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NHS (Co-operation/Competition)

None of the new GP-led health centres, which are in every primary care trust area—I think the hon. Gentleman is asking about that—will involve the closure of existing services. The centres are extra capacity, over and above existing services. Any of his constituents who want to use the new GP-led health centres because of their convenience and long opening hours will be able to do so while remaining registered with their existing GPs. It is an extra rather than an alternative service, so it should not have the detrimental impact on existing GPs that he fears. The founder of the NHS, Nye Bevan—a Welshman—understood that how services are delivered and who delivers them is never as important as the quality of the healthcare provided. In England, what do we mean by competition? Competition is not and never will be about the privatisation of the NHS. The health service is concerned with patients' needs, not shareholders'. The hon. Member for Wyre Forest has raised the spectre of health care in the United States in the House. In my view, the US has the kind of competitive health market that is disastrous in terms of both cost and the results for the American people. America spends twice as much of its gross domestic product per head on health care as we do, yet it has worse health outcomes. Some 50 million Americans have no health cover at all. Providers in America compete first and foremost on price, and insurers battle to gain market share by stripping the services they provide to the bone while pushing their costs ever higher. In our system, providers do not compete on price: they have to compete on quality and patient experience. As the American academic and big fan of the NHS, Professor Michael Porter, said:"““The fundamental flaw in the health care sector is not competition, but the wrong kind of competition””." I believe that in England we have the right kind of competition: it increases value to the patient and the taxpayer. Competition operates on two levels in the NHS. First, PCTs, holders of around 80 per cent. of the entire NHS budget, commission services from a wide range of providers based on the expressed needs of their patients. Public sector partners, social enterprises and private companies all compete to supply PCTs in a free, fair and transparent way. It is the job of the local NHS and local PCTs to hold providers to account through their contracts. The end of a contract is an opportunity for the PCT to see whether there is a better provider of care for its patients. If the current contract holder is still the best, the PCT will keep it. If not, it will not. As the hon. Gentleman has acknowledged, PCTs need to see it as their role not to commission services in order to prop up a local underperforming or failing provider, but to get the best services and best value possible for their public. The second level of competition is patient choice. Today, patients—in most cases, we hope, with the support of their GP—play a significant and growing role in choosing their treatment and where and when they are treated. That ability to choose will soon be enshrined as a right in the NHS constitution. I am tired of hearing the frankly patronising line that patients do not want a choice. It is nonsense and, I am afraid, reflects the remnants of an outdated paternalism in which doctor or bureaucrat always knew best. In the recent British social attitudes survey, 95 per cent. of people said that they want some choice over which hospital they attend and what treatment they receive. As more people learn that they have a choice, more people are making one. As the hon. Gentleman has acknowledged, this debate is not just about competition; it is also about co-operation. I am grateful to him for his historical references not just to Ruskin but to the more recent event—I am embarrassed to say that I did not pick up on it in researching my speech for this debate—of my party's replacement of clause 4 of our manifesto. As he rightly said, although some people see co-operation and competition as mutually exclusive principles, the co-existence of which creates an unstable tension at the heart of current health policy, I do not agree—nor, I believe, does he. For a patient, any one provider or service is only one part of the story. Patients do not care and need not know that a range of organisations are taking care of them; they just want to deal with the NHS. Everything should happen seamlessly behind the scenes. Without the in-built fundamental principle of co-operation, as the hon. Gentleman said, that would not be possible. Far from being mutually exclusive, co-operation is a vital and necessary counterbalance to competition to ensure seamless and high-quality care. Holding the ring, we have the local NHS, through PCTs, the strategic health authorities at a regional level, the NHS boards and, ultimately, the Department of Health and its Ministers at a national level, to intervene where necessary. Recently, we have added to that mix by forming the panel on co-operation and competition to give people confidence that where arguments or disputes cannot be resolved locally, there is a fair, transparent and independent process. The hon. Gentleman is right to highlight that important development. It is a shame that it has not got more publicity outside this place. We have created, in effect, the NHS's own Competition Commission. Under the chairmanship of Lord Patrick Carter of Coles, it will provide impartial, expert advice and recommendations on specific disputes. If an independent provider, a social enterprise or an existing NHS provider feels that it has not been given a fair crack of the whip in bidding for a contract and the dispute cannot be resolved by the SHA, it will have somewhere trusted to go to settle the dispute. As the hon. Gentleman acknowledged, the principles for the panel's operation are laid down in the principles and rules for co-operation and competition, which effectively set out the NHS's first ever competition policy. They outline the rules governing choice, co-operation and competition, and detail the behaviours that we expect of commissioners and providers. Their aim is to ensure fairness by putting the interests of the patient and the taxpayer first. The hon. Gentleman raised a number of specific questions about the panel's workings. I was thinking as he made his speech that Patrick Carter or some of his colleagues from the panel might be prime candidates for an invitation to give evidence to the Select Committee on Health, on which the hon. Gentleman sits, so that he can ask the sort of detailed question that he asked here directly of Lord Carter. Indeed, he could also seek a meeting with Lord Carter himself, who I am sure—although I hesitate to add to his diary commitments—would be happy to meet with him or other hon. Members to go through some of the issues. I want to reassure the hon. Gentleman about the role of local involvement networks. We certainly think that the panel should seek representations from LINks in its investigations. The role of the independent reconfiguration panel will depend on how fundamental a service change is being proposed in any particular case. I am glad that he acknowledges the panel's important work in helping to resolve the issues and to take the politics out of controversial local proposals and disputes on reorganisation of services. Clearly, it will still be up to the democratic lock at local level—the overview and scrutiny committees—to decide whether a full consultation is necessary on a proposal or, if they do not agree with a proposal, to refer it to the independent national reconfiguration panel. That will remain the case. It will depend on their view of how important the proposal is. The mix of competition and co-operation in the NHS is a unique model in the world. It is, in my view, no accident that Governments around the world, including Barack Obama's recently elected Administration in America, look to learn from our NHS as they address the serious crises in their own health care systems. I think the hon. Gentleman gives us the benefit of the doubt on having got the balance about right. I agree, and from all the recent international comparator studies of different health care systems, the international experts seem to agree too. In its latest annual report, the prestigious Commonwealth Fund in Washington rated the UK as one of the highest performing health services for the past three years. It specifically praised the NHS on quality, managing chronic illnesses and access to primary care. It also highlighted the NHS as one of the most cost-effective systems of health care. Harvard medical school's Donald Berwick called the NHS the"““bridge between the rhetoric of social justice, and the fact of it.””" The people of this country seem to agree. The latest public attitude survey shows satisfaction with the NHS to be higher than at any time since we began measuring it and dissatisfaction to be lower than at any time since the 1980s, although, of course, one will not read any of that in our newspapers; the good news on the NHS is no news as far as most of our media are concerned. That has been achieved through unprecedented investment and reform, getting the delicate balance right between the principles of competition and co-operation, and staying true to the founding values of the NHS, as well, of course to the amazing skill and dedication of those who work and have worked in the NHS, including the hon. Gentleman himself. Question put and agreed to.