NHS (Private Sector)

Rosie Cooper Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

It did not, and I would expect a Minister not to make misleading statements like that in a debate of this kind. It did not propose the removal of the cap: it said that more freedom would be given to NHS hospitals with a modest loosening of the cap. That was my policy as Health Secretary. We did not propose removal of the private patient cap.

[Rosie Cooper (West Lancashire) (Lab)]

Does my right hon. Friend know whether the private operations will be charged at tariff? Is there a limit on the charge hospitals can make? Will it be at tariff or at a premium on tariff? Would that not be a way of increasing the amount of resources coming in? Less work would be done on the NHS.

[Andy Burnham]

My hon. Friend raises an important issue. We have not had those safeguards; there has been no explanation from the Government of any safeguards that will be introduced under this liberal measure. This evening, we need to probe exactly what they have in mind. During the pause, they said that they would restrict any competition on price in the NHS, yet they are bringing forward a measure that would allow NHS facilities to be used for the treatment of private patients with no guarantee that the private sector would not try to undercut NHS tariffs. Those are precisely the questions that the Government have to answer.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

There is no escaping the fact that the role of the private sector in the national health service is one of the most contentious issues to arise when discussing or debating the health service. Some people would suggest that there was no appreciable difference between the policies of the Labour Opposition and the Conservative Government, especially on the use of private companies to deliver services.

I believe that there is a huge chasm of difference, which has been borne out by this debate. It comes down to this: what we saw under previous Labour Governments was the private sector being used to add grit to the system. It operated in the system with strict limitations, and it was deployed, for example, to drive down waiting times from 18 months to 18 weeks. In tandem with targets, the private sector offered a means of improving the efficiency and effectiveness of the NHS, delivering choice and quality to patients. That is where our policies and those of the Government diverge.

It is clear that the intention of the Conservative-led Government is completely different. The NHS is under siege from the Government, who regard the private sector as a means to undermine and weaken the NHS. For all the rhetoric of the Prime Minister and the Health Secretary about their love of the NHS, I would assert that their actions have shown only that they do not fundamentally believe in the principles, values and ethos of the NHS. Those actions attack its very purpose and everything that people hold dear in that world-revered service.

The Government are pushing ahead with their Bill in the face of widespread opposition. Along with the majority of health professionals and the British public, I believe that the Bill should be stopped. Let me make it clear: nothing that I have heard from Health Ministers is reassuring for anyone who has fought to save the NHS. When the Government talk about a regulated market for the NHS people are, and should be, filled with fear.

There will be an increasing role for the private sector, and organisations can be both providers and commissioners. Any A-level business student could explain that that leads to a conflict of interest, and it contradicts and inhibits the notion of introducing genuine competition in the NHS, if that was the intention. I think that the Health Secretary may be mixing up words beginning with “c”. Instead of “competition”, I believe that the word he has been looking for is “cartel”. However it is dressed up, there is one thing I am certain of: allowing such a situation to develop is not in patients’ best interests. There are many questions that need answering. With the private income cap set at 49%, what guarantees are there that hospitals will be able to deliver choice and meet waiting times? What assurance can the Secretary of State give the House that private providers will not cherry-pick the best income-generation services, leaving cost-intensive services such as—

[Julie Elliott (Sunderland Central) (Lab)]

Does my hon. Friend agree that removing the cap will do nothing to help the problem of health inequalities and that it will in fact exacerbate the problem?

[Rosie Cooper]

National health services should be provided on the basis of need, not the ability to pay, so I agree.

I was saying that cost-intensive services such as accident and emergency services may well be threatened. How will the overall capacity of the health care market be managed effectively? How would the Government ensure that the proposal did not impact on the ability of hospitals to deliver urgent care?

We have had to proceed very quickly, but there are some major issues to consider. In conclusion, I urge Members to support the motion for the simple reason that it shines a light on how, once again, the Government are developing policy based on ideology and not on what is best for patients. The people’s trust was hard won and the Government have broken that trust yet again. It is another example of ill conceived, poorly developed, incomprehensible policy that we have come to expect from the Government, which leaves Members, the medical profession and our constituents with more questions than answers. A commentator said that the NHS was on the verge of a nervous breakdown. I believe that the way to save it is to kill the Bill.

National Health Service

Rosie Cooper Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

If that is the case, I respectfully ask the Health Secretary why he has not responded to a letter from my hon. Friend the Member for West Lancashire—

[Rosie Cooper (West Lancashire) (Lab)]

indicated assent.

[Andy Burnham]

My hon. Friend is nodding. Why has the Secretary of State not responded to the letter that my hon. Friend sent to him several weeks ago pointing out the discrepancy between his evidence and the statements from the RCN? If he wants to adopt a pious tone in the House, he needs to reply to his letters on time and put his facts on the record.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I would like to inform both my right hon. Friend and the Secretary of State that I did, in fact, write to you but have received no reply. In my letter, which I shall ensure gets to you again, I asked you to publish the minutes of that meeting. It was very clear. One or other of you have made a severe error.

[Mr Speaker]

Order. We must preserve the proper parliamentary terms. Nobody has written to me and I have not made a severe error. We will leave it at that.

--- Later in debate ---

[Mr Lansley]

I entirely agree with my right hon. Friend. That is not only the case in hospitals, where people can sometimes ask, “Under whose care is my husband?” It is also especially true in community care. I hope that there will be more integrated services in the community, but although there may be a range of providers, there must be an integrated service with a clear line of accountability.

[Rosie Cooper]

Will the Secretary of State give way?

[Mr Lansley]

No, as I need to conclude my speech. [Interruption.] I am sure what the hon. Lady says is true.

The NHS in Wales is not cutting its budget because everything is going well. Labour Members are fond of citing waiting times, but the latest figures on waiting times show that in England 90.4% of admitted patients and 97.3% of non-admitted patients were referred to treatment within 18 weeks, whereas the figures for Wales are 67.6% and only 74% respectively.

Let me tell the House about infection rates. In 2007, the clostridium difficile mortality rates in England and Wales were similar—in fact, the rate was slightly higher in England. However, in the latest year for which figures are available there were 23.4 deaths per million for men and 23.5 deaths per million for women in England, whereas the figures for Wales were 54.9 deaths per million for men and 59.5 deaths per million for women, so the level in Wales is more than twice that in England. In four years, the gap has widened to the point where Wales has double the number of deaths from C. diff infections relative to England. Less money, less innovation and less good care is what has been happening in Wales under a Labour Government.

I must make it clear that we are going to put patients at the heart of the NHS. We are going to focus on the NHS delivering excellent care every time. Labour focused on the targets and the averages, and never got to the place of really caring about the specifics. A patient about to go into hospital for knee replacement surgery does not want to know about the national figure; they want to know about their hospital, their ward and what will happen to them. The same is true for mixed-sex accommodation. Labour turned a blind eye to variation in performance. We are going to open it up to clinical and public scrutiny, so that we can reward and celebrate achievement and excellence across the service, and shine a light on poor performance.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his appointment as shadow Secretary of State for Health, a brief to which he brings valuable experience. We are going to need every bit of that experience, given what the current Secretary of State is doing to bring the NHS to its knees.

I strongly disagree with my colleague on the Health Committee, the hon. Member for Kingswood (Chris Skidmore). This is not their NHS. This is not your or my NHS. It belongs to the people, all of us. We all have an incredible stake in the NHS. The Secretary of State and the Government play with it, with their reputation and with patients’ needs at their peril. I believe your policy will fundamentally damage the NHS—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. May I remind the House not to use the word “you”? Members speak through the Chair and should use the third person, please.

[Rosie Cooper]

Forgive me. I have a great propensity to do that. I believe passionately in the NHS and I take this all very personally. I apologise.

The Government’s policy will fundamentally damage the health service in terms of both the quality of care available to patients and the founding principles of the NHS. The more we debate Government health policy, the less the Secretary of State seems to be listening, whether to Opposition Members, medical professionals, patients, patient groups or constituents.

I might go further and say that I now believe the Secretary of State occupies a parallel universe—a universe where everyone wholeheartedly supports his policy and believes him when he says that there is real-terms growth in NHS spending, a universe where waiting times are not increasing, people are not being refused treatments, bed-blocking is not happening because of pressure on the social care system, a universe where he never discussed the issue of re-banding of nurses with the Royal College of Nursing.

Unfortunately, while the Secretary of State, ably supported by the Prime Minister, is off in that parallel universe, which we shall call delusional, the rest of us are left facing the terrifying reality of what the Government’s policy means to our constituents and to the national health service. We must disregard the rhetoric and the myth-making of the Conservative party as it seeks to demonstrate that it has changed when it comes to the NHS. Sadly for the health service, the Conservatives have not changed at all.

I have spoken repeatedly about the Prime Minister’s clear promises to the British people—one was that there would be no more pointless top-down reorganisation. He even said:

“When your family relies on the NHS all the time—day after day, night after night—you know how precious it is”.

How quickly those words were forgotten. Michael Portillo comments on the BBC’s “This Week” spoke volumes. He could not have made it clearer that the Government meant to misrepresent their position and mislead their voters. He said:

“They did not believe they could win if they told you what they were going to do.”

My fear is that their broken promises are leading us headlong into a broken NHS.

There is much I could say about how disgracefully the Government started to change NHS structures without the consent of the people or the House. Because of those broken promises, a failure to secure a clear mandate for the reforms from the British public, and an abject failure to secure support from the clinicians and the medical profession, we are left in the present mess. I hear time and again that the doctors, the nurses and the professionals are all behind the Government. Where are they? They are shouting loud and clear, “We’re not with you.”

[Henry Smith]

Will the hon. Lady give way?

[Rosie Cooper]

I fell for that last time and did not get to the end of what I had to say.

I will not go on about the rest of the problems that I see with the Bill—the financial challenge, the fact that we are open to European competition regulation, or the fact that the chair of the NHS Commissioning Board believes the Bill is unintelligible. I believe the Bill has been driven forward as an ideological exercise, rather than by an ideological desire to improve the quality of health care available.

[Barbara Keeley]

Will my hon. Friend give way?

[Rosie Cooper]

Forgive me; I need to get to the end of my speech.

My right hon. Friend the Member for Leigh dealt with the finances and the myth of real-terms growth in the NHS budget. My local trust is being asked to go beyond the 4% savings compounded over the next four years and will be expected to achieve 6% or £8.5 million in this financial year. On top of that, Monitor expects trusts to make a 1% profit. People who have given evidence to the Select Committee have said it is clear that there will need to be hospital closures in order to release money back into the wider health service. We are told that this is all part of managing demand and redesigning pathways—two horrible phrases that appear to be back in vogue.

I want to deal quickly with the re-banding of nurses to reduce budgets, which the Health Secretary appears to have little understanding of. I am sorry he is no longer in his place. He clearly told the Health Committee that he was unaware that re-banding was taking place. His problem is that Janet Davies from the Royal College of Nursing told the Committee that, although the RCN does not release conversations, that issue was clearly discussed. I really worry about that. Does he have a twin he is sending into meetings on his behalf? Does he simply not listen? It would not be the first time. Or is the truth even worse, and should he be described in terms that Mr Speaker would call unparliamentary? The Secretary of State said earlier that he stood by his answers to the Committee. He has also claimed that he did not receive a letter from me, but I can confirm that he received it at 11.57 on 13 October, and I have confirmation from his office.

[Mr Simon Burns]

Will the hon. Lady give way?

[Rosie Cooper]

I will not.

The point is that even if the Secretary of State was not aware of the re-banding, as he claims, that speaks volumes about how out of touch he is with the hard-working staff he is supposed to represent. Perhaps he would like to remove himself from his parallel universe—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I call John Pugh.

--- Later in debate ---

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

It is always a pleasure to follow the right hon. Member for Rother Valley (Mr Barron). He would be surprised if I agreed with everything he said, but he made some good points in the first half of his speech.

Today’s debate has been a wasted opportunity for the Opposition, because nothing positive has come out of it—nothing about how we will better look after patients or how we will address very real needs in all our constituencies. There has been a lot of mud-slinging but very little talk about what will benefit patients and how we will deliver a patient-centred NHS.

That is to the detriment of the Opposition and to the way in which they have addressed the motion. It is disingenuous of Opposition Members to attack the Prime Minister and the Secretary of State for Health, and to try to give the impression that my right hon. Friends do not care about the NHS. All politicians and, I believe, everyone in the country care about the NHS, but we have slightly different views about how the service should be run.

I have a great deal of time for the hon. Member for West Lancashire (Rosie Cooper) and I like her very much on a personal level, but some of her points were wrong. In particular, it was wrong to bring the Prime Minister’s personal experience into the debate. He had a difficult family circumstance, and of course someone with that background will understand the NHS very well.

[Rosie Cooper]

rose—

[Dr Poulter]

The hon. Lady did not make her point very well, and she did not allow me to intervene on her. I am sure that the Minister will address the points that she made about the letter.

Health and Social Care (Re-committed) Bill

Rosie Cooper Excerpts

Wednesday 7th September 2011 Commons Chamber

[Paul Burstow]

The power to establish NHS trusts is contained in previous legislation. The Bill provides for, in due course, the repeal of the provision to establish NHS trusts. As we indicated in our response to the NHS Future Forum, that will not take place for several years to come. Regardless of that, however, the Secretary of State will retain the power to establish special health authorities that can exercise a provider function.

[Rosie Cooper (West Lancashire) (Lab)]

The Minister just said that the Secretary of State will have the power directly to remove the management of hospitals or provider organisations. Will that apply both to NHS and private providers? Will the Secretary of State’s reach go that far?

[Paul Burstow]

We discussed yesterday at some length the role of Monitor and its powers through the licensing regime, which will apply not just to NHS public sector providers but to private and voluntary sector providers. The powers there are extensive and I recommend that the hon. Lady should look at the debate we had yesterday.

Another issue that comes up is the duty of autonomy. Amendment 1197, which was tabled by my hon. Friend the Member for St Ives—not all of Cornwall—(Andrew George), seeks to remove clause 4, entitled “The Secretary of State’s duty as to promoting autonomy”. This clause was highlighted by the legal team advising 38 Degrees about the changes to the role and functions of the Secretary of State. The specific purpose of the autonomy duty is to free front-line professionals to focus on improving outcomes for patients rather than looking up to Whitehall. It does not undermine the overarching duty to promote a comprehensive health service, nor enable Ministers to abdicate responsibility for the NHS.

It is our view that the legal opinion published by 38 Degrees overstates the effect of clause 4. The opinion suggests that the court will expect the Secretary of State to demonstrate that any steps he took that interfered with the autonomy were “really needed”, or “essential”, and that no other course of action could be followed. This is not the Government’s intention and we do not believe that that is the effect of the clause. It would be sufficient for the Secretary of State to demonstrate that he had reasonable grounds for concluding that a course of action was the most effective way to act in the interests of the health service and fulfil a duty imposed on him by, for example, clause 1 or a new section 1A in the Bill.

--- Later in debate ---

[Rosie Cooper]

Great play keeps being made about consultation. I do not hear any play being made about the right to be heard or a right of veto, or whatever. CCGs can ask the health and wellbeing boards what they think; health and wellbeing boards might make a recommendation, but there is no obligation for anyone to listen.

[Paul Burstow]

The hon. Lady is completely wrong when she says that there is no obligation. There are clear duties in the Bill for health and wellbeing boards’ views, and their preparation of joint strategies on health and well-being and joint strategic needs assessments, to be legally binding documents, in the sense that CCGs must have regard to them. They are not pieces of paper that can be just tossed aside and dismissed. They are very important documents in the emerging system.

--- Later in debate ---

[Owen Smith]

As the Minister has just confirmed by omission, there will be no power to direct and therefore no power to deliver absolutely a comprehensive, universal health service as we have come to expect and understand it. Those are the key differences. [Interruption.] The Minister can shake his head, but that is an accurate interpretation of what has happened.

[Rosie Cooper]

My hon. Friend has been talking about mandates. Will he explain under what mandate and how the Secretary of State is implementing all these structural changes? The House has not voted on them and the process started before the Bill came to the House. You are making structural changes, damaging the health service and making it impossible—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I am sure that the hon. Lady will not be using “you”.

[Rosie Cooper]

Forgive me. I am for ever doing that, and I must stop. In essence, I am saying that the Secretary of State and Ministers keep talking about mandates and what they will and will not do, yet they are disregarding everything because they are implementing the Bill before it has been sanctioned by the House or the other place.

[Owen Smith]

I am grateful to my hon. Friend for that intervention. As she will know, the Government have no mandate for any of these things—they were not in the manifesto, the election or the coalition agreement. There is a mandate, but not one to effect these sorts of changes. That is another disgrace given how large the changes are.

I am going to move off this issue, but I will conclude by reading back to the Government their own words, which make it absolutely clear what they are doing in getting rid of direction. Paragraph 66 of the explanatory notes states:

“Currently, the Secretary of State is directly responsible for providing or securing the provision of all health services as set out in the NHS Act, a function which is largely delegated to Strategic Health Authorities and Primary Care Trusts…However, the new commissioning structure proposed by the Bill means that this would no longer be the case.”

The explanatory notes also state that

“functions in relation to the health service are conferred directly on the organisations responsible for exercising them”.

Effectively, the Secretary of State will move on and his focus will shift to public health.

--- Later in debate ---

[Rosie Cooper]

I fear that for all the listening, the work of the Future Forum, the concerns voiced by health professionals and our constituents who rely on the health service, and the two days of debate in this place, we have ended up on Third Reading with something that is not substantively different from the original idea. Although it is three times longer than the National Health Service 1946 Act, which created the NHS, the Bill before us leaves us with more questions than answers. I suspect that that will remain the case for some time, as the Government have indicated that more amendments will be tabled.

It is astonishing that we have progressed from a Bill that was never meant to be, because the Conservative party had promised no top-down changes to the NHS, to the Conservatives’ having a supposedly well-thought-out plan—which required a pause because of the sheer scale of the public’s and medical professions’ opposition—and then to the Bill that we have today, which needs more amendments. Sadly, the changes are not substantive enough. The Minister told us yesterday that 715 of the 1,000 amendments were intended merely to change the words “commissioning consortia” to “clinical commissioning groups”. I believe that the public, clinicians and those of us who could see right through the Bill were looking for something more substantive when the Government stopped to pause and promised to listen to people’s concerns.

The Health and Social Care Bill that we now have is still as confused and muddled as on the day it was first brought before the House. I expect that Ministers hoped to confuse and bore people into submission. Disgracefully, the Government began to change the NHS structures without the consent of the people even before they produced the Bill, and they continue to do so even though it has not passed through this House or proceeded to the other place—where it is to be hoped that it will receive the thorough and tough consideration that we should have had the time to give it here.

What we have is a Bill that is high on autonomy and low on accountability. It is supposed to be built on the principles of efficiency, reducing bureaucracy and cutting out waste, yet I do not believe it achieves any of them. In fact, in practice it does the opposite. The Bill will leave us with an organisational malaise, as the number of bodies and organisations significantly increases, with the relationship between them all being complex and incoherent and severely lacking in detail and accountability. The Bill leaves us with a financial challenge that has never been achieved in any health economy anywhere in the world at the same time as removing great swathes of the people with the experience and skills to deliver this outcome. The Secretary of State said that he admired NHS employees. If that is so, why have his policies led to so many of them losing their jobs?

The Bill will leave the NHS open to European competition regulation, all of which will be overseen by an economic regulator enforcing competition who appears to think the system can be based on an outdated and failing regulatory model like that of the utilities sector, and whose accountability to Parliament and the Secretary of State is unclear. Ultimately, I believe the Bill has been driven forward as an ideological exercise, rather than through a desire to improve the quality of health care available to the people of this country. The Government could have achieved the changes they said they wanted without all this structural mayhem, such as by reducing the number of primary care trusts, changing the make-up of the boards and putting clinicians firmly in the driving seat, but perhaps that was not macho enough.

This evening, the Government are in serious danger of consigning to the bin 13 years of progress, in which patients were being treated within four hours in accident and emergency and were guaranteed an operation with 18 weeks. Tonight, I genuinely fear that the Bill before us will be the equivalent not of throwing a grenade into the NHS, but of pushing the button on the nuclear option: a completely disproportionate response to the challenges facing the NHS.

In my speech on Report, I referred to the former NHS employee Roy Lilley and his blog. Today, he takes a quote from Mary Anne Evans, otherwise known as the novelist George Eliot:

“It is never too late to be who you might have been.”

I therefore urge the Liberal Democrat Members of this House to consider whether they genuinely believe this Bill will deliver a better, more caring and more patient-led NHS.

Earlier in the debate there were suggestions of scaremongering, so let me be clear: I am not scared; I am terrified—terrified that this Conservative Government will kill off the NHS, a system of health care that is envied throughout the world and that is being threatened for the sake of ideology. I am not scaremongering when I say that if this Government destroy the NHS, they will never be forgiven.

Health and Social Care (Re-committed) Bill

Rosie Cooper Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

I said that I would come on to the continuing role of the OFT in relation to mergers, and I will.

Returning to this substantial group of Government new clauses and amendments, the purpose of which is to set out the regime for the continuity of services, our new proposals focus on five particular changes. Together, the proposed changes significantly improve upon the existing situation. First, the Bill puts clinically led commissioning at the heart of securing high-quality services for local populations. It is therefore right that commissioners should have a leading role when continuing access to services is threatened. Our amendments therefore strengthen the role of commissioners. For the first time, commissioners will have an explicit role in working with Monitor to agree plans to secure continuity of services.

There will also be an oversight role for the NHS commissioning board. Where issues involve more than one clinical commissioning group, it will be the board’s role to co-ordinate agreement so that a joint plan is agreed. Secondly, commissioners will need to be supported in acting with providers to ensure that they have access to the scope, quality and choice of services they need. It is about promoting high-quality, effective and integrated services, as set out in clause 58. This will be the task of Monitor.

If need be, when continued access to services is threatened because of failure occurring in a particular provider, Monitor will have a range of actions it can take. For example, it could take action to secure sustainability of essential services by adjusting prices. This would be necessary where a provider is otherwise unable to cover the costs of essential services—for example, because of lower patient volumes in more remote areas of the country. That was included in the Bill from the outset, and our amendments strengthen the provisions by ensuring that Monitor must agree the methodology with the NHS commissioning board.

[Rosie Cooper (West Lancashire) (Lab)]

Will the Secretary of State be clear on this issue? Can the enhanced tariff that I think he is suggesting Monitor can use to save a provider apply to private companies as well as the NHS?

[Mr Lansley]

It would apply in any circumstances where it was necessary in order to secure continued access to essential services for patients, so a methodology would be in place. As I have described, the intention is to have a regime through which, although specific mechanisms will be applied to foundation trusts and to other providers—of course, the overwhelming majority of activity is in the hands of foundation trusts—the principles of intervention will be the same between the two sets of providers. We want to arrive, wherever possible, at a consistent application of failure rules. Why? Our concern is to make sure that we deal with this, which has not been the case in the past. Under Labour’s regime, if a private sector or independent sector provider failed financially, there was no appropriate mechanism for intervention and continuity of services.

--- Later in debate ---

[Mr Dorrell]

I am grateful to the hon. Gentleman, who is a member of the Select Committee, because he provides me with a link to my next point—I was beginning to wonder how I was going to get on to it.

The health service has not always provided services from a public sector provider. Until this Bill and the powers it gives to Monitor, regulatory bodies in the public sector had not had the opportunity to inquire into the sustainability of services provided by private sector providers. My right hon. Friend the Secretary of State made the point that the role of Monitor under the Bill is to ensure first—if I may repeat myself—that foundation trusts are of a high quality when they are launched; secondly, that they are accountable for retaining their high standards; thirdly, that we intervene early if they start to go off the rails; and, fourthly, that if they get into serious difficulty, we have the capacity, through Monitor, to continue to deliver continuity of service to those who rely on public health provision, whether from an NHS foundation trust or, as a result of the Bill, for the first time from the private sector. I regard that as a significant step forward in the delivery of continuity of care for NHS patients, whether provided, as the vast majority still will be, by public sector institutions or by some of the independent sector treatment centres introduced by the previous Government.

[Rosie Cooper]

Does the right hon. Gentleman think that standards can be maintained, and be seen to be maintained, in foundation hospitals if they are allowed to do what they are currently doing, which is not to disclose all information relating to, for instance, complaints procedures or whatever? Furthermore, does he not think that board meetings should be held in public?

[Mr Dorrell]

My understanding is that the Government have clarified that foundation trust board meetings should be held in public and that, in future, it will be a requirement of licensing by Monitor. On the much broader point, I absolutely agree—the hon. Lady, who is another member of the Select Committee, knows that I agree—that providers of care to NHS patients, whether public or private, ought to have an obligation to provide information on the outcomes that they achieve and certainly on any complaints and other processes initiated by patients about the care they receive. That was one of the strong recommendations that the Select Committee made following its work on complaints. I think that that obligation ought to rest on all providers of care to NHS patients, whether they are foundation trusts or any other form of provider.

--- Later in debate ---

[Grahame M. Morris]

I am afraid I do not agree with the hon. Lady, as she might expect. The Secretary of State said that it was a question of communication, but I suspect that part of the problem with the Bill is that, far from there being additional clarity, the more that Members of Parliament, the medical profession, health care workers, members of the public and informed commentators have examined the proposals in detail, the greater the number of concerns that have arisen.

If the Secretary of State had been open and honest about the direction of travel and the motivation for these health reforms, perhaps we could have avoided some of the confusions that have arisen. There is no electoral mandate for a huge structural review and reorganisation. I suspect that there is something seriously wrong with the whole privatising agenda and philosophy, which the Secretary of State denies.

[Rosie Cooper]

Does my hon. Friend believe that misinformation and emotive language almost began and ended when the Prime Minister said that the NHS was safe in his hands? The misinformation began when he fooled the British public into thinking that the NHS was safe. This is the result.

--- Later in debate ---

[Grahame M. Morris]

I am grateful for that example. It illustrates the importance of that improvement, the value that people place on it and how critical it is to people’s health and well-being.

I know that we shall come later to the clauses that lift the cap on private patient work, which the Minister mentioned in his opening remarks. If the cap on private patient work in NHS foundation trusts is lifted and those trusts are under financial pressure—those of us who are in touch with our hospital trusts know that they are under financial pressure, with the reductions in the tariff and other issues—the level of private sector involvement in NHS trusts will increase.

[Rosie Cooper]

The hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who is also a member of the Select Committee, pointed out that Labour reduced waiting lists and private providers were involved. Does my hon. Friend agree that the general public now face longer waiting lists and more private providers?

[Grahame M. Morris]

This is the danger. Labour Members have attempted to highlight it, and people are increasingly aware of it.

--- Later in debate ---

[Mark Simmonds]

I will not get into the nuances and the legal battles that other hon. Members have raised. Professor Steve Field and his team did an excellent job thoroughly and comprehensively in a relatively short time. To be fair to the Secretary of State and his team, they looked carefully at the suggested changes and have incorporated some of them in the clauses before us. I agree with many of them, and I highlighted some of these points on Second Reading—a greater emphasis on integration, wider engagement with a broader range of clinical commissioning teams, and greater protection for services which, in financial or quality terms, may not be providing the service that patients expect. All those have been changed in the Bill.

Almost all the Members on the Government Benches would not support the Bill if it was about privatisation of the national health service. It is not. It tries to ensure that the national health service has a future, and that the organisation that is in the best position to provide a particular service in a particular geographical locality has the ability to do so. That is not just the private sector; it is the voluntary sector, the charitable sector, the not-for-profit sector and the social enterprise sector. The mantra coming from the Opposition seems to dictate that those organisations should not be allowed to provide health care—that unless health care is provided by the state, it should not be allowed. That clearly is wrong. What is important is not the delivery mechanism, but patient outcomes and the quality of service provided.

I shall deal specifically with new clause 2 and amendments 100 to 104, 106 and the subsequent related amendments. They ensure that equity of access continues, irrespective of whether the provider is in a good financial state or not. My right hon. Friend the Member for Charnwood (Mr Dorrell) put his finger on exactly the right point, as he so often does. What matters is continuity of service, but not necessarily from the same provider.

The national health service has always changed in that way. It has always reconfigured services to make sure that the patient receives care of the best possible quality. New clause 2 puts in place an essential mechanism to ensure continued access for patients to NHS services. It is right that the Government are putting in place safeguards to protect patients and taxpayers, but the clause does more than that. It also enables commissioners to replace services with higher quality and better value options. Among the major failures of the last decade in which Labour was in charge of the national health service was not only the decline in productivity, but the fact that there was insufficient decommissioning of poor services and insufficient replacement and improvement of poor-quality service provision. Nowhere is that more marked than in Tunbridge Wells and Stafford.

The primary purpose is to enable Monitor to support commissioners to access services and place conditions on a licence holder. Some of those conditions are set out in the Bill. All hon. Members know that there is considerable variation in performance of organisations within the national health service. Providers who are providing excellent services should be allowed to thrive, innovate and drive the quality of clinical care. Those that are under-performing will require challenging, and support where necessary. Ultimately, if they cannot respond to that support and that challenge, they should be replaced by an alternative provider. That should apply both to the independent sector and to state sector provision. It is not acceptable that, purely because a service is provided by the state, it should be allowed to continue as a substandard service.

Some of the key changes in the new clauses and amendments allow that to happen. They make sure that funding is much more transparent. The existing framework has allowed hidden bail-outs to take place, which all too often have hidden poor management, poor service provision, and the need for clinically appropriate and evidence-driven reorganisation. All too often that has not happened, to the detriment of patient care.

I was pleased to see that the Secretary of State had allowed a safety valve in this part of the Bill, which would enable tariffs to be topped up, particularly for the provision of services in rural areas, such as my constituency in Lincolnshire. This must not be seen as an opportunity for the Department of Health to support and subsidise inefficient management and service provision. All too often there are inefficient cost bases and money could be transferred instead to front-line patient care.

I would be grateful if the Minister, when winding up, confirmed some specific points relating to new clause 2 and the subsequent amendments. Will he confirm that the new system will ensure that innovation is not inhibited—that providers and clinicians will have to configure services not only to satisfy patients, but to improve the quality and productivity of services, which, as we all know, have been very poor in the past decade or so? Will he confirm that the structure set out in the new clauses will enable Monitor to intervene early to ensure that the service provided is safe and provides good-quality, patient-centric services?

Will the Minister also confirm that the proposals build on the system set out in the Health Act 2009, which is in line with the Secretary of State’s consistent assertion that the Bill is about evolution, not revolution? Ministers must not allow the importance of integrated services, vital though they are, to be an excuse to maintain poor-quality providers. In the interests of patients, underperforming incumbents must be challenged and continued innovation must be facilitated and incentivised.

If the Minister has time when winding up, I would like him to address the point that I made to my right hon. Friend the Member for Charnwood, which is that the new clauses seem to ensure that Monitor will maintain minimum-based standards, particularly as they relate to acute foundation hospital trusts. We need commissioners, the Care Quality Commission and Monitor to work together to ensure that there is continuing improvement in patient care and continuing determination and drive to make sure that services are better the next year than they were the previous year. It is unclear from the amendments who will be responsible for co-ordinating that effort to drive up standards continually.

I have two final questions. What will happen if Monitor has to step in to provide advice, shore up a service or provide an alternative service provider, but the commissioners cannot agree on who should be the subsequent service provider? Who will resolve disputes between two commissioning consortia? Will it be the NHS commissioning board, Monitor or the Department of Health? Where a provider delivers a service to more than one commissioner, and one of the commissioning groups has access to an alternative provider already in existence but not another, who decides who will provide the service that has failed?

I will draw my remarks to a close. I am, as I believe are most Government Members, an avid supporter of the national health service. I defer to no other group more than I do to those who work tirelessly in the NHS to provide the excellent care that, more often than not, is delivered, and not only in the state service but across the range of NHS providers. However, if we are to continue the NHS, free at the point of delivery and based on need, not ability to pay, it must reform and change. We cannot allow it to stand still. I believe that these clauses and amendments provide an essential framework to ensure continuity of access to service, value for money for taxpayers and better quality patient care.

[Rosie Cooper]

Members of the public listening to Government Members this afternoon might wonder whether we were having this debate in a parallel universe, because they have heard the Prime Minister promise that there would be no top-down reorganisation of the NHS, and what did we get? We got the biggest reorganisation in the history of the NHS. The Prime Minister said only recently that everyone was on board and behind the Bill, and yet we find that clinicians, professionals and the public are far from being on board. The Government talk about the protection of services, but the public will have read only yesterday that the Government are meeting McKinsey about the possible transfer, albeit a slow transfer, of up to 20 hospitals.

[Mr Simon Burns]

indicated dissent.

--- Later in debate ---

[Rosie Cooper]

The Minister keeps saying no, but the reality is that, as I told the Secretary of State, you may very well be fooling yourselves, but you are not fooling the public, and the Bill was wrong. That was followed by a pause, and when you admitted that you had got various bits of it wrong, you then said—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. The hon. Lady must desist from using the word “you”, as it refers to the Chair.

[Rosie Cooper]

I apologise, Mr Deputy Speaker. Each time I said “you”, I meant the Secretary of State.

The Secretary of State simply threw the Bill at the British public after the Prime Minister had promised that this would not happen. I have been very clear in the speeches I have made so far on the Bill that the only people the Secretary of State is fooling are those in the Tory party. He has made changes to the Bill, but we are now beginning the great mix-up and going back to exactly where we were.

The hon. Member for Boston and Skegness (Mark Simmonds) said that Labour did not want progress and good value, and that the coalition programme was all about ensuring that the NHS survived and getting a good return for the taxpayer. Let me tell him that I am absolutely passionate about the NHS. I expect value for money, cutting-edge treatment, efficiency and the best possible care for everyone in this country. The lives of every taxpayer and every family depend on the care they get from the NHS. Second rate will not do for me at all.

However, I do not believe that throwing a grenade into the NHS systems will achieve that. Even breaking big promises will not achieve that, because that will break the trust. I suggest to the Conservative party that the Great British public gave tentative support during the general election and will now withdraw that support rapidly as the Bill progresses. The Conservatives expect the public to believe that the party that promised no top-down reorganisation and then broke that promise can be trusted when it says that there will be no privatisation of the NHS, yet evidence comes to light via freedom of information requests that that is not the case.

What are patients out there actually experiencing? Again, Conservative Members can fool themselves. When they went to accident and emergency units they saw that the four-hour waiting time was being exceeded, so they abolished it. It is already taking longer to treat fewer people, which does not strike me as particularly efficient or good value for money. It took 13 years of a Labour Government to rebuild the NHS after what the previous Conservative Government did to it. Labour reduced waiting lists from two years to 18 weeks. It has taken the coalition Government less than a year to wreck it all again. Broken promises are leading us to an NHS that is broken again.

Let us look at what is currently happening in the NHS. There are two different processes at work: financial efficiency gains and structural reform. The idea was to ask the system to make efficiency gains of 4% each year for four years. On top of that there is the reorganisation, which a Conservative Member has likened to tossing a grenade into the system. We have had muddle, pause, fog and are now effectively back to where we were some time ago.

The reforms do not address the financial challenges, especially the Nicholson challenge. This is costly—making people redundant, throwing organisations into disarray and telling people, “You don’t have a future, you might have a future,” “Let’s have a cluster, let’s not have a cluster,” “Where are you going to work?”, “It’s all going to disappear by 2013,” “There are no PCTs—well, they’re there really, but clusters will do the work,” “No, we don’t have strategic health authorities—well, okay, we’ll keep four of them.” The Marx brothers would be proud of the stops, turns, U-turns, pauses and muddle that there have been. But the bottom line is that the great British public have to watch those antics and are worried about their health service.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Does my hon. Friend have any idea of how much the reorganisation is going to cost? The hon. Member for Boston and Skegness (Mark Simmonds) made a very reasonable speech, but I noticed that he was confessing at the end that he did not know how some of the central parts would work, and he posed those questions. Does my hon. Friend have any idea of how it is all going to work at this stage, and what it will cost? If not, does she think it conceivable that enough members of the public can know, and have any confidence in the changes?

[Rosie Cooper]

I can categorically say that we have asked the questions over and again and we do not get any answers.

[Mr Burns]

The impact assessment.

[Rosie Cooper]

How much? I will give way if the Minister tells me exactly how much it is all going to cost. I shall happily sit down; there you go. [Interruption.]

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. This is not a conversation but a debate. I do not think that the Minister indicated that he wished to intervene.

[Rosie Cooper]

Thank you, Mr Deputy Speaker. You will forgive me; my lip reading was obviously slightly wrong. He looked as if he was trying to tell me something, and I hoped that it might be the answer.

In all such situations I always say, “Follow the money.” What is actually going to happen? If this is costing a lot of money—there is a lot of muddle—it has to be really clear that the driver of the reforms cannot be, as the Secretary of State has previously said, the idea that the NHS is unaffordable; we seem to be able to afford a lot of other things. If the reason is not financial efficiency, it has to be purely ideological.

I understand that 85% of respondents to the NHS Confederation survey were very clear: the hardest job that they could have is to deliver both NHS changes and savings simultaneously. That makes it harder for them to deliver objectives for improving efficiency and quality—but that is what I am told that Government Members are all about; the Bill is supposed to improve efficiency and quality.

Who is going to deliver the health care? The Royal College of Nursing suggests that 27,000 front-line jobs, equivalent to nine Alder Hey children’s hospitals, will disappear. I asked the NHS Confederation whether we would see hospital closures, and it is clear that we will; we are seeing that in various reports. The Bill is three times longer than the Act that created the NHS, and it leaves more questions than answers. I say to the Government that if they believe that the great British public will be fooled by any of this, they are sadly wrong.

I do not normally make personal statements about anybody, but Roy Lilley, a former NHS professional, writes a blog in which he refers to the Secretary of State as “LaLa”; I am sure the Secretary of State has seen it. I have been hearing “La la” all afternoon. This is just nonsense. Just because the Secretary of State or the Tory party says that the world is square, that does not mean that it is. They are insulting the public if they think that they will go along with them.

Monitor makes decisions about the future sustainability of individual services and the patterns of local health services under the failure regime. It is unclear how those decisions would be made, and how and to whom Monitor is accountable. Technically it is an independent body and it should be responsible to Parliament and the Secretary of State, but perhaps the Secretary of State will clarify that.

As the economic regulator, Monitor is given a whole series of powers that ultimately focus on enforcing competition in the NHS. There are still fundamental gaps in how that organisation will be held to account. There is a lack of clarity about how health services can engage with and influence the work of Monitor. Having been chair of a foundation trust hospital, albeit only for a month—because I stood for Parliament and had to resign—I can say that Monitor was a law unto itself. And before the Health Committee, Monitor likened the NHS to utility companies, which does not give me any confidence whatever.

I want to talk about Monitor not consulting commissioners on changes to enhance tariff. Private providers can apply to Monitor for an enhanced tariff to preserve the services that they, as private businesses, are providing to the NHS.

[Tom Blenkinsop]

One essential point that we have to raise about Monitor is that it is a replica of an economic regulator of the utilities. The four to six companies in the energy sector have just raised gas prices by 18% and electricity by 11%. How does my hon. Friend think Monitor will be able to cope with private companies and health?

[Rosie Cooper]

I would suggest that it is a failing model, and not one that we should be looking at.

I should like to look at the idea of risk pooling, in which Monitor will have a role. Monitor will be required to top-slice the budgets of foundation trust hospitals to obtain that pool of money. The problem is that if the trust is already in financial difficulty, the fact that Monitor needs to top-slice the FT hospital’s budget could tip it into being unsustainable, and then Monitor would have to act. Does that not seem back to front? It needs looking at. If the foundation trust is unsustainable, Monitor has a duty to take action, yet Monitor may well have precipitated the situation; there seems to be a conflict at the core of that relationship. There is no clarity about how top-slicing will be calculated, or what it will involve. Will the Secretary of State please comment on that?

I shall bring my comments to a close with a quotation that I used in a speech I gave a while ago. In “This Week”, Michael Portillo was asked by Andrew Neil why the Government had not told us before the general election about their plans for the NHS. He replied:

“Because they didn’t believe they could win the election if they told you”—

the public—

“what they were going to do. People are so wedded to the NHS. It’s the nearest thing we have to a national religion—a sacred cow.”

He could not have been more clear. The Government intended to misrepresent their position and mislead voters. I believe that this is the latest stage of that misrepresentation, and the Government must be held to account if they force the Bill through in its current form.

[Dr Poulter]

I was hoping to begin on a more consensual note, picking up on a few things that have been said around the Chamber on which I thought we could all agree. However, I will first remind the hon. Member for West Lancashire (Rosie Cooper) of why the Government are introducing this Bill. We do have problems in the NHS. Far too much money—about £5 billion a year—is wasted on bureaucracy and could be much better spent on front-line patient care. Over the past 10 years, the number of managers in the NHS has doubled, going up six times as fast as the number of front-line nurses; the hon. Lady is very concerned about that. A lot of things need to change in the NHS so that the service can become more patient-focused and patient-centred. That is why we are making these changes and why the reforms in this Bill have to go through the House.

Particularly important—this has come out of the pause for reflection and the Future Forum report—has been an increased focus on one of the key challenges for the health service and for adult social care: better care of our growing older population. People are living a lot longer and living longer with multiple medical conditions, or co-morbidities as they would be termed in medical parlance. That is a very big human challenge for the NHS, and also a very big financial challenge. We must have a service that better meets and better responds to those challenges. The pause for reflection has led to much more focus on improved integration of care, and that will be very much to the benefit of the older patients and frail elderly whom we all care about.

We have had a lot of discussion about the benefits, or otherwise, of using the private sector. The case for the private sector may have been made much more eloquently by Labour Members than by members of the Government. The hon. Member for Easington (Grahame M. Morris) argued that because the previous Government used the private sector to reduce waiting times, it was effectively used to improve patient care for patients with cataracts and for those needing hip operations or waiting for heart operations. That, in itself, was a good thing, but the problem was that the previous Government used the private sector far too much in a way that allowed it to make profits but not to look towards the integrated care that Government Members would like to see as a result of these health care reforms. As regards looking after the frail elderly, for example, there was cherry-picking of hip operations as part of orthopaedics but without the follow-up care that was required—the physiotherapy, occupational therapy and social services that those older people so badly needed. Yes, the private sector can bring value and benefits to the NHS, as the previous Government recognised, but it has to be done in an integrated way, and that is what we will do as a result of these health care reforms.

Why else do we need to reform the NHS? Are we really happy with the status quo?

Caring Responsibilities

Rosie Cooper Excerpts

Wednesday 15th June 2011 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

Thank you, Mr Streeter, for the opportunity to contribute to this vital debate, and I congratulate my hon. Friend the Member for Edinburgh East (Sheila Gilmore) on securing it. I will not rehearse the arguments that we have already heard, because time is short.

As a carer for my 86-year-old father, who was born deaf, I have a deep personal understanding of the issues and challenges that many carers face. I am deeply concerned that the decisions taken by this Government will massively compound the financial and emotional pressures that carers face. Others have discussed the national policy changes, but I would like to talk quickly about issues that affect my constituents.

Both of the two cases that I wish to address relate to services provided by Lancashire county council as the social care provider in my constituency. The Derby day centre is a fantastic facility in Ormskirk. The staff are committed to providing high-quality care and support to people who use the centre. It offers a wide range of facilities to meet the needs of the individual, whether they have dementia or a physical disability. I have visited the centre many times and I am always impressed by it.

In a shock move, however, Lancashire county council has announced that it is increasing the daily cost from £5 a day to £30.75. That is not a small increase, but an increase of nearly 500%. I wonder how that fits with the mantra of not affecting front-line services. The council says that, this year, it will not charge users more than £30 a week extra. However, next year that will also increase so that people will not pay more than £60 extra. It is clear that, before long, anyone attending or wanting to attend the centre will have to pay the full cost of using it. Today, my office received a call from a centre user’s family who were angered by the scale of the increases. For them, the cost will rise from £40 a month to £160 a month for two days a week at the centre. That is just one issue in Ormskirk. There are many cases in which the elderly or disabled are being impacted by Lancashire county council decisions. The dial-a-ride service, for example, has been almost decimated. Some families will grumble about the cost but will be able to pay. Others will not be able to meet the costs and the council will help. However, a great number of families in the middle will be sitting at home wondering whether, financially, they can afford to continue to use the centre and, conversely, whether, emotionally, they can afford not to.

The second case is a group of mums who told me of their concern about funding for Aiming Higher for Disabled Children. That programme finished at the end of March and since then no short breaks or activities have been available for families, even for a day or a few short hours. The county council has said that it will consult parents on how the scheme will work but, in the meantime, there are no services—zilch, nothing. No support is being offered whatsoever, and that is a huge burden. I understand that the summer holidays are coming up and that interim arrangements will be made, but that still does not address the proper concerns that exist. In 2010-11, the funding for Aiming Higher was £4 million. Officers are now telling us that only £3.5 million will be available for two years. That is a reduction of a half. Does the county council believe that half the need for the scheme will evaporate while it is considering its budget cuts, or is it dumping the care, responsibility and the cost of children with disabilities back on to hard-pressed parents?

I will end my remarks because I have to cut them short. I am really, really sad that when the local newspaper asked me about the matter, I said, “Well, this is now the typical Conservative attitude. They know the price of everything and the value of nothing.” I find it gut-wrenching that the elderly and the most vulnerable will have to live with the consequences of the Government’s decisions. We keep hearing that we are all in this together. Families with caring responsibilities in West Lancashire are now realising that some people are in this more than others. How can the Minister justify this, and look carers and their families in the face?

NHS Future Forum

Rosie Cooper Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

The hon. Gentleman must know that the money available to the NHS in Wales is available to the NHS in Wales, and that it is separate from England. The Labour Welsh Assembly Government have made their own decisions about the priority that they attach to the national health service in Wales, and the result is, as the King’s Fund says, that they plan to reduce its budget by 8.3% in real terms. We are going to increase the NHS budget in real terms. The result can be seen in waiting times, which we were talking about. In England, the proportion of patients admitted to hospital who are seen within 18 weeks, according to the latest data, is 89.6%. He might like to reflect on the fact that the figure for Wales is 64.5%.

[Rosie Cooper (West Lancashire) (Lab)]

Although it has been difficult to hear during this debate, I would like to address my comments to the statement made by the Secretary of State.

[The Minister of State, Department of Health (Mr Simon Burns)]

Question.

[Rosie Cooper]

Question, sorry. [Interruption.] Let us get to the point and stop playing around. The Secretary of State said in the statement that consortia will now have one nurse and one secondary care doctor and that:

“To avoid any potential conflict of interest, neither should be employed by a local health provider.”

How will the Secretary of State apply that rule to GPs? Would not the Secretary of State and his reforms be best described as like Schrodinger’s cat—in a state of uncertainty and both alive and dead at the same time?

[Mr Lansley]

The hon. Lady misses the point. If GPs were providers as well as providing primary medical services, they would be unable to make decisions about those responsibilities because of a conflict of interest. Of course, as primary medical services providers in their area, they are not commissioned by the clinical commissioning groups—if the hon. Lady is listening to the answer at all—because the commissioning of primary medical services is undertaken by the NHS commissioning board, not by the local groups.

NHS Reorganisation

Rosie Cooper Excerpts

Wednesday 16th March 2011 Commons Chamber

[Rosie Cooper (West Lancashire) (Lab)]

I have spoken in this place on several occasions about the deeply disturbing reforms that the Government are proposing to our national health service. On those occasions I have accused the Secretary of State of glibness and hubris, and as each day passes, as each new piece of information comes to light and as we scrutinise the detail of the Health and Social Care Bill, he proves my assertions right. He currently presides over what I can only describe as an unholy mess that will have huge negative consequences for the NHS and the people who love it and depend on it.

I tell the Secretary of State that the Opposition have seen through his plans, and the Liberal Democrats, who are on his side of the Chamber, see through them as well. Many of his colleagues are very nervous about them, and yesterday the British Medical Association and medical professionals made a clear and unequivocal statement that they, too, see through them. As the plans unfold further, I can tell hon. Members that patients and the British public see through them as well.

Despite the broken promises, the Secretary of State and the Prime Minister seem to think that their NHS reforms are a good idea. I am not sure that they are 100% convinced, though, given that they did not seem confident enough to share the details of their plans with the British public before the general election. In fact, the Prime Minister was very clear in his promise to the British people:

“no more pointless top-down reorganisations”

of the NHS. He even said:

“When your family relies on the NHS all of the time—day after day, night after night—you know how precious it is.”

How quickly forgotten those words were.

Some people felt reassured that, whatever else might happen if the Tories were elected, the NHS would be left untouched. How wrong they were. Today we find the NHS in a state of turmoil and facing massive reorganisation, with hundreds of health workers laid off and its very future threatened by a desire to set up a commercially driven market in health care. This very lunchtime, the Prime Minister said, “We are not reorganising the bureaucracy of the NHS. We are abolishing the bureaucracy of the NHS.” The bit he left off was that private providers would be doing that work. Who is he kidding?

[Graham Evans (Weaver Vale) (Con)]

rose—

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

rose—

[Rosie Cooper]

I give way.

[Graham Evans]

I thank the hon. Lady—

--- Later in debate ---

[Rosie Cooper]

No, I was giving way to—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The hon. Lady will have to sit down during the hon. Gentleman’s intervention.

[Graham Evans]

I am new to the House, but I seem to recall the right hon. Member for Leigh (Andy Burnham), who was then the Secretary of State for Health, saying that we should

“celebrate the role of the private sector in the NHS.”

What has changed for Labour Members? [Interruption.]

[Rosie Cooper]

I am sorry, I did not hear the end of that.

[Graham Evans]

When he was Secretary of State, the right hon. Member for Leigh said that we should be celebrating

“the role of the private sector in the NHS”.

What has changed since he made that comment?

[Rosie Cooper]

The health service was not an issue at the general election, and why? Because people broadly supported it and were not worried about the state that it was in. Government Members must listen to the furore that will happen and prepare to defend their seats in light of the decisions that they take now.

[Mr Steve Brine (Winchester) (Con)]

Will the hon. Lady give way?

[Rosie Cooper]

No, I have very little time now.

I believe that what Michael Portillo said on the BBC’s “This Week” programme was an accurate reflection of how the Government have sought to mislead the people of this country. When asked by Andrew Neil why the Government had not told us about the plans for the NHS prior to the general election, he responded:

“Because they didn’t believe they could win the election if they told you what they were going to do. People are so wedded to the NHS. It’s the nearest we have to a national religion—a sacred cow.”

He could not have been more clear: the Government intended to misrepresent their position and to mislead voters.

As I have said previously, this Conservative Government have been prepared to play to the gallery while playing Russian roulette with the future of people’s health services. That is still the case, but the gallery is now empty. They are on their own and have no mandate—

[Mrs Main]

On a point of order, Mr Deputy Speaker. On two occasions the hon. Lady has accused the Government of misleading the public. I cannot believe that that is the case, and I am sure she would like to withdraw those remarks.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. That is not a point of order, because the accusation was not against individual Members.

[Rosie Cooper]

Oh how the truth hurts! Michael Portillo could not have been more clear that the Government intended to misrepresent their position and to mislead voters.

I believe very clearly that you are playing Russian roulette with people’s futures, but the gallery is empty and you are on your own. I still believe that you have no mandate for these ill-advised reforms. You do not have that support, and it seems to me you do not have a clue—[Interruption.] It is impossible to make a speech with that noise.

I shall just recap. I do not believe that you have any mandate for these reforms. You do not have the support out there and it seems to me that you do not have a clue. For goodness’ sake, stop now before you kill the NHS.

[Several hon. Members]

rose—

Health and Social Care Bill

Rosie Cooper Excerpts

Monday 31st January 2011 Commons Chamber

[Gordon Birtwistle (Burnley) (LD)]

I shall support the Bill, because it will mean an end to the disruption and devastation of local hospital services owing to overpaid, faceless bureaucrats in palatial offices many miles from people’s local hospitals deciding that a particular service is no longer needed or is better off elsewhere. The Bill’s local democratic legitimacy policy strives to ensure that decisions on serious hospital reconfigurations never again ride roughshod over the wishes of the local community.

[Rosie Cooper (West Lancashire) (Lab)]

When I asked the Secretary of State who would make the decision if the consortium and the health and wellbeing board disagreed on the reconfiguration of hospitals, he said the reconfiguration panel as it exists today—no difference.

--- Later in debate ---

[Henry Smith]

I do not see how multiple providers is a definition of a monopoly. However, I must make progress in the short time left to me.

My constituents are pleased that for the first time in many years health decisions will be made in Crawley, rather than, as has happened up until now, on the south coast, in east Surrey or up in Whitehall, and that more decisions will be made by local people.

[Rosie Cooper]

Will the hon. Gentleman give way?

[Henry Smith]

I am sorry, but I have not got enough time.

I will support the measures in the Bill, as should all right hon. and hon. Members. However, I would like briefly to ask for clarification on two points from those on the Treasury Bench. First, hospices are greatly valued in our local area—on Friday, I was privileged to visit the Chestnut Tree House children’s hospital, which serves my constituency—so some clarity over future support for hospices would be greatly appreciated. Secondly, I would also like an assurance that the merry-go-round of failing managers in our acute sector will be addressed. I regret to say that on new year’s eve, at East Surrey hospital—the acute hospital for my constituency— 14 ambulances were queuing to get into accident and emergency. That is not good enough. It is another area of the sector that needs to be reformed.

Forgive me, Mr Speaker, because in the seven seconds I have left, I would like to report that there is well-being in Crawley today, because they are due to play at Old Trafford in about three weeks’ time.

--- Later in debate ---

[Nadine Dorries]

Absolutely, and the Bill will address that, in as much as care will be more easily accessed by the GP and the patient, in a much more streamlined process.

When nurses sat their medical exams 62 years ago, when the NHS was first established, the answer to each question had to begin and end with the words: “Reassure the patient”. It did not matter what someone said in the answer; if they did not emphasise the fact that the patient had to be reassured, they failed. That has gone. That demonstrates exactly how the patient has become invisible in today’s NHS.

I support the Bill because I support GPs working in consortia. A common myth—an urban myth—that we have heard in the few weeks leading up to this debate, and which has been thrown at us from the Opposition Benches, is that GPs are simply not up to the task of becoming business managers. The truth is that they already are business managers, because they all manage their own businesses. They will not be working as individuals or in individual practices; they will be working as part of a consortium, which is quite different from the impression given by the Opposition. Right now, 141 pathfinder consortia are demonstrating that they are ready and able to take on commissioning, and that they endorse patient involvement in the decision-making process. As a result of the “any willing provider” provisions, there will be a genuinely wider choice of care options available to the GP and the patient.

I would like to rebut the argument that the private sector will come in and undercut the NHS. That is complete nonsense. There will be no undercutting of the NHS whatever. Services will be—[Interruption.] I can only say that Opposition Members have not read the Bill, because there will be a tariff. Charities and the private sector will be able to provide services, but with a tariff. I shall give an example. If a patient requires a surgical procedure, which they discuss with their GP, and the local hospital has no bed available for six weeks, two months or however long, but if the local private hospital can provide a bed the next morning at the same price, are the Opposition really saying that an ideological obstruction should be put in the way of that patient being admitted to that private bed for that procedure the following day?

[Rosie Cooper]

Will the hon. Lady give way?

[Nadine Dorries]

I cannot, because I have given way twice and I have no more time.

If that patient were in pain, why should they not be admitted into that bed if it were available? That is how the market will be opened up by GPs, to the benefit of patients.

We recently heard from my right hon. Friend the Prime Minister about an extra £60 million that will be available to fund the latest bowel cancer screening technology, with wider deployment of the flexible sigmoidoscope. That does not need to be provided in secondary care in a hospital; it could be provided in the GP practice under the “any willing provider” provisions, perhaps via charities with specialised trained technicians. The Bill will ensure a new approach to providing services to the patient. “Any willing provider” will give patients the choice that they have not had for 62 years, empowering them to make decisions over that choice and opening up health care that patients in this country have not had, certainly for the past 15 years. With new technologies coming on stream and new ways of delivering care, both in the patient’s home and in the GP practice, that has to be welcomed. The Bill has to be welcomed, and Government Members will vote for it because the most important person in the Bill is the patient. That is why I support it wholeheartedly.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I am delighted to follow a fellow member of the Health Committee. I, too, am looking forward to the answers to the very many questions asked by the Select Committee that were not answered comprehensively. The issues have been elucidated today by my right hon. Friend the Member for Croydon North (Malcolm Wicks) and my hon. Friend the Member for York Central (Hugh Bayley), so I will not rehearse the arguments again.

I fear that today marks a watershed in the future of the NHS, and I say that as one who has proudly dedicated 30 years of my life to the service. Today is the day that the broken promises of the Tory-led Government will lead us down a path that, sadly, will end with a broken NHS. I characterise the Department of Health’s policy position on the most far-reaching reforms since the inception of the national health service as, “Don’t ask us about the detail; we haven’t made it up yet.” I am not sure what is more worrying—not having the detail or now seeing an outline of what the Tory-led Administration plan to do with the national health service.

I do not know why it took so long to bring the Bill to the House. It cannot be because of extensive consultation and discussion with professionals and advisers, because we cannot seem to find any body willing to own up to advising or having had discussions with the Secretary of State about the future direction of health services. If he had had such discussions, he would have heard the resounding message that his reform package is not what the NHS needs right now.

We should have built on the best in an evolutionary way. Instead, the Secretary of State has inflicted on the NHS a massive structural change while it has to cope with the Nicholson challenge, which we are led to believe are the 4% compound cost savings for the next four years. As David Nicholson acknowledged to the Health Committee, the scale of the productivity challenge is huge and has never been done on this scale either in the NHS or elsewhere in the world, and it is all taking place during a transition into the new NHS commissioning world.

It now transpires that the feat that the Health Secretary set for the NHS has been made even more improbable—some might say, impossible—to achieve because of decisions being taken below the radar. For example, there is the reduction in the market forces factor, which means a reduction in some NHS hospitals’ budgets. Instead of the 4% that the Government have talked about, the reality of the cuts to some hospital budgets is closer to 5%, and perhaps even 5.5% in some cases—mission impossible.

At the same time, we hear about wards having to be closed because of budget cuts. The NHS Confederation says that some hospitals might need to close under the reforms. Yet this weekend’s newspapers talked about the Department of Health having meetings with private sector providers who have 10,000 beds at their disposal.

When will the Secretary of State stop peddling myths and start dealing with the reality, before it is too late for the NHS? The Bill will deliver a service that is low on accountability and high on autonomy. I do not have time to go into this in detail, but I am certainly not persuaded by the accountability measures in the Bill. I am not convinced by the wellbeing boards, local healthwatch or national HealthWatch. We have no evidence that they will be able to deal with accountability or respond to patients themselves. The issue is very clear. If we as Members of Parliament want to ask questions, whom should we ask?

As far as I am concerned, the Secretary of State has a nice little soundbite that he often wheels out—“No decisions about me without me”. Government Members have stated that over and over, but have not demonstrated any evidence base for it. To me it is clear: the fundamental principles of the Bill are about taking decisions “about me without me”. I am really not persuaded by the democratic accountability provisions. A whole series of decisions have already been made about my health care, our health care and this nation’s health care—and they have been made without us.

It has taken until today for us to be able to debate these proposals properly, and in six minutes I am not able to deal with the points that I should like to cover. This Bill comes to us now after many of the fundamental decisions have already been taken and are being implemented. It is a set of short-term measures that will have long-term consequences for the future of the NHS, the quality of health care, and the accessibility of services available to people in communities across this country.

The Prime Minister and the Secretary of State deny breaking their promises, but like the emperor and his new clothes, they can fool themselves for as long as they like, but they are not going to fool the people. As people’s services disappear, as they wait longer for their operations, and as things get more difficult, they will know who to blame, and Government Members will really need to worry about it. Last time I spoke in this Chamber on health matters, I accused the Secretary of State of glibness; today, I accuse him of hubris.

NHS Reorganisation

Rosie Cooper Excerpts

Wednesday 17th November 2010 Commons Chamber

[John Healey]

Part of the problem is that there is so little detail in the White Paper that we simply cannot see how the bodies taking big decisions about taxpayers’ money will be accountable to the public. I lost count of the number of times during the last Government when Health Ministers came to this House and to Westminster Hall and had meetings with Members in order to respond to and sort out the problems that their constituents were experiencing with NHS services.

What the Secretary of State says he wants from the White Paper plan is to put patients first, to improve health care outcomes, to cut bureaucracy and to improve efficiency. These are “motherhood and apple pie” aims. We can support his aims, but we cannot support the action he is taking or the breakneck speed with which he is forcing these changes on the NHS. He wants shadow GP consortiums to be in place by April, and he will remove primary care trusts entirely two years after that. What he is doing is rushed and reckless. Almost every respondent to the White Paper has warned of the risks and said, “Slow down.”

[Rosie Cooper (West Lancashire) (Lab)]

Is my right hon. Friend aware that yesterday the Health Committee was told by health service organisations that some London PCTs would close by March 2011? Is anything happening in that regard? We know that there was a suggestion that PCTs would close in 2012, but we heard for the first time yesterday that they might close in 2011.

[John Healey]

I am very concerned if those plans are being speeded up rather than slowed down, because that would be entirely contrary to the view that has been consistently expressed by patients groups, experts in the NHS and professional bodies in response to the consultation on the White Paper. “Too far, too fast,” says the King’s Fund. According to the NHS Confederation:

“It will be exceptionally difficult to deliver major structural change and make £20 billion of efficiency savings at the same time.”

The Alzheimer’s Society says:

“The pace of structural change has the potential to undermine the progress made in services for people with dementia and their families, unless handled carefully”.

Almost every other group representing patients says the same. Even the chief executive of the NHS has written to the Secretary of State saying:

“Implementing the White Paper will require us to strike the right balance between developing early momentum for change and allowing enough time to properly test the new arrangements. Getting this balance right will be critical to maintaining quality and safety”.

--- Later in debate ---

[Mr Lansley]

Yes, my hon. Friend makes a good point. What we are looking for is not a league table at all, as health care should not be regarded in that way; we are looking for proper benchmarking to take place. We are going to benchmark this country’s performance against that of the best health care systems around the world—the Labour party never did that—and we are going to ensure that there is a culture of continuous improvement in the NHS in respect of both the one-year and the five-year cancer survival rates, which my hon. Friend rightly mentioned.

The reforms that I was talking about are not a radical departure from the past. The principles of the White Paper should be what the NHS has always been about, but it has been distracted too often by the bureaucratic processes that the Labour party was always supporting. Let me make it clear that many of the things that we are doing were championed by former Labour Ministers. When John Reid was Health Secretary he championed patient choice, and we know why. His view was, rightly, that in the NHS, in a bureaucratic system, the articulate middle classes get access to the best health care, and it is only through institutionalising and embedding patient choice—shared decision making for every patient—that we will ensure that the most disadvantaged in society get the right access to health care.

As for GP-led commissioning, the Labour party was supposed to have introduced practice-based commissioning.

[Rosie Cooper]

rose—

[Mr Lansley]

I am not giving way, so the hon. Lady must sit down. [Interruption.]

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

I often comment that when I became an MP I did not get two items that would have made life so much easier—tarot cards and a crystal ball. In considering the coalition Government’s health policy, they would be essential tools for the job, because before the general election, the statements of the Leader of the Opposition—now the Prime Minister—gave us the impression of a future for the NHS that was completely different from the one we now face. He said:

“We are the only party committed to protecting NHS spending…I’ll cut the deficit, not the NHS.”

He spoke about a period of organisational stability in the NHS. Those were broken promise No. 1 and broken promise No. 2. Instead, we are faced with a vision from the Secretary of State which could set us back 20 years. I say so not as political rhetoric, but from 30 years’ direct involvement in the NHS, including 10 years as chair of a hospital.

The press seems to share that pessimistic view—“extraordinary gamble,” “cocktail of instability,” “accident waiting to happen”—hardly a ringing endorsement of the Government’s health policy. For me, it is a recipe for disaster: one part reduced financial resources, two parts structural reform and three parts break-neck speed—

[Lyn Brown]

Does my hon. Friend agree that the estimated cost of £2 billion to £3 billion for the reorganisation could be far better spent on outcomes for our citizens and treatments for our children?

[Rosie Cooper]

Absolutely. I am sure the Secretary of State will give due cognisance to the comments being made, especially about putting resources right there on the front line, delivering for the very people who are paying the wages.

In his evidence to the Select Committee on 20 July, the Health Secretary set out five aims of the White Paper, and he went through them here today. I shall review some of those in the light of the dribbles of information that we have received, and see how they stand up. The first aim was creating a patient-led NHS. Let us start with the Secretary of State’s glib catch-phrase, “No decision about me without me”—

[Mr Lansley]

Glib?

[Rosie Cooper]

Yes, glib. Where is the substance? Will it make any difference if the GP consortiums do not agree with the Secretary of State? Will those consortiums meet in private or in public? Will he listen to those patient voices? Will he be able to hear them?

[Jim Shannon (Strangford) (DUP)]

Does the hon. Lady agree that when it comes to prevention and early diagnosis of diseases, the GP and what happens at the clinic and the surgery is critical? Money can be saved in the long term. Perhaps that is what the Government should be doing—making sure that money is there on the front line, in the GP surgeries and in the clinics.

[Rosie Cooper]

Nobody could disagree with that.

The NHS will be one where the area and street where people live will determine whether they have access to certain drug treatment, because of the weakening of NICE and a shift back to value-based pricing, placing drug companies back in control, and a return to postcode prescribing—an NHS where people may or may not get certain operations. Already in my area, across Lancashire, primary care trusts are reviewing funding for 70 procedures, so if patients require an endoscopic procedure for their knee or back, or a hysterectomy, those may no longer be available.

How far people travel to their hospital depends on whether they have a hospital close by that offers the treatment that they need. On 26 October at the Select Committee, various witnesses gave evidence that hospital closures will be necessary to release moneys back into the wider health service. How many patients would agree that such a state of affairs is part of a patient-led NHS? Not many, I bet.

Improving health care outcomes was the Secretary of State’s second aim. It seems highly unlikely, given that the ability to deliver improved outcomes is reliant on front-line services and the availability of the staff to deliver them. The Royal College of Nursing expects to lose 27,000 front-line jobs. That is the equivalent of losing nine Alder Hey children’s hospitals. The work of the RCN suggests that under the guise of 45% management cuts, the NHS will lose health care assistants, nurses and medical staff—front-line cuts by stealth.

All this must be set in the context of what was said to be the lowest financial settlement since the 1950s, reputed to be 0.1%—as we heard today, that is already disputed—together with massive pressure on NHS budgets from increased VAT costs—[Interruption.]—redundancy payments, budget short-falls and hospitals having tariffs frozen—[Interruption.]

[Madam Deputy Speaker]

Order. The Secretary of State does not need to shout across the Chamber. He has had his time.

[Rosie Cooper]

It would help if I could hear the right hon. Gentleman, but never mind.

The difficulties are topped up with increasing demand for services, an ageing population, an increase in the number of people with complex illnesses and the rising cost of treatment. That is all very worrying.

At the Select Committee the Secretary of State spoke about increasing autonomy and accountability in the NHS. I have raised that with him on a number of occasions and I tried to intervene today. It is a further example of the two health policies of the Administration, one mythological and the other the reality. Perpetuating the myth, the Secretary of State said at the Select Committee that

“the conclusion that we reached was that we could achieve democratic accountability more effectively by creating a stronger strategic relationship between the general practice-led consortia and the local authority.”

We might imagine that that meant patients and elected representatives at the heart of decision-making, and that the consortiums would operate with councillors on the board, who would be able to vote, but no. Scrutiny will come from well-being boards, which means that patients and councillors will not be there offering their opinions and able to vote. Well-being boards, like the current NHS overview and scrutiny arrangements, may as well not exist because they will be nothing more than a focus group.

I said at the Select Committee that those arrangements were nothing short of throwing snowballs at a moving truck—they would make little or no difference. The Government are giving a budget of more than £80 billion to GPs who just want to practise medicine and not get involved in the experiment.

[Lisa Nandy (Wigan) (Lab)]

May I mention the issue of GPs and safeguarding, the key role that GPs play in keeping children safe, and the fact that if they are spending time commissioning services, who will fulfil that vital function?

--- Later in debate ---

[Rosie Cooper]

We need to get more GPs to do that, and I think that is what the Secretary of State is trying to say.

The Government plan no testing or pilots, just a big bang, using consortiums as a shield to deflect criticism from them, rather as they currently use the Liberal Democrats.

The fourth aim was promoting public health. Everybody agrees that prevention is key to easing the cost burdens further down the health pathway, so if we were serious, we would be doing more about promoting public health. Simply allocating 4% of the NHS budget and giving it to cash-strapped local authorities does not seem the best and most effective way of promoting public health. We await more detail, although that might be as difficult to follow as the Department of Health’s £1 billion allocation to social care.

That brings me to the fifth aim of the White Paper. Following the publication yesterday of “A Vision for Adult Social Care” by the Department, the foreword gives us a sense of where we are heading with the Government’s policy. Under the third value, responsibility, it states:

“Social care is not solely the responsibility of the state. Communities and wider civil society must be set free to run innovative local schemes and build local networks of support.”

I wonder whether that is code for “We’ve got no real money to invest. Local authorities are not going to be able to meet the demand. Oh well, you’d better get on with it yourself.”

It is no use the document quoting Frederick Seebohm from 1968, as that might not reflect the world of today. As an ideal, it is great, but not every family and every individual can offer the help and support that are required. There are incredible strains on hard-working families and individuals trying to make ends meet while struggling to provide care for ill and elderly relatives—

[Madam Deputy Speaker]

Order. Time is up.

--- Later in debate ---

[Mr Brine]

No, there is absolutely no reason for them to do that. My right hon. Friend the Secretary of State for Communities and Local Government will make an announcement on council funding, but the Secretary of State for Health has already announced in the comprehensive spending review that the Government have allocated moneys for social care.

I know that the Labour party will try to rubbish our proposals, and that is their choice. My point is this: the people I represent do not care much about how the NHS is structured, but they care a great deal about ensuring that their NHS is there when they need it. They pays their money, and they expect the NHS to be there when they need it, free at the point of use. That is the cornerstone of what we are proposing.

I am very happy to defend outcome-focused, GP-led commissioning for my constituents. Every health care system in the world worthy of the name has the GP-patient relationship at its heart, and our proposals for GP consortiums seek to strengthen that for the sake of all the people we represent. Why on earth would we propose anything different? GP consortiums are an enormous opportunity for the NHS, and the perfect way to further the “no decision about me without me” agenda that is so important. I do not think that that is glib, as an Opposition Member said earlier. It is about rejecting the “Like it or lump it—this is the service you’re going to get” view that we have heard for far too long in our health service.

[Rosie Cooper]

I would like to state on the record that the expression is glib when it is uttered by a Secretary of State who does not back it up, who does not place patients at the centre, who will not have patients or their elected representatives serving on consortiums and who makes grand statements that are baseless and meaningless.

[Mr Brine]

I am sorry I gave way; I expected something else. I do not think for one minute that it is glib. We are not suggesting that every single patient will be involved in every single element of their care, but how could anybody disagree with “no decision about me without me”?

GP consortiums are an opportunity for the health service finally to realise one of its original aims—the sophisticated management and prevention of illness through the intelligent use of the patient list. That is still a largely untapped resource in our national health service.

GPs I speak to are up for their new role in commissioning for their patients. Of course they have questions—it would be strange if they did not—but they are not calling, as the Opposition’s motion is, for us to ditch our plans because things have got difficult and they have a fear of change. The Opposition cannot have it both ways. They support our plans for more GP involvement in patient care, but call plans for GP consortiums inefficient and secretive.

I see my job as a Member of Parliament as being an important link in helping GPs to answer some of those questions about consortiums that are coming down the line. I know that my right hon. Friend the Secretary of State has met groups of GPs in other areas of the country, and I ask him today to check his inbox because an invitation from me is coming his way.

As we know, following the establishment of GP consortiums, primary care trusts will no longer have NHS commissioning functions. It would be nonsense to create GP consortiums and keep two other tiers of management commissioning alongside them. Investment in the NHS has not been matched by reform. Yes, we will protect NHS investment, but our reform agenda builds on the best of the reform process over the previous 20 years. An Opposition Member said that we reject everything that went on under the previous Government, but of course we do not. We have made that very clear. These proposals build on Labour Government measures such as practice-based commissioning and NHS foundation trusts, and rightly so.

I sometimes hear it said—I heard it put to my right hon. Friend the Secretary of State yesterday morning on the “Today” programme—that the Government’s health policy was a bit of a surprise to everybody. I do not know why that would be. I mentioned earlier that the Health Secretary visited the Royal Hampshire county hospital. That was in May 2008, and he discussed the policy with people there then. He will remember the visit.

Health (CSR)

Rosie Cooper Excerpts

Thursday 11th November 2010 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

Thank you for allowing me to contribute to this debate under your chairmanship, Mr Gale. I am a passionate advocate for the national health service. For more than 30 years, I have been directly involved in it. Through the health authority, I was chair of Liverpool Women’s hospital for 10 years; just before I became an MP, we took the hospital to foundation status. I am also currently a member of the Select Committee on Health.

I explain my background because I want the Minister to understand that I have witnessed at first hand the roller coaster that the NHS has been on—reorganisations, crises, investment, disinvestment and improvements—as it has sought to deal with a dramatically changing world and shifting demands and expectations. However, today the NHS faces perhaps its most far-reaching and fundamental challenge since its inception. I will lay out some of the challenges for the future of the NHS that will be driven directly by the Department of Health settlement in the comprehensive spending review.

The Chancellor’s announcement in the CSR that health would receive a real-terms increase of 0.1% revealed the tension and struggle that will define the future of the health service. It is not exaggerating to say that decisions in the CSR and subsequently in the Department of Health are life-and-death decisions. We cannot afford to play Russian roulette with the future of the people’s health services.

We must disregard the rhetoric and myth-making of the Conservatives as they seek to demonstrate that they have changed when it comes to the NHS. Sadly for the health service, I am not convinced that they have changed at all. Before the general election, the now Prime Minister pledged clearly to end the merry-go-round of organisational change and to protect NHS funding. Those two clear and definitive statements would have suggested to voters a period of stability and continuity for the NHS, even in these difficult and challenging economic times.

There was certainly no indication at that point of what the Secretary of State was about to unleash. We are only now starting to get to grips with the implications of the proposed changes. As a member of the Select Committee who has addressed Department of Health officials and the Secretary of State, I am not sure that the Department of Health is really in control of what is happening. As far as I can see, the current policy in the Department of Health is “Don’t ask for the detail; we haven’t made it up yet.” All the changes are being led by the Secretary of State.

Statements change from one minute to the next. We are told that primary care trusts and strategic health authorities will remain until 2013 to underpin the changes; then, today, Sir David Nicholson, chief executive of the national health service, warned the Secretary of State that his proposal to abolish all PCTs by 2013 could affect quality and safety. The whole thing is becoming a circus. The plans were described by one journalist as an accident waiting to happen, and by a doctor as a politically motivated reorganisation of the NHS. That is hardly critical acclaim.

The Secretary of State for Health said to the Conservative party conference that the Government had made

“An historic commitment to increase NHS resources in real terms each year”.

That is over-egging the pudding somewhat, given the 0.1% increase. The Government could not have done any less without failing to keep their commitment. It is the lowest settlement since the 1950s. That promise must be seen in context: in-year efficiency savings of £20 billion; £1 billion taken out of the NHS to make up half the £2 billion allocated to local authorities for social care, which is not ring-fenced; an increase of £200 million to £300 million in VAT costs after the coalition increases the VAT rate; a possible £800 million to £900 million in redundancy payments over the next two years; an anticipated budget shortfall of about £6 billion by 2015; a 17% cut in capital expenditure; a two-year freeze for those earning £21,000 or more, with the expectation of a catch-up in salaries post-2013. Hospitals face financial pressures because the Department of Health has frozen the tariff. Those are the downward pressures on the financial strength of the NHS, without even taking into account the long-term strategic pressures that will shape the nature of health services and increase the strain on the NHS. They will inevitably require a more substantial budgetary provision than 0.1% year on year.

The Minister knows that the NHS faces increasing demand for services, an ageing population, an increasing number of people with complex long-term illnesses, rising treatment costs and more and more expensive medical technology. On top of that comes the far-reaching organisational restructuring of the entire health service. Sir David Nicholson told the Health Committee that the productivity challenge was huge and had never been done on the same scale in the NHS or anywhere in the world, and it is expected to happen during the transition into the new world of NHS commissioning.

With your permission, Mr Gale, I will quote Nigel Edwards, chief executive of the NHS Confederation. I asked him:

“I just wonder whether you could address this in a few sentences: do you think that we can release these productivity gains, face the furore of the populace, who will not be happy with the comments you have made about hospitals closing, and GPs in consortia trying to manage this system and, in the interim of trying to get there, a lot of the PCTs and strategic health authorities––the good people––are jumping ship? So you are now facing a huge, dangerous area where you may not have the personnel to keep what we have got going. How are we going to get the consortia—the GPs who are commissioning services—facing the wrath of their people, when some of the services they are well used to are closing down? At the same time we are busy saving all this money, do you actually think we can do it?”

He responded:

“I was going to say I think you have encapsulated the problem extremely well…my personal view is there is a very, very significant risk associated with the project that you have just described.”

On top of that, we have heard warm words from the Secretary of State. In various speeches, he has said that the guiding principle will be:

“‘No decision about me, without me’”,

yet when we examine the detail—very little of which is available—the truth appears different.

[Frank Dobson]

My hon. Friend is right to deal with such global matters. Does she think that it is possible for the Secretary of State or the Minister to reconcile all that benign guff about the money being there with the Government’s proposal to take £16 million away from Great Ormond Street hospital for sick children in my constituency? It is the most famous of its kind in Britain, with world-renowned staff, and it now faces major cuts.

[Rosie Cooper]

I share my right hon. Friend’s view. Alder Hey, which is adjacent to my constituency and serves my constituents, will be similarly affected. We are taking a worrying direction.

On “No decision about me, without me”, the Secretary of State said to the Select Committee that

“the conclusion that we reached was that we could achieve democratic accountability more effectively by creating a stronger strategic relationship between the general practice-led consortia and the local authority.”

Many people might imagine that that would mean patients being at the heart of decision making and that consortia would operate with councillors, the public and non-executives on the board with a vote. However, that will not be the case. The scrutiny will come from well-being boards. The fact that they will not be at the table and will not have a vote means—as with the current local authority overview and scrutiny arrangements—they might as well not be there. In the Health Committee, I said that such a situation was like throwing snowballs at a moving truck—in other words, the decisions and views of the well-being boards would make little or no difference.

In reality, the Government are giving the NHS budget to GPs, many of whom just want to practise medicine, rather than get involved in this giant policy experiment. There will be no testing; it will just be a big bang. The Government will use the consortiums as a shield to deflect criticism, rather like the way they are currently using the Liberal Democrats. There are rumours that the Prime Minister is getting worried about all of this. I can only hope that that is true.

The warning signs of what this means for the national health service are already apparent. There was an 80% increase in bed blocking in hospitals between May and September. I expect that that situation will only get worse, especially when the cuts to local government budgets really start to bite. Hospitals are once again increasingly becoming the safety net when the funding for social care has been used up. If a local authority cannot afford to provide the necessary care, people will end up in hospital.

Questions were asked at the Health Committee about reserves held by NHS organisations and how they would be treated. Primary care trusts are beginning to refuse to provide certain treatments. We have also had announcements on the future role of the National Institute for Health and Clinical Excellence, which will no longer advise on drug treatment and is moving towards value-based pricing. Will the Secretary of State control the drug companies pricing policies or, as most people think, will the drug companies shortly be back in control? We will soon be back to postcode prescribing and, more worryingly, we are making the availability of drugs a political rather than a clinical decision.

When I hear Government statements about their commitment to the quality of health care and delivering outcomes, my thoughts return to the fight between myth and reality. The idea that front-line services will not be affected seems somewhat delusional. During questions at the meeting of the Health Committee on 26 October, it became apparent from a witness giving evidence that hospital closures would be necessary to release moneys back into the wider health service. We were told that that was part of “managing demand” and “redesigning care pathways.” I have heard those two phrases throughout my health service attachment and they are very much back in vogue at present.

The failure adequately to address the true budget requirements of the NHS will not deliver and continue the quality of care that patients expect and need. These are short-term measures that have long-term consequences. They are ill thought out and will have major ramifications for the people who rely on access to vital health services. For those people, such services are a lifeline. Nobody is pretending that nothing can be improved in the health service. However, does it have to be subject to untested reorganisation while we are trying to manage increasing demand in the current financial climate?

The Labour Government were rightly proud that they reduced waiting lists from 18 months to 18 weeks. It took 13 years of proper investment to turn the NHS around, and it is a service that we should rightly be proud of. My fear is that Conservative policies could destroy all that hard work within a matter of 13 months. I agree with the comments of my right hon. Friend the Member for Wentworth and Dearne (John Healey) about the “broken promises” of the coalition. My fear is that those broken promises will lead us headlong into a broken NHS—or is that the intention?

--- Later in debate ---

[Mr Burns]

The shadow Minister must be patient; I will come to social care.

The Department’s capital budget will be sufficient to ensure that key schemes that have already been agreed are continued and that the NHS estate is properly maintained. The NHS capital budget will pay for, among other things, publicly funded projects at North Cumbria University Hospitals NHS Trust, Pennine Acute Hospitals NHS Trust, and Epsom and St Helier University Hospitals NHS Trust.

Notwithstanding the real-terms increase in funding, we always knew that the NHS was facing challenging times. That is self-evident and we have never sought to hide behind it; everyone recognises it. As a number of hon. Members said, that challenge is due to an ageing population, expensive treatments, and health care and social care costs rising substantially every year. That is why the NHS and social care need to do more with their resources and make every penny count. In health, we are asking the NHS to secure, as a number of hon. Members said, up to £20 billion of efficiency savings over the next four years through the QIPP—quality, innovation, productivity and prevention—programme.

In addition, every penny of those savings will be reinvested in front-line services, enabling us to meet the costs of increased demand for care. The savings will come from cutting administration costs across the system by a third, as well as from other efficiencies throughout the NHS. Frequently, better care can save money. It is cheaper, as well as better for people, to get the right care first time, rather than the inappropriate or insufficiently relevant care that is involved when people have to go back to be provided with extra care—an expensive way to provide care and not an experience that patients should have.

[Rosie Cooper]

I appreciate what the Minister is saying, but does he not agree that radical change to or redesign of a system often requires investment to get those costs out at the end? We are hearing about lots of cost cutting, but there are no obvious signs of a process or pathway where investment is taking place to get those gains out.

[Mr Burns]

In the overall run of things, the hon. Lady makes a genuine point, but most of the cost cutting that I heard about during the speeches involved accusations of services being cut without the reasons for the status of what are, in many cases, reconfigurations being gone into. Also, until conclusions have been reached, there is no guarantee that those reconfigurations will happen. They might do so, but there is no automatic guarantee that, just because there is to be a reconfiguration, the end product will be what was first proposed.

Furthermore, I heard very little comment—indeed, I do not think that anyone passed comment, although I apologise if someone did—on the QIPP programme, which is so important and vital for raising standards, using innovation to improve quality of care and delivery. In that, we have examples across the country of the NHS finding changes that can make a big difference.

For example, Southend Hospital NHS Trust is saving £160,000 a year by mapping postcodes—patients who live near each other can be picked up together for their dialysis appointments. Oxford Radcliffe Hospitals NHS Trust is saving £1 million a year by implementing an electronic blood transfusion system, which cuts the staff time taken to deliver blood and reduces transfusion errors, thereby improving services for patients. Ten NHS trusts have been piloting a new pathway to improve care for patients, mainly elderly people who have suffered a fractured neck of femur. If that were rolled out across the country, it could save £75 million a year.

Those are just small examples of things that can be done where savings are made, the quality and appropriateness of care improve, and money can be ploughed back into front-line services, which is so important.

While we are talking about resources, I shall answer the important question asked by the right hon. Member for Holborn and St Pancras (Frank Dobson). He specifically mentioned Great Ormond Street hospital, but this applies across all the specialist children’s hospitals. The Department is having ongoing discussions with Great Ormond Street and the other relevant hospitals in England about potential—I emphasise “potential”—changes to the tariff for specialist children’s hospitals for 2011-12.

I can tell the right hon. Gentleman that no decisions have yet been taken and the discussions are continuing. On his specific question about how much less money is going to be given, there is no answer at the moment, because no decisions have been taken. The discussions will continue. I hope, for the time being, that he is reassured by that answer.

--- Later in debate ---

[Mr Burns]

The hon. Gentleman is right. I do not claim that the demographic time bomb will be resolved by this measure. The trouble with personal social care is an historic one; Governments have always been playing catch-up. That is beyond dispute. I am saying that we recognised the growing pressures, and we believed that we had to act. That is why we have done so. It will reduce the problem, but the hon. Gentleman is right that it will not solve it, as more work has to be done. No doubt, it will be done, as we catch up with the past. I hope that I have reassured the hon. Gentleman. I now wish to make progress.

We believe that funding social care is important not only in its own right but for the sake of the hundreds of thousands of people who rely on it—and because the NHS cannot function without social care. Without it, people have to stay in hospital beds for longer, inappropriately blocking beds that other patients could use. It is important that we invest the money to ensure that there are no delayed discharges, and that we can provide an appropriate setting for those who are discharged.

[Rosie Cooper]

I thank the Minister for giving way. I am trying to be helpful. My hon. Friend the Member for Easington (Grahame M. Morris) is right. The Select Committee suggested that there was a £3 billion or £3.5 billion gap. Evidence to the Committee clearly showed that local authorities believed that if they invested a pound, the saving and the benefit was likely to be seen in the health service through exactly what the Minister mentioned—beds not being blocked and so on. This might help my hon. Friend the Member for Halton (Derek Twigg), the shadow Minister; I suggested in Committee that the element of funding that lies currently with local authorities should be transferred to the NHS. We would not then have such a gap. The local authorities resisted, but the core of the problem that both Front Benches are outlining is that the £1 billion that the councils have is not ring-fenced and will be spent on whatever provisions are desperately needed. The money that the Minister says is for the NHS will be spent only on NHS re-ablement and other stuff that is absolutely within the NHS, but the local authorities do not believe that. They think that it will be dropped on their toes at any minute, and that they can spend it.

[Mr Burns]

I fully understand the issue that the hon. Lady raised about whether we merge the NHS part of social care in local government into the NHS, or vice versa. That has been an ongoing debate for many years. The hon. Lady may find it difficult to believe, but 13 years ago I was the Minister with responsibility for social care. The argument was raging then. I have no doubt that it will continue to rage for some time to come. I, too, have heard the worries that the money that comes through the RSG will not be spent on social care. From the discussions that the NHS has had with local authorities, I have been led to believe that that will not be such a problem. Given that there is a problem with social care and a need to provide support, there will be a determination and a positive attitude to ensure that the money is appropriately spent on what it is designed for and that it will, with the money from the NHS, make a significant difference to a very serious and sensitive problem that we, as a society, have to address.

In conclusion, the spending review is the necessary consequence of this Government’s facing up to the financial responsibilities and problems that we inherited when we came to power. If we are to secure a future of growth, prosperity and jobs and if we are to fulfil our commitment to increase funding for the NHS in real terms for every year of this Parliament, then we must place our public finances on a stable, sustainable footing.

We will not ask the sick, the disabled or the elderly to pay the price of the previous Government’s economic mismanagement. We are increasing the health budget in real terms and reforming the service, not only to make the most of every penny but to put power in the hands of those who know best how to improve services. I am talking not about the Ministers and civil servants in Whitehall but about the NHS staff and patients on the ground.