15:59 - The House divided: - Ayes: 228 / Noes: 307 - Question accordingly negatived.
Andy Burnham
I think I should refer the hon. Gentleman back to the King’s Fund speech, because I did not say the NHS should be the preferred provider regardless of the quality of care it provided. I believe that the public NHS should have the first chance to change, and that was the preferred provider policy. We did not want to pull the rug from under the public NHS with a policy of “any willing provider”. If the NHS needed to change, we wanted to tell it, “You have to rise to the challenge, and you have a chance to do so. If you cannot, other providers will get a chance to come in.” That was the preferred provider policy, and I would be grateful if he did not misrepresent it.
As I said, a year ago the Government provided a 0.1% increase—or that was the headline, but the fine print began to emerge and their case began to fall apart from day one. It soon became clear that for the years 2011-12 to 2014-15, that figure included an annual £1 billion transfer to local government, ostensibly for social care but not ring-fenced, so councils would be free to spend it as they saw fit. The health funding settlement therefore already went below a real-terms increase. That transfer turned the apparently minuscule real-terms increase into a real-terms cut.
That still leaves 2010-11. When the coalition came into government, it immediately required primary care trusts to cut spending by increasing waiting times and restricting access to treatment, to generate an underspend in 2010-11.
The Minister of State, Department of Health (Paul Burstow)
indicated dissent.
Andy Burnham
Ministers are shaking their heads, but I will read them the Treasury figures published in July this year, and let them tell me then that what I have just said is not true. The public expenditure statistical analyses from this year provide official confirmation of what I have just said. They show that in 2009-10 health spending was £102,751 million. That was in the last year of the Labour Government. In 2010-11, health spending was £101,985 million. There we have it in black and white—the first real-terms cut in health spending for 14 years. In fact, it is the first real-terms cut since the last year of the last Tory Government in 1996-97.
Andy Burnham
I will give way in a moment.
I mentioned that the Prime Minister is out of touch, and that he promised to recruit 3,000 more midwives and then handed out redundancy notices to them. However, if the Prime Minister is out of touch, I worry that the Secretary of State is in outright denial. On 11 October, when my hon. Friend the Member for West Lancashire (Rosie Cooper) asked him about the practice of hospitals re-grading or down-banding nursing posts to cut their costs, he replied:
“I am not aware—my colleagues may be—of…trusts…seeking to manage their costs by the downgrading of existing staff. If you are aware of that, then, by all means, tell us, but I was not aware.”
The very next day, that version of events was directly contradicted by Janet Davies of the Royal College of Nursing, who said that
“the Royal College of Nursing has raised the issue of downbanding with the Secretary of State on a number of occasions, alongside other concerns such as recruitment freezes and redundancies in the NHS…Our members’ survey released earlier this month also revealed that 7% of nurses expect to be downbanded in the next 12 months”.
If the Secretary of State would like to correct the evidence that he gave to the Select Committee on Health and confirm that he was aware of the practice of down-banding, he can be my guest right now.
Mr Lansley
I am grateful to the right hon. Gentleman. I do not change a word of what I told the Health Committee—it was entirely accurate. I have checked the records, and at no stage had the RCN raised that issue with me.
Andy Burnham
The Secretary of State directly contradicts, on the record, a spokesperson from the Royal College of Nursing. If he stands by his evidence, will he publish the minutes of his meetings with the RCN in which it states that the issue of down-banding was specifically discussed?
Andy Burnham
When I am ready.
Will the Secretary of State promise today to publish those minutes?
Mr Lansley
Yes, I shall publish the minutes of those meetings, but I resent the implication from the right hon. Gentleman that I would stand at this Dispatch Box or sit before a Select Committee and say anything other than what I believed to be the complete truth.
Andy Burnham
If that is the case, I respectfully ask the Health Secretary why he has not responded to a letter from my hon. Friend the Member for West Lancashire—
Andy Burnham
My hon. Friend is nodding. Why has the Secretary of State not responded to the letter that my hon. Friend sent to him several weeks ago pointing out the discrepancy between his evidence and the statements from the RCN? If he wants to adopt a pious tone in the House, he needs to reply to his letters on time and put his facts on the record.
Andy Burnham
Is the right hon. Gentleman telling or asking? [Interruption.] I give way to the right hon. Gentleman.
Mr Lansley
If the right hon. Gentleman is going to insult me, he ought at least to give way. I have seen no letter from the hon. Member for West Lancashire (Rosie Cooper). I have seen a letter from the Chairman of the Health Select Committee, to which I approved an answer.
Andy Burnham
Well, that is no good to me. We have not seen that answer. The right hon. Gentleman needs to reply to hon. Members’ correspondence in a timely fashion, especially when it relates to serious issues about discrepancies between his evidence and statements made by the RCN.
The Secretary of State for Health (Mr Andrew Lansley)
I ask the House to reject the motion. I am sorry about the tone of much of what the right hon. Member for Leigh (Andy Burnham) said. This was his first opportunity to make a speech about the NHS and I thought that he might take the trouble to thank NHS staff for what they have achieved over the past year, rather than disparage and denigrate everything they have been doing. I also thought that he might take the opportunity to approach the issues facing the NHS from the standpoint of patients, rather than simply playing politics with the service, but he did not. Insulting me was the least of the problems in his speech. It seemed like the Burnham memorial speech—clearly no hard feelings about losing the election, then. Having spent 13 years in the House in opposition, I shall—at the risk of patronising him—give him a few words of advice: do not keep fighting the election that you lost. It is not the way to win any future election, and it will carry absolutely no credibility in the NHS.
Equally, the right hon. Gentleman will carry no credibility by wandering around telling people that he was not planning to cut the NHS budget, given that he made it absolutely clear in The Guardian last year that that was exactly what he intended to do and that he told us, in the run-up to the spending review, that it would be irresponsible to increase the NHS budget in real terms. I searched the Labour manifesto for any commitment to funding the NHS in real terms, but there is none. In March 2010, he might have said that he knew all these things, but he did not tell the public about any of it—[Interruption.] Well, it is here in his manifesto. The only reference to any kind of investment in the NHS is a plan to
“refocus capital investment on primary and community services”.
Mr Lansley
In a moment.
We know what that meant, because when we opened the books on arriving in the Department we saw that Labour was planning to slash by more than half the capital budget of the NHS. Every Member of Parliament who has a major hospital building programme in their constituency would have been affected by that. That might include my hon. Friend the Member for Harrow East (Bob Blackman), who has the Royal National Orthopaedic hospital in his constituency, or Members from Liverpool, who have the rebuild of the Royal Liverpool and Broadgreen hospitals and, all being well, the rebuilding of Alder Hey. That might also include the hon. Member for Copeland (Mr Reed). The last Labour Government, before the election, cut the capital budget, and his project—the West Cumberland hospital at Whitehaven—could have been at risk as a consequence of that. [Interruption.]
The Minister of State, Department of Health (Mr Simon Burns)
No, he saved it.
Mr Lansley
I went with my colleagues; in fact, the Chief Secretary to the Treasury stood here at the Dispatch Box and reconfirmed support for that project, so I will not have any nonsense from the hon. Member for Copeland. [Interruption.] Withdraw that. I have not misled the House. The Chief Secretary to the Treasury came here and reconfirmed support for that project. I will not put up with being told from a sedentary position that I am misleading the House. I ask the hon. Gentleman to withdraw that accusation.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I am sure that it was not intentional, and I am sure that the hon. Member for Copeland (Mr Reed) would not wish to leave it on the record. [Hon. Members: “Withdraw. The hon. Gentleman has been asked to withdraw.”] Order. I do not need any advice. I am sure that it was not intentional, and that the hon. Member for Copeland would not wish to leave it on the record.
Mr Deputy Speaker
Order. I think that we have established that it was not intentional. I call the Secretary of State.
Mr Lansley
Thank you, Mr Deputy Speaker. I will now give way to the hon. Member for West Ham (Lyn Brown).
Mr Lansley
One of the reasons that the House should reject the motion is that it is deeply flawed. Let me just take up the hon. Lady’s argument. What an own goal it is for Labour to say that NHS funding fell in 2010-11. That was the last year of the Labour Government’s spending plans, not ours. The amount available to the NHS in 2010-11—[Interruption.] I am answering the hon. Lady’s question. The amount available to the NHS in 2010-11 was exactly the same amount as the last Labour Government determined under their spending plans. So if Labour is accusing the NHS of having a reduction in real terms in 2010-11, that is a complete own goal, because it happened as a consequence of its decisions, not ours.
Andy Burnham
May I just explain to the Secretary of State the difference between projected budgets and out-turn figures, as published by the Treasury? Will he confirm that the figures published in the Treasury’s public expenditure statistical analysis will be the figures that go into the historical record, and that they will record a real-terms cut because of underspends that he ordered?
Mr Lansley
That is absolutely not true, because we ordered absolutely no cuts in the NHS budget in 2010-11 compared with the spending plans that we inherited. So that is a complete own goal on the right hon. Gentleman’s part. And in regard to all that stuff that he talked about the support that the NHS is giving to social care, I can tell him that, with the exception of the underspend in the departmental central budgets, because we cut back on all of its bureaucracy and its IT programme, we spent over £150 million, or whatever it was—
Mr Lansley
Sit down for a minute. I am answering the shadow Secretary of State. As I was saying, more than £150 million was generated from underspends in the departmental central budget in the last three months of the last financial year, and it was spent with local authorities in supporting social care. The rest of the social care support is for 2011-12, so what the right hon. Gentleman said cannot be a reason for the underspend in 2010-11. The amount spent was all in PCT allocations; there was no mechanism by which the Department of Health could go out and ask PCTs to spend less—the money was allocated to them. The shadow Secretary of State shakes his head, but he knows it is true. The money was allocated to the PCTs and they were free to spend the money they had.
The first reason to reject the motion is that it is a spectacular own goal. The second reason to reject it—
Andy Burnham
The right hon. Gentleman says it is not true that PCTs were asked to set aside funds and generate underspends, so may I remind him of a letter sent by the chief executive of the NHS shortly after the White Paper was published, telling primary care trusts to set aside funding for the cost of transition? That is clear; it is in black and white. He did ask PCTs to generate those funds to spend on the costs of his reorganisation.
Mr Lansley
I am sorry, but that is another spectacular own goal. Both before and after the election, the chief executive of the NHS set aside, as the right hon. Gentleman had planned before the election, £1.7 billion for non-recurrent expenditure for the costs of NHS reorganisation. It was done before the election; we never changed the figure. It is not a consequence of any of our plans, but a precise consequence of the right hon. Gentleman’s. He said he accepted the Nicholson challenge, and the £1.7 billion non-recurrent set aside in 2010-11 was to fund that challenge. That was set out before the election, not after it. I thought that one of the benefits of the former Secretary of State coming here to debate matters would be that we would be treated to a bit of knowledge of the NHS and of how it works, but that does not seem to be the case at all.
Mr Lansley
No, I want to make a bit of progress. Strictly speaking, I have not yet said anything I intended to say.
Mr Lansley
The second reason the House should reject the motion is that it fails to pay tribute to the hard-working staff of the NHS. I participated in many debates such as this when I was shadow Secretary of State and I thought that they provided an incredibly good opportunity for Members to raise issues relating to their own constituencies. I hope that that happens in this debate, as it is important. Every one of us has in our constituencies thousands of committed and hard-working NHS staff who want to know that we recognise it. I do not see any of that in the motion.
Mr Lansley
In this motion, there is nothing to recognise the contribution from NHS staff; it just denigrates them. It says nothing about people who rely on the NHS to care for them.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Three Members are trying to catch the Secretary of State’s eye. I am sure that he has noted that and that he will give way, but we cannot have three Members continuously on their feet.
Mr Lansley
It is surprising that I am being embarrassed by so many interventions from the Labour Benches, because there are so few Labour Members here. I remember that before the election it was my recurrent experience that when we held Opposition day debates on the NHS, the Labour or Government Benches were nearly empty while our Benches were pretty full of Members who, because of our commitment to the NHS, were seeking to make points about it. Funnily enough, it does not seem to have happened in reverse. The Government Benches are still full while the Opposition Benches are nearly empty. [Interruption.]
Paul Farrelly
Staff of the High Street medical practice at Newcastle-under-Lyme are dedicated and hard working, yet that practice, which has 5,000 patients, is being forced to close. The Secretary of State has written me a letter, from which it is quite clear that closing directly run GP practices with salaried doctors is NHS policy. It is also clear that the closures are pre-empting proposed legislation to abolish PCTs, which is yet to go through Parliament. If the Secretary of State believed in a patient-focused NHS, surely he would be trying to save such practices, not encouraging their closure.
Mr Lansley
I will not delay the House at length with further explanation of what I wrote in my letter, as the hon. Gentleman quite properly raised the matter with me at topical questions. It is our intention to move to more consistent commissioning of primary care across the country through the NHS Commissioning Board, but the driver for that is still local decisions about what GP services should be available in an area and which practices are involved. The hon. Gentleman knows from my letter that this is the view of the local primary care trust. In future, it will be for the health and wellbeing boards, not least the clinical commissioning groups, to look at whether primary medical services can be provided with or without the sort of facilities that the hon. Gentleman mentioned.
Barbara Keeley
The Secretary of State asked for some examples of the impact on constituencies; I can give him two. First, the savings being forced on Salford PCT have led to the shutting of the NHS walk-in centre in one of our most deprived wards, which was serving 2,000 patients a month. Secondly, there is the serious issue of the closedown of active case management for long-term conditions. Patient services in Salford are being downgraded as a result of the savings and cuts that have to be made.
Mr Lansley
The hon. Lady will forgive me for not commenting in detail on that. If my memory serves, that has been the subject of a referral by the local authority to me, which I have sent to the independent reconfiguration panel for initial advice. It would be unhelpful and improper for me to prejudice that.
Mr Lansley
Yes, I will, as I am interested to hear what the hon. Gentleman has to say.
Mr Love
A year or 18 months into this Administration, does the right hon. Gentleman regret the announcement he made on the steps of Chase Farm hospital? Does he accept that the four tests have seriously misled local people about the future of the health service in their area? Does he recognise the demoralisation that that has caused in the local health service in Enfield, and what steps will he take to try to recover the situation and move forward?
Mr Lansley
The hon. Gentleman also intervened on the shadow Secretary of State. I am afraid that I do not recognise his description. I said before the election that we would have a moratorium on top-down and forced closure programmes affecting A and E and maternity services—and that is exactly what we did. A moratorium means what it says; it provides an opportunity to stop, to take stock and to subject something to the right tests. I set out for the first time the tests that needed to be met—that proposals needed to be consistent with prospective patient choice, consistent with the views of the local community, not least as expressed through the local authority, consistent with the views of the commissioners in the area, especially the developing clinical commissioning groups, and consistent with clinical evidence of safety.
In the context of Enfield and Chase Farm, the hon. Gentleman knows—because he was a participant in these discussions—that that moratorium was applied, that the opportunity was given to the local authority and the general practice community in Enfield to come forward with alternative solutions. We should also remember that among those four tests is the one about clinical evidence and safety. However, when those community groups came back and said, “We don’t have a specific alternative, but we just don’t want things to change”, I had to ask the independent reconfiguration panel to examine it. Its view was that that was not clinically sustainable.
Mr Lansley
No. I have given way many times. I am answering the hon. Member for Edmonton (Mr Love). It was very clear that we could not proceed on that basis.
I have another point for the hon. Member for Edmonton about what I found in a number places. Although this was not true of the moratorium in Maidstone and Chase Farm, the moratorium has led to substantially improved outcomes for local services elsewhere, as with Burnley, Solihull, Sidcup, Ealing, the Whittington hospital and other places.
Mr Lansley
No. I am still answering a point raised in an earlier intervention. In all those places and others, the moratorium has led to better solutions.
Mr Lansley
No. I think that the moratorium has led to a better way forward even in Enfield. It is in the hands of the commissioners and the local authority in Enfield collectively, to make decisions for Enfield. Within two months I shall receive a report from NHS London advising whether it would be better organisationally for Chase Farm to be combined with North Middlesex rather than Barnet, and I should be interested to know the hon. Gentleman’s view on that. We continue to seek not top-down forced reconfigurations, but reconfigurations that consistently meet the four tests, and do so in the best interests of the NHS.
Tony Baldry
The right hon. Member for Leigh (Andy Burnham) implied that my right hon. Friend should have completely ignored the advice of the independent reconfiguration panel. Can my right hon. Friend tell us whether, when the right hon. Gentleman was Secretary of State for Health, there were any occasions on which he sought to ignore the panel’s advice?
Tony Baldry
What is the point of having such a panel if it is to be ignored?
Mr Lansley
The right hon. Member for Leigh says from a sedentary position that he did not ignore the panel’s advice. I do not believe that a Secretary of State has directly sought to contradict the panel since its establishment, or has sought not to comply with its recommendations. After all, it is there for a reason. The point is that, as I have made clear, the panel should be involved in the application of those four tests, and in the past that has tended not to happen.
Let me explain why I am asking the House to reject the motion. I believe—and this was always my approach in opposition—that when we table such a motion, we ought at least to be clear about what our alternative solution would be, but there is no such solution in the motion. Let me remind the new, or recycled, shadow Secretary of State what his old friend James Purnell wrote last February:
“The Tories appear to have the centre ground. Labour need to take it back—by coming out in favour of free schools and GP commissioning”.
The right hon. Gentleman did not come out in favour of free schools. He now says that he is coming out in favour of GP commissioning. If he believed in GP commissioning, why did he do nothing about it? Why did everyone in the general practice community, throughout the length and breadth of the country, believe that practice-based commissioning had come to a virtual halt? Why did David Colin-Thomé, the right hon. Gentleman’s own national clinical director for primary care, effectively say that it had completely stalled and was not going anywhere?
I know that the right hon. Gentleman agreed with this at one time. Back in 2006, he said of GP commissioning:
“That change will put power in the hands of local GPs to drive improvements in their area, so it should give more power to their elbow than they have at present. That is what I would like to see”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]
If the right hon. Gentleman wants that to happen, he must support the Bill that will make it happen. The same applies to health improvement and public health leadership in local government, and to our finally arriving at a point when, as was the last Labour Government’s intention, all NHS trusts become foundation trusts. We are going to make those things happen, but in order to do so we must have a legislative structure that supports them. That is evolutionary, not revolutionary. However much the right hon. Gentleman rants about the changes being made in the Bill, the truth is that it will do—in what his predecessor, the right hon. Member for Wentworth and Dearne (John Healey) described as a “consistent, coherent and comprehensive” way—much of what was intended by our predecessors as Secretaries of State under the last Government. The fact that the right hon. Gentleman turned his back on that at the end of his time in office—mainly at the behest of the trade unions, which seem to be the dominant force in Labour politics—does not absolve him of his responsibility to accept that we are now delivering the reforms that he talked about.
Grahame M. Morris
The Secretary of State told my right hon. Friend the Member for Leigh (Andy Burnham) that there had been no cuts in the NHS budget. Does he recall cancelling the building project for a new hospital serving my constituents in south Easington as part of the comprehensive spending review?
Mr Lansley
On the occasion when the Chief Secretary to the Treasury told the House that we were supporting a number of hospital projects, we made it clear that the hon. Gentleman’s local trust was a foundation trust. As his colleagues should tell him, the point of a foundation trust is that it should take more responsibility for securing the resources—
Mr Lansley
I am answering the hon. Gentleman’s question. The point of a foundation trust is that it should take more responsibility for securing the resources enabling it to undertake its own building projects. Foundation trusts cannot walk into the Department of Health imagining that they will receive a capital grant of more than £400 million. That is simply not the way it works. It is to the credit of the hon. Gentleman’s local trust that it accepted that, and is working, as a foundation trust, on a better solution for the hon. Gentleman’s area.
Mr Lansley
No, because I have already given way to the right hon. Gentleman many times. Let me tell him this. If he was going to offer to try to work with others on GP commissioning, he ought at least to have demonstrated before the election that he was going to do something about it; and using a transparent political ploy to try and interfere with the passage of the legislation in another place carries no credibility with me or with anyone else. Labour’s tabling of a motion in the other place in an attempt to block the Bill completely showed no willingness to work together, and the fact that it was defeated by 134 votes ought to have given the right hon. Gentleman a reason—and sufficient humility—not to try to return to the subject by tabling today’s motion.
As I said earlier, I find it regrettable that neither the right hon. Gentleman’s motion nor his speech made any attempt to deal with what has happened in the NHS over the past year. Let me tell him, and the House—for I know my right hon. and hon. Friends will be interested as well—what has, in truth, happened during that time.
At the end of the last Labour Government, the average in-patient wait was 8.4 weeks. According to the latest available figures, that has fallen to 8.1 weeks. The average waiting time for out-patients was 4.3 weeks at the time of the last election; it is now 4.1 weeks. Over the last year, the number of MRSA bloodstream infections in hospitals has fallen by a third, and the number of clostridium difficile infections by 16%. Nearly three quarters of a million more people have access to NHS dentistry. Nearly 2 million people have access to the new 111 urgent care service, and the whole country will be covered within the next 18 months. When we came to office, I discovered that there had been talk about a 111 telephone system, but nothing had been done. It is now happening.
More than 75% of stroke patients now spend 90% or more of their hospital stay in a stroke unit. That is a 20% increase in two years. The Cancer Drugs Fund has given more than 5,000 patients access to the drugs that they desperately need, and which under the last Government’s regime would not have been available to them. We have embarked on an £800 million investment in translational research, increasing our financial support for it by 30%, to help to secure the United Kingdom as a world leader in health research.
The NHS is leading the way in the prevention of venous thromboembolism, with 86% of patients receiving an assessment for the condition. I believe that that constitutes an increase of some 30% in the last year. The bowel cancer screening programme is enabling many more patients and members of the public to be screened, there is more screening for diabetic retinopathy than ever before, and there were 188,000 more diagnostic tests in the three months to August than there were last year. Pathfinder clinical commissioning groups have been established virtually through England, and there are 138 health and wellbeing boards in local authorities, meeting and putting together their strategies to deliver population health gain across their areas.
In a single year, the year preceding the election, the right hon. Member for Leigh presided over a 32% increase in NHS management costs. That was the year after the banks had gone bust. It was the year when it was obvious that Government deficits were out of control. It was the year when the debt crisis was just about to crash over the whole public sector. What happened on the right hon. Gentleman’s watch? There was a 23% increase in management costs in a single year, to £350 million. In the year that followed, we reduced those costs to £329 million.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Can the Secretary of State tell us what the percentage of senior managers is, and how that compares with the percentage in the private sector?
Mr Lansley
Does the hon. Lady act as parliamentary private secretary to the shadow Secretary of State? Ah, she does. Well, she has the merit of consistency. I am reminded that in June 2006, when for a short period she was chair—I think—of Rochdale primary care trust, she resigned. She said that she resigned because the radical changes happening under the then Labour Government in 2006 would
“destroy the NHS as we know it.”
The hon. Lady has the merit of being consistent: she is against every Government and every change. She does not think that any steps will make the NHS into what it ought to be. I will not take any lectures from her, therefore.
I was explaining to the hon. Lady and the House what has been achieved. We have stripped out pointless bureaucracy. The number of managers more than doubled under Labour, but we have cut their number by more than 5,000, and we have increased the number of doctors in the NHS by more than 1,500. The Bill includes measures to abolish primary care trusts and strategic health authorities, but in the meantime we have clustered PCTs and SHAs together.
We are reducing the cost of bureaucracy in the NHS not only because it is necessary to do so. The transfer to clinically led commissioning in the NHS, for which there is a very good case of course, also involves reducing such costs. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), has frequently made clear, as part of the transfer process we will deliver £4.5 billion in savings in administration costs this year across the national health service. The transition itself involves costs of course, but they will be recovered by the end of 2012-13, and by the end of the Parliament we will have gone on to save more than £4.5 billion in total.
Chris Leslie (Nottingham East) (Lab/Co-op)
Will the Secretary of State give way?
Mr Lansley
No.
Productivity fell in every single year that Labour was in charge of the NHS. However, according to the Audit Commission, in the last year—2010-11—we saved £4.3 billion. As the deputy chief executive of the NHS has reported, PCTs are intending to save a further £5.9 billion in 2011-12. Contrary to what the right hon. Member for Leigh repeatedly said, the NHS is not failing to deliver on the quality, innovation, productivity and prevention challenge; it is on target to meet that challenge. The modernisation that is at the heart of the Bill and the White Paper is not about frustrating the NHS in that endeavour; it is about enabling it to meet the QIPP challenge.
Last summer, I announced that we would be measuring mixed-sex accommodation and then driving down the extent to which patients were put in such accommodation when they should not have been. The right hon. Gentleman said at the time:
“This hollow announcement is an attempt by Mr Lansley to claim credit for something Labour has done”.
That is absolutely wrong. The evidence showed that almost 150,000 patients a year were being placed in mixed-sex accommodation in breach of the rules. We ensured that figures were published for the very first time. The first set of results was published in December, and it showed that in that month alone there were well over 11,000 such patients. Since then, there has been a 91% reduction in the number of patients put into mixed-sex accommodation. The right hon. Gentleman was prepared to see issues of care, service and standards in the NHS covered up. We are determined to shine a light on where the NHS can, and should, improve its performance; we are determined to enable the NHS to do so and to challenge it wherever it is not doing so.
Mr Lansley
I will give way to the hon. Gentleman shortly.
If the public want to know how the NHS in England would have fared under Labour since the last general election, they should look across the border at what has happened in Wales—I am not sure whether any Members representing Welsh constituencies are present. We are protecting the NHS and increasing its budget in real terms. However, I have brought along to the Chamber a report by the Auditor General for Wales that was published just a few days ago, on 14 October 2011. If I could, I would enter it in evidence, but I can at least hold it up in order to show Members a series of bar charts. They demonstrate that in England there is real-terms growth in the NHS, in Northern Ireland there is small real-terms growth that is unevenly distributed across the years, in Scotland there is tiny real-terms growth, and in Wales there is a large downward curve, which shows the reduction in real-terms spending on the NHS in Wales. Wales is the only part of the UK that is run by Labour, and there are real-terms cuts in the NHS budget there.
Chris Leslie
The right hon. Gentleman must know that “real terms” means taking account of inflation. For the record, can he tell the House what the retail prices index was for the last month for which figures are available? That will give us a sense of what “real terms” ought to mean in this context.
Mr Lansley
The hon. Gentleman is a shadow Treasury Minister, so he must know that the expression “real terms” has consistently been used in relation to the GDP deflator, which is independently estimated by the Office for Budget Responsibility. That is the basis on which we do these calculations, so the Wales Audit Office will have calculated the real-terms changes in budgets in each of the countries of the United Kingdom on that basis. John Appleby from the King’s Fund has estimated an 8.3% real-terms cut in the NHS budget in Labour Wales.
Simon Hughes (Bermondsey and Old Southwark) (LD)
The Secretary of State is, justifiably, giving a robust performance. He said that his job is to shine a light into the NHS to make sure there is a better service for patients. Can he assure us that the recent findings about the care of the elderly in our hospitals and the recommendations of the Cavendish report on that issue will receive the Department’s full attention, as that is one of the areas where the NHS often fails to fulfil the expectations of patients and their families?
Mr Lansley
I agree with my right hon. Friend, and I appreciated the opportunity to talk with Camilla Cavendish and to read much of what she has written.
In January, I asked the Care Quality Commission to undertake dignity and nutrition inspections. They were nurse-led, unannounced inspections across NHS hospitals. The reasons for doing so were clear. I do not say this to denigrate the NHS, but many of us were concerned about two issues. First, although patients admitted to hospitals might get very good clinical care, the standards of personal care were often not as good as they should be, and they were seriously deficient in some cases. Secondly, the last Labour Government had star ratings for hospitals, the net effect of which was as follows. On the Healthcare Commission website, there would be a green dot against a hospital, which was often taken to mean, “This hospital is fine.” However, we all knew that some hospitals had tremendous reputations and world-beating clinical care in some respects and some wards where care was fantastic, but that care in neighbouring wards could be seriously deficient. The dignity and nutrition inspections have addressed that.
The CQC will follow up wherever it has found concerns. In addition, it will undertake similar unannounced inspections of learning disability services and there will be 500 unannounced inspections of care homes, to seek out and expose poor performance or poor care in those areas—and, I hope, demonstrate where good care is provided. There will be an additional follow-up inspection of a further 50 NHS hospitals.
Simon Hughes
I am grateful to my right hon. Friend for his comments. May I raise a linked point? One of the issues most frequently raised with me both in my constituency and elsewhere is that families and patients often do not feel that they have consistent contact with just one person who is responsible for the management of the care in a hospital. Instead, there is a range of people whom they do not know, except for what is printed on their name badges. They know the consultant, but they do not know who is responsible on a day-to-day basis for the delivery of 24-hour care. Can my right hon. Friend assure me that that is also on his agenda?
Mr Lansley
I entirely agree with my right hon. Friend. That is not only the case in hospitals, where people can sometimes ask, “Under whose care is my husband?” It is also especially true in community care. I hope that there will be more integrated services in the community, but although there may be a range of providers, there must be an integrated service with a clear line of accountability.
Mr Lansley
No, as I need to conclude my speech. [Interruption.] I am sure what the hon. Lady says is true.
The NHS in Wales is not cutting its budget because everything is going well. Labour Members are fond of citing waiting times, but the latest figures on waiting times show that in England 90.4% of admitted patients and 97.3% of non-admitted patients were referred to treatment within 18 weeks, whereas the figures for Wales are 67.6% and only 74% respectively.
Let me tell the House about infection rates. In 2007, the clostridium difficile mortality rates in England and Wales were similar—in fact, the rate was slightly higher in England. However, in the latest year for which figures are available there were 23.4 deaths per million for men and 23.5 deaths per million for women in England, whereas the figures for Wales were 54.9 deaths per million for men and 59.5 deaths per million for women, so the level in Wales is more than twice that in England. In four years, the gap has widened to the point where Wales has double the number of deaths from C. diff infections relative to England. Less money, less innovation and less good care is what has been happening in Wales under a Labour Government.
I must make it clear that we are going to put patients at the heart of the NHS. We are going to focus on the NHS delivering excellent care every time. Labour focused on the targets and the averages, and never got to the place of really caring about the specifics. A patient about to go into hospital for knee replacement surgery does not want to know about the national figure; they want to know about their hospital, their ward and what will happen to them. The same is true for mixed-sex accommodation. Labour turned a blind eye to variation in performance. We are going to open it up to clinical and public scrutiny, so that we can reward and celebrate achievement and excellence across the service, and shine a light on poor performance.
Joan Ruddock
Two weeks ago, I had an operation in Guy’s hospital. Because of possible complications, I had to ask my consultant directly, “Would you advise me to go ahead or not?” He advised me to do so, and I had complete trust in him. He was not thinking about whether he had to fulfil a quota, whether there was competitiveness in his hospital or his department, or whether a private patient would be preferred in the bed that I was to occupy. He was someone I could trust. In the health service that the Secretary of State proposes in his Bill, I could never have that confidence. I ask him please to abandon this Bill.
Mr Lansley
The right hon. Lady is simply wrong. There is nothing in the legislation that will do anything other than support clinicians to exercise their judgments in order to deliver the best care for their patients. It was under her Government, when people were told to pursue 18-week targets, that managers were literally walking in to speak to consultants who were about to do waiting lists and surgery lists and telling them that, because of the 18-week target, they had to treat a certain patient rather than another whose interests would mean that they would be seen first. So I will not take any lectures about that. We are going to put clinicians at the heart of delivering care and put patients at the heart of the service that is delivered.
The Labour motion does not reflect reality. It is based on a misleading set of interpretations and representations. Labour Members have a very short memory, but I am afraid that they have left us a shocking legacy. The motion contains no appreciation of the challenges the NHS faces, no appreciation of the care the NHS has provided to patients day in, day out over the past year, and no vision of how the NHS can be better in the future. Modernisation of the NHS will deliver an NHS that we can rely on for future generations, that is based on need, not ability to pay, and that is able to deliver the best outcomes for patients. I urge the House to reject the motion.
Grahame M. Morris
I think we saw an unprecedented period of growth with the building of new hospitals and new facilities. I have some sympathy with the hon. Member for Enfield North (Nick de Bois) and what he is going through with the Chase Farm downgrading, because in my area the Hartlepool accident and emergency facility is also being downgraded to an urgent treatment centre. That is a cause of consternation among the public.
Grahame M. Morris
Well, it is being done under the Secretary of State’s Administration when an impression was given that there would be a moratorium and that we would not face such downgrading and closures. That was clearly a con that was sold to the public, so I do not accept the contention that the hon. Member for Crawley (Henry Smith) has put forward.
Let me press on, because time is limited. The NHS is hurting under this Government and these reckless reforms. On the promises for a real-terms increase, we know that health inflation has surged and that the spending power of the NHS is going down, so will the Minister now admit that the NHS is receiving a real-terms cut? This is not just about the NHS being held hostage to inflation. It is facing real financial pressures on the front line—which Labour promised to protect—for a number of reasons including the Government’s decision to push through this latest reorganisation, which is the biggest the NHS has ever faced, at the same time as pushing through £20 billion-worth of efficiency savings. The figure of £1 billion a year is being taken from the NHS’s existing budgets to meet the growing and ever-increasing costs of social care. The Select Committee on Health is now looking into that issue and I hope that we are able to come forward with some positive ideas that the Minister will consider.
Rosie Cooper
Forgive me; I need to get to the end of my speech.
My right hon. Friend the Member for Leigh dealt with the finances and the myth of real-terms growth in the NHS budget. My local trust is being asked to go beyond the 4% savings compounded over the next four years and will be expected to achieve 6% or £8.5 million in this financial year. On top of that, Monitor expects trusts to make a 1% profit. People who have given evidence to the Select Committee have said it is clear that there will need to be hospital closures in order to release money back into the wider health service. We are told that this is all part of managing demand and redesigning pathways—two horrible phrases that appear to be back in vogue.
I want to deal quickly with the re-banding of nurses to reduce budgets, which the Health Secretary appears to have little understanding of. I am sorry he is no longer in his place. He clearly told the Health Committee that he was unaware that re-banding was taking place. His problem is that Janet Davies from the Royal College of Nursing told the Committee that, although the RCN does not release conversations, that issue was clearly discussed. I really worry about that. Does he have a twin he is sending into meetings on his behalf? Does he simply not listen? It would not be the first time. Or is the truth even worse, and should he be described in terms that Mr Speaker would call unparliamentary? The Secretary of State said earlier that he stood by his answers to the Committee. He has also claimed that he did not receive a letter from me, but I can confirm that he received it at 11.57 on 13 October, and I have confirmation from his office.
Rosie Cooper
I will not.
The point is that even if the Secretary of State was not aware of the re-banding, as he claims, that speaks volumes about how out of touch he is with the hard-working staff he is supposed to represent. Perhaps he would like to remove himself from his parallel universe—
Dr Poulter
The hon. Lady did not make her point very well, and she did not allow me to intervene on her. I am sure that the Minister will address the points that she made about the letter.
Mr Simon Burns
It might be useful at this stage to clear up the point about the letter. The hon. Member for West Lancashire (Rosie Cooper) said that my right hon. Friend the Secretary of State had not replied to her letter, as though it had been sent months ago. It was dated 12 October, so I presume that it arrived in the Department of Health on 13 or 14 October, about 12 or 13 days ago. Hon. Members know that the guidelines, which the Department rigorously keeps to, state that it may take up to 20 days to receive a response. My right hon. Friend has not been discourteous, and the hon. Lady will receive a reply within the time scale.
Dr Poulter
I thank my hon. Friend for clarifying an earlier point.
I will not engage in mud-slinging, but will talk about what hon. Members on both sides of the House want to emerge from the NHS. The right hon. Member for Leigh (Andy Burnham) was absolutely right that some service reconfiguration is necessary to deliver services in communities, improve community care and build an integrated health service with integrated health care. The right hon. Gentleman spoke specifically about an integrated system and better integrating adult social care, especially for the elderly, with current NHS providers, breaking down some of the silos between primary care, the hospital sector, and adult social services.
The Minister of State, Department of Health (Mr Simon Burns)
It has been an interesting experience listening to the range of contributions that have been made over the past few hours. Having studied the shadow Secretary of State’s tweets yesterday afternoon heralding today’s debate, one would have expected this to be an action-packed afternoon. One remembers the grand old Duke of York marching his troops up to the top of the hill and then down to the bottom, but the grand old Duke of York had 10,000 men. For most of this debate, apart from the wind-ups, the shadow Secretary of State has barely managed to get more than six Opposition Back Benchers here, which is fewer than the Government have had, so on that point I fear that he has failed.
Let me turn to some of the speeches that I had to listen to. It was a delight to hear the hon. Member for Easington (Grahame M. Morris) again, after a break from the Committee stage of the Health and Social Care Bill. Broken record his speech may have been—it was the same story—but it was worth listening to, even though the accuracy gained nothing in the telling.
My hon. Friend the Member for Kingswood (Chris Skidmore) made an excellent speech, as did my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke fluently and knowledgably, on the basis of his intense and intimate experience of working in the NHS and his insights into the challenges we face in social care and improving the integration of care.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made an interesting contribution, although at times I began to think that she might be the only person who believed what she was saying. None the less, it was interesting.
The hon. Member for Ealing North (Stephen Pound)—as always, a jokester in our midst—put forward a serious message in a jocular way. From my experience of the NHS, both personal and professional, however, I felt that a lot of what he said bore little relation to reality. I can assure him that Government Members share the core principles of the NHS. I was also interested to hear the comments of my hon. Friend the Member for Stafford (Jeremy Lefroy). Anyone who represents that part of the country will have a deep understanding of the problems, as well as the successes, of the local health service. He was right in what he said about the future of accident and emergency services and about the critical issue of training.
I am saddened by the fact that the Opposition have once again shown themselves to be more interested in trying to revive their own political fortunes than in improving the outcomes of patients. Once again, they prefer to scaremonger and blindly attack, rather than put forward any policies of their own. They have been a policy-free zone in this debate. Once again, they reveal themselves to be on the back foot when it comes to securing the future of the NHS, as well as wrong-headed.
The Opposition claim that the Government are cutting NHS spending, which is not only nonsense but outrageous. Surprisingly, only last summer, the right hon. Member for Leigh said—this has been quoted before, but I will repeat it—that it would be
“irresponsible to increase NHS spending in real terms”.
Ironically, that is not a view that I share. I fundamental disagree with it, because I believe that we should increase the funding of the NHS in real terms. [Interruption.] I do not care how much the right hon. Gentleman says it; if he looks at the—
Mr Burns
I will in one minute, just to disprove what the hon. Member for Leicester West (Liz Kendall) says.
If the right hon. Gentleman does not want to believe what I say, he can look at the chart produced by the Wales Audit Office, an independent body, which shows, if one cares to read it, real-terms spending increases in each year in the English NHS. Ironically, it also shows such increases in Northern Ireland and Scotland, but if we look at the red parts of the chart, we can see that there are certainly no increases in Labour-controlled Wales.
Andy Burnham
The Minister says that the Government are providing real-terms increases, but he does not take into account inflation or the £1 billion transfer to social care. Will he accept the figures that I have here? They are the total departmental expenditure limits published by the Treasury in July 2011. They show that, in 2009-10, £102 billion was spent on the NHS. The figure for 2010-11 was £101 billion. I invite him to tell me that those figures are not correct.
Mr Burns
One minute. The right hon. Gentleman wants a reply, so he must hold his horses.
It is the gross domestic product deflator that determines how one increases in real terms the funding of the NHS. The right hon. Gentleman has once again scored an own goal in reading out those figures, because they are based on the Labour Government’s spending for the year in which they were leaving power.
Mr Burns
No, I said that I would give way once. I must now make progress.
We are increasing funding for the NHS in real terms over this Parliament, and stripping out unnecessary bureaucracy to focus precious resources on the front line and not the back office. So in place of management-led primary care trusts and strategic health authorities, we are introducing clinically led clinical commissioning groups, to put money and power in the hands of front-line doctors and nurses. That is why we are driving through the plans to make the NHS more efficient by focusing on prevention, on innovation, on productivity and on driving up the quality of care. A fact that Labour Members appear rapidly to have forgotten is that better care is very often less expensive care, and less expensive care means there is more money to spend on the health service.
Mr Burns
In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers. These people are then given intensive personalised help, including the use of modern telemedicine to monitor their vital signs. The result is better care for patients as well as—
Mr Barron
On a point of order, Mr Deputy Speaker. As you know, I took part in this debate and I asked the Minister a question and requested him to answer it in his winding-up speech. Yet he will not even acknowledge that I spoke in the debate. Is there anything you can do, Mr Deputy Speaker, to help Back Benchers keep the Executive in check?
Mr Deputy Speaker (Mr Nigel Evans)
Absolutely nothing. I am sure, however, that the Minister will have heard the point.
Mr Burns
Did I hear the right hon. Gentleman’s point, Mr Deputy Speaker? I heard it about three times in Committee and I heard it on Report; I replied each time, as well as writing to the right hon. Gentleman. He does not like the answer, so there is no point in taking the intervention again.
As I was saying, in Yorkshire and the Humber the ambulance service gives PCTs—[Interruption.] I know I have already said it, but there was so much disruption and noise that Labour Members did not hear it. In Yorkshire and the Humber, the ambulance service gives PCTs a monthly list of their top 10 most frequent callers so that they can talk to them and help them in future, saving money and staff time that can be concentrated elsewhere.
Mr Burns
Just as Labour Members are wrong about NHS funding, they are also wrong about the Bill. [Interruption.] The Bill focuses on the most important thing for patients—the outcome of the treatment they need either to cure them or to stabilise their long-term conditions. Doctors, nurses and other health care professionals—[Interruption.]
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am finding it difficult to hear the Minister. [Interruption.] Order. He has made it quite clear that he is not giving way.
Mr Burns
Doctors, nurses and other health care professionals are being empowered to take decisions and to design the innovative, integrated services that will best serve the interests of their patients, with a resolute focus on outcomes. The NHS outcomes framework, and the growing number of National Institute for Health and Clinical Excellence quality standards will mean that patients and clinicians will be able to see clearly just how good individual providers—even individual consultant teams—are performing and then demand the treatment that they deserve.
In the short time since this Government have been elected, care for patients has improved significantly in many areas. For example, MRSA down; C. difficile, down; mixed-sex accommodation, massively down; more doctors, fewer managers; more patients with an NHS dentist; more cancer screening; the cancer drugs fund; the new 111 urgent care service; more money; less bureaucracy; and a far brighter future for the national health service. The motion before us is devoid of reality and it was backed up by a number of speeches that were divorced from the real world. Its claims are false, its premises unsound. For those reasons, I urge the House to reject it.
Question put.
Mr Speaker
We come to the next matter to be debated on this Opposition day, namely the Government’s record on environmental protection and green growth.