National Health Service

Andy Burnham Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move

That this House regrets the growing gap between Ministers’ statements and what is happening in the NHS; notes mounting evidence of rationing of treatments and services by cost, despite Ministers’ claims to have prevented it; further regrets the increasing number of cost-driven reconfigurations of hospital services, despite the Coalition Agreement’s promise of a moratorium on changes to hospital services; further notes growing private sector involvement in both the commissioning and provision of NHS services, contradicting Ministers’ claims that the NHS reorganisation would not increase levels of privatisation; recognises that, according to the Government’s Public Expenditure Statistical Analyses figures, actual Government spending on the NHS in 2011-12 fell by £26 million, the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office, in breach of the commitment in the Coalition Agreement; believes the Government’s decision to reorganise the NHS has distracted its focus from the financial challenge, with seven out of 10 acute hospital trusts in England missing savings targets in the first half of 2011-12; calls on the Government to take action to prevent rationing by cost in the NHS, based on the evidence presented; and further calls on the Government to honour pledges on NHS spending in the Coalition Agreement, and the commitment that future savings will be reinvested into the NHS front line, and to return at least half of the underspend to the Department of Health budget.

The year 2011 was the first full year of the coalition Government and the year of the biggest ever fall in public satisfaction with the national health service. As I shall set out, those two facts are not unconnected. The NHS in England is reeling from the Government’s catastrophic decision to reorganise it at a time of huge financial pressure. Warnings by Opposition Members and others during the passage of the Health and Social Care Act 2012 of a postcode lottery, of destabilised hospitals and of increasing privatisation are, sadly, beginning to materialise.

For the coalition, attention has moved to other battles—more pressing priorities—but for the NHS the moment of greatest danger is now, as the unstoppable force of reorganisation hits the immovable object of the financial challenge. That is why the Opposition make no apology for introducing this debate, or for bringing the House’s attention back to where it should be: our country’s most important public service and the struggle it faces.

I am grateful for the Secretary of State’s letter—[Interruption.] I can hear him mumbling away on the Government Front Bench. I would have thought the debate would justify his attention, as it justifies that of the Minister of State, the right hon. Member for Chelmsford (Mr Burns). The Opposition have introduced this debate to support NHS staff. We thank them for what they do. They have a huge capacity to deal with whatever is thrown at them, but they have been set mission impossible by the Government. One can only wonder how they felt on hearing the news that the Deputy Prime Minister had the chance to stop this reorganisation but chose to prioritise House of Lords reform. A million hearts will have sunk.

It was not just the Government’s decision to reorganise that was wrong; the way they have gone about it was wrong as well.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

The right hon. Gentleman will know that the Chair of the Public Accounts Committee said that productivity fell continuously for a decade under the previous Government. Does he regret that and recognise that radical change is required to get the productivity improvements this country desperately needs if we are to be able to afford the NHS we all want?

[Andy Burnham]

I am afraid the hon. Gentleman is out of date, because the figures cited by the Government are wrong. NHS productivity was improving by the time Labour left office. The independent and authoritative Commonwealth Fund pronounced the NHS the most efficient health care system in the world in June 2010. That was the legacy of the Labour Government, which the Conservative party is putting at risk.

As I have said, it was not just the decision to reorganise that was wrong; the way the Government have gone about it is also wrong. Before the ink was dry on their White Paper, Ministers set about dismantling existing NHS structures before the new ones were in place. That is a dangerous move at any time, but disastrous at a moment of financial crisis.

We have therefore had drift in the NHS: a loss of focus at local level and a loss of grip on the money just when it was most needed. At a stroke, the Government demoralised the very work force who would be crucial to managing the transition, with primary care trust managers dismissed as worthless. Experienced people left in droves. Those who stayed hoping for jobs in the new world were issued with scorched earth instructions: “Get on and do the unpopular stuff now—the rationing and the reconfiguration—so the new clinical commissioning groups don’t have to.”

We can now see the consequences across England: brutal, cost-driven plans for hospital reconfiguration being railroaded through on an impossible timetable without adequate consultation; walk-in centres being closed left, right and centre; and people left in pain and discomfort, or facing charges for treatment, as PCTs introduce restrictions on 125 separate treatments and services.

[Mr Andy Slaughter (Hammersmith) (Lab)]

On the subject of brutal closures, did my right hon. Friend have a chance to look at the authoritative report by David Rose in The Mail On Sunday yesterday about the “Beeching-style” closure of major casualty units? Four out of nine of the units to be closed are in west London, leaving my constituents and 2 million people in west London without adequate health cover.

[Andy Burnham]

I have no idea how Ministers expect west London to cope with service reductions on that scale, nor do I know how they square them with the moratorium on hospital closures and changes which they promised at the last election. Perhaps we will hear some justification later today, although I will turn to reconfigurations shortly.

[Stephen Pound (Ealing North) (Lab)]

Further to the previous question, the hon. Member for Ealing Central and Acton (Angie Bray) has said that this is all about finance, and she may well be right. However, bearing in mind the fact that Ealing hospital not only came in under budget but produced an operating surplus last year, what possible justification can there be for ripping this crucial and much-needed service from the heart of our community?

[Andy Burnham]

My hon. Friend makes his point powerfully. With some reconfigurations there is a clinical case supporting change, such as the changes I introduced in London before the last election to improve stroke services. We reduced the number of centres from 12 to eight. That was a difficult decision for many London Members at the time, but it was the right thing to do because lives are being saved. However, there is a world of difference between those changes and the crude, cost-driven reconfigurations in the NHS that those on the Government Benches said they would not allow.

I spent my weekend reading a very entertaining book entitled “Never Again? The story of the Health and Social Care Act 2012: A study in coalition government and policy making”. It is a very interesting book and offers a new, detailed account, by Nick Timmins, of the Government’s NHS reorganisation—or, as it says on the blurb, the inside story of a “car crash”. I particularly enjoyed the quotation from the Minister of State—I gather that he has not read it, but there he is, up in lights at the very beginning of the book. He made this comment about the then Bill, which the author thought worthy of special attention:

“You cannot encapsulate in one or two sentences the main thrust of this.”

He should know that better than anybody, as he toured more media studios than anybody, and used more sentences than anyone, in a vain attempt to sell the technocratic and dense plans that made sense to his boss and nobody else.

[Mrs Anne Main (St Albans) (Con)]

Given that the biggest strain on most health authorities is staff pay, does the right hon. Gentleman regret the fact that Labour doubled the remuneration of GPs, allowing them to opt out and thus putting huge stresses on many health care authorities, which then had to buy in additional services? Does Labour not regret allowing doctors to be paid more for doing less?

[Andy Burnham]

I am interested in the argument that the hon. Lady is beginning to develop, which is that she wants to deliver pay cuts to NHS staff across her constituency. Presumably she wants the same as people in the south-west are getting. Is that what she is calling for? It is an interesting argument, and I would be interested to hear her expand on it later.

[Barry Gardiner (Brent North) (Lab)]

Will my right hon. Friend give way?

[Andy Burnham]

In a moment.

What I found most useful about the book is that it answered a question that has been nagging away in my mind for some time. As a former Health Secretary, I remember clearly the warnings I received from senior civil servants about the sheer scale of the £20 billion efficiency challenge. “It would be a major undertaking,” they said. “The NHS would need to focus all its energy on that alone. To be negotiated safely, new policy initiatives would have to be put on hold.” Over the months that have followed, I have often had cause to recall those words, as I watch the Secretary of State add to the financial challenge with the biggest ever reorganisation in NHS history. Did the same civil servants issue the same apocalyptic warnings to the incoming Secretary of State as they did to me? Finally I have my answer, in a quotation in the book from an unnamed senior civil servant:

“The biggest challenge was trying to get the secretary of state to focus on the money—the £20 billion and the sheer scale of the financial challenge”.

According to that civil servant, however, the Secretary of State’s attitude was:

“I am going to do these reforms anyway, irrespective of whether there are any financial issues. I am not going to let the mere matter of the financial context stop me getting on with this”.

Another civil servant is quoted as saying:

“We did point out to him that his plans were written before the big financial challenge, and didn’t that change things? He completely did not see that at all. He completely ignored it”.

Then the question is asked: was the Secretary of State presented by the Department with alternatives to inflicting legislative upheaval on the NHS? A senior civil servant said that

“it was clear that having posed the question of did he want to see other options, that Andrew was not very interested at all in us presenting alternatives.”

A picture is emerging of a Secretary of State with an inability to listen, take advice or heed warnings, who is going to have his Bill regardless of the upheaval that it will cause to the national health service.

[Barry Gardiner]

I am grateful to my right hon. Friend for giving way, although I fear that the moment might have passed. I simply wanted to ask him to reflect on the challenges that the hon. Member for St Albans (Mrs Main) issued to him about doctors and pay. Does he agree that those doctors are now the very people who are in charge of commissioning the services of which they are also the providers? I wonder whether the hon. Lady thinks that that is a good thing or a bad thing.

[Andy Burnham]

At the heart of the defective legislation that the Government rammed through the House of Commons is an unresolved conflict of interest, in which commissioners can also be providers who can remove services from hospitals and then provide them themselves. Under pressure in the other place, the Government came up with a requirement for a statement of such interests, but without introducing any mechanism for enforcement to ensure that decisions in the NHS are being made for the right reasons. I fear that that conflict of interest will return to haunt the Government.

[Andrew George (St Ives) (LD)]

The right hon. Gentleman knows that I share his critique of the Health and Social Care Act 2012. He mentioned the fact that civil servants had given him warnings and cautioned him about the consequences of his decisions during his time in office. Was he warned about the changes in regulations that have resulted in the decision of the south-west consortium to suggest changes to the terms and conditions and pay of staff in that area? That was a direct result of regulations brought in by his Government.

[Andy Burnham]

No, it was not. Agenda for Change was one of the proudest achievements of our Government, and we always staunchly defended national pay arrangements. The hon. Gentleman talks about warnings, but I have just read out the explicit warning that was given to the current Secretary of State that this was the wrong time to reorganise the NHS. It was unforgivable to proceed in those circumstances. This was the single most reckless gamble ever taken with the NHS, and patients and staff are already proving to be the biggest losers.

[Steve Brine (Winchester) (Con)]

I was not reading the book that the right hon. Gentleman has mentioned at the weekend, but I was listening to Radio 4 last night while I was doing the washing up, as I do. I heard one of his colleagues, the hon. Member for Wigan (Lisa Nandy), say that Labour was committed to repealing the Health and Social Care Act in its entirety. Will the shadow Secretary of State tell me whether, when I am in Winchester over the summer recess, I should tell the clinical commissioning groups that are getting on with their work that all that work would be undone, and that the Hampshire primary care trust and the South Central strategic health authority would be recreated if Labour were to form the next Government?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We are short of time, so may I request short interventions, please?

[Andy Burnham]

There is a simple answer: yes, we will repeal the Act. It is a defective, sub-optimal piece of legislation and it is saddling the NHS with a complicated mess. The hon. Gentleman should listen to the chair of the NHS Commissioning Board, whom his Secretary of State appointed. He has called the legislation “unintelligible”. In those circumstances, it would be irresponsible to leave it in place.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way to the Chair of the Select Committee in a moment.

Wherever we look, we see warnings of an NHS in increasing financial distress, yet according to Ministers everything is fine. The gap between their complacent statements and people’s real experience of the NHS gets wider every week. They are in denial about the effects of their reorganisation on the real world. That dangerous complacency cannot be allowed to continue.

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

In the light of what the right hon. Gentleman has just said, will he clear up this confusion? His leader, the right hon. Member for Doncaster North (Edward Miliband), has said that he would keep clinical commissioning, yet the shadow Secretary of State has just said that he would repeal the Act in toto, which would include the provisions on clinical commissioning.

--- Later in debate ---

[Andy Burnham]

One of the great tragedies in this book is the Secretary of State’s admission, during a statement in the House in which he announced the “pause”, that he could have done most of what he wanted to do without legislation. The former Secretary of State, the right hon. Member for Charnwood (Mr Dorrell), is quoted as muttering to a colleague, “Why on earth are we doing it, then?” Well, why on earth did he do it? Because he wanted his Bill, regardless of other people.

[Mr Dorrell]

A moment ago, the right hon. Gentleman told my hon. Friend the Member for Winchester (Steve Brine) that Labour was committed to repealing the Act in its entirety. Does that not mean that an incoming Labour Government would be committed to precisely the kind of pre-cooked reorganisation of which he has just accused my right hon. Friend the Secretary of State?

[Andy Burnham]

No, it does not. This is what Government Members do not understand. It is not about the organisations, but about the services that they provide. The existing organisations can be asked to work differently, and I would ask them to work differently. I do not want NHS organisations to be in outright competition, hospital versus hospital; I want them to work collaboratively. So yes, we will repeal the Act, but no, there will not be a pointless top-down reorganisation of the kind that we have seen the Secretary of State inflict on the NHS.

This complacency is dangerous, and it cannot be allowed to continue. We had two clear purposes in initiating today’s debate. First, although we cannot stop the Government’s reorganisation, we can hold them to account for promises that they made to get their Bill through. I shall shortly identify five such promises in respect of which we are asking Ministers to live up to their words. Secondly, we wanted to give the House a chance to help the NHS by voting to hold the Government to account and enforcing the coalition agreement’s commitments on NHS spending.

Let me first deal with Ministers’ claim that there is no evidence of rationing of treatments by cost. They have promised to act if any evidence is presented. In fact the evidence is plentiful, and it is simply not credible for Ministers to deny it. The postcode lottery of which we warned is now running riot through the NHS. We have identified 125 separate treatments that have been stopped or restricted in the past two years, in some cases in direct contradiction of guidance from the National Institute for Health and Clinical Excellence.

[Mr George Howarth (Knowsley) (Lab)]

Last week I was at Whiston hospital, which, as my right hon. Friend will know, covers Knowsley and St Helens. The net effect of all the changes is that its staff, particularly the nursing staff, are thoroughly demoralised. Does my right hon. Friend accept that any commitment that he makes to changing the system will be welcomed by NHS staff?

[Andy Burnham]

I have heard the same from staff throughout the system. Morale has never been lower. People have been badly let down by a Government who promised them no top-down reorganisation, a moratorium on hospital changes, and real-terms increases. None of those things has been delivered. During the run-up to the general election the Conservatives cynically used the NHS to try to gain votes, and they will pay a heavy price for breaking the promises that they made then.

[Mr Simon Burns]

rose—

[Clive Efford (Eltham) (Lab)]

rose—

[Andy Burnham]

I will give way to the Minister one more time, and then to my hon. Friend the Member for Eltham (Clive Efford), but after that I must make some progress.

[Mr Burns]

I am grateful to the right hon. Gentleman. Although he did not answer the question that I asked him earlier, he did spread more confusion. If he were ever in a position to repeal the entire Act and did so, given that the strategic health authorities and the primary care trusts will have long since gone, how does he envisage care being commissioned for patients?

[Andy Burnham]

The Minister seems to equate removal of the Act with bringing back PCTs and SHAs. I do not have a problem with clinical commissioning, and I said as much during the Bill’s passage. I introduced it myself. I do not have a problem with clinical commissioning groups; my problem is with the job that they are asked to do, and the legal context in which they are asked to operate. We reject the Secretary of State’s market, and that is why we will repeal his Act.

[Clive Efford]

Clinicians in south-east London presented proposals for the reorganisation of our health care provision in “A picture of health”. It was all agreed by local commissioners, but when the Tories took office, they imposed a two-year delay that cost our health care trust £16 million a year—and that is the same trust that the Secretary of State has just put into administration.

[Andy Burnham]

This is what happened: when they came into government, they had a cynical policy of a moratorium, and they went up to Chase Farm hospital to announce it, saying, “There will be no cuts and no closures at this hospital.” They traded and touted for votes in that constituency for years on the back of that issue, and now that hospital is going to close. They delayed the reconfiguration and then they delayed the savings that came to the NHS. It was disgraceful, and people will have seen through it.

[Mr Dave Watts (St Helens North) (Lab)]

I wish my right hon. Friend well in trying to hold this Government to account. The NHS is paying consultancy fees all around the country: hundreds of thousands of pounds are being wasted, and the Government are refusing to publish the information. They are also bullying many of the trusts. How are we going to get the information out when the Government are doing this?

[Andy Burnham]

My hon. Friend is absolutely right about the waste of money the Government have brought into the NHS through this reorganisation. The total is over £3 billion. That is simply unjustifiable at this time. Staff who had been working in primary care trusts are either being re-employed as consultants or are going into clinical commissioning groups. This is such a waste of money at a time when the NHS needed every penny to maintain standards of patient care.

I was talking about rationing, and let me focus on cataract surgery. GP magazine has found limits on cataract surgery in 66% of PCTs. The Royal National Institute of Blind People found that 58% of PCTs are using visual acuity thresholds to restrict surgery. This is the evidence, so the Secretary of State had better start listening. What has happened since those restrictions on cataract operations have been introduced? Unsurprisingly, the number of cataract operations in England fell by over 12,000 between 2010 and 2011. That is a direct result of the new restrictions. There is no less need, however. Thousands of older people need such procedures, but they are now being forced to live with very poor sight.

This is truly a false economy. Cataract surgery is one of the most cost-effective procedures carried out by the NHS. It helps people live independently and have a quality of life, and research has shown that in the last two years poor vision has been a factor in 270,000 falls by people aged 60 or over. This is the rationing by cost that Ministers have repeatedly denied is happening. So let me ask the Secretary of State again: does he agree with these restrictions on cataract surgery? If he does not, will he take immediate action to lift them?

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will my right hon. Friend confirm that under the last Labour Government the number of cataract operations carried out by the NHS rose from 160,000 a year to 310,000 a year, as a result of the commitment of the staff? What will the staff in the south-west think about all this if they have their pay cut?

[Andy Burnham]

For staff who are trying to hold things together through the chaos the Government have brought about, what a kick in the teeth it must have been to read in the Sunday newspapers that unless they accept pay cuts, they will be made redundant. My right hon. Friend says the staff made those improvements, but so did he. As the incoming Secretary of State, he made improvements to waiting times for cataract surgery, which, if I remember rightly, were commonly about a year in the late-1990s. We brought those waiting times right down. Now what do we hear? We hear that under this crowd people with two cataracts are being told, “You can have one done, but not both.” That is what the NHS has been reduced to under this Government. The Secretary of State has promised action, and I have given him the evidence. He now must take action.

The second area on which the Government need to be challenged is privatisation. As the debate on the Bill drew to a close, the Secretary of State made this clear statement:

“The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS.”—[Official Report, 27 March 2012; Vol. 542, c. 1335.]

It is hard to know where to start, but how about the NHS walk-in centre in Sheffield, which is managed by a private company and has just started charging patients with whiplash injuries £25 for treatment, or the NHS hospitals now marketing private treatments for in vitro fertilisation, cancer screening or bone screening since the cap was lifted? How about the letter sent to all PCTs requiring them to identify three or more services for tendering under the “any qualified provider” measure in 2012-13? How about the 100 or so tenders for a range of services that have been offered to the private sector on this Secretary of State’s watch, with a total value of more than £4 billion? So let me ask the Minister and the Secretary of State today: will they now at least be honest about their true intentions for the level of private sector involvement in the NHS?

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Is my right hon. Friend as concerned as I am about the exponential rise in the number of private health care ads that we see on our television screens and in our newspapers every day? These ads had almost disappeared under the previous Government. Advertisers advertise only when they know that there is a market.

[Andy Burnham]

This is really important; it is where all of what the Government are doing comes together. They have put in place restrictions in treatments— 125 separate treatments, as I have just mentioned— and at the same time they have given a 49% cap to NHS hospitals to do more private work. So as the NHS decommissions services, hospitals are then free to start offering those services. That is why my hon. Friend is beginning to see the changes that she is noticing, and this is the clear agenda of the Conservative party.

[Huw Irranca-Davies (Ogmore) (Lab)]

Does not the fragmentation that my right hon. Friend is describing raise the crucial question about when the national health service ceases being a national health service under this Government?

[Andy Burnham]

The Bill that the Government brought through is an attack on the N in the NHS; that is what it was designed to do. It was designed to break national standards; to break national pay; to break waiting time standards; and to allow primary care trusts to introduce random rationing across the system. That was the intention of the Bill that they brought through; they wanted an unfettered market in the health service, and my hon. Friend is absolutely right. That is why we are saying that we will repeal this Act and restore the N in NHS at the earliest opportunity.

[Andrew Percy (Brigg and Goole) (Con)]

On 28 June, in response to misinformation put out by Labour councillors, the medical director of my local hospital trust, a doctor of 30 years, wrote an article in my local paper under the headline “NHS faces greatest challenge”. She talked about staff costs, treatment costs and the 2008 Nicholson challenge. She said that the trust’s problems date “back to 2008”, and she continued:

“Having been a doctor for nearly 30 years, the 2008 Nicholson challenge is, by far, the greatest challenge the NHS has ever faced”.

What should we believe: the picture being presented by the right hon. Gentleman or this article?

[Andy Burnham]

The hon. Gentleman is making my point; if he was listening to what I said at the start of my speech, he would have heard me say clearly that the £20 billion Nicholson challenge, which I set, was always going to be a mountain to climb for the NHS. Let us be clear that it was. What was unforgiveable was combining that Nicholson challenge with the biggest ever top-down reorganisation in history, when the whole thing was turned upside down, managers were being moved or made redundant and nobody was in charge of the money. That was what was so wrong, and that is what the hon. Gentleman should not be defending if he is defending staff in the NHS.

The third area where we need action from Ministers is on protection for staff. The Deputy Prime Minister said recently:

“There is going to be no regional pay system. That is not going to happen.”

But we heard yesterday that a breakaway group of 19 NHS trusts in the south-west has joined together to drive through regional pay, in open defiance of the Deputy Prime Minister. They are looking at changes to force staff to take a pay cut of 5%; to end overtime payments for working nights, weekends and bank holidays; to reduce holiday time; and to introduce longer shifts. We even hear that if staff will not accept this, they are going to be made redundant and re-employed on the new terms. So let us ask the Secretary of State and the Minister to answer this today: do the Government support regional pay in the NHS and the other moves planned by trusts in the south-west? If they do not, will they today send a clear message to NHS staff in the south-west that they are prepared to overrule NHS managers?

Fourthly, I shall deal with reconfigurations. The House will recall the promise of a moratorium on changes to hospitals and the Prime Minister’s threat of a “bare-knuckle fight” to resist closure plans. In 2010, the Secretary of State set out four tests that all proposed reconfigurations had to pass. They related to support from general practitioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. He said:

“Without all those elements, reconfigurations cannot proceed.”

So let me ask the Minister: does he think that the A and E units closing at Ealing, Hammersmith, Charing Cross and Central Middlesex pass that test? How about St Helier, King George, Newark and Rugby? Is it not clear to everyone that the Prime Minister’s bare-knuckle fight never materialised? Is it not also clear that no one told the Foreign Secretary, the Work and Pensions Secretary or even the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for care and older people and who has launched a campaign against his own Department? What clearer sign could there be of the chaos in the Department of Health and of the chaos engulfing the NHS? Will the Secretary of State now take action to stop reconfigurations on the grounds of cost alone?

That brings me to my fifth and final area for action, which is NHS spending. The coalition agreement said:

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

That is health spending, not the health allocation. Official Government figures show that actual spending has fallen for two years running and the underspend has been clawed back by the Treasury. Of all the promises the coalition has broken, people will surely find that one the hardest to understand given that the Prime Minister appeared on every billboard in the land, on practically every street in the land, promising to do the opposite just two years ago.

[Gordon Birtwistle (Burnley) (LD)]

Will the right hon. Gentleman advise me who he consulted before he closed the A and E unit in Burnley?

[Andy Burnham]

I was prepared to make difficult decisions and be honest about them. I am not proposing the reversal of that decision and I note that clinicians in his area recently said how it had improved outcomes for his constituents. What I will not do—what I will never do—is go to marginal constituencies, as the Secretary of State did, and make false promises that I will reopen such units. The Secretary of State did that before the last election; no wonder he is looking shifty in his seat right now. He went to the hon. Gentleman’s constituency and said that he would reopen that unit. Has he done that? I do not believe that he has.

[Clive Efford]

On that very point about turning up in constituencies just before general elections promising to save A and E services, the Tories pledged to save 999 services at my local hospital, Queen Mary’s, Sidcup. They pledged to keep that A and E open—the Secretary of State did so himself. Where is the A and E?

[Andy Burnham]

I do not know how the Secretary of State justifies what has been done. Even in my own patch, Greater Manchester was going through a children’s and maternity services review and some constituencies were benefiting from the changes—Bolton, for example, was getting a bigger maternity unit—but some were not and this Secretary of State went both to Bury, where he said that he would defend the maternity unit, and to Bolton, for a photo call celebrating the new investment. If anything illustrates the sheer opportunism of the Secretary of State in opposition, surely that is the example that does.

[Several hon. Members]

rose—

[Andy Burnham]

I will give way to the hon. Member for Totnes (Dr Wollaston) before I conclude.

[Dr Sarah Wollaston (Totnes) (Con)]

I hope that in his conclusion, the right hon. Gentleman will address a point raised by the King’s Fund. It said that the greatest policy failure of the previous Administration was the failure to tackle health inequalities. He says that he wishes to appeal the whole of the Health and Social Care Act 2012, but does he accept that shifting public health back to local authorities gives us one of the greatest opportunities to tackle health inequalities? Will he seriously put public health back where it was before and, by so doing, continue to fail to address health inequalities?

[Andy Burnham]

The hon. Lady mentions the Act, and I seem to remember that she called the Bill a hand grenade thrown into the health service. She seems to have changed her tune since then. We made huge progress on tackling smoking and improving the public health of this country, progress of which we are very proud. We can always say that we could have done more, but I remember putting through measures on smoking towards the end of our time in government that were opposed by those on the Government Front Bench. I am not sure how she could justify that.

The budget cut combined with the distraction of reorganisation means that six out of 10 hospitals in England are now off target for their efficiency savings. That brings me back to where we started: this is the wrong time to reorganise the national health service. In conclusion, the House cannot reverse tonight the damage of the NHS reorganisation, but we are not powerless. There are things we can do to help the NHS at one of the most dangerous moments it has faced. Our constituents will expect us to hold Ministers to account for promises made on rationing and reconfigurations. They will want us to do the right thing by NHS staff facing pay cuts and redundancy. Our constituents have a right to expect that one of the central pledges in the coalition agreement—not to cut the NHS—will be honoured. That is the simple call of our motion this evening which, we hope, can unite all sides of the House. A vote tonight for the motion would be a positive vote for an NHS under siege and a message of appreciation for NHS staff facing uncertain times. I commend the motion to the House.

--- Later in debate ---

[Mr Burns]

I will now make progress.

To return to waiting times and the record as a fact, rather than the fiction that Opposition politicians like to peddle, 96% of patients wait for fewer than four hours in accident and emergency, and every ambulance trust in England meets its core response times.

[Andy Burnham]

On accident and emergency waiting times, let us be clear. In the 2013 year to date, has the NHS met the 95% target or not?

[Mr Burns]

Yes; 96% of patients wait for fewer than four hours in A and E, and as the right hon. Gentleman knows, the percentile is 95%.

--- Later in debate ---

[Mr Burns]

If hon. Gentlemen and Ladies will bear with me, I would like to make some progress, because this is a short debate and many hon. Members would like to participate, but I will give way later.

The motion, like the right hon. Member for Leigh, mentions a fall in spending on the NHS of £26 million in 2011-12. I will give him one statistic: £12.5 billion. There will be £12.5 billion extra for the NHS in this Parliament, £12.5 billion that would never have been made available had he had his way, as he said that to do so would be irresponsible. That is exactly what his party is doing in Wales, where it is in control of the NHS. It is cutting the NHS budget in Wales by 6.5% in real terms from 2011-12 to 2014-15. His motion talks about a £26 million underspend, but what he does not understand is that there has been a real-terms increase in funding for the NHS this year. Because we are no longer wasting hundreds of millions of pounds on a bloated bureaucracy and the national programme for IT, we have been able to save an extra £1.1 billion in real terms from the back office and put it into front-line care.

[Andy Burnham]

So that there is no confusion, because this is a very important matter, I will quote from a Department of Health press release of Friday 6 July:

“PESA figures released today show that in real terms NHS spending has reduced slightly by 0.02%.”

For the record, will the Minister say whether NHS spending rose or fell over the last financial year?

[Mr Burns]

What I was saying that the right hon. Gentleman—[Interruption.] He must wait one minute, because I will answer him. What I said, which is correct, is that, in keeping with our commitments, we have increased funding on the NHS in real terms—

[Andy Burnham]

It is your press release.

--- Later in debate ---

[Mr Burns]

I will now make some progress.

The motion seeks to give the impression that NHS care is being rationed. That is worse than inaccurate: it is scurrilous nonsense and scaremongering on a grand and somewhat desperate scale. [Interruption.] I will come to cataracts in a moment. We did some rudimentary checking of our own into the veracity of those claims, which were originally made as part of the Labour party’s NHS health check. It was not long before it became abundantly clear that that was not worth the press notice it was printed on. It claimed that there was a blanket ban by NHS Hull on the removal of risk ganglia. We spoke with NHS Hull and found that there is no such ban. It claimed that 11 out of 100 PCT clinical commissioning groups restrict laser revision surgery for scars, but such cosmetic surgery has never been routinely available on the NHS, under either this Government or the previous Government, when the right hon. Member for Leigh was Secretary of State. It claimed that weight-loss treatment is restricted, stating that

“patients generally have to be over 18 and have a BMI over a certain level to receive weight loss surgery”.

Amazing—people actually have to be overweight to be entitled to weight-loss surgery. I would have thought that that was startlingly obvious, but obviously the right hon. Gentleman does not think so.

[Andy Burnham]

rose—

[Mr Graham Stuart]

rose—

[Mr Burns]

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

[Andy Burnham]

Is the Minister aware that the National Institute for Health and Clinical Excellence guidance recommends that bariatric surgery should be offered only to people with a BMI of 40? Is he also aware that numerous PCTs all over the country are restricting access to that surgery by introducing their own arbitrary limits? That is evidence of the rationing I am talking about. He will know that the NHS constitution guarantees people access to NICE-approved treatments, so why does he not take action on those PCTs that are standing outwith the NICE guidance?

[Mr Burns]

What the right hon. Gentleman rather cunningly does not mention—[Interruption.] I am answering the question, if the hon. Member for Copeland (Mr Reed) can just keep quiet for a second. The right hon. Gentleman says that the NICE guideline refers to a BMI of 40, and that is absolutely correct, but I point him in the direction of one area in central London that does not go by that guideline, because it uses a BMI of 35, which is lower.

--- Later in debate ---

[Mr Dorrell]

I agree with my hon. Friend, but let us not go down that route. At the time when Sir David Nicholson was writing, the Labour Government were contemplating the possibility not of a real-terms freeze, which is in effect what is planned under the coalition, but of a cash freeze, which would have been substantially more difficult to achieve.

The main issue now is how we deliver services that meet the demands placed on the system against the background of a resource allocation to the health service that was always going to be dramatically less generous than it was during the earlier years of the Labour Government. We heard from the right hon. Gentleman a commitment that an incoming Labour Government would go through a clean-sheet-of-paper redrawing of the map—

[Andy Burnham]

indicated dissent.

[Mr Dorrell]

The right hon. Gentleman shakes his head, but he said that he would repeal the Health and Social Care Act 2012, the result of which would be to commit the health service to precisely the kind of reorganisation—or re-disorganisation—that he accuses the Government of introducing.

The challenge for the Opposition is to show that they are willing to map a future for the health service, in much more constrained financial circumstances, that allows it to meet the demand for services that is going to be placed on it and to fulfil the aspirations that we all have for improved quality of service. That becomes increasingly difficult in the light of motions such as the one that the right hon. Gentleman has put down for the House to consider. He invites us to regret

“the increasing number of cost-driven reconfigurations of hospital services”

and

“growing private sector involvement in both the commissioning and provision of NHS services”.

Yet when he was Secretary of State and bore my right hon. Friend’s responsibilities for meeting this challenge, he made it clear that service reconfiguration was precisely how the health service needed to meet the challenges that it faced, and that the private sector had an important role—of course, not an exclusive role—in introducing the solutions to the challenge that Sir David Nicholson articulated in May 2009. The same approach was taken in the Labour party’s manifesto for the 2010 general election.

The challenge that the right hon. Gentleman has to address if he is to discharge his responsibilities as shadow Health Secretary is to move on from party political ding-dongs, of which we have had too many. [Interruption.] The right hon. Member for Holborn and St Pancras (Frank Dobson) is commenting from a sedentary position. I have always been aware that he, at least, does not agree with the commissioner-provider split that the shadow Health Secretary operated as Secretary of State and has always said that he is in favour of considering.

--- Later in debate ---

[Mr Lansley]

The right hon. Gentleman should not interrupt from a sedentary position. I am answering the question. Members are interested in this. When I went to the pay review body, I made it clear that, in my view, we could achieve that through negotiations on the “Agenda for Change”. That continues to be my view, and the south-west pay consortium makes it clear in its documentation that it supports such a negotiation. It is right to pursue such a negotiation nationally and for local pay flexibilities to be used in the national pay framework. That is what most NHS employers do, with the exception of Southend.

I have made it clear, as the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns) has, that we are not proposing any reductions in pay as a consequence. I do not believe they are necessary or desirable in achieving the efficiency challenge.

[Andy Burnham]

I have a simple question for the Secretary of State. Is he therefore overruling the south-west consortium?

[Mr Lansley]

No, because the south-west consortium has made no such proposal. Its document is clear: it wants the “Agenda for Change” national pay framework to give it the necessary flexibilities. My view is that we should do that, and I hope that the Opposition, along with the trade unions and the staff side, will support it. As a consequence, no proposal for the reduction of pay or the dismissal and re-engagement of staff is, in my view, desirable or necessary. Indeed, when I went to the pay review body, I made the point that I did not believe reduction of pay in the NHS to be necessary.

Let me conclude. There was a lot that those of us in the Chamber did not hear from Opposition Members. Much of it was in the annual report that I published just two weeks ago—waiting times below what they were at the time of the last election; the number of people waiting beyond 18 weeks cut by 50,000; the number waiting beyond a year reduced by nearly two thirds; infection rates in hospitals at their lowest ever level; cancer waiting times met; ambulance trusts all meeting the category A8 standard; 95.8% of patients seen, treated and discharged from A and E within four hours; 92% of in-patients and 95% of out-patients saying that their care was good, very good or excellent; and patients across the NHS saying that they support the NHS and believe the care they received to have been excellent. On that basis, the House should reject the motion as unfair in its characterisation of the NHS and wrong in its denigration of the NHS.

Question put.