Five Year Forward View

Andrew George Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

Two things. I have had a very interesting visit to Goole hospital. It was very impressive to see how it has responded to the special measures programme and how, as a result of the new inspection regime, which Labour Front Benchers tried to vote down, it has made real improvements in care on the front line for the hon. Gentleman’s constituents. Those at the hospital will be pleased to see that this report endorses the new transparent approach to dealing with variations in care. It also says that we need to continue with increases in real-terms funding for the NHS, which we only get with a strong economy.

[Andrew George (St Ives) (LD)]

The theme of integration is re-emphasised in this plan, but how can commissioners ensure that they achieve that integration if they are forced against their will to outsource many services and also fear that their commissioning decisions will be challenged for being anti-competitive?

[Mr Hunt]

They are not forced against their will to outsource. They make the decisions as to where they want to purchase services from, and they do so on the basis of what is best for patients. Just like the primary care trusts that they succeeded, they have to follow European law in the way that they do that.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

I hope that I can reassure the hon. Gentleman that there are now 1,000 more GPs in training and working in the NHS under this Government than when we came to power in 2010. We are committed to training even more GPs to ensure that we can widen access to general practice services.

[Andrew George (St Ives) (LD)]

In what circumstances can clinical commissioning groups treat the NHS as a preferred provider, and in what circumstances are they forced to contract out services?

[Dr Poulter]

As my hon. Friend will be aware, when commissioning services, it is important that regard is given not only to competition because, under the 2012 Act, we have ensured that there must be regard to delivering an integrated and joined-up approach for local services. That is an issue for local commissioners to decide in the best interests of the patients they look after.

NHS Services (Access)

Andrew George Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

We brought in other providers in a supporting role to add capacity to bring down NHS waiting lists to the lowest ever level. That is what the previous Government did. By contrast, this Government are doing something different. It is mandating tendering on GP commissioners, requiring people to compete, wasting money on running tenders and privatising the national health service, which is why they must be stopped.

[Andrew George (St Ives) (LD)]

It is fair to say that the previous Labour Government did introduce the private sector to many areas of the NHS. They also introduced a requirement for the tendering of many NHS services. If we follow the logic of Lord Warner, who is setting out the general direction of Labour party policy, we will find that that is clearly where the heart of Labour party policy has been and probably will go.

[Andy Burnham]

May I remind the hon. Gentleman, for whom I have a lot of respect, that I, as Health Secretary in 2009, introduced to the national health service a policy of NHS preferred provider? That is because I am not neutral about the NHS. I believe in the public NHS and what it represents, which is people before profits. Any policy that I develop will always be based on that principle. I was attacked at the time by the Conservative party for introducing such a policy, but I make no apology for it. We used the private sector in a supporting role, but the Government want to use it in a replacement role, and there is a very big difference between the two things. If they were continuing what we had done, why did they need a 300-page Bill to rewrite the whole legal basis of the national health service?

--- Later in debate ---

[Andrew George (St Ives) (LD)]

It was in fact the Liberals who were the architects of the NHS, but perhaps that might be lost from history. The fact is that we have yet another occasion when the nation will be looking down and counting their shirt buttons as Members on the two Front Benches trade dodgy statistics and rewrite history. I am talking about the nature of the rather tribal debate that we had in the opening exchanges. My fear is that that is the biggest risk to the NHS—too much tribalism and not enough time spent addressing the serious issues of the NHS.

The right hon. Member for Leigh (Andy Burnham) is absolutely right that there are serious issues in the NHS that need to be addressed. What usually happens on these occasions is that the Secretary of State beats the right hon. Gentleman around the head with a report from Mid Staffs. I am pleased that on this occasion he did not, because that is often done in very bad taste and rather inappropriately.

Equally, I have to say to the right hon. Member for Leigh that, as the Secretary of State reasonably pointed out, he failed to acknowledge that Labour cannot ignore the fact that it ushered in and rolled out the red carpet for the private sector. The arrangements for the tendering for Hinchingbrooke hospital happened under a system set up by the then Labour Government. No matter at which stage various companies or NHS trusts fell out of or withdrew from the process, the course had been set by Labour. Unless he is telling us that he was going to preordain the outcome of a proper and open tendering process, which would of course be anti-competitive, he must have known that one of the options—this is what happened—was that a private company would take over the running of the hospital.

[Andy Burnham]

I am grateful to the hon. Gentleman for giving way, as I want him to be absolutely clear about how I operated that process. It followed the NHS preferred provider principle, which I introduced, and I began by asking the officials in the Department to see whether a local NHS trust was prepared to come in and take over. Addenbrooke’s was the trust I had in mind, but for some reason it was not prepared to do so at that point so we had to find a runner. I said that we had to go out more broadly, but my intention was clear: I wanted an NHS provider. That was where things had got to. The former Minister, the right hon. Member for Chelmsford (Mr Burns), mentioned March, but things were going into purdah at that point. That was where the process was when we left government and I want the hon. Gentleman to be clear on that point.

[Andrew George]

I am grateful to the right hon. Gentleman and, of course, he has now had the opportunity to put that point on the record. However, he must recognise that as others have said—indeed, I made this point when I intervened on him—the Labour Government rolled out the red carpet with the policy of independent treatment centres, walk-in centres and other services, where the taxpayer paid dearly for services that were not delivered.

The right hon. Gentleman knows that I did not support the Health and Social Care Act 2012. I saw it as a missed opportunity to address a large number of issues and it engaged in a top-down reorganisation that was not necessary. I fear that both the Conservative party and the Labour party appear to have been beguiled by a set of PowerPoint-wielding management consultants who have persuaded them that changing how the system works is an easy solution when, as a number of Members have mentioned, more than anything else the NHS needs much more integration of services—certainly not fragmentation—and for standards within it to be addressed.

The House knows that I always look to make a constructive contribution to such debates, so, as the Minister knows, I have been championing the case for safe staffing levels. The campaign of the Safe Staffing Alliance has argued for no more than eight acutely ill patients for every registered nurse, excluding the nurse in charge, on acute hospital wards. We need to establish a floor below which standards cannot fall, because services are often engaged in a race to the bottom because of financial pressures. That is very important. It is encouraging that that issue is now being taken seriously and I hope that the Government will consider the recommendations from other bodies to advance the cause.

With regard to the integration of health and social care in the wider community, there has always been the mantra that we need fewer hospital beds, and that certainly happened under Labour. That has resulted in many of our acute hospitals being on red alert and unable to manage the situation, with patients on inappropriate wards or stuck in ambulances queuing outside. That was clearly predicted by many people, not least me, when the policy was being pursued.

What we need to do is front-load the system to ensure that we can discharge patients from hospitals safely. We do not have the facilities for that, either in the community or in primary care. Of course, having that system of discharge and avoiding unnecessary admissions depends on having adequate services at home. Ultimately, that falls on the shoulders of home care workers, who themselves face a race to the bottom, as they are often paid the minimum wage and their travel times and costs are not properly covered. We therefore need a new benchmark that puts a floor in the system by paying those workers a living wage, covering their travel times and expenses, and protecting them so that we do not end up with the race to the bottom that I fear we are seeing in the system.

We need to ensure that we have safe services. Ultimately, we need to address care standards in our hospital wards and press for, rather than simply talk about, the integration of health and social care in order to address the fundamental challenges that the NHS faces.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

That is not actually a matter for NHS Property Services Ltd; it has to be locally driven. However, my hon. Friend is absolutely right that we need to enhance community care services, whether in community hospitals or through services delivered at home. My hon. Friend has a high proportion of older people in his constituency and the transformation will be incredibly important for all his constituents.

[Andrew George (St Ives) (LD)]

Will my right hon. Friend join me in welcoming the National Institute for Health and Care Excellence’s statement today on the establishment of safe staffing levels on hospital wards? He will be aware that I have been campaigning on the matter for many years. The 1:8 ratio is certainly not a target but a baseline against which safe staffing and patient care can now be measured.

[Mr Hunt]

I welcome what NICE has done today, because it is incredibly important that we end the scandal of short-staffed wards in our NHS, which was a feature for many years under Governments of both parties. The lesson of Mid Staffs is that the oldest and most vulnerable patients, such as people with dementia, can be forgotten when a hospital is under pressure, so NICE’s guidance will be welcomed and useful. It is important to say that it can save money, because nothing is more expensive than unsafe care.

Health

Andrew George Excerpts

Monday 9th June 2014 Commons Chamber

[Mr Speaker]

Order. I say to the hon. Member for Rhondda (Chris Bryant), who has just published an extremely cerebral tome on the history of Parliament, that he should not be yelling and exhorting from a sedentary position as though he is trying to encourage a horse to gallop faster. It is not an appropriate way to behave.

[Andrew George (St Ives) (LD)]

The Secretary of State mentioned the importance of integrating secondary and primary care. He will be aware that the chief executive of NHS England recently addressed the large number of community hospitals with a sword of Damocles hanging over them and whether or not they will continue to exist. He said that that issue should be revisited and, indeed, has argued that community hospitals should be developed and that we should protect that area of care. Does the Secretary of State believe that the chief executive of NHS England is calling for the retention and reopening of community hospitals?

[Mr Speaker]

Interventions should be brief—the hon. Gentleman is experienced enough to know that.

Oral Answers to Questions

Andrew George Excerpts

Tuesday 1st April 2014 Commons Chamber

[Mr Hunt]

I am interested and rather astonished that the hon. Lady dares to mention the words “GP” and “contract” in the same sentence. It was Labour’s GP contract changes in 2004 that made it disastrously more difficult for people to see their GP and destroyed the link between patients and doctors by getting rid of named GPs. She will be pleased to know that from today we are reintroducing named GPs for the over-75s, which is big step forward in making it easier for people to see their GP.

[Andrew George (St Ives) (LD)]

Although the Secretary of State says that he is getting rid of tick-box targets, new targets are being introduced, including hourly ward rounding for nurses and the introduction of a requirement for nurses to undertake a year as a care assistant. Would it not be better to depend on the professionalism of the nursing profession?

[Mr Hunt]

That is exactly what we are doing. There is no target to introduce hourly rounding, but there is very good evidence from the hospitals that have it, such as Salford Royal, that it results in the buzzer going off less often, calmer wards and problems being nipped in the bud. People are given food and water before they feel the need to ask for it and we end up with much better and safer care. That is something the hon. Gentleman should welcome. We certainly want to work with the nursing profession to ensure we deliver that.

Care Bill [Lords]

Andrew George Excerpts

Tuesday 11th March 2014 Commons Chamber

[Andy Burnham]

Before the hon. Gentleman makes that argument, I suggest that he speaks to the people of Lewisham to see whether they think that the process was fair. I suggest that he goes and speaks to the people of Stafford to see whether they think that the process has been fair. I do not know how he can argue that the new process is better than the original process, whereby there was always local engagement and through which elected Members had a chance to refer matters to the Independent Reconfiguration Panel.

[Andrew George (St Ives) (LD)]

We often debate this matter in the House and we all agree in principle with the concept of reconfiguration, until it is the local hospital in our constituency that is affected. That is the conundrum. What facility does the right hon. Gentleman think the Secretary of State and the Department of Health need to overcome the fact that every MP will defend their local hospital, even though reconfigurations are clearly required?

[Andy Burnham]

The hon. Gentleman makes that argument as if there were no changes to hospitals under the previous Government. There was plenty of change, but there is a right way and a wrong way of doing things. I would argue, as I just have, that the previous way of doing things was a better way.

--- Later in debate ---

[Mr Hunt]

Let me first tell the hon. Gentleman that the TSA did not recommend the closure of the A and E unit at Lewisham hospital, and he knows that perfectly well.

I will say what this Government are determined to ensure does not happen again. Mid Staffs went on for four years before a stop was put to it. Patients’ lives were put at risk and patients died because the problem was not tackled quickly. The point of these changes today is to ensure that, when all NHS resources are devoted to trying to solve a problem and they fail, after a limited period of time it will be possible to take the measures necessary to ensure that patients are safe. I put it to the hon. Gentleman and to all Opposition Members that if they were in power now they would not be making the arguments that they have been making this afternoon, because it is patently ridiculous to say that we will always be able to solve a problem without reference to the wider health economy. They know that: it was in the guidance that they produced for Parliament when they introduced the original TSA recommendations. What Government Members stand for is sorting out these problems quickly and not letting them drag on in a way that is dangerous for patients.

[Andrew George]

Following the concessions announced by the Under-Secretary in the previous debate, do I understand correctly that if the TSA makes recommendations to a non-failing trust to its detriment and the trust objects to those proposals, NHS England can, through its arbitration process, impose those changes?

[Mr Hunt]

Let me clarify, but first let me add that we want to listen to the consultation that will be led by my right hon. Friend the Member for Sutton and Cheam and the new Committee that he chairs. We are requiring local clinical commissioning groups and GP groups to come to an agreement on the right way forward in these difficult situations. We need an arbitration system for when agreement is not possible, which this clause allows for. We would like there to be agreement but we cannot allow a situation where, when there is not an agreement, we end up with paralysis and being unable to sort out the problem of a trust that is failing, particularly when it is unsafe and patients’ lives are being put at risk. That is exactly what was happening in the South London Healthcare NHS Trust.

As the Bill leaves the House to return to the other place for the final stages of its passage, we can be justly proud. This is a landmark piece of legislation that will transform the experience of those who rely on the NHS and care systems by giving patients and their carers both legal rights and a much better joined-up service. It will reduce the money wasted on duplication and allow more resources to be directed at the front line. It will remove the uncertainty and worry of unpredictable care costs in later life and will put individuals at the heart of a system built around their needs and not its own priorities.

Most of all it will send a signal loud and clear that when it comes to the challenge of treating an ageing population with dignity, compassion and respect, this House has not shirked its responsibilities but has risen confidently to the challenge.

Care Bill [Lords]

Andrew George Excerpts

Monday 10th March 2014 Commons Chamber

[Mrs Lewell-Buck]

I entirely agree. The budgets of council adult social care departments are now so stretched that they fill a gap wherever they can, as cheaply as they can.

[Andrew George (St Ives) (LD)]

The hon. Lady is making an excellent point. In new clause 32, I propose that the Secretary of State should undertake a review of care standards, including hourly pay and other kinds of remuneration for home care workers. Does she agree that unless we have decent national standards for visiting times and remuneration, we shall be faced continually with a race to the bottom?

[Mrs Lewell-Buck]

I apologise for not having read the hon. Gentleman’s new clause. I have been focusing on my own new clauses and amendments, but I will look at his new clause at a later stage.

Amendments 31 to 33 would establish firm time scales for assessments and reviews of service users’ care needs. During the Bill’s passage so far, the Opposition have repeatedly tried to raise the issue of the funding gap in adult social care, which threatens some of the positive changes that the Bill would bring about. In my constituency, our local authority has been forced to make £24.3 million-worth of savings, with predictable consequences. One of the consequences for local authorities has been a decline in the regularity of assessments and reviews. I have spoken to people whose assessments have been grossly delayed; I have also visited care homes in which some residents have not been reviewed for up to three years, during which time their needs may have changed dramatically and their support may have become inadequate.

It is easy to understand how that happens. Under-resourced departments must set priorities, and routine steps such as the reviewing of someone’s care plan are often at the bottom of the list because there is no pressure for them to be taken in a timely way. However, those steps are very important, because they identify changes in a person’s condition which, if ignored, might lead them to a crisis point. The amendments would reverse a worrying trend which has seen delayed assessments rise significantly since 2010, when 18.7% of new clients waited four weeks or more for an assessment. By 2011-12, the latest year for which figures are available, the figure had risen to 22.7%. In some individual local authorities, the change is even more worrying. In one authority, the number of new clients waiting to be assessed jumped from 12.6% to 70.7% between 2010 and 2012. It is important to remember that those are not just percentages, but represent vulnerable people whose needs are not being met.

In Committee, the Minister said that he was concerned about assessments being rushed to meet the timetable, and that a simplistic time scale would not be tailored to meet individual needs. I agree that that is of concern, but it should not be necessary for the time scale drawn up by the Secretary of State to be a “one size fits all”. The timetable for more complex cases could take into account the more complex nature of the assessment and allow more time for completion. It would be much more dangerous to have no benchmark at all and for those people to have their assessments delayed and their needs not met. The amendments would improve the situation for people with more complex needs, for whom putting support in place quickly is most important.

--- Later in debate ---

[Paul Burstow]

Absolutely. That is why the duty on market shaping set out in the Bill is about stretching the local authority to take that wider population-level interest, and not only for the people for whom they will arrange care and for whose care and support needs they will pay, but for the whole population who might need care and support but will be funding it themselves. I do not see how local authorities can satisfactorily discharge that new and important responsibility if there is not also a fairly critical examination of commissioning practices themselves. That is why I have tabled the new clause.

[Andrew George]

My right hon. Friend is making an excellent case. There is another reason why it is essential that inspection in that area becomes paramount, and that is because of the drivers in the system itself that discourage avoidable hospital and community hospital admissions and seek the earliest possible discharge into the community. What we have is a scenario in which people are being cared for in their homes, in an “out of sight, out of mind” environment, so inspections become all the more important because of the need to ensure that they are safe—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Paul Burstow.

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[Grahame M. Morris]

The hon. Gentleman makes an interesting point which echoes a point made on the Labour Benches a few moments ago. The problem is that a number of private health care companies are also insurance companies, so it would be quite a task to ensure that data are not shared with companies that might have a commercial interest in them. To restrict access in the way we would all want is not as simple as the Government would have us believe.

[Andrew George]

The hon. Gentleman and I often agree on these issues, but I am slightly concerned. Of course we want reassurances, and while we have the pause we should seek further reassurances on the anonymisation of data and that they will not be misused. How far is he prepared to push this point? Is he prepared to push it to the extent that the initiative falls, with all the consequences for the lack of progress in advances in medical care? In 10 years’ time we could be talking about hundreds of thousands of lives that could have been saved as a result of pressing on with this very important development.

[Grahame M. Morris]

The hon. Gentleman makes an excellent point. It is not my intention to do that, but we have to recognise that the public awareness campaign—the Government’s early assurances about leaflets and letters—has been wholly inadequate. At a time when it is important for the Government to instil public confidence in the scheme, they keep doing things that undermine public confidence, for example by giving the hated company Atos—if you do not mind me using the term, Mr Speaker, because of the debacle in the Department for Work and Pensions—the contract to extract the data. There seems to have been a catalogue of errors.

I accept that this proposal has the potential to be a huge step forward. The Minister said it was not revolutionary, but I am quite often in favour of things that are revolutionary. It is revolutionary, because previous data collections from a hospital-based setting, from secondary care, have been largely episodic. This scheme will harvest data from GPs and primary care to follow the whole of the patient journey, and to identify trends and follow-ups. That is a revolutionary step forward, provided we have the necessary safeguards and assurances, and that we rebuild public trust. I am not suggesting that the scheme is unworkable and cannot be reformed, but there is a huge job to do to ensure that we restore public confidence.

Francis Report

Andrew George Excerpts

Wednesday 5th March 2014 Commons Chamber

[Mr Hunt]

The truth is that the process takes time, and there are still examples of where candour is lacking. Allegations have recently surfaced in the press, the substance of which makes it appear that that reporting has not happened. There is much work to do, but the signal has gone out loud and clear that if people are open, transparent and honest from the start when something goes wrong, that should not be punished but should be recognised as a way of improving how we look after patients, in the same way as profound changes in the airline industry have made our aeroplanes much safer. We need that change in the NHS.

We also now recognise that however important ministerial objectives and national targets may be, NHS organisations should never prioritise them at the expense of dignity and respect for patients. We now know that the best way to deal with poor care is for people to speak out about it, whether they are a health care assistant, doctor, nurse or even Secretary of State, and that that should never be confused with “running down the NHS”. We also know that failing to speak out about poor care, or to support those who do, is a betrayal not just of patients but of the kindness and humanity of more than 1 million dedicated NHS staff, thousands of whom pledged themselves to compassionate care just two days ago on NHS change day.

What has happened in the past year? Robert Francis asked why the system effectively failed to detect or deal with the problems at Mid Staffs for a shocking total of four years. We have re-established the CQC as a rigorous and independent inspectorate, with three powerful new chief inspectors appointed to speak truth to power. The Keogh review inspected 14 hospitals last summer, and the new chief inspector of hospitals, Professor Sir Mike Richards, has already completed inspections of a further 18 trusts, with 19 more inspections taking place now. As a direct result, 14 trusts are now in special measures—a record in NHS history—and, thankfully, long-standing problems are finally being tackled.

On staffing, the inquiry found

“an unacceptable delay in addressing the issue of shortage of skilled nursing staff.”

The latest figures show that not only are there 3,500 more nurses on our hospital wards since the Francis report, in just a year, but we now have more nurses, midwives and health visitors in the NHS than ever in its history. From this summer, all hospitals will publish their staffing levels monthly, on a ward by ward basis, so that shortfalls are speedily identified.

Robert Francis identified a closed, defensive and secretive culture at Mid Staffs. In response, we have ended gagging clauses and we are making it a criminal offence for trusts to publish or provide specified information that is false or misleading. We are also placing a statutory duty of candour on organisations so that they are required to be honest with patients about poor care, and professional regulators are consulting on a new professional duty of candour that provides protection for staff against being struck off if they are open about the problems they see. I believe that will create one of the most transparent and open health care systems in the world.

[Andrew George (St Ives) (LD)]

I welcome the important steps in the right direction that have been taken with regard to recording and safe staffing on acute hospital wards. The Secretary of State also announced last year that he intended to introduce a system whereby nurse trainees would shadow or work alongside care assistants for up to a year. Is that idea being developed at the moment?

[Mr Hunt]

Yes, it is. I will come on to that, but we are making good progress with the pilots.

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[Andy Burnham]

My hon. Friend is right: it is the poor relation that has always been on the fringes of the system, and is always the first service to be targeted for cuts. That has happened again in these difficult times. The Government are cutting mental health services more deeply than the rest of the NHS, and that has led to all the problems that I have been describing.

I went to Stafford recently to meet campaigners who are working to support the hospital. One of them told me that because of the lack of available mental health beds, beds had had to be found in the hospital for people who were experiencing serious mental health crises. That is what begins to happen when we do not have adequate capacity on the ground. Government Members say that this is not relevant, but it is directly relevant to all the matters that we are discussing today.

[Andrew George]

As the right hon. Gentleman knows, I was critical of the last Labour Government for rather bizarrely rolling out the red carpet for the private sector and, indeed, allowing financial targets to distort clinical priorities to an extent which, I think, created the circumstances that led to the Mid Staffs difficulties. He has mentioned integration of care. Does the Labour party propose full integration in terms of the pooling of budgets, and does he support the campaign for a fundamental safety standard in respect of the ratio of registered nurses to patients on acute hospital wards?

[Andy Burnham]

I do support that campaign, because I think that we need transparency so that local people can see whether their hospitals have enough staff. I also support the full integration of health and social care into a single service—an even deeper integration than a pooled budget—because I believe that that is the only way in which we will build a service based on the individual. We need a system in which all the needs of one person are clear and the service can start in the home, rather than this fragmented world in which care in the home is being cut and older people are being left at ever greater risk of hospitalisation.

I find it worrying that Government Members seem to be in denial about what I have been saying, and that brings me to the central point that I want to make. I believe that the Government have mishandled their response to the Francis report, and I shall cite three examples in support of my claim. First and most obviously, the Government have failed fully to implement 88 of the report’s recommendations, as they have themselves acknowledged. Secondly, Stafford hospital has, in my view, been hung out to dry. Thirdly, by overtly politicising the whole issue of care failure, the Government have created a climate of fear throughout the NHS—the worst possible response to what Francis said.

It seems to me that the Government have missed the entire point of the Francis report. If we distil the report into a few words, it called for a culture change. A range of measures were proposed with the aim of achieving that change, including a duty of candour for individuals and organisations, regulation of health care assistants, and, crucially, moves to strengthen the patient voice at local level by giving Healthwatch more protection and prominence. Francis recommended that local authorities be required to pass centrally provided funds to local Healthwatch groups, but that recommendation was not accepted. Of the £43 million allocated by the Department last year, HealthWatch groups have received only £33 million, which leaves £10 million unaccounted for. The Patients Association has said that

“vital recommendations have not been accepted and…patient care could suffer as a result.”

We support measures that the Government are introducing in the Care Bill on the appointment of chief inspectors, but let us be clear: they were not recommendations of the Francis report, and, if we are not careful, they will risk reinforcing a much more top-down approach to regulation. The position is not helped, I might add, by the Secretary of State’s new habit of calling hospital chief executives directly himself. Indeed, one of the great ironies of the Government’s reorganisation is that it has left the NHS a more top-down organisation than it was before, with clinical commissioning groups yet to find their voice and NHS England calling all the shots.

Let me quote from the Nuffield Trust’s report, entitled “The Francis Report: one year on”. In his foreword to the report, Francis himself says:

“Perhaps of most concern are the reports suggesting a persistence of somewhat oppressive reactions to reports of problems in meeting financial and other corporate requirements. It is vital that national bodies exemplify in their own practice the change of cultural values which all seem to agree is needed in the health service.”

Robert Francis himself says that national bodies are still behaving in a top-down fashion—one year on.

NHS

Andrew George Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

I am afraid that under the coalition, NHS treatment for “Gove-itis” is being rationed, like everything else, unfortunately. As my hon. Friend said, the Government claim they are keeping A and Es and call them “local” A and Es, but they are actually downgrading A and E units all over the country. How can it make sense to close and downgrade A and Es in the midst of an A and E crisis? In west London, as my hon. Friend knows, incredible changes are being introduced without proper regard for the evidence I am presenting to the House today of a change in A and E and of sustained pressure on A and E units. The Government must go back and consider their plans for my hon. Friend’s constituency and the rest of London.

[Andrew George (St Ives) (LD)]

I totally agree with the right hon. Gentleman that the last thing the health service requires is complacency, but synthetic rage does not help either. He must remember that when he was Health Secretary, and indeed a Health Minister, up to seven ambulances were queuing outside Treliske hospital in Cornwall. That problem happens from time to time and it would be better for parties to co-operate and to come together to try to find a solution, rather than simply trying to score political points and ignoring the past.

[Andy Burnham]

I will put forward a solution that the hon. Gentleman might support. I think he supported the campaign to oppose the Government’s Health and Social Care Bill, and I pay credit to him for that as we worked across party lines on that issue. It is my job to hold the Government to account where there are problems in the national health service, and if the Minister is saying to me that there are no problems in the health service right now, I am afraid I do not agree with him. Emergency services are under intense pressure. If he looks back to our time in government, as he invited me to do, he will see that the winter crisis was a regular feature at the turn of the millennium and the early years of the last decade, although it got progressively better and better and we did not see the annual winter crisis. Now it is back with a vengeance, although it is different. The winter/spring crisis has become a summer/autumn crisis too. The pressure is relentless and it needs a proper, lasting solution.