Future of the NHS

Debate between John Pugh and Grahame Morris

Monday 9th May 2011 Commons Chamber

[John Pugh (Southport) (LD)]

This is déjà vu. In the last Parliament, it seemed like every other Opposition day debate was a health debate, normally called by the Secretary of State as the then Opposition spokesman. I trust that his enthusiasm for these debates is undimmed, although given that he has left us, possibly it is.

The Opposition allege that the Bill prepares the ground for the complete privatisation and fragmentation of the NHS through the introduction of an open market, pricing and competition regulation and the general disengagement of Government. However, the often very pained response of Ministers—this was certainly true in the Bill Committee—is that they are building and improving on previous policy, linking clinical decision making to cost control and adding a dimension of accountability that has not existed hitherto. All those statements are true. I noticed that in the Bill Committee, Ministers talked all the time about “refracting mirrors”, “Opposition fantasies” and “deliberate distortions”. In turn, the Opposition talk of “hidden agendas”.

On reflection, I have come to the conclusion that there has to be an explanation for this strange phenomenon, this persistent conflict between interpretations of the same legislation, this clear non-meeting of minds.

[Grahame M. Morris]

Will the hon. Gentleman give way?

[John Pugh]

I was just about to give the answer, but I will give way.

--- Later in debate ---

[Grahame M. Morris]

Is there not a simple solution? It is the Government’s Bill, so why did they not explicitly rule out price competition in the Bill?

[John Pugh]

I have a different explanation, which is that both interpretations can be sustained by a reading of the Bill. It is a kind of Jekyll-and-Hyde thing. I have a vision of the Bill being drafted during the day by a sane, pragmatic Dr Jekyll-like Minister, but during the night some rabid-eyed Mr Hyde with right-wing ideology breaks into Richmond House and changes many of the sentences. That is the only way I can explain the fact that the explanatory notes to the Bill provided in Committee explained very little.

The House might know that I am a long-term critic of the Bill and the White Paper before it. At the annual Liberal Democrat conference in October, I and the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow) went around with a double act on the Bill—him for, me against. This is not, therefore, as the hon. Member for Easington (Grahame M. Morris) might think, a hissy fit following poor election results. Like nearly everyone in the House, I do not disagree with the Bill’s objectives: more clinical involvement, less bureaucracy and more local accountability. Like everyone else, I am concerned not about its objectives, but about its likely effects. I have met no one who takes issue with the Bill’s avowed intentions, but I have met many who dread its consequences.

According to one reading of the Bill—the Mr Hyde version—the eventual outcome of the Bill will be that the NHS opts out of direct health provision and becomes simply a funding body; NHS hospitals, services and clinics become indistinguishable from private ones; everyone competes on business terms for a slice of whatever funds the Government have allocated for health purposes; and what health care a person gets depends on what can be purchased on their behalf in a largely unconstrained, privately run health market. That is a perfectly consistent view of how a health service can be run, but in our country any party that advocates it commits political suicide. Furthermore, of course, it is likely to accentuate health inequalities and overall costs.

The question for us is this: what will prevent such a situation from arising out of a Bill that appoints a competition regulator along the lines of Ofgem to promote competition, that blurs many of the lines between private and public provision, and which removes the Government’s duty to provide a comprehensive health service? Hence the importance of today’s debate, which, knockabout apart, is crucial to the wider debate on the Bill. To be alarmed by the prospect I have set out is not to oppose competition in principle. The previous Government set up competition and collaboration panels to encourage a degree of challenge in the system. In fact, if hon. Members look at their record, they will see that they were knee-deep in competition initiatives. Neither is holding these concerns to be alarmed by the presence of private business in delivering NHS services. There is not a person here who has not used a private optician or a private pharmacist when they need it. There is a long tradition of involvement by the private sector in the NHS.

Rather, to be concerned about the proposals is to be alarmed by the fear of an unconstrained, uncontrolled market in health—this is a point that has been made previously—partly because it can lead to fragmentation, potential conflicts of interest, profiteering and so on, but mainly because identifying competition as the main engine of improvement in health care ignores the simply enormous gains in service quality, cost reduction, efficiency and patient experience that can be gained through co-operation, collaboration and integration of services.

The NHS is built on the principle of co-operation, in which we, the hale and hearty, make a moral compact to support the lame and the sick. To make commercial competition the main driver of improvement in the NHS, even if it is not competition on price, would be a serious mistake. It would be to subscribe to a perverse and misguided form of social Darwinism. Competition is a mechanism; it is not an end in itself. The role of competition in the NHS, as seen by the Government, is the real issue. The problem is made a lot worse by the hopeless lack of clarity over how European competition law will apply. We struggled with that issue in Committee. We did not resolve it, and I do not think that we will do so.

NHS (Public Satisfaction)

Debate between John Pugh and Grahame Morris

Wednesday 30th March 2011 Westminster Hall

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I pay tribute to my hon. Friend the Member for Leyton and Wanstead (John Cryer) for securing this important debate on public satisfaction with the NHS. Some important issues have been raised by my right hon. and hon. Friends, but I will not rehearse them. Suffice it to say that we are having this debate because information has been released as the result of a debacle in the Department, and I am delighted that the information is now available. There may be a good reason for the Secretary of State wanting to keep the contents of the satisfaction report under wraps. It confirms the outstanding NHS legacy that Labour passed to the Health Secretary in 2010. He inherited a national health service that was rescued from 18 years of Tory mismanagement, and now enjoys the highest rate of public satisfaction in its history.

The Ipsos MORI survey, to which my hon. Friend the Member for Leyton and Wanstead referred, states:

“Public satisfaction with the running of the NHS remains very high at 72%. This high level of satisfaction has now been sustained for over a year making the public’s perception of the NHS a real success story.”

The real reason why the Health Secretary hoped that his Department had not published that report is that it shows him to be completely out of step with the British public. He cites his former boss, Lord Tebbit, as his political hero, but he does not understand what the public so value about the NHS. Instead, he is doing to it exactly what he did to the utilities in the 1980s, when he was working for his hero, Lord Tebbit, by applying 1980s privatisation principles and policies to the health service.

Current polls of public satisfaction with the NHS are all the more important when we consider that the revolution—that is what it is—now under way in the NHS was not described or set out for the British people until some months after the general election. The Conservative manifesto said the Conservatives would

“defend the NHS from Labour’s cuts and reorganisations”,

yet the Government are delivering a real-terms cut in spending, and a radical reorganisation that will undermine the NHS.

Nowhere did the Health Secretary explain his plan to apply 1980s-style privatisation mechanisms to the NHS; to create an economic regulator for health in the form of Monitor, costing upwards of £500 million over the lifetime of this parliament, an issue that was raised by the hon. Member for Banbury (Tony Baldry) in respect of the Government’s commitment to reduce bureaucracy; to expose the NHS to European competition law, which also applies to our utilities; or to handing the £80 billion NHS budget to private bodies with GPs as figureheads, but to which freedom of information provisions will not apply.

Instead, the Health Secretary spent the previous six years as Opposition spokesman doing everything possible to avoid giving any indication of his plans for radical change for the NHS. I am sure that there was no mention of removing the private patient cap to allow uncontrolled focus on profit-making in hospital trusts, a mechanism that will push NHS patients to the back of the queue.

The Secretary of State’s coyness had paid off, because the public, who are overwhelmingly satisfied with the NHS service that Labour had rebuilt over 13 years in government, did not suspect a thing. Health was not raised once in the last prime ministerial debate before the general election.

I want to focus my remarks on how public satisfaction, and in some areas dissatisfaction, might apply to the Health Secretary’s proposals in the Health and Social Care Bill. Now that the Ipsos MORI survey has found its way into the public domain, we may consider its implications for the current upheaval planned by the Secretary of State. Three specific polls in the survey give a clear indication of public preference for the future of the NHS, with between 63% and 65% agreeing with the following statements: first, the

“NHS provides good value for money to taxpayers”;

secondly, the

“NHS provides patients with the best treatment possible”,

and thirdly,

“people are treated with dignity and respect when they use NHS services.”

In-house NHS provision of a high quality is favoured by the public, but the Tory-led proposals in the Health and Social Care Bill threaten that. Over time, as the private sector wins contracts from NHS bodies, the NHS provider that is displaced will have to close, and there is a risk that we will be left with private companies competing with one another for multi-million pound contracts. That is the Lansley vision of the NHS, and it is completely out of step with British public opinion.

[John Pugh]

People were asked whether major changes or only minor changes were needed in their local health system. The figures for the UK show that 62% believe that only minor changes are needed, which is by far the highest figure on the graph of most of the comparable systems.

[Grahame M. Morris]

I thank the hon. Gentleman for that intervention. His point is a good one, and was well made. There is no need for the revolutionary change that we are facing.

Time is limited, so I shall conclude. Without polling and without understanding the facts, the Government would take a reckless step in the dark. If they do not consider public opinion in their annual surveys, they may end up with a shock in the biggest survey of all—the one planned for May 2015.