17:03 - The House divided: - Ayes: 233 / Noes: 303 - Question accordingly negatived.
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.
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.
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
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 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
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.
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.
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.