NHS (Private Sector)

Simon Burns Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

No, I would not agree. I shall explain the policy that our Government adopted on the private sector and how different it was from that of the Government whom the right hon. Gentleman supports. In making our argument we will expose the terrifying gap between the Prime Minister’s rhetoric on the NHS and what he is doing in reality. People will recall the efforts that went into rebranding the nasty party. The Conservatives were at great pains to tell us that they would be pro-environment, a bit less tough on crime and pro-NHS going forward. Many photo calls were arranged to send those messages to the public, but it was poor old NHS staff who featured far more than huskies or hoodies in being brought in to promote hastily made political promises. We were told there would be real-terms increases for the NHS, a moratorium on accident and emergency department closures, thousands more midwives and, famously, no top-down reorganisation—four promises made in opposition: four promises broken in government. I still have not worked out how a Prime Minister can go from agreeing there should be no top-down reorganisation with his coalition partners after the election to bringing forward just weeks later the biggest top-down reorganisation ever in the history of the NHS. How does that work? Perhaps Lib Dem Members will enlighten us this evening.

Our evasive Prime Minister is the master of making statements that sound good at the time only to turn out to be meaningless in practice. Tonight we will focus on his most outrageous yet. On Monday 16 May last year, under pressure to reassure people about the Health and Social Care Bill and in the middle of the enforced pause, the Prime Minister said, in a speech:

“That’s why, when I think about what our NHS will look like in five years time, I don’t picture some space-age institution, a million miles away from what we have now. Let me make clear: there will be no privatisation”.

Those were his words—“no privatisation”.

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

indicated assent.

[Andy Burnham]

The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.

The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on 8 May, he promised that safeguards would be brought forward in the health Bill. He said:

“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”

He followed that up on 14 June with this promise:

“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”

Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.

Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.

Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.

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[Mr Dorrell]

rose—

[Mr Simon Burns]

rose—

[Andy Burnham]

I shall give way to the Chairman of the Select Committee on Health once more and then to the Minister.

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[Andy Burnham]

That is not what I said. I understand that the preferred policy was to have no caps or limits, but even if a generous and liberal cap was introduced there would be a major risk that hospitals under financial pressure would give beds, theatre time and appointments to private patients, enabling them to jump the queue and giving a much worse deal to NHS patients. That is the risk that the cap was designed to mitigate and that is why we support it.

[Mr Simon Burns]

Could the right hon. Gentleman explain the logic, under his Government, of having a cap on a minority of trusts—foundation trusts—while he as the Secretary of State and his Government did not impose a cap on the majority of trusts that were not foundation trusts?

[Andy Burnham]

There is a simple explanation. The right hon. Gentleman will remember, as I do, the debate on the foundation trust legislation. There were worries that if hospitals were made more independent and were not directly managed by the Department they would put the treatment of private patients before that of NHS patients. The cap was introduced to mitigate that risk. He will know that we had a policy that all trusts should become foundation trusts in time—a policy that his Government have adopted—so that the cap would apply to all NHS hospitals in time. I think that answers his question.

[Mr Burns]

If that is the case, rather than that it being forced on the Labour party by a rebellion of Back-Bench MPs in 2002, why did the right hon. Gentleman’s election manifesto in 2010 say that Labour would remove the cap?

[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.

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[Andy Burnham]

I remind the Health Secretary that he is the Secretary of State, not me. It is for him to bring forward proposals. Forty-nine per cent: in that proposal he is saying that NHS hospitals can give equal priority to the treatment of private patients—that it can be as legitimate an objective for an NHS facility, paid for by the taxpayers, to be used equally for the treatment of private and NHS patients. I put it to the hon. Member for Kingswood (Chris Skidmore) that I am not prepared to accept a cap on that scale. It could lead to an explosion of private sector work in NHS facilities and I do not think that is in the best interests of NHS patients. I would be prepared to accept the Government’s bringing forward proposals that fulfilled a modest loosening of the cap, to give the NHS more freedom at this difficult time, but I am talking in single figures. I am not talking about a doubt-digit, 50% cap—a recommendation that hospitals devote half their resources to private patients.

[Mr Simon Burns]

Will the shadow Secretary of State kindly answer the questions put by my right hon. and hon. Friends about what modest means? [Interruption.] If I might read it out, the 2010 Labour manifesto says:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”

There was no mention of a modest increase; it was open-ended.

[Andy Burnham]

The Minister is not listening. I answered his question. I proposed a small increase in the cap—in single figures; a couple of per cent, as I am on record saying at the time, to give NHS hospitals more freedom to generate more income, to be put back into improving standards for NHS patients. Can the Minister honestly look me in the eye and tell me that 49% is not a world away from the NHS that he inherited from our Government?

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

To begin on a conciliatory note, I congratulate the hon. Member for Copeland (Mr Reed) on his first speech from the Front Bench as a junior shadow Health spokesman. I did not agree with a single word that he said, but I congratulate him on the way in which he spoke.

I have no idea what new year resolutions the Labour party has made, but perhaps I could suggest one: to get their facts right. Having listened to the endearing speech of the right hon. Member for Holborn and St Pancras (Frank Dobson), the same speech that I have heard on many occasions from the hon. Member for Easington (Grahame M. Morris), the slightly bizarre speech of the hon. Member for Blaydon (Mr Anderson) and the speech from the hon. Member for West Lancashire (Rosie Cooper), I have to say that they really have got it wrong. It is wrong to seek to misrepresent by repeating a fallacy.

I congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on his lucid exposé of the contradictions in the arguments of the right hon. Member for Leigh (Andy Burnham). I thank my hon. Friends the Members for Central Suffolk and North Ipswich (Dr Poulter), for Crawley (Henry Smith) and for Battersea (Jane Ellison) for their thoughtful contributions. I listened carefully and with great interest to the speech by the hon. Member for Southport (John Pugh) but, to be honest and frank, I was not carried by the strength of his argument on the issues.

I fear that many of the contributions of Opposition Members that my hon. Friends and I have had to listen to have given a series of misrepresentations and misinformation. I remind them that for 36 years, just over half the 64 years of the national health service, it has been under the stewardship of the Conservative party. We have never sought to privatise the health service and we never will privatise the health service.

[Frank Dobson]

Will the Minister give way?

[Mr Burns]

Because of the time, I will give way to the right hon. Gentleman, but to no one thereafter.

[Frank Dobson]

The Minister suggested that I had used figures that were not factual. If they are not, he should know that they all came from parliamentary answers signed by him.

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[Mr Burns]

I did not in any shape or form suggest that the right hon. Gentleman’s figures were wrong. I argued that his arguments and his philosophy were wrong. They are based in a time that is pre-Blair, let alone Blair, which I know is now anathema to the Labour party. Ironically, one might say, as I think did my right hon. Friend the Member for Charnwood, that Government Members, in this respect, are all Blairites now.

Rather than pour scorn on an invented problem, the Opposition should welcome the healthy relationship between the national health service and private providers—a relationship that is mutually beneficial, that has existed since 1948, that is better for patients and, I hesitate to remind the right hon. Member for Leigh, that flourished under his Government. The previous Labour Government expanded the involvement of the private sector in the provision of NHS care in a way that no previous Conservative Government had done. Labour’s general election manifesto of 2010, which was written by the current Leader of the Opposition, said:

“We will support an active role for the independent sector working alongside the NHS in the provision of care”.

Rather more surprisingly, given the nature of today’s debate, the Labour manifesto also stated:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs.”

To reinforce that, it went on to promise to remove the private patient cap on foundation trusts. In addition, on 8 February 2010—at No. 10 Downing street, no less—the now Leader of the Opposition and the right hon. Member for Dulwich and West Norwood (Tessa Jowell), who I believe is a close personal friend of the right hon. Member for Leigh, hosted a meeting with non-NHS providers to examine their future role in delivering NHS services, among other public services. There is a certain irony and nerve in Labour’s bringing this motion before the House tonight.

I remind Members of the benefits of extra income to the NHS, which are so clear as to be self-evident. Any and all money made by the NHS is returned straight into care, not to the Treasury. The principal purpose of NHS providers has always been to serve NHS patients, and that will not change. In fact, trusts say that changing the cap will help them do that better than ever. The Labour party knows that. In 2009, the then Health Minister, Mike O’Brien, said that to cap the number of private patients would be nothing but a sop to militant Labour MPs. It now seems, though, that they are all militant Labour MPs.

I know that he has not been the flavour of the month for a while now, but as none other than Tony Blair once said, the private sector

“has got a valuable role to play in delivering NHS services.”

Even the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown) called for greater use of the private sector.

I wish to take a second to look at the last Government’s record on using the private sector. Through choose and book and through giving patients the right of the choice of provider, the number of patients treated as NHS patients in the private sector escalated. Under choose and book alone, the number of procedures increased from only 11 in 2000-01 to more than 208,000 10 years later. By May 2010, more than 7% of all NHS-funded first out-patient appointments were booked with independent sector providers. In monetary terms, between 2006 and 2010, £12.6 billion was spent in the private sector on NHS health care.

Let us pick an example at random—say, independent sector treatment centre contracts. “Wonderful things”, said Labour. “Cutting waiting times”, it said. What happened? Private companies were paid even when they had not treated any patients; hundreds of millions of pounds were taken from the public purse and wasted; and the NHS was barred from competing with private companies, even if it could offer a better service. What is more, seven of those ISTC contracts were signed while the right hon. Member for Leigh was a junior Minister at the Department of Health—hardly a glorious record.

My hon. Friends and I had a while in opposition, and I know how uncomfortable the Benches on that side of the House are. They make people itch—itch to disagree with everything that is said by Government Members. However, I say to the right hon. Gentleman that it is wrong to scaremonger about the role of the private sector in the NHS. As he found out in government, because his Government greatly expanded that role, there is a responsible role for the private sector not at the expense of the NHS but working with it. On that basis, I urge my right hon. and hon. Friends to vote against the motion.

Question put.