Future of the National Health Service

Margaret Greenwood Excerpts

Wednesday 22nd September 2021 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate my hon. Friend the Member for Leeds East (Richard Burgon) on securing this important and extremely timely debate.

The NHS is under great strain. Nurses I met over the summer told me how over-stretched the service is, not just because of covid but because of staff shortages, which my hon. Friend the Member for Rhondda (Chris Bryant) spoke so eloquently about. In June, there were almost 94,000 full-time equivalent vacancies in the NHS, and then of course we have the backlog of patients waiting for hospital treatment in England, which is getting worse. In July, 5.6 million people were waiting. Sadly, that is not just because of the impact of covid; the upward trend was in progress before the pandemic. In February 2020, there were about 4.4 million people waiting for hospital treatment, up from 3.7 million in February 2017.

Yet instead of addressing those extremely serious issues, the Government are pressing ahead with a major reorganisation of the NHS in the form of the Health and Care Bill, through which they will establish statutory integrated care boards and statutory integrated care partnerships, thus breaking the NHS up into 42 local integrated care systems. Each will set out which services to prioritise and which to reduce in their area, embedding a postcode lottery into the NHS in England. It is clear that that variation in the offer, depending on where people live, coupled with strict local financial limits, would lead to increased rationing of healthcare. If that is allowed to happen, I am concerned that people will have to wait longer for care or go without. That is contrary to the founding principles of the NHS.

It is important that we understand just how fortunate we are to have the NHS and why we must defend it. Looking across to America makes very clear our good fortune. Over there, typical costs for health treatment, as advertised by insurance companies looking for business, are as follows. People can expect to pay anything between $400 and $1,200 for an ambulance; between $9,000 and $17,000 for a baby to be delivered; and between $7,000 and $10,000 to have surgery for a broken wrist. Typical annual insurance costs for an individual are around $1,440 and for families around $5,700. That covers only part of the cost because, in America, employers pay the bulk of insurance costs for the individual, with all the cost that that adds to the business communities. Clearly, we do not want an American-style insurance-based system here.

As it stands, the Government’s Bill would put big business at the heart of our NHS. The Government have indicated that they would ensure that individuals with significant interests in private healthcare are prevented from sitting on ICBs, but that is simply not good enough. Private companies should have absolutely no say in how public money should be spent in the NHS. There should be no place whatsoever for private companies on ICBs or integrated care partnerships.

The Government intend to revoke the national tariff and replace it with an NHS payment scheme, with NHS England consulting with ICBs, NHS and independent sector providers. There are real concerns that this will give big business the opportunity to undercut NHS providers. We will see healthcare that should be provided by the NHS increasingly being delivered by big business, with all the implications that that has for patients, for all those working in the service, “Agenda for Change”, and the future of national collective bargaining.

The Government’s reforms would also create a power to deregulate NHS professions, and would have serious implications for the quality of care as well as the employment status, pay, terms and conditions of workers in the service. The NHS is our finest social institution and it has served us well since 1948 but now its future is in peril.

During the campaign against the Conservative-Lib Dem privatisation Bill, which became the Health and Social Care Act 2012, a man told me of his experience of life before the NHS. When he was about eight years old, his baby brother was seriously ill. Everyone in the street was worried for the child. One of the neighbours called for the doctor but, on hearing that, the mother said to the boy, “Run up the street and tell the doctor he is fine and there is no need to call.” The boy ran to the doctor, who had just turned into their street, and sent him away, just as his mother had told him to. Shortly after, the baby died, as the mother knew he would. She had told him to send the doctor away because she knew she could not afford to pay him.

We cannot begin to know the agony that that woman went through. The man who told the story had carried the burden of that action with him through life. That was life and death before the foundation of the NHS, when that family and countless others could not afford medical treatment. It is sobering to think that, after 73 years, the Government’s Bill undermines the principles of the NHS as a comprehensive and universal service.

History will not be kind to those who support such changes. I believe we all have a responsibility to protect the NHS and fight for it as a universal, comprehensive, public service for this generation and those to come. I ask Government Members to reflect on the importance of the decisions that they face in the coming weeks and months, and I urge them to consider the needs of their constituents and oppose the Health and Care Bill.

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[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Ms Bardell; I think that I do so for the first time.

Although I suspect that it is fair to say that the hon. Member for Leeds East (Richard Burgon) and I are not fellow travellers in the same direction on many things politically, I congratulate him on securing this debate on a very important subject. Although his speech was long on opinion and perhaps short on fact, I do not think that anyone could doubt the passion or the sincerity with which he spoke, whether one agrees with everything he says or not. I pay tribute to him in that respect.

I think it is clear to everyone in this Chamber, as I hope it will be to people watching on Parliament TV and those who read the transcript of our debate, the genuine affection and respect that every Member of this House has for our NHS and those who work in it. It is right that I join the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), and others—I often do so on these occasions, because this cannot be said too often—in paying tribute to those who work in our NHS, including the shadow Minister herself. On the occasions when she and I see each other across the Dispatch Box, I always try to make that point.

A number of key themes have emerged today. The legislation is currently in Committee, and I know that a number of Opposition Members have argued that it should be paused or even scrapped. I have to say that the former chief executive of the NHS, Lord Stevens, said that about 85% of the Bill is exactly what the NHS asked for, wanted and wanted done now—ideally, the NHS wanted it done two years ago, before the pandemic.

In the evidence sessions of our Bill Committee, which continues to meet, we heard NHS Providers, the NHS Confederation and the Local Government Association all saying, “This is the right Bill at the right time.” I should acknowledge that some of those witnesses said there were certain elements that they would question or challenge, but they said it was the right time to pass this legislation. In fact, in a joint statement the NHS Confederation, NHS Providers and the LGA said,

“we believe that the direction of travel set by the bill is the right one.”

At the heart of this legislation is the principle of integration underpinned by evolution. Colleagues across the House who have served with me since 2015 will know that I am not by nature revolutionary, so the legislation is evolutionary in what it seeks to achieve, but it seeks to achieve greater integration. I think it was the hon. Member for Liverpool, Wavertree (Paula Barker) who spoke about accountability needing to be upwards, downwards and sideways. With these proposals we seek to do exactly that: to achieve greater integration at a local level within the NHS and, at the ICP level, to achieve greater integration with local authorities.

[Margaret Greenwood]

What would the Minister say to the British Medical Association council, which passed a resolution overwhelmingly

“calling for the Health and Care Bill to be rejected, arguing that it is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability”?

[Edward Argar]

I will turn to those key points in a moment, but first I will address the specifics. The point I made to the Chair of the BMA council in Committee was that, if I recall rightly, every single piece of legislation on the NHS, including the National Health Service Act 1946 that brought it into place, has been opposed by the BMA. I challenged him to tell me which pieces of legislation the BMA had supported, and he said he would write to us. I have yet to get that letter; I am sure, knowing Dr Chaand Nagpaul as I do, that he will write to us, but in the Committee he was unable to say which piece of legislation—including Labour legislation in 1999, 2001, 2003 and 2006—the BMA had supported.

[Margaret Greenwood]

Will the Minister give way?

[Edward Argar]

I will make a little bit of progress, because I want to address the hon. Lady’s allegations about privatisation and workforce. If we have time at the end, I will of course seek to let her come back in.

On allegations or suggestions of furthering privatisation, I know it is tempting for some, even when they know better—and they do—to claim that this is the beginning of the end for public provision. It is not, and Opposition Members know it. There have always been key elements of the NHS that have involved private providers, voluntary sector providers and so on.

What is instructive is the extent to which that was accelerated when the Labour party were in power. The shadow Minister talked about the 2012 legislation and any qualified provider, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10 under the term “any willing provider”. The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

The other point I would make is that one of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, under the Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

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[Edward Argar]

My hon. Friend makes a fair point about the need for us to create the conditions—the physical spaces with the technology—in which the workforce, which is the heart of our NHS, can work. He makes a subtle—or not so subtle—plea for his own local hospital. He will not be surprised that I will not comment on the detail of that.

To finish my response to the hon. Member for Strangford, the Command Paper recognises the challenges posed by the current arrangements in the Northern Ireland protocol around the supply of medicines and other goods, for example. The approach that the hon. Member set out, of removing medicines and medical devices from the orbit of the protocol, is reasonable. I hope that discussions between the European Commission and Lord Frost are productive, and that a consensus can be reached on the way forward.

I have to take issue slightly with the hon. Members who raised the role of Sam Jones, one of the Prime Minister’s advisers. They focused on one particular aspect—that for a brief period she worked for an independent provider. What they did not do, which is extremely unfair to a dedicated public servant, is highlight that she worked for NHS England, running new care models; that she has been an NHS paediatric and general nurse; that she was the chief executive of Epsom and St Helier University Hospitals NHS Trust; that she was the chief executive of West Hertfordshire Hospitals NHS Trust; and that she was the Health Service Journal chief executive of the year for 2014 and was highly commended for her work in driving forward patient safety. I gently say that it ill behoves Members of the House to attack public servants, who cannot answer for themselves in this Chamber, with partial references to their careers rather than recognising that they have contributed a huge amount in the past.

The hon. Member for York Central was absolutely right to highlight health inequalities as one of the greatest challenges—not the only challenge—that we face as a society and as a health system. The measures on integration and change in the Bill will help us tackle those health inequalities. I suspect that on Report and Third Reading she may test and challenge me on those assertions and assumptions, but she is absolutely right to highlight the centrality of health inequalities.

The hon. Member for Liverpool, Wavertree (Paula Barker) spoke about residential care and the link to social care. While I am not the social care Minister, everything that I do in my role as Health Minister must have an eye to social care. I was a cabinet member for adult social care in the dim and distant past, when I had rather more hair, and I also sat on the primary care trust, as it then was, at that time. I recognise the need for those two parts of the system to work together to achieve the best outcomes for our constituents. She makes a valid and important point.

I found what the hon. Member for Wirral West (Margaret Greenwood) said about the US experience of great interest and instructive, but it is utterly divorced from what the Bill and the Government are doing in respect of our NHS. It was an interesting reflection on what is going on in America, but it certainly does not bear any resemblance to what is happening or will happen in this country.

[Margaret Greenwood]

Does the Minister not recognise that, where we have a postcode lottery and the increased rationing of care—my constituents are very aware of the rationing of care, and a number of Members have spoken about what happens when people cannot get the treatment that they need on the NHS—there is the spectre of an individual, private insurance-based system? Members of his own party have in fact argued for such a system. People need to be mindful of just how dangerous for us all it would be to introduce a private insurance-based system.

[Edward Argar]

Will the hon. Lady forgive me? I was not questioning the integrity of what she said, but I was suggesting that there was no risk of that system as she described it developing in this country.

I will sum up, because I want to give the hon. Member for Leeds East a little more than two minutes, if I can. We are determined to continue supporting our NHS; this Bill, this legislation, the funding announcements we have made and the reforms we are putting in place do just that. We want to create an NHS that is fit for the future, renewing the gift left to us by previous generations, building on that gift and strengthening our NHS as it evolves to meet the challenges of the future. We remain the party of our NHS; we will give it the support it needs—as we always have done.