NHS Reorganisation

Nadine Dorries Excerpts

Wednesday 16th March 2011 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

This costly reorganisation of the NHS has no mandate from the British people, and no support from health professionals or, apparently, the Liberal Democrats. It will be the end of the NHS that we know and love. As I have said before, the NHS is not just an organisation that plans and provides our health services; it also represents the values of our society by which this country sets much store. Contrary to the assertions from the Government Front Bench, the NHS reorganisation defined in the Health and Social Care Bill will wipe out the founding principles of the NHS in one fell swoop.

For the first time since the NHS was established in 1948, the Secretary of State for Health will not have a duty to provide a comprehensive health service. I will let that sink in. Instead, it is to be replaced with duties to “promote” and to

“act with a view to securing”

health services—weasel words that beggar belief. The original duty is fundamental to protecting the provision of a universal, comprehensive health service. It is the foundation on which the NHS was established. Without it, we will no longer be sure that a comprehensive national health service will be provided, and Members of Parliament will no longer be able to hold the Secretary of State to account on behalf of the constituents who elected them.

Rather embarrassingly for the Secretary of State, he might recall that, when he presented evidence to the Health and Social Care Bill Committee, I questioned him on this and asked him why he was repealing that fundamental duty. He said that he was not. However, it is absolutely clear from the Bill’s explanatory notes that that is exactly what will happen. Paragraph 64 states that clause 1

“removes the current duty on the Secretary of State in subsection (2) of section 1 to provide or secure the provision of services for the purposes of the health service.”

That duty is absolutely core: the NHS was established to provide a universal, comprehensive health service, but that will soon be gone. It is worrying that the Secretary of State did not appear to understand the implications of competition law, or to know what was being repealed in his own Bill.

The Government have suggested that these functions will now be the duty of the NHS commissioning board and the GP consortia, but the exercise of the functions will be discretionary. There will be no requirement to provide those services. So I repeat that the Bill will take away the duty to provide a comprehensive, universal health service.

[Nadine Dorries (Mid Bedfordshire) (Con)]

Will the hon. Lady give way?

[Debbie Abrahams]

No, I am sorry, I am going to make progress so that everyone gets a chance to speak.

The Government have also said that the NHS commissioning board will ensure that NHS delivery is free from political control, but I am not so sure about that. The Bill contains a variety of contradictions, particularly in relation to the Secretary of State’s appointments to the various quangos. Another of the founding principles under threat from this Government is that treatment should be based on clinical need and not the ability to pay. We heard the Secretary of State say that that would be protected, but the Government’s reorganisation of the NHS will result in opening up that fundamental principle. The NHS commissioning board and the GP consortia will have the power to generate income, perhaps by charging for non-designated services. What constitutes designated and non-designated services has yet to be defined, however. My hon. Friend the Member for Leicester West (Liz Kendall) tried to get some elucidation on that, but none was forthcoming.

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[John Pugh (Southport) (LD)]

I am glad to be called to speak. I had a hand in drafting both amendments and the motion in that it is taken from the Liberal Democrat conference. I appear to be responsible for the lot, so I may be a parliamentary first.

I begin by stating the blindingly obvious: the Health and Social Care Bill is in trouble. There is hostility to it from the professions, anxiety about it among the public, concern in the Cabinet and an unease that can be felt spreading in all sections and all parties in this House and the other place. That is just a fact, and it matters more than the political knockabout here or any loss of face, because the effects of the policy—for good or ill, for better or worse—announced with unseemly and misguided haste last June are going to be felt in every home in the country.

[Nadine Dorries]

I thank the hon. Gentleman for having the good grace to give way. Would he describe the 5,000 GPs who agreed to be part of the pathfinder consortia as “uneasy”? It appears to me that they are incredibly enthusiastic to get going.

[John Pugh]

I think it is Hobson’s choice.

This is not the first health reform—the last Government introduced more “step changes” than could fill an episode of “Strictly Come Dancing”—but it is certainly the biggest, the most expensive and possibly the most risky. The Secretary of State seems to have chosen for himself a path on which future generations will either put up statues to him or burn him in effigy. However, it is no longer his Bill; it is our Bill. No Secretary of State currently commands a majority in this House.

This Parliament may act like all the others hitherto—and, sadly, it usually does, as it has largely done today—but it is not like any other Parliament. There is no party in this House with a majority, so we should dump the tribalism, the point scoring and the political games. We can get round to doing what we have to do and what we need to do. We have the chance to scrutinise, to seek to amend and improve—and, if unsatisfied, the chance to reject the Bill on Third Reading. That applies to Members of all parties. It is not just “top-down reorganisation” of the health service that we should have dropped with the coalition; we should have dropped “top-down legislation”, whereby MPs simply become pawns in a wider political game, and conviction takes second place to coercion.

There has never been a Secretary of State who has looked at the NHS and found it to be perfect and incapable of improvement. That is largely because we demand so many incompatible things of it that any incarnation is unlikely to satisfy all. Each successive Secretary of State suggests proposals for reform, rather like the Flying Dutchman in a hopeless and sadly doomed pursuit of the ideal format for the NHS. I have to say that the current Secretary of State is probably better equipped for this eternal task than any others: he is committed, passionate, well informed—probably the best informed Secretary of State we have had for some time—and he is brave. He voyages on, undeterred by the siren voices of think-tanks from right and left and the warnings about costs and practical difficulties, and unfazed by the lack of enthusiasm, if the polls are to be believed, among the NHS crew and staff. Of course, as a Liberal Democrat I am disinclined to believe polls at the moment. He carries on, unmindful of the uncharted nature of the course he has set. In Committee, we found real gaps in the understanding of how things will proceed. It is not that he is unaware of the possible danger, but the big danger is that any potential shipwreck will cause us all to be engulfed if costs overrun, if productivity falls, if hospitals close, if waiting lists grow, if morale declines, or if the NHS appears to be denatured, privatised, and not safe in our hands. That is why Parliament’s role is so important in this context, and why good argument rather than the Government machine must prevail.

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[Karl Turner (Kingston upon Hull East) (Lab)]

It is a privilege to follow the hon. Member for Southport (John Pugh). Like him, I am a member of the Public Bill Committee considering the Health and Social Care Bill, and I always listen intently to his well-informed and reasoned speeches. I think that many Opposition Members, at least, will agree with what he has said today.

The Government’s proposed changes will fundamentally alter the nature of the health care system for the worse. That opinion is held not only by Opposition Members but by numerous experts, including the British Medical Association, the Royal College of Nursing and the Royal College of Surgeons, to name but a few. I am pleased to say that we now know that the Liberal Democrats agree with us on this issue, but it is not enough for them to talk tough. They must do what they say they can do. They should not just sit on the fence. They have a real opportunity to prove to the electorate that they can change Government policy when it is damaging and destructive to their constituents.

The damage that this policy will do is, in my view, irrevocable. Let us make no mistake: the Government are ripping the N from the NHS. They are planning, by stealth, a wholesale change in the structure of our health service system. The plans are damaging and, without question, revolutionary rather than evolutionary.

[Nadine Dorries]

Will the hon. Gentleman give way?

[Karl Turner]

Not at the moment.

The Government Front-Bench team and its Lib Dem colleagues can argue against what I say until they are blue in the face, but we know what the reality is. The chief executive of the NHS, Sir David Nicholson, says:

“The scale of the change is enormous—beyond anything that anybody from the public or private sector has witnessed”.

When we bear in mind the context of the plans, the destruction to the NHS becomes very apparent. The plans are to be implemented at a time when the NHS is to make £20 billion in efficiency savings. This is a costly, unnecessary and reckless top-down reorganisation of the NHS, and it is without any real mandate. The coalition agreement clearly states that the new Government will stop the top-down reorganisation of the NHS. Instead, we are faced with a reorganisation that is described as being so big

“you can see it from space.”

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[Paul Blomfield]

No. I have said it once: I have given way, and will not give way again, because I want to make progress.

The Government’s plans mean that as we return to the days of long waiting lists, in will step the health insurance companies, perhaps with their links to new commissioning bodies, which will pitch to those who understandably want the assurance of prompt treatment when they need it. There would be a self-reinforcing cycle: more patients would go private to escape worsening NHS services, and NHS providers would then prioritise private patients, worsening services further. Before long, the NHS would be changed beyond recognition. Its founding principles of free and equal treatment for all who need it would be fundamentally undone. No wonder that the chair of the Royal College of General Practitioners has attacked the plans as

“the end of the NHS as we currently know it”,

or that the Royal College of Midwives has said that

“this could accelerate the development of a two-tier service within foundation trusts, with resources directed towards developing private patient care service at the expense of NHS patients.”

[Nadine Dorries]

Will the hon. Gentleman give way?

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[Helen Jones]

I am sorry—I have not got time. [Interruption.] Other Members are waiting to speak and I will not give way.

The market, not the patient will be king. That is being done under the cloak of localism—the Government’s current buzz word. Remove the cloak and we will see the realities: an NHS driven by the market, run by a vast, unelected and unaccountable bureaucracy, with accountability to Parliament greatly reduced.

The Government plan to give all commissioning to GPs. They conveniently ignore the fact that if GPs wanted to be managers, they would have taken MBAs rather than medical degrees. They will bring in other companies—mostly private—to do the managing.

[Nadine Dorries]

Will the hon. Lady give way?

[Helen Jones]

I have said no. The hon. Lady was not even here for the beginning of the debate.

It is not sufficient for the Government to ensure that private companies determine our health care; they will also introduce EU competition law into the NHS. That means that the private health companies that are currently hovering over the NHS like a bunch of vultures will threaten legal action if services are not put out to tender. They will then cherry-pick the services in which they can make the most money—they do not want to do geriatric care, paediatrics or A and E. That will fatally wound and undermine local hospitals and some, no doubt, will go to the wall. It is no surprise that the Health and Social Care Bill includes detailed insolvency provisions.

Some hospitals will bring in more private patients to fill the gap, because the Bill lifts the cap on private patients. We will therefore have the absurd situation of private companies making decisions on health care, and of NHS staff and facilities being used not for those most in need, but for those with the ability to pay. There is a word for that and it is not often used in this House: it is quite simply immoral. It is also indefensible.

At the same time, these plans will undermine our ability to deal with long-term conditions. Progress has been made on conditions such as stroke through co-operation, not competition. It has been made through stroke networks, by sharing expertise and by reconfiguring services to get the best deal. All the expertise in primary care trusts on delivering those services will be swept away.