A day in the Commons for the Efford Bill – a personal view

A day in the Commons for the Efford Bill – a personal view by Peter Roderick, barrister and co-author of the draft NHS Reinstatement Bill.

Clive Efford debating his NHS Bill21st November 2014.  The National Health Service (Amended Duties and Powers) Bill, introduced by Labour MP Clive Efford in a passionate speech, was successfully given its second reading in the House of Commons today by 241 votes to 18. Labour turned out in force, Tories in the chamber were mainly in single figures, plus a couple of Lib Dems and a sprinkling of others – not least the new UKIP MP, Mark Reckless, who voted for the Bill. The Secretary of State, Jeremy Hunt, and the 2012 Act’s architect Andrew Lansley were nowhere to be seen – junior Minister Dan Poulter fielded for the government.

Little light was shed on the questions we had asked beforehand to be clarified.  The debate itself was a lively mixture of slagging the other side off, statistics trading, quite a bit of meandering and pomposity, and the occasional thoughtful and concerned intervention. The main question in my mind at the end of the debate was ‘what and whom do I believe?

Some cameos. Only John Pugh, Lib Dem MP for Southport, spoke in favour of abolishing the purchaser-provider split, though seemingly on a local rather than national basis. John Healey, Labour MP for Wentworth and Dearne, announced a meeting on Monday with the EU chief TTIP negotiator and Unison’s Dave Prentis. Sleep-deprived Mark Reckless got ribbed mercilessly – from both sides over his UKIP colleague’s view of the 2012 Health and Social Care Act as not having gone far enough, and by Dennis Skinner over the effect of UKIP’s policies on his “United Nations heart by-pass”, apparently performed by a Syrian cardiologist, a Malaysian surgeon and a Nigerian registrar.

 

Committee Room 9 meeting organised by Save Lewisham Hospital

Peter Roderick speaking in Committee Room 9 at the House of Commons on the Efford BillMore enlightening was the meeting afterwards in Committee Room 9 of about 50 people, organised by the Save Lewisham Hospital Campaign. Mr Efford came along and spoke, but he was in a defensive mood.

He was questioned closely on several issues, and I will mention three here.

The first one involved him and me in a heated exchange over the repeated claim that the Bill will re-establish the Secretary of State’s legal duty to provide the NHS. Mr Efford began by describing the view that the Bill did no such thing as “stupid” and “annoying”. I tried to demonstrate to him why the Bill did no such thing. My reasoning is set out here, and in my letter to the House of Commons library.

In a nutshell, the duty to provide or secure provision in section 1 of the NHS Act until 2012 is not reinstated by the Bill; and the duty to provide listed services throughout England in section 3 of the Act until 2012 would become a duty to arrange provision – i.e., to commission – with no mention of ‘throughout England’. This isn’t rocket science – anybody can read the original section 1 of the 2006 Act and section 3 and see that the duty to provide mentioned in both sections would be amended by the Bill, not reinstated.

But some clarity emerged. Mr Efford’s argument really is that looking at all the provisions of the Bill as a whole, the Secretary of State is being put back in charge of the NHS. What kind of NHS is another question, but that at least is a proper argument, regardless of whether one agrees with it. It’s not a proper argument to say that the Bill re-establishes the Secretary of State’s legal duty to provide the NHS, when it doesn’t.

Transforming the duty to provide into a duty to commission leads nicely to the second point: the reference to the NHS being a ‘service of general economic interest’ (SGEI), which voluntarily defers to EU competition law. Far from being a misprint for ‘service of general non-economic interest’, Mr Efford said that this was because the private sector provided health services and so the reference was correct. What he did not say was that Member States have considerable discretion in determining what are SGEI, and why the Bill makes this reference when it is not legally required.

Finally, Mr Efford – and several speakers during the debate – made it clear that Parliament should decide whether the NHS is exempt from TTIP. Hear hear. But why does Clause 14 of the Bill not say that?

As the meeting closed, John McDonnell MP said that Labour was still in denial over its role in marketising the NHS – a constant attack from the Tories and Lib Dem Julian Huppert during the debate to which there was no persuasive response. This makes sense to me.

 

What next?

At the meeting the understanding was that the government might refuse to allow the Bill to go to the committee stage, and that we should do what we can to prevent them refusing. Since then, I have heard that blocking the Bill in this way would be at least highly unusual. It would certainly be a poke in the eye for democracy. The Efford Bill takes a step in the right direction by reducing tendering procedures and the committee stage will provide a forum for detailed consideration and clarification of several issues and an opportunity for tabling amendments along the lines of the NHS Reinstatement Bill – all steps on the road to the Queen’s Speech in May 2015.


Update on Clive Efford NHS Bill


Duty to provide throughout England? Request for correction of House of Commons Library Briefing

Peter Roderick has written to the House of Commons Library to request for a correction in its briefing paper for the Clive Efford NHS Bill. The briefing paper is incorrect to interpret a duty on the Secretary of State to commission NHS services without national scope as amounting to resinstatement of the Secretary of State’s duty to provide the NHS throughout England.

Read in full: Peter Roderick’s letter requesting for correction of House of Commons library briefing (pdf)

Read in full: The Library’s briefing paper is available here.

 


Efford Bill 2nd Reading – Friday 21st November

On Friday 21st November 2014, the House of Commons will debate a Private Member’s Bill introduced by Labour MP Clive Efford on the NHS.  This debate is called the Second Reading. If enough MPs vote for the Bill on Friday, then the Bill can move to Committee stage.  It is at this stage that the Bill can be debated more thoroughly, and amendments proposed.  After which there is Report stage and Third Reading before it goes to the Lords.  It is very unlikely to go through all these stages before the General Election in May.

You can read our response to where we think the Efford Bill needs major amendment here.

We have written to all MPs asking them to attend the debate on Friday, and to vote for the Bill so that it has a chance to get to Committee stage. A copy of that letter is below.

Our aim is for MPs to amend this Efford Bill and use the parts with which we agree later in the NHS Reinstatement Bill 2015.  The Efford Bill does need significant changes and we will urge MPs to vote for some major amendments which we will propose.

If you haven’t yet written to your MP and candidates about the Reinstatement Bill please do so. We are collecting all the responses from candidates, so please do let us know any replies you receive.

The Save Lewisham Hospital Campaign is organising a vigil outside the House of Commons on November 21st – find out details here.

Here is the letter that Lord David Owen wrote to all MPs last week, asking for their support.
David Owen Letter MPs Efford Bill 13-11-2014

 


Response to Clive Efford MP’s NHS Bill

On Friday 21st November 2014, the House of Commons will debate a Private Member’s Bill introduced by Labour MP Clive Efford.

The National Health Service (Amended Duties and Powers) Bill 2014 would repeal the ‘Competition’ sections of the 2012 Health and Social Care Act. This is to be welcomed as a step in the right direction of reducing procurement and tendering procedures, subject to clarification that the National Health Service (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013 would also be revoked. These are the Regulations that require commissioners to advertise new NHS contracts unless the services are only capable of being provided by a single provider.

The Bill, however, would not re-establish the Secretary of State’s duty to provide the NHS, despite the long title of the Bill saying that it would. Neither would it abolish the commissioner-provider split, as proposed by the NHS Reinstatement Bill.

Other points of concern are that it would for example:

  • appear to defer unnecessarily to EU competition law;
  • not reverse the 2012 Act’s prospective abolition of NHS trusts, and their transformation into NHS foundation trusts or take over by private companies; and
  • leave Monitor in place with the same main duty, without a statutory purpose and continuing to licence private providers.

Further clarification is also required as regards the provisions covering the Transatlantic Trade and Investment Partnership Treaty and use of the term ‘‘service of general economic interest”.

Professor Allyson Pollock, Peter Roderick and David Price have prepared a response to the Bill, which includes their provisional views as to whether some of the key provisions deserve to be supported or opposed and where clarification is needed.  That response is here:

Response to the National Health Service (Amended Duties and Powers) Bill 2014, published on 7th November 2014 (“the Efford Bill”)


Roger Godsiff MP supports the proposed NHS Reinstatement Bill

Roger Godsiff, Labour MP for Birmingham Hall Green is backing the proposed NHS Reinstatement Bill.

“I entirely support the campaign to return the NHS to public hands. Our health service should be run as a public service that protects people’s health, not as a cash cow for private companies to skim off profits. The voices of UK citizens have been loud and clear on this – they want their health service to remain public and accountable. The Government needs to start listening.”

Roger Godsiff MP, October 2014

Does your MP support the NHS Reinstatement Bill? Ask them now.


Marcus Chown announces his support for the Campaign for the NHS Reinstatement Bill 2015

The writer and broadcaster Marcus Chown has announced his support for the Campaign for the NHS Reinstatement Bill 2015

“It is astonishing and shocking that the Coalition has got away with removing the government’s ‘duty to provide’ healthcare for you and your family, which has existed since 1948 and which is the foundation stone of the NHS. The effective abolition of the NHS by stealth – under a smokescreen of lies – is the worst thing a government has done to its people in my lifetime. I wholeheartedly support the principles and objectives of the Pollock/Roderick NHS Reinstatement Bill.”

Marcus Chown, 20 October 2014

If you agree please contact your local MP and prospective parliamentary candidates to ask if they support the NHS Reinstatement Bill.


Allyson Pollock explains how our NHS is being abolished

Allyson Pollock explains how our NHS is being abolished in a local TEDx event, produced independently of the TED Conferences.

The 1948 Act establishing the NHS gave the Secretary of State for Health the duty to provide universal health care.  The Health and Social Care Act 2012 removed this duty and introduces a market. Allyson Pollock describes why we need to worry.

If after watching it, you would like to do something, please contact your local MP and prospective parliamentary candidates to ask if they support the NHS Reinstatement Bill.

 


Max Pemberton backs the Campaign for the NHS Reinstatement Bill 2015

Max Pemberton is a psychiatrist in the NHS. He is also an author of three books about his experiences as a doctor, and is a weekly columnist for the Daily Telegraph.  He has announced his support for the Campaign for the NHS Reinstatement Bill

I wholeheartedly support the proposed NHS Reinstatement Bill. The NHS reforms brought in by the coalition government have been a costly, unnecessary disaster, as the government has now admitted. The Health and Social Care Act 2012 fundamentally undermined healthcare in this country and is bad for patients, especially those with complex or chronic conditions. As the market has been introduced into the NHS, the layers of bureaucracy have grown and swelled to levels of byzantine complexity and urgently need to be brought under control. Managers have proliferated in recent years with no clear benefit to the overall efficiency of services.

The NHS needs to be lean and efficient – I do not know of a single healthcare professional that would disagree with this. I had hoped the Health and Social Care Act would deftly dissect out these unwanted and unhelpful elements within the NHS, but instead the scalpel has been used to stab the NHS in the back. All the Act achieves is the atomising of the NHS. It is being spliced and diced into bite-sized portions to be thrown down the gullet of the corporate sector. And ultimately it is the weak and vulnerable who will suffer. We cannot stand by while this butchering of our health service goes on.

Max Pemberton, psychiatrist, author and Daily Telegraph columnist

If you agree please contact your local MP and prospective parliamentary candidates to ask if they support the NHS Reinstatement Bill.


Will NHS England be whittled down to a core service?

BMJ Front cover 11 October 2014 copyProfessor Allyson Pollock, a public health doctor based at Queen Mary, University of London, and Peter Roderick, barrister and senior research fellow also at Queen Marys, are the driving force behind the proposed NHS Reinstatement Bill.

In the BMJ (11 October 2014) they have published their paper ‘A Wolf in Sheep’s Clothing – Is Monitor reducing hospital and Community services in England under the guise of continuity?’

They outline how market forces and budget cuts are challenging the financial viability of hospitals in England, with NHS beds and other services continuing to close as thousands of staff are laid off.

TBMJ Monitor Article p15 11 October 2014 copyhe proposed NHS Reinstatement Bill would abolish Monitor and prevent the reduction of Foundation Trust services from proceeding.

You can read the rapid responses to the article at the BMJ site here.

If you would like to see the proposed Bill become law, then please ask your local MP and prospective parliamentary candidates to ask if they support the NHS Reinstatement Bill.

Below you can listen to Allyson Pollock and Peter Roderick discuss the issue in ‘Is NHS England being whittled down to a core service’ from BMJ talk Medicine. (They discuss the proposed NHS Reinstatement Bill from 15.04 onwards.)

 

 

Images © the BMJ