NHS (Private Sector)

Andy Burnham Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House believes there is an important role for the private sector in supporting the delivery of NHS care; welcomes the contribution made by private providers to the delivery of the historic 18-week maximum wait for NHS patients; recognises a need, however, for agreed limits on private sector involvement in the NHS; notes with concern the Government’s plans to open up the NHS as a regulated market, increasing private sector involvement in both commissioning and provision of NHS services; urges the Government to revisit its plans, learning from the recent problems with PIP implants and the private cosmetic surgery industry; believes its plan for a 49 per cent. private income cap for Foundation Trusts, in the context of the hospitals as autonomous business units and a ‘no bail-outs’ culture, signals a fundamental departure from established practice in NHS hospitals; fears that the Government’s plans will lead to longer waiting times, will increase health inequalities and risk putting profits before patients; is concerned that this House has not been given an opportunity to consider such a significant policy change; and calls on the Government to revise significantly downwards its proposed cap on the level of private income that can be generated by NHS hospitals.

It is a year this week since the Health and Social Care Bill was introduced in this House. Unlike the Government, we wanted to mark the anniversary, and having this Opposition debate seemed the right way to do it. It is being held because the Government have effectively sidelined this elected House from the debate about the future of the national health service. No single issue matters more to the people who put us all here, but what the future holds for the hospitals in our constituencies is no longer up to us. Instead, it is the unelected House that is right now carving up England’s NHS through back-room coalition deals. Ministers are making a series of desperate concessions in the other place to try to preserve the pitiful levels of support that remain for this unwanted and unnecessary Bill.

For the avoidance of doubt, let me summarise this scandalous situation. Here we have a Bill that nobody voted for. It was not in either the Tory or the Lib Dem manifestos, and it was ruled out specifically by the coalition agreement, yet it was rammed through this elected House so that the real decisions could be taken down the corridor in the unelected House. It is truly an affront to democracy that our nation’s most valued institution should be treated in this way. It thus falls to the Opposition to let this House take a view this evening on the far-reaching amendments to the Bill that are now being tabled, which Ministers were clearly too scared to table in this House.

[Mr John Redwood (Wokingham) (Con)]

As we are debating the role of the private sector in health, does the right hon. Gentleman agree with the former Labour Health Secretary who said “PFI or bust”, and should he not have said “PFI and bust” given the way Labour ran PFI?

[Andy Burnham]

No, I would not agree. I shall explain the policy that our Government adopted on the private sector and how different it was from that of the Government whom the right hon. Gentleman supports. In making our argument we will expose the terrifying gap between the Prime Minister’s rhetoric on the NHS and what he is doing in reality. People will recall the efforts that went into rebranding the nasty party. The Conservatives were at great pains to tell us that they would be pro-environment, a bit less tough on crime and pro-NHS going forward. Many photo calls were arranged to send those messages to the public, but it was poor old NHS staff who featured far more than huskies or hoodies in being brought in to promote hastily made political promises. We were told there would be real-terms increases for the NHS, a moratorium on accident and emergency department closures, thousands more midwives and, famously, no top-down reorganisation—four promises made in opposition: four promises broken in government. I still have not worked out how a Prime Minister can go from agreeing there should be no top-down reorganisation with his coalition partners after the election to bringing forward just weeks later the biggest top-down reorganisation ever in the history of the NHS. How does that work? Perhaps Lib Dem Members will enlighten us this evening.

Our evasive Prime Minister is the master of making statements that sound good at the time only to turn out to be meaningless in practice. Tonight we will focus on his most outrageous yet. On Monday 16 May last year, under pressure to reassure people about the Health and Social Care Bill and in the middle of the enforced pause, the Prime Minister said, in a speech:

“That’s why, when I think about what our NHS will look like in five years time, I don’t picture some space-age institution, a million miles away from what we have now. Let me make clear: there will be no privatisation”.

Those were his words—“no privatisation”.

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

indicated assent.

[Andy Burnham]

The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.

The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on 8 May, he promised that safeguards would be brought forward in the health Bill. He said:

“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”

He followed that up on 14 June with this promise:

“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”

Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.

Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.

Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the right hon. Gentleman accept that the cap was not clearly defined but was very variable according to the hospital, and will he now say that it was wrong for the previous Government to set the cap at over 30% for the Royal Marsden hospital, which is a centre of excellence?

[Andy Burnham]

I agree that the cap varied according to historical levels of private sector activity within the different trusts. The hon. Gentleman is absolutely right about that, but he must agree that it was clearly defined in respect of every individual NHS hospital. They had a clear number and local people were able to hold them to account for that number. Where hospitals had large numbers, the cap froze their level of activity at the level when the cap was introduced.

[Mr Stephen Dorrell (Charnwood) (Con)]

Just to be clear, could the right hon. Gentleman explain why it is in the interests of NHS patients in a particular hospital for that hospital’s capacity to generate additional revenue from the private sector to be limited by a cap?

[Andy Burnham]

I will explain that very clearly. I am sure the right hon. Gentleman will have read the impact assessment to the Bill, which warns of the risk of lengthening NHS waiting lists if existing capacity is made available to private patients. It says that if additional capacity is provided, there might be no effect on NHS waiting lists. That is why this is dangerous, because all the progress that Labour made on reducing long NHS waits would be put at risk by the careless and cavalier policy of simply abandoning the principle of the cap, which has stood us in good stead.

[Mr Dorrell]

rose—

[Mr Simon Burns]

rose—

[Andy Burnham]

I shall give way to the Chairman of the Select Committee on Health once more and then to the Minister.

[Mr Dorrell]

I apologise to my right hon. Friend on the Front Bench. Could the right hon. Gentleman explain more clearly than he has so far why a hospital should reduce capacity at the same time as it is increasing revenue?

--- Later in debate ---

[Andy Burnham]

That is not what I said. I understand that the preferred policy was to have no caps or limits, but even if a generous and liberal cap was introduced there would be a major risk that hospitals under financial pressure would give beds, theatre time and appointments to private patients, enabling them to jump the queue and giving a much worse deal to NHS patients. That is the risk that the cap was designed to mitigate and that is why we support it.

[Mr Simon Burns]

Could the right hon. Gentleman explain the logic, under his Government, of having a cap on a minority of trusts—foundation trusts—while he as the Secretary of State and his Government did not impose a cap on the majority of trusts that were not foundation trusts?

[Andy Burnham]

There is a simple explanation. The right hon. Gentleman will remember, as I do, the debate on the foundation trust legislation. There were worries that if hospitals were made more independent and were not directly managed by the Department they would put the treatment of private patients before that of NHS patients. The cap was introduced to mitigate that risk. He will know that we had a policy that all trusts should become foundation trusts in time—a policy that his Government have adopted—so that the cap would apply to all NHS hospitals in time. I think that answers his question.

[Mr Burns]

If that is the case, rather than that it being forced on the Labour party by a rebellion of Back-Bench MPs in 2002, why did the right hon. Gentleman’s election manifesto in 2010 say that Labour would remove the cap?

[Andy Burnham]

It did not, and I would expect a Minister not to make misleading statements like that in a debate of this kind. It did not propose the removal of the cap: it said that more freedom would be given to NHS hospitals with a modest loosening of the cap. That was my policy as Health Secretary. We did not propose removal of the private patient cap.

[Rosie Cooper (West Lancashire) (Lab)]

Does my right hon. Friend know whether the private operations will be charged at tariff? Is there a limit on the charge hospitals can make? Will it be at tariff or at a premium on tariff? Would that not be a way of increasing the amount of resources coming in? Less work would be done on the NHS.

[Andy Burnham]

My hon. Friend raises an important issue. We have not had those safeguards; there has been no explanation from the Government of any safeguards that will be introduced under this liberal measure. This evening, we need to probe exactly what they have in mind. During the pause, they said that they would restrict any competition on price in the NHS, yet they are bringing forward a measure that would allow NHS facilities to be used for the treatment of private patients with no guarantee that the private sector would not try to undercut NHS tariffs. Those are precisely the questions that the Government have to answer.

[Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)]

Does my right hon. Friend agree that the fundamental change in the Bill is that the Government are imposing a new form, Monitor, which directly applies competition regulation in NHS delivery of services and undermines the principles and rules for co-operation and competition—PRCC—that arbitrate between commercial services and the NHS, which controlled the market?

[Andy Burnham]

That is exactly the point. The proposal has to be seen in the context of the health system the coalition Government want to create. They want a broken-down system where one hospital is pitted against another, where there is a duty on the Secretary of State to promote the autonomy of NHS organisations, so that they are out there on their own, having to stand or fall on their merits, with a clear incentive to drive up income gained through a relaxed private patient income cap. I shall come to that point in a moment.

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

Ministers are shouting, “Choice”, but is my right hon. Friend prepared to reflect on the merits of the private sector, both in the UK and abroad, in the efficiency of the service that it delivers?

[Andy Burnham]

When the Bill was introduced, great claims were made that it would improve NHS efficiency. That was one of the reasons the Government gave for subjecting the NHS to a huge top-down reorganisation; they wanted to make the system more efficient, but they made a mistake that many people make over time. They claimed that the NHS is inherently inefficient when in fact international evidence shows the exact opposite: the NHS model is the most efficient health care system in the world. That is because control of the system is democratically accountable, and national standards can be set through bodies such as the National Institute for Health and Clinical Excellence and entitlements can be set at national level. If that control is removed, we will see the emergence of a much less efficient health care system, like the many market-based systems.

[Charlie Elphicke (Dover) (Con)]

The motion

“notes with concern the Government’s plans…increasing private sector involvement in…commissioning and provision of NHS services.”

In Dover, our hospital was run down over the 13 years until 2010 and is now a shell. Why should the GPs not be able to commission another provider if the foundation trust will not fulfil its long-standing pledge to build a hospital and provide proper services for my constituents?

[Andy Burnham]

My argument would be that if those decisions are to be made, the people who make them should be accountable to the hon. Gentleman and the House, whereas the Bill that his right hon. Friend the Secretary of State is introducing proposes to push those things away. There will be an independent commissioning board that GPs and clinical commissioning groups will not be able to overturn; it will make the decisions. That is a completely unacceptable state of affairs.

Before the last election, we proposed a modest loosening of the private patient cap in response to pressure in another place when we were debating the Health Act 2009, but compared with our modest reforms, the Government’s plans are off the scale. Instead of private sector activity at the margins, the Health and Social Care Bill places market forces at the heart of the system. The private sector will not support the NHS, but will replace large chunks of the service in commissioning and provision.

[Chris Skidmore (Kingswood) (Con)]

I should be interested to learn—as I am sure would the whole House—the right hon. Gentleman’s definition of modest loosening. In the four years between 2006 and 2010, the amount of money going to the private sector rose from £2 billion to about £12.2 billion. Does the right hon. Gentleman simply oppose the 49% cap or will he pledge to reverse it if he returns to government? What exactly would the cap be? Would it be 30% or 12%? Please let us know.

[Andy Burnham]

May I refer the hon. Gentleman to the motion? Its request to the Government is not unreasonable; it asks them “to revise significantly downwards” the cap they have proposed.

[The Secretary of State for Health (Mr Andrew Lansley)]

To what?

[Andy Burnham]

I remind the Health Secretary that he is the Secretary of State, not me. It is for him to bring forward proposals. Forty-nine per cent: in that proposal he is saying that NHS hospitals can give equal priority to the treatment of private patients—that it can be as legitimate an objective for an NHS facility, paid for by the taxpayers, to be used equally for the treatment of private and NHS patients. I put it to the hon. Member for Kingswood (Chris Skidmore) that I am not prepared to accept a cap on that scale. It could lead to an explosion of private sector work in NHS facilities and I do not think that is in the best interests of NHS patients. I would be prepared to accept the Government’s bringing forward proposals that fulfilled a modest loosening of the cap, to give the NHS more freedom at this difficult time, but I am talking in single figures. I am not talking about a doubt-digit, 50% cap—a recommendation that hospitals devote half their resources to private patients.

[Mr Simon Burns]

Will the shadow Secretary of State kindly answer the questions put by my right hon. and hon. Friends about what modest means? [Interruption.] If I might read it out, the 2010 Labour manifesto says:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS.”

There was no mention of a modest increase; it was open-ended.

[Andy Burnham]

The Minister is not listening. I answered his question. I proposed a small increase in the cap—in single figures; a couple of per cent, as I am on record saying at the time, to give NHS hospitals more freedom to generate more income, to be put back into improving standards for NHS patients. Can the Minister honestly look me in the eye and tell me that 49% is not a world away from the NHS that he inherited from our Government?

[Mr David Anderson (Blaydon) (Lab)]

The manifesto that we put together in 2010 did not envisage a health service where the Health Secretary had given up control. It envisaged a health service where the Health Secretary would still have control and could set a cap for foundation trusts.

[Andy Burnham]

That is absolutely the point. The Government want to create an NHS where Ministers can no longer say what can or cannot be done, so we have GP practices, such as Haxby in York, sending letters to their patients saying, “We have decided that we are not going to fund your minor operations any more, but by the way, we are now providing those operations. Here’s our price list.” That is absolutely disgraceful, but it is a glimpse of the NHS that will emerge if the Health and Social Care Bill goes through. My hon. Friend is absolutely right: we must consider the wider context, within a system with competition at its heart and where every hospital is on its own and they are fighting each other. That is the context in which this 49% proposal needs to be considered. It represents a break with 63 years of NHS history and a “genie out of the bottle” moment. That is why we ask the House to reject it.

[Tom Blenkinsop]

My right hon. Friend is making a strong point. The Minister says that the cap was flexible during our term, but that was under principles and rules for co-operation and competition rulings. That meant that the servicing out of the contract was based on care quality. Unfortunately, the Bill does not have any area dealing with quality of care; it is purely about price. It is about allowing Monitor to apply the pure regulatory format of the Competition Commission as it exists in other utility markets.

[Andy Burnham]

My hon. Friend anticipates me. I shall come to precisely that point in a moment, and it will backs up his point that the Bill is akin to the privatisations of the 1980s.

[Anna Soubry (Broxtowe) (Con)]

What?

[Andy Burnham]

Just hang on and listen. Nothing has been done to the Bill to bring together the Prime Minister’s and Deputy Prime Minister’s promises that there would be no privatisation. There has been no substantial change since the pause.

Let me come directly to whether the Bill represents a privatisation of the kind that we saw in the 1980s. In doing so, I shall refer to a report from the King’s Fund, which I recommend to the hon. Lady. The Government have failed to introduce measures that they promised, months after the pause, so it is still considered appropriate for a body as respected as the King’s Fund to make a fairly shocking comparison that, indeed, the Bill is similar to the privatisations of the Thatcher Government. The report says:

“The Government’s proposals draw heavily on the regulatory framework developed in telecoms and utilities regulators …Interestingly, Secretary of State for Health Andrew Lansley’s own ideas for the reform of the NHS, developed while in opposition, were born out of his experience of the privatisation and regulation of utilities in the mid-1980s when he was Principal Private Secretary to Norman Tebbit.”

There we—[Interruption.] Okay, there we have it. That is the view of the King’s Fund—this is a privatisation along the lines of those we saw in the 1980s.

To back up that point, the King’s Fund quotes from a speech that the Secretary of State gave in 2005 to the NHS Confederation. He said this of the 1980s privatisations:

“The combination of the introduction of competition with a strong independent regulator delivered immense consumer value and economic benefits.”

There are two problems with that statement. First, there are real questions about whether gas, electricity, water and rail customers feel that they have had immense value. Secondly, it is troubling that the Secretary of State for Health, of all people, considers the delivery of health care directly comparable to telecoms and utilities.

[Henry Smith (Crawley) (Con)]

Does the right hon. Gentleman recall saying in 2007 that he celebrated the role of the private sector in the NHS?

[Andy Burnham]

This is getting a little tedious. May I refer the hon. Gentleman to the motion, which indeed does the very same thing? It recognises the fact that there is

“an important role for the private sector”

in the delivery of good NHS care and celebrates the role that it played in helping us to deliver the lowest ever NHS waiting times. Before intervening in future debates, he might like to read the motion that the House is considering.

Let me quote the Secretary of State’s interesting 2005 speech to the NHS Confederation, which set out the essential ingredients that we now see in his Health and Social Care Bill. His plan was to

“maximise competition, transfer risk to the private sector…appoint a strong, pro-competitive regulator…set out clearly the standards which have to be met and how operators will be held accountable for them…be clear about how and by whom universal service obligations are to be met…ensure high quality information for customers”

and have

“more customers rather than fewer.”

That is, do not have a few monopolistic health authority purchasers. The Secretary of State is nodding in assent that that is, essentially, his Health and Social Care Bill. This is, of course, the basic framework that the House of Lords is considering, despite the Deputy Prime Minister’s claim to have rejected

“the free market dogma that can fragment the NHS.”

A phrase leaps out of that 2005 speech that, in the light of recent events, needs to be challenged. It is

“transfer risk to the private sector”.

While acceptable in theory, I wonder whether recent experience with the private cosmetic surgery industry has led the Secretary of State to reconsider whether and how, in the health context, that can be delivered in practice. In an NHS based on commercial contracts, would there not always be arguments about legal liability when things went wrong? Would it not be much harder to control quality and costs in such a way, rather than through the current planned and managed NHS system that we have?

[Mr Redwood]

On the point about implants, why did the NHS under Labour buy the same difficult implants that the private sector bought?

[Andy Burnham]

The point that I am making is about how to manage the system, how to ensure proper regulation and how to ensure that NHS providers and the system work in the interests of NHS patients. If the right hon. Gentleman is arguing that there would be the same control managing the system through a series of fragmented commercial contracts, I would be interested to have that debate with him. Frankly, I do not believe that he is being serious, if that is his point.

[Lyn Brown (West Ham) (Lab)]

I have been contacted by constituents who access their cancer and cardiac care from Barts and from the London hospital. They fear that as a result of the Bill their health needs will be deprioritised in favour of private patients who can afford to pay. What would my right hon. Friend say to my constituents about their fears?

[Andy Burnham]

I wish I could allay the fears of those people, but when there is a proposal placed at the heart of the NHS for hospitals to devote half their facilities—their beds, their appointments—to private patients, how is it possible to give that guarantee to those patients, particularly when the Government are relaxing the waiting time standards that we did so much to establish in the NHS, with the two-week wait for cancer referrals and 18 weeks for elective operations, and a four-hour wait in A and E? How can we have that confidence when, effectively, the Government are taking those safeguards off the public and giving the green light for a massive expansion of private sector treatment in NHS hospitals?

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

Does my right hon. Friend have any answer to the question whether private providers with obligations to their shareholders will inevitably face a conflict if risk is offloaded to them when their responsibility to their shareholders is naturally to ensure the best possible financial outcome for them?

[Andy Burnham]

My hon. Friend is absolutely right: this proposal brings that conflict right to the heart of the NHS. At the moment, NHS hospitals have a paramount and overriding duty to the treatment of NHS patients, but considering a health care system whereby services would be delivered through a series of commercial contracts brings that conflict of interest into the health care system—shareholders on the one hand, patients on the other. That is why there is such deep disquiet among health professions about these proposals. It is why those professions applied so much pressure last year, and the pause was ordered. It is why, I am afraid, they are still unhappy today—the Government have not addressed their concerns.

[Mr Lansley]

Before the right hon. Gentleman continues with this wholly erroneous line of discussion, will he reflect on the fact that the Bill introduces, for the first time, a transparency in accounting between NHS activity and any private income in any foundation trust, which he did not put into legislation? The Bill introduces a transparency that there can be no cross-subsidisation between NHS resources and any private activity. It introduces a legal requirement for any foundation trust to explain to the public at its annual meeting how it has used any private income to the benefit of NHS patients. Will he reflect on the fact that the primary purpose of a foundation trust is to provide NHS services? For it to do anything that was to the detriment of NHS patients, involving private patients, would be contrary to its primary purpose and unlawful.

[Andy Burnham]

There are a lot of questions there. The Secretary of State discusses the safeguards, but he has introduced them precisely because he has made a major break with 63 years of NHS history. He needs them because he wants a different health care system in this country, in which much more work is done by private providers and in which the commissioning of services is largely handed over to the private sector. That is why he has had to introduce those safeguards. We had a health service that was planned, managed and publicly accountable, but he is throwing all of that away.

[Dr Poulter]

I thank the right hon. Gentleman for giving way; he is very generous. Does he not agree that the two hospitals with the highest patient cap—the Royal Marsden and the Royal Brompton—use the money that they make through private income very effectively, and put it back in to make them centres of excellence for all patients, particularly their NHS patients?

[Andy Burnham]

That was the policy of the previous Government, but the cap was clearly defined. It was a tight cap, and it reflected historical levels of work. What we are talking about is a liberalising measure to enable the private sector to double if not quadruple the amount of work that it is doing, which is why we are debating the motion.

I shall pose a question for the Health Secretary, who mentioned safeguards. If it is all fine to create a different NHS in which we have many more private contracts, might not the NHS risk register have something to say about the risks of creating such an NHS and the additional challenges of delivering health care through a system based on commercial contracts? Might it not lead to a diversion of spending on lawyers and consultants, away from patient care? Is there not a great irony, as we have heard the Health Secretary bemoan a lack of ability to intervene in the recent situation while, at the same time, here he is promoting a Bill that removes his ability to do so on a much wider basis? He wants to hand over his ability to intervene to the independent NHS Commissioning Board. The irony of his position will not be lost on many people listening to the debate.

[Dr Phillip Lee (Bracknell) (Con)]

I have attended this debate to try to ascertain the direction of travel of Labour policy and to try to gain an understanding of its philosophy and underlying principles. I am somewhat confused, because you seem to be all over the place. Do you believe that health care is a commodity—[Interruption.] I apologise; I meant the right hon. Gentleman. Do you believe that health care is a commodity or not? Do you believe that access to health care is a right or not? The answers to those questions underpin the policies that you will introduce, I presume, in the next couple of years.

--- Later in debate ---

[Andy Burnham]

I do not know whether those questions were for me or for you, Mr Deputy Speaker, but let us assume that they were for me.

I introduced the NHS constitution, which enshrined for the first time the basic rights of NHS patients. I am proud to have done so, so I do not need any lectures from the hon. Gentleman about what we should do to improve health care in this country. I said in the motion that I am prepared to go back to my policy before the election in which we said that we would consider loosening the private patient cap. That is the policy that I have introduced to the House tonight. I am not prepared, however, to accept the wholesale abolition of that control to create a situation in which NHS hospitals can devote half their beds to private patients. If he is happy with that in his constituency, let him make the argument for it, but I am making an argument for a very different NHS from the one envisaged by Ministers.

[Tom Blenkinsop]

Is not the real question for the Government why on earth they have written the Competition Act 1998 into the Bill? Why have they written the Enterprise Act 2002 into it, and why have they allowed European competition law to create the haemorrhaging of a socially provided service under category B legislation? Why have they done that? What is the point? It can only be to loosen enterprise within the NHS for competitive purposes so that the private sector can come in.

[Andy Burnham]

My hon. Friend makes an important point. If the Bill was really about clinical commissioning, as the Government said at the beginning, and putting GPs in control, that could have been done through existing NHS structures. They could simply put clinical teams in charge of existing PCT structures. It could be done without any hassle or cost, but no, they completely broke down and rethought the whole system, because it was an ideological reform. Doctors oppose the measure, because they saw through the Bill, and saw it for what it was: a privatisation plan for the NHS.

Let me give three examples that demonstrate why the Prime Minister has not lived up to his “no privatisation” claim. The first is a letter sent by the Department on 19 July last year to NHS and social care leaders entitled “Extending Choice of Provider”:

“The NHS is facing a period of significant transition and financial challenge. But this is not a reason to delay action to address patient demands for greater choice”.

It went on to require all PCT clusters and clinical commissioning groups to identify three community services by 31 October that would be subject to an “any qualified provider” tendering process. That is significant because it exposes the ideological agenda behind the Bill and explodes the myth that it is about putting doctors in charge. If that was the case, logic would demand that it should be for doctors to decide whether or not any underperforming services could benefit from open procurement. That mandating of compulsory competitive tendering, even before Parliament has given its consent to the Bill, reveals the real direction of the policy. We simply ask how that can possibly be consistent with the Prime Minister’s promise of no privatisation.

The second example is the Department's guidance document to CCGs entitled “Developing commissioning support: towards service excellence”. I shall quote from the beginning of the document, which gives a clear statement of intent:

“The NHS sector, which provides the majority of commissioning support now, needs to make the transition from statutory function to freestanding enterprise.”

It could not be clearer, which is why members of the British Medical Association council called the document a “smoking gun”, confirming their fears of a stealth privatisation. The document confirmed that the Government envisaged large-scale privatisation of services to support commissioning—jobs that are currently carried out by public servants. It puts into practice the comments made by Lord Howe on 7 September 2011 at the Laing and Buisson independent healthcare forum:

“The opening up of the NHS creates genuine opportunities for those of you who can offer high quality, convenient services that compete favourably with current NHS care. If you can do that then you can do well. But you know that won’t be easy, the NHS isn’t a place to earn a fast buck...they will not give up their patients easily”.

On commissioning, he said:

“Commissioning support is an absolutely critical area for CCGs. Some of it will come from the PCT staff who will migrate over to the groups but there will need to be all sorts of support at various levels…There will be big opportunities for the private sector here.”

With reference to that second example, I ask the Secretary of State how on earth is that policy consistent with the promise made by the Prime Minister and the Deputy Prime Minister of no privatisation?

That brings me to the third example, which we have discussed tonight. Just before the Christmas recess, the plan, which threatens to change the very character of our hospitals, was sneaked into the House of Lords. I do not seek to argue that that provision would change the NHS overnight, but in the context of a competitive NHS, where there is an obligation to promote the autonomy of hospitals, I believe that it would completely change the character of our hospitals and the way they think and function over time. The effect of a cap at this scale—a staggering 49%—means that hospitals could give equal priority to private patients. It sets the NHS and private sector in direct comparison with each other, and creates the conditions for an explosion of private work in NHS hospitals.

It is such a liberal provision that the Government’s amendment will have virtually the same impact as abolishing the cap completely, and it is a world away from the current situation. It fails to protect the interests of NHS patients by giving equal priority to other patients. Indeed, it creates a conflict of interest, as trusts could even seek to push patients into their private beds.

[Charlie Elphicke]

I thank the right hon. Gentleman for giving way; he has been extraordinarily generous in accepting interventions. When he discusses privatisation of services, does that include services taken on by charities, social enterprises and mutuals?

[Andy Burnham]

I am not against services being taken on by charities, voluntary providers and, indeed, the private sector. I have never set my face completely against that, but I see clear limits on the involvement and the role of the private sector in the delivery of NHS services. I see the private sector supporting the NHS, working at the margins, providing innovation and support. The Health Secretary sees the private sector replacing large chunks of the NHS, set up in direct competition with it, which is a very different policy. I ask the hon. Gentleman whether he was elected to the House to support such a policy. Do not the constituents of Dover quite like the NHS that we have, and want it to continue as it has for its first 63 years?

I want briefly to mention the impact assessment. It gives this specific warning if hospitals loosen the private patient cap without creating additional capacity:

“there is a risk that private patients may be prioritised above NHS patients resulting in a growth in waiting lists and waiting times for NHS patients. This is the eventuality that the PPI cap was originally introduced to prevent.”

In other words, there would be a return to that traditional Tory choice in health care—wait longer or pay to go private.

That sums up the big difference between this Government’s approach to the private sector and that of the previous Government. In our system, the private sector was encouraged to throw its lot in with the delivery of the best possible NHS standards of care to NHS patients. By contrast, the world view of this Government sees private health care as a way out of the public NHS, trading on its failures as a means of boosting the private market.

The next question that I ask the right hon. Gentleman to answer is whether the 49% plan can possibly be consistent with the Prime Minister’s promise of no privatisation. We make a reasonable request this evening. We do not reject out of hand any change to the existing PPI cap on foundation trusts. Voting for the motion does not imply opposition to the entire Health and Social Care Bill. But we do reject a 49% cap, which is tantamount to abolition, and we call on the Government to revise it significantly downwards. Voting for the motion will send a signal from the House that the Government need to rethink.

In conclusion, I give notice that we will continue to oppose the Bill outright, and we will put everything we have got into that fight. Let me be clear. The Prime Minister should withdraw his “no privatisation” promise or he should withdraw his Bill. He cannot have it both ways. If the Bill is passed, I do not think there is any question but that it will lead to the privatisation of large chunks of commissioning and NHS provision. The truth is that this is an illegitimate Bill. Nobody voted for it, and it is a Bill that the Health Secretary has mis-sold to the public and professions. He claimed that it was about putting doctors in the lead, but doctors can see it now for what it is. From here on in, we on the Opposition Benches will call it what it is—a privatisation plan for the national health service.

We have called the debate tonight to bring these dangers home to a much wider audience. Time is running out for the NHS and I will give everything I have got to protect the NHS that I believe in. This is worth fighting for because the NHS stands for something different in a world where large parts of our national life have been taken over by profit and money. Recent events have shown the dangers of mixing medicine with the market. People see health as different from other areas and overwhelmingly support the NHS as it is. By and large they trust it and see it as one area of national life where the money motive has not taken over. They want it to stay that way and they look at social care as a warning, showing how a fragmented system can drag standards down. Nye Bevan said there would be an NHS for

“as long as there are folk left with the faith to fight for it”.

This is the moment of greatest threat to our health service and I tell the Health Secretary and the Government straight tonight to drop this illegitimate Bill or face the fight of their lives. I appeal to Members in all parts of the House who have worries about where the Government are going with the Bill to send a direct message to the Government and to vote as their constituents would want them to—for an NHS that will always put patient care before profits. I commend the motion to the House.

--- Later in debate ---

[Mr Lansley]

What the hon. Lady describes is precisely what has happened time and again under the legislation we inherited, which is not transparent. Primary care trusts were not accountable or transparent and an enormous amount of activity went on with tenders that involved the private sector and was not conducted in the way that we want, which is on the basis of a tariff and on the basis of which provider is best able to deliver the highest quality.

Let me deal with the first of the myths propagated by the right hon. Member for Leigh: that we have some kind of privatisation agenda. We do not. As I recollect, the only time any Government had a specific objective to increase the role of the private sector in the NHS was when he was a Minister, his hon. Friend the Member for Leicester West (Liz Kendall) was a special adviser to the Department for Health and Patricia Hewitt was Secretary of State. That was when they were saying they wanted to increase the role of the private sector to 10% or 15%, and the Health and Social Care Bill contains specific provision not to allow such discrimination in favour of private providers in future.

[Andy Burnham]

The Secretary of State says that he has no proposals to increase privatisation. Will he confirm that he has sent a letter through the Department asking clinical commissioning groups to identify three community services that will be subject to a compulsory competitive tender?

[Mr Lansley]

No, because it is not compulsory competitive tendering. It will extend access to any qualified provider—

[Andy Burnham]

That is the same thing.

[Mr Lansley]

It is not. The right hon. Gentleman, having been Secretary of State, ought to understand the difference between compulsory competitive tendering and any qualified provider. Under compulsory competitive tendering, it is the primary care trust that gets to choose who provides the service, but under any qualified provider it is patients who get to choose. One example is access to wheelchair services. Voluntary sector organisations, such as Whizz-Kidz, are setting out to provide a better service. From its point of view, that is not competitive tendering. Wherever Whizz-Kidz provides the service, patients in that area—[Interruption.] If he wants to have a conversation with other Members, he may by all means do so, but I will sit down.

I answered the right hon. Gentleman’s point and I am afraid that it proceeds from a fundamental misunderstanding of the difference between competitive tendering processes, which have been the stuff of primary care trusts—in the past it was they that decided who should provide services—and giving patients access to choice so that they can drive quality. Unlike competitive tendering, which was generally price-based tendering decided on cost and volume, under any qualified provider it is not about price, but about quality.

--- Later in debate ---

[Mr Lansley]

No, it is nothing to do with Monitor in those circumstances; those whom I have mentioned will make the choice.

The more choice there is, the more innovation there is, the more new ideas there are and the more pressure there is on all providers from all sectors constantly to raise their game for patients. The evidence supports that.

[Andy Burnham]

I have been listening to the right hon. Gentleman very carefully, and he made a statement a moment ago about there being no privatisation—that privatisation will not result from the Bill. Is he saying to us that his Health and Social Care Bill will lead to no additional privatisation of commissioning or provision in the national health service? It is a very clear question.

[Mr Lansley]

There will not be any transfer of responsibility for services from the NHS to the private sector; the NHS will continue to be responsible. The balance in the NHS—[Interruption.] No, I shall answer the right hon. Gentleman’s point. He is trying to interpret “privatisation” as every service currently provided by an NHS provider being provided by an NHS provider in the future, but whether services are provided by the NHS or by a private enterprise, a social enterprise or a charity will be determined by patients choosing who is the best-quality provider. So that is not privatisation; the service remains free, and it remains an NHS service. It is guaranteed to patients in exactly the same way, and there is no presumption in the legislation—in fact, it excludes any presumption—in favour of a private sector provider as against an NHS provider.

The right hon. Gentleman is in absolutely no position to make any criticism of that, because he served in a Government who introduced independent sector treatment centres. They went through the process of giving the private sector contracts that were not available to the NHS, with an 11% higher price on average and a guarantee that they would be paid even if they did not necessarily provide the treatment. The net result was £297 million spent on operations that never took place, and the private sector walked away with that money, so he is in absolutely no position to make any criticism, because we are going to exclude such practices. The contracts that the Labour party gave to the private sector when he was a Minister are exactly the contracts that our legislation will exclude.

[Mr Lansley]

Interestingly, under the so-called extended choice network that the Labour Government introduced, the number of elective operations conducted in the private sector went from, I think, 16,000 in 2005-06 to 208,000 in 2009-10—an enormous increase. From the right hon. Gentleman’s point of view, it was marginal capacity that did not really matter, but the point is that patients said that they thought it provided good quality care. In a Care Quality Commission survey, some 96% of NHS patients using independent facilities said that the elective surgery they received was “excellent” or “very good”. The figure for NHS facilities was 79%. On the NHS Choices website, nine of the top 20 highest-rated NHS-funded providers were run by the independent sector; there were no independent-sector hospitals in the bottom 20. The general proposition is that the private sector is worse in the NHS, but there is no evidence to support that.

The right hon. Gentleman will recall that the Royal College of Surgeons conducted a study of the quality of care, and its general conclusion was that the quality of clinical care offered to NHS patients by private sector providers was as good as the care offered by the NHS. So what is his point? He used the private sector, patients used the private sector and patients were happy. What is his point?

[Andy Burnham]

We did, and I have celebrated it already, because it delivered the lowest-ever NHS waiting lists, which I celebrate again. But I am listening to the right hon. Gentleman, and I get the impression that he is completely confused. He cannot admit that his Bill will lead to more privatisation, but that is at its core, and people listening to this debate would have more respect for him if he came to the Dispatch Box and made an argument for what he is trying to do—to create a market in health care. Is he just floundering around? He is no longer able to say what the Bill is really about. It is about more privatisation, so why does he not try to make an argument for what he is trying to do, instead of avoiding the issue?

--- Later in debate ---

[Mr Lansley]

No, I am going to move on. There has to be time for people to contribute to the debate, so I do not want to go on for too long.

The Health and Social Care Bill will, for the first time, ensure that private and voluntary sector organisations have to meet the same exacting standards and be regulated in exactly the same way as NHS organisations when they provide NHS services. Because that extends to any organisation providing NHS services, whether it be private or voluntary, it is disingenuous at best and possibly disreputable for the right hon. Member for Leigh to draw any comparison with the PIP breast implants scandal. There is no comparison between the position of a private company working in the private sector providing private services and the role of a private company operating inside the NHS under NHS controls. He knows that there is no comparison. In the NHS, the patient will be wholly protected. It is our intention to ensure for the first time—this did not happen under the Labour Government—that when a private sector provider operates in the NHS, it has to provide equivalent indemnities to its patients as would be provided through the NHS. That did not happen when the independent sector treatment centres and other things were brought in. There will be better protection. The private sector operating outside the NHS is a different matter.

Myth No. 3 is that raising the cap on private income will lead to a worse deal for patients. The paradigm example is the Royal Marsden NHS Foundation Trust. Its private patient cap is set at 31%. That is because in 2002, 31% of its income was derived from private sources and that was the basis on which it became a foundation trust in 2004. Its current private patient income is 25.8% of its total income. The fact that it has a cap does not mean that it goes up to it. In fact, its private patient level has come down slightly. The effect of setting the cap at 10%, as suggested by the right hon. Member for Leigh, would be to take about a fifth out of the income of the Royal Marsden. The Royal Marsden, like Great Ormond Street, is a classic example of how having a thriving private income from research, joint ventures and patients coming from overseas can get a hospital to a place where it can also consistently be recorded as one of the most excellent hospitals in the NHS, where NHS patients get the best care. It has on one hand the highest level of private patient activity—or, strictly speaking, private income—and on the other hand the highest standard of NHS care. The two things are entirely compatible.

[Andy Burnham]

May I just ask the Secretary of State to correct what he has said about the statements that I made? I did not say that I would reduce the Marsden’s cap. I said that we would allow a small increase on the existing cap that is linked to trusts’ own historical levels of private work. It would help the debate if he would be careful to get my position right. I was not talking about an across-the-board, blanket 10% cap, I simply said that some trusts with a much tighter cap of 1% or 2% were asking for a little extra leeway, which I said should be provided. I am not proposing a 10% cap across the board.

[Mr Lansley]

I think I could be forgiven for not understanding what on earth the right hon. Gentleman was talking about, since he did not put it in his motion and my colleagues had to ask him three or four times before they got anything close to an answer—he was saying “10%, or in single figures, we’re not quite sure what it would be”.

We have always been clear that there is an inherent unfairness in some foundation trusts having a cap set at the maximum 31% and others having it set at 1.5%, as all mental health trusts did when they were allowed to become foundation trusts. Technically, all NHS trusts have no cap at all, and some of them use that flexibility. Great Ormond Street, for example, is an NHS trust, not a foundation trust, and it uses that freedom, mainly to treat patients from overseas. Are we to stop that happening? I ask the right hon. Gentleman where he would set the cap for Great Ormond Street. I will give way to him if he will tell me.

[Andy Burnham]

I am not defending the existing policy. The cap was set for each trust individually to reflect historical levels. The reason trusts such as the Marsden and Great Ormond Street have a more generous cap is the large amounts of private work that they carry out. [Interruption.] Yes, but if and when they become foundation trusts under the Secretary of State’s policy, they will have caps reflecting their historical levels of work if he adopts my suggestion. I have proposed that each individual cap be modestly loosened, but he proposes an across-the-board 49% cap applying to all NHS hospitals, effectively meaning that every NHS hospital could devote half their beds to the treatment of private patients. Will he confirm that that is the effect of the policy that he is bringing forward?

[Mr Lansley]

Answer came there none. The truth is, we are doing exactly what the right hon. Gentleman and his party intended to do. At the election, Labour said in its manifesto:

“Foundation Trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values, and provided they generate surpluses that are invested directly into the NHS”.

That is what we are doing.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the hon. Member for Easington (Grahame M. Morris). He and I are both members of the Health Committee and, surprisingly perhaps, we more often find ourselves in agreement about the objectives that we are trying to deliver than is obvious from the nature of the debates across the Floor of the House.

I shall focus my remarks on the speech by the shadow Health Secretary. I have some quite good news for him—he was a far better Secretary of State than he himself appears now to believe. As Secretary of State, he did not allow himself to fall victim to the kind of prejudices that have been ventilated this evening. Tonight, he fell into the old trap of eliding two concepts and pretending that they are the same. The two concepts are, on the one hand, privatising the health service, and on the other, involving the private sector in the improvement of care available to patients. As Secretary of State, he was well able to distinguish between those two concepts and pursued policies of involving the private and voluntary sector when there were opportunities to improve care for patients. He now prefers to forget the fact that during his time as a Minister we not only heard plans for involving the private sector in improving the care delivered to patients but saw an open-minded attempt to bring in the private sector to improve the process of commissioning in the health service. That was what world-class commissioning was designed to deliver. We are now asked to turn our mind away from all those ideas.

I, like my right hon. Friend the Secretary of State, am in favour of tax-funded care for patients. I am in favour of equitable access to high-quality care, like my right hon. Friend the Secretary of State and like the shadow Health Secretary. I am also, however, in favour of plural provision, looking for the best solution for patients and the best value for taxpayers. In that respect, I am, as the shadow Health Secretary used to be but apparently no longer is, a straightforward Blairite. This was the breakthrough that Tony Blair taught the Labour party that it now appears to have forgotten. It was Tony Blair who advocated the introduction of private hospitals into the delivery of care and Tony Blair who stressed the importance of the third sector in finding new ways of improving care for patients, yet it is now my right hon. Friend the Secretary of State who has to pick up the Blairite torch that has been so unceremoniously dropped by the shadow Health Secretary.

It is worth reflecting, is it not, on whether this Blairite consensus is the inevitable consequence of the principle of commissioning—

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Dorrell]

I would be delighted to.

[Andy Burnham]

If the policy that the Secretary of State is pursuing is a continuation of our policy in government, why do the Government need many hundreds of pages of legislation and a new Bill?

[Mr Dorrell]

The right hon. Gentleman is in danger of creating another consensus. Indeed, there is a debate about whether the Bill moves things forward as far as the rhetoric suggests. I am on the record many times saying that the claims made for the Bill by, if I am honest, both the Government and the Opposition spokesmen are grossly overstated. It introduces greater engagement by clinicians in commissioning and greater engagement by local authorities in commissioning through the health and wellbeing boards, and those are good things. I agree, however, with the tone of the right hon. Gentleman’s last intervention: the new world is not quite as far removed from the old as he sometimes likes to suggest and as he suggested in his speech.

Let us focus for a second on what it means to have commissioners in the health service. When the shadow Secretary of State has more time one day, I would like to hear him talk us through the process, which he would, on occasion at least, advocate, of turning down a good idea that is brought to a commissioner to improve care for patients and good value for taxpayers because that idea comes from the private sector. I hold no brief for the private or public sector in the delivery of care; I hold a brief for tax-funded equitable access to higher quality care from whomsoever provides that care. That is what I mean when I say that I am a straightforward Blairite and I look forward to welcoming the shadow Health Secretary back into the fold.

Breast Implants

Andy Burnham Excerpts

Wednesday 11th January 2012 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, I would like to make a statement about PIP breast implants. The House will be aware that approximately 40,000 women in this country have had implants manufactured by the French company Poly Implant Prothese, and that these implants could have been made of a non-medical grade silicone gel. My concern throughout has been for the safety and well-being of all these women. I wish now to update the House on what happened; how we are looking after the women concerned; and the further actions required.

In 1997, PIP received a European CE mark for its silicone breast implants. The CE mark was overseen by the German notified body, TUV Rheinland. The Medicines and Healthcare products Regulatory Agency adverse incident centre received a number of reports annually about PIP implants. Based on such reports, in 2008, the MHRA raised its concerns with the German regulatory authorities and the manufacturer. The MHRA was reassured by the notified body that the number of adverse reports was adequately explained by changes in the company’s reporting practices and by the increasing number of implants sold.

However, in March 2010, the French regulator discovered that rather than using medical grade silicone gel in the implants, PIP had in fact been using unauthorised silicone gel. This is in clear violation of the CE mark. The mark was promptly withdrawn and all EU member states immediately alerted. The MHRA immediately issued advice to stop using PIP breast implants in the UK. The French authorities are currently investigating this as a criminal matter, and the UK Government will help in any way we can with their investigation.

Initial toxicology tests in both France and the UK found no significant health risk to women with the implants. Also the MHRA could find no evidence of an increased risk of cancer. However, on 23 December 2011, following an increase in the number of reported ruptures, the French Ministry of Health announced that it was advising women, as a non-urgent precautionary measure, to consider having their PIP implants removed. The MHRA’s advice was that there was no scientific basis for recommending routine removal of implants in the absence of symptoms.

The available data, however, were incomplete. For this reason, I asked Sir Bruce Keogh, the NHS medical director, to form an expert group and to review the available data, including information from the French authorities, and to offer more definitive advice. I received the group’s interim report on Friday 6 January and a copy has been placed in the Library. I would like to thank the experts and members of the profession for their hard work and commitment in producing this rapid report.

The main findings of the expert group were, first, that there is no causal link between these implants and breast cancer. Secondly, the evidence on the rate of ruptures for PIP implants compared with other implants is incomplete and so this risk cannot be assessed definitively. Thirdly, although the rupture of implants or leakage of material can result in inflammation, there is no clear evidence that these problems are more serious in relation to PIP implants than other implants, or that they result in increased long-term health risks. Therefore, they have not recommended routine removal of the implants. Fourthly, there are risks inherent in the removal of breast implants, just as with any surgery, and these risks should be taken into account when taking any clinical decisions. However, for this particular group of women the risk is very low. Fifthly, the expert group recognises, as we have throughout, that women with PIP implants will be understandably concerned that they did not have the character of implant that they thought they did. The expert group advises, as we have, that we should give every woman an opportunity to secure advice, investigation and remedy.

The women who received the implants did so on the understanding that the implants met the requirements of the CE mark and were safe. That was not the case, and every provider has a responsibility to put things right. Although the majority of women will have received their implants privately, some—such as those who have had reconstructive surgery following mastectomy—will have received PIP implants through the NHS. All those patients will receive the highest possible standard of care. First, they will be contacted to inform them and give them all the relevant information and advice. Women who wish to will be able to speak to their GP or the surgical team that carried out the original implant to get advice on the best way forward for them. If the woman chooses, that could include an examination by imaging. If, when informed by an assessment of clinical need of the risks involved and the impact of any unresolved concerns, a woman decides with her doctor that it is right to do so, the NHS will remove and replace the implants, if the original operation was done by the NHS. Last week the NHS chief executive wrote to the service, and Dame Sally Davies, the chief medical officer, wrote to GPs and relevant health professionals. Copies of those letters are available in the Library.

It is right that those who received their care privately should also receive a similar level of service and reassurance from their care provider. However, I do not think it fair to the taxpayer for the NHS to foot the bill for patients who had their operation privately. Eight private health care companies, including Nuffield Health, Spire Healthcare and BMI, have confirmed that they will follow the same guidelines as those that I have set out for NHS patients. However, I want to be absolutely clear that the NHS will continue to be there to support any woman. If a clinic that implanted PIP implants no longer exists or refuses to remove the breast implants, where that patient is entitled to NHS services, the NHS will, in consultation with their doctor, support the removal of PIP implants in line with the guidance that I have just outlined. Any NHS service in that instance would cover only the removal of the implant, which would not include the replacement of private cosmetic implants. In such cases the Government would pursue private clinics to seek recovery of our costs.

These events highlight the need to ensure the safety of people having cosmetic interventions. It is clear from the information that we have received from the industry that the safety information that it collects and provides to the regulator is of variable quality. Without good data, we have no way of knowing when problems arise. I believe that there are a number of things that we now need to do. First, lessons need to be learned from this case and incorporated into the ongoing review of the EU medical devices directive. I spoke to Commissioner Dalli yesterday, and can confirm that this European work is under way. We also need to understand what happened in this instance in the United Kingdom. A review for that purpose will be led by the Minister for Quality, Earl Howe, with expert advice, and will shortly put its terms of reference in the Library. That review will investigate and report rapidly. The blame for what happened lies with PIP, but the review will enable us to learn lessons to improve future regulatory effectiveness and will feed into the Commission’s review.

In addition, the Care Quality Commission will conduct a swift review of private clinics. That review will look at evidence of compliance, patient safety and clinical quality, and the information and support given to their patients. Where a provider does not meet those requirements, the CQC has a wide range of enforcement powers that it can use to protect the safety of patients. The findings of that review will be published before the end of March.

Looking to wider issues of clinical safety and regulation, I have also asked Sir Bruce Keogh to reconstitute his expert group to look at how the safety of patients considering cosmetic interventions can be better ensured in the future. That will include treatments such as cosmetic surgery and dermal fillers. I expect his review to consider whether cosmetic products and interventions are appropriately regulated and have strong clinical governance; whether patients and consumers can be confident that the people who carry out procedures have the skills to do so; and whether the settings in which such procedures take place are able to ensure the care and welfare of people who use their services. That review will consider issues of governance, data quality, record keeping and surveillance, as well as ensuring that proper information is provided to secure patients’ informed consent.

I expect the review also to include consideration of an outcomes-based register of frequently implanted devices, covering everything from breast implants to heart valves and replacement joints, in order to provide the United Kingdom with a valuable asset for further innovation and safety improvement. There is already considerable clinical support for such a comprehensive register. The Government’s commitment is to provide effective reassurance and remedy for women with these implants, and also to learn the lessons to deliver safety and quality for the future. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the Health Secretary for his statement, and for the steps that he is taking to help the thousands of women who have found themselves in this worrying situation. We welcome much of what he has just announced, including the further reviews that he has commissioned. I assure him that we will support him in his efforts to reach a resolution as quickly as possible for all those people who are affected, but I have to tell him that he has a lot of work to do, and a lot of ground to recover, as his response to date has not helped to build those people’s confidence.

Over the Christmas break, the mixed messages coming from the Government did not go unnoticed. They only added uncertainty in what has been an anxious time for many people. The Health Secretary has gone from downplaying the dangers on 23 December to announcing an urgent review on new year’s eve, then giving an inconclusive statement late last Friday evening. This has left the people affected struggling to make sense of what it means. For the vast majority whose implants were fitted privately, there was precious little practical advice or help from the Department of Health as they began approaching their private providers. Many women were unable to access their records or told that long delays would be involved. Others have been asked to pay large fees to access their records. Many have simply hit a brick wall when they have sought medical advice or removal, even where there is evidence of rupture.

What people needed at the earliest stages was a strong statement from the Government of what was expected of all private providers—namely, that records should be provided without delay and without charge; that consultations should be arranged when people were worried; and that removal should be arranged urgently when there was evidence of rupture. The reality is that the Government’s failure to provide that leadership from the outset has left people fending for themselves in the face of a self-serving and unaccountable industry.

The Health Secretary was right, however, to establish an urgent review of the evidence by the NHS medical director, Professor Sir Bruce Keogh. We welcome the speed with which that review was conducted, and we echo the Health Secretary’s thanks to the members of the review panel. We accept the Government’s judgment on the advice to women regarding the removal of implants on the basis of the data that they have seen, but what confidence can we have in the evidence and data on which those decisions were reached?

We note the Secretary of State’s public comments about the industry’s failure to provide quality information in a timely fashion, and the interim report’s finding that the evidence is subject to “considerable uncertainty”. The review concludes that it should reconvene in “about four weeks time” to examine any new evidence, and to consider whether to update its recommendation on removal. I have to tell the Health Secretary, however, that that feels way too vague and ad hoc. May I press him to give a clearer timetable for this further process of review on whether to change the recommendation on removal? People need absolute clarity on when further statements will be made, so that they can make informed decisions. This is of course a separate matter from the long-term reviews that he has announced today.

This is particularly important in the light of the different decisions that other Governments are beginning to make in response to the situation. Yesterday, the Welsh Government announced that all women who received PIP implants, including those treated privately, will be offered replacement implants on the NHS. That is of course different from what the Health Secretary has announced today. What discussions did he have with his counterpart Minister in the Welsh Assembly Government before their announcement was made? Will he assure the House today that all the data that were available to Welsh Ministers and officials were also available to, and considered by, the Keogh review? Governments around Europe have responded sooner, more decisively and with greater clarity than the coalition has done. By contrast, people here have found the Government’s statements in response to be both inconclusive and ambiguous.

We support the decision to help NHS patients to have PIP implants removed and replaced, but does the Secretary of State appreciate how that decision has added to the confusion that many people feel and was interpreted as contradictory to the review’s overall finding? The clear implication of the Keogh review is that the best course of action is, in fact, to have the implants removed, but again no practical help was offered beyond the statements of expectation for private providers to match the support on offer from the NHS and the reference made to “moral duty”.

I, too, commend the private providers, such as Nuffield, Spire and BMI, that have done the right thing by their patients, but in recent days we have heard how some of the leading cosmetic surgery clinics have simply ignored the Health Secretary’s appeal. Transform, which used PIP implants on over 4,000 patients, has said that all women affected will have to pay £2,800 for removal, while the Harley Medical Group, which has 13,900 patients with PIP implants, has offered to pay for the cost of the new implant, but only if the NHS pays the far greater bill for the surgery. I am sure the whole House will agree that this is an appalling response to this situation, and that the failure of these companies to face up to their duty of care for their patients leaves everybody, including the Government, in a difficult position. It is simply unacceptable for any woman in England to be left in a position where she is worrying about her health and thus has no peace of mind, but is unable to afford to do anything about it.

I appreciate what the Health Secretary has said today about helping people out of this predicament. I agree with his decision where private clinics no longer exist, but in accepting that the NHS will provide private treatment where private providers refuse to, is he not in danger of letting those providers off the hook? May I remind him that most people will not accept that the NHS should subsidise the failures of private companies, and will look to him to pursue them to the nth degree to get any costs back? For instance, has he fully explored the insurance position of these private providers as a means of recovering costs? He says he will pursue them, but what assumptions has the Department of Health made about the likelihood of his success, and how much money is expected to be recovered? Has he fully explored the position of the French Government and considered whether there is any residual liability on the device manufacturer in that company?

Let me turn briefly to questions of regulation. Can we support what the Secretary of State said today about the wider review of regulation of the cosmetic surgery industry? If there are any loopholes, we will support him in closing them down.

Finally, the right hon. Gentleman’s Health and Social Care Bill envisages a much expanded role for the private sector in the delivery of health care. I make no comment about that, but has he reflected on the Bill and revisited the assumptions behind it? Will he assure us that issues of quality and safety will be safeguarded in the NHS that he seeks to create? We want to be assured that he is giving careful consideration to all these issues, as he considers his response to this worrying situation.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Burns]

My right hon. Friend is absolutely right; of course, when he was Secretary of State he did a considerable amount of work to lay the ground rules for the move towards greater integration, because that is the way forward. My right hon. Friend makes a very valid point: it is the way forward and we fully recognise that. We are deeply committed to achieving that aim, and that is why my right hon. Friend the Secretary of State has added an extra £150 million to the existing £300 million, to facilitate progress towards it.

[Andy Burnham (Leigh) (Lab)]

May I tell the Secretary of State and the Minister that he will receive more representations on his Bill later this week from two hospital doctors who, early this morning, began a 160 mile run to protest against his Bill, from Bevan’s statue in Cardiff to his Department? [Interruption.] The Secretary of State should listen. Let me remind him why people are so angry. Nobody voted for the Bill. It was ruled out by the coalition agreement, and it is now the unelected House deciding the future of the NHS, passing amendments that he was too scared to table in this House.

Will the Minister today have the courage to admit that it is now the Government’s intention to allow NHS hospitals to make 49% of their income, effectively devoting half of their beds, from the treatment of private patients?

[Mr Burns]

May I say a happy new year to the right hon. Gentleman as well? I believe that his analysis of the support for the Bill is flawed, because there are a number of areas where a number of organisations warmly welcome its contents. For example, the BMA voted in favour of GP commissioning at its special general meeting last year.

On the question of 49%, the shadow Secretary of State has been uncharacteristically forgetful, because of course he will appreciate that the cap applies only to foundation trusts, not to non-foundation trusts, and that is no different today from what it will be after the modernisation—and it was a policy that his Government brought in.

[Andy Burnham]

No, it was not. That policy would never, ever have come forward under a Labour Government—and I know that the right hon. Gentleman has not denied it. We, the Opposition, will now make it our business to tell every single patient in England about his plans for the NHS. People can finally see the Bill for what it is: a privatisation plan for the NHS. England’s hospitals will never be the same again if the Bill gets through: an explosion of private work; longer waits for NHS patients; profits before patient care. Will not the only choice on offer for patients be the old Tory choice in the NHS: wait longer or pay to go private?

[Mr Burns]

I am afraid that the shadow Secretary of State is just totally wrong. This Government have no intention to and will not privatise the national health service. We want to improve patient outcomes and the patient experience. The right hon. Gentleman should look again at the 49% that he talks about, because we are not changing the situation, particularly because it does not apply to trusts at the moment; it is only for foundation trusts.

[Andy Burnham]

That is garbage.

[Mr Burns]

The right hon. Gentleman says it is garbage. I think that is confusing from him, because I remind him that of course it was in the Labour party manifesto at the last general election to remove the private patient cap.

Life Sciences

Andy Burnham Excerpts

Monday 5th December 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, I would like to make a statement about the strategy for UK life sciences that the Prime Minister is launching this afternoon at a leading life sciences conference. The life sciences industry is one of the most promising areas for growth in the UK economy. It has consistently shown stronger growth than the United Kingdom as a whole, and it accounts for 165,000 UK jobs and totals more than £50 billion in turnover. Pharmaceuticals alone account for more than a quarter of our total industrial research and development spend. Global pharmaceutical sales are predicted to grow by up to 6% a year in the coming years, and in emerging economies medical technology is achieving growth rates of more than 12%. A flourishing life sciences sector is essential if we want to build a more outward-looking, export-driven economy. The partnership between industry, the NHS and our outstanding universities is not just essential to economic growth; it will benefit millions of future and current NHS patients, fuelling the more rapid development of cutting-edge treatments and earlier access to those treatments for NHS patients.

Like many industries, the life sciences industry is undergoing rapid change. The old “big pharma” model of having thousands of highly-paid researchers working on a pipeline of blockbuster drugs is declining. A new model has emerged—one that is more about collaboration, the outsourcing of research and early clinical trials on patients. Excessive regulation can mean that the uptake of new treatments and technology is slow. That is a challenge felt acutely by an industry that sometimes feels that the return is not there quickly enough to satisfy investors. It is felt even more acutely by patients, who understandably expect that they should be able to access the latest and most effective treatments, and that new innovations in care should be adopted rapidly by the NHS.

We have a leading science base, four of the world’s top 10 universities and a national health service that is uniquely capable of understanding population health characteristics, but those strengths alone are not enough to keep pace with what is happening. We must radically change the way we innovate and the way we collaborate.

The life sciences strategy we launch today, alongside the NHS chief executive’s review on innovation, health and wealth, sets out how we will support closer collaboration between the NHS, industry and our universities, driving growth in the economy and improvements in the NHS. All the documents have been placed in the Library.

Among other key measures, we will set up a new programme between the Medical Research Council and the Technology Strategy Board to bring medical discoveries closer to commercialisation and use in the NHS. There are many medical products being developed to treat patients and the cost of developing them is high because they take a long time to develop and test. Investors want to see at least some evidence that the products might work in people and robust validation of the quality of the research and development work being undertaken, as well as of the capability of the company to bring the product to market, before they will finance the development of the products. That means that some of the best medical innovations are not making it through to patients. We are already providing investment to address that, but we believe that we can do more to support the development of these products across funding organisations and the successive stages of product development, which will support the development of promising innovations and help to increase the number of treatments made available to patients. We are therefore introducing a £180 million catalyst fund for the most promising medical treatments.

It can take more than 20 years from the first discovery of a drug until patients can be prescribed it by their doctor and we have already taken steps to address that. Through the National Institute for Health Research, we are investing £800 million in new research centres and two major translational research partnerships that will help cut the time between the development of new treatments and their application in the NHS—from the bench to the bedside.

Now, we are going further. As part of a major drive to improve innovation and access to medicines in the NHS, we are announcing proposals on a new early access scheme that could allow thousands of the most seriously ill patients to access new cutting-edge drugs up to a year earlier than they can now. Through the early access scheme, the medicines regulator, the Medicines and Healthcare products Regulatory Agency, would provide a scientific opinion on the emerging benefits and risks of very promising new drugs to treat patients with life-threatening or debilitating conditions for whom there are no satisfactory treatment options. That will mean that seriously ill patients of any age who have no other hope of being treated or having their life extended could benefit from drugs more quickly, around a year before they are licensed.

We must also ensure that we make better use of our unique NHS data capability. It is often said that the NHS is data-rich but information-poor. As a national health service, it contains more data about health than any other comparable health system in the world, but neither the NHS nor scientists developing new drugs and treatments have always been able consistently to make good use of the data or to use them to drive further scientific breakthroughs.

We have seen how powerful the release of data can be. For example, South London and Maudsley NHS Trust and the Institute of Psychiatry now have access to a database covering 250,000 patients. It includes their brain scans, medical records and notes—a wealth of information, all consented to and all anonymised, that is helping them find new answers in the fight against dementia.

We need powerful data-handling capacity and the skills to write the software to mine them. That is why we are investing in e-infrastructure, which will provide secure data services to researchers. The clinical practice research datalink is being introduced by the MHRA in partnership with the NIHR and will provide a specialised service to the research and life sciences communities. Let me reassure the House that we will take all necessary steps to ensure safeguards for patient confidentiality.

We will also make sure that more UK patients get the opportunity to take part in national and international clinical trials and play a much greater role in the development of cutting-edge treatments. We believe that patients should have the right to access new treatments and be involved in research to develop new medicines.

We have responded to calls from research charities and clinicians for Government to get patients more involved in supporting research. A recent Ipsos MORI poll in June found that 97% of people believed it is important that the NHS should support research into new treatments and, in addition, 72% would like to be offered opportunities to be involved in research trials. We will therefore consult on changing the NHS constitution so that there is an assumption, with the ability to opt out, that data collected during a patient’s care by the NHS may be used for approved research.

That would make it clear that researchers and companies with new and potentially life-saving medicines could access the data of patients and could approach patients whom they feel could benefit in order to discuss their involvement in research studies. This would encourage growth in the life sciences industry as more people and more detailed data would be available for the important trials and research needed to get breakthrough treatments used more widely.

Additionally, we have set out actions to improve incentives for investment in innovation and to reduce regulatory bureaucracy. With the creation of the Health Research Authority, we will streamline regulation and improve the cost-effectiveness of clinical trials. As the NHS chief executive’s review of innovation has shown, the NHS needs to be quicker and smarter in adopting new technologies and approaches to care that can both save more lives and cut costs.

Sometimes, it is a question of evidence. Until recently, we could not say with certainty that telehealth could keep people out of hospital and save lives, and there was understandable reluctance among parts of the NHS and councils to invest in untried technology. However, as early results from the whole system demonstrator pilots show, the potential of telehealth is nothing short of remarkable, with dramatic reductions in mortality, in hospital admissions, in emergency visits and in the number of hospital bed days. To make the most of this, we will support the NHS and work in partnership with industry and councils dramatically to spread the use of telehealth over the next five years. In doing so, we are looking to transform the lives of 3 million people in this country.

We will become a global leader in the management of chronic and long-term conditions, generating massive opportunities for UK companies developing this technology. It will be innovation in practice and we will foster other proven innovations such as fluid management technology techniques that were developed for use in high-risk surgery and critical care to help clinicians administer fluids and drugs safely. In March 2011, the National Institute for Health and Clinical Excellence published guidance recommending that this technology should be used for patients undergoing major or high-risk surgery. Currently, it is used for fewer than 5% of applicable patients despite evidence showing that it could benefit 800,000 patients and save the NHS £400 million. We will launch a national drive to make sure that fluid management technology is used in appropriate settings across the NHS. That is one example of many.

The innovation review sets out how we will address all the barriers to innovation in the NHS, whether they involve culture, leadership, training, use of information or lack of incentives and investment. We will also introduce a NICE compliance regime that will mean that medicines approved by NICE will be available on the NHS much more quickly. The plans set out in today’s strategies will help to drive the development of new technologies to diagnose and treat the most complex diseases in this country for the benefit of NHS patients. This is a strong package of measures that will support economic growth and innovation in the NHS and will drive significant improvements in patient care. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

May I thank the right hon. Gentleman for his statement and start by setting out two points of common ground with the Government? First, we too have pride in Britain’s life sciences industry and its strength. We agree that the industry needs Government support and focus if its potential to contribute to the country’s industrial future is to be maximised. Secondly, we agree that there are huge potential benefits to British patients from closer collaboration between the NHS and the industry. We all want patients to have the quickest possible access to the latest life-saving and life-enhancing treatments.

It was for those two principal reasons that Labour, when in government, prioritised the life sciences sector and established the Office for Life Sciences. In Lord Drayson, we created a life sciences Minister who was a contact point for the industry—someone of huge experience and with real personal commitment to the industry. One of our criticisms of this Government is that they have allowed the momentum that Labour had established in promoting the industry to fall away. Progress has stalled because of the Government’s failure to understand that economic growth needs a proper partnership between the public and private sector and because of the combined effect of a number of their policies. Such policies include: damaging 15% real-terms cuts to the science budget; the loss of the regional developments agencies, many of which were heavily involved in this area; cuts to regional investment; and the destabilising effect of the unnecessary reorganisation of the NHS, particularly the disintegration of the strategic health authorities, which played a role in promoting research. The unexpected closure of Pfizer earlier this year exposed a Government asleep at the wheel and was a wake-up call, and now we see a Government playing catch-up.

Although we welcome their belated recognition of the importance of the sector, there are sensitive issues involved and Ministers need to tread carefully so as not to undermine public trust. What they are fond of calling red tape are, to others, essential safeguards. Some areas will always need proper regulation and the use of patient data is most certainly one of them. As we have heard from patients groups today, some have been caused real anxiety by this media-briefed statement from the Government and the lack of accompanying detail.

Ministers need to be aware that people with terminal illnesses and long-term conditions will react differently from others to a statement of this kind, so for them we seek direct assurances today from the Secretary of State that he failed to give in his statement. Will all patients have the ability to opt out of the sharing of their data, even in anonymised form? Surely that fundamental principle of consent should form the bedrock of any new system, and that control of data should be possible in today’s information age. If the Secretary of State cannot give that assurance, why not? How can he justify that?

Did patients’ representatives walk away from the Department of Health working group on these important matters and, if so, why? One representative said on the radio this morning that the whole process “stinks”. Does the Secretary of State not accept that he and his Department will need to do better than this to uphold public confidence in the process or risk undermining trust in the whole principle? What safeguards will there be to ensure that patient data are stored securely? Does he not need to articulate a more positive statement of patients’ rights in this important area, rather than the loose opt-out he proposes in the NHS constitution?

Is it the case that the anonymity of data cannot always be guaranteed? If so, what are those circumstances and, again, why not? Even within anonymised datasets, particularly dealing with small numbers of very specific conditions, it is possible to identify individual patients. What steps are being taken to guard against those risks? Will the Secretary of State give a categorical assurance that data cannot be used for purposes other than research—passed on to third parties or used by the same company to target people for other products and services?

Today’s announcement also needs to be considered in the context of the Government’s reorganisation of the NHS. Does not a more market-based health system with a greater number of private providers create much greater challenges for the control of data? I had many dealings with senior figures in the pharmaceutical industry in my time as a Minister. They were clear that it was the national structure of the NHS, and the ability to collaborate and share information across a whole health system, that was a huge attraction to the industry and a competitive strength for this country.

Does not the Secretary of State’s Health and Social Care Bill risk turning the NHS into a competitive market, where collaboration is discouraged in an any-qualified-provider free-for-all? So how can he guarantee that that competitive strength will be there in the future and will continue to be used by the pharmaceutical industry? Although he will not admit it today, were not many of the measures he has announced, particularly the expansion of telecare, made possible by the steps that we took to invest and modernise NHS IT?

More broadly, this announcement raises questions about the Government’s policy on the involvement of the private sector in the NHS. The Government need to set out what, if any, limit they see on the involvement of the private sector in the NHS. The Prime Minister has said that he wants the NHS to be a fantastic business. Let me quote from a recent leaked document on NHS commissioning, “Towards Service Excellence”. It says:

“The NHS sector . . . needs to make the transition from statutory function to freestanding enterprise.”

It is no wonder that, on the back of these worrying words, the British Medical Association has adopted a position of outright opposition to the Secretary of State’s Bill. Our worry is that, in their desperation to develop a credible industrial strategy, Ministers seem ready to put large chunks of the NHS up for sale.

Patient data are not the Secretary of State’s to give away. The NHS is not his to sell. The truth is that the Government are running huge risks with patient confidentiality and patient safety by opening up the NHS to the private sector and reorganising at a time of financial stress, but we do not yet know the full scale of those risks.

[Mr Speaker]

Order. I am pretty sure that the shadow Secretary of State is on his last sentence, which is almost certainly a short one.

[Andy Burnham]

It is.

The great irony is this: while Ministers are happy to offer up other people’s data, they continue to withhold the NHS risk register, which shows the risk they are running with our NHS. Is that not why people are increasingly asking what the Secretary of State has to hide?

[Mr Lansley]

I am afraid that the last sentence was not really worth it, Mr Speaker. The right hon. Gentleman, while talking about things that were completely irrelevant to my statement, asked a number of questions. Will patients be able to opt out? Yes. It is clear that they will be able to opt out, as I have said. Are there risks relating to a small number of patients being identified? No. As he should know, and as has been done in relation to the general practice research database, where there are small populations of patients in which it might be possible to indentify individuals, or where a small number of patients have very specific sub-sets of conditions and there is a risk of identification, it is perfectly possible to ensure that that information cannot be accessed through the database. We have made it clear that data would be not only anonymised—in fact, it would be double anonymised—in order to ensure that it cannot be recreated, but viewed in such a way that will make it impossible to identify from the circumstances of the data where the patient comes from.

The right hon. Gentleman asked whether the database must be used for approved research or could be used for other purposes. It must be used for approved research and cannot be used for other purposes. It is not a database that people, whoever they may be, whether from universities or pharmaceutical research companies, can simply access in order to go mining for information; they must do so only through the MHRA and for approved research purposes.

Finally, the right hon. Gentleman asked—frankly, I think it is irrelevant—about the extent of the private sector’s role. Unlike his predecessor, Patricia Hewitt, who was Secretary of State when he was a Health Minister, and who said that she was aiming for 10% or 15% private sector involvement, we are not looking for a specific level of private sector involvement or creating a free market in the NHS. It will continue to be a national health service with the national characteristics that we would expect, funded through taxation and available to all based on need, not ability to pay, and in this context it will continue to be a national NHS. The simple fact that, among other measures in the life sciences strategy, we are able to show how we can bring data sets together, including the general practice database, the hospital episodes statistics, the cancer registries and so on, in order to show the power of data across the whole NHS to support research for new treatments is a complete vindication of the fact that it will be a national health service—that it will change in that respect and that patients will benefit from both the national health service and the research that comes with it.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Burns]

If the hon. Gentleman had read it, he would know that the important aspect—[Interruption.] He says that he cannot read it, but if he listens for a minute, he will hear that the important parts that are relevant to the Health and Social Care Bill were published in January and September this year in the impact assessment for the Bill.

[Andy Burnham (Leigh) (Lab)]

May I first commend the Health Secretary on his ingenious new approach to cutting delayed discharges? If his appearance on continuous loop on hospital TV does not cut length of stay, I do not know what will. One area where he has been noticeably less forthcoming is on the recent ruling by the Information Commissioner, which could not be clearer: Parliament and the public have the right to know what extra risks and threats his Department expects the NHS to face as a result of this top-down reorganisation. Let us give him one more chance to give us a clear commitment: will he live up to the Prime Minister’s words on transparency and openness and publish the report in full without delay?

[Mr Burns]

The right hon. Gentleman may not have been listening to the response I gave to his hon. Friend, which was that the relevant aspects of the risk assessment have been incorporated into the impact assessments published in January and September. [Interruption.] Before he, too, gets too pious, may I remind him that it was he himself who, in September 2009, blocked the publication of his Department’s risk assessment?

[Andy Burnham]

I would happily have paid £5 to opt out of that particular pre-scripted loop message. Unlike the Minister and his fellow Front Benchers, I was not subject to a ruling from the Information Commissioner. People watching this today will be left wondering what he and the Secretary of State are so desperate to hide. He can hide the report, but he cannot hide the growing warning signs we are seeing in our NHS: waiting lists up, delayed discharges up, and nurses made redundant. The truth is that he has placed the NHS in the danger zone, with a destabilising and demoralising reorganisation when it most needed stability. He says he wants feedback, so why does he not listen to patients and staff, put the NHS first and drop his dangerous Bill?

[Mr Burns]

It is marvellous how the right hon. Gentleman repeats his soundbite every time he discusses the NHS. I have to tell him that he is wrong. He knows that the NHS has to evolve. He knows that we have to improve and enhance patient care. I think he does himself a disservice by simply joining the ranks of organisations such as 38 Degrees, which is frightening people and getting them, almost zombie-like, to send in e-mails.

National Health Service

Andy Burnham Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House recalls that the Prime Minister made a series of personal pledges on the NHS in the run up to the General Election which were carried over to the Coalition Agreement; believes it is now clear he has failed to honour three of the headline commitments in the Coalition Agreement; notes firstly that Treasury figures from July 2011 confirm that NHS spending fell in real terms in 2010-11, contrary to the guarantee that health spending will increase in real terms in each year of the Parliament; notes secondly recent central approval of changes to hospital services, in breach of a moratorium on such changes; notes thirdly the Prime Minister’s continuation, despite widespread opposition, with the Health and Social Care Bill, contrary to the pledge in the Coalition Agreement to stop top-down reorganisations of the NHS; believes there is mounting evidence that the combination of an unprecedented financial challenge combined with the biggest reorganisation in the history of the NHS is damaging patient care and leading to longer waiting times; is concerned that huge cuts to adult social care in England will further limit hospitals’ ability to cope with coming winter pressures; and calls on the Government to listen to GPs and NHS staff, drop the Bill and accept the offer of cross-party talks on reforming NHS commissioning.

We read today that the Government were in open retreat last night on their Health and Social Care Bill in the House of Lords. Given that, we thought it only right to bring the Secretary of State here today to be held to account by this elected House. He tried to shuffle off his responsibilities and dug in when the Bill was in this place, only to give in down there. That came just hours after he had to confirm that he would still take oral questions in this House, despite a claim to the contrary by his preferred candidate to take over the running of the NHS. The Secretary of State may be on the run, but we will not let him hide. Our NHS is too precious to too many people in this country to be carved up in dodgy coalition deals in the unelected House. His Bill is unravelling before his eyes, and coalition health policy is in chaos. Today, we hold him to account for that.

To be fair to the right hon. Gentleman, the responsibility is not all his. It goes right up to the door of No. 10 Downing street. People will remember only too well, in the run-up to the general election, the then Leader of the Opposition’s ostentatious shows of affection for the NHS, his airbrushed face on the posters and three very personal promises—real-terms increases in every year of this Parliament, no accident and emergency or maternity closures, and no top-down reorganisation of the NHS. He protested his love for the NHS, and at photo call after photo call on the wards he routinely wore his heart on his sleeve. As we now know, he was protesting a little too much, and today we expose the hollowness of his promises.

[Tracey Crouch (Chatham and Aylesford) (Con)]

May I take this opportunity to congratulate the right hon. Gentleman on his new post? He is back where he once was, but on the other side of the House.

Last year, in The Guardian, the right hon. Gentleman stated that it was

“irresponsible to increase NHS spending in real terms”.

Does he still stand by that statement?

--- Later in debate ---

[Andy Burnham]

I am not sure whether I should thank the hon. Lady for reminding me that I am now a shadow of my former self, but I thank her for her words. I will come to the precise question that she asks. I did indeed say those words, and I will explain why in a moment.

I was talking about the three headline promises that the Prime Minister made on the wards. They were part of a calculated and self-serving political strategy to detoxify the Tory brand, not a genuine concern for the NHS. It was cynical because, as we will show today, those were cheques for the NHS that the Tories knew they could not cash, and promises that they had no real intention of keeping. Let us take the Prime Minister’s three personal promises in turn, starting with the one on NHS funding. It will be good to get to the bottom of that once and for all.

At the last election, Labour promised to guarantee to maintain NHS front-line funding in real terms. The now Prime Minister, by contrast, offered real-terms increases. How big those increases would be was undefined, but that did not matter. The important thing was that, according to the requirements of the detoxification strategy, it sounded as though the Tories were planning to spend more.

I remember well our resulting exchanges with the then shadow Health Secretary, now the Heath Secretary, on the hustings. Indeed, the Prime Minister has in recent weeks been quoting what I said then, as the hon. Member for Chatham and Aylesford (Tracey Crouch) did a moment ago. I did indeed say that it was cynical and irresponsible to make those promises, and I repeat that today.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Does the right hon. Gentleman consider “protecting the front line” to be the closure of many hospitals throughout the UK, mergers and the loss of vital cardiac services in such places as Ipswich? That was exactly what happened when he was Secretary of State.

[Andy Burnham]

The hon. Gentleman goes right to the heart of my speech today. We made those difficult decisions to get the NHS ready for the future. We grasped the nettle and took services out of hospitals and moved them into the community, because that is what has to happen if we are to have an NHS that is sustainable for the future. He stood on an election manifesto that promised the opposite. It was a dishonest pledge, and I will come to it in a moment.

I said a moment ago that it was irresponsible to promise real-terms increases. I say that because I completed a spending review of the NHS in March 2010 and knew the figures inside out. I had also been in detailed discussions with the Treasury on the funding of adult social care, in preparation for a White Paper. The implication of what the Conservatives featured on an election poster—cutting the deficit on an accelerated timetable while giving the NHS real-terms increases—could mean only one thing: unpalatable cuts to other public services, particularly adult social care, on which the NHS relies.

Despite that, the election pledge was carried over into the coalition agreement, which could not be clearer. It states:

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

A year ago, at the time of the comprehensive spending review, the official figures claimed that that had been delivered, with a 0.1% settlement—essentially the same as Labour promised at the election.

[Mark Simmonds (Boston and Skegness) (Con)]

Does the right hon. Gentleman recall that before the general election, when he was Secretary of State, he said in the now infamous King’s Fund speech that the state should always be the preferred provider, irrespective of the quality of care that it provided to patients? Does he stand by that statement today, or is he now trying to drive a patient-centric health service rather than putting political ideology above patient care?

[Andy Burnham]

I think I should refer the hon. Gentleman back to the King’s Fund speech, because I did not say the NHS should be the preferred provider regardless of the quality of care it provided. I believe that the public NHS should have the first chance to change, and that was the preferred provider policy. We did not want to pull the rug from under the public NHS with a policy of “any willing provider”. If the NHS needed to change, we wanted to tell it, “You have to rise to the challenge, and you have a chance to do so. If you cannot, other providers will get a chance to come in.” That was the preferred provider policy, and I would be grateful if he did not misrepresent it.

As I said, a year ago the Government provided a 0.1% increase—or that was the headline, but the fine print began to emerge and their case began to fall apart from day one. It soon became clear that for the years 2011-12 to 2014-15, that figure included an annual £1 billion transfer to local government, ostensibly for social care but not ring-fenced, so councils would be free to spend it as they saw fit. The health funding settlement therefore already went below a real-terms increase. That transfer turned the apparently minuscule real-terms increase into a real-terms cut.

That still leaves 2010-11. When the coalition came into government, it immediately required primary care trusts to cut spending by increasing waiting times and restricting access to treatment, to generate an underspend in 2010-11.

[The Secretary of State for Health (Mr Andrew Lansley)]

indicated dissent.

[The Minister of State, Department of Health (Paul Burstow)]

indicated dissent.

[Andy Burnham]

Ministers are shaking their heads, but I will read them the Treasury figures published in July this year, and let them tell me then that what I have just said is not true. The public expenditure statistical analyses from this year provide official confirmation of what I have just said. They show that in 2009-10 health spending was £102,751 million. That was in the last year of the Labour Government. In 2010-11, health spending was £101,985 million. There we have it in black and white—the first real-terms cut in health spending for 14 years. In fact, it is the first real-terms cut since the last year of the last Tory Government in 1996-97.

[Henry Smith (Crawley) (Con)]

I am interested to hear how the right hon. Gentleman is trying to manipulate those figures. How does he reconcile what he is saying with what his party’s Administration is doing in Wales, where the health service has been cut and hospital infections and waiting times have risen?

[Andy Burnham]

The hon. Gentleman uses the word “manipulate”. May I say that I take great exception to that? I have read out the Treasury statistical analysis from this July. If he is telling me that I have misrepresented it, let him stand up again now and say so. If not, he should hold his peace. I remind him that his party’s Government delivered a much deeper cut to Wales than to Scotland or Northern Ireland. The Labour Administration are now dealing with the consequences of that.

[Ben Gummer (Ipswich) (Con)]

The right hon. Gentleman’s figures depended on the lack of what he called a ring fence in the social care transfer of £1 billion. I can assure him that as far as Suffolk is concerned, there is absolutely no problem in trying to deal with the ring fence. In fact, the county council spends more than the amount that was previously ring-fenced, because of the pressure on social care.

[Andy Burnham]

The hon. Gentleman was not listening. The social care transfer comes in for the years 2011-12 to 2014-15, but I was talking about the year 2010-11 and, in the year ended, there was a real-terms cut to the NHS, as confirmed by Treasury figures. This debate is about that fact. He and his hon. Friends stood at the election, with those airbrushed posters all around them, promising that they would not cut the NHS, but in their first year in office, they delivered a real-terms cut to the NHS.

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

Is it not the case that, whatever Government Members say, 82% of councils offer social care only in critical and substantial cases, that thousands of people up and down the country are suffering the loss of their services, and that that will have a real hit on the NHS in years to come?

[Andy Burnham]

My hon. Friend makes a very important point. That was precisely why I said it was irresponsible for the Conservatives to promise increases to the NHS in the way that they did, on a much-reduced public spending envelope. That has led to precisely the consequences that she describes. Indeed, that hidden cut to adult social care has been quantified at £2 billion.

I remember well Conservative party claims before the election about death taxes, but what about the dementia taxes that the Conservatives have loaded on to vulnerable older people up and down this country, who are now paying more out of their own pockets to pay for the care that they desperately need? That is the effect of cutting adult social care and cutting council budgets in that way.

We today the nail the position once and for all. The real position is worse than the one I described because of spiralling inflation, which in effect means even deeper real-terms cuts for the NHS this year and in all the years that follow.

[Chris Skidmore (Kingswood) (Con)]

The right hon. Gentleman mentions that the £2 billion transfer from the NHS social care budget is not ring-fenced, but I am sure he is aware that ring-fencing can have the perverse effect of ensuring that local authorities do not spend existing budgets. Will he clarify his position? Is ring-fencing a good idea or not?

[Andy Burnham]

I disagree with the hon. Gentleman. I said that it was irresponsible to pledge the money for the health service in the way that the then Opposition did in the run-up to the election precisely because I realised that more would be needed for adult social care. However, if the NHS is to transfer money to local government for adult social care, we must be certain that it will pay for that and not for weekly bin collections or for whatever else he thinks is more important than supporting older, vulnerable people with the costs of care. He makes my point that that money should have been ring-fenced, so that adult social care could have been protected.

[Chris Skidmore]

indicated assent.

[Andy Burnham]

The hon. Gentleman nods, but I am afraid that that was not the Secretary of State’s policy.

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

I compliment my right hon. Friend on how he is moving the motion. What are his views on the impact of the reduction of funding for the NHS on the front line, and on the number of hospital trusts that are breaching the 18-week target?

[Andy Burnham]

I am grateful to my hon. Friend for those words and I shall come to precisely that point, but let us be clear about this one: the Prime Minister promised a real-terms increase, but he has delivered a real-terms cut. He stands at the Dispatch Box week after week boasting about increasing health funding when he has not. All the while, NHS staff deal with the reality on the ground of his NHS cuts. Does he not realise how hopelessly out of touch he sounds? Hospitals everywhere are making severe cuts to services, closing wards, reducing A and E hours and closing overnight, making nurses redundant, and cutting training places. Last week, The Guardian revealed the random rationing that is taking place across the country. There are cuts to pay for management services, one third of neo-natal units are reducing the number of nurses, and midwife places are being cut despite the Prime Minister’s promise to recruit 3,000 more.

[Dr Poulter]

The right hon. Gentleman is making a great deal out of cuts. The Government have committed an extra £15 billion to the NHS over the lifetime of this Parliament, but the Opposition have consistently failed to agree to commit to any additional funding. Will he make that commitment now?

[Andy Burnham]

A moment ago, the hon. Gentleman acknowledged that I protected the NHS front line as Health Secretary. As Health Secretary, I would not have introduced a £2.5 billion reorganisation when the NHS is facing severe financial stress.

[Dr Thérèse Coffey (Suffolk Coastal) (Con)]

Is it fair to say that under his leadership of the NHS, Monitor suggested that it needed to make efficiency savings? Those are coming through now, but the right hon. Gentleman is trying to present them as cuts to front-line services.

--- Later in debate ---

[Andy Burnham]

No. Let me explain the position to the hon. Lady so that she understands it. It is correct that in the previous Parliament, not Monitor, but the chief executive of the NHS, suggested that the NHS would have to make around £20 billion of efficiency savings over the four years of this Parliament. That is called the Nicholson challenge, which I accepted. However, contrary to what the Prime Minister said at the Dispatch Box last week, it was intended that every penny of that money would go back into the NHS to help it to deal with the pressures that it faces. I am afraid that the Government are again misrepresenting my position.

My position is different from the Secretary of State’s because that challenge, on its own, would have been all-consuming for the NHS, meaning that it would have had to focus every ounce of its energy on rising to that challenge. The last thing in the world that the NHS needs is a huge reorganisation, because it will take its eye off the ball, meaning that it cannot rise to that challenge.

[Paul Farrelly (Newcastle-under-Lyme) (Lab)]

Is my right hon. Friend aware that during the so-called “pause for thought”, nothing was done to stop the NHS reorganising ahead of legislation that was yet to go through Parliament? Was that not contemptuous of both Parliament and of the genuinely held concerns of Liberal Democrat coalition partners?

[Andy Burnham]

Frankly, it is disgraceful that primary care trusts were allowed to disintegrate before Parliament had given its consent to those changes, leaving the NHS in limbo in most communities represented in the House. I have said that the Government have put the NHS in the danger zone, and I mean it. There is no capacity on the ground to help the NHS through these difficult times. It has lost the grip it would have needed to take us through the financial challenge, and I lay that charge directly at the Secretary of State’s door.

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

Will my right hon. Friend give way?

[Andy Burnham]

I will give way in a moment.

I mentioned that the Prime Minister is out of touch, and that he promised to recruit 3,000 more midwives and then handed out redundancy notices to them. However, if the Prime Minister is out of touch, I worry that the Secretary of State is in outright denial. On 11 October, when my hon. Friend the Member for West Lancashire (Rosie Cooper) asked him about the practice of hospitals re-grading or down-banding nursing posts to cut their costs, he replied:

“I am not aware—my colleagues may be—of…trusts…seeking to manage their costs by the downgrading of existing staff. If you are aware of that, then, by all means, tell us, but I was not aware.”

The very next day, that version of events was directly contradicted by Janet Davies of the Royal College of Nursing, who said that

“the Royal College of Nursing has raised the issue of downbanding with the Secretary of State on a number of occasions, alongside other concerns such as recruitment freezes and redundancies in the NHS…Our members’ survey released earlier this month also revealed that 7% of nurses expect to be downbanded in the next 12 months”.

If the Secretary of State would like to correct the evidence that he gave to the Select Committee on Health and confirm that he was aware of the practice of down-banding, he can be my guest right now.

[Mr Lansley]

I am grateful to the right hon. Gentleman. I do not change a word of what I told the Health Committee—it was entirely accurate. I have checked the records, and at no stage had the RCN raised that issue with me.

[Andy Burnham]

The Secretary of State directly contradicts, on the record, a spokesperson from the Royal College of Nursing. If he stands by his evidence, will he publish the minutes of his meetings with the RCN in which it states that the issue of down-banding was specifically discussed?

[Mr Lansley]

Will the right hon. Gentleman give way?

[Andy Burnham]

When I am ready.

Will the Secretary of State promise today to publish those minutes?

[Mr Lansley]

Yes, I shall publish the minutes of those meetings, but I resent the implication from the right hon. Gentleman that I would stand at this Dispatch Box or sit before a Select Committee and say anything other than what I believed to be the complete truth.

[Andy Burnham]

If that is the case, I respectfully ask the Health Secretary why he has not responded to a letter from my hon. Friend the Member for West Lancashire—

[Rosie Cooper (West Lancashire) (Lab)]

indicated assent.

[Andy Burnham]

My hon. Friend is nodding. Why has the Secretary of State not responded to the letter that my hon. Friend sent to him several weeks ago pointing out the discrepancy between his evidence and the statements from the RCN? If he wants to adopt a pious tone in the House, he needs to reply to his letters on time and put his facts on the record.

[Mr Lansley]

Will the right hon. Gentleman give way again?

[Andy Burnham]

Is the right hon. Gentleman telling or asking? [Interruption.] I give way to the right hon. Gentleman.

[Mr Lansley]

If the right hon. Gentleman is going to insult me, he ought at least to give way. I have seen no letter from the hon. Member for West Lancashire (Rosie Cooper). I have seen a letter from the Chairman of the Health Select Committee, to which I approved an answer.

[Andy Burnham]

Well, that is no good to me. We have not seen that answer. The right hon. Gentleman needs to reply to hon. Members’ correspondence in a timely fashion, especially when it relates to serious issues about discrepancies between his evidence and statements made by the RCN.

--- Later in debate ---

[Mr Speaker]

Order. We must preserve the proper parliamentary terms. Nobody has written to me and I have not made a severe error. We will leave it at that.

[Andy Burnham]

It is clear that we will get to the bottom of this, because the Secretary of State has committed to publishing the minutes, and if he is suggesting that the RCN has been inaccurate, he needs to produce the evidence.

That takes me to the Prime Minister’s second personal promise on the NHS, which deals with hospital reconfiguration and the mythical moratorium.

[Tony Baldry (Banbury) (Con)]

rose—

[Andy Burnham]

I shall give way in a moment.

If we thought that the Conservative party’s promises on funding were bad enough, the sheer audacity of its claims on hospital closures is breathtaking. Before the last election, the right hon. Gentleman toured the country promising the earth to every Conservative candidate he met. I recall seeing his commitments—I have them here—pile up in the Ashcroft-funded glossy leaflets that landed on my desk in the Department of Health. He said that he would reopen the accident and emergency department in Burnley; he said that he would save and A and E in Hartlepool, but, scandalously, only if the town elected a Conservative MP; and I well remember the day he visited his hon. Friend—although, after this week, I doubt that the Government Front Bench team still consider him a friend—the hon. Member for Bury North (Mr Nuttall) and promised the people of Bury in the leaflets I have here:

“Vote Conservative and if there is a Conservative government the maternity department will be kept open.”

It could not be clearer. However, the maternity department at Fairfield hospital is scheduled to close next March. It is disgraceful. However, the Prime Minister’s most shameful politicking came in north London. I lost count of the number of times he promised to save the A and E department at Chase Farm hospital.

[Chris Skidmore]

On a point of order, Mr Speaker. Is it in order for the right hon. Gentleman to name my hon. Friend the Member for Bury North (Mr Nuttall) without telling him?

[Mr Speaker]

Yes, it is.

[Andy Burnham]

I point out to the hon. Gentleman, with his clever point of order, that I did contact the office of the hon. Member for Bury North and, indeed, the hon. Member for Enfield North (Nick de Bois).

[Mr Speaker]

Order. I am grateful to the right hon. Gentleman for that clarification, but perhaps this is an opportunity for me to make the position clear. I am not cavilling at the hon. Member for Kingswood (Chris Skidmore), but the position is basically this: if a Member is going to impugn the integrity or attack the record of an individual hon. Member, the Member who is the subject of the criticism should be notified in advance. The fact that someone simply intends to refer to another Member and something that may or may not have happened in his constituency during an election campaign, or at any other time, is not something of which prior notification is required.

[Andy Burnham]

After that rude interruption from the hon. Member for Kingswood (Chris Skidmore), I shall get back to my script.

Just days after the election, the Prime Minister went to Chase Farm hospital, with the Secretary of State, to announce the coalition’s new policy of the moratorium and the following commitment in the coalition agreement:

“We will stop the centrally dictated closure of A&E and maternity wards.”

I have with me the photograph from that very visit of the Secretary of State holding up a placard stating his opposition to any changes to the A and E at Chase Farm hospital. However, he has recently failed to prevent those changes to the A and E department and maternity unit at Chase Farm hospital, leaving the new hon. Member for Enfield North writing a desperate letter to the Prime Minister stating that his constituents had been utterly let down by them both. I do not know whether the Prime Minister or the Secretary of State have the decency to feel embarrassed today, hearing these cynical promises repeated in the House. The proposed moratorium and opposition to closures were purely political and designed to help the Conservatives win votes in marginal seats. That is a fact.

[Tony Baldry]

I apologise for not having intervened quickly enough earlier, but the right hon. Gentleman says that he accepts the Nicholson challenge. Given that efficiency savings will have to be made in the NHS, where does he envisage those savings being made? It seems to me that every hospital trust will have to make efficiency savings somewhere, as a result of the Nicholson challenge.

[Andy Burnham]

The hon. Gentleman asks a very fair question. It is precisely such issues—about how to produce the savings—that are the important issues. Care has to be taken out of the hospital setting and we have to prevent too many elderly people, in particular, from going into hospital in the first place if we are to create an NHS that is able to face the future and that is financially and structurally sound. That is why I take such exception to the naked opportunism that we saw before the election, when I, as Health Secretary, was taking on some of those difficult challenges and grasping the nettle, including in my own backyard in Greater Manchester, where there was a difficult review of maternity and children services, involving the closure of four maternity units and shrinking their number to eight. We did that, we took on that debate, and yet the now Health Secretary was touring those marginal constituencies in Greater Manchester, saying that he would overturn our decision in office, but he has not done it. That is precisely the point that I am making to the House. We need a Health Secretary prepared to take those difficult decisions, if the NHS is to be able to make the savings that will sustain it in the long term.

[Joan Ruddock]

I am grateful to my right hon. Friend for giving way, because like the hon. Member for Banbury (Tony Baldry), I missed the opportunity to intervene when efficiency savings were being discussed. Does my right hon. Friend agree that the key to this problem is proper discussion with the experts within the health service—with the nurses, doctors and all the people who administer our fantastic service? They are the ones who can give us ideas for efficiency savings. The hallmark of the Government is their failure to listen to the professionals.

[Andy Burnham]

My right hon. Friend makes an important point. When we were in government, we said that there had to be a clinical case for change, if changes to hospital services were to be made. I mentioned Greater Manchester a moment ago. There was a clinical case to support those reforms. The experts, to which she rightly pointed, said that about 50 babies’ lives would be saved every year by specialising care in fewer locations. In such circumstances, politicians have a moral obligation to listen to those experts and to make changes, no matter how politically difficult they are. That is why I say that it was sheer opportunism of the worst kind for the Government, when in opposition, to say that they would have a moratorium on any changes and to tour those marginal constituencies promising to overturn decisions, when in fact they had no intention of doing so. I put it to the House that the people of Bury, Burnley and Enfield have now clearly discovered what opportunism there is from those on the Conservative Front Bench.

[Sarah Newton (Truro and Falmouth) (Con)]

Does the right hon. Gentleman therefore welcome one of the Government’s first actions, which was to change the NHS operating guidelines for reconfigurations to ensure categorically that clinicians and the communities they serve were in the driving seat for future reconfiguration of the NHS?

[Andy Burnham]

If that is the case and the people of Enfield are in control of the decision, would Chase Farm A and E be closing? What the hon. Lady describes is a complete and utter reinvention of the moratorium policy. She stood on an election manifesto that promised a moratorium. Where is it? It has not materialised. It is a mythical policy that was designed to win votes; it had nothing to do with the good stewardship of the national health service.

[Mr Andrew Love (Edmonton) (Lab/Co-op)]

rose—

[Andy Burnham]

I give way to my hon. Friend, who has a nearby interest in Chase Farm.

[Mr Love]

I thank my right hon. Friend for giving way, and yes, I do have an interest because constituents of mine have been affected by the decision at Chase Farm. Not only did the Secretary of State come to Chase Farm immediately after the election, but he announced the change in policy on reconfigurations. He introduced the so-called four tests, none of which has ever saved any unit, in any part of the country. The reality is that he seriously misled the people of Enfield, who are now bearing down on their Member of Parliament, who also misled them on this policy. It is an outrage and they feel badly let down by this Government on health service reform.

--- Later in debate ---

[Andy Burnham]

For the avoidance of doubt, let me address directly what my hon. Friend has said. A moment ago I mentioned a photograph of the Secretary of State on a visit to Chase Farm hospital just days after the election, when he announced his so-called moratorium—although no one has yet seen any evidence of it. He is holding up a placard in that photograph that says, “HANDS OFF! Chase Farm A & E”, underneath which are the words: “I oppose any cutbacks to our A & E,” and on the bottom we can see his signature. How on earth he can square that with the letter that he recently exchanged with his hon. Friend the Member for Enfield North, I do not know. I do not know how the Secretary of State can reconcile those two things in his mind or how he could look anyone in Enfield North in the eye, having promised them that he would save their accident and emergency department. It is quite scandalous. People across the country are discovering that the Prime Minister’s moratorium is utterly meaningless, as A and Es restrict opening hours and maternity wards close.

We now come to the third of the Prime Minister’s broken promises, on NHS reorganisation. Again, the coalition agreement could not have been clearer:

“We will stop the top-down reorganisations of the NHS”.

I have never understood how those in the coalition could possibly sign up to those words, when only weeks later they would bring forward a White Paper heralding the mother of all reorganisations, the biggest since 1948. I can see the cynical politics behind the Prime Minister’s first two pledges, but on this pledge at least he was right. A reorganisation is precisely the last thing that the NHS needs right now. I am clear: the abandonment of that pledge is the Prime Minister’s biggest mistake in office. If he ploughs on, he will ultimately pay a heavy price for it, because it is a catastrophic error of judgment to combine the biggest ever financial challenge in the NHS with the biggest ever reorganisation.

As Health Secretary, I was told by officials that rising to the financial challenge would require every ounce of our energy and focus. The NHS would need stability. Instead, this Government have picked up the pieces of the jigsaw and thrown them up in the air, distracting the service at the very moment it needed maximum focus. Grip has been lost; the NHS is drifting.

[Henry Smith]

Does the right hon. Gentleman not agree, however, that our NHS needs greater efficiency and localism, and that this requires reorganisation?

[Andy Burnham]

I said just a moment ago that I was the one who put my name to the Nicholson challenge, because that money was going to help the NHS respond to the new demands placed on it at this difficult time, so the hon. Gentleman need not lecture me about efficiency. He needs to tell me how placing a moratorium on change in the NHS helps it to respond and deliver those efficiencies. That is the contradiction of his position, and he stood for election on that policy, as did others.

[Grahame M. Morris]

rose—

[Andrew George (St Ives) (LD)]

rose—

[Andy Burnham]

I will give way to the hon. Gentleman and then to my hon. Friend.

[Andrew George]

I accept that the Health and Social Care Bill is the longest and most incoherent suicide note in NHS history. Indeed, I am robust on this issue: I have voted against the Bill and will continue to take that view. However, considering that the right hon. Gentleman was involved when preferential arrangements were provided for private sector providers coming into the NHS, is this debate not an opportunity for him to acknowledge that at the Dispatch Box and apologise to the House for what was a rather ridiculous and one-sided policy?

[Andy Burnham]

Let me first acknowledge the hon. Gentleman’s courage in standing up and voting against the Health and Social Care Bill. I just wish that more of his Liberal Democrat colleagues had similar conviction and principle, and could stand up to the Government on a Bill that he knows—and which, in their heart of hearts, many of them know—will seriously damage the NHS.

The hon. Gentleman also asked me about the introduction of private sector capacity. I will not apologise for that, because that additional capacity was brought in to bring down NHS waiting lists, something that benefited his constituents. By bringing in that extra capacity we brought down NHS waiting lists to an all-time low and delivered the 18-week target. I am not going to apologise for that. The reason the NHS commands such strong support in the country today is that people’s experience of it improved in those years. I mentioned the preferred provider policy a moment ago. I believe that the private sector has a role to play in delivering world-class care to patients, and I am happy to put that on record.

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

At the heart of the current Bill are the 98 clauses that introduce competition law into the national health service—something that the last Government did not pass even one clause to do. Is not the ideology lying at the heart of the Bill what will wreck our national health service?

[Andy Burnham]

My right hon. Friend makes an incredibly important point. Make no mistake: if the Bill passes, the NHS will never be the same again. The Bill will unpick the fabric of a public national health care system—a planned system—and turn it into a free-for-all, as he says. Indeed, it is unbelievable to see a letter in The Guardian today from senior Liberal Democrats—many of whom made the same argument a few weeks ago as my right hon. Friend—now saying that, because of a few tweaks to the Secretary of State’s powers, the time has come to abandon all their concerns about the provisions. That is a ridiculous statement to make. If they still have concerns about competition and privatisation, they should have the courage of their convictions and stand up against the Bill, instead of writing sanctimonious letters to The Guardian.

Grip has been lost; the NHS is drifting. However, the Government cannot say that they were not warned. Sir David Nicholson, the chief executive of the NHS, told the Public Accounts Committee that the reorganisation had increased the scale of the financial challenge:

“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of…the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as a whole.”

This has been a lost year in the NHS—a crucial year, when it needed to face up to the financial challenge—but things are not getting better. We face months of further uncertainty, as the Secretary of State battles on with his complicated and unwanted Bill. Four-hundred and ninety pages, 70-page letters to peers, amendments made on the hoof: it is a total mess. The NHS deserves better than this. Even the man the Secretary of State brought in to run his new NHS Commissioning Board describes his Bill as “completely unintelligible,” and went on to say:

“It is going to be messy as we go through a very complex transitional programme.”

And this from the Secretary of State’s friends.

The harsh truth is that the Secretary of State has comprehensively failed to build the consensus he needs behind his Bill. GPs do not want it; nurses do not want it; midwives do not want it; patients do not want it. I say to the Prime Minister and the Health Secretary today: stop digging in. Drop this Bill. If they do, my offer still stands, as our motion makes clear. We will work with the Secretary of State to reform NHS commissioning, giving GPs and other clinicians a bigger role. That can be achieved without legislation and a major structural upheaval of the entire NHS. It can be done through existing legal structures, giving immediate stability and saving millions.

We make our offer again today, as it is time for all politicians to put the NHS first. It is slipping backwards, and the warning signs are there for all to see. Waiting lists and waiting times are getting longer, with a 48% rise in the last year in the numbers of patients waiting more than 18 weeks. When patients are waiting longer, it is unforgivable that £2 billion to £3 billion has been set aside to pay for the costs of reorganisation. It is also unforgivable that £850 million is being spent on making people redundant who will end up being re-employed elsewhere in the system, in the new clinical commissioning groups.

We are witnessing a return to the bad old days of waiting longer or paying to go private. This is just a glimpse of the future. If the Bill passes, the NHS will never be the same again. We have all seen the adverts on television for the health lottery. Is this the right hon. Gentleman’s early marketing and his new brand name for our NHS?

[Bob Blackman (Harrow East) (Con)]

Does the right hon. Gentleman not accept that one of the severe problems that the national health service is facing came about on his watch, when primary care trusts were allowed to build up huge deficits without making the economies and efficiencies that should have been made at that time, rather than on this Government’s watch?

[Andy Burnham]

I have never said that the NHS was perfect, or that there were no challenges during our time in government. But let me tell the hon. Gentleman what happened when the NHS was facing those deficits in 2006 and 2007. We took a grip at the centre and we brought those trusts back into financial balance, through hard work. There was a turnaround team in the Department, and we made sure that those difficulties were tackled at root. I do not see the same grip in the national health service right now. I see drift and lack of focus, and I see huge distraction as a result of this unwanted Bill.

[Sarah Newton]

The image that the right hon. Gentleman has just painted is totally inaccurate. The Royal Cornwall Hospitals NHS Trust is struggling with an enormous debt, which it incurred as a result of enormous reorganisations under Labour and a ridiculous accountancy measure that doubles the debt every year. I will not take comments like that from the right hon. Gentleman, because Cornwall has been left in a very difficult situation that this Government have been left to sort out.

[Andy Burnham]

I did not say that everything was perfect, but I said a moment ago that we took a grip on those problems and dealt with them from the centre. In the hon. Lady’s Government’s NHS, there will be—what are the words?—no bail-outs. Everyone will be left to fend for themselves. Does that mean that her hospital will be allowed to go bust? I do not know, but that is the implication of the Secretary of State’s White Paper and Bill, and she needs to direct her questions to him.

The fact is that we are now looking at a national postcode lottery, in which GPs are free to send letters to patients telling them that minor operations must now be paid for, and in which hospitals no longer have maximum waiting times for NHS patients and can devote the freed-up theatre time to private patients as there is no longer any cap on private work. The Government have placed the NHS in the danger zone. It has been placed there by a Prime Minister who said “Trust me” and has gone back on his word. He wrote cheques for the NHS in opposition that he knew he would not be able to cash when in government. He made promises that he knew he would be unable to keep, in order to win votes. This is the Prime Minister’s very own great NHS betrayal, and, far from detoxifying his party, he has proved once and for all that we really cannot trust the Tories with our NHS.

--- Later in debate ---

[Mr Lansley]

One of the reasons that the House should reject the motion is that it is deeply flawed. Let me just take up the hon. Lady’s argument. What an own goal it is for Labour to say that NHS funding fell in 2010-11. That was the last year of the Labour Government’s spending plans, not ours. The amount available to the NHS in 2010-11—[Interruption.] I am answering the hon. Lady’s question. The amount available to the NHS in 2010-11 was exactly the same amount as the last Labour Government determined under their spending plans. So if Labour is accusing the NHS of having a reduction in real terms in 2010-11, that is a complete own goal, because it happened as a consequence of its decisions, not ours.

[Andy Burnham]

May I just explain to the Secretary of State the difference between projected budgets and out-turn figures, as published by the Treasury? Will he confirm that the figures published in the Treasury’s public expenditure statistical analysis will be the figures that go into the historical record, and that they will record a real-terms cut because of underspends that he ordered?

[Mr Lansley]

That is absolutely not true, because we ordered absolutely no cuts in the NHS budget in 2010-11 compared with the spending plans that we inherited. So that is a complete own goal on the right hon. Gentleman’s part. And in regard to all that stuff that he talked about the support that the NHS is giving to social care, I can tell him that, with the exception of the underspend in the departmental central budgets, because we cut back on all of its bureaucracy and its IT programme, we spent over £150 million, or whatever it was—

[Mr Lansley]

Sit down for a minute. I am answering the shadow Secretary of State. As I was saying, more than £150 million was generated from underspends in the departmental central budget in the last three months of the last financial year, and it was spent with local authorities in supporting social care. The rest of the social care support is for 2011-12, so what the right hon. Gentleman said cannot be a reason for the underspend in 2010-11. The amount spent was all in PCT allocations; there was no mechanism by which the Department of Health could go out and ask PCTs to spend less—the money was allocated to them. The shadow Secretary of State shakes his head, but he knows it is true. The money was allocated to the PCTs and they were free to spend the money they had.

The first reason to reject the motion is that it is a spectacular own goal. The second reason to reject it—

[Andy Burnham]

The right hon. Gentleman says it is not true that PCTs were asked to set aside funds and generate underspends, so may I remind him of a letter sent by the chief executive of the NHS shortly after the White Paper was published, telling primary care trusts to set aside funding for the cost of transition? That is clear; it is in black and white. He did ask PCTs to generate those funds to spend on the costs of his reorganisation.

[Mr Lansley]

I am sorry, but that is another spectacular own goal. Both before and after the election, the chief executive of the NHS set aside, as the right hon. Gentleman had planned before the election, £1.7 billion for non-recurrent expenditure for the costs of NHS reorganisation. It was done before the election; we never changed the figure. It is not a consequence of any of our plans, but a precise consequence of the right hon. Gentleman’s. He said he accepted the Nicholson challenge, and the £1.7 billion non-recurrent set aside in 2010-11 was to fund that challenge. That was set out before the election, not after it. I thought that one of the benefits of the former Secretary of State coming here to debate matters would be that we would be treated to a bit of knowledge of the NHS and of how it works, but that does not seem to be the case at all.

--- Later in debate ---

[Mr Lansley]

The hon. Gentleman also intervened on the shadow Secretary of State. I am afraid that I do not recognise his description. I said before the election that we would have a moratorium on top-down and forced closure programmes affecting A and E and maternity services—and that is exactly what we did. A moratorium means what it says; it provides an opportunity to stop, to take stock and to subject something to the right tests. I set out for the first time the tests that needed to be met—that proposals needed to be consistent with prospective patient choice, consistent with the views of the local community, not least as expressed through the local authority, consistent with the views of the commissioners in the area, especially the developing clinical commissioning groups, and consistent with clinical evidence of safety.

In the context of Enfield and Chase Farm, the hon. Gentleman knows—because he was a participant in these discussions—that that moratorium was applied, that the opportunity was given to the local authority and the general practice community in Enfield to come forward with alternative solutions. We should also remember that among those four tests is the one about clinical evidence and safety. However, when those community groups came back and said, “We don’t have a specific alternative, but we just don’t want things to change”, I had to ask the independent reconfiguration panel to examine it. Its view was that that was not clinically sustainable.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Lansley]

No. I have given way many times. I am answering the hon. Member for Edmonton (Mr Love). It was very clear that we could not proceed on that basis.

I have another point for the hon. Member for Edmonton about what I found in a number places. Although this was not true of the moratorium in Maidstone and Chase Farm, the moratorium has led to substantially improved outcomes for local services elsewhere, as with Burnley, Solihull, Sidcup, Ealing, the Whittington hospital and other places.

--- Later in debate ---

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Lansley]

No. I think that the moratorium has led to a better way forward even in Enfield. It is in the hands of the commissioners and the local authority in Enfield collectively, to make decisions for Enfield. Within two months I shall receive a report from NHS London advising whether it would be better organisationally for Chase Farm to be combined with North Middlesex rather than Barnet, and I should be interested to know the hon. Gentleman’s view on that. We continue to seek not top-down forced reconfigurations, but reconfigurations that consistently meet the four tests, and do so in the best interests of the NHS.

[Tony Baldry]

The right hon. Member for Leigh (Andy Burnham) implied that my right hon. Friend should have completely ignored the advice of the independent reconfiguration panel. Can my right hon. Friend tell us whether, when the right hon. Gentleman was Secretary of State for Health, there were any occasions on which he sought to ignore the panel’s advice?

[Andy Burnham]

No.

[Tony Baldry]

What is the point of having such a panel if it is to be ignored?

--- Later in debate ---

[Mr Lansley]

I am answering the hon. Gentleman’s question. The point of a foundation trust is that it should take more responsibility for securing the resources enabling it to undertake its own building projects. Foundation trusts cannot walk into the Department of Health imagining that they will receive a capital grant of more than £400 million. That is simply not the way it works. It is to the credit of the hon. Gentleman’s local trust that it accepted that, and is working, as a foundation trust, on a better solution for the hon. Gentleman’s area.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Lansley]

No, because I have already given way to the right hon. Gentleman many times. Let me tell him this. If he was going to offer to try to work with others on GP commissioning, he ought at least to have demonstrated before the election that he was going to do something about it; and using a transparent political ploy to try and interfere with the passage of the legislation in another place carries no credibility with me or with anyone else. Labour’s tabling of a motion in the other place in an attempt to block the Bill completely showed no willingness to work together, and the fact that it was defeated by 134 votes ought to have given the right hon. Gentleman a reason—and sufficient humility—not to try to return to the subject by tabling today’s motion.

As I said earlier, I find it regrettable that neither the right hon. Gentleman’s motion nor his speech made any attempt to deal with what has happened in the NHS over the past year. Let me tell him, and the House—for I know my right hon. and hon. Friends will be interested as well—what has, in truth, happened during that time.

At the end of the last Labour Government, the average in-patient wait was 8.4 weeks. According to the latest available figures, that has fallen to 8.1 weeks. The average waiting time for out-patients was 4.3 weeks at the time of the last election; it is now 4.1 weeks. Over the last year, the number of MRSA bloodstream infections in hospitals has fallen by a third, and the number of clostridium difficile infections by 16%. Nearly three quarters of a million more people have access to NHS dentistry. Nearly 2 million people have access to the new 111 urgent care service, and the whole country will be covered within the next 18 months. When we came to office, I discovered that there had been talk about a 111 telephone system, but nothing had been done. It is now happening.

More than 75% of stroke patients now spend 90% or more of their hospital stay in a stroke unit. That is a 20% increase in two years. The Cancer Drugs Fund has given more than 5,000 patients access to the drugs that they desperately need, and which under the last Government’s regime would not have been available to them. We have embarked on an £800 million investment in translational research, increasing our financial support for it by 30%, to help to secure the United Kingdom as a world leader in health research.

The NHS is leading the way in the prevention of venous thromboembolism, with 86% of patients receiving an assessment for the condition. I believe that that constitutes an increase of some 30% in the last year. The bowel cancer screening programme is enabling many more patients and members of the public to be screened, there is more screening for diabetic retinopathy than ever before, and there were 188,000 more diagnostic tests in the three months to August than there were last year. Pathfinder clinical commissioning groups have been established virtually through England, and there are 138 health and wellbeing boards in local authorities, meeting and putting together their strategies to deliver population health gain across their areas.

In a single year, the year preceding the election, the right hon. Member for Leigh presided over a 32% increase in NHS management costs. That was the year after the banks had gone bust. It was the year when it was obvious that Government deficits were out of control. It was the year when the debt crisis was just about to crash over the whole public sector. What happened on the right hon. Gentleman’s watch? There was a 23% increase in management costs in a single year, to £350 million. In the year that followed, we reduced those costs to £329 million.

--- Later in debate ---

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

It has been an interesting experience listening to the range of contributions that have been made over the past few hours. Having studied the shadow Secretary of State’s tweets yesterday afternoon heralding today’s debate, one would have expected this to be an action-packed afternoon. One remembers the grand old Duke of York marching his troops up to the top of the hill and then down to the bottom, but the grand old Duke of York had 10,000 men. For most of this debate, apart from the wind-ups, the shadow Secretary of State has barely managed to get more than six Opposition Back Benchers here, which is fewer than the Government have had, so on that point I fear that he has failed.

Let me turn to some of the speeches that I had to listen to. It was a delight to hear the hon. Member for Easington (Grahame M. Morris) again, after a break from the Committee stage of the Health and Social Care Bill. Broken record his speech may have been—it was the same story—but it was worth listening to, even though the accuracy gained nothing in the telling.

My hon. Friend the Member for Kingswood (Chris Skidmore) made an excellent speech, as did my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke fluently and knowledgably, on the basis of his intense and intimate experience of working in the NHS and his insights into the challenges we face in social care and improving the integration of care.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made an interesting contribution, although at times I began to think that she might be the only person who believed what she was saying. None the less, it was interesting.

The hon. Member for Ealing North (Stephen Pound)—as always, a jokester in our midst—put forward a serious message in a jocular way. From my experience of the NHS, both personal and professional, however, I felt that a lot of what he said bore little relation to reality. I can assure him that Government Members share the core principles of the NHS. I was also interested to hear the comments of my hon. Friend the Member for Stafford (Jeremy Lefroy). Anyone who represents that part of the country will have a deep understanding of the problems, as well as the successes, of the local health service. He was right in what he said about the future of accident and emergency services and about the critical issue of training.

I am saddened by the fact that the Opposition have once again shown themselves to be more interested in trying to revive their own political fortunes than in improving the outcomes of patients. Once again, they prefer to scaremonger and blindly attack, rather than put forward any policies of their own. They have been a policy-free zone in this debate. Once again, they reveal themselves to be on the back foot when it comes to securing the future of the NHS, as well as wrong-headed.

The Opposition claim that the Government are cutting NHS spending, which is not only nonsense but outrageous. Surprisingly, only last summer, the right hon. Member for Leigh said—this has been quoted before, but I will repeat it—that it would be

“irresponsible to increase NHS spending in real terms”.

Ironically, that is not a view that I share. I fundamental disagree with it, because I believe that we should increase the funding of the NHS in real terms. [Interruption.] I do not care how much the right hon. Gentleman says it; if he looks at the—

[Andy Burnham]

Will the Minister give way?

[Mr Burns]

I will in one minute, just to disprove what the hon. Member for Leicester West (Liz Kendall) says.

If the right hon. Gentleman does not want to believe what I say, he can look at the chart produced by the Wales Audit Office, an independent body, which shows, if one cares to read it, real-terms spending increases in each year in the English NHS. Ironically, it also shows such increases in Northern Ireland and Scotland, but if we look at the red parts of the chart, we can see that there are certainly no increases in Labour-controlled Wales.

[Andy Burnham]

rose—

[Mr Burns]

I will give way once, briefly, then I must make progress, because I have only eight minutes.

[Andy Burnham]

The Minister says that the Government are providing real-terms increases, but he does not take into account inflation or the £1 billion transfer to social care. Will he accept the figures that I have here? They are the total departmental expenditure limits published by the Treasury in July 2011. They show that, in 2009-10, £102 billion was spent on the NHS. The figure for 2010-11 was £101 billion. I invite him to tell me that those figures are not correct.

[Mr Burns]

The right hon. Gentleman told us that, when he was Chief Secretary to the Treasury, he understood figures, so he will understand, as I do, that “real terms” means an increase over and above inflation—

[Andy Burnham]

rose—

[Mr Burns]

One minute. The right hon. Gentleman wants a reply, so he must hold his horses.

It is the gross domestic product deflator that determines how one increases in real terms the funding of the NHS. The right hon. Gentleman has once again scored an own goal in reading out those figures, because they are based on the Labour Government’s spending for the year in which they were leaving power.

[Andy Burnham]

Will the Minister give way?

[Mr Burns]

No, I said that I would give way once. I must now make progress.

We are increasing funding for the NHS in real terms over this Parliament, and stripping out unnecessary bureaucracy to focus precious resources on the front line and not the back office. So in place of management-led primary care trusts and strategic health authorities, we are introducing clinically led clinical commissioning groups, to put money and power in the hands of front-line doctors and nurses. That is why we are driving through the plans to make the NHS more efficient by focusing on prevention, on innovation, on productivity and on driving up the quality of care. A fact that Labour Members appear rapidly to have forgotten is that better care is very often less expensive care, and less expensive care means there is more money to spend on the health service.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 18th October 2011 Commons Chamber

[Paul Burstow]

If the hon. Gentleman would care to write to me setting out where he believes there are inaccuracies, we will examine them.

[Andy Burnham (Leigh) (Lab)]

It is good to be back. I see that in my absence, the Secretary of State has at last made some progress with his plans for a US-style health care system.

I have a letter sent by the practice that my hon. Friend the Member for Warrington North (Helen Jones) mentioned a moment ago, in which it wrote that

“we can no longer offer your procedure as one of our NHS services…I am writing to make you aware of some of the options that you have to have the procedure completed as a private patient.”

Helpfully, it enclosed a leaflet announcing the practice’s new private minor operations service. Can the Minister point me to any part of the Health and Social Care Bill that will prevent that practice in future?

[Paul Burstow]

I wonder whether the right hon. Gentleman could have pointed me to any such arrangements in current legislation. There is none. However, Dr David Geddes, the medical director of NHS North Yorkshire and York, has stated:

“We have some concerns about the activities of the Haxby and Wigginton health centre in York and we will be discussing these issues with them directly as a matter of urgency. These concerns are around possible breaches of the Data Protection Act and the accuracy of the information sent to patients. For example, of the eight procedures they list, three are routinely funded by NHS North Yorkshire and York”.

Let us be clear that when he was Secretary of State, that PCT was in a worse financial state.

[Andy Burnham]

That is total bluster, because that vision is precisely what the Government want to do to our NHS. As my hon. Friend the Member for Warrington North said, it is a terrifying glimpse of a Tory NHS in future—not a national health service but a postcode lottery writ large, in which, as we read today, random rationing is taking place around the country. The NHS is in chaos because the Secretary of State made the mistake of combining a £2.5 billion reorganisation, at a time when every ounce of energy should be focused on the NHS front line. This Secretary of State has placed our national health service in the danger zone, and he has lost the confidence of GPs, nurses and midwives. Is it not time that he stopped digging in, listened to NHS staff and dropped this damaging Bill?

[Paul Burstow]

That was a good example of bluster—perhaps that is what we will see from the Opposition under the right hon. Gentleman’s stewardship.

The right hon. Gentleman ought to be aware, because it happened on his watch, that primary care trusts and strategic health authorities have seen their management costs increase by more than £1 billion. There was a 120% increase from 2002 to when this Government took office. That is why we are determined to cut overhead costs in the NHS, so that we can reinvest every penny in the front line.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 7th September 2010 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. We visited St Cross hospital together, so he knows the importance that we both attach to the service that is provided there for his constituents locally, but that happens in the context of the resources that we provide to enable the NHS to do its job. The Government have made an historic commitment to increase resources for the NHS in real terms each year, notwithstanding the appalling financial circumstances that we inherited from the Labour party.

The policy of the right hon. Member for Leigh (Andy Burnham) is to cut the NHS budget. Under those circumstances and under the policies of the Labour party, the number of redundancies in the NHS would proliferate.

[Andy Burnham (Leigh) (Lab)]

The right hon. Gentleman is planning the biggest reorganisation in the history of the NHS, and yet he is unable to give basic information on it, such as how many people may lose their jobs, to my hon. Friend the Member for Coventry South (Mr Cunningham). Tens of thousands of people who work for primary care trusts and strategic health authorities are at risk of losing their jobs, so it is no wonder that after a just a few short weeks in his job, the Secretary of State has brought morale in the NHS to rock bottom.

In his letter to the NHS, the NHS chief executive says that £1.7 billion should be set aside to pay for the Secretary of State’s reorganisation. Others have said that the cost of his reform could be up to £3 billion. At a time when the NHS needs every penny to maintain standards of patient care, it is scandalous for money to be diverted in that way. He may be ignoring the human cost, but can he tell the House today his latest estimate from the Department of how much his ideological reorganisation will cost?

[Mr Lansley]

I do wish the right hon. Gentleman would at least remember what he was responsible for before the election. He said that the NHS in this financial year should set aside 2%—£1.7 billion—for the cost of reorganisation. I have not changed that figure by one penny. However, I have taken his policies, which led to a proliferation in management costs—an 80% increase in the cost of management consultants in the NHS in two years and a doubling of management costs in PCTs and SHAs in eight years—and reversed them. We are cutting management costs in the NHS this year by more than £220 million and by up to £1 billion over four years. I make no apology for that, because if we are to protect front-line services and improve health outcomes, that is exactly what we need to do.

[Andy Burnham]

rose—

[Mr Speaker]

Order. The remainder of this exchange—on both sides— needs to be shorter.

[Andy Burnham]

Let us first get some facts straight. I asked PCTs to set aside money to invest in patient care, changing patient pathways and better services. I did not say that a Labour Government would cut the NHS budget; I said that we would maintain it in real terms, not increase it, as the Secretary of State proposes. The effect of his increase will mean severe cuts to councils, which need to provide care support to older people to get people out of hospital.

However, the Secretary of State would not today tell us what his proposals would cost. Is it not the case that the plans were not in the Conservative or Liberal Democrat manifestos, and that there is no democratic mandate for the break-up of the NHS? Given that there is now a chorus of protest at his plans, will he step back, listen to patients and staff and consult on those reforms before taking them forward further?

[Mr Lansley]

I and my colleagues are engaging right across the country with patients, the public, local authorities, PCTs and general practitioners, and we are meeting enthusiasm for our proposals. Why? Because we are focusing on delivering improving outcomes for patients, and doing so in the context of an historic commitment by this coalition Government to increase resources for the NHS in real terms each year. The right hon. Gentleman’s policy would be to cut the NHS budget.

[Andy Burnham]

The Secretary of State thinks he can behave any way he likes with the NHS, the most beloved institution in this country, but we will not let him—we will give him a fight every inch of the way. The latest example of his high-handed and arrogant behaviour came on the eve of a bank holiday weekend, when he casually let slip that NHS Direct would be scrapped. NHS Direct is a valued service that receives 27,000 calls every day and saves millions of pounds for the NHS, and that has more than 3,000 staff working for it. Will he today apologise for making that statement in such an outrageous manner? Will he listen to the 14,000 people who signed a petition to save NHS Direct, and going forward, stop acting in such a cavalier manner with our NHS?

[Mr Speaker]

Order. A question should be a question—it should not really be three questions.

NHS White Paper

Andy Burnham Excerpts

Monday 12th July 2010 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

With permission, Mr Speaker, I would like to make a statement on the future of the national health service.

The NHS is one of our great institutions, and a symbol of our society’s solidarity and compassion. It is admired around the world for the comprehensive care it provides and for the quality, skill and dedication of its staff. I begin today by paying tribute to the staff of the NHS and the commitment they daily show to patients in their care.

This Government will always adhere to the core principles of the NHS: a comprehensive service for all, free at the point of use, based on need, not ability to pay. That principle of equity will be maintained, but we need the NHS also consistently to provide excellent care.

The NHS today faces great challenges: it must respond to the demands of an increasing and ageing population, advances in medical technology and rising expectations; it remains stifled by a culture of top-down bureaucracy, which blocks the creativity and innovation of its staff; and it does not deliver outcomes in line with the best health services internationally—many of our survival rates for disease are worse than those of our neighbours. The NHS must be equipped to meet those challenges. We believe it can do much better for patients, so today I am publishing the White Paper, “Equity and Excellence: Liberating the NHS”, so that we can put patients right at the heart of decisions made about their care, put clinicians in the driving seat on decisions about services, and focus the NHS on delivering health outcomes that are comparable with, or even better than, those of our international neighbours.

For too long, processes have come before outcomes, as NHS staff have had to contend with 100 targets and over 260,000 separate data returns to the Department each year. We will remove unjustified targets and the bureaucracy that sustains them. In their place, we will introduce an outcomes framework setting out what the service should achieve, leaving the professionals to develop how.

We should have clear ambitions, and our approach will be set out shortly in a further consultation document. For example, our aims could be: to achieve one and five-year cancer survival rates above the European average; to minimise avoidable hospital-acquired infections; and to increase the proportion of stroke victims who are able to go home and live independently—in short, care that is effective, safe and meets patients’ expectations.

The outcomes framework will be supported by clinically established quality standards, and the NHS will be geared across the board towards meeting them. We will do that by rewarding commissioners for delivering care in line with quality standards; strengthening the regulatory regime so that patients can be assured that services are safe; and reforming the payment system in the NHS, so that it is a driver not just for activity, but also for quality, efficiency and integrated care.

Patients will be at the heart of the new NHS. Our guiding principle will be “no decision about me, without me.” We will bring NHS resources and NHS decision making as close to the patient as possible. We will extend “personal budgets”, giving patients with long-term conditions real choices about their care. We will introduce real, local democratic accountability to health care for the first time in almost 40 years by giving local authorities the power to agree local strategies to bring the NHS, public health and social care together. Local authorities will also be given control over local health improvement budgets. This will give an unprecedented opportunity to link health and social care services together for patients. We will give general practices, working together in local consortiums, the responsibility for commissioning NHS services, so that they are able to respond to the wishes and needs of their patients. This principle is vital, bringing together the management of care with the management of resources. With commissioning support, GPs collectively will lead a bottom-up design of services.

In addition, we will introduce more say for patients at every stage of their care, extending the right to choose far beyond a choice of hospital. Patients will have choice over treatment options, where clinically appropriate, and the consultant-led team by whom they are treated. They will have the right to choose their GP practice, and they will have much greater access to information, including the power to control their patient record. We must ensure also that patients’ voices are heard, so we will establish HealthWatch nationally and locally, based on local involvement networks, to champion the needs of patients and the public at every level of the system.

To achieve these improvements in outcomes, we need to liberate the NHS from the old command-and-control regime, so all NHS trusts will become foundation trusts, freed from the constraints of top-down control, with power increasingly placed in the hands of their employees; and we will allow any willing provider to deliver services to NHS patients—provided that they can deliver the high-quality standards of care we expect from them. Our aim is to create the largest social enterprise sector in the world, but it is not a free-for-all. Monitor will become a stronger economic regulator to ensure that the services being provided are efficient and effective, and that every area of the country has the NHS services it needs to provide a comprehensive service to all. The Care Quality Commission will safeguard standards of safety and quality. An independent and accountable NHS Commissioning Board will be established to drive quality improvements through national guidance and standards, in order to inform GP-led commissioning. The board will allocate resources according to the needs of local areas, and lead specialised commissioning.

In the coming weeks, detailed consultation documents will enable people to comment on the implementation of this strategy, leading to the publication of a health Bill later this year. I recognise that the scale of today’s reforms is challenging, but they are designed to build on the best of what the NHS is already doing. Clinicians are already working to facilitate patient choice, giving patients the information they need to make effective decisions. GP consortiums are already established in some areas of the country and are ready to go. Local authorities in some areas are already working closely with local clinicians to co-ordinate health and social care and improve public health. Payment by results already gives us a starting framework for building a payment system that really drives performance. Foundation trusts are already using the freedoms they have to innovate. We will build on this progress, not dismantle it.

With this White Paper we are shifting power decisively towards patients and clinicians. We will seek out and support clinical leadership. That means simplifying the NHS landscape and taking a further, radical look at the whole range of public bodies. We will reduce the Department of Health’s NHS functions, delivering efficiency savings in administration. We will rebalance the NHS, reducing management costs by 45% over the next four years and abolishing quangos that do not need to exist, particularly if they do not meet the Government’s three tests for public bodies. We will also shift more than £1 billion from back-office to the front line. Form must follow function. As we empower the front line, so we must disempower the bureaucracy. Therefore, after a transitional period we will phase out the top-down management hierarchy, including both strategic health authorities and primary care trusts.

Later in the summer, we will be publishing a report setting out how we see the future of NHS-related quangos. I can say now that this will mean a reduction of at least a third in the number of such bodies. This is part of a wider drive across government to increase the accountability of public bodies and reduce their number and cost. The dismantling of this bureaucracy will help the NHS realise up to £20 billion of efficiency savings by 2014, all of which will be reinvested in patient care. Today’s reforms set out a long-term vision for an NHS that is led by patients and professionals, not by politicians. It sets out a vision for an NHS empowered to deliver health outcomes as good as any in the world. I commend this statement to the House.

[Andy Burnham (Leigh) (Lab)]

I thank the right hon. Gentleman for his statement and for giving me advance sight of it, although in keeping with the style of this Government, it would appear that this House was the last to find out, behind every media outlet in the land.

Last month, the Commonwealth Fund gave its verdict on Labour’s NHS, saying that it was top on efficiency and second overall on quality compared with other developed health care systems. Today, we have further evidence of progress, with figures from Cancer Research UK showing that long-term cancer survival rates have doubled. This progress was hard won; it took 10 years of painstaking work piecing together a detailed jigsaw. The right hon. Gentleman, with this White Paper, has today picked it up and thrown the pieces up in the air. It is a huge gamble with a national health service that is working well for patients.

The right hon. Gentleman’s spin operation bills this as

“the biggest revolution in the NHS since its foundation 60 years ago”.

That is something of a surprise, given the ink was barely dry on a coalition agreement that said:

“We will stop the top-down reorganisations of the NHS that have got in the way of patient care.”

What has happened since the publication of the coalition agreement to justify a U-turn of such epic proportions? Manifesto commitments have been casually dropped but this must be the first time that that agreement has been so spectacularly ripped up.

This reorganisation is the last thing that the NHS needs right now; it needs stability, not upheaval. All its energy must be focused on the financial challenge ahead. It needs confident, motivated staff, but the 1.3 million people who work for the NHS will not be comforted by this White Paper and they will be alarmed that their systems of national pay bargaining are being torn up. We support a strong say for clinicians and GPs in improving quality. That was the direction that Lord Darzi set out, after broad consultation. We introduced practice-based commissioning within a framework of public accountability and population-wide commissioning supported by primary care trusts. What we do not support is the wiping away of oversight and public accountability, and the handing over of £80 billion of public money to GPs, whether they are ready or not. Michael Dixon, chair of the NHS Alliance, says that only about 5% of GPs are ready to take over commissioning. Sir David Nicholson, chief executive of the NHS, has judged that even the best GP practice-based commissioners are “only about a three” out of 10 in terms of the quality of their commissioning. So what sound evidence does the right hon. Gentleman have that 100% of GPs are ready, willing and able to commission services for the entire population?

The right hon. Gentleman’s statement talked of rewarding commissioners who hit outcomes. Does he mean yet more money for GPs? How much will all GPs be paid for taking on this role? How many jobs does he expect to be lost in the NHS and how much money has he put aside for redundancy costs? What guarantees can he give the House that people will not simply be paid off by the NHS to be re-employed by a GP practice?

How does the right hon. Gentleman think loyal primary care trust staff felt when they read this quote—I apologise, in advance, for the language, Mr Speaker—from

“a senior Department of Health source”,

which was anonymously briefed to the Health Service Journal? It reads:

“PCTs are screwed. If you’ve got shares in PCTs I think you should sell”.

That is no way to treat loyal public servants, who have served the NHS and are now worried about their future. On page 10, the right hon. Gentleman says that the reforms are vital to deal with the financial situation, but is it not the case that there has never been an NHS reorganisation that did not cost money and divert resources in the short term? Is not the handing of the public budget to independent contractors tantamount to the privatisation of the commissioning function in the NHS? Will there be any restrictions at all on the use of the private sector by GPs?

Added to this, the right hon. Gentleman is bringing a series of market reforms into hospitals. He tells us that the first role of Monitor will be to promote competition and talks of any willing provider and freedoms for foundation trusts. Is not that the green light to let market forces rip right through the system with no checks or balances? Are not the hearts of NHS staff sinking as they read the White Paper?

On bureaucracy, we will support the Government where sensible reductions can be made, but what he calls pointless bureaucracy, we call essential regulation. What are his plans for the Food Standards Agency and are the reports correct that he has waived his right to regulate in return for funding for Change4Life? Can he explain how 500 or more GP consortiums, all of whom will need administration and management, can be less bureaucratic than 152 primary care trusts?

Lastly, where are the public accountability and the accountability to this House? How will GPs be held to account for the £80 billion of public money for which they will be responsible and how will the new NHS commissioning board—the biggest quango in the world—be accountable to this House and to Members of Parliament?

In conclusion, this White Paper represents a roll of the dice that puts the NHS at risk—a giant political experiment with no consultation, no piloting and no evidence. It is the right hon. Gentleman at his confused and muddled worst, but the sadness is that he is taking an £80 billion gamble with the great success story that is our national health service today. At a stroke, he is removing public accountability and opening the door to unchecked privatisation. He is demoralising NHS staff at just the time we need them at their motivated best. For patients, it opens the door to a new era of postcode prescribing where services vary from street to street. It turns order into chaos, and we will oppose it.

[Mr Lansley]

I am just astonished that the shadow Secretary of State seems to have gone to the barricades for the primary care trusts. The primary care trusts and strategic health authorities are organisations that, under his watch as Secretary of State—for about a year—increased their management costs by 23%. In the year for which he was in charge, they spent £261 million on management consultants. Before the election, when it had a majority of Labour Members, the Select Committee on Health said that PCT commissioning was weak and that it was not delivering what was intended. He set up a programme called world class commissioning—it never worked. Central to delivering better commissioning in the health service is ensuring that those people who incur the expenditure—the general practitioners, on behalf of their patients—and who decide about the referral of patients are the same people who, through the commissioning process, determine the shape of the services in their area. It is more accountable.

How often have all of us, on both sides of the House, asked Labour Ministers about what primary care trusts are doing locally in terms of service change only to be told, “It’s nothing to do with us; it’s all happening locally”? We are going to be very clear about the accountability. One thing that the coalition programme has enabled us to do, as two parties bringing our programmes together, is to strengthen the accountability to local authorities. Local authorities, through their strategies that mesh NHS services, public health and social care, will ensure that major service changes and the design of services reflect the interconnection between those things. Those who have complaints and problems will be able to have them addressed through HealthWatch and through their local authority. We will be able, through local authorities, to ensure that the commissioning support to GP commissioning consortiums can be more effective.

The shadow Secretary of State talked about the Commonwealth Fund. I do not know whether he has even read the Commonwealth Fund report, but it said that the UK health care system was the second worst on hospital-acquired infections, that the UK delivers the poorest level of patient-centred care and that, on outcomes, we performed the second worst overall on mortality amenable to health care.

The right hon. Gentleman stood up and said that cancer mortality rates have improved. They have—since the 1970s, and all over the world. However, the issue is where we stand in relation to the rest of the world. If we were to meet the European average on cancer survivals, 5,000 more people would live each year rather than die. If we were to do the best in Europe, 10,000 more would live each year. For stroke, the figure is 9,000. We have to measure ourselves on the outcomes relative to the other health systems that are comparable to ours.

Nine years ago, the right hon. Gentleman’s Prime Minister, Tony Blair, said that we must spend as much as Europe. Through this White Paper and the reforms that we will bring in, we are determined to achieve results for patients that are at least as good as those in the rest of Europe. It is not just about inputs and spending, but about the results we achieve. The right hon. Gentleman, on behalf of his party, has just abandoned the reforms that his Prime Minister, Tony Blair, put forward. In 2006, Tony Blair said that we must have patient choice, practice-based commissioning, the independent sector and foundation trusts—reforms that Labour failed to deliver and, indeed, undermined. We, as a coalition Government, are now determined to put those reforms in place to deliver results for patients.

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[Mr Lansley]

The shadow Secretary of State will have had the chance to see that there is nothing in today’s White Paper about the FSA—no such proposal.

[Andy Burnham]

You have been briefing about it.

[Mr Lansley]

I have not been briefing anything to anybody. [Interruption.] I have not. It is very straightforward. The FSA, along with other bodies associated with our public health responsibilities, will be the subject of a public health White Paper in the autumn. There is no proposal.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 29th June 2010 Commons Chamber

[Mr Speaker]

Order. May I gently ask the Minister to face the House? I am sure that Opposition Members will want to see his face.

[Andy Burnham (Leigh) (Lab)]

We do, Mr Speaker, very much; we want to see him squirm.

First, let me say that we welcome the Minister back to the Department of Health; he was a Minister in the Department 13 years ago. As I have said before, we trust that he finds the NHS in much better condition than when he left office. Last week we had an independent verdict on those 13 years. The independent and respected Commonwealth Fund said that the NHS was one of the best health care systems in the world, and, indeed, that it was top on efficiency: a ringing endorsement of Labour’s stewardship of the national health service. That verdict reflects the huge progress on waiting times that has been made over those 13 years. So does not the abolition of the 18-week target, which the Minister announced last week, put all that progress at risk? Will he today give us a straight answer to this question: can he guarantee that waiting times will not rise, and that patients will still be treated within 18 weeks?

[Mr Burns]

I thank the right hon. Gentleman for the kind comments at the beginning of his remarks; things went downhill thereafter, but that is politics.

The right hon. Gentleman needs to understand that patients have to come first in a national health service, and the trouble with the approach he took was that he wanted politicians and bureaucrats to micro-manage it from the top down, rather than having a bottom-up system that listened to local people. One of the key aims is to ensure that people get the finest and best treatment possible, and I am afraid that his approach—a straitjacket of targets in certain areas—did not work then, and will not work now.

[Andy Burnham]

I shall take that as a no, because the Minister did not answer the question; he could not give that guarantee. He says that we must put people and patients first, yet at a stroke he has taken power away from patients and handed it back to the system, turning the clock back to the bad old days of the Tory NHS. Let me quote some comments by Jill Watts, chair of the NHS Partners Network, which represents private providers. In the Financial Times on 18 May, she is reported as saying the following about the loss of targets:

“Waiting times will go up and if people want a procedure they have a choice: they can wait or they can look to pay”.

Is that not always the Tory choice on the NHS: wait or pay?

[Mr Burns]

The right hon. Gentleman is not right. We have not taken that attitude; we never have taken that attitude. We want to have a system whereby the health service is not in a straitjacket of targets that disrupt and distort clinical decisions. We want to empower clinicians and GPs to take decisions about who should be treated when according to their clinical judgment.

[Andy Burnham]

Waffle!

[Mr Burns]

It is not waffle. The right hon. Gentleman is clinging to an outdated philosophy, and he is in denial about the need to change it.

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[Mr Lansley]

I am very grateful to my hon. Friend, who will know that I entirely understand and applaud the work of St Catherine’s hospice, because we have visited it together. She makes a very important point, because those whom I know in the hospice movement want to think not just about the service that they provide in their buildings, but about an holistic service for patients’ families and for those who require palliative care. I might just say that on Saturday I made it clear that up to £30 million will be available in this financial year to support children’s hospices, specifically, in extending their work so that they can provide a service in the community for children with life-limiting illnesses.

[Andy Burnham (Leigh) (Lab)]

The right hon. Gentleman will remember our exchanges at the election hustings, where there was a real difference between us: we said that we would protect the NHS budget in real terms, and I stand by that commitment; the right hon. Gentleman said that he would increase the NHS budget. After last week’s Budget, however, we now know the price of that commitment: 25% cuts to social care will mean vulnerable people either left without the support that they need or facing higher charges to pay for care, and huge pressure on carers. It means also that the NHS itself stops working, because it cannot discharge people from hospital when there is no support in the community. That unbalanced approach to public spending is dangerous and will decimate services on which the NHS depends. Is it not time to drop a pledge that had more to do with votes and nothing to do with people’s lives?

[Mr Lansley]

So there we have it, Secretary of State. [Hon. Members: “Secretary of State?”] I meant “Mr Speaker”—you are far more elevated than a Secretary of State, Mr Speaker.

The shadow Secretary of State’s belief is that the NHS budget should be cut. I fail to see how that could help social care. We are going to look much more positively at how we can join up the work of the NHS and social care. What my colleagues and I have announced on 30-day support for patients leaving hospital, including rehabilitation and re-ablement, will do precisely that, relieving some of the pressures on social care by seeing the NHS as a more holistic service for patients.