Privatisation of NHS Services

Andrew Selous Excerpts
Monday 23rd April 2018

(2 years, 10 months ago)

Westminster Hall

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Department of Health and Social Care
Mike Hill Portrait Mike Hill
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23 Apr 2018, 4:43 p.m.

I cannot disagree with such a well made point.

The impact of austerity has been a double-edged sword, according to the union Unison. On one hand, less money can be made from the NHS, so some firms have shrunk away. On the other hand, the NHS has opted increasingly for short-term fixes as it struggles with insufficient funding, and that has created opportunities for the private sector. For example, the Carter review includes the threat that hospitals that cannot make sufficient savings in their support services or pathology functions might have to use outsourcing instead. Most recently, the development of wholly owned subsidiary companies has brought a whole new set of fears for the NHS, and for health staff in particular.

The old fears from the 1980s and 1990s are beginning to resurface. When we add social care into the mix, those fears multiply. The NHS is one of our proudest achievements, and we need to protect it, not privatise it. To do so, we need to revoke section 75 of the Health and Social Care Act.

Andrew Selous Portrait Andrew Selous (South West Bedfordshire) (Con)
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23 Apr 2018, 4:45 p.m.

I am grateful to be called to speak in this important debate, Sir Graham.

Let me say at the outset that I very much support our national health service, paid for out of taxation and available for all at the point of need, irrespective of the ability to pay. The NHS saved my life when I was 24—it was there for me when I needed it, and I always want to be there to defend it for all those who will need it.

I have the privilege of serving on the Select Committee on Health and Social Care. Given that advantage, because some of these issues have come up recently at our evidence sessions, I want to quote some of what people who know an awful lot about the NHS have said about the alleged privatisation of the NHS, and particularly about sustainability and transformation plans, which the Government are rightly introducing to give us proper, integrated place-based care.

Simon Stevens is the chief executive of NHS England, and on 20 March he gave evidence to the Health and Social Care Committee. In particular, he responded to some of the claims made by Professor Allyson Pollock. I have met her only the once, when she came to give evidence before the Committee, but I have no doubt that Professor Pollock is sincere about what she believes. Members, however, should listen with an open mind to what Simon Stevens—first appointed to a senior position by a Labour Government, incidentally—says about her concerns. I hope that it will be helpful to the debate.

On the sustainability and transformation plan agenda, which is all about integrated care systems, Simon Stevens said in answer to question 270:

“We will probably see a significant decrease in the number of services that are subject to procurements.”

Talking about some of the comments made recently about the issue, he went straight on:

“Having had a chance to look at some of the evidence that you received from one of the panels of activists”—

Professor Pollock—

“I have to say that, frankly, some of the claims that were being made are made year in, year out, almost regardless of what is happening in the national health service. Indeed, I came across an article talking about how the NHS was being turned into an American health system, which it is not.

The article talks about the fact that the Government’s reforms are going to ‘move the NHS towards an insurance model,’ where ‘primary care groups could sound the death knell of equity, universal coverage and care free at the point of need in the NHS.’ That privatisation and Americanisation article was written 20 years ago by Allyson Pollock. Then I see in the British Medical Journal in 2001 an article by Allyson entitled, ‘Will primary care trusts lead to US-style health care?’ The answer is no, and they did not. We look forward to 2010 and see another article from the same author saying that the NHS in England is to be dismantled, and instead healthcare will be run on US healthcare lines. That is not true.

We see a subsequent article saying that Brexit is in fact going to lead to the destruction of health as a human right in this country. We see the really curious claim that ‘the Health and Social Care Act 2012 abolished and dismantled the NHS in England.’ The million patients who are being looked after by their GPs, in A&Es or as hospital outpatients, let alone the 1.3 million staff who are working in the NHS today, will find it a curious claim that the NHS was in fact abolished four years ago.”

I am grateful to Simon Stevens for giving us a bit of historical perspective on some of those claims, which have been doing the rounds for 20 years or more.

Let us move on to some respected, independent observers of the health scene. Those who follow health will probably agree that one of the most respected is Professor Chris Ham of the King’s Fund. On 6 March he said to the Health and Social Care Committee:

“If you look at what is happening in the partnerships—places such as Salford, Northumbria, Wolverhampton, Yeovil and south Somerset—there is absolutely no evidence of privatisation. These are public sector partnerships based on collaboration between NHS and local government organisations working around their populations and places.”

Mike Amesbury Portrait Mike Amesbury (Weaver Vale) (Lab)
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23 Apr 2018, 4:49 p.m.

Equally, I have some information that was released to The Independent under a freedom of information request, which states that the Royal Marsden in London had an income from private patients in 2010-11 of £44.7 million. By 2016-17, that had risen to a massive £91.9 million—a rise of almost 105%. That clearly demonstrates that there has been a considerable rise in the private income of that world-leading NHS hospital.

Andrew Selous Portrait Andrew Selous
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23 Apr 2018, 4:51 p.m.

I am not aware of where exactly that income came from. The Royal Marsden is a world-leading hospital; perhaps some of that was from foreign patients who had come to the United Kingdom and would not have been entitled to NHS care.

Professor Chris Ham of the King’s Fund went on to say:

“In some of these areas”—

sustainability and transformation plan areas—

“we are actually seeing previously privatised services coming back in-house.”

I will not quote any more from that session of the Committee, but Nigel Edwards of the Nuffield Trust and Professor Katherine Checkland, a professor of health policy and primary care, gave evidence—much respected, independent witnesses who also agreed with Professor Chris Ham.

I have to say to Opposition Members that a number of Labour MPs have a slightly different take from some of the remarks that have been made today. The right hon. Member for Exeter (Mr Bradshaw), who serves with me on the Committee and is a former Health Minister, said in question 24 of our session on 27 February:

“The other advocates of these integrated models are not just people such as Chris Ham”—

of the King’s Fund, who I have just spoken about—

“but people we have spoken to on the ground, trying to deliver a service for their local population. First, it helps them overcome the purchase-provider split, which has already been referred to, and, secondly, it makes it less likely that they are going to be private contracting.”

A lot of the accusations have been around for a long time. It is important that we look at what happened to those previous accusations: did they have a basis in fact? Often, that was not the case. Let us just be fair, because to me, STPs are about taking a sensible approach to integrated place-based care to join up health and social care and to get the world-class health service that we all want to see.

Graham P. Jones (Hyndburn) (Lab)
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23 Apr 2018, 4:53 p.m.

It is a pleasure to serve under your chairmanship, Sir Graham. I thank my hon. Friend the Member for Hartlepool (Mike Hill) for introducing the petition and the petitioners for instigating a very worthwhile debate.

I will speak briefly, because I know that many Members want to speak, about fragmentation, accountability, privatisation, and how the NHS in Lancashire is going backwards. We will hear from across the United Kingdom —or certainly England—about the fragmentation of the NHS. It is not providing the services that patients expect.

The Health and Social Care Act was introduced in 2012. It was a top-down reorganisation, although it was promised that it would not be, that cost £3 billion and has caused chaos in Lancashire. That was a promise made by David Cameron that he broke. It has fragmented the NHS: we have lost accountability, we have opened the door to privatisation and we have reintroduced the purchaser-provider competition, which has been mentioned. In the 1990s, that was implemented in social care—it failed, and there was a U-turn.

In Lancashire, we have the high-profile case of Virgin Care’s £104 million contract signed by the Conservative Lancashire County Council, which has been blocked by a High Court judge for reasons of “considerable cost and disruption.” We are seeing the fragmentation of our NHS through the desire to privatise and move towards the purchaser-provider model. There has also been the removal of the Lancashire Care NHS Foundation Trust from Calderstones. The trust has been involved in taking up contracts and being relieved of contracts. The Walton jail mental health service unit is in crisis. It is an important service because we are trying to tackle the issue of mental ill health, yet there is a significant problem at Walton jail. Lancashire Care NHS Foundation Trust picked up the contract from somebody else, but it is struggling; it is underfunded, and the provider keeps changing. That fragmentation is having an impact on those who require these services.

At Calderstones, there was a very large mental health unit on the fringes of my constituency—in fact, it was just inside the constituency of the hon. Member for Ribble Valley (Mr Evans). The unit was rebuilt in 2007, costing £11 million, to provide a cutting-edge mental health service. It was rated “good” by the Care Quality Commission, but it was closed in 2016. How can the £11 million Calderstones unit, which was rated good and moving towards outstanding, be closed in this age and only nine years after that refurbishment? Calderstones Partnership NHS Foundation Trust itself will cease to exist, to be replaced by the Mersey Care NHS Foundation Trust, which will provide services. One service provider is being swapped for another. We are not getting continuity, and there are problems in NHS services, particularly mental health services, in my area.

The public want to say no to the Health and Social Care Act—they do not like these changes. GPs were told that they would hold budgets; I will come to that, but first I want to talk briefly about STPs. Again, there is little democratic involvement; the changes are being ushered in across the north-west and across Lancashire.

Break in Debate

Rachael Maskell Portrait Rachael Maskell
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23 Apr 2018, 6:53 p.m.

As a union leader who spent 20 years working in the NHS, I certainly spoke up for all my members, who were deeply concerned about the destruction of the NHS because of the privatisation and fragmentation that was happening across it.

The second issue is what is happening to NHS buildings. We know that buildings were moved into NHS Property Services, which is a wholly owned company with one shareholder: the Secretary of State. He is looking through the Naylor report, which is not included in legislation at the moment, to reduce the estate. There may be some good cases for that, but profit should not be at the head of the argument. We should look at how the estate can be reinvested for the benefit of the community.

Parkland at Bootham Park Hospital in my constituency would make a fantastic public park and would address some of the mental health challenges in our city, which was the purpose of the hospital. I ask the Minister to take a further look at that opportunity. Under Treasury rules, the building and the parkland have to be sold to one private provider. Clearly, that would not work for my city. With regard to the rest of the estate at Bootham Park Hospital, it would be great to see the old mental health hospital converted into key-worker housing to support the rest of the NHS. York is in real crisis with regard to recruiting staff, because they cannot afford to live in the city. If we had key-worker homes on that estate, it would create a sea change. That is about putting public interest at the front, not private profit.

Finally, I want to talk about the future, because I am aware that time is moving on. I truly believe that the only way forward for our NHS is to have one planned public service, with full integration of mental health, physical health, public health and social care, provided in the interests of the community. We need play-space to look after the community, and no more fragmentation. It is ridiculous that we have so many regulators and so many different providers. The whole system is fragmented and fighting against itself. If we had one planned system, it would not only simplify the system, but ensure that the money is invested back into the heart and needs of patients.

Andrew Selous Portrait Andrew Selous
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23 Apr 2018, 6:53 p.m.


Rachael Maskell Portrait Rachael Maskell
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23 Apr 2018, 6:54 p.m.

That is exactly how we should move forward, whether with consensus across all parties, which of course I would like to see, or just by putting forward what is logical.

Break in Debate

Andrew Selous Portrait Andrew Selous
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23 Apr 2018, 6:54 p.m.

Will the hon. Lady give way on that point?

Philippa Whitford Portrait Dr Whitford
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23 Apr 2018, 6:55 p.m.

No, because there is very little time.

Andrew Selous Portrait Andrew Selous
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We have 35 minutes left.

Stewart Hosie Portrait Stewart Hosie (in the Chair)
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23 Apr 2018, 6:55 p.m.

Order. The hon. Lady will decide what interventions she wants to take.