National Health Service

John Pugh Excerpts

Wednesday 26th October 2011 Commons Chamber

[John Pugh (Southport) (LD)]

May I take it as read that the NHS will struggle to find the £20 billion savings agreed in the Labour Budget? May I take it as read that that will impact on services and that people will notice and probably blame this Government’s legislation regardless of whether or not it compounds the problem? The debate we have been having on how NHS spending is or is not to be ring-fenced is almost a sideshow, compared with the huge challenge that is consistently emphasised by the Chairman of the Health Committee.

I draw Members’ attention to the fact that serious financial trouble is already breaking out in the acute sector. Seven of the 19 foundation trusts in the north-west have a red light, and that region is one of the more stable ones that we could consider. I cannot see any obvious happy endings, even without the Bill. Without the Bill we would still have competition by price, competition law would still be applicable, PCTs would still be capable of looking for the lowest common denominator and we would still have an unaccountable NHS.

To add to the general misery I am trying to perpetuate, on Saturday I had a severe abscess on my tooth, which was extraordinarily painful and unpleasant. After taking large doses of ibuprofen, which gave me a little relief for an hour, and my face being swollen and peculiar—a little more peculiar than it currently is—I sat up in bed in the middle of the night with my iPad looking up home remedies on the internet—cloves, bicarbonate of soda and so on. I found forums populated by desperate sufferers looking for a fix. What surprised me most were the American contributors, a considerable number of whom were obviously afraid to go to a dentist, despite the fact that the US is a rich country with no shortage of good dentists. They were settling for severe and continuous pain or for hit-and-miss experimentation, rather than risking debt and bankruptcy. Thankfully, I was in the UK and we have the NHS. On Sunday night, almost unbelievably, I was seen at 6.15 by an emergency dentist, a Polish dentist at the former Litherland town hall, which is now a busy Sefton NHS walk-in centre with a pharmacy attached—a service I did not know existed prior to these events.

Thankfully, the NHS is an institution built on solidarity. Through the state, we guarantee by our taxes each other treatment according to need and irrespective of means. It is a moral compact and Governments have been prepared to carry out that compact by ensuring that the services that are needed exist. Historically, they have done this in two ways: first, by buying services on our behalf; and secondly by providing services directly on our behalf. Governments and the people working in the NHS have done this relatively well and relatively efficiently, as the Wanless report and the Commonwealth Fund report have rigorously and exhaustively demonstrated. That is indisputable.

What is strange about recent developments is the Government shying away from their role as a provider of health care. The original debate was over the renouncing of the Secretary of State’s role as a provider, but we can also see the cutting loose of all hospitals as free-standing foundation trusts; the blurring of boundaries between NHS providers and other sorts of providers, with NHS providers doing more private work and the private sector doing more public work; the forcing—genuine forcing in some places—of non-hospital staff working for the NHS to become independent social enterprises; the neutrality of the Department of Health on whether individual NHS providers or provider networks survive, a neutrality that will be severely tested in the months to come; and the willingness to make NHS provision contestable as a matter of principle, rather than one of pragmatism. Not many people have noticed the ending of the Secretary of State’s powers to create a new foundation trust or hospital post-2015. We might have seen the last new NHS hospital opened by a Secretary of State in this country.

I found the Secretary of State’s unwillingness to stick to the wording of the Health Act 2006 slightly bizarre, if only because that would easily have brought peace, and may have brought peace now, depending on what exactly has happened in the House of Lords. In a sense, we all know that the Secretary of State does not, has not and cannot provide all the services himself and should not try to micro-manage. I did not seriously expect him to turn up at Litherland town hall on Sunday—visions of Marathon Man come before me. What concerns me is the ideological presumption that the Secretary of State should only be a purchaser or commissioner. There is a good reason for that concern; it is only possible to purchase in a market what that market offers. Markets are splendid things, offering choice and variety, but they do not have a guarantee that people will get what they are entitled to, and they do not ensure that health inequalities, or any sort of inequality, can be eroded, and they do not guarantee that public resources are spent and used in the most efficient way. They may lead to that, but not necessarily. Direct state provision is often a better option.

[Dr Thérèse Coffey]

I respect my hon. Friend’s point of view, but surely what matters is quality of care for patients, which can be provided as well in the private sector as it can in the public sector, and it is not necessarily guaranteed in the public sector, as events at the Mid Staffordshire hospital have shown.

[John Pugh]

I did not say that it was guaranteed by the public sector. That is not the point I was making at all. Guaranteeing entitlement, addressing inequalities and ensuring public value are, to be blunt, largely the point of the NHS. I can quite understand—I partly regret it—that a degree of cynicism might exist about the public service ethos, and a sort of nostalgic support for that can sometimes be in place when the reality is that it is not there. There is doubt about its true impact and people inside and outside the NHS sometimes show that degree of cynicism, which is regrettable. I can understand the worry that NHS providers can become lax or inefficient or unambitious if they are not challenged, but the answer to that is not necessarily or obviously to get out of the provision business full stop, embrace the market, set up strange control markets with huge transactional costs, strange tariffs and the multiplicity of bean counters that go along with that. Of course there is also greater legal complexity. The end result of that is something that has few of the virtues of a real market and most of the vices. The Labour Government were to some extent part and parcel of producing such a market. I see no reason to make the state just a purchaser and never a provider, and it is not obvious to me that the answer is to hand over the money to one set of providers, the GPs, particularly if the pretext for doing so is to harden the commissioner-provider split, because GPs are providers.

In conclusion, publicly funded provision—public service infused with the right ethos—is often the most efficient and effective option, provided that it is coupled with genuine, local and rigorous accountability. That is what happens in many successful systems, such as Sweden’s, and it is a liberal solution. So far, there is not enough of it, although the Bill makes laudable moves in that direction, with health and wellbeing boards and so on, but this strange, unargued and ideological withdrawal from provision or interest in provision taints everything and leaks poison into the system—like an abscess.

--- Later in debate ---

[Liz Kendall]

The hon. Gentleman, who is a constituency neighbour of mine, would do better focusing his attention on the RCN and RCM in our area, which are asking us why the Government are not fulfilling their commitment on extra midwives. If he goes to the hospitals in Leicester, as his constituents do, he will know that there are concerns about that.

The Government deny that the number of front-line NHS staff is being cut, that waiting lists are rising and, worst of all, that there is still widespread and growing opposition to their NHS plans.

[John Pugh]

Does the hon. Lady seriously believe that the £20 billion-worth of savings required by the last Labour Budget could be achieved without cuts?

[Liz Kendall]

We have been clear on this side of the House. My right hon. Friend the Member for Leigh (Andy Burnham) took some difficult decisions when he was Secretary of State for Health, unlike the current Secretary of State. My right hon. Friend looked at what was happening in local hospitals and took the difficult decisions, based on clinical advice, to improve patient care. That is what this Government should be doing.

The Prime Minister says that

“the whole health profession is on board for what is now being done,”

but that is simply not the case. The RCN says that the Bill

“will have a seriously detrimental effect upon the NHS and the delivery of patient care”.

Four hundred of the country’s leading public health experts warn that the Government’s plans will cause “irreparable harm” and fail to deliver

“efficiency, quality, fairness or choice”.

The British Medical Association says that the Bill

“poses an unacceptably high risk to the NHS”.

Government Members now like to criticise the BMA, but before the general election they applauded everything the BMA said. They always want to have it both ways. Three quarters of GPs—the very people this Government claim they want to empower—have said through the Royal College of General Practitioners that the Bill should be withdrawn. [Interruption.] The Minister of State, the right hon. Member for Chelmsford (Mr Burns), says from a sedentary position that those groups—the RCN, public health experts, the BMA and the Royal College of General Practitioners—are self-selecting. That is the kind of dismissal of front-line staff that has caused such problems for the Government.

It is not just NHS staff whom the Government refuse to listen to. Organisations such as Age UK and Carers UK say that social care is in financial crisis too. The Government repeatedly claim that they have increased funding for social care, but eight out of 10 local councils are now restricting services to cover only those with substantial or critical needs. Two thirds say that they are closing care homes or day care centres too. The Government’s huge cuts to local council budgets mean that vital services and support for older people, their carers and their families are being eroded. That is not protecting the most vulnerable in our society, nor is it protecting taxpayers’ interests, because if we do not help older people to stay healthy and independent in their own homes, they end up in hospital.

In conclusion, when people think back to what the Prime Minister said before the election and the personal promises he made on the NHS, they now see the truth: a Government who are out of touch with what is really happening; a Government who refuse to listen to front-line staff; a Government in total denial about the true impact of their reckless NHS plans. This Government’s record on the NHS is one of promises cynically made and shamelessly being broken. I commend the motion to the House.