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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“My hon. Friend is absolutely right: the claim that this Government, whose top-down reorganisation has caused so much chaos in the national health service, are responsible for the standards of the NHS now is laughable. They claim to have turned the NHS around in a short space of time, but they are standing on the shoulders of the achievement of the previous Labour Government.”
“I am grateful for my hon. Friend’s kind words and for the support of all the thousands of people, particularly health service staff, who have supported the Bill.”
“10 did not understand what was going on in 2012. The Chancellor was asleep at the wheel, and the Liberal Democrats, suffering from some form of terminal Stockholm syndrome, were led by the nose to turn the NHS from a public service into a free market. My Bill takes a scalpel to cut the heart out of the hated 2012 Act and put right the worst of the Government’s mistakes. It will remove the sections that require the tendering of NHS services for competition with the private sector, the result of which has been millions of pounds being diverted from patient care into the pockets of lawyers and accountants through the tendering process. NHS bodies are spending millions either bidding or managing bidding processes, and that is all money being diverted from patient care. That must stop, and this Bill will end it.”
“I hope the hon. Gentleman does not mind, but I am going to make some progress. Never before have we had market tendering of the health service as we have today, and it is breaking down our NHS. The Bill is not a solution to all the mistakes that this Government have made in their top-down restructuring of the NHS, but it is an important block on enforced privatisation. The argument can be simplified into two distinct sides. If people believe the NHS should be a pure market, open to competition regulations, where the interests of competition are put before those of patients, they belong on the side of the Government. If people believe the NHS is a public service that should be free of competition rules, where the interests of patients are put first, they should vote for the Bill today. We know that No.”
“Absolutely. It is the capacity of the NHS to continue to provide services in the future that is under threat. Eventually and inevitably, with continuing privatisation of all its services, the NHS will end up as just a patchwork of contracted-out services, and that will put us at the mercy of the private sector.”
“There are issues about PFI, which we need to sort out. I must say, though, that the hon. Gentleman has picked on the wrong Member of Parliament. I have one of the very first PFIs in my local hospital. When was it advertised in the European Journal ? In March 1995. It was a Tory PFI and it is one of the most expensive in the national health service; it is costing millions of pounds for my local hospital. Both Governments have something to answer for when it comes to PFI. There are issues that need to be put right, but people must understand that that will not happen under a Tory Government.”
“All Governments have lessons to learn. This party is not saying that it has nothing to learn, but it wants to end the privatisation of the national health service. We must understand one thing: next May is when we have to fight to save our national health service. If we continue under this Act to keep privatising our services, we will not have a national health service as we understand it.”
“We have seen the names—64 of them. We will see how they vote today, and then let the public know what they are doing with our national health service.”
“I should like to make some progress. The Bill is in four parts. Part 1 deals with the powers and duties of the Secretary of State. It reinstates the legal duty of the Secretary of State to promote a comprehensive national health service. It gives powers of direction to the Secretary of State over NHS England and local commissioners. It also requires the Secretary of State to put the needs of patients above those of the providers, or the market within which providers operate. It also provides that all contracts will be deemed to be “NHS contracts”. The significance of that is that they will not be subject to competition rules. All complaints will be dealt with within the framework of the NHS, with the Secretary of State having the final say—not lawyers or the courts.”
“The Bill does not attempt to rid the NHS of the purchaser/provider split. That would require a new top-down reorganisation of the national health service, which people in the NHS say they do not want. What I can say is that this Bill will create a framework in which NHS contracts are not open to competition rules. As long as the commissioners of services stay within the confines of the NHS contracts, they will not be open to competition. They will be compelled to do that by sheer cost, because if they step outside of NHS contracts they are then into European competition rules and will have to spend millions on lawyers and accountants to oversee the tendering process.”
“That provision ensures that article 168(7) of the treaty on the functioning of the European Union is given proper effect in UK domestic law. The article states: “Union action shall respect the responsibility of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of resources assigned to them.” This provision prevents the market from interfering in mergers of services and makes it clear that the disposal of assets will require the permission of the Secretary of State. The Secretary of State will exercise his duties in the interests of patients.”
“I shall make some progress before giving way again. Part 2 deals with the private patient income. It empowers the Secretary of State to set the cap and reduce it from 49%. It also ensures that any income derived from private care is in the interests of NHS patients. Part 3 gets to the core of the issue. It repeals the sections of the 2012 Act that require health service commissioners to put services out to tender, particularly the hated section 75. Clause 9 provides that no legally enforceable procurement obligations shall be imposed on NHS commissioners in relation to any arrangement that is proposed to take effect or takes effect by way of an NHS contract. It further provides that commissioners who place NHS contracts shall not be within the scope of the Public Contracts Regulations 2006.”
“I am sure that is music to the ears of Government Members.”
“My hon. Friend has guessed the next part of my speech. Part 4 of the Bill deals with TTIP. I have heard some criticisms that the Bill does not protect the NHS from TTIP. Clause 14 reads: “No ratification… of the proposed Transatlantic Trade and Investment Partnership Treaty shall cause any legally enforceable procurement or competition obligations to be imposed on any NHS body entering into any arrangement for the provision of health services in any part of the health service.” There are differing legal views on whether the proposed TTIP will or will not impose legally enforceable procurement or competition obligations on the NHS. However, without this clause the question of which set of highly paid lawyers is right will be decided only after the treaty is signed and will be a decision for the courts, not the elected Government.”
“My hon. Friend is absolutely right; TTIP is a UK treaty, negotiated by the UK Government, and it will affect England, Scotland, Wales and Northern Ireland.”
“My hon. Friend is absolutely right. We know that the Prime Minister has accepted it was a mistake, so the Government’s position on the Bill is a bit curious.”
“Absolutely essential. The question for the House is whether that policy issue should be decided by Parliament or the courts. Clause 14 is either unnecessary or essential, depending which set of lawyers ends up being proved correct. We say it should be a decision for Parliament, not the courts. Clause 14 puts the matter beyond doubt. The public must decide whom they trust with the NHS. Do they believe the Tories who say they will protect it? After all, the Tories said there would be no top-down reorganisation, they said there would be no closure of A and E departments, and they said there would be no closure of maternity units except where local people agreed.”
“On behalf of everyone who holds our national health service dear, I move that this Bill be read a Second time.”
“These are the people who fought for the values that created the national health service. There is nothing in our society today that embodies those values more than our national health service. It is these values that cannot be defended by a party that talks about fairness while it justifies the bedroom tax and measures people’s worth. That is not what our NHS does. This Bill will not solve all the problems in our national health service—it will take a Labour Government to rescue it from a crisis—but it is an essential step in rebuilding our national health service. Mr Speaker, I do not beg to move that this Bill be read; I demand it be read, on behalf of NHS patients, on behalf of the staff—the nurses, the doctors, the support staff, the carers, the volunteers.”
“Are these the values of the party that gave us the poll tax or the bedroom tax, or the party that plunges thousands of disabled people into poverty by denying them benefits and forcing them through an unending cycle of appeals to get what they are entitled to? Throughout history working-class people have had to fight to assert the undeniable truth that all men and women are created equal. From the very first poll tax rebellions, John Ball asked: “When Adam delved and Eve span, who was then the gentleman?” He educated common people that they were all created equal. It is a theme that working-class people have been forced to return to throughout the centuries, whether through Christianity or a political fight for social justice from the Levellers to the Diggers, from Thomas Paine and the Chartists to the trade union movement today.”
“You guessed it: Lewisham. But Lewisham A and E would not have been there if the Government had had their way. On top of that, the Care Quality Commission has condemned A and Es in our area because of lack of resources and lack of capacity. At the same time the CQC commended the staff for their dedication in keeping the service running, yet the Government would have closed Lewisham A and E. So, what of their pre-election commitment not to do anything over the heads of local people or local health managers? Do we believe the Tories when they say the NHS is safe in their hands? [Hon. Members: “No.”] To defend the NHS, one has to believe in the founding values that led to its creation. Our NHS treats everyone equally—from each according to their means, to each according to their needs.”
“That is what the Government said they would do. What happened? The then shadow Secretary of State for Health, the right hon. Member for South Cambridgeshire (Mr Lansley), came to the A and E proposed for closure in “A Picture of Health”, marched around the area and told local people, “We’re not going to close your A and E.” What happened then? The Tories got into Government and closed the A and E. In London they put nine out of 31 A and E departments under threat, then they attempted to force the closure of Lewisham A and E. When they were beaten off by local people, they took powers to themselves to close it over the heads of local people. Now, my constituents who get in an ambulance are handed a leaflet that says, “If you come from SE9 or SE3, you can’t go to the local A and E at the Queen Elizabeth.” Where do they have to go?”
“My hon. Friend is right. Before the election the Tories said that they would seek the agreement of local people in decision making, but in south-east London in 2007 my local health managers published a document called “A Picture of Health”. It was drawn up by doctors, nurses and midwives. They held a conference and reviewed all our services. They came to politicians like me and said, “We want you to behave sensibly. This is about improving the quality of care for patients, but at A and E it is also about saving lives.” Just before a general election, it is quite a thing for people to say, “We’re going to close one of your A and Es.” I differed with the health managers over which A and E should close, but when clinicians come and say, “We can save lives and improve quality of care,” we have to listen.”
“Does the right hon. Gentleman think that all those things would have been achievable had the level of funding for the NHS continued at the rate we inherited in 1997 and had Labour not almost tripled the amount of GDP put into our health services?”
“If the Act did not introduce competition to the NHS, will the right hon. Gentleman explain the following? Bristol hospital wanted to restructure its head and neck cancer surgery service. Monitor considered the proposal and concluded that it was likely to improve the quality of service to patients, but that “the merger removes important competitive constraints for elective head and neck, ENT, OMF, urology and symptomatic breast care services in the absence of other competitors”. In effect, it said that the restructuring could have improved the quality of care, but that because it would have removed competition, it could not go ahead.”
“I welcome support for my Bill from all quarters, but why should anyone believe what the hon. Gentleman says about the NHS? Does he accept that the Government were elected with no mandate to introduce the 2012 Act, and that he voted for it?”
“The hon. Gentleman is taking us through a very detailed list of bureaucratic costs. Obviously, the Government are paying close attention to that, but why is it that when I asked them about the cost of overseeing the tendering process—the cost of lawyers, accountants and other advisers—they said that they do not collect that information?”
“That really will not wash. The Minister is saying that we must trust the Government and that they will not allow TTIP to apply to the national health service. The Bill says that this House will be sovereign; this House will decide whether TTIP applies to our national health service. Does he support that?”
“claimed to move the closure (Standing Order No. 36 ). Question put forthwith, That the Question be now put. The House proceeded to a Division .”
“On a point of order, Mr Deputy Speaker. I understand that, in order to go into Committee, this Bill requires a resolution from the Government. Given the overwhelming number of people who turned up on a Friday to support it, would it not be churlish of the Government not to pass that resolution and make sure that this Bill goes into Committee forthwith?”
“The Prime Minister apparently admits that his top-down reorganisation of the national health service and the Act that imposed it were mistakes. My Bill on Friday is an opportunity for him to put right some of those mistakes and repeal the parts of that Act that imposed privatisation on our NHS. The Bill is backed by the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, Unison, Unite and the GMB—who represent the workers. Never have so many people been united against the Government about an Act that imposed so much on the national health service. Will he back my Bill on Friday and tell people that the national health service is not for sale—not now, not ever?”
“The problem with pubs in inner-city areas such as London is that the land they sit on is so valuable that they fall prey to property developers who want to build houses, as has happened to the Dutch House public house in my constituency. Is it not about time that we told developers that they are not going to take away these assets, which are highly valued by local communities, just for their profits? Will the Minister take some action to ensure that we protect pubs in such a situation?”
“I think the Chancellor should calm down when it comes to leadership and loyalty. Why did we have a by-election last month that his party lost to the UK Independence party and why do we have another one this month? Will he confirm that the ECOFIN Ministers he discussed the rebate with are of the opinion that we will pay no less than we would have done if we had paid the full £1.7 billion on 1 December and then received our rebate?”
“It has been Labour policy to encourage more fan ownership of clubs through co-operatives or provident societies, and we are sympathetic to and welcome clause 4 on the community trust aspect of that. I commend the hon. Gentleman for introducing this important private Member’s Bill. He raises a number of issues that are worthy of detailed discussion, and I look forward to having those debates in Committee should the Bill make it that far.”
“On the football creditors rule, the hon. Gentleman makes the powerful point that extraordinarily wealthy footballers can be further ahead in the queue than some local small business person. That cannot be right or fair. There are always unintended consequences to changing rules such as this, but the hon. Gentleman has raised an important point that is worthy of further examination and discussion with the leagues and football authorities, while we deliberate on the matter in Committee. Current arrangements frequently fall into disrepute when clubs go into administration, and there is clearly a strong moral case for changes to the rules. We can examine in detail what those changes may be in Committee, and the hon. Gentleman is right to raise the issue.”
“Mr Cellino was able to enter into a financial arrangement with Leeds before it had been determined whether he was acceptable to the Football League. I am sympathetic to the view that we should have some sort of pre-test. We should be able to determine whether somebody is acceptable as an owner of a football club before they enter into any financial transaction, because football authorities have to make a decision about whether they plunge the club back into more financial turmoil, or accept the person who has already put money into the club, as seems to have been the situation with Leeds at that time. I am sympathetic to the idea of having some sort of pre-examination of whether someone is a fit and proper person, and I look forward to considering that in detail in Committee—I sincerely hope that the Bill makes it that far.”
“Gentleman in his Bill? I am sure we would all like to know whether the Government intend to deal with those issues. On the detail of the Bill, the hon. Gentleman is right to call for a declaration of ownership of football clubs, because there is widespread concern about people who are completely anonymous—as he pointed out, at one stage the chief executive of Leeds United did not know who owned the club he was running. That is a ridiculous situation, and it is a surprise that football associations have not tried to sort it out before. The hon. Gentleman is right to try to move clubs down that road with this Bill, and he has Labour’s full backing. I agree with the hon. Gentleman about the fit and proper person test.”
“Gentleman, a former member of the Culture, Media and Sport Committee, does so too—that the Government have finally set up the expert working group. They said they would do so in their response to the Select Committee’s report in 2011, but it took three years to the month for them to do it. We have all been very patient, and it has finally been set up. In their response, the Government said that they would investigate and deal with the issue of fan ownership. Just before the announcement about the expert working group, the Minister said that it would also look at ticketing and ticket prices, seating, the naming of grounds and so on, but those consumer issues were not part of the original proposal. Will he shed some light on the scope of the expert working group, and about whether it will consider the issues raised by the hon.”
“They must be responsible in carrying out the functions of a board member, and they must respect the confidentiality of matters that are under negotiation. We are very much in tune with the hon. Gentleman, and our proposals have been very much welcomed by fans, trusts and supporters groups across the country. We have also said that fans should have the right to buy a stake in their club. When 30% or more of a club is up for sale, fans should have the right to buy up to 10% of the shares on offer until they own up to a limit of 10% of the club. That cannot be used as a means to take over a club, but it is a means of taking a stake in it. In our consultation, fans were quite clear that they wanted to be able to do that. We would welcome such a right. We welcome the fact—I am sure that the hon.”
“That is not to give fans a veto over what an owner does with their club—that would be foolish—but to give them a voice. In our consultation, they were quite clear that they wanted to be heard, so we concluded that they should have the power to elect representatives to the board of directors of a football club. They should be able to elect up to 25% of the members of the board, and be able to remove them when necessary. We recognise that it is a two-way street: the policy is not just about giving fans the keys to the sweet shop; they must be held responsible. We have spoken to fans about that. They must ensure that they have a proper democratic process, and that the people they elect are representative.”
“I congratulate the hon. Member for Folkestone and Hythe (Damian Collins) on his Bill. I commend him for his consistency on this issue—he has frequently spoken out, particularly on the football creditors rule—and for being a consistent fighter on behalf of football clubs and fans. I also congratulate my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) on his speech. I am grateful to him for his comments about our policy, which we announced a couple of weeks ago, on fans’ involvement in the management of football clubs. As he said, we undertook an extensive consultation over a long period. Like the hon. Member for Folkestone and Hythe, we concluded that fans should be given more powers, and that they should at least be represented at board level in football clubs.”
“Given that the recalculation of GNI has been known about for two years, it is a bit rich for the Prime Minister to say that he wants to understand the detail of the methodology. Should he not have been engaging with that recalculation and investigating its exact implications on behalf of the British people?”
“Is it not actually the case that the Government have used the expert working group to avoid giving football fans a real voice in the running of their football clubs?”
“It is now three years to the month since the Government published a response in which they said that they would set up expert working groups on the barriers to football fans’ owning football clubs. Yesterday, the Minister said that she has set up the expert working group—three years on. She went on to say that it will consider some of the consumer issues about pricing. I have the report in my hand and it clearly says that the expert group will look into issues to do with supporter ownership of football clubs, so the Minister seems to have rewritten the terms of reference. Can she tell us who is on the working group, when it will meet and whether the members of the group know that she has rewritten the terms of reference?”
“I am aware that nagging people does not work and so we need to be aware of other ways in which we can encourage people to be active. Inactivity is an issue, so we need to make sure that we focus on that first, from the very earliest age. I passionately believe that we need to equip young children, from the earliest age, to have confidence in their bodies, their core physical strength and their physical literacy, so that they can access not just sport but the sort of recreational activities that hon. Members have spoken about today.”
“It is possible for people who are overweight to be in better physical condition than someone who does not seem from their weight to be suffering from the consequences of inactivity. It is important to encourage people to be aware of that and to be more active. The hon. Member for Carmarthen West and South Pembrokeshire said that we should encourage young people to get involved in one hour of physical activity a week, and I would like to achieve that goal, starting with my own children—believe me, I consider myself a complete failure in that regard. My wife and I have run the London marathon and recognise the importance of staying active, but we are not successful in getting our children to be active, so are not great examples.”
“Although such investment creates jobs, benefits businesses and is an extremely good way of bringing economic activity into rural areas where it can otherwise be difficult to generate—many Governments have struggled with that—that payback is not just economic; as my hon. Friend said, there are also benefits to the individual, including health benefits. Outdoor activity helps people be healthier and feel better in themselves, and an increasing amount of evidence and research is demonstrating that investing in outdoor activity and encouraging people to become more active has a positive impact. Many hon. Members spoke about the cost to the economy of inactivity. People refer to obesity, but that is not the only issue.”
“He has a great deal of experience in sports and physical activity: he has been employed in the industry and is an enthusiastic participant and organiser. It is a tribute to his work that we have had this debate and that so many people have taken part. My hon. Friend talked about the benefits that people can easily derive from outdoor activities. The “Reconomics” report points out that outdoor activities are often free and easily accessible, and that many of the barriers to taking part in physical activity are removed when enjoying the outdoors. He is absolutely right to highlight the benefits of investing in outdoor activities, and the report demonstrates that there is a payback.”
“It is a pleasure to serve under your chairmanship, Mrs Main, for what I think is the first time. I congratulate all hon. Members who have taken part in the debate. We have heard from my hon. Friends the Members for Ogmore (Huw Irranca-Davies) and for Worsley and Eccles South (Barbara Keeley) and the hon. Members for Macclesfield (David Rutley), for Carmarthen West and South Pembrokeshire (Simon Hart), for Hexham (Guy Opperman), for Chatham and Aylesford (Tracey Crouch), for High Peak (Andrew Bingham) and for Leeds North West (Greg Mulholland). They all raised similar issues, which I will try to deal with as I go through my notes. My hon. Friend the Member for Ogmore made a passionate opening speech, entreating all of us to get out there and enjoy the countryside.”
“Under the heading “Why sport matters”, we refer to the “Reconomics” figures and discuss the importance of rural tourism and walking, and the need to recognise those sectors as part of not just a sports strategy but an economic one. I welcome comments from hon. Members and the Minister on that document. Our consultation document recognises that virtually all Government Departments have a role in promoting sport and physical recreational activity. The Department of Health has a role, for example; the Ministry of Justice could, in terms of trying to divert young people from antisocial behaviour and provide them with the opportunity to experience something they might not get many opportunities to experience otherwise.”