National Health Service

Margaret Greenwood Excerpts

Wednesday 13th July 2016 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That leave be given to bring in a bill to re-establish the Secretary of State’s legal duty as to the National Health Service in England and to make provision about the other duties of the Secretary of State in that regard; to make provision about the administration and accountability of the National Health Service in England; to repeal section 1 of the National Health Service (Private Finance) Act 1997, sections 38 and 39 of the Immigration Act 2014 and Part 9 of the Health and Social Care Information Act 2012; to make provision about the application of international law in relation to health services in the United Kingdom; and for connected purposes.

It is a privilege to have the opportunity to present this Bill to the House. I pay tribute to the many patients, nurses, doctors, trade unions and campaigners across the country who have been working tirelessly to combat the privatisation of our national health service. I also pay tribute to my hon. Friend the Member for York Central (Rachael Maskell) and the hon. Member for Brighton, Pavilion (Caroline Lucas) for the work that they have done.

The Bill is intended to fully restore the NHS as an accountable public service by reversing marketisation in the NHS, abolishing the purchaser-provider split, ending contracting, re-establishing public bodies and making public services accountable to local communities. The Health and Social Care Act 2012 provided the framework for the privatisation of the NHS, and we are seeing that privatisation happen at pace. I believe that the Act brought in three core changes that are driving that privatisation. First, it removed the legal duty on the Secretary of State for Health to provide and secure a comprehensive national health service in England. Secondly, it included a requirement to put NHS contracts out to competitive tender in the free market, putting the profit motive at the heart of the service. Thirdly, it allowed NHS hospitals to make up to 49% of their money out of private patients.

The Bill makes the case for a planned, managed health service. It would reinstate the duty of the Health Secretary, lost under the 2012 Act, to provide a secure and comprehensive NHS. That is important because, under the current arrangements, clinical commissioning groups do not have to serve a particular geographic area and are not required to tend to all illnesses and conditions. In some areas, certain treatments, such as hip and knee replacements and cataract operations, are already being rationed. Reinstating the Secretary of State’s duty is vital to provide the Government accountability needed to maintain a comprehensive NHS.

The 2012 Act forces NHS contracts out to competitive tender in the marketplace, allowing private companies to cherry-pick NHS services from which they can make money. Since 2012, we have seen the effect of NHS contracts going to private companies—it undermines NHS services and the pay and conditions of staff and fragments the service. The sums of money involved are eye-watering. The Government would have us believe that only 6% of contracts go to private firms, but according to the NHS Support Federation, private firms won 36.8% of contracts in 2014-15, securing £3.54 billion of the £9.628 billion of deals awarded.

Does that matter? I say yes, absolutely, without question. Contracting out is very expensive. In the USA, the cost accounts for about 30% of healthcare expenditure, compared with 5% in the non-marketised NHS pre-1990. Any private company has a duty to generate profit for shareholders, but the money we pay through our taxes should be spent on patient care and should not go to shareholders. Putting healthcare contracts out to competitive tender means money being spent on marketing and contract lawyers that could be spent on patients. A proliferation of providers also means a proliferation of administrative costs and opens up opportunities for fraud.

The only way the private sector can reduce costs is ultimately by cutting quality, which might happen by a number of means—for example, by cutting the pay and terms and conditions of health service staff or by selling off nationally owned assets. As a nation, we hold our doctors, nurses and other NHS staff in high esteem, and it is important that we protect their pay and conditions. The Bill therefore includes a requirement for the use of national terms and conditions of employment for relevant NHS staff under the NHS Staff Council and its “Agenda for Change” system. It also includes provisions aimed at preventing the application of competition law and procurement rules to the NHS. It would abolish Monitor, the sector regulator that licenses health service providers and oversees the operation of procurement, choice and competition rules in the health service, and it would repeal sections of the 2012 Act relating to procurement, competition, tariff pricing and health special administration.

Under the 2012 Act, NHS hospitals can make up to 49% of their money from private patients. How they make it is up to them, but the startling fact is that they can do it. They can choose to devote 49% of patient beds to private patients, 49% of theatre time to private patients or 49% of consultants’ time to private patients—and absolutely nobody voted for it. It was in neither the Conservative party’s nor the Liberal Democrats’ manifesto, yet they went ahead and passed legislation to make it happen. That is nothing short of a national scandal. I ask hon. Members to reflect on what it would mean for their constituents if their hospital made such choices. How soon could that happen? In some places, it is happening already. The Royal Marsden hospital now makes 26%—over a quarter—of its money from private patients.

I turn to the NHS financial crisis, which we are all aware of, which is particularly notable in our hospitals and which is accelerating at a frightening pace. NHS trusts in England have recorded a deficit of £2.45 billion for 2015-16—the biggest overspend in the history of the NHS, nearly three times that of the preceding year and more than 20 times the 2013-14 deficit. Three in four hospitals predict that they will be in deficit this year, and the financial crisis is also having an impact on the delivery of care. In those circumstances, it is not difficult to see how hospital managers might feel that increasing the number of private patients they treat in order to generate more income is one of the few options open to them.

We can also look at the recent arrival of sustainability transformation plans to see the bigger picture. England has been divided into 44 areas, each of which is required to come up with an STP. The first priority for the STP is that CCGs and providers must cut expenditure, stay within budget for 2016-17 and continue to do so for the next four years in order to be entitled to access centrally controlled transformation funding. They will face tough choices—they could sell assets, cut services, ration services or actually charge for services. In that landscape, we can expect to see hospitals taking private patients to generate extra cash, putting NHS patients at the back of the queue.

Doubtless the Government would argue that hospitals will be able to reinvest the money earned from private patients, but that argument does not stack up. If we cut 49% of resources from NHS patients, waiting times will grow and the quality of service will decline. We will see the emergence of a two-tier health service: first-rate for those with the money to pay, but NHS patients receiving a much diminished service. The concept of a comprehensive service free at the point of use will be lost within a generation, and we will all face the real possibility of having to buy health insurance, just as people do in America.

Let us remind ourselves that these hospitals are ours. They have been paid for out of our taxes and are run by our NHS staff—they are not the Government’s to give away. This Bill addresses that and would remove the right of NHS hospitals to make 49% of their money out of private patients.

We will not be able to manage our NHS properly until we address the issue of social care. We are all aware of how important that is. Why should we settle for an NHS that is free to all who need it unless they are elderly or have complex needs? The Bill provides an opportunity to change that. It would give the Secretary of State a duty to exercise his functions with a view to integrating the provision of health and social care services. That integration was a key aim of my right hon. Friend the Member for Leigh (Andy Burnham) when he was shadow Secretary of State for Health in the last Parliament and formed part of the Labour party manifesto. I believe that families up and down the country would welcome that development.

The Bill would also provide for the transfer of financial obligations on NHS private finance initiative agreements to the Treasury, which would also be required to assess and publish those obligations. That would improve public health, stop the privatisation of the NHS and return it to its founding principles. It would remove competition and the profit motive as the drivers of policy and replace them with the public service ethos that has been the hallmark of the NHS since its foundation. The NHS is currently on life support, and the public, patients and NHS staff know it. The Bill provides a viable alternative. The NHS was 68 years old last week; we need to make sure it is there for all who need it for the next 68 years, too.