National Health Service Bill

Philippa Whitford Excerpts

Friday 11th March 2016 Commons Chamber

[Caroline Lucas (Brighton, Pavilion) (Green)]

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

It is an honour to have brought this Bill to Parliament today. It is the result of widespread consultation and has extensive backing from a raft of doctors and nurses delivering front-line care, as well as from local NHS campaign groups. Its backers include the British Medical Association council, the president of the Royal College of Paediatrics and Child Health and many local NHS staff and campaigners. I want to pay tribute to them all for their amazing work. I pay tribute, too, to Allyson Pollock, the professor of public health research and policy at Queen Mary University of London, and to Peter Roderick, a barrister and senior research fellow there, for their expertise and help.

The incredibly positive and wide-ranging popular support for the Bill reflects a strong belief in a publicly provided NHS. People are rightly worried because the NHS, consistently ranked one of the best in the world, is under threat like never before. It is under threat from underfunding dressed up as efficiency savings; under threat from cuts; under threat from the wasteful bidding of the internal market; under threat from increasing commercialisation and the steep increase in corporate sector contracts since the Health and Social Care Act 2012.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

A Select Committee on Health report in 2010 showed that the NHS’s running costs had more than doubled from 6% to 14%, based on the purchaser-provider split, and that was before the outsourcing and tendering of the Health and Social Care Act 2012.

[Caroline Lucas]

I am grateful to the hon. Lady, who speaks with great expertise in this area. She is absolutely right that the creeping privatisation and marketisation are, along with all the other problems they bring, incredibly inefficient.

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[Caroline Lucas]

I pay tribute to Labour colleagues who are here. Unfortunately, there were not enough to ensure that we could have had a closure motion earlier, about which I am sorry. However, the hon. Lady is absolutely right that we need to tackle reorganisation head-on. Some will argue that the NHS cannot face yet more reorganisation. I agree with that on one level, but the alternative of carrying on down the current route is absolutely impossible. The Bill is framed in such a way to ensure that reforms are implemented organically over time. Frankly, I do not think that we can do without it.

[Dr Philippa Whitford]

The NHS is being reorganised on a daily, weekly and monthly basis. Every time a service is outsourced, it is completely reorganised. By being taken over, people’s contracts are altered, and the shape of the service changes. In Scotland, we reversed the purchaser-provider split in 2004, and it was relatively painless. What we need is simply a decision not to outsource further and gradually to move back to geographical health planning instead of the fragmentation of clinical commissioning groups at a time when we need integration.

[Caroline Lucas]

That intervention is incredibly helpful, as it shows what is possible. The fact that it has been done in Scotland without major problem demonstrates that, if the political will is there, changes can be made.

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[Dr Philippa Whitford]

I have asked on several occasions in the Chamber about the contribution of the Health and Social Care Act to the current financial state of the NHS in England. We constantly hear that it is all just due to agency nurses, yet when we look at the five years before the change, we see that the NHS managed, somehow, to balance its books. It then had a debt of £100 million, then £800 million, and now we are looking at a debt of £2.5 billion. That is because we are not looking after everyone. We are giving the private sector the cheap people and the NHS ends up with the expensive people.

[Caroline Lucas]

The hon. Lady puts her point well.

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[Caroline Lucas]

I thank the hon. Gentleman. I think that point will be explored in Committee. I cannot point him right now to the relevant clause, but it is a serious point. I would say that we will have a better chance of having such a managed and planned NHS, in which we can ensure that there are appropriate services in rural and urban areas, if we have a guiding mind back in charge of the NHS. That is exactly what was broken by the provider-purchaser split. The hon. Gentleman’s point is a good one, and I would love to see it debated further in Committee.

When it comes to the overall direction of travel and the duty to provide, it is shocking that the private hospital share of NHS-funded patients grew rapidly between 2006 and 2011. By 2010-11, private companies performed 17% of hip replacements and 17% of hernia repairs, and handled 8% of patients. First attendances for orthopaedics or trauma, such as broken limbs, also increased, yet it is the NHS that invests in training and picks up the pieces when things go wrong in the private sector, and it is the NHS that so often innovates.

Following the coalition’s Health and Social Care Act 2012, the NHS Support Federation has been charting the impact of Government policy on the use of outside providers to deliver and plan NHS care. Its report, which came out last month, charts the continuing steep escalation of creeping private sector involvement in the NHS. Its research shows that more than 400 NHS clinical contracts, worth £16 billion, have been awarded through the market since April 2013. Over that time the private sector has won nearly £5.5 billion of them, so let me give a few examples of the kind of corporate takeover that we are talking about.

In September 2015, Capita, despite its chequered record in the provision of public services, took control of a contract worth £1 billion to be the provider of primary care services in England. In October 2015, Virgin Care won a five-year, £64 million contract from Wiltshire clinical commissioning group, Wiltshire Council and NHS England to provide community child health services in Wiltshire. As of April 2016, services including children’s specialist community nursing, health visiting and speech and language therapy will all transfer to Virgin Care. In my constituency, the private company Optum, part of the giant American corporation UnitedHealth, last year won a £1.5 million contract from Brighton and Hove CCG for referral management services.

Such outsourcing goes on despite a trail of failed, terminated and collapsed contracts, such as the £235 million contract for provision of musculoskeletal services in West Sussex, which was awarded but never begun once it was determined just how much damage it would do to other NHS services in the region. Then there was the collapsed £800 million contract for Cambridgeshire and Peterborough older people’s services. There are estimates that the collapse of that contract has cost the local hospitals, GPs and community care providers about £20 million. There is a third example, of course—that of Circle, the private company running Hinchingbrooke hospital, which pulled out after just two years of a 10-year contract. That company’s announcement came just after the publication of a damning report on the hospital from the Care Quality Commission that raised serious concerns about care quality, management and the culture at the hospital.

[Dr Philippa Whitford]

One of the areas in which I have concerns relates to the case of Mid Staffordshire. A lot of the blame in the Francis report was on the drive for foundation status, which meant that senior management were totally fixated on that instead of on the quality of care to the patient. Consideration should be given to clinical governance, so that management are responsible for the clinical outcomes and not just the financial outcomes.