Health and Social Care Bill

Andy Burnham Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House notes the e-petition signed by 170,000 people calling on the Government to drop the Health and Social Care Bill; and declines to support the Bill in its current form.

I do so on behalf of the 170,000 people who have signed the e-petition calling on the Government to drop the Health and Social Care Bill.

The petition was initiated by Dr Kailash Chand, a distinguished general practitioner in the north-west of many years’ standing, and I pay tribute to him today. He has united patients who depend on the NHS and professionals who have devoted their lives to it in this simple but sincere call on the Government: “Drop the Bill”. Today, their voice will be heard in this House, as it is entitled to be. We will not let them be silenced, even though attempts were made to stop this debate taking place.

That takes us—

[Chris Skidmore (Kingswood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No. I have been listening to the strictures from the Chair, and I want to get into my speech so that Back-Bench colleagues have a chance to contribute.

That takes us straight to the heart of the predicament in which we find ourselves. There is huge concern in the country about the Bill, but the Government and Parliament—

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

Will the right hon. Gentleman give way?

[Andy Burnham]

I will in a moment.

There is huge concern in the country about the Bill, but the Government and Parliament are seen simply not to be listening. I give way to the Secretary of State, and I hope that he might prove us wrong.

[Mr Lansley]

I am grateful to the right hon. Gentleman, but before we move beyond that point will he confirm that Dr Chand is an adviser to the Labour party, which inspired the petition? Further, given that Dr Chand has called on the British Medical Association to take strike action against the Bill, does the right hon. Gentleman share that view, or will he disown him?

[Andy Burnham]

Dr Chand is not an adviser to the Labour party, and the Secretary of State, in seeking to inject that party political note so early on in today’s debate and to claim that the petition of 170,000 people is a political petition, continues, it suggests to me, to misread the mood of this country on his unnecessary Bill.

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

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I will not.

We have arrived at a dangerous moment, not only for the NHS but for our democracy. To recap, this is a Bill for which nobody voted at the general election and which does not have a mandate, a Bill ruled out by the coalition agreement, and a Bill that has been so heavily amended in another place that in effect the unelected Chamber has written a new legal structure for the national health service that we are being asked to rubber-stamp. Yet despite all that, it could be rammed through this House in just seven days’ time, in defiance of an outstanding legal ruling from the Information Tribunal and in the teeth of overwhelming professional and public opposition.

This is an intolerable situation, and it is no way to treat our country’s most valued institution. Far-ranging changes to the NHS of the kind proposed by the Secretary of State can be made only by public consent and professional consensus, and it is plain for all to see that the Government have achieved neither of those things.

[Sajid Javid (Bromsgrove) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I will not.

To proceed as planned risks profound damage to the relationships of trust that underpin a successful health service and risks a further erosion of trust in our democratic process that this House can ill afford.

Today there is one final chance for this House to ask the Government to step back from this dangerous course and reflect the feeling that there is in every single constituency in England. In introducing this debate, I have a bigger responsibility than speaking for Labour Members. The call to drop the Bill is not a narrow Labour campaign, as was claimed just now and in Gateshead at the weekend—it is a new coalition for the NHS that has brought together patients, professionals and people of all political views, including, I dare say, some of those in the Secretary of State’s own party. People who have signed the petition will be watching our proceedings closely. They will be hoping against hope that somehow we will put the NHS first, put aside the customary clash of party politics, and find common ground that can help the NHS.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

I have here a letter to the Prime Minister from Dr Clare Highton and Dr Haren Patel, the chairs of City and Hackney clinical commissioning group, who say that they want

“to add our voice to the call for the Bill to be withdrawn.”

Does my right hon. Friend agree that that underlines his point about the wide range of people who want it to be dropped?

[Andy Burnham]

I think that Government Members are misjudging the mood of the country, and particularly of health professionals, who have not given a knee-jerk political response to the Bill but have given it careful consideration since it began as a White Paper and then proceeded on its tortuous path through Parliament. They have come to the conclusion that it is better, even now, to abandon it and work back through the existing legal structures of the NHS rather than proceed with the new legal structure and all the upheaval that that entails.

[Mr George Howarth (Knowsley) (Lab)]

Yesterday I was at a meeting with people with diabetes who expressed grave concern that they do not know what services would be available if the Bill were to go ahead. Is not that another good reason to take a pause and decide to drop the Bill until all these problems can be resolved?

[Andy Burnham]

I am aware of the concerns expressed by Diabetes UK and, indeed, by many other organisations representing people with long-term conditions, who have not been given the clarity that they need in order to give their support to these changes. [Interruption.] The Secretary of State says “Rubbish”, but I am afraid that those questions have not been answered, and that is not good enough.

[Sajid Javid]

rose—

[Andy Burnham]

I will not give way.

As I said, we need to see whether we can find common ground and put the NHS before party politics. That is the test that I set for the debate, and it is the spirit in which I wish to frame it. Today is not just an Opposition day but Merseyside derby day. Usually both occasions put me in a highly partisan mood, yet despite having double reason to be in tribal mode, I am going to take the unusual step of urging Labour Members not to vote for our motion but to consider the amendment tabled by the hon. Member for St Ives (Andrew George) and his Liberal Democrat colleagues. We will listen with interest to what he has to say. The amendment sets out a sensible way forward that we can all unite around. It sends out the simple message that the importance of the NHS to us all and to our constituents should trump any tribal loyalty. It is important to say that, because I fear that sheer gut loyalty, political pride and the need to save face are the only forces driving a deeply defective Bill towards the statute book.

[George Freeman (Mid Norfolk) (Con)]

I had the great privilege of working in biomedical research in and around the NHS for 15 years before coming to the House. Is it not the case that the challenges of an ageing population, the explosion of new biomedical treatments, diagnostics and devices, and the aspirations of modern patients demand reform? Did not the Labour party use to be the party of reform? Is not the right hon. Gentleman’s partisan posturing simply an illustration that Labour is no longer fit for Government?

[Andy Burnham]

Those factors demand service reform. I remind the hon. Gentleman that he stood at the election for a moratorium on such reform, which was a dishonest pledge that would have prevented the NHS from making the changes that it needs.

The NHS model that the hon. Gentleman and his colleagues seek to break with the Bill is judged to be the most efficient health care service in the world. The Secretary of State says today that that model is simply unsustainable in this century, with the ageing society and all the other pressures on it. I put it to the hon. Gentleman and the Secretary of State that that model is not the problem but the solution to the challenges of an ageing society, because it is proven to be the most fair and cost-effective way of delivering health care to the whole population.

We need to be honest with ourselves today. I mentioned the fact that it is just political pride and gut loyalty that are driving the Bill towards the statute book. Those motivations, however understandable and human they are and however familiar to politicians of every stripe, do not justify inflicting a sub-optimal legislative structure on our most cherished public service and making the already difficult job of health professionals even harder as they struggle to make sense of Parliament’s intentions.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the right hon. Gentleman agree that it is ideology, not evidence-based policy, that is driving ever greater competition in health care markets? Does he agree that the evidence suggests that that is the way to undermine our NHS, not to improve quality and equity?

[Andy Burnham]

I agree with the hon. Lady. It is that ideology that the NHS and health professionals are rejecting. They want to work in an essentially collaborative health service. They do not accept the vision that pits hospital against hospital and doctor against doctor.

Barely anybody has a good word to say about this busted flush of a Bill, which has lurched from one disaster to another. The unprecedented pause did not address the real concerns, but simply added bureaucracy and complexity. The 1,000-plus amendments are not a sign of improvement, but of confusion, complexity and contradiction. They have left a mess of a Bill that even the Health Secretary cannot recognise as his own. If that was not bad enough, an unfolding communications disaster has alienated the very people the Government are depending on to implement their Bill. A Downing street summit was called to discuss the implementation of a reform that is about clinical leadership, but doctors’ and nurses’ leaders were shut out of Downing street. It was hard to see how the situation could get any worse, but it just has.

First, on Friday, the Information Tribunal ruled against the Government and in favour of my right hon. Friend the Member for Wentworth and Dearne (John Healey). I pay tribute to the assiduous way in which he has pursued his principled case. The tribunal ruled against the publication of the strategic risk register, but in favour of the publication of the transition risk register, vindicating our position and dismissing the Prime Minister’s claims against my actions as Health Secretary.

Let us be clear about what that ruling represents. It is an incredible state of affairs for any Government to suffer such a serious legal reversal at this stage of a protracted parliamentary process. It is an indictment of the judgment, or lack of it, of the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) and others in the Department, in their handling of the Bill. Where is the Minister’s good grace in defeat? It is simple: my right hon. Friend the Member for Wentworth and Dearne won and the Government lost. What are they waiting for? They must publish the risk register today and give Parliament the courtesy of knowing all the relevant information on Ministers’ plans before they ask us to approve them. Instead, what do we get? Silence and playing for time. They are hoping to string it out until after 20 March. That is simply not good enough.

[Bill Esterson (Sefton Central) (Lab)]

My right hon. Friend is, as ever, making the case for the NHS, not for the privatisation that the Tories and their Lib Dem friends are pursuing. We are talking about the future of the NHS, so let me quote Victoria Roberts, a student nurse from Merseyside, who starts her training in two weeks. She says:

“I am a student nurse due to start my training in 2 weeks. This is not the NHS I want to serve or work in, but rather will help only those who can pay the most.”

Does my right hon. Friend agree with that assessment of where the Tories are taking the NHS?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We must have shorter interventions. A lot of people want to speak and we have got to get on with it.

[Andy Burnham]

I wish the Government would listen to voices such as the student nurse that my hon. Friend the Member for Sefton Central (Bill Esterson) quoted—people who want to dedicate their lives to the NHS. Frankly, their views are brushed aside by an arrogant Government.

It gets worse as the Bill enters a new crisis, with one of the coalition parties formally withdrawing permission from its peers to support the Bill. It is not at all clear what happens now—whether Lib Dem peers will defy the wishes of their party or their leader. Given the developments of the last few days, it is simply inconceivable that the Government can continue on their current course and present the discredited Bill here in seven days. The only responsible thing to do is listen to what Lib Dem Members are saying and support what the amendment tabled by the hon. Member for St Ives seeks to do. I will deal with that shortly.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

Just so that the right hon. Gentleman is clear, the motion that the Liberal Democrats passed on Sunday did not tell the Lords that they should or should not support the Bill. It simply reserved our party members’ judgment until we see the work that the Lords are continuing to do. That is our position. I think that that is sensible and fair for the NHS and our party.

--- Later in debate ---

[Andy Burnham]

I am afraid that I cannot read all the intricate smoke signals of a Lib Dem conference, but to my simple mind, removing permission from the motion for peers to endorse the Bill is a pretty clear signal that that permission has been withheld.

Before I deal with the amendment that the hon. Member for St Ives has tabled, I want to tackle directly the charge of scaremongering that has been levelled at Labour Members, and draw the House’s attention to evidence already emerging that supports our central concerns about the effect of the reorganisation. We have consistently said that it is the wrong time to reorganise the NHS—indeed, it is the worst time imaginable. The Government are asking the NHS to do too much. It is facing its toughest ever financial challenge. Combining that with the biggest ever reorganisation was a catastrophic misjudgment. The Government dismantled the existing structures of the NHS before the new ones were in place, leading to a loss of grip and focus at local level just when that was most needed.

We have now had two lost years in the NHS. When the system should have been getting to grips with the financial challenge, it has been distracted and destabilised by reorganisation. Information is now emerging that bears that out. The Nicholson challenge is a huge task for the NHS, but after only six months, we hear that it is already falling behind. New information provided from the Department to the Health Service Journal in response to a freedom of information request reveals how two out of three—68%—non-foundation trust acute trusts missed their savings targets for the first six months of the Nicholson challenge. At least five have made less than 20% of their planned savings for the year 2011-12. Overall, at the half-year point, the non-FT acute sector had a net deficit of £135 million. That is a real warning sign, which suggests that the Government are storing up huge problems for the future.

That is not conjecture. There is evidence that a destabilised NHS is losing its grip on finances and operational standards. For the tenth week in a row, the NHS last week missed the Secretary of State’s lowered standard for accident and emergency, with fewer than 95% of people seen within four hours. That is the main barometer of pressure on NHS hospitals. The figures clearly tell us that hospitals are not coping with the pressure that they are under, and that job losses and staff shortages are having a real impact.

[Sajid Javid]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will not.

Rather than just reel off statistics about elective waiting times, I ask the Secretary of State today to address A and E performance. Why does he think the NHS is missing his relaxed target and what steps is he taking to address that?

Another of our central concerns—

[Sajid Javid]

Will the right hon. Gentleman give way?

[Andy Burnham]

Just one second. I have said that I want to give hon. Members a chance to comment in the debate, and that is what I am going to do.

[Alok Sharma (Reading West) (Con)]

Will the right hon. Gentleman give way?

--- Later in debate ---

[Andy Burnham]

No.

The Opposition have said that the plans will bring huge variation and a postcode lottery writ large, which is what we are beginning to see, with random rationing decisions across the system. Minor operations are being restricted, generic drugs are being prescribed, and procedures, for instance to remove varicose veins, are being withdrawn from patients.

More worryingly, we have seen the emergence of a new trend: trusts are restricting access to treatment and surgery based on body mass index levels or lifestyle factors such as smoking. Those have been dressed up as initiatives to improve public health, but many people see them as crude attempts to save money. It seems to me that that is a straightforward breach of the NHS constitution, and indeed of its founding values. Treatment should be according to need, not according to judgmental decisions by unaccountable health professionals. I put it to the House that that is a dangerous departure. Treatment according to need must mean what it says. There is no sign of Ministers intervening to say that that is unacceptable and that they will reverse those decisions. That is a worrying glimpse of the future, in which the NHS becomes a huge postcode lottery and people have limited chance to challenge decisions, and it takes us to one of people’s central worries about the Bill: that there is no longer a duty on local commissioners to provide comprehensive health services.

There is other evidence around the system of the concerns that the Opposition have raised. There is evidence of fragmentation, not integration, as clinical commissioning groups are ordered to run an “any qualified provider” tendering process on three community services; of damage to the doctor-patient relationship; and of hospitals, such as St Helier, which is in the constituency of the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), being destabilised by the effects of the emerging market, as clinical commissioning groups begin to withdraw services.

Those are not invented risks or scaremongering; they are there in black and white in local and regional risks registers, which Opposition Members have highlighted. We are now seeing those risks begin to materialise on the ground, which is why the difficult judgment that so many royal colleges have reached is that, even now, as difficult as it is, it is safer for the NHS to work back through the existing legal structures of the system than to proceed with the introduction of a new one.

I want to assure the House that “Drop the Bill” is not pure oppositional opportunism. I have always balanced the “Drop the Bill” call with the words, “And we will work with the Government to introduce GP-led commissioning.” I have never had any objection to doctors being more able to shape services, nor to more control and choice for patients, but the simple truth is that the Government did not need a new Bill to introduce those things. Indeed, the very fact that they have arrogantly already introduced those changes in advance of the Bill makes the argument that the Bill is simply unnecessary.

The Bill is a huge exercise in futility, but the reason we have one is that the Government want to go further on a misguided mission to rewrite the entire legal structure of the NHS to facilitate more competition and a market-based system. That, more than anything, is worrying people and why they are withholding support. That is the Government’s problem. They were not open and honest about those plans at the beginning, and have openly extolled the competition argument only in more recent weeks. That is why people are worried by the hidden agenda they see behind the Bill.

The amendment from the hon. Member for St Ives offers a way forward that can bring politicians and professionals back together, but, in urging the Opposition to support it, I wish to make something very clear: in supporting the amendment, the Opposition are offering no endorsement of the health policies in the coalition agreement. We are simply saying that if the Government were to stick to the precise terms of the coalition agreement, and specifically to the clear pledge of no top-down reorganisation, that would be a better position for the NHS and would represent real progress.

The talks could take as a starting point the stability plan proposed by the Faculty of Public Health. GP-led commissioning could be delivered by the clinical commissioning groups that the Secretary of State has created. Furthermore, to build confidence among clinicians, I offer to agree with him some principles by which important service change in the NHS could be introduced without every hospital being used as a political football at a local level. That is because the NHS needs service change, not structural reform. If we continue to play politics with hospital changes, we will do the NHS the ultimate disservice of condemning it to an outdated service model.

In conclusion, I am in politics to protect the things I care about, and the NHS comes top of that list. This is not about politics, as was claimed at the weekend. To be honest, it suits our narrow political objectives for the Government simply to plough on. The great irony is that dropping the Bill would be the right political decision for both coalition partners. Nevertheless, we desperately want them to do that, because if they do not, the damage to the NHS will be profound and possibly irreparable.

We have called this debate both to reflect the views of the e-petitioners and to try to find a way forward around which people can coalesce. We are ready to play a constructive part in that process. But I need to be clear with the Secretary of State: it would be a constitutional outrage were he to bring his discredited Bill back to this House in seven days. Put simply, he does not have the permission of the people of this country to proceed with his plans for the NHS. He is wrong to say that the NHS model we have known for 63 years is unsustainable in the face of the challenges of this century.

The NHS is the solution to those challenges, not the problem, having been judged the most efficient and fair system in the world. Those are truly great strengths, and my plea to the Secretary of State is to build on them, not throw them away. However, if he will not listen, the House can still intervene. Time is running out for the NHS. Tonight we have a final chance to put the NHS first and party politics second. The country wants us to do that. Let us rise to the occasion. I commend the motion to the House.

--- Later in debate ---

[Mr Lansley]

Let us try this one. For the first time the Bill introduces in clause 3 a duty that embeds the need to act to reduce inequalities firmly within the health system. After 13 years of widening health inequalities under Labour, surely he cannot be against that—or is he? No. Well, what about clinically led commissioning, with doctors and nurses who are responsible for our care given the leadership role in designing services? We heard earlier about one CCG, but 75 leaders of clinical commissioning groups wrote to The Times a fortnight ago. Let me quote them, because it is instructive of what is happening. They said:

“Since the…Bill was announced, we have personally seen more collaboration, enthusiasm and accepted responsibility from our GP colleagues, engaged patients and other NHS leaders than through previous ‘NHS re-organisations’”.

They continued:

“Putting clinicians in control of commissioning has allowed us to concentrate on outcomes through improving quality, innovation and prevention”—

precisely the things that the NHS needs for the future.

Now the right hon. Gentleman says, “Oh, yes, we can do GP commissioning”, but let us recall that in 2005, practice-based commissioning was in the Labour manifesto, and that in 2006, he said he was in favour of it. He said that he was

“introducing practice-based commissioning. That change will put power in the hands of local GPs to drive improvements in their area”—[Official Report, 16 May 2006; Vol. 446, c. 861.]

[Andy Burnham]

rose—

[Mr Lansley]

I will give way in moment. The right hon. Gentleman said he was in favour of practice-based commissioning. In 2010, he was the Secretary of State and was in charge of the manifesto, yet practice-based commissioning disappeared out of the Labour manifesto —it was not there at all. After the election, he pops up and says, “Oh, we are in favour of it again”. The truth is that practice-based commissioning was always the right idea: the Labour Government did not do it; the primary care trusts suppressed it. The Bill makes it possible for clinical commissioning groups to take responsibility and for doctors and nurses to design and deliver better services. Because of this Bill, it will happen—and it will not be suppressed by a top-down bureaucracy.

--- Later in debate ---

[Andy Burnham]

I made the Secretary of State an offer in my opening remarks. I said I would work with him to introduce his vision of clinically led commissioning, but he seems strangely silent about that and is pursing a very partisan tone. Will he confirm that he could introduce GP-led commissioning without any need for legislation—and without all the upheaval that is coming with his reorganisation?

[Mr Lansley]

The short answer to that is no. If one wishes to arrive at a place where the clinical commissioning groups have responsibility for budgets and proper accountability—including democratic accountability for what they do—legislation is required to get there. That is why we are putting legislation in place to make it happen.

--- Later in debate ---

[Mr Lansley]

I am grateful to my hon. Friend for her initiative in bringing doctors, dentists and nurses together to have that conversation. I really appreciated it, and I thought that it illustrated exactly what I have found—that, although not everybody in the room agreed with the Bill—[Laughter]—many did. Contrary to what I see on the Labour Benches, they all wanted to design better services for patients. They cared about patients and engaged in a proper debate about how to achieve that.

I am still trying to find out what it is in the Bill that the right hon. Member for Leigh is against. Is it the fact that the Bill strengthens the NHS constitution? He should be proud of that; he introduced it. For the first time, however, the Bill requires the Secretary of State to have regard to it and the NHS Commissioning Board and clinical commissioning groups to promote it. He is not against that, I presume.

What about the fact that, for the first time, the NHS Commissioning Board and commissioners will have a duty to promote integration throughout health and social care? Is the right hon. Gentleman against integrated care? I do not know. Let me try another question. What about the prohibition in clauses 146, 22 and 61 of discrimination in favour of private providers, which is in legislation for the first time? The right hon. Gentleman may be against that, because when his party was in office, that is what the Government did. They discriminated in favour of private sector providers, and we ended up with £250 million being spent on operations that never took place and the NHS being paid more for operations when it was not even allowed to bid for the work.

What about the creation of a strong statutory voice for patients through HealthWatch? The Labour Government destroyed the community health councils, they destroyed patient forums, and they left local involvement networks neutered. When they were in office, they were pretty dismissive of a strong patient voice. Well, we on the Government Benches are not, and the Bill will establish that patient voice. Is the right hon. Gentleman against all trusts becoming foundation trusts? The Bill will make that happen, and will support it—oh, no, I forgot: according to the Labour party manifesto, Labour wanted all trusts to become foundation trusts.

Let us keep moving through the Bill. Is the right hon. Gentleman against directly engaging local government in the commissioning of health services, integrating health and social care, and leading population health—public health—improvement plans? I ask the question not least because Labour local authorities throughout England are in favour of that. They want to improve the health of the people whom they represent. Is the right hon. Gentleman against local democratic accountability? The list could go on. Is he against the provision of a regulator—Monitor—whose duty is to protect the interests of patients by promoting quality, stopping anti-competitive practices that could harm patients, supporting the integration of services, and securing the continuity of services? Is he against that? It is in the coalition agreement, but I do not know whether the right hon. Gentleman is against it or not, because he does not say.

Is the right hon. Gentleman against statutory backing for the National Institute for Health and Clinical Excellence to support its work on quality? I do not know; we have not heard. Is he against developing the tariff so that it pays for quality and outcomes, not for activity? He knows that that has to happen, and he knows that it has been the right thing to do for the best part of a decade, but we have no idea whether he is against it now.

I cannot discover what the right hon. Gentleman is actually against. He sits there and says that he is against the Bill, but he is not against anything that is in the Bill. He is against the Bill because he has literally made up what he claims it says. He says that it is about privatisation—

[Andy Burnham]

rose—

[Mr Lansley]

All right, I will give way to the right hon. Gentleman one more time. Come on, then: let us find out what he is against.

[Andy Burnham]

I will tell the Secretary of State what I am against. I am against the rewriting of the entire legal structure of the national health service to plant market forces at the centre of the system, and to pit doctor against doctor and hospital against hospital. That is what I am against, it is what 170,000 people signed a petition against, and it is what the overwhelming consensus of health professionals is against. Would the Secretary of State not do well to listen to them for once?

[Mr Lansley]

So now we know, Mr Deputy Speaker. It is sheer invention. There is nothing in the Bill that creates a free-for-all. There is nothing in it that creates a market of that kind. The Bill means competition for quality, not price. It gives patients choice—and the Labour party’s manifesto was in favour of giving patients choice. Competition is not being introduced to the NHS by the Bill; it is being channelled in the interests of patients to support quality throughout the NHS.

The Opposition talk about privatisation. As I said to my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes), there is nothing in the Bill that allows any privatisation of NHS services. There is nothing in it that promotes such a privatisation.

The left-leaning papers talk about privatisation at Hinchingbrooke hospital because Circle is an independent mutual organisation. That is interesting, because the process for the franchising out of the management of Hinchingbrooke was started by the right hon. Gentleman when he was Secretary of State. So there we are: the only secret Tory plan that Labour can find turns out to be a Labour plan.

[Mr Lansley]

My hon. Friend makes an important point. When Labour Members talk about the private sector in the NHS, they leave out of account the fact that not only did they give the private sector a sweetheart deal to get it into the independent sector treatment centres, but they have left us with 102 hospitals that were built by the private sector and £67 billion of debt to the NHS. They wandered around the country saying, “Look how we’re spending all your money to build all these new hospitals,” but they did not spend the money to build the new hospitals. They have left the NHS to have to deal with it now, which is why I am having to support hospitals that have unsustainable private finance initiative debt that the right hon. Member for Leigh and his colleagues did not deal with.

What do we have? We have policies that the right hon. Gentleman disowns, and we have nothing to replace them with. We have political opportunism, distortions dressed up as arguments, and a shameful campaign to scare people about a Bill that, in reality, is about strengthening the NHS for the benefit of patients.

Of course, if we want to see what Labour would do, we only have to look at the situation in Wales. I have to hand a Wales Audit Office bar chart; I shall hold it up so Opposition Members can see it. One bar shows rising real-terms expenditure on the NHS in England, and the blue bar shows rising real-terms expenditure on the NHS in Scotland, while the green bar shows the rate for Northern Ireland, where the rise is lower. Another bar, however, shows a very large real-terms cut in NHS spending in Labour-run Wales. Labour in Wales did not just agree with the right hon. Gentleman that it would be “irresponsible” to increase NHS spending; Labour in Wales went further, and cut spending.

In order to see the result of that, we must look at performance. In England, 91% of patients are seen and treated within 18 weeks, compared with just 68% in Wales. In England, only 1.4% of patients waited over six weeks for diagnostic tests; in Wales, 29% waited over six weeks. In Wales, Labour says it wants to insulate the NHS against reform. It ought to adopt it, however, because all that is happening in Wales is that the Labour party is, once again, putting politics before patients.

It is patients who should be at the heart of the NHS —patients and those who care for them. This Bill is simply the support to a far more important set of changes, which make shared decision-making with patients the norm across the NHS, which bring clinical leadership to the forefront of the design and delivery of health and care services, which make local government central to planning for health and care, which strengthen the patient voice, and under which the NHS is open about the results we achieve and how to improve those results so we genuinely match the best in the world. We will continue to work with the royal colleges, and others with an interest in the future of the NHS, to implement our plans, so that we provide the best possible care for patients. The right hon. Gentleman’s motion and speech gave no credit to the NHS for what it is achieving, but I will.

We are proud of the services we deliver for patients: the lowest ever number of patients waiting over six months for treatment—[Interruption.] Labour Members do not like to listen to this, but it is the reality. Average time spent waiting for treatment is lower than at the last election. The number of patients waiting over a year for treatment has more than halved since the election. MRSA and C. difficile are at their lowest ever levels. There are more diagnostic tests—up by 300,000 over a year. There is more planned care, and there are fewer unplanned emergency admissions to hospital. Some 11,800 patients have benefited from the cancer drugs fund, and 990,000 more people have had access to NHS dentistry, while mixed-sex accommodation is down by 95%.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Lansley]

No, because I am going to tell the right hon. Gentleman what he did not admit. Reform is going ahead. We are delivering efficiencies across the NHS.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Lansley]

All right, I will give way, but the right hon. Gentleman might like to explain why in the year before the election the administration costs of the NHS rose by 23% and he added more than £320 million to the administration costs of primary care trusts and strategic health authorities, but in the year since, we have cut those costs. Absolutely contrary to what he said—because he was completely wrong—we are on track to deliver the Nicholson challenge. We delivered £2.5 billion in savings in the first six months of this year, having delivered £4.3 billion in savings during the course of the last financial year. Come on: explain that one.

[Andy Burnham]

I should just point out that the Secretary of State is trading on the successful legacy he inherited from Labour: the lowest ever waiting lists; the highest ever patient satisfaction. Let me leave that to one side, however. We on the Opposition Benches have noticed that he has not once mentioned his tribunal defeat on the NHS risk register, and all the achievements he just reeled off are at risk, are they not, because of this misguided reorganisation? I ask him to answer this point today: will he now comply with the ruling of the Information Tribunal, publish this risk register today, and let the public know the full truth about what he is doing to their national health service?

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the right hon. Member for South Shields (David Miliband) and it was notable that his hon. and right hon. Friends were listening to his words, rapt, possibly reflecting on what they had missed out on. The kernel of his argument for this side of the House appeared to be the offering of advice to us about where our party advantage lay. He will forgive me if I say that I think we should look elsewhere for advice about where our party advantage lies.

The right hon. Gentleman was raising a voice for Blairite reform of the NHS, and that is a theme to which I want to return. Some opponents of the Bill can claim the virtue of consistency. Some opponents of the Bill can claim that they always opposed the development of structures in the health services that encouraged flexibility and encouraged a focus on the patient voice and on general practitioners and the wider clinical community as an effective voice for patients in the health service.

Some can claim that they have always opposed having a health service open to private and independent sector provision alongside the national health service provision—that they have always preferred a centrally planned, state-provided service. The right hon. Member for Holborn and St Pancras (Frank Dobson), who is not in his place, can claim the virtue of consistency on that argument, but the shadow Health Secretary cannot claim that consistency because he, like the right hon. Member for South Shields, was once a Blairite. As my right hon. Friend the Secretary of State has shown with the quotations he gave from the shadow Health Secretary when he was at the Department, the shadow Health Secretary used to be an advocate of the policies that underlie this Bill. The Bill will deliver effective practice-based commissioning —a policy that the shadow Secretary of State used to espouse.

[Andy Burnham]

If this Bill simply continues our policy, why does it rewrite the entire legal structure of the national health service over 500 pages?

[Mr Dorrell]

The right hon. Gentleman knows that there is room for more than one view about the extent to which there is a need to rewrite the full statutory basis of the Bill, but that is not the issue now. The question is how, if we went down his route, had a summit and talked for another 12 months about what the institutional structure of the health service should be, that would serve the policy objective that he seeks to espouse, of greater clinical engagement in commissioning. How would it serve the policy objective of which he says he is in favour, of engaging local authorities and the wider political community in decisions that shape the future of the health service?

One issue that the right hon. Gentleman did not mention in his speech is the shift of public health out of the relatively narrow interpretation that is implicit when it is located in the national health service. Instead, public health can properly be understood as being part of the wider range of local government. Those changes do not justify some of the more ambitious rhetoric being used in support of the Bill but they certainly do not come close to justifying the rhetoric being used against it. If half the things being said about the Bill by Opposition Members were true, I and most of my right hon. and hon. Friends, and certainly my right hon. Friend the Secretary of State, would not support it.

--- Later in debate ---

[Andrew George (St Ives) (LD)]

I beg to move an amendment, to leave out from “Bill;” to end and add:

“declines to support the Bill in its current form; and calls for an urgent summit of the Royal Colleges, professional bodies, patients’ organisations and the Government to plan health reforms based on the Coalition Agreement.”

It is a pleasure to follow the hon. Member for Walsall South (Valerie Vaz), a fellow member of the Health Committee, who talks with great knowledge and, from the manner in which she handles herself in the Committee, is clearly very committed. The primary concern of us all in this debate is the future of the NHS; I do not question anyone’s motives as far as that is concerned. That is why I was particularly pleased when the right hon. Member for Leigh (Andy Burnham) opened the debate by reassuring us that we would have a non-tribal, non-partisan debate, and that is also why I feel rather saddened that the debate so quickly degenerated once again into tribalism, which I am sorry to say will seriously undermine our chances of coming forward with a rational solution to the intractable problem of what to do with the Bill.

Although the positions have become further entrenched by the debate, I am concerned about its outcome, because ultimately we will not defeat the Bill. This is not Second Reading, when Members could independently make up their mind on the issue outside the tribal mix. We should debate the matter in a manner that might assist the Government to reflect on where we are. I hope that ultimately they will withdraw the Bill, which is what many of us want them to do. As far as I can see, the Bill cannot be defeated by either House, so the power, and the fate of the Bill with it, lies pretty much entirely in the hands of the Government.

Although I understand that the Secretary of State is obliged to advance the arguments in the way he did today, I am concerned. Therefore, if we are to advance as I propose by withdrawing the Bill and, as set out in the amendment, calling a summit of those who want to take forward a lot of what I think is good in the Bill and in the coalition agreement, I am not sure how that could be achieved on the basis of what we have heard so far. Clare Gerada, the chair of the Royal College of General Practitioners, this morning talked about withdrawing the Bill in order to stabilise the NHS and ensure that we go forward without basing the future of the NHS on ideology, but we of course need to do that while ensuring that everyone is working together.

I agree with the Secretary of State’s approach to the issue, which is that no change is not an option and that change and reform are of course required in the NHS, but I think that it is better that we take this forward on a more consensual basis than the Government have achieved so far.

I already have only a little time left, so let me say something about the Secretary of State himself, because his commitment to the NHS has been questioned in today’s debate. Let me make it clear to my right hon. Friend—in this regard—that, as I said on Second Reading, I believe that he approaches the issue with the very best of intentions, and I would never question the sincerity of his commitment to the NHS over many years, which I highly respect, along with his knowledge of the subject; our disagreement is on the judgment of the legislation. I do not know whether that metaphorical embrace will damage his reputation among his Conservative colleagues, but I hope that it will not.

There are many failings in the current legislation.

[Andy Burnham]

I am listening very carefully to the hon. Gentleman, but may I push him a little? He says that the Bill cannot be defeated, because of parliamentary arithmetic, but what is his take on the points that his right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) made? Is it not the hon. Gentleman’s understanding that the Lib Dem conference withdrew its permission for his peers to vote for the Bill? Does that not therefore take permission away from Liberal Democrat MPs to support it?

[Andrew George]

The right hon. Gentleman is aware that the conference was advisory on the issue. The motion before it actually congratulated our noble Friends in the House of Lords on having achieved significant amendments to the Bill. They have made the Bill less bad but not good enough to make it acceptable to myself—or indeed to many of my colleagues.

The right hon. Gentleman knows very well that Liberal Democrat Ministers and others cannot vote against the Government, so it is not very helpful of him to try to tease out such a situation. The pressure on those who are not so constrained has, however, been lifted.

--- Later in debate ---

[Chris Skidmore]

No, I will not. The right hon. Member for Leigh (Andy Burnham) did not give way to me, I am afraid, so I am not feeling too charitable.

Despite the coalition Government’s added investment of £12.5 billion over the course of this Parliament, demand will only rise further, with 1.6 million people turning 65 in the course of this Parliament and many living into their 80s and beyond. The number of 85-year-olds will double by 2030. The NHS is facing a perfect storm—an ageing population combined with a rise in chronic conditions, including an increase in diabetes, which will take up as much as 25% of the health budget. That is why we are reforming the NHS. Just as this Government are committed to dealing with the deficit so that future generations will not be burdened with debt racked up yesterday, we must be committed to reforming the NHS so that future generations can enjoy an NHS that is free at the point of delivery regardless of the ability to pay. I am sure that that is what everyone in this House is committed to.

By placing GPs rather than management in control of patient treatment, we will not only drive up standards of care, allowing patients access to more treatments under any the qualified provider scheme, but ensure that recurrent cost savings are made to be reinvested in the NHS to cope with the rising demand. Above all, this is an evolutionary measure. My right hon. Friend the Member for Charnwood (Mr Dorrell) touched on the Blairite doctrine. It was a pleasure that we had Professor Julian Le Grand come to the Health Committee, where he said that if Tony Blair were still Prime Minister and he were advising him, he would have urged him to undertake this measure. It is great to see the right hon. Member for South Shields (David Miliband) in his seat. It would have been fascinating to see what would have happened if he had become leader of the Labour party. I am sure that we would not have seen the rank tribalism that we have seen from those on his Benches today.

[Andy Burnham]

We are supporting the amendment.

[Chris Skidmore]

I am talking about the right hon. Member for South Shields, not the hon. Member for St Ives (Andrew George).

Professor Julian Le Grand stated on 28 February:

“With respect to the NHS bill, it is important that even those who generally prefer to rely upon their intuitions should avoid muddying the waters by accusing the bill of doing things that it does not, like privatising the NHS; and that all those involved should acknowledge the peer-reviewed evidence demonstrating that its provisions with respect to public competition…are likely to improve patient care.”

More hours have been given to debating this Bill than any other during this Session. Despite Labour’s message, which seems to be opposition for opposition’s sake, we are gradually learning what its policy will be for the next general election. It is interesting that at a rally in Manchester last week, the right hon. Member for Leigh stated, in front of his union faithful,

“And I will make you a promise today—if I am the health secretary after the next general election I will repeal this bill.”

According to the Opposition, this is the greatest reorganisation in history. Yet the Bill will save £4.5 billion straight away and then £1.5 billion recurrently, year on year, thereafter.

--- Later in debate ---

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

I agree with my hon. Friend the Member for Witham (Priti Patel), who observed in her vigorous and punchy speech that there was an element of déjà vu in the debate.

I was delighted to listen to the speech of the right hon. Member for South Shields (David Miliband). As I listened to it, and to the speech of the right hon. Member for Leigh (Andy Burnham), I reflected on how odd changes in political fortunes are. Those two were the über-Blair reformers, but it was clear from their speeches—both thoughtful in their different ways—that they had turned away from their reforming zeal. I can only put that down to “what a difference a leadership election makes”.

I congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on another good and compelling contribution. I also congratulate my hon. Friends the Members for Kingswood (Chris Skidmore), for South West Bedfordshire (Andrew Selous), for Loughborough (Nicky Morgan) and for Witham, as well as the hon. Member for Burnley (Gordon Birtwistle). It seems that in his part of the world they call a spade a spade.

I must also mention the speech of the hon. Member for Walsall South (Valerie Vaz), which was at times fanciful, that of the hon. Member for Stoke-on-Trent North (Joan Walley), that of the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), which was passionate but, I fear, misguided, and that of the hon. Member for Stallybridge—[Hon. Members: “Stalybridge!”] I mean the hon. Member for Stalybridge and Hyde (Jonathan Reynolds). I am afraid that I am from the south. I was disappointed that the hon. Gentleman did not answer my question about the political allegiance of Dr Chand, whom he prayed in aid, given that Dr Chand has had aspirations to become a Labour candidate. Indeed, I think he even had aspirations to fight the seat that the hon. Gentleman fought, so it was very generous of the hon. Gentleman to mention him.

Let me make clear to the House that no party has a monopoly on caring for the NHS. We all care for the NHS passionately, and I find it distressing when Opposition Members seek to misrepresent the position by accusing us of trying to privatise it. Let me tell them that this party, my party—this Government, the coalition Government—will never privatise the NHS, and let me tell my hon. Friends to reinforce that message. Clause 1 of the Bill gives the Secretary of State a duty to provide a comprehensive health service, and subsection (3) gives a commitment—just as Nye Bevan did in his original Act—that it will be free at the point of use.

Let me tell Opposition Members that what they are saying is scaremongering, that it is unfair, and that it is a gross distortion of the facts. Let me also tell them that shroud-waving does not do them any credit. Pulling out examples that have no basis in proof and are simply intended to misguide and mislead the public is a disgrace—

[Andy Burnham]

Will the Minister give way?

[Mr Burns]

No, because I have no time.

I urge hon. Members to reflect—

[Andy Burnham]

Will the hon. Gentleman give way?

[Mr Burns]

No, because I have no time. I have only five minutes.

The right hon. Gentleman was seductive in his speech. He came across as trying to be eminently reasonable by saying that he did not want this to be a party political football. I must say to him, however, that it is he and his friends who have turned the NHS into a party political football, and I must say to them that the NHS is too precious to be turned into a party political football simply for the purpose of trying to gain votes.

Our reforms will help to prepare the NHS for the future, making it more balanced and better suited to the demands of the 21st century so that it has a long and healthy life based on its founding principles. First, our reforms will give patients more choice, enabling them to choose where to go, see who they want to see, and influence the kind of services that they want in their communities. Secondly, they will give doctors more freedom to commission care for their patients, so that they can shape the NHS around the needs of their local communities. Thirdly, they will reduce bureaucracy so that money—£4.5 billion of it between now and 2015—can be saved and reinvested in front-line services. Those are the basic premises and that is the basic ethos of the Bill.

Not once during the speech of the shadow Secretary of State, and not once during the speeches of any of his right hon. and hon. Friends, did we hear a single answer to the question of what they would do. I do not know how many Members saw the right hon. Gentleman being interviewed on “Newsnight” by Jeremy Paxman two weeks ago. Some of us live in fear of that experience, while some of us come to enjoy it. Five times during that brief one-to-one interview, Mr Paxman asked the right hon. Gentleman “What would you do?” and answer came there none. That was because the right hon. Gentleman is prepared to criticise and try to scare people in order to win votes, but he is not prepared to confront, in a realistic and meaningful way, the challenges facing the NHS and the way in which it must move forward.

What we need is less carping, less criticism, and more constructive engagement. When the right hon. Gentleman says in his flowery way that he is prepared to engage in all-party discussions there is a hollowness in his claim, because he has no policies to discuss, and can identify no positive way in which to resolve the problems of the NHS and enable it to evolve to meet the pressures to which it is subject.

This Bill, which has been discussed at length in this House and in another place, is the Bill that will move the NHS forward and enable it to meet the challenges of an ageing population and an escalating drugs spend. I urge my hon. Friends to reject the motion and to reject the Liberal Democrats’ amendment if it is pressed to a vote, because neither is in the interests of the health service or those of the country.

Question put, That the amendment be made.