---

NHS (Co-operation/Competition)

It is very nice to see you in the Chair, Mr. Taylor, and it is good to see the Minister in his place, because in my experience he is a listening Minister who takes note of what people say and tries to answer questions put to him. The Government have just founded another panel—the co-operation and competition panel—which is such a crucial development in the NHS that I thought that we should shout it from the rooftops. I realise that there are not many hon. Members here, but at least this debate will get into Hansard, which hopefully means that it will be widely read, because this panel is crucial. When I started thinking about this subject, I thought that the words ““co-operation”” and ““competition”” were the opposite of each other. I was browsing around and came across something that John Ruskin said in 1862:"““Government and cooperation are in all things the laws of life; anarchy and competition the laws of death.””" I do not quite hold to that extreme view, and as can be understood I was staggered when, again while browsing, I came across new clause 4 of the Labour party constitution, which I had never come across before. In part, it refers to"““a community in which power, wealth and opportunity are in the hands of the many not the few, where the rights we enjoy reflect the duties we owe…in which the enterprise of the market and the rigour of competition are joined with the forces of partnership and co-operation””." There we have the origin of this apparent paradox between those two particular words. The scene for competition was set by the previous Government in the 1980s and 1990s with the purchaser-provider split, contracting and so on, and that approach is now espoused in the constitution of new Labour. A very significant change in words has taken place. We no longer talk about NHS services, but about NHS-funded services, which immediately poses the question of whether NHS services will now be provided by a wide range of organisations. For someone such as myself who grew up passionately believing that the NHS could cope and work so well that the private sector would not be needed, it goes against the grain to accept that there are possible benefits to competition. When parts of the NHS are unable to improve, there is a place for competition. As we are so firmly set on this path, we must accept that it is the only way to go. There is not much point in trying to fight against it. In the Financial Times a fortnight or so ago, the appointed chairman of the panel, Lord Carter of Coles, said:"““But once you have created a market as the NHS has, up to a point, the law of unintended consequences kicks in and big issues arise. People want clarity about what the contracting relationship should be.””" He goes on to say that the shift to the more competitive market for health services is ““inexorable”” and that"““ultimately most things will be contested.””" In the 1980s, when I was on the local health authority, domestic services were being considered for privatisation. Domestic staff were about to go on strike, but we explained to them that such an action would do no good. We told them that the only way they could compete was to put in a competitive tender. They did that, and they won the contract and retained the services. I have two messages to give during this debate. I say to NHS staff that it is possible to win a tendering process, and to the Government I say that the tendering process has to be fair and on a level playing field for all potential providers. Richard Smith, a former editor of the British Medical Journal, had almost a Damascene conversion. In 2008, in the journal of the Royal Society of Medicine, under an article entitled, ““The NHS: losing my religion”” he said:"““There would be regulated competition, because, much as we might bemoan the fact, competition is one of the few drivers that can consistently deliver higher quality and lower costs.””" If regulated competition is really what the co-operation and competition panel is going to promote, then I for one welcome it. I now want to address some of the information that we already have about this panel. The information is voluminous to say the least. There has been not just one consultation, but four separate ones. I welcome the statement about the target audience. Such an audience includes commissioners, providers of health services—including GPs—and patients and other interested parties. In other words, it includes everyone. I hope that notice will be taken by all interested parties and that they will get in some responses. On page 4 of the consultation document, the seven criteria for consultation are listed. I will not go through them all, but let me mention a few. Consultation must be early enough to influence the policy outcome. The process must be at least 12 weeks or longer; it must be clear and have an appropriate scope, and the analysis of it must be open and honest. Those criteria, which came out in July 2008, reflect the Cabinet code of practice that was published in January 2004, and they are welcome and timely. I often refer to my election to this place. If consultation had gone according to those criteria, I am sure that I would not be here. During the downgrading of my hospital in 1997 to 1998, consultation was a complete mockery. Analysis of the responses was decidedly odd. There was no consultation over the private finance initiative. The initiative was portrayed as the only game in town. Bringing us right up to date, the NHS Support Federation has recently compiled a report on public consultations around GP-led health centres. The executive summary says:"““A survey of all 152 PCTs showed that there were wide variations in the timetables and approach to consulting taken by each PCT and even confusion about the need to consult at all.””" Some of the PCTs said that because it was Government policy, they did not need to consult on it. The report then looked in detail at the consultation of 37 PCTs outside London to consider the consultation process. It said:"““Only 22% of PCTs are explicit in their consultation documents about the fact that a new health centre could be run by a commercial or voluntary sector provider.””" It went on to say:"““2/3 of PCTs do not ask local people whether they agree with the overall plan for a GP-led health centre; 16% provided less than 12 weeks for responses…only 16% of PCTs asked about the importance of the distance of travel to the new health centre””." There were many deficiencies in that consultation, which took place after the Cabinet guidelines of 2004 and probably before the latest criteria of July 2008. The report concluded:"““There is a need for far greater accountability of NHS bodies and providers especially in the new market-based era for the health service. Diminishing is the inherent protection of a public service ethos. Public consultation is therefore an essential check to safeguard the public interest.””" Let me turn to the principles and rules for co-operation and competition that are mentioned on page 6 of the document. It says:"““The aim of the Principles and Rules is to ensure seamless services for patients; foster patient choice, transparency and fairness; encourage competition for NHS-funded services; and establish the ground rules for mergers and other transactions involving an NHS body.””" I should like to pick out one or two of the principles. Again, I will paraphrase rather than quote them. They say that commissioners must commission from the best providers. That is both obvious and correct. Commissioners and providers must co-operate to produce a seamless experience without boundaries and with continuity. This is where co-operation comes in. The Department of Health is talking about co-operation between commissioners and providers. Another principle says that commissioning and procurement should be transparent and non-discriminatory. I hope that that refers to the level playing field that I want to see. Another principle says that the payment regime must be transparent and fair. I hope that that means we will not have any loss-leaders, because loss-leaders from the commercial sector would not help. On page 10, the document says that the panel will work closely with stakeholders. Absolutely correctly, the first group of stakeholders mentioned are patients and the public, but the document does not go into detail on how they are going to be involved. The document mentions choice, and by choosing and providing feedback, people give a certain amount of comment. It states:"““The public also hold the Government to account for their stewardship of health services, to ensure the taxpayer gets good value for money””," but only once in five years do the public actually hold the Government to account for that sort of thing. I am disappointed that the document does not mention active participation of patients and the public in the form of general practice participation groups and local involvement networks, which should have been set up for exactly such processes. Digressing for a moment, it appears that LINks are rather slow in forming and becoming functional, and the all-party parliamentary group on patient and public involvement in health has been rather distressed by the delay. It is crucial that the panel communicates with LINks. On mergers, the place of overview and scrutiny committees is mentioned, but the place of the independent reconfiguration panel is not. I can see the latter being removed from the field, which would be a great shame, because it has proved its use and independence frequently recently. We have heard that the Department of Health is talking about co-operation between commissioners and providers, but there has been staggering news in the press recently about much wider co-operation between competitors. It was reported that GlaxoSmithKline has pledged to cap the prices of its drugs to the 50 poorest countries and, amazingly, to pool intellectual property with its competitors. That goes towards the ““Webster's”” definition of ““co-operate””, which is:"““Work or act with others for a common end.””" The common end for the NHS must always be the patients, to whom it belongs. I just hope that the consultation on the new co-operation and competition panel will result in a valuable body that works to make competition fair and transparent. It should foster co-operation not only between commissioners and providers, but between providers.