduced by the previous Government, and the 2012 Act, introduced by this Government. In particular, two matters have been, and continue to be, of great significance: first, the two Francis inquiries into cases of dreadful care in my constituency, and secondly, the reports that have had such a major influence on the entire NHS. Just yesterday, my wife was giving a lecture to medical students on aspects of the Francis reports. It is vital that these lessons, particularly on patient safety and zero avoidable harm, are not forgotten, which is why I introduced a Bill on the subject two weeks ago.

The second concerns a more recent matter referred to already today: the review, supported by Macmillan, of cancer and end-of-life services in north Staffordshire, Stoke-on-Trent, Stafford and Cannock, which has resulted in a tender of all these services to be managed through an integrator. Just to correct the record, it is not just private companies on the tender—NHS organisations are also on it—but I still have major concerns. I am looking at this through the eyes of patients everywhere. The NHS must not be about structures or be in thrall to political dogma of any kind; it must be about safety and quality of care for all patients. I hope the Government might see the Bill in that way and use it as an opportunity to make improvements to both the 2006 Act and the 2012 Act.

I welcome clause 1. During the trust special administrator process that we had to go through, the inability of providers and commissioners to speak to one another—in some cases because of so-called commercial confidentiality —was ridiculous and without doubt delayed the process. At certain points, the whole process cried out for someone, if necessary the Secretary of State, to put everyone in a room for a day with instructions not to leave until everything had been sorted out. However, everybody was walking on eggshells in case they did something that might result in a judicial review and a reversion to square one. That was not in the interests of patients. That is not to be critical of those involved: for the most part they tried very hard and we got a better result than at some points we feared.

I want to make a serious point about clause 1 and the desire for the Bill to place the running of the NHS firmly in the hands of the Secretary of State. It is vital that there should not be too much hands-on running of the NHS by the Secretary of State—the British Medical Association, which has some very positive comments about the Bill, says that as well.

I am short of time, so let me conclude by talking about cancer and end-of-life services, which have been raised today. The problem is the way in which the NHS is funded and the fact that the tender is for all services involved in those pathways. It would have been much more sensible for the tender to help the work of integration, which would have involved a much smaller amount, rather than the full amount of services.

[Clive Efford]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

The House proceeded to a Division.