No party wants to privatise the NHS,but the NHS has always used a lot of private sector work

 

One of the most ill informed debates which Labour regularly makes us have is the debate about “privatising the NHS”. Labour, Conservative, Lib Dem and UKIP all say they will not privatise the NHS.  I think what they all mean by this is we are all fully signed up to the proposition that health care should be available  free at the point of need for UK citizens who want it from the NHS, a very popular principle.

In practice the private sector plays a large role in the NHS, and has done so since its foundation. It would be a good idea if we began the debate with a proper explanation of the current structure of the NHS. Labour, Conservative and coalition governments with the Lib Dems have all preserved the extensive use of the private sector inherited from the original NHS scheme, and have extended the role of the private sector in certain ways.

From the beginning it was decided to depend entirely on the private sector for the supply of drugs and other medical supplies. A very profitable competitive industry has grown on the back of NHS contracts and their equivalent elsewhere in the world. We still depend on large pharmaceutical and medical supplies companies for everything from pills to scanners, from bandages to beds.

From the beginning it was determined that most GPs would be private sector businesses, earning much of their living from NHS contract payments. So it has remained, with a majority of GPs today being private sector contractors working under the NHS banner. On average 95% of their income comes in NHS contract payments and 5% from private sector fees and charges. The typical  GP partnership receives gross payments based on the size and composition of their list of patients registered, and based on particular services they provide which qualify for additional remuneration. Out of the gross payments they pay their practice costs and then receive the rest as personal remuneration. According to NHS England  in 2011-12 the average GMP received £178,200 gross , which gave take home pay before  personal tax of £106,100. I think it right that we seek to reward  people with medical qualifications at good levels for their expertise and professional study.

In hospitals many years ago under the Conservatives  it was decided in some cases to introduce private sector contractors to do the cleaning, to provide the meals and some of the other hotel services. Labour continued with this approach. Labour  also added some limited use of private sector medical services, bought in to relieve shortages of capacity in particular specialities or to improve the patient outturns and reduce the waiting lists. In office Labour argued that the essence of the NHS was to offer good quality care free at the point of use. Sometimes, they said, this could be done more quickly and more cheaply and better by buying in service from the private sector and paying for it with NHS  funds for patients.

It is therefore curious that today Labour wish to maker a political issue out of the “threat” of privatisation. As far as I can see there is absolutely no threat from any political party to the idea that the NHS should be free at the point of need to those who want it. Nor do I see any likelihood that Labour, who used the private sector extensively in power to help deliver NHS services, would want to nationalise doctors and drug companies were it to get back  back into office.

Why does Labour despise or marginalise England? The curious case of 3 English flags.

 

The reason Emily Thornberry’s picture and tweet was so damaging was it revealed Labour’s scorn for England. I can think of no other country in the world where democratic politicians in a major party would regard their country’s flag as a hostile sign, an unbecoming adornment of a voter’s house. Clearly Ms Thornberry does not warm to our flag even though she is an English MP which I guess is why she apologised for sending out pictures of it.

When I come to a house with an English flag I am pleased. It provides a talking point. Is it there to support an English team? Or is it there as a general statement that people now want our country to be recognised and taken into account?   Perhaps it is both. Labour is going to have to get used to many more English flags in the years ahead. Our football, rugby and cricket teams still attract a great following, especially when they are doing well. Now our country too is gaining traction with voters who have seen and heard the Scottish referendum debate and want England to have a new deal as a result.

Some say the tweet was so damaging because it was snobbish. That might be true, though nothing she said or wrote confirms that. Some say she was looking down on white van man. Again there is no proof. The photo itself is all we have to go on, and the most dominant feature of the photo, and the thing that distinguished that house from other houses with white vans, was the three English flags.

Mr Miliband decided to sack her, rather than argue that she meant it nicely and was thrilled to see three English flags. So that tells us a lot about Mr Miliband’s view of the situation. Before anyone could concoct a half decent explanation she had been made to apologise and spokesmen were wheeled out to distance the hapless leader from the unfortunate interpretation of the photo.

All this seeks to imply that Mr Miliband has at last grasped the importance of England in the hearts of voters and in the present political debate. Unfortunately there is no confirmation of this. There is no movement from Mr Miliband to give us English votes for English issues in Parliament. He has no matching list of powers to devolve to England as he seeks with the other parties to devolve powers to Scotland. He may now wish to show respect to voters with English flags on their homes or in their vans, but he does not intend to make any change to Labour’s resolutely anti English policies.

I think the Thornberry tweet is far less important than Mr Miliband’s dogged refusal to recognise England in any way in what he proposes for the UK. The best he can do is to mouth failed platitudes  about devolution to some English cities, when the issue now is the central one of England herself. If Mr Miliband you now wish to respect our flag and the voters who take pride in it, you need to change your policy on devolution.

 

NHS is not about to be privatised

 

I have taken up the issue of NHS privatisation and today’s private members bill with Ministers, as some constituents have sent me copies of an  email expressing worries on the topic. The Minister tells me:

 

“This Bill seeks to prevent ‘privatisation’ that simply isn’t happening.

 

  • There are no new competition provisions in the Health and Social Care Act – it simply codified practices the old PCTs were obliged to follow under European law.
  • Private sector provision grew at twice the rate under Labour than under this Government. Only 6 pence in every pound spent by the NHS is spent with private sector providers.
  • Labour signed contracts with the private sector that guaranteed levels of income to Independent Sector Treatment Centres regardless of the amount of work they actually carried out – which we have stopped.
  • We have made it a matter of law that commissioners cannot pursue competition in the NHS if it is not in the interests of patients.

 

The NHS Confederation, the independent membership body that represents the service, has already expressed serious concerns about the Bill, citing the ‘potential for disruption caused by further changes’.

 

The Bill stops local doctors making decisions about the best services for their patients. Clinical leadership is highly valued in the NHS – but this Bill seriously undermines it.

 

What the reforms actually did was remove layers of bureaucracy in the old SHA and PCT organisations so we have been able to recruit additional frontline staff:

 

  • They removed 19,000 managers;
  • They save the NHS £5.5 billion in this Parliament alone and then £1.5 billion every year after that;
  • They mean we can afford to employ 8,000 more doctors and 5,600 more nurses on our wards compared to 2010;
  • They help us to carry out nearly a million more operations a year, perform millions more diagnostic tests, and refer 51% more patients for cancer treatment, ensuring people get the care they need.

 

The Bill also claims that it will stop the NHS being affected by TTIP. Labour ignore the facts here too – because if there was any risk to the NHS, I would be the first to oppose the deal. The EU’s chief negotiator on the deal has said that ‘provisions in TTIP could have no impact on the UK’s sovereign right to make changes to the NHS’.

 

  • The EU have acknowledged that the deal ‘excludes any commitment on public services, and the governments remain at any time free to decide that certain services should be provided by the public sector’.
  • Labour MP John Healey, a former Minister, has said the deal protects the NHS and ‘progressives should keep campaigning’ for a TTIP deal ‘that will be good for British consumers and workers’  “

 

 

 

I

 

The Eurosceptic split

Some will welcome the by election result this morning. I cannot, because it just reminds us how split the Eurosceptic movement is. UKIP want to deny that many Conservatives are good Eurosceptics, to diminish the Eurosceptic army. Their tests of purity make it impossible for them to unite the movement and gain a majority.Indeed, some UKIP supporters now are so exclusive that anyone who fails to join their party by definition cannot be a Eurosceptic. Some Conservatives get  cross with UKIP for splitting the movement, and a few well known Conservatives condemn some Eurosceptic policies, making it more difficult for committed  UKIP voters to trust Conservatives. They do not speak for the party, but that gets ignored.

The end result of the battle of Conservative against UKIP is little has changed for Rochester or in the Commons. UKIP merely sought to relabel a Conservative MP, who was already speaking and voting in a very Eurosceptic manner as a Conservative. There are no more Eurosceptic voices and votes in the  Commons today than yesterday That is why I can neither rejoice nor welcome what has happened.

UKIP will argue that something has changed for the General Election. They will hope their good vote here will lead to better votes in May 2015. The polls suggest that if the UKIP vote stays in the range 10-20% nationwide  there will be no breakthrough in seats, but the UKIP effect is to help Labour. I remind people of this not because I wish to use it as an argument, nor because I am pleased it is true. Far from it. I raise it because it just shows how difficult it is to do the right thing for Euroscepticism given the competition for votes.

What do I mean by Euroscepticism? I mean that majority view in the UK which thinks our current relationship with the EU is not working. The majority think we are paying too much and getting too little back. They think there are too many rules and the UK has to impose and enforce them too strongly. They think the UK should be able to control its own borders and settle its own welfare policies without accepting EU directions to open the borders and pay the same to anyone who comes.

This is not yet the same as a reliable majority wanting simply to leave the EU as  UKIP suggest. The public understand that the UK does have to have a trading and working relationship with the continent, and think it probably best to try to sort this out first. If we were able to hold an In/Out referendum now without any negotiation first there is no guarantee the Outs would win. If we can have a negotiation and then a referendum the majority will be able to come to sensible view in the light of what has or has not been achieved by negotiation. If  UKIP are right in thinking nothing worthwhile  will be offered the UK then winning for Out will be much easier.

That is why I would like Eurosceptics to unite to fight for that negotiation and referendum which we Eurosceptic Conservatives have persuaded our leader to offer. Revolutions end in tears when the radicals fall out over how far and quickly to go in their agreed direction instead of concentrating on maximising support for reform. The issue is not my or your purity of intent in our Euroscepticism. The issue is not what divides us. The issue is how can we harness a majority movement which gets us out from Brussels control in the way the majority want and need.

Taxes can do damage

The Japanese economy is back in recession. One of the main reasons is the pattern of consumer spending. Ahead of the sales tax increase people made their purchases. Once the tax rise came in they cut back sharply, leading to a fall in demand and output. It was far less helpful in raising revenue to pay for public services than the increase in VAT introduced in the UK, which did succeed in raising more revenue and did not have the same impact on demand as the Japanese hike.

In the UK it was the rise in higher rate income tax and capital gains tax that led to losses of revenue. The halving of the increase in the higher rate helped bring in more money again. Despite the recovery of property values and the rise in share prices, capital gains tax revenue at the 28%  tax rate is still well down on the levels it reached at the  18% rate  before the crash.

The art of taxing is to find the rates and taxes that maximise revenue to pay for the health and education services and welfare that modern advanced democracies expect, so people can have the services and borrowing can be kept under control. The danger is governments set rates that reduce revenues or do considerable harm to economic activity as in Japan.

The Japanese tax rise initiated by a previous Japanese government has now led to the decision to delay the second planned rise, and to hold a general election for Mr Abe to seek a renewed mandate very early so he can get on with the economic reforms Japan clearly needs. Meanwhile, the price of the higher tax rate is more quantitative easing, as we have seen with the recently announced expansion of the Japanese programme.

Japan is the one of the world’s largest economies, in recession. Euroland, another of  the world giants, is struggling to avoid another recession, generating very little growth. The strategy of bringing deficits down by growth is not working well in Japan or Euroland. The inclination to raise taxes instead has misfired  in  Japan, just as surely as it did in France. Governments need to learn that higher tax rates  may be self defeating. They may lower output and incomes and may even lower revenues.

The government’s new proposals for pub tenants and small brewers

A number of constituents wrote to me seeking  changes to the law to make life easier for pub tenants.  The government Bill this week did take some steps to help, and I supported the government.  The Commons decided it did not go far enough and put through a further amendment based on some of the points many of us  had put to the government on behalf of constituents. Following that the government has sent me the following changes it now intends to put through to reflect the views expressed  inside and out side Parliament:

 

“Colleagues with an interest in pubs may be interested to know that, following discussions, the Government will be amending its approach to Part 4 of the Small Business Bill on the Pubs Code.

 

Concerns had been raised that the measures in the Bill inadvertently bring small family brewers into statutory regulation, when they are not the cause of difficulties tenants face. Other concerns had also been raised that we were not giving tenants of large pub companies the ability to get a fair deal by running their pub without the tie.

 

We are therefore proposing the following.

 

First, all pub companies with fewer than 350 tied pubs will now be excluded from the Statutory Code altogether. This means almost all the family Brewers, except for the biggest, will not be subject to the Statutory Code and only three further Brewers would be brought in.

 

Secondly, for the eight large pub companies with over 350 tied pubs, we will take a power to introduce a Market Rent only option. A Market Rent only option would allow tenants to choose to go free of tie. This power would only be permitted after 2 years if, after a review, the measures already in the Bill are found to be ineffective. Any exercise of this power would be by affirmative resolution of the House.

 

The result of the second change is that large pub companies would need to act on all the other measures in the Bill. If they don’t act to tackle the widely reported problems in two years, then the Government can bring in a full Market Rent only option.

 

Etc

 

 

 

 

 

Mr Redwood’s contribution to the debate on EU Reform, 19 November

Mr John Redwood (Wokingham) (Con): I rise to talk about two large European powers that are both, in their own ways, reluctant Europeans. It is well known that the United Kingdom made an historic and important decision, under the previous Labour Government, not to join the euro. Many of us campaigned actively for that decision. We strongly believed that if the United Kingdom joined the euro it could probably bring the currency down. It would be extremely damaging to our own economy and financial system. How glad I am that we prevailed on that Government. If the United Kingdom had been in the euro at the time of the great banking crash of 2007-08, we would have brought the euro down. The House may remember that it was the United Kingdom that brought down the euro’s progenitor, the exchange rate mechanism, which a previous Government mistakenly went into. Just as the forces of the Great British trading economy—an international economy with a strong dollar base—brought down the ERM, so I think we would have brought down the euro.

Now that we have made that historic decision, I see no intention on the part of any serious force in the United Kingdom to reverse it. I am pleased at that. I confidently predict that no party with any serious chance of winning a single seat in the Westminster Parliament in 2015 will campaign on the UK joining the euro between 2015 and 2020. I confidently predict that the same will be true if we have a general election in 2020. I do not see the mood changing. We have learned our lesson. We have understood that it will not work as an economic project.

We understood also that it does not work from the point of view of our democracy. As soon as a country begins to share a currency with other member states of the EU it must share many other things. Those countries are on a long journey towards a united states of Europe. They are discovering that they will need to share their policy on tax and public spending. It is no longer possible for people in Spain, Italy or Greece to think that they have a democratic right to choose their level of public spending, public borrowing or taxation. They are under increasingly tough controls from the centre. Germany is right about that: strong financial discipline is needed in a currency union if it is to work.

That is exactly the kind of control that the United Kingdom would never accept. I do not see parties of the left accepting that Europe should tell us to spend less; and I do not see parties of the right accepting that Europe should expect us to tax more. Indeed, some of us on the right would not want to be told to spend less in certain areas; and some on the left would not want to be told to tax more, in certain ways. We as a democracy say that the fount of our democracy is the elected Members of this Parliament; and that controlling taxation and our budget are central to our great national story. Our mother of Parliaments emerged to control the finances of the King and to say to the King or Queen, “You shall not tax more—or not without redress of grievance, or without our having a say over how the money is spent.” That is why the United Kingdom will rightly remain a reluctant European. We cannot accept the continuing pressure from the logic of the euro, that we should give away those fundamental birthrights—the democratic right to elect people to tax and spend, and change them if they tax and spend too little or too much, or in the wrong way.

I remember, as part of the anti-euro campaign, hitting on the phrase that joining a single currency would be like sharing a bank account with the neighbours. I used to say that I get on well with my neighbours. We have Christmas drinks and the odd summer party, and enjoy each others’ company. However, I do not know about other hon. Members, but I am not ready to share a bank account with my neighbours. I just have this feeling that if I were the prudent one, when I wanted to draw out some of my money to spend, the neighbours would have spent it. They might have wanted a fancier house, and taken out a big mortgage; then when I wanted a mortgage I would discover that our mortgage capacity had already been used up. That is exactly what being in a single currency is like. My opponents in those debates used to look for what was wrong with my analogy. I thought it was broadly right, but even I thought it might be a little bit of a try-on. Now that we have seen the euro scheme I realise that it was completely apt. That is exactly the position of countries such as Greece, Italy and Spain, in relation to Germany. Germany says “We do not want you using the collective mortgage, because we know you will borrow more, and we have got to do the saving.”

There is therefore an unhealthy tension, which is why I must talk about two reluctant Europeans. The other big power in Europe that is proving to be reluctant about the scheme of full European integration, providing the political backing to the single currency, is none other than Germany itself. At the very time when some Germans presume to lecture the United Kingdom on being a reluctant European—a very counterproductive thing to do, because it encourages Euroscepticism no end when Germans lecture us in that way—we find that Germany is busily trying to restrain the others from the impelling political logic of the euro, which must be to complete the political union to provide the backing to the currency.

If we exchange banknotes in the United Kingdom, we see on the banknote a symbol of our country. We see the monarch’s portrait. It is there partly because we like our monarch, but also as a symbol that the whole taxable capacity, the whole parliamentary and political weight, and the whole authority of the United Kingdom Parliament stands behind that banknote. People trust it, trade it and use it because they know that that is true. In time of crisis Parliament stands behind the Bank of England; the Bank of England stands behind the banknote; and the taxable capacity of the country is there for whatever crisis might arise. The problem with the euro is that there is as yet no symbol or political union to stand behind the banknote. That is why it has been subject to crisis after crisis. Pictures of bridges had to be used on the notes, and they could not be like any actual bridge to be found anywhere in Europe, because that might offend people. An Italian bridge might mean the Spaniards would be jealous; or perhaps they would be grateful that their bridge was not being pledged on the banknote—I do not know. There would have been tension or difficulties even over choosing the symbols for the banknote, so they had to choose something more anodyne.

There is a much bigger and more important political reality behind that; we are discovering that the full taxable capacity of the German state does not yet stand fully behind the euro, and that the rich and successful countries do not want to pool their riches and success with the poorer countries in the Union. Until they do, the currency will be crisis-stricken. The development of a second euro has already happened. The second euro was the Cypriot euro. Unbelievably in a first-world currency, people who had been foolish enough to deposit euros in a Cyprus bank could not take them out. When it was allowed, they were not worth €1; they were devalued before people could have their money back. That had to happen because the German taxable capacity would not stand behind the Cypriot bank. There is no way that, if a city or part of the United Kingdom—it would be invidious to give names—got into balance of payments or financial difficulties, people’s pounds, deposited in a bank in a part of the United Kingdom, would be first frozen and then devalued before they could be taken out. Everyone would rightly be scandalised and think it absurd. Yet that happened in the eurozone, because our reluctant European, Germany, would not stand behind the euro.

My prediction is that Germany is on a slow but inevitable march to standing behind the euro. In a way, I hope it is, because I wish the euro well and it needs to be a grown-up currency with proper transfers behind it; but the more Germany is on that movement towards being the paymaster, founder and discipline-provider of the euro area, the less possible it is for Britain to belong to that system. That is why I welcome the magnificent contribution that my hon. Friend the Member for Stone (Sir William Cash), has once again made to our national debate, and why I hope people are listening outside the Chamber, in addition to those who have kindly come to listen. Today’s debate is about the mighty subject of our generation. We wish our continent and the euro area well, but the United Kingdom must now find a new relationship. Just as surely as Germany needs to become the centrepiece of the political union to make a proper reality of the euro, so the United Kingdom, unwilling and unable to join it, will need a new, looser and different relationship with that emerging superpower—which will be not an armed superpower but an economic one, with, at last, the taxable capacity of Germany standing behind the rest.

It is important for that to happen quickly. I do not want to live in a Europe where there is practically no growth year after year and where there are sometimes rather bad crashes. I do not want to live in a Europe where the banking system is still riven by difficulty and disaster because there is not full support from the euro-area in the way we would expect from an integrated economic zone. I want to live in a Europe that is more vibrant, more exciting and more interesting.

I am very pleased that my country has stayed out of the euro; I am very pleased that, with our own financial and monetary policies, we now have a growth rate of which we can be proud and that gives our people hope; and I am very pleased that unemployment is coming down. It would make things so much easier for us if Europe had a growth rate of which we could be proud, if its unemployment rate was coming down and if it could offer hope to its young people. Europe cannot do that unless it either completes its currency union properly or breaks it up as soon as possible. We cannot join Europe in the former, and we do not wish to lecture it on the latter, so can we please get on with negotiating a relationship that works for Britain? Can we privately, not publicly, remind Germany that if she wishes this mighty project to work, she has to commit herself to it as fully as we have to disengaging?

What happens if the SNP do well in the May 2015 Election?

Before the referendum I sought an assurance in the Commons from the SNP that they would accept the result of the Referendum either way, and regard the matter as settled. I pointed out that those backing the Union would facilitate Scottish separation if they won by just one vote, so would expect the SNP to accept the Union if the Union won by one vote. I was given the necessary assurance. The talk was of having settled the matter for a generation.

It perhaps should come as no surprise to learn that the SNP did not mean those assurances given prior to the vote. Their recent conference has made it quite clear they regard the last referendum as a stepping stone on the way to another vote where they hope to win. It looks as if their candidates for the May 2015 General Election will be believers in an independent Scotland, as well as presenting themselves as the people best able to maximise the gains for Scotland out of the current round of further devolution negotiations.

Up to this point supporters of the Union could always take comfort from the fact that Scotland has never voted for a majority of independence seeking MPs at Westminster. Scottish voters up to this point have mainly wanted to influence whether Labour or the Conservatives run the Union government. We have never been faced with more than 6 SNP MPs saying they just want to leave the Union and have no interest in how the rest of the UK is governed.

It will all look very different if recent polls stay the same come May. If Scotland were to elect a majority of SNP MPs the rest of the Union cannot ignore that force. If a large group of SNP MPs were part of a Parliament with no majority party then the SNP could be in a position to decide who if anyone did govern,and to demand a constitutional price for their support.

Scotland will only be a settled member of our union again if the SNP decide to change from wanting independence to agreeing to a given amount of devolution and then using its influence to make people happy with that new settlement. Alternatively it will only be a happy member of the union again if Scottish voters reject the SNP for the Westminster Parliament. Voting SNP to maximise leverage over the rest of the UK may seem good tactics to many Scottish voters, but it would mean the referendum had settled little.

Mr Redwood’s intervention during the Statement on the G20, 17 November

Mr John Redwood (Wokingham) (Con): Given that the United States has been the fastest-growing advanced economy since 2009, based on the exploitation of cheap energy, was there any discussion about what we and others need to do to compete with America industrially? We will need to invest in a lot of cheap energy to keep up.

The Prime Minister (Mr David Cameron): There was a discussion about energy, and it is notable now that America starts these interventions by explaining that it is the world’s largest producer of oil and gas. My right hon. Friend makes an important point though: we should not be left out in the shale gas revolution. It has helped American competitiveness and energy prices, and I want to ensure that we do everything in the UK to take advantage of it too.

Stumbling growth?

The government has drawn attention to the slowing German economy, recession ridden Italy, and the lack of upwards momentum in the French economy. Japan has also now suffered two more quarters of declines in output and incomes, so is back in recession. None of this helps the UK recovery, as that means bad news from some of our export markets.

I have been asked if the world is about to move back into recession. I think that unlikely. The US economy is still working well, with a large boost to output from shale gas and oil, a boost to industrial output from cheap energy, and leadership in internet and communications technologies. India is improving under the leadership of Mr Modi, and China is still growing quickly by world standards despite all the talk of the end of the Chinese growth miracle, and some slowing of the rate.

When I asked the Prime Minister yesterday about the need for us to pursue more plentiful supplies of cheaper energy to relieve the pressure on our industry, he confirmed that the government is keen to get on with finding and extracting the shale gas that is thought to lie under the surface in several parts of the UK.

He also expressed the view that monetary experiments in the UK and US had helped fuel the recoveries, and that the European Central Bank needed to do more to help Euroland. Without new policy initiatives in the Euro area, and without further stimulus in Japan the world economy will slow a bit, but will still be growing.

It seems likely that Japan will cancel or delay the proposed additional tax rise, and is now embarking on additional monetary stimulus. Mr Abe is determined to see growth return as soon as possible.