NHS

Andy Burnham Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House is concerned about recent pressure in Accident and Emergency departments and the increase in the number of people attending hospital A&Es since 2009-10; notes a recent report by the Care Quality Commission which found that more than half a million people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in the last year; believes that better integration to improve care in the home or community can relieve pressure on A&E; notes comments made by the Chief Executive of NHS England in oral evidence to the Health Select Committee on 5 November 2013, that the NHS is getting bogged down in a morass of competition law, that this is causing significant cost and that to make integration happen there may need to be legislative change; is further concerned that the competition aspects of the Health and Social Care Act 2012 are causing increased costs in the NHS at a time when there is a shortage of A&E doctors; and calls on the Government to reverse its changes to NHS competition policy that are holding back the integration needed to help solve the A&E crisis and diverting resources which should be better spent on improving patient care.

Our purpose in calling this debate is twofold. First, we want to help the House to develop a more sophisticated understanding of the underlying reasons for the sustained pressure in accident and emergency departments throughout England. Secondly, we want to remove what we see as the major barrier to a lasting solution in A and E.

What has been happening in A and E over recent years? Between 2007 and 2010, attendances at A and E were fairly stable, although they rose slightly. Over those three years, attendances at hospital A and E departments increased by 16,000. Between 2010 and 2013, something changed. In the first three years of this Government, attendances at A and E increased by a staggering 633,000.

What is going on? It is all too easy to reach for simplistic answers. In truth, the picture is complex and a range of factors has contributed to the rise. However, it is possible to point to underlying causes. One of those is clearly the general economic climate. People have been living under greater pressure and are struggling with the cost of living. A and E has become the last resort for people who are not able to cope for a range of reasons. If Members speak to A and E staff, they will be told that there has been a rise in people arriving at A and E who have a range of problems linked to their living circumstances, from people who have severe dental pain because they cannot afford to see the dentist, to people who are suffering a breakdown or who are in crisis, to people who cannot afford to keep warm and are suffering a range of cold-related conditions.

[Stephen Mosley (City of Chester) (Con)]

The right hon. Gentleman is explaining why there is increased pressure on A and E. Does he not accept that A and E performance has improved since the general election? The average waiting time is down from 77 minutes under the last Government to 30 minutes.

--- Later in debate ---

[Andy Burnham]

No, I do not accept that. This has been the worst year in a decade in A and E departments. Almost 1 million people have waited more than four hours to be seen. In my year as Secretary of State for Health, the figure was 350,000. There has been a big increase in the number of people who are waiting a long time. I was going to come on to the average waiting time, but since the hon. Gentleman mentions it, let me make the situation clear now. The figure that he is talking about and which appears in the Government amendment relates to the waiting time until an initial assessment, not the total waiting time in A and E. [Interruption.] The Secretary of State is nodding because, as ever with him, it is all about the spin. That figure does not mean anything to the public. They want to know how long they will spend waiting in A and E in total. We need to have a bit of truth in this debate.

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

My right hon. Friend was making a point about the wider economic pressures that are leading to greater pressure within A and E. Was he as shocked as I was to read in the Manchester Evening News last year that people in our area are presenting at A and E as a result of malnutrition? Is it not an appalling indictment of the Government that they have allowed that to happen in the 21st century? It is putting huge pressure on A and E departments across the north-west, including those at Wythenshawe hospital and Manchester Royal infirmary.

[Andy Burnham]

That is an indictment of the Government. They have made it harder for people to afford a good basic diet. We have seen a rise in hypothermia, rickets and scurvy. Sadly, we have also seen the rise of food banks under this Government. That is why I am beginning my speech by saying that there is a range of reasons for the sustained pressure on A and E.

[Margot James (Stourbridge) (Con)]

rose—

[Yasmin Qureshi (Bolton South East) (Lab)]

rose—

[Andy Burnham]

I will make a little progress and then I will give way.

There have been record levels of hypothermia this year and thousands of over-75s have been treated in hospital for respiratory or circulatory diseases. That brings me to the second underlying cause of the increase in attendances at A and E. The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.

We all need to face up to the uncomfortable fact that our hospitals are increasingly full of extremely frail elderly people. Too many older people are in hospital who ought not to have ended up there or who are trapped there because they cannot get the right support to go home. That situation is unacceptable and it has to be addressed.

[Margot James]

Does the right hon. Gentleman not accept that the emergence of older people visiting A and E in far greater numbers has been coming on for a long time? I know that he does not like to be reminded of the 2004 GP contract, but surely he agrees that it is a factor, because older people have not been able to get the necessary support over a long period. The Government are putting that right by integrating health and social care far better.

[Andy Burnham]

The hon. Lady wants me to answer that question, but I direct her to her right hon. Friend, the Chairman of the Health Committee, who has dismissed the self-serving spin from the Government that says that these problem are all to do with a contract that was signed 10 years ago. I began my speech by citing figures that show an exponential rise in the number of people attending A and E since 2010. Many of those people are very frail older people. That is the issue before the House, so it does not help the debate for the hon. Lady to stand up and make a spurious political point.

[Yasmin Qureshi]

Is not one of the reasons why more elderly and frail people are going to hospital that there has been a £1.8 billion cut in adult social services and support? Those people are ending up in hospital because they are not receiving the care that they need at home.

[Andy Burnham]

My hon. Friend is absolutely right. I will come on to say that the single most important underlying cause of the A and E crisis is the severe cuts that we have seen to adult social care. That has created a situation in which older people are trapped on the ward and cannot go home because there is not adequate support at home. That means that A and E cannot admit to the ward because the beds are full. Hospitals are operating way beyond safe occupancy levels. Because of that, the whole hospital begins to jam up and the pressure backs up through A and E. When A and E cannot admit to the ward it becomes full, so ambulances queue up outside because they cannot hand people over to A and E.

That is exactly what is happening in our NHS at the moment. A and E is the barometer of the whole health and care system. If there is a problem anywhere in the system, it will be seen eventually as pressure in A and E. That is what is happening. The simplistic spin from the Conservative party, which says that it is all to do with a GP contract from 10 years ago, is discounted by expert after expert.

[Helen Jones (Warrington North) (Lab)]

My right hon. Friend rightly said that back-ups in A and E cause problems elsewhere. May I draw his attention to the fact that over the past 18 months, more than 1,600 people have waited more than 20 minutes in ambulances outside Warrington hospital before they could even get to A and E and the clock starts ticking? North West Ambulance service says that it cannot be accurate about the waiting time for hundreds of incidents. Does that show that waiting times may be even worse than first thought?

[Andy Burnham]

I fear my hon. Friend is absolutely right. I know Warrington hospital well and the pressures that have been on it, and I agree that ambulance response times have increased across the country because so many ambulances have been held in queues outside A and E, unable to hand over patients to A and E staff because it is full. That has left large swathes of the country—particularly in rural areas—without adequate ambulance cover, and very serious incidents have taken place across the country, not least in the Minister’s area of Norfolk where people have not received ambulances on time. That is the consequence of the pressure on A and E not being addressed, and it is threatening to drag down the rest of the NHS.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

My right hon. Friend is making an incredibly powerful speech that goes to the very heart of our NHS and the staff who work in it. North East Ambulance Service is one of the highest performing services in the country and reaches 80% of most seriously ill or injured patients within eight minutes. Last week, however, it had to hold an emergency summit because staff morale is at an all-time low. Assaults on staff are increasing dramatically, and the stress and pressure of waiting outside A and E to admit patients is having a deeply damaging impact on the wider NHS. Does my right hon. Friend agree that that is not what the Prime Minister meant when he said that the NHS was safe in his hands?

[Andy Burnham]

My hon. Friend’s point was also made powerfully by ambulance staff at an A and E summit held by the shadow Front-Bench team in Parliament before Christmas when a paramedic spoke of the phenomenon she has just described. He mentioned an occasion when staff were at the door of A and E waiting to hand over a patient to A and E staff, when the patient had a heart attack. The staff did not know what to do and had to go back to the ambulance to try to stabilise the patient. Those sorts of joining points or disconnects in the system are leading to real pressure on staff who do not know what to do in those difficult circumstances. The system is in danger of being overwhelmed, and the pressure on staff must be addressed urgently.

[The Minister of State, Department of Health (Norman Lamb)]

I share the right hon. Gentleman’s view that delays in handover at A and E are not acceptable, and I remember well that last decade, under the previous Government, ambulances were stacking up outside the A and E at the Norfolk and Norwich hospital. Does he welcome the fact that this winter, delays of longer than 30 minutes are down by more than 30% compared with last year?

[Andy Burnham]

Yes, there has always been pressure on the ambulance service at this time of year, but if the Minister wants me to join in with his complacency, I am afraid I will not. The past 12 months have been the worst in A and E in a decade, and there are reports of ambulances across the country held in queues. Is the Minister satisfied with the performance of the ambulance service in his region of east England? Was he satisfied with the way the case I mentioned was handled? I do not believe he was or that his complacency at the Dispatch Box will be appreciated by his constituents.

[George Freeman (Mid Norfolk) (Con)]

As a Norfolk MP I assure the right hon. Gentleman that we are on the case regarding ambulances, and the Minister is leading the charge. I am interested in the facts. Is not the truth that we are treating 2,000 more patients every day in under four hours in A and E, and that we have 350 more A and E consultants? In Norfolk and Norwich hospital, people tell us that it was under Labour, with the IT issues, integration, GP contracts and working time directive that A and E became chaotic. The right hon. Gentleman’s attack is unfair, ill-judged and overly partisan.

[Andy Burnham]

I acknowledged that there is always pressure in A and E, but the fact is that it performed better in every month when I was Health Secretary than it has under the current Health Secretary. The hon. Gentleman mentions Norfolk again. We have been looking at the Minister’s website, which makes us wonder whether he considers himself a Minister or an observer of events in the NHS. Under the headline “Norman Lamb’s North Norfolk Ambulance Survey” he states:

“I have been campaigning over the last year to improve unacceptable ambulance response times in rural Norfolk.”

My God, this is the Minister! He is campaigning against his own Government.

[Steve Rotheram (Liverpool, Walton) (Lab)]

I wonder whether the Minister will write to the Minister about that problem. The spin from those on the Government Front Bench may kid some of their Back Benchers, and it has certainly kidded some Liberal Democrats who I have been speaking to across the Chamber, but it will not kid patients who go to A and E and see people on trolleys, camp beds or blocked in ambulances.

[Andy Burnham]

My hon. Friend is absolutely right, and I would love the Government to explain that everything is fine and that there is no problem at all to more than 100,000 people who have waited more than four hours on a trolley this year, or almost 1 million people who have waited more than four hours in A and E. The complacency is not justified, and if those people were to read the Government’s motion, I am afraid, quite frankly, they would be astonished.

[Mr Andy Slaughter (Hammersmith) (Lab)]

Perhaps I may help my right hon. Friend by saying that the campaign in North Norfolk began on the Minister’s website after the excellent campaign run by the Labour prospective parliamentary candidate, Denise Burke, who pointed out how deficient local services were—[Interruption.]

[Mr Slaughter]

Will my right hon. Friend join me in condemning the Government for still classing A and Es as such when, like the one at Charing Cross, they are in practice closing and turning into GP-run clinics? The Government are still calling them A and Es, and people are misled. That will lead them to go to the GP-run centres when they should be going to properly staffed A and Es, and we will get tragedies such as the one at Chase Farm.

[Andy Burnham]

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

[Andrew George (St Ives) (LD)]

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

[Andy Burnham]

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

[John Glen (Salisbury) (Con)]

Would the right hon. Gentleman care to reflect on the fact that we now have 350 more A and E consultants in the NHS? Given his commitment to cut the NHS at the last election, if he is going to offer a sensible improvement, where will the money come from? How will he pay for it? That is what the people out there want to understand.

[Andy Burnham]

First, I would be grateful if the hon. Gentleman did not continue to misrepresent what I said on the NHS. I have never said, “Cut the NHS”. I stood at the last election on a commitment to protect the NHS budget in real terms. He stood on a manifesto promising real-terms increases for the NHS. I said that if there were to be increases for the NHS, they should be given to social care instead, and that would have relieved some of the pressures on A and E. Let us have the facts straight.

Secondly, the hon. Gentleman boasts about having enough A and E doctors. Perhaps he should speak to people from the College of Emergency Medicine and hear what they have to say on that subject. They talk of warning the Government of a recruitment crisis in A and E about two or three years ago. They said that they could not get through to Ministers who were obsessed with structural reorganisation. They were left feeling like John the Baptist crying in the wilderness—their words. Perhaps before the hon. Gentleman shouts the odds in the House, he should speak to the people who know about these things and who warned his Government —who failed to act.

One of the major problems with the pressure on A and E is the number of older people trapped in hospital. This is a product of demographic pressure and the ageing society. Nursing staff talk of how, when they first qualified, it was rare to see someone in their 90s on the ward. Now they are there in great numbers and that makes the task of meeting their needs much more complex. When people reach an advanced age it is simply not possible to separate out their physical, social and mental needs. Need becomes a blur of all three. Our hospitals are not geared up to provide the additional mental and social support that very frail elderly people often need.

[Margot James]

Will the right hon. Gentleman give way?

[Andy Burnham]

I have given way to the hon. Lady once: I want to make some progress.

Some, but not all, of the needs of older people are met in an acute hospital environment, which explains why their condition often drops like a stone. It is a phenomenon that was accurately identified by Robert Francis QC in his report, published a year ago this week. He called for an overhaul of the way in which older people are cared for in acute hospitals. He was right to do so, and while I applaud some of the steps the Secretary of State has taken in that regard, such as the move towards a named consultant, I do not believe it will tackle the root cause of the problem, which is the arrival of far too many older people in hospital in the first place. Only when that is tackled will we begin to address the underlying causes of the A and E crisis.

[Mr Jeremy Browne (Taunton Deane) (LD)]

I am grateful to the former Secretary of State for giving way, because I am concerned—especially as we are talking about not distorting the facts—by his initial analysis. He attributed part of the pressure on A and E to an outbreak of scurvy and rickets cases. I do not want anybody in my constituency or elsewhere to be unduly alarmed, so can he please put on the record what proportion of people reporting to A and E, including those who are not seen within four hours, are doing so because they have scurvy? He can give the numbers in absolute figures or percentages, but it is important that the House not be misled and that we are given the unvarnished truth.

[Andy Burnham]

The hon. Gentleman should climb off his high horse for a moment. In answer to an important point made by my hon. Friend the Member for Stretford and Urmston (Kate Green), I pointed to the increase in cases of scurvy, rickets and malnutrition. If he wants—[Interruption.] If he wants to deny that that is the case, that is up to him—[Interruption.] If he speaks to A and E staff, he will hear that people who are not eating properly are turning up in ever greater numbers—[Interruption.] I have answered his point and I will now make some progress.

It is the case that too many older people are arriving at hospital in the first place. A recent Care Quality Commission report found avoidable emergency admissions for pensioners topping 500,000 for the first time—[Interruption.]

[Mr Speaker]

Order. The exchange between the hon. Member for Liverpool, Walton (Steve Rotheram) and the hon. Member for Taunton Deane is most unseemly. I remind the latter that he is a distinguished former member of Her Majesty’s Government and he should comport himself with appropriate dignity. That is what we look for in an hon. Member who aspires to be a statesman.

[Andy Burnham]

I suggest—[Interruption.]

[Mr Speaker]

Order. I am not dismissing the statesmanlike potential of the hon. Member for Taunton Deane, but I think his journey has some way to go.

[Andy Burnham]

The beard is certainly helping. I suggest that the hon. Member for Taunton Deane (Mr Browne) visit Liverpool Walton, because he will see more food banks there than anywhere else in the country. He will meet families who cannot afford to put enough food on the table to give their kids a decent diet. He will see the direct effects of some of his Government’s policies on some of the most deprived communities in the country.

[Steve Rotheram]

If people who turn up to A and E have malnutrition, it plays havoc with their medication. If they are not eating properly, they can be violently ill from their medication. Does my right hon. Friend agree that that is a growing problem?

[Andy Burnham]

I agree, and the last time we had a debate on this issue I quoted a well-known GP who said that she has taken to asking her patients whether they are eating properly, because many are presenting with unexplained symptoms that she cannot identify. People on several prescription medicines who are not eating properly are putting themselves at risk—

[Mr Browne]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way once more, but I hope the hon. Gentleman makes a legitimate and reasonable point.

[Mr Browne]

I am grateful to the right hon. Gentleman for giving way. I do not dispute that there are people who live on a small amount of money or that some of those who go to see doctors are not eating adequately. But he attributed the pressures on A and E in part—he raised the issue, not me—to an increase in the number of people who are reporting to A and E with scurvy and rickets. He made that point with all the authority of a former Secretary of State, so he should tell the House how much of the extra pressure on A and E is attributable to people who have scurvy or rickets. If he does not know, why did he raise the issue in the first place?

--- Later in debate ---

[Andy Burnham]

I began by saying that the reasons for the rise in A and E attendances were complex. I did not say—if the hon. Gentleman was listening—that there were any simplistic reasons. I did say that there had been a rise in malnutrition and diseases linked to it. If hon. Members on the other side of the House want to dispute that fact, I will have that debate any time they wish. They seek to suggest that malnutrition is not a problem, but they are confirming how out of touch they are.

As I was saying, the number of emergency admissions of pensioners has topped 500,000 for the first time. It is rising faster than the increase in the ageing population. There were 65,000 more emergency admissions in the last 12 months compared to the previous 12 months, a clear sign of more frail, elderly people ending up in A and E. Hospitals are operating way beyond safe recommended bed occupancy levels, with increasing numbers of frail, elderly people on the wards. That means that A and E finds it increasingly difficult to admit people, and pressure backs up through A and E.

The Government’s amendment seems to have been written in a parallel universe. Let us get this clear: the last 12 months have been the worst in A and E for a decade. Hospital A and Es have missed the Government’s target in 44 out of the last 52 weeks. How can that equate to A and E performing strongly, as the amendment suggests? It serves only to confirm an impression that has been building about this Secretary of State since he took office: that he seems to spend more time paying attention to spin doctors than he does to real doctors.

[Julie Hilling (Bolton West) (Lab)]

One problem my food bank has reported to me is that people are reducing the number of drugs they are taking because they cannot afford to buy them. There is a queue in A and E departments to register. Not only are people waiting in ambulances outside, but there are queues of people, as happened in a hospital very close to this place, waiting to be registered.

[Andy Burnham]

My hon. Friend is absolutely right. She knows the pressure people are under in our area. What we have heard from the Government is denial that this is the reality in many parts of the country. [Interruption.] We can hear them shouting now, claiming that it is a myth that people are using food banks and not eating properly, and that they cannot afford to heat their homes because of the rise in fuel bills under this Government. All of that is placing extra pressure on A and E, and people are waiting longer and longer to be seen.

[Margot James]

rose—

[Andy Burnham]

I give way to the hon. Lady, but this will be the last time.

[Margot James]

I thank the right hon. Gentleman for giving way; he is being very generous. As he is widening the debate out to the wider economy, does he not accept that, although there are many reasons for increased A and E consultations and some of the issues relating to nutrition are valid, the point made by the hon. Member for Bolton West (Julie Hilling) about people not being able to afford prescriptions must be fallacious? They will receive free prescriptions if they have a very low income and are attending food banks. There are many more reasons than the right hon. Gentleman is giving credit for.

[Andy Burnham]

Not for the first time, Government Members are showing how out of touch they are with what is happening. The hon. Lady says that she is not aware that any family is unable to afford a prescription item. Let me put her straight: that is what many families are facing at the moment, particularly those who are in work, who do not get free prescriptions. They are facing difficult choices about whether they can afford to buy their prescriptions. If she is saying she does not recognise that problem, then I am afraid she really needs to get out of this place a bit more.

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

I did not intend to intervene, but I should say to the House and to the hon. Member for Stourbridge (Margot James) that I met recently representatives from community pharmacy associations and others who said to me, explicitly and clearly, that people from what one would assume to be relatively well-off families—middle class and relatively affluent—who are prescribed multiple prescriptions are now choosing not to pay for them because of the cost of living and the squeeze on their finances. They are choosing to go without, and that is apparent at pharmacy counters.

[Andy Burnham]

My hon. Friend puts his finger on it. There are families who are choosing between eating, heating or other essentials, such as prescriptions. That is the reality for many families and it is having an impact on their health. For those on the Government Benches not to recognise that that is the reality of life for many people, I fear for the state that we are in. They have been shouting at me for the past few minutes about scurvy. I can tell the hon. Member for Taunton Deane (Mr Browne) that the number of admissions has doubled. There are a relatively small number of cases, but they are on the rise. He really should not sit there barracking and dismissing the whole problem. He would do well to look at the facts.

Today, the Secretary of State says that the NHS got better in the past year. He should say that to the 131,000 people left waiting on trolleys for more than four hours. He should say that to the people finding it harder to get a GP appointment under his Government, left ringing the surgery at 9 am to be told that nothing is available. He should tell that to the families of children who have suffered a mental health crisis, but are told that there are no beds available anywhere in the country and end up being held in police cells. The truth is that the Government have failed to get the A and E crisis under control and it is threatening to drag down the rest of the NHS. In the past 12 months trolley waits are up, waiting times are up, emergency admissions are up, cancelled operations are up and delayed discharges are up, too. That is the reality of what is happening in the NHS.

One of the main reasons for the intense pressure on A and E is the collapse of social care in England. In December, a report from the Personal Social Services Research Unit found that, due to local government cuts, social care support in the home has been withdrawn from about 500,000 older and vulnerable people. These are people who were receiving support in the home, but are no longer getting any help. Even for those people still receiving some support, we continue to hear stories of corners being cut: slapdash 15-minute visits where staff have to choose between helping people wash or helping people eat. If we carry on like this, our hospitals will become more and more full of older people. A and E will be overwhelmed by the pressure and that really is no answer to the ageing society. That brings me to the second part of our debate today: the solution.

What is clear to most people is that there will not be a solution to the sustained pressure on A and E without better integration of hospital services with social care, primary care and more collaboration between the two. What is also clear is that there is now great frustration among people working in the NHS that they are being prevented from developing solutions to the A and E crisis by a large barrier standing in their way: the Health and Social Care Act 2012. This Government like to talk about integration, but the fact is that they have legislated for fragmentation. Under this Government, market madness has run riot throughout the NHS and is now holding back solutions to the care that older people need.

[Guy Opperman (Hexham) (Con)]

Will the right hon. Gentleman welcome the exact example that he so urgently seeks: Haltwhistle hospital in Northumberland? It is currently being built and I have been around it. It is integrated, with the local authority on the top floor and the NHS on the bottom floor. That is surely the model and the way forward.

[Andy Burnham]

I agree with the hon. Gentleman. There are examples of good practice out there, but I suggest that he speaks to chief executives of clinical commissioning groups and trusts. They are telling me that the competition regime introduced by his Government is a barrier to that kind of sensible collaboration. The chief executive of a large NHS trust near here says that he tried to create a partnership with GP practices and social care, but was told by his lawyers that he could not because it was anti-competitive. Does the hon. Gentleman support that? Is that what he thought he was legislating for when he voted for the Health and Social Care Act? People are being held back from doing the right thing for fear of breaking this Government’s competition rules.

Recently, we heard of two CCGs in Blackpool that have been referred to Monitor for failing to send enough patients to a private hospital. The CCG says that there is a good reason for that: patients can be treated better in the community, avoiding costly unnecessary hospital visits. That is not good enough for the new NHS, however, so the CCG has had to hire an administrator to collect thousands of documents, tracking every referral from GPs and spending valuable resources that could have been spent on the front line.

[Yasmin Qureshi]

My right hon. Friend might be aware that recently the trust in Bournemouth wanted to merge with neighbouring Poole trust, but the competition rules stopped the merger taking place.

[Andy Burnham]

My hon. Friend is right. For the very first time in the history of the NHS, competition intervenes to block sensible collaboration between two hospitals seeking to improve care and make savings. Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit. That is what has happened. That is not just what I say; listen to what the chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS:

“I think we’ve got a problem, we may need legislative change…What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it”—

that is, the law. That is from the chief executive of NHS England.

[The Secretary of State for Health (Mr Jeremy Hunt)]

That was Labour’s law.

[Andy Burnham]

No, it was your law, your Government’s law, the Health and Social Care Act 2012—the same law against which his own care Minister, the hon. Member for North Norfolk (Norman Lamb), has recently been speaking out. He recently told the King’s Fund:

“I have a problem with the OFT being involved in all of these procurement issues… I think that’s got to change… In my view I think it should be scrapped in the future… That might happen at some future date… we’ve got to look at the barriers and address them and sort them out.”

Is that just his view, or the view of the whole Government? [Interruption.] He voted to let the OFT into the NHS. Why is he now changing his tune?

The former care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), said the same:

“The one area I have my concerns about is the way”—

the 2012 Act—

“opened up the role of the OFT.”

Yes, but did we not tell him that two years ago when he voted for the Act and when his hon. Friend the Member for St Ives (Andrew George), who is sitting next to him, joined us in the Lobby to oppose it? This is exactly what we warned them about. We warned them that it would let the market run riot through the NHS, but they would not listen, and that is why we are where we are today.

It is not just Ministers who are saying it; the comments by the chair of the Care Quality Commission at the weekend show the utter confusion in Government policy on competition in the NHS:

“We need more competition…more entrants into the market from private-sector companies”.

Will the Secretary of State clarify? Is that a statement of official Government policy? Is it his policy to get more private sector companies and more competition into the NHS? Is that what he wants? If that happens, it will mean more enforced competition leading to the fragmentation of care, and it will load extra costs on to the NHS at the worst possible time.

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

My right hon. Friend is making some positive points about the privatisation of the NHS, but does he share my concern that Monitor’s board is packed with executives who have come from private health sector companies?

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[Andy Burnham]

We are seeing this across the NHS. We have also seen contracts going to companies whose shareholders are Tory party donors. The closeness of the links between the Tory party and private health care is worrying.

Since April, when their Act came in, seven out of the 10 contracts let have gone outside the NHS. That is the clearest of all wake-up calls about what is happening to the NHS under this Government: it is being broken up and sold off. Under section 75 of the Act, clinicians have to put services out to tender, regardless of whether they are performing well, and that is the big difference between this Government and the last one. They are enforcing competition and marketisation in the NHS, but nobody voted for it.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Why, when the right hon. Gentleman was Secretary of State, were the previous Government prepared to pay private sector providers 11% more than NHS providers?

[Andy Burnham]

Let me explain the difference to the Minister. When we were in government we used the private sector in a supporting role to help bring down NHS waiting times; he is using the private sector to replace the public NHS. There is a very big difference. He might remember that as Secretary of State I introduced the NHS preferred provider policy. At the time, his party complained—it said it was wrong—but I did it because I believed in the public NHS. I believe in what it stands for, unlike him and his party.

[Dr Poulter]

I remind the right hon. Gentleman that, unlike him, I have worked for the NHS and understand what it is like to work on its front line. Will he confirm that the previous Government introduced private sector provision into the NHS and paid 11% more to private sector providers than to NHS providers? This Government will not allow that.

[Andy Burnham]

The Minister looks pleased with himself, but I am afraid he has got his facts wrong. We did not introduce the private sector into the NHS; it has always worked with the private sector to relieve pressure on waiting lists. As a doctor, he should know that. He might also know that waiting lists and times came right down under the last Government, because the private sector supported the NHS, and I am proud of how we brought waiting lists down, but he is using the private sector to replace the public NHS. He is saying that any qualified provider can provide NHS contracts. I had a policy of designating the NHS as the preferred provider. So let us get the facts straight. There is a major difference between the two positions.

[Mr Marcus Jones (Nuneaton) (Con)]

If the right hon. Gentleman is so anti private sector involvement in the NHS, why did he allow an NHS hospital to be managed by the private sector?

[Andy Burnham]

I think the hon. Gentleman is referring to Hinchingbrooke, the contract for which, he will recall, was signed under his Government. If he comes to the House, he should at least have the decency to get his facts straight. A procurement exercise began under the NHS preferred provider policy that I introduced, but he will find that his Government changed that to any qualified provider, and then appointed Circle health, whose shareholders also happen to be major donors to the Conservative party, to run the hospital.

The Government are spending millions of pounds on competition advice under the regime introduced by the 2012 Act. Since last April, CCGs, have spent £5 million on external competition legal advice. How can that be justifiable at a time when we have a shortage of A and E doctors? Around the world, we see that competition not only costs more, not less, than a planned system such as the NHS, but results in more fragmentation. It will never be an answer to the pressures in A and E. We need an approach where clinicians can collaborate and develop integrated solutions to relieve pressure. How can we possibly achieve integrated care when there are several different providers, each providing a different part of the same patient pathway?

The A and E crisis will be permanent, unless the Government accept its root causes and remove the barriers to its solution. The answer is in the motion before the House. The House can vote to reverse the competition policy introduced by the Government in the 2012 Act and to remove the market madness now holding back the NHS, and it could all be done because it would be consistent with the coalition agreement. The simple fact is that nobody voted for the NHS to be broken up in this way. Who gave this Prime Minister and Government permission to put the NHS up for sale? Nobody. They said there would be no top-down reorganisation. In the fullness of time, “No top-down reorganisation of the NHS” will be to this Prime Minister what, “No rise in tuition fees” is to the Deputy Prime Minister.

The choice on the NHS in 2015 is becoming clear: it can stay on the fast track to fragmentation or it can return to its values of putting integration over fragmentation, collaboration over competition, and people before profits. That is what the Opposition believe in. Let us have that debate so that we can save our NHS for future generations.

[Paul Uppal (Wolverhampton South West) (Con)]

On a point of order, Madam Deputy Speaker. In response to yesterday’s sensitive statement on Sri Harmandir Sahib, the shadow Foreign Secretary, the right hon. Member for Paisley and Renfrewshire South (Mr Alexander), made a point about documents pertaining to Lady Thatcher not being released. In fact, they were released back in January. I would appreciate your guidance, Madam Deputy Speaker, as this is a very sensitive matter, and I would hate to see it politicised.

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[Mr Hunt]

That is exactly what is happening in so much of the country. Despite a lot of pressure, our A and E departments are holding up extremely well. I wonder how the staff in that hospital would feel about the constant running down of the NHS that we get from the Opposition.

Let us look at the figures that the right hon. Member for Leigh quoted in more detail. How does he get the number he quoted for the worst winter for a decade?

[Andy Burnham]

Let us have a proper debate. I did not say the worst winter for a decade; I said the worst year in A and E for a decade. Let us get it straight. The Secretary of State should not redefine the question at the beginning of his speech. I am talking about the last 12 months, from this day today back to February 2013. Let us get that absolutely clear and let him answer for the last year, during which he has missed the A and E target 44 times out of 52.

[Mr Hunt]

Let us be absolutely clear. Why has Labour decided to remove the word “crisis” from the motion it submitted to the House this afternoon? It does not mention the word “crisis” at all, because the winter crisis that the right hon. Gentleman has been predicting for over six months now has simply not materialised.

Let us look—this is important—at how the right hon. Gentleman has been manipulating the statistics. He knows perfectly well that there is no A and E target for single categories of A and E; rather, the target applies to all A and Es. He gets his numbers by singling out the biggest A and E departments, type 1s, which are extremely important. How did type 1s—the most important and biggest A and Es—perform during the winter when he was Health Secretary? Let me tell the House: they missed their target every single week up until this point in the year. There are indeed pressures on A and E departments, but why does he think the country will listen to him, when by his own yardstick he failed to deliver every single week up until this point in the year?

The right hon. Gentleman has been predicting a winter crisis for months, and we are still waiting. For him, these debates are not about the reality on the ground; they are about hyperbole and spin. As someone who has been Health Secretary, he must know—this is a serious point—the effect that lurid headlines based on dubious statistics have on morale for staff and those using the NHS, but still we get the same cracked record, because for him, politics always matters more than patients.

It is not just A and E performance; under this Government—[Interruption.] It might not be comfortable for the Opposition, but let us look at the figures. Under this Government, MRSA rates have virtually halved, mixed-sex wards have nearly been eliminated and when it comes to elective care, more than 35,000 fewer people are waiting more than 18 weeks. That is thanks to the efforts of hard-working front-line staff. Our NHS is doing 800,000 more operations year in, year out than it did under Labour—something we can be immensely proud of.

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[Mr Hunt]

I will give way in a minute, but this is an Opposition day debate, so I want to return to the central motion. Let me remind the right hon. Member for Leigh that he told this House—in fact, he had an Opposition day debate to do it—that the NHS budget had been cut in real terms. It had not: it rose. He also claimed that the number of nurses was being cut, when actually it went up. His attempts to talk up a winter crisis have been disproved time and again. That is important, because we have not had a proper apology to this House in relation to the letter he received from the chief executive of the south-western ambulance trust complaining about his spinning, which stated:

“information provided to your office in response to a Freedom of Information request…has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain.”

The right hon. Gentleman should not be playing politics with the pressures in A and E; he should be getting behind front-line staff, who are working extremely hard and who find that kind of tactic extremely demoralising.

[Andy Burnham]

For the record, I am afraid that the letter the Secretary of State quotes had its facts wrong. The information provided by the south-western ambulance service that I quoted was accurate. I wrote to the service the day it wrote to me to put it straight, and I am afraid it has not come back since and said that I was wrong; so again, let us get the facts straight. We have had enough spin from the Secretary of State; he needs to start dealing in a bit of fact.

[Mr Hunt]

I will tell the right hon. Gentleman exactly what the facts are. The other word I heard him use several times in his speech was “complacency”. I will tell him what complacency is: it is complaining about an English NHS that is hitting its A and E targets and completely ignoring Labour-controlled Wales, where the NHS has been missing its A and E targets since 2009. Something else that is complacent is this idea Labour has that, almost a year after the Francis report, the lessons of Mid Staffs stop at the border of England and Wales—that Wales has nothing to learn and does not need to do a Keogh report into excess mortality rates, which the Welsh Labour Government have consistently refused to do. People in Welsh hospitals are suffering because the Welsh NHS has refused to bite the bullet on excess mortality rates.

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[Mr Hunt]

Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.

If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.

Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.

[Andy Burnham]

If everything is exactly the same, why did the Government legislate? Why did they need a 300-page Bill if they were doing everything that the previous Government had done? Let the Secretary of State answer this question directly. There was a huge debate in the House about section 75 of the Health and Social Care Act, and his Minister had to withdraw the regulations and rewrite them, but the view of the entire NHS is that section 75 requires services to be put out to open tender, and does not leave discretion with GPs. GPs cannot decide, as the Secretary of State has claimed. Services are being forced out to open tender. Is that the correct position, or is it not?

[Mr Hunt]

Let me make the position absolutely clear.

[Andy Burnham]

Answer!

[Mr Hunt]

I am about to answer, if the right hon. Gentleman will be a little bit patient. The Act does not change the procurement requirements under which PCTs operated. It does not change the locus of the Competition Commission or the OFT under the Enterprise Act.

While we are correcting some facts, the right hon. Gentleman may be interested to know—as would my hon. Friend the Member for Taunton Deane (Mr Browne), but he is no longer in the Chamber—that we have the figures for the number of people admitted to the NHS with scurvy in 2011-12 and in 2012-13. In 2011-12, the number of admissions not just to A and E departments but in total—[Interruption.] Yes, including A and E departments. In 2011-12, eight people were admitted—[Interruption.] This was the right hon. Gentleman’s big argument about why A and E departments are under so much pressure. In 2012-13, 18 people were admitted. With the greatest respect, I think that the right hon. Gentleman is building his house on sand.

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[Paul Burstow]

The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.

[Andy Burnham]

The right hon. Gentleman seems to be arguing that the Health and Social Care Act 2012 is perfect—[Interruption.] It was his Act; he was a Minister. I quoted him in my speech as saying that it now needs to be amended. Will he be straight with the House this afternoon: does it need to be amended to remove the role of the OFT?

[Paul Burstow]

The right hon. Gentleman must be reading my notes as that was my very next point. One thing about our politics is that it is very difficult for people to admit their mistakes, so let me do just that today. I regret that we included in the 2012 Act a provision for the OFT to deal with the specific issue of mergers. At the time, the argument was that the OFT had the expertise, but it clearly did not. Monitor should have that role. I want to address that issue either through agreement—the Secretary of State has suggested how that might happen—or by amending the legislation. That is my view based on how things have developed over time, and one cannot be more straightforward than that.

[Andy Burnham]

Fair enough.

[Paul Burstow]

I thank the right hon. Gentleman.

The right hon. Gentleman spoke about Hinchingbrooke hospital and the franchising arrangement. The process started and was two thirds of the way through by the time the previous Government left office. There were only private sector providers in the competition when the previous Government left office—

[Andy Burnham]

indicated dissent.

[Paul Burstow]

I hope the right hon. Gentleman has had the opportunity to go and see what is happening at Hinchingbrooke, because it is doing fantastically well. It is being led by clinicians and is making a huge difference as a result. We should take heart from that.

Let me end by drawing out one point about A and E pressures. The situation is complex and driven by a multifactoral set of problems. There are seasonal changes, with high-volume, less complex A and E attendance in the spring and summer, and a pattern of fewer but more complex cases in the autumn and winter that often drive up admissions. It is also important to note that it is a question not just of an ageing society but of a rise in co-morbidity, which drives the pressures in our A and E departments. There are also changes in behaviour as people regard A and E as the first point of access for any ailment, driven by the fact that nine out of 10 GPs opted out.

In conclusion, the motion is flawed and does not celebrate the successes of this Government, not least in driving integration in a way that the previous Administration failed to do. For that reason and many others besides, it should not be supported and the Government amendment should be supported instead.

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

It is a great pleasure to follow the hon. Member for Suffolk Coastal (Dr Coffey) and to speak in this debate.

I have spoken several times about the experience in my area, where in recent months we have been undergoing a major reconfiguration of hospital services, particularly accident and emergency. I have to report that, whatever the metrics or the resourcing may be demonstrating, the patient experience as reported to me, particularly regarding our A and E departments at Manchester Royal infirmary and at Wythenshawe hospital, is that there is a great deal of pressure and strain in the system. People are reporting long waits in very pressured environments, and there is a genuine sense of unhappiness about the atmosphere in which they feel emergency care is being provided because of the stretched services. A whole range of pressures are coinciding. There is rising demand due to some of the social reasons that right hon. and hon. Members have mentioned, including individuals’ behaviour; public health crises; pressures on resourcing in the NHS; and the pressures brought about by reconfiguration itself. It is hard to disentangle which of those different pressures is contributing to so much stress in the system.

I would like to highlight a few key points that I hope the Minister will take on board. There is no doubt that more change is coming in the NHS and we are learning quite a lot in my area as we go along. First, the reconfiguration of accident and emergency services and their downgrading to an urgent care centre at Trafford general hospital has immediately been followed by rising numbers at neighbouring A and E departments. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) mentioned the huge rise, in percentage terms, at Salford Royal hospital. That is also the case at Wythenshawe, in particular, as we are discovering on the doorsteps in Wythenshawe and Sale East. My colleague Mike Kane, who I hope will very soon be an hon. Friend in this House, has been talking to hundreds of local people, and we know that Wythenshawe hospital is experiencing very great pressure.

On 10 out of 13 days in January, Manchester Royal infirmary’s A and E department failed to meet the four-hour waiting time target, as did Wythenshawe on 11 out of 13 days, and four Manchester trusts failed to meet the target in quarter 3. It is difficult to disentangle whether that is attributable wholly or in part to the reconfiguration of services. None the less, there are real pressures in our A and E departments in Greater Manchester. Particularly in the immediate aftermath of the reconfiguration at Trafford, there have been reports of long ambulance queues, especially at Wythenshawe. That is not surprising, because the reconfiguration has inevitably created significant numbers of additional ambulance journeys as people are presenting at what is now an urgent care centre but may have to be transferred elsewhere for specialist care. I understand that there have been 100 extra ambulance journeys in the immediate aftermath of the reconfiguration. People are also going to what are, in effect, their own places. I think that is understandable, because, as the hon. Member for Stafford (Jeremy Lefroy)—who is no longer in his place—has said, the picture is confusing.

Local road signs used to say, “A&E”, but now they say, “A&E not 24 hours”, following the reconfiguration at Trafford. To be frank, that is an utterly meaningless piece of information for somebody driving to an A and E department, because it gives them no idea of when during those 24 hours the service will not be open. There is also real confusion about what is or is not available at the urgent care centre and whether it is safe to go there.

Local people tell me that the reason they do not go to Trafford is that they do not believe they are any longer allowed to go there. That was not the clinicians’ planning assumption when the urgent care centre was introduced, but that is what patients believe. As the hon. Member for Stafford said—Sir Bruce Keogh has put his finger on this, too—it is really important that patients are given clarity about what is available, where to go and when. We have to pay much more attention to educating the public about that.

Another difficulty that we discovered very quickly is that the decision tree used by North West ambulance service has resulted in its taking cases to Wythenshawe and to Salford Royal and Manchester Royal infirmary which should, under the original plan, have gone to Trafford urgent care centre. We are learning a lot from what is going on in the aftermath of the reconfiguration. It would be interesting to hear from the Minister how the lessons will be taken on board and distributed.

Pressure is also being created in a wider context. My right hon. Friend the Member for Leigh (Andy Burnham) mentioned in particular the pressure of rising poverty, which is, without question, leading to higher levels of need and people presenting at our hospitals. The number of hospital admittances as a result of malnutrition nearly doubled—it went up from 3,161 to 5,499—between 2008-09 and 2011-12. They did not all present at A and E, but they did all present at a hospital and that is of real concern.

[Andy Burnham]

Was as my hon. Friend as surprised as I was at some of the sneering from Government Members when she intervened on me to point out that the number of malnutrition cases has gone up significantly? All we got from them was sneering abuse, but the facts speak for themselves.

[Kate Green]

When the Manchester Evening News published a report about the shocking rise in malnutrition in our region, people were horrified and commented voluntarily on how disgraceful and shameful it was that, in such a rich economy, we could be in such a situation. There is no doubt that that is partly because of pressure on family incomes.

I want to highlight the position of disabled people in particular, who face extra costs for special diets, aids and adaptations, prescription charges and continence pads. All of those costs have to be met by disability benefits that are of dwindling value. There is also further pressure on the services on which they rely, including day services, respite care, access to mobility aids and care at home, which is under great pressure because of social care budget cuts.

In conclusion, against a backdrop of great pressure—some of it to do with changes to the NHS, some with rising remand and some with wider environmental factors—change and further reconfiguration may be necessary, but it is very difficult to do it. I want to finish by making three points to the Minister about what we are learning from the situation in Trafford, where we are integrating health and social care. First, it is not a quick fix. Secondly, it is not possible to remove services from our hospitals before the care and provision is available in the community—that is of real concern at a time when budgets are pressed. Thirdly, there is a huge piece of work to be done—the Government have not embarked on it—on educating the public and driving up public understanding. The public in my local area are extremely confused about what the NHS is able to provide to them and where they should go to get it. I am sure we are not unique. The situation is undoubtedly creating additional pressure for hospitals and other NHS providers, and I hope the Minister and his colleagues will address it.

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[The Minister of State, Department of Health (Norman Lamb)]

This afternoon, we have been presented with more of the same from the Labour party—the same scaremongering, the same misinformation, the same unwillingness to offer solutions. In short, it is the same old Labour party.

Earlier this week, we heard from the right hon. Member for Leigh (Andy Burnham) that the N was being wrenched off the NHS and that it was being sold to any company, but in reality only 6% of expenditure in the NHS goes to private providers. He talks about “market madness running riot through the NHS”, but listen to the facts: between 2006 and 2010, under Labour, total spending on the independent and private sector more than doubled; and between 2007-08 and 2010-11, under Labour, the number of operations conducted by the independent sector tripled. Since then, the figure has been around 46%.

Labour is desperately trying to make the public believe that its skewed vision is the reality of the NHS, but this view is of course total nonsense, and I am happy to try to set the record straight.

[Andy Burnham]

I think the Minister was in the Chamber when his predecessor as care Minister held his hands up and admitted he got it wrong on competition when the Health and Social Care Bill went through the House. He has given hints to newspapers that he feels the same way. Would he care to step into the confessional and admit that the Liberal Democrats got it wrong on competition in the NHS?

[Norman Lamb]

I certainly think we have to avoid any repeat of what happened in Bournemouth. It is absolutely right for politicians to make that clear.

The Labour party has tried to paint a picture of crisis in A and E. We know that there is more pressure on this vital service.