Accident and Emergency Waiting Times

Andy Burnham Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House is concerned about the growing pressure on Accident and Emergency (A&E) departments across the country over recent months; notes this week’s report from the King’s Fund which concludes that waiting times in A&E recently hit a nine-year high; further notes that in the Labour Government’s last year in office 98 per cent of patients were seen within four hours; believes that a combination of factors lies behind the extra pressure on hospitals but that severe cuts to social care budgets are one of the most significant causes; is further concerned that one in three hospitals in England say they do not have sufficient staffing levels to deal safely with demand on services; further notes that over 4,000 nursing posts have been lost from the NHS since May 2010 and that a recent survey by the Health Service Journal revealed that a further round of front-line clinical job losses are planned for the coming year; further believes that the Government has failed to show sufficient urgency in dealing with these problems; and calls on the Government to bring forward an urgent plan to ease pressure on hospitals by, amongst other things, re-allocating £1.2 billion of the 2012-13 Department of Health underspend to support social care in 2013-14 and 2014-15, and ensuring adequate staffing levels at every hospital in England.

Since the turn of the year, the Opposition have been warning the Government about building pressure in A and E departments, and yesterday there was confirmation of just how bad things have got. This year, waiting times in A and E hit a nine-year high, according to the King’s Fund. The pressure is not confined to A and E, however, and wherever we look we can see warning signs: hospitals operating with close to 100% bed occupancy, way beyond safe recommended levels; a treatment tent in a car park; long queues of ambulances outside A and E, double the number waiting longer than 30 minutes; a huge spike in the number of A and E diverts, where ambulances are turned away from units that cannot accept any more patients; reports of some hospitals issuing more black alerts in the past year than in the previous 10 years combined; more cancelled operations than for a decade; and a 30% increase in bed days lost to delayed discharges because care plans cannot be put in place, leaving older patients stranded on the ward and A and E unable to admit them.

The evidence is clear: this health and care system is showing serious signs of distress. In truth, A and E is the barometer of the system, and problems or blockages anywhere will soon show up in A and E as the pressure backs up. The situation requires decisive action and a comprehensive plan, both of which have been distinctly lacking in the Government’s response so far.

Today the Prime Minister complacently implied that the problems had been fixed, but for 34 of the 38 weeks this Secretary of State has been in post, major A and Es have missed the Government’s lowered A and E target. Today, six in 10 trusts are warning that next winter will be even worse. The Government’s response to date has been totally inadequate for the scale and urgency of the problems. First, they came to the House and denied there was a problem. On 15 January, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) stated that

“patients are being treated in a much more timely manner than under the previous Government.”—[Official Report, 15 January 2013; Vol. 556, c. 720.]

An inaccurate statement without any basis in fact.

As the pressure built, it was clear that that line would not hold, so the Secretary of State’s spin operation began. He said that the root cause of the pressure was the 2004 GP contract and changes to out-of-hours care. One must ask how the Secretary of State pushed that line with such confidence, given that a freedom of information request from his Department revealed that the first time he went to an A and E as Secretary of State was on 3 April—a full six months after he was appointed. Even then, it was the A and E within walking distance of this building. Did he just repeat back on camera what the first person he met said to him?

Throughout the early months of 2013 the NHS was going through the worst winter for a decade, yet the Secretary of State did not bother to visit any A and E department to see for himself the ambulance queues, the patients held on trolleys, or the staff stretched to breaking point. Just weeks before his first visit to A and E, he told us that hospitals were “coasting”. What an unbelievable statement. Would he have dared to say that if he had actually visited an A and E beforehand?

[Helen Jones (Warrington North) (Lab)]

Does my right hon. Friend agree that one of the pressures on A and E comes from this Government’s cuts to adult social care? We all know that if old people are not given care in their own homes they are more likely to end up in hospital, yet the Government have cut more than £2.6 billion from adult social care, and more than 230,000 people are now not getting help, compared with four years ago.

[Andy Burnham]

My hon. Friend is absolutely right. Two-thirds of NHS finance directors have identified social care and its collapse as the single biggest driver of the pressure on A and E. The Government do not like to talk about that because of the record my hon. Friend just outlined, and I will come to that later in my remarks.

The Secretary of State visited his first A and E in April, and NHS England requested action plans only on 9 May, when hospitals had already been battling with the problem for months. It is simply not good enough. The NHS needs leadership and he has not provided it; instead, he has stuck to the spin. He continued to blame the GP contract, even when experts queued up to tell him it was not the cause of the problem. The NHS Confederation, the Royal College of General Practitioners, the King’s Fund and the Foundation Trust Network all told him that the causes lay elsewhere, but he was not listening because it did not suit his argument. When the NHS needed a Secretary of State, it was left with a spin doctor-in-chief.

That brings us to the crux of this debate and the charge that I lay directly at the Secretary of State’s door. By persisting with spin and by diverting attention elsewhere, the real causes of this crisis have been left neglected.

[Andrew Selous (South West Bedfordshire) (Con)]

If the right hon. Gentleman looks at the graph of A and E attendances, he will see that the figure was pretty constant at 14 million until 2003-04, when it rose steadily to 21 million. Why does he think that there was that big rise in A and E attendances at the time of the change to the GP contract?

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[Andy Burnham]

The spin continues, doesn’t it, Mr Deputy Speaker? Let me explain why that happened. [Interruption.] I will explain if the hon. Gentleman will listen. Perhaps he should look at the subject in more detail before he comes to this place and makes a comment like that. In 2003-04 the statistics changed, and visits to walk-in centres and minor injuries units were added to the figures. If he read the King’s Fund analysis of trends in A and E over the past decade, he would see that it says that very clearly. Perhaps the next time he comes to a debate like this he might do his homework.

In the vacuum that the Government have left, it has been left to Labour to show the leadership that the NHS desperately needs. Last week, Labour convened an A and E summit here in Parliament to refocus minds on the real underlying causes of this pressure. We wanted to give front-line staff from all over England the chance to tell us in their own words about the reality on the ground right now and to suggest practical ways in which the pressure might be relieved. Now, today, we bring this urgent debate to the House to shock the Government out of their complacency and to force them to act on what was said at the summit. There were two overriding messages that all politicians would do well to hear: first, the pressure in A and E is an issue for the whole health and care system; and secondly, there is no one simplistic, single cause but a range of complex underlying factors.

[Sir Bob Russell (Colchester) (LD)]

Let me bring a note of conciliation to the debate. Does the right hon. Gentleman agree that if the nation had more people who are knowledgeable about first aid, fewer people would make their way to A and Es in the first place?

[Andy Burnham]

That is a laudable aim. I do not think it is going to solve the A and E crisis right here, right now, but I do not disagree with it as an aim.

Drawing on what was said at the summit, I have developed an A and E rescue plan with five practical proposals. [Interruption.] Government Members do not want to hear it. Okay, later on they can give me their plan. I am putting forward a plan and calling this debate. They are not calling this debate. Why are they not doing something to take a grip on the situation? It is no good just sitting back and saying, “Oh”—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I want to hear the right hon. Gentleman, as I am sure that people on both sides of the House do, and all the shouting is not going to allow any of us to do that.

[Andy Burnham]

It has been left to us to call this debate, and now Government Members sit there and groan. Well, it is not good enough. They are going to hear what I have to say because they need to do something about what is happening.

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

Before my right hon. Friend gets on to his plan, may I ask him a question? Given the chaos that he has described throughout the whole country—in London, ambulance queues have doubled in the past couple of years—why does he think that the Secretary of State believes it is sensible to downgrade the A and E service at Lewisham and divert tens of thousands of people to other hospitals where the ambulances are queuing all down the road?

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[Andy Burnham]

My right hon. Friend rightly identifies some of the contradictory chaos that now passes for Government health policy. I will deal directly with her point later in my speech.

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

In the preceding debate, the Government tabled an amendment of great worth answering all the points with regard to badgers, but there is no amendment for this debate. They have no answer and are not prepared to put anything on paper about how to get over this current crisis in A and E. Does that not speak volumes?

[Andy Burnham]

The Government have more to say about badgers than about the current crisis that NHS staff up and down the country are dealing with. That says a lot about this Government.

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

I absolutely agree with the right hon. Gentleman that there are no simple answers. Does he agree that one of the pressures that is adding to the problems in A and E is that £3 billion has been taken out of the NHS to fund a reorganisation under the Health and Social Care Act 2012 that nobody needs and nobody wants?

[Andy Burnham]

I agree entirely. That decision was catastrophic for the NHS. Not only did it siphon £3 billion out of the front line to pay for back-office restructuring; it took people’s eyes of the ball. When they should have been focusing on the front line and patient care, they were worrying about their jobs and which organisations they would work in. The Government were warned about this reorganisation and I will come on to that. I have new evidence, which I will put before the House today, that says that this Government were explicitly warned about the risks to A and E of proceeding with their reorganisation at a time of financial stress. It is pretty damning and I will come on to it later.

What I want to do today is achieve something for NHS staff watching this debate. Let us try to reach some agreement about the causes and the practical steps that now should be taken. First, on social care, which my hon. Friend the Member for Warrington North (Helen Jones) has mentioned, the survey of NHS financial directors says that this is the single biggest cause of the pressure. More than £1 billion has already been taken out of budgets already by this Government, and the Association of Directors of Adult Social Services says that councils are planning further spending and services cuts this year. This is simply not sustainable. It is a false economy. Social care is the preventative part of the care system. If the Government continue to hammer councils, the problem will simply end up on the doorstep of the NHS and it will get bigger and bigger. The human cost will be huge.

We heard at last week’s summit that more and more people with dementia are presenting at A and E. That is intensely sad and it is the wrong place for them to be.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

Does my right hon. Friend agree that the most upsetting comment made at the summit was by the nurse at Kingston who told us of a lady with dementia who, when she is hungry or lonely, phones 999 for an ambulance and says that she has heart pain?

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[Andy Burnham]

The room went quiet when the nurse spoke at the summit. I pay tribute to my hon. Friend for being at the summit during the parliamentary recess to hear that nurse. It was a valuable event. My hon. Friend is absolutely right: the loss of simple support in the home for people such as that woman means that they are left with no alternative but to go to A and E or the hospital as the last resort. That is the false economy that I am talking about. By ransacking council budgets to pay for their NHS spending plans, the Government have left this system with major problems that they urgently need to address. The worst thing of all is that they have left older people with no option but to end up in hospital.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I am grateful to my right hon. Friend for giving way; he is being very generous with his time. He is absolutely right: areas such as Stoke-on-Trent have had their budgets slashed and destroyed year on year under this Government. In Stoke-on-Trent, which is the third hardest hit area, the local authority is expected to spread the money it does have even more thinly across a population that is not only deprived, but ageing. The sniping and comments from those of the Government Front Bench are totally inappropriate. Does my right hon. Friend know when the Government got the NHS to write to accident and emergency departments to ask for their plans?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. A lot of Members want to speak, so we need very short interventions.

[Andy Burnham]

That is part of my point. NHS England wrote to clinical commissioning groups on 9 May. What is going on here? They were all in the chaos of reorganisation until then—no one could have received a letter, because CCGs were not in place. In the crucial period between January and March, when the NHS was under intense pressure, primary care trusts were on the way out and CCGs were not in place. As a result, the NHS was in limbo; at the precise moment that it needed grip and leadership, it was drifting. That is absolutely shocking.

As I have said repeatedly, the Government must act to shore up social care in England, which is collapsing. Our solution is for the Secretary of State to use about half of last year’s underspend in the NHS, £1.2 billion, to provide emergency support to councils over the next two years to maintain integrated, home-based support. As he knows, the Budget revealed a £2.2 billion underspend in last year’s Department of Health budget. No use was made of the budget exchange scheme. In other words, he handed that money back to the Treasury. I call on him to reconsider his decision, reopen negotiations with the Treasury and act to prevent a social care emergency.

[Margot James (Stourbridge) (Con)]

Between 2005 and 2010, the population of over-65s grew by 730,000 and the population of over-80s—the very elderly—grew by 27%. Why did the previous Government increase the budget for adult social care by less than 1% a year to cope with that additional demand?

[Andy Burnham]

Oh dear, Mr Deputy Speaker. It is hard for this Government, who have decimated social care, to lecture us about it. Between 2005 and 2010, A and E waits fell. That was after the GP contract was signed. Let us have some facts. We did much to support social care and to deliver an NHS with the lowest ever waiting lists and the highest ever patient satisfaction.

The second point in our A and E rescue plan concerns safe staffing levels—another aspect that we have raised repeatedly with the Secretary of State.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way to the right hon. Gentleman in a moment.

All over the country, NHS staff are saying that there are not enough people on the ward to deal safely with the pressure that they are under. The College of Emergency Medicine has warned of a “workforce crisis” in A and E and of

“a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care.”

More than 4,000 nursing posts have been lost since May 2010 and the Care Quality Commission says that one in 10 hospitals in England is understaffed. It emerged last week that the problem is set to get worse. A survey of NHS HR directors by the Health Service Journal found that 27% of trusts were planning to cut nursing jobs in the coming year, that 20% were planning to cut doctors and that one in three was not confident that they had enough staff to meet demand.

As I have said before, all parties in this House, including my own, need to learn the lessons of the failures in care at Mid Staffs and of the Francis report. The primary cause of those failures was dangerous cuts to front-line staffing. There is a clear risk that the NHS is repeating that mistake. I therefore call on the Secretary of State to intervene in the further round of job cuts and to ensure that all hospitals in England have safe staffing levels.

[Mr Dorrell]

May I bring the right hon. Gentleman back to the interface between social care and health care? He knows that I have a lot of sympathy for the points that he made about the importance of making that interface work more smoothly than it has done for a long time. Is the House to interpret his remark that an additional £1.2 billion ought to be made available for social care as a spending commitment that has the consent of the shadow Chancellor, on the day when the Labour party has said that it will not make good the child benefit changes that it opposed earlier in the Parliament?

[Andy Burnham]

It is important for me to answer the Chairman of the Health Committee. Those of us who are in the club of former Secretaries of State understand that the health and social care systems are interconnected and must be seen as one system, because the failure of social care lands on the doorstep of the NHS.

To answer the right hon. Gentleman’s point directly, the money that I was talking about would come from the underspend. It is part of the allocated budget that his Government gave to the Department of Health for 2012-13. The Department did not spend the whole budget so there was a £2.2 billion underspend. As he knows, the practice has been that Departments can take forward that resource to meet new pressures in later years. I am asking the Secretary of State please to ask for access to that money to relieve the pressure on social care. Simply handing it back to the Treasury when there is an A and E crisis and social care is collapsing is not good enough.

The third point I want to address is out-of-hours advice and the introduction of the 111 service. Last week’s summit heard worrying evidence that the problems of 111 are not just teething problems, as the Secretary of State has claimed. We were told that the problems were more structural and were a result of how 111 has been set up—a feature of the cost-driven contracts that have replaced the successful and trusted NHS Direct. Contracts have gone to the lowest bidder, and they are saving money by having inexperienced call handlers working to a computer algorithm that too often results in the advice “Go to A and E”. There has also been a huge reduction in nurse-led call back, which was the norm with NHS Direct.

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

Does my right hon. Friend know that we had a useful debate on this subject in Westminster Hall this morning, when I made the point that the dropping back from clinician-led triage has caused a problem that the chief executive of my local hospital told me about—that falling back on computer and non-clinician advice has led to patients being brought into the emergency departments when they were actually on end-of-life pathways and should have community input?

[Andy Burnham]

That shows the human cost of the failure that we have seen in recent weeks; my hon. Friend has identified yet another aspect of it.

There has been a huge reduction in nurse-led call back, so inexpert advice is being to people who should probably have other options put to them. An internal graph produced by NHS Direct shows that under the old 0845 NHS Direct service, about 60% of calls received a nurse call back; under 111, that has now dropped to between 17% and 19%. What is happening to these people? They are getting poor advice, so they are frightened and are going to A and E. What is this Secretary of State doing about it? Absolutely nothing.

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

The Public Accounts Committee recently heard evidence about out-of-hours services in Cornwall. The bad experiences there showed that a lot of cost shunting was going on. If there was even a risk of taking somebody on through the GPs on call, it was cheaper and easier for that service to shunt the costs to the NHS through for ambulance services. Does my right hon. Friend agree that that is a complete waste of money and that it underlines the shambles that he has just described?

[Andy Burnham]

I agree that there is a false economy here. The picture is repeated. The Government go for these privatised contracts, such as with 111, at the lowest cost, resulting in a drop in standards and less clinical support. What happens? People then turn up at A and E. What happens when social care is cut? People turn up at A and E. What happens when NHS walk-in centres are closed? People end up at A and E. This has serious implications. Across England, 22 serious incidents, including three deaths, are being investigated in connection with NHS 111, and we know that one in five calls is abandoned. This service is failing; it needs urgent action to tackle these problems.

[Andrew George (St Ives) (LD)]

With the Serco contract for out-of-hours GP services in Cornwall having been referred to the Care Quality Commission, the manipulation of the data, falsely representing the outcomes of the service, has been identified. It is worth reminding the right hon. Gentleman that this was set up under a contract that resulted from decisions made when he was in government.

[Andy Burnham]

I remember debating that with the hon. Gentleman when I was the Secretary of State. Those problems rightly needed to be addressed, and the particular issue he raises today should be investigated. I hope, however, that he will also understand the problem that I am describing to the House. If we go down the path of fragmenting services—if we take a successful national service such as NHS Direct, for example, which was trusted by the public, and then break it up into a patchwork of fragmented, some privatised, services—this sort of chaos will be the result.

A report has emerged this afternoon, showing that the viability of NHS Direct is in serious question. The headline states, “Leaked report casts doubt over NHS Direct’s ‘overall viability’ in the wake of NHS 111 failings”. This is a warning that NHS Direct may well go down altogether. What an indictment that would be of this Government’s mismanagement.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

rose—

[Andy Burnham]

I shall give way one last time before concluding.

[Mr Thomas]

Are the closures and restricted opening hours of many walk-in centres not having an impact on the increasing A and E crisis? Alexandra Avenue polyclinic, which serves my constituents, now restricts its opening hours to weekends.

[Andy Burnham]

I entirely agree, and I shall say more about that issue shortly.

Let me return to the subject of the 111 service. Will the Secretary of State review the contracts with the aim of negotiating changes so that more calls can be handled by nurses? The use of the computer algorithm should be reviewed as a matter of urgency, and the full roll-out of 111 should be delayed until the problems have been solved.

There are more general questions to be asked about the scale and pace of NHS privatisation. NHS Direct offers an illustration of what happens when services are broken up. Those who attended last week’s summit heard that in some areas there had been a huge increase in the provision of 999 ambulances by private companies. It was said that on a single day in Yorkshire, 50% of 999 calls had been responded to by private operators. I think that the public would be surprised to know that. It shows that there is no part of our NHS that cannot be put up for sale by this Government.

Is the Secretary of State satisfied that those private crews are appropriately trained and have the right equipment? Is there not a danger that because contractors are operating in isolation from the rest of the system, they will all too often simply transport people to A and E? Does the Secretary of State envisage any limits to private 999 services? Given that the issue raises fundamental questions about emergency services, should there not be a debate about it before this goes any further?

Fourthly—I come now to the point raised by my hon. Friend the Member for Harrow West (Mr Thomas)—there is good evidence to show that NHS walk-in centres have diverted pressure from A and E units. In 2010-11, there were about 2.5 million visits to such centres from people who might otherwise have gone to A and E. Analysis by the House of Commons Library shows that 26 of them closed in the last year alone, and that the number is down by a quarter. The Government have let that happen, but at least Monitor has intervened and set up a review of the loss of walk-in centres. Will the Secretary of State halt all further closures while the review is taking place?

That brings me to my fifth and final point, which concerns A and E closures and downgrades. At least 25 A and E units—one in 10—are under threat or have recently closed. The trouble with these plans is that they were drawn up in a different context, when A and E was not under the pressure that it is under today. Let me say this to the Secretary of State: if a clinical case can be made in support of closures—if there is evidence that lives can be saved—the Opposition will not oppose the plans. However, we cannot accept the pushing through of proposals that have not taken enough account of the latest evidence, and cannot show that extra pressure can be safely absorbed by neighbouring units. That is important, because the public will rightly ask this simple question: how can it make sense to close A and Es in the middle of an A and E crisis? To reassure people, will the Secretary of State personally review all the ongoing A and E closure or downgrade proposals on a case-by-case basis, in the light of the very latest evidence of pressure in the local health economy?

[Mr Andy Slaughter (Hammersmith) (Lab)]

rose—

[Kate Green (Stretford and Urmston) (Lab)]

rose—

[Andy Burnham]

I will give way one last time to each of my hon. Friends, but then I must finish my speech.

[Mr Slaughter]

What my right hon. Friend has been saying will be music to the ears of people in west London, where four A and E units are slated for closure. All of them are coping with dreadful circumstances. Will my right hon. Friend—and perhaps also the hon. Member for Enfield North (Nick de Bois), who seems to share his view—have a word with my local Conservatives, who are supporting all those closures?

[Andy Burnham]

I think that everyone needs to consider their position in the light of the evidence that is emerging about pressure on A and E, particularly in London. I pay tribute to the excellent and determined campaign run by my hon. Friend, and I noted what was said yesterday by the hon. Member for Enfield North. Perhaps one of the consequences of today’s debate will be agreement across the Floor of the House to delay any closures pending a personal review of the evidence by the Secretary of State.

[Kate Green]

rose—

[Andy Burnham]

I will give way for the last time.

[Kate Green]

As my right hon. Friend will know, my local A and E unit at Trafford general hospital is one of the 30-odd units that are scheduled for downgrading. Meanwhile, it is more than 30 weeks since the two nearest A and E units, at Central and South Manchester hospitals, failed to meet the 95% performance target last September. Does my right hon. Friend agree that the Secretary of State should also publish advice that he has received from the Independent Reconfiguration Panel which will inform his decisions, so that we can determine whether the latest pressures have been taken into account?

[Andy Burnham]

I think that full openness about these decisions is essential in the current context. I know that the panel’s report is with the Secretary of State, and I think he owes it to local Members of Parliament to be open about its conclusions and the evidence on which they were based. That is why I ask him to review every proposed A and E closure personally, and to give a guarantee to communities such as that represented by my hon. Friend that no changes will be made unless he is personally satisfied that it is safe to make them.

In conclusion, this is a crisis that could have been avoided. For the last three years the NHS has been struggling with the toxic medicine of budget cuts and top-down reorganisation. All the focus should have been on the front line, but instead the Government siphoned £3 billion out of it to pay for a back-office reorganisation that no one wanted and no one voted for—a reorganisation that has placed the NHS on a fast track to fragmentation and privatisation.

But it is worse than that. The Government’s own risk registers, which they refused to publish during the passage of the Health and Social Care Act 2012, warned them of the consequences of pushing ahead with a reorganisation when the NHS was facing great financial stress:

“The consequences could be compromised clinical care and patient safety, the failure of the 95% operational standard for A&E wait and a concomitant impact on other trust services”.

So they knew the risks they were taking when they reorganised the NHS at a time of financial stress; they were warned about this A and E crisis, but ploughed on regardless. It is the height of irresponsibility. No wonder they wanted to keep the risk registers secret. But with the looming cuts to jobs and social care, the problems in A and E will get worse, not better, if no action is taken on the points I have outlined today.

We have given the Secretary of State a practical plan, and he either needs to accept it or put one forward of his own. Right now, his complacency is one of the biggest dangers facing the NHS. He has failed to act on warnings about the collapse of social care. He has sat on his hands while front-line jobs are cut in their thousands. He has presided over the disastrous 111 service. He has closed NHS walk-in centres and downgraded A and Es without a convincing clinical case. It is no good his standing up today and blaming everyone else: this is a mess of his making—his first real test as Secretary of State and he has been found badly wanting. People want answers and action, and he needs to start providing them right now.

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[Mr Hunt]

I will give way to the shadow Health Secretary in a minute. One patient there had a cardiac arrest in the eye-examination room as there was no room in the resuscitation bay, and 24 to 36-hour waits for beds are now common in Wales. One patient spent a full three days in a Welsh emergency department. So let me give him a chance finally to condemn what is happening in Wales.

[Andy Burnham]

People watching this debate will be wondering why the Secretary of State is talking about something that is not his responsibility; nor is it mine. He is not responsible for the NHS in Wales; nor am I. I have put to him today serious questions about the NHS in England right now. He is the Secretary of State for the NHS in England, so will he now address the questions I put to him?

[Mr Hunt]

So there we are. Labour totally fails again to condemn the appalling shambles in the part of the country where it runs the NHS. I will tell the right hon. Gentleman why what is happening in Wales is completely relevant to the debate in England.

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[Mr Hunt]

I will give way to the hon. Gentleman, if he will just take his place for a moment while I make my point. I will also give way to my hon. Friend the Member for Enfield North (Nick de Bois)—[Interruption.] I will reflect on whether I want to give way to the hon. Member for Rhondda (Chris Bryant), but I will certainly give way to the hon. Member for Caerphilly (Wayne David).

What is happening in Wales is directly relevant to what is happening in England, because in England the NHS budget has increased in real terms and NHS spending has increased in real terms. If we did not increase them both, that would mean fewer doctors, fewer nurses and longer waits for operations—[Interruption.] The shadow Secretary of State shouts from a sedentary position that the NHS—

[Andy Burnham]

On a point of order, Mr Deputy Speaker. The Secretary of State has just said at the Dispatch Box that the budget for the NHS has increased in real terms. In December, I referred the Secretary of State’s comments to the UK Statistics Authority and I received a letter back saying that they were incorrect. Will you ask the Secretary of State to correct the parliamentary record and ensure that when the statistics commissioner makes a ruling it is adhered to by the Secretary of State?

[Mr Deputy Speaker]

That is not a point of order, but the right hon. Gentleman has certainly made his clarification for the record.

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[Mr Dorrell]

I have four minutes, or with two interventions, six minutes, so if the hon. Gentleman will forgive me, I shall not go off into a discussion about immigration policy.

I want to focus on the changing needs that the health service has to meet. I sometimes wonder whether people talking about rising demand on the health service and rising demand for emergency care have ever sat in a GP’s surgery. Have they noticed around them in a GP’s surgery the kind of people who present in a surgery and the conditions that bring them there—dementia, diabetes and drug and alcohol abuse? How can we expect a service that was designed to meet the needs of patients, inasmuch as it was designed at all, in the 1950s, 1960s and 1970s to meet the needs of today’s increasingly elderly and dependent patients, without rethinking the way care is delivered?

This is—I come back to my core point—a shared analysis. It is not a subject of party political debate. It is a shared analysis between the two Front Benches, and what is even more surprising is that not only is the analysis shared, but the conclusions about the right policy response are shared.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Dorrell]

Forgive me. I have a minute and a half and I want to develop what I think is an important point.

When I make the case for greater urgency about integration between the different parts of the health and care system, I am often told that I am supporting Andy Burnham’s plan. I am quite happy to support Andy Burnham’s plan. Actually, I gently claim credit for the fact that the Health Committee on a cross-party basis has been advancing this analysis from the beginning of this Parliament, and with due deference to the right hon. Gentleman and to my colleagues on the Select Committee I will also point out that part of the answer that the right hon. Gentleman is—rightly, I think—advancing builds on health and wellbeing boards, which are the creation not of me or of him, but of my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), the former Secretary of State for Health and now the Leader of the House of Commons.

The right hon. Member for Holborn and St Pancras (Frank Dobson) talked about a duty of candour. Could we not have a duty of candour about agreement in the House of Commons—agreement that what needs to happen is not to find artificial divisions, but to build on the need for urgent change to meet the needs of today’s patients?