National Health Service (Amended Duties and Powers) Bill

Tony Baldry Excerpts

Friday 21st November 2014 Commons Chamber

[Sir Tony Baldry (Banbury) (Con)]

I congratulate the hon. Member for Eltham (Clive Efford) on introducing his Bill and on the robust candour with which he did so. I am only sorry that he was displaced from his usual perch in the House. However, I am confident that when, after the next general election, the Labour party finds itself again in opposition on those Benches, Labour Members will not have to share them with the UK Independence party because we will have won those seats back.

I can understand why, when there was a coalition Government at the start of this Parliament, the Liberal party wanted, as a condition of the entering into the coalition Government, a five-year fixed-term Parliament. However, one of the difficulties and drawbacks of five-year fixed-term Parliaments is that we have some of the longest general election campaigns ever, and that makes it quite difficult to differentiate substantive and serious political points and what is essentially electioneering. I can just imagine the hon. Gentleman making that speech on a wet Thursday evening during the general election campaign in the trades hall somewhere on Eltham high street.

[Sir Oliver Heald]

Does my right hon. Friend agree that it is good to hear an authentic south London voice speaking up for Labour values rather than the snooty lot from north London who manage the party now?

[Sir Tony Baldry]

Yes, but the first point I want to make is this. We need to be careful about what we say about the NHS in the run-up to general elections. The first general election campaign that I was seriously involved in was back in 1966. In every one since then, there has been a period when the Labour party has run around saying things along the lines of “24 hours to save the NHS.” That is very destabilising, as was evidenced today in a letter to a national newspaper by Dr Michael Dixon, the chairman of the NHS Alliance, and a number of other GPs, in which they say:

“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.

The Bill’s proponents claim it will remove competition from the NHS and guard against ‘privatisation’ by repealing key clauses of the 2012 Health and Social Care Act.

We believe this would be a backwards step for patient care, reorganising the NHS in a top-down way at a time when it needs to be looking ahead to the huge challenges of the future. These were set out in the NHS England Five Year Forward View, and we urge all politicians to support it rather than using the NHS as a political football.

Suggesting that GP commissioners have a ‘privatisation agenda’ is an ill-informed attack on the clinical leadership which improves services and helps patients.”

I agree. It is disappointing if politicians use the NHS as a political football.

The NHS is an enduring part of the post-war consensus on the welfare state. That consensus was agreed on by everyone who had gone through the deprivations of the second world war, had lived through the blitz, and were determined that there would be a better Britain. The NHS was supported by everyone, including Archbishop Temple, a brilliant Archbishop of Canterbury, who was the person who first coined the phrase “the welfare state”.

I have always been interested in the NHS, not least because both my parents became part of the NHS on its very first day. When it came into being in 1948, my father was a recently qualified registrar and my mother was a theatre sister, having served as a theatre nurse during the Coventry blitz. My parents spent the whole of their working lives in the NHS: my father went on to become the research secretary of the British Tuberculosis Association and a chest and heart specialist, and my mother went on to become a sister tutor.

The other reason I have always been extremely interested in the success of the NHS is that, in the nearly third of a century I have been fortunate to be the Member of Parliament for north Oxfordshire, the most important issue in my constituency has probably been the position of Horton general hospital and the retention of its services.

I have left instructions in my will that my body should go to the anatomy department of the university of Oxford, partly because there is quite a lot of it for them to work on, but also because I feel that the liver of anybody who has been an MP for nearly a third of a century must be worthy of some anatomical research. I am also determined that when they open me up, they will discover engraved on my heart, “Keep the Horton general.”

What we heard from the hon. Member for Eltham was a litany of gloom in the NHS, but Horton general hospital now has more consultants than at any time in its and the NHS’s history. The Oxford University Hospitals NHS Trust employs 11,598 staff, including 1,800 doctors and 3,600 nurses. It is important to make clear that, since 2010, the number of patients seen by the trust, including at Horton, has increased significantly. There has been a 19% increase in elected in-patient admissions, a 9% increase in emergency in-patient admissions, a 24% increase in day-care admissions and a 12% increase in out-patient attendances. Those are significant increases in just over four years, so the NHS continues to treat more out-patients and in-patients.

Over the past two years, the Oxford University Hospitals NHS Trust has managed completely to eliminate its financial deficit and increase the amount paid to the Oxfordshire clinical commissioning group, such that the group finished the year with a surplus. Most importantly, over the past couple of years the trust has managed to create 400 new jobs, almost all of them new doctors and new nursing posts. Sir Jonathan Michael and his team deserve considerable congratulations on managing to balance the finances of the trust and securing a large number of new medical and nursing posts.

[Clive Efford]

Does the right hon. Gentleman think that all those things would have been achievable had the level of funding for the NHS continued at the rate we inherited in 1997 and had Labour not almost tripled the amount of GDP put into our health services?

[Sir Tony Baldry]

Every Government have invested money in the NHS, and quite rightly so. This Government have invested real-terms increases in the NHS, as evidenced by the Commonwealth Fund, which compares health systems internationally. It found this year that, although the United States health care system is the most expensive in the world, it underperforms relative to other countries on most dimensions of performance. The fund studied 11 nations: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The United States ranks last, but who ranks first as the best health care system in the world? The United Kingdom. We should all, wherever we sit in this House, be proud that we have the best health care system in the world.

[Mr Christopher Chope (Christchurch) (Con)]

The picture is not quite as rosy as my right hon. Friend paints it, is it? Even The Guardian newspaper reported that the Commonwealth Fund survey showed that the

“only serious black mark against the NHS was its poor record on keeping people alive.”

[Sir Tony Baldry]

I am not entirely sure what point my hon. Friend is trying to make. The fact is that the Commonwealth Fund found that the NHS is the best health care system in the world. I hope that he and everyone in the House takes pride in that. The NHS has many challenges—we are all conscious that with an ageing demography and advances in medical technology, every health care system faces challenges—but we should take pride in being the best.

We also need to be honest about what has gone before. There was an enormous amount of rewriting of history and revisionism in the speech of the hon. Member for Eltham. For those of us who have been in the House for some time, it may be worth looking back and reminding ourselves about what happened in the not-too-distant past.

In the introduction to the NHS plan of July 2000, the then Secretary of State for Health, Alan Milburn, wrote:

“This NHS Plan sets out the steps we now need to take to transform the health service so that it is redesigned around the needs of patients. It means tackling the toughest issues that have been ducked for too long.”

I do not think anyone would ever disagree with that as a statement of intent. He went on:

“For the first time the NHS and the private sector will work more closely together not just to build new hospitals but to provide NHS patients with the operations they need.”

[Bob Stewart (Beckenham) (Con)]

I am big fan of the NHS. It is my NHS too. I was badly hurt in the Army in 1997, and the NHS sent me to get fixed as a private patient, because the NHS could not do it. I am very grateful to the NHS. That was under a Labour Government, and I hope such a scheme continues.

[Sir Tony Baldry]

My hon. Friend makes his own point very well in his own way. It is important for all of us to remember that the NHS is our NHS and our constituents’ NHS. It does not belong to any particular political party; it is a national heath service.

Alan Milburn concluded that the “major reforms”, which included working more closely with the private sector, would

“deliver real benefits for NHS patients”.

Chapter 11 of the NHS plan of July 2000, on “Changes in the relationship between the NHS and the private sector”, said:

“The NHS is a huge organisation. Using extra capacity and extra investment from voluntary and private sector providers can benefit NHS patients… The time has now come for the NHS to engage more constructively with the private sector”.

Under the heading, “The basis for a new relationship”, it went on:

“Ideological boundaries or institutional barriers should not stand in the way of better care for NHS patients…By constructing the right partnerships the NHS can harness the capacity of private and voluntary providers to treat more NHS patients…Under our proposals a patient would remain an NHS patient even if they were being treated in the private sector. NHS care will remain free at the point of delivery, whether care is provided by an NHS hospital, a local GP, a private sector hospital or by a voluntary organisation.”

[John Pugh]

The right hon. Gentleman is outlining a thread of continuity very well. Is it not strange that the principal adviser to Alan Milburn has now been appointed by this Government as the head of NHS England? Does that not show that there has been continuity from one Government to another with the same policies?

[Sir Tony Baldry]

I would hope, with an organisation like the NHS, that it would not become a political football—that there would be considerable continuity. The fact that the person now in post worked with a Labour Government on NHS proposals is a strong point rather than a weak one.

[Mr Brian H. Donohoe (Central Ayrshire) (Lab)]

I am wondering whether the right hon. Gentleman supports or opposes the Bill, because he has been speaking for some time and has not made that clear.

[Sir Tony Baldry]

The point I am making, which I shall develop, is that the Bill is completely unnecessary. I also want to make the point that all Opposition Members seem to wish to deny that there has been any involvement of the NHS with the private sector. It is important to remind the House of the fact that it was the Labour party, and a Labour Government, who introduced the private sector into the NHS, and the 2012 legislation in no way significantly changed that relationship.

[Philip Davies]

Does my right hon. Friend agree that those people who support the Bill would be supporting the removal of the cap on the amount of private income that hospitals can receive? Does he think that, when 38 Degrees was encouraging people to write in about the Bill, it made that clear to the people who signed its petition?

[Sir Tony Baldry]

My hon. Friend makes a good point. I think the Labour party will regret signing up to every 38 Degrees campaign, because if 38 Degrees starts drafting the Labour party manifesto rather than the Labour party, the Labour party will never sort out whether it is new Labour, old Labour or any other sort of Labour, which is why it did so incredibly badly yesterday in the Rochester by-election.

[Andy Burnham (Leigh) (Lab)]

The right hon. Gentleman has just made a comment that cannot go unchallenged. He claims that the relationship that this Government have with the private sector is the same as that of the previous Government. That is absolute rubbish. When his Government’s legislation went through, he said that doctors would decide. Doctors throughout the country are now saying that they are mandated to put services out to the open market under section 75 of the Health and Social Care Act 2012—his Government’s legislation. That was not the case under the previous Government. If this Government are just doing the same as the previous Government, why did they need a 300-page Bill to rewrite the legal basis of the national health service?

[Sir Tony Baldry]

May I remind the right hon. Gentleman of a document published on 31 October 2000, under the last Labour Government? The printout that I have is entitled, “A Concordat with the Private and Voluntary Health Care Provider Sector”. It is headed, “Socialist Health Association—Promoting health and well-being through the application of socialist principles”. It was a concordat introduced by the previous Government with the private and voluntary health care sector. It says:

“Introduction. There should be no organisational or ideological barriers to the delivery of high quality healthcare free at the point of delivery to those who need it, when they need it. The Government”—

the last Labour Government—

“has entered into this concordat with the Independent Healthcare Association to set out the parameters for a partnership between the NHS and private and voluntary health care providers. It describes a partnership approach that enables NHS patients in England to be treated free in the private and voluntary health care sector.

The key tests for any relationship between the NHS and private and voluntary health care providers is that it must represent good value for money for the tax payer and assure high standards of care for the patient. The involvement of private and voluntary health care providers in the planning of local health care services at an early stage will enable the NHS to use a wider range of health facilities within their locality. To achieve this Health Authorities in their strategic leadership role will be expected to ensure that local private and voluntary health care providers are involved in the processes designed to develop the local Health Improvement Programme as appropriate.”

And it carries on. The document is headed, by the last Labour Government, “Socialist Health Association…A Concordat with the Private and Voluntary Health Care…Sector”. Indeed, the last Labour Secretary of State for Health signed a concordat with the Independent Healthcare Association on 31 October 2000.

The decision to make greater use of private sector facilities for NHS patients did not require new legislation and it was possible to undertake it within the existing legislation on the NHS, but for the avoidance of doubt let me quote the Labour party manifesto from 2001. In the chapter on NHS reform, Labour promised to

“work with the private sector to use spare capacity, where it makes sense, for NHS patients”

and to

“create a new type of hospital—specially built surgical units, managed by the NHS or the private sector—to guarantee shorter waiting times”.

In my constituency, we have an independent orthopaedic treatment centre run by the private sector and introduced under the Labour Government. We have a Darzi walk-in centre run by private GPs, which was also introduced during the time of the Labour Government.

[Mr Anderson]

I thank the right hon. Gentleman for giving way in his long diatribe. He quotes the 2001 Labour manifesto, but it also said that any relationship with the private sector would not be at the expense of the terms and conditions of the staff working in the private sector who were transferred out. Today, Care UK people who work in Doncaster are facing a 40% cut in their take-home pay. Does he not see that that is one of the consequences of the Health and Social Care Act 2012?

[Sir Tony Baldry]

With respect, I think the hon. Gentleman is seeking to avoid the point, which is that the 2012 Act did not fundamentally change the situation in the NHS between the public and private sectors. I draw the House’s attention to a debate that took place in Westminster Hall in 2002 on the subject of the private sector in the NHS that was initiated by the then Chair of the Select Committee on Health, the then Member for Wakefield, David Hinchliffe. The Minister, John Hutton, made a speech in response that could easily have been made in identical terms by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). John Hutton said:

“I do not want to repeat arguments that have already been made about the future of our relationship with the private sector, but I shall deal with some more specific points. My hon. Friend the Member for Wakefield was concerned about whether reference costs provide a sufficient measure of value for money in the NHS. We accept that they do not, and we have tried to set out in our report several ways in which we can strengthen reference cost data.”

He went on to say:

“My hon. Friend also referred to the evidence that my right hon. Friend the Secretary of State gave to the Committee. He set out four essential tests that we apply to each prospective partnership in the NHS and private sector. Is it in the interests of patients? Is it consistent with the local and national strategies of the NHS? Is it value for money? Is it consistent with public sector values, including that treatment is determined by clinical need and staff are treated fairly? Those are the yardsticks by which we will judge and develop our relationship with the private sector. Provided that those tests are satisfied, we should use the private and voluntary sector where it has a track record of achievement or where it can offer clear potential gains.”—[Official Report, 11 July 2002; Vol. 388, c. 354WH.]

I have absolutely no doubt that those are views that my hon. Friend the Minister would endorse today. It is an entirely sensible approach to how the NHS and the private and independent sector should work. The National Health Service Bill passed during the Session of 2005-06 further enshrined the relationship between the national health service and the private sector in statute.

The Bill promoted by the hon. Member for Eltham misses the point. The Health and Social Care Act did not and does not introduce competition into the NHS, it does not change the rules on when to tender competitively and there is no requirement to tender all services. What it does do is manage the competition that has been introduced.

[Clive Efford]

If the Act did not introduce competition to the NHS, will the right hon. Gentleman explain the following? Bristol hospital wanted to restructure its head and neck cancer surgery service. Monitor considered the proposal and concluded that it was likely to improve the quality of service to patients, but that

“the merger removes important competitive constraints for elective head and neck, ENT, OMF, urology and symptomatic breast care services in the absence of other competitors”.

In effect, it said that the restructuring could have improved the quality of care, but that because it would have removed competition, it could not go ahead.

[Sir Tony Baldry]

The hon. Gentleman misunderstands my point. The Act did not introduce competition into the NHS because that competition had already been introduced by the previous Labour Government, who introduced greater private sector involvement in the NHS. Labour made binding rules to manage the competition, and the Act continued that approach with an expert health sector regulator working in the best interests of patients. Removing Monitor as the health sector regulator would merely leave commissioners facing actions through the courts under Labour’s own 2006 procurement regulations, which I do not think would be in the best interests of patients.

[Andy Burnham]

I am afraid that the right hon. Gentleman has undermined his entire speech with the ignorance he has displayed in response to my hon. Friend the Member for Eltham (Clive Efford). For the first time in the history of the NHS, the Act gave a role to the competition authorities, under the Enterprise Act 2002, in taking precisely the kind of action that my hon. Friend referred to. I am very surprised the right hon. Gentleman does not know that; may I suggest that he does not know what he is talking about?

[Sir Tony Baldry]

We heard that argument during the passage of the Act, and it is simply wrong. It is wrong to suggest that somehow the Act opened the door to competition.

[Sir Oliver Heald]

I wonder if my right hon. Friend shares my consternation at the shadow Secretary of State’s remarks, given that throughout the 2000s, all we heard from Labour, John Hutton and the other Ministers he has mentioned was the importance of value for money and tendering for things. They are going back to the days of the right hon. Member for Holborn and St Pancras (Frank Dobson) being in charge.

[Sir Tony Baldry]

My hon. and learned Friend makes a very good point. There is confusion about whether we have got new Labour or old Labour. The Labour party has to set out how it would undo the market it created without further top-down reorganisation. It could not do it simply by removing the health rules that manage it. There has been no change on when to tender competitively; the rules on procurement are the same as those used by the previous Government. The Act makes it clear that the Secretary of State remains politically accountable to the NHS. The changes in the Bill would restrict the greater autonomy given to the NHS and inhibit staff from making the innovative changes needed to secure sustainable, high-quality care for patients. In particular, it would tie the hands of clinical leaders on CCGs, which the NHS England five-year forward view says should have more powers, not fewer.

[Grahame M. Morris]

The right hon. Gentleman is engaging in a lengthy filibuster, in my opinion. I served on the Committee for the 2012 Act, and a plethora of organisations pointed out during the passage of that Bill the folly of what the Government were doing. They introduced a lengthy Bill; we spent 40 sittings in Committee; they tabled more than 1,000 amendments to their own Bill; it had 20 different sections; part 3 introduced Monitor. To suggest to the House that that Act introduced no change to the system operated under Labour is—well, it is not disingenuous, but it is not correct. I am not sure what term is best to use.

[Sir Tony Baldry]

During the passage of that Bill, the Labour party and certain organisations, including some trade unions, sought to rewrite history. Interestingly, when Labour introduced things such as the independent treatment centres, the Darzi centres and the 2002 concordat, the trade unions that rallied to support the hon. Gentleman in Committee were totally silent. I do not think it lies in the mouth of those organisations, which did not complain when the Labour party introduced a partnership and a concordat with the independent and voluntary sector when it was in government, now to complain, simply because it is the Conservative party in a coalition Government, that we are somehow “privatising” the NHS. It is simply not true.

[Mr Anderson]

Will the right hon. Gentleman give way?

[Sir Tony Baldry]

I have given way to the hon. Gentleman once, and as the hon. Member for Easington (Grahame M. Morris) accused me, ungallantly and unfairly, of filibustering—even though everything I have said is relevant and to the point—I would like now to make a little more progress and come to my final point, or almost my final point.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. It is not possible for the right hon. Gentleman to filibuster, because if he was not in order, I would not allow him to continue speaking.

[Sir Tony Baldry]

I know that; you know that, Madam Deputy Speaker; I just wanted to make quite sure that the hon. Gentlemen below the Gangway knew that I was speaking relevantly.

I want to say something about the transatlantic trade and investment partnership. This is another of those things that people run around saying will be the end of civilisation as we know it. The transatlantic trade and investment partnership will not change the fact that it is up to the UK Government alone to decide how UK public services, including the NHS, are run. Any assertion that TTIP will undermine the NHS is a complete red herring. The position has been confirmed by both the European and the US negotiators, and indeed the chair of the all-party group on European Union-United States trade and investment. Excluding health from the agreement would prevent our pharmaceutical and medical devices sectors from benefiting from TTIP.

As we approach the next general election, I hope the Labour party will not treat the NHS as a political football. I hope we will not see, as we have at every general election since I have been an adult, the Labour party running around saying that it has 24 hours to save the NHS or that the Conservative party is seeking to privatise it, which is completely and utterly untrue. We all have a collective interest in ensuring that our NHS continues to be the best health care service in the world. There are huge challenges ahead for health care in this country, with an ageing population and ever-increasing improvements in medical technology. We should be facing up to those changes in an adult and responsible way. The Labour party should not be reneging on the clear commitments it made in both legislation and policy when it was in government. This Bill is totally unnecessary and it should not pass.

--- Later in debate ---

[Dr Poulter]

I think that the hon. Gentleman’s remarks are very clearly on the record, and I am sure that NHS staff, many of whom come from very diverse, multicultural backgrounds, will be very aware of them. In this Conservative-led Government, we are very proud of the contribution that people from all over the world make to our NHS, and I believe that that needs to continue in the future. As we have seen from the hon. Gentleman’s leader, his party makes it up as it goes along on things to do with the NHS. It is in favour of privatisation and does not value the contribution—[Interruption.]

[Sir Tony Baldry]

On a point of order, Madam Deputy Speaker. There is so much noise coming from the Opposition Bench below the Gangway that it is impossible even for someone who is as near to the Minister as me to hear what he is saying. Given that Labour Members appear to support this Bill, it would be a courtesy for them at least to listen to the Minister with some attention.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The right hon. Gentleman knows very well that all Members exercise their right to speak loudly, quietly, in stage whispers and in other ways in this Chamber. I am listening very carefully to the level of noise, and if it reaches much higher than it already has, I will ask Members to be more courteous to the Minister. However, I am quite sure that the Members present will wish to be courteous to the Minister and to hear what he has to say.