Privatisation of NHS Services

Steve Barclay Excerpts

Monday 23rd April 2018 Westminster Hall

[The Minister for Health (Stephen Barclay)]

It is a pleasure once again to serve under your chairmanship, Mr Hosie. I thank all Members who have contributed to this wide-ranging debate, in particular the hon. Member for Hartlepool (Mike Hill) who, as a member of the Petitions Committee, introduced today’s debate on the petition.

I join the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), in expressing our condolences for Connor McDade, the constituent of the hon. Member for Hartlepool, especially given Connor’s tender age. That must be extremely traumatic for his family.

“As the NHS moves from a public sector monopoly to a truly patient-led service, exciting opportunities are opening up for hospitals and other providers, whether public, private or not-for-profit”—

those are not my words, but the words of a Labour Secretary of State for Health in 2007. Perhaps, however, I am looking too far in the past and we should look to a more current Labour politician, such as the Mayor of Manchester, who was the last Labour Secretary of State. He said:

“Now the private sector puts its capacity into the NHS for the benefit of NHS patients”,

which I think most people in this country would celebrate. Indeed, the other of the three most recent Labour Secretaries of State, Mr Milburn, joined PwC in 2013 as chair of its UK health industry oversight board, whose objective was to drive change in the health sector and assist PwC in growing its presence in the health market.

As the hon. Member for Hartlepool recognised, from the outset, the NHS has always had a private treatment offer—I think he used those words. The key issue is where the care remains free at the point of access. That is enshrined in the 2012 Act and is reflected in many of the remarks made by Conservative Members.

My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) addressed the question of whether, alongside care being free at the point of access, there had been a step change in the number of private suppliers—that seems to have been the suggestion— notwithstanding the clear support from the last three Labour Secretaries of State for Health for such provision. It may surprise you, Mr Hosie, to learn that in the last year for which financial data is available, NHS commissioners purchased 7.7% of total healthcare from the independent sector. In 2010, the figure was just under 5%, so the rates of growth in the use of private providers under this Government are not the same, as my hon. Friend suggested; they are lower than those under the previous Government. We need to put into a degree of context some of the scaremongering that there has been in this debate about privatisation and weaponisation of the NHS.

The hon. Member for Colne Valley (Thelma Walker), who is not in her place, talked about privatisation—in that context, several Members mentioned Carillion. Again, it may be helpful to remind the House that of 13 PFI contracts signed with Carillion for facilities management, 12 were agreed prior to May 2010. The hon. Member for Dewsbury (Paula Sherriff) suggested that she was keen to talk to Ministers about her concerns with Virgin Care. I accept that, just as with care within the NHS, often there are lessons to be learnt in care from a private provider. The hon. Lady is not her place, but I am happy to accept her offer to meet her to learn from any past experience she has. The hon. Member for Crewe and Nantwich (Laura Smith) referred to PFI deals; as I said, many of those were signed by past Governments.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous), in a first class, wide-ranging speech, referred to one of the key themes that came out of the debate: the importance of integrated care. Again, the weaponisation of this debate is highlighted by the fact that sustainability and transformation plans—as he said, they were endorsed by non-political bodies such as the King’s Fund—were characterised at the time by people such as Mrs Pollock as secret Tory privatisation. Indeed, the same person previously characterised Labour’s foundation trusts as privatisation. We have seen this privatisation badge given to successive changes as they have been applied. My hon. Friend is quite right that Simon Stevens was appointed as a special adviser by a Labour Government. His evidence to the Health and Social Care Committee was quite clear when he highlighted how many of these issues have been cited before.

The hon. Member for Hyndburn (Graham P. Jones) spoke of his concerns about fragmentation. I hope that he will welcome the shift to place-based commissioning and a focus on greater integration between commissioners. My hon. Friend the Member for Chichester (Gillian Keegan) identified the fact that patients’ outcomes are uppermost in the approach. That is very much reflected in the example she gave of the better care fund, which is all about how we bring health and social care together. An example of that is the change that the Prime Minister made by bringing the Minister for Care, my hon. Friend the Member for Gosport (Caroline Dinenage), into the Department to look at how we can better integrate.

The hon. Member for Warrington South (Faisal Rashid) suggested that the role of private firms had doubled since 2010. As I said, that is just not correct—the figure has gone from 5% to 7.7%, so the facts dispute that. My hon. Friend the Member for Gloucester (Richard Graham), in a very good speech, correctly highlighted the poor value for money of many PFI deals. That is why the Treasury changed the terms by which those Labour PFI deals are now contracted. It is right that we learn many lessons from them.

The hon. Member for Stroud (Dr Drew) raised a number of very fair, genuine and worthwhile points. I will quickly try to address them, although I refer to a previous debate in this Chamber on subsidiaries, where we aired some of the points that he raised. Subsidiaries are 100% owned by the NHS, so any financial benefit they gain is retained within the NHS family. They are an alternative to having to contract outside the NHS family, so they help to keep money in the NHS. It is also worth bearing in mind that the staff surveys often show, contrary to some of the remarks, that many staff have welcomed them—there was a 15% increase in staff survey responses in one hospital. To take another, Barnsley saw a six-fold increase in the number of applicants to roles, because the better flexibility and up-front salary offset against pension is one of the attractions that many staff feel that subsidiaries offer.

My hon. Friend the Member for Thirsk and Malton spoke about his experience, which underscored a point made by a number of my hon. Friends: the absolute, rock-solid commitment on this side of the House to treatment being free at the point of use. He gave the example of waiting for care—a critical point and something that none of us wishes to see; under this Government we will not see that. My hon. Friend the Member for Cleethorpes (Martin Vickers) very correctly identified how private provision can, when correctly commissioned, bring quicker care. A good example of some of the subsidiaries is diagnostic care, where clearly it is in the interest of patients to get the results of their tests quicker.

I recognise, as the hon. Member for West Lancashire (Rosie Cooper) highlighted, that there needs to be transparency in respect of outsourced contracts. When I was a member of the Public Accounts Committee, a phrase we often referred to was “following the taxpayer’s pound.” That stood then and it stands now. I am very happy to work with the hon. Lady on how we can ensure that we are able to follow the taxpayer’s pound and address areas of variance. Variance applies in the NHS family, but it also applies in the private sector. I am very happy to work with her, just as I am looking forward to a visit, on a cross-party basis, to look at some of the specific issues at the Liverpool Community trust that she correctly identified and brought to the House. The hon. Member for York Central (Rachael Maskell) said that no one wants to work for subsidiary companies; as I said, patients’ survey data suggests that is not the case.

My hon. Friend the Member for Cheltenham (Alex Chalk) highlighted how outsourcing is dressed up as a threat to treatment being free at the point of use; he is right to highlight the way that is being misportrayed and his pride in the fact that there is no payment requirement for treatment. He also highlighted the diverse mix in hospices, with charities such as Macmillan, which are not part of the NHS. No one would suggest that that is privatisation; this petition, which likens all outsourcing to privatisation, is deeply misleading.

I want to allow a minute for the hon. Member for Hartlepool to make his concluding remarks, so I conclude by reaffirming the absolute commitment of this Government to maintain treatment free at the point of use, but also always to put the needs of patients first and to respect value for money for the taxpayer. That has been reflected in many of the remarks from hon. Members across the House, and it is the essence of this Government’s approach.