National Health Service

Debate between Tom Blenkinsop and Andy Burnham

Wednesday 21st January 2015 Commons Chamber

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

I asked the Prime Minister some weeks ago about the number of nurses in the NHS. In December, the number of NHS nurses in the system had been reduced by over 900 since May 2010, but we were told in November that it was up by about 2,500. The Government were using the figures, and the Prime Minister was answering questions, in terms of hours worked. As we know, nurses are working massive amounts of overtime on single-rate time. Nominal headcount nurses, at this moment in time, are minus over 900 compared with May 2010.

[Andy Burnham]

My hon. Friend makes his point very well. This is what we must challenge as we move forward. Before the general election, people need the facts about what is happening to the NHS. There has been a big drop in the number of nurses working in the community, as my hon. Friend mentioned, and these are the facts that we need to bring home to people.

It is not just the fact that the GP headcount has gone down. One of the present Government’s first acts was to scrap the guarantee of an appointment within 48 hours and incentives to open GP surgeries in the evenings and at weekends. That, combined with cuts to the GP budget, means that it has got harder and harder to get a GP appointment in recent years. The constituents of all the Members present say, “I am ringing the surgery at 8 or 9 every morning and being told that nothing is available for days.” In 2010, the vast majority—80%–of people said they could get an appointment within 48 hours; now, according to the GP survey, one in four people say they must wait a week or more to see a GP.

Health

Debate between Tom Blenkinsop and Andy Burnham

Monday 9th June 2014 Commons Chamber

[Andy Burnham]

My hon. Friend is absolutely right—the deterioration in general practice has been marked during the past few years. There have been changes that have disadvantaged patients. Within weeks of taking office, the Government removed the guarantee that patients could have an appointment within 48 hours. That explains the situation that my hon. Friend describes, alongside cuts to funding of general practice to the point that some practices now say they are on the brink of deciding whether or not they can remain open. The Government have responsibility for that situation, but there is not a word from the Secretary of State about it and there is not an acknowledgement that people have severe problems in accessing their GP.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

In my constituency, the minor injuries unit at Guisborough hospital, the minor injuries unit at East Cleveland hospital in Brotton, a walk-in centre and medical centre in Skelton, and a medical centre in Park End—all primary or intermediary level facilities—will be closed, putting further pressure on the excellent but already outlying A and E unit at James Cook University hospital. When I write to Ministers to ask questions and for a meeting, I am told that I have already had too many discussions with them and that I cannot bring it up any further. Will my right hon. Friend please enlighten me about what he would do if he were in power?

[Andy Burnham]

I will move on to that point. Whenever there is a problem, we are told, “Speak to NHS England.” I am afraid that is not good enough. Up and down the country we are seeing services closed without adequate consultation. NHS walk-in centres continue to be closed, piling more pressure on A and E departments. It is just not good enough. We have seen top-down changes driven through, and the hospital closure clause is on the books, so sadly this will continue. It will only change when we have a Labour Government back in control—a Government committed to putting the public and patient voice at the very heart of the NHS.

I was talking about A and E and the reorganisation. We know that Ministers were explicitly warned about an A and E recruitment crisis by the College of Emergency Medicine a couple of years ago, but they said they were too absorbed with the reorganisation to listen or act. That brings me to the nub of the matter before the House: the root cause of the deterioration in the NHS is that reorganisation, which nobody wanted and nobody voted for. It threw the service into chaos just when it needed stability. As we warned, it has damaged standards of patient care. Four years ago the Government inherited a self-confident and successful NHS, with the lowest ever waiting times and the highest ever public satisfaction. Since then it has been destabilised, demoralised and reduced to an uncertain organisation that is increasingly fearful of the future.

NHS (Private Sector)

Debate between Tom Blenkinsop and Andy Burnham

Monday 16th January 2012 Commons Chamber

[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.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Does my right hon. Friend agree that the fundamental change in the Bill is that the Government are imposing a new form, Monitor, which directly applies competition regulation in NHS delivery of services and undermines the principles and rules for co-operation and competition—PRCC—that arbitrate between commercial services and the NHS, which controlled the market?

[Andy Burnham]

That is exactly the point. The proposal has to be seen in the context of the health system the coalition Government want to create. They want a broken-down system where one hospital is pitted against another, where there is a duty on the Secretary of State to promote the autonomy of NHS organisations, so that they are out there on their own, having to stand or fall on their merits, with a clear incentive to drive up income gained through a relaxed private patient income cap. I shall come to that point in a moment.

--- Later in debate ---

[Andy Burnham]

That is absolutely the point. The Government want to create an NHS where Ministers can no longer say what can or cannot be done, so we have GP practices, such as Haxby in York, sending letters to their patients saying, “We have decided that we are not going to fund your minor operations any more, but by the way, we are now providing those operations. Here’s our price list.” That is absolutely disgraceful, but it is a glimpse of the NHS that will emerge if the Health and Social Care Bill goes through. My hon. Friend is absolutely right: we must consider the wider context, within a system with competition at its heart and where every hospital is on its own and they are fighting each other. That is the context in which this 49% proposal needs to be considered. It represents a break with 63 years of NHS history and a “genie out of the bottle” moment. That is why we ask the House to reject it.

[Tom Blenkinsop]

My right hon. Friend is making a strong point. The Minister says that the cap was flexible during our term, but that was under principles and rules for co-operation and competition rulings. That meant that the servicing out of the contract was based on care quality. Unfortunately, the Bill does not have any area dealing with quality of care; it is purely about price. It is about allowing Monitor to apply the pure regulatory format of the Competition Commission as it exists in other utility markets.

[Andy Burnham]

My hon. Friend anticipates me. I shall come to precisely that point in a moment, and it will backs up his point that the Bill is akin to the privatisations of the 1980s.

--- Later in debate ---

[Andy Burnham]

I do not know whether those questions were for me or for you, Mr Deputy Speaker, but let us assume that they were for me.

I introduced the NHS constitution, which enshrined for the first time the basic rights of NHS patients. I am proud to have done so, so I do not need any lectures from the hon. Gentleman about what we should do to improve health care in this country. I said in the motion that I am prepared to go back to my policy before the election in which we said that we would consider loosening the private patient cap. That is the policy that I have introduced to the House tonight. I am not prepared, however, to accept the wholesale abolition of that control to create a situation in which NHS hospitals can devote half their beds to private patients. If he is happy with that in his constituency, let him make the argument for it, but I am making an argument for a very different NHS from the one envisaged by Ministers.

[Tom Blenkinsop]

Is not the real question for the Government why on earth they have written the Competition Act 1998 into the Bill? Why have they written the Enterprise Act 2002 into it, and why have they allowed European competition law to create the haemorrhaging of a socially provided service under category B legislation? Why have they done that? What is the point? It can only be to loosen enterprise within the NHS for competitive purposes so that the private sector can come in.

[Andy Burnham]

My hon. Friend makes an important point. If the Bill was really about clinical commissioning, as the Government said at the beginning, and putting GPs in control, that could have been done through existing NHS structures. They could simply put clinical teams in charge of existing PCT structures. It could be done without any hassle or cost, but no, they completely broke down and rethought the whole system, because it was an ideological reform. Doctors oppose the measure, because they saw through the Bill, and saw it for what it was: a privatisation plan for the NHS.

Let me give three examples that demonstrate why the Prime Minister has not lived up to his “no privatisation” claim. The first is a letter sent by the Department on 19 July last year to NHS and social care leaders entitled “Extending Choice of Provider”:

“The NHS is facing a period of significant transition and financial challenge. But this is not a reason to delay action to address patient demands for greater choice”.

It went on to require all PCT clusters and clinical commissioning groups to identify three community services by 31 October that would be subject to an “any qualified provider” tendering process. That is significant because it exposes the ideological agenda behind the Bill and explodes the myth that it is about putting doctors in charge. If that was the case, logic would demand that it should be for doctors to decide whether or not any underperforming services could benefit from open procurement. That mandating of compulsory competitive tendering, even before Parliament has given its consent to the Bill, reveals the real direction of the policy. We simply ask how that can possibly be consistent with the Prime Minister’s promise of no privatisation.

The second example is the Department's guidance document to CCGs entitled “Developing commissioning support: towards service excellence”. I shall quote from the beginning of the document, which gives a clear statement of intent:

“The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to freestanding enterprise.”

It could not be clearer, which is why members of the British Medical Association council called the document a “smoking gun”, confirming their fears of a stealth privatisation. The document confirmed that the Government envisaged large-scale privatisation of services to support commissioning—jobs that are currently carried out by public servants. It puts into practice the comments made by Lord Howe on 7 September 2011 at the Laing and Buisson independent healthcare forum:

“The opening up of the NHS creates genuine opportunities for those of you who can offer high quality, convenient services that compete favourably with current NHS care. If you can do that then you can do well. But you know that won’t be easy, the NHS isn’t a place to earn a fast buck...they will not give up their patients easily”.

On commissioning, he said:

“Commissioning support is an absolutely critical area for CCGs. Some of it will come from the PCT staff who will migrate over to the groups but there will need to be all sorts of support at various levels…There will be big opportunities for the private sector here.”

With reference to that second example, I ask the Secretary of State how on earth is that policy consistent with the promise made by the Prime Minister and the Deputy Prime Minister of no privatisation?

That brings me to the third example, which we have discussed tonight. Just before the Christmas recess, the plan, which threatens to change the very character of our hospitals, was sneaked into the House of Lords. I do not seek to argue that that provision would change the NHS overnight, but in the context of a competitive NHS, where there is an obligation to promote the autonomy of hospitals, I believe that it would completely change the character of our hospitals and the way they think and function over time. The effect of a cap at this scale—a staggering 49%—means that hospitals could give equal priority to private patients. It sets the NHS and private sector in direct comparison with each other, and creates the conditions for an explosion of private work in NHS hospitals.

It is such a liberal provision that the Government’s amendment will have virtually the same impact as abolishing the cap completely, and it is a world away from the current situation. It fails to protect the interests of NHS patients by giving equal priority to other patients. Indeed, it creates a conflict of interest, as trusts could even seek to push patients into their private beds.