NHS Reform

Andy Burnham Excerpts

Thursday 16th July 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for advance sight of it. Let me say at the beginning that I support much of what he said. I will focus my remarks on his plan for seven-day working, and then touch on some of the other issues he raised.

Ensuring that our health services are there for everyone whenever they are needed—be that a weekday or a weekend—should be our shared goal across this House for a 21st-century national health service. Illnesses do not stop at the weekend and nor should our NHS. Although we support the principle of what the Secretary of State is trying to achieve with seven-day working, and will work with him where possible, I urge some caution in the manner in which he is attempting to drive through these changes. His remarks contain no acknowledgment that the NHS right now is in a very fragile condition. It has gone backwards, not forwards, in recent times. A&E is in crisis, and primary care services are overwhelmed. There is a shortage of staff and an over-reliance on agency workers. Staff are demoralised and worn out. If he does this in the wrong way, many may walk away and that would make matters even worse. Given all that, it is not immediately clear how seven-day services can be delivered in the timeframe he has set out without significantly impacting on the rest of the NHS.

The Secretary of State said that around 6,000 people lose their lives every year because we do not have a proper seven-day service. Of course that is an appalling statistic, but is there not a risk of implementing seven-day services by simply spreading existing resources more thinly? A recent study published in “Health Economics” concluded:

“There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths.”

Will the Secretary of State tell us on what evidence he has based his announcement and, crucially, what steps he is taking to guard against what the study warns could be an increase in weekday deaths?

If the Secretary of State wants to make changes on this scale, it is vital that he works in partnership with NHS staff. I gently say to him that briefing headlines such as “Declaring war on doctors” have not got us off on the right foot, as doctors are already feeling worn out and put upon. The British Medical Association said:

“Today’s announcement is nothing more than a wholesale attack on doctors to mask the fact that for two years the Government has failed to outline any concrete proposals for introducing more seven-day hospital services.”

Will the Secretary of State take care to avoid provocative statements such as “Declaring war” and will he rethink the manner in which he is pursuing these negotiations? Talk of imposing deals at this stage is not helpful; it is premature and it would be better to proceed in a more constructive manner.

Staff across the entire hospital system—not just doctors —will be needed to run these services, but the Government confirmed only last week that many of them will face another five years of pay cuts. In total, that will amount to a decade of pay cuts. Has the Secretary of State looked at the detail of the Chancellor’s announcement on pay for NHS staff? Will he tell the House what effect he believes this deal could have on staff numbers and retention?

The Secretary of State said very little about how he will fund seven-day services, but given that the NHS is struggling to fund weekday services, it is likely to need significant investment over the next five years, over and above funding attached to the five-year forward view. Can he confirm that the money allocated to fund the five-year forward view does not include seven-day working? That is not specifically mentioned in the “Five Year Forward View”. If so, what extra funding will be made available specifically to deliver seven-day working, and when will this funding be available? The announcement today appears to be unfunded and it will not escape the House’s attention that the 2010 Conservative manifesto also promised to deliver seven-day services. The Secretary of State has a lot of convincing to do if he expects people to believe him this time.

In a statement last week in another place, Lord Prior, the Under-Secretary of State with responsibility for NHS productivity, said he was establishing an independent inquiry into extending charges in the NHS. This has sounded alarm bells among many patient groups. Will the Secretary of State say more about the terms of reference for this independent inquiry and when it will proceed with its work?

The Francis “Freedom to speak up” report contained a number of important recommendations to foster a more open culture and we support his work to implement them. The right hon. Gentleman will know that there have been a number of appalling examples of poor care in recent times at Orchid View, Oban Court and Winterbourne View, and these scandals were exposed only when undercover reporters infiltrated the care home. Will he look seriously at the idea of an independent body to receive complaints from NHS staff and social care staff so that they are not faced with the problem of always going to their employer if they are to blow the whistle?

I welcome what the Secretary of State had to say about the Kirkup report and his acceptance in full of its recommendations. We, too, think of the families affected by the failures at Morecambe Bay. I supported steps to improve the regulation of midwives, but the big question mark over the right hon. Gentleman’s commitment is the failure to bring in a Bill on professional regulation. This was an important recommendation of the Francis report and the continued delay in implementing this proposal is putting patients at risk and preventing regulators from doing their job. Will the Secretary of State now commit to legislating at the earliest opportunity for the Law Commission’s reforms?

These are extremely serious matters and I do not believe that some of the Secretary of State’s more political comments today were appropriate, nor do I believe they will build the consensus that will be needed across this House to deliver these important changes. Labour introduced more transparency into the NHS with the establishment of independent regulation and the inspection of hospitals. I appointed Robert Francis to begin the work of looking at what went wrong at Mid Staffs. Where the Secretary of State seeks to build on these constructive changes, we will support him, but he will not achieve his goals by provoking confrontation with doctors or playing politics with patient safety.

[Mr Hunt]

I thank the right hon. Gentleman for his support on many of the measures that we are announcing today. Where we can work together, we should. I thank him for his support for the principle of seven-day working, although I gently point out that this was in our manifesto in May and it was not in his. I shall deal in turn with the points that he raised.

On funding for seven-day services, the right hon. Gentleman has just fought an election on plans that would have meant that the NHS would get £5 billion less than this Government are prepared to commit. We are committing £10 billion to the NHS to implement the five-year forward view, which we can do on the back of a strong economy. That includes plans for a seven-day service.

The right hon. Gentleman talked about comments by Lord Prior in another place. There is no independent review on charging for NHS services. After the election, he should be very careful of such scaremongering. That is what he was doing for the whole election. When he makes such comments, he frightens NHS staff. He should think about the effect on morale when he does that.

The right hon. Gentleman said that the NHS has gone backwards, not forwards, but I have just presented figures showing that public confidence in the NHS is going up; the number of people who think that the NHS is one of the best systems in the world has increased. I gently point out that the reports we are publishing today are a response to problems that happened on his watch and that we are facing up to, so he should have a little modesty in this situation.

The right hon. Gentleman asked an important question about spreading services currently offered on five days over seven days. A lot of work has been done on this. The truth is that having services only on five days is not only dangerous for patients but incredibly inefficient for hospitals. For example, someone admitted to hospital on a Friday in need of a diagnostic test might not get the result until the following Monday or Tuesday so will have to stay in hospital for the weekend even though they could possibly have been discharged. That is bad for the patient and expensive for the NHS, so these measures will result in huge cost savings.

Most importantly, the right hon. Gentleman talked about carrying staff with us. Doctors go into work every weekend throughout the NHS and do a fantastic job, but often it is not recognised and they are not thanked. We want a more professional contract that recognises that contribution. That is why these measures are supported by the Royal College of Surgeons, the Royal College of Physicians and the Royal College of Emergency Medicine.

When the previous Labour Government changed the consultants’ contract in 2003, senior doctors did not like it. They said that it led to

“a loss of a sense of vocation and what it means to be professional”.

That quote is from a King’s Fund report. It undermined the basic relationship between doctor and patient. We are not blaming doctors, and actually we are not blaming unions, because unions will always ask to see what they can get—the right hon. Gentleman spends more time with unions than I do, so he knows that better than I do. The people responsible for that decision in 2003 were the Ministers who signed off changes to the consultants’ contract and the GPs’ contract. It was Labour politicians who were responsible for those changes, and they must take responsibility for the fact that it was the wrong thing to do.

Finally, this is the most important question of all, and we have not heard an answer today: does the right hon. Gentleman support the measures that the Government are putting forward to make our hospitals safer with seven-day working or not? Leadership is about making choices, and today’s choice is this: is he on the side of the patient or on the side of the union? We know whose side we are on. For Labour, once again, the politics matters more than the patients.