National Health Service (Amended Duties and Powers) Bill

John Pugh Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

My hon. Friend is absolutely right. There are too many examples of money being wasted on the tendering process.

Those who suggest that what the Labour Government did can be compared in any measure with what this coalition has inflicted on our national health service are completely misguided. When the Labour Government were elected in 1997, we spent 5.2% of our GDP on our health services. In 2010, we had increased that to 8.6%. We increased the number of doctors by 48,000. We increased the number of GPs by 5,000. We increased the number of training places for doctors, which had been cut by the previous Tory Government. We increased the number of nurses by 70,000. We had the biggest hospital building programme in the history of the national health service. We rebuilt or refurbished every accident and emergency department in the country. When Labour left office, the NHS had the highest satisfaction ratings from its patients that it had ever had in its history. The NHS was in crisis in 1997, and Labour saved it. It is in crisis again now.

[John Pugh (Southport) (LD)]

Does the hon. Gentleman accept that Labour also guaranteed the private sector a fixed slice of NHS income in a way that the Bill does not do?

[Clive Efford]

The hon. Gentleman was on the Bill Committee for the 2012 legislation, and I wonder how many amendments he tabled to put those issues right. And he has the cheek to come here and ask questions about my Bill, which seeks to put right what he did not attempt to put right when he was on that Committee.

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[Sir Tony Baldry]

My hon. Friend makes his own point very well in his own way. It is important for all of us to remember that the NHS is our NHS and our constituents’ NHS. It does not belong to any particular political party; it is a national heath service.

Alan Milburn concluded that the “major reforms”, which included working more closely with the private sector, would

“deliver real benefits for NHS patients”.

Chapter 11 of the NHS plan of July 2000, on “Changes in the relationship between the NHS and the private sector”, said:

“The NHS is a huge organisation. Using extra capacity and extra investment from voluntary and private sector providers can benefit NHS patients… The time has now come for the NHS to engage more constructively with the private sector”.

Under the heading, “The basis for a new relationship”, it went on:

“Ideological boundaries or institutional barriers should not stand in the way of better care for NHS patients…By constructing the right partnerships the NHS can harness the capacity of private and voluntary providers to treat more NHS patients…Under our proposals a patient would remain an NHS patient even if they were being treated in the private sector. NHS care will remain free at the point of delivery, whether care is provided by an NHS hospital, a local GP, a private sector hospital or by a voluntary organisation.”

[John Pugh]

The right hon. Gentleman is outlining a thread of continuity very well. Is it not strange that the principal adviser to Alan Milburn has now been appointed by this Government as the head of NHS England? Does that not show that there has been continuity from one Government to another with the same policies?

[Sir Tony Baldry]

I would hope, with an organisation like the NHS, that it would not become a political football—that there would be considerable continuity. The fact that the person now in post worked with a Labour Government on NHS proposals is a strong point rather than a weak one.

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[John Pugh (Southport) (LD)]

It is a pleasure to follow the right hon. Member for Wentworth and Dearne (John Healey), and I agree with most of what he said, but probably not the conclusion.

It gives me pleasure that we are having this debate. I think we all accept that the Bill will not go right the way through Parliament and end up on the statute book by 2015. We know what will happen: private Members’ Bills are lining up behind one another, and most of them will hit the buffers. However, the Bill moves the NHS debate up a notch.

It is fashionable at the moment to regard the Health and Social Care Act 2012 as a disastrous mistake. In fact, I believe that view is now shared in the Treasury. I did not support the Act, and not for the usual reasons—that it was not in the manifesto or the coalition agreement and was sprung upon Parliament. Those were good reasons, but they were not my main reason, nor was it because I am awkward or I thought it was a good career move. It was not because I did not see some of the upside, which I am sure the Minister will rehearse later—the emphasis on public health, clinical involvement, health inequality and mental health, and a smidgen of democratic accountability.

My main reason for opposing the Lansley Bill was that I saw it as the logical conclusion of a trend that began under Mrs Thatcher, was carried on by Blair and survives to this day. That trend, fundamentally, is an attempt to run the NHS as a market—not a real market, of course, but an internal market; a funny sort of Alice in Wonderland market with none of the advantages of a real market and most of the downside. It is one where everything is free, but prices, wages and policies are set by the Government; where NHS bodies compete not just against the private sector but against one another; where, as others have said, integration and real efficiency often go out of the window; where strategic leadership just does not seem to exist, as the right hon. Member for Wentworth and Dearne said; where we struggle to deliver not products, as in ordinary markets, but entitlements; and where half the NHS, which we call commissioners, is billing the other half, which we call producers—that point has already been made—and bean-counters proliferate on either side and lock horns over bills.

In my view, the Health and Social Care Act was not so much about privatisation, or private industry helping to deliver NHS services—that was already happening under Labour—but primarily about marketisation. Some of course see that as a conspiracy—marketisation as the prelude to total privatisation—but I have to tell hon. Members that marketisation as a faith is still very much around, including on the Front Benches of most political parties, and is supported by practically every health think-tank we talk to.

The market, external or internal, tweak it as we may, simply cannot deliver entitlements and the moral objectives of the NHS in anything like an efficient manner. It cannot deliver to people the care that they need regardless of their means. Worse still, it solves none of the current problems of the NHS, which were largely parked in 2010—the financial pressures on the acute sector, which have come back to haunt us recently; the poor integration of services, which we have still not got right; and the separation of health and social care, which is unfinished business.

If I have a proposal to put to the House, it is that I would like to see the commissioner-provider split ended. That has been mentioned already. We moved an amendment at the Liberal Democrat conference to try to see whether and how that could be permitted. I would like to see the creation of local health boards, charged with integrating services and running them efficiently.

[Dr Huppert]

The amendment my hon. Friend is talking about was proposed by Cambridge Liberal Democrats, and I pay particular tribute to Councillor Kilian Bourke, who chairs the health committee in Cambridgeshire. It suggested allowing NHS commissioners and providers in a local area to form an integrated health organisation if that was what they wanted to do. Does my hon. Friend agree that that would achieve the benefits that he and I seek without the need to force through a massive top-down reorganisation? Would he urge the hon. Member for Eltham (Clive Efford) to accept such an amendment if the Bill made progress?

[John Pugh]

If the hon. Member for Eltham (Clive Efford) wished to talk about that, we could happily move away from the internal market where local circumstances required and demanded it. That would be an entirely sensible policy. I see no reason, though, why health boards should not procure goods and services based on simple best-value principles without all the competition legislation that has been vilified in the debate. They should be funded—as most services are—by capitation and according to local need, and they should be in some way democratically accountable, and I think we can get a genuine public service element back into the NHS. However, not every political party is advocating that at the moment, and some are steering in quite the opposite direction.

[Philip Davies]

The hon. Gentleman is making a thoughtful speech, as is typical of him. Does he agree that what we are dealing with today is an Opposition party in desperate straits that knows exactly what it is doing in using the word “privatisation”? It knows that people out in the country associate it with having to buy private health care, but actually nobody is proposing to change the fundamental ethos of the NHS, which is that treatment is free at the point of need. The Labour party is conflating the two as a desperate political tactic.

[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.

[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.