NHS Reorganisation

Liz Kendall Excerpts

Wednesday 16th March 2011 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

This debate is about one of the most important issues facing this House and this country: the future of our NHS. It has been an excellent and at times lively discussion, with important contributions from all parts of the House.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) spoke with great passion about his recent experience of using the NHS and the importance of the NHS for his constituents. My hon. Friends the Members for West Lancashire (Rosie Cooper), for Oldham East and Saddleworth (Debbie Abrahams) and for Kingston upon Hull East (Karl Turner) gave compelling speeches about their concerns over what is really in the Health and Social Care Bill, including the implications of removing certain duties from the Secretary of State and of introducing competition law explicitly in the NHS for the first time. The hon. Members for Southport (John Pugh) and for St Ives (Andrew George) raised important and serious issues with regard to the Bill, including the implications of centralising services such as dentistry, pharmacy and primary care. It is far from clear how a national body will know what primary care services need to be commissioned in my constituency. They also expressed concerns about the dangers in the Bill. My hon. Friend the Member for Warrington North (Helen Jones), whom I am proud to be following, raised the importance of the threats to the “national” in the national health service and concerns about patients with long-term and chronic conditions, of whom we know there are an increasing number in the NHS.

The debate has shown that, as on so many occasions with this Government, it is not their rhetoric but the reality that counts. They promised in their manifesto an end to top-down reorganisations, but instead they are forcing the NHS through the biggest reorganisation of its life. As the right hon. Member for Charnwood (Mr Dorrell) has said many times, although unfortunately not in the House today, they are doing that at a time when the NHS faces its toughest ever period of funding, when jobs are already being cut and when, far from what the Secretary of State told the House earlier, waiting times are starting to rise.

The Government also say that they want clinicians to lead changes in the NHS, but their Health and Social Care Bill fails to guarantee even that GPs will be running consortia, let alone that hospital doctors, nurses or other NHS staff, who are so crucial to improving the quality of care, will be involved. As eight of the country’s leading patient charities said in a letter to The Times last month:

“The reforms will place £80 billion of the NHS budget into the hands of GPs, but plans to make GP consortia accountable to the public are far too weak.”

There is no requirement to have elected representatives on GP consortia, as the coalition agreement promised for primary care trusts. The new health and well-being boards will have no power to require GP consortia to do anything, and local councils’ scrutiny committees will actually lose some of their powers to refer decisions to the independent reconfiguration panel in the case of services not on the safe list of designated services.

At the heart of the Bill are proposals to change the NHS fundamentally that the Secretary of State simply does not want to talk about: his plans to run the NHS along the same lines as the gas and electricity companies.

[Nicky Morgan]

I know that the hon. Lady is a hard-working fellow Leicestershire MP, but I disagree with her. Is not the fundamental principle of the Bill, as we have discussed in the Public Bill Committee, that what constituents want is an NHS free at the point of need and the delivery of services, and funded by taxpayers? Which part of the Bill changes that fundamental principle?

[Liz Kendall]

What patients want is their views and voices to be heard. As the hon. Lady well knows, eight of the country’s leading patient charities, including the Alzheimer’s Society, Asthma UK and Diabetes UK, have said that the patient and public voice is not strong enough under the Bill, and they have demanded changes. I respectfully ask that she look at their comments and act on their views.

The fundamental issues at the heart of the Bill are turning Monitor, which is currently responsible for foundation trusts, into a powerful new economic regulator to promote competition across the NHS, and enshrining UK and EU competition law into primary legislation on the NHS for the first time. That is not my view but the view of David Bennett, the new chairman of Monitor, expressed in his evidence to the Public Bill Committee. The Government are explicitly modelling the NHS on the gas, electricity, railway and telecoms industries. Government Members who are shaking their heads or looking blank should read the explanatory notes to the Bill, which make that absolutely clear.

[Grahame M. Morris]

May I point out that yesterday, in an Adjournment debate in Westminster Hall about the future of the blood services contract, the Under-Secretary of State said in response to a question from my hon. Friend the Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) that EU competition rules would apply?

[Liz Kendall]

The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), also said yesterday, in the Health and Social Care Bill Committee, that EU competition law would apply, and gave me some assurances that that would somehow not change anything. When I asked whether the Government had taken legal advice on that, he admitted that they had. I asked him then to publish that advice so that hon. Members did not have to take my word for it, and I shall do so again. Will he publish that advice so that hon. Members can see whether GP-commissioning consortia and providers will be subject to EU competition law? Sadly, it appears that he will not do so.

[Dr Poulter]

If the hon. Lady is so concerned about competition and markets, why did the previous Government introduce Monitor, and why were they happy to pay the private sector 11% more than the NHS to provide NHS services?

[Liz Kendall]

I am sure the hon. Gentleman knows that Monitor was established as part of the regulation of foundation trusts. Removing that responsibility will mean that there will be no outside checks and balances on those trusts as there are now. Government Members should think seriously about that.

Our health and our NHS are not the same as gas, electricity or the railway. That the Secretary of State believes that they are shows how dangerously out of touch he is. What is the likely result? GPs will be forced to put local services out to tender even if they are delivering good quality care that patients choose and like; hospitals and community services will be pitted against one another when they should work together in patients’ interests; care, which as many hon. Members have said is vital as our population ages and there is an increase in long-term conditions, will become more and not less fragmented; the financial stability of local hospitals will be put at risk, and they will have no ability to manage the consequences of choice and competition in the system; and the whole system will be tied up in the costs of red tape, as GPs and hospitals employ an army of lawyers and accountants to sign contracts and fight the threat of legal challenge, huge fines and the potential of being sued. Let us also be clear that the Bill gives Monitor the same functions as the Office of Fair Trading, so it can fine organisations up to 10% of their turnover.

The more we see of the Bill, the more the truth becomes clear. The Secretary of State says that he wants clinicians to be more involved, and “no decision about me without me” for patients, but when the Royal College of General Practitioners, the Royal College of Surgeons, the Royal College of Nursing, the Royal College of Midwives, the British Medical Association or anyone else tells him that he should stop, think again and halt his reckless NHS plans, he refuses to listen. When the Alzheimer’s Society, the Stroke Association and Rethink tell him that his proposals will not give patients a stronger voice and improve public accountability, he simply tells them that they are wrong. When health experts such as the King’s Fund warn that driving competition in every part of the NHS will make it more difficult to commission the services that best serve patients’ interests, he simply puts his fingers in his ears and walks away. What makes this Secretary of State think that he is right when professional bodies and patient groups know that he is wrong?

Doctors and nurses do not support the Government’s plan, patients do not want it, some Conservative Back Benchers and members of the Cabinet do not like it, and the Liberal Democrats hate it. They had the sense last Saturday to see what the hon. Member for St Ives (Andrew George) called the potential catastrophe as far as the future of the NHS is concerned, and to ask for amendments to the Bill. I hope they have the sense to join us in the Lobby tonight. I commend the motion to the House.