Health and Social Care

Andy Burnham Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. The big change we need to see in the NHS over this Parliament is a move from a focus on cure to a focus on prevention. In this Parliament, we will probably see the biggest single public health challenge change from smoking to obesity. It is still a national scandal that one in five 11-year-olds are clinically obese, and I think we need to do something significant to tackle that in this Parliament.

[Andy Burnham (Leigh) (Lab)]

There is a big difference between the Secretary of State’s view of the health service and mine—he believes in a market; I do not. It is as simple as that. But I want to correct him on something. He just said that privatisation was not happening, but I will not let him stand at that Dispatch Box and claim that black is white any more. Figures show that as many contracts are going to private sector organisations as to NHS organisations. Will he confirm that that is the case and stop giving wrong information to the people of this country?

[Mr Hunt]

I gently say to the right hon. Gentleman that I believe in exactly the same use of the independent sector in the NHS as he did when he was Health Secretary; there is no difference at all. What has happened is that for whatever reason—I dare not think what—since he became shadow Health Secretary, he has changed his tune. The facts on privatisation are that it increased from 4.9% at the start of the last Parliament to 6.2% towards the end of the Parliament. That is hardly a massive change. Our approach is to be neutral about who provides services but to do the right thing for patients.

--- Later in debate ---

[Mr Hunt]

As I said earlier, I do not think these decisions should be made by politicians; I think they should be made by GPs on the ground, on the basis of what is best for the hon. Gentleman’s constituents. That is a dividing line between me and the shadow Health Secretary, if not the shadow Health Minister, because I think there is a role for the independent sector when it can provide better or more cost-effective services to patients. It appears that the Labour party, under the leadership of the right hon. Member for Leigh, would rule that out in all circumstances.

[Andy Burnham]

The right hon. Gentleman said right there that there is a role for the independent sector and that he is neutral about it but wants to see it increase. Then he says that privatisation is not happening. Is he trying to take everybody for mugs? He needs to come to this Dispatch Box and be quite clear about what is happening. Section 75 of his Health and Social Care Act 2012 does not give discretion to doctors; it forces NHS services out on to the open market. That is why we are seeing privatisation proceeding at a pace and scale never seen before in the NHS.

[Mr Hunt]

I am afraid that this is exactly the sort of distortion and scaremongering that got the right hon. Gentleman nowhere in the election campaign. He knows perfectly well that the 2012 Act does nothing different from what the EU procurement rules required under the primary care trusts when he was Health Secretary. Yes, I do believe that there is a role for the independent sector in the NHS, but I think the decision whether things should be done by the traditional NHS or the independent sector should be decided locally by GPs doing the right thing for their patients. That is the difference between us.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

During Health questions, I congratulated the Secretary of State on his reappointment, and I do so again now, but I hope he will not be too offended if I point out gently that it was not universally welcomed in the NHS. In fact, as far as reappointments go, his makes the recent one at FIFA look positively popular. We wish him well, of course, but he has a lot of work to do to regain the trust of staff throughout the NHS, and he should not underestimate the scale of the task.

I welcome all the new Health Ministers, but I particularly welcome the new Minister for Community and Social Care, the right hon. Member for North East Bedfordshire (Alistair Burt). He did outstanding work during the last Parliament in seeking justice for the victims of contaminated blood, alongside other Members in all parts of the House. I am sure that the victims and their families will see his appointment as a hugely encouraging sign. Let me also say to him that if he wishes to continue to pursue that issue with the same zeal during the current Parliament, he will have my full support.

Our thoughts are with our Liberal Democrat colleagues today, and I want to pay tribute to the right hon. Member for North Norfolk (Norman Lamb), although he has now left the Chamber. He had an obvious commitment to mental health, even if his words were not always matched by Government action. That said, one of the great achievements of the last Parliament was the profound change that we all witnessed in the public and parliamentary debate about mental health. For the first time, Members of the House spoke openly and honestly about their own mental health problems.

[Jo Cox (Batley and Spen) (Lab)]

It was my honour last week to visit Priestley mental health unit at Dewsbury and District hospital. It does amazing work for local people. The welfare changes implemented over the past five years have put an incredible strain on vulnerable people who need mental health care, and, according to the projection for the next five years, the number of people in that terrible situation will increase and our mental health care services will have to meet an increased demand. Does my right hon. Friend share my concern about that?

[Andy Burnham]

As my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) pointed out a moment ago, NHS services are often not there for young people in particular when they need them, but we must also ask ourselves why people end up in that position in the first place. We have seen, in some of the public policy decisions that have been made in recent times, a failure to understand how changes can affect people’s mental health. The work capability assessment, for instance, did not pay sufficient regard to mental health, and that needs to change if we are to give people proper support in this Parliament.

Let me, at the start of the new Parliament, urge all new and all re-elected Members to bear in mind the momentum on mental health that was built in the last Parliament, and to do everything they can to build on it. Given the nature of modern living and the stress and insecurity that we all have to absorb, mental health will remain the issue of our times, and we shall need public policy to match. The last Parliament made huge progress in raising mental health issues, but this Parliament needs to translate those words into action.

Progress was also made on patient safety, and the Secretary of State deserves credit for that, but, again, it is important for the momentum not to be lost in this Parliament. In that context, there appears to be a significant omission from the Gracious Speech. Improving the regulation of health professionals was a central recommendation that emerged from the Francis report, and a Bill to modernise professional regulation has long been anticipated. It would have had cross-party support, and would have enabled the regulators to get on with the job of protecting and safeguarding the public from poor care. The failure to introduce such a Bill means that there is now no prospect of reducing the time it takes to deal with complaints, which, at present, is typically 15 months from start to finish. Jackie Smith, chief executive of the Nursing and Midwifery Council, has said that she is “deeply disappointed” by the omission, and that it is a “major setback” to the response to the Francis report. Can the Secretary of State explain why no such Bill was mentioned in the Queen’s Speech, and tell us when it can be expected? We need a professional regulatory regime that is modern, up to date and fit for purpose.

The issue on which I now intend to focus is finance. For the last five years, we have been treated to repeated lectures from Ministers about the importance of sound management of the public finances. That is the signature of this Government, or so they like to claim. Today I want to put that claim to the test in respect of the NHS, and to look in detail at the Government’s stewardship of NHS finances.

The Government like to talk about the deficit, but they do not often mention the very large deficit they have created at the heart of the NHS. We will put that right today, and consider the promises they made in the run-up to the election: local promises to reopen A&E departments, and national promises to deliver GP opening hours of 8 am to 8 pm and seven-day NHS working. We will ask how all that can be delivered, given that the NHS finances are deteriorating fast.

[David Tredinnick]

I am listening with interest to the right hon. Gentleman, but surely he has forgotten about the private finance initiative, which was his initiative and which got us into all sorts of trouble financially.

[Andy Burnham]

The Conservatives are fond of saying that we did not fix the roof when the sun was shining, but I can tell the hon. Gentleman that we did fix the leaking roofs of hospitals and GP surgeries that they left behind, and we had to invest a significant amount to do so. When we came to office in 1997, more than half the NHS estate predated the NHS itself, and people remember those days. We had to put that right: we had to rebuild substantial portions of the NHS simultaneously by means of the PFI, which, I might add, was inherited from the Major Government.

[Mr Stewart Jackson (Peterborough) (Con)]

The right hon. Gentleman has clearly forgotten the patient records IT project—at £12 billion, it is officially the most disastrous white elephant IT project in British political and Government history—and the £250 million spent on independent sector treatment centres and on higher tariffs to private providers for operations not done, and the £63 billion on the private finance initiative. That is the record of the Government of which he was a part. Has he forgotten that voters made their decision on that record on 7 May?

[Andy Burnham]

I will tell the hon. Gentleman what I remember: I remember NHS waiting lists in 2010 being at their lowest ever level; I remember public satisfaction with the NHS being at its highest ever level; and I also remember leaving behind a financially solvent national health service. Let us look at it today: NHS waiting lists at a six-year high; cancer patients waiting longer for their treatment to start; A&E in crisis; and, as I said, a £1 billion deficit, and rising, at the heart of the NHS. That is the Secretary of State’s record, and a little more humility might not go amiss.

[Ms Karen Buck (Westminster North) (Lab)]

Is it not true that the NHS’s greatest resource, and indeed greatest cost, is its staff? Imperial College Healthcare NHS Trust overspent on staff by £24 million last year, and at the end of the financial year 12% of all its spending was going on agency and “bank” staff. While it is completely right to clamp down on the ludicrous overspend on agency staffing, does this not reflect the reality of cuts in training and of an attitude to staff pay by the Government? Does my right hon. Friend agree that we will not deal with agency staff without having a better deal for the recruitment and retention of permanent staff in the NHS?

[Andy Burnham]

My hon. Friend anticipates me, because this is precisely the issue I am coming on to. Under the Lansley reorganisation, workforce planning went out of the window, and that led to today’s huge workforce crisis and hospitals being in the grip of private staffing agencies. That is the single biggest driver of the NHS deficit that I mentioned a moment ago, and I will talk about that shortly.

The Secretary of State gave us a pious warning about temperate language, yet this is the Secretary of State who today on the front page of The Daily Telegraph is saying that the NHS has enough cash and now must deliver:

“the time for debating whether or not”

it has enough money is over, it

“now needs to deliver its side of the bargain”.

Not for the first time, that is a statement by the Secretary of State that will have caused jaws to drop across the NHS. People will not forget the time he accused hospitals of coasting when they were in the middle of an A&E crisis, but even by his standards this was a staggering piece of spin.

The simple fact is that the NHS does not have enough money. In fact it is seriously short of money. It is facing a £1 billion deficit this year, with two thirds of hospitals in the red, which marks a major deterioration from what the Conservatives inherited in 2010, when there was a surplus of over £500 million.

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

Are not some rather stupid decisions about to be made? Wythenshawe hospital has a £3 million deficit and is talking about cutting 28 district nursing posts. The Secretary of State said earlier that community resources are important. Of course they are, but if we are going to cut district nurses every time there is a trust deficit like the one at Wythenshawe, we are not going to get through another winter without a much more serious A&E crisis.

[Andy Burnham]

That is exactly the point. When we are in a crisis like this, short-term, knee-jerk cuts are made, which make the situation wrong in the long term.

When I raised these deficits in the election campaign, the Secretary of State said I was scaremongering, but just two weeks after the election the truth emerged. [Interruption.] He says I was, but we now know the truth. There was an £822 million deficit in the NHS last year, a sevenfold increase on the previous year. [Interruption.] The Secretary of State says he is dealing with it. That is not good enough. That is appalling mismanagement of the NHS. Financial grip in the NHS has been surrendered on this Secretary of State’s watch, and things are looking even worse this year. Far from scaremongering, these issues are real and should have been debated at the last election. The NHS is now facing a £2 billion deficit this year. As my hon. Friend the Member for Warrington North (Helen Jones) said earlier, that will mean cuts to beds, to staff and to services.

[Mr Jeremy Hunt]

The right hon. Gentleman talks about appalling mismanagement. Why did we have that growth in deficits? We had it because those hospitals were, in the wake of the Francis report and the appalling tragedy at Mid Staffs, desperately trying to make sure they did not have a crisis of short-staffed wards. If there was any appalling mismanagement, it was when the right hon. Gentleman was Health Secretary; he left behind an NHS where there were too many wards and too many hospitals that did not have enough staff. We are doing something about that. That is not mismanagement; that is doing the right thing for patients.

[Andy Burnham]

I am grateful that the Secretary of State has intervened because yet again he has got his facts wrong. Am I not correct in saying that in the first two years of the last Parliament the Government cut staffing further from the levels I left by 6,000? [Interruption.] No, he and his predecessor cut nurse places by 6,000 in the first two years of the last Parliament. Separately, they cut nurse training places, leading to a shortfall in nurse recruitment of around 8,000 in the last Parliament. When the Francis report was published, the NHS had fewer staff than it had in 2010 and fewer nurses coming through training.

The Secretary of State likes to blame everybody else, but how about taking a bit of blame himself for once? He left the NHS in the grip of private staffing agencies, and since the Francis report a small fortune has had to be spent on private staffing agencies. The figures have gone through the roof on his watch and he has failed to do anything about it. That is why people will not believe that the NHS is safe in his hands.

[Paul Farrelly]

Would my right hon. Friend care to remind the Secretary of State of a privatisation that has increased the NHS deficit and not improved efficiency? After the proposed transfer of a scanning contract from the Royal Stoke university hospital there was rightly a public outcry. The scanner remains there, but none the less the private company, Alliance Medical, is staying in there, taking its cut and the cost to the taxpayer has increased.

[Andy Burnham]

I remember visiting with my hon. Friend. Let us put the facts on the record. The Secretary of State said a moment ago that privatisation was not happening, but it is happening. It is affecting my hon. Friend’s constituents, where cancer scanning has now been privatised. What happened? The contract was, I believe, given to Alliance at £87 million, whereas the NHS had bid £80 million. It was given to the private sector, however, which has now subcontracted the NHS at the same price of £80 million, creaming off £7 million. That is a scandalous waste of NHS resources when the NHS is facing a £2 billion deficit this year.

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

Does my right hon. Friend think it is a matter of concern that a significant report by Lord Stuart Rose, a Conservative peer, was suppressed by the Secretary of State? It would have given an indication of failings in NHS management and allowed us to correct some of the problems identified.

[Andy Burnham]

My hon. Friend raises an important point. Again, the Secretary of State is quick to lecture about openness and transparency, but a report compiled at huge cost to the public purse by Lord Rose, former chief executive of Marks & Spencer, was not published in the last Parliament even though it was submitted to the Department months before. What possible justification can there be for that? The Secretary of State is avoiding my gaze right now. I would be very interested to hear his answer on why that report was not published, and if he wants to take to his feet now—[Interruption.] He says from a sedentary position that it was not finished. Well, if you believe that, Mr Speaker, you will believe anything. Even though Lord Rose says it was finished, the Secretary of State sent Lord Rose’s homework back and said it was not good enough. People will draw their own conclusions from what we have just heard.

We have seen a staggering deterioration in the NHS finances on the Secretary of State’s watch and a loss of financial grip across the whole system. If we are to see the finances brought under control, it means we will see more of the cuts mentioned a few moments ago.

The warning lurking behind the front page of The Daily Telegraph will not be lost on NHS staff today. The Secretary of State knows the NHS is facing very difficult times and this is an early attempt to shift the blame on to NHS staff. Basically, he is saying, “If things go wrong it’s not my fault, it’s yours because I gave you enough money.” It is the classic style of this Government and this Secretary of State in particular: “Get your blame in on somebody else first.”

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

I have been listening with a great deal of interest to the right hon. Gentleman, but I have to tell him that the country rejected Labour’s plan for the NHS. Will he now pledge to support the NHS’s own five-year plan, so that we can make some progress in the debate instead of hurling abuse across the Dispatch Box?

[Andy Burnham]

I must point out to the hon. Lady that Labour had a 20-point lead on the NHS going into the general election, which suggests that the public believed what we were saying about the NHS rather than what the Conservatives were saying. We do support the five-year forward view, and I have said as much, but it needs money now. If that plan is to be made real, it needs investment now. The NHS will not be able to deliver it while it has a £2 billion deficit this year; instead, it will go backwards. It will be unable to make the progress it needs to make.

Let us look at why the grip has been lost. This all goes back to the disastrous decision during the last Parliament to ignore the pleas of patients and staff and to force through the biggest-ever reorganisation in the history of the NHS, which nobody wanted and nobody voted for. Back then, a financially solvent NHS was turned upside down and, just when the service should have been focusing on making savings, it was instead firing and rehiring staff, abolishing and recreating organisations and making front-line nursing staff redundant. That destabilised the NHS, and it has never recovered since.

[Helen Whately (Faversham and Mid Kent) (Con)]

I welcome the right hon. Gentleman’s support for the five-year forward view, but how can he make all these criticisms of the NHS and give that support in the light of Labour’s not supporting our election commitment to give the NHS the £8 billion of funding it needs?

[Andy Burnham]

I shall come to the £8 billion, which was the centrepiece of what the Conservatives were proposing during the election campaign. The simple question was: where is it coming from? They never answered that question. The other question they need to answer is: what are they going to do for the NHS now? The £8 billion was promised for five years’ time, but, as I have been saying, the NHS is facing a crisis this year and next year. An IOU for five years’ time is not much use to the NHS when it faces laying off staff and closing services.

[Heidi Allen (South Cambridgeshire) (Con)]

Forgive me; I am new here and very confused. This seems very simple to me. At the election, I promised every person who voted for me in South Cambridgeshire that I would not join in with this negative campaigning, and as Andrew Lansley’s successor I feel that now is the time I should stand up. Is it not time to put the past behind us? The NHS has a fabulous leader in Simon Stevens. That man is standing up for the NHS and saying, “Let’s do this together.” Okay, let us have a debate about where the £8 billion is coming from—that is a financial debate and I am happy to have it—but let us believe in the man who is standing up and saying we can do this together. Let us work as a team and let us listen to the man with the plan. It is him we should be talking about.

[Andy Burnham]

The hon. Lady makes a very good point, and I hope she does a lot more for the NHS than her predecessor did. He caused a huge amount of damage. She is right to say that the NHS is looking for the consensus she describes. NHS staff would hugely value more consensus on the five-year forward view.

The problem, as I have said to the Secretary of State before, lies in the privatisation. The Health and Social Care Act 2012, which the hon. Lady’s predecessor took through Parliament, is forcing NHS services out on to the market. As I have said, 40% of those services are now going to private sector organisations, with 40% going to the NHS. The Secretary of State claims that privatisation is not happening, but I am afraid that that is just not correct in any way. If there is to be consensus, the Government should repeal that Act. They never had a democratic mandate from the people of this country. They never gave their permission for the NHS to be put up for sale in this way. If the hon. Lady’s party were to repeal section 75 of the Act, she could help to create the basis for consensus on the NHS.

[Jake Berry (Rossendale and Darwen) (Con)]

The day after the general election, I was approached by someone outside my constituency office. He congratulated me on winning, but said that he was terrified. He had been told by the local Labour party that if the Conservatives won the election, he would personally have to find £80,000 to pay for his son’s operation because the NHS would be privatised. Will it ever be possible to build consensus when one political party in this House is seeking to weaponise the NHS?

[Andy Burnham]

I do not know which election the hon. Gentleman was fighting, but I went round the country and heard stories from patients who were having their treatment rationed. Older people were not being given cataract operations, for example, and were having to consider going private. Varicose vein operations were being rationed. If he never heard those stories, he could not have been listening to his constituents on the doorstep.

The NHS is in the grip of private staffing agencies because of the cuts to front-line posts and to nurse training, and because of low morale. This is the Secretary of State who denied NHS staff a 1% pay increase after years of pay freezes. What a kick in the teeth for staff who are working flat out to try to keep the NHS going! Good will in the NHS is at an all-time low, and it is no wonder that so many disillusioned staff are going to work for agencies to supplement their income. The Secretary of State has woken up to the problem today, and he has promised to take tough action on the agency bill, but will not put a cap on the agency spend in financially troubled trusts that results in those trusts being understaffed, because he will not permit them to recruit the staff they need? He needs to clarify that point. Will he also consider the rates paid on internal banks, and correct the ridiculous situation in which staff have a greater incentive to work for external agencies than for their own employer?

Why has there been no mention of staff training? Surely increasing the number of nurses coming through training is the only proper long-term answer to cutting agency spend. If the Secretary of State wants a fresh start, why does he not make an immediate pledge to increase nurse training commissions this year, as I would have done if Labour had won the election? Will he do that? If not, why not? Until he corrects this situation, the NHS will continue to be saddled with long-term agency costs. The truth is that the chickens are coming home to roost. The Secretary of State has left the NHS in the grip of private staffing agencies, and the measures he has announced today will not help.

The Secretary of State has also tried to paper over the cracks with a headline promise of £8 billion. There are three problems with that. As I said to the hon. Member for Faversham and Mid Kent (Helen Whately), it represents an IOU for five years’ time, but it will not deliver real money now, which is what the NHS needs. Secondly, the £8 billion makes sense only if the NHS manages to make £22 billion of efficiency savings by 2020. That is the five-year plan, as I am sure Members agree. To date, the Secretary of State has not provided any real details of where that £22 billion of savings is going to come from. Many of the people I speak to in the service say that the NHS has already had five years of hard efficiency savings, and that savings on that scale cannot be achieved without causing real harm to services. Does the £22 billion involve cuts to staff? Does it involve service closures? Does it involve more rationing of drugs and treatments? Will he now set out a plan for those £22 billion-worth of efficiencies? People have a right to know how he plans to achieve them.

Thirdly, can the Secretary of State tell us where this £8 billion is coming from? During the election, Ministers repeatedly failed to answer this question. The Chancellor was asked about it 18 times on “The Andrew Marr Show”, and his evasion was excruciating. So can the Secretary of State now give us an answer? If he cannot, people will conclude that the Conservatives either knew they were going to break this promise or did not want people to know where the money was going to come from. But people need to know, because the Government could be about to repeat the big spending mistake that they made in the last Parliament.

Five years ago, I warned the Government that it would be irresponsible to pay for the NHS by raiding social care, but that is exactly what they did. Around a third of a million vulnerable older people lost social care support at home and, unsurprisingly, many of them ended up in hospital. Those cuts to social care had terrible human costs, but they also created huge operational and efficiency problems for the NHS, with record numbers of frail people occupying hospital beds. I say this again to the Secretary of State: if you let social care collapse, it will drag the rest of the NHS down with it. It is a false economy on a grand scale to cut social care to pay for the NHS. Will he be clear today: will he confirm that, if the Government have no plans for new taxes, the money for the NHS will come from cuts to other unprotected Departments? If that is the case, are we not looking at even deeper cuts to local government and social care in this Parliament than we saw in the last?

The Secretary of State cannot keep dodging those questions. The Gracious Speech promised plans to integrate the NHS and social care, but there will be nothing left for the NHS to integrate with if he carries on in this way. The care cuts in the previous Parliament were the root cause of the A&E crisis. Hospital accident and emergency departments have now missed the Government’s lower target for 97 weeks in a row. If they cut social care again, we will have to deal with a full-blown NHS crisis.

Attendances at A&E departments increased 10 times faster in the four years after 2010 than in the four years before 2010. That was caused not just by the ageing society, as the Secretary of State likes to claim, but by his failure to look after that ageing society.

Where was the action in the Queen’s Speech on the scandal of 15-minute care visits? The truth is that there is no solution for the NHS without a solution for social care, but the only plan on offer from this Government is more cuts, and those cuts will pile pressure on an already overstretched NHS. This is where the NHS finds itself at the start of this Parliament.

The Secretary of State has promised us a seven-day NHS, which we all support. He has promised us 8 am to 8 pm GP opening. How on earth will he deliver those promises when he cannot say where the money is coming from, and when the NHS is facing a huge financial deficit? He will make a grave mistake if he tries to introduce seven-day working in the NHS on the backs of NHS staff. Staff who work the most unsocial shift patterns often face the greatest cost. For instance, they have no choice but to use their car if public transport is not running. It would be utterly wrong to pay in part for seven-day working by removing the unsocial hours payment, and we will oppose any attempt by him to do that. Good will is evaporating in the NHS and we cannot afford to lose any more.

In conclusion, to listen to the Secretary of State today, we might be forgiven for thinking that everything is fine in the NHS, but it is not. People are waiting longer and longer for cancer treatment to start, and the cancer standard has been missed for the past five consecutive quarters. NHS waiting lists are at a seven-year high. People cannot get GP appointments when they need them; they are left ringing the surgery for hour after hour in the morning to be told that nothing is available for days. Ambulances are taking longer to arrive, as we heard at Health questions earlier, A&E remains in permanent crisis mode, mental health services are in crisis, social care is being cut, NHS services are being privatised, and the bill for agency staff has left the NHS in the grip of private agencies.

The uncomfortable truth for the Secretary of State is that he is running out of people to blame. This is the NHS that he inherits from himself, and it is heading downhill fast. The onus is now on him to produce a plan to turn round NHS finances, turn round A&E and deliver on the promises he has put before the country. The NHS enters this Parliament facing one of the most dangerous moments in its history. We will not let him shift the blame on to NHS staff. The party that created the NHS will hold him to account for the damage that he is doing to it right now.

[Several hon. Members]

rose—