NHS Outsourcing and Privatisation

John Lamont Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Chris Stephens (Glasgow South West) (SNP)]

I will be as brief as I can, Madam Deputy Speaker, to accommodate Members with clear constituency interests who I know will want to contribute to the debate. It was interesting to watch the Secretary of State being the pantomime villain of the day and trolling us about the Conservatives’ record on the national health service.

I want to make some observations about privatisation and outsourcing in particular. I think that I should start off with the World Health Organisation’s definition of privatisation:

“a process in which non-government actors become increasingly involved in the financing and provision of health care, and/or a process in which market forces are introduced in the public sector”.

Patients who attend health service centres throughout these islands will receive amazing care, but that is predominantly due to the dedication of the people who work in the NHS, some of whom—as we need to recognise—are working under much greater pressures than others.

Some have argued that outsourcing such services as cleaning or car parking is a good thing, but there is evidence that the outsourcing of cleaning, and poor-quality cleaning, led to the rise of hospital-acquired infections. The Conservatives created the internal market in 1990, and that led to an “us and them” mentality in many local areas because it introduced competition between hospitals. In 2010, they promised “no top-down reorganisation”, but then introduced the Health and Social Care Act 2012, section 75 of which pushed commissioning groups into putting contracts out to tender.

We have seen the rise of the independent treatment sector, which won approximately 34% of contracts in 2015-16. That figure rose to 43% in 2016-17, and it now stands at approximately 60%. It cannot be denied that private companies are more involved in healthcare in England.

[John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)]

Will the hon. Gentleman give way?

[Chris Stephens]

I am sorry, but I will not take any interventions because many Members with constituency interests wish to speak.

We often hear about the costs of service redesign. The new organisations, the external consultants and the change managers are all described as one-offs. However, the experience of NHS workers over the past 30 years is that the process has led to a huge amount of waste.

[John Lamont]

Will the hon. Gentleman give way?

[Chris Stephens]

I did say that I would not take interventions.

[John Lamont]

This is a debate.

[Chris Stephens]

The hon. Gentleman is right: many Members representing English constituencies want to talk about their constituents’ experience, and I think it only fair to allow them to do so—[Interruption.] The hon. Gentleman can try all he likes, but I will not be shouted down by anyone in this Chamber.

What about running costs due to market forces themselves? What about the contracting design, the tendering, the bid teams, the corporate lawyers, the billing and the profits? The Government appear to have moved from an internal market to the external market that is now in England. [Interruption.] Members keep trying to shout me down, but I will continue talking. It is disrespectful to shout Members down in this Chamber. I will continue my speech, but I want to accommodate other Members. I do not think that they should be subject to a four-minute time limit, and I want to give them time to talk about their constituents.

A petition that received 237,095 signatures was debated in Parliament in April. The signatories are very concerned about outsourcing in the NHS, and they have every right to be concerned about the approach of this Administration. Others have warned of the threat of English health privatisation as it applies to devolved services. The trade union Unison has warned:

“The Tories might not run NHS Scotland, but that doesn’t mean they aren’t attacking it. We must fight to save it.”

It also says:

“Devolution means they can’t run down and privatise our NHS directly, the way they are doing in England”,

but what the Tories can do is starve it of resources. The NHS is under threat from privatisation and cuts. The Tories’ health Act pushed the profit motive to the heart of the English national health service.

I hope that the Minister will address a number of things mentioned by the hon. Member for Leicester South (Jonathan Ashworth) when he responds to the debate because I find what has been happening astonishing. I opposed outsourcing and privatisation before I was in this place, as a trade union activist for 20 years. The issue of West Sussex has been mentioned, but we have heard no response. We have also heard about Carillion—I was on the joint inquiry into Carillion—and the effects of what happened on Liverpool. We heard about the collapse of the £800 million contract in Cambridgeshire and Peterborough for older people’s services.

Those issues are all serious, and people across the UK who are watching our proceedings will be concerned about the outsourcing and privatisation of the NHS in England—[Interruption.] I will not be shouted down. The Scottish Tories think that they can shout people down, but that will not happen with me. I am reaching the conclusion of my remarks, so the hon. Members for Berwickshire, Roxburgh and Selkirk (John Lamont) and for East Renfrewshire (Paul Masterton) will have to be patient until another day.

Those who are watching these proceedings will be very concerned about the outsourcing and privatisation of the national health services in England. People want to see a publicly owned national health service across these islands.

PACE Trial: People with ME

John Lamont Excerpts

Tuesday 20th February 2018 Westminster Hall

[Carol Monaghan]

Yes. I will come on to how an appropriate trial could be done. First, I will mention the self-reporting that was a part of the trial. Questionnaires provided the data and measures of success. There were no physiological or scientific measurements. For patients the damage was done. I am a science teacher by profession and I always told my pupils that there are a number of stages to any scientific investigation: “Start with a hypothesis. Decide how you will test this theory, what measurements you will make, how you will record your results and how you will use these results to draw your conclusions. Those conclusions, which might be different from the original hypothesis, must be based on the evidence you have gathered.”

That did not happen in the PACE trial, which relied on patient self-reporting, rather than measurable physiological parameters. Furthermore, when the results were not as expected, rather than revise the original hypothesis, the investigators simply changed the success criteria. Thus patients participating in GET who had deteriorated during the study were considered recovered.

There are, of course, ways of measuring the physiological impact of exercise. The two-day cardiopulmonary exercise test can objectively measure post-exertional malaise. We know that a person with ME can perform adequately—sometimes even well—on the first day, but can have greatly reduced cardiopulmonary function on the second. The test requires the participant to exercise on a static bicycle, and allows data on oxygen consumption, workload and gas exchange to be measured. Two identical tests, separated by 24 hours, must be carried out to properly measure the impact of exercise. Results from a single test could be interpreted as a lack of fitness. Two tests change that to something quite different. A healthy person will perform better the second time; an ME sufferer will most likely be worse.

Of course, the failure of the PACE trial to do that could simply be put down to bad science, but unfortunately I believe that there is far more to it. One wonders why the DWP would fund such a trial, unless it was seen as a way of removing people from long-term benefits and reducing the welfare bill.

[John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)]

The hon. Lady is speaking very well about the challenges that this illness presents to people, but does she share my concern that in Scotland there is only one specialist, nurse-led ME facility and there are no specialist ME consultants? She raises an important point, but in terms of NHS awareness of the condition, we need to do more to ensure that people are getting the treatment that they undoubtedly need.