Privatisation of NHS Services

Mike Amesbury Excerpts

Monday 23rd April 2018 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I am grateful to be called to speak in this important debate, Sir Graham.

Let me say at the outset that I very much support our national health service, paid for out of taxation and available for all at the point of need, irrespective of the ability to pay. The NHS saved my life when I was 24—it was there for me when I needed it, and I always want to be there to defend it for all those who will need it.

I have the privilege of serving on the Select Committee on Health and Social Care. Given that advantage, because some of these issues have come up recently at our evidence sessions, I want to quote some of what people who know an awful lot about the NHS have said about the alleged privatisation of the NHS, and particularly about sustainability and transformation plans, which the Government are rightly introducing to give us proper, integrated place-based care.

Simon Stevens is the chief executive of NHS England, and on 20 March he gave evidence to the Health and Social Care Committee. In particular, he responded to some of the claims made by Professor Allyson Pollock. I have met her only the once, when she came to give evidence before the Committee, but I have no doubt that Professor Pollock is sincere about what she believes. Members, however, should listen with an open mind to what Simon Stevens—first appointed to a senior position by a Labour Government, incidentally—says about her concerns. I hope that it will be helpful to the debate.

On the sustainability and transformation plan agenda, which is all about integrated care systems, Simon Stevens said in answer to question 270:

“We will probably see a significant decrease in the number of services that are subject to procurements.”

Talking about some of the comments made recently about the issue, he went straight on:

“Having had a chance to look at some of the evidence that you received from one of the panels of activists”—

Professor Pollock—

“I have to say that, frankly, some of the claims that were being made are made year in, year out, almost regardless of what is happening in the national health service. Indeed, I came across an article talking about how the NHS was being turned into an American health system, which it is not.

The article talks about the fact that the Government’s reforms are going to ‘move the NHS towards an insurance model,’ where ‘primary care groups could sound the death knell of equity, universal coverage and care free at the point of need in the NHS.’ That privatisation and Americanisation article was written 20 years ago by Allyson Pollock. Then I see in the British Medical Journal in 2001 an article by Allyson entitled, ‘Will primary care trusts lead to US-style health care?’ The answer is no, and they did not. We look forward to 2010 and see another article from the same author saying that the NHS in England is to be dismantled, and instead healthcare will be run on US healthcare lines. That is not true.

We see a subsequent article saying that Brexit is in fact going to lead to the destruction of health as a human right in this country. We see the really curious claim that ‘the Health and Social Care Act 2012 abolished and dismantled the NHS in England.’ The million patients who are being looked after by their GPs, in A&Es or as hospital outpatients, let alone the 1.3 million staff who are working in the NHS today, will find it a curious claim that the NHS was in fact abolished four years ago.”

I am grateful to Simon Stevens for giving us a bit of historical perspective on some of those claims, which have been doing the rounds for 20 years or more.

Let us move on to some respected, independent observers of the health scene. Those who follow health will probably agree that one of the most respected is Professor Chris Ham of the King’s Fund. On 6 March he said to the Health and Social Care Committee:

“If you look at what is happening in the partnerships—places such as Salford, Northumbria, Wolverhampton, Yeovil and south Somerset—there is absolutely no evidence of privatisation. These are public sector partnerships based on collaboration between NHS and local government organisations working around their populations and places.”

[Mike Amesbury (Weaver Vale) (Lab)]

Equally, I have some information that was released to The Independent under a freedom of information request, which states that the Royal Marsden in London had an income from private patients in 2010-11 of £44.7 million. By 2016-17, that had risen to a massive £91.9 million—a rise of almost 105%. That clearly demonstrates that there has been a considerable rise in the private income of that world-leading NHS hospital.

[Andrew Selous]

I am not aware of where exactly that income came from. The Royal Marsden is a world-leading hospital; perhaps some of that was from foreign patients who had come to the United Kingdom and would not have been entitled to NHS care.

Professor Chris Ham of the King’s Fund went on to say:

“In some of these areas”—

sustainability and transformation plan areas—

“we are actually seeing previously privatised services coming back in-house.”

I will not quote any more from that session of the Committee, but Nigel Edwards of the Nuffield Trust and Professor Katherine Checkland, a professor of health policy and primary care, gave evidence—much respected, independent witnesses who also agreed with Professor Chris Ham.

I have to say to Opposition Members that a number of Labour MPs have a slightly different take from some of the remarks that have been made today. The right hon. Member for Exeter (Mr Bradshaw), who serves with me on the Committee and is a former Health Minister, said in question 24 of our session on 27 February:

“The other advocates of these integrated models are not just people such as Chris Ham”—

of the King’s Fund, who I have just spoken about—

“but people we have spoken to on the ground, trying to deliver a service for their local population. First, it helps them overcome the purchase-provider split, which has already been referred to, and, secondly, it makes it less likely that they are going to be private contracting.”

A lot of the accusations have been around for a long time. It is important that we look at what happened to those previous accusations: did they have a basis in fact? Often, that was not the case. Let us just be fair, because to me, STPs are about taking a sensible approach to integrated place-based care to join up health and social care and to get the world-class health service that we all want to see.

--- Later in debate ---

[Kevin Hollinrake (Thirsk and Malton) (Con)]

It is a pleasure to speak while you are in the Chair, Sir Graham. I add my congratulations to the hon. Member for Hartlepool (Mike Hill) on his introduction of the debate. May I start by clarifying a point in his opening remarks? He conflated, I think, paying for healthcare and outsourcing, which to my mind are two completely separate things.

Let me explain something that informed my thinking on this subject many years ago. When my son, who is now 21, was only one, my wife and I went to Menorca as new parents, and our son took ill on the last day, after a lovely week there. He deteriorated quite badly in the middle of the night, and we were told by the doctor to take him to a hospital. We went to a lovely, shiny steel-and-glass hospital and rushed him in. By the time we got to the hospital, he was barely breathing, and new parents panic so much in those situations. We carried him to reception, thinking that he was only a few gasps from passing away, and we were asked, before they treated him, to present our credit card. We waited for 20 minutes while that was dealt with, and those were the longest 20 minutes of our lives, so I think that any Government Member or, indeed, anybody in the Chamber today who would consider moving the current system from a system of taxpayer-funded care to one in which people pay at the point of delivery would be misguided, to say the least.

This debate is not about whether we pay for care, and let us be clear: healthcare in this country is not free; it is taxpayer-funded. But the foremost principle—the foremost thing we must get right—is what is in the best interests of the patient. That is the principal thing that we should be discussing. The second thing that we should be discussing is what is in the best interests of the taxpayer, who funds the care of all the people who need care in this country. The third thing is who provides that care. This is patient first and certainly profit second. No ideology about private sector interest or involvement, or purely public provision, should get in the way of that. This debate should be about how we deliver the best service most effectively and efficiently. The question we should be asking today is how we provide a world-class service to get the best outcomes for patients and the best deal for the taxpayer.

To me, what the evidence points to is clear, despite the very good points that Opposition Members make about fragmentation. I accept that there are at times problems with commissioning that we need to resolve and get right, but to me a blend of public and private sector interests—a partnership between the two—would provide the best outcomes. Indeed, a report by the World Health Organisation emphasised the value of competition and the incentive structures of private organisations as spurs to good performance, while recognising the need for a public role in resource allocation. That, to me, says everything about how we should manage our health system.

As has been said, there are a number of different private providers. I do not think that anybody is arguing that GPs, for example, should not be involved in our healthcare system, or community care or residential care, and they are all private sector providers. It is also fair to point out that the rate of growth for private sector provision over the last seven years, since the coalition Government of 2010, is very similar to that for private sector provision before that time. This issue should not be party political; those are the facts. The figure went from 2.8% in 2006-07 to 4.4% in 2009-10 and then, I think, to the current 7.7%, so the rate of growth is very similar. Those facts are from Full Fact, which is an independent fact-checking organisation.

[Mike Amesbury]

Does the hon. Gentleman agree that the great battle of ideas in the past resulted in something that seemingly we now all take for granted and claim to love—the NHS? Historically, the NHS was opposed; in fact, it was opposed 22 times on a three-line Whip by the Tory party, so the idea of the NHS, which is free at the point of delivery and based on need, is of course politically driven. My political party helped to create the NHS. It was a key driver in that and will certainly save and grow the NHS.

[Kevin Hollinrake]

I agree with that point entirely. We all love the NHS and respect so much the work of the people who work in that service, so congratulations on the fact that Labour introduced the NHS, but that is not the point. This debate should not be about ideology; it should be about what works.

NHS Wholly Owned Subsidiary Companies

Mike Amesbury Excerpts

Tuesday 6th March 2018 Westminster Hall

[Liz Twist]

That is absolutely correct, and I have raised with my local trust the potential move away from NHS pay rises.

The main way trusts can make savings is by employing the new staff on worse terms and conditions, which means lower pay rates, less holiday, inferior sickness schemes and no access to the NHS pension scheme. As colleagues said, even transferred staff may be moved on to the worse terms and conditions over time. Trusts are doing that to the lowest-paid workers, who are essential to keeping our hospitals going.

[Mike Amesbury (Weaver Vale) (Lab)]

Does my hon. Friend agree that doctors and clinicians should prescribe only medicines that have a strong evidence base and have been shown to be effective in trials? On that basis, does she agree that wholly owned subsidiaries for the treatment of illness would be ineffective?

Oral Answers to Questions

Mike Amesbury Excerpts

Tuesday 14th November 2017 Commons Chamber

[Steve Brine]

It is not a complacent answer; it is a factual one. That is an important point to make. The Circle contract has been uplifted by approximately £10 million because of the increases in tariff costs, as the hon. Gentleman rightly says. That increase would have been applied to any provider, not just Circle. I am sorry that he does not support the new MS services across his constituency. My understanding is that, previously, those services were delivered by a number of different providers, with a wide variation in clinical outcomes for his constituents, in costs of care and in-patient experience. This is a step forward.

[Mike Amesbury (Weaver Vale) (Lab)]

11. What progress he has made on the contaminated blood inquiry and on providing people affected with financial support.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

After the Prime Minister announced an independent inquiry into infected blood, the Department of Health consulted on the form of that inquiry. The Cabinet Office updated the House on 3 November, stating that it would be a statutory inquiry under the Inquiries Act 2005, and that the Cabinet Office would be the sponsoring Department. The NHS Business Services Authority started administering the new English infected blood payments support scheme on 1 November.

[Mike Amesbury]

From April next year, those affected by contaminated blood, including Michael in my constituency of Weaver Vale, could face considerable cuts in their discretionary support as the whole matter is currently under review by the Business Services Authority. Will the Minister give a clear-cut guarantee that absolutely nobody will be left worse off as part of that review?

[Jackie Doyle-Price]

I can absolutely give the hon. Gentleman that assurance, and that will form part of my statement on the response to the consultation, which we announced earlier. Those discretionary payments will be maintained.

Social Care

Mike Amesbury Excerpts

Wednesday 25th October 2017 Commons Chamber

[Mike Amesbury (Weaver Vale) (Lab)]

The benchmark of a civil society is how it treats its elderly, its vulnerable and those who need support the most. Those are the values that underpin the outstanding work that happens every day in my constituency, Weaver Vale, and in constituencies across the country.

Whether care workers, nurses, social workers or volunteers who look after their neighbours, these people are motivated by a simple principle. As a country, we should care for, and care about, everyone in our society. Sadly, the reason we are having this debate today is that, when it comes to sharing and showing support for those values, this Government have let down the very people who deliver them and have failed those who rely on them.

Year after year, as they delivered their cuts, the Government who claimed that we were “all in it together”—remember that one—took aim at the most vulnerable instead of protecting them. Councils in my constituency have seen their budgets cut by 43%, with the most vulnerable struggling to access the care they need. Like many former councillors in this Chamber, I saw at first hand what cuts did to services and the effect on the people who relied on them. Now, as an MP, I witness this all too often. That effect was ignored by this Government again and again, until the Prime Minister was finally forced to listen. Even then, the action offered failed to deliver what was needed, putting the burden once again on local councils and residents, rather than on Downing Street, the only place that can deliver the proper funding needed to rectify this crisis.

The good news is that with proper, decent funding we can make a difference, by providing our amazing social care staff with the support they so desperately need. That is why we need a Labour Government. Earlier this month, I met the integrated care team in Cheshire West and Chester. Based at a local medical centre, they bring together district nurses, care workers, social workers, occupational therapists and co-ordination staff, providing excellent integrated care. The innovation and dedication of the team is exemplary, but unfortunately the funding is not. The workload exceeds staffing resources. The team needs six district nurses, but it typically operates with three or four. Recruitment is a struggle, and there is a shortage of carers in the area. Patients can be ready to leave hospital but no care packages are in place because of the lack of funding. This is the consequence of years of cuts and of pay freezes, zero-hours contracts—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

Oral Answers to Questions

Mike Amesbury Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

This is a very important issue and the hon. Lady is right to raise it. The Time to Change campaign has said that this year it will focus on men, specifically to try to address the issues she mentioned. We are rolling out crisis plans throughout the country to make sure we are better able to reach people who reach out to us.

[Mike Amesbury (Weaver Vale) (Lab)]

What reassurance can the Secretary of State give to the Amplify youth project in Northwich in my constituency that timely and improved access to mental health services will be provided?

[Mr Hunt]

We have said that by 2020-21 we want to be treating an extra 70,000 young people every year, but the truth is that that is still not enough. We need to bring down waiting times much more dramatically, which is why we are doing a lot of work across Government and we have a Green Paper coming out shortly.

Autism Diagnosis

Mike Amesbury Excerpts

Wednesday 13th September 2017 Westminster Hall

[Helen Whately (Faversham and Mid Kent) (Con)]

I congratulate the hon. Member for Enfield, Southgate (Bambos Charalambous) on securing the debate, and I am pleased to see so many people in the Chamber; it reflects the level of concern about the waiting times for autism diagnosis.

First, I welcome the efforts that clearly are being taken by Governments and local authorities to provide more support for children and adults with autism. Just last week, the doubling of the number of health visitors since 2010 was brought to my attention in my constituency. That has had benefits in supporting young families and, in particular, parents, when their child is not behaving as they expected. There are good things going on, but I want to talk briefly about the gap between the NICE guidelines on waiting times and what appears to be happening on the ground.

When I talk to parents in my constituency, it is clear that their experience does not involve a three-month waiting time. I have several accounts from parents who have experienced much longer waits. For example, one set of parents raised concerns when their child was four. That child is now 10 and they still do not have a diagnosis, despite many professionals seeing the child and indicating that they think that they are on the autism spectrum. In another family, the mother raised concerns when her son was 15 months old and the child was nearly four before she got a diagnosis. During that period, not only did the child regress and go, for instance, from talking to not talking and communicating to not communicating, but a lot of concern was raised about the mother’s mental health. Rather than her being given support to look after the child, it was all about whether she had mental health problems. She went for all the support that she could get, but it very much felt like the focus was not on supporting the child. I have a whole raft of such stories.

[Mike Amesbury (Weaver Vale) (Lab)]

Will the hon. Lady give way?

[Helen Whately]

We are very short of time, so I had best press on.

I draw on examples in part because we do not have regional data on waiting times. I asked the local clinical commissioning group and was told that it does not have easy access to those data, so I do not know what the waiting times are—I just have stories that make it clear that they are extraordinarily long. My first request is therefore for more transparency about the data, as well as addressing the problem of parents saying that they are waiting to wait—that is, that they are being passed from one list to another. Let us have transparency. Let us have people who are waiting getting seen sooner and then, following the diagnosis, let us have really good support services, because the story is very patchy in that area, too.

--- Later in debate ---

[Jo Platt (Leigh) (Lab/Co-op)]

I thank my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) for bringing this important debate here today. Like many others, I have many constituents who have contacted me and highlighted the effect that delays in diagnosis can have. The process is often a long and confusing experience for the child and a source of great stress for parents, carers and family members. My work with children and young people during my previous role within the local authority has given me a really good understanding and great insight into the huge gaps that children and families face. Delays in obtaining diagnosis vary widely from child to child and from area to area.

As others have done, I will read out a statement from a constituent; she has two autistic children. Debates such as this are for hearing directly from those affected. This is Katy, who said:

“My first child had a reasonably short period of assessment lasting 12 months, but my youngest son is just beginning the process and we have been advised that it could take up to three years. As he is nearly three, he would be expected to go onto a school place and as such could potentially struggle and fall behind.”

They will not get access to an education, health and care plan, and

“he will not be accepted into a SEN school without this diagnosis.”

How is it right for her and her son to go through the agony of not receiving appropriate care due to the assessment process? That process has a huge impact on children being able to access the schooling environment and support they need.

[Mike Amesbury]

I want to illustrate this. A constituent has a son, Sam, who is seven years of age. They have been waiting a considerable length of time—months and months—and no longer know what to do or how long to wait. They came to me in frustration. With no diagnosis, there is no EHCP, which means no provision, as hon. Members from across the Chamber have said. They must battle on and on.

[Jo Platt]

That is exactly the point that we have all been raising. As mentioned by many here, people have gone through their entire lives without being diagnosed. In some cases, that does not present a real issue, but for others it presents decades of being misunderstood and misdiagnosed with other conditions.

Dawn is another woman in my constituency. She had spent all of her life being treated differently and feeling ill at ease with all that went on around her. This year, she was diagnosed with autism at the age of 46. She said to me that now that she understands her condition, the world makes sense. Dawn and many like her are determined to make a difference. She is exploring ways in which she can help and support other adults in the same situation and to advocate for better understanding of the condition. I applaud Wigan Council, because it understands the gaps and wants to bridge communities, businesses and other public services to create that better understanding for people affected.

I urge the Minister to ensure that the process of diagnosing and supporting people with autism is consistent across the country, with that process informing and supporting all public services and the wider community, and that the latest recommendations and resources are allocated at the earliest opportunity to support the individual’s needs and promote better outcomes for all.

Contaminated Blood

Mike Amesbury Excerpts

Tuesday 11th July 2017 Commons Chamber

[David Hanson]

The hon. Gentleman makes a good point. The constituents who have approached me are concerned about what will happen to their children in the event of their death. They are concerned about the lack of insurance and the costs as a whole. This worry has been mentioned already, but in one case the records relating to the time of the infection have been lost by the state so some people may not be able hold anyone liable because the records have simply disappeared. I hope that the inquiry looks in detail at that those challenges.

I was pleased to hear from the Minister that the inquiry will be UK wide. The scandal happened before devolution, but I have constituents in Wales who were infected in Liverpool, which is under the Department of Health’s jurisdiction. I have constituents who were infected in Wales who live in Wales. I have also had correspondence with people who were infected in Wales but now live in other constituencies. It is important that we look at the picture as a whole. The Minister has given some indication of it today, but I will be interested to hear about how the devolved Administrations will be involved under the ultimate terms of reference. I want to hear about how the consultation will happen, what the terms of reference will be, and what opportunities there will be for input into the process. My constituents will want to ensure that we get to who is responsible, why it happened, what could have been done and, ultimately, whether any compensation or redress is needed to help meet the challenges they face, such as the one mentioned by the hon. Member for Huntingdon (Mr Djanogly).

Given that it will be a Hillsborough-style inquiry, it is important that the Minister—not today, but in due course—clearly sets out not only the terms of reference, but the terms of engagement. I was going to make the same point as the hon. Member for North Down (Lady Hermon) in that, to be frank, my constituents want to try to get on with their lives. Something happened to them when they were younger over which they had no control, but it has not engulfed their entire lives, so it would be helpful if the Government set out how victims can engage with the public inquiry in due course. It may be possible to engage through organisations such as the Haemophilia Society and others, but how will individuals who may not be involved with any organisation get representation? They may need financial support for that representation—perhaps they could have the independent advocate that was mentioned by the hon. Member for North Down—and they need to be able to put their case to the inquiry effectively.

[Mike Amesbury (Weaver Vale) (Lab)]

I am also pleased to speak on this occasion with you in the Chair, Madam Deputy Speaker. Picking up on my right hon. Friend’s point, a constituent of mine called Michael from Runcorn wants justice, but he wants justice that involves all the families. He wants them to be engaged and to be able to shape this Hillsborough-style inquiry. I welcome the inquiry that the Prime Minister and the Minister have announced, but people are impatient for justice that is shaped by the victims.

[David Hanson]

I am grateful to my hon. Friend. The point that I want to finish on—[Interruption.] Does the Minister want to intervene?