Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

Of course. One of my biggest concerns is that many of the hospitals now facing huge deficits are seeing their situation made infinitely worse by PFI debt. We will continue to do everything we can to help hospitals deal with that.

[Andy Burnham (Leigh) (Lab)]

On behalf of everyone on the Opposition Benches, I echo the Secretary of State’s warm tribute to Charles Kennedy. I cannot have been the only person this morning wondering why politics always seems to lose the people it needs most. Charles was warm, generous, genuine and principled. We will miss him greatly. We send our love and deepest sympathy to his family.

I congratulate the Secretary of State on his reappointment, but I commiserate with him on the financial position in the NHS that he inherits from himself. He told The Daily Telegraph today that the NHS has enough money, but that is not true. The deficit in the NHS last year was nearly £1 billion. Can he tell the House what the projected deficit is for the whole of the NHS for this year?

[Mr Hunt]

I welcome the right hon. Gentleman to his place. We have seen many feisty disagreements on health policy, and that is just in the shadow Health team. Perhaps he no longer believes his mantra about collaboration, not competition—we know that the shadow care Minister has disagreed with that for some time. To answer his question directly, there is a lot of financial pressure in the NHS, and that is because NHS hospitals took the right decision to respond to the Francis report into Mid Staffs by recruiting more staff to ensure that we ended the scandal of short-staffed wards. As a temporary measure it recruited a lot of agency staff, which has led to deficits, and that is what we are tackling with today’s announcement about banning the use of off-framework agreements for recruiting agency staff.

[Andy Burnham]

It is a new Parliament, but there are the same non-answers from the Secretary of State. He did not answer; he never does. I will give him the answer: NHS providers are predicting the deficit to double this year to more than £2 billion. Why has financial discipline been lost on his watch? It is because early in the previous Parliament the Government cut 6,000 nursing posts. They cut nurse training places and, when the Francis report came out, they left hospitals with nowhere to turn other than private staffing agencies. The Bill for agency nurses has gone up by 150% on his watch. He even admitted on the radio this morning that it was a mess of their making. Will he now apologise for this monumental waste of NHS resources and get our hospitals out of the grip of private staffing agencies by recruiting the 20,000 nurses that the NHS needs?

[Mr Hunt]

I have here the figures on nurse training placements, which started to go down in 2009-10, by nearly 1,000. Who was Secretary of State at the time? I think it was the right hon. Gentleman. [Interruption.] I have the figures here, and they show that planned nurse training places went down from 21,337 to 20,327. He talks about apologies, but where is the apology for what happened at Mid Staffs, which led to hospitals having to recruit so many staff so quickly? That is the real tragedy, and that is what this Government are sorting out.

Health and Social Care

Andy Burnham Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

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

[Andy Burnham (Leigh) (Lab)]

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

[Mr Hunt]

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

--- Later in debate ---

[Mr Hunt]

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

[Andy Burnham]

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

[Mr Hunt]

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

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

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

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

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

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

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

[Andy Burnham]

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

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

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

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

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

[David Tredinnick]

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

[Andy Burnham]

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

[Mr Stewart Jackson (Peterborough) (Con)]

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

[Andy Burnham]

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

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

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

[Andy Burnham]

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

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

“the time for debating whether or not”

it has enough money is over, it

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

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

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

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

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

[Andy Burnham]

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

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

[Mr Jeremy Hunt]

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

[Andy Burnham]

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

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

[Paul Farrelly]

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

[Andy Burnham]

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

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

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

[Andy Burnham]

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

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

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

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

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

[Andy Burnham]

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

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

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

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

[Andy Burnham]

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

[Heidi Allen (South Cambridgeshire) (Con)]

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

[Andy Burnham]

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

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

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

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

[Andy Burnham]

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

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

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

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

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

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

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

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

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

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

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

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

[Several hon. Members]

rose—

Penrose Inquiry

Andy Burnham Excerpts

Thursday 26th March 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

The 2010 to 2015 Parliament will be remembered for some extraordinary work to right historical wrong—on Bloody Sunday, on Hillsborough, on child abuse—but as it comes to an end this Parliament has not made enough progress on perhaps the greatest injustice of them all: the loss and ruination of many thousands of lives through the use of contaminated blood.

That is not to say there has not been progress. I pay tribute to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) and many others across the House who have worked assiduously in this Parliament to keep this issue on the agenda. The Prime Minister was right to apologise yesterday, but my hon. Friend is right that it will have real meaning only if it is followed by efforts to bring truth, accountability and redress.

Let me ask the Minister about the one recommendation that the Penrose report makes: that all people in Scotland who had a blood transfusion before 1991 now be tested for hepatitis C. Does the Minister think that recommendation should apply in England?

Given that, as my hon. Friend says, Penrose does not answer all the questions, and nor does it apply accountability to those who made decisions in this regard, does the Minister think there now needs to be a further process of inquiry in the next Parliament to produce that accountability?

Finally, while we cannot bring about a resolution today, does the Minister agree that the best thing we can say to the many thousands of people affected who will be watching these proceedings is that we will work together across the House in the next Parliament to bring a full, fair and final resolution to this terrible injustice?

[Jane Ellison]

I absolutely agree with the right hon. Gentleman’s last point. This is a tragedy that goes beyond party and has spanned many Parliaments now and we do need to move forward. I can only reiterate my frustration at the fact that we were not able to make more progress in this Parliament, but I can give the assurance to the House, and through Members to their constituents, that a great deal of detailed work has been going on, and I am sure it will continue as the many pages of Lord Penrose’s inquiry are considered.

With regard to the one recommendation that Lord Penrose makes—that the Scottish Government take all reasonable steps to offer a hepatitis C test to everyone who had a blood transfusion before 1991—I can confirm that the Department of Health concluded a UK-wide look-back exercise in 1995 to try to identify everyone who might have received infected blood prior to 1991, but the Department will consider if anything more can be done on this in England. That work is very important and will be undertaken.

On the next steps, as confirmed in the written ministerial statement yesterday, all relevant documents have been, or will be, released. The Government’s initial reaction is that another inquiry would not be in the best interests of sufferers and their families as it would further delay action to address their concerns. The strong message I have had is that it is time for action, and I have just heard the same message from the shadow Secretary of State.

The apparent thoroughness of Lord Penrose’s report and the fact that it sets the events in Scotland in a wider UK context gives us a sense of the fact that he has looked at these events in the widest possible way, including for England. He has done a thorough job of examining the facts, and we now for the first time ever have that detailed authoritative narrative account of what happened, and that is an important building block on which the next Government can take their policy forward.

Barts Health NHS Trust

Andy Burnham Excerpts

Thursday 19th March 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on Barts Health NHS Trust being placed into special measures.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

The NHS Trust Development Authority announced on Tuesday 17 March that Barts Health would be placed into special measures. This followed a report by the Care Quality Commission which rated services at the Barts Health site at Whipps Cross as inadequate. As a result of this decision the trust will receive a package of tailored support to help it rapidly make the necessary improvements for patients. This will include the appointment of an improvement director and the opportunity to partner with a high-performing trust. The chief inspector of hospitals has highlighted the scale of the challenge ahead and this is an opportunity to ensure that the trust has the extra support it needs to meet that challenge. Barts Health has already announced that it has begun to strengthen management arrangements at Whipps Cross, in response to concerns raised by the CQC.

We make no apology for the fact that, under the new rigorous inspection regime led by the chief inspector of hospitals, if a hospital is not performing as it should, the public will be told. If a hospital is providing inadequate care and we do not have confidence in the ability of its leadership to make the required improvements without intensive support, it will be put into special measures. It will remain in special measures until it is able it to reach the quality standards that patients rightly expect.

While the trust is in special measures, it will receive increased support and intensive oversight to help it address its specific failings. This process is publicly transparent, so patients and the public can see and track for themselves, online through the NHS Choices website, the progress that their trusts are making. Any changes or additional support required for the trust leadership are put in place early on in the improvement process, as has already taken place at Barts Health.

The expectation is that an NHS trust or foundation trust will be re-inspected by the CQC within 12 months of being placed in special measures. It is the job of the chief inspector of hospitals to recommend when a trust is ready to exit special measures. The NHS TDA or Monitor will then formally decide to take the trust out of special measures when it considers the trust is able to sustain the quality of care at the level patients rightly expect.

[Andy Burnham]

Barts Health NHS Trust is no ordinary hospital trust: it is the largest NHS trust in England, employing more than 14,000 staff and treating patients from all over London and indeed the whole country. Importantly, it is also one of the few trusts directly managed by the Trust Development Authority and the Department of Health.

Is it not true that the problems at Whipps Cross have been known for some time and have not just been uncovered this week? Is it not also true that these problems have been allowed to get worse over the past two years, with 208 serious incidents in the last year alone, and that specific warnings have not been acted on? Given all this, is it not a cause for real concern that this trust has become the 20th to be placed in special measures under this Government? People in east London need to know why, and what is being done to bring their hospital back up to an acceptable standard. Does the Minister accept that, given the seriousness of this issue, they are entitled to be disappointed that the Secretary of State is not here today to respond to these concerns?

One of the report’s main conclusions is that the root cause of care problems in the past two years was the reorganisation of the trusts in 2013. It states that

“the decision…to remove 220 posts across the trust and down band several hundred more nursing staff had a significant impact on staff morale and has stretched staffing levels in many areas”.

These findings raise significant questions for the Department and Ministers. Given that it is a directly managed trust, was a proper assessment made of the reorganisation plans, and was it signed off by Ministers? Why did Ministers overrule the Co-operation and Competition Panel, which advised against the proposed merger and warned of material costs to patients? What action did the TDA, the Department and Ministers take on the warnings raised at the time?

The Minister will know that my hon. Friend the Member for Leyton and Wanstead (John Cryer)—I am afraid he has a constituency engagement this morning; otherwise, he would have been here—and, as I understand it, her Cabinet colleague the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith), raised specific concerns about the decision to remove the management structure from Whipps Cross Hospital, concerns echoed by my hon. Friend the Member for Walthamstow (Stella Creasy). Why were those concerns ignored, leaving Whipps Cross without an adequate management structure?

Looking ahead, can the Minister say more about what is now being done to improve management at Whipps Cross, and to reassure local people that their hospital is safe? What immediate steps are being taken to improve staff numbers? On finance, is she aware that the bill for agency staff across the trust has gone up by a huge 44% in the last year alone, and what is she doing to bring that down? It is unsustainable and unaffordable, but it is also damaging standards of patient care on the ward and continuity of care.

The inspection took place in November. Why was it published only this week—one day before the Budget? Given that this is about a failure of NHS management, why is the Department of Health still sitting on the report by Lord Rose on NHS management? Will the Minister give a firm commitment to this House today that it will be published before Parliament is dissolved?

This report has been widely described as the worst assessment ever seen from the CQC. It will be seen as a symbol of the decline of the NHS on this Government’s watch, and people are looking now, today, for an urgent plan to turn things around.

[Jane Ellison]

The whole House will have noted that the right hon. Gentleman asked why the report has only just come out. He might reflect on his own time in office, when there were reports that did not come out at all just before the general election. If there is any better example of weaponising the NHS—we have just seen it. Instead of trying to make political capital, should the right hon. Gentleman not admit that the new CQC inspection regime illustrates exactly why transparency is so important, and why this Government were right to implement it?

Under the previous Government, failures of care were swept under the carpet and not acted on, which led to the tragic consequences we know about. Before the last general election, Labour tried to block the publication of a devastating report into Basildon and Thurrock hospital. [Interruption.] These are serious matters, and that is exactly why the CQC inspection has to be taken seriously. As I have said, local management is looking at these important issues, some of which we have debated before in the House, and which need to be addressed very seriously. However, the hospital management are beginning to do that, and they must take such action to ensure that they bring care up to the right standards.

All the things that the CQC has identified have to be addressed. As I have said, this illustrates exactly why the new CQC inspection regime is so important. Even now, a week before Parliament dissolves before the general election, this Government are committed, without fear or favour, to transparency and to bringing out this report. We are committed to ensuring that we put into the public domain the measures that need to be taken to put that hospital back on track and to ensuring that its patients can have confidence in the safety of its operation.

--- Later in debate ---

[Mr Speaker]

Order. I note the interest—

[Andy Burnham]

On a point of order, Mr Speaker—

[Mr Speaker]

Yes, in a moment. I notice that the interest in this debate grew as it was taking place. The First Deputy Chairman of Ways and Means, the hon. Member for Epping Forest (Mrs Laing), and the right hon. Member for Chingford and Woodford Green (Mr Duncan Smith) have toddled into the Chamber. [Interruption.] Yes, I understand that the right hon. Gentleman has a constituency interest, and that others have taken a keen interest.

I will now allow a point of order, because it relates directly to the exchanges that have just taken place. I know that the right hon. Member for Leigh (Andy Burnham) will not abuse his privilege.

[Andy Burnham]

I am grateful to you, Mr Speaker, for allowing this point of order.

In the Minister’s non-reply to my questions, she inadvertently misled the House. She said that, before the last election, I had blocked a report on Basildon hospital. I wish to place it on the record that I made an oral statement to this House about Basildon hospital and published reports on it on 30 November 2009. I followed that up with a written statement to the House on 5 March 2010. I would be grateful to the Minister if she withdrew her comments.

[Mr Speaker]

I note what the shadow Secretary of State has said. He has put it on the record. The Minister is welcome to respond if she wishes, but she is not obliged to.

Maternity Services (Morecambe Bay)

Andy Burnham Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his well-judged statement, and echo entirely the sentiments he expressed. Families in Barrow and the wider Cumbria area were badly let down by their local hospital and by the NHS as a whole. The Secretary of State was right to apologise to them on behalf of the Government and the NHS, and today I do the same on behalf of the previous Government.

It is hard to imagine what it must be like to lose a child or partner in such circumstances, but to have that suffering intensified by the actions of the NHS is inexcusable. Bereaved families should never again have to fight in the way that these families have had to fight to get answers. The fact that they have found the strength and courage to do so will benefit others in years to come, and I pay tribute to them all, and particularly to James Titcombe.

This report finally gives the families the answers that they should have received many years ago. It explains in detail what went wrong, the appalling scale of the failings and, as the Secretary of State said, the opportunities missed to identify those failings and put them right.

I echo the Secretary of State’s praise for Dr Bill Kirkup, his investigation team and the panel that assisted them. The report’s analysis is thorough, and its recommendations are powerful but proportionate. The Opposition support all the recommendations made today. I understand that the Secretary of State will want to take time to consider each individually, but he can rely on our full support in introducing them at the earliest opportunity.

People’s first concern will be whether local services are safe today. The report identifies the root cause of the failures as a dysfunctional local culture and a failure to follow national clinical guidance. There are suggestions in the report that that culture has not entirely disappeared. The report finds:

“we…heard from some of the long-standing clinicians that relations with midwives had not improved and had possibly deteriorated over the last two to three years…we saw and heard evidence that untoward incidents with worryingly similar features to those seen previously had occurred as recently as mid-2014.”

I am sure the fact that problems have been acknowledged means that there has already been significant improvement, but will the Secretary of State say more about those findings, and about what steps he is taking to ensure that the trust now has the right staff and safety culture?

After safety, people will rightly want accountability, as the Secretary of State said, not just for the care failings, but for the fact that the problem was kept hidden from the regulators and the public for so long. When information came to light, it was not acted on. Lessons were not learned, and problems were not corrected. The investigation recommends that the trust formally apologises to those affected. The whole House will endorse that call, and will want it done both appropriately and immediately. Further, will the Secretary of State ensure that any further referrals to the GMC and NMC are made without delay? Will he also ensure that any managerial or administrative staff found guilty of wrongdoing are subject to appropriate action? A number of staff have left the trust in recent years, many with pay-offs. Will he review those decisions in the light of the report and take whatever steps he can to ensure that those who have failed are not rewarded?

One of the central findings of the investigation is on the challenges faced by geographically remote and isolated communities in providing health services. The investigation warns of the risks of a closed clinical culture in which

“practice can ‘drift’ away from standards and procedures found elsewhere”.

Is not the report right to recommend a national review of maternity care and paediatrics in rural and isolated areas, and will the Secretary of State take that forward? Alongside that, there are concerns about the sustainability of the Cumbrian health economy. My hon. Friend the Member for Copeland (Mr Reed) has today written to the chief executive of NHS England to call for a review of the specific challenges it faces. I hope the Secretary of State will be sympathetic to that call.

On the CQC, the role of the regulator has always been to oppose poor care and challenge practice, but it is clear that it failed in its duty in this case. Given what was known, the decision to register the trust without conditions in April 2010 was inexplicable, as was the decision to award foundation trust status later in 2010, as was the decision to inspect emergency care pathways but not maternity services—in so doing, it failed to act on specific warnings. As the report states, there was and remains confusion in the system over who has overall responsibility for monitoring standards, with overlapping regulatory responsibilities. The Opposition support moves to make the CQC more independent, but does the Secretary of State agree that the journey of improvement at the regulator needs to continue, and that there is a need for further reform? Will he ensure that NHS England draws up the recommended protocol on the roles and responsibilities for all parts of the oversight system without delay, and does he agree that the CQC should take prime responsibility?

I want to close by focusing on two proposals that I believe get to the heart of the matter before us. I have thought carefully about how we truly do justice to the families’ campaign and learn the lessons of both this investigation and the Francis report. In my view, the answer is a much more rigorous system of the review of all deaths in the community and in hospitals than currently exists.

First, is the reform of death certification and the introduction of a new system of independent medical examination well overdue? The Kirkup report echoes findings that go back as far as Dame Janet Smith’s inquiry into the Shipman murders, which were repeated recently by Sir Robert Francis in his two reports on Mid Staffordshire. The previous Government legislated for those reforms and made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to a coroner. That has been piloted and proven to be effective. The investigation says that those reforms could have raised concerns at Morecambe Bay before they eventually became evident.

The second point is that we need a better system for scrutinising deaths in hospital. The report recommends mandatory reporting and investigation of serious incidents of all maternal deaths, stillbirths and unexpected neonatal deaths. Is there not a case to go further, including by looking at moving to a mandatory review of case notes for every death in hospital, and at how we can use a standardised system of case note review to support learning and improvement at every trust?

To help to guide the Opposition’s new approach to quality improvement, Professor Nick Black has agreed to advise us and inform the review, which will be concluded by the end of the month. In our view, that reform is much needed, because rather than looking at a sample of deaths to avoid harm, we would look at every single death to learn lessons, which means that every single person matters. Ideally, the review should be cross-party. I hope the Secretary of State feels able to endorse the review I have announced, which will make recommendations that the next Government can act on immediately. Is that not the best way to do justice to the issues that the families have fought to raise, and to ensure that the legacy of their campaign is to ensure that no others go through what they have gone through?

[Mr Hunt]

I thank the right hon. Gentleman for his measured tone. I am sure he is absolutely sincere in wanting to learn from this tragedy. I thank him for his moving words and for his apology. He will understand that there is nervousness among the families because, in the past, when the Government have talked about rooting out poor care, we have been accused of running down the NHS. We have had a different tone today, and I welcome it.

To answer the right hon. Gentleman’s specific points on the quality of care at the hospital currently, the best person and people to make that judgment are the new CQC and chief inspector of hospitals, Professor Sir Mike Richards. He has said that, in his view, the care at the maternity unity in Furness general hospital is good, and indeed safe—it is more than safe; it is good. That should reassure many people who are using the hospital. He is also very clear that there are many, many improvements to make, and his overall rating for the trust is not good. The report highlights many areas that still need to be addressed, but it is important to give that reassurance.

On death certification, I assure the right hon. Gentleman that we fully support that policy. As he knows, it was recommended in January 2005, so it has taken a long time for both Governments to address. We fully support the policy and have had successful trials. We are committed to introducing it as soon as possible and we want to go further. There may be some common ground, because we, too, have been talking to Professor Nick Black about case note reviews. The latest advice I have had is that it would be technically very difficult to review the case notes of all the 250,000 deaths every year in NHS hospitals, because of the resource implications and the doctors’ time it would take. I asked whether it would be possible to do that. I was advised that, if we looked at case notes hospital by hospital, there would be a risk of trusts getting into big disputes about whether or not a death was avoidable. I asked Professor Black to help me to devise a methodology so that we can assess the level of avoidable deaths by hospital trust. We would be the first health economy in the world to do that. I hope we will have his full support as we take that forward.

On the decision to give the trust foundation trust status, the report makes it clear that Ministers were advised that they had no locus to intervene, because the process had already been set in train—the decision had been deferred but not stopped, so they were not able to intervene. It is clear that the level of knowledge in the Department of Health, as in the rest of the system, was wholly inadequate given what was happening in that hospital.

I should like to make one other point, on a comment made by Labour this morning that the report would say that the failings were very localised. In fact, the report says the opposite. I want to read what Dr Kirkup says in the introduction to the report:

“It is vital that the lessons, now plain to see, are learnt and acted upon, not least by other Trusts, which must not believe that ‘it could not happen here’.”

It is important that we take that lesson from the report extremely seriously.

I would like to finish on a note of consensus. I appreciate that it is not always easy for Oppositions to support the Government publicly as they put right policy mistakes that they have inherited, but I think there is one thing where we can make common ground: the need for culture change in the NHS. Policies can be changed over one Parliament, but culture change takes a generation. What the families who have suffered so much want to know more than anything else is that Members on all sides of the House are committed to that, so that we never again go back to the closed ranks and institutional self-defence that piled agony on to their tragedies, and that, once and for all, we all make the commitment that patients will always come first.

Jimmy Savile (NHS Investigations)

Andy Burnham Excerpts

Thursday 26th February 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his considered and thorough statement, and for his evident concern for the many lives that have been damaged by these vile acts and systemic failures. He was right to repeat his apology to Savile’s many victims and their families, and the whole House will support his decision to do so. I add my thanks to all those involved in compiling these reports, and particularly Kate Lampard and Ed Marsden for their “Lessons Learned” report. Through their diligent work, the full scale and horror of Savile’s sickening behaviour across the NHS has finally been laid bare. It beggars belief that abuse on this scale, known to so many people, was allowed to continue for so long. As the analysis of what happened becomes more complete and the full picture emerges, the question will grow in people’s minds: “Where is the accountability?” That is what victims are crying out for, and that is what must follow. It must be the single most important question occupying the Government in dealing with these matters, and it must continue to be a priority for the next Government and the next Parliament.

Much of what is revealed in the reports confirms what we already know about a pattern of criminal behaviour in hospitals where patients and victims were not listened to and staff felt unable or unwilling to challenge, but what changes with the Stoke Mandeville report is that it is now no longer possible to say that although the abuse was widespread, it was not known to people in senior positions. Nine verbal reports and one formal complaint were made, but none was acted upon. Why? The questions do not just extend to senior staff at the hospitals, and the Secretary of State was right to raise questions about the role of civil servants and former Ministers. To quote one of the main observations of the “Lessons Learned” report:

“As the investigations at Broadmoor and at Stoke Mandeville show, Savile’s involvement with those hospitals was supported and facilitated by Ministers or senior civil servants”.

We already knew that he was appointed by Edwina Currie to the taskforce that ran Broadmoor between 1988 and 1989, but today’s Stoke Mandeville report states:

“From 1980 Savile’s relationship with Stoke Mandeville Hospital underwent a significant change when he was appointed by Government Ministers…to fundraise for…the new National Spinal Injuries Centre”.

The “Lessons Learned” report concludes:

“In appointing Savile to these roles, and in allowing him the licence and free rein he had in exercising these roles, Ministers and/or civil servants either overrode or failed to observe accepted governance processes.”

That extremely serious finding needs to be acted upon.

I do not expect the Secretary of State today to answer these points in detail, and I welcome what he said in facing up to the findings, but does he agree that they point to the need for a more formal inquiry process involving senior people from that time—senior people in the hospitals concerned, senior people in the Department of Health and former Ministers? Knowing what we now know, we cannot simply leave this here. Victims must have accountability. That must be our shared goal across the House.

Alongside accountability, Savile’s victims need help. As the Secretary of State said, many lives have been damaged by what happened and will never recover. Nothing can be done to heal their pain, but there are things that could help them. In his last statement, he said that he would continue to explore the possibility of compensating victims using Savile’s estate to fund any claims. Will he update the House on that work? Is the value of Savile’s estate anywhere near enough to provide adequate compensation to his many victims? Has the Secretary of State made any judgment about whether public funding is needed to help compensate them? Today’s news will distress everyone directly affected. What steps are being taken to offer them counselling and other support?

Turning directly to the “Lessons Learned” report, while these appalling events come from a very different era, it would be a major mistake for the House or anybody reading the reports to think they have no relevance to today. To quote a chilling conclusion from the Lampard and Marsden report:

“The evidence we have gathered indicated that there are many elements of the Savile story that could be repeated in future.”

We know that a child cancer specialist from Addenbrooke’s was recently convicted for sexual offences against vulnerable boys as young as eight who were in his care.

Even though the world was very different in the 1970s and 1980s, it is impossible to read these reports without wondering how so many people could have known what was going on, yet felt they could not do anything about it. It must never again be the case that a member of staff should be made to feel unable to speak up for fear of “letting the hospital down”. They must feel fully supported at all times in reporting any act of abuse against anybody in the place in which they work. While we welcome the action the Secretary of State is taking to support NHS whistleblowers and strengthen their position, we cannot complacently think that this will be enough in these kinds of situations.

On Monday, the Government voted against the new legal requirement for those working in schools, hospitals and child care settings to report to the police child abuse in institutional settings. The purpose of such a requirement would be to make sure that no professional ever felt the protection of the reputation of the institution should take priority over the protection of a child or pursuing the truth. I listened carefully to what the Secretary of State said about this today. He said that there will now be a process of consultation on a proposed mandatory reporting duty. That is indeed a step forward, which I welcome. I understand why the Government would want to consult—because of the effect such a requirement could have on the working of an organisation. I want to push the right hon. Gentleman a little further and say that this consultation should not be open-ended, but a consultation leading to a firm commitment to legislate at the earliest opportunity—if not in this, in the next Parliament. I believe that that is the growing will of this House and I believe it will be the growing will of the next one.

On vetting and barring, the Secretary of State made some welcome proposals, and Kate Lampard has highlighted the need for a new focus on this area. There is a concern that changes to the vetting and barring scheme in this Parliament have significantly weakened its ability to protect children from convicted sex offenders. There is a concern that some offenders are being left off the list or that there is now a limit to the number of roles that offenders can be checked against, so that the potential for offenders to gain access to vulnerable people has increased.

Will the Secretary of State look again at the proposals put forward by my right hon. Friend the shadow Home Secretary, and ensure that every possible step is taken to close any possible loophole that could be exploited by a sex offender? As Kate Lampard rightly said, hospitals in the coming era are going to have to be more reliant on the work of volunteers and on fundraising. That is the context in which the NHS will operate for some considerable time and, in that context, there will be a need for a greater number of checks to ensure that those participating in the volunteering or the fundraising are appropriate people for roles in any hospital organisation. I ask the Secretary of State to ensure that the vetting and barring scheme is up to that task, so that we leave no loopholes for convicted paedophiles or sex offenders to exploit.

In conclusion, these are painful, appalling and sickening events that are a dark chapter in the history of the NHS and indeed of our country. We applaud the Secretary of State and the Government for their commitment and thoroughness in facing up to these events of our past. I can assure the right hon. Gentleman of our full support in bringing accountability and redress for the victims, and in ensuring that whatever can be done across the Floor of the House is done, so that these kind of events can never take place again in our national health service.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

We do understand those concerns. It is absolutely essential that CCGs make sure that they have the right bed capacity to deal with the pressures of winters.

[Andy Burnham (Leigh) (Lab)]

Let me take the Secretary of State back to a subject he likes to avoid—NHS privatisation. He tries to deny that it is happening on his watch, but we heard earlier about the ideological privatisation of cancer scanning in Cheshire and Staffordshire, despite its being more expensive than the NHS bid—and now it could get much worse. On the Friday before the recess, the Government sneaked out the public contracts regulations, which require NHS contracts worth over €750,000 to be opened up to full EU competition. Will the Secretary of State confirm that that is indeed the case in these regulations, and can he explain what mandate he has from the public to open up the NHS to private bidders across Europe?

[Mr Hunt]

Since the last time the right hon. Gentleman and I met, the King’s Fund has published its assessment of the NHS reforms over the past few years, and its words were:

“Claims of mass NHS privatisation were and are exaggerated”.

He knows perfectly well that outsourcing grew at double the rate under the previous Labour Government than it has grown under this Government.

[Andy Burnham]

The King’s Fund report said that as a result of the Secretary of State’s reforms there is

“greater marketisation of the NHS”.

People will notice that he failed to answer my question. That is because he wants to sneak these plans through under the radar. I serve notice on him today that we will fight him all the way, right to the very last day of this Parliament. If passed, these regulations will mean that almost every NHS contract will be forced to be advertised across Europe, shattering the promise he made to protect the NHS from EU competition law. Is it not now abundantly clear that he has forfeited the public’s trust on the NHS, and that five more years of this Government will lead to huge acceleration in NHS privatisation?

[Mr Hunt]

I repeat:

“Claims of mass NHS privatisation were and are exaggerated”.

If the right hon. Gentleman does not like the reforms, let us look at a country that did not have them—Wales. The number of people waiting too long for A and E is nearly double that in England, the number of people waiting too long for urgent ambulances is nearly double that in England, and the number of people waiting for operations is 10 times that in England. That is our record—it is a record of success.

Francis Report: Update and Response

Andy Burnham Excerpts

Wednesday 11th February 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I welcome the Secretary of State’s statement and his obvious commitment to improve the culture of tackling poor care in the NHS; there is plenty of common ground between us. We endorse the principles laid out in Sir Robert Francis’s new report and we will work with the Secretary of State to get new safeguards on the statute book in the remainder of this Parliament, as he requested.

It was the Labour Government who, in 1998, introduced the first legal protection for whistleblowers in the Public Interest Disclosure Act 1998, reinforced in the NHS constitution in 2008. Sir Robert’s new principles build on those foundations. We thank him and the review team for their work and praise every whistleblower who has had the courage to come forward.

Our shared aim must be to create a climate in which every NHS worker feels able to raise concerns and feels confident that they will be listened to, that appropriate action will be taken and that they will not face mistreatment as a result. Sir Robert’s report will help achieve that. We particularly welcome the call for whistleblowers worried about losing their jobs to be offered alternative employment and for training in whistleblowing for all staff. Those measures are overdue. Will the Secretary of State say more about how Sir Robert’s principles will be enforced across the NHS and about the timetable for implementation? Will he confirm that they will apply equally to all providers of NHS services, including voluntary and private providers?

That brings me to an issue of major substance not covered in Sir Robert’s report. As he points out, his remit did not apply to any form of social care. That is a major concern, given that it could be argued that some of the poorest care provided in England today is in social care settings or in people’s own homes. Only at the weekend, a BBC investigation found that one in five care homes for older people is failing to meet standards for safety. Should we not today, across this House, establish the firm principle that Sir Robert’s recommendations should apply equally to all places where people receive care?

Let me turn to the recommendation for an external organisation that staff can approach for advice and support. In response to the first Francis report in February 2010, I established an expert group to update whistleblowing guidance. It reported in June 2010, and the Secretary of State’s predecessor announced plans for a “safe and independent authority” to which staff could turn when their organisations were not acting on concerns. Will the Health Secretary say why that has not progressed since then and assure us that there will be no further delays now that Sir Robert has reinforced that recommendation?

Although I believe that the Secretary of State’s commitment to improve the culture in the NHS is genuine, he will no doubt be concerned by Sir Robert’s findings that it might have got worse in recent years. In his report, he said about the cases he examined:

“Many were relatively recent or current. This is not about a small number of historic high profile cases from a time when organisations might argue the culture was different. We had a significant number of contributions about cases in 2014.”

The report specifically references figures from the latest NHS staff survey, which shows that reports of bullying have increased from 14% of staff in 2011 to 22% in 2013. Over the same period, the percentage of staff who feel able to speak out about poor care or to report errors or near misses has fallen from 98% in 2011 to 94% in 2013. Those figures suggest that things are getting worse, not better. Will the Secretary of State explain why he thinks that is and whether he will investigate the reasons further? That underlines the importance of any moves to improve the culture being introduced in the right spirit and being supportive rather than punitive, so that they do not reinforce the wrong culture and have the opposite effect to that which the Secretary of State is obviously trying to achieve.

At the weekend, the Secretary of State proposed fines and jail sentences for failure to be open about poor care. Although we support his zero-tolerance approach, is he certain that how this is perceived on the ground will not create a climate of fear and have the opposite effect?

Those concerns also apply to the new inspection regime introduced since the Francis report. In advance of today, I was contacted by a whistleblower who works in a hospital about a Care Quality Commission inspection planned for later this month and about the growing practice of hospitals running mock inspection days in advance of the CQC’s arrival, as schools have come to do with Ofsted. The whistleblower’s letter states:

“I enclose a document that invites us for a mock inspection to show us what to do and say when the CQC comes. Is this the correct thing to do? I think not. I cannot reveal my name as I would be instantly dismissed. Can you help?”

I am sure that the Secretary of State will be as concerned as I am to hear that and I will forward the information to him this afternoon.

I turn now to the Secretary of State’s update on the Francis report on Mid Staffordshire. Both sides of this House supported Sir Robert’s original recommendations and we give credit to the Secretary of State for making significant progress with their introduction, but gaps remain where progress has not been made and that is a concern when standards overall in the NHS are recorded to be falling, not rising.

In particular, there is a long-standing need to reform the system of death certification which goes back to Dame Janet Smith’s inquiry into the Harold Shipman murders. I took a personal interest in that as a Minister on the back of concerns raised by my hon. Friend the Member for Denton and Reddish (Andrew Gwynne)and James Purnell, the former Member for Stalybridge and Hyde. I legislated for reforms of death certification in the Coroners and Justice Act 2009, which made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to the coroner.

Following successful pilots, Sir Robert Francis reinforced Dame Janet Smith’s recommendation. Dr Suzy Lishman, the president of the Royal College of Pathologists, says that introducing these reforms will

“improve patient care whilst reducing harm and saving money”.

It will therefore be a cause of great concern to a great many people, not least the families of the victims of Harold Shipman, that those reforms appear to be stuck in the long grass. Chris Bird, whose mother Violet was one of those victims, recently told the “Today” programme that

“it is criminal that the Government is stalling on implementing something like this that could save lives.”

I have been informed by senior officials in the Secretary of State’s own Department that he personally is holding up this reform. Can he say whether that is true, and if so why? If it is not true, which I am prepared to accept, will he today set out a clear timetable for the introduction of this vital reform?

Alongside that, we need better arrangements in hospitals for reviewing case notes when patients have died, as the Secretary of State mentioned in his statement. Over the weekend, the Government announced plans to introduce an annual review from a sample of patients. Although that will help us to develop a more accurate measure of avoidable deaths than mortality rates, does the Secretary of State think it goes far enough? Should not the NHS learn from all serious failings? Will he give consideration to our suggestion that every death in hospital should be subject to an appropriate level of review?

We welcome the renewed focus on staff numbers since the Francis report, but we also remind the House that in the first three years of this Parliament almost 6,000 nurses were lost and, with record numbers of people in hospital, nurse-patient ratios have not kept pace with demand and there are fewer nurses per head of population now than in 2009-10. One of the problems with having made so many permanent staff redundant is that, post Francis, recruitment has been heavily reliant on agency staff. As Robert Francis warns today, that has made it even harder to get the culture right. We welcome the Secretary of State’s recent focus on nurse numbers, but will he concede that it was a mistake to cut staff so heavily? Will he back Labour’s plan to bring down the agency bill by recruiting 20,000 more nurses?

We welcome the progress made at some hospitals in special measures, but may I caution the Secretary of State on his use of statistics? Is he aware of the graph on page 8 of the Dr Foster report, which shows that mortality rates at the Keogh trusts fell faster between 2006 and 2010 than between 2010 and 2014? There was never a tolerance or denial of high mortality, as he seemed to suggest in his statement.

On openness and transparency more broadly, the Secretary of State will be aware that the King’s Fund delivered a damning verdict on the Government’s reorganisation, concluding that it had damaged patient care. That is consistent with a survey of NHS staff, which found that 69% said the reorganisation had harmed patient care, with only 3% saying it had improved. It is suggested that the Government’s own risk register on the reorganisation warned that reorganising the NHS at a time of financial stress would damage front-line care. So that any future Government can learn the lessons of the past few years, will the Secretary of State publish the risk register, as recommended by Sir Robert Francis?

In conclusion, as I have always said, the lessons from Mid Staffordshire need to continue to be learned if the NHS is to be what we all want it to be: the safest and best health care system in the world. The Secretary of State has today taken some important steps towards that goal, but I hope he will respond fully to the serious questions I have raised.

[Mr Hunt]

I welcome the broadly constructive tone that we have heard today. May I say, in that spirit, that I hope that that represents a change in substance from some of the other exchanges we have had on these topics? The right hon. Gentleman tried to vote down the legislation that set up the new chief inspectors and he opposed the holding of a public inquiry into Mid Staffs. If we are to have constructive agreement across the House, I do think we need to agree on substance as well as on tone. Let me just take the individual points he mentioned.

We are completely committed to death certification. That was recommended in the wake of the Shipman inquiry. The right hon. Gentleman’s Government took a very long time to do anything on this and we have been trying hard to do it. It is a complicated thing to get right. On the question of looking properly at avoidable deaths, I just want to say this. It is very difficult, when one looks at case notes, to work out whether a death was avoidable or not, but we think we have a methodology to do that. It is more difficult to relate that to individual trusts, but we want to try to achieve that as well. I was disappointed at the weekend that when we announced that, his response was that it was unambitious. Two weeks earlier, he had published Labour’s 10-year plan for the NHS, which did not actually mention reducing avoidable deaths at all. What we are proposing is the most ambitious thing that any health care system has proposed anywhere in the world, and I hope it will have his full support.

On the right hon. Gentleman’s comments about not generating a climate of fear, he is absolutely right; it is really important, in getting the culture right, to make sure that people are supported to speak out and that there is not, as an unintended consequence, the kind of bullying and intimidation that Sir Robert says is all too common today. I suggest to him that one of the reasons for that climate of fear has been over-dependence on top-down targets as a way of running the NHS. That is what has created the fear in managers that sometimes has led them to treat their staff in the wrong way. What would be very constructive would be a recognition from Labour that that top-down targets culture did go too far, and that we need to rely on transparency as a way of improving performance as a much better tool than endless new targets.

In anything we do—this is something else where I agree with the right hon. Gentleman—we must look very closely at making sure that we learn these lessons in the social care sector as well. That is particularly clear when we look at the scandal of what happened in Rotherham. That is why, when we introduced the new CQC inspection regime following the original Francis public inquiry, we did not just set up a chief inspector for hospitals but set up a chief inspector for general practice and for adult social care. We are now getting the same Ofsted-style transparent rankings of how good care is in care homes, and indeed in domiciliary care. I know that he, like me, is concerned about 15-minute care visits. I think those inspections will help to root out those problems.

With respect to nurse numbers, I really do think that is something on which, if the right hon. Gentleman wants to be constructive, he should commend the Government’s efforts. We have 8,000 more nurses in our hospital wards than we had four years ago. Of course, as a short-term response a lot of hospitals are employing nurses through agencies. That must only be a short-term response. We need proper long-term commitment to institutions, which we do not get with agency staff, but I commend hospitals that have said, “While we try and get enough staff in place for the long term we are not going to wait, because we need to make sure that patients are safe today.” They want to do what it takes to do that.

Finally, on the risk register, I simply remind the right hon. Gentleman that when he was Secretary of State he blocked the publication of the risk register. As a Minister, he said:

“This would inhibit the free and frank exchange of views about significant risks and…management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

More broadly, I just want to say this. There are many patients and whistleblowers looking at today’s exchanges and wanting to see constructive agreement on the way forward. I think we can get a measure of that. What they say they want is not just words, but actions.

As we put staff and patients first in England, will Labour do the same for patients in Wales and today commit to a Keogh review of high mortality hospitals, commit to a chief inspector of Welsh hospitals and commit to protect staff who speak out in Wales, as we want to do in England? Will he commit to putting right a top-down culture that prioritised the needs of the system over the needs of individuals? Will he, as we do, recognise that that is always the danger of treating the NHS as a political possession and not as a service for patients? Patients must always come first. Staff who want to do the right thing for patients should always be heard. Our NHS deserves nothing less.

NHS (Government Spending)

Andy Burnham Excerpts

Wednesday 28th January 2015 Commons Chamber

[Dr Poulter]

The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means a greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.

As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under the right hon. Member for Leigh (Andy Burnham), the number of managers in the NHS went up six times as fast as the number of nurses.

[Andy Burnham (Leigh) (Lab)]

I am grateful to the Minister, because I was going to mention my last year in office. Would he care to inform the House what the bill for management consultancy in the NHS was in 2010 and what it is now?

[Dr Poulter]

I have just told the right hon. Gentleman very clearly that the cost of NHS managers doubled under the previous Labour Government, a profligate record of spending that has taken money away from front-line patient care.

[Dr Poulter]

My hon. Friend makes a very important point. We could stand here all day talking about the inefficiencies and profligacy in running the NHS finances by the previous Labour Government. He is also right to highlight—

[Andy Burnham]

Will the Minister give way?

[Dr Poulter]

I am going to make some progress. I will give way to the right hon. Gentleman later. I have been very generous and I need to make some progress. I remind him that under the previous Labour Government, as my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) highlighted quite rightly, NHS providers were paid less than private sector providers. The right hon. Gentleman and the previous Labour Government paid the private sector 11% more than the NHS for performing the same NHS operations—something we have clearly outlawed under our legislation.

If we needed a further reminder of what Labour does when it runs the health service we need only look at Wales today, where almost every indicator of NHS performance shows that the Welsh NHS, run by Labour, is performing poorly when compared with the NHS in England. While we protected and increased our NHS budget in England, Labour in Wales has cut the NHS budget and patients are paying the price. Thanks to Labour in Wales, people have to wait about 100 days longer than patients in England for knee and hip operations. On finances and on care, Labour has let down our hard-working NHS staff and patients in Wales by its lack of investment in front-line services.

--- Later in debate ---

[Dr Poulter]

My hon. Friend is absolutely right. The fact that the shadow Health Secretary’s colleague, the hon. Member for Nottingham East, opened the debate perhaps shows a lack of confidence. The shadow Health Secretary’s record is very difficult to defend.

[Andy Burnham]

Will the Minister give way?

[Dr Poulter]

If the right hon. Gentleman wanted to contribute to the debate in such a meaningful way, why did he not have the courage to stand here and speak in this debate? I have been very generous in giving way. I know he does not like to be reminded of his record in office. Frankly, on NHS finances his record is abysmal, just like the previous Labour Government’s record of running our economy. If he wants to contribute he should speak in the debate. I will give way generously again later, but I want to make some progress.

On the Government Benches, we know that we cannot have a strong NHS without a strong economy. In spite of the profoundly challenging financial position we inherited from Labour, I am proud that this Government have increased NHS funding in each year of this Parliament. As a result of the additional funding announced in the autumn statement for 2015-16, funding will be £16 billion higher in cash terms in 2015-16 than it was in 2010-11. That equates to an increase of £6.8 billion in real terms for our national health service under this Government.

Our NHS is also on track to deliver up to £20 billion of efficiency savings this Parliament, having reported about £15 billion of efficiencies in the first three years. All of that has, or will be, reinvested into front-line patient care. Our commitment to our NHS has meant that, since the last election in 2010, there are now more than 17,200 more professionally qualified clinical staff, including over 9,000 more doctors, enabling 850,000 more people to have operations than in 2010, and over 3,300 more nurses, midwives and health visitors. Fewer patients are waiting to start treatment, and hospital infections have virtually halved. Mixed-sex wards, a great scandal of the previous Government, have largely become a thing of the past. I could, and will, go on in a moment.

NHS Major Incidents

Andy Burnham Excerpts

Wednesday 28th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what guidance has been issued by NHS England on declaring a major incident.

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

As you know, Mr Speaker, I am always happy to come to the House to discuss the NHS, but today we have been brought here to discuss a local operational issue that, regrettably, the Opposition have tried to spin as part of their policy to “weaponise the NHS.”

As I said to the House earlier this month, a major incident is part of the established escalation process for the NHS, and has been since 2005. It enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally, and there is no national definition. We must trust the managers and clinicians in our local NHS to make these decisions and support them in doing so by ensuring that there is sufficient financial support available to help them to deal with additional pressures. The document that has been questioned this morning by the Opposition Health spokesman was issued by the local NHS in the west midlands. That was done to help its clinical commissioning groups to work with local NHS organisations to deal with the unprecedented pressures they have been facing this winter. The chief operating officer of NHS England, Dame Barbara Hakin, has said this morning that this was a local decision and neither the responsibility of Ministers nor the result of pressure by Ministers.

Let me finish by praising the NHS for coping well with the unprecedented pressures. Performance against the A and E standard improved to 92.4% last week, which is testament to hard-working staff, and this Government will support them, not try to turn their efforts into a political football.

[Andy Burnham]

In the first week of January, at least 14 trusts across England declared major incidents, including three in the west midlands. Official figures show that pressure continued into the second and third weeks of January, with only seven A and Es out of 140 meeting the Government’s target. There were ambulance diverts, and even an A and E closure, but no further major incidents were declared. On 7 January, when the Health Secretary was called to the House to answer an urgent question, he said:

“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]

He has just repeated that now, and called this a “local operational issue”, but that does not appear to be entirely accurate. Let me quote from the guidance that was sent in the middle of January. It is headed “NHS England” and it states:

“Major incidents should be agreed with…the Director on call for NHS England”.

Will the Secretary of State now withdraw his earlier statement to the House and confirm that this decision is not purely local, in that it has to be approved by NHS England?

Let me turn to the impact that this has had on trusts. There are 17 enhanced criteria set out, including requirements that may cause serious time delays for trusts in an emergency. For instance, there is a requirement on the on-call CCG manager to visit the trust and undertake a review. Let me tell the Secretary of State how those new rules were perceived by senior managers. I shall quote from an e-mail sent by the head of operations at one trust, who said that the requirement had been

“introduced by NHS England to effectively stop trusts from calling a major incident…Our hands will be tied in most cases if they wish to call a major incident for capacity reasons”.

Is the Secretary of State confident that the new enhanced criteria are not unduly burdensome and will not cause unnecessary delays for a trust in an emergency situation? Is he satisfied that this guidance is consistent with good practice at national level and safe to be left in place?

The Secretary of State has used the word “local” many times today, and spoken of the only consideration being relieving pressure on hospitals facing severe demand. However, his claim that this matter is purely local is called into serious question right now by this 86-page document headed “NHS England”—[Interruption.] He says it is from the local team, but this is a regional function of the national body, NHS England. The local claim will not wash, I am afraid.

I will tell the Secretary of State what the guidance tells trusts to take into account. He says that it concerns only operational matters, but section 7.2.3 is headed “Politics”, and subsection (a) asks:

“Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?”

Subsection (c) asks:

“Is there a risk of reputational damage?”

Does not this muddy the waters hugely? Will it not distract doctors whose sole focus should be on the emergency situation, and not on media and political considerations that should form no part of their judgment? If the Secretary of State agrees with me on that, will he today instruct NHS England to withdraw this guidance and issue more appropriate instructions to the NHS in the region? The NHS remains under serious pressure, and it needs the clearest of instructions based on what is best for patients. Will he act today, so as to leave the NHS in no doubt that that must be its paramount and only concern at all times?

[Mr Hunt]

In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.

As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.

Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

--- Later in debate ---

[Mr Hunt]

My hon. Friend eloquently points out the great irony in what we have heard from the Opposition Front Bench. We do not want an NHS in which every single operational decision is made from behind the Secretary of State’s desk. We want to trust people on the ground. Why do we want to do that?

[Andy Burnham]

Politics.