Health and Care Bill

Mike Amesbury Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to speak for the Opposition in this first part of the debate on the Bill.

A decade ago, virtually to the day, I was a young activist taking part in marches, protests, online campaigns, letter writing campaigns, petitions and much more in opposition to what would become the Health and Social Care Act 2012. We argued that it would lead to more fragmentation, less integration, confused decision making and more privatisation and that it would not make anybody any healthier.

Despite significant opposition to the legislation, the Government pushed on. But as campaigners, we were right, weren’t we? The 2012 Act created a fragmented system that did not promote health and care integration. Performance against NHS targets, even pre-pandemic, was dismal and now it is even worse. Waiting lists have grown extraordinarily, and staff vacancies have grown to crisis proportions.

We are here today and tomorrow to consign that legislation to history—perhaps less the end of an era and more the end of an error. But the same Government who broke the system now offer a new package of reforms, and that should really scare us. These are the wrong reforms at the wrong time. There are no answers in them to the waiting times crisis, no answers to the capacity issues in accident and emergency or our ambulance services, no answers to access issues for our GPs or dentists, and no answers to the environmental factors that make a country with so many assets so unhealthy.

[Mike Amesbury (Weaver Vale) (Lab)]

Does the shadow Minister agree that the Bill gives the green light to private profit making companies sitting on integrated care organisations?

[Alex Norris]

Yes. That was a strong theme in Committee that we on the Opposition Benches are very much against; it is likely to be a prominent theme during our discussion of upcoming amendments. Through what we are discussing now, we at least have the chance to put something in the Bill that might improve the public’s health.

--- Later in debate ---

[Justin Madders]

At the moment, ICBs are not a legal entity, so they do not own anything. When the Bill comes into force, they will effectively take over mainly administrative buildings from the CCGs, and the trust will hold ownership of most of the assets. We hope that there will not be the risks that my hon. Friend outlines, although it is not impossible for ICBs to set up their own trusts at some point in the future.

We do not believe that the question of private providers sitting on the place-based boards can be left open in this way, because this is really about who runs the NHS. There is a complete and utter incompatibility between the aims of private companies and what we say should be the aims of the NHS and the ICBs. I can do no better than refer to the evidence of Dr Chaand Nagpaul from the Bill Committee. He identified the concern perfectly:

“We forget at our peril the added value, the accountability, the loyalty and the good will that the NHS provides. We really do…I am saying that it does matter. Your local acute trust is not there on a 10-year contract, willing to walk away after two years. It is there for your population; it cannot walk away.”––[Official Report, Health and Care Public Bill Committee, 9 September 2021; c. 90, Q113.]

Those final words sum it up perfectly. Put a company on the board, and its interest lasts as long as the contract, and those interests will of course not be the same as the NHS’s anyway. A company’s primary concern is the shareholders, not the patients. With that clear and unanswerable concern about conflicts of interest, we invite the Government to withdraw their amendment and support ours.

We have already had some discussion of who goes on the ICB. Apparently, the answer is not the most appropriate people chosen by an independent external process or individuals directly accountable to the public; the answer is left to guidance that leaves open the risk that voices we think need to be heard will slip through the net. Our amendment 76 deals with that by setting out the requirements for ICB membership. Allocating scarce NHS resources should be robustly debated and will always be political. Tough choices have to be made, so we need people on the ICB who will be there to cover all the necessary interests for the wider good.

If Members look at what amendment 76 suggests, I hope nobody would argue that those interests do not have to have some voice. The public, patients, staff, social care, public health and mental health—which of those can be safely ignored and which has no part to play? As I have already mentioned, there is a major area of uncertainty because of the complete absence of anything that sets out how the much-vaunted place-based commissioning will work. Who will sit at the place-based table is, I am afraid, still completely opaque.

The next major area covered in the Bill is a further deconstruction of Lansley with the removal of compulsory competitive tendering for clinical services. We have seen the NHS proposals for a provider selection regime to replace the regulations under section 75 of the 2012 Act. That is to be regarded as a work in progress, so our amendment 72 covers the issue and would reintroduce some safeguards into how our money is spent. Since its inception, the NHS has always relied on some non-NHS providers, with the model developed for GPs being an obvious example. However, in recent decades there has been an increase in the use of private providers of acute care, most notably in diagnostics and surgery.

To be clear, we on the Opposition Benches believe that the NHS should be the default provider of clinical services. If it is not the only provider, it should be the predominant provider in geographical and services terms. Where a service cannot be provided by a public body because the capability or capacity is not there, there is still the option to go beyond the NHS itself, but that should be a last resort and never a permanent solution. Amendment 72 therefore sets out a clear framework for how we could achieve that. We hope that extra transparency and extra rigour would mean we avoid buying stuff that is unsuitable and sits in container mountains, stuff that does not meet specifications, and stuff made by companies that have no experience, but are owned by friends and family. In short, we would stop the covid crony gravy train.

The use of private sector capacity in the covid emergency turned out to be a farcical failure. It became very clear, very quickly that it was not there to support the NHS; it was there just to make profits. Use of private providers through dodgy deals during the PPE scandal has highlighted the need for greater transparency and greater capacity in the NHS. We can never allow a repeat of what we have seen there. We need the rigour set out in the amendment to be put into legislation, rather than left to guidance. We need to be able to challenge NHS bodies that do not comply, as well as Ministers who try to flout the rules.

I will now deal with new clause 49, saving the best—or more accurately, the worst—until last. Because of how Report stage works, it has fallen to me to express our opposition to this measure, rather than my expert colleague, my hon. Friend the Member for Leicester West (Liz Kendall), who shares my dismay at what has been produced and how it has been presented to us. Starting with the process, it is wholly wrong to bring such a fundamental change forward as a last-minute addition to this Bill. That means it cannot be debated properly today. There is no impact assessment and, as we have already heard, this change was not discussed in Committee at all. In fact, in 22 Committee sessions spanning some 50 hours, we never once heard mention of this amendment coming forward or discussion on the care cap. Indeed, when this Chamber was busy debating the social care levy, we were beavering away in Committee on the Bill, oblivious to the fact this measure was coming down the track. If the Government cannot even get their decision-making processes integrated, what hope is there for integrating health and social care?

As we know, the aim of the new clause is to remove means-tested benefits from the costs that count towards the care cap. As has been pointed out far and wide by Members from all parts of the House, that change adversely impacts some more than others. It is a wholly regressive measure, to say the least, to give support through means-testing, but then to penalise people later for receiving it in the first place. We will vote against this iniquity, and I hope many Conservative Members will vote with us. They should be used to the Prime Minister’s broken promises by now; this is their chance to make the point that he should stand by what he says.

[Mike Amesbury]

Does my hon. Friend agree that it is Robin Hood in reverse? I encourage Conservative Members who wax lyrical about levelling up, particularly in the north, to do the right thing.

[Justin Madders]

My hon. Friend must have sneaked a look at my speech, because I will say later that it is Robin Hood in reverse.