(11 years, 6 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
17:03 - The House divided: - Ayes: 233 / Noes: 303 - Question accordingly negatived.
Andy Burnham (Leigh) (Lab)
I beg to move,
That this House notes with concern the letter of 4 December 2012 from the Chair of the UK Statistics Authority, Andrew Dilnot CBE, to the Secretary of State for Health concerning public expenditure on health, further notes Mr Dilnot’s statement that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10; and calls on Ministers to reflect this position in their public statements.
Some people question whether Opposition days ever achieve anything, but not us. Last month, we brought to the House our concern about plans for regional pay in the national health service, which found an echo among Government Members. Within days, the plans of the previous Health Secretary for market-facing pay in the NHS were scuppered in the autumn statement. To some, that was just another day, another U-turn, in the life of this shambolic coalition—no big deal—but to thousands of NHS staff in the south-west facing pay cuts it was a real relief, although we are still waiting for the consortium formally to back down. We will be vigilant until it does so.
Fresh from that success, we set ourselves a more challenging task in today’s Opposition day debate to bring some much-needed honesty to the public debate on the NHS, particularly on NHS spending. Across the country, people can see the signs of an NHS in increasing distress: cataract operations are restricted; A and E departments and walk-in centres have been closed; hospitals are full to bursting, some struggling for survival; over 7,000 nursing jobs have been lost—[Interruption.] Government Members should listen to the facts before they shout out, because this is the reality and the chaos that the previous Secretary of State created on the ground. People can see that with their own eyes, but when they go home and switch on the television they see Ministers standing at the Dispatch Box making complacent boasts about “real-terms increases” that they have given the NHS and saying that everything is fine.
John Glen (Salisbury) (Con)
If the right hon. Gentleman wants to have integrity and demonstrate honesty in this debate, will he at the outset condemn the Labour party in Wales for the real cuts that everyone knows are being made in the Welsh health service? Will he level with the British people about that, rather than offer this empty political rhetoric that does not deal honestly with what is happening in Wales?
Andy Burnham
We are discussing the hon. Gentleman’s Government today, but let me deal with Wales. His Government have given the Welsh Assembly Government a real-terms £2.1 billion cut. The Welsh Assembly Government have done their best to protect health spending in that context: they have protected the NHS budget in cash terms. May I also point out to the hon. Gentleman that since 2010 there has been no real reduction in front-line staff, particularly nurses, in Wales, which is quite unlike the position under his Government? Before he appears a bit too cocky on these matters he should read up on the facts. The Welsh Assembly is doing the best that it can with the awful hand of cards that he and his Government dealt it.
There is a mismatch between ministerial rhetoric and the reality on the ground in the NHS, and it is in danger of causing confusion. If left unchallenged, it may lead to unfair claims that the problems in the NHS are all down to its staff and have nothing to do with the Government. Today we need a bit of accountability and a bit of honesty. Once and for all, we will nail the myths, spin and sheer misrepresentation of the facts that roll off the Government Benches week after week.
Julian Smith (Skipton and Ripon) (Con)
In North Yorkshire, we have some of the lowest spending per capita in Britain. Does the right hon. Gentleman regret the removal and reduction of health spending on old people and rural areas under his watch?
Andy Burnham
I think that the hon. Gentleman should withdraw that remark, because there was no reduction in health spending on my watch. I left plans for an increase, as I am about to explain. He illustrates the point that I am making: we are getting half-truths, spin and misrepresentation from Government Members on NHS spending. Indeed, we just got some more, and it is about time that we had a bit more accuracy in the House from them.
The story starts with the 2010 Conservative party manifesto. Let me quote from it:
“We will increase spending on health in real terms every year”.
The Parliamentary Under-Secretary of State for Health (Anna Soubry)
Absolutely right.
Andy Burnham
Mr Dilnot may be watching; the Minister needs to be careful what she says.
That promise was carried into the coalition agreement, which said:
“We will guarantee”—
guarantee, mind—
“that health spending increases in real terms in each year of the Parliament”.
The Secretary of State has stopped nodding; he was nodding earlier. [Interruption.] I will be interested to hear how the Conservatives make those claims stack up, because week after week, Ministers from the Prime Minister downwards have stood at the Dispatch Box and claimed that that is exactly what they have delivered.
Until recently, this appeared prominently on the Conservative party website:
“We have increased the NHS budget in real terms in each of the last two years”.
Then, on 23 October, the Secretary of State said to the House:
“Real-terms spending on the NHS has increased across the country.”—[Official Report, 23 October 2012; Vol. 551, c. 815.]
[Interruption.] “It has”, he says again today. Okay, but this is where the story changes, because last week, he received a letter from the chair of the UK Statistics Authority, Andrew Dilnot CBE. Let me quote the key sentence, which puts Mr Dilnot and the Secretary of State at odds, if I heard the Secretary of State correctly a moment ago:
“On the basis of these figures, we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”
[Interruption.] I am coming on to it all. In other words, NHS spending is lower, in real terms, after the first two years of the coalition, than when Labour left office.
Mr Stephen Dorrell (Charnwood) (Con)
Can the right hon. Gentleman confirm that the next sentence says:
“Given the small size of the changes and the uncertainties associated with them, it might also be fair to say that real terms expenditure had changed little over this period”?
Andy Burnham
Let me say to the Chair of the Health Committee that today I am challenging the veracity of ministerial statements made at the Dispatch Box. I am sure that as a former Secretary of State with many years’ experience of the House, he will know that when Ministers are at the Dispatch Box, they have to be accurate; they have to say the truth. A moment ago, the Secretary of State for Health said that he and the Conservative party were right to say that NHS spending had increased in real terms. That directly contradicts the letter that the Secretary of State had just been sent. Is it any wonder that the public are losing trust in the Government if that is the kind of arrogant spin that comes from those on the Government Benches, week after week?
Andy Burnham
I give way to the right hon. Gentleman once more, but then I will make some progress.
Mr Dorrell
Is it fair to characterise the letter as saying that
“real terms expenditure had changed little over this period”?
Andy Burnham
That is what the letter says, but it is a cut; that is what the letter says. The right hon. Gentleman might say that, in the context of the NHS budget, £1.9 billion is not very much, but it is still a change, and it is a cut. He stood for election on a manifesto promising a real-terms increase. He has just acknowledged that there has been a real-terms cut. Does he acknowledge that there has been a real-terms cut? I think he will have to. I am amazed; the Conservatives come here today to try to con the public, yet again, into thinking that they are fulfilling their promise.
Robert Flello (Stoke-on-Trent South) (Lab)
I enjoy every moment in which a blow is landed on the Government; they squirm and try to come back. Will my right hon. Friend comment on how much of the budget is being thrown away and wasted on top-down reorganisation, redundancy payments and everything else that is going on?
Mr Deputy Speaker (Mr Lindsay Hoyle)
We need short interventions. There are a lot of Members who wish to speak. I am a little bothered by the comments made; I am sure that the right hon. Member for Leigh (Andy Burnham) did not want to suggest that the Prime Minister conned people.
Andy Burnham
I am coming to the point made by my hon. Friend the Member for Stoke-on-Trent South (Robert Flello), because the context is that £1.6 billion, on the Government’s own figures, was spent on the back office, and taken away from the front line. The Chair of the Select Committee says that the cut was a little one, as though that is okay—“It’s really an increase, because it’s only a little cut”—but one has to add £1.6 billion to that to see the full extent of the diversion of funds from the NHS front line.
As the chair of the UK Statistics Authority has established, NHS spending was lower in the first two years of this coalition than when Labour left office. [Interruption.] The Secretary of State says that it is the same. Let us have some honesty here. Mr Dilnot says that it was a cut; accept what he says, and get on with the job. If the Secretary of State starts being a bit more honest at the Dispatch Box, he might get a bit more respect from the public.
The Prime Minister has cut the NHS—fact; but just as he airbrushed his poster, he has tried to airbrush the statistics, and he has been found out. To be fair, the Conservatives admitted it and corrected the Tory party website, but the problem is that we have a long list of similarly false claims made in the House that, as of now, stand uncorrected. Today, we invite the Secretary of State to correct the parliamentary record in person.
I am not surprised to see a few sheepish looks on the Conservative Benches, because we have been checking Conservative Members’ websites, and we found that the hon. Members for South West Bedfordshire (Andrew Selous), for North Herefordshire (Bill Wiggin), and for Hendon (Dr Offord), the hon. and learned Member for Sleaford and North Hykeham (Stephen Phillips), and the hon. Member for Mid Derbyshire (Pauline Latham)—
Andy Burnham
They are certainly sheepish today; they need to get back to their offices pretty sharpish to amend their websites in light of the letter from the chair of the UK Statistics Authority.
Barbara Keeley (Worsley and Eccles South) (Lab)
The website of the Conservatives in Salford says, on the budget that was going to increase,
“we would see more investment in our local NHS”
under a Conservative Government, but in Salford Royal hospital, 750 jobs have been cut. Between them, all our local hospitals have had 3,100 jobs cut in the past couple of years, and two walk-in centres have closed. If the budget is the same, why all these cuts?
Andy Burnham
This is the reality on the ground, as my hon. Friend says. There is also the mental health budget cut. There has been a mismatch; people see all those things, yet they hear the statements from the Government, and it does not make any sense, but now the truth and the facts about our NHS are being told, and things will begin to make sense to people.
What I find most troubling about all this, and most revealing about the Government’s style and the way that they work, is that even when they are warned by an official watchdog, they just carry on—as they are doing today—as if nothing had happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? Labour left plans for a cut; that is what the Prime Minister said at the Dispatch Box last week. It is what the Secretary of State said in a letter replying to Mr Dilnot. Again, that is simply untrue.
According to Treasury statistics, Labour left plans for a 0.7% real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this Government who slowed spending in 2010-11, who allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the Secretary of State’s promise that all savings would be reinvested, and who still have published plans, issued by Her Majesty’s Treasury, for a further 0.3% cut to the NHS in 2013-14 and 2014-15, contrary to the new statement that the Conservatives have just put on their website. The Secretary of State has a lot of explaining to do.
Andrew Selous (South West Bedfordshire) (Con)
I should be interested in the right hon. Gentleman’s comments on the statement by John Appleby, the chief economist of the King’s Fund, who said that before the general election, the former Chancellor left plans for 2011-12 and 2012-13 that would see a cut in real terms. What does the right hon. Gentleman say to that?
Andy Burnham
I have not seen the quote, but I did the deal with the former Chancellor of the Exchequer just months before the general election, protecting the NHS in real terms. A deal was done for schools and for the Home Office too. Those were the plans. At the election I was arguing for real-terms protection. The Secretary of State was on the hustings calling for real-terms increases. I said it would be irresponsible, yes, to give real-terms increases over and above real-terms protection because the only way he could pay for that would be taking it off councils, hollowing out the social care budget. That is what I said at the election, but the right hon. Gentleman has not even given real-terms protection. He has cut the NHS in real terms, so it beggars belief that he has the nerve to heckle and shout out from the Front Bench, when he has cut the NHS lower than the plans that I had left in place.
Clive Efford (Eltham) (Lab)
It is not just on the budget that the Government have let people down. They promised that they would not close accident and emergency departments. Before the general election the former Secretary of State went to Bexley and said he would not close the accident and emergency department at Queen Mary’s, Sidcup, and it closed after the general election. Now they are planning to close the A and E at Lewisham—another broken promise about the NHS. It just goes to show: you can never trust the Tories with the NHS.
Andy Burnham
The two guilty men here have a list of broken promises as long as their arm. The previous Secretary of State toured marginal seats before the election, promising the earth—“Burnley A and E? Oh, we’ll re-open that. Whatever you want. Chase Farm? That won’t close.” It was unbelievably cynical politics. It was all self-serving politics for their own ends and it had nothing to do with the reality in the NHS, but the problem for the present Secretary of State is that he has presented this false version of events to the House. On 13 November he said that
“there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans.”—[Official Report, 13 November 2012; Vol. 553, c. 188.]
[Interruption.] He says there has been. I ask for your help, Mr Deputy Speaker. How can Ministers deny the facts—deny what the watchdog is telling them? What do we do in such circumstances, when they have the sheer nerve and brass neck to carry on making these false statements?
Based on what we know, there is no way the Secretary of State can back up that claim, and I ask him to withdraw it today. It is an inaccurate claim. He made it at the Dispatch Box; the onus is on him to withdraw it. We know that he is taking time to come to terms with his brief, but he is in danger of developing a credibility problem with his utterances in the House. Take this from last month’s Health questions:
“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]
But again the truth emerges, and it is somewhat different from the version of events presented to us by the Secretary of State. On Monday, responding to excellent research by my hon. Friend the Member for Leicester West (Liz Kendall), the national cancer director conceded that in future cancer networks would have to live with a smaller budget. What are we to do? Who are we to believe? We have a Secretary of State who is making statements that contradict his national cancer director. It is shameless.
Lucy Powell (Manchester Central) (Lab/Co-op)
Even the north-west regional centre for cancer treatment, the Christie hospital, recently announced that 213 posts will go. I do not know how it stacks up with the Secretary of State’s claim that the NHS budget is going up, when we see cancer patients getting a reduced service at the Christie hospital.
Andy Burnham
The priorities are all wrong. The Government are spending the money on a reorganisation that none of us wanted in the north-west, and as my hon. Friend says, cancer networks are being cut and are shedding staff. As my hon. Friend the Member for Leicester West revealed this week, they are cutting back on the vital work that they do—and there could be no more vital work. Yet we continue to have a false version of events given to us. Ministers must think we are daft, but we are telling the facts to the country today and people will judge for themselves.
When we put the whole picture together, what we see is a tissue of obfuscation and misrepresentation of the real position on NHS spending. The hon. Member for Mid Bedfordshire (Nadine Dorries), who is, sadly, not in the House today, once made some interesting observations about those on the Government Front Bench, but it is not just that they
“don’t know the price of pint of milk”.
The arrogance of which she spoke seems to give them a feeling that they can claim that black is white and expect everyone to believe it. If they say it is so, then it must be so. Well no, actually. The intelligence of the House need not be—
Chris Skidmore (Kingswood) (Con)
On a point of order, Mr Deputy Speaker. Has the right hon. Member for Leigh (Andy Burnham) informed the hon. Member for Mid Bedfordshire (Nadine Dorries) that he would be making comments about her in the debate today?
Andy Burnham
Yes, I have done so, Mr Deputy Speaker.
If in future any Minister mentions the NHS and real-terms increases in the same sentence at the Dispatch Box, Members on all sides will at least have the facts. Better still, by carrying our simple motion this evening, we can give the House the opportunity to make sure that Ministers take much more care than they have previously shown with their statements on NHS spending.
Let us look to the future. What does all this mean for the NHS and what effect is the Government’s cut to its budget having in the real world? In its briefing for today’s debate, the NHS Confederation refers to a survey of NHS leaders which found that a full 74% described the current financial position as “the worst they had ever experienced” or “very serious”. The reason why the Government’s cuts feel much deeper to people working in the NHS, as we heard a moment ago, is that they are contending with the added effect of a reorganisation that nobody wanted and that they pleaded with the former Secretary of State to stop.
Cuts and reorganisation are a toxic mix. According to the Government’s own figures, a full £1.6 billion has been diverted from patient care and the NHS front line and spent on back-office restructuring. Look at the waste already: a full £1 billion spent on managerial redundancies—1,300 six-figure pay-outs and, scandalously, 173 pay-outs over £200,000. [Interruption.] The Secretary of State chunters away. I am surprised he has the nerve even to be here. Such pay-outs are unforgivable and unjustifiable when patients are seeing treatment restricted and nurses laid off in their thousands. But it is not just the financial cost. It is the opportunity cost—the colossal distraction this has proved to be from having the focus where it should be—on the money.
After the election, the £20 billion Nicholson challenge should have been the only show in town. Instead, no one stood up in Cabinet to the previous Secretary of State, who was allowed to proceed with his vanity reorganisation of the NHS. The consequence has been two years of drift, where no one knows who is making the decisions. The danger of this unwieldy and unmanaged approach to the efficiency drive is that, as trusts start to panic about the future, increasingly drastic cuts are being offered up that could have serious consequences for patient care.
I want to end by focusing on four such consequences. First, let us look at staffing levels on the NHS front-line. For two years, we have had the mismatch of Ministers making boasts about rising spending while the number of staff was dropping at an alarming rate. A full 7,134 nursing posts have been lost since the coalition came in, with 943 in the past month alone. [Interruption.] Government Members keep mentioning doctors. We left those plans for doctors coming through. The Secretary of State has not done anything about the training of those doctors, but on his watch he has seen more than 7,000 nursing posts cut.
Training places are being been cut by 4.6% this year, after a 9.4% cut in 2011-12. No wonder the chief executive of the Royal College of Nursing warns that we are “sleepwalking” into a crisis. Peter Carter says:
“On a daily basis, nurses are telling us they do not have enough staff to deliver good quality care.”
The situation has taken a serious turn. In its annual report, the Care Quality Commission found that 16% of hospitals in England did not have adequate staffing levels. I am surprised that a warning of this seriousness has not received more attention. It cannot go ignored. It would seem that the NHS is failing to learn the lessons of the failure at Mid Staffordshire, where the first Francis inquiry found inadequate staffing levels to be one of the main reasons why care standards fell so low.
The Health Secretary tells the Health Service Journal today that he is not going to interfere with the day-to-day running of hospitals, but let me remind him that it is his responsibility to ensure that our hospitals are safe. He must develop an urgent plan to stop the job losses and protect the NHS front line. He should tell us which hospitals do not have enough staff and explain what action he is taking on the CQC’s warning to ensure that all hospitals in England have safe staffing levels.
The second consequence of Government cuts to the NHS is the growing number of restrictions on treatment. We have revealed how 125 separate treatments have been restricted or stopped altogether since 2010, including cataracts, knee replacement and varicose veins. Just as they make false boasts about increasing NHS spending, so we hear repeated claims about reducing waiting lists. But that is because people cannot get on the waiting list in the first place.
Figures from the House of Commons Library show the effect of those restrictions on patients. More than 50,000 patients are being denied treatment and kept off NHS waiting lists, and there have been big falls in operations for cataracts, varicose veins and carpal tunnel syndrome. Ministers have promised to stop cost-based rationing if they are given evidence of it, but we have presented them with the evidence on a number of occasions, so let us now see some action.
Thirdly, the lethal mix of cuts and reorganisation is destabilising our hospitals. They are the first to feel the full effects of the free-market ideology that the Government have unleashed on the NHS. There is no longer one NHS approach in which spending is managed across the system; there is a broken-down, market-based NHS. The Government’s message to England’s hospitals is this: “You’re on your own. There’ll be no bail-outs. Sink or swim. But if it helps, you can devote half your beds to treating private patients.” We see the signs of increasing panic as hospitals struggle to survive in this harsh new world. In Bolton, South Tees, and Maidstone and Tunbridge Wells, a large number of staff have been given 90-day redundancy notices, and we see half-baked plans coming forward to reconfigure services with efforts to short-circuit public consultation.
Will the Secretary of State today remove the immediate threat to Lewisham A and E by stating clearly that it is a straightforward breach of the administration process rules to solve the problems in one trust through the back-door reconfiguration of another? Will he ensure that the future of all A and E provision in Greater Manchester is considered in the round as part of a city-wide review, rather than allowing the A and E at Trafford to be picked off in advance. In St Helens and Knowsley Hospitals NHS Trust, will he reverse the comments of the previous Secretary of State, who told the clinical commissioning groups that they had no obligation to honour financial commitments to the hospitals entered into by the previous primary care trusts? It is chaos out there. The Secretary of State urgently needs—[Interruption.] In fact, all the Health Ministers urgently need to get a grip, not just the Secretary of State.
Robert Flello
Is my right hon. Friend aware that the West Midlands ambulance service only yesterday advised that there are about half a dozen hospitals in the west midlands whose A and E staffing situation is so critical that it is having a knock-on effect on their ambulance turnaround times?
Andy Burnham
I hear reports from ambulance services all over the country that they simply cannot hand over patients at the door of A and E departments and are having to queue outside. Consequently, large swathes of the country are being left without adequate ambulance cover. That is unacceptable, especially as we go into winter and temperatures drop. We need to see some evidence that the Government have a grip on these things. I have been told that large parts of my constituency have occasionally been left without adequate ambulance cover. We must have answers on these matters today.
Dr Sarah Wollaston (Totnes) (Con)
I am very disappointed to hear the right hon. Gentleman talk down the NHS. As he has just acknowledged, before the election the NHS knew that it was facing an unprecedented efficiency challenge. He will also know that under Labour productivity in the NHS fell continuously. I wonder whether—[Interruption.] Okay, but for almost every year—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Lady needs to ask a sharp and punchy question as an intervention, and very quickly.
Dr Wollaston
Will the right hon. Gentleman acknowledge the NHS’s achievement in making a productivity gain?
Andy Burnham
The hon. Lady just made another untrue statement. She talks about talking down the NHS, but productivity has not fallen. I am sorry, but let us have some honesty. We are not just going to sit here and take one statement after another—
Mr Deputy Speaker (Mr Lindsay Hoyle)
We all know that all Members are very honest in this House.
Andy Burnham
Inadvertent claims are being thrown around the House all the time.
Fourthly, and finally, cuts and reorganisation are resulting in a crude drive to privatise services, prioritising cost over clinical quality. Across England, deals have been signed to open up 396 community services to open tender under any qualified provider, but those deals are not subject to proper public scrutiny because they are held back under commercial confidentiality. In Greater Manchester, plans are advanced to hand over patient transport services to Arriva, despite the fact that an in-house bid scored higher on quality and despite the fact that the CQC recently found serious shortcomings with the same provider in Leicestershire. The trouble is that nobody has asked the people of Greater Manchester, or more importantly the patients who rely on that service, whether they want that change.
Lucy Powell
My right hon. Friend might not be aware of another point. The patients who use the Greater Manchester passenger transport service are coming to me regularly and crying their eyes out in distress at this decision—[Interruption.] The hon. Member for Beverley and Holderness (Mr Stuart) says “Aaah”, but those are poor and vulnerable people who rely on that service to take them to and from hospital. It is an absolute disgrace that the contract has been given to Arriva bus service, so don’t patronise them or me. I thank my right hon. Friend for giving way.
Andy Burnham
Thank God my hon. Friend got up to deliver that to Government Members, because they need to hear a bit more of it. They say “Aaah,” but we are talking about people who desperately need that service, trust it and like it the way it is. The Government have not even bothered to consult them about the changes they are making. That is what is so wrong.
“Any qualified provider” is turning into the NHS version of compulsory competitive tendering, a race to the bottom and a rush to go for the cheapest bid, regardless of the effect on patients and services. What clearer symbol could there be of a privatised, cut-price coalition NHS than the decision to award patient transport in Greater Manchester to a bus company?
Let me remind the Secretary of State of the rights of patients and staff as set out in the NHS constitution:
“You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.”
If the people whom my hon. Friend the Member for Manchester Central (Lucy Powell) referred to sought to enforce those rights by bringing a legal action against the North West ambulance service, can the Secretary of State confirm that there would be a fair chance that it would have to halt its plans? If so, why does he not just press that pause button and ask people whether they want their ambulance services run by a bus company?
The first line of the NHS constitution states:
“The NHS belongs to the people.”
But it will not when this Government have finished with it. We are losing the NHS, and that is why we will keep stepping up the fight for it. People will remember the personal promises the Prime Minister made on the NHS in order to win office, promises that it now seems had more to do with his desire to detoxify the Tory brand than with any genuine regard for the NHS. He promised no top-down reorganisation of the NHS; that was broken. He promised a moratorium on hospital changes; that was broken. He promised real-terms increases in every year of this Parliament; that was broken. They can now see the chaos that the breaking of those promises is visiting on the NHS: nurse numbers cut, health visitors cut, mental health cut, cancer networks cut, and cataract operations cut. He is the man who cut the NHS, not the deficit. The House cannot vote tonight to stop the damage, but it can put down a marker against an arrogant and incompetent Government who need to show the NHS, its patients and staff a little more respect. I commend the motion to the House.
The Secretary of State for Health (Mr Jeremy Hunt)
We have heard a lot of bluster and nonsense today. At its heart is an extremely uncomfortable truth for the Opposition: this Government are spending more on the NHS than Labour would have spent. That spend has moved away from consultancy and the back office to the front line, so the NHS is now performing better—I know that it is uncomfortable, but it is true—than it ever did under Labour. That means more treatment—[Interruption.] This might not be what Opposition Members want to hear, but they might as well listen. That means more treatment, more care and more lives saved. The previous Government talked the talk on the NHS, but it is this Government who have delivered an NHS of which we can be immensely proud.
Mr Hunt
I said that I would make a little progress, if that is all right.
I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:
“It is irresponsible to increase NHS spending in real terms”.
So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?
Andy Burnham
Yes, I do. I said in my speech that the NHS should be protected in real terms at the front line. That is what the Secretary of State has not done. I cannot believe that he is contradicting the contents of the letter from Andrew Dilnot. He really needs to tread very carefully before he goes any further.
Mr Hunt
Let me say very gently to the right hon. Gentleman that he can hardly come to this House criticising us for an alleged cut in NHS spending if his own plans would have led not to higher but to lower NHS spending. We are increasing spending by £12.5 billion, and he thinks that that is irresponsible.
Grahame M. Morris
Will the Secretary of State at least acknowledge that the previous Labour Government increased resources in the NHS from £30 billion when we took office to over £100 billion when we left office in 2010?
Mr Hunt
I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.
Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.
While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?
Susan Elan Jones (Clwyd South) (Lab)
Can the Secretary of State tell us whether that has anything to do with the cuts in capital spend from Westminster central Government? Does he have any comment to make on National Audit Office figures showing that spending on health in Wales is higher than that in England, or does that not fit with his fictitious version of events?
Mr Hunt
I gently remind the hon. Lady that this is about the choice made by the Labour Government in Wales. They had a choice. They could have protected the NHS budget—they had the money under Barnett to do that—but they chose not to do so, and that is supported by the right hon. Gentleman.
Julian Smith
Does it surprise my right hon. Friend that we heard nothing from Labour Members about productivity, innovation or the Derek Wanless report, which demonstrated that Labour’s health spending led to lower productivity rather than higher productivity?
Heidi Alexander (Lewisham East) (Lab)
Will the Secretary of State give way?
Mr Hunt
I am going to make a little progress, if I may.
The right hon. Member for Leigh rather helpfully spelled out the difference between his position and our position when he admitted in the New Statesman that we are spending more than he wanted to spend on the NHS. He said of the NHS budget:
“They’re not ring-fencing it. They’re increasing it.”
In respect of NHS spending, he said:
“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us’…it is true, but that’s my point.”
It was a good point, because we are spending more and he would have spent less. So why on earth call an Alice in Wonderland Opposition day debate condemning levels of spending in the NHS when he has so clearly put it on the record that he wanted that spending to be less?
Mr Graham Stuart (Beverley and Holderness) (Con)
Does my right hon. Friend agree that it is disingenuous, should it be allowed by the Deputy Speaker to say that, of the shadow Secretary of State and Labour Members—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. We are not going to be disingenuous, are we? We are going to be friends together, and I am sure that a good experienced Member like you, Mr Stuart, could word it better.
Mr Stuart
Thank you, Mr Deputy Speaker, for that correction, which I required. Obviously, it is an inadvertent tendency towards disingenuousness on the subject. I would like to apologise for pointing out, on behalf of patients right across the country, that for the Opposition to have a debate on health funding, when they were proposing to cut it—when they are actually cutting it in Wales—and when productivity fell, is the height of hypocrisy.
Mr Deputy Speaker
Order. I do not think we can have “hypocrisy” either, so we will have the Secretary of State instead.
Heidi Alexander
The Secretary of State seems to be very keen to ask questions of our Front Benchers. Why will he not answer the question put to him by my hon. Friend the Member for West Ham (Lyn Brown)? How many nurses have lost their jobs on his watch? I do not want to be told about the nurses-to-beds ratio—answer the question.
Mr Hunt
It is because we have protected the NHS budget that the number of clinical staff in the NHS has gone up and not down. [Interruption.] Okay, let me explain this, because there is a very important point here. Unlike Labour Front Benchers, I do not want to micro-manage every hospital in the country and tell them exactly how many doctors and how many nurses they should have. I want them to put money on the front line, and the result is that the number of clinical staff—doctors, nurses, midwives and health visitors—has gone up and not down.
Mr Deputy Speaker
Order. I am sure that the hon. Member for Broxbourne (Mr Walker) is not going to walk out after his intervention and will stay a little longer.
Mr Walker
The meeting is in thirteen minutes.
My right hon. Friend knows that it is not just about funding but about good management. He cannot be responsible for management across the NHS, but in the East of England ambulance service there are question marks over the quality of its senior management. Will he find time to cast his eye over those senior managers?
Mr Hunt
I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.
Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[Interruption.] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.
Andy Burnham
Would the Secretary of State care to remind the House of the commitment in the coalition agreement? Could he read that out for us?
Mr Hunt
I have just said that spending will go up in every year of the Parliament. Let me point out to the right hon. Gentleman that these are small real-terms increases, albeit ones that he bitterly opposed. That is why, given the uncertainties around GDP deflators, Andrew Dilnot’s letter says, in the sentence that the right hon. Gentleman did not want to read out, that
“it might also be fair to say real terms expenditure has changed little over this period.”
There it is, exposed for all to see: a bogus Labour motion trying to paint a picture of cuts to the NHS budget when even the head of the UK Statistics Authority says that the broad picture of NHS spending is that it has been protected in real terms—something that almost certainly would not have happened had Labour been in power.
Andy Burnham
I am struggling to believe what I am hearing. The Secretary of State is saying that Andrew Dilnot agreed with him that there had been real-terms increases in every year of this Parliament—[Interruption.] That is what he just said at the Dispatch Box. Let me quote Andrew Dilnot again, for the sake of accuracy. He said that
“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10”.
How can the Secretary of State square what he has just told the House of Commons with what is in Andrew Dilnot’s letter? Is he saying that Andrew Dilnot is wrong?
Mr Hunt
Some politicians walk into the same trap not once but twice. Let me give the right hon. Gentleman the sentence that comes straight after that, which he did not want to quote. It says that
“it might also be fair to say that real-terms expenditure had changed little over this period.”
That is what Andrew Dilnot is saying, which is why the motion is so completely bogus.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I am no statistician, but my understanding of that English is that things have not changed much. However, the Secretary of State has consistently said that he and the Government have pledged to implement an increase. There is nothing in that letter to suggest that any increase has occurred.
Mr Hunt
The right hon. Lady’s party has been saying that spending has been cut, and it had the foolishness to call an Opposition day debate on the basis of a letter from Andrew Dilnot that states that, broadly speaking, spending has remained unchanged. That is why, at its heart, the motion is bogus.
The sad fact is that this is not the debate that the Opposition planned to have, two years into this Parliament. The right hon. Gentleman dreamed of coming to the House to remonstrate about an NHS that was on its knees and that was not delivering for the public. He wanted to argue about waiting times, but they have gone down, with fewer people waiting a long time for an operation than at any time under Labour. He wanted to argue about treatments, but there are more people getting new hips and knees and many other treatments than under Labour. [Interruption.] Opposition Members should listen to this. He wanted to argue about cancer, but 23,000 people are now getting drugs under the cancer drugs fund that Labour refused to set up.
Today, the right hon. Gentleman has tabled a motion criticising the decisions taken by the coalition and my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) on NHS spending in our first two years in office. This is also about how we spend the money, as many of my hon. Friends have said. What are the decisions that the right hon. Gentleman is criticising? They are precisely the decisions that mean that the NHS is now performing at record levels, and vastly better than at any time under Labour.
Let us look at those decisions. There was the decision to reduce the number of managers by 7,000 and transfer resources to the front line. There was also the decision to cancel Labour’s disastrous attempt to embrace the technology revolution that cost billions and set the NHS back by years. Then there was the decision to end the wasteful consultancy spend, which has now been cut by 39%. [Interruption.] The right hon. Gentleman needs to listen to this. There was the decision to stop the scandal of unsustainable private finance initiative projects that left the NHS with a £73 billion debt and £1.6 billion-worth of repayments every year. [Interruption.]
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Christmas is coming. Let us show a little bit more Christmas spirit towards each other. Members on both sides of the House want to hear the Secretary of State.
Mr Hunt
I could not agree with you more, Mr Deputy Speaker. I am trying to give the House some good news, but it is difficult for the Opposition to take it in.
There was also the decision, championed by both coalition parties, to transfer that money to the front line, so we now have more clinical staff, including 5,000 more doctors; better access to drugs, including £600 million invested in the cancer drugs fund; 500,000 more elective admissions every year than under Labour; over 3 million more out-patient appointments every year than under Labour; nearly 1 million more going through accident and emergency every year than under Labour; and 1.5 million more diagnostic tests every year than under Labour. On top of all that, we have 60,000 fewer people waiting longer than 18 weeks than under Labour; 90% fewer people waiting more than a year than under Labour; clostridium difficile down more than a third compared with under Labour; MRSA halved compared with under Labour; and the number of people facing the indignity of mixed-sex wards down by 98% compared with under Labour.
Of course the NHS faces huge challenges with an ageing population and increasing demand, but we are now facing up to those challenges with ambitious plans to tackle dementia, to reduce mortality rates for the big killer diseases to the lowest in Europe, to embrace the technology revolution—but getting it right this time—and to improve the quality of care which, in parts of the system, has been allowed to become shockingly poor for far too long. All those priorities were ignored by Labour in office and, even worse, they have been rejected by Labour today as a “meaningless list”. Those were Labour’s words. Well, tell that to the 157,000 people who die from cancer every year, or the 800,000 people who have dementia, or the people whose families suffer from the poor care that we read about every week in the newspapers.
None of the improvements to the NHS, and none of the ambitions for our NHS, would be possible without the extraordinary dedication of our doctors, nurses and front-line professionals, to whom I pay tribute today. But none of them would have been possible either if we had not increased the NHS budget and NHS front-line spend, contrary to what Labour intended and wanted. Labour’s plans would have meant less spending in real terms on the NHS, and vastly less spending on the NHS front line. No clever fiddling with baselines can obscure the harsh reality that Labour’s policy towards the NHS is a mass of contradictions that fools nobody—certainly not the brilliant doctors, nurses and professionals who have given their lives to saving and improving the lives of others. I urge the House to reject this ridiculous motion.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The time limit on Back-Bench speeches is displayed on the annunciator screen.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Today’s debate centres on the Prime Minister’s broken promise to protect the NHS, which was expressed as a commitment to increase spending on the NHS year on year. That is not the only promise that he made. In opposition, he spoke passionately about retaining essential local services and named my local hospital, Lewisham, as one of the 29 hospitals that he would personally defend. Today we can offer him and the Secretary of State for Health that opportunity. The bottom line for NHS spending has to be the provision of safe, quality health care that meets the needs of the local population and is free at the point of need. Nothing is more important to the vast majority of our people.
The four tests that the Government have set for any local reorganisation proposals are: that they should have the support of local GPs; that they should have strong public and patient engagement; that they should be backed by sound clinical evidence; and that they should provide support for patient choice. Not one of those criteria has been met by the current proposals for Lewisham hospital by the trust special administrator.
Mr Graham Stuart
The right hon. Lady is speaking movingly about local services. Does she welcome, as I do, the £12.5 billion increase proposed for the NHS budget during this Parliament? Does she disagree with the right hon. Member for Leigh (Andy Burnham), who believes that such increases are irresponsible?
Dame Joan Ruddock
If the hon. Gentleman will be patient, he will discover that I find it impossible to see the increase. What I see on the ground are cuts, cuts, cuts. That is what I want to speak about today.
As I was saying, not one of those criteria is met by the trust special administrator’s proposals for Lewisham hospital. The TSA was appointed in July by the Secretary of State for Health to sort out the considerable financial problems of the neighbouring South London Healthcare NHS Trust. His remit required him to find tens of millions of pounds of savings from the services provided by the trust’s hospitals in Woolwich, Farnborough and Sidcup. That could not be done, so the TSA’s response was to grab a successful, solvent and highly regarded hospital, Lewisham, and propose to destroy it to raise money from the sale of two thirds of the site currently occupied by the hospital, a fact that was not even mentioned in the consultation document.
Andy Sawford (Corby) (Lab/Co-op)
My right hon. Friend will be aware that my constituents have similar concerns about the future of their local hospital in Kettering, despite assurances that changes are being driven by the best clinical advice and guidance and by clinical outcomes. Contrary to the unrecognisable picture described by those on the Government Benches, we know that the cuts in Kettering hospital’s services, which will affect my constituents in Corby and east Northamptonshire, are a result of a £48 million deficit that is a direct result of the Government’s policies. Does my right hon. Friend share my concern that this is about those cuts in funding rather than the clinical outcomes?
Dame Joan Ruddock
I thank my hon. Friend for his intervention. If all hon. Members are honest in providing a record of what is happening on the ground, we will see that the reality is, indeed, cuts and reductions in services.
It is a case of not only how much money we spend on the NHS, but how wisely we can spend it, and there may be agreement throughout the House on that. [Interruption.] I say to the hon. Member for Beverley and Holderness (Mr Stuart) that just four years ago, Lewisham hospital gained a new wing through a successful and affordable private finance initiative contract. Just two years ago, a state of the art new birthing centre was opened, and only in April of this year the £12 million refurbishment of the A and E department was completed.
Now, however, the trust special administrator proposes to close both the full A and E service and the full maternity service at Lewisham hospital. The consequence of closing the A and E department and replacing it with an urgent care centre means the closure of the intensive care unit, the coronary care unit and the acute medical and elderly medical services. Every year, more than 13,000 people benefit from those acute services, 4,500 babies are born in the maternity unit, and more than 120,000 people use the A and E department.
The proposals are, to be frank, catastrophic—they will remove vital services from a growing population of more than 270,000 people. This is an accountant’s solution to a problem that does not even exist in Lewisham itself. Not a single constituent, patient, GP or hospital specialist has come to me in support of the plans.
My colleagues, Lewisham hospital trust and I are not opposed to change aimed at greater efficiencies and higher standards. Indeed, that was the Labour Government’s policy and philosophy for the NHS all along. We know that closures of small hospitals have led to safer services. We know that paramedic services and blue-light ambulances taking people to highly specialised centres save lives every day. We also know that the NHS could be more efficient, but there is no evidence that the needs of Lewisham people for A and E or maternity services can be safely met elsewhere in south-east London. All other existing provision is full to capacity, and travel from most of Lewisham to Woolwich is highly problematic.
The TSA report is full of assertions and aspirations that are completely divorced from the realities of people’s lives in a borough that contains some of the most deprived wards in the UK. If the proposals were to go ahead, the 750,000 residents in the boroughs of Lewisham, Greenwich and Bromley would be dependent on a single A and E department. As the report says, hospitals are part of a bigger NHS family, which is why the Secretary of State must look at London as a whole. It cannot be just or sensible to try to find enormous financial savings to rescue one health trust by destroying another.
The public have had just 30 days to respond to the extraordinary proposals in what is a deeply flawed consultation process, but such is the anger that more than 32,000 people, including more than 100 local GPs, had added their names to a petition started by my hon. Friend the Member for Lewisham East (Heidi Alexander) by the time we presented it to No. 10 last Friday.
Last week the trust board of Lewisham hospital issued its response. It supports in principle the merger of Lewisham with Queen Elizabeth hospital in Woolwich, and I must say that that is worth considering, but the trust says:
“We are concerned that the financial modelling completed by the TSA team at pace will include errors that will work against financial viability of the proposed Lewisham Healthcare NHS Trust and Queen Elizabeth hospital reorganisation.”
That would simply repeat the history of the hospitals in the South London Healthcare NHS Trust that have had continuing financial problems.
The trust board goes on to say:
“The TSA process has made it impossible to have the engagement and involvement that proposals such as these would normally warrant, and our clinicians do not feel they have been listened to in this process.”
The rest of its submission to the TSA is entirely damning. It says:
“We do not believe there is a convincing case for the major change of services proposed in Lewisham. The TSA has overlooked the significant role that LHT provides in the broader provision of services to local people. The TSA recommendations will result in worse, rather than better, care for the people of Lewisham. We believe a health and equalities impact assessment would show this but has not yet been completed—a significant weakness of the TSA Report.”
When the Secretary of State comes to view the TSA’s report, whatever form it takes, I urge him also to review all of the evidence that has been presented by local people, local experts, local consultants, GPs and the hospital trust itself. As the local Save Lewisham Hospital campaign says, this is not a difficult decision for the Government—it is potentially a deadly one. I urge him to give the most careful consideration to what is being said. The criticisms are damning and we have absolutely no faith in the proposals that the TSA will put before him.
Mr Stephen Dorrell (Charnwood) (Con)
You challenged us earlier, Mr Deputy Speaker, to introduce a little Christmas good will to the debate, and I want to try to do that in two ways. First, I want to respond to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who spoke from the perspective of the local constituency and community interest in Lewisham. The challenges that she described repeat themselves many times over in the health care system, and it is those challenges that I want to address.
Secondly, I want to surprise the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), by welcoming the fact that his motion, although I do not endorse it, refocuses the health debate on the core challenge facing the health service, and the health and care system more broadly, as it thinks about how we meet demand—in truth, there is bipartisan agreement on this—in the more challenging resource environment in which we now live.
Although we were not able to detect it in the right hon. Gentleman’s speech, the fact is that he, as Secretary of State, introduced the changed resource outlook within which the health and care system now operates. It was in May 2009—not on election day in May 2010—that Sir David Nicholson issued his annual report on the challenges facing the national health service. He made it clear that the system has to meet demand against the background of a resource outlook that is not only unrecognisably different from that during the generous funding of the Labour years between 1997 and 2010, but that has fundamentally changed from the one that the NHS has experienced throughout its whole history since 1948.
Andy Burnham
I agree with the right hon. Gentleman that I had to give the NHS that reality check and set the Nicholson challenge. With that in mind, does he agree that the Nicholson challenge should have been the only show in town after 2010, and that it was catastrophic to combine it with the biggest ever reorganisation that the NHS has ever seen?
Mr Dorrell
The right hon. Gentleman knows that I agree that the prime focus of health policy since 2010 should have been on how we can change the way that care is delivered in the health care system and the social care system to ensure that we can meet demand against the very different resource outlook that I have described. However, I say to the right hon. Gentleman, as I have done many times in this Chamber, that he shares some of the responsibility for the two-year trip down memory lane that we have had. It has been comfortable for the Labour party to say that the Tory party does not believe in the health service. We have been reminded numerous times that Tory MPs—all of whom are now dead and most of whom died before most of the current Members of the House of Commons were born—voted against the establishment of the national health service in 1946. We have had reminders from Government Members that the Labour party voted against the establishment of NHS trusts and then went ahead with the policy in office. The Labour party says that it is against choice and competition, but it was that party that established the choice and competition panel to ensure that those influences were brought to bear in health care policy.
We have had a two-year trip down memory lane, in which we have engaged in party political arguments that have avoided the issue that the right hon. Gentleman articulated as Secretary of State: how can we meet rising demand for health and care services against the background of a budget that, as the Select Committee has said repeatedly, is flatlining in real terms? That is why I was so keen earlier to read out the sentence from the Dilnot letter that states that it is
“fair to say that real terms expenditure had changed little over this period.”
The way that I prefer to put it is that if the decimal points are knocked out, real-terms expenditure is running at zero. The question is how to act against the background of a very small growth in resources, which is what the Government are committed to.
What the right hon. Gentleman did not cover in his speech is that the revenue expenditure of the NHS, which is what actually treats patients on a day-by-day basis, has grown modestly in real terms since his last year as Secretary of State. In my view, it will continue to grow modestly in real terms. He is frowning, but it is there in the arithmetic that there has been modest real-terms growth in the revenue expenditure, which is another definition of front-line services. That is the expenditure that funds the delivery of services to patients on a day-by-day basis and that is where the pressure is felt.
Lucy Powell
In addition to the point that the right hon. Gentleman is making, has he considered the chronic pressure that is being put on the NHS, which will get much worse from next April with the cuts to adult social care and the desperate cuts to local government? The conversation that we are having has to take into account what the money has to be spent on. The service will decline dramatically from next April.
Mr Dorrell
I have made the point more than once that we should look across the traditional divide between the national health service and the social care system towards a health and care system. The only way of responding to the efficiency challenge that the right hon. Member for Leigh was the first Secretary of State to set out—what the Select Committee has described as the Nicholson challenge—is to rethink the way in which services are delivered across the health and social care divide. The National Audit Office, another independent body, has stated that 30% of non-emergency hospital admissions are avoidable—not unnecessary, but avoidable. We need decent community-based services that meet the demand early in the development of the condition to avoid the unnecessary development of acute cases that have to be treated though hospital admission.
Andy Sawford
The right hon. Gentleman has been a vocal advocate for a long-term solution to the issues relating to the integration of health and social care. I have enjoyed engaging with him on those issues in the past. Does he agree that it is incredibly disappointing that we are not making the progress that we should be making in finding consensus on the future of social care funding and, in the short term, on diverting more funding, particularly from NHS underspends, to prevention?
Mr Dorrell
I agree completely with the hon. Gentleman’s characterisation of the challenge. I was looking forward to him congratulating the Government on taking a step in the right direction, although it is not a total solution, by investing in prevention some of the resources in the health care. [Interruption.] The hon. Gentleman indicates that it is only a little and that it should be more.
We need to look across the statutory divide that reflects history, but not the demands of today’s generation of patients. The key thing that we must recognise in the debate about health and care is that we have inherited a system, which all of us have supported through most of its history, that is built on the assumption that the typical patient will be restored to good health. In Bevan’s day, that was true of the typical patient in the health and care system, but it is not true of the typical patient in today’s system. The majority of the resources in today’s health and care system go towards delivering care to people who will not be restored to full health. That, not surprisingly, requires a different set of institutions, shaped in a different way from the institutions that we have inherited from history.
The challenge that faces all of us in this House who care about the health and care system is not to protect the different bits of the system as though they were listed buildings, but to change the system so that it uses today’s technologies to meet the needs of today’s patients. That is the core challenge that faces my right hon. Friend the Secretary of State and his colleagues and, if I may say so, the right hon. Member for Leigh and his shadow ministerial colleagues.
Mr Dorrell
If my hon. Friend will forgive me, I will not.
For the second half of this Parliament, we could have a reprise of the first half and we could trade party political slogans about a system that increasingly thinks that the political debate has nothing to do with it, or we could engage with the people who understand what real life feels like on the front line of the system, which has been described by one or two Opposition Members, and we could show that we in this House support the need for change in order to use taxpayers’ resources to meet taxpayers’ health and care needs. That is the real challenge that faces the House this evening.
Mr Kevin Barron (Rother Valley) (Lab)
I am sorry that the Secretary of State is leaving because, before going on to discuss what is happening in my local health community and local hospital, I want to pick up on a couple of the things that have been said. First, I am pleased that this very dry motion has been tabled because I hope that it will concentrate our minds on what is happening in the national health service and, in particular, to spending.
The Secretary of State said that spending is related to budgets. He did not respond to the point posed by my right hon. Friend the Member for Leigh (Andy Burnham) that in 2010-11, there was a £1.9 billion underspend in the national health service budget. No use was made of the budget exchange scheme, so none of that money was moved into the following financial year. We can assume that £1.9 billion went back to the Treasury.
In the following year, 2011-12, the underspend was £1.4 billion, and £316 million was carried over into 2012-13. An underspend in the region of £3 billion from the first two years of this Government—including the year they won the general election—has gone back to the Treasury. Those are the facts; I do not know if any Front Bench Member wishes to dispute them.
The Minister of State, Department of Health (Norman Lamb)
Does the right hon. Gentleman also acknowledge that the average underspend in the last four years of the Labour Government was £1.9 billion?
Mr Barron
I recognise that there has been underspend, but I take this debate, and the debate we had running up to the general election, a bit more seriously. The chairman of the UK Statistics Authority said that there had been an underspend, and what we have just heard is not true. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the Conservative party manifesto stated:
“We will increase health spending in real terms every year.”
Mr Barron
I will give way in a few minutes. When the Conservative party was in opposition, the current Prime Minister said in 2009:
“With the Conservatives there will no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.”
I want to keep reminding hon. Members of that because, as my right hon. Friend the Member for Leigh pointed out, we may be able to take £20 billion out of a budget over four years—that is a big ask and has never been done anywhere in the public or private sector—but to do it while we are also having mass reorganisation is creating chaos in the health service. I will refer to what is happening in my local health service in a few minutes.
In 2007 the right hon. Member for South Cambridgeshire (Mr Lansley) was shadow Secretary of State for Health, although he has now moved to Leader of the House. He said that the NHS needed
“no more top-down reorganisations.”
Indeed, in terms of expenditure the coalition agreement stated:
“We will guarantee that health spending increases in real terms, in each year of the Parliament, while recognising the impact this decision will have on other departments.”
It also stated:
“We will stop the top-down re-organisations of the NHS”
so we can take that with a pinch of salt as well.
Mr Stuart
Like my right hon. Friend the Member for Charnwood (Mr Dorrell), the right hon. Member for Rother Valley (Mr Barron) is a former distinguished Chairman of the Health Committee. My right hon. Friend rightly said that spending on the NHS is broadly flat, and that the most important question we should be debating, rather than scoring points over 0.1% of spend, is how to use the money most effectively. Does the right hon. Gentleman agree with that, and that we must look at the allocation of spend around the country? I represent a rural area and it does not seem as if funds are fairly allocated now.
Mr Barron
The issue of allocation has been looked at by many Select Committees, including by the Health Committee when I chaired it in the last Parliament. We did not find the level of unfairness that people, particularly those from rural areas, used to say there was. We looked for it but we did not find it.
Let us look at what is happening in the real world. My local Rotherham hospital foundation trust is not a bad hospital trust in any way and scores quite well in many areas. It received foundation trust status a number of years ago, and when this Government took office, it is fair to say that the efficiency factor was there already. On 16 March 2011 the trust announced that more than 60 jobs were to be axed at Rotherham general hospital, and confirmed a potential reduction of 62 posts in medical and surgical areas. Earlier this year on 6 March 2012, the local BBC announced that more than 70 NHS staff were facing the threat of redundancy, and the trust is seeking to save about £4 million. On 26 October 2012, an internal report given to the local media stated that the trust now intends to cut 750 jobs—about 20% of its work force—by 2015.
The NHS trust said that it needed a smaller hospital with substantially fewer beds and a smaller work force to save £50 million over the next four years. The internal report—aptly named, “Creating Certainty in an Uncertain World”—said that it was necessary to save £50 million from the £220 million budget before 2015 to meet Government targets. That was confirmed by the trust in a press release.
On 5 November 2012, the chief executive of the trust said that it would show staff the plans and invite them to come back with alternative views on how things might be done differently. The trust stated:
“We’ve made it very clear that there may have to be redundancies, but to be honest with you until we have gone through the process, I don’t know how many we will be able to lose through natural turnover and how many will have to be made redundant.”
What type of planning is there in any of this when we have such a situation in a district general hospital on which about 80% of my constituents rely if they have to go into secondary care?
On 20 November 2012, the chief executive announced his retirement. On 3 December 2012, the hospital announced that staff will be informed about the decision to postpone the formal consultation launch into work force restructuring. It went on:
“We realise this an anxious time for all members of staff, but it is imperative that we do what is right for the Trust, our staff and our patients. This means that we need to take more time to ensure our workforce proposal is exactly what the Trust requires and we anticipate the launch to take place later in the month.”
On 7 December 2012—last Friday—a headline in the local newspaper stated that the trust had recently engaged the services of a director of transformation on a time-limited basis. The acting chief executive said:
“It is important that the trust acts quickly to take the action required to safeguard the future clinical and financial sustainability of the Trust. This appointment, which was made after a competitive process, is required to provide additional expertise and impetus to the changes we need to make, whilst allowing others to remain focused on delivering the healthcare services that the people of Rotherham need and deserve.”
I do not stand here and support the way the NHS has been structured now or in the past, and I have been critical about many areas of that. I agree with the chief executive of the NHS, David Nicholson, who said at the NHS confederation conference this year:
“We need to change the model of care to one which supports patients and focuses more on preventing ill health from happening in the first place...and move away from the default position of getting someone into a hospital bed.”
At the same conference the then Health Secretary said that closure decisions were not an issue for national politicians, and my right hon. Friend the Member for Leigh said that the current Health Secretary said very much the same thing—“It’s nothing to do with me, guv.”
Let me say to the Minister, and other hon. Members who have made relevant interventions, that if changes and reconfigurations inside the national health service are getting better care to more patients, that is fine. However, the chaos in my local health service is about cutting back and saving money. I have played an active role in health care in my constituency over many years and, as far as I know, there has been no debate with local Members of Parliament, patients, patient groups, local doctors or people engaged in health provision in Rotherham. There have been no discussions whatever about reconfiguring the district general hospital to improve the position of patients and of the people of Rotherham and the surrounding area. Instead there is a drive to save money, which is creating chaos in my local health service.
Norman Lamb
Does that not demonstrate a complete failure at local level to address the real problems that we are trying to grapple with? There is therefore a case for a changed system whereby a health and wellbeing board brings all the parts of the system together to debate such issues.
Mr Barron
The events of the past two months suggest to me that the people in whom the Minister has faith to reorganise health care in Rotherham do not know what they are doing. They have brought in new systems and produced a report inside the hospital, which I understand was given to the trade unions. It ended up on the front page of a local newspaper and was countered by a press release by the hospital itself. Where is the debate about improving health care for my constituents and others? It is absent.
I say to the Minister that it was wholly wrong for the previous and current Secretaries of State—he is not the Secretary of State himself, but we never know, he may be one day—to say “These are not matters for Ministers”. I have not been consulted about them. The three local MPs had an appointment with the chief executive of the trust about two weeks ago, but it was cancelled because he had announced his retirement the week before. That is not acceptable.
The hard reality on the ground is that no matter what we would like to happen in health care, trusts are charging into cutting budgets. They are cutting jobs, because that is where the major expenditure is in health care, and that is creating the chaos that I have described. It is not acceptable. My constituents pay their taxes to pay for health care—it does not come out of the budget down here in Westminster—and they deserve better than what they are getting at the moment.
John Pugh (Southport) (LD)
While you were not in the Chair, Mr Speaker, you missed a lively and interesting but predictably arid debate. We have reached a kind of stalemate. Those who understand the dark art of political messaging tell me that it is important to say the same things again and again, and psychologists tell me that those who do that are more likely to be believed. Prior to the election, the Tories were unique in having as an important part of their messaging the wish to ring-fence and preserve NHS spending.
That message was then embodied in the coalition agreement and has influenced subsequent spending decisions. We all recognise that there are good reasons for that—the NHS is a demand-led service. It is therefore perfectly sensible, in the Westminster bubble, for the Opposition to make an issue of it. Members have come to the debate with predictable information from the Whips-SpAd axis about the private finance initiative, the misdemeanours of Wales, evidence of unexpected service rationing, reconfiguration trouble, positive and negative variations in waiting lists and ambiguous data on productivity. We have all been given that stuff, and we can use it as we wish.
Meanwhile, the public have clocked that we have a real problem. The demands on and expectations of the NHS will continue to rise, resources are tight and there will potentially be a huge problem. They know that politicians cannot be seen to reduce the NHS offer—they simply would not tolerate that. They do not know quite how all the sums will ultimately stack up, and nor do we. That is the big question.
Andy Sawford
Will the hon. Gentleman accept, though, in the interests of being transparent with the public, last week’s letter from Andrew Dilnot, the chair of the UK Statistics Authority?
Andy Sawford
The letter stated unequivocally that
“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”
Until both Government parties acknowledge that truth, which independent experts have told us about, they will not have any credibility in health debates.
John Pugh
I think I will take the advice of my hon. Friend the Member for Beverley and Holderness (Mr Stuart) and move on.
I think we all agree that the only acceptable answer to the problem is to spend public money wisely. Currently, the NHS is holding up—sort of—by making economies and savings, largely off the back of a wage freeze, which is not sustainable. However, I am starting to be alarmed by the disagreement about what else we can do and what strategies we should follow. I will run briefly through the suggested options.
It has been suggested that we should keep people out of hospital, but we already have fewer hospital beds than almost anywhere else in Europe, and according to the NHS Confederation there is no clear evidence that treating people outside hospital would necessarily be cheaper.
Some people recommend personalisation and personal budgets, but it can be argued that that would not lead to better use of scarce resources, despite the fact that it would be more popular than some current service configurations. Telehealth has also been suggested, and I am a great enthusiast for it—it is my personal favourite suggestion, and I am chair of the all-party telehealth group. However, although there are cost-effective pilots, the Nuffield Trust has expressed some criticism of telehealth, saying that it may not save us anything like the money that we believe it will. The industry itself is concerned that if the roll-out is not efficient and effective enough, telehealth simply will not take off.
Mr Dorrell
I am listening carefully to my hon. Friend, and I have some sympathy with him, but will he acknowledge that the arguments for those options are partly about health economics but partly related to the need to deliver better quality to those who rely on community-based services? We do not want acute cases if they are avoidable.
John Pugh
I agree; none the less, we both agree that there is still a huge economic problem.
Even reducing the number of managers has mixed impacts, because asking doctors to manage services or buy in management service from elsewhere has cost implications. It uses up medical time, which needs to be replaced. Then there is the blighted history of IT and the uncertain role of technology and innovation, which can increase demand but also reduce cost. Even if we see public health as the answer, it is still not a complete answer by itself, because if we do not solve the huge problem of dementia, there is no saying that prolonging life and keeping people fit will necessarily reduce overall costs in the long run. If we look at things such as rewarding doctors through the quality and outcomes framework, and so on, we find some pretty expensive deployment of public money, albeit not always to massive effect. The point I am trying to make is that there is a whole medicine chest of remedies available, but no complete agreement on precisely how or where best to use them. None of them seems to be a cure-all, and many have undesired side effects.
As we choose to use those remedies, they need to be employed with skill, judgment and the benefits of experience, because we are dealing with an almost insurmountable problem. We have to approach the problem—almost like good medicine—using the right remedy, at the right time, in the right way and with skill, judgment and experience. However, that will not result simply from using market forces or creating some sort of ersatz market—that is just another tool we might choose to use. What we want—I am sure the Minister agrees—is integrated services, which would avoid expensive duplication, cost-shunting and piecemeal provision. It would be really nice if we could exploit better economies of scale in procurement, for example, or make better use of the NHS estate. It would be nice if we could discover good practice and roll it out across the piece quickly. It would be really nice if the NHS was a well oiled and efficient machine—a truly integrated system with proper clinical networks that were properly protected. It would be nice if we got what the Minister describes as integration, which is a kind of holy grail at the moment.
However, I have a problem—I am sure the Minister has a response to it—in that we have just abolished what I think would be the best agency for integration. The strategic health authority, unloved as it was—a bit obese, misunderstood, and so on—was a vehicle that could perform that role, applying the right remedies in the right place. I must own up: we decided in the Lib Dem manifesto that we wanted to get rid of the SHA. However, perhaps over the fullness of time the NHS Commissioning Board will create something like that—quietly, privately—because to some extent, I think we all agree, it is needed. Meanwhile, there are key things we need to get on with. We can certainly improve procurement without any difficulty. We can try to release ourselves from the pointless grip of the EU working time directive, which adds appreciably to salary costs. We can also work hard to move data around the system better. There is an enormous amount to do and it is not obvious who is going to do it.
Ann Clwyd (Cynon Valley) (Lab)
I am not going to make a speech as such; I am just going to read some quotations from the hundreds and hundreds of personal testimonies that I have received in the last few days.
“I am a former director of nursing at a university teaching hospital…Since my retirement…there have been four occasions when it was necessary for me to visit family and friends in hospital. Each visit resulted in a serious formal complaint about the standard of nursing care and medical diagnosis, experiences that have caused me to be ashamed of the profession I was once very proud of.
In the first incident a friend, dying, was left sat in a chair at visiting time with no pyjamas and his genitals exposed. On making inquires we were told that no clean pyjamas were available.
My mother was in hospital suffering from a bladder infection some weeks after bowel surgery for cancer…When we arrived she wanted to use the toilet, having asked for help several times. We found her being completely ignored so I took her to the toilet myself. On our way there she could not hold the flow of urine, most of which poured onto the floor of the ward. Naturally she felt ashamed, embarrassed and humiliated. At that time, and in full view, not one nurse was attending patients at their bedside and we counted eight nurses and a doctor doing nothing at the nurses station. My family insisted that mother be transferred to another hospital where within two hours she was diagnosed with malnutrition and dehydration—mother had been in the previous hospital for three weeks! Unfortunately the new hospital, a few days later, ran out of colostomy bags and just left mother in a faeces-covered bed.”
Another statement says:
“I was trained as a nurse myself when I was young, and subsequently retrained as a Community Worker and then a Social Worker. I worked in community care Social Work for 20 years. I also witnessed many incidents of inhumane treatments in hospital settings whilst working in Community Care…My… father was admitted to hospital due to some long standing serious bowel problems...Not long after being admitted, my father contracted C. difficile, from which he did not recover. He was frequently left lying in his own faeces. His basic care needs were neglected on every level, and he was made to feel guilty every time he soiled the bed. He developed such severe Thrush in his mouth, he was unable to eat or wear his false teeth. Despite numerous requests for treatment, it was never treated. I also tried numerous times to have him transferred to the small local hospital for palliative care as it was obvious to me that he was dying, but the staff insisted that he was NOT terminally ill…In the end, I DID stand in the corridor in desperation and virtually scream. I shouted at the nurse in charge, ‘The treatment of my father is f***ing inhumane’ and demanded that he was moved for palliative care…This happened after I found my dying father lying half out of a chair with freezing cold bare feet and one light blanket in late afternoon. According to other patients he had been sitting there since early morning. (It was easier for nurses to clean him up if he soiled himself in the chair, although they used the excuse of it being good for him.) He died in the small local hospital 3 days later. The staff there said his bed sores were so extensive and severe, there was nothing they could do for him. They kept him comfortable, and thankfully allowed him to finally die with some dignity and tender, loving care. However, by this time, my beloved gentle father had endured 3 months of indignity, abuse and misery.”
Another testimonial said:
“Your story was so similar to the loss of my dad exactly 2 years ago in our local hospital…he had worked from the age of 14 until his 65th birthday, he was in the RAF in the war and he was treated in the most dreadful way by most of the nursing staff, doctors and administrators at the hospital. We became frightened of pushing them to be kinder whilst he was in their care, in case, if possible, things became even worse. Surely something must be done about this situation. I could hardly believe my ears the other day when a representative of the nursing profession was saying they are pushing for an emphasis on compassion and consideration in nursing—when did this disappear? I would have thought it was part of the human condition to want to care for and help a person or a creature who is suffering.”
Another letter says:
“My friend and I have both experienced appalling neglect and abuse to close relatives at the hands of NHS nurses (at completely different hospitals—one in the Midlands and one in Surrey) who received no dignity or care right up to the moment they died…We find it equally sickening when we hear people…describe nurses as ‘Angels’! We also have to endure the continual mythology surrounding Nursing as a profession, e.g. ‘it’s low paid, low morale, poor staffing levels etc.’—when in reality nursing pay scales have increased dramatically over the last decade and it is now a well paid profession compared to many other jobs like hospital porters., and crucially, even if there is genuinely low morale it never excuses such blatant cruelty.”
Another letter read:
“When I sat at my husband’s bedside I did wonder…why some of the so called nurses bothered to put on their uniforms. The arrogance and indifference of some left me bewildered. The Ward Sister of the ward my husband had the misfortune to be sent to after the excellent intensive ward did not bother to speak to me for the whole 17 days he was on her ward and I am told that she was so busy running the ward she did not have time to talk to relatives…As a Doctor said in an article in the Daily Telegraph a few weeks ago since they made nursing a degree course the wrong kind of people are entering the profession and they think they are above the menial tasks that the old fashioned nurses undertook from day one. We do not need a load of snooty nosed pen pushers, we need compassionate nurses who are entering the profession because they care for people not for the salary.”
Another letter read:
“My father, who was a GP…had a severe stroke. He went to hospital and they would leave the food in front of him to ‘look at’. He was paralysed and could not use his arms or legs. If we were not there, he would not be fed or given any fluid. Then they didn’t pull the side gates up on the bed and he fell out and broke his femur.”
Another letter read:
“I feel that indifference by nursing staff to patients’ suffering and needs is all too common, and those nurses who show kindness and take time with their patients stand out as the exception.”
Another letter read:
“I do know how understaffed the nurses were in my mother's ward but I found a dismissive attitude from all levels of medical staff including nurses, consultants, surgeons and ward orderlies. Nobody cared about our mother or took a moment to get to know her. I barely managed to keep my temper, fearful that an angry outburst from me would rebound on my poor mother. Cruelty, indifference and a cavalier attitude to my mother's care marked her final weeks of a long life in which she devoted herself to the care of others.”
I ask the Secretary of State: what is going wrong?
Stephen McPartland (Stevenage) (Con)
Thank you, Mr. Speaker, for giving me the opportunity to contribute to this important debate. Let me first pay tribute to the impassioned speech made by the right hon. Member for Cynon Valley (Ann Clwyd). The tales that she told almost left me in tears, and it is hard to imagine how difficult it must have been for her to read so many stories of that kind, given the unfortunate position in which her own family have been. I know that there are a number of nurses in the Chamber today, and in my constituency, who would be horrified to hear what happened to those individuals, and to the right hon. Lady’s family. No one would want anyone to be treated in such a manner. I think that her speech illustrated the difficulties involved in arguing about whether 0.1% is an increase or a decrease, and underlined the fact that today’s debate should focus on whether or not we provide good-quality patient care.
Sarah Newton (Truro and Falmouth) (Con)
Will my hon. Friend join me in praising NHS members of staff, including nurses, who are brave enough to come forward and express concern to the senior management of hospitals and in other settings when they see that their colleagues are not putting patient care first and are providing poor-quality care, so that appropriate action can be taken and atrocities such as those about which we have just heard can be prevented?
Stephen McPartland
I entirely agree. My hon. Friend has made an important point about the courage of staff whom many would describe as whistleblowers, and who are getting into a great deal of trouble not only with their management for casting light on what is going on in a particular hospital, but with their colleagues for telling tales.
I am proud of the NHS, I am very proud of the staff who work in it, and I am proud to have the Lister hospital in my constituency. We have heard much impassioned talk about the NHS throughout the Chamber today. I think it is fantastic that Members on both sides of the House, and all Members individually, do all that they can to improve the NHS and the service with which their constituents are provided on a day-to-day basis. I know how proud I am of the doctors, nurses and clinical staff who save lives every day in my constituency, and I know that the headlines only appear when things go wrong.
In my constituency there is an organisation called POhWER that provides an advocacy service to some of the most vulnerable individuals who are having difficulties with the NHS. It now has contracts for London, the south-east, the midlands and the east of England. It was created many years ago by a group of service users who were severely disabled and had difficulties daily in interacting with their NHS and other services. They created this charity and are its trustees. It has helped hundreds of thousands of people. It launched a telephone service in the middle of last year, and it has already received 30,000 telephone calls. I had the great pleasure yesterday of taking those involved to see the Minister with responsibility for charities, The Party Secretary, Cabinet Office, my hon. Friend the Member for Ruislip, Northwood and Pinner (Mr Hurd), to demonstrate some of the work they are doing.
Every Member, irrespective of party, wants their NHS to be the best it can be and to provide the best possible care to their constituents. We can all make political points, and my hon. Friend the Member for Southport (John Pugh) referred to the fact that the Whips on both sides put out lots of statements for us to use to attack each other. We could argue that spending in the health service in Wales is going down by 8% under the Labour Administration there, but I do not want to put that case.
Instead, I want to say how much I respect the right hon. Member for Leigh (Andy Burnham). It was refreshing to hear him say he felt he did all he could in terms of NHS spending given the constraints of the budget he had. I do not want to cast political aspersions, because I have a great deal of respect for the right hon. Gentleman. I believe he wanted to improve the NHS every bit as much as our Secretary of State and Ministers want to do so. I dearly wish the NHS was not a political football and we did not bandy about figures and information.
A great deal has been said about the first and second part of a sentence in a letter from Mr Dilnot. I have read the letter. I imagine most people would not really care about whether 0.1% less or more money was going into the NHS. They are interested in the fact that £12.5 billion extra is going in over this Parliament. The Health Committee Chairman, my right hon. Friend the Member for Charnwood (Mr Dorrell), made a powerful and eloquent speech—it was far more eloquent than mine. He explained that revenue expenditure has been growing modestly over the past couple of years, and that is the expenditure that the day-to-day care delivered to patients in the NHS comes from.
Nigel Adams (Selby and Ainsty) (Con)
Does my hon. Friend accept that there is discrimination against certain parts of the country, such as rural constituencies, including mine in North Yorkshire? As my constituency is rural and has a lot of elderly residents, we do not seem to get our fair share from the funding formula.
Stephen McPartland
I do not represent a rural constituency, but I think everybody in every part of the country should have access to the best possible heath service and there should not be any postcode rationing issues. My hon. Friend’s constituents should have access to the best NHS care; indeed, I hope it is almost as good as the care my constituents get.
NHS spending should be focused on improving the quality of care and the experience of patients and their families. We all know that things go wrong, and one of the problems is that when things go wrong, doors get closed and people feel very vulnerable and lonely. People put their mother, father, brother, sister, son or daughter in the hands of someone whom they consider a professional, and they place their trust in them. I hope all of us feel able to put our trust in those professionals.
Gloria De Piero (Ashfield) (Lab)
In Ashfield, there are proposals to close down wards at the community hospital. If the closure goes ahead, the situation will be particularly difficult for some patients who suffer from severe dementia, as their relatives will have to travel 17 miles to see them. Does the hon. Gentleman agree that that is unacceptable?
Stephen McPartland
I understand that the hon. Lady has a specific issue in her constituency, and I would like to point out one in mine: anyone in my constituency who requires radiotherapy treatment has to travel to Hillingdon in London to have access to the linear accelerators, with the typical journey being more than 4,000 miles during the course of the treatment. I do not want to blame any particular Government or party, but the reality is that there are difficulties everywhere. I have a campaign, which I would love all hon. Members to join, to bring cancer care closer to people’s homes, and I want to have a radiotherapy unit based in my constituency. There are discrepancies and disparities all over the country, and it would be great if we could iron them out.
Grahame M. Morris
Does the hon. Gentleman agree that a good use, not only in Stevenage, but across the country, of some of the underspend that has been mentioned by hon. Members from across the House would be to buy advanced forms of radiotherapy equipment?
Stephen McPartland
That would be fantastic use of the money, but Hillingdon already has eight linear accelerators and a cyber knife, which reduces the course of someone’s treatment from about 25 visits to eight. The key for my constituents is that the people accessing that service are generally elderly and they would have to access it by public transport, which they find very difficult, so they rely on friends and family. I want that treatment to be brought closer to their home, which goes back to my point about the patient’s experience.
Earlier in the debate, Mr Deputy Speaker called for a little bit of Christmas cheer, so I have great pleasure in being able to announce that earlier this morning, when it was minus 6°, I was outside my local hospital having my photograph taken and the Government were announcing £72 million of funding for infrastructure in the Lister hospital—the money is part of an ongoing investment programme worth more than £150 million. That is the third of 11 projects. We are having a huge accident and emergency department rebuilt, and a lot of people are going to be accessing it; and we are having new ward blocks, theatres and endoscopy units. A huge range of services are coming to the Lister hospital in Stevenage; it is fast becoming a centre of clinical excellence. I know that many hon. Members think I am quite lucky, and I am very proud and happy about what is happening.
That investment highlights one of the issues I want to raise. When we have these debates, we often find that the passions of hon. Members on both sides about small amounts and figures can create a sense of fear in the NHS that services are being delivered poorly day to day. In my constituency, for the past two years, construction has been going on and new services have been coming to my local hospital, with a range of users able to access them. That building will go on until 2014 to early 2015, and it is what we are calling phase 4. I refer to my radiotherapy campaign as phase 5—people are not aware of that, but we are keen to access the money for it. The hon. Member for Easington (Grahame M. Morris) suggested using the £1.6 billion underspend, and it will now be my target for where we get the funding.
In my constituency, the NHS is daily delivering better and better care; a legion of doctors, nurses and clinical staff, backed up by great administration staff, are providing a fantastic level of service and improving the NHS. I am proud of the NHS and of the staff in my constituency who work in the NHS, and I am delighted that we have had the opportunity to have this debate.
Heidi Alexander (Lewisham East) (Lab)
It is a pleasure to follow the measured and thoughtful speech that the hon. Member for Stevenage (Stephen McPartland) has just given. May I also put on the record my tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd) and the vital work she is doing, at what must be an incredibly difficult time for her, on putting the importance of care and compassion back at the heart of our NHS?
I wish to focus on the current threats to NHS services in south-east London. My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) has already spoken about the threats to Lewisham hospital and the plans on the table, and I am going to treat the House to my own concerns about that matter. We are rightly debating national expenditure levels on the NHS today, but the harsh reality in Lewisham is that my constituents are confronted with the fact that their local accident and emergency and maternity departments may have to close in order to deal with financial pressures elsewhere in the NHS.
The Government can claim all they like that they are investing in the health service, but it does not feel that way in Lewisham. Last Friday, along with local doctors, my right hon. Friend the Member for Lewisham, Deptford and my hon. Friend the Member for Lewisham West and Penge (Jim Dowd), I presented a petition against the closure of Lewisham’s A and E and maternity departments to No. 10 Downing street. As has been said already, in five weeks the petition has been signed by more than 32,000 people. The proposed changes at Lewisham hospital are not only unwanted, but arguably unsafe and unjustified.
Lewisham is a busy hospital. More than 120,000 people visit the A and E each year and last year more than 4,000 babies were born there. Lewisham is a place where average life expectancies for both men and women are below national averages. Sadly, it is a place where sometimes, admittedly infrequently, a stab victim will walk into the A and E from the streets and a place where many teenage girls will give birth to their babies.
The A and E and maternity departments at Lewisham hospital are a matter of life and death for many of my constituents. I am therefore not surprised that more than 32,000 people signed the petition to keep a full A and E and full maternity service there; I am also not surprised that more than 100 local GPs, including the chair of the new clinical commissioning group and the head of every single clinical group at the hospital, have written to the Prime Minister to express their concern about the proposals.
The question for the Minister today is: will the Government listen? Will the special administrator to the South London Healthcare NHS Trust, a man appointed to sort out financial problems in neighbouring hospitals, think again about his plans for Lewisham when he draws up his final recommendations to the Secretary of State for Health?
I do not think that anyone can be under any illusion about the degree of local opposition to closing the A and E and maternity departments at Lewisham. I recognise that trying to balance the books at the South London Healthcare NHS Trust is a hard job, but asking a hospital that is not even part of the trust to pay such a heavy price seems patently unfair.
The plans for Lewisham are based on inaccurate data and flawed assumptions. The size and nature of the caseload at Lewisham’s A and E have been misunderstood. The estimated additional journey times to neighbouring hospitals have been woefully underestimated, yet the speed with which it will be possible to reduce the need for hospital care seems to be hopelessly optimistic and based more on wishful thinking than on hard fact.
Those are not the only problems with the proposals. I also cannot see how the current plans make financial sense. In the past week, we have had—even though the Government dispute this—independent verification that there has been a real terms reduction in spending on the NHS in the past few years. Surely it then becomes all the more important that every pound spent is spent wisely and well. How can it be wise to sell off more than half the Lewisham site for £17 million only to have to reinvest £55 million in reconfiguring the remaining buildings on that site to do different types of work? Why sell off the existing buildings, only to shell out money at other hospitals to increase capacity to enable other parts of the NHS to do the work that Lewisham is already doing very well?
The 4,000 babies who are born to Lewisham mothers every year will have to be born somewhere. Where? There is no free capacity in the system at the moment, so that will require investment. Where are the people who use Lewisham’s A and E going to go? We have all seen the reports of more and more ambulances queuing outside hospitals, with patients waiting to be taken into A and E but being kept in the ambulance because of a lack of space.
It is asserted that in Lewisham, if the proposal to close the A and E went ahead, only one in four people would have to go to other A and Es, while the other 77% would still be treated in the urgent care centre that would remain. That figure is fanciful. The emergency doctors at the hospital say to me, based on their analysis of patient numbers and the nature of the work that they do, that just 30% of people could still be treated at the urgent care centre.
I accept that the NHS cannot be preserved in aspic and I understand that it must change to meet the demands and challenges of the 21st century. However, those changes must be driven by patients’ health needs, not an accountant’s bottom line. That is not what is happening.
Nick de Bois (Enfield North) (Con)
The hon. Lady may be aware that we have had a long fight against the downgrading of my hospital, Chase Farm. Many people think that that fight is over, but I do not. With the new demographic figures and population increases in London, it is important that we continue to press authorities and Ministers to take these things into account, even at this late stage, because where people go is even more of a priority than she assessed it was before the figures came out.
Heidi Alexander
The hon. Gentleman is completely right. Lewisham’s population is growing, and has increased by 10% in the past 10 years. All the indicators suggest that London’s population will continue to grow. It is a diverse population with varied health needs, so it is imperative that people in our capital city can access high-quality services close to home.
In conclusion, before the election, the Prime Minister told us that he would cut the deficit and not the NHS. In 2007, he promised a bare-knuckle fight over the future of services at Lewisham hospital. How times have changed. He has broken his promises on NHS spending and he has broken his promises about Lewisham hospital. If anyone needs proof that the Government cannot to be trusted with the NHS, they need look no further.
Andy Sawford (Corby) (Lab/Co-op)
I am grateful for the opportunity to speak in a debate that is incredibly important to my constituents. I thank my right hon. Friend the Member for Leigh (Andy Burnham) for opening the debate. He is aware of my grave concerns about the future of hospital services that serve people in Corby and east Northamptonshire.
It has long been the ambition of people in Corby—a large, important town that is growing—to have their own hospital. I hope that in future we can realise that ambition. For a long time, however—and for the foreseeable future—we will be served by Kettering general hospital for most of our hospital needs. At Kettering general hospital there are 650 beds and more than 3,000 staff. The hospital is more than 115 years old, and received massive investment, including under the Labour Government. I make that point not so much politically point but as a local person who remembers driving down Hospital hill in Kettering and seeing the fundraising barometer outside the hospital and wondering why we relied on car-boot sales to fund vital hospital services.
My right hon. Friend the Member for Leigh, a former Health Secretary, and his predecessors began to put that right, and there was huge investment. Kettering general hospital now has 17 operating theatres and an obstetrics unit that delivers more than 3,500 babies a year. It has something that serves only a few of my constituents but is incredibly important to all of us—a neonatal intensive care unit, or special care baby unit. My own family has had cause to be grateful to that unit and its brilliant staff.
Kettering general hospital offers a 24-hour accident and emergency service, with level 2 trauma services, which sees more than 2,000 trauma patients a year. There are concerns, however, and I have agreed with the hospital and local people to champion certain issues in the House as the local Member of Parliament, including per capita funding of Kettering general hospital, which we believe is inadequate and lower than average compared with other areas. With a growing population and growing health needs, that must be addressed.
Recently, a report on the hospital by Monitor raised serious concerns, particularly about accident and emergency. I have met the hospital chief executive and the chair of the trust to discuss those concerns, and to assure them that I will seek to do whatever I can, including making sure that a case for adequate funding for the hospital is made, so that those concerns are addressed.
The big issue that causes us all concern locally is a major review of health services—the kind of review that other Members have experienced in their areas. In Kettering, the Healthier Together review of five hospitals has already cost more than £2 million; that was the figure in the summer, and I have no doubt that it is rising rapidly. The review has also taken a great deal of time and effort. In early September, together with local nurses and others, I met the people leading that review, as a public member of the trust, and I was incredibly worried about what I heard, both as a user of the services, and as a representative of local people.
The Healthier Together team gave us a pledge card telling us about their plans and giving us some assurances. The context was also set. We were told that the review was driven by a desire for the best clinical outcomes, by expertise, and by research on how local people could be provided with the best health care. We were told that there were considerations to do with more services being provided in the community, and a shift to prevention, which are things I recognise it is important for our local hospital and its partners—the clinical commissioning group and the other hospitals—to consider.
It was slide 2 that really got to the heart of the problem. It told us that the five hospitals face a combined funding gap of £48 million, and that my local hospital, Kettering general hospital, faces a future funding gap of £6 million a year. I have no doubt that the comments that Andrew Dilnot recently made about the real-terms reduction in funding are very much connected to that, but I do not want to make that wider political point again; it has already been made eloquently by my right hon. Friend the shadow Secretary of State. I simply say that all local people recognise that resources are getting tighter and tighter at the hospital.
Norman Lamb
Does the hon. Gentleman share my view that in many local health economies, private finance initiatives are causing a massive strain on resources?
Andy Sawford
I want to keep my remarks to Kettering general hospital, and I do not think that PFI is the issue there.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
The hon. Gentleman mentioned the Healthier Together programme; it is clear that many of the hospitals in that programme have very high PFI debts. We will get the figures for him, to clarify that, in the closing remarks.
Andy Sawford
A few weeks ago, the hon. Gentleman—I am sure that he had no intention of misleading the House—talked about the funding issues at Kettering general hospital being driven by PFI deals in Anglian hospitals, which are not really part of the group that I am talking about.
Andy Sawford
I will not give way; I want to make important points for my constituents. It is important that these things are put on record, so I shall not be giving way to the hon. Gentleman again. He has not done a great service to people in my constituency in the way that he has addressed these issues.
Mr Andy Slaughter (Hammersmith) (Lab)
I had the pleasure of visiting my hon. Friend’s constituency earlier this year, and I am sorry to hear about Kettering. Both the accident and emergency departments and one 500-bed hospital in my constituency are due to close. Neither of those A and E departments is PFI, and none of the four A and Es closing in west London is PFI, so is that point not a complete red herring?
Andy Sawford
I have had some experience of my hon. Friend in the past, and as ever, he talks a great deal of sense. Certainly, in Kettering, we are looking at something driven by funding cuts.
I want to address the issues, because I seek real answers from the Front Benchers, and real assurances about the future of my local hospital. Healthier Together has assured us that no hospitals in the group of five of which Kettering is part will close. I have never heard any claims that those hospitals will close. The local media have been very clear that they are not aware of any assertions that Kettering hospital will close. There has, at times, been the presentation of an Aunt Sally by some of my political opponents, who have sought to say, “The hospital won’t close, so there’s nothing to worry about.”
Let us be clear what is being talked about. The Healthier Together review had six different models, and it has refined that to two options. The status quo is very clearly not an option, and it is not consulting on it. One of the two options would see five hospitals going into three for some of the services, though all the hospitals would remain open and provide some services. The services that are at real risk in two of the five hospitals include in-patient paediatrics. Last year I took my son, who had pneumonia, late at night to the Dolphin ward at Kettering general hospital. It concerns me deeply that paediatrics might not be there. I would have had to go elsewhere, and so will local people in the future if the paediatric ward goes.
Under the proposals, obstetrics would go at two of the five hospitals and be replaced by a midwife-led unit. People in Corby have experience of a midwife-led unit. At one time there was a births in the community facility in Corby, as there still is in some other smaller midwife-led hospitals around the country. Where those exist, if local people want them to continue, they should have that opportunity, but we have a full maternity service in my area and people are very concerned that that could be lost under the proposals.
I have talked to midwives who tell me that during labour it would not be possible to give an epidural, for example, if the labour became more painful for the mother. Among my family and friends, I have heard about people who hoped their children would be born at Melton hospital, which is a midwife-led unit, describing the worst hour of their life as following a blue light on an ambulance taking their wife and hoped-for child across to Leicester royal infirmary or another available hospital so that the care that was needed could be given. We want our proper obstetrics-led unit to remain and we do not want it downgraded to a midwife-led unit.
At two of the five hospitals, trauma services would be lost. I have already described how Kettering general hospital provides level 2 trauma and treats more than 2,000 trauma patients a year.
As to where we go from here, it is important for Healthier Together and the Government to be honest about the proposals. It is important for geography to be recognised as a critical factor. Healthier Together will talk about the clinical evidence and the clinical drivers, but it must recognise that local people are very concerned that Luton and Dunstable hospital is 50 miles away, and that the nearest hospital in the group is 45 minutes away from Corby at Northampton along a very busy road. The journey takes 45 minutes at the best of times; the road is seriously in need of upgrading and improving. People are really concerned about the geography, and that has to be balanced with specialisms which people understand. There are already specialisms in our local health care system at other hospitals.
I am pleased that despite the empty assurances from Government Front Benchers, the hon. Member for Kettering (Mr Hollobone) had the courage to raise these issues on 9 November—notwithstanding the by-election inconvenience for Government Front Benchers. I now look to work with him as we seek real assurances from the Healthier Together team and from the hospital that they will not proceed with the proposals if they mean that we will lose all those vital services for my constituents.
Julie Hilling (Bolton West) (Lab)
I am confused: the Government continue to state that they are increasing health spending in real terms; the UK Statistics Authority says that expenditure on the NHS in real terms was lower in 2011-12 than in 2009-10; the Government say that that is not true and that they are still spending more. Of course, they have wasted millions on their top-down reorganisation, which has seen the biggest shake-up of the NHS since its inception.
However, the people of Bolton West are pretty clear in their beliefs. Their local health services are being cut. They know that their local hospital has faced 5% cuts each year since 2010, and they know that it has been told to save £50 million over the next three years—a sixth of its budget. They see no growth, only cuts. We all know that the Royal Bolton is in a mess. Some of that is of its own making; contracts were signed that repaid less money than the cost of treatment that the hospital is outlaying, and it has faced fines for missing targets, such as £4 million for missing its clostridium difficile target.
That seems utterly mad to me. On the one hand the Government say, “Your treatment was inadequate.” On the other hand, they take a fine of £4 million from the hospital, taking that money from the health care of my constituents, which must make that treatment more inadequate. The Royal Bolton has a new leadership in place and I am confident that it will turn around financial and clinical control in the hospital, but faced with £50 million-worth of cuts, services will have to be reduced.
Already, 7% of patients are having to wait longer than 18 weeks for treatment, and more and more people are having to wait longer than four hours in accident and emergency—and of course that will lead to more fines, which seems nonsense to me. Royal Bolton hospital will have to shed between 300 and 500 jobs. Of the positions at risk, 146 are for nurses, midwives and health care assistants, 20 are medical and dental, 93 are for technicians, scientists and clinical support staff, 193 are for non-clinical staff and 45 are in estate facilities.
The Government parties would like us to believe that hundreds of public sector workers are sitting around and doing nothing, but the hard-working nurses, porters, cleaners and—yes—administrative staff across the NHS utterly disagree. If the Government cut a job, they cut the work that that person was doing, so there must be a reduced service. My constituent Colin was admitted to Royal Bolton hospital for four nights with a strangulated hernia. He told me that only one nurse was on duty for the entire ward for the 12-hour shift from 7 pm to 7 am, and she often had to leave the ward to help a colleague in a similar position on an adjoining ward. Owing to staffing levels, patients were woken in the middle of the night for their medication and blood tests. Colin was full of praise for the hospital staff, who were determined to do their best and apologised profusely for having to wake patients. He told me that he feels that their dedication and commitment are being seriously compromised by Government cuts.
It just does not make any sense to me. The Government are adamant that they are spending more on the NHS, but every Opposition Member looking at local provision sees cuts, so where is the supposed increase in spending going? It is certainly not going to Bolton or Wigan, and it does not seem to be going to any of the areas represented by Labour MPs, but I cannot believe that the Government would be so cynical as to put money into the more affluent areas represented by Tory MPs. Who should we believe? Should we believe Dilnot, the Secretary of State or the shadow Secretary of State, or should we believe our own eyes, which tell us that our local hospitals are undergoing cuts? The 99-year-old man who waited for 75 minutes for an ambulance while bleeding on a cold pavement and the 69-year-old woman who waited for more than an hour while lying in a park with a broken shoulder think that it is the cuts in health services that affected their treatment.
Now, of course, we face the challenge of Healthier Together. NHS Greater Manchester’s review of the area’s health care programme is likely to see the closure of a number of A and E departments across the conurbation. None of us would argue against changes made on the basis of clinical need. Indeed, Bolton has a super neonatal unit, which provides enormous expertise for extremely premature babies across Greater Manchester, and Hope hospital is our neurology and stroke centre. However, I cannot accept changes and closures that are based simply on saving money. For me, it is not about the blue-light service to accident and emergency, because we know that they can travel incredible distances in an incredibly short amount of time; it is about people with broken legs and illnesses who need to get themselves to an A and E and need their families and friends around them.
Owing to the time limit, I will not talk about the funding difficulties for public health and care services. My right hon. Friend the Member for Cynon Valley (Ann Clwyd) talked movingly about what is happening in hospitals, and Members will know about some of the issues that have affected my family directly. However, I will say that the NHS is in crisis, and it does not help when the Secretary of State says that there is no problem and that funding is increasing, because on the ground we see cuts and patients waiting longer. We see patients being neglected and not being fed, and we see an increase in trolley waits and ambulances not in service because they are queuing outside A and E departments. Let us have honesty in this debate. Whatever the figures say, needs are not being met. Action is needed, not rhetoric. Our constituents are at risk. They need the Government to act.
Grahame M. Morris (Easington) (Lab)
I rise to speak in favour of the motion tabled by my right hon. and hon. Friends on the Opposition Front Bench. The Deputy Speaker suggested that we might introduce a bit of Christmas cheer into the proceedings, and the hon. Member for Stevenage (Stephen McPartland) certainly painted a very rosy picture of investment in his constituency. I thought he made a very good speech, incidentally.
In case Ministers are making their Christmas lists, let me tell them that one of the first things that this Government did was cancel a new hospital that served part of my constituency in order to save £464 million. Restoring that funding might be a good use for some of the £3 billion underspend. It was not a private finance initiative scheme but a scheme that was approved by the Department of Health and the Treasury but stopped in the emergency Budget.
I want to concentrate on two specific issues that are directly linked to the motion and on the important question of trust in the Government’s pledge on the funding of our NHS. I believe that the Government are keeping the public in the dark about a range of issues relating to publicly funded contracts delivered by private sector organisations, including on cancer care.
On trust, none other than the Prime Minister broke yet another pre-election promise. Having said before the election that he would extend the Freedom of Information Act 2000 to all publicly funded organisations, he did not do so. As a result, the public cannot access information about private sector providers in the NHS. This does not apply just to the NHS. In his comments, the Prime Minister referred to other publicly funded organisations such as the Carbon Trust, the Energy Saving Trust, the Local Government Association, and traffic penalty tribunals. It is increasingly apparent that many of the large corporations that apparently enjoy cosy relations with this Tory-led Government are extremely anxious that the Prime Minister does not extend the Freedom of Information Act to them. Currently, it instead allows them to hide behind a cloak of commercial confidentiality as billions of pounds of taxpayers’ money are awarded to them in barely transparent contracts. The public are deliberately being kept in the dark, and I have no doubt that an expensive lobbying campaign is under way to ensure that the Prime Minister and the Tory party do not change their minds on this issue.
Meanwhile, private companies benefit by gaining intimate knowledge of public sector bodies through their own submissions of freedom of information requests. That information is then used to undercut or outbid the very same public sector bodies when contracts are tendered or put up for renewal. Members might ask what the relevance of this is in the NHS context, but as someone who worked in the NHS, who is passionate about it, and who has tremendous admiration for the people who deliver the service, I can say that it is a huge concern to me. The area that I worked in—the pathology service that carries out diagnostic tests—is under threat. This huge uncertainty continues, and we need to know precisely what the position is.
Virgin Care, Circle, Serco, Care UK and any other private sector companies awarded a public contract to provide hospital, community or even specialist diagnostic cancer services are not subject to the FOI Act. We have no idea how these companies went about winning those lucrative, taxpayer-funded contracts. Under current arrangements, the best that may be hoped for in terms of any rudimentary accountability is achieved through a Commons Select Committee inquiry of the type conducted by the Public Accounts Committee chaired by my right hon. Friend the Member for Barking (Margaret Hodge). However worthy this process, it is by its very nature very limited in scope, and such inquiries can only ever touch the tip of the iceberg.
This is a national scandal that has prompted me to table early-day motion 773, which has attracted quite a wide range of support, mostly from Labour Members. It calls for the FOI Act to be extended to private sector bidders for public service contracts, particularly in organisations such as the NHS.
My concern is that this has overtones of the Government’s response to Leveson, in so far as I do not believe that the Government want their corporate friends to be accountable to Parliament, even though our public services are being awarded to those companies in ever greater numbers. We should follow the public pound and ensure that we know who is getting it, and how and why they are spending it.
The Secretary of State has said that there will be no large expenditure projects that are not fully thought out and properly costed. That brings me to my second point. Responses to FOI requests from my hon. Friend the Member for Leicester West (Liz Kendall) have made it clear that the Secretary of State is presiding over cuts to essential cancer networks, yet we know that he is planning to spend £250 million of taxpayers’ money on two proton machines, even though, according to the Department of Health’s own report, there is little evidence that they provide any benefit. There are no clinical trial data and no randomised control trials, which are the gold standard by which the National Institute for Health and Clinical Excellence judges the effectiveness of clinical therapies. Indeed, the new chair designate of NICE appeared before the Health Select Committee earlier this week and said exactly that.
The economic justification for purchasing those two machines has been based on informal discussions with the manufacturers who make them. If the machines are to be viable for the two hospitals that are to have them, they will need to treat 1,350 patients a year at a cost of £40,000 per patient. However, according to the Department of Health’s own dataset, the highest number of patients ever treated with proton therapy in one year is 79.
I would like to draw the House’s attention to the situation in Germany, which has invested more than most in proton therapy. Today, two of the three proton machines in that country are being mothballed. In Kiel, €250 million was spent last year on a machine, but it is now being dismantled and put into storage because of a lack of demand.
Ian Lavery (Wansbeck) (Lab)
Can my hon. Friend explain to the House what a proton machine actually is?
Grahame M. Morris
Probably not, in the very limited time available, but I can tell my hon. Friend that proton therapy is a form of advanced cancer treatment.
My argument is that the money the Department is proposing to spend on those incredibly expensive machines would be far better spent on advanced radiotherapy machines such as the stereotactic body radiation therapy machines that the hon. Member for Stevenage mentioned. There are other forms of therapy that are far more cost- effective. I might add that we in the northern region have no access to such therapies. Indeed, whole regions of the country do not.
The one remaining proton machine in Germany is at the university of Heidelberg, and it treats a maximum of 1,200 patients each year. The German Radio-oncology Society has said—[Interruption.] I hope that the Minister will listen to this. The society has said that
“for the vast majority of cancers there is no proof that proton therapy is more beneficial than other forms of innovative radiotherapy that are one hundred times less expensive”.
This proton debacle highlights the perversity with which the Government are running the NHS budget, and these questions lie at the very heart of whether we can trust Conservative promises on the NHS.
The Prime Minister tells the public that by April next year every cancer patient who needs innovative radiotherapy will get it, while at the same time the Secretary of State for Health starves dozens of hospitals and cancer networks of vital money needed to buy innovative radiotherapy equipment. We now know that money is being redirected into those two highly dubious projects. The Secretary of State needs to cancel those projects now and redirect the money into radiotherapy machines that will help tens of thousands of people in my constituency and across the country. This has the potential to be a monumental scandal and a waste of public money. I urge hon. Members who share my concern to sign early-day motion 773, to lobby the Health Secretary and ask him to reconsider his spending priorities in relation to cancer therapies, and to support the motion on the Order Paper.
Mr Deputy Speaker (Mr Nigel Evans)
I call Jim Shannon. I am not putting the clock on him, but he must resume his seat by 4.44 pm.
Jim Shannon (Strangford) (DUP)
Thank you, Mr Deputy Speaker. I have no doubt that I will finish in time.
We are well aware of the pressures in every area to implement Government cuts and how difficult it is to do that. Whether we are in government or in opposition, we all have a job to do in sorting out that problem. In my opinion, there is no worse place to carry out cuts than the NHS. Sick people need treatments that are often expensive and doctors are working out treatment plans and thinking about how they can keep to their budget and provide top-class care. There are pressures on the doctors in the system and they are ever mindful of the budget that they have to work to.
Everyone inside and outside the Chamber is aware of the issues and of the value of the NHS. The debate is about how we can do things better. The Opposition tabled the motion and their concerns have been well rehearsed today.
In my constituency—many hon. Members have given similar examples—a young lady had been unwell for 10 years with ulcerative colitis. She was responsive to her treatment of infliximab, and yet the doctor had to take her off it because it was too expensive and other more serious cases needed the treatment. However, once she was off the treatment she worsened, had to go on the sick and received numerous warnings from her workplace about losing her job. Where would the money truly be saved in such a scenario—stay on the treatment, stay in work, or go off the treatment, go off work?
My mother had a saying—I am sure that many hon. Members will be able to relate to this—“Your health is your wealth.” It clearly is and those of us who are in good health are fortunate.
The right hon. Member for Cynon Valley (Ann Clwyd) is no longer in her place, but she made an excellent, compassionate speech. I think that she probably told the story of this debate in the examples she gave. I told her before she left the Chamber how important it was to have those comments on the record.
It must be remembered that in its review of independent NHS trust three-year plans up until 2014-15, Monitor, the NHS’s economic regulator, warned that cuts were unlikely to be matched by any let-up in the number of patients requiring care. There is an emphasis on preventive medicine and how best to use it. I am sure that the Minister will address how we can ensure that people who are getting older do not succumb to the many diseases and other problems. Sometimes, there is nothing gracious about growing old—it is a fact of life.
The Minister will talk about efficiency savings—they can achieve much—but when I consider the great job that the Northern Ireland Minister of Health, who happens to be a colleague of mine, has done on efficiency savings, I wonder whether the further cuts to Northern Ireland’s block grant will be applied to health again over the next few years. How much more can we save through efficiency? There is a limit—a ceiling—to what efficiency savings can do without affecting health. John Appleby, the chief economist of the King’s Fund think-tank, has said that the outlook for hospitals in 2013-14 and 2014-15 is particularly severe, with anticipated cuts of about 1% when the Government’s inflation forecast is 2.5%. That is a clear difference.
Some hospitals plan to partially offset the radical drop in NHS income by expanding their private patient work, aided, as their financial plans say, by moves to restrict NHS funding for certain surgical procedures. This is expected to fuel an increase in patients funding surgery privately. That greatly undermines what the NHS is about—its very thrust—namely care, no matter the condition, provided by national insurance contributions. As has been said, if we introduce a two-tier care system to operations, how long will it take until we find ourselves providing a system similar to America’s private health care system? How ironic it is that the Americans are attempting at this time to a design a system that is in line with our own NHS. Perhaps we can take some lessons from that.
I also want to comment on the problems that arise when we cut NHS funding. The number of MRSA cases in hospitals has increased. That is not through any particular fault of the staff—I am clear about that—but it is a problem that occurs whenever cost-cutting becomes the No. 1 priority for hospitals. We have to be careful.
We have already implemented cost-saving measures, such as carrying out certain treatments as day procedures followed by care at home, which, as well as being cost-effective, makes a lot of people feel more secure. However, it is essential that the patient is at the heart of any decision made and any strategy must incorporate that. There is a fine balance between cutting costs and cutting care. My fear is that the latest cuts, which will filter through to Northern Ireland through the block grant as a matter of course, will tip the balance for many people.
Many people in my office tell me that they were brought up to respect authority and that if a doctor tells them something, they accept their word. I come across other people who challenge their doctors and push them for the experimental treatment that they know is available, although at a cost, or for a referral to the mainland for innovative treatment. It saddens me that the results differ between those two types of people. In my opinion, it puts our health care professionals in the difficult position of choosing who deserves and who does not deserve the nth degree of care.
Recently in this Chamber I questioned the Secretary of State about the shocking use by doctors of so-called death lists—I am very careful about using that terminology—for elderly people, whereby they withhold certain treatments from those who they believe will die anyway. It is a dangerous precedent to set for the NHS when that can and does happen. If one puts oneself in the doctor’s shoes and realises that the Government are putting a great emphasis on cost, one can see that they are almost forcing that choice. That makes it a little more understandable, but no more acceptable.
As an MP, I have come across many constituents who have come to the mainland to have hospital operations and examinations. We are thankful that we are able to do that, but it involves a cost.
I am not the kind of person who believes that money grows on trees. I wish that it did. I have some trees in my garden, but I cannot find any money on them. We could spend, spend, spend, but I know that we must reduce the deficit. In my opinion, there are other ways of doing so, such as adopting the proposals put forward in the debate in May on the NHS and foreign nationals. To give a brief reminder of that debate, an article in The Daily Telegraph stated that official figures suggest that
“more than £40 million is owed to NHS hospitals by foreign patients who were not eligible for free care”.
It stated that a freedom of information request showed that
“the average unpaid debt for the provision of care to foreign nationals was £230,000 in the 35 trusts which responded.”
The article went on to note that the doctors’ trade magazine Pulse claimed:
“If this figure was the same across all 168 English acute trusts, the total debt would be almost £40 million”.
Perhaps in his response the Minister could give some detail about whether that money has been collected, and if not, when it will be.
In that debate, it was suggested that there should be a £1,000 threshold. Has that been implemented yet? Have those who owe the money been chased down? Has the six-month registration period for a GP been altered? In my opinion, by acting on such matters urgently, we can save money without cutting care. Does the Secretary of State agree that such angles must be pursued if we are to stop cutting services and still save money?
Time has got the better of me, so I will end by urging the Government to look at people and not simply at numbers. If everybody does their job more effectively, we can ensure that all people have top-class care, no matter where they live, without having to pay for it. The NHS is truly a jewel in the crown of this country. Many owe their lives to it and many depend upon it. Let us retain it and build upon it to ensure that in the years to come, it will still be the jewel in the crown that all in this nation cherish, love and depend upon.
Liz Kendall (Leicester West) (Lab)
During this debate, Ministers and the few Government Members who have spoken have either denied that the Government have broken their promise to increase NHS spending or have claimed that it does not matter, as if the Prime Minister’s clear, direct and personal pledge to voters can easily be swept to one side. They—perhaps with the exception of the hon. Member for Southport (John Pugh)—have also skated over or ignored the waste, confusion and utter distraction of their back-room NHS upheaval.
In contrast, Opposition Members have talked about the harsh reality of the double whammy of cuts and reorganisation on their constituencies. My hon. Friend the Member for Lewisham East (Heidi Alexander), my right hon. Friends the Members for Lewisham, Deptford (Dame Joan Ruddock) and for Rother Valley (Mr Barron), my hon. Friends the Members for Corby (Andy Sawford), for Bolton West (Julie Hilling) and for Easington (Grahame M. Morris), and the hon. Member for Strangford (Jim Shannon) spoke powerfully about their concern that changes to local services are being driven by money alone, not by improving patient care. I also pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), who spoke with bravery and compassion about the unacceptable standards of care in parts of the country, which must be tackled.
Perhaps the most worrying example of the combination of cuts and reorganisation that the Government are forcing through involves what is happening to cancer networks. Those groups of local specialists were set up more than a decade ago under Labour’s 2000 cancer plan to help tackle one of Britain’s biggest killers. It is widely acknowledged that cancer networks have played a central role in improving mortality rates, cancer survival rates and equality of cancer care, and they have done that on small budgets with few staff, offering good value for taxpayers’ money. Crucially, the specialist local skills of cancer networks are vital to making even greater improvements that cancer patients need and deserve in the future.
Ministers have repeatedly promised to protect budgets for cancer networks. On 31 January last year, the then Health Secretary told the House that
“cancer networks funding is guaranteed during the course of 2011-12.”—[Official Report, 31 January 2011; Vol. 522, c. 612.]
On 27 November this year in a debate on the NHS mandate, the new Health Secretary told the House:
“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]
Those promises have been broken.
In response to a freedom of information survey from Labour, cancer networks report budget cuts of 13% in 2011-12 alone—[Interruption.] The Secretary of State shakes his head but he can look through all the figures, including individual examples, if he wants to see those cuts. In total, budgets have been slashed by 26%—by a quarter—since the Government came to power.
The Government’s national cancer director, Professor Mike Richards, at least has the honesty to say that
“cancer networks will have a smaller proportion of the budget in future.”
I understand that the Health Minister in the House of Lords, Earl Howe, has also been forced by an urgent question to admit that less money will be available to cancer networks.
Mr Hunt
First, these networks are brilliant. They are a good thing and they have done a huge amount. The Government support them and we are expanding them. That is why instead of just having cancer, cardiac and stroke networks, we will also have networks for dementia and maternity. The budget for those networks is going up by 27%.
Liz Kendall
The budget for cancer networks has been cut by a quarter. The Secretary of State is not expanding those networks but merging them and diluting their specialist expertise, as I will show. The cuts and the Government’s NHS upheaval mean that cancer networks have lost one fifth of their staff, withdrawn or scaled back current work, and put future projects on hold—[Interruption.] The Secretary of State is still denying that so let me tell him what the networks actually say.
The Arden cancer network in Coventry and Warwickshire says that it has lost its vital chemotherapy nurse. The Peninsula cancer network in Devon and Cornwall says it has had to turn down £150,000 from Macmillan Cancer Support to fund a programme for cancer survivors because its future is so uncertain. Essex cancer network says that posts have been removed, its staff are in a redeployment pool, and that it will have
“no presence in Essex from April 1st next year.”
Instead of supporting those vital local experts, as well as specialists in heart and stroke networks, the Government are merging them into 12 generic clinical networks that cover bigger geographical regions and far more health conditions. No one is against sharing the skills and experience of cancer and cardiac networks. However, as Maggie Wilcox, a former palliative care nurse, breast cancer patient, president of Independent Cancer Patients’ Voice and the layperson on the recent review by the Department of Health into breast screening said,
“subsuming cancer networks into generic clinical networks could be disastrous for cancer patients…you cannot be both a specialist and a generalist.”
That is especially important in an area as complex and fast-developing as cancer. Staff will not be able to make the same depth or scale of improvements if they are forced to cover a large area and more conditions with fewer members of staff.
The Secretary of State ploughs on regardless, denying that there is a problem and telling BBC Radio 5 Live that it is too early to know what will happen. How utterly complacent and out of touch. Networks are already disappearing. Their staff have left or are looking for jobs because their future is in such disarray. With their reckless NHS reorganisation, the Government have wasted not just taxpayers’ money but the knowledge and expertise of specialist staff, and patients are paying the price.
Liz Kendall
I do not think the Secretary of State understands that in a really complex and fast-developing area such as cancer, we need to know about individual, specific issues and concerns. If there are fewer staff covering bigger areas and more health conditions, we will not get specialist expertise.
If the Secretary of State does not believe me, perhaps he would like to comment on what Dr Mick Peake, the clinical lead for NHS cancer improvement and the national cancer intelligence network, has said. He has stated:
“With the shift towards GPs commissioning, the need for this expert…clinical advice will become ever more crucial…I am worried that in the process of reorganisation of the networks…we will lose many expert and very committed individuals, and that this could impact on the quality of commissioning and cancer services in the future.”
What will be the impact on patients, who are what the network is supposed to be about? Let us take prevention. Who has championed prevention by increasing the uptake of screening programmes? Cancer networks. Who trains GPs to spot the signs of cancer so that patients get earlier diagnosis? Cancer networks. Who has helped patients get their tests and scans done in days, not months, and slashed waits for cancer specialists to two weeks? Who has helped hospitals compare their performance, use the best drugs and treatments and transform patient information and support, and who has been central to setting up the new national cancer outcomes database, which the Government rightly say will help reduce cancer variations and drive improvements in future? Cancer networks. So why is the Secretary of State diluting—[Interruption.] Oh, now he switches to talk about the cancer drugs fund, because he knows that by stripping away vital local expertise, he is putting care at risk.
When the Secretary of State tells Radio 5 Live that he does not know why Labour is flogging this issue, calls cancer networks a mere pilot and says that his upheaval will be in patients’ best interests, cancer specialists, patients and Opposition Members know that he is wrong. We know that he cannot sustain the progress on cancer and make even more improvements in future when he is ripping away the foundations of better cancer care. As Earl Howe has just told Members of the Lords, it is “perfectly correct” that the share of the pot that cancer networks will be able to get will be smaller next year than it is this year. I rest my case.
The Prime Minister said that he would increase spending on the NHS, but NHS spending is lower in real terms today than it was when Labour left office—broken promise No. 1. Health Ministers repeatedly claim that they have protected cancer network budgets—broken promise No. 2. No top-down NHS reorganisation, mental health a priority and social care budgets protected—broken promises three, four and five. The list goes on. The Prime Minister claims that his priority can be summed up in three letters—NHS. That very same organisation is responding with its own three letters—SOS. I commend the motion to the House.
The Minister of State, Department of Health (Norman Lamb)
I start by acknowledging the moving contribution of the right hon. Member for Cynon Valley (Ann Clwyd). Her testimony was shocking and should force the whole system to recognise that such experiences are utterly intolerable and have no place in a modern health system in which kindness and compassion must always take first place. My right hon. Friend the Secretary of State is absolutely right to put that at the top of his agenda. The hon. Member for Strangford (Jim Shannon) also spoke about that point.
I have sat in this Chamber for many debates on the NHS; I have spoken in many of them too. I have heard many arguments about a lot of different things, but unfortunately this is one of the most misguided motions I have ever seen. I get on well with the right hon. Member for Leigh (Andy Burnham), but on this occasion he is completely wrong. As my right hon. Friend the Member for Charnwood (Mr Dorrell) said, the debate should be about the massive challenge we face in caring for people with long-term chronic conditions.
The right hon. Gentleman blames us for his spending plans when he was in office—plans that he signed off when he was in government. Let us have a quick reality check. The coalition’s spending plans kicked in in 2011-12, not before, and in that year there was an increase in real-terms spending. However, hon. Members should not take my word for it: they should ask Andrew Dilnot, the chair of the UK Statistics Authority and a highly respected and eminent economist. He confirmed that in 2011-12, NHS spending increased in real terms compared with the previous year by 0.1%. It says it all that the right hon. Gentleman refused to complete the sentence from Andrew Dilnot’s letter and give the complete picture. Spending will carry on going up for years to come, despite the legacy of financial irresponsibility left us by the last Government—the billions frittered away on a failed IT programme; the vice-like grip of PFI schemes mortgaging—
Norman Lamb
I have very little time.
Seventy-three billion pounds outstanding on PFI projects, mortgaging the NHS’s future and causing a massive strain on local health economies—that was something alluded to by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Members for Lewisham East (Heidi Alexander) and for Corby (Andy Sawford). The problems of PFI are massive. Labour also had 25,000 people working in health quangos. That is Labour’s legacy, but now, under the coalition, over the four years to 2014-15 the NHS budget will rise by more than £12.5 billion.
Nigel Adams
May I appeal to the Minister to ensure that rural areas such as North Yorkshire are given a fairer funding formula when the Secretary of State reassesses the formula shortly?
Norman Lamb
I understand the concern about rural areas and I will write to my hon. Friend about that. That £12.5 billion will go into improving services, hiring staff and keeping people well. That money will help to protect our health even as the age of the population goes up.
Lucy Powell
I thank the Minister for giving way. [Interruption.] Let me tell the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) that I am not going to read anything out. After such a long and lively debate, I just want to know whether the Minister will now clarify the matter that is before the House. Was NHS expenditure, in Dilnot’s words, lower in 2011-12 than it was in 2009-10? Yes or no?
Norman Lamb
The letter from Andrew Dilnot—the part that the right hon. Member for Leigh did not read out—also said that
“it might also be fair to say that real-terms expenditure had changed little over this period.”
In 2011-12, it went up according to Andrew Dilnot.
My right hon. Friend the Secretary of State for Health has already gone through the numbers outlining what is happening in the NHS today. He has already mentioned all those areas where the NHS is now healthier than under Labour—60,000 fewer people waiting longer than 18 weeks than under Labour; a determination to give access rights to those with mental health problems, as well as those with physical health problems, which was something bizarrely left out by Labour; more than 3 million more out-patient appointments every year than under Labour; more clinical staff, including 5,000 more doctors; and better access to drugs than ever before, including £600 million for the cancer drugs fund. On the cancer networks, the budget for networks as a whole is going up by 27%, which includes dementia and maternity—something that was also left out by Labour. Had the Labour party had its way and cut NHS spending, what would have happened to the networks in those circumstances?
Here is the important point, a point that Labour Members have unsurprisingly chosen not to mention throughout the length of this debate—that money would not be there under Labour. I have no doubt that they will protest, but it is there in black and white, immortalised in Hansard and in the press: for years, they have consistently advocated spending less than us on the NHS. In 2010, the right hon. Member for Leigh, in an interview with the New Statesman, said:
“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us.’”
The interviewer fired back:
“Which is true, isn’t it?”,
and the right hon. Gentleman admitted ,“Yes, it’s true”. In the same year, as reported in The Guardian, the right hon. Gentleman said:
“It is irresponsible to increase NHS spending in real terms”.
Yet it goes even further than that. A year before those interviews, in 2009, he could not even promise that the NHS would be protected from cuts. The chief economist from the King’s Fund agrees. Commenting on Labour’s plans, he said that the implication of the overall budget for the NHS was that it would be cut in real terms from between a very small amount to up to 5% over two years. That is what would have happened, had Labour won the election. It will fool no one: it will not fool the public, patients, the professionals or this House. We all know that the coalition is moving heaven and earth to protect the proud heritage of the NHS and drive up standards for everyone—whoever they are and wherever they live.
As my right hon. Friend the Member for Charnwood rightly says, the challenge is how we rethink how services are delivered across the health and social care divide to prevent crises from occurring. Prevention is what we should be doing, as the right hon. Member for Rother Valley (Mr Barron) rightly pointed out. If Labour Members do not like our plans, it is up to them, but if they think the NHS would be doing better with less money, more mixed-sex wards, longer waiting times and fewer clinical staff, they are more than welcome to that position. They can cling on to that as long as they wish, but what is unforgivable is for them to try to hoodwink the public into belittling an NHS that is getting better and better all the time. We have an NHS that is treating more people than ever better than ever, an NHS that is preparing itself for new challenges every day.
Let us compare that with Labour’s real NHS project in Wales, where we see cuts—cuts that have resulted in half a billion pounds taken out of the NHS in Wales by Labour. Waiting times are longer than in England and a higher proportion of patients is waiting for treatment. That is the true face of Labour on the NHS, and in England we should fight it as passionately as we can.
We have seen clearly today the desperation of the Labour party—a desperation that has led it to try to misinterpret inconvenient statistics. Frankly—
Ms Rosie Winterton (Doncaster Central) (Lab)
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question agreed to.
Main Question accordingly put.