National Health Service (Amended Duties and Powers) Bill

John Healey Excerpts

Friday 21st November 2014 Commons Chamber

[John Healey (Wentworth and Dearne) (Lab)]

It is a pleasure to follow the right hon. Member for Banbury (Sir Tony Baldry). He made an attempt to make a serious speech, but his 30 minutes were based on one argument that is fundamentally wrong, which is that this Government have made no changes to the basis of the NHS in this country. These 457 pages of his Government’s legislation show that that is wrong. If he looks at sections 72, 73 and 80 of the Health and Social Care Act 2012, he will see that the Competition Act 1998, the Enterprise Act 2002 and the Office of Fair Trading are brought into play for the first time in our NHS.

So why no Tory apology to NHS staff, patients and the public? Why no Tory apology to NHS staff for forcing through the largest internal reorganisation in 65 years of NHS history and for forcing them to cope with increasing confusion, complex bureaucracy and wasted cost? Why no Tory apology to the public for an NHS that they now see has longer waiting lists and service cuts? Why no Tory apology to the public for breaking election promises and the terms of the coalition agreement to stop top-down reorganisations of the NHS, which have often got in the way of patient care? Finally, while we are at it, why no apology to this House for the way we were misled about the reorganisation and the legislation in 2010 and 2011, which became the 457-page Health and Social Care Act 2012?

[Mr David Nuttall (Bury North) (Con)]

I will tell the right hon. Gentleman why there has been no apology: because there is nothing to apologise for. That is the simple reason. We have a better health service now than we had before; that is why there has been no apology.

[John Healey]

Patients say exactly the opposite of what the hon. Gentleman has just argued. However, I understand that he feels he has nothing to apologise for. If he fundamentally believes that the NHS should be a system based on full-blown competition, delivered by the private sector, then of course he would want to legislate in that way.

[Philip Davies]

While the right hon. Gentleman is going back to fighting some 1980s ideological warfare, I think most constituents are bothered about what happens in practice. Is he really asking me to apologise to my constituents for the fact that there are now 9% more professionally qualified clinical staff at Bradford teaching hospital and 42% fewer senior managers, or that there are 7% more professionally qualified clinical staff at Airedale NHS Foundation Trust and 14% fewer managers, or, I might add, for the brand spanking new, state-of-the-art A and E department at Airedale hospital? Does he really think that is something to apologise for?

[John Healey]

The hon. Gentleman normally finds a common touch in the way he makes his points. I have to tell him that if he tries to trot out those sorts of figures on the doorstep in the next five months, he will find that they cut no ice with the public, because they know what is happening to their NHS day to day, and we will make sure they understand why it is happening.

[Sir Oliver Heald]

rose—

[John Healey]

I will give way to the hon. and learned Gentleman and then make some progress.

[Sir Oliver Heald]

Why should I apologise for the £150 million of investment in Lister hospital in Stevenage or the £98 million in Addenbrooke’s hospital in Cambridge—fantastic, world-beating facilities?

[John Healey]

We on the Labour Benches cannot wait for the debate on the NHS to be put right at the heart of the next five months of policy and political debate, and my right hon. Friend the shadow Secretary of State will make sure that happens.

Let me return to my point about the way that we in this House were misled about the reorganisation and the legislation. I am disappointed to see that the man who led it, the right hon. Member for South Cambridgeshire (Mr Lansley), is not in the Chamber today to explain himself. He argued—it was completely wrong, but he argued it—in the debate on Second Reading in January 2011:

“It is about gearing the entire system towards supporting the relationship between doctor and patient”.—[Official Report, 31 January 2011; Vol. 522, c. 617.]

Of course, it was not and it is not. As I argued, at the time from the Opposition Front Bench:

“The reorganisation and legislation is designed to break up the NHS, to open up all areas of the NHS to private health companies, to remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law.”—[Official Report, 16 March 2011; Vol. 525, c. 378.]

The Government were and are driving free market political ideology through the heart of our NHS.

The arguments that those of us on the Opposition Benches made then are those that we make now, and that my right hon. Friend the Member for Leigh (Andy Burnham) makes especially strongly from our Front Bench. That is why the Bill that my hon. Friend the Member for Eltham (Clive Efford) has introduced is so essential and why I am so pleased and proud to be one of his sponsors.

[Grahame M. Morris]

My right hon. Friend made some powerful points when the Health and Social Care Act 2012 was going through Parliament, when Tory Members were denying the purpose of the legislation. He quoted the last Health Secretary, but the current Health Secretary, the right hon. Member for South West Surrey (Mr Hunt), said in a book:

“Our ambition should be to break down the barriers between private and public health provision, in effect denationalising the provision of healthcare in Britain”.

What could be a more succinct and clear expression of their intentions?

[John Healey]

My hon. Friend has been a strong champion of the NHS and followed this issue from day one of this Parliament. To answer directly his question of what could be more succinct and clear, I suspect that when we hear from the new Member for UKIP, the hon. Member for Rochester and Strood (Mark Reckless) or his colleague, the hon. Member for Clacton (Douglas Carswell)—given some of the things that they have argued should be the basis of the NHS in future—they will make the vision of the right hon. Member for South West Surrey look positively UKIP-lite.

This Bill is essential because it starts to correct the three fundamental flaws, brought about by the reorganisation legislation, that are now driving the NHS. We could call them the three Cs—cost, complexity and competition.

On cost, the scale of the reorganisation was simply huge. As the chief executive of the NHS said at the time, it was

“beyond anything that anybody from the public or private sector has witnessed”.

The cost of the waste has been huge. We reckoned beforehand that it was about £2 billion; we now reckon £3 billion. What is clear is that getting on for £1 billion has been paid out in redundancies, much of which was to staff who were paid off and then re-hired by our NHS.

[Valerie Vaz (Walsall South) (Lab)]

Could my right hon. Friend say what steps were taken to publish the risk assessment during the passage of the Health and Social Care Bill?

[John Healey]

I did not want to open up all the old arguments that we fought in 2010-11, though it was extraordinary to see the extreme lengths to which the Government went—seen before only on matters of military information—to stop the disclosure of the risk register about the potential impact and likely consequences of their policy. My hon. Friend was a great supporter of mine in trying to use the Freedom of Information Act to allow the public and this House to see the terms of what the Government knew could happen to the NHS if they passed the legislation.

My second C is complexity. NHS services are now so much harder to plan and so much harder to hold to account because of the changes the Government have made. We saw new national quangos responsible for tens of billions of pounds of spending of public money in each and every one of our local areas in England. The commissioning role, which was previously undertaken by one body, the primary care trust, is now fragmented with at least five different bodies trying to do the same job.

On the third C, competition, the Secretary of State has his foot lightly on the accelerator of privatisation for now, but let us make no mistake, if the Tories win the next election, he will press it hard down to the floor immediately afterwards. Even though they are soft-pedalling on the privatisation that their Act put in place, we have seen in the 18 months since it came into force 131 contracts won by companies such as Care UK, Virgin Care and BUPA. According to the NHS Support Federation, that is already valued at £2.6 billion. At that win rate, the contracts already currently advertised will mean another £6.6 billion in the private sector—getting on for 10% of our NHS run by private companies in private hands.

[Andy McDonald (Middlesbrough) (Lab)]

Has it come as any surprise and is it just a coincidence that the very companies securing these major contracts are six-figure donors to the Tory party?

[John Healey]

It comes as no surprise, and I am grateful to my hon. Friend for underlining that point. I was not planning to make that point, but I am glad that it has been made so clearly.

My argument is with the Prime Minister. So much for what he said, and so much for his word when he said back in 2011 that

“we will not be selling off the NHS”.

Perhaps the most serious consequence of this fragmentation, this privatisation and this contractualisation is the fact that the most important and fundamental value at the heart of the NHS—an imperative at its heart—is the ability properly to plan, co-ordinate and deliver services. That is being made much harder, as the Health Select Committee has said, and sometimes impossible by the operation of the Health and Social Care Act and competition law. If anybody doubts it, they should look at the case of the two NHS trusts—the Royal Bournemouth and the Poole NHS Trusts—whose merger made great sense to patients, but was prevented by this Government’s legislation.

Let me say a few words about the transatlantic trade and investment partnership. I have chaired the all-party group that has followed these negotiations for the last 18 months in order to try to encourage a better and more balanced public and parliamentary understanding and debate, as well as to put the Government on the spot and hold them to account for what they are doing. We are trying to ensure that if we get a deal, it will bring real benefits not just to British business, but to British workers and British consumers.

Two things have become clear. First, the NHS can be fully protected in TTIP. I am convinced of this, not just because other EU trade agreements have protected public services, but because if the Government want them, there are specific member state reservations to cover public services and because we have heard the confirmation, directly from the chief negotiator whom I have met twice about this, that even with ISDS—investor-state dispute settlement—provisions, which I do not support, nothing could prevent a future Labour Government from bringing parts of the NHS now in private hands back into public hands.

The second thing that has become clear is that these commitments have been secured despite, not because of, Government Ministers. It is clear that Ministers have done next to nothing to try to influence the negotiations and secure the full exclusion and protection we require for our NHS and wider public services. Indeed, rather as the right hon. Member for Banbury (Sir Tony Baldry) observed, the Minister for Trade and Investment, Lord Livingston, who is responsible in government for leading the British position, has said that he would welcome the inclusion of health services in any deal. When the Minister gets up to speak, perhaps he will—formally, in this House—make the Government’s position clear. What is clear is that if we are properly to protect our NHS in any future TTIP, we must have a strong British voice in Brussels, which we do not have at the moment.

[Sheila Gilmore]

I gave the Prime Minister an opportunity on Monday to say that he would take specific action to ensure that the NHS would be protected if TTIP were successfully negotiated. He did not do so, but does my right hon. Friend feel that this debate provides an opportunity for that to be done in his name?

[John Healey]

I would expect these trade negotiations to stretch into at least the end of next year, so I hope and expect that the responsibility for making sure that this deal is good for Britain will become that of a Labour, not a Tory, Government and of Labour Ministers, not Tory Ministers.

[Jonathan Edwards (Carmarthen East and Dinefwr) (PC)]

rose—

[John Healey]

I will give way to the hon. Gentleman before finishing on the issue of the Prime Minister, which my hon. Friend the Member for Edinburgh East (Sheila Gilmore) has just raised.

[Jonathan Edwards]

I am grateful to the right hon. Gentleman for making a very important point about TTIP. I know that the Scottish Government want the Scottish health service excluded and I would hope that the Welsh Government would have the same position. Is there not an onus on the UK Government to make those representations on behalf of the devolved Governments?

[John Healey]

Indeed. There is an onus, a responsibility and, I would argue, a duty on British Ministers to make those representations and to secure those protections in any deal for the whole of the UK.

Finally, the Prime Minister made his most personal pledges before the last election to protect the NHS and to stop top-down reorganisations. He has broken those pledges to the British people, and the damage that he and his Tory Ministers have inflicted through this NHS reorganisation and legislation has been unwanted, wasteful and wrong. It will fall to a Labour Government, after May, to put right this damage and to rescue the NHS, as my hon. Friend the Member for Eltham said in his opening speech, just as we did in 1997. This Bill—it is why I am pleased and proud to support it—is an essential step towards doing that, but the election of a Labour Government must follow if we are to do the job properly.

--- Later in debate ---

[John Pugh]

The hon. Gentleman is not altogether wrong, but if we are to continue to deliver, in stressed circumstances, a service that is free at the point of need, we cannot run the NHS as an internal market for ever. In fact, the NHS is already trying to morph into something different. We now have health and wellbeing boards, which mean that commissioners and providers get together to try to agree a local plan. They are struggling in every way to behave like a health board, but they do not have the executive powers to do so. There has been the move away from tariffs, which have been used to try to adjust the market, and we are now talking about whole-treatment costs. There is also talk about integration.

What is clearly entirely disruptive, though, is the intrusion of competition where it is not needed—where it is simply dogma; where it is seen as a panacea for producing good results, whether or not there is a good case for saying that; where it derails sustainable services; or where it becomes a central operating principle of the NHS. None of those things is particularly helpful.

I do not want to comment on TTIP, because I do not think it is well understood at the moment, but we will certainly need to look at how it plays into the competition agenda.

[John Healey]

If the hon. Gentleman or any other Members want to know a little bit more about TTIP, particularly the potential impact on the NHS and public services, we have a meeting of the all-party group on European Union-United States trade and investment at 2 o’clock on Monday, at which the EU chief negotiator will be on the panel alongside Dave Prentis, general secretary of Unison. The hon. Gentleman might like to come along.

[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.

--- Later in debate ---

[Clive Efford]

rose—

[John Healey]

rose—

[Dr Poulter]

I will give way to the hon. Member for Eltham and then I will conclude.

[Dr Poulter]

I was simply quoting the reassurances that his right hon. Friend had given to all hon. Members, which was that

“any ISDS provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS”.

If TTIP is good enough for the right hon. Member for Wentworth and Dearne , it should be good enough for everyone in the Labour party.

[John Healey]

Would the Minister be good enough to concede that that has absolutely nothing to do with what the Government have been arguing; that is to do with the EU and their negotiation. The Trade Minister in charge has said that he does not want the NHS to be excluded in the way that we want.

[Dr Poulter]

No; I am simply quoting what the right hon. Gentleman has already put on the record about reassurances that he has received from the EU about an EU trade settlement. Surely, if the reassurances were good enough for him when he wanted to communicate them more broadly to his colleagues, and more broadly to members of the public, they are good enough now. It is very difficult to climb down from those reassurances, which he has previously given, and in the remarks I have made I have further reassured the House about the protection that this Government have made for the NHS in TTIP.

I am immensely proud of the way our NHS has already responded to the challenges of a growing and ageing population, meeting increased demand through a purpose and drive to improve the quality of patient care. That is why our NHS was recently ranked No. 1 in the Commonwealth Fund’s assessment of 11 global health care systems. This is at a time of unprecedented challenge to public finances across the globe, and testifies to the incredibly hard work of NHS staff and a very tough choice by this Government to protect our NHS budget and increase it by £12.7 billion between 2010 and 2015—a decision that the right hon. Member for Leigh called irresponsible but one of which we are very proud.

I remind the House of the words of the right hon. Member for Leigh when he was a Health Minister defending Labour’s record on introducing private providers into our NHS:

“I think the NHS can finally move beyond the polarising debates of the last decade over private or public sector provision”.

I agree: it is definitely time to move on. Our NHS focus needs to be on delivering for patients, so let us put distractions aside and let our hard-working doctors, nurses and health professionals get on with the job.