Health and Social Care (Re-committed) Bill

Debate between John Pugh and Caroline Lucas

Tuesday 6th September 2011 Commons Chamber

[Caroline Lucas]

New clauses 19 and 22 also have my name on them, and I should like to say a few more words in support of them as I have not been reassured by the Minister. I find it unacceptable that taxpayers’ money has ever been used to allow private patients to jump the queue and use NHS facilities. The history of the cap was all very interesting, but the bottom line is that it serves an important purpose, which is why it should stay. The Government argue that income from private patients is put back into the NHS and ultimately benefits the health service, but the reality is that when people become ill and need treatment, it is hard to justify asking them to wait longer because capacity in our NHS hospitals is being taken up by private patients. The bottom line is that an NHS hospital has to treat NHS patients, and I do not believe that we have adequate spare capacity sloshing about in the system to justify private queue-jumping.

Some Members will recall that foundation trusts were brought in after Alan Milburn visited the state-owned but privately run Fundación hospital in Madrid. The then Health Secretary was apparently impressed when he was told that the foundation hospital outperformed the Government-controlled hospitals. However, he ignored the argument put forward by the local unions that it was able to do so precisely because the more costly and difficult patients were sent to the fully public hospital nearby.

It is often argued that foundation trusts are about choice, but I would argue that such private treatment should be offered only when there is surplus provision in the system. It is one thing to talk about a choice of general goods and services, but it is enormously inefficient and massively costly to apply that mentality to the health service. Now, we see the present Government trying to use the model introduced by the previous one to allow foundation trusts to do as they please, and lifting the cap on the income that can be derived from private sources.

The hundreds of constituents who are contacting me about this do not want private queue-jumping; they want NHS services paid for from taxation. The future of the NHS should be about developing whole systems, not isolated institutions, and private health care in the NHS should be phased out. The NHS needs to be about building networks across professional and institutional boundaries, not about creating new barriers. It needs to be about IT and information sharing, not reducing connectivity, and about getting more people treated in the community and in primary care. The danger with this Bill is that it will do exactly the opposite and return us to the fragmentation of the time before the NHS.

[John Pugh]

I supported the amendment tabled by the hon. Member for Islington South and Finsbury (Emily Thornberry)—or, rather, I tabled it independently. I accepted at the time that it was not the most elegant way of dealing with the problem, but I recognise that there is a problem, as do foundation trusts. The cap as it stands has certain perverse consequences, and the NHS cannot fully profit from sources such as intellectual property. NHS profits help to subsidise public services. As the Minister has pointed out, there is no cap on non-foundation trusts, and the current format was to some extent a political compromise because Labour Members raised certain considerations during the passage of the legislation on foundation hospitals. That does not mean that their concerns were not valid at the time.

I am not concerned by the prospect of dramatic privatisation overnight; nor do I think that queue-jumping is the real danger. By abolishing the cap altogether, however, we run the risk that foundation trusts will run on the wrong side of state aid rules, and that their activity will be perceived as economic activity under EU competition law. The more they subsidise general NHS services, the more they will be perceived as engaging in economic activity.

I do not take a doctrinaire view on this issue. Very sensible people, such as Steve Field and the NHS Confederation, have raised the matter. The hon. Member for Leicester West (Liz Kendall) raised it, as did, if I recall correctly, the hon. Member for Islington South and Finsbury in a spirit of compromise in Committee, making the point—I think I am quoting her correctly—that the only alternative to a bad cap is not no cap at all.

There is a genuine fear, however, among people who are far more expert than most hon. Members in this field, which is caused by the blurring of the boundaries between public and private hospitals. We could end up theoretically with a private hospital that has 90% of its patients provided by the NHS. I know we cannot end up with an NHS hospital filled by 90% of private patients, but there is a threshold at which things could quite easily start to become complicated. This a critical issue, which will have to be dealt with in the House of Lords.

Academies Bill [Lords]

Debate between John Pugh and Caroline Lucas

Monday 26th July 2010 Commons Chamber

[Dr Pugh]

I am arguing simply that we should be at least as permissive as Baroness Thatcher was in 1988. My hon. Friend argues that we should be more permissive, but the Government are arguing, and anyone who votes against my amendment will clearly be convinced by that argument, that we should be less permissive.

Amendment 9 would delete the words “an Academy order, or”, the effect of which would be to ensure that consultation on academy status would have to occur prior to the order being made. It is good common sense and, in essence, it is supported by the Chair of the Education Committee. As he said on Second Reading:

“The Government’s concession in clause 5 at least makes governing bodies consult those whom they deem appropriate, but it is blunted by the fact that they do not have to do so prior to applying to the Secretary of State and because they can do so even after they have been issued with an academy order. Those consulted in such circumstances would have good grounds for feeling that they were participating in a charade.”—[Official Report, 19 July 2010; Vol. 514, c. 49.]

I do not think that it is our business in this place to encourage charades.

I am aware that, from time to time, it suits Members to parody, simplify and stereotype their opponents. The last Government are characteristically portrayed by the current Government as an unmitigated disaster and, in return, Labour Members portray the Government as an unmitigated evil. If people want to live in a world of hyperbole, that is fine—if a little wearisome—but let us conduct a simple thought experiment. Let us imagine a Government—any Government—different from ours, who propose to allow a public institution to change its character. They agree that the institution must consult people about the change, but they allow consultation only after the irreversible change has happened. Would Members back such a Government? Would they applaud them? What would be the point of consultation? What would that process do for public cynicism about public service consultation—already significantly eroded by the pseudo and sham consultations organised by the previous Government? But on the coalition side of the Chamber, how many quotes—showing our previous attacks, time and again, on sham consultation—do we want dragged up and used against us? At least those consultations did not take place after the event. Why do we want to invite comparison with the twisted politics of a communist plebiscite?

Is the only reason why we support the provision that the Government are proposing it? I notice that no one has said that post-hoc consultation is a cracking idea. It cannot be a case of “my Government right or wrong”. That is not a good basis for a working democracy. It will not help the Government if we vote for indefensible nonsense. It will not help the Government if we vote, but compromise our beliefs in the process. Inconsistency and duff arguments will not help the coalition in the long or short term.

Amendment 10 is genuinely probing. It makes the obvious and, for me, slightly unkind point that the last time schools were given greater financial freedoms under local financial management, which I have always supported, nearly every governing body was presented with a paper from the headmaster showing that his salary should go up because the headmaster down the road would be getting a significant increase. We saw salary inflation across the headmaster class, so headmasters may have something to look forward to from new academy status. Of course, they may not think in those terms, and I am sure that the majority do not, but the point is pretty obvious to all of us—imagine asking MPs to consult on a change that might possibly result in improved salaries. The concept of declaration of interest has some relevance in these provisions, so it is important that consultation is led by those who have none.

I acknowledge that I have not shown a lot of enthusiasm for the Bill, but despite that and despite my doubts as to its cost and effects, I am not seeking to derail it. I do not wish to cause trouble. Free schools and academies are in the coalition agreement. All I hope I have done is to make a case for good sense, which I think most people are up for, the primacy of the Commons Chamber, which I think most of us support, and the right of parents to be taken seriously. I hope rational beings on both sides of the Committee will see their way to supporting the amendment.

[Caroline Lucas (Brighton, Pavilion) (Green)]

I want to speak to new clause 1, on the reversion of academies to maintained status, and amendment 4, on consultation on conversion to an academy. I shall concentrate the majority of my remarks on new clause 1, and will speak only briefly to amendment 4, as consultation has been pretty much covered in our previous debates.

I tabled new clause 1 because there is no provision in the Bill for academies to revert to maintained status. That means that all the potential problems that the Bill would permit—such as restrictive curriculum, discriminatory admissions and employment policies—would be made permanent at the point of conversion. The Government admit that problems are likely. I have cited this before, but it bears repeating that the Minister responding for the Government in a debate in the other place stated:

“I fully accept that if you trust people things do go wrong, but that is the direction that we want to try to go in.”—[Official Report, House of Lords, 7 July 2010; Vol. 720, c. 299.]

It beggars belief that the Government would not want to guard against certain things going wrong, so is it really necessary to give schools complete freedom over admissions, curriculum and employment just to show that the dedicated people running our schools are trusted? I would argue not. The public are funding these schools, so on their behalf we must ensure that children are protected from indoctrination, that they are taught key subjects and that their staff are fairly treated. But given the Bill’s failure to make proper consultation mandatory when schools convert to academy status, it is crucial to have a mechanism for parents to say that they want their schools to revert to maintained status if, as an academy, things do go wrong.

The Government want academies to be like private schools funded by the state, yet if things go wrong at a private school, parents have more recourse than parents of children at an academy as envisaged in the Bill. For example, if a private school behaves in a way that a parent does not like, the parent can stop paying the fees, withdraw their child or pay for their child to go somewhere else. There is no comparable control in the Bill for parents of children in academies. For example, it may well not be practical or possible for there to be the surplus capacity necessary for children to be pulled out of one academy and be sent to the next state-funded school of choice.

If parents see things going wrong in schools and believe that the Government’s complete trust has been misplaced, surely they should be able to do something about it. The amendment is designed to provide a remedy to parents as a group—if, for example, an academy failed to teach key subjects or sought to impose religious beliefs on pupils. The amendment means that where 10% of the parents of pupils at an academy request it, the governing body must make arrangements for the holding of a ballot of parents to determine whether they want the academy to be converted back into a maintained school. If the Government are in favour of decentralising, as they constantly say they are with their big society rhetoric, why do they not want to let parents have the power to act if they decide that an academy is not better and if they want the school to go back to being a maintained school?