Clive Efford
MP for Eltham and Chislehurst · Labour · United Kingdom
“Thank you for allowing me to take part in this statement, Madam Deputy Speaker, given that I was not here at the beginning—I was carrying out my duties elsewhere in the House. I welcome the Secretary of State’s statement. What is she likely to do in my part of south-east London for technical and vocational places?”
“I rise to speak to amendment 97 in my name, which would remove clause 10 from the Bill. Clause 10 gives powers to the Secretary of State to vary the proportion of public and private provision of health services if they consider that to do so is in the interests of the health service.”
“Labour’s 2024 plan to make work pay set out a welcome desire to bring more essential services back into public control—something that is welcomed by health workers across the country, because so far the “biggest wave of insourcing in a generation”, as was promised, has felt more like a trickle when it comes to the NHS.”
“The explanatory notes for the Bill say that this new flexibility is necessary “where there may otherwise be a breakdown in provision of a health service.” Can we imagine a situation where the Secretary of State has concerns about a health service and that an approach to assist a local provider would be rebuffed?”
“There are ample powers to enable the Secretary of State to intervene and resolve breakdowns in the provision of a health service. On clause 10, we must balance what it adds in those situations against its potential misuse by an ideologically driven Government that are determined to privatise our NHS.”
“It was a pleasure to join my right hon. Friend at Greenwich council’s development of 435 council properties in my constituency for the launch of the social and affordable housing programme. Some 70,000 homes are planned, and that is welcome and overdue.”
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“It is wrong to just say that any reconstruction of the FA will be the right thing to do. The FA board, as currently constructed, is clearly too weak to deal with the English Football League and the Premier League. The people on the council stood up to clubs that wanted to change their colours against the will of the fans. They stood up to clubs that wanted to move grounds and change grounds’ names.”
“It is not acceptable for there to be an ancient body such as the FA Council, which has representatives from the Army, Cambridge university, independent schools, Oxford university, the Air Force and the Royal Navy. The historic construction of this organisation clearly needs reform. I favour the Football Supporters’ Federation’s recommendations. We should have fans’ representatives on the board of the FA. The time has also come for fans’ reps to be on the boards of football clubs. They are an early warning system for problems that exist in our game. It is the fans we turn to when we look to save clubs that fall into difficulties. They are of the communities from which those clubs have sprung. We have to be clear in our aims. Who are we seeking to empower? What problems are we seeking to solve?”
“In England, there is one artificial grass pitch for every 42,000 people; in Germany, there is one for every 22,000 people. In England, there is one coach per 38,000 people; in Germany, there is one per 11,000 people and in Spain one per 3,000. Since 1992, when the Premier League came into being, Germany has won the European championship and the World cup, and Spain has won the World cup and the European championship twice. The council is not at fault for the lack of investment. The enormous wealth that has come into this country has not been reflected in investment in grassroots football, or the coaches and facilities that will develop our game. When we look at reform of the FA, we have to be clear about what we want to achieve.”
“I congratulate the hon. Member for Folkestone and Hythe (Damian Collins) on securing the debate. I welcome this opportunity to try to influence the Minister before she concludes her discussions with the FA on its reform. I accept that the FA needs reform. It has proven itself to be extraordinarily weak at times—as the letter from its previous three chairmen and two chief executives said, it has been unable to wield any power over the influence of the Premier League and the Football League—but we have to be clear about what we are trying to achieve. Many of the problems we are highlighting are not caused by the unwieldy construction of the council, but the weak and feeble nature of the FA board. What do we want the FA to achieve?”
“Right across sport, people from a small gene pool move about different sports and become involved in governing bodies. We need to look beyond that group of people for some real independence at the top of our national game—in other sports as well, but particularly in football.”
“Absolutely. Many fans, for instance, want to see the FA have more influence over the number of home-grown players developed in our leagues. The number is woefully inadequate. Far too many of these prêt-à-porter players are imported because there is so much wealth knocking about in the Premier League; rather than develop and take a chance on a youngster, clubs buy someone off the peg and bring them in. We do not impose the rules that are there to ensure that those players contribute and add to the game. Many fans would like to see an FA that can deal with that kind of issue, and I do not see how just changing the council will make a difference. I support the idea that there should be more independence on the board. However, I have another concern, which I will finish on.”
“Will the Minister confirm that the Government’s position is to diminish the status of this House compared with that of the European Parliament in respect of having oversight of this process?”
“Should not any Member of this House want as a minimum requirement access to information and opportunities at least equal to those of any Member of the European Parliament—surely no Member of this House can justify arguing for anything less?”
“I ask the hon. Gentleman the same question that I asked the right hon. Member for Forest of Dean (Mr Harper) earlier: should he not be arguing, as somebody who has spent a great deal of his time in Parliament scrutinising the European Union, for Members of this House to have rights of scrutiny that are at least equal to those held by Members of the European Parliament?”
“What is the point in the Minister coming here, reading out a pre-written statement to the House and not listening to interventions from hon. Members who have legitimate questions to ask of the Government?”
“Q How much of the local government grant comes from the business rate collected by the Government and redistributed to local authorities? Mr Jones: All of the business rate, bar the £12.5 billion —or £12.8 billion, to be more exact—that has been mentioned, currently goes to local authorities, with the exception of the amount raised from the central list. That list relates to the business rate that comes from infrastructure, for example, and that money does not go directly to local government. The quantum of the funding is set out in the document.”
“Q Sorry, can you remind me what it is? Mr Jones: As I say, the quantum of the funding that local government gets is all of the funding from the business rate, less the amount that we are looking to bring to local government.”
“That is particularly the case with regard to the current levy in the 50% business rate retention system. In effect, that is a tax on growth and the Bill will remove it.”
“Q It is quite a small proportion that is actually raised through council tax, so the ability of local authorities to raise money at local level is very limited in many areas in relation to business rate. What incentives are there for areas where it will prove very difficult to generate extra income through the local business rate? Will the Government be putting anything aside for those local authorities? Mr Jones: As I say, there will be a form of redistribution, and that is important because we do not want areas to be left behind by the implementation of the new system. The system significantly incentivises local areas to encourage business growth and the growth of new businesses on the basis that they will be able to keep far more growth than ever before.”
“We need to think about how we can balance the contributions that various parts of the capital can make to its future success, and part of that will be the ability to invest in transport, to provide housing and to raise revenue through various types of resources.”
“Guy Ware: It is clearly not a straightforward measure of the efficiency of the local authority or indeed its ability to raise resources in other ways, as you suggest. There clearly are differences between authorities. There are also a number of restrictions around the use to which such income can be put. Our approach in London Councils and the GLA has been to argue for the need to be able to look at London as a system as a whole. In order to make the success of the economy that I was talking about earlier continue, you cannot look purely at a borough-by-borough level, because the concentration of employment in the centre of the city means that that is where the majority of the jobs—not all of them, but a very large proportion—are going to be, but that is not where people are going to live.”
“Q Mr Ware, following on from Mr Hollinrake’s questions, does not the capacity to raise income through fees and charges and to generate local economic activity—that is what we are talking about in business rates—need to be taken into consideration? Let me explain myself. I am from the borough of Greenwich, sitting on the outskirts of inner London, and I look in on Camden and Westminster, which can raise money through things such as parking charges, which enables them to finance local government expenditure in a way that other areas cannot. Is that not a major factor? You cannot take the face value of how much one local authority charges for council tax as a way of demonstrating its efficiency.”
“Q It is that ongoing ability to raise income from other sources that areas such as London can benefit from, but other local government areas struggle to do so. Guy Ware: Again, I would make the point that some areas of London have greater capacity than others—that is the point from which you started—and some of those are comparable to cities and rural areas outside the capital and some are not.”
“There is probably less headroom than there used to be; but nevertheless if some of the restrictions were lifted it might just help with our overall funding issues.”
“So, yes, it is significant to the ability of councils to budget and maintain their services, and as a sector we would like more flexibility and control over how we use that ability. Graham Soulsby: I would like to supplement Guy’s answer. If we are going to move a simpler but more effective needs-based system, obviously a local authority’s ability to generate income in other ways needs to be taken into account, to make it fair to other authorities. To do that in a more effective way, look at the current restrictions that are in place. Many local authorities have, over the last few years and longer, tried to maximise their income base in the best way they can, because they have had to do that.”
“Q How much is the capacity to raise money from fees and charges a factor for different local government areas across the country? Guy Ware: The ability to raise fees and charges makes a significant contribution to local government’s overall financial sustainability. I know that, as a sector as a whole, we will be arguing that there should be fewer restrictions on the capacity to make charges and the rates at which we can charge. A number of them are constrained not only by what you can spend them on, but the levels at which you can charge in the first place, which do not necessarily cover the costs of the services being charged for. Planning is probably the most well-rehearsed example.”
“That is why this House of Commons has got to have a say over the process and scrutinise in detail what this Government are doing on behalf of this country. We as Members of Parliament have a duty to do that, and the Government should not stand in the way of democratic accountability in this House under the guise of saying, “You’re trying to renegotiate the outcome of the referendum.” That is not true, but that does not mean they cannot avoid accountability. I hope the Government will accept an amendment on that basis so that we do bring sovereignty back here to this House of Commons.”
“We are going to have to do that at several levels—over article 50, over future trade agreements and over trade agreements through the WTO. What is going to happen with those countries who have vested interests, like Spain, who might want to use this vulnerability of the UK to open up negotiations about Gibraltar? If we go into the World Trade Organisation, would Argentina start to challenge agreements with the UK to open up negotiations about the future of the Falklands Islands? This is the reality of international trade agreements; this is the real world that we are going to be moving into. The idea that we can just fall out of Europe and fall into the World Trade Organisation with absolutely no consequences is folly.”
“In fact, it is highly likely that our easiest way into the World Trade Organisation is to take as a package all the agreements that we have under the EU and adopt them under the WTO; that is the easiest way possible to avoid all sorts of challenges to the UK. Incidentally, we do not have the teams of lawyers, accountants and officials who are used to dealing with these sorts of negotiations to act on our behalf. We are opening up all these negotiations without having the expertise in place. The Government have repeatedly been asked questions about building up these Departments and the expertise: where are the experts who are used to negotiating on behalf of the UK? They are all in Europe; they have been doing it at a European level, and they are not here.”
“I will be voting to trigger article 50, and I have heard speeches from the Government Benches where Members have said that they also want to have a say over the process here in Parliament. I hope that we will see them voting on amendments to ensure that that actually takes place in the three days of debates we will have next week. I have heard all the talk about a brave new world that is going to open up for us under the World Trade Organisation, but people do not seem to be respecting the fact that there are rules, regulations and tariffs to be negotiated with the World Trade Organisation.”
“Then, when it came to the meeting about the outcome of the American presidential election, he spoke down to the people attending a meeting specially convened to discuss that, and said: “I would respectfully say to my beloved European friends and colleagues”. What sort of language is that to use—talking down to the very people we want to co-operate with us in future negotiations? He also went on to describe Donald Trump as “a liberal guy from New York”. He may well be rethinking that one. The Government have clearly shown that they are not to be trusted with these negotiations without having oversight from this House of Commons. We must have a say in this process.”
“We had the spat with the Italian Economic Development Minister over whether Italy would be hurt by selling less prosecco to the UK, where he turned around and said, “We may sell a little less prosecco, but that’ll be happening in one country, while you’ll be selling less to 27 countries.” We had the comments of the Foreign Secretary over freedom of movement as a founding principle of the European Union, where he used a very unfortunate word in an interview with a Czech newspaper and said it is a “total myth” and “nonsense” to say it is a “founding principle”. He may well believe that that is true, but that is not the way to go about negotiating with people who are going to have an important say over future trade agreements for this country.”
“I will vote in favour of triggering article 50 for that reason, but also because I do not want the Conservatives, every time I challenge them over the process and every time I challenge them to come back to the House to be held accountable for what they are negotiating on behalf of this country, to turn around and say that I am seeking to second-guess the outcome of the referendum. They must be accountable to the House for what they are doing. There are some questions to be asked about whether members of the Government are acting in our best interests.”
“I find myself in the invidious position of agreeing with virtually everything that was said by the right hon. and learned Member for Rushcliffe (Mr Clarke), and with virtually everything that has been said by my hon. Friends who intend to vote against the Bill’s Second Reading tomorrow evening. I differ from them in one respect only: I do not think it is possible for me, as a democratically elected Member of Parliament who entered into the referendum process having accepted that we were going to have a referendum, then to tell the public that somehow I know better, and that I am not going to honour the outcome of that referendum.”
“The intervention shows what lies behind this anti-democratic measure. In the mind of the Tories, this is the way the Labour party is funded and the way our democracy operates, and they want a one-party state. Through the resources available to them, they want to dominate the political process in this country. They cannot abide the fact that working people fund a political party to put working-class people’s representatives in the biggest debating chambers in this country. That is what they cannot abide and that is what is behind this legislation.”
“We do not see this sort of interference in regulation of businesses—far from it—but we do hear, “Deregulation, deregulation.” When it comes to democratic trade unions that are responsible and accountable to their members, and democratic representation voted on by their members, the Conservative party wants to regulate, regulate and bind them down under a plethora of bureaucracy. It is not good enough. The regulations weaken workers’ representation and are ill conceived. The Conservative party will rue the day when it undermined free and democratic trade unions; they are an essential part of a mature democracy, which the Conservatives are chipping away at constantly. The changes are rushed and unacceptable, and I am determined to vote against this statutory instrument.”
“That is typical of how the Government adopt the language of the workers, trade unions and the labour movement: their national living wage is nothing of the sort; they talk about being a party of the worker; they even suggested they favoured putting workers on boards, but I will not hold my breath for that. They adopt the language, but they do not will the means. This measure is a typical example of an attempt to weaken trade union representation of hard-working people who need protection. I would love to see enthusiasm from Conservative Members for regulation to deal with zero hours contracts, but we do not see it.”
“The political levy funded workers’ representation through the Labour party here in Parliament, and the Tories cannot bear it and have always chipped away at it. Imagine a Labour Government having proposed regulation for businesses such that they had to consult their shareholders in the way trade unions are now being required to go through all this bureaucracy. I wonder whether the Conservative party writes every year to everyone who has a standing order explaining how they can stop it. I suspect not. The explanatory notes to the measure say that its aim is a collaborative approach to resolving industrial disputes.”
“It is a pleasure to serve under your chairmanship for the first time, Mr Stringer. The question behind this is the one that the hon. Member for Shrewsbury and Atcham asked us Labour Members about the political levy, “What is it worth?” The truth is, if we think of the contribution that trade unions have made to this country as social reformers, going back to the early days when workers were seeking not just decent conditions and decent pay but the right to a job, it is priceless. They realised then that they needed to pay a political levy to put political representatives in the most powerful debating chambers in the country so that their voices could be heard. The consequence was huge social reform on pay and conditions, health and education, and the creation of the Labour party.”
“My hon. Friend is talking about the broken pledge on increasing funding for schools. Is she aware that 74 out of 77 schools—that is 96% of them—face real-terms cuts of more than £200,000 by 2019? How is that defensible? How is it evidence of a Government who care about education?”
“There was a manifesto commitment to increase school spending per capita, but secondary schools in Greenwich face the prospect of having to make on average £1 million savings between now and 2019, with primary schools saving more than £200,000 each. Some 74 out of 77 schools face those cuts. Is that consistent with what the Conservative party told parents in my borough before the election?”
“Notwithstanding that, household debt is very high, and housing costs are a big proportion of households’ expenditure. Has the Chancellor made an assessment of the impact of an interest rate increase on growth, given that that growth is driven by consumer spending?”
“We now know that the Secretary of State is putting politics before the interests of passengers, and he is taking a dogmatic approach by ignoring what could improve our railway system. He has refused to allow the Mayor of London to take over suburban services, in spite of the fact that his predecessor thought that that was a good idea. The public are in favour of public ownership: 58% of people polled by Transport for London are in favour of the Mayor having greater control over suburban services and only 14% support his position. Is it not time that public ownership of our railways was considered by the Government, and are not the public in favour of it?”
“In Bedford, there has been a 30% reduction in its contracting with the local Bedford hospital for MSK services and the private services in that area are brimming with profitable elective MSK surgery. The process for awarding the contract is unsafe and has put patients at risk. Worse still, it has put at risk patients who are not in need of MSK services, due to the knock-on effect on other services. It cannot be that patients will unwittingly attend their local hospital and find that services have been cut because another service in the local health economy has been privatised. It is time to call a halt to this process. I hope that the Minister will step in, stop the process and stop the contract being let to Circle plc, because it is clearly flawed and not in the interests of patients in Greenwich.”
“It let a £73 million contract without any consideration of the knock-on effects on other vital health services, particularly A&E. The illegality of the process was disregarded and Ministers were given false assurances about the process and the consultation with Lewisham and Greenwich NHS Trust. There was no proper assessment of the suitability of Circle as a health provider. It provides not one clinician in the process—it is purely a management operation and another tier of bureaucracy. We hear endlessly from the Government about the need to cut back bureaucracy, but Circle is simply a signposter in the process, and for the pleasure of doing that it will take private profit out. It contracts with existing private services.”
“Chris Clough, who was appointed to investigate what was going on there, described it as “an unmitigated disaster”. To keep that service going, Circle brought in locums from overseas costing £300,000 a year. Today, the centre is no longer a centre of excellence. The Government and NHS England did not learn a single lesson from what happened with the Cambridgeshire and Peterborough social care contract, where the private provider handed the contract back after eight months, saying that it was not viable. They ignored warnings from the National Audit Office about that in July 2016. It seems that the Government are happy to see any process go forward as long as the services are being privatised. The process is completely and utterly flawed and is completely unsafe. The meeting in June last year was inquorate.”
“I do not accept that we need the private sector to do it. If we continue to privatise services like this on the pretext of saving money, we will see a lot of money that should be being spent on patients going out in private profit. It is time to call a halt to the drip, drip of privatisation in our national health service. If we want to modernise the NHS we need to find ways of doing that, but I wonder how someone could come to the conclusion that Circle is the organisation to take us forward. We know what happened at Hinchingbrooke hospital—Circle walked away the day before the Care Quality Commission was to put the hospital in special measures. At the Nottingham NHS treatment centre, a dermatological national centre of excellence, the consultants walked out.”
“Within 18 months of the opening, 20 beds were closed temporarily, to save money during the summer period when there was allegedly a low level of demand, but they were due to open again when winter came along. Now we are told that the beds are not opening. Lewisham and Greenwich NHS Trust is lobbying very hard because it desperately needs the beds back—it is now running at more than 100% occupancy for beds in its hospitals. We are now told that the space available for those 20 beds is part of the MSK project. That is not what my local community signed up for. It is not acceptable that the whole business plan for that hospital and the services to be provided there has been completely changed without any consideration of the local community. I accept that there is a need for change in the NHS.”
“The local community watched the much loved and admired local building, the Eltham and Mottingham community hospital, being knocked down because they had been told they were going to get a walk-in GP service and a new hospital in the heart of their community, which they could attend for blood transfusions, X-rays and other diagnostics; more importantly, there were to be 40 rehabilitation beds for people leaving hospital and returning to the community. The community were very supportive of that scheme, which started in 2007. I and others in the local community lobbied very hard to make sure that the project stayed on track, and it finally opened in 2014.”
“There would be an impact on doctors’ training and rotas; on the quality of training provided to junior doctors and other staff; on related professional services and posts such as nursing and physiotherapy; and, in the longer term, on recruitment at Queen Elizabeth hospital and specifically to its trauma service, including the emergency department, which is a designated trauma unit. It is disgraceful that no impact assessment was carried out to assess these impacts on other services. The new Eltham community hospital was very much welcomed by my local community. Lots of lobbying has gone on.”
“How is that acceptable? The trust has to plan ahead for other services, and it is finding that impossible. The trust has been through a couple of scenarios of what would happen if it was forced to cut its services as a result of losing elements of the MSK contract. It currently has a team of surgeons and some 45% of their surgical workload comes through the MSK contract. Those surgeons are vital to the support of other services, such as A&E. If those surgeons are lost, it will have an impact on other services in the trust. Activity could be reduced in consultant trauma services at Queen Elizabeth hospital which support the A&E.”
“The Minister was also told that Circle was engaging with Lewisham and Greenwich NHS Trust, but the trust says there is no clarity around the clinical model and no commercial offer. That was still the case in November at the council’s scrutiny meeting, with the contract then due to begin on 1 December. The trust had no idea of the money or business that would come its way as a result of the Circle contract. The Circle contract is a prime contractor model. That means that all patients will be directed to Circle, which will triage them and direct them to whichever services. Lewisham and Greenwich NHS Trust receives something in the region of £10 million for MSK services. It has nothing in its future budget for that service, because it is simply unaware of what it can expect from the contract that will be managed by Circle.”
“When the White Paper was launched by Andrew Lansley, he made it clear that local clinicians should be at the heart of decision making. In this case, we see that local clinicians were anything but at the heart of decision making. I asked whether the local healthcare trust had been consulted at all in the process, and the Minister told me in an answer that it had been discussed at a meeting in March 2016 and as part of an assurance procurement process in August. That did not happen. Lewisham and Greenwich NHS Trust managers have no recollection of a meeting in August where the matter was discussed. Who told the Minister that the meeting had taken place when it clearly had not? It was not possible for anyone to give that assertion to the Government when the meeting simply had not taken place.”
“We do not know how much Circle intends to take out of the £73 million for its profits, but she will be aware that it is required to be paid the national tariff. If that is the case, will Circle be treating the same volume of patients as are currently being treated under the MSK process? If not, where are the savings and the profit for Circle going to come from? I asked the Minster some questions to satisfy myself that the Government were happy with the procedure that had been followed. Were NHS England or the Minister informed of how Greenwich CCG achieved its quorum and the fact that the required number of GPs were not present? It was the GPs who were part of the consortium that was bidding who were required to leave the room.”
“His answer was simple: “No, it is illegal.” At a subsequent health scrutiny panel meeting at Greenwich Borough Council, which was held to investigate the circumstances surrounding the allocation of the contract to a private provider, a representative of NHS England passed the procedure off as common practice. Can the Minister tell me whether it is common practice? Is it acceptable procedure? Is the advice that I have been given—that it is illegal—correct? Does she believe it to be a satisfactory way for such contracts to be allocated? If she is not satisfied, what do the Government intend to do? The Minister will be aware that it is not permissible to pay anything other than the NHS tariff for services. Circle promised savings of £12 million as part of its successful bid for the contract.”