Matt Vickers (Stockton South) (Con) I beg to move, That this House
has considered e-petition 598732, relating to the future of the
NHS. It is an honour to serve under your chairmanship, Mr Gray.
Today I have the privilege of bringing the petition to the House
for debate. I congratulate Marcus Hynes, the writer of the petition
and a proud Unite member, on achieving over 135,00 signatures.
Marcus and other esteemed members of Unite shared their views ahead
of the...Request free trial
(Stockton South) (Con)
I beg to move,
That this House has considered e-petition 598732, relating to the
future of the NHS.
It is an honour to serve under your chairmanship, Mr Gray. Today
I have the privilege of bringing the petition to the House for
debate. I congratulate Marcus Hynes, the writer of the petition
and a proud Unite member, on achieving over 135,00 signatures.
Marcus and other esteemed members of Unite shared their views
ahead of the debate.
The NHS is a truly British innovation. It is there to help us in
our hour of need, supporting us from cradle to grave. The NHS has
an enormous role in the lives, health and welfare of British
people. As a result, it is rightly at the centre of much debate
in this place, as we constantly look at how it can be expanded,
improved and made more efficient. I thank the NHS and all its
amazing doctors, nurses, staff and volunteers for what they do.
Throughout the past two years, they have been the crutch that has
kept this country upright. No words will ever be able to
articulate how thankful people across the UK are for the work
that they do for us every day.
The NHS is a great British institution, founded in the wake of
the war by a society that wanted better for everyone. It is, and
always shall be, free at the point of use. The NHS carries the
weight of our country’s health problems on its shoulders, which
is why I am delighted to support the Government’s ongoing
commitment to it.
(Weaver Vale) (Lab)
The hon. Member referred to the NHS being free at the point of
delivery, but NHS dentistry is on its knees. In my constituency,
Rachel Elizabeth has been waiting over two years to see a
dentist. It is the same in Runcorn, Frodsham and so forth. There
is a similar situation in the neighbouring constituency of my
hon. Friend the Member for City of Chester (), in Ellesmere Port and
right across the country. Does the hon. Member for Stockton South
() agree that NHS dentistry is
in crisis?
I have shared concerns about NHS dentistry from my own part of
the world, and I am fairly confident that the Minister will fill
us in and give a more extensive response.
The NHS carries the weight of our country’s health problems on
its shoulders, which is why I am delighted to support the
Government’s ongoing commitment to it. The biggest cash boost in
the history of the NHS is allowing us to put thousands more
doctors and nurses into our hospitals, coupled with major capital
investment programmes that have already benefited my local
hospitals. I know that the Minister is only too aware of my
ongoing campaign to secure more sizeable improvements at the
University Hospital of North Tees. That said, I know from my
constituency that there remain huge challenges for the NHS and
its role in improving the health of the nation.
In 2018, Stockton was labelled England’s “most unequal town” by
the BBC. It is a town where people born in one area can be
expected to live 18 years fewer than those living just a few
miles up the road. Such health inequalities are not acceptable in
modern Britain. The NHS rightly looks to prevention as well as
cures, and furthering this cause requires not just more resources
and improved efficiency, but joined-up co-operation with other
agencies, which lies at the heart of the reform agenda.
Putting my experiences and observations aside, the lead
petitioner, Mr Hynes, and those from Unite wanted to let me know
that they are fundamentally opposed to the Health and Care Bill.
As part of their reasoning, petitioners cited concerns about the
staffing crisis, overwhelmed human resource departments and the
backlog as core reasons for their belief that the Bill should not
be brought on to our statute book. Petitioners shared their
concerns about staff shortages and worker fatigue in an NHS that
already stretches itself to meet the needs of the UK’s ageing
population and the exponential growth in the public’s health
needs. They talked of how the pandemic has compounded this
problem.
Moreover, the pandemic paused elective surgery, leaving the NHS
to deal with backlogs and extended waiting lists. The view of the
petitioners was that the NHS should be given time to stabilise
and respond to those challenges before taking on the challenges
of reform. On a more institutional level, Unite said that it
fears that this Bill would open the NHS up to deregulation,
worsening staff shortages, and create a pay-for-use system akin
to America’s.
The petition states that
“The Government has no democratic mandate to privatise the
NHS”.
I agree: the Government have no democratic mandate to privatise
the NHS, which is why they are doing no such thing. Access to NHS
services will continue to be based on clinical need, not an
individual’s ability to pay.
(Strangford) (DUP)
I congratulate the hon. Gentleman on having secured this debate.
I put to him—this is perhaps a challenge to the Minister and the
Government—that we need to be careful with the NHS as it is
today. We all love the NHS—we love the workers and we love what
it does—but if we are not careful, it could come to a point where
if a person does not have the money, they cannot pay for their
care. Does the hon. Gentleman agree that if that were to happen,
the whole principle of the NHS would be knocked on the head?
This is a debate that we have in every election campaign, and
other than the issues around dentistry, which I am sure we will
come to, the NHS remains free at the point of use. I will fight
the corner to keep it that way, and I am sure that the hon.
Gentleman will do so as well.
(Blackley and Broughton)
(Lab)
I think everybody in this room would agree with the principle
that the NHS was founded on—care that is free at the point of
use—but the NHS has had many structural forms since its inception
immediately after the second world war. My concern is that its
current form and the proposals that the Government are bringing
forward further centralise the NHS, and waste further money on
bureaucracy, mimicking the private sector and creating an
artificial market. Does the hon. Gentleman agree that that is a
waste of money, and that the NHS should be decentralised in order
to provide better services to local communities?
I am sure we are going to hear about the ways in which these
structural reforms will take place with that very aim in mind. I
am going to try to get through my speech, because I am sure that
Members would prefer for everybody to get in and to hear from the
Minister, who is wiser on this issue than I am.
In my view, the Health and Care Bill does not represent an
attempt to create a “pay for play” system—quite the opposite.
While I am sure the Minister will go into detail about this point
in his response, my understanding is that the Bill is largely the
work of the NHS itself, inspired by NHS England’s own desire to
restructure its organisational system to be more efficient and
effective. It builds on the NHS’s own long-term plan, as set out
in 2019, and the NHS people plan, which was published in 2020.
Many of my conversations with leaders from my local NHS trust
suggest that the answers to improving health outcomes require
multi-agency working and empowerment of local health agencies,
and my understanding is that the reforms and structural changes
in the Bill set out to do exactly that.
One point on which I strongly agree with the petitioners is the
need to drive value for money within our NHS, reducing management
costs and excessive use of consultants, so that the huge
increases in funding for the NHS can actually reach the
frontline, not just fund more fruitless layers of bureaucracy. I
am hopeful that the Minister will update us on what is being done
to drive efficiency in that regard. Another point that I
fundamentally agree with is the petitioners’ view that private
finance initiative contracts have no place in our NHS. I know all
too well the debilitating effect they have on the ability of the
NHS to administer care across our country. Nationally, PFI
contracts cost our NHS £1 billion a year and restrict numerous
hospitals across the breadth of Great Britain.
I have seen at first hand how PFIs have damaged our local
services in the Tees Valley. South Tees Hospitals NHS Foundation
Trust, in particular, has been plagued by a dodgy new Labour PFI
contract. The James Cook University Hospital was completed in
2003, but its PFI contract does not run out until 2034, and will
cost over £1.5 billion. The trust currently has to meet annual
payments of £57 million a year—more than £1 million every week.
Of course, hospital upgrades and rebuilds are expensive, but that
trust is paying £17.5 million over and above what an equivalent
Treasury-funded hospital would cost annually. Shockingly, that is
enough to pay for more than 530 nurses. It is ludicrous.
Even if there were not an extra 530 nurses at South Tees, there
is so much the hospital could do with this money, such as
investing in its building, equipment and staff to help improve
health outcomes and inequalities. Excessive costs from historic
PFI contracts are listed as the largest single contributory
factor to the hospital’s troublesome financial position. At time
when retention is a huge issue for our NHS, this money would be
crucial to making a substantial difference to the working lives
of our NHS heroes. I am glad that in 2018 a Conservative
Government decided that PFI contracts would be phased out.
However, hospitals up and down the country are now stuck dealing
with a Labour legacy that has damaged our NHS, our people and our
ability to tackle health inequalities across this country.
(Middlesbrough) (Lab)
Will the hon. Member give way?
I will carry on; I am sure that there will be a chance for the
hon. Member to contribute. I look forward to hearing the rest of
the debate and to listening to the input of Members from across
the House.
(in the Chair)
Members will see from a glance around the room how many people
intend to speak. I do not intend to impose a formal limit, which
seems to sacrifice quality in favour of quantity, but I do
suggest that, as a courtesy to one another, speeches are limited
to around three minutes.
6.11pm
(City of Chester)
(Lab)
It is a pleasure to serve under your chairmanship, Mr Gray.
There are actually a couple of aspects of the speech of the hon.
Member for Stockton South () that I agree with and
congratulate him on. First, I do not support PFI either. History
suggests that although that hospital was completed and perhaps
started under a Labour Government, PFI was originally a
Conservative initiative under the Major Government, so I would
not be too confident about attacking it but I am pleased that it
is gone.
I also profoundly agree with the hon. Member’s support for NHS
staff; I think we will be hearing a lot of that this evening. The
NHS is recognised and envied around the world. It is something
that we should celebrate and admire, not chop up, neglect and
sell off piecemeal at every opportunity. It is the NHS and its
staff that are getting us through this pandemic. I would like to
take this opportunity, as I am sure all hon. Members would, to
once again thank the NHS and care staff who have worked so hard
and sacrificed so much over the last two years.
The NHS cannot continue to look after us if we do not look after
it. Tory mismanagement over the last decade and the pressures of
the pandemic mean that the NHS is running on empty and surviving
solely on the good will of its employees. Even before the
pandemic, we were seeing record waiting lists and staffing
shortages. Now the numbers are through the roof.
(Wansbeck) (Lab)
On that point, my hon. Friend mentions that the NHS is running on
empty—of course it is. A Unite survey published in January 2022
showed that 77% of the NHS workforce believe that they are worse
off than they were a year before, 55% are working during their
lunch breaks, and more than 50% are working in excess of their
contracted hours. Is it any wonder that the NHS is running on
empty?
I could not have put it better myself. The NHS is running on
empty, but also on the good will of the staff because they
believe in the NHS and in what they are doing. There were 6
million people on the waiting list in England in November—the
highest number ever recorded. In my constituency of City of
Chester, the latest figures show that 36,000 people are waiting
for care at the Countess of Chester Hospital.
Those record waiting lists are also true for NHS dentistry, as my
constituency neighbour, my hon. Friend the Member for Weaver Vale
(), has pointed out. Some
people are being told that they may have to wait up to two years
for a NHS dental appointment. Over the past few months, many of
my constituents have told me the difficulties that they have had
in finding and accessing an NHS dentist in my constituency and
the surrounding areas. On average, there are only 4.4 dentists
per 10,000 people in England, and the number is shrinking. With
shortages of staff, a lack of funding, the pressures of the
pandemic and dissatisfaction with NHS dentists’ contracts, the
waiting lists are growing. Many dental practices are feeling
pressure to turn private just to be able to cover wages and
equipment costs, and to survive as a business.
Dr Simon Gallier, who owns a dental practice in my constituency,
wrote to me with a heavy heart to say that earlier this month, he
had to make the difficult decision to make his dental practice
private; he had to inform over 7,500 patients that they will no
longer be receiving NHS treatment. Practices around the country
are doing this not through choice, but out of necessity and lack
of funding. Dr Gallier just cannot make ends meet. Indeed, in the
last year for which figures were available, 2018-19, the amount
spent on dentistry fell in real terms, compared with the six
years previously. While the £50 million announced recently by the
Minster is welcome, only £7 million of that will go to dentistry
in the north-west, which is clearly insufficient when the
national budget for England was over £2 billion in 2019. With
fewer NHS dental practices, many constituents have no choice but
to go private—an option many will not be able to afford,
especially given the cost-of-living crisis we face. I worry that
the Tory masterplan all along has been to starve the NHS of
funding, resulting in inevitable back-door privatisation—or
perhaps there has been a more sinister scheme to monetise
dentistry, as there has been in similar services, including some
GP practices and many vets practices.
Dentists cannot afford to operate under the NHS, so they sell the
practice to an umbrella company, which is the front for a finance
company. That company then offers quasi-insurance or membership
programmes, in which the patients pay an amount every month that
entitles them to an annual check. That stream of money from
numerous practices becomes a valuable commodity in the City of
London, which the Conservative party exists to serve, along with
Putin-linked Russian oligarchs, but we will not mention that
now.
Talking of privatisation, what I fear is not the sale, lock,
stock and barrel, in a public floatation, as happened in the
1980s, but sale bit by bit, behind the scenes, to private
companies that extract money for their profit—money that should
surely instead be spent on patient care. NHS dentistry is in
crisis. I will not look that £50 million gift horse in the mouth,
but let us be clear: much more is needed.
6.16pm
(Hornsey and Wood Green)
(Lab)
It is a pleasure to serve under your chairmanship, Mr Gray. I am
proud that so many of my constituents in Hornsey and Wood Green
signed this important petition about funding for the national
health service, and about keeping it in the public sector.
There is no doubt that the national health service is the most
popular public service in my constituency, but there is a basic
lack of staff, whether we are talking about primary care, GPs and
other practice staff—they always seem to be looking for more
staff—the 40,000 nurses of whom we are in desperate need
nationally, or the thousands more doctors who are needed.
Compared to other European countries, we simply do not have the
correct ratio of patients to doctors. For example, in psychiatry
there are increasing numbers of patients, particularly following
the stresses and strains of coronavirus, waiting days and days in
a hospital bed to see a consultant. I heard a story this week
about a patient who waited 10 days to be seen during doctors’
rounds. That is a very long time to use a bed without getting the
correct medical attention.
Many Members have mentioned the insufficient funding for
dentistry. Sadly, my constituency of Hornsey and Wood Green, and
the London Borough of Haringey, has some of the worst rates of
caries in children’s teeth in Europe.
As my hon. Friend the Member for Wansbeck () said, 77% of NHS staff believe that they are worse
off this year than last year. We know that they are working in
excess of their hours, and that since 2010, hourly pay has been
frozen or increased by a tiny increment. That does nothing to
help staff cope with the challenges of the Tory-driven
cost-of-living crisis, be it domestic fuel bills, the cost of
food, children’s clothing, basic travel to work, or petrol to
drive to work.
The Health and Social Care Levy Act 2021 has recently passed
through Parliament. Social care is crucial to fix bottlenecks in
the health service. We need a properly funded care system in
which the hourly rate is correct in the light of the needs of the
people working in it, and we need better overall management to
get people into the right sort of care as quickly as possible, so
that we can free up the national health service to look after
people coming into hospitals through accident and emergency. That
is a basic point that every Member in Westminster Hall has made
on a number of occasions, but it still seems as if this
Government are sitting on their hands and failing to address the
crucial question of how we get the flow through the system. The
problem also comes down to the terrible cuts to local government.
If local government was adequately funded, we would have a much
better, more proportionate system. I will stop there, Mr Gray, as
other Members wish to contribute.
6.19pm
(Bradford East) (Lab)
It is, of course, a pleasure to serve under your chairmanship, Mr
Gray. Time does not permit me to repeat the excellent points made
by my hon. Friends the Members for City of Chester (), and for Hornsey and
Wood Green (), but I certainly align
myself with what they said.
I want to concentrate on two areas of huge concern to my
constituents. The first, which has already been mentioned, is
privatisation. Three years ago, in Bradford, I fought alongside
trade unions and NHS staff to stop plans to introduce dangerous
back-door privatisation into our local hospitals. Although we
beat those plans to move key services out of the NHS and place
them in the hands of private companies, the danger of the
privatisation of our NHS in Bradford has not passed.
That threat has only grown as a result of this Government’s
Health and Care Bill. While removing enforced competition, the
Bill does nothing whatever to roll back the wave of privatisation
that successive Tory Health Ministers have unleashed on our NHS
over the last decade. Rather than improving patient care, the
Bill allows private companies with a vested stake in driving
greater privatisation in the NHS to sit on local health boards
and make decisions about our health care; at the forefront of
their mind are not patients, but profits. There is no greater
threat to the future of our NHS—free at the point of use and in
public hands—than the Health and Care Bill and this Tory
Government. We must stop both before it is too late.
We also have to look at the future of our NHS for GPs, who are at
the coalface of health care but are all too often overlooked.
Each week, without fail, a worrying number of constituents tell
me that they have been unable to get any form of appointment, let
alone a face-to-face appointment with a GP; that they have been
left on hold when calling, waiting for phones that are never
answered; or that, when they are given an appointment, it is
weeks away, even when it is an urgent issue that simply cannot
wait.
I dealt with two such cases this week. I heard from a son whose
82-year-old mother went to accident and emergency, but was sent
away and told to go see her GP the next morning. Her son began
ringing the GP practice first thing next morning, but when he
eventually got through, hours later, he was given an appointment
in two weeks’ time. In the other case, involving very similar
circumstances, my constituent was once again told to wait for
weeks. It is unacceptable.
That level of service would be unacceptable anywhere. However, in
Bradford—where we have higher rates of deprivation, where life
expectancy is below the national average and where we have
greater rates of preventable illnesses—it is beyond serious, and
can even be fatal. No one should have to wait for more than a
fortnight for an appointment, and certainly not for urgent cases,
but as the inner city of Bradford has one of the worst
GP-to-patient ratios in the country, that comes as little
surprise.
Although fewer GPs being forced to see more patients explains the
scarcity of appointments, it does not explain the poor service
that patients in Bradford are reporting to me. I want to use this
debate to put on notice those practices that are letting their
patients down. I want to be clear: there should be a better
service to ensure that urgent cases receive urgent appointments,
and to help close the health inequality gap between the richest
and the poorest in Bradford.
Finally, I listened to the hon. Member for Stockton South (), who opened this debate. His
speech implied that he was anti-privatisation. I say this to him
and all those on the Government Benches: the reality is, over the
last decade, we have seen an ideological, intentional attack on
our NHS. Let us not beat around the bush: if the hon. Member for
Stockton South and others wish to stop the back-door
privatisation of our NHS, they should be opposing the Health and
Care Bill. Any form of privatisation needs to be taken out of the
Bill. We do not need the smoke and mirrors that we see in the
current legislation.
6.25pm
(Salford and Eccles)
(Lab)
It is a pleasure to serve under your chairmanship, Mr Gray. I
speak in full support of the petition. I would like to make
particular mention of the recent Health and Care Bill. The
clearest example of what could happen to our NHS if this Bill
goes ahead lies in NHS dentistry. Net Government spend on general
dental practice in England has been cut by about one third in the
last decade. The results of this are stark; there are reports of
people resorting to pulling out their own teeth because they
cannot afford private treatment.
The British Dental Association states worryingly that the Bill
worsens the situation and
“does not ensure that the voice of three quarters of NHS primary
care professionals is heard in the making of commissioning
decisions”.
Whose voices will be heard, then? The Bill would put private
companies right at the heart of NHS decision making and service
delivery—on the new integrated care system boards, where they
will be given power to make decisions about people’s care and how
NHS money is spent. The Bill will allow private healthcare
providers to award contracts for clinical care without
considering any other bids. The doctor-led campaign organisation
EveryDoctor states:
“This Bill will embed private companies in the NHS in England,
and give them the power to decide who gets what treatment
when.”
Members on the Government Benches might wax lyrical about the NHS
being free at the point of use, but what happens when people
cannot access the care that they need? It might be because of
rationing, or because of lengthy waiting lists due to lack of
funds. It might simply be because those with a seat at the
integrated care system board table determine that a person’s care
should not be available on the NHS, because it is just not
profitable enough. The result is this: if a person cannot afford
private medical cover, they do not receive treatment. That is
already happening in NHS dentistry, where it has been normalised.
The risk is that it will be normalised throughout the healthcare
system.
This is not a Bill to tackle the crisis facing the NHS. It is not
a Bill to tackle the care backlog, or to properly fund our NHS.
It is a Bill to reduce our rights to access healthcare and to
privatise our NHS. It must be scrapped.
6.27pm
(Brent North) (Lab)
I begin by praising all the staff in the NHS, who, often at
enormous personal risk, have provided dedicated care to so many
of us over the past two years. The Minister must know—and the
Government should acknowledge—that they are exhausted. As a
country, we must show that we care for all of them as they
address the backlog of over 5 million people waiting for
treatment.
That care must be more than warm words and clapping. It must be
tangible and financial, and it must be realistic. That means
expanding workforce capacity, both as regards beds and staffing,
in order to reduce the pressures our NHS heroes are facing. It
means meeting the capital maintenance backlog of more than £9
billion. It was dereliction by the Chancellor to entirely omit
any funding for infrastructure and building repairs when
announcing the NHS settlement. There are two futures for the NHS:
the disastrous one contained in the Health and Care Bill, or one
that integrates health and social care in an efficient,
comprehensive service that is free to everyone, from cradle to
grave, whatever their medical need. It would be delivered
entirely by, and be accountable to, our public sector—staff who
are fairly treated and properly rewarded. I want to pay tribute
to all the unions, particularly my own, Unite the union, for the
work they have done to ensure that that is the case for
staff.
By “comprehensive”, I mean that the service should include mental
health and public health. If the pandemic has taught us anything,
it should be the importance of public health, yet the integrated
care boards have no delegated places for directors of public
health, mental health or adult social services. There is not even
a place for the voice of the patient, around whom everything
should be centred.
By “efficient”, I mean that the service must deal with the
backlog of 5.3 million patients waiting for treatment. By
“whatever their medical need”, I mean that it should definitely
include dentistry, as we have heard from my hon. Friends. By
“accountable public service”, I mean that there should be no
conflict of interest that allows a private company to sit on the
ICB and commission contracts from which it will then be able to
benefit. In 2012, I railed against the imposition of section 75
because it put competition, rather than co-operation, at the
heart of our health system. I thought—correctly, as it turned
out—that this would give rise to increasing privatisation, the
rationing of care and the lessening of patients’ access to the
care they need. Putting competitive tendering at the heart of the
service destroyed trust and introduced a profit motive, rather
than allowing a focus on successful medical care outputs.
It may be wondered why the reversing of the Health and Social
Care Act 2012, introduced by , would be of concern to me.
In 2012, none of us could have conceived of the fact that doing
away with competitive tendering might mean not less, but more
privatisation, unregulated by the tendering process. In 2012, we
would not have believed that we would see VIP commissioning
routes, through which contracts for medical equipment worth
billions—not millions—of pounds would be given out to friends of
Ministers, but that is what we face in the Bill. It puts that
ability into legislation, which is why the Bill should be
stopped.
6.32pm
(Cynon Valley) (Lab)
The impact of the Health and Care Bill on Wales is limited, but I
have come to speak in the debate because over 150 of my
constituents signed the petition, and because it is right for
people from across the UK to defend the NHS as a service that is
run publicly, in the way that the great Welsh hero Nye Bevan
intended. I have real concerns about the situation faced by the
health service and the care sector, both in England and in
Wales.
The King’s Fund has estimated that NHS commissioners spend £9.7
billion on services delivered by the private sector, which
represents around 7% of NHS revenue spending. While we are
handing over NHS provision to the private sector, waiting lists
are going up, waits for treatments are getting longer, NHS pay is
going down, staff sickness is going up and staff vacancies are
going up. The Health and Care Bill does nothing to address
that—indeed, it will make things worse. Many of my colleagues
have already set out concerns, particularly about the new
integrated care boards and the private sector’s increasing role
on them. The Bill will also reduce oversight of how contracts are
awarded, and move the NHS from being a regulated market to a less
regulated one.
The Bill will do nothing to improve social care. It has been two
years since the Prime Minister stood on the steps of Downing
Street and promised a plan for social care. When will we see that
plan? Unison has found that more than two thirds of care staff
said they were so busy at night that they managed to get only a
couple of hours’ sleep, and staff are sleeping on makeshift beds
in offices. A quarter of the workforce are on zero-hours
contracts, and only about 10% are getting the real living wage.
Why is this Tory Government continuing to fail our social care
sector, its recipients and its workforce? In 2019, I stood on a
manifesto that pledged to establish a national care service. That
would have been a historic development along the lines of the
establishment of the NHS in 1948, but regrettably, we are not in
a position to implement it.
I want to make a few comments about the position in Wales. I
suggest that people look at the Welsh Government, because in
spite of Tory austerity Governments and years of underfunding, we
have successfully managed to retain a largely public sector NHS.
We have free prescriptions, and we are now proposing significant
extra funding for local authorities to help with maintaining and
developing the social care sector. Last year’s co-operation
agreement and the programme for government in the Welsh Senedd
committed to the implementation of the real living wage and to
establishing a Welsh national care service, which will be
implemented by the end of 2023. Before Christmas, the Welsh
Social Services Minister, , pledged that the Welsh
Government would provide Welsh local authorities and health
boards with £43 million so that they can implement the real
living wage—not the living wage that the Tories are
proposing—from April.
I reiterate my support for those campaigning to defend a publicly
owned and run NHS and to deliver a similarly public national care
service. We are trying to do it, and we will achieve it in Wales,
despite the barriers put up against us by the Tory Government. I
really hope that we will have a Labour-led Government in
Westminster soon to do the same. Diolch yn fawr.
6.36pm
(Strangford) (DUP)
It is a pleasure to speak in the debate. I concur with the
comments of others. Like the hon. Member for Stockton South
(), I acknowledge the
incredible work of all healthcare workers across all spheres of
the health system over the past two years, through the pandemic.
The commitment and dedication that they have all demonstrated
throughout the public health crisis is of course not unique to
the pandemic but is a defining characteristic of all the staff
our wonderful national health service produces. Each one of us
present is here to say thank you to them from the bottom of our
heart.
I commend the NHS staff who have been working hard day in and day
out to ensure that their patients are looked after in the same
caring way as they are in normal times. It is important that we
acknowledge the sacrifices made by the families of nurses and
doctors who have been called in at short notice when wards and
A&Es have been short-staffed. Many of my constituents do that
every day, and have done it almost every day through the crisis.
Many do so having only just left a long overnight shift, and many
saw very little of their families during those times. We tend to
take it for granted that our NHS staff will go above and beyond
to serve the public, which should make us even more proud of
them. There is an onus on us in this House, and on the Minister
and the Government, to ensure that we deliver for our staff for
all that they have done.
The NHS is very different in the scope of the services that it
delivers from how it was at its inception on 5 July 1948. I am
certain that if Florence Nightingale walked its corridors today
she would be more than impressed by how far the delivery of
medical services has advanced, but she would also see the
familiar aspects of local doctors delivering a first-rate service
in community hospitals. The building blocks remain unchanged, and
as our NHS looks to the future it is vital that the foundations
never change. The NHS is central to our society. We do not want
it to be Americanised. We all know what that means: that we would
have to pay for it, which would be wrong. We have a duty to
deliver for the people we represent, without having to gauge
whether their wage packet can pay for treatment, or whether their
wallet is big enough.
The future of our NHS will be supported by revolutionary
technology, just as revolutionary as the first penicillins when
they worked what seemed to be miracles. We do not have a crystal
ball, but we can be certain that increased funding will be
necessary to support the radical adoption of innovative
technology, to improve resources and, without question, as the
hon. Member for Cynon Valley () said, to pay our NHS workers
a wage that reflects the work that they do, have done, and will
do in future.
I will conclude, as I am conscious of the three-minute limit, Mr
Gray. Today, GPs and hospitals are under severe pressure, which I
believe will not ease for the next generation of GPs and NHS
workers. In order to ensure that the original building blocks of
the NHS that we cherish remain in place, we need, as policy
makers, to build firm bridges between now and then. Most
importantly, the NHS of the future must have the same ethos of
care and compassion at its core in 2050, when we may not be here,
as it did at the beginning in 1948, when I was not here
either.
6.39pm
(Wirral West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Gray. It is
a truly extraordinary achievement that we have the national
health service. We are so indebted to Nye Bevan and all those
people who have fought for it. I pay tribute to everyone who
signed the petition, which refers to the Health and Care Bill
“locking in privatisation and dividing the English NHS into
Integrated Care Systems.”
If the Bill is enacted, we can expect to see the NHS split up
into 42 locally managed health systems, which will be required to
balance the books each year, rather than a national health
service responding to patient need. Following intense pressure
from the Labour party, campaign groups and other stakeholders,
the Government have conceded that anyone who
“could reasonably be regarded as undermining the independence of
the NHS because of their involvement in the private healthcare
sector”
will not be able to sit on integrated care boards. Such
individuals will still be able to have significant influence
through a complex array of sub-committees, however, including
place-based partnerships and provider collaboratives. It is there
in black and white in NHS guidance:
“The Health and Care Bill, if enacted, will enable ICBs to
delegate functions to providers including, for example, devolving
budgets to provider collaboratives.”
That exposes the Government’s real intentions of increasing the
involvement of private companies in the running of the NHS.
The Bill also includes measures to revoke the national tariff and
replace it with an NHS payments scheme. As private providers
would be consulted on the NHS payment scheme, it would
effectively give the them the opportunity to undercut NHS
providers. I am concerned that as a result, we will see more and
more healthcare delivered by the private sector rather than by
the NHS, with money going into shareholders’ pockets rather than
being spent on patient care. If that happens, NHS staff could be
forced out of jobs that are currently on the agenda for changed
rates of pay and the NHS payments scheme, with only private
sector jobs available—potentially with far worse pay and
conditions.
I am also concerned that the Bill will lead to an increased
rationing of services because ICBs would have strict financial
limits each year. Once that money has been spent, patients would
have to wait longer or go without treatment. Some may be tempted
by the adverts for private healthcare, of which we are seeing
more and more, but it is worth looking at where that path leads.
According to Will Russell, a provider of international health,
life and income-protection insurance, the average annual cost of
health insurance in the US is an eye-watering $7,470 for an
individual and $21,342 for a family. Employers typically fund
roughly three quarters of those bills, so they also create a
massive burden on businesses. The average cost for an individual
of purchasing their own health insurance is $456 per month,
according to a 2020 survey by eHealth.
In this country, we can only imagine just how devastating such
costs would be to individuals, businesses and the economy. We
cannot afford to let such a system take hold here. We must defend
the NHS as a universal comprehensive national service that is
there to treat us when we need it. Time is running out. I urge
MPs across the House to appreciate just how fortunate we are to
have the national health service, to join the campaign against
NHS privatisation, and to oppose the Health and Care Bill.
6.42pm
(Birkenhead) (Lab)
It is a privilege to serve under your chairmanship, Mr Gray, and
to follow the powerful contributions of my hon. Friends. I draw
hon. Members to my entry in the Register of Members’ Financial
Interests for my ongoing links with Unite the Union, which has
played such a central role in the fight against privatisation of
our health service.
I am enormously grateful to the hundreds of people in my
constituency who put their names to the petition, and to the
countless others who got in touch to ask me to speak in this
incredibly important debate. They know what the Government so
clearly do not know: the reforms are totally wrong and come at
the worst time. Our NHS is in the midst of the darkest day of its
long history. Exactly two years since the first covid patient was
admitted to a UK hospital, morale is collapsing, staff are past
the point of exhaustion, and many frontline services are at
breaking point. For all the Government’s talk of life after
covid, the virus continues to stalk hospital wards across the
country—85 patients have died of covid in the last day alone.
Instead of doing anything in their power to tackle a catastrophic
staffing shortage and a record-breaking backlog, Ministers
instead seem intent on forging ahead with reforms that threaten
to open the doors of our precious health service to ravenous
multinationals that are interested only in making a quick buck,
not in addressing the country’s health needs.
We should not be surprised that the Government have so cynically
sought to exploit the crisis to advance an agenda of
privatisation and fragmentation. After all, that is the logical
next step of a project that has been consistently pushed forward
by successive Prime Ministers and Health Secretaries since 2010.
When the last Labour Government left office, they entrusted to
the Conservatives the care of a health service that was
world-beating by every conceivable metric. Despite the best
efforts made by our healthcare heroes, the NHS entered the
pandemic woefully unprepared and under-resourced, having had its
resources and resilience sapped away since the passage of the
Health and Social Care Act 2012.
I fear that the Government’s latest reforms, which include the
introduction of integrated care systems and American-style
healthcare management systems, will leave our NHS in a far worse
state for confronting the public health challenges of the coming
decades. I urge the Minister not only to listen to what has been
said today, but to take heed of the public anger surrounding this
issue. The British people are not in the least convinced by the
claims that the Government have the NHS’s best interests at
heart, and they look anxiously towards America as a sign of what
might yet come to pass. They want an NHS that lives up to its
founding principles—a public service that is free and accessible
to all—which is why Ministers must return to the drawing
board.
6.45pm
(Leeds East) (Lab)
It is a real pleasure to serve under your chairship, Mr Gray, and
it is wonderful to hear all these passionate speeches today. We
need to be clear that whether they admit it or not, the
Conservatives have always had a problem with the national health
service. They might try to rewrite the history books, but the
truth is recorded: they voted against the creation of our
national health service on more than 20 occasions, and the reason
is purely ideological. They see it as an unwelcome intervention
into the market, a point I will return to in a second.
Some of the more vocal supporters of that neoliberal agenda see
the NHS as a last bastion of socialism in our society. I am proud
that our national health service was created by socialists, and I
think it is the greatest example in this country’s history of
socialist principles put into practice. What does that mean? It
means that there are some things in life more important than the
pursuit of profit. However, what we now see—what we have seen
since 2010—is an increased drive for the Americanisation of our
national health service. The Conservatives want to turn it into a
system where they feel for a patient’s wallet before they feel
for their pulse. The truth is that however the history books are
rewritten, it was a struggle to create the NHS in the first
place, and it is now a great struggle to maintain it in
accordance with its founding principles.
There are two key issues for our health service—deep underfunding
and greater use of the private sector—and they go hand in hand,
with the national health service being underfunded so that people
can supposedly be persuaded to stomach greater and greater
private sector involvement. First, the Conservatives defund
things so that people get frustrated, and then they say that
there is no choice but to hand them over to the private
sector—that is the plan. We hear from the Conservatives that the
staffing crisis in our national health service was caused by
omicron or by covid, but the truth is that the huge vacancies and
understaffing in the NHS did not start with omicron or with
covid: the vacancies have been there for a long time, and now
there are nearly 100,000 of them. An unbelievable £100 billion
has gone to non-NHS providers of healthcare over the past decade
alone. Every pound spent bolstering the private companies means
less spent on people’s healthcare, as the profits are creamed
off.
People out there are right to be worried about what the
Conservatives want to do with the NHS. I mentioned earlier the
Conservatives’ historical and ongoing objection to interventions
in the market, but the truth is they believe in free markets for
the 99%—with all the harm it brings them in their lives, their
pay packets and their health service—but believe in intervention
in the market for the benefit of those at the top. That is what
we saw during the covid crisis, with all those corrupt contracts,
the VIP fast-track lane, and billions of pounds going to Serco
for the failed test and trace system. What the Tories did with
the corrupt covid contracts, they want to do right across our
national health service. That is why the Health and Care Bill
would be better renamed the corporate takeover Bill. We cannot
allow that to happen. The Conservatives want to create a race to
the bottom, and we know that cuts and privatisation go hand in
hand.
Before I finish, I will say a word about our NHS staff. We saw
the Prime Minister—who no one trusts anymore, and quite rightly
so—standing outside Downing Street clapping for the NHS heroes,
but claps do not pay the bills. If we have a Government that
values NHS staff in the way they say they do, they need to pay
those staff properly. I put on the record my support for the 15%
pay increase for NHS staff, who have suffered a decade of
real-terms pay cuts. We need to be clear about what that means:
that 15% increase would bring their pay back in line with where
it was a decade ago.
What is the way forward? It is for us to realise that no Prime
Minister or Government will say to the public, “Do you know what?
We’re going to privatise the NHS. Do you know what? We’re going
to turn it into an American-style healthcare system.” Of course
they will not do that. They will manufacture consent for those
changes through underfunding and through creeping privatisation
carrying on at ever greater pace. It was a struggle to create our
NHS, and it will be a struggle to save it from this final
Americanisation. Regardless of which party we are in, history
will judge us poorly if we betray those who went before us and
created our national health service—the greatest achievement in
our country’s history, and the greatest example of socialist
principles put into practice, which may be why this Government
dislike it so much.
6.51pm
(Liverpool, Riverside)
(Lab)
It is a pleasure to serve under your chairmanship, Mr Gray. The
future of the NHS hangs in the balance, and the petition is
entirely correct in calling on the Government to renationalise
the NHS, scrap integrated care systems and end private finance
contracts.
The Health and Care Bill threatens to open the floodgates to
further privatisation by implementing a healthcare model that
incentivises cuts and closures and rations funding to health
boards while welcoming private profit-driven companies such as
Virgin and Serco on to the boards of integrated care systems,
giving them a say on where NHS money gets spent. The new
legislation will further dilute the voice of patients and the
public, with the new boards covering populations of up to 3
million people that will be remote and centralised, with no
obligation to be open, transparent or accountable to ordinary
people.
My hon. Friend is making an excellent speech. Does she agree that
if we have that lack of transparency we might see a repetition of
the Government’s wasting £4 billion during covid? There is a fear
about related-party transactions, where people know exactly where
the money is going—into their pockets.
I fully support what my hon. Friend says. The boards will be
remote and centralised and will seriously restrict the power of
local authorities to protect local services. With these changes,
private healthcare giants will not only have a bigger say over
the NHS but will be granted contracts with even less scrutiny
than now.
By opening the door to private healthcare providers to take
decisions on NHS budgets and services, the Bill makes it easier
for public health contracts to be distributed to private
providers, with less transparency and accountability. Safeguards
in the Public Contracts Regulations 2015 will be excluded,
watering down protections for employment and environmental
provisions in procurement processes. There is no doubt that the
Bill will put on steroids the cronyism we have seen during the
pandemic while our NHS heroes have worked day and night, putting
their lives on the line. The Government have cut real pay for
nurses while handing out billions of pounds of contracts through
an illegal VIP system to their mates and donors and to the failed
track and trace system.
The NHS is the jewel in the crown of our public services—our
proudest achievement. However, 12 years of Tory austerity, and
now the pressures of the pandemic, have stripped it to the bone.
An unbelievable £100 billion has gone to private healthcare
providers in the last decade alone. The last thing the NHS needs
right now is a dangerous overhaul that puts the private sector at
its heart. We must take this and every opportunity to support
amendments to the Bill that establish the NHS as the default
option for all NHS contracts, to mitigate the worst parts of it.
We must stand up to these new attacks or risk losing the NHS to
privatisation by stealth. We must go further in our demands to
roll back the damage done, reinstating the NHS as a truly
national service and establishing a fully integrated national
care service with staff and patients at its heart.
6.54pm
(Liverpool, West Derby)
(Lab)
It is a pleasure to serve under your chairmanship, Mr Gray. The
privatisation of the NHS has been a lengthy and well-documented
process that started during Thatcher’s Conservative Government in
the 1980s. It has shifted the responsibility for the long-term
care of the elderly and the vulnerable from the NHS to local
authorities, and allowed hotel-type charges for long-term care.
This violated a key NHS principle that patients should not pay
health charges. Charges became means tested, and homes had to be
sold to pay for the bills. Local authorities were forced to pass
on their responsibility for healthcare to outsourced private
companies. That created a for-profit industry worth £6 billion a
year.
Ninety per cent. of nursing home beds are now operated on a
for-profit basis. Almost 400,000 elderly patients are now a
source of income in an increasingly privatised sector. The staff
in those nursing homes are an increasingly casualised and
deskilled workforce. The privatisation of care for the elderly
created such a mess that we are still trying to sort it out 40
years later. That is the shameful legacy of privatisation in one
sector of healthcare. We can see clearly that the process of
privatising the NHS itself will follow the same pattern. It will
be run by private contractors who will de-professionalise and
casualise a temporary workforce.
There has been a creeping privatisation of the NHS. In 2012, an
Act was passed that, among other things, required all NHS
contracts to be tendered to any qualified provider. Now we have
ambulance services run by taxi firms, private companies that have
taken over GP practices covering half a million patients in
London, and a private company taking over an NHS hospital and
cancelling the contract when there was no more money to be made.
I have seen first hand, working for Unite and organising
outsourced workers in the health sector, the damage that
privatisation does to our essential care services.
If that tale of incompetence was not enough, the Government are
now pushing through a new reorganisation, this time to establish
what they call “integrated care”. It does the complete opposite,
instead butchering our NHS into 42 separate areas. It should not
be called integrated care but “disintegrated care”. Each area has
a fixed budget that cannot be overspent. This will create a
postcode lottery and force each area not to co-operate with each
other to save cash. Each area board will allow private healthcare
companies—another play on words: they are mostly private health
insurance companies—to make decisions about the provision of
healthcare.
Here we go again: the Government’s answer to underfunding our NHS
is to let private companies run it. History has taught us that
this is not the solution. NHS staff employed by 42 different
organisations face a most uncertain future of casualisation,
deskilling and the introduction of poorer terms and conditions.
The people of England face a regional, not a national, health
system, which will have different terms and conditions for its
workforce and different provision of treatment. It is chaotic and
irresponsible.
Every Government of the day have been entrusted to preserve and
protect one of the country’s greatest achievements—to cherish,
not cherry-pick and hive off to the private sector. I urge the
Minister to listen to the calls of my constituents, campaigners
and the trade unions and scrap the catastrophic Health and Care
Bill, which destabilises, fractures and imperils our NHS.
rose—
(in the Chair)
I apologise to the hon. Member for Middlesbrough; I fear we have
no time.
6.58pm
(Coatbridge, Chryston and
Bellshill) (SNP)
It is a pleasure to serve under your chairmanship, Mr Gray. I
thank all those who signed this petition. The position of the SNP
on this matter is clear: the NHS was created to be free at the
point of use and to treat all citizens equally from cradle to
grave. That is the NHS we want to see back—an NHS for the people,
by the people and firmly in the hands of the people. Despite the
fact that the Government lack a democratic mandate to privatise
the NHS, vast sums of public money are being wasted on business
managers, private providers, PFI debts, multinational accounting
firms, and corporate consultants. By enshrining privatisation in
NHS England, the Tory Government continue to jeopardise access to
care and universal standards.
Let us look at social care, for example. Scotland has
successfully integrated health and social care services since
2014 and has put in record investment to allow continued quality
improvements in services year on year, and that is without any
privatisation. It has been achieved even with the culture of cuts
to public services that has been forced on Scotland by
Westminster’s austerity agendas. If Scotland can create a social
care system that works with one hand tied behind our back, what
is England’s excuse?
We have heard hon. Members refer to dental health and the lack of
dental care in England. Of course, in Scotland we made provision
for free NHS dental care for 18 to 25-year-olds in our last
manifesto, and that is coming through the Scottish Parliament
just now. That is on top of free annual and biennial eye tests
for everybody, because those are the things that matter and they
can have a better effect on the management of our NHS and address
the clogging up of appointments.
For the UK Government, it seems that healthcare is a hassle; for
the Scottish Government, it has been our priority. The covid
crisis has demonstrated why the NHS is our most important public
service, and Scotland has recognised that. We gave our NHS
workers a bonus as we came out of the pandemic. The Scottish
Government have also put record funding into our health and
social care services of up to £18 billion, with resource funding
up 90% under the Scottish Government. Frontline health spending
is £111 higher per head in Scotland than it is in England. These
figures speak for themselves.
The SNP Government in Holyrood have a history of making different
parts of the health and social care system work together. They
have used legislation to get these efforts under way. We also
contributed to the betterment of the UK system by voting against
the Health and Care Bill going through this House. That Bill
gives the UK Health Secretary enormous powers over NHS
England—over its structure, functions and budget—giving him more
leeway during trade negotiations, with particular risks from
American healthcare interests. Such ministerial control over NHS
England is concerning, as there will be long-term consequences
for the national health services in Scotland and the other
devolved nations, particularly in terms of funding and what is
included in any free trade agreements. The Bill eliminates the
requirement for competitive bidding and allows NHS bodies to
award some contracts directly. Can you imagine if the future care
of your family and friends, your children and relatives, was all
dependent on how much money was left in somebody’s locker, as
opposed to whose expertise and resources were best to deliver it?
The SNP has been clear that those in charge of services should
have only the best interests of patients at heart, not the vested
interests of private healthcare.
We appreciate our healthcare system and in particular its staff,
who have been invaluable to every member of our society before
and throughout the covid pandemic and will be after the pandemic
has, thankfully, gone.
We heard what was said by Dr Pelle Gustafson, the chief medical
officer of the Swedish patient insurer. When asked which country
he would
“hold at the very top of the pillar”
with regard to patient safety, he replied:
“If you take all preventive work as regards patient safety, I
would say that I am personally very impressed by Scotland. In
Scotland, you have a long-standing tradition of working. You have
development in the right direction. You have a system that is
fairly equal all over the place and you also have improvement
activities going on. I am very impressed by Scotland.”
If the Minister is listening to that, this is the NHS that the UK
Government could and should be using as a basis to drive
improvements for the health and social care sector across these
nations, because if they do not, we are at a very real risk of
doing citizens the greatest injustice that this country has ever
seen.
7.03pm
(Denton and Reddish)
(Lab)
It is a pleasure to serve under your chairmanship, Mr Gray. This
has been a spirited and emotional debate, and one that captures
the unique place that the NHS holds in the heart of this nation.
On behalf of the Labour Front Bench, I want to personally thank
the petitioners and the campaigners behind the petition, because
the NHS is more than just an institution. It is an example of the
difference that politics, society and individuals can make. It
gives us hope that Governments can make real differences to
people’s lives, so long as there is the requisite willpower and
determination to do so.
Over the last 12 years, NHS staff have had to move heaven and
earth just to keep the service on its feet. They have faced
extraordinary upheaval, underfunding, neglect and Government
mismanagement. I would like to place on record my thanks to all
NHS staff, at every level, for the work they have done—not just
over the last 12 years and before, but particularly in the last
two years, when we were hit by the covid pandemic and the NHS was
placed under enormous strain. I am in awe of the work that the
staff have done, but I am angry that they have had to step up to
try to mitigate the failures of this Government.
Even before the pandemic, the scale of the crisis in the NHS was
stark. Covid has compounded the problems, but it did not cause
them. Any attempt by the Government to blame covid for the state
of our national health service is nothing more than an abdication
of responsibility.
This debate is about the future of the NHS, but to understand the
future, we must understand how we got here in the first place and
how the steps we must take are informed by principles that have
been too easily forgotten by the Conservative Government. The NHS
is Labour’s finest moment: emerging from the tragedy and upheaval
of world war two, the British public decided to put their faith
in a Labour Government. British people suffered from endemic
health inequalities and squalid living conditions, and were
bearing the brunt of decades of public health neglect.
The NHS, spearheaded by the great Aneurin Bevan and Clement
Attlee, aimed to change all of that. Many said it could not be
done, but it was. It was done through courage of conviction and a
belief in the necessity of a service based on need rather than
income—a simple principle with revolutionary consequences.
We now find ourselves in 2022, almost 74 years on. If the Labour
pioneers who built our health service were here today, what would
they see? They would see record waiting lists, an acute staffing
crisis, morale at its lowest ebb, health inequalities growing,
and a Government fundamentally incapable of addressing their own
failings. Yet if they twisted the dials of their time machine to
2010, they would see an NHS in a pretty healthy condition.
Waiting times had dropped, public satisfaction was at the highest
level ever, and hospitals were staffed at record numbers. In 12
years, that progress has been systematically undone.
The first priority of the next Labour Government will therefore
be to sort out the immediate mess that the Tories have left our
health service in—once more. That means throwing everything at
slashing waiting times and reducing the care backlog, and it
means recruiting, training and retaining the staff we need across
the NHS and social care. The last Labour Government brought
average waiting times down from 18 months to 18 weeks. We will
have to do the same again as a matter of urgency. That must all
come alongside a long-term plan for the care workforce and wider
reforms to fix social care.
However, the Government are doing none of that. Instead, they are
faffing around with an unnecessary and distracting top-down
reorganisation of the NHS, in the form of the Health and Care
Bill, while doing precious little to tackle waiting lists or
address the staffing crisis. I would be grateful if the Minister
recognised those concerns in his response and outlined what steps
the Government will take to ensure that any NHS reorganisation
comes alongside a proper plan to address soaring waiting times
and critical staffing shortages.
However, the future of the NHS is about more than just addressing
the immediate crisis; it is also about adapting to the needs of
our population and recognising that health is about more than
just surgeries and hospitals. Last week, here in Westminster
Hall, I spoke about health inequalities and about how health is
all too often viewed as an isolated issue, without considering
the external factors that influence our wellbeing. Wellbeing is
linked to our communities, our access to green spaces, our mental
health, our opportunities and much more. If we fail to consider
those influencing factors, our health service will always be
geared to address the symptom, as opposed to the root cause of
the symptom.
That is why the future of our NHS relies on prioritising
preventive health measures. One example of that is Labour’s
recent announcement that we would recruit more than 8,500 mental
health professionals to support 1 million more people every year.
That is exactly the kind of progressive, proactive and preventive
policy that the Government should be driving. Such an investment
in mental health would mean that every community had access to a
mental health hub for young people, and every school specialist
support. Wellbeing would be addressed beyond the clinical
setting, and the health consequences of stress, depression and
anxiety addressed before they reached the hospital waiting
room.
So far, I have seen little evidence from the Government that they
realise the importance of preventive health measures. In fact, I
would go as far to say that the withdrawal of funding from
community centres, green spaces and sports clubs over the past 12
years shows that the Government are not sensible and are not
serious about preventive health policy. In his response, perhaps
the Minister will correct me on that and advise how the
Government intend to reverse their disastrous cuts to local
services, which have had a calamitous impact on health
outcomes.
Our NHS was built to provide security. It was built to recognise
that our prosperity is innately linked to our health, and that we
all deserve to live long, fulfilling lives—all of us,
irrespective of our background or where we have come from. It is
an issue of basic respect. To be healthy and have access to care
is not a privilege; it is a fundamental right of every human
being, a right that we expect the Government to protect and
defend at all costs. The job of the Government of the day is to
pass the national health service on in a better condition than
they found it in when they came to office. I am afraid to say
that this Government have failed in that obligation
massively.
I am hopeful, however, that with the right support, the right
investment, the right approach and the right values—values matter
when it comes to our health and wellbeing—Labour can undo years
of neglect and equip the NHS with the tools it needs to survive
and then to thrive. That day cannot come quickly enough.
(in the Chair)
We have a few minutes in hand so, unusually—although I am told it
is perfectly in order—I will call the hon. Member for
Middlesbrough, , to make a brief
contribution.
7.13pm
(Middlesbrough) (Lab)
Thank you, Mr Gray; I am grateful to you for accommodating me. I
declare an interest as a private member of Unite the union.
The level of involvement of private interests that has built up
in our NHS over decades is deeply troublesome. That concern has
been expressed forcefully in the demands set out in the petition
that we are debating. That petition has garnered more than
135,000 signatures.
In our manifesto at the last election, Labour stated:
“Our urgent priority is to end NHS privatisation”,
because
“Every penny spent on privatisation and outsourcing is a penny
less spent on patient care.”
We committed to repealing the Health and Social Care Act 2012 and
reinstating the responsibilities of the Secretary of State to
provide a comprehensive and universal healthcare system. We also
committed to ending the requirement on health authorities to put
services out to competitive tender, to ensure that services are
delivered in-house and that subsidiary companies are brought back
in-house.
In the moments remaining to me, I will address the issue of the
private finance initiative. The hon. Member for Stockton South
() set out a lot of the detail
very accurately. He told us about a hospital in my constituency,
the James Cook University Hospital, and I pay tribute to the work
of all its team, ably led by Sue Page, the chief executive. That
hospital has performed marvels during this period, and offered
services to other hospitals across the entire north of
England.
I am appealing to the Minister for some help for my hospital,
because the burden of PFI has been absolutely colossal: the
hospital has cost £1.5 billion to build and maintain since it
opened in 2003. The amounts paid by the trust increase every year
until the final payment in 2034. I do not want to get into debate
about how rotten the PFI deal was, quite frankly. All PFI deals
were rotten. They were started in 1992 under John Major’s
Government—please, let us not have any of that nonsense. The PFI
deal costs an absolute fortune: £20 million more than an
equivalent hospital would have to pay for maintenance.
What was missing is what we are going to do about it. As an
initial solution, we could look at the decisive action of the
Department of Health in 2012 to make £1.5 billion available in
grants—not loans—to seven hospitals in England with some of the
heaviest PFI debts through a stability fund. The seven trusts
were able to use that money, rather than their usual budgets, to
meet their PFI payments. It has been done elsewhere. I appeal to
the Minister to look very carefully at providing assistance to
get this PFI albatross from around our neck and let my hospital
thrive and continue to do the wonderful work it has done for many
years.
7.16pm
The Minister for Health ()
It is a pleasure to serve under your chairmanship, Mr Gray. I pay
tribute to my hon. Friend the Member for Stockton South () for leading this debate on
behalf of the Petitions Committee. I am pleased we were able to
find time to hear from the hon. Member for Middlesbrough (); I offered to take an
intervention from him, which I suspect was a brave offer on my
part given the intervention that might have come my way. I am
pleased he got to give his speech.
I am grateful to the shadow Minister, the hon. Member for Denton
and Reddish (). I think this is the first
time we have properly been opposite one another since his
appointment to this role on the Opposition Front Bench. Although
I did not agree with everything he said, he made a typically
well-informed and well-argued speech. He is right to pay tribute
to all hon. Members who have spoken today, regardless of whether
one agrees with the positions advanced. This has been a
passionate debate. At its heart is, perhaps, the most precious of
our country’s institutions; understandably, right hon. and hon.
Members and our constituents have very strong views on the
subject.
Before turning to the substance of the debate, and although I may
not agree with their position, I pay tribute in a broader context
to the work of Unite, Unison and other trade unions. I do not
always agree with the stance they adopt, but they play a hugely
important role in our democracy and society. It is right to put
that on the record. As always in these debates, and as the shadow
Minister has done very clearly, I also put on the record our
gratitude—from both sides of the Chamber equally—to all NHS staff
and those working in social care, local government and other key
workers across the country for what they have done across the
past two years and, indeed, what they do every year, day in, day
out.
As I have said before, the Health and Care Bill reflects
evolution, not revolution. It supports improvements already under
way in the NHS and, crucially, builds on what the NHS recommended
and consulted on back in 2019.
Will the Minister give way?
I will make a little progress before giving way; I will always
give way to the hon. Lady. The Bill is backed by not only the NHS
but many others working across health and social care. In a joint
statement, the NHS Confederation, NHS providers and the Local
Government Association state that they
“believe that the direction of travel set by the bill is the
right one”,
noting that local level partnership is the only way we can
address the challenges of our time.
The Minister is talking about a consultation that, as I recall,
took place over the Christmas period, when NHS staff are
absolutely exhausted. He talks about these changes being
requested by the NHS, but what percentage of NHS staff does he
actually think took part in the consultation?
As the hon. Lady will know, the former chief executive of the
NHS, Lord Stephens, was clearing in saying that the
“overwhelming majority of these proposals are changes that the
health service has asked for.”
We should do the right thing by them and by patients. It is the
right time for the Bill: it is the right prescription at the
right time.
The substance of the petition, which has framed many speeches by
hon. Members today, calls for the Government to renationalise the
NHS. I have to say that it has never been denationalised. The NHS
is and always will be free at the point of use. The Government
are committed to safeguarding the principles on which the NHS was
created. The hon. Member for Denton and Reddish set that out very
clearly. We have no plans for privatisation.
Will the Minister give way?
I will make a little progress; if I have time, I will give way to
the hon. Lady, with whom I sat on a committee of London councils
when we were looking at social care reform way back in 2010.
We all recognise the importance of preserving this great national
asset for the future and ensuring that the NHS remains
comprehensive and free at the point of use, regardless of income,
on the basis of need. The Government remain steadfast in their
commitment that the NHS is not, and never will be, for sale to
the private sector.
We are determined to embrace innovation and potential where we
find it, but that is different from many of the accusations in
the speeches we have heard today. I know it is tempting to
scaremonger and set out accusations about what this Act does,
even when people know better, as I know hon. Members do, but that
reflects scaremongering rather than reality. There has always
been an element of private provision in healthcare services in
this country. Labour Members should know that because, as the
Nuffield Trust said in 2019,
“the available evidence suggests the increase”—
in private provision—
“originally began under Labour governments before 2010”.
Will the Minister give way?
I will just finish this point and then give way to the hon. Lady.
The hon. Member for Liverpool, West Derby () made the point, which the hon.
Member for Middlesbrough touched on as well, that it is important
to look at the extent of the involvement of private sector
providers, which accelerated when the Labour party was in power.
The hon. Member for Liverpool, West Derby talked about the 2012
legislation and “any qualified provider”, but that was not
brought in by the 2012 legislation; it was brought in by the
Government in 2009-10, under
the term “any willing provider.” The name was changed, but
nothing substantive changed from what the Labour Government had
introduced in terms of the ability to compete for contracts.
Will the Minister give way?
One more sentence and I will give way to the hon. Member for
Hornsey and Wood Green (); then I will try to bring
in the hon. Gentleman.
One of the key changes allowing private sector organisations to
compete for and run frontline health services came in 2004, again
under a Labour Government, when the tendering for provision of
out-of-hours services by private companies was allowed.
The Minister is being very gracious. How is the Act going to
ensure that there is no conflict of interest between private
providers who sit on integrated care boards and who then provide
services? Are we going to end up with another Randox scandal?
The hon. Lady will know that when it comes to integrated care
boards we, as a Government, introduced an amendment building on
the already clear provisions in the Bill to prohibit conflicts of
interest. I do not know whether she voted for the Government
amendment, but it did exactly that, making it clear when the Bill
was on Report that private providers and those with significant
private interests could not sit on NHS integrated care
boards.
The Minister is being generous with his time. Let us get the
history right. The reason why the Labour Government increased the
involvement of private sector bidders was simply to be able to
increase capacity quickly—to get the waiting list and waiting
time backlogs down, which they had inherited from the previous
Conservative Government and that were massive. In terms of the
2009 Bill, I seem to remember that there was a provision in there
that gave preference to NHS bidders.
I am grateful to the hon. Gentleman. Although we occasionally
cross swords in the main Chamber or here, he knows I have a great
deal of respect for him. All I would say gently on the point
about the 2004 changes is that they came seven years into a
Labour Government, so I do not know the reason why they had not
been able to make progress before then.
We continue to work closely with the NHS to implement the changes
that it has asked for, so that we can build back better and
secure our NHS for future generations. As the shadow Minister,
the hon. Member for Denton and Reddish, rightly said, the
covid-19 pandemic has tested our NHS like never before, and all
our NHS staff have risen to meet these tests in extraordinary new
ways.
Hon. Members on both sides have rightly raised the point about
the pressure that NHS staff have been under. Those who have been
under pressure dealing with this pandemic are the people who will
also be working flat out to deal with waiting lists and backlogs.
We need to ensure that we are honest with the British people and
that those staff have the time and space to recover, emotionally
and physically, from the pressures they have been under. That is
hugely important and we acknowledge the workforce.
Will the Minister give way?
I will not give way to the hon. Lady now. I have given way to her
before. I will try to make progress, but if there is time I will
try to give way to her.
We have seen innovative new ways of working: new teams forged,
new technologies adopted and new approaches found to some old
problems. There is no greater example of that than the phenomenal
success of our vaccine roll-out. That would not have been
possible without the staff, who are the golden thread that runs
through our NHS. As we look to the future and a post-pandemic
world, we know that, as the shadow Minister said, there is no
shortage of challenges ahead of us: an ageing population, an
increase in people with multiple health conditions and, as he
rightly says, the challenge of deep-rooted inequalities in health
outcomes and the need to look at the broader context. I do not
know the shadow Minister as well as I knew his predecessor, but
both his predecessor and I had a career in local government as
councillors. I suspect that the shadow Minister may have had one
too, so he may well know that I understand his point about the
broader context.
Will the Minister give way?
I will make a little more progress. If I can, I will then try to
give way to hon. Members.
More needs to be done, and we are giving the NHS the support that
it needs and has asked for. In addition to our historic
settlement for the NHS in 2018, which will see its budget rise by
£33.9 billion a year by 2023-24, we have pledged a record £36
billion for investment in the health and care system over the
next three years. The funding will ensure that the NHS has the
long-term resources that it needs to tackle the covid backlogs
and build back better from the pandemic.
The hon. Member for Stockton South referred to recruitment within
the NHS. What is the Government’s response to that, to ensure
that we have the recruitment and the staff in place?
As the hon. Gentleman will know, there are 1.2 million full-time
equivalents in the NHS—a record number of staff. Take one
example: our pledge for 50,000 more nurses by the time of the
next scheduled general election in 2024. Last year alone, we saw
the number of nurses in our NHS increase by 10,900. We have a
plan in place, and we are recruiting and training more staff
through increased numbers of places—at medical schools, for
example.
Will the Minister give way?
I will not, because I have only two or three minutes left. If I
make sufficient progress, I will try to give way, but I cannot
promise the hon. Lady.
We know that different parts of the system want to work together
and deliver joined-up services, and we know that when they do, it
works; we have seen that with non-statutory integrated care
systems over the past few years. The petition calls for the
Government to “scrap integrated care systems”, but to do so would
be to let down our NHS. The reforms have been developed by the
NHS, and integrated care systems are already in place. The Health
and Care Bill places them on a statutory footing to allow for
that integration and joined-up working to continue.
In the minute or two I have left before I hand back to my hon.
Friend the Member for Stockton South, I will touch on PFI
contracts, which is an issue that he and other hon. Members have
raised. In 2018, the Government announced that PFI and PF2 will
not be used for any future public sector projects, including
those in the NHS. The Government will honour existing PFI
contracts, as wholesale termination would not necessarily
represent good value for money. We need to look at each on its
merits; many have clauses for early termination, which would cost
a lot more than the life of the contract.
However, we have committed to undo the worst of the contracts
inherited from the previous Government. The hon. Member for City
of Chester ()—I hope he will let me
tweak his tail a little on this—chided my hon. Friend the Member
for Stockton South by saying he should be careful about
references to PFIs. Of the 124 significant PFIs currently in
place, 122 were signed between 1997 and 2010.
Mr Gray, I think you want me to give my hon. Friend the Member
for Stockton South some time to sum up, so I will conclude. We
believe that this Government are doing everything necessary to
ensure that the NHS remains free at the point of use. We are
working with the NHS to deliver what it has asked for through the
Health and Care Bill. There is huge support from those working in
the system for the direction of travel. The Bill will create a
more efficient and integrated healthcare system that is less
bureaucratic, and allegations that this is privatisation by the
back door are simply misleading. Through the legislation, we will
ensure better and more joined-up services, improving health and
care outcomes for all.
7.28pm
I thank the 135,000 petitioners for triggering this important
debate on our most essential and treasured service. I thank
Members for their valuable, emotional and passionate
contributions, and I thank the Minister for what was a
comprehensive response. The NHS is a great British institution,
and we should be proud of it. From Borough to Burnley, our NHS
staff are rightly celebrated as heroes. Their dedication got us
through the pandemic and will help us reach the 6 million people
on our waiting lists. We owe them a gratitude that cannot be
expressed in words.
Dentistry remains an issue for constituents across the UK, and I
look forward to the debate on NHS dentistry, which I understand
is to take place in the near future. I am delighted that the NHS
has the biggest cash boost in its history, and I am delighted to
see thousands more doctors and nurses working in our amazing
hospitals. I look forward to more debates on the NHS, so that we
can continue to appreciate, extend and improve our great British
NHS.
Question put and agreed to.
Resolved,
That this House has considered e-petition 598732, relating to the
future of the NHS.
|
