16:30 - The House divided: - Ayes: 270 / Noes: 309 - Question accordingly negatived.
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
May I take this opportunity to congratulate you on your election, Madam Deputy Speaker? It is a great pleasure to speak for the first time with you in the Chair. You will have noted that the subject for debate on the Order Paper is A&E services—an important matter that everyone in this House cares much about. You will also have noted that there are several proposers of the motion, including the Leader of the Opposition, the shadow Secretary of State and the shadow Minister for care and older people. My first question is why, on this important issue, which the Opposition seem to think is critical to their programme for the NHS, the shadow Secretary of State for Health cannot be here to make the argument himself. Further, we understand that the shadow Minister for care will not be wrapping up the debate.
Mr Jamie Reed
I can tell the Minister where they are not: they are not hiding behind trees, and they are not meeting Rupert Murdoch in an underground car park.
Ben Gummer
I am not sure I get the gist of the hon. Gentleman’s point, but I do think that the shadow Secretary of State for Health should propose the motion in an Opposition day debate on health matters. I hazard a guess that there has been a disagreement between the two shadow Ministers—perhaps a suggestion that one of them is using health debates as opportunities to grandstand. I hope that that is not the case.
I am slightly concerned that we are about to see another episode of the ongoing psychodrama which is the Labour party. We had the TB-GBs and then, when that very happily came to an end, we had the Miliband “Band of Brothers”—a disaster for that family but happily not for the country.
Barbara Keeley
On a point of order, Madam Deputy Speaker. I really wonder whether this is within scope. Is it at all orderly to be debating which Minister is answering or proposing a debate? This happens quite a bit in this House—for example, the Chancellor did not come last week. It is just not orderly to be starting off the debate in this way.
Madam Deputy Speaker (Natascha Engel)
I thank the hon. Lady for that point of order. I think the point has been made. Perhaps we can move on with the debate.
Ben Gummer
It is a matter of importance, Madam Deputy Speaker, because in this episode of “Health Handbags”, we have been given an insight into the crisis within the Labour party and Labour Members’ inability to understand what the priorities are for the NHS and for the country.
If the NHS and A&E services are of such importance to the Labour party, one would expect the shadow Secretary of State—
Madam Deputy Speaker (Natascha Engel)
Order. If the Minister could sit down for a moment, I will take the point of order, which I imagine is very similar to the previous one. It would be nice if we could move the debate on, as there are several maiden speeches waiting to be taken. It is an important subject and I would like to move on, rather than get bogged down in this. I will take the point of order, and then I hope we will move on.
Madam Deputy Speaker (Natascha Engel)
Thank you very much. It is the person in the Chair’s decision whether something is within scope or not. I did not take the Minister’s response to my decision as a challenge to the Chair; I merely wanted to point out that it would be nice to get on with the debate and to allow other hon. Members to speak, especially new Members who wish to make their maiden speech. If the Minister could move on, we would all be very grateful.
Ben Gummer
With pleasure, Madam Deputy Speaker.
In the absence of the shadow Secretary of State, I shall channel him, which is something I enjoy doing. I like the right hon. Member for Leigh (Andy Burnham); he is a man who often—sometimes; a few times—speaks some sense. Just before the last election, he said that after the election,
“we need to come together, and then allow the NHS to get on with the job of building 21st-century services”.
What I do not understand about the motion that he and other Opposition Members have put before the House is that, far from coming together and trying to build consensus on the future of the NHS, what they are seeking to do—once again—is reproduce the golden oldies of criticism that they put before the country before the last election, and that were so roundly rejected.
That comment was about after the election. What I do not understand is what the shadow Secretary of State felt was the purpose of leading a campaign so politicising the NHS before the election. I, like so many others, had a leaflet through my letterbox saying that there were 24 hours to save the NHS—
Madam Deputy Speaker (Natascha Engel)
Order. We are straying into the general election, which has passed, and away from what is on the Order Paper, which is a debate on A&E services. If the Minister could stay on that subject, I would be enormously grateful.
Ben Gummer
With pleasure, Madam Deputy Speaker. The point is that we were warned that there were 24 hours to save the NHS, yet it is still there, and the A&E crisis, which is named at the top—
Madam Deputy Speaker (Natascha Engel)
Order. If the Minister could resume his seat, we are beginning to stray into the realms of challenging the Chair’s decision. We do not have much time and I do not want to take any more points of order on this one subject, so if he could stick to the subject on the Order Paper and let us move on, I would be very grateful to him.
Ben Gummer
I apologise, Madam Deputy Speaker.
The motion is about A&E services, and I would like to talk about the progress that the NHS has made in the past five years. Far from the picture painted today by the hon. Member for Copeland (Mr Reed) and Members who intervened during his speech, the NHS is treating more people than ever before, it is treating more people in A&E than ever before and it is treating more people at a higher rate of satisfaction than ever before, and the result of that is that patient outcomes—something we did not hear much about from the shadow Minister—have improved. We are treating more people to a higher standard.
John Redwood
Is it not the case that the excellent policy of seven-days-a-week GP services means an expansion in the amount of GP services, which will provide welcome relief from the pressures on A&E, which will add to the good work being done in hospitals?
Ben Gummer
That is precisely the sort of policy on which we will seek consensus in the months and years ahead. There is a choice for Opposition Members. I know there are many new Members who wish to make their maiden speech in this debate, and I would just say to them that the choice is this: to come together to try to model better care within the NHS and better outcomes for patients, or to seek division.
Helen Hayes (Dulwich and West Norwood) (Lab)
I want to raise a point of substance that affects my constituents. There are young people in my constituency who would love to train as nurses and work in the NHS, but by cutting the number of training places in London by 25%, the Government have made that much harder. At the same time, when I last spoke to the recently retired chief executive of King’s College Hospital NHS Foundation Trust, he told me that he was recruiting nurses in the Philippines, because there are not enough nurses—
Madam Deputy Speaker (Natascha Engel)
Order. When the Chair is on her feet, Members sit. I have said before that interventions need to be very short and kept to a minimum. That was too long.
Ben Gummer
The shadow Secretary of State cut the number of training places for nurses; it was increased under the last Government and is now at a record level.
We were on the subject of performance, which is at the heart of the motion. The shadow Minister can speak warm words about the workforce, but he failed to congratulate them on their exceptional performance under unprecedented pressures. At no point in his speech did he acknowledge the real increase in pressure on A&E services in the NHS. Some 3,000 additional patients a day are being seen, treated and discharged in accordance with the 95% target; that is being delivered by NHS staff across the service. He fails to point out the places where we have seen remarkable successes. He fails to give the example of Barking, Havering and Redbridge University Hospitals NHS Trust, which saw a 16% improvement in A&E performance times in the last year. That is front-line staff delivering better outcomes as a result of changes made by the Secretary of State over the past five years.
Mr Jamie Reed
I am grateful to the Minister for giving way, but he gives an absolutely fictional account of my remarks to the House. If he is so confident in his description of what is happening in the health service, can he explain why a comedy document produced by the Conservative research department says:
“New polling by Conservative peer Lord Ashcroft found that 47 per cent of voters believe Labour has the best approach to the health service while just 29 per cent picked the Tories”?
Ben Gummer
As Madam Deputy Speaker pointed out, we have just had an election, and the voters’ voice on the NHS was loud and clear. There is a simple point to make about the performance of this nation’s NHS: an independent think-tank—one of the most respected in the field—has rated it the best performing national health service in the world. It is better than that of Scotland, Northern Ireland or Labour-run Wales. A&E, as measured by countries across the world, performs no better in any country than in this. If we wish to go to international comparisons, the shadow Minister would do well to accept the extraordinary work that NHS staff are already delivering to make this the best health service in the world.
Mr Reed
I wish the Minister was right. I genuinely wish ours was the best A&E provision in the world. However, I have to draw his attention to an article in the International Business Times in January this year. When a journalist contacted the Department of Health to learn the basis for that claim by the Secretary of State, they were told that there was
“no concrete research on which Hunt had made the statement”.
This is a complete fabrication. Will the Minister set the record straight?
Ben Gummer
The shadow Minister should know that we in this country perform best of all countries that measure A&E, and that is the only way that we can judge this. The trouble is that by talking down that remarkable fact, all we do is denigrate the work of the people who deliver that every day.
I move on to the financial performance of the NHS, the second point that the shadow Minister raised, which lies at the heart of his motion. Let me set the financial context. [Interruption.] While Opposition Members are giggling, they might like to remember that they went into the last election not willing to commit to the NHS’s own plan for the next five years. Only one major party pledged to give the NHS the funding that it requested for the next five years: the Conservative party. The history on delivery is clear: we are talking about an additional £12.9 billion of cash in the last five years; a contribution of £2 billion this financial year, and a further £8 billion to fulfil the five-year plan. That is the financial background to this debate—a background that the Opposition refused to match at the last election. Money on its own does not get to the root of the problem, which I am afraid is not recognised in the motion, namely the relationship between quality, standards and money.
Byron Davies (Gower) (Con)
Does the Minister agree that it would probably do the shadow Minister and other Opposition Front Benchers a great deal of good to move down to Wales, where there has been an 8% cut in the budget? Wales has not met A&E targets since 2008.
Ben Gummer
It is a real delight to respond to my hon. Friend. It is a good thing for the shadow Minister and those living in England that they do not have to endure the experiences of people in Wales, which have, I am afraid, been inflicted on them by the appalling management of the Labour Government there, who chose not to invest in the NHS in the way that we did, in a time of constrained budgets across the public sector. I have to say to the shadow Minister that by concentrating on money—he cannot match the Conservative party’s commitments on that anyway—he misses the points around quality and safety, which are conjoined with money. If we go back to the Mid Staffordshire NHS Foundation Trust—[Interruption.] Opposition Members may groan, but they may wish to reflect on why Stafford hospital went wrong. It was within budget and was hitting its targets, yet at the same time it was killing people. Until that simple fact is remembered, and until we put quality and patient care first, we will not get the efficiency, as regards either care or money, that I am sure Members on both sides of the House wish to see.
Ben Gummer
I am sure that the shadow Minister has come to the House without reading the speech in which my right hon. Friend the Secretary of State directly addressed the issues caused, in some trusts, largely by agency spending, which took place because of the chronic understaffing created by the previous Government, and put right by us. That led in part to the catastrophe at Mid Staffs. The shadow Minister has not read my right hon. Friend’s comments about limiting the salaries of highly paid managers in the NHS, or his comments about cutting consultancy pay. It is precisely that kind of action—including enabling chief executives of NHS trusts to control their budgets—that this Government are taking to ensure that, nationally and locally, we are living within our means.
Clive Efford
The Minister says that the Government responded to Mid Staffs. Will he give us a guarantee that there will be no removal of the minimum staffing requirement that came in on the back of the Mid Staffs report?
Ben Gummer
I can guarantee that to the hon. Gentleman. On minimum staffing, it was in response to the Francis inquiry that this Government, in their previous incarnation, set the Care Quality Commission a specific target of doing something about minimum staffing. That did not happen before then. He understands that relationship between safe care and money. I just wish that he was able to explain it to his colleagues on the Front Bench, because if they went to the Salford Royal hospital, they would see how, through instigating safer care, it is saving £5 billion a year. It is by combining quality and efficiency that we get the double benefit of better care for patients and better returns for the taxpayer.
Tom Pursglove
Under the coalition Government, a new urgent care centre opened in Corby, which is providing an excellent service for my constituents. That is in addition to the service in Kettering. Does the Minister agree that it is important that care is not only accessible, but as local as possible?
Ben Gummer
My hon. Friend, and our hon. Friends in Northamptonshire, have worked hard together—as Northamptonshire MPs did previously on a cross-party basis—to find the best configuration of services for their county. It is a great shame that that model of cross-party working cannot be echoed or reflected across the House. In that vein, I would prefer it if the Opposition had come here to talk about plans for social care. They have two competing visions for social care. We sometimes hear thoughtful remarks from the shadow Minister for care and older people, but then there is the shadow Secretary of State’s repetition of the phrase about wanting a top-down reorganisation of the NHS around a social care model. None of that will deliver what we all want: an integrated NHS and social care model, which is what we are beginning the journey of creating. We are doing that by reflecting locally what local places need in terms of integration rather than creating a national model to which they have to adhere. Again, it is important to fix all this—
Ben Gummer
I will after I have finished this comment.
It is important to put all this in the financial context. I have been through the Lobby with the shadow Minister and with many Labour Members who were in the previous Parliament. We went through the Lobby just before the election when we agreed to cuts in public expenditure in the first two years of this Parliament and the former shadow Chancellor committed the Labour party to cuts in local government spending. Difficult choices are forced on us by the catastrophe and chaos that we were left in 2010. Labour Members need to confront those difficult choices. They cannot have it both ways. They cannot, on the one hand, say that we need massive increases in payments for social care and, on the other, say that they are going to constrain public spending. The answer to that dilemma is surely to try to find a better way of integrating social care that I hope would see cross-party consensus rather than the politicking we have just seen at the Dispatch Box.
Heidi Alexander (Lewisham East) (Lab)
The Minister is talking about the financial context. My worry is that a lot of NHS managers in London talk about a Lewisham-sized hole in the NHS budget in south-east London. We stopped the Secretary of State closing Lewisham’s A&E last time. Can the Minister promise me today that he will not be coming back to Lewisham for another go?
Ben Gummer
My right hon. Friend never planned to close Lewisham hospital. I give the hon. Lady this promise: I will certainly come and speak to her about her constituency before anything happens—in fact, if nothing happens—because I care very much about the provision of secondary and tertiary care there. That also goes for my colleagues on the Front Bench.
Let me give the facts of what we are doing in funding better social care and integrated social care in the NHS. We are already transferring £1.1 billion of NHS spending into social care funding as part of the additional £8 billion over the next five years. That money will be for social care as well as the NHS. It is part of an integrated system that NHS England envisages. Through the better care fund, funded to the tune of £5.3 billion, we are funding the local integration of social care and health care. That will produce a different solution in Manchester than in Ipswich, and that is a good thing because those two places are different.
Barbara Keeley
I thank the Minister for giving way eventually, because he has made a number of points about my local area. In Salford, we are moving heavily into integration—we are one of the better places in the country for that—but the work there is not assisted by a number of things. The better care programme funding is not extra funding. A large hole has been created, as in Lewisham, by cutting back on social care funding. Even at a smaller level, the closure of walk-in centres in Salford and the ending of active case management as efficiency cuts are made have not helped. All these things are part of the jigsaw. All we have seen is cuts.
Ben Gummer
Walk-in centre closures were supported by the hon. Lady’s hospital because that gave a safer service. I walked through the Lobby with her also. Because her party is unable to make a decision about money being spent on benefits and on the general budget for government, she would not be able to pledge any more than my party; in fact, she could only promise less funding for social care. She has to be straight with voters. Labour Members cannot have it both ways. They cannot spend money on the NHS, benefits and all the other things that they are pledged to increase funding on, and also claim to be the party of fiscal responsibility. It just does not hang together.
Mr David Burrowes (Enfield, Southgate) (Con)
I welcome the focus on integration, particularly in relation to social care. Enfield suffers from historical underfunding, with a lack of fairness in relation to the growing deprivation and age profile. We have made great progress, but we need to make more to ensure that there are winners, such as Enfield. That may lead to other parts of London, and inner London, being losers, but let us take these decisions now and make funding fairer, particularly in relation to social care.
Ben Gummer
My hon. Friend is right. Again, he highlights a local solution to a serious problem, and one that will not reflect what is needed in other parts of the country. That is why it is so important that we concentrate the additional money that we are providing on local solutions rather than on a top-down reorganisation.
The shadow Minister spoke about primary care. He does not seem to have listened to my right hon. Friend’s latest announcements on the new deal for GPs to increase the workforce, support new buildings for GPs, and improve access through local innovation. We are trying to reduce the pressures that we understand are on GPs and that go back many years, not helped by the GP contract signed by his Labour predecessors. We have a choice in government about whether we declare an ambition—the ambition on primary care declared by Labour at the last election was, the Royal College of GPs said, an
“ill-thought out, knee-jerk response”—
or we can try to do something about it, listen to concerns, and remodel care so that it helps patients. That is what the Government have done. My right hon. Friend has spoken about it, and the work is being carried on by the Minister with responsibility for primary care, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt).
Ben Gummer
I am not going to take any more interventions, if my hon. Friend does not mind, because I want to cover the additional issues raised by the shadow Minister. Before I do so, I would like to know whether the shadow Minister agrees with our target for 5,000 additional GPs, which can be afforded only because of the £8 billion that we have committed to the NHS—a commitment that, again, he has been unable to sign up to.
Mr Jamie Reed
The Minister has touched repeatedly on issues of finance. He has not given an accurate reflection of the Labour party’s position going into the general election with regard to NHS funding. Let me ask him again: will he explain how the £22 billion of efficiency savings is going to be made, and will he give a guarantee that it will not affect hospital services, A&E services, staff numbers, or any front-line services in any community in this country?
Ben Gummer
I find it difficult to have to repeat to the hon. Gentleman, as I have to the shadow Secretary of State on a previous occasion, that this is a plan by NHS England. It is a plan that we supported before the election and afterwards, and a plan that the Opposition failed to support. The details of the plan have been worked out by NHS England and will be revealed in due course. Our part of the deal is that we provide the money that it has requested, which is £8 billion. We will see the plan as it is revealed by NHS England. It is an ambitious plan but one that we will fund from our side of the bargain.
The shadow Minister reveals in his comments and in the motion to which he has put his name that his motives are not pure. He speaks about the reporting targets for A&E departments around the country, but does not mention that the decision to change the reporting standard was made not by the Government but on the basis of a recommendation made by Professor Sir Bruce Keogh, who did so as part of a general review of reporting standards. When the shadow Minister talks about reporting standards, he does not mention that we are bringing those for cancer waiting times forward from a quarterly to a monthly basis, which I would hope he would have welcomed.
The shadow Minister does not mention that, for the first time, we are introducing mental health waiting times, as well as putting into the NHS constitution parity of esteem, which was not in the original constitution written and instituted by the shadow Secretary of State. Those are two matters of vital concern to our constituents which we are correcting on the recommendation of Professor Sir Bruce Keogh. Nor does the shadow Minister mention that Sir Bruce recommends that the A&E targets are brought on to a monthly reporting basis so that they can have clinical parity with all other standards and produce a better quality of statistical reporting.
In this debate, the shadow Minister finds himself on the wrong side of the clinical evidence given by Sir Bruce; the Patients Association, which welcomed the change; and the Royal College of Emergency Medicine, which said:
“The move from weekly to monthly reporting better reflects meaningful trends and will in fact increase the validity of this key metric, by reducing the effect of short term and unforeseeable events”.
The Nuffield Trust said that
“the replacement of weekly A&E figures with a monthly publication of indicators for many targets should help us understand changes in performance in a more meaningful way”.
The hon. Gentleman is on the wrong side of clinicians, academics, the Patients Association and the Royal College of Emergency Medicine—and on the wrong side of the argument.
The reason why is that the hon. Gentleman has made a choice. I appeal to the new Opposition Members who are sitting behind him: they can go through the next five years, motion by motion, vote by vote, opposing everything that is done on the basis of clinical evidence, just for the purpose of making political gain. If they do that, I, in turn, will remind the Opposition of the scandal of mixed-sex wards; the scandal of the highest hospital infection rate in the developed world; the scandal of a doubled pay bill for managers; the scandal of Morecambe Bay; the scandal of Mid Staffs; and the scandal of some of the worst cancer outcomes in the world. I will remind them of those every time they seek to oppose us for political reasons. The choice is theirs—or they can take the other tack and try to listen to clinicians, to be constructive and to de-weaponise the NHS.
I will seek to do what the shadow Secretary of State claimed to want to do, which is to come together and allow the NHS to get on with the job of building 21st-century services. However, if the Opposition make the wrong choice, all they will do is confirm in the minds of the British people that they put politics before the NHS, and that for the Labour party, the party comes first—always—whereas for Conservative Members, the NHS and patients always come first.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
Time is rather short, but I want to start by acknowledging one or two things. First, it is nice to see at least one signatory to the Labour non-grandstanding pact present for the closing speeches, if not the opening ones.
More importantly, there were three maiden speeches. The hon. Member for Dewsbury (Paula Sherriff) mentioned James Brown, and the hon. Member for Salford and Eccles (Rebecca Long Bailey) mentioned The Pogues, so a musical theme has run through the debate. The hon. Member for Dumfries and Galloway (Richard Arkless) took us to the Scottish Riviera, via a wonderful Burns quote. We all enjoyed their maiden speeches very much. We also heard some thoughtful speeches from people with experience in the service.
I say to those who are new to the House that those of us who were here in the last Parliament have a sense of déjà vu about this debate and, indeed, the motion. We want to move on from that. The public gave us a mandate in the election based on our record on the NHS, our commitment to safeguard its future, our honesty in accepting the challenges that lie ahead and the need to find long-term solutions. A number of right hon. and hon. Members alluded to those challenges and solutions. The public saw through the Opposition’s tired attack at the election and realised that we were the party that was not only acknowledging the long-term pressures, but committing the resources that the NHS said it needed to continue to be the best health service in the world. That remains the big challenge for the Opposition.
As was said by the Chair of the Health Committee, whom I congratulate on her re-election, the election is behind us and we need to look forward; we need to look at the areas where there is consensus and remember the impact that debates in this House have on the wonderful staff in our NHS.
Let me put on the record what is happening in our accident and emergency services. The NHS in England achieved 94.9% of people in A&E being seen, treated and discharged in four hours. The hon. Member for Central Ayrshire (Dr Whitford), who spoke for the SNP, underlined just what an achievement it is to deliver on those targets. We all enjoyed her thoughtful and measured contribution very much.
The change from weekly to monthly A&E performance reporting is based on the clinical advice of Professor Sir Bruce Keogh, the NHS medical director, as other Members have said. Far from reducing transparency, the change will increase it because, from August, NHS England will publish the key NHS performance data together. That will include more frequent reporting of cancer waits—something that is widely welcomed by cancer charities. The change is not only clinically based, but is supported by the Royal College of Emergency Medicine, the Nuffield Trust, the NHS Confederation and the Patients Association. The Opposition are way out of line with all those bodies in their criticisms of the change.
There has been talk of deficits in NHS providers. Of course that is cause for concern, but we are taking action on those deficits. As I said, during the general election campaign we talked about what we could do to address such long-term challenges. In opening the debate, the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer) mentioned the specific measures that are being taken to address trusts’ deficits and help them get back into a better situation.
On GP access, the fact is that four out of five people are able to get an appointment when it is convenient. We are building on that by investing £175 million in extending GP access. By March next year, the Prime Minister’s challenge fund will cover 18 million people, who will get extended hours and weekend appointments if they need them.
We have heard from hon. Members that GPs and other health professionals are responding positively to the challenges that the circumstances have set them. I was interested to hear of the innovations that my hon. Friend the Member for Sittingbourne and Sheppey (Gordon Henderson) told us about in his area. We heard about the focus on increased access to mammography in Crawley. There were many other great examples of how the service is innovating.
To meet demand, we have 1,200 more GPs than in 2010. The Secretary of State spoke only last week about a new way forward for GPs and an increased focus on under-doctored areas. That came out in a number of contributions, including that of the hon. Member for Hartlepool (Mr Wright).
Providing the funding to support the NHS’s “Five Year Forward View” has only been possible because of our long-term economic plan. We remain committed to listening to and supporting the NHS as it works through the detail of the delivery of the “Five Year Forward View”.
We are building on our record of achievement. Compared with five years ago, our NHS performs over 1 million more operations; has 9,100 more doctors and 8,800 more nurses; and sees, treats and discharges 3,000 more people within the four-hour target. We intend to build on those achievements in this Parliament. It is a great track record. However, the NHS simply cannot go on treating more people at that rate, so as Simon Stevens has said, we need to go up several gears on prevention—a subject to which I hope we will return at another time.
There is growing political consensus on the need to integrate health and social care, which hon. Members have spoken about, and this Government have started to do that. It is all right to talk about it, but with the better care fund the Government have started to do it.
A strong NHS needs a strong economy, and that remains the unanswered question for the Opposition, both in the election and every time they sponsor one of these debates. We are committed to supporting our NHS, not running it down. We are backing the NHS’s own plan for meeting the challenges and opportunities of the future. That promise was not matched by the Opposition, and the public knew it. It remains the elephant in the room for their Front Benchers.
As we go forward, that is where we on the Government side will be putting our collective energy: patients before party; prevention as well as cure; backing our NHS, not running it down. I urge the House to reject the motion.
Question put.