NHS Outsourcing and Privatisation

Jonathan Ashworth Excerpts

Wednesday 23rd May 2018 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move,

That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be provided to the Health and Social Care Committee: written submissions received by Ministers since 8 June 2017 on proposals for reform of the Health and Social Care Act 2012, on the creation of accountable care organisations in the NHS, and on the effect of outsourcing and privatisation in the NHS including the creation of wholly-owned subsidiary companies; and minutes of all discussions on those subjects between Ministers, civil servants and special advisers at the Department of Health and Social Care, HM Treasury and the Prime Minister’s Office.

In six weeks’ time, we will celebrate the 70th anniversary of the national health service, a great civilising moment for the nation, which the Secretary of State’s predecessor, Nye Bevan, described in the House on Second Reading of the National Health Service Bill. He said of the creation of the NHS that

“it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.”—[Official Report, 30 April 1946; Vol. 422, c. 63.]

They are certainly stirring and inspirational words, but as we approach the celebrations and the 70th anniversary of the NHS, we see a service in crisis, underfunded and understaffed, and patient care is suffering.

After eight years of the biggest financial squeeze in its history, and at a time when England’s population has increased by 4 million, when the falling real value of tariff payments for hospital care means that trusts now lose 5% of costs for every treatment, and when the Government have refused time and again to give the NHS the funding required, we see patients suffering every day in our constituencies. That is why we have just suffered the worst winter in the history of the NHS, when our hospitals were overcrowded and our A&E departments were logjammed. The number of hospitals operating at the highest emergency alert level—the OPEL 4 level—was nearly double what it was the year before, which itself was branded a humanitarian crisis.

In the first week of January 2018, there was a point when 133 out of 137 hospital trusts in England had an unsafe number of patients on their wards. Sixty-eight senior accident and emergency doctors wrote in January to the Prime Minister raising

“the very serious concerns we have for the safety of our patients.”

In response, we had a blanket cancellation of elective operations and cancellations of more than 1,000 emergency operations, causing misery for patients and financial difficulties for trusts already in deficit.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

My hon. Friend should also be aware that many walk-in centres have closed. In my constituency, the superb Alexandra Avenue centre has had a 20,000 cap imposed on the number of patients it can see. This service is run by popular GPs, but it faces the risk of being outsourced, to a Virgin healthcare or someone else. It originally served 40,000 patients, and many of my constituents are genuinely worried for its future.

--- Later in debate ---

[Jonathan Ashworth]

My hon. Friend makes the point well. I believe about 50 walk-in centres have closed and there are another 50 whose future has been reviewed.

[Karen Lee (Lincoln) (Lab)]

Lincoln’s walk-in centre was closed. A consultation was undertaken by the clinical commissioning group and 94% of those who responded did not want the centre to close. So what did the CCG do? It closed it.

[Jonathan Ashworth]

I thank my hon. Friend for her contribution. I know that she, as the relatively new Member for Lincoln, will be campaigning for the future of health provision in her constituency.

The response of the Prime Minister to those cancelled operations this winter was to shrug her shoulders and say, “Nothing is perfect,” but by the end of the winter reporting 185,000 patients, often elderly, vulnerable and in distress, had been left waiting in the back of an ambulance or treated in a corridor for more than 40 minutes. We do not have a crisis in our NHS just in winter; we have a crisis all year round. Since 2010, we have seen a reduction of about 16,000 beds, including more than 5,000 acute beds and nearly 6,000 mental health beds—that is almost 20% of them. Among equivalent wealthy countries, only Canada and Poland have fewer doctors per head, and only two countries have fewer beds per head.

A report today in The Guardian details how old and out of date the equipment is in hospitals because infrastructure budgets have been raided. According to the OECD, we are bottom of the league for the provision of CT and MRI scanners. Meanwhile, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) has pointed out, eight years of multi-billion cuts to social care provision have decimated the sector and have denied 400,000 people, often the elderly and the vulnerable, the support they would otherwise get.

Years of pay freeze, and failure to invest in and plan properly for the workforce, have meant vacancies for 100,000 staff, including vacancies for 40,000 nurses, 3,500 midwives and 11,000 doctors. In the past two years, we have lost more than 1,000 GPs. In our communities, we have seen district nurses cut by 45%. We have lost more than 2,000 health visitors in two years. We have lost nearly 700 school nurses. There are 5,862 fewer psychiatric nurses and 4,803 fewer community health nurses than in 2010, and the Prime Minister’s hostile environment has meant the Home Office has turned down visas for at least 400 staff.

[Conor McGinn (St Helens North) (Lab)]

In the St Helens and Knowsley Teaching Hospitals NHS Trust, the spending on agency nurses has quadrupled since 2011. Is it not a fact that under this Tory Government we have a retention, recruitment and resources crisis in our NHS?

[Jonathan Ashworth]

My hon. Friend has, with great eloquence, explained why failing to plan properly on the workforce is such a false economy. It means that trusts are spending more and more on locums and expensive agencies.

I trust that no Conservative Member will try to pretend in this debate that it is possible to reduce beds, reduce staff, cut social care and fail to invest while patient numbers are increasing without the quality of care suffering. If any Conservative Member does try to tell us the opposite, they should look at the latest performance standards. The lack of hospital capacity and staffing means that the waiting list has risen to more than 4 million. Simon Stevens, of NHS England, has warned that

“on the current funding outlook, the NHS waiting list will grow to five million people by 2021. That’s an extra million people on the waiting list. One in 10 of us waiting for an operation—the highest number ever.”

The blanket cancellation of elective operations has seen waiting lists rise by nearly 5% compared with last year, and we have waiting times up and performance against targets down. In overcrowded A&Es, in the past year, 2.5 million have waited more than four hours. Just 76.4% of patients needing urgent care were treated within four hours at hospital A&E units in England in March—that is the lowest proportion since records began in 2010.

[Wes Streeting (Ilford North) (Lab)]

Of course, A&E waiting times would not be as long if the Government were investing properly in primary care. In my borough, we have the ludicrous situation of private companies advertising in London underground stations, saying:

“Fed up waiting? Our private GPs can see you now…ONLY £80”.

Does my hon. Friend agree that people should not be forced to pay £80 to see a GP, and they should not be waiting unnecessarily long in A&E because of the Government’s failure properly to fund and deliver the workforce that primary care needs?

[Jonathan Ashworth]

My hon. Friend has hit the nail on the head. The problem is that, when the Government allow our national health service to deteriorate by such a scale and push it into this level of crisis, they are essentially forcing people, often reluctant refugees from a public NHS, into self-pay options. That is what happened last time the Conservatives were in government and it is happening again.

[Anna Soubry (Broxtowe) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the former Health Minister.

[Anna Soubry]

Will the hon. Gentleman confirm that five GP surgeries in Broxtowe have been rated outstanding and that we yet again have a 2% increase in CCG spending? Why is he always talking down the NHS?

[Jonathan Ashworth]

I am delighted that GPs in Broxtowe have been rated outstanding, but patients in Broxtowe will be concerned that bed occupancy rates at Nottingham University Hospitals Trust are at 94.9%. That is what people in Broxtowe and across the east midlands are concerned about.

[Anna Soubry]

Would the hon. Gentleman like to speak to Nottingham City Council, which is run by Labour? It has repeatedly refused to unblock beds at NUHT, unlike Conservative-run Nottinghamshire County Council, which always ensures that it has social care available so that there is no bed-blocking in Nottinghamshire. The problem is Labour in the city—

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[Jonathan Ashworth]

I know that Councillor Jon Collins of Nottingham City Council is a talented man, but he does not run Nottingham University Hospitals Trust. The people running the health trusts are the chief executives, who have to rely on the budget settlements that the right hon. Lady and her party have been denying—

[Anna Soubry]

rose—

[Jonathan Ashworth]

No, I am not giving way again. The right hon. Lady has had two chances; she can contribute to the debate later.

We have overcrowded A&Es and—perhaps the right hon. Lady can listen to this—patients are not even able to get a bed, often lying confused on trollies in corridors. In the last year of the previous Labour Government, 60,000 people were designated as trolley waits—

[Anna Soubry]

On a point of order, Mr Deputy Speaker. Could the record please record that indeed the leader of Nottingham City Council does not run NUHT, but he is responsible for social care in the city? That was the point I was making.

[Mr Deputy Speaker]

I think that is clarification.

[Jonathan Ashworth]

I am grateful to the right hon. Lady for that. I invite her to make another point of order, because Nottinghamshire County Council is closing five care homes.

[Anna Soubry]

I am happy to take that up. My understanding is that Nottinghamshire County Council is looking responsibly at the provision of—[Interruption.] Well, the hon. Gentleman invites me to give him information; I am trying to assist him. In my constituency, the county council is making sure that the money that it spends on social care goes to the very many care homes in my constituency that are rated as good or outstanding—

[Mr Deputy Speaker]

Order. May I just help a little? We have 25 speakers to come in after the Front Benchers, so I appeal to the Front Benchers to leave time for Back Benchers to contribute.

[Jonathan Ashworth]

I shall take your guidance, Mr Deputy Speaker. It is always a pleasure to indulge the right hon. Lady, but I have to point out to her that Councillor Cutts of Nottinghamshire County Council is cutting care homes across Nottinghamshire. The record will show that.

[Mr Jim Cunningham (Coventry South) (Lab)]

rose—

[Jonathan Ashworth]

Given that Mr Deputy Speaker has just castigated me, let me make a little progress. Hopefully, I will be able to take more interventions towards the end of my remarks.

Underfunding and lack of capacity have driven more and more—

[Kevin Hollinrake (Thirsk and Malton) (Con)]

rose—

[Jonathan Ashworth]

Mr Deputy Speaker has asked me to make a bit of progress, so let me do so.

Underfunding and lack of capacity have driven more and more NHS purchasing from the private sector. We have seen beds lost in NHS hospitals, which are then increasingly forced to use the private sector. Spending on elective treatments outsourced to the private sector rose from £241 million in 2015-16 to £381 million in 2016-17. In many instances—from mental health provision and detox services for those suffering from substance misuse, to routine elective operations—we often see a poor quality of service in the private sector. The House does not have to take my word for it; the Secretary of State himself intervened recently to demand that the private sector gets its house in order. These risks have been known for years, since the Paterson scandal, and I note that the Government are not proposing to legislate.

[Several hon. Members rose—]

[Jonathan Ashworth]

I will make a bit of progress because Mr Deputy Speaker has asked me to do so.

I say to the Secretary of State that, if he is prepared to legislate, we will support him because we know that, when things go wrong in the private sector—often these hospitals have no intensive care units—it is the NHS that has to step in and act as a safety net, with patients often being transferred from a private hospital to an NHS hospital. That risk has been estimated to cost the NHS £60 million.

[Several hon. Members rose—]

[Jonathan Ashworth]

Let me make a bit of progress and then I will try to let others in.

If the Secretary of State brings forward legislation, we will work constructively with him.

The latest and perhaps most pernicious consequence of underfunding is the move to so-called wholly owned subsidiaries. Many are saying that this is a VAT scam. Hospital trusts feel that, because of underfunding, they have no option but to transfer staff to these so-called subsidiaries, set up at arm’s length but still owned by the trust. We have trusts paying management consultants a total of £3 million, according to freedom of information requests, for advice on setting up these new arrangements. That is money that should be going on patient care. It will mean a two-tier workforce as new joiners no longer need to be on “Agenda for Change” terms and conditions. That looks to many like forcing staff to pay for the Government-imposed financial crisis in the NHS.

[Mr Philip Dunne (Ludlow) (Con)]

I thank the hon. Gentleman for giving way. He is under a lot of pressure, rightly, in this debate. When he selected the motion for the Opposition debate today, was he aware, given the liturgy of supposed privatisation that he has alleged has taken place under this Government, that the proportion of spend on the independent sector under the Conservative Government in the last year was zero and that the proportion of spend on the independent sector in Wales, run by the Labour Administration, went up?

[Jonathan Ashworth]

I am grateful to the former Minister of State. We do miss him during our exchanges at the Dispatch Box. The figures that he has quoted are different from those provided by the Library. The Library says that the percentage of the total budget spent on private providers has gone up to 1% in Wales, but it has gone up by 2% in England in the past year. The Department of Health and Social Care may have different figures, but those are the figures from the Library.

[Yvonne Fovargue (Makerfield) (Lab)]

Will my hon. Friend send his support to the staff from Wigan hospitals who are today striking in protest at the creation of Wrightington, Wigan and Leigh Solutions? Does he agree that that is just privatisation by the backdoor?

[Jonathan Ashworth]

I do agree. May I reassure my hon. Friend that those Unite and Unison members who are taking industrial action at Wrightington, Wigan and Leigh have our support? We stand with them in solidarity. I congratulate her and my hon. Friends the Members for Leigh (Jo Platt) and for Wigan (Lisa Nandy) on the campaign that they have been running. These jobs should not be outsourced to wholly owned subsidiaries; they should be in-house.

[Sir Nicholas Soames (Mid Sussex) (Con)]

I am very grateful to the hon. Gentleman for giving way. I know him to be a good man. May I put this to him? None of these figures or statistics means anything to people wanting treatment on the NHS. May I assure him that my constituents, like his, are not over-concerned where their treatment comes from? What they are concerned about is that they should be competently, effectively and caringly treated under the national health service.

[Jonathan Ashworth]

I say to the right hon. Gentleman, of whom I am tremendously fond, as he knows, that I agree broadly with the point that he is making. If my memory serves me correctly, he sits for a Sussex constituency and, of course, in Sussex, we had the shambles of a patient transport contract that went to a firm, Coperforma, which did not even own any ambulances and which was leaving patients stranded on their doorstep waiting for transport to dialysis appointments and to chemotherapy appointments. It often could not then pick up the patients from the hospital and take them home. That contract had to come back in-house. It is these types of privatisation that we believe are doing great damage to the health service.

[Mr Jim Cunningham]

rose—

[Jonathan Ashworth]

My hon. Friend has been very patient, so I will give way to him.

[Mr Cunningham]

My hon. Friend has been generous in giving way. Does he agree that private companies are also increasing car parking charges, which is a tax on patients, and that, more importantly, because of the lack of social workers we have bed-blocking in the national health service, too?

[Several hon. Members rose—]

[Jonathan Ashworth]

The hon. Member for East Worthing and Shoreham (Tim Loughton) seems so desperately keen that I will take his intervention and then I will hear from Ashfield and make some progress.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I am really grateful to the shadow Minister. Under the last Labour Government, before Worthing became the outstanding hospital it is now, there was a long list of patients requiring hip and knee replacements. To speed up the list, the hospital contracted with a local private hospital. Those patients were treated much more speedily, at least to the same quality, and actually at a lower cost per patient than if it had been done in-house— and, of course, the patients did not have to pay a penny themselves. Is that the sort of privatisation the hon. Gentleman so opposes?

[Jonathan Ashworth]

I can reassure the hon. Gentleman that no, it is not. I agree with the Secretary of State that the

“use of the independent sector to bring waiting times down and raise standards is not privatisation.”

They were the words of the Secretary of State when he spoke at his own party conference the other year. The Labour Government did spot-purchase from the private sector to bring down the huge waiting lists that we inherited in 1997; but our concern is about contracts for delivery of healthcare services being handed out to private sector providers who not only provide poor quality to patients but give the taxpayer a poor deal. It is a different situation.

[Gloria De Piero (Ashfield) (Lab)]

Thirty-five pounds a week to watch the basic TV channels from a hospital bed; 60p a minute for a relative to call a patient on a hospital phone; a minimum of £1.80 for the car park for a short visit: these charges are happening at my hospital and at hospitals across the land. They are a tax on sickness and a particular tax on long-term sickness. They have to stop.

[Jonathan Ashworth]

My hon. Friend has hit upon a brilliant new campaign, which I am sure she will be running. The charges for watching television in wards are absolutely extortionate. It is a scandal; it is a tax on sickness; but it happens because the hospitals, and the health service in general, are so desperately underfunded.

[Several hon. Members rose—]

[Jonathan Ashworth]

I will take an intervention from Chesterfield and then I will make some progress.

[Toby Perkins (Chesterfield) (Lab)]

Chesterfield Royal Hospital is consulting on setting up a subsidiary company. Does it not seem madness that, to save £3 million that the hospital is paying the Government, it is creating this new organisation, which is being funded by the Government anyway? It is the emperor’s new clothes. The money is going round in circles without doing any good.

[Jonathan Ashworth]

In addition, hospitals have wasted millions in consultancy fees in setting up these organisations. They create a two-tier workforce because new joiners will not necessarily be on “Agenda for Change” terms and conditions, and they could at some point be completely sold off to the private sector. It is a back-door privatisation.

[Several hon. Members rose—]

[Jonathan Ashworth]

If Members will forgive me, I will make a little bit of progress, and then hopefully we will get a chance for more to come in later.

Labour has been calling for a long-term economic plan for the NHS. We are led to believe that the Secretary of State agrees with us, because according to The Guardian, in an article headed “Hammond and Hunt in battle over NHS funding boost”, the Secretary of State and Chancellor are reported to be “at loggerheads”, with the Secretary of State calling for £5.3 billion extra, but the Chancellor only wanting to offer £3.25 billion. Of course, neither is quite as generous as the extra £45 billion for the NHS and social care across the Parliament that Labour was offering, but we will watch carefully.

Our plans would have been funded from increasing taxation on the top 5% of the wealthiest in society. Perhaps the Secretary of State can tell us how he proposes to fund his extra £5 billion. Will it be an increase in national insurance for pensioners, as has been floated? Or will other Departments be cut? Will the defence budget be cut to fund the extra £5 billion increase in the NHS? Will it be a move towards co-payment and charges? Or will it be another conjuring trick from the Secretary of State, whereby he claims to be increasing the funds going into the health service, only for us to subsequently find out that public health budgets, training budgets and infrastructure budgets have been cut and the settlement is not quite as generous as we have been led to believe? According to tomorrow’s Spectator, there will be a Tory splurge on the NHS, so he should honour the House today with his confidence and tell us where he thinks this splurge will come from—tax rises, cuts elsewhere, or charges and co-payments.

I remind the right hon. Gentleman: it was a Labour Government with Gordon Brown who increased taxation to pay for the NHS and helped us treble funding in cash terms, and it will be the next Labour Government who will increase taxation for the very wealthiest in society to fund a long-term, sustainable plan for the NHS. When we face the demographic challenges of an ageing population, with people living longer, the disease burden shifting and people living with co-morbidities, and when we are on the cusp of great advances and innovations from artificial intelligence and genomics, is it not clear that the current fragmented structures of the NHS are wasting energy, wasting time and wasting resources?

We are now led to believe that, according to the BBC, the Prime Minister and the Secretary of State, despite both having sat in a Cabinet that agreed the Health and Social Care Act 2012, have realised that the structures produced by that Act have been a dismal failure. I do not like to say, “We told you so,” but we did actually tell you so. The Act has created a fragmented mess, with healthcare leaders trying to work around it. I say to the Secretary of State that it does not need amending—it simply needs consigning to the dustbin of history to be included in the next edition of “The Blunders of Our Governments”.

We will test any new legislation that the Secretary of State brings forward to see if it moves towards greater collaboration—away from a purchaser-provider split model in favour of partnership and planning. Any new legislation should bring an end to the creeping, toxic privatisation of the NHS and instead restore and reinstate a public universal national health service. The Health and Social Care Act has contributed to the reality today where, according to the Department of Health’s own figures, £9 billion is spent on private providers—a doubling in cash terms since 2010. Indeed, we have seen about £25 billion of contracts awarded through the market since the Act came into force.

Of course, there has always been a role for the private sector in providing services, as I said to the hon. Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place, as indeed there has always been a role for the voluntary and co-operative sector. But the combination of years of underfunding alongside the constant tendering of contracts via the any qualified provider arrangements has led to creeping privatisation. Before Government Members tell us that this is just 8% of the total budget—in fact, the Secretary of State told the House in January that it is “not huge”—let me point out that the problem is that that 8% is located almost exclusively in areas like elective care, community services and patient transport, meaning that the private sector is disproportionately influential in those areas. Moreover, the way in which the funding mechanism works restricts NHS income from those areas and leaves NHS providers picking up the more complex, costly cases—emergencies and the chronic sick. In other words, outsourcing and privatisation is increasingly a false economy where supposed savings are easily outweighed by the costs.

But more importantly than that, privatisation has first and foremost a detrimental impact on patient care.

[Maria Caulfield (Lewes) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the hon. Lady because she is a nurse.

[Maria Caulfield]

Does the hon. Gentleman not agree that the any qualified provider system was brought in under the previous Labour Government in 2009?

[Jonathan Ashworth]

I remind the hon. Lady, whom I greatly respect in this House because of her work in the NHS, that we moved away from that system to a preferred provider mechanism because we knew that the any qualified provider mechanism did not work and was not in the interests of patient care or the interests of the taxpayer.

Let me give some examples. On support services, GPs have warned repeatedly of the dangers of NHS England outsourcing primary care services to Capita, in a contract designed to save £40 million. Those fears proved well founded, as the National Audit Office found that there was a real risk of “serious patient harm” stemming from Capita’s handling of the contract, with major problems around the secure transfer of patient notes, with notes going missing or delivered to the wrong surgery. Capita’s work in providing back-office services such as payment administration, cervical screening tests, medical records and supplies orders had fallen

“well below an acceptable standard.”

On patient transport contracts, I mentioned to the right hon. Member for Mid Sussex (Sir Nicholas Soames) what happened with Coperforma. This was a contract worth £63.5 million.

[Maria Caulfield]

rose—

[Jonathan Ashworth]

And the CCGs are still paying out to Coperforma—is that not correct?

[Maria Caulfield]

With regard to Sussex—I am sure that my right hon. Friend the Member for Mid Sussex (Sir Nicholas Soames) would agree with me—the last time Labour was in government it proposed to close the Princess Royal Hospital in Haywards Heath.

[Jonathan Ashworth]

I am sure that the hon. Lady accepts that it is a scandal that the CCGs—her local health economy—are still paying out to Coperforma. She should be getting up and complaining about that.

What about support services? Interserve was brought in to provide facilities management across 550 NHS buildings across Leicestershire, with a seven-year, £300 million contract. The contract was scrapped four years early because of reports of patients receiving meals up to three hours late, bloodstains in the corridors and bins not emptied. How about Carillion, which won a £200 million, five-year estates and facilities management contract with Nottingham University Hospitals NHS Trust? It failed to clean the hospitals properly, with reports that infectious waste was seen overflowing in the children’s ward.

[Vernon Coaker (Gedling) (Lab)]

The concerns that my hon. Friend is raising are the same as those raised by the Chair of the Health Committee in a letter to Sir Simon Stevens, chief executive of NHS England, in which she said:

“My central concern is that contracted services can seemingly fail to meet the basic clinical requirements without being held to account or compelled to acknowledge and remedy their failings. This risks undermining the effective commissioning of services and could, ultimately, compromise patient care and safety.”

[Jonathan Ashworth]

My hon. Friend, who is extremely experienced, shows with great eloquence the dangers of this relentless outsourcing of services. It damages patient care and is not in the interests of the taxpayer.

[Helen Whately (Faversham and Mid Kent) (Con)]

I thank the hon. Gentleman for giving way. I remember well when I worked in the NHS under a Labour Government, before I was a Member of Parliament. All around me was talk of independent sector treatment centres, offering more choice through bringing in more private sector provision to the NHS, and PFI contracts. That was under the previous Labour Government, who I believe were trying to make the NHS give better patient care, but Labour has changed its tune. I am concerned that this seems to be all about ideology. I care—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. Members cannot make speeches in interventions.

[Jonathan Ashworth]

I greatly respect the hon. Lady, and I greatly enjoyed her Red Box blog on mental health provision last week. I know she thinks carefully about these matters, but this is not about ideology. It is about what works. Let us take the example of the East Kent contract for integrated NHS 111 and GP out-of-hours services, which began in January 2017. After only seven months of Primecare running it, the service was placed in special measures after it was rated inadequate. That is happening in her own backyard. This is not working, and that is the point we are making.

The history of PFI is that when we came into government, a third of hospitals were more than 50 years old. That is why we carried on with the John Major PFI scheme, which was the creation of that Government. Current Cabinet Ministers such as the shadow Health Secretary at the time, now the Secretary of State for International Trade, stood at the Dispatch Box and congratulated the Labour Government on taking up the private finance initiative developed under the previous Government. He said he would not object to the use of PFI

“exclusively to fund private capital projects”—[Official Report, 8 January 2003; Vol. 397, c. 181.]

In this House, the current Chancellor of the Duchy of Lancaster gave a “warm welcome” to a PFI in his own constituency. The Brexit Secretary said in this House:

“The PFI has many virtues—after all, it was a Conservative policy in the first instance.”—[Official Report, 10 March 1999; Vol. 327, c. 429.]

The Business Secretary said:

“PFI was initiated by the previous Conservative Government”—[Official Report, 12 February 2013; Vol. 558, c. 787.]

The Scottish Secretary has said that PFI is a “successful basis for funding”. The Welsh Secretary said:

“I am a fan of PFI in general.”—[Official Report, 4 November 2010; Vol. 517, c. 1124.]

We will take no lessons from the Tories when it comes to PFI.

We have not only seen facilities management contracts having to be brought back in-house in Leicestershire and Nottingham; we have also seen them deliver a poor quality of service across Lewisham and Greenwich. Those contracts at Lewisham Hospital should come back in-house. I know that the Labour candidate in Lewisham East will be campaigning to bring them back in-house, and I hope the Tory candidate will do the same.

[Vicky Foxcroft (Lewisham, Deptford) (Lab)]

Will my hon. Friend give way?

[Jonathan Ashworth]

I will give way to my hon. Friend from Lewisham, and then I will make progress.

[Vicky Foxcroft]

I thank my hon. Friend. He is right: the candidate in Lewisham East will absolutely be campaigning on that, because it is out of order and outrageous that many of the people working under that contract are not receiving pay for one week because Interserve is not paying them.

[Jonathan Ashworth]

Absolutely. I wish the Labour candidate in Lewisham East well and will be campaigning with them. We will be sending a firm message to the Tories that privatisation of the NHS will end. The NHS is not for sale.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

Will the hon. Gentleman give way?

[Rachael Maskell (York Central) (Lab/Co-op)]

Will my hon. Friend give way?

[Jonathan Ashworth]

I will give way to my hon. Friend and then to the hon. Member for Dwyfor Meirionnydd.

[Rachael Maskell]

I am grateful to my hon. Friend for giving way. Is not the biggest scandal of privatisation in facilities management the sharp rise in infectious diseases, which really compromised patient care?

[Jonathan Ashworth]

My hon. Friend, who is an authority on these matters and campaigned on them for many years before entering this place, speaks well and she is absolutely right.

I will take an intervention from the hon. Lady from Wales, but then I will not take any more because I fear I am really testing your patience, Mr Deputy Speaker.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

It is not about my patience, but about Back Benchers.

[Liz Saville Roberts]

I have only one question: will the hon. Gentleman explain why the Welsh Labour Government have outsourced dialysis services at Wrexham?

[Jonathan Ashworth]

We have always said that there is a small role for the private sector. This is what I said earlier—[Interruption.]

[Mr Deputy Speaker]

Order. I want to hear Members on both sides, and I certainly want to hear the answer, but I cannot do so if everybody is shouting.

[Jonathan Ashworth]

We have always said that, and I do not know why Government Members are so surprised about it. Indeed, the Prime Minister, thinking she had a humdinger, quoted me at Prime Minister’s questions, but I was decidedly nonplussed by her response to my right hon. Friend the Leader of the Opposition.

Perhaps the biggest area in which private contracts have gone out is in community services, where the private sector has taken over 39% of contracts compared with the 21% in the NHS. NHS Providers said last week:

“The fragmentation of the community sector is…due to the private provider share of the community…service market being much larger than in other sectors”.

It also said:

“it is almost always a legal requirement for commissioners to go out to tender competitively for community services. Tendering for contracts is therefore much more competitive in the community sector than in the acute sector, and contracts are sometimes won on cost savings, rather than improvements in the quality of care.”

We have seen this time and again. For example, Serco was awarded a £140 million contract in Suffolk, but could not meet key response times, such as the four-hour response time for nurses and therapists to reach patients at home 95% of the time. Before Serco took over the contract, the target was achieved 97% of the time.

[Helen Goodman (Bishop Auckland) (Lab)]

Will my hon. Friend give way?

[Jonathan Ashworth]

I did say that I would not take any more interventions. I apologise to my hon. Friend; I know her intervention would have been excellent.

How about the seven-year contract worth £70 million per annum to Virgin Care that was awarded in November 2016 across Bath and Somerset, with services including health visitors, district nurses, speech and language therapists, occupational therapists, physiotherapists and social workers? The first few months were beset with IT problems, and there were problems with payroll transfers and delays in paying staff. How about the dermatology contract in Wakefield, which again went to Virgin Care? The IT systems did not work, and it was not consultant-led. Satisfaction fell by so much that GPs refused to refer, and again the contract had to come back in-house.

In fact, Virgin Care is now picking up over £1 billion of NHS contracts, and when it does not win a contract and believes something is wrong with the tendering process, it becomes increasingly aggressive in the courts. Most recently, and disgracefully, it sued the NHS in the Secretary of State’s own backyard and forced it to pay out £1.5 million. That money should be spent on patients in Surrey, not go into the coffers of Virgin Care.

The legal action by Virgin Care reveals a bigger truth. Not only does the Health and Social Care Act lead to many community health contracts going to the private sector, but the regulations underpinning the Act are dysfunctional, which results in millions being wasted on increasing numbers of failed privatisation projects. Perhaps the most prominent example is the 10-year contract worth £687 million for end-of-life and cancer care in Staffordshire that has had to be abandoned, costing CCGs over £840,000—money that should have been spent on patients.

That is why we are raising concerns about the proposed accountable care organisation model, which is currently subject to judicial review. We favour integration and accountability, and we agree that services should be planned around populations and, indeed, that funding should be allocated by means other than an internal market. We favour a strategic hand in the delivery of services and greater local collaboration, and our vision is one of planning and partnerships.

However, the existence of piecemeal contracts and the contracting out of services is a major barrier preventing the real integration of health and social care. The enforcement of competition obstructs collaboration and the proper, efficient organisation of services. A model in which billions of pounds of NHS and local authority funds can be bundled up and go through a commercial contract for 10 years is not accountable and neither, depending on the level of funding, will it deliver the level of care we expect, while it could also go to the private sector. What sense does it make to offer binding long-term contracts for delivering a vast range of services over 10 years? Surely the lesson of PFI is not to guess the future, not to write healthcare contracts for services 10 years hence and not to get locked into a deal when so much will change in the delivery of healthcare over the next 10 years.

This is a tired, outdated, failing approach. Quite simply, privatisation has failed. Almost every day in the NHS, we hear of a further investigation, a further failure, a contract handed back or a problem uncovered—from scandalous failures in patient transport, to poor standards in private hospitals, to millions wasted on huge tendering exercises that go nowhere, to Circle failing to manage Hinchingbrooke, to Capita failing to manage vital patient records, to Interserve failing to clean hospitals and deliver meals, to Virgin Care suing the NHS for £1.5 million.

I challenge the Tories to point in this debate to a significant success in outsourcing to offset that total mess. No Tory can tell us that the competition and markets in the Health and Social Care Act have led to shorter waits, innovations in care or better services. The reality is that the NHS and the provision of healthcare are too important to be left to the chasing of market forces. The principles on which our NHS was founded seven decades ago are being betrayed by this Government, and the staff and patients of the NHS are being betrayed with it. There are longer waiting times, intolerable pressures on staff, daily stories of human heartbreak and operations cancelled.

On the 70th anniversary of the NHS, the staff can hold their heads up high, but the Government should bow their heads in shame. In this anniversary year, it will fall again to this party—the party that founded the NHS and that believes in the NHS—to rebuild and restore a public universal national health service.

[Several hon. Members rose—]

--- Later in debate ---

[Mr Hunt]

As Chinese Premier Zhou Enlai said about the French revolution, it is too early to tell.

As my hon. Friend the Member for Solihull (Julian Knight) alluded to, there is one ideology that we will not compromise on: our belief that the NHS should be free at the point of use and available to all. And why will we not compromise on this? It is because, contrary to Labour’s creation myth about the NHS, it was a Conservative Health Minister, Sir Henry Willink, who first proposed it in 1944. Here are his words from 1944 announcing the setting up of the NHS:

“Whatever your income, if you want to use the service…there’ll be no charge for treatment. The National Health Service will include”—

[Interruption.] I know this is difficult for Labour Members, but let me tell them what the Conservatives said when we were setting up the NHS:

“The National Health Service will include family doctors”

and will

“cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness”.

Nye Bevan deserves great credit for delivering that Conservative dream, but let us be clear today that no party has a monopoly on compassion, and no party has a monopoly on our NHS. There are some other myths—

[Jonathan Ashworth]

Will the Secretary of State give way?

[Mr Hunt]

I will give way, with great pleasure.

[Jonathan Ashworth]

I really do think the Secretary of State has some brass neck. The Tory party voted against the creation of the NHS 20-odd times. That is the reality of what happened in 1948, including on Third Reading in this House. It is a Labour creation.

[Mr Hunt]

As the shadow Health Secretary knows perfectly well, the way that this House works is that Oppositions often vote against the Government when they disagree with elements of a Bill, but that does not mean that they disagree with the principles of the Bill. I remember the hon. Gentleman’s party voting against the Care Act 2014. That does not mean that they disagreed with the principles behind it.