National Health Service (Amended Duties and Powers) Bill

Julian Huppert Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

There are numerous examples of contracts that are going out to tender, and the cost to the national health service of lawyers and accountants is increasing. The Government have made so much of the issue of bureaucracy in the NHS, but when I asked the Secretary of State about the cost of those lawyers and accountants to oversee the tendering process, what was the response? It was, “We do not collect those figures centrally.” I wonder why that is.

[Dr Julian Huppert (Cambridge) (LD)]

rose—

[Clive Efford]

Ah! The hon. Gentleman is presumably getting to his feet to apologise for supporting the 2012 Act.

[Dr Huppert]

I have no need to apologise, because I voted against it. I was actually about to give the hon. Gentleman credit for introducing this Bill, which I look forward to supporting, and for his role in opposing some of the things that the Labour Government did. Does he welcome the fact that the £800 million tender for older people’s services in Cambridgeshire stayed within the NHS? Does he also accept the concerns that many of us had about the contract at Hinchingbrooke that was put out to private tender by the last Labour Government? I am sure he would agree that that was a problem.

[Clive Efford]

It is just not realistic to compare what went on under the previous Labour Government with what is going on now. Yes, the contract in Cambridgeshire, at Peterborough, was won by an NHS bidder, but what was the cost? How much money was diverted from patient care into running that tendering process? That is an increasing cost to the NHS that we cannot allow to continue. By the way, I unreservedly withdraw my accusation that the hon. Gentleman voted in favour of the 2012 Act, because that is a calumny I would not use against my worst enemy.

Through the House, the Secretary of State would be accountable—

--- Later in debate ---

[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.

--- Later in debate ---

[Mark Reckless]

I will continue, if I may.

[Dr Huppert]

rose—

[Mark Reckless]

I will give way to the hon. Gentleman.

[Dr Huppert]

Although I do not agree with the hon. Gentleman on many things, I welcome him back to the House. He has talked about the history and the evidence. He might be interested to know that, according to the House of Commons Library, the amount spent by NHS England on buying health care from outside the NHS rose from £1.1 billion in 1997-98 to £7.5 billion in 2009-10. Those are the facts, according to the Library.

[Mark Reckless]

The hon. Gentleman is correct. There was a great deal of privatisation and, indeed, fragmentation of the NHS under Labour, and I do not deny that there has been more of it under the current Government. I think that it is a problem that has afflicted both main parties.

--- Later in debate ---

[David Tredinnick]

The Act is complicated. It is a big Act and it landed with a thump when the right hon. Member for Wentworth and Dearne (John Healey) dropped it on the Opposition Benches. I think he did so intentionally; and it was very theatrical and effective. It is true that there is more money there, and it is clear that the Government pledged at the last election to maintain the funding of the health service and have done so. We also have in place the Nicholson challenge, a phrase coined by my right hon. Friend the Member for Charnwood (Mr Dorrell)—formerly the Member for Loughborough—when he was Chair of the Health Committee, and we now face even greater challenges.

Let me set out to the hon. Member for Eltham what he could include in his Bill if it goes forward. He could examine the next stage of bringing together health and social care. On Tuesday, the Health Committee heard from Dame Kate Barker, the chair of the Commission on the Future of Health and Social Care in England. We were examining the transitional costs of bringing health and social care together, and looking ahead at the savings that can be made. The hon. Gentleman might apply his mind to the complications arising from the different streams of funding represented in health and social care, whereby health is funded by general taxation and some private support, which I have already discussed, whereas social care is the subject of means tests and other constraints. We are therefore talking about completely different funding stream. I do not know how the Health Committee will report this, but I was struck by Dame Kate Barker’s determination that there should be one person running health and social care. That is essential if we are going to bring those two things together.

The other point the hon. Gentleman should take on board as we look at the Bill is the high profile that the Secretary of State and his predecessor, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), have given to patient choice. The Government have said time and again that patient choice is at the heart of the health service, and we have already seen the benefits. The personal budgets now available for people who are seriously ill have had three benefits. First, they enable the patient to choose whatever treatment they want, be it tai chi, yoga or piano therapy—I believe that there have even been cases where tickets to a football match have been given. This is not something regulated by double-blind placebo controlled trials, as some of the other access arrangements for health care are. Secondly, the personal budgets enable the carers to go out into the world and get jobs, so freeing them up. Thirdly, when the personal budget money is given, it is spent responsibly by the patients. We have a whole new paradigm of health through personal budgets, and that should be examined through this Bill.

I have always felt that the 2012 Act and the reforms that were made produced something that put in place two legs on the stool, not three. The third leg comprises the vast and diverse multiplicity of support services that are not used in great depth in the health service now. Using them would considerably reduce costs and increase choice. The choice of these other support services will inevitably come to the fore as patients demand what they want, and we really have to bring this into the health service.

I have had many conversations about these things with the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter)—the Minister on the Front-Bench today. He has entrusted me with being vice-chair of the herbal working group, which is trying to sort out herbal medicine regulation. When we examine the support services that are not now part of mainstream health care, we see that we have a fundamental problem relating to the insistence that we rely on evidence-based medicine. I do not know where that phrase came from—it has not been around for a long time. Various bodies protect the public, and all new drugs are carefully scrutinised, by the pharmacists and the Herbal Medicines Advisory Committee, which has put together a list of what are, in effect, poisons and bans the use of some herbs. The public are protected in that way, but it is very difficult to use normal measurements to assess the effectiveness of, for example, acupuncture, which the National Institute for Health and Care Excellence has approved for treating lower back pain. A lot of evidence shows that acupuncture can reduce the effects of lower back pain and save the NHS a lot of cost. With homeopathic medicine, which I have long supported and advocated, it is impossible to run trials on every dilution: some are so dilute that they do not show up.

[Dr Huppert]

Will the hon. Gentleman give way?

[David Tredinnick]

I am always glad to give way to the hon. Gentleman—I am sure he will agree with my every word.

[Dr Huppert]

My hon. Friend will be well aware that there have been many trials of homeopathic medicines, and the fact is that none of them has shown that they work better than a placebo. He is right that they are very dilute; that is why they do not work.

[David Tredinnick]

The hon. Gentleman makes my point. I remember when some of his friends went to Boots in Kensington high street and consumed the entire stock of homeopathic medicine. They saw that as a huge triumph, as they felt it illustrated the fact that homeopathic medicine was not effective. Of course it did nothing of the sort; it proved that it was absolutely safe to take these preparations under any circumstances, and that the only time they work is if they are in the right preparation and are taken in the right amount, as prescribed by a professional.

I say to the Minister—I hope he will tune in to what I am saying—that we must move away from this insistence on evidence-based medicine and look at evidence-based practitioners. This is an area that has been overlooked for a very long time. There is much evidence that practitioners are well regulated, and we do not need to insist on checking every single preparation that people consume. Five areas of regulation already exist. The hon. Member for Eltham might want to think about that, as it is a matter that could be put into the Bill if it goes to Committee.

--- Later in debate ---

[Andy Burnham]

I told the hon. and learned Gentleman earlier that that was incorrect and that he should withdraw the suggestion, because I did not do that. The contract for Hinchingbrooke was awarded under his Government. I will tell him who this man is. This is the man who, when Secretary of State, introduced the concept of NHS preferred provider, because I believe in the public NHS and what it represents, unlike him. I believe in an NHS that puts people before profit, unlike him. That is the man he is talking to, and that is what I will always stand up for.

[Dr Huppert]

The right hon. Gentleman correctly says that the contract for Hinchingbrooke was let under this Government, but does he not accept that it was he who, when Health Secretary, reduced the list of bidders to five, none of which were NHS bidders, and then to three, all of which were private companies? Does he accept that he could have left NHS bidders in the process, rather than only private bidders? Then he complains when one of the providers that he shortlisted got the contract.

[Andy Burnham]

I am afraid that the hon. Gentleman has to get his facts right, because they are wrong. When I was Health Secretary and Hinchingbrooke needed to find a new operator, I asked local NHS trusts in his area to come forward, and at the time none of them wanted to do that, so we had to find an operator—

--- Later in debate ---

[Andy Burnham]

“Attempted” is the operative word, Madam Deputy Speaker. The hon. and learned Gentleman says that it was my decision, but it was the decision of his right hon. Friend the Member for South Cambridgeshire (Mr Lansley). He did it when their Government came in, and the hon. and learned Gentleman should have the good grace to withdraw what he said.

I was in the middle of answering the intervention from the hon. Member for Cambridge (Dr Huppert)—the hon. and learned Gentleman should listen to this, because he will get his answer. I said that the process should go forward under the NHS preferred provider principle, which I introduced—he seems not to understand that. To correct him, when the previous Government left office there were three bidders, one of which was an NHS provider, so he really needs to get his facts straight—

[Dr Huppert]

Will the right hon. Gentleman give way?

[Andy Burnham]

No. The hon. Gentleman needs to get his facts straight before he tries to shout the odds in my direction.

The Bill gives back to this House sovereignty over the national health service, which millions of people will welcome. The Bill means so much to so many people who are concerned about what is happening to the NHS right now under this Government.

[Andy Burnham]

My hon. Friend is right to remind the House that in 1997 people were spending years on NHS waiting lists, and even dying while still on them. As my hon. Friend the Member for Bolsover (Mr Skinner) said, we brought those waiting lists down, and by the time we left government in 2010 this country had the lowest ever NHS waiting lists and the highest ever level of public satisfaction in the NHS. That is Labour’s record, and we will not let the Government forget it.

What is happening now? NHS waiting lists are back at a six-year high. That is the result of the reorganisation that the Government ploughed through, which nobody wanted. The country did not want it. There are millions of people out there who are concerned about what the Government are doing. It will not have escaped their notice that scores of Government MPs have failed to turn up today to defend what was one of their flagship Bills. What a shower! There are people who kept a vigil outside the House last night, in cold temperatures, imploring Members to be here to pass this Bill because the issues it raises matter so much to them. Then we have the spineless MPs of a disintegrating Government, some loaded up to the eyeballs with links to private health care, who do not have the guts to come here today to argue for what they have done. Is it any wonder that people are losing faith in this place?

[Dr Huppert]

On a point of order, Madam Deputy Speaker. The right hon. Gentleman claimed earlier that one of the bidders at Hinchingbrooke was an NHS provider, but according to the National Audit Office there was Circle, Serco and Ramsay. Can he now either correct the record for the House, or let us know which of those three he believes is an NHS provider?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The hon. Gentleman makes a perfectly good point of debate, but it is not a point of order.

--- Later in debate ---

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I am grateful to have the opportunity to make a few short remarks. The hon. Member for Worsley and Eccles South (Barbara Keeley) is right to be concerned about any problem that occurs in the NHS, but I am sure she would accept that it is an enormous organisation and that the key point is that when things go wrong, the lessons are learned and things are put right. Most of the life of the NHS has been under Conservative Governments, and we on the Government Benches are as proud of the NHS as Labour Members are.

I congratulate the hon. Member for Eltham (Clive Efford) on being a strong voice for Labour principles, but I am concerned that the effect of his Bill will be to undermine the operational independence of the NHS, cause disruption and introduce unnecessary bureaucracy. Putting powers back with the Secretary of State through the re-establishment of powers of direction is going in the wrong direction. Preventing illness, diagnosing and treating patients are not political activities. They should be in the hands of professionals and the operational independence of the NHS means that clinical considerations are paramount. When I was a health spokesperson, I went to look at health systems in Europe, and the key point I took away was that the best systems were those with a lot of clinical input in management.

It is not necessary to rewrite the Act. Instead, the changes we have made need to work their way through. The shadow Secretary of State said that the competition element is dominant in the Act, but that is not true. The procurement policy is set out to secure the needs of patients and improve quality and efficiency. I want to give an example from my constituency of how the reforms are working. Royston is part of the Peterborough and Cambridge CCG. Before that was so, we had a proposal for the redevelopment of Royston hospital. A Royston hospital action group was formed, while the friends of Royston hospital were concerned about the proposals, which were top down. However, Tom Dutton, the CCG strategic lead, has worked tirelessly with the NHS and the local community, as has the local chairman, Dr John Hedges, a GP in Royston, and they understand local needs, so we are now getting tailored provision that suits the needs of my constituents.

I meet the CCG, councillors, local groups and other stakeholders every six weeks, and I believe that we are now getting a service for Royston and a proposal that meet local needs. The £1 billion tender for older people’s services was in our CCG area. The hon. Member for Eltham criticised the cost, but we had a consultation meeting in Royston that 150 local people attended, while 250 local people filled out the questionnaire. The proposal and consultation will have cost money, yes, but the end result was that the tender process was won by the Uniting Care partnership, an NHS partnership involving Addenbrooke’s hospital and the Cambridge and Peterborough NHS trust, and it is now delivering more joined-up care.

[Dr Huppert]

I was delighted with that outcome. One of the successes I hope the hon. and learned Gentleman will mention is the better joint working between acute care, mental health care and community services to avoid delays in the transfer of care. This could be a very good outcome for the NHS and patients.

[Sir Oliver Heald]

That is exactly the point I was going to make. The process, which involved local people, has resulted in a reform that gives us the sort of joined-up care the hon. Gentleman mentions.

To conclude, the Bill seeks to prevent privatisation that is not happening on the ground, while some of the changes we have made are bringing positive benefits for people in my constituency.