National Health Service

Andy Burnham Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House recalls that the Prime Minister made a series of personal pledges on the NHS in the run up to the General Election which were carried over to the Coalition Agreement; believes it is now clear he has failed to honour three of the headline commitments in the Coalition Agreement; notes firstly that Treasury figures from July 2011 confirm that NHS spending fell in real terms in 2010-11, contrary to the guarantee that health spending will increase in real terms in each year of the Parliament; notes secondly recent central approval of changes to hospital services, in breach of a moratorium on such changes; notes thirdly the Prime Minister’s continuation, despite widespread opposition, with the Health and Social Care Bill, contrary to the pledge in the Coalition Agreement to stop top-down reorganisations of the NHS; believes there is mounting evidence that the combination of an unprecedented financial challenge combined with the biggest reorganisation in the history of the NHS is damaging patient care and leading to longer waiting times; is concerned that huge cuts to adult social care in England will further limit hospitals’ ability to cope with coming winter pressures; and calls on the Government to listen to GPs and NHS staff, drop the Bill and accept the offer of cross-party talks on reforming NHS commissioning.

We read today that the Government were in open retreat last night on their Health and Social Care Bill in the House of Lords. Given that, we thought it only right to bring the Secretary of State here today to be held to account by this elected House. He tried to shuffle off his responsibilities and dug in when the Bill was in this place, only to give in down there. That came just hours after he had to confirm that he would still take oral questions in this House, despite a claim to the contrary by his preferred candidate to take over the running of the NHS. The Secretary of State may be on the run, but we will not let him hide. Our NHS is too precious to too many people in this country to be carved up in dodgy coalition deals in the unelected House. His Bill is unravelling before his eyes, and coalition health policy is in chaos. Today, we hold him to account for that.

To be fair to the right hon. Gentleman, the responsibility is not all his. It goes right up to the door of No. 10 Downing street. People will remember only too well, in the run-up to the general election, the then Leader of the Opposition’s ostentatious shows of affection for the NHS, his airbrushed face on the posters and three very personal promises—real-terms increases in every year of this Parliament, no accident and emergency or maternity closures, and no top-down reorganisation of the NHS. He protested his love for the NHS, and at photo call after photo call on the wards he routinely wore his heart on his sleeve. As we now know, he was protesting a little too much, and today we expose the hollowness of his promises.

[Tracey Crouch (Chatham and Aylesford) (Con)]

May I take this opportunity to congratulate the right hon. Gentleman on his new post? He is back where he once was, but on the other side of the House.

Last year, in The Guardian, the right hon. Gentleman stated that it was

“irresponsible to increase NHS spending in real terms”.

Does he still stand by that statement?

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[Andy Burnham]

I am not sure whether I should thank the hon. Lady for reminding me that I am now a shadow of my former self, but I thank her for her words. I will come to the precise question that she asks. I did indeed say those words, and I will explain why in a moment.

I was talking about the three headline promises that the Prime Minister made on the wards. They were part of a calculated and self-serving political strategy to detoxify the Tory brand, not a genuine concern for the NHS. It was cynical because, as we will show today, those were cheques for the NHS that the Tories knew they could not cash, and promises that they had no real intention of keeping. Let us take the Prime Minister’s three personal promises in turn, starting with the one on NHS funding. It will be good to get to the bottom of that once and for all.

At the last election, Labour promised to guarantee to maintain NHS front-line funding in real terms. The now Prime Minister, by contrast, offered real-terms increases. How big those increases would be was undefined, but that did not matter. The important thing was that, according to the requirements of the detoxification strategy, it sounded as though the Tories were planning to spend more.

I remember well our resulting exchanges with the then shadow Health Secretary, now the Heath Secretary, on the hustings. Indeed, the Prime Minister has in recent weeks been quoting what I said then, as the hon. Member for Chatham and Aylesford (Tracey Crouch) did a moment ago. I did indeed say that it was cynical and irresponsible to make those promises, and I repeat that today.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the right hon. Gentleman consider “protecting the front line” to be the closure of many hospitals throughout the UK, mergers and the loss of vital cardiac services in such places as Ipswich? That was exactly what happened when he was Secretary of State.

[Andy Burnham]

The hon. Gentleman goes right to the heart of my speech today. We made those difficult decisions to get the NHS ready for the future. We grasped the nettle and took services out of hospitals and moved them into the community, because that is what has to happen if we are to have an NHS that is sustainable for the future. He stood on an election manifesto that promised the opposite. It was a dishonest pledge, and I will come to it in a moment.

I said a moment ago that it was irresponsible to promise real-terms increases. I say that because I completed a spending review of the NHS in March 2010 and knew the figures inside out. I had also been in detailed discussions with the Treasury on the funding of adult social care, in preparation for a White Paper. The implication of what the Conservatives featured on an election poster—cutting the deficit on an accelerated timetable while giving the NHS real-terms increases—could mean only one thing: unpalatable cuts to other public services, particularly adult social care, on which the NHS relies.

Despite that, the election pledge was carried over into the coalition agreement, which could not be clearer. It states:

“We will guarantee that health spending increases in real terms in each year of the Parliament”.

A year ago, at the time of the comprehensive spending review, the official figures claimed that that had been delivered, with a 0.1% settlement—essentially the same as Labour promised at the election.

[Mark Simmonds (Boston and Skegness) (Con)]

Does the right hon. Gentleman recall that before the general election, when he was Secretary of State, he said in the now infamous King’s Fund speech that the state should always be the preferred provider, irrespective of the quality of care that it provided to patients? Does he stand by that statement today, or is he now trying to drive a patient-centric health service rather than putting political ideology above patient care?

[Andy Burnham]

I think I should refer the hon. Gentleman back to the King’s Fund speech, because I did not say the NHS should be the preferred provider regardless of the quality of care it provided. I believe that the public NHS should have the first chance to change, and that was the preferred provider policy. We did not want to pull the rug from under the public NHS with a policy of “any willing provider”. If the NHS needed to change, we wanted to tell it, “You have to rise to the challenge, and you have a chance to do so. If you cannot, other providers will get a chance to come in.” That was the preferred provider policy, and I would be grateful if he did not misrepresent it.

As I said, a year ago the Government provided a 0.1% increase—or that was the headline, but the fine print began to emerge and their case began to fall apart from day one. It soon became clear that for the years 2011-12 to 2014-15, that figure included an annual £1 billion transfer to local government, ostensibly for social care but not ring-fenced, so councils would be free to spend it as they saw fit. The health funding settlement therefore already went below a real-terms increase. That transfer turned the apparently minuscule real-terms increase into a real-terms cut.

That still leaves 2010-11. When the coalition came into government, it immediately required primary care trusts to cut spending by increasing waiting times and restricting access to treatment, to generate an underspend in 2010-11.

[The Secretary of State for Health (Mr Andrew Lansley)]

indicated dissent.

[The Minister of State, Department of Health (Paul Burstow)]

indicated dissent.

[Andy Burnham]

Ministers are shaking their heads, but I will read them the Treasury figures published in July this year, and let them tell me then that what I have just said is not true. The public expenditure statistical analyses from this year provide official confirmation of what I have just said. They show that in 2009-10 health spending was £102,751 million. That was in the last year of the Labour Government. In 2010-11, health spending was £101,985 million. There we have it in black and white—the first real-terms cut in health spending for 14 years. In fact, it is the first real-terms cut since the last year of the last Tory Government in 1996-97.

[Henry Smith (Crawley) (Con)]

I am interested to hear how the right hon. Gentleman is trying to manipulate those figures. How does he reconcile what he is saying with what his party’s Administration is doing in Wales, where the health service has been cut and hospital infections and waiting times have risen?

[Andy Burnham]

The hon. Gentleman uses the word “manipulate”. May I say that I take great exception to that? I have read out the Treasury statistical analysis from this July. If he is telling me that I have misrepresented it, let him stand up again now and say so. If not, he should hold his peace. I remind him that his party’s Government delivered a much deeper cut to Wales than to Scotland or Northern Ireland. The Labour Administration are now dealing with the consequences of that.

[Ben Gummer (Ipswich) (Con)]

The right hon. Gentleman’s figures depended on the lack of what he called a ring fence in the social care transfer of £1 billion. I can assure him that as far as Suffolk is concerned, there is absolutely no problem in trying to deal with the ring fence. In fact, the county council spends more than the amount that was previously ring-fenced, because of the pressure on social care.

[Andy Burnham]

The hon. Gentleman was not listening. The social care transfer comes in for the years 2011-12 to 2014-15, but I was talking about the year 2010-11 and, in the year ended, there was a real-terms cut to the NHS, as confirmed by Treasury figures. This debate is about that fact. He and his hon. Friends stood at the election, with those airbrushed posters all around them, promising that they would not cut the NHS, but in their first year in office, they delivered a real-terms cut to the NHS.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Is it not the case that, whatever Government Members say, 82% of councils offer social care only in critical and substantial cases, that thousands of people up and down the country are suffering the loss of their services, and that that will have a real hit on the NHS in years to come?

[Andy Burnham]

My hon. Friend makes a very important point. That was precisely why I said it was irresponsible for the Conservatives to promise increases to the NHS in the way that they did, on a much-reduced public spending envelope. That has led to precisely the consequences that she describes. Indeed, that hidden cut to adult social care has been quantified at £2 billion.

I remember well Conservative party claims before the election about death taxes, but what about the dementia taxes that the Conservatives have loaded on to vulnerable older people up and down this country, who are now paying more out of their own pockets to pay for the care that they desperately need? That is the effect of cutting adult social care and cutting council budgets in that way.

We today the nail the position once and for all. The real position is worse than the one I described because of spiralling inflation, which in effect means even deeper real-terms cuts for the NHS this year and in all the years that follow.

[Chris Skidmore (Kingswood) (Con)]

The right hon. Gentleman mentions that the £2 billion transfer from the NHS social care budget is not ring-fenced, but I am sure he is aware that ring-fencing can have the perverse effect of ensuring that local authorities do not spend existing budgets. Will he clarify his position? Is ring-fencing a good idea or not?

[Andy Burnham]

I disagree with the hon. Gentleman. I said that it was irresponsible to pledge the money for the health service in the way that the then Opposition did in the run-up to the election precisely because I realised that more would be needed for adult social care. However, if the NHS is to transfer money to local government for adult social care, we must be certain that it will pay for that and not for weekly bin collections or for whatever else he thinks is more important than supporting older, vulnerable people with the costs of care. He makes my point that that money should have been ring-fenced, so that adult social care could have been protected.

[Chris Skidmore]

indicated assent.

[Andy Burnham]

The hon. Gentleman nods, but I am afraid that that was not the Secretary of State’s policy.

[Grahame M. Morris (Easington) (Lab)]

I compliment my right hon. Friend on how he is moving the motion. What are his views on the impact of the reduction of funding for the NHS on the front line, and on the number of hospital trusts that are breaching the 18-week target?

[Andy Burnham]

I am grateful to my hon. Friend for those words and I shall come to precisely that point, but let us be clear about this one: the Prime Minister promised a real-terms increase, but he has delivered a real-terms cut. He stands at the Dispatch Box week after week boasting about increasing health funding when he has not. All the while, NHS staff deal with the reality on the ground of his NHS cuts. Does he not realise how hopelessly out of touch he sounds? Hospitals everywhere are making severe cuts to services, closing wards, reducing A and E hours and closing overnight, making nurses redundant, and cutting training places. Last week, The Guardian revealed the random rationing that is taking place across the country. There are cuts to pay for management services, one third of neo-natal units are reducing the number of nurses, and midwife places are being cut despite the Prime Minister’s promise to recruit 3,000 more.

[Dr Poulter]

The right hon. Gentleman is making a great deal out of cuts. The Government have committed an extra £15 billion to the NHS over the lifetime of this Parliament, but the Opposition have consistently failed to agree to commit to any additional funding. Will he make that commitment now?

[Andy Burnham]

A moment ago, the hon. Gentleman acknowledged that I protected the NHS front line as Health Secretary. As Health Secretary, I would not have introduced a £2.5 billion reorganisation when the NHS is facing severe financial stress.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

Is it fair to say that under his leadership of the NHS, Monitor suggested that it needed to make efficiency savings? Those are coming through now, but the right hon. Gentleman is trying to present them as cuts to front-line services.

--- Later in debate ---

[Andy Burnham]

No. Let me explain the position to the hon. Lady so that she understands it. It is correct that in the previous Parliament, not Monitor, but the chief executive of the NHS, suggested that the NHS would have to make around £20 billion of efficiency savings over the four years of this Parliament. That is called the Nicholson challenge, which I accepted. However, contrary to what the Prime Minister said at the Dispatch Box last week, it was intended that every penny of that money would go back into the NHS to help it to deal with the pressures that it faces. I am afraid that the Government are again misrepresenting my position.

My position is different from the Secretary of State’s because that challenge, on its own, would have been all-consuming for the NHS, meaning that it would have had to focus every ounce of its energy on rising to that challenge. The last thing in the world that the NHS needs is a huge reorganisation, because it will take its eye off the ball, meaning that it cannot rise to that challenge.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

Is my right hon. Friend aware that during the so-called “pause for thought”, nothing was done to stop the NHS reorganising ahead of legislation that was yet to go through Parliament? Was that not contemptuous of both Parliament and of the genuinely held concerns of Liberal Democrat coalition partners?

[Andy Burnham]

Frankly, it is disgraceful that primary care trusts were allowed to disintegrate before Parliament had given its consent to those changes, leaving the NHS in limbo in most communities represented in the House. I have said that the Government have put the NHS in the danger zone, and I mean it. There is no capacity on the ground to help the NHS through these difficult times. It has lost the grip it would have needed to take us through the financial challenge, and I lay that charge directly at the Secretary of State’s door.

[Joan Ruddock (Lewisham, Deptford) (Lab)]

Will my right hon. Friend give way?

[Andy Burnham]

I will give way in a moment.

I mentioned that the Prime Minister is out of touch, and that he promised to recruit 3,000 more midwives and then handed out redundancy notices to them. However, if the Prime Minister is out of touch, I worry that the Secretary of State is in outright denial. On 11 October, when my hon. Friend the Member for West Lancashire (Rosie Cooper) asked him about the practice of hospitals re-grading or down-banding nursing posts to cut their costs, he replied:

“I am not aware—my colleagues may be—of…trusts…seeking to manage their costs by the downgrading of existing staff. If you are aware of that, then, by all means, tell us, but I was not aware.”

The very next day, that version of events was directly contradicted by Janet Davies of the Royal College of Nursing, who said that

“the Royal College of Nursing has raised the issue of downbanding with the Secretary of State on a number of occasions, alongside other concerns such as recruitment freezes and redundancies in the NHS…Our members’ survey released earlier this month also revealed that 7% of nurses expect to be downbanded in the next 12 months”.

If the Secretary of State would like to correct the evidence that he gave to the Select Committee on Health and confirm that he was aware of the practice of down-banding, he can be my guest right now.

[Mr Lansley]

I am grateful to the right hon. Gentleman. I do not change a word of what I told the Health Committee—it was entirely accurate. I have checked the records, and at no stage had the RCN raised that issue with me.

[Andy Burnham]

The Secretary of State directly contradicts, on the record, a spokesperson from the Royal College of Nursing. If he stands by his evidence, will he publish the minutes of his meetings with the RCN in which it states that the issue of down-banding was specifically discussed?

[Mr Lansley]

Will the right hon. Gentleman give way?

[Andy Burnham]

When I am ready.

Will the Secretary of State promise today to publish those minutes?

[Mr Lansley]

Yes, I shall publish the minutes of those meetings, but I resent the implication from the right hon. Gentleman that I would stand at this Dispatch Box or sit before a Select Committee and say anything other than what I believed to be the complete truth.

[Andy Burnham]

If that is the case, I respectfully ask the Health Secretary why he has not responded to a letter from my hon. Friend the Member for West Lancashire—

[Rosie Cooper (West Lancashire) (Lab)]

indicated assent.

[Andy Burnham]

My hon. Friend is nodding. Why has the Secretary of State not responded to the letter that my hon. Friend sent to him several weeks ago pointing out the discrepancy between his evidence and the statements from the RCN? If he wants to adopt a pious tone in the House, he needs to reply to his letters on time and put his facts on the record.

[Mr Lansley]

Will the right hon. Gentleman give way again?

[Andy Burnham]

Is the right hon. Gentleman telling or asking? [Interruption.] I give way to the right hon. Gentleman.

[Mr Lansley]

If the right hon. Gentleman is going to insult me, he ought at least to give way. I have seen no letter from the hon. Member for West Lancashire (Rosie Cooper). I have seen a letter from the Chairman of the Health Select Committee, to which I approved an answer.

[Andy Burnham]

Well, that is no good to me. We have not seen that answer. The right hon. Gentleman needs to reply to hon. Members’ correspondence in a timely fashion, especially when it relates to serious issues about discrepancies between his evidence and statements made by the RCN.

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[Mr Speaker]

Order. We must preserve the proper parliamentary terms. Nobody has written to me and I have not made a severe error. We will leave it at that.

[Andy Burnham]

It is clear that we will get to the bottom of this, because the Secretary of State has committed to publishing the minutes, and if he is suggesting that the RCN has been inaccurate, he needs to produce the evidence.

That takes me to the Prime Minister’s second personal promise on the NHS, which deals with hospital reconfiguration and the mythical moratorium.

[Tony Baldry (Banbury) (Con)]

rose—

[Andy Burnham]

I shall give way in a moment.

If we thought that the Conservative party’s promises on funding were bad enough, the sheer audacity of its claims on hospital closures is breathtaking. Before the last election, the right hon. Gentleman toured the country promising the earth to every Conservative candidate he met. I recall seeing his commitments—I have them here—pile up in the Ashcroft-funded glossy leaflets that landed on my desk in the Department of Health. He said that he would reopen the accident and emergency department in Burnley; he said that he would save and A and E in Hartlepool, but, scandalously, only if the town elected a Conservative MP; and I well remember the day he visited his hon. Friend—although, after this week, I doubt that the Government Front Bench team still consider him a friend—the hon. Member for Bury North (Mr Nuttall) and promised the people of Bury in the leaflets I have here:

“Vote Conservative and if there is a Conservative government the maternity department will be kept open.”

It could not be clearer. However, the maternity department at Fairfield hospital is scheduled to close next March. It is disgraceful. However, the Prime Minister’s most shameful politicking came in north London. I lost count of the number of times he promised to save the A and E department at Chase Farm hospital.

[Chris Skidmore]

On a point of order, Mr Speaker. Is it in order for the right hon. Gentleman to name my hon. Friend the Member for Bury North (Mr Nuttall) without telling him?

[Mr Speaker]

Yes, it is.

[Andy Burnham]

I point out to the hon. Gentleman, with his clever point of order, that I did contact the office of the hon. Member for Bury North and, indeed, the hon. Member for Enfield North (Nick de Bois).

[Mr Speaker]

Order. I am grateful to the right hon. Gentleman for that clarification, but perhaps this is an opportunity for me to make the position clear. I am not cavilling at the hon. Member for Kingswood (Chris Skidmore), but the position is basically this: if a Member is going to impugn the integrity or attack the record of an individual hon. Member, the Member who is the subject of the criticism should be notified in advance. The fact that someone simply intends to refer to another Member and something that may or may not have happened in his constituency during an election campaign, or at any other time, is not something of which prior notification is required.

[Andy Burnham]

After that rude interruption from the hon. Member for Kingswood (Chris Skidmore), I shall get back to my script.

Just days after the election, the Prime Minister went to Chase Farm hospital, with the Secretary of State, to announce the coalition’s new policy of the moratorium and the following commitment in the coalition agreement:

“We will stop the centrally dictated closure of A&E and maternity wards.”

I have with me the photograph from that very visit of the Secretary of State holding up a placard stating his opposition to any changes to the A and E at Chase Farm hospital. However, he has recently failed to prevent those changes to the A and E department and maternity unit at Chase Farm hospital, leaving the new hon. Member for Enfield North writing a desperate letter to the Prime Minister stating that his constituents had been utterly let down by them both. I do not know whether the Prime Minister or the Secretary of State have the decency to feel embarrassed today, hearing these cynical promises repeated in the House. The proposed moratorium and opposition to closures were purely political and designed to help the Conservatives win votes in marginal seats. That is a fact.

[Tony Baldry]

I apologise for not having intervened quickly enough earlier, but the right hon. Gentleman says that he accepts the Nicholson challenge. Given that efficiency savings will have to be made in the NHS, where does he envisage those savings being made? It seems to me that every hospital trust will have to make efficiency savings somewhere, as a result of the Nicholson challenge.

[Andy Burnham]

The hon. Gentleman asks a very fair question. It is precisely such issues—about how to produce the savings—that are the important issues. Care has to be taken out of the hospital setting and we have to prevent too many elderly people, in particular, from going into hospital in the first place if we are to create an NHS that is able to face the future and that is financially and structurally sound. That is why I take such exception to the naked opportunism that we saw before the election, when I, as Health Secretary, was taking on some of those difficult challenges and grasping the nettle, including in my own backyard in Greater Manchester, where there was a difficult review of maternity and children services, involving the closure of four maternity units and shrinking their number to eight. We did that, we took on that debate, and yet the now Health Secretary was touring those marginal constituencies in Greater Manchester, saying that he would overturn our decision in office, but he has not done it. That is precisely the point that I am making to the House. We need a Health Secretary prepared to take those difficult decisions, if the NHS is to be able to make the savings that will sustain it in the long term.

[Joan Ruddock]

I am grateful to my right hon. Friend for giving way, because like the hon. Member for Banbury (Tony Baldry), I missed the opportunity to intervene when efficiency savings were being discussed. Does my right hon. Friend agree that the key to this problem is proper discussion with the experts within the health service—with the nurses, doctors and all the people who administer our fantastic service? They are the ones who can give us ideas for efficiency savings. The hallmark of the Government is their failure to listen to the professionals.

[Andy Burnham]

My right hon. Friend makes an important point. When we were in government, we said that there had to be a clinical case for change, if changes to hospital services were to be made. I mentioned Greater Manchester a moment ago. There was a clinical case to support those reforms. The experts, to which she rightly pointed, said that about 50 babies’ lives would be saved every year by specialising care in fewer locations. In such circumstances, politicians have a moral obligation to listen to those experts and to make changes, no matter how politically difficult they are. That is why I say that it was sheer opportunism of the worst kind for the Government, when in opposition, to say that they would have a moratorium on any changes and to tour those marginal constituencies promising to overturn decisions, when in fact they had no intention of doing so. I put it to the House that the people of Bury, Burnley and Enfield have now clearly discovered what opportunism there is from those on the Conservative Front Bench.

[Sarah Newton (Truro and Falmouth) (Con)]

Does the right hon. Gentleman therefore welcome one of the Government’s first actions, which was to change the NHS operating guidelines for reconfigurations to ensure categorically that clinicians and the communities they serve were in the driving seat for future reconfiguration of the NHS?

[Andy Burnham]

If that is the case and the people of Enfield are in control of the decision, would Chase Farm A and E be closing? What the hon. Lady describes is a complete and utter reinvention of the moratorium policy. She stood on an election manifesto that promised a moratorium. Where is it? It has not materialised. It is a mythical policy that was designed to win votes; it had nothing to do with the good stewardship of the national health service.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

rose—

[Andy Burnham]

I give way to my hon. Friend, who has a nearby interest in Chase Farm.

[Mr Love]

I thank my right hon. Friend for giving way, and yes, I do have an interest because constituents of mine have been affected by the decision at Chase Farm. Not only did the Secretary of State come to Chase Farm immediately after the election, but he announced the change in policy on reconfigurations. He introduced the so-called four tests, none of which has ever saved any unit, in any part of the country. The reality is that he seriously misled the people of Enfield, who are now bearing down on their Member of Parliament, who also misled them on this policy. It is an outrage and they feel badly let down by this Government on health service reform.

--- Later in debate ---

[Andy Burnham]

For the avoidance of doubt, let me address directly what my hon. Friend has said. A moment ago I mentioned a photograph of the Secretary of State on a visit to Chase Farm hospital just days after the election, when he announced his so-called moratorium—although no one has yet seen any evidence of it. He is holding up a placard in that photograph that says, “HANDS OFF! Chase Farm A & E”, underneath which are the words: “I oppose any cutbacks to our A & E,” and on the bottom we can see his signature. How on earth he can square that with the letter that he recently exchanged with his hon. Friend the Member for Enfield North, I do not know. I do not know how the Secretary of State can reconcile those two things in his mind or how he could look anyone in Enfield North in the eye, having promised them that he would save their accident and emergency department. It is quite scandalous. People across the country are discovering that the Prime Minister’s moratorium is utterly meaningless, as A and Es restrict opening hours and maternity wards close.

We now come to the third of the Prime Minister’s broken promises, on NHS reorganisation. Again, the coalition agreement could not have been clearer:

“We will stop the top-down reorganisations of the NHS”.

I have never understood how those in the coalition could possibly sign up to those words, when only weeks later they would bring forward a White Paper heralding the mother of all reorganisations, the biggest since 1948. I can see the cynical politics behind the Prime Minister’s first two pledges, but on this pledge at least he was right. A reorganisation is precisely the last thing that the NHS needs right now. I am clear: the abandonment of that pledge is the Prime Minister’s biggest mistake in office. If he ploughs on, he will ultimately pay a heavy price for it, because it is a catastrophic error of judgment to combine the biggest ever financial challenge in the NHS with the biggest ever reorganisation.

As Health Secretary, I was told by officials that rising to the financial challenge would require every ounce of our energy and focus. The NHS would need stability. Instead, this Government have picked up the pieces of the jigsaw and thrown them up in the air, distracting the service at the very moment it needed maximum focus. Grip has been lost; the NHS is drifting.

[Henry Smith]

Does the right hon. Gentleman not agree, however, that our NHS needs greater efficiency and localism, and that this requires reorganisation?

[Andy Burnham]

I said just a moment ago that I was the one who put my name to the Nicholson challenge, because that money was going to help the NHS respond to the new demands placed on it at this difficult time, so the hon. Gentleman need not lecture me about efficiency. He needs to tell me how placing a moratorium on change in the NHS helps it to respond and deliver those efficiencies. That is the contradiction of his position, and he stood for election on that policy, as did others.

[Grahame M. Morris]

rose—

[Andrew George (St Ives) (LD)]

rose—

[Andy Burnham]

I will give way to the hon. Gentleman and then to my hon. Friend.

[Andrew George]

I accept that the Health and Social Care Bill is the longest and most incoherent suicide note in NHS history. Indeed, I am robust on this issue: I have voted against the Bill and will continue to take that view. However, considering that the right hon. Gentleman was involved when preferential arrangements were provided for private sector providers coming into the NHS, is this debate not an opportunity for him to acknowledge that at the Dispatch Box and apologise to the House for what was a rather ridiculous and one-sided policy?

[Andy Burnham]

Let me first acknowledge the hon. Gentleman’s courage in standing up and voting against the Health and Social Care Bill. I just wish that more of his Liberal Democrat colleagues had similar conviction and principle, and could stand up to the Government on a Bill that he knows—and which, in their heart of hearts, many of them know—will seriously damage the NHS.

The hon. Gentleman also asked me about the introduction of private sector capacity. I will not apologise for that, because that additional capacity was brought in to bring down NHS waiting lists, something that benefited his constituents. By bringing in that extra capacity we brought down NHS waiting lists to an all-time low and delivered the 18-week target. I am not going to apologise for that. The reason the NHS commands such strong support in the country today is that people’s experience of it improved in those years. I mentioned the preferred provider policy a moment ago. I believe that the private sector has a role to play in delivering world-class care to patients, and I am happy to put that on record.

[Mr Kevin Barron (Rother Valley) (Lab)]

At the heart of the current Bill are the 98 clauses that introduce competition law into the national health service—something that the last Government did not pass even one clause to do. Is not the ideology lying at the heart of the Bill what will wreck our national health service?

[Andy Burnham]

My right hon. Friend makes an incredibly important point. Make no mistake: if the Bill passes, the NHS will never be the same again. The Bill will unpick the fabric of a public national health care system—a planned system—and turn it into a free-for-all, as he says. Indeed, it is unbelievable to see a letter in The Guardian today from senior Liberal Democrats—many of whom made the same argument a few weeks ago as my right hon. Friend—now saying that, because of a few tweaks to the Secretary of State’s powers, the time has come to abandon all their concerns about the provisions. That is a ridiculous statement to make. If they still have concerns about competition and privatisation, they should have the courage of their convictions and stand up against the Bill, instead of writing sanctimonious letters to The Guardian.

Grip has been lost; the NHS is drifting. However, the Government cannot say that they were not warned. Sir David Nicholson, the chief executive of the NHS, told the Public Accounts Committee that the reorganisation had increased the scale of the financial challenge:

“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of…the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as a whole.”

This has been a lost year in the NHS—a crucial year, when it needed to face up to the financial challenge—but things are not getting better. We face months of further uncertainty, as the Secretary of State battles on with his complicated and unwanted Bill. Four-hundred and ninety pages, 70-page letters to peers, amendments made on the hoof: it is a total mess. The NHS deserves better than this. Even the man the Secretary of State brought in to run his new NHS Commissioning Board describes his Bill as “completely unintelligible,” and went on to say:

“It is going to be messy as we go through a very complex transitional programme.”

And this from the Secretary of State’s friends.

The harsh truth is that the Secretary of State has comprehensively failed to build the consensus he needs behind his Bill. GPs do not want it; nurses do not want it; midwives do not want it; patients do not want it. I say to the Prime Minister and the Health Secretary today: stop digging in. Drop this Bill. If they do, my offer still stands, as our motion makes clear. We will work with the Secretary of State to reform NHS commissioning, giving GPs and other clinicians a bigger role. That can be achieved without legislation and a major structural upheaval of the entire NHS. It can be done through existing legal structures, giving immediate stability and saving millions.

We make our offer again today, as it is time for all politicians to put the NHS first. It is slipping backwards, and the warning signs are there for all to see. Waiting lists and waiting times are getting longer, with a 48% rise in the last year in the numbers of patients waiting more than 18 weeks. When patients are waiting longer, it is unforgivable that £2 billion to £3 billion has been set aside to pay for the costs of reorganisation. It is also unforgivable that £850 million is being spent on making people redundant who will end up being re-employed elsewhere in the system, in the new clinical commissioning groups.

We are witnessing a return to the bad old days of waiting longer or paying to go private. This is just a glimpse of the future. If the Bill passes, the NHS will never be the same again. We have all seen the adverts on television for the health lottery. Is this the right hon. Gentleman’s early marketing and his new brand name for our NHS?

[Bob Blackman (Harrow East) (Con)]

Does the right hon. Gentleman not accept that one of the severe problems that the national health service is facing came about on his watch, when primary care trusts were allowed to build up huge deficits without making the economies and efficiencies that should have been made at that time, rather than on this Government’s watch?

[Andy Burnham]

I have never said that the NHS was perfect, or that there were no challenges during our time in government. But let me tell the hon. Gentleman what happened when the NHS was facing those deficits in 2006 and 2007. We took a grip at the centre and we brought those trusts back into financial balance, through hard work. There was a turnaround team in the Department, and we made sure that those difficulties were tackled at root. I do not see the same grip in the national health service right now. I see drift and lack of focus, and I see huge distraction as a result of this unwanted Bill.

[Sarah Newton]

The image that the right hon. Gentleman has just painted is totally inaccurate. The Royal Cornwall Hospitals NHS Trust is struggling with an enormous debt, which it incurred as a result of enormous reorganisations under Labour and a ridiculous accountancy measure that doubles the debt every year. I will not take comments like that from the right hon. Gentleman, because Cornwall has been left in a very difficult situation that this Government have been left to sort out.

[Andy Burnham]

I did not say that everything was perfect, but I said a moment ago that we took a grip on those problems and dealt with them from the centre. In the hon. Lady’s Government’s NHS, there will be—what are the words?—no bail-outs. Everyone will be left to fend for themselves. Does that mean that her hospital will be allowed to go bust? I do not know, but that is the implication of the Secretary of State’s White Paper and Bill, and she needs to direct her questions to him.

The fact is that we are now looking at a national postcode lottery, in which GPs are free to send letters to patients telling them that minor operations must now be paid for, and in which hospitals no longer have maximum waiting times for NHS patients and can devote the freed-up theatre time to private patients as there is no longer any cap on private work. The Government have placed the NHS in the danger zone. It has been placed there by a Prime Minister who said “Trust me” and has gone back on his word. He wrote cheques for the NHS in opposition that he knew he would not be able to cash when in government. He made promises that he knew he would be unable to keep, in order to win votes. This is the Prime Minister’s very own great NHS betrayal, and, far from detoxifying his party, he has proved once and for all that we really cannot trust the Tories with our NHS.

--- Later in debate ---

[Mr Lansley]

One of the reasons that the House should reject the motion is that it is deeply flawed. Let me just take up the hon. Lady’s argument. What an own goal it is for Labour to say that NHS funding fell in 2010-11. That was the last year of the Labour Government’s spending plans, not ours. The amount available to the NHS in 2010-11—[Interruption.] I am answering the hon. Lady’s question. The amount available to the NHS in 2010-11 was exactly the same amount as the last Labour Government determined under their spending plans. So if Labour is accusing the NHS of having a reduction in real terms in 2010-11, that is a complete own goal, because it happened as a consequence of its decisions, not ours.

[Andy Burnham]

May I just explain to the Secretary of State the difference between projected budgets and out-turn figures, as published by the Treasury? Will he confirm that the figures published in the Treasury’s public expenditure statistical analysis will be the figures that go into the historical record, and that they will record a real-terms cut because of underspends that he ordered?

[Mr Lansley]

That is absolutely not true, because we ordered absolutely no cuts in the NHS budget in 2010-11 compared with the spending plans that we inherited. So that is a complete own goal on the right hon. Gentleman’s part. And in regard to all that stuff that he talked about the support that the NHS is giving to social care, I can tell him that, with the exception of the underspend in the departmental central budgets, because we cut back on all of its bureaucracy and its IT programme, we spent over £150 million, or whatever it was—

[Mr Lansley]

Sit down for a minute. I am answering the shadow Secretary of State. As I was saying, more than £150 million was generated from underspends in the departmental central budget in the last three months of the last financial year, and it was spent with local authorities in supporting social care. The rest of the social care support is for 2011-12, so what the right hon. Gentleman said cannot be a reason for the underspend in 2010-11. The amount spent was all in PCT allocations; there was no mechanism by which the Department of Health could go out and ask PCTs to spend less—the money was allocated to them. The shadow Secretary of State shakes his head, but he knows it is true. The money was allocated to the PCTs and they were free to spend the money they had.

The first reason to reject the motion is that it is a spectacular own goal. The second reason to reject it—

[Andy Burnham]

The right hon. Gentleman says it is not true that PCTs were asked to set aside funds and generate underspends, so may I remind him of a letter sent by the chief executive of the NHS shortly after the White Paper was published, telling primary care trusts to set aside funding for the cost of transition? That is clear; it is in black and white. He did ask PCTs to generate those funds to spend on the costs of his reorganisation.

[Mr Lansley]

I am sorry, but that is another spectacular own goal. Both before and after the election, the chief executive of the NHS set aside, as the right hon. Gentleman had planned before the election, £1.7 billion for non-recurrent expenditure for the costs of NHS reorganisation. It was done before the election; we never changed the figure. It is not a consequence of any of our plans, but a precise consequence of the right hon. Gentleman’s. He said he accepted the Nicholson challenge, and the £1.7 billion non-recurrent set aside in 2010-11 was to fund that challenge. That was set out before the election, not after it. I thought that one of the benefits of the former Secretary of State coming here to debate matters would be that we would be treated to a bit of knowledge of the NHS and of how it works, but that does not seem to be the case at all.

--- Later in debate ---

[Mr Lansley]

The hon. Gentleman also intervened on the shadow Secretary of State. I am afraid that I do not recognise his description. I said before the election that we would have a moratorium on top-down and forced closure programmes affecting A and E and maternity services—and that is exactly what we did. A moratorium means what it says; it provides an opportunity to stop, to take stock and to subject something to the right tests. I set out for the first time the tests that needed to be met—that proposals needed to be consistent with prospective patient choice, consistent with the views of the local community, not least as expressed through the local authority, consistent with the views of the commissioners in the area, especially the developing clinical commissioning groups, and consistent with clinical evidence of safety.

In the context of Enfield and Chase Farm, the hon. Gentleman knows—because he was a participant in these discussions—that that moratorium was applied, that the opportunity was given to the local authority and the general practice community in Enfield to come forward with alternative solutions. We should also remember that among those four tests is the one about clinical evidence and safety. However, when those community groups came back and said, “We don’t have a specific alternative, but we just don’t want things to change”, I had to ask the independent reconfiguration panel to examine it. Its view was that that was not clinically sustainable.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Lansley]

No. I have given way many times. I am answering the hon. Member for Edmonton (Mr Love). It was very clear that we could not proceed on that basis.

I have another point for the hon. Member for Edmonton about what I found in a number places. Although this was not true of the moratorium in Maidstone and Chase Farm, the moratorium has led to substantially improved outcomes for local services elsewhere, as with Burnley, Solihull, Sidcup, Ealing, the Whittington hospital and other places.

--- Later in debate ---

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Lansley]

No. I think that the moratorium has led to a better way forward even in Enfield. It is in the hands of the commissioners and the local authority in Enfield collectively, to make decisions for Enfield. Within two months I shall receive a report from NHS London advising whether it would be better organisationally for Chase Farm to be combined with North Middlesex rather than Barnet, and I should be interested to know the hon. Gentleman’s view on that. We continue to seek not top-down forced reconfigurations, but reconfigurations that consistently meet the four tests, and do so in the best interests of the NHS.

[Tony Baldry]

The right hon. Member for Leigh (Andy Burnham) implied that my right hon. Friend should have completely ignored the advice of the independent reconfiguration panel. Can my right hon. Friend tell us whether, when the right hon. Gentleman was Secretary of State for Health, there were any occasions on which he sought to ignore the panel’s advice?

[Andy Burnham]

No.

[Tony Baldry]

What is the point of having such a panel if it is to be ignored?

--- Later in debate ---

[Mr Lansley]

I am answering the hon. Gentleman’s question. The point of a foundation trust is that it should take more responsibility for securing the resources enabling it to undertake its own building projects. Foundation trusts cannot walk into the Department of Health imagining that they will receive a capital grant of more than £400 million. That is simply not the way it works. It is to the credit of the hon. Gentleman’s local trust that it accepted that, and is working, as a foundation trust, on a better solution for the hon. Gentleman’s area.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Lansley]

No, because I have already given way to the right hon. Gentleman many times. Let me tell him this. If he was going to offer to try to work with others on GP commissioning, he ought at least to have demonstrated before the election that he was going to do something about it; and using a transparent political ploy to try and interfere with the passage of the legislation in another place carries no credibility with me or with anyone else. Labour’s tabling of a motion in the other place in an attempt to block the Bill completely showed no willingness to work together, and the fact that it was defeated by 134 votes ought to have given the right hon. Gentleman a reason—and sufficient humility—not to try to return to the subject by tabling today’s motion.

As I said earlier, I find it regrettable that neither the right hon. Gentleman’s motion nor his speech made any attempt to deal with what has happened in the NHS over the past year. Let me tell him, and the House—for I know my right hon. and hon. Friends will be interested as well—what has, in truth, happened during that time.

At the end of the last Labour Government, the average in-patient wait was 8.4 weeks. According to the latest available figures, that has fallen to 8.1 weeks. The average waiting time for out-patients was 4.3 weeks at the time of the last election; it is now 4.1 weeks. Over the last year, the number of MRSA bloodstream infections in hospitals has fallen by a third, and the number of clostridium difficile infections by 16%. Nearly three quarters of a million more people have access to NHS dentistry. Nearly 2 million people have access to the new 111 urgent care service, and the whole country will be covered within the next 18 months. When we came to office, I discovered that there had been talk about a 111 telephone system, but nothing had been done. It is now happening.

More than 75% of stroke patients now spend 90% or more of their hospital stay in a stroke unit. That is a 20% increase in two years. The Cancer Drugs Fund has given more than 5,000 patients access to the drugs that they desperately need, and which under the last Government’s regime would not have been available to them. We have embarked on an £800 million investment in translational research, increasing our financial support for it by 30%, to help to secure the United Kingdom as a world leader in health research.

The NHS is leading the way in the prevention of venous thromboembolism, with 86% of patients receiving an assessment for the condition. I believe that that constitutes an increase of some 30% in the last year. The bowel cancer screening programme is enabling many more patients and members of the public to be screened, there is more screening for diabetic retinopathy than ever before, and there were 188,000 more diagnostic tests in the three months to August than there were last year. Pathfinder clinical commissioning groups have been established virtually through England, and there are 138 health and wellbeing boards in local authorities, meeting and putting together their strategies to deliver population health gain across their areas.

In a single year, the year preceding the election, the right hon. Member for Leigh presided over a 32% increase in NHS management costs. That was the year after the banks had gone bust. It was the year when it was obvious that Government deficits were out of control. It was the year when the debt crisis was just about to crash over the whole public sector. What happened on the right hon. Gentleman’s watch? There was a 23% increase in management costs in a single year, to £350 million. In the year that followed, we reduced those costs to £329 million.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

It has been an interesting experience listening to the range of contributions that have been made over the past few hours. Having studied the shadow Secretary of State’s tweets yesterday afternoon heralding today’s debate, one would have expected this to be an action-packed afternoon. One remembers the grand old Duke of York marching his troops up to the top of the hill and then down to the bottom, but the grand old Duke of York had 10,000 men. For most of this debate, apart from the wind-ups, the shadow Secretary of State has barely managed to get more than six Opposition Back Benchers here, which is fewer than the Government have had, so on that point I fear that he has failed.

Let me turn to some of the speeches that I had to listen to. It was a delight to hear the hon. Member for Easington (Grahame M. Morris) again, after a break from the Committee stage of the Health and Social Care Bill. Broken record his speech may have been—it was the same story—but it was worth listening to, even though the accuracy gained nothing in the telling.

My hon. Friend the Member for Kingswood (Chris Skidmore) made an excellent speech, as did my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke fluently and knowledgably, on the basis of his intense and intimate experience of working in the NHS and his insights into the challenges we face in social care and improving the integration of care.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made an interesting contribution, although at times I began to think that she might be the only person who believed what she was saying. None the less, it was interesting.

The hon. Member for Ealing North (Stephen Pound)—as always, a jokester in our midst—put forward a serious message in a jocular way. From my experience of the NHS, both personal and professional, however, I felt that a lot of what he said bore little relation to reality. I can assure him that Government Members share the core principles of the NHS. I was also interested to hear the comments of my hon. Friend the Member for Stafford (Jeremy Lefroy). Anyone who represents that part of the country will have a deep understanding of the problems, as well as the successes, of the local health service. He was right in what he said about the future of accident and emergency services and about the critical issue of training.

I am saddened by the fact that the Opposition have once again shown themselves to be more interested in trying to revive their own political fortunes than in improving the outcomes of patients. Once again, they prefer to scaremonger and blindly attack, rather than put forward any policies of their own. They have been a policy-free zone in this debate. Once again, they reveal themselves to be on the back foot when it comes to securing the future of the NHS, as well as wrong-headed.

The Opposition claim that the Government are cutting NHS spending, which is not only nonsense but outrageous. Surprisingly, only last summer, the right hon. Member for Leigh said—this has been quoted before, but I will repeat it—that it would be

“irresponsible to increase NHS spending in real terms”.

Ironically, that is not a view that I share. I fundamental disagree with it, because I believe that we should increase the funding of the NHS in real terms. [Interruption.] I do not care how much the right hon. Gentleman says it; if he looks at the—

[Andy Burnham]

Will the Minister give way?

[Mr Burns]

I will in one minute, just to disprove what the hon. Member for Leicester West (Liz Kendall) says.

If the right hon. Gentleman does not want to believe what I say, he can look at the chart produced by the Wales Audit Office, an independent body, which shows, if one cares to read it, real-terms spending increases in each year in the English NHS. Ironically, it also shows such increases in Northern Ireland and Scotland, but if we look at the red parts of the chart, we can see that there are certainly no increases in Labour-controlled Wales.

[Andy Burnham]

rose—

[Mr Burns]

I will give way once, briefly, then I must make progress, because I have only eight minutes.

[Andy Burnham]

The Minister says that the Government are providing real-terms increases, but he does not take into account inflation or the £1 billion transfer to social care. Will he accept the figures that I have here? They are the total departmental expenditure limits published by the Treasury in July 2011. They show that, in 2009-10, £102 billion was spent on the NHS. The figure for 2010-11 was £101 billion. I invite him to tell me that those figures are not correct.

[Mr Burns]

The right hon. Gentleman told us that, when he was Chief Secretary to the Treasury, he understood figures, so he will understand, as I do, that “real terms” means an increase over and above inflation—

[Andy Burnham]

rose—

[Mr Burns]

One minute. The right hon. Gentleman wants a reply, so he must hold his horses.

It is the gross domestic product deflator that determines how one increases in real terms the funding of the NHS. The right hon. Gentleman has once again scored an own goal in reading out those figures, because they are based on the Labour Government’s spending for the year in which they were leaving power.

[Andy Burnham]

Will the Minister give way?

[Mr Burns]

No, I said that I would give way once. I must now make progress.

We are increasing funding for the NHS in real terms over this Parliament, and stripping out unnecessary bureaucracy to focus precious resources on the front line and not the back office. So in place of management-led primary care trusts and strategic health authorities, we are introducing clinically led clinical commissioning groups, to put money and power in the hands of front-line doctors and nurses. That is why we are driving through the plans to make the NHS more efficient by focusing on prevention, on innovation, on productivity and on driving up the quality of care. A fact that Labour Members appear rapidly to have forgotten is that better care is very often less expensive care, and less expensive care means there is more money to spend on the health service.