NHS

Kevin Barron Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

I understand my hon. Friend’s frustration. This is the shadow Secretary of State who said that it was irresponsible to maintain the NHS budget at its current levels and who actually believes that it should be cut, and he has stuck to that position. It is not possible to make such investments by following the right hon. Gentleman’s advice.

The right hon. Gentleman talked a great deal about competition, and I am afraid that his comments about that also showed a wilful disregard for the facts. He raised two distinct issues, and he was right to do so, because they are important. The first relates to mergers. NHS hospitals often need to concentrate services for clinical and safety reasons, but the involvement of the Office of Fair Trading and the Competition Commission is not a result of the Health and Social Care Act 2012, as the right hon. Gentleman alleged. As he well knows, it is as a result of powers that they have under Labour’s Enterprise Act 2002. All my Front-Bench colleagues agree with me that we must ensure that when those powers are exercised, they are exercised in a way that is in the best interests of patients. For that reason, I have had useful discussions with both the Competition and Markets Authority—which is replacing the OFT and the Competition Commission—and Monitor about how their respective roles can be clarified.

[Kevin Barron (Rother Valley) (Lab)]

If the Secretary of State believes that, can he explain why the Health and Social Care Act contains a section stating that any mergers of NHS trusts must be referred to the Office of Fair Trading and the Competition Commission?

[Mr Hunt]

Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.

If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.

Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.

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[Kevin Barron (Rother Valley) (Lab)]

First, I thank my right hon. Friend the Member for Leigh (Andy Burnham) for tabling the motion, because it gives us an opportunity to examine the whole issue of competition. Hon. Members will recall that I intervened on the Secretary of State on the subject of when competition came in to health care in this country, and he said that it had always been there. The hon. Member for Stafford (Jeremy Lefroy) and the right hon. Member for Sutton and Cheam (Paul Burstow) will recall, as they served on the Committee for the Health and Social Care Bill, that when I intervened on the right hon. Member for Chelmsford (Mr Burns), a Minister at the time, to ask what the Competition Commission and the Office of Fair Trading had got to do with the mergers of NHS trusts, he did not answer me. I asked that question during a clause stand part debate and he did not know that the question was coming. It was not part of an amendment and it was not flagged up to the advisers as being something likely to happen. I raised it on several occasions in that Committee and on the Floor of the House during an Opposition day when he was winding up, and he did not answer me then either.

We have now got the answer, and it came in November. My right hon. Friend mentioned what the then outgoing NHS chief executive said to the Health Committee last November. Commenting on the new rules, he said:

“I think we’ve got a problem, which may need legislative change.”

Of course, that is absolutely right, because we had legislative change when the Health and Social Care Act 2012 came in—that is the truth. It changed statute: it meant that the OFT and the Competition Commission can interfere in health care. That is what it did and that is what it was meant to do. That is what the Opposition questioned and voted against at the time—that is the truth.

My right hon. Friend talked about the cost of all this in terms of the Freedom of Information Act and the millions of pounds spent on external competition lawyers. My local Rotherham hospital has spent tens of thousands of pounds on London lawyers, and for what? There is no prospect of a merger or anything else. This money is seeping out of the local health pot, just so that advice about competition law can be got from lawyers based in London. This is real: if people want to do anything, they are going to have to take legal advice about doing it. That is the truth.

I have to say to my right hon. Friend the shadow Health Secretary that he may have an ally in the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). I am told that he said last week:

“I have a problem with OFT being involved in all these procurement issues…I think that’s got to change. In my view it should be scrapped in the future.”

I wait to see how he is going to address these things—if he did indeed say that—when he winds up this debate. If he did say it, I agree with him, as would many others out there.

I wish to make a couple of other points, one of which is about what happened in Bournemouth and Poole, where a merger was blocked by the Competition Commission last autumn. When it was blocked, the chief executives of the Bournemouth and the Poole hospital trusts said in a joint statement that they were “deeply disappointed” by the decision. They said:

“The benefits of merger, which included increased access to consultant care and new patient facilities, will now be much more difficult to deliver, which is disappointing for both our patients and staff.”

They went on to say:

“We recognise that the Competition Commission has a statutory role to perform”—

my argument is that it never had such a role before a change in the law—

“and specific criteria which it must use to assess benefits, but we believe that the outcome of the process is fundamentally wrong. The assessment of the merger was always weighted to put competition ahead of benefits to patients, and we do not believe the NHS is best served in this way.”

The Government amendment to our motion today states that

“clinicians are in the best position to make judgements about the most appropriate care for their patients.”

That is not the case in Bournemouth and Poole. The Competition Commission has decided, against clinicians’ wishes, to stop the merger going ahead. That is the truth, and that is how we should read the amendment. It is false in what it says. It then goes on to say that it

“notes that the rules on tendering are no different to the rules that apply to primary care trusts.”

That is not true. The rules changed when the Health and Social Care Act was passed. That is why competition and changes in the health service are matters for lawyers now. [Interruption.] The hon. Member for Bournemouth East (Mr Ellwood) might represent one of the hospitals, but his hospital and his local clinicians stopped the merger because the Competition Commission said that it was wrong. This is about competition law, and not about providing patient services.

[Mr Tobias Ellwood (Bournemouth East) (Con)]

This came in in 2002.

[Kevin Barron]

Let me touch briefly on the matter that is in today’s press. The Secretary of State said that we had to keep people out of A and E; he is absolutely right. If I made an addition to our motion today, it would have been around the issue of alcohol. Alcohol is a major problem in accident and emergency departments throughout the land. It used to be an issue on Friday and Saturday nights, but now it is an issue seven nights a week in cities. Not that long ago, the Prime Minister said that the Government were considering putting a minimum price on a unit of alcohol to reduce binge drinking and to improve public health. Today we had an announcement from the Minister for Crime Prevention, the hon. Member for Lewes (Norman Baker)—not from the Department of Health—that the Government are to ban the sale of cheap alcohol in England and Wales because they want to cut back on alcohol-related crime. People who work daily with the problems of alcohol and alcoholism have expressed views on the matter. The Alcohol Health Alliance, which includes the medical royal colleges, said that the impact of the ban on selling at below duty plus VAT would be negligible. It will affect about 1.3% of sales.

Eric Appleby, the chief executive of Alcohol Concern, said:

“The idea that banning below-cost sales will help tackle our problem with alcohol is laughable, it’s confusing and close to impossible to implement. On top of this, reports show it would have an impact on just 1% of alcohol products sold in shops and supermarkets leaving untouched most of those drinks that are so blatantly targeted at young people. The government is wasting time when international evidence shows that minimum unit pricing is what we need to save lives and cut crime.”

I could go on, but suffice it to say that the Government have completely dumped the idea that alcohol is a threat to the public health of this country. The measure will not stop people bingeing. It will not stop alcohol-fuelled people turning up at A and E. The truth is that some 50% of people who turn up at A and E get no treatment at all. We should be looking at the societal effects that are driving people into A and E departments—whether it is closure of walk-in centres or the fact that too many people are falling down because they have had too much to drink and believe that they have a right to block up A and Es and potentially slow down treatment for those who are facing an emergency. The Government are ducking the issues related to alcohol and are ducking the problems in A and E departments up and down the land. It is about time they showed some courage and did something positive. Alcohol is a public health issue, not a crime issue.

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[Paul Burstow]

That is absolutely right. For example, in continuing health care there is often a great deal of contestability that leads to discharge delays, but they are NHS-caused delays. I am not saying that the NHS should be blamed any more than social services, but I want some honesty about how the figures are presented as they do not bear close scrutiny in the argument made by the right hon. Member for Leigh. His solution is simplistic, too. It is good to have a debate about competition policy—I remember Labour Ministers trumpeting the introduction of the first competition policies in the NHS and the establishment of the competition and collaboration committee in the Department of Health. Labour established those policies.

Monitor’s role is to protect the interests of patients—that is what it says in the Health and Social Care Act 2012—not to promote competition. The idea that we can solve the problem by sweeping away Monitor opens the doors to competition red in tooth and claw. Of course, the Competition Act 1998, the EU’s competition legislation and procurement law would still apply without any of the fetters, barriers or protections that Monitor can and should be providing in its role as the regulator of competition in the NHS.

[Kevin Barron]

It is interesting that the right hon. Gentleman says that, because he knows from his time on the Health Committee that European competition law is not used in any health care system across the European Union.

[Paul Burstow]

The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.