National Health Service (Amended Duties and Powers) Bill

Oliver Heald Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford (Eltham) (Lab)]

I beg to move, That the Bill be now read a Second time.

Today we begin to restore the sovereignty of this House over our national health service. We begin to put patients at the heart of decision making. We will restore the responsibility of the Secretary of State to promote a comprehensive national health service. We will tear the heart out of the hated Health and Social Care Act 2012. We will remove the health service commissioners’ obligation to put services out to tender. We will replace the 49% private patient cap, and allow the Secretary of State to set limits. We will prevent competition authorities from interfering in mergers that are in the interests of NHS patients. We will stop the sale of assets that are in the long-term interests of patients and our national health service. We will restore the powers of the Secretary of State to direct health commissioners. We will create a framework for national health service contracts that will put the interests of patients before competition. We will protect the NHS from the imposition of competition rules by the transatlantic trade and investment partnership, and give sovereignty to this House.

Through this House, the Secretary of State will be accountable for promoting a comprehensive national health service. If any Government dare to impose competition on our national health service in the future, they will have to come before the House and repeal this Bill, if it becomes an Act. We, as Members of the House, will be accountable to our constituents for how we vote in that debate. There will be no hiding place.

Some have expressed the fear that the Bill opens the door to further privatisation. It does not. I accept that the last Labour Government unlocked the door to competition, albeit in a modest and measured way. I voted against the creation of hospital foundation trusts, which introduced legally binding contracts with NHS commissioners; in retrospect it was a mistake, because it brought procurement law into parts of the NHS.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I congratulate the hon. Gentleman on being so lucky in the draw. He has referred to competition. Does he not accept that Labour did much more than he is suggesting? The then Secretary of State, who is now the shadow Secretary of State, privatised an entire hospital in the east of England. That is privatisation. [Interruption.]

[Clive Efford]

It is not possible to compare what went on under the last Government with what has been introduced by the raw market mechanisms of the 2012 Act.

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[Sir Tony Baldry (Banbury) (Con)]

I congratulate the hon. Member for Eltham (Clive Efford) on introducing his Bill and on the robust candour with which he did so. I am only sorry that he was displaced from his usual perch in the House. However, I am confident that when, after the next general election, the Labour party finds itself again in opposition on those Benches, Labour Members will not have to share them with the UK Independence party because we will have won those seats back.

I can understand why, when there was a coalition Government at the start of this Parliament, the Liberal party wanted, as a condition of the entering into the coalition Government, a five-year fixed-term Parliament. However, one of the difficulties and drawbacks of five-year fixed-term Parliaments is that we have some of the longest general election campaigns ever, and that makes it quite difficult to differentiate substantive and serious political points and what is essentially electioneering. I can just imagine the hon. Gentleman making that speech on a wet Thursday evening during the general election campaign in the trades hall somewhere on Eltham high street.

[Sir Oliver Heald]

Does my right hon. Friend agree that it is good to hear an authentic south London voice speaking up for Labour values rather than the snooty lot from north London who manage the party now?

[Sir Tony Baldry]

Yes, but the first point I want to make is this. We need to be careful about what we say about the NHS in the run-up to general elections. The first general election campaign that I was seriously involved in was back in 1966. In every one since then, there has been a period when the Labour party has run around saying things along the lines of “24 hours to save the NHS.” That is very destabilising, as was evidenced today in a letter to a national newspaper by Dr Michael Dixon, the chairman of the NHS Alliance, and a number of other GPs, in which they say:

“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.

The Bill’s proponents claim it will remove competition from the NHS and guard against ‘privatisation’ by repealing key clauses of the 2012 Health and Social Care Act.

We believe this would be a backwards step for patient care, reorganising the NHS in a top-down way at a time when it needs to be looking ahead to the huge challenges of the future. These were set out in the NHS England Five Year Forward View, and we urge all politicians to support it rather than using the NHS as a political football.

Suggesting that GP commissioners have a ‘privatisation agenda’ is an ill-informed attack on the clinical leadership which improves services and helps patients.”

I agree. It is disappointing if politicians use the NHS as a political football.

The NHS is an enduring part of the post-war consensus on the welfare state. That consensus was agreed on by everyone who had gone through the deprivations of the second world war, had lived through the blitz, and were determined that there would be a better Britain. The NHS was supported by everyone, including Archbishop Temple, a brilliant Archbishop of Canterbury, who was the person who first coined the phrase “the welfare state”.

I have always been interested in the NHS, not least because both my parents became part of the NHS on its very first day. When it came into being in 1948, my father was a recently qualified registrar and my mother was a theatre sister, having served as a theatre nurse during the Coventry blitz. My parents spent the whole of their working lives in the NHS: my father went on to become the research secretary of the British Tuberculosis Association and a chest and heart specialist, and my mother went on to become a sister tutor.

The other reason I have always been extremely interested in the success of the NHS is that, in the nearly third of a century I have been fortunate to be the Member of Parliament for north Oxfordshire, the most important issue in my constituency has probably been the position of Horton general hospital and the retention of its services.

I have left instructions in my will that my body should go to the anatomy department of the university of Oxford, partly because there is quite a lot of it for them to work on, but also because I feel that the liver of anybody who has been an MP for nearly a third of a century must be worthy of some anatomical research. I am also determined that when they open me up, they will discover engraved on my heart, “Keep the Horton general.”

What we heard from the hon. Member for Eltham was a litany of gloom in the NHS, but Horton general hospital now has more consultants than at any time in its and the NHS’s history. The Oxford University Hospitals NHS Trust employs 11,598 staff, including 1,800 doctors and 3,600 nurses. It is important to make clear that, since 2010, the number of patients seen by the trust, including at Horton, has increased significantly. There has been a 19% increase in elected in-patient admissions, a 9% increase in emergency in-patient admissions, a 24% increase in day-care admissions and a 12% increase in out-patient attendances. Those are significant increases in just over four years, so the NHS continues to treat more out-patients and in-patients.

Over the past two years, the Oxford University Hospitals NHS Trust has managed completely to eliminate its financial deficit and increase the amount paid to the Oxfordshire clinical commissioning group, such that the group finished the year with a surplus. Most importantly, over the past couple of years the trust has managed to create 400 new jobs, almost all of them new doctors and new nursing posts. Sir Jonathan Michael and his team deserve considerable congratulations on managing to balance the finances of the trust and securing a large number of new medical and nursing posts.

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[Sir Tony Baldry]

We heard that argument during the passage of the Act, and it is simply wrong. It is wrong to suggest that somehow the Act opened the door to competition.

[Sir Oliver Heald]

I wonder if my right hon. Friend shares my consternation at the shadow Secretary of State’s remarks, given that throughout the 2000s, all we heard from Labour, John Hutton and the other Ministers he has mentioned was the importance of value for money and tendering for things. They are going back to the days of the right hon. Member for Holborn and St Pancras (Frank Dobson) being in charge.

[Sir Tony Baldry]

My hon. and learned Friend makes a very good point. There is confusion about whether we have got new Labour or old Labour. The Labour party has to set out how it would undo the market it created without further top-down reorganisation. It could not do it simply by removing the health rules that manage it. There has been no change on when to tender competitively; the rules on procurement are the same as those used by the previous Government. The Act makes it clear that the Secretary of State remains politically accountable to the NHS. The changes in the Bill would restrict the greater autonomy given to the NHS and inhibit staff from making the innovative changes needed to secure sustainable, high-quality care for patients. In particular, it would tie the hands of clinical leaders on CCGs, which the NHS England five-year forward view says should have more powers, not fewer.

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[John Healey]

The hon. Gentleman normally finds a common touch in the way he makes his points. I have to tell him that if he tries to trot out those sorts of figures on the doorstep in the next five months, he will find that they cut no ice with the public, because they know what is happening to their NHS day to day, and we will make sure they understand why it is happening.

[Sir Oliver Heald]

rose—

[John Healey]

I will give way to the hon. and learned Gentleman and then make some progress.

[Sir Oliver Heald]

Why should I apologise for the £150 million of investment in Lister hospital in Stevenage or the £98 million in Addenbrooke’s hospital in Cambridge—fantastic, world-beating facilities?

[John Healey]

We on the Labour Benches cannot wait for the debate on the NHS to be put right at the heart of the next five months of policy and political debate, and my right hon. Friend the shadow Secretary of State will make sure that happens.

Let me return to my point about the way that we in this House were misled about the reorganisation and the legislation. I am disappointed to see that the man who led it, the right hon. Member for South Cambridgeshire (Mr Lansley), is not in the Chamber today to explain himself. He argued—it was completely wrong, but he argued it—in the debate on Second Reading in January 2011:

“It is about gearing the entire system towards supporting the relationship between doctor and patient”.—[Official Report, 31 January 2011; Vol. 522, c. 617.]

Of course, it was not and it is not. As I argued, at the time from the Opposition Front Bench:

“The reorganisation and legislation is designed to break up the NHS, to open up all areas of the NHS to private health companies, to remove requirements for proper openness, scrutiny and accountability to the public and to Parliament, and make the NHS subject to both UK and European competition law.”—[Official Report, 16 March 2011; Vol. 525, c. 378.]

The Government were and are driving free market political ideology through the heart of our NHS.

The arguments that those of us on the Opposition Benches made then are those that we make now, and that my right hon. Friend the Member for Leigh (Andy Burnham) makes especially strongly from our Front Bench. That is why the Bill that my hon. Friend the Member for Eltham (Clive Efford) has introduced is so essential and why I am so pleased and proud to be one of his sponsors.

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[Andy Burnham]

I am sure that Tory central office has been ringing around for a few days trying to find some doctors who are still in favour of the 2012 legislation, and they found 11. Well, I think that is probably about the limit for the number of people prepared to put their name to it. I can tell the hon. Lady that thousands of doctors lined up with the Opposition and pleaded with her party to call off its reorganisation, and that included the British Medical Association and the royal colleges, but it would not listen. The Government ploughed on regardless, and the NHS has gone downhill ever since.

That is why my hon. Friend the Member for Eltham gave a stirring speech of the kind this House needs to hear more, full of conviction and passion, standing up for the national health service that he believes in. He has brought before the House a Bill that reaffirms the words of Nye Bevan’s original National Health Service Act 1946 on the democratic accountability of the NHS to the Secretary of State and, by extension, to this House. The Bill abolishes the compulsory tendering of NHS services and removes market forces. It reduces the private patient income cap back down to single figures. Once and for all, it fully exempts the NHS from EU procurement and competition law, as is our right under the Lisbon treaty. It sends the Government an uncompromising message that the NHS will never be touched by any TTIP treaty.

In particular, I commend my hon. Friend for saying that it is about time this House regained full sovereignty over the national health service. They gave it away—the Eurosceptics sitting there on the Government Back Benches—when they mandated open tendering of services. By doing that, they placed the NHS in the full glare of European competition law. [Interruption.] They do not like to hear it, but that is what they did.

[Sir Oliver Heald]

Is the right hon. Gentleman the same man who used to talk about an end to the polarising debate on private and public sector provision? Is he the same man who, when Secretary of State, privatised the services for an entire hospital at Hinchingbrooke? What is he doing today? It is buff and blow party politics.

[Andy Burnham]

I told the hon. and learned Gentleman earlier that that was incorrect and that he should withdraw the suggestion, because I did not do that. The contract for Hinchingbrooke was awarded under his Government. I will tell him who this man is. This is the man who, when Secretary of State, introduced the concept of NHS preferred provider, because I believe in the public NHS and what it represents, unlike him. I believe in an NHS that puts people before profit, unlike him. That is the man he is talking to, and that is what I will always stand up for.

[Andy Burnham]

I am afraid that the hon. Gentleman has to get his facts right, because they are wrong. When I was Health Secretary and Hinchingbrooke needed to find a new operator, I asked local NHS trusts in his area to come forward, and at the time none of them wanted to do that, so we had to find an operator—

[Sir Oliver Heald]

On a point of order, Madam Deputy Speaker. I may have inadvertently said that the contract was let, but I do not believe that I did. The true position is that it was the right hon. Gentleman who took the decision to privatise the services in that hospital, and it is wrong for him to seek to deny it. [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I appreciate that the hon. and learned Gentleman wishes to ensure that the record is set straight. He has attempted so to do, but it is not a point of order for me to deal with.

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[Sir Oliver Heald (North East Hertfordshire) (Con)]

I am grateful to have the opportunity to make a few short remarks. The hon. Member for Worsley and Eccles South (Barbara Keeley) is right to be concerned about any problem that occurs in the NHS, but I am sure she would accept that it is an enormous organisation and that the key point is that when things go wrong, the lessons are learned and things are put right. Most of the life of the NHS has been under Conservative Governments, and we on the Government Benches are as proud of the NHS as Labour Members are.

I congratulate the hon. Member for Eltham (Clive Efford) on being a strong voice for Labour principles, but I am concerned that the effect of his Bill will be to undermine the operational independence of the NHS, cause disruption and introduce unnecessary bureaucracy. Putting powers back with the Secretary of State through the re-establishment of powers of direction is going in the wrong direction. Preventing illness, diagnosing and treating patients are not political activities. They should be in the hands of professionals and the operational independence of the NHS means that clinical considerations are paramount. When I was a health spokesperson, I went to look at health systems in Europe, and the key point I took away was that the best systems were those with a lot of clinical input in management.

It is not necessary to rewrite the Act. Instead, the changes we have made need to work their way through. The shadow Secretary of State said that the competition element is dominant in the Act, but that is not true. The procurement policy is set out to secure the needs of patients and improve quality and efficiency. I want to give an example from my constituency of how the reforms are working. Royston is part of the Peterborough and Cambridge CCG. Before that was so, we had a proposal for the redevelopment of Royston hospital. A Royston hospital action group was formed, while the friends of Royston hospital were concerned about the proposals, which were top down. However, Tom Dutton, the CCG strategic lead, has worked tirelessly with the NHS and the local community, as has the local chairman, Dr John Hedges, a GP in Royston, and they understand local needs, so we are now getting tailored provision that suits the needs of my constituents.

I meet the CCG, councillors, local groups and other stakeholders every six weeks, and I believe that we are now getting a service for Royston and a proposal that meet local needs. The £1 billion tender for older people’s services was in our CCG area. The hon. Member for Eltham criticised the cost, but we had a consultation meeting in Royston that 150 local people attended, while 250 local people filled out the questionnaire. The proposal and consultation will have cost money, yes, but the end result was that the tender process was won by the Uniting Care partnership, an NHS partnership involving Addenbrooke’s hospital and the Cambridge and Peterborough NHS trust, and it is now delivering more joined-up care.

[Dr Huppert]

I was delighted with that outcome. One of the successes I hope the hon. and learned Gentleman will mention is the better joint working between acute care, mental health care and community services to avoid delays in the transfer of care. This could be a very good outcome for the NHS and patients.

[Sir Oliver Heald]

That is exactly the point I was going to make. The process, which involved local people, has resulted in a reform that gives us the sort of joined-up care the hon. Gentleman mentions.

To conclude, the Bill seeks to prevent privatisation that is not happening on the ground, while some of the changes we have made are bringing positive benefits for people in my constituency.