National Health Service (Amended Duties and Powers) Bill

Philip Davies Excerpts

Friday 21st November 2014 Commons Chamber

[Clive Efford]

It is just not realistic to compare what went on under the previous Labour Government with what is going on now. Yes, the contract in Cambridgeshire, at Peterborough, was won by an NHS bidder, but what was the cost? How much money was diverted from patient care into running that tendering process? That is an increasing cost to the NHS that we cannot allow to continue. By the way, I unreservedly withdraw my accusation that the hon. Gentleman voted in favour of the 2012 Act, because that is a calumny I would not use against my worst enemy.

Through the House, the Secretary of State would be accountable—

[Philip Davies (Shipley) (Con)]

Will the hon. Gentleman give way?

[Clive Efford]

Yes, I will, because I have lost my place.

[Philip Davies]

I am delighted to help the hon. Gentleman out. Helpful as ever! He talks about stopping what he calls privatisation and about putting the Secretary of State in charge. At the moment, there is a cap on the amount of private income that a hospital trust can gain, but does he agree that clause 7 of his Bill would remove that cap, giving discretion to the Secretary of State? Does he acknowledge that the amount of private income a hospital could receive could actually go up under his Bill?

[Clive Efford]

There are a number of provisions relating to the Secretary of State which state that everything that is decided has to put patients first, rather than competition. That is the key difference in this Bill. The Secretary of State will have to be satisfied that every penny raised from private income serves the needs of patients. The Secretary of State will set the limit, which can be variable, but it will have to come down because this House will demand that.

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[Clive Efford]

I am grateful for my hon. Friend’s kind words and for the support of all the thousands of people, particularly health service staff, who have supported the Bill.

[Philip Davies]

Will the hon. Gentleman give way?

[Clive Efford]

I hope the hon. Gentleman does not mind, but I am going to make some progress.

Never before have we had market tendering of the health service as we have today, and it is breaking down our NHS. The Bill is not a solution to all the mistakes that this Government have made in their top-down restructuring of the NHS, but it is an important block on enforced privatisation. The argument can be simplified into two distinct sides. If people believe the NHS should be a pure market, open to competition regulations, where the interests of competition are put before those of patients, they belong on the side of the Government. If people believe the NHS is a public service that should be free of competition rules, where the interests of patients are put first, they should vote for the Bill today.

We know that No. 10 did not understand what was going on in 2012. The Chancellor was asleep at the wheel, and the Liberal Democrats, suffering from some form of terminal Stockholm syndrome, were led by the nose to turn the NHS from a public service into a free market. My Bill takes a scalpel to cut the heart out of the hated 2012 Act and put right the worst of the Government’s mistakes. It will remove the sections that require the tendering of NHS services for competition with the private sector, the result of which has been millions of pounds being diverted from patient care into the pockets of lawyers and accountants through the tendering process. NHS bodies are spending millions either bidding or managing bidding processes, and that is all money being diverted from patient care. That must stop, and this Bill will end it.

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[Clive Efford]

Absolutely. It is the capacity of the NHS to continue to provide services in the future that is under threat. Eventually and inevitably, with continuing privatisation of all its services, the NHS will end up as just a patchwork of contracted-out services, and that will put us at the mercy of the private sector.

[Philip Davies]

The hon. Gentleman talks about money being diverted away from patient care and about extended privatisation, but will he comment on the private finance initiatives that the previous Labour Government imposed right across the NHS, bankrupting many of its institutions and taking money away from patient care?

[Clive Efford]

There are issues about PFI, which we need to sort out. I must say, though, that the hon. Gentleman has picked on the wrong Member of Parliament. I have one of the very first PFIs in my local hospital. When was it advertised in the European Journal? In March 1995. It was a Tory PFI and it is one of the most expensive in the national health service; it is costing millions of pounds for my local hospital. Both Governments have something to answer for when it comes to PFI. There are issues that need to be put right, but people must understand that that will not happen under a Tory Government.

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[Sir Tony Baldry]

The point I am making, which I shall develop, is that the Bill is completely unnecessary. I also want to make the point that all Opposition Members seem to wish to deny that there has been any involvement of the NHS with the private sector. It is important to remind the House of the fact that it was the Labour party, and a Labour Government, who introduced the private sector into the NHS, and the 2012 legislation in no way significantly changed that relationship.

[Philip Davies]

Does my right hon. Friend agree that those people who support the Bill would be supporting the removal of the cap on the amount of private income that hospitals can receive? Does he think that, when 38 Degrees was encouraging people to write in about the Bill, it made that clear to the people who signed its petition?

[Sir Tony Baldry]

My hon. Friend makes a good point. I think the Labour party will regret signing up to every 38 Degrees campaign, because if 38 Degrees starts drafting the Labour party manifesto rather than the Labour party, the Labour party will never sort out whether it is new Labour, old Labour or any other sort of Labour, which is why it did so incredibly badly yesterday in the Rochester by-election.

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[John Healey]

Patients say exactly the opposite of what the hon. Gentleman has just argued. However, I understand that he feels he has nothing to apologise for. If he fundamentally believes that the NHS should be a system based on full-blown competition, delivered by the private sector, then of course he would want to legislate in that way.

[Philip Davies]

While the right hon. Gentleman is going back to fighting some 1980s ideological warfare, I think most constituents are bothered about what happens in practice. Is he really asking me to apologise to my constituents for the fact that there are now 9% more professionally qualified clinical staff at Bradford teaching hospital and 42% fewer senior managers, or that there are 7% more professionally qualified clinical staff at Airedale NHS Foundation Trust and 14% fewer managers, or, I might add, for the brand spanking new, state-of-the-art A and E department at Airedale hospital? Does he really think that is something to apologise for?

[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.

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[John Pugh]

If the hon. Member for Eltham (Clive Efford) wished to talk about that, we could happily move away from the internal market where local circumstances required and demanded it. That would be an entirely sensible policy. I see no reason, though, why health boards should not procure goods and services based on simple best-value principles without all the competition legislation that has been vilified in the debate. They should be funded—as most services are—by capitation and according to local need, and they should be in some way democratically accountable, and I think we can get a genuine public service element back into the NHS. However, not every political party is advocating that at the moment, and some are steering in quite the opposite direction.

[Philip Davies]

The hon. Gentleman is making a thoughtful speech, as is typical of him. Does he agree that what we are dealing with today is an Opposition party in desperate straits that knows exactly what it is doing in using the word “privatisation”? It knows that people out in the country associate it with having to buy private health care, but actually nobody is proposing to change the fundamental ethos of the NHS, which is that treatment is free at the point of need. The Labour party is conflating the two as a desperate political tactic.

[John Pugh]

The hon. Gentleman is not altogether wrong, but if we are to continue to deliver, in stressed circumstances, a service that is free at the point of need, we cannot run the NHS as an internal market for ever. In fact, the NHS is already trying to morph into something different. We now have health and wellbeing boards, which mean that commissioners and providers get together to try to agree a local plan. They are struggling in every way to behave like a health board, but they do not have the executive powers to do so. There has been the move away from tariffs, which have been used to try to adjust the market, and we are now talking about whole-treatment costs. There is also talk about integration.

What is clearly entirely disruptive, though, is the intrusion of competition where it is not needed—where it is simply dogma; where it is seen as a panacea for producing good results, whether or not there is a good case for saying that; where it derails sustainable services; or where it becomes a central operating principle of the NHS. None of those things is particularly helpful.

I do not want to comment on TTIP, because I do not think it is well understood at the moment, but we will certainly need to look at how it plays into the competition agenda.

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[Mark Reckless]

That is an excellent website, which I recommend to all Members. The Minister has said that my hon. Friend made those observations when most of the Committee stage of the Bill had been completed. Was that during the “pause” that had been invented as a new mechanism for Parliament? My hon. Friend is not here at the moment, but I think he would agree with me that the 2012 Act is not as it was billed to us by those on the Government Front Bench. It has led to an extraordinary degree of additional complexity in the NHS, and the introduction of competition bodies—and, in particular, European competition law—into the NHS is not welcome.

[Philip Davies]

Will the hon. Gentleman give way?

[Mark Reckless]

No, I will continue for a bit, if I may.

I do not think that the extent of the difficulties that doctors and others would encounter as a result of section 75 of the Act and the bureaucratic, market-based—or quasi-market-based—commissioning rules that it requires was any more apparent to my hon. Friend the Member for Clacton than it was to other Members, although some Opposition Members may have had premonitions of it. I thought that the Bill was intended to allow the various local bodies to get on with running the NHS in their areas. Some would run it better than others; there would be local decision-making and discretion, and people would learn from each other. Now, however, there are centrally determined rules that force everyone into, in particular, commissioning or contracting behaviour, but do not make sense in the context of the service that is being delivered.

[Philip Davies]

I congratulate the hon. Gentleman on his victory in last night’s by-election. It was an excellent result for him and it would be churlish not to point that out. I know that he is a long-standing believer in localism. Is he not worried by the British Medical Association’s concerns that the Bill would give much wider powers to the Secretary of State, thereby centralising powers and taking the day-to-day running of the NHS away from clinical staff and putting it in the Secretary of State’s hands? As a champion of localism, is he not worried by that?

[Mark Reckless]

I am grateful to the hon. Gentleman for his congratulations; that is very decent of him. I am not a fan of quasi-autonomous bodies, of great amounts of regulators or of overlapping layers of bureaucracy; they rarely work. Given the degree of complexity that has now been brought into the NHS, I think it is possible—although I am not certain—that the centralisation of power in a single Secretary of State who is at least accountable to the House might be better than the current diffusion and fragmentation of powers, which does not seem to be working effectively. My party would like to replace the alphabet soup of regulators and the overlapping layers of bureaucracy with a single, elected health board for each county area. That would give a degree of clarity to the oversight and management of the NHS.

[Mark Reckless]

There is an argument for doing that, and a judgment has to be made. It might be possible, depending on the different areas of the countries—particularly in the devolved Administrations—that the solution to that question might be different. My general view is that it is much better to have democratic accountability than not to have it, and in many areas I would prefer that to be local. My party wants to see health boards elected on a county basis.

My party also wants European competition law to be taken out of the NHS, and the Bill is exemplary in that regard. I strongly support that provision.

I have signed a pledge on TTIP, along with most other candidates in the by-election, except for the Conservative—[Interruption.] No, not the Liberal one—that was not a good one to sign—although I did vote against tuition fees, along with most Opposition Members. I would like to see the NHS excluded from TTIP. There are arguments as to whether it will be or not, but those arguments should be settled in the House as per this Bill, rather than being left to the unpredictability of future legal actions.

[Philip Davies]

Will the hon. Gentleman give way?

[Mark Reckless]

I am just reaching my conclusion, if I may.

The hon. Member for Eltham made a mistake in talking about the UK negotiating on TTIP. That is an area of exclusive competence for the European Community, and it is therefore the EU Commission that will negotiate with the United States on that matter. When I first heard about TTIP, it sounded as though it would be all about free trade and I thought that it would be broadly a good thing. The more I looked into it, however, the more it seemed to be not about free trade but about the creation of a single set of transnational regulations between the US and the European Union, and that it would be illegal for anyone not complying with them to sell goods and services. I am therefore very sceptical about TTIP and I am not sure it is something that I would want to support. I certainly do not want to see the NHS included in it.

I congratulate the hon. Member for Eltham on his Bill, and I look forward to supporting him in the Lobby.