National Insurance Contributions: Healthcare

Lord Clarke of Nottingham Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

Under previous Governments, including her own, this was exactly what happened, and it will continue to happen. There are established processes on NHS guidance and the national tariff system, and there will be consultations on primary care contracts, which will play out in the normal—and what I regard as a fair and open—way. I make that point in respect of all Governments, not just this one.

[Lord Clarke of Nottingham (Con)]

My Lords, the root of this problem is that, in an election that the Labour Party was bound to win, it made a promise that it would not raise income tax, national insurance or corporation tax. The taxes it promised not to raise provide 70% of the Government’s income and are the basic toolbox of any Chancellor in any Budget. They sometimes go up or down according to the economic needs of the nation, and they are the broadest-based and fairest taxes. Now that the Government have imposed these rather damaging taxes to raise revenue in this last Budget and have gone for the choices they have, can I have the Minister’s assurance that this promise is not good for the next five years? It will confine the Government’s ability to raise revenue when they need to, so they will go into more areas and will do unintended damage to employment or particular sectors of the economy.

[Baroness Merron (Lab)]

I appreciate hearing the view of the noble Lord, with his considerable experience, but this is a place where I know the current Chancellor would beg to differ. I gently point out that I believe the root cause is something rather different: this Government inherited a £22 billion black hole.

Coronavirus Act 2020: Temporary Provisions

Lord Clarke of Nottingham Excerpts

Monday 28th September 2020 Lords Chamber

[Lord Clarke of Nottingham (Con) (Maiden Speech)]

My Lords, for about 50 years now, I have been in the habit of making parliamentary speeches quite regularly. I retired from that when I left the other place in November last year. So I am particularly honoured to find that I can now resume this practice in this most illustrious setting with such distinguished colleagues on all sides, including many old friends. I trust I will not abuse the privilege of being back in parliamentary debate, but my maiden speech will be the first time I have ever attempted to make a speech subject to a four-minute time limit. Many of my noble friends will be, at this moment, doubting my ability to manage that.

I echo what my former Commons colleague the noble Baroness, Lady Clark, said about the welcome new Peers receive here. This is, in every way, a remarkable institution. Fellow Peers—not just old friends—are especially welcoming, and I share her gratitude to all the staff here, who go out of their way to help people utterly baffled by the rabbit warren of corridors and the somewhat strange new practices we have to take on.

The major change I am having to face is that I find that this historic Chamber has all its logistics based on the use of IT of various kinds which I have previously scorned. It is most surprising that, in this particular House, a 20th-century man is being forced to get into the 21st century. Trying to open and switch on a laptop and an iPad, then contemplate how to use them, is my biggest problem at the moment, because of the generosity of all those who are helping me in every other way.

On this subject I can only say that I have every sympathy with the Government, as a former Secretary of State for Health and a former Chancellor of the Exchequer. This is the worst health crisis to have hit this country and the worst depression—no, recession, so far—and economic crisis that has occurred in my lifetime. The difficulty of dealing with it is that it is shrouded in total uncertainty. All forecasts on all fronts are quite useless because the disease is new, its behaviour is unknown and therefore the range of scientific and medical opinion about the way in which it can be controlled and what is going to happen is not a unanimous science: it is immensely varied. Quite unprecedented choices have to be made on the tensions between the life-saving prospects of doing one thing and the damaging economic consequences that step will have. Everybody is going to second-guess every decision that Ministers come to as they go along. As we are now in the days of public inquiries, with the wisdom of hindsight everybody will be able to see what should have been done in the light of what we know has happened, and everybody will say how obvious it was that steps should have been taken.

Yes, the Government have made mistakes; every western Government have made mistakes. The mistake at the beginning was not being tough enough. It is quite obvious that we should have gone into lockdown probably about three weeks before we did. It is quite obvious that we should have quarantined flights in from places such as Spain and Italy almost instantly. We should obviously have been more aware of the dangers to the residents of care homes and ended the practice of discharging patients from hospitals to care homes without testing before doing so. But, if the Government had done those things at the beginning of March, they would have faced all the protests about civil liberties, excess infringements, controls and so on that we are hearing now. We must not repeat that. The policy succeeded after that because we had only about 60,000 excess deaths and, although we are as bad as almost any other country in the world, people have now got used to the small level of deaths—each of them tragic—and disaster we are having. The demand now is: let us have more liberty and protect our freedom and let us not step things up.

The Government should subject themselves to more parliamentary scrutiny of the next steps. I totally agree with all who have voiced that. It would strengthen them and give them more authority. It would give them a better defence when they make an obvious mistake—and they will make more. The position now is that they would also be strengthened by the support they would get. The majority of the public support the measures that the Government are now taking. The rule of six is not particularly severe, while closing pubs at 10 pm takes us back to the days of my teens but is not actually a tremendous infringement of civil liberties. Opinion polls show that the public would accept tougher measures from the Government and I think that, after proper debate and scrutiny, the majority in Parliament would allow most of them. That would, however, save us from the occasional strange dilemmas and slips that we know have occurred. The Government, the public and the nation will be held together better if we scrutinise more firmly, but not on the basis that we second guess every decision that any Minister makes and start politicising it in this extremely dangerous world.

Interim NHS People Plan

Lord Clarke of Nottingham Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

Perhaps that is the soundbite that the hon. Gentleman and his colleagues—including the hon. Member for Dewsbury, who is shouting across the Chamber yet again—should remember.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I welcome the Minister’s announcement that the Government are giving higher priority still to the recruitment and retention of staff in the NHS. It is an undeniable fact that there are acute shortages, particularly of nurses, in practically every part of the NHS, and we urgently need to improve our recruitment and retention. With that in mind, will he confirm that in finalising the people plan, serious consideration will be given to the immigration rules that will apply to recruitment after we leave the European Union? About one in 20 of the whole staff of the NHS at the moment are citizens of the European Union, and it would make no sense at all to put new restrictions of any kind on people coming from the European Union who want to make a valuable contribution to our health service. In Nottingham, we used to run recruitment campaigns for nurses in Romania. We are a long way away from being able to in any way put restrictions on staff coming from any part of the continent.

[Stephen Hammond]

My right hon. and learned Friend the Father of the House is completely correct. We want to make sure it is clear that the EU nationals who work in the national health service—there are more than 63,000 of them—are valued and make a huge contribution to our NHS. He will probably be aware that my right hon. Friends the Secretary of State and the Home Secretary are in continuing negotiations, to ensure that there is no change to that position. I guarantee that we want to see EU nationals continue to work in and contribute to our great health service.

Eurotunnel: Payment

Lord Clarke of Nottingham Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

Unlike in the question from my hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont), what I did not hear in the hon. Gentleman’s long question was a statement about whether he supports the decision or not. I think that is because he does support the decision to ensure we have what we need to get the unhindered supply of medicines. More than that, he and his Scottish National party friends complain endlessly about a no-deal Brexit, yet they do not do what is needed to avoid a no-deal Brexit, which is to vote for the deal.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

It is always a pleasure to see my right hon. Friend the Secretary of State for Health and Social Care, although rather a surprising one on this occasion. The usual reason for settling an action is to minimise your losses when you are obviously on a loser in defending it, but I am relieved to hear that this was done in order to ensure the safety of medicines. As we are on that subject, can he give me some reassurance about the long-term future for the regulation and approval of medicines in this country? If and when we leave the EU—we look as though we are bound to do so—we of course leave the European Medicines Agency, which is leaving this country, and I am not clear what our long-term arrangements will be. Are we going to seek some association with the EMA system, or will we be setting up a totally new British system to replace it? Can he guarantee continuity of the proper regulation of medicines while that process is under way?

[Matt Hancock]

The short answer to that is yes. The medium length answer is that we will ensure that medicines can be licensed in this country with no further burdens than under the EMA system by matching some of the EMA processes, but in a no-deal scenario we would also be looking to introduce our own processes so that some medicines could be brought and licensed here before they could be licensed in Europe. Indeed, changes to this area is one of the examples of advantages from Brexit, which I am sure my right hon. and learned Friend will be delighted to hear about, because they mean that we can grasp some of the opportunities that the future of medicines presents. The long answer is so long that I will be happy to write to him with full details and place a copy of the letter in the Library of the House.

NHS Long-term Plan

Lord Clarke of Nottingham Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Well, I think we discovered from that that Labour has absolutely nothing to say about the future health of the nation. The hon. Gentleman did not even deign to thank the people who work in the NHS for their incredible work. Did we hear any acknowledgement of the million more people who are seen by the NHS, of the record levels of activity going on in the NHS and of the fact that we have more nurses and doctors in the NHS than we had in 2010? He had nothing to say. He talked about the workforce. Chapter 4 of the document is all about the workforce plan. He gives me the impression that, like his leader on Brexit, he has not even read the document he is talking about.

The hon. Gentleman asked about targets and legislation. On legislation, when clinicians make proposals on what legislation needs to change to improve the NHS, we listen. We do not then come forward with further ideological ideas. We listen. So we will listen to what they have said. The clinicians have come forward with legislative proposals and we will listen and study them closely.

On the money that the hon. Gentleman talked about, it was a bit like a broken record. He asked about a £1 billion shortfall in the NHS budget. I will tell him what we are doing with NHS budgets: we are putting them up by £20.5 billion. There is an error in the analysis by the Nuffield Trust, because it does not take into account an improvement in the efficiency of the NHS. Is it true that every year we can improve the way the NHS delivers value for taxpayers’ money? Absolutely. We can and we must, because we on the Government Benches care about the NHS and about getting the right amount of money into the NHS, but we also care about making sure that that money is spent wisely. The hon. Gentleman would do well to heed the views of the NHS itself, which says that yes, the NHS is probably the most efficient health service in the world, but there is always more to do.

The hon. Gentleman argued about various budgets. The budgets in the NHS are going up because we care about the future of the NHS. The Labour party called for an increase of 2.2% a year; we are delivering an increase of 3.4% a year. Labour has nothing to say on health, as it has nothing to say on any other area of domestic business. We will make sure that we are the party of the NHS for the long term.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

First, I congratulate my right hon. Friend on his paying tribute to the work of the late Sir Henry Willink, who served in Churchill’s Conservative Government. I met him once or twice when he became master of a Cambridge college. The Conservatives have shown respect for the NHS ever since, as he foreshadowed.

I also congratulate my right hon. Friend on the large increases in funding that are almost as big as some of the funding increases that I received when I was a Health Minister and then Secretary of State. Ever since it was founded, all Governments have increased spending on the NHS—they are bound to—and whichever party is in opposition we always have these knockabout exchanges about whether it is enough. As my right hon. Friend rightly says, what matters is how effectively the money is spent to produce the right patient outcomes. The plan appears to reflect that very well.

Does my right hon. Friend agree that the biggest pressure facing the health service is the extraordinary growth in demand, and the change in the nature of that demand, which is being caused by the ageing population, with chronic conditions playing such a large part? Does he also accept that his most urgent priority is to build further links between the hospital service, the GPs, the community services and local authority social services, so that we have people working no longer in silos, but together to produce the best package for the patient? We have achieved something, but not very much. I hope that when we produce our adult social care policy, which I hope is soon, my right hon. Friend will begin to think about some reforms to make sure that all elements of the service work together properly to produce the proper and most cost-effective personalised treatment for each individual patient.

[Matt Hancock]

I pay tribute to my right hon. and learned Friend, who of course did so much to set in train the modern health service that we know and whose reforms were kept and, indeed, enhanced during the period when Labour was in government. He is right about the need to run the NHS so that it can be the best that it possibly can be. Yes, we need the money, but we also need to run it well. It is no good just to argue about the money. On that he may have a surprising ally, because the shadow Secretary of State, who is currently looking at his mobile phone—well, he is not any more—said a couple of months ago:

“we need to augment the debate beyond the current mantra of ‘we can spend the most’”.

However, it appears that the Labour party only has a mantra of “We can spend the most.” We care about the money, but we care about the NHS being the best that it possibly can be, too.

NHS Winter Crisis

Lord Clarke of Nottingham Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

I am glad that the hon. Gentleman mentioned the Secretary of State. I want to put on record my tribute to my right hon. Friend, who has served in that position for almost as long as Aneurin Bevan, who was the first Secretary of State for the NHS.

I am delighted to be here to respond to the hon. Gentleman, who, as usual, listed a cacophony of allegations, very few of which are directly related to the challenges that our hospitals face today—the increase in demand and pressure on our NHS as a result of a combination of the increase in population and challenges posed by demographics, as well as the weather and the presence of flu in many parts of the country, adding to the pressure on staff at this time of the year.

The hon. Gentleman asked several questions. On the funding issue, he is well aware that the £337 million announced in the Budget was allocated in December. His own local trust, which includes the Leicester Royal Infirmary, received £4.2 million. It is a great shame that he chose not to welcome that extra money for his local trust. The money announced in the Budget has been allocated, but we have kept £50 million in reserve to allocate this month if particular pressures that become apparent during the course of the month need addressing.

The hon. Gentleman asked about the impact of the cancelled operations. We do not know that operations are cancelled. There have been a few thus far; procedures and treatments are being deferred. It will not become apparent until after this period has finished how many actually do end up being cancelled, so it is not possible to calculate the financial impact on any of the trusts where deferral is taking place.

The hon. Gentleman referred to the situation as unprecedented. I gently remind him that we have a winter crisis of some kind or another every year. He will have been in Downing Street in 2009-10, when, as it happens, the then Conservative shadow Health Secretary chose not to try to take advantage of the near flu pandemic at the time because he recognised that there were operational pressures on the NHS and it was not down to him to score party political points. The hon. Gentleman has unfortunately chosen to do that. At that time, tens of thousands of elective procedures were cancelled to provide capacity to cope with the emergency at the front doors of our hospitals. So this is a routine way to deal with pressure coming through hospital front doors.

What distinguishes this year from previous years is that in the past elective procedures were cancelled within hours of operations being due to take place. Sometimes it was the day before and sometimes it was on the day. That caused patients considerable distress and gave rise to considerable problems for staff. We have set up the national emergency pressures panel to anticipate problems when we see the signals, and we can then give notice to patients that their procedures are going to be deferred. That is a much more humane and sensible way to do things and it provides much more opportunity for hospitals to cope with the pressures that are coming through the door.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

NHS acute services have never been better and are among the best in the world. As the Minister just said, every year we have this slightly ritual exchange about winter pressures, but does he accept that the problems are changing because of the increased number of elderly people in the population and the increased urgency of the need to solve the problem of how to admit them promptly to the right part of the service and then discharge them properly and safely as soon as they are recovered? Will he advertise further to the many people who are not aware of it the availability of emergency GP services? Will he concentrate on the reform and integration of the community care system, the social care system and the primary care services and make sure that co-operation among them is steadily improved so that they can cope better in future years, because this problem is undoubtedly going to develop?

[Mr Dunne]

I am grateful to my right hon. and learned Friend for making those points. He brings to the House considerable experience of what it is like to be responsible for the NHS. He is absolutely right: the number of over-80s who are presenting to hospital A&Es is going up exponentially each year. Hospitals need to adapt the way that they treat such patients to try to keep them as healthy as possible so that they can live independently for as long as possible. That is why many hospitals are now introducing frail elderly units close to or at the front door of A&E departments so that they can turn around patients and avoid admissions. My right hon. and learned Friend is also right to point to the increasing integration between the NHS and social care that is necessary to encourage more people to live independently out of hospital and leave emergency departments for those people who are urgently ill.

NHS and Social Care Funding

Lord Clarke of Nottingham Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

My hon. Friend makes a powerful point about Wales. As a Member for Cardiff, he understands what is happening in the Welsh health service. I wish Conservative Members understood that better.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I will give way to the right hon. and learned Gentleman, but I will then make some progress.

[Mr Clarke]

Does the hon. Gentleman accept that every winter, for as long as I can recall, we have had a winter crisis in the NHS? It usually happens after Christmas. In winter the demands on the service become unpredictable, infections spread and the NHS starts losing staff. There are bound to be parts of the system that come under very real strain, and no one is trying to minimise the fact that they do. Apart from just producing this year’s crop of stories of very unfortunate incidents in various places, does he have any policy proposal at all, apart from simply spending more money wherever the reports are coming from?

[Jonathan Ashworth]

I am very grateful to the right hon. and learned Gentleman, who is a very experienced parliamentarian, for his intervention, but he will know that this is one of the worst winters for probably 20 years. He casually suggests that this happens every year, but I remember the years of a Labour Government when it did not happen. I remember the years of a Labour Government when we went further than the financial settlements he delivered as Chancellor of the Exchequer and were more than doubling the money going into the NHS—and tripling it in cash terms.

Junior Doctors: Industrial Action

Lord Clarke of Nottingham Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Hunt]

Thank you, Mr Speaker.

The shadow Health Secretary needs to recognise that working people, the people her party claims to represent, need a seven-day NHS. The vulnerable people that Labour claims to represent get admitted to hospital at the weekends, and in industrial disputes patients should always matter more than politics. The next time she meets a constituent who has suffered because of not having a seven-day service or because their operation has been cancelled because of a strike, she and her colleagues should hang their heads in shame.

The hon. Lady has used some very strong words. She used words such as “vilifying” and “demonising” in relation to the junior doctor workforce, and that is a very serious thing to say. I challenge her to find a single piece of evidence that has come from me or anyone in the Government, and if she cannot do so, she needs to withdraw those comments and apologise to the House. The fact is that the single most demoralising thing for the NHS workforce is strikes, because they entrench and harden positions, which results in people getting very angry, and it becomes much harder to find consensus.

The hon. Lady also talked about the use of statistics. She does not have to listen to what I say—and I understand, given the sparring that goes on between us, that she might not want to—but we have had eight academic studies in the past five years that describe increased mortality rates for people admitted to hospitals at weekends. Her response to this, in a phrase she used in another context, was that there was “zero empirical evidence” for a weekend effect. I would caution her on this, because taking that approach to hard data is exactly what happened at Mid Staffs, where hard evidence was swept under the carpet year after year because it was politically inconvenient. This Government will not make that mistake.

Finally, the hon. Lady said that my civil servants had apparently advised me that this policy would not work. Not at all. What happens with every Government policy, as you would expect, is that smart civil servants kick the tyres of every aspect of the policy to enable us to understand the risks involved. She did not mention the fact that the same document to which she referred actually says that we are on track to deliver the four clinical seven-day standards to 20% of the country by next April. I think that her constituents will welcome that, even if she does not. These strikes are going to harm patients, damage the NHS and make it harder, not easier, to resolve the challenges facing junior doctors. Labour has chosen political opportunity today, but we will do the right thing for patients.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Does my right hon. Friend agree that it has been an indefensible anomaly for many years that the national health service so reduces its services at weekends when the patients it serves are vulnerable to urgent or emergency conditions and need the highest standards of care for chronic conditions on a seven-day basis? Will he continue to make what he has described as careful progress? Will he also make it clear that the seven-day service will not simply do routine work and that it will be introduced as resources and staffing allow in line with civilised conditions? Further, on the strange politics of the dispute that keeps coming back to haunt him, does he agree that while the BMA has always been one of our most militant trade unions and while the Labour party has been very left wing in its leadership before—most notably in the 1980s—it is almost inconceivable that at any time in the past such extreme militant action that threatens patients would have been supported by the BMA or the Labour party? They are now opposing a contract that union leaders praised as a sensible settlement, given the improvements that it offered, only two or three months ago.

[Mr Hunt]

As ever, my right hon. and learned Friend speaks incredibly wisely. Actually, his last comment goes to the nub of why this is totally extraordinary, unprecedented and completely unacceptable. It is true that the junior doctors have rejected the agreement that was reached in May in a ballot, and we have to accept that. There are all sorts of reasons why that might have happened, but the choice to escalate the industrial action and to call the worst strike in NHS history was made not by those junior doctors but by the BMA leaders. They made that decision about a contract that they themselves had described as being good and safer for doctors and patients only in May. How can they justify that? Is there not perhaps a desire to pick a very big fight?

We were making good progress over the summer in a whole series of dialogues in different areas to try to resolve some of the non-contractual issues that the junior doctors are worried about, but this action makes it virtually impossible to continue that progress, although we will try very hard to do so. My right hon. and learned Friend is absolutely right to say that this is completely unacceptable and damaging for patients. I am afraid that I am having to go through some of the very same battles that he had to go through when he was Health Secretary.

Junior Doctors Contract

Lord Clarke of Nottingham Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for her constructive comments, which are born of her NHS experience. She is right: we are phasing in the contract carefully to make sure that we learn lessons. She is absolutely right to talk about rota gaps. Unfortunately, the problem of rota gaps cannot be solved at a stroke on signing a contract; it has to do with making sure that we have a big enough supply of doctors in the NHS to fill those rota gaps. We now have much greater transparency about the safety levels that are appropriate in different hospitals; that is one of the lessons that we learned post Mid Staffs. We are investing more in the NHS in this Parliament. We recruited an extra 9,300 doctors in the last Parliament and we are increasing our investment in the NHS in this Parliament, so that we can continue to boost the doctor workforce in the NHS. In the long run, that is how we will deal with the rota gap issue; but unfortunately, that cannot be done overnight.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

I congratulate the Secretary of State on taking the only responsible decision that he could take, in the interests of the service and patients, to bring this sad, extraordinarily long episode to an end. I also congratulate him on being conciliatory, because he made concessions in May to produce the final contract, and now he is phasing it in, in its negotiated form. I hope that we get back to a peaceful settlement. Does he agree that the surprising fact that so many dedicated junior doctors were prepared to take industrial action over rather ill-defined problems with the contract shows that there is a problem with morale in the service? Will he give an undertaking that the very welcome steps that he has announced today to try to address the wider issues will last not just a few months, until the dust settles on this dispute, but will be part of a continuous process to make sure that we restore to the service the morale and dedication on which we all know the NHS relies?

[Mr Hunt]

As ever, my right hon. and learned Friend speaks with great wisdom and experience. He is absolutely right to say that tackling the morale deficit in the NHS has to be a key priority. That is why we have to recognise that for doctors—particularly junior doctors starting out on their medical careers—the most depressing and dispiriting thing of all is when they cannot give the patients in front of them the care that they want to. That is why we are looking at a number of things to make it easier for doctors to improve the quality of care. One of the things that is particularly challenging and that we in this House have to think about and discuss a lot more is how difficult doctors and nurses find it to speak out if they see poor care, or if they or a colleague make a mistake, because they are frightened of litigation, a General Medical Council referral, or disciplinary action by their trust. The problem is that people then do not go through the learning processes necessary to prevent those mistakes from happening again. The key is creating a supportive environment, in which learning can really happen, in hospitals.

Defending Public Services

Lord Clarke of Nottingham Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Hunt]

We will find out those figures when the full audit is complete. I just say to the hon. Gentleman that efficiency savings are never easy, but a party with the true interests of NHS patients at heart should support those efficiency savings, because every pound saved by avoiding waste is one we can spend improving patient care.

Let me therefore outline to the House what we are doing to deliver those efficiencies, as well as to support NHS trusts to return to financial balance. First, we are taking tough measures to reduce the cost of agency staff, including putting caps on total agency spend and limits on the rates paid to those working for agencies. So far, that has saved £290 million, with the market rate for agency nurses down 10% since October and with two thirds of trusts saying that they have benefited. Our plan is to reduce agency spend by £1.2 billion during this financial year. Secondly, we are introducing centralised procurement under the Carter reforms. Already 92 trusts are sharing, for the first time, information on the top 100 products they purchase in real time, and we expect savings of more than £700 million a year during this Parliament as a result. Thirdly, given that the pay bill is about two thirds of a typical hospital’s costs base, we are supporting trusts to improve on the gross inefficiency of the largely paper-based rostering systems used at present. This should also significantly increase flexibility and the work-life balance for staff, as we announced last week. Finally, and perhaps most critically, we will reduce demand for hospital services by a dramatic transformation of out-of-hospital care, as outlined in the five-year forward view. If we meet our ambitions, we will reduce demand by more than £4 billion a year through prevention, improved GP provision, mental health access and integrated health and social care.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

For as long as I can remember, unfortunately, discussions about the NHS have always been reduced to simplistic arguments about whether enough money is being spent on it, and whether efficiency is being improved enough. I think that the Government, in the present financial circumstances, have increased spending and pursued efficiency at least as effectively as any of their predecessors.

Does my right hon. Friend agree that the real issues that we ought to be considering are the rapid rise in, and the changing nature of, demand on this important service? Will he have time to consider things such as moving to a seven-day service; ending the curious divisions between the hospital service, GPs, community care and local council social services; providing for an ageing population with chronic conditions; and, at the same time, giving extra emphasis to mental health and all the things that have been neglected in the past? All these exchanges such as, “You should be spending more,” and “You are cutting, and we would spend more” are the sterile nonsense pursued by every Opposition that I can recall when they cannot think of anything positive to say.

[Mr Hunt]

My right hon. and learned Friend speaks with great wisdom, as he did during the junior doctors’ strike. Perhaps that is based on his experience of featuring in a BMA poster, which was put up across the country, as someone who ignored medical advice, because he smoked his cigar.

My right hon. and learned Friend is absolutely right. The crucial issue for the future of the NHS is the simple statistic that by the end of this Parliament we will have 1 million more over-70s to look after in England, and their needs are very different from those of the population whom we had to look after 20, 30 or 40 years ago. In particular, their need to be looked after well at home, before they need expensive hospital treatment, is a transformation. That is why a core part of what we are doing is to transform the services offered in mental health and in general practice, which I will come on to a bit later.

--- Later in debate ---

[Heidi Alexander]

From memory, I seem to think the budget going to the NHS in Wales has been cut in Westminster.

Let us have a look at the figures. In March 2011—[Interruption.] The Health Secretary would do well to listen to these figures, because I am about to tell him the record of his term in office. In March 2011, 8,602 patients waited more than four hours on trolleys because no beds were available. Four years later, the figure was up sixfold, to 53,641. In March 2011, just one patient had to wait longer than 12 hours on a trolley. Four years later, 350 patients suffered that experience. The NHS waiting list now stands at almost 3.7 million people—the equivalent of one in every 15 people in England. Only 67% of ambulance call-outs to the most serious life-threatening cases are being responded to within eight minutes.

I could reel off more statistics, but I will instead read a letter that I received the other week:

“Dear Ms Alexander,

I recently had the misfortune of using the A&E at my local hospital in Margate. My wife feels that I was lucky to escape with my life.

My experience has convinced me that our health service has never been more under threat than since Mrs Thatcher.

The fact that I was sent home after 4 hours without seeing a doctor and returned by emergency ambulance with a now perforated appendix I blame mostly on the conflict between the Health Secretary and the Junior Doctors. Had this been resolved he would have been able to concentrate on the woeful lack of resources our NHS faces.”

Take the experience—[Interruption.] The Parliamentary Private Secretary to the Health Secretary says, “Show us the letter”. I have it here, and I got the permission of the individual who wrote to me before referring to it.

Let me refer to another example—the experience of Mr Steven Blanchard at the Swindon Great Western hospital last November. He said in an open letter to the Swindon Advertiser:

“We arrived at 6.40pm and were asked to sit with about 15 others in the unit. It became apparent this was a place of great suffering and misery…Firstly, there was a lady who was doubled up in pain who had been promised painkillers three hours before and I witnessed her mother go again and again to reception until she was begging for pain relief for her near hysterical daughter.”

Another old lady

“who had been left on her own by her son…was sat picking at a cannula in her arm trying to pull it out…A very frail and sick old man was sat in a wheelchair and he had been in the unit since 8am. He kept saying over and over ‘a cup of tea would be nice’…then I watched as urine trailed from him and fell on to the floor beneath the chair…At 10.30pm he was taken to a ward after 14 hours.”

Mr Blanchard said that he and his partner were finally seen at 1.20 am, and stated:

“Never before have I seen people crying out of desperation…I don’t know what is to blame or whether it’s lack of money or lack of staff but this place was what I can only describe as ‘hell on earth’.”

That is what is happening in our NHS in 2016, and such stories are becoming more common. Ministers may not like to hear it, but they need to start taking responsibility.

[Mr Kenneth Clarke]

There are always pressures in the giant national health service as demand grows and expectations rise, and there always will be. The hon. Lady could have made this speech as an Opposition spokesman 10, 20, 30 or 40 years ago. After 20 minutes, she has not yet suggested a solitary policy proposal as an alternative to the Secretary of State’s, and she has not said whether she agrees with him about seven-day working and all the rest of it. She is describing sad incidents in which things have obviously not been ideal or as they should be, but does she have anything to suggest by way of policy that may contribute to helping the NHS in future?

[Heidi Alexander]

Having had these exchanges over the Dispatch Box for the past nine months, it strikes me that the reality of what people are experiencing in hospitals is sometimes missing from these debates, and that is why I thought it important to quote from those letters.

On workforce challenges, nothing sums up this Government’s failure on the NHS more than the way that they have treated NHS staff. We have had pay freezes, cuts to training places, and the first all-out doctors strike in 40 years—a strike that the Health Secretary did not even try to prevent; in fact he provoked it. He has spoken about seven-day services, but he said little about how he proposes to improve weekend care without the extra resources and staff that the NHS will need. We can only assume that his plan is to spread existing resources more thinly, asking staff to do even more and putting patients at risk during the week.

The Health Secretary also failed to say what experts think about his approach. For example, Professor Sir Bruce Keogh said that the NHS was making good progress towards improving weekend care, but that that became “derailed” when the Health Secretary started linking seven-day services to junior doctors. Fiona Godlee, editor of The British Medical Journal, said that, by picking a fight with doctors, the Health Secretary has set back NHS England’s established programme of work on improving services at weekends. Not only does he have no plan to deliver a seven-day NHS, but he has ripped up the plan that was already in place to improve weekend care. You couldn’t make it up, Mr Speaker.

The Health Secretary often reads out his usual list of stats on staff numbers, but to know what is really happening we must look beyond the spin. A recent survey of nurses by Unison found that almost two-thirds believe that staffing levels have got worse in the past year, and 63% said that they felt there were inadequate numbers of staff on the wards to ensure safe and dignified care—that figure was up from 45% the year before. Whether GPs, nurses or midwives, numbers of staff have not kept pace with demand.

Analysis by the House of Commons Library shows that, in the Labour Government’s last year in office, there were 70 GPs per 100,000 of the population, but that figure has now fallen to just 66. In Labour’s last year, there were 679 nurses per 100,000 of the population, but there are now just 665. No wonder that doctors and nurses feel pushed to breaking point. If we do not look after the workforce, patients will suffer. There was nothing in the Queen’s Speech to help the workforce—no U-turn on scrapping NHS bursaries, no plan to train the staff the NHS so desperately needs, and no plan to improve working conditions.