National Health Service

Debate between Marcus Jones and Andy Burnham

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.

I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?

Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.

That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how

“hundreds of thousands of older people who need social care are being left high and dry.”

[Mr Marcus Jones (Nuneaton) (Con)]

If we were unfortunate enough for Labour to win the forthcoming general election, by how much would it increase councils’ adult social care budgets?

[Andy Burnham]

I am talking about creating a single budget. There is a big difference between that and what the hon. Gentleman says. I am saying that the time has come to merge the adult social care budget and the NHS budget. More than that, we are going to put an extra £2.5 billion into that integrated system. He should not come here today telling me what I need to do: where is his plan to put more money into the national health service?

--- Later in debate ---

[Andy Burnham]

I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.

The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.

For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E

“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”

My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?

The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.

As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?

Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?

On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?

[Mr Marcus Jones]

Will the right hon. Gentleman give way?

[Andy Burnham]

I have said that I will not give way again.

All those measures could help in the short term, but the truth is that all parties must recognise that there will not be a long-term solution to the A and E crisis until we face up to the crisis in social care, and rethink how we care for the most vulnerable older people. It is not just about money; we need radical changes in the way we use existing budgets for health and care. We need to merge them so that we can change the way in which we care for older people. We need a model of care that starts in the home and supports people there, so that we can drastically reduce the numbers unnecessarily ending up in hospital and becoming trapped there.

Although that model is not just about money, it is partly about money: if such a transformation is to happen, extra investment will be needed to stimulate it. The Secretary of State likes to hold up the better care fund, but I am afraid that councils and the NHS simply do not share his optimism. It robs Peter to pay Paul: the money transferred to councils is nowhere near enough to backfill the cuts to social care, and it leaves a deepening hole in NHS finances. [Interruption.]

The Secretary of State asks where I would get the money from, and I will tell him. The Opposition have committed to provide extra money for an integrated NHS—£2.5 billion a year over and above what he has committed—with social care as part of a single service for the whole person. By contrast, under the public spending plans the Government have set out for the next Parliament, it is clear not only that the A and E crisis will deepen every year, but that it will soon become a full-blown NHS crisis.

The NHS used to be the Prime Minister’s priority; now it does not feature in his top six election themes. We know that there will be no money for it beyond what the Government have promised, because the priority is tax cuts for higher rate taxpayers, although they have not yet identified where the money for that will come from. If the outlook for the NHS is grim, it is utterly dire for local government and social care. Taking public spending back to 1930s levels will absolutely decimate what is left of our social care system, and if the system goes into freefall today’s problems in the NHS will become entrenched. Will the Secretary of State go back to the Chancellor, argue for a better deal for the NHS and social care, and match Labour’s pledge to prevent a permanent care crisis in the next Parliament?

The NHS is now at the crossroads, and the coming election presents an enormous choice between Labour’s plan to lift the NHS out of its current crisis by investing £2.5 billion in the NHS of the future, and the coalition approach under which—with the Government unable to face up to the mess of their own making in A and E or to produce a plan to turn it around, and unwilling to find the extra money it needs—the NHS is dragged down by a toxic mix of cuts and privatisation. The stakes could not be higher. This crisis cannot go on: patients have suffered enough. They need an election, a change of direction and a Labour Government to secure the NHS.

NHS

Debate between Marcus Jones and Andy Burnham

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

The Minister looks pleased with himself, but I am afraid he has got his facts wrong. We did not introduce the private sector into the NHS; it has always worked with the private sector to relieve pressure on waiting lists. As a doctor, he should know that. He might also know that waiting lists and times came right down under the last Government, because the private sector supported the NHS, and I am proud of how we brought waiting lists down, but he is using the private sector to replace the public NHS. He is saying that any qualified provider can provide NHS contracts. I had a policy of designating the NHS as the preferred provider. So let us get the facts straight. There is a major difference between the two positions.

[Mr Marcus Jones (Nuneaton) (Con)]

If the right hon. Gentleman is so anti private sector involvement in the NHS, why did he allow an NHS hospital to be managed by the private sector?

[Andy Burnham]

I think the hon. Gentleman is referring to Hinchingbrooke, the contract for which, he will recall, was signed under his Government. If he comes to the House, he should at least have the decency to get his facts straight. A procurement exercise began under the NHS preferred provider policy that I introduced, but he will find that his Government changed that to any qualified provider, and then appointed Circle health, whose shareholders also happen to be major donors to the Conservative party, to run the hospital.

The Government are spending millions of pounds on competition advice under the regime introduced by the 2012 Act. Since last April, CCGs, have spent £5 million on external competition legal advice. How can that be justifiable at a time when we have a shortage of A and E doctors? Around the world, we see that competition not only costs more, not less, than a planned system such as the NHS, but results in more fragmentation. It will never be an answer to the pressures in A and E. We need an approach where clinicians can collaborate and develop integrated solutions to relieve pressure. How can we possibly achieve integrated care when there are several different providers, each providing a different part of the same patient pathway?

The A and E crisis will be permanent, unless the Government accept its root causes and remove the barriers to its solution. The answer is in the motion before the House. The House can vote to reverse the competition policy introduced by the Government in the 2012 Act and to remove the market madness now holding back the NHS, and it could all be done because it would be consistent with the coalition agreement. The simple fact is that nobody voted for the NHS to be broken up in this way. Who gave this Prime Minister and Government permission to put the NHS up for sale? Nobody. They said there would be no top-down reorganisation. In the fullness of time, “No top-down reorganisation of the NHS” will be to this Prime Minister what, “No rise in tuition fees” is to the Deputy Prime Minister.

The choice on the NHS in 2015 is becoming clear: it can stay on the fast track to fragmentation or it can return to its values of putting integration over fragmentation, collaboration over competition, and people before profits. That is what the Opposition believe in. Let us have that debate so that we can save our NHS for future generations.