division_name: Royal Assent &#8212; NHS Outsourcing and Privatisation
motion: <p class="indent" pid="c904.0/2" pwmotiontext="yes">That an humble Address be presented to Her Majesty, that she will be graciously pleased to give directions that the following papers be provided to the Health and Social Care&#160;Committee: written submissions received by Ministers since <phrase class="date" code="2018-06-08">8 June</phrase> 2017 on proposals for reform of the Health and Social Care Act 2012, on the creation of accountable care organisations in the NHS, and on the effect of outsourcing and privatisation in the NHS including the creation of wholly-owned subsidiary companies; and minutes of all discussions on those subjects between Ministers, civil servants and special advisers at the Department of Health and Social Care, HM Treasury and the Prime Minister&#8217;s Office.</p>
  
  <p class="indent" pid="c904.0/4" pwmotiontext="yes">&#8220;it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people of Great Britain.&#8221;&#8212;[Official Report, <phrase class="date" code="2018-04-30">30 April</phrase> 1946; Vol. 422, c. 63.]</p>
  
  <p class="indent" pid="c904.0/8" pwmotiontext="yes">&#8220;the very serious concerns we have for the safety of our patients.&#8221;</p>
  
  <p class="indent" pid="c905.4/3" pwmotiontext="yes">&#8220;on the current funding outlook, the NHS waiting list will grow to five million people by 2021. That&#8217;s an extra million people on the waiting list. One in 10 of us waiting for an operation&#8212;the highest number ever.&#8221;</p>
  
  <p class="indent" pid="c906.0/2" pwmotiontext="yes">&#8220;Fed up waiting? Our private GPs can see you now&#8230;ONLY &#163;80&#8221;.</p>
  
  <p class="indent" pid="c910.0/2" pwmotiontext="yes">&#8220;use of the independent sector to bring waiting times down and raise standards is not privatisation.&#8221;</p>
  
  <p class="indent" pid="c912.3/3" pwmotiontext="yes">&#8220;well below an acceptable standard.&#8221;</p>
  
  <p class="indent" pid="c913.0/2" pwmotiontext="yes">&#8220;My central concern is that contracted services can seemingly fail to meet the basic clinical requirements without being held to account or compelled to acknowledge and remedy their failings. This risks undermining the effective commissioning of services and could, ultimately, compromise patient care and safety.&#8221;</p>
  
  <p class="indent" pid="c913.4/3" pwmotiontext="yes">&#8220;exclusively to fund private capital projects&#8221;&#8212;[Official Report, <phrase class="date" code="2018-01-08">8 January</phrase> 2003; Vol. 397, c. 181.]</p>
  
  <p class="indent" pid="c913.4/5" pwmotiontext="yes">&#8220;The PFI has many virtues&#8212;after all, it was a Conservative policy in the first instance.&#8221;&#8212;[Official Report, <phrase class="date" code="2018-03-10">10 March</phrase> 1999; Vol. 327, c. 429.]</p>
  
  <p class="indent" pid="c913.4/7" pwmotiontext="yes">&#8220;PFI was initiated by the previous Conservative Government&#8221;&#8212;[Official Report, <phrase class="date" code="2018-02-12">12 February</phrase> 2013; Vol. 558, c. 787.]</p>
  
  <p class="indent" pid="c913.4/9" pwmotiontext="yes">&#8220;I am a fan of PFI in general.&#8221;&#8212;[Official Report, <phrase class="date" code="2018-11-04">4 November</phrase> 2010; Vol. 517, c. 1124.]</p>
  
  <p class="indent" pid="c915.4/3" pwmotiontext="yes">&#8220;The fragmentation of the community sector is&#8230;due to the private provider share of the community&#8230;service market being much larger than in other sectors&#8221;.</p>
  
  <p class="indent" pid="c915.4/5" pwmotiontext="yes">&#8220;it is almost always a legal requirement for commissioners to go out to tender competitively for community services. Tendering for contracts is therefore much more competitive in the community sector than in the acute sector, and contracts are sometimes won on cost savings, rather than improvements in the quality of care.&#8221;</p>
  
  <p class="indent" pid="c917.2/5" pwmotiontext="yes">&#8220;claims of widespread privatisation are exaggerated.&#8221;</p>
  
  <p class="indent" pid="c917.2/11" pwmotiontext="yes">&#8220;we will reverse Tory privatisation by renationalising the NHS&#8221;</p>
  
  <p class="indent" pid="c919.3/3" pwmotiontext="yes">&#8220;Whatever your income, if you want to use the service&#8230;there&#8217;ll be no charge for treatment. The National Health Service will include&#8221;&#8212;</p>
  
  <p class="indent" pid="c919.3/4" pwmotiontext="yes">[Interruption.] I know this is difficult for Labour Members, but let me tell them what the Conservatives said when we were setting up the NHS:</p>
  
  <p class="indent" pid="c919.3/5" pwmotiontext="yes">&#8220;The National Health Service will include family doctors&#8221;</p>
  
  <p class="indent" pid="c919.3/7" pwmotiontext="yes">&#8220;cover any medicines you may need, specialist advice, and of course hospital treatment whatever the illness&#8221;.</p>
  
  <p class="indent" pid="c921.1/6" pwmotiontext="yes">&#8220;Putting the risk register in the public domain would be likely to reduce the detail and utility of its contents. This would inhibit the free and frank exchange of views about significant risks and their management, and inhibit the provision of advice to Ministers.&#8221;&#8212;[Official Report, <phrase class="date" code="2018-03-23">23 March</phrase> 2007; Vol. 458, c. 1191.]</p>
  
  <p class="indent" pid="c922.4/3" pwmotiontext="yes">&#8220;a process in which non-government actors become increasingly involved in the financing and provision of health care, and/or a process in which market forces are introduced in the public sector&#8221;.</p>
  
  <p class="indent" pid="c923.5/4" pwmotiontext="yes">&#8220;The Tories might not run NHS Scotland, but that doesn&#8217;t mean they aren&#8217;t attacking it. We must fight to save it.&#8221;</p>
  
  <p class="indent" pid="c923.5/6" pwmotiontext="yes">&#8220;Devolution means they can&#8217;t run down and privatise our NHS directly, the way they are doing in England&#8221;,</p>
  
  <p class="indent" pid="c924.0/4" pwmotiontext="yes">&#8220;Labour will stop the privatisation of the NHS.&#8221;</p>
  
  <p class="indent" pid="c928.0/5" pwmotiontext="yes">&#8220;I am putting the ball right back in&#8230;Osborne&#8217;s&#8230;court. It is irresponsible to increase NHS spending in real terms within the overall financial envelope that he, as chancellor, is setting.&#8221;</p>
  
  <p class="indent" pid="c930.0/5" pwmotiontext="yes">&#8220;where in order to increase capacity you need to use the private sector&#8221;,</p>
  
  <p class="indent" pid="c930.0/7" pwmotiontext="yes">&#8220;the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.&#8221;&#8212;[Official Report, <phrase class="date" code="2018-05-15">15 May</phrase> 2007; Vol. 460, c. 250WH.]</p>
  
  <p class="indent" pid="c931.0/4" pwmotiontext="yes">&#8220;must be fearless. Ministers must have the confidence to challenge each other in private. They must ensure that decisions have been properly thought through, sounding out all possibilities before committing themselves to a course of action&#8230;They must not be deflected from expressing dissent&#8221;.</p>
  
  <p class="indent" pid="c937.0/4" pwmotiontext="yes">&#8220;the &#8216;winter crisis&#8217; has truly been replaced by a year-round crisis. Doctors and patients have just endured one of the worst winters on record&#8230;We cannot accept that this is the new normal for the NHS.&#8221;</p>
  
  <p class="indent" pid="c941.0/2" pwmotiontext="yes">&#8220;contrary to what some of the demonstrators suggest will make it easier for the NHS not to go down the private contracting route&#8221;.</p>
  
  <p class="indent" pid="c942.0/4" pwmotiontext="yes">&#8220;There is no requirement to change the terms of authorisation when setting up a wholly owned subsidiary and therefore, the Department does not hold the information requested. If trusts hold community interest assets then these are considered public assets and cannot be sold unless subject to a Departmental/Secretary of State approval, however this is only a limited number of assets.</p>
  
  <p class="indent" pid="c942.0/5" pwmotiontext="yes">For other assets trusts should consider whether transactions are &#8216;reportable&#8217; under the transactions guidance and therefore would be subject to a review if above the thresholds outlined.</p>
  
  <p class="indent" pid="c942.0/6" pwmotiontext="yes">NHS Improvement has committed to:</p>
  
  <p class="indent" pid="c942.0/7" pwmotiontext="yes">The proposed creation of subsidiary companies becoming a reportable transaction to NHS Improvement under the Transactions Guidance, irrespective of size; and&#8221;</p>
  
  <p class="indent" pid="c942.0/10" pwmotiontext="yes">&#8220;without the approval of the regulator&#8221;</p>
  
  <p class="indent" pid="c942.0/12" pwmotiontext="yes">&#8220;property of the trust designated as protected in its authorisation.&#8221;</p>
  
  <p class="indent" pid="c949.1/2" pwmotiontext="yes">&#8220;sucking money out of the NHS&#8221;,</p>
  
  <p class="italic" pid="c952.0/5" pwmotiontext="yes">The House divided:</p>
  
  <p pid="c952.0/6" pwmotiontext="yes">Ayes 230, Noes 295.</p>