Health and Social Care Bill

John Pugh Excerpts

Tuesday 13th March 2012 Commons Chamber

[Mr Lansley]

There is absolutely nothing in the Bill that promotes or permits the transfer of NHS activities to the private sector. Of course, NHS trusts are technically able to do any amount of private activity at the moment, with no constraint. The Bill will make absolutely clear the safeguard that foundation trusts’ governors must consent if trusts are to increase their private income by more than 5% in the course of one year, and that they must always demonstrate in their annual plan and their annual reporting how that private activity supports their principal legal purpose, which is to provide services to NHS patients.

Labour sought to oppose the Bill in another place, but its motion was defeated by 134 votes. We have reached a stage at which the Labour party, and the right hon. Member for Leigh in particular, having embraced opposition —for which they are well suited—now oppose everything. They even oppose the policies on which Labour stood at the election. Labour’s manifesto stated that

“to safeguard the NHS in tougher fiscal times, we need sustained reform.”

The trade unions have got hold of the Labour party in opposition, and it is now against reform. Its manifesto also stated that

“we will deliver up to £20bn of efficiencies in the frontline NHS, ensuring that every pound is reinvested in frontline care”.

I remind Labour Members, who are all wandering around their constituencies telling the public that there are to be £20 billion of cuts to the NHS, that that £20 billion was in their manifesto. Now they are talking about it as if it were cuts; it is not. We are the ones who are doing it, and they are the ones who are now opposing it. They scare people by talking of cuts—[Interruption.] They do not like to hear this. Actually, this year, the NHS has an increased budget of £3 billion compared with last year, and in the financial year starting this April there will be another increase of £3 billion compared with this year. The Labour manifesto also stated:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services”.

[John Pugh (Southport) (LD)]

The right hon. Gentleman has just mentioned reform. In 2009, he said in this place:

“Organisational upheaval and reform do not seem to correlate well.”—[Official Report, 19 November 2009; Vol. 501, c. 225.]

What did he mean by that?

[Mr Lansley]

We know that it is necessary for us to reform in order to deliver the improvements that the NHS needs, as well as the sustainability that it needs. We are not even speculating about this; we can demonstrate that it is happening. This is in contrast to what the right hon. Member for Leigh said. He said that he was not scaremongering, then he got up and did just that. He scaremongered all over again. He went to a completely different set of data on the four-hour A and E provision, for example. He went to the faulty monitoring data, which are completely different from the ones that we have always used in the past—namely, the hospital episodes statistics data, which demonstrate that we are continuing to meet the 95% target.

When we look across the range of NHS performance measures, we can see that we have improved performance while maintaining financial control. The monitoring data from the NHS make that absolutely clear, and that is in contrast to what happened when the right hon. Gentleman was a Minister in the Department, when Labour increased the NHS budget and lost financial control. That happened when the hon. Member for Leicester West (Liz Kendall) was a special adviser in the Department. Now, we have financial control across the NHS and we have the NHS in financial surplus.

Let me return to the Labour manifesto—[Interruption.] Labour Members do not like to hear this. It stated:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”

Yes—choice and any qualified provider are in the Labour manifesto. We are doing what Labour said should be done in its manifesto—and it is now opposing it.

Let us find out what it is that the right hon. Member for Leigh opposes in the Bill. I did not find that out in his speech; I heard generalised distortions, but I genuinely want to know. Let us take some examples. Is it the Secretary of State’s duty in clause 1 to promote a comprehensive health service free of charge, as now? No, he cannot possibly be against that. Is it that the Bill incorporates for the first time a duty on the Secretary of State to act to secure continuous improvement in quality—not just access to an NHS service, but putting quality at the heart of the NHS? Is he against that? No, surely not. Anyway, that approach began with Ara Darzi, and we have strengthened it.

--- Later in debate ---

[John Pugh (Southport) (LD)]

I was cut off when I previously spoke on the subject. Perhaps that was welcome, because I was quoting a strangely prophetic entry in Chris Mullin’s diary. It was a conversation with a Labour Member, whom he describes as a “mild-mannered” Yorkshireman—surely an oxymoron—who said in 2005:

“I think we will lose the next election. The Tories will come to some sort of understanding with the Lib Dems and we’ll find we’ve opened the door to the market in health and in education. And when we protest they will reply, ‘But this is your policy; you started it.’”

That is the story of our debate.

Critics of the Bill often fail to realise how far Labour had exposed the NHS to all sorts of market forces such as EU competition law, encouraged and subsidised the private sector, and imposed “any willing provider” in all sorts of places where it might not have been appropriate. Essentially, Labour set up the building blocks for a market system.

The Bill continues that process. To put it bluntly, no one in this House regards the Bill as anything but risky. Even the Whips, who are normally the most cheerful about legislation, can barely summon a smile when dragooning Members into voting for it. Why? There is a simple explanation. It is the combination of the biggest ever organisational upheaval and the biggest ever financial pressure: the £20 billion Nicholson challenge.

The Bill is also considered risky because the confidence of staff and the public is low, concern is justifiably high, and, to quote Donald Rumsfeld, there are too many “known unknowns”—about the interaction with EU law, how GPs can commission themselves legally, and what the law actually means. Nigel Crisp, the former chief executive of the NHS, recently described the Bill as “confused and confusing”.

There is also a lack of trust. To some, the thrust of the Bill seems essentially unchanged. As the Secretary of State warned us in 2009—I repeat his words in case people missed them in the earlier intervention:

“Organisational upheaval and reform do not seem to correlate well.”—[Official Report, 19 November 2009; Vol. 501, c. 225.]

The Bill also represents a significant generator of future over-regulation and, to some extent, a perpetuation of micro-management. There is no essential difference between a Government imposing AWP and telling everyone what to commission and when, regardless of local circumstances, and instructing everyone to have a Darzi clinic, as the Labour party did.

We are considering a strange spectacle—a sort of paradox. We genuinely have gradual improvement of legislation, but simultaneously there is increasing professional detachment and disillusionment. That is possibly because people view the Bill as big government; as a centralising measure. The right hon. Member for South Shields (David Miliband) was right to point out that a huge quango had been set up— “the biggest quango in the land”, in the words of my hon. Friend the Member for North Norfolk (Norman Lamb), who is now a Minister.

There are alternatives. Life without the Bill is possible. However, with or without it, the gap between professional and political opinion is fatal. The gap between ideology and evidence is fatal. The gap between what the Prime Minister thinks he needs—not to look weak—and what the NHS needs, which is a two-way dialogue, is also fatal. We must find some way of bridging those gaps. My hon. Friend the Member for St Ives (Andrew George) has tried to find a particular way.

Spin and propaganda will not get any of us out of this. The reality will be played out in the next year and the subsequent year in hospitals, surgeries and homes. Spin will not help because, across the land, reality will kick in—and reality has a horrible habit of trumping spin.