Renationalise the NHS, scrap integrated care systems, and end PFI contracts

We demand the Government restore England’s publicly funded, publicly provided NHS by reversing all privatising legislation, ending ongoing PFI contracts, and scrapping plans for Integrated Care Systems and for-profit US-style ‘managed care’.

This petition closed on 14 Apr 2022 with 137,708 signatures

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The Government has no democratic mandate to privatise the NHS, yet vast amounts of public money are being squandered on the internal market, business managers, private providers, PFI debts, multinational accounting firms and corporate consultants. We believe the Health and Care Bill could undermine access to care and universal standards by locking in privatisation and dividing the English NHS into Integrated Care Systems. The Government should renationalise the NHS, and reverse all of the above reforms.

Petition Signatures over time

Debate - Monday 31st January 2022

Future of the NHS

Monday 31st January 2022

(2 years, 3 months ago)

Westminster Hall
Read Full debate Read Hansard Text Read Debate Ministerial Extracts
[James Gray in the Chair]
Matt Vickers Portrait Matt Vickers (Stockton South) (Con)
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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.

Mike Amesbury Portrait Mike Amesbury (Weaver Vale) (Lab)
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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 (Christian Matheson), in Ellesmere Port and right across the country. Does the hon. Member for Stockton South (Matt Vickers) agree that NHS dentistry is in crisis?

Matt Vickers Portrait Matt Vickers
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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.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
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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?

Matt Vickers Portrait Matt Vickers
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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.

Graham Stringer Portrait Graham Stringer (Blackley and Broughton) (Lab)
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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?

Matt Vickers Portrait Matt Vickers
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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.

Andy McDonald Portrait Andy McDonald (Middlesbrough) (Lab)
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Will the hon. Member give way?

Matt Vickers Portrait Matt Vickers
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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.

James Gray Portrait James Gray (in the Chair)
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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.

Christian Matheson Portrait Christian Matheson (City of Chester) (Lab)
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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 (Matt Vickers) 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.

Ian Lavery Portrait Ian Lavery (Wansbeck) (Lab)
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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?

Christian Matheson Portrait Christian Matheson
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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 (Mike Amesbury), 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.

Catherine West Portrait Catherine West (Hornsey and Wood Green) (Lab)
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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 (Ian Lavery) 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.

Imran Hussain Portrait Imran Hussain (Bradford East) (Lab)
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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 (Christian Matheson), and for Hornsey and Wood Green (Catherine West), 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 (Matt Vickers), 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.

Rebecca Long Bailey Portrait Rebecca Long Bailey (Salford and Eccles) (Lab)
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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.

Barry Gardiner Portrait Barry Gardiner (Brent North) (Lab)
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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 Andrew Lansley, 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.

Beth Winter Portrait Beth Winter (Cynon Valley) (Lab)
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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, Julie Morgan, 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.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
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It is a pleasure to speak in the debate. I concur with the comments of others. Like the hon. Member for Stockton South (Matt Vickers), 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 (Beth Winter) 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.

Margaret Greenwood Portrait Margaret Greenwood (Wirral West) (Lab)
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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.

Mick Whitley Portrait Mick Whitley (Birkenhead) (Lab)
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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.

Richard Burgon Portrait Richard Burgon (Leeds East) (Lab)
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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.

Kim Johnson Portrait Kim Johnson (Liverpool, Riverside) (Lab)
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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.

Catherine West Portrait Catherine West
- Hansard - Excerpts

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.

Kim Johnson Portrait Kim Johnson
- Hansard - Excerpts

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.

Ian Byrne Portrait Ian Byrne (Liverpool, West Derby) (Lab)
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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.

James Gray Portrait James Gray (in the Chair)
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I apologise to the hon. Member for Middlesbrough; I fear we have no time.

Steven Bonnar Portrait Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)
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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.

Andrew Gwynne Portrait Andrew Gwynne (Denton and Reddish) (Lab)
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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.

James Gray Portrait James Gray (in the Chair)
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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, Andy McDonald, to make a brief contribution.

Andy McDonald Portrait Andy McDonald (Middlesbrough) (Lab)
- Hansard - Excerpts

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”,


“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 (Matt Vickers) 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.

Edward Argar Portrait The Minister for Health (Edward Argar)
- Hansard - Excerpts

It is a pleasure to serve under your chairmanship, Mr Gray. I pay tribute to my hon. Friend the Member for Stockton South (Matt Vickers) 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 (Andy McDonald); 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 (Andrew Gwynne). 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.

Margaret Greenwood Portrait Margaret Greenwood
- Hansard - Excerpts

Will the Minister give way?

Edward Argar Portrait Edward Argar
- Hansard - Excerpts

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.

Margaret Greenwood Portrait Margaret Greenwood
- Hansard - Excerpts

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?

Edward Argar Portrait Edward Argar
- Hansard - Excerpts

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.

Catherine West Portrait Catherine West
- Hansard - Excerpts

Will the Minister give way?

Edward Argar Portrait Edward Argar
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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”.

Catherine West Portrait Catherine West
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Will the Minister give way?

Edward Argar Portrait Edward Argar
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I will just finish this point and then give way to the hon. Lady. The hon. Member for Liverpool, West Derby (Ian Byrne) 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 Gordon Brown 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.

Christian Matheson Portrait Christian Matheson
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Will the Minister give way?

Edward Argar Portrait Edward Argar
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One more sentence and I will give way to the hon. Member for Hornsey and Wood Green (Catherine West); 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.

Catherine West Portrait Catherine West
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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?

Edward Argar Portrait Edward Argar
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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.

Christian Matheson Portrait Christian Matheson
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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.

Edward Argar Portrait Edward Argar
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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.

Margaret Greenwood Portrait Margaret Greenwood
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Will the Minister give way?

Edward Argar Portrait Edward Argar
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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.

Jim Shannon Portrait Jim Shannon
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Will the Minister give way?

Edward Argar Portrait Edward Argar
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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.

Jim Shannon Portrait Jim Shannon
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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?

Edward Argar Portrait Edward Argar
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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.

Margaret Greenwood Portrait Margaret Greenwood
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Will the Minister give way?

Edward Argar Portrait Edward Argar
- Hansard - Excerpts

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 (Christian Matheson)—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.

Matt Vickers Portrait Matt Vickers
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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.


That this House has considered e-petition 598732, relating to the future of the NHS.

Sitting adjourned.

Government Response

Thursday 23rd December 2021

The government has been steadfast in its commitment to the guiding principles of the NHS which mean the NHS is not and never will be for sale to the private sector.

This government has no intention of privatising the NHS.

We firmly refute the claim that the Health and Care Bill undermines access to care or universal standards. It is not a privatising Bill. It delivers on the NHS’s own proposals for reform in its 2019 Long Term Plan and makes permanent some of the innovations we have seen in the system due to Covid. It captures learning from the response to the pandemic and the vaccine rollout. And it goes even further, improving access and standards with a range of measures to level-up health outcomes across the country, enabling people to live longer and healthier lives.

The Bill establishes Integrated Care Boards (ICBs) to take on the commissioning functions of existing CCGs and some of NHS England’s commissioning functions. They will be directly accountable for NHS spend and performance, and will be NHS bodies. They will bring in representatives from a range of other NHS bodies including NHS commissioners and NHS providers. The work of ICBs will be driven by health outcomes, with no space for profit, competition, or private interests.

The new commissioning bodies being set up are all public bodies and will not, indeed cannot, be controlled by private providers. Independent providers, as corporate entities, will not be able to sit on Integrated Care Boards, nor will any individual appointed there be a representative of such an interest in any capacity.

The Bill includes ample safeguards to ensure that the interests of the public and the NHS are always put first. The ICB chair has the power to veto members of the board if they are unsuitable, and NHS England has the power to issue guidance to ICBs in relation to appointments as part of its general guidance-making power. That sits alongside the robust requirements on ICBs to manage conflicts of interests, including publishing and maintaining a register of Members’ interests, and NHSE’s wider duty to issue guidance to ICBs.

At Report Stage the Government further clarified, by amendment, existing provisions that ensured private sector organisations would not be able to sit on ICBs.

It is the view not just of this Government but of the NHS that local commissioners are the best people to determine what services a local population needs. Commissioners will continue to be responsible for managing contracts to ensure services are arranged with all providers, including those with the independent sector, to provide high quality of care at efficient prices.

In line with NHS recommendations on competition and procurement rules, we are changing the way the NHS arranges healthcare services in a way that provides more flexibility, reduces bureaucracy for both commissioners and providers and reduces the need for competitive tendering where it adds limited or no value.

The vast majority of NHS care has and will continue to be provided by public sector organisations. However, successive Governments of all political affiliations have allowed the NHS to commission services from the private and voluntary sector. Whether that is to improve accessibility and experience for patients, to increase capacity quickly, or to introduce innovation. NHS commissioners may commission services to meet the needs of their local area from any CQC-registered provider, regardless of their corporate status, provided they follow procurement rules and regulations.

NHS England will remain accountable to the Secretary of State and Parliament. The Health Secretary has duties, including to the continuous improvement of quality of services, and to the NHS constitution, which as one of its guiding principles has that NHS services are free of charge, except in limited circumstances when sanctioned by Parliament. Access to NHS services continues to be based on clinical need, not an individual’s ability to pay.

The NHS is and always will be free at the point of use. The government has been steadfast in its commitment to the guiding principles of the NHS which mean the NHS is not and never will be for sale to the private sector.

Department of Health and Social Care

Constituency Data

Reticulating Splines