Privatisation of NHS Services

Debate between Philippa Whitford and Alex Chalk

Monday 23rd April 2018 Westminster Hall

[Alex Chalk (Cheltenham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hosie, and to say a few words in this important debate about healthcare. Only this morning I had the pleasure of visiting Charlton Lane Hospital in my constituency. It treats people with functional mental health problems and dementia. It was striking to see so many dedicated nursing staff who work in such a challenging field, but show such consistent humanity and dedication.

NHS outsourcing to private providers is a sensitive topic, but that is essentially because it has been dressed up as a threat to the NHS’s guiding principle—namely that treatment should be provided free at the point of use and regardless of ability to pay. Nothing could be further from the truth, however. That principle is fundamental, inviolable and enduring. It is all those things because it reflects so much about the kind of country we are and want to continue to be.

This point has already been powerfully made by my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), but it bears repetition. When a member of the public is rushed into hospital needing emergency care, we take pride in the fact that the ability to pay is irrelevant. NHS staff are interested in vital signs, not pound signs. That is why it was no accident that the NHS featured so heavily in the stunning opening ceremony for the London Olympics in 2012. It did so because it reflects our nation’s values. While it is perfectly legitimate to have a debate about the precise mechanics and arithmetic of how to deliver the principle of providing care free at the point of need, it would be wholly wrong to pretend that the principle itself is in play, because it is not. There is simply no appetite for the Americanisation of British healthcare. Even if there were, I could never support it, and I am entirely confident that my colleagues on the Government Benches could never support it either. It is vital that we do not conflate the word “privatisation” with Americanisation or fragmentation. It is neither of those things.

[Dr Whitford]

What is the hon. Gentleman’s view of patients who are being asked to provide co-payments of more than £800 to have a second eye cataract surgery or to pay for their second hearing aid? That has been creeping into NHS England. Patients are being asked to pay for more and more items.

[Alex Chalk]

I am grateful to the hon. Lady. I respect her past record and her contributions to the House. There is an ongoing debate among clinicians—no doubt colleagues of hers—about what the NHS should cover. Most of the clinicians I speak to would welcome a more open, non-partisan and grown-up debate about the full extent of the NHS, but the guiding principle should not be confused. Whatever it is that the NHS can provide, the core principle is that it will provide it to individuals in our country regardless of their personal circumstances. I am at pains to emphasise that, because from listening to some of the contributions of Opposition Members—no doubt made entirely sincerely, but made none the less—one could be confused into thinking that that principle was under attack. It is not, and it never will be.

The debate is about the delivery of a common goal. Many take the view, with some justification, that we should be open to solutions that deliver that goal most effectively for patients. Last year, the respected and politically independent King’s Fund wrote in its report:

“Provided that patients receive care that is timely and free at the point of use, our view is that the provider of a service is less important than the quality and efficiency of the care they deliver.”

When debating this important question, we should not rewrite history. As the hon. Member for Ealing North (Stephen Pound) has conceded, it is a fact that certain services have been provided independently since the NHS’s inception 70 years ago. Most GP practices are private partnerships; the GPs are not NHS employees. Equally, the NHS has long-established partnerships for the delivery of clinical services such as radiology and pathology, and non-clinical services such as car parking and the management of buildings and the estate. To give an everyday example, the NHS sources some of its bandages from Elastoplast. That is common sense. It would be daft if public money was diverted away from frontline patient care to research and reinvent something that was already widely available. It would be just as daft if the NHS had to do the same for its water coolers or hand sanitisers.

As the King’s Fund put it in its 2017 report:

“These are not new developments. Both the Blair and Brown governments used private providers to increase patient choice and competition as part of their reform programme, and additional capacity provided by the private sector played a role in improving patients’ access to hospital treatment.”

Throughout Europe there are healthcare systems that offer high-quality care, free at the point of use, and make use of far greater numbers of private providers than the UK.

I want to say a few words about the impact on my constituents in Cheltenham. I will give three brief examples. First, Cobalt is a Cheltenham-based medical charity that is leading the way in diagnostic imaging. It provides funding for research, including into cancer and dementia, which it does as part of a research partnership with the ²gether NHS Foundation Trust. It assists with training for healthcare professionals, and it even provided the UK’s first high-field open MRI scanner, which is designed for claustrophobic and larger patients. Are we seriously suggesting that is an affront to patient care in Cheltenham? Not a bit of it. Are we seriously suggesting that getting rid of it would be a good idea? Emphatically no.

Secondly, we have the Sue Ryder hospice at Leckhampton Court, which is a 16-bed hospice that delivers truly excellent care in the Gloucestershire countryside. It also provides hospice-at-home services. It also supports, as I know, family, carers and close friends. It is part-funded by the NHS and by charitable donations. It shows astonishing compassion, but also creativity and innovation in how it delivers care. The third example is Macmillan and its nurses. I need say no more about it—it is a fantastic organisation. To suggest that these independent providers and charities are somehow not good for patient care is to stretch a political principle beyond breaking point.

We also need to slay the myth—there was just a glimmer of it today, but it was not really developed—that somehow different types of providers are held to different standards. All providers are held to the same standards and given rigorous Ofsted-style inspections and ratings by the Care Quality Commission. For my constituents in Cheltenham, I want to see resources allocated as effectively as possible to free up resources for facilities such as A&E at Cheltenham General Hospital, which can only be delivered there. There is growing demand for A&E in Cheltenham, and the service needs to be 24/7.

It is right to say, however, that there are some legitimate concerns that can be properly addressed. The experience of Carillion has laid bare the chaos that can be caused when private providers take on significant contracts and then fail to deliver. We have to recognise that the consequences of failure in health services would not simply be an unfinished construction project, important though that is, but could be a decline in the quality of patient care. I mention that only because community services are disproportionately served by independent providers, but let us keep this in context. Based on a survey of 70% of CCGs in 2015, Monitor published analysis in its report, “Commissioning Better Community Services for NHS Patients”, showing that independent providers were responsible for just 7% of contracts. We should be vigilant, not dogmatic and quasi-religious in our approach. The NHS as a whole must ensure that no contract ever becomes too big to fail and that contingencies are always in place to cater for such an eventuality.

GP Recruitment and Retention

Debate between Philippa Whitford and Alex Chalk

Wednesday 28th March 2018 Westminster Hall

[Dr Whitford]

If the hon. Gentleman will bear with me, I shall come to that naturally later.

The issue of indemnity has been touched on. I am not sure whether it is realised how extreme the position is. GPs in England are paying three to four times the indemnity that GPs in Scotland are paying. The range in Scotland would be £1,500 to £2,300 on a range of half a dozen to 14 sessions, but in England that would be £5,500 to £9,500. That is a considerable chunk of money to ask of someone, and it is very significant when it comes to taking on the extra weekend surgeries of seven-day working, or out-of-hours work.

[Alex Chalk]

That is an acute point. Does the hon. Lady share my consternation, particularly with respect to out-of-hours work, that in the past few years the premiums have been rising stratospherically? I think they went up by close to 10% last year.

[Dr Whitford]

I absolutely agree. As I have said, it is not particularly an issue in Scotland, but it is very much one in England. I know that it is being looked at under the new contract. Hon. Members may remember the Prime Minister’s challenge fund: extra surgeries at the weekend are better paid and do not involve the same indemnity issues as going to do a stint at the local out-of-hours. Unconsidered consequences of that kind must be looked at.

There is obviously increasing demand. We talk negatively about the ageing population, but living longer is a good thing, and I would like to recommend it. I spent 30 years trying to achieve it. In Scotland the number of GPs increased by 9% between 2005 and 2015, but the number of patients over 65 increased by 18%. Obviously, much innovation across the UK is to do with trying to reduce workload. Scotland was first to get rid of the quality and outcomes framework, which had encouraged significant quality improvements but grew into a huge bureaucratic machine. We are working on developing the multi- disciplinary team, with physios, access to counsellors, and pharmacists. That is happening in England as well. One innovation in England is known as “time for care” and concerns extra training at the frontline—reception—to encourage triage of patients to the right member of the team. However, my attention has been caught by the development of a new app that allows patients to book appointments directly; that would remove the option for triage. It is important for innovations to be joined up.

We need to innovate and to use all community resources. Scotland has for 10 years had community pharmacies providing minor ailment services. Our optometrists are allowed to make direct referrals to hospital for cataracts, and now they treat 90% of all acute eye problems. Those are things that may at the moment be referred to general practice simply to ask for a letter to be passed on. That is a waste.

There has, obviously, been a climb in the number of practice vacancies, including in Scotland. Our whole-time equivalent has fallen, in the past three years, by 1.9%—in England the figure is 2.8%. There has been a 50% increase in the number of GPs taking early retirement, at the age of about 57. Some of that is because of the change in pension tax rules. The problem of having too big a pension is a nice one to have; however, if people who invested 40 years ago in very expensive added years are finding suddenly, as they approach retirement age, that that means they are accruing no further pension, we have a problem.

Brexit is definitely a threat. In Scotland, 3.5% of the health and social care workforce—and 5.8% of doctors—are from the EU. In London the figure is 14%. We know that 14% of EU doctors in Scotland, and 19% in England, are already in the process of leaving and, as has been said, that is simply because they feel unwelcome. As we have seen with the difficulty of getting tier 2 visas over the past four months, recruiting from outside the EU is a real issue. Businesses in London can increase someone’s salary to get past the limitations, but the NHS is not able to be so flexible.

Rights of EU Nationals

Debate between Philippa Whitford and Alex Chalk

Wednesday 19th October 2016 Commons Chamber

[Alex Chalk (Cheltenham) (Con)]

The contribution of EU nationals to our country is difficult to overstate, which is why I do not disagree with a word of the first part of the motion. There are now 3 million EU nationals living in the UK. They are overwhelmingly in employment, living decent, law-abiding lives and enhancing British society. A fact that has sometimes been lost in the discussions about immigration over recent months is that the success of the British economy over recent years owes a great deal to the contribution of EU nationals. In 2014, more jobs were created in the county of Yorkshire than in the whole of France, and more jobs were generated in the UK than in the rest of the EU put together. EU nationals have helped to build that success, and in doing so helped to pull our country back from the financial abyss we were staring into in 2010.

In Cheltenham alone, Polish nationals in particular have, in a short period, become part of the backbone of our community and our way of life. They are there working in Monkscroft care home, in Cheltenham general hospital, in the shops on the Promenade and in our bars and restaurants, and the overwhelming majority of them do so quietly, diligently and uncomplainingly. Their work ethic and “can do” attitude are an object lesson. They seek nothing more than the right to stand on their own two feet. The message that must ring out from this Chamber then is that those who have come and built their lives here are welcome, valued and respected.

In that context, it is—unusually, perhaps—hard to disagree with the SNP sentiment, but I fear that the motion appears to be political. I am sorry to say that it appears to be mischief-making at best and irresponsible at worst. I say that with some diffidence, because much of what comes from SNP Front-Bench spokesmen bears listening to. I have concerns about the motion, however.

First, as my hon. Friend the Member for Newark (Robert Jenrick) indicated, the fact is that by the time Brexit happens—I was a remainer—the overwhelming majority of EU nationals will have the right to remain in the United Kingdom because they will have indefinite leave to remain.

[Dr Philippa Whitford]

Will the hon. Gentleman give way?

[Alex Chalk]

Let me just develop my point and then I will come to the hon. Lady.

Secondly, let us be clear: EU nationals are not going to be required to leave. It is not going to happen. I would not vote for it. The House would not vote for it. It would be morally bankrupt and economically ruinous. There is therefore a danger that the motion unnecessarily sets hares running. It stokes fear when none need exist.

The reality is that the duty of any British Government—this is plain as a pikestaff—is to protect the rights of their citizens. The SNP’s contributions have been disappointing because they have not acknowledged the fair point that 1 million British citizens living abroad want reassurance, too, because—guess what?—they have families, jobs and livelihoods that they do not want to lose. It is a fair point that no EU Head of State has provided our nationals with that reassurance, including Scottish nationals.