National Health Service
Andy Burnham Excerpts(9 years, 5 months ago)
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Andy Burnham (Leigh) (Lab)
I beg to move,
That this House notes comments from leading experts that the NHS is under unprecedented levels of pressure and that this is putting patient care at risk; further notes that attendances at hospital A&E departments increased by 60,000 in the last four years of the previous Government and 600,000 in the first four years of the current Government; believes that this is linked to decisions taken by this Government, including cuts to adult social care, the abolition of NHS Direct, the closure of almost one in four walk-in centres and removing the GP access guarantee; and calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion a year for the NHS, funded by measures including a tax on properties worth over £2 million, to help ease the current pressure and ensure that the NHS is fit for the future.
We have called this debate today to see if we can establish a shared analysis across the House of the causes of the current crisis in accident and emergency departments, and from that, shared solutions. I hope we can all agree that the staff of the national health service and of the ambulance service are working wonders in the most trying circumstances, and that it behoves all of us to put forward our ideas today to relieve the pressure on them, but more importantly, to reduce the risks that too many patients are facing right now.
As I have said to the Secretary of State before, things cannot carry on as they are. As the British Medical Association said last week,
“these ongoing challenges are placing patient care and safety at risk.”
Very poorly people are waiting hours for ambulances to arrive, hours to be seen in A and E, and hours on trolleys in corridors, and too many elderly people are then being held on hospital wards, trapped for days, weeks, even months or, in one case that I will come to later, a full calendar year.
Hywel Williams (Arfon) (PC)
Can the right hon. Gentleman establish for the benefit of the House whether the figure quoted in his motion applies to England and Wales or to England only?
Andy Burnham
I am not sure which figure the hon. Gentleman is referring to, but the figures in the motion apply to England. I will say more about them in a moment.
The stories of failure keep coming. Today we read that a 38-year-old man in Bristol died of meningitis after an ambulance took four hours to arrive. This is by no means an isolated example. The response time target for the most serious calls has been missed for the past six months in a row. We need to hear today what the Secretary of State is doing about this. Rather than work to improve response times, the only proposal we have heard so far is to allow a pilot relaxing response time standards. There will be two pilots, one in the south-west and one in London. London, as the right hon. Gentleman knows, is the worst-performing ambulance service in the country right now, and we hear today that the chief executive of London ambulance service, Ann Radmore, has resigned. The Secretary of State will need to explain to us today why it makes sense, in the middle of a difficult winter, to run an experiment in the most troubled ambulance service in the country.
Mr John Redwood (Wokingham) (Con)
I am grateful to the shadow Secretary of State. Can he explain why Labour only ever now has any interest in England’s health service? We would like to hear about Labour’s conduct of the Welsh health service and its message for Scotland. Does Labour not know that this is an English devolved matter?
Andy Burnham
It is my responsibility to hold the Government to account on behalf of patients in England for what is happening in England now. That is my job, and I will make no apologies to the right hon. Gentleman or anybody else for doing it.
The response times in the ambulance service are not good enough, nor is the plan to introduce an experiment in the middle of winter, but the problems are not confined to the ambulance service. We need, too, to relieve the pressure on hospitals. Last week just seven out of 140 hospital A and E departments in England met the Secretary of State’s lowered A and E target. Hospital staff are trying their best, but it is as if the Government have simply given up on it. If that is so, it means that they are giving up on the thousands of people waiting hours to be seen. What is his plan to stop the decline and bring A and E back up to acceptable standards? It is time he told us.
Dr Sarah Wollaston (Totnes) (Con)
I thank the right hon. Gentleman for giving way. I am concerned. Does he understand the difference between a pilot and an experiment? Does he not think it is right that the Secretary of State should listen to clinically led advice about how we might improve ambulance waiting times, rather than just roll out changes without a pilot, not an experiment?
Andy Burnham
I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do.
I need to hear today the Secretary of State’s plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.
Andy Burnham
I shall give way in a moment.
Another recent case symbolises just how bad things have got. Michael Steel, a dad of two, aged 63, was moved from his ward to a store cupboard while being treated for an inflamed liver. Mr Steel was unable to sleep because he was wheeled in and out of the cupboard while staff went to get drugs from the fridge. One nurse apparently told him it was “absolute chaos”. His son Tom took pictures of the ordeal, including a photo of the ward’s whiteboard where nurses listed his dad’s location as “stock room”. This is the NHS on the Secretary of State’s watch.
Mr David Anderson (Blaydon) (Lab)
I agree with the Chair of the Health Committee that the Secretary of State and his Ministers should listen to the professionals on the front line. If they had listened three years ago, we would not have been lumbered with the Health and Social Care Act 2012, because everyone at the professional end of the health service said, “Do not do it.” But they were ignored by the Secretary of State.
Andy Burnham
What we can see is that this decline began when the Government made the monumental misjudgment of bringing forward a top-down reorganisation that should never have happened, that nobody voted for, and that took 1.5 million eyes off the ball in the NHS. The Government should have been looking at the front line and maintaining standards there, instead of which they looked backwards, and focused on the reorganisation and the jobs merry-go-round that then carried on. It is really disgraceful that they did that and plunged the NHS into the chaos that it is today.
Derek Twigg (Halton) (Lab)
Last Friday evening, I spent time at Whiston A and E talking to doctors and nurses, who do an unbelievable job. I heard about the problem of getting elderly people back into the community when they have undergone treatment. There were also issues around recruiting and retaining nurses and the tariff there, but there does not seem to be any answer coming from the Government.
Andy Burnham
My hon. Friend describes the problems well. I know the hospital because I have been there with him. He is right that older people are becoming trapped in hospital. The support is not there for them in their own homes, and nursing home places are not available. I will come back to that theme in a moment.
Barbara Keeley (Worsley and Eccles South) (Lab)
On exactly that point, the Health Committee looked at the A and E crisis last week and was told by the president of the College of Emergency Medicine that delayed discharges were due to underinvestment in the community, by which he meant social care, GPs and district nurses. Indeed, one third of delayed discharges were down to social care. One third of frail elderly people, or vulnerable people, cannot go home because of the issues with social care, which has been cut by £3.53 billion under this Government.
Andy Burnham
We have record numbers of delayed discharges in the NHS right now. The number may even go past the 1 million mark—I am talking about days lost in the past year. That reorganisation that I mentioned a moment ago cost at least £3 billion, probably more. The budget was flat so where did that money come from? As my hon. Friend rightly says, it came from cuts to the general practice budget, cuts to the community services budget, cuts to the mental health budget and cuts to the social care budget. That is why the community has been stripped bare and people are trapped in hospital. This is a mess of the Government’s making.
Angela Smith (Penistone and Stocksbridge) (Lab)
Does my right hon. Friend not agree that the same explanations apply to ambulance response times, by which I mean the closure of the NHS Direct service, the cuts to the social care and the difficulties in seeing a GP?
Andy Burnham
I will make some progress.
I mentioned record numbers of delayed discharges. There are also record numbers of people visiting A and E, record numbers of frail people being admitted through A and E, record numbers of people waiting on trolleys and record numbers of people trapped in acute hospital beds. This is the simple question that has not yet been answered by this Government: why is there this unprecedented pressure in accident and emergency? Until there are proper answers to that simple question—and agreement about the true causes of the A and E crisis—we will not be able to move forward with a proper solution, and that is the point of today’s debate.
When the Secretary of State came here to answer the urgent question two weeks ago, he was asked by my hon. Friend the Member for Halton (Derek Twigg) what he saw as the causes of the increased attendances at A and E. Let me remind the House of what he said:
“We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population...The second factor is changing consumer expectation among younger people who want faster health care…The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.—[Official Report, 7 January 2015; Vol. 590, c. 280.]
In other words, “Nothing to do with us, Guv.” It is the same old story with this Secretary of State. It is always someone else’s fault: older people’s fault, younger people’s fault, the previous Government’s fault—anyone but him.
Helen Jones (Warrington North) (Lab)
My right hon. Friend knows Warrington well. As well as increasing ambulance response time and having fewer GPs than we had in 2010, we are now seeing one of the last specialisms—spinal services—moved from Warrington to Walton with no public consultation whatever. Does he agree that this is exactly the result of the Government’s reorganisation in which no one is accountable for any decisions and the future of hospitals such as Warrington is at risk?
Andy Burnham
My hon. Friend is right; I do know Warrington well. Speaking up for my own family who live in Warrington, I will not accept a situation in which their services are taken away without them having the democratic right to challenge those decisions. But that is what has been growing under this Secretary of State. We had the decision on Lewisham—the most outrageous example—in which he tried to close a successful A and E that was serving a very deprived part of London, without any proper process, and he lost in the High Court. Then we had a clause brought before the House that tried to close hospitals anyway. That is what the Government want to do; they want to ride roughshod over local people and close services where they want to, and we will not let it happen.
Ms Karen Buck (Westminster North) (Lab)
If the causes of the A and E crisis are deep and structural, as the Secretary of State has implied, why is it that the number of people in London waiting outside A and E in ambulances rose by 66% in one month—between November and December?
Andy Burnham
As usual, my hon. Friend puts her finger on the issue: the crisis is not as the Secretary of State describes. I will come on to that right now, but the first request I will make of him today is to publish the research that proves that the three top reasons he gave in this House two weeks ago are indeed the reasons for the increased demand in A and E, because I do not believe that they are. Perhaps they have made a small contribution, but they are not the real reason for the crisis. Our analysis of what is behind the extra pressure is very different from his. Let me introduce an important and revealing fact into this debate, which picks up on my hon. Friend’s point.
Over the past four years of the previous Government, annual attendances at A and E increased by 60,000. Over the first four years of this Government, they have increased by 600,000. That is a dramatic increase, which is explained not by those long-term structural issues, but by decisions taken by this Government.
Henry Smith (Crawley) (Con)
Under the previous Government, Crawley’s accident and emergency was closed. Will the right hon. Gentleman now commit to increasing funding on the NHS, as this Government have done every single year of this Parliament, and promise to do for the next?
Andy Burnham
Changes we made were done in a planned way, with measures to increase capacity at neighbouring accident and emergency departments, and they were done for reasons of patient safety. Have a look at west London, where plans to close A and E departments are being railroaded through, leaving intolerable pressure on the remaining A and E departments. It is not acceptable, and the hon. Gentleman should challenge his own Government on what they are doing.
Caroline Lucas (Brighton, Pavilion) (Green)
Does the right hon. Gentleman agree that with private health firms now on course to win more than £9 billion of NHS contracts, one of the real problems is the fragmentation of the NHS in front of our eyes. Is that a good reason to oppose further privatisation of the NHS, and will he admit that the process that set in train the privatisation of Hinchingbrooke should never have happened?
Andy Burnham
I have said that the market was let in too far, and, as Health Secretary in 2009, I changed policy away from what was a version of “any willing” or “any qualified” provider to “NHS preferred provider” and I stand by that. I agree with the hon. Lady that the market is simply not the answer to 21st-century health and care. When the Prime Minister stood at the Dispatch Box about an hour or so ago and said no privatisation on his watch, he was not being straight with the public. Services across the country are being put out to open tender and then transferred to the private sector. That is the Government’s record and the people of this country know it.
Paul Blomfield (Sheffield Central) (Lab)
Does my right hon. Friend agree that it says everything about this Government’s attitude to the NHS that general practices that serve the most needy and vulnerable patients, like Devonshire Green and Hanover medical centres in my constituency, are under threat because of the withdrawal of the minimum practice income guarantee introduced by Labour? Does he agree that the Government should immediately stop the phased withdrawal of funding and review their decision to end MPIG?
Andy Burnham
I said earlier that there had been cuts to the GP budget, and that is one of the implications of those cuts. The Government have developed a plan to phase out the guarantee that secures practices in some of the more deprived communities. In east London there have been campaigns against practice closures; I know there are similar concerns in Sheffield. That process should be reviewed and if necessary stopped, because no practice should close as a result of any of those changes. That is the commitment I give to my hon. Friend today.
Andy Burnham
I want to make some more progress; I will give way later.
We need to know the reasons for the increase in A and E attendance. Safely meeting that demand would require an extra eight accident and emergency departments in England, but the Government have been closing, not opening, A and E’s. That is why there is so much pressure in the system.
There has been an even more dramatic increase in the last year. NHS England figures show that there were an extra 446 extra visits to A and E in the 2014 calendar year. That is a dramatic change on the Secretary of State’s watch and the time has come for some honesty from him about the real reasons for it. Until he faces up to those reasons, however uncomfortable they may be for him, he will not be able to develop a proper solution and the situation will get worse. We cannot let that happen.
Let me list what I believe are the decisions of this Government that led to the increase. I will identify four and take each in turn. The first, as Opposition colleagues mentioned, is the decision to scrap NHS Direct and replace it with the flawed NHS 111 service. NHS 111 was originally intended to be a call-handling service, and indeed was conceived by the previous Government. It was intended to simplify access; it was intended to patch people through to the relevant agency, be it the GP out-of-hours service or NHS Direct.
However, when the present Government came into office, they made a major change: they decided that NHS 111 would not signpost NHS Direct but replace it. That was a major mistake. The established and trusted NHS Direct model, a single national contract in the public sector, was replaced with 46 patchwork contracts in the public and private sectors across the country. They replaced the model of nurses on the end of the phone, to provide reassurance for families, with call handlers and computer screens. As a result, where 60% of calls to NHS Direct were handled by nurses, with NHS 111 it is only 20%.
But the present system of call handlers and computer screens is not a case of “computer says no”. The problem is that too often it is a case of “computer says, ‘Go to A and E.’” NHS England figures show that there has been a dramatic increase, in the last year, in the number of people calling NHS 111 who are referred to A and E, or to whom an ambulance was dispatched. In November 2014, there were 67,000 referrals to A and E—a 26% increase on the same month in 2013—and 108,000 ambulances dispatched—a 20% increase on November 2013.
Alex Cunningham (Stockton North) (Lab)
All these problems have led to an increase in the number of days that people are taking off as a result of stress—nurses especially. Thousands of days are being lost to the system, adding to the crisis. Should we not be appreciating the staff in our NHS hospitals, and maybe starting by awarding them the 1% pay rise that the pay review body recommended for all of them?
Andy Burnham
The Secretary of State’s decision to reject the independent advice of the pay review body about what was fair and affordable, and to single out NHS staff for exclusion from the promise that the Chancellor had made that the public sector, as part of his restraint policy, would get 1%—to say that NHS staff would get less than that—was a kick in the teeth, and was to risk staff morale just at the moment that the NHS needed to be recognising and rewarding those staff, who are working so hard to keep things going. To make inflammatory comments such as those that the Secretary of State has made in the newspapers today is the wrong response. He should be getting back round the negotiating table with those staff. He should be working with them to find solutions. They are keeping the NHS going right now, and they deserve a bit better than they have had off this Secretary of State.
Alison McGovern (Wirral South) (Lab)
May I return my right hon. Friend to something very important that he said? He pointed to the distress of our constituents who are being told to go to A and E rather than having reassurance from a nurse on the end of the phone. This is the experience of all our constituents right now, and I would far rather all my constituents had access to a qualified nurse than were just told to go to A and E.
Andy Burnham
My hon. Friend calls it just right. One thing the Government could do right now would be to get more nurses on the end of those phones, to provide that experienced voice, that reassurance, that people with young children need before they decide to get in the car and go to A and E. I remember using NHS Direct in such circumstances myself. That reassuring voice has gone, and that is why NHS 111 is placing additional pressure on our A and E. The Secretary of State would not recognise it, with the reasons that he gave, but it is. Staff know it is. The ambulance service know it is. It is time we had a Government who faced up to that reality. My question for the Secretary of State today is: will he now concede that that flawed 111 service has contributed to the 600,000 annual increase in A and E attendances?
The second policy decision that I shall discuss is the closure of NHS walk-in centres. Colleagues who have been in the House for some time will recall that there was a winter crisis in A and E in most, if not all, winters in the 1990s. Then, in the late ’90s, NHS Direct was launched and NHS walk-in centres were opened, with the specific intention of giving people alternatives to attending A and E, which were then under major pressure. The locations of the first wave of walk-in centres were carefully chosen, often where an A and E had recently closed, including at Leigh infirmary in my constituency. In the decade from 2000 to 2010, around 230 walk-in centres were opened across England. Many of those centres became an established and understood alternative to A and E.
However, despite strong evidence to support them, a review by Monitor has found that almost one in four walk-in centres have closed under the coalition Government. Many more are under threat today. Monitor’s review surveyed people who used walk-in centres, and one in five said they would have gone to A and E if that alternative had not been available. Here is my next question for the Secretary of State: will he now concede that, in the areas where those centres have closed, there will have been extra attendances at A and E, and that was it a mistake to close those centres?
Thirdly, I will mention GP services, but let me start by clearing something up. The Prime Minister claimed today at Prime Minister’s questions that there are more GPs now than when he took office. I am afraid, as so often is the case at Prime Minister’s questions, that claim is simply not true. The last census of the GP work force conducted under the previous Government, in September 2009, found that there were 35,917 GPs working in England. The latest census for which figures are available, September 2013, finds 35,561 GPs working in England. When will Ministers start giving out facts from that Dispatch Box, rather than the spin we get week after week?
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
I asked the Prime Minister some weeks ago about the number of nurses in the NHS. In December, the number of NHS nurses in the system had been reduced by over 900 since May 2010, but we were told in November that it was up by about 2,500. The Government were using the figures, and the Prime Minister was answering questions, in terms of hours worked. As we know, nurses are working massive amounts of overtime on single-rate time. Nominal headcount nurses, at this moment in time, are minus over 900 compared with May 2010.
Andy Burnham
My hon. Friend makes his point very well. This is what we must challenge as we move forward. Before the general election, people need the facts about what is happening to the NHS. There has been a big drop in the number of nurses working in the community, as my hon. Friend mentioned, and these are the facts that we need to bring home to people.
It is not just the fact that the GP headcount has gone down. One of the present Government’s first acts was to scrap the guarantee of an appointment within 48 hours and incentives to open GP surgeries in the evenings and at weekends. That, combined with cuts to the GP budget, means that it has got harder and harder to get a GP appointment in recent years. The constituents of all the Members present say, “I am ringing the surgery at 8 or 9 every morning and being told that nothing is available for days.” In 2010, the vast majority—80%–of people said they could get an appointment within 48 hours; now, according to the GP survey, one in four people say they must wait a week or more to see a GP.
Bill Esterson (Sefton Central) (Lab)
One of the problems in my constituency is that GP surgeries are relying on locums because it is not possible to find GPs to recruit on a full-time basis. Those locums provide a very erratic service; sometimes there is not even a locum available. That is adding to the problem, because as a result, all that is left to people is to go to A and E. I am sure that my right hon. Friend agrees that that is one of the contributory factors, and it proves his point that a chronic shortage of GPs has come about under this Government.
Andy Burnham
That is an absolutely vital point. It is not just about GP locums; there are also A and E locums. The Government have, throughout, cut training places, which were another victim of the reorganisation. Ever since then, the number of places commissioned for doctors—and nurses, I might say—has gone down. That leaves us with a bill for agency staff that is literally out of control—it has gone through the roof—and that means that money is now being siphoned out of the NHS at an alarming rate. That is mismanagement; that is what has happened. How must staff working in the NHS feel when they see the bill for agency staff spiralling in this way and know that they will not even get a 1% increase from this Government? They will draw their own conclusions about how this Government value them.
Richard Fuller (Bedford) (Con)
The shadow Secretary of State has spent quite a large part of his speech on diagnosis, but at the beginning he asked for solutions, so in that spirit I offer a creative solution. He will be aware that East of England ambulance service has had very poor response times for a number of months—in fact, a couple of years. Would he support a merger of the Red 1 and Red 2 ambulance response services with the fire and rescue service in the east of England, because such a combined force might be in a better position to provide quicker response times? Does he agree with that idea?
Andy Burnham
I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.
I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?
Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.
That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how
“hundreds of thousands of older people who need social care are being left high and dry.”
Mr Marcus Jones (Nuneaton) (Con)
If we were unfortunate enough for Labour to win the forthcoming general election, by how much would it increase councils’ adult social care budgets?
Andy Burnham
I am talking about creating a single budget. There is a big difference between that and what the hon. Gentleman says. I am saying that the time has come to merge the adult social care budget and the NHS budget. More than that, we are going to put an extra £2.5 billion into that integrated system. He should not come here today telling me what I need to do: where is his plan to put more money into the national health service?
John Healey (Wentworth and Dearne) (Lab)
My right hon. Friend is giving the House a very good analysis of the social care system. He may have looked at the National Audit Office analysis published in March 2014, which said:
“The intention in the 2010 spending review was to protect spending on adult social care”.
Despite that, because Ministers cut central Government funding for local authorities by 26%, councils have cut nearly £1 in every £10 spent on adult social care in the past four years, leaving Age UK’s director to describe the system as being in calamitous decline. That is clearly a central cause of the current A and E crisis, exactly as my right hon. Friend is arguing.
Andy Burnham
My right hon. Friend has absolutely nailed it. Those Ministers on the Front Bench decided—it was a political decision—to cut councils to the bone, and in doing so cut social care to the bone. That was precisely the warning that I gave back in 2010, having just left the Department of Health, where I remember being told that allowing social care to be cut would be a false economy of massive proportions because it would lead to huge inefficiency in the NHS. Hospitals would be unable to function because they could not get people home, and therefore the NHS would back up and the pressure would become impossible. That is what is happening. Those Ministers have done it, and they must be held to account for it.
Andrew George (St Ives) (LD)
At the start of his speech, the right hon. Gentleman said he was calling for common ground and consensus in this debate, although he seems to have become somewhat deflected from that path. He knows that I very much agree with his criticisms of the Health and Social Care Act 2012 and other things. He has said, on a constructive basis, that he wants to bring health and social care together. There is potential consensus and common ground in that regard. I would like to hear what more he can say constructively on the areas where, I think, we can find, across all parties, common ground and a way forward.
Andy Burnham
To find common ground, one has to tell it straight and put on the table the real reasons why there is pressure in A and E. I bet the hon. Gentleman would not disagree with a single reason I have given: NHS 111, closure of walk-in centres, difficulty in getting GP appointments, the collapse of social care—[Interruption.] Yes, he says he does not disagree with any of those things. If we have a shared analysis, then he and I will have a basis on which to devise solutions. I will come to those solutions later.
Andy Burnham
I said that I am going to make progress.
Today’s Age UK survey finds that the number of over-65s receiving care has fallen by 380,000 under this Government. Half of the 1 million people who struggle to wash or bathe now get no help at all. Two thirds of the 250,000 people who struggle to feed themselves every day are now left to fend for themselves. There are over 100,000 fewer day care places and over 50,000 fewer people getting meals on wheels. Age UK says:
“Our state-funded social care system is in calamitous, quite rapid decline.”
But worse, it is dragging down the NHS.
Sarah Newton (Truro and Falmouth) (Con)
Will the right hon. Gentleman give way on that point?
Andy Burnham
In a moment. I said that I had given way for the last time, but I will do so once more for the hon. Lady.
Record numbers of very frail, elderly people are arriving at A and E due to a lack of support in their own homes. Between 2009-10 and 2012-13, there was a 48.1% increase in the number of people aged over 90 being admitted to A and E via blue-light ambulance—in other words, 100,000 very frail, very frightened people in the backs of ambulances going round our towns and cities to be dropped off at a busy A and E. That is what is happening on this Government’s watch.
Sarah Newton
Today’s Age UK report contains aggregated England data. Does the right hon. Gentleman not agree that all over our country there are councils integrating social care with the NHS, and, indeed, increasing their social care budgets? Does he not recognise the good work that is going on in the integration pilots in Cornwall, for example?
Andy Burnham
I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.
The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.
For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E
“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”
My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?
The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.
As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?
Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?
On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?
Andy Burnham
I have said that I will not give way again.
All those measures could help in the short term, but the truth is that all parties must recognise that there will not be a long-term solution to the A and E crisis until we face up to the crisis in social care, and rethink how we care for the most vulnerable older people. It is not just about money; we need radical changes in the way we use existing budgets for health and care. We need to merge them so that we can change the way in which we care for older people. We need a model of care that starts in the home and supports people there, so that we can drastically reduce the numbers unnecessarily ending up in hospital and becoming trapped there.
Although that model is not just about money, it is partly about money: if such a transformation is to happen, extra investment will be needed to stimulate it. The Secretary of State likes to hold up the better care fund, but I am afraid that councils and the NHS simply do not share his optimism. It robs Peter to pay Paul: the money transferred to councils is nowhere near enough to backfill the cuts to social care, and it leaves a deepening hole in NHS finances. [Interruption.]
The Secretary of State asks where I would get the money from, and I will tell him. The Opposition have committed to provide extra money for an integrated NHS—£2.5 billion a year over and above what he has committed—with social care as part of a single service for the whole person. By contrast, under the public spending plans the Government have set out for the next Parliament, it is clear not only that the A and E crisis will deepen every year, but that it will soon become a full-blown NHS crisis.
The NHS used to be the Prime Minister’s priority; now it does not feature in his top six election themes. We know that there will be no money for it beyond what the Government have promised, because the priority is tax cuts for higher rate taxpayers, although they have not yet identified where the money for that will come from. If the outlook for the NHS is grim, it is utterly dire for local government and social care. Taking public spending back to 1930s levels will absolutely decimate what is left of our social care system, and if the system goes into freefall today’s problems in the NHS will become entrenched. Will the Secretary of State go back to the Chancellor, argue for a better deal for the NHS and social care, and match Labour’s pledge to prevent a permanent care crisis in the next Parliament?
The NHS is now at the crossroads, and the coming election presents an enormous choice between Labour’s plan to lift the NHS out of its current crisis by investing £2.5 billion in the NHS of the future, and the coalition approach under which—with the Government unable to face up to the mess of their own making in A and E or to produce a plan to turn it around, and unwilling to find the extra money it needs—the NHS is dragged down by a toxic mix of cuts and privatisation. The stakes could not be higher. This crisis cannot go on: patients have suffered enough. They need an election, a change of direction and a Labour Government to secure the NHS.
Mr Hunt
I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.
Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.
Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.
It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.
Andy Burnham
I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?
Mr Hunt
Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.
I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.
What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.
While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!
Mr Hunt
Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.
Andy Burnham
Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.
The Secretary of State reeled off a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.
Mr Hunt
I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.
Mr Hunt
But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.
The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members, poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.
Paul Burstow
I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.
In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?
Paul Burstow
I will, unlike the right hon. Gentleman on many occasions earlier.
Andy Burnham
The right hon. Gentleman clearly was not listening to my speech. The central proposition is that what I described as the “root cause” of the A and E crisis was the imposition of devastating cuts in social care, which are leaving people unsupported in their own homes. Will the right hon. Gentleman now say—because he was there—that it was wrong of him and his colleagues to allow social care to be cut in that way, given that the cuts are now presenting the NHS with an enormous productivity and efficiency problem?
Paul Burstow
The right hon. Gentleman is right to raise that question. I wanted to ask him a question that relates directly to his point, and, indeed, answers it. I hope that he will agree with me—and, indeed, with the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb)—that we need a fundamental review of NHS and care spending, in the round, and that finances in that area need to be addressed before the spending review that any Government will carry out later in the year. We need to ensure that we are clear about the level of investment that will go into our health and social care system. So far, I have heard no clear indication from the right hon. Gentleman of his relative spending priorities when it comes to health and social care, and they need to be made clear if we are to establish a consensus.
Paul Burstow
I will give way once more, but then I must make rapid progress.
Andy Burnham
My answer to the right hon. Gentleman’s question is that I want a single service: a single service for the whole person. I want a national health and care service. We should no longer have two budgets; we should have a single budget, and we should then use the money as best we can to support people, starting in their own homes—and we are going to invest an extra £2.5 billion.
The right hon. Gentleman did not answer the question that I asked him. I asked him whether he and his Government colleagues, in those early days, made a mistake in allowing social care to be cut to the bone? Every week I am accused of saying that it is irresponsible to give real-terms increases. The right hon. Gentleman allowed social care to be raided. Should we not receive an apology for that today?
Sir Oliver Heald
Does my hon. Friend agree that Labour took things a bit too far? The shadow Secretary of State tendered out the Hinchingbrooke hospital, which ended up in the private sector. That has not been a success, and I think it is better if a trust runs the hospital—
David T. C. Davies
I agree with my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald). The reality is that Labour Secretaries of State said over and over again that they were quite happy to use the private sector, and they did. They were probably right to do so in many instances, and we have continued to do so. There has been no departure from that policy.
Andy Burnham
On a point of order, Mr Deputy Speaker. I have always to correct the record when these statements are made. I apologise for delaying the House, but I am going to carry on doing it. I did not put it out to tender; it was a process I inherited, and in the middle of that process I changed the policy from “any willing provider” to “NHS preferred provider”. Contrary to what the Secretary of State said at the Dispatch Box, NHS Peterborough and Stamford was still in the race.
Mr Deputy Speaker (Mr Lindsay Hoyle)
You have certainly corrected that. It is a point of correction, rather than a point of order. It is all on the record now and everyone can continue. Let us see whether we can turn the heat down a bit.
Mr Hepburn
That is exactly the point that the shadow Secretary of State made in his opening speech.
As we heard earlier, local managers are not listening. They are stooges of the Government and they are carrying out the cuts without listening to local people. It is disgraceful. They are not incompetent, and nor are the Government—they know exactly what they are doing. There is a deliberate effort to sabotage the NHS by piling those 27,000 patients a year on to the local doctors.
Andy Burnham
I am listening carefully to what my hon. Friend says. His walk-in centre, like mine, was one of the first to open and is greatly valued by the community. I make this offer to him today: if he and his community can keep the campaign going and keep that centre open, and if I am the Secretary of State in May, it will stay open for good.
Mr Hepburn
I am sure people in the area are extremely grateful for that statement of support and commitment and that pledge from the shadow Secretary of State. I only hope he will become Secretary of State.
The Government and the management of the NHS are not incompetent. They are acting deliberately. The 27,000 patients in Jarrow who now go to the walk-in centre will have to go to the doctors’ surgeries, where it is difficult enough already to get an appointment. That will only exacerbate the problem. When they go down to A and E, which is doing a terrific job, the situation will only get worse. The Government know exactly what they are doing. They are trying to sicken people of the NHS so that they can turn round and say, “The NHS is not working. We will bring in the private sector to help out and to take it over.” That is the policy of this Government.
Mr Burns
No, I will not, because I only have eight minutes.
What I decry, however, is when, in the generality, the health service is used to attack a political party, whether the Government or whatever, simply to try to score cheap party political points. That does a grave disservice to the NHS. As the right hon. Member for Manchester, Gorton said, people in this country love the health service. They believe in it, free at the point of use for all those who are eligible to use it. I, like I imagine millions and millions of taxpayers, have no objection to paying our taxes to have a free health service. To appropriate the four freedoms of Franklin Roosevelt, there is a fifth freedom: the freedom from fear of a medical bill dropping on one’s mat and financially ruining one’s family.
Where I see the greatest and, to my mind, the most disgraceful attack is in the accusation, which is not new—it was being made in 1979, and, I suspect, before then, but fortunately I am a bit too young to remember exactly—that the Conservative party wants to privatise the health service. We do not and we never have done. As long as I am a politician, and my right hon. Friend the Prime Minister is, we never will. I find it extremely aggravating and hurtful when this cheap shot is made.
One of the examples of privatisation given is the use of the private sector to improve and enhance the health care of our constituents. Let me just explain something. Over Christmas, I read an extremely good new book, which I strongly recommend to the right hon. Member for Leigh (Andy Burnham), if he has not already come across it. “Nye”, by Nicklaus Thomas-Symonds, is the new biography of Nye Bevan. It is a fascinating book, particularly the part about when he was the Minister for Health from 1945 to July 1948 and putting together and negotiating the creation of the NHS. It sets out the arguments he had with the medical profession and others, and the compromises he had to make to establish the NHS. Many people do not realise that even to this day, as a result of those compromises, 95% of GP practices are private small businesses. I do not decry that, because they are treating patients, under the national health service, free of charge.
Historically, a lot of mental health care has been free of charge, but provided by the private sector. In the 1990s, when I was a Health Minister, I remember John Major using the private sector to bring down waiting lists and waiting times for operations. My constituents had no problem whatever with that, providing it was free and kept to the core principle of the NHS. The last Labour Government, the Blair-Brown Government, were quite happy to use the private sector providing it was benefiting NHS patients.
The shadow Secretary of State kindly mentioned—albeit in passing—Chelmsford walk-in centre and suggested it was a great political scandal and the next bandwagon he was going to jump on. May I point something out to him? The walk-in centre was created from the dying embers of his stewardship of the NHS, in March 2010, to be run by a private company. I have no problem with that, if it is serving NHS patients. However, its sole purpose was to reduce pressures on A and E at the local hospital, and I am afraid it has singularly failed to do that. The use of A and E at Broomfield hospital, just down the road, has increased inexorably and, in that respect, the walk-in centre has failed.
Andy Burnham
I am listening carefully to the right hon. Gentleman. As he knows, I have huge respect and affection for him, but he is arguing that NHS privatisation is a myth and that our accusation is wrong. If he does not mind, I will quote what he said during the Committee stage of the Health and Social Care Act 2012:
“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”—[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]
Why, then, is it a myth that he and his Government have exposed the NHS to a greater risk of commercialisation, marketisation and, indeed, privatisation?
Mr Burns
First, competition was introduced on the current scale by the Blair-Brown Government, and secondly, there is nothing wrong, per se, with competition to get the best providers providing the best care for patients, so long as they keep to the sole ethos of the NHS, which is that that good care be provided free at the point of use for NHS patients. We saw that under his Government and under the Major Government, and this Government have used the private sector to ensure that patients are treated more quickly. We want them to be treated as quickly as possible, and if there is not enough capacity in the NHS, and if a private provider can provide the capacity, I see nothing wrong with that, and neither do most people in this country, if they are treated more quickly.
Returning to the walk-in centre, there were 40,000 attendances last year, 10,000 of which were by people beyond the Mid Essex CCG area. Of the remaining attendances, one third should have been self-caring or using their community pharmacy or 111, which the CCG is paying for, and another third should have been using their community pharmacy or GP, which the NHS is paying for. The CCG was therefore paying twice for the same care for the same patients, which is an utter waste of money. That money should be being used to care for more patients quicker, which is why the CCG has taken the decision it has. It is a rational decision, because the centre is failing to meet the aims it was set up for and instead ensuring that the NHS pays twice for the same patient to be treated. In place of the walk-in centre, there will now be an urgent care service at the local hospital for those people who should be going there. Sometimes, politicians have to do the right thing, regardless of political point scoring. Where it is in the interest of patients and the configuration of services, they should take the right decision, be reasonable and responsible and explain why it is the case.
In conclusion, I am delighted to see the hon. Member for Hackney North and Stoke Newington (Ms Abbott) in her place. I am fascinated to note that the nub of the motion is a call for an extra £2.5 billion for the NHS, which I am sure she strongly supports. What worries and concerns me—she may have a problem when it comes to voting at 7 o’clock tonight—is that the motion goes on to say that it is going to be
“funded by measures including a tax on properties worth over £2 million”.
Given the battle the hon. Lady had on the radio with a member—a right hon. Member— of her party from a southern Scottish constituency, I imagine that she is in turmoil, wondering how to justify that funding from that source.
Norman Lamb
Let me make this point.
If Labour Members are concerned about the interests of patients, why do they not agree to the suggestion by Professor Bruce Keogh, a respected clinician, for an investigation into safety in the Welsh NHS? Why do they remain silent?
Andy Burnham
The Minister accuses us of bringing politics into the NHS, but did not he and his colleagues put politics at its heart when they signed up to a Tory agenda to put market forces at the heart of the national health service?
Norman Lamb
That is absolute rubbish. Indeed, one of the right hon. Gentleman’s predecessors, the right hon. Member for Hull West and somewhere—
Contaminated Blood
Andy Burnham Excerpts(9 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham (Leigh) (Lab)
We have heard a series of fine speeches today—as has been said, Parliament truly at its best—but none more powerful and affecting than that of the right hon. Member for North East Bedfordshire (Alistair Burt) in leading the debate. Many of the things he said will have affected people greatly, but the words that remain with me now are those that he quoted from a letter he had received: “Every day is like a day on death row for a crime I did not commit.” If that does not convey the sense of injustice we are dealing with, nothing else will, because it really is that appalling.
When historians come to look back at the 2010-15 Parliament, it will be seen to be characterised by a welcome drive to correct historical injustice. First, we saw the apology in relation to the events of Bloody Sunday. We have seen a range of ongoing inquiries related to historical child abuse. There was the action on the injustice that I know too well from my own personal background—the death of 96 innocent people at Hillsborough. The right hon. Gentleman was absolutely right to pay tribute to my hon. Friend the Member for Liverpool, Walton (Steve Rotheram), who put those names on the record. But we cannot put on record the names of the people in this case who have suffered such devastation—not just the people who have died but those whose lives have been ruined as a result of this scandal, and it is a scandal.
What opened up those other injustices has not been the Government voluntarily moving to correct those wrongs, but Parliament. The resolution to those other injustices began here. It is beholden on each and every one of us here today to remember that and to use the power that we have from the office that we hold to work together across the Floor of this House to find a resolution for the thousands of people whose lives have been ruined by this scandal. If we hold to the cross-party spirit that delivered the beginnings of justice in those other campaigns, then we will do so in this case too. The right hon. Gentleman described it as the 15th worst peacetime disaster—like Hillsborough, entirely man-made. To add to that, Lord Winston has described it as
“the worst treatment disaster in the history of the NHS.”
We must resolve today, even if we cannot do it in the time that remains in this Parliament, to make sure that this injustice and this scandal is resolved early in the next Parliament, and that the people who have suffered finally have truth and justice.
I want to explain why I am standing at this Dispatch Box today. Like many others who have spoken, I have constituents who have been victims, including somebody who does not want to be named who speaks of having lived for more than 30 years seeking justice and support, and who contracted HIV and hepatitis C through contaminated blood in the 1970s and ’80s; and my constituent Simon Carter, whose father died and left the family facing a whole range of financial problems—people whose lives have been for ever altered and devastated by the scandal.
There is another reason I am here today. It goes back to a time towards the end of the previous Parliament, when somebody who has been mentioned by Members in all parts of the House, my good, late friend Paul Goggins, asked me to meet him and his constituents Fred and Eleanor Bates and Peter Mossman—now the constituents of my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) whom he mentioned so movingly—in my constituency office in Leigh, and I did. I had no real understanding of what they had been through, and were going through, until I sat down with them, at Paul’s request, and listened to what they said. That campaign mattered hugely to Paul, whom I miss every day. I will continue to work in his memory to get justice not just for his former constituents but for everybody who has been mentioned in the debate. I want to signal the seriousness with which I will address this issue by speaking in this debate today.
As people have said, it is not that nothing has been done. Plenty has been done. There have been well-meaning attempts in all parts of the House down the years to put in place mechanisms to try to lessen the hardship and address the problems that people face in their daily lives. However, as many hon. Members have said, that has left a patchwork of support that is complex and bureaucratic—that, in the end, is about handing out bits and pieces, with people having to go cap in hand, not even given the dignity they should now have in having the problems that they were given rectified in a proper manner.
As a result of that meeting with Paul and his then constituents in my office in 2010, I reopened the issue at the end of the previous Parliament. Many Members have mentioned the Archer report. A resolution was put in place after that report, but it was not good enough, and that was recognised in all parts of the House. Paul asked me to look again at the issue, and I did.
I want to bring a new perspective to this debate—that of a former Minister who tried to do something; indeed, a former Secretary of State, because that is what I was at the time. I do not say this to blame any individual in the Department of Health, but more in terms of speaking as I found as I tried to lift the shutters that had been pulled down on an issue that the Department wanted to go away. The hon. Member for South Norfolk (Mr Bacon), who is no longer in his place, said that Governments of both parties have failed, and that is absolutely right— they have; there is no debate about that. But I do not detect the failure being caused by Members of Parliament or, indeed, Ministers; I have met many who want to resolve this in the right way. I have to say that in my experience the resistance is found in the civil service within Government. That is often the case in examples such as this; I found the same with Hillsborough too. It is very hard to move that machine to face up to historical injustice.
Mr Robinson
My right hon. Friend is making a very important point. Nobody wants to point the finger of blame, but he has gone to the heart of a problem in Government. He speaks with great authority as a previous Secretary of State. He says that it is hard to get officials to do what a Minister wants, and that is certainly true, but is it not also the case, and therefore a failure of successive Governments, in the plural, and Ministers, in the plural, that officials advise and Ministers decide? That is part of the failure so far.
Andy Burnham
I believe that it is. The hon. Member for Bedford (Richard Fuller) made this point. Perhaps there is a resistance that comes from not wanting to point the finger or to show the culpability of people who perhaps did not do their jobs as well as they might, but that is unacceptable. That is not something that anybody elected to serve in this place should accept. On a personal level, I know how hard it is when faced with such resistance. The way to help a Minister in that position is by giving them the sort of support that has been expressed throughout this Chamber today. That is what gives a Minister the power to have the courage to make a change.
The result of my efforts led to a review of the Skipton Fund, and I give credit to the current Government for continuing that work. It led to a small improvement, which has been mentioned, but, by God, it was hard enough to get that, so I do not underestimate how difficult it will be to move things forward.
Part of the problem is that the people dealing with the issue inside Government are insulated from the people we sit alongside in our constituencies and whose stories we listen to. Could there be a more heart-breaking story than that told by my hon. Friend the Member for Ogmore (Huw Irranca-Davies) about the damage that this scandal has caused down the years? People need to hear and listen to what is being said, to understand why it is immoral to allow the situation to persist and go uncorrected.
I will not go through all the problems raised by colleagues about the inadequacy of the current process of applying for support, but I will pay tribute to the all-party group on haemophilia and contaminated blood, which, under the leadership of my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), produced an outstanding report yesterday. I believe it will further reinforce the case for truth and justice.
I wish to draw the House’s attention to another development, which has not been mentioned today, namely the filing of a legal case by three unnamed victims. They have written to the Health Secretary, asking him to come forward with a settlement before full legal proceedings take place. Of course, it should not have to come to that, but, as colleagues have said, people are still waiting and they have waited long enough. We hope the Health Secretary will listen to that request and take action as soon as he can.
If the Minister, working with the Secretary of State, is able to find a solution, she will have the support of Labour Front Benchers and, I am sure, Members throughout the House. We will offer our good offices to ensure that a settlement can be reached. There needs to be a proper and fair resolution. None of us can predict what the make-up of the House or, indeed, the Government will be after the coming election, but I personally commit to working towards that full and final settlement for which people have waited long enough. I hope that Members on both sides of the House will make a similar commitment. As Paul Goggins said in the Westminster Hall debate mentioned by the right hon. Member for North East Bedfordshire,
“no debate about the issue should omit the need for a proper acknowledgement of what took place and why, and a profound and sincere apology for the suffering created by the disaster.”—[Official Report, 29 October 2013; Vol. 569, c. 201WH.]
The full and final settlement should have four components. First, there must be a national apology for the suffering down the years. Secondly, to echo what my hon. Friend the Member for Hammersmith (Mr Slaughter) has said, there must be an inquiry. Whether it should be a public inquiry or not is a matter to be debated, but, having been involved in the campaign for justice for the 96 victims of the Hillsborough disaster, I know that other forms of inquiry can reach the truth and unlock a campaign for justice. There may be other ways to do it, but people need disclosure: they need to understand how this was allowed to happen. In my view, all papers held by the Department of Health should be released so that people can begin to see the full truth of what went wrong. I do not believe there is any reason at all to prevent that from happening.
The third element is, of course, a proper settlement for all those who have suffered—not just those who are still suffering, but families who suffered greatly as a result of the disruption caused to their lives. Fourthly, as my hon. Friend the Member for Kingston upon Hull North has said, we must give the best treatment possible to those who are still suffering.
The all-party group’s report quoted somebody infected with hepatitis C:
“You can’t give us back our health. But you can give us back our dignity. This tortured road has been too long for many of us. But for the rest of us, please let this be the final road to closure.”
Everybody present needs to listen to those words and act on them. Sadly, many of those affected have died and are not able to listen to our proceedings, but they, those who remain and the families they have left behind deserve the dignity of a full and lasting settlement.
Oral Answers to Questions
Andy Burnham Excerpts(9 years, 5 months ago)
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Mr Hunt
My hon. Friend makes an important point about the way targets are set up. It is possible for ambulance services to hit their targets while not delivering a satisfactory service to the most rural areas, and we have discussed that issue a number of times. Because we are in the middle of a challenging winter, we do not think that now is the right time to review the issue, but he should rest assured that we are keeping it under review.
Andy Burnham (Leigh) (Lab)
Although focus has been on A and E, it is becoming clear that the knock-on crisis in the ambulance service is more serious than people realise. Evidence is emerging of services unilaterally abandoning national standards and putting patients at risk. We know of one ambulance service that left patients at the door of A and E without handing them over to A and E staff, and last night East of England ambulance service was forced to release an internal report on the downgrading of thousands of 999 calls, including calls made by terminally ill patients. The report covered only a sample, but it showed that at least 57 of those patients died after a decision was taken not to send an ambulance. Withholding ambulances from terminally ill people is the most cruel form of rationing imaginable. Will the Secretary of State today order a full, independent investigation into how that happened, and into every death or adverse incident?
Mr Hunt
We investigate deaths and adverse incidents carefully, and the East of England ambulance service got £3.6 million of extra support to help it this winter. Let us look at what is happening in the ambulance service. Year on year, the number of the most serious category A calls—those that need to be answered within eight minutes—has increased by 26% over one year, and the number of ambulances dispatched within eight minutes has increased by 22%. That is 1,900 extra ambulance journeys arriving within eight minutes, which is a record of an ambulance service doing well under a lot of pressure. The right hon. Gentleman should be getting behind the paramedics and ambulance services, not trying to politicise the issue.
Andy Burnham
I raised a very serious issue, which came to light last night, regarding 57 terminally ill patients. As that was only a sample, it is not the whole story. I am surprised that the Secretary of State did not answer the very specific question about a serious failure in the East of England ambulance service. The truth is that this is not confined to the ambulance service in the east of England. Last year, we heard of a 77-year-old great-grandfather from Bolton who waited for more than four hours on a freezing pavement and a 92-year-old grandmother who tragically died after waiting for five hours in agony on the floor of her home in Muswell Hill.
Whatever the Secretary of State says, those are not isolated cases. New figures last week showed that in November a staggering 17,000 critically ill patients who were classified as needing an urgent category A 999 response waited longer than 19 minutes for an ambulance to arrive. Will the Secretary of State agree that this chaos is now putting lives at risk and cannot carry on? Will he tell the House what precise steps the Government are taking to bring responses to 999 calls back up to acceptable standards?
Mr Hunt
But we are taking measures. That is why we have 2,000 more doctors and 5,000 more nurses compared with a year ago. Frankly, the last thing those doctors and nurses on the front line want is scaremongering by the right hon. Gentleman—posters saying that the NHS might cease to exist under this Government; and leaflets like the one I have here from Lancaster saying that the local hospital might close. We are backing the NHS with more doctors, more nurses, more resources and a long-term plan. Will he now back the NHS by disowning this kind of scaremongering and stop trying to weaponise the NHS?
A and E (Major Incidents)
Andy Burnham Excerpts(9 years, 5 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the major incidents that have been declared at a number of hospitals and on A and E performance in England.
The Secretary of State for Health (Mr Jeremy Hunt)
Mr Speaker, I welcome this opportunity to come to the House and make a statement on accident and emergency services.
First, we must recognise the context. The NHS always faces significant pressures during the winter months, but, with an ageing population, we now have 350,000 more over-75s than just four years ago. As a result, we are seeing more people turning up at our A and Es, with 279,000 more attendances in quarter three of this year as compared with last, and a greater level of sickness among those who do arrive, leading to an increase in emergency admissions of nearly 6% on last year. This picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland all missing key performance standards as a result.
A number of hospitals have declared major incidents over the past few days, in what is traditionally a particularly busy time in A and E. A major incident is part of the established escalation process for the NHS, and has been since 2005. This 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—there is no national definition—and we must trust the managers and clinicians in our local NHS to make these decisions, and support them in doing so by making sure there is sufficient financial support available to help deal with additional pressures.
I chaired my first meeting to discuss that support on 17 March last year. On 13 June, we gave the NHS an additional £400 million for winter pressures, topped up in the autumn by £300 million to a record total of £700 million, ensuring local services had the certainty of additional money and time to plan how best to use it.
The NHS started this winter with 1,900 more doctors and 4,800 more hospital nurses than a year ago. This planning and funding has been widely welcomed by experts in the system, including NHS England, NHS Providers, the College of Emergency Medicine and the NHS Confederation. The funding the Government have put in, which is on top of the year-on-year real-terms increases in funding, is made possible by a strong economy, and will pay for the equivalent of 1,000 more doctors, 2,000 more nurses and 2,000 other NHS and care staff including physiotherapists and social workers. It will fund up to 2,500 additional beds, both in the acute and community sectors, and also provide £50 million to support ambulance services.
But the NHS also needs longer-term solutions to these pressures. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, with over 4 million already benefiting. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. And we have funded the NHS’s own plan to deal with these pressures, the five-year forward view, with an additional £1.7 billion for the NHS in 2015-16 and £1 billion of capital over the next four years to improve primary care facilities.
Mr Speaker, let me finish by thanking hard-working NHS staff across the country for the outstanding care they continue to deliver under a great deal of operational pressure.
Andy Burnham
All over England, the NHS is stretched to the limit—and in places is at breaking point. Staff are working flat-out and we thank each and every one of them for all they are doing, but the situation is now serious and getting worse. Right now, too many vulnerable people are exposed to too much risk, waiting hours for ambulances to arrive, and held in the back of them outside A and E or on trolleys in corridors. This cannot be allowed to carry on. Patients and staff deserve better answers than they have had to date about what is being done to address this issue, and that is why, faced with this complacency, we have again had to force the Secretary of State to come here today.
Fourteen hospitals have declared major incidents. Will the right hon. Gentleman explain clearly what this means for services in those areas? What is the official advice to people living in those areas? Is he providing any central support and advice to those hospitals? If a number of major incidents are declared in the same area at the same time, what contingency plans will be put into place to protect the public? More broadly, what new measures does he have under active consideration to ease pressure at all hospitals?
The Secretary of State mentioned resources. When he allocated additional resources for winter pressure, what assessment was used to determine how much was needed? Clearly, it is not working. Does he now plan to reassess the situation and perhaps allocate more? Ministers keep blaming unprecedented demand, but the question is this: why is there such unprecedented demand? Could it have anything to do with the difficulty in getting a GP appointment, the closure of walk-in centres or the cuts to social care?
Let me turn to ambulance services. There are alarming reports of people waiting hours for ambulances to arrive. This is because ambulances are trapped in queues outside A and E departments. We are hearing that at least one service has implemented a policy of leaving patients at the door of A and E without handing them over to A and E staff. Is the Secretary of State aware of this practice, and is he satisfied that it is not putting patient safety and care at risk?
The last time we had to drag the Secretary of State here, he failed to inform the House that he had approved a proposal to relax 999 response times. So will he today tell the House what the current status of those plans is and whether they are still going ahead this winter? I have real concerns, which I have relayed to ambulance leaders, about making any such change without proper consultation and evidence. There are also reports of police and fire vehicles being used to carry people to A and E. What discussions has he had with police and fire service leaders about this practice? What training or advice has been given to front-line police and fire staff? Is he fully satisfied that patient safety is not being compromised?
Finally, cuts to social care are a root cause of the pressure on hospitals. A record number of elderly people are trapped in hospital beds, and any solution to this crisis must involve councils and a solution for social care. So will the Secretary of State now act on our constructive proposal to hold an urgent summit of all the public services affected—councils, police and fire services—and to develop a co-ordinated plan to ease this crisis? NHS staff deserve it. Safe patient care demands it. When will he deliver it?
Mr Hunt
First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.
In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday
“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”
to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.
The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:
“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.
What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?
The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.
UK Ebola Preparedness
Andy Burnham Excerpts(9 years, 5 months ago)
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Andy Burnham (Leigh) (Lab)
Over the break, there have been a number of reports suggesting that the Ebola outbreak is far from under control and we saw, as the Secretary of State has said, the first case diagnosed here in the UK. Concerns are rising and that is why the Secretary of State was right to give his informative update to the House at the very first opportunity.
May I echo the tribute he paid to all the NHS staff, members of the armed forces and aid workers who are showing immense courage in the most difficult of circumstances? In particular, we echo his moving words and good wishes for Pauline Cafferkey. Our thoughts are with her and her family right now, and we know she could not be in better hands than those of the team at the Royal Free.
On the substance of the Secretary of State’s statement, we welcome what he had to say and the action he is taking. As I said the last time he updated the House, we will play a constructive part in helping the Government to minimise the risk to the public. That remains the case and the questions I will put to him—some of which will cover areas he has not mentioned, particularly treatment and vaccine—will be asked in that constructive spirit.
Let me begin with the circumstances surrounding the case. The Secretary of State mentioned the Save the Children review of how Pauline caught the disease. Are the Government part of that review and/or are they carrying out their own, and when will the results be known? He did not mention when it would be published, but that is important as the next group of NHS volunteers will leave for west Africa in the coming weeks. They will want to know whether procedures and guidance for medical staff working out in west Africa will be reviewed in the light of this case.
I would also be grateful if the Secretary of State could tell us whether he is satisfied with current guidance to NHS staff here on handling Ebola patients. He will be aware that the US Centres for Disease Control and Prevention have recently strengthened their infection control guidance, and on the last occasion he updated the House he said he would follow their lead. What revisions, if any, have been made to those protocols following the CDC’s changes?
Let me turn to screening. We know that Pauline travelled to Glasgow via London Heathrow and despite informing screening staff at Heathrow that she felt unwell she was still allowed to fly home. I welcome what the Secretary of State has just said about reviewing procedures for future passengers in a similar position, but there are broader concerns. Martin Deahl, who was part of the same volunteer group as Pauline and sat next to her on the plane home, said:
“The precautions and checks at the airport were shambolic. There seemed to be too few staff and too few rooms or places to put us in. We were crowded into a small reception area where we waited for an hour or more. I had a higher temperature so they wanted to put me in a room by myself—but they could not find one because they were using every inch of space.”
I welcome the Secretary of State’s commitment to keep the arrangements under review, but may I ask him to look into the specific concerns raised by Mr Deahl and to rectify any problems as a matter of urgency, and certainly before the return of the next group of volunteers?
More broadly, is the Secretary of State satisfied that the screening procedure is adequate in terms of the medical checks that are carried out—are more checks needed than just temperature checks—and, indeed, is he satisfied that staff have had sufficient training? Were the Scottish NHS, the Scottish Government and, crucially, Glasgow airport informed that Miss Cafferkey had warned officials that she felt unwell? In the light of this case, should screening checks be expanded to cover more ports? I would be interested in the Secretary of State’s views on those points. I am sure he would agree that maintaining public confidence in the screening procedure is crucial, and I hope he will continue to keep all those questions under review, as he has said he would.
Let me turn to post-arrival monitoring. A number of states in America have introduced it for all travellers returning from an affected country, whereas only those showing symptoms on return are actively monitored here. Given that symptoms of Ebola can emerge up to 21 days after exposure, is there a case for strengthening post-arrival monitoring in line with other countries?
On treatment, we understand that Pauline is receiving an experimental drug, not ZMapp, owing to a worldwide shortage. When the Secretary of State last updated the House, I asked him whether plans were in hand to increase supplies of ZMapp, so the latest news is a matter of concern. Are any efforts under way to increase manufacturing capacity for ZMapp and/or any other potential treatments? Of course, what would give most confidence to people in the countries affected and further afield is the development of an effective vaccine. Will he say something about the timetable for that, and about the Government’s role in trying to expedite it?
More broadly, will the Secretary of State give the House his latest view on the adequacy of the international response to Ebola. We hear that the health system in Sierra Leone is in danger of collapse, immunisation programmes have come to a halt and people are not going to the hospitals or clinics because they are frightened of catching Ebola, and that might lead to the spread of other diseases. Over Christmas, William Pooley said:
“This is a global problem and it will take the world to fix it.”
Does the Secretary of State share that sentiment, and what are the Government doing to bring about a better global response than we have seen to date?
In conclusion, it is clear that Ebola will remain a threat for the foreseeable future, and it will not be easy to meet that challenge. We join the Secretary of State in sending our best wishes to Pauline and her family, and we will continue to work with him and the Government to minimise the risk to others.
Mr Hunt
May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.
The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.
We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.
It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.
The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.
On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.
On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.
Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.
I again thank the right hon. Gentleman for his constructive approach to this issue.
A and E and Ambulance Services
Andy Burnham Excerpts(9 years, 6 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the performance of accident and emergency departments and ambulance services, and what plans are in place to help them cope with winter pressures.
The Secretary of State for Health (Mr Jeremy Hunt)
I welcome this opportunity to come to the House and confirm NHS plans to support A and E and ambulance services over the challenging winter period. First, we must recognise the context. The NHS always faces significant pressures during the winter months, and with an ageing population we have 350,000 more over-75s than four years ago. As a result, more people are turning up at our A and Es, with attendances up 5% on last year, and a greater level of sickness among those who turn up has led to an increase in emergency admissions of nearly 6% on last year. That picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland, as well as England, missing key performance standards as a result.
In England, where performance has been relatively better than in other home nations, we have been preparing for this winter for more than nine months—indeed, I chaired my first meeting to discuss the issue on 17 March. On 13 June we gave the NHS an additional £400 million for winter pressures. That was topped up in autumn by £300 million, making a total of £700 million to ensure that local services had the certainty of additional money and time to plan how it should best be used. That funding was provided earlier than ever before in NHS history, and was possible because a strong economy has allowed us to make year-on-year real-term increases in NHS spending. That funding will pay for the equivalent of 1,000 more doctors, 2,000 more nurses, and 2,000 other NHS and care staff, including physiotherapists and social workers. It will fund up to 2,500 additional beds in the acute and community sectors, and provide £50 million to support ambulance services.
We are also progressing with a long-term plan to reduce pressures on A and E. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, and more than 4 million people are already benefiting from that. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. The Five Year Forward View is funded by an additional £2 billion of new money announced in the autumn statement—we have a long-term plan for our NHS, just as we do for the economy.
The winter will be tough, but a number of changes made over the last four years will put us in a much stronger position. Since 2010, the NHS has nearly 1,200 more A and E doctors, including 400 more consultants, almost 600 more registrars, 1,700 more paramedics and 17,200 more clinical staff overall. Our A and E departments are seeing and treating around 2,000 more people within four hours every day, and our ambulances are making nearly 2,000 additional emergency journeys every day. The Care Quality Commission has confirmed that compassionate care in A and Es has improved over the last two years, and according to patients the NHS is getting record scores for the safety of care, and for treating people with dignity and compassion.
I will conclude by thanking hard-working NHS staff across the country for the outstanding care that they continue to deliver under a great deal of operational pressure. On behalf of the whole House I also thank the 70 NHS front-line volunteers who will be making this country safer by spending their Christmas in Sierra Leone on the front line in the fight against Ebola. They are the bravest of the brave and make our entire country proud.
Andy Burnham
I thank the Secretary of State for his statement. I of course echo the sentiments he expressed about NHS staff and volunteers fighting Ebola.
I have to say, however, that I heard a good deal of misplaced complacency in what he had to say. Winter has not begun in earnest, but there are already signs of A and Es and ambulance services being stretched to the limit. Last week, a record number of people waited more than four hours in A and E and on trolleys. Ambulance response times are getting worse across England, with some 999 calls taking hours. Overnight, news has emerged of an 82-year-old man who waited more than three hours for an ambulance to arrive at his nursing home. He then waited a further 19 hours on a trolley in a corridor. That is appalling, and there are fears that things will get worse when the House is in recess.
Given that, it should not be for me to drag the Secretary of State here today to explain what he is doing to prevent a full winter crisis in the NHS. The question he did not answer, but must answer today, is this: does he have a winter plan? If he does, will he publish it? People working in the NHS need to know what is in it. [Interruption.] He seems to suggest that he has one, but let me quote Dr Mark Porter, chair of the British Medical Association. He criticises what he calls the
“total failure by government to come up with a meaningful plan”.
The Secretary of State will have to reassure Dr Porter.
The Secretary of State mentions money, but is it not the case that £300 million of it was allocated only in November? Does he really think that that gave the service enough time to plan? Dr Clifford Mann, chair of the College of Emergency Medicine, does not think so. He says:
“Had these funds been used back in summer and early autumn we might have more resilience in the system now.”
Dr Mann also questions where this money has gone, saying “very little” has been seen by front-line A and E staff, and instead
“a lot of it has gone to shoring up balance sheets in acute trusts”.
Is that true? Will the Secretary of State provide of full breakdown of how that money was allocated and has been spent to date? Were any conditions attached? I am sure he will claim the money has been used properly, but, if that is the case, why is the NHS already under so much pressure?
Over the break, hon. Members will want to monitor the situation in their local hospitals very closely. However, we have learnt that from tomorrow the publication of data on A and E will be suspended for three weeks over the crucial Christmas period. That is simply unacceptable. Given that we know the figures are still being collected, there is absolutely no reason why they should not be published. The Secretary of State rightly puts a premium on transparency. Will he today order an end to the news blackout and instruct NHS England to maintain weekly reports?
I have visited a number of acute trusts in recent days and they all say that the pressure on A and E is critically linked to the severe shortage of places in nursing and residential homes and cuts to social care. The sad truth is that today a record number of older people are trapped in hospital. They are well enough to go home, but do not have the support to do so. When are the Government going to wake up to the very real crisis in social care and the fact that it is dragging down the NHS?
Finally, no one can predict what this winter will hold, but the warning signs are there and the NHS needs to plan for all eventualities. What discussions has the Secretary of State held with other Departments, and do the Government have a wider contingency plan for the NHS?
This is a serious situation. If patients and staff are to have confidence, they need better answers than they have had so far. I hope the Secretary of State will start providing them now.
Mr Hunt
First, may I thank the shadow Health Secretary for bringing this matter to the attention of the House? As a former Health Secretary, he knows that operational pressures are one of the biggest challenges facing any Health Secretary. Indeed, he had many examples of very, very poor care on his own watch and he is absolutely right to give the House a chance to hear more about our plans for winter.
The shadow Secretary of State asks whether we have a plan. It seems to me that he prepared his comments before he listened to the statement. We have put in more money than ever before. Plans were announced in June. NHS England had a press conference in which it went through the plans relating not just to the £400 million, but the extra £300 million that was agreed in September and allocated through October. That is a record amount. Let us consider what is happening in his own constituency. In Wigan borough, since 2010, because of spending that he opposed, Wrightington, Wigan and Leigh NHS Foundation Trust has taken on 78 more doctors, 149 more nurses and 209 more clinical—[Interruption.] He says, “Does this help?” These are extra doctors and nurses on the front line, helping patients in his own constituency.
The right hon. Gentleman talked about care homes. The £3.3 million going to help his own constituents with winter pressures is to monitor the mental and physical health of patients in care homes and to help reduce the number of emergency admissions. We have a winter plan that is working in his own constituency to help improve the lot of his constituents. He needs to acknowledge that.
The right hon. Gentleman talked about the publication of figures over Christmas. We have never published figures over the Christmas period because it would mean forcing NHS staff to work over Christmas, whereas, where possible, we would like them to be able to go home for Christmas, just like Members of this House. When he was Health Secretary, did he publish performance or weekly A and E figures over Christmas? He did not. He did not publish them at Christmas or Easter; he did not publish any weekly A and E figures at all, so to come to the House and call it a news blackout says to me that he is more interested in political opportunism than in care for patients.
It is disappointing that the right hon. Gentleman did not take this opportunity to disown his own leader’s instructions to weaponise the NHS. The NHS is not, and never should be, a political weapon. This is what third parties say. Dr Mann, president of the College of Emergency Medicine, whom the shadow Secretary of State mentioned, said yesterday that
“the system is under pressure but it’s working pretty well”.
The Foundation Trust Network said:
“NHS providers prepared for this Winter earlier and more fully than ever before”
and that—he should listen to this bit—the
“NHS needs support not criticism”
please. The NHS Confederation said the NHS was pulling out all the stops on urgent care and A and E, and that earlier planning and extra money were helping.
The right hon. Gentleman wants to draw comparisons. Nine out of 10 people are being seen within four hours in this country, which is a higher proportion than in any country anywhere in the world that measures A and E performance—faster than Australia, New Zealand, Canada, Scotland, Northern Ireland and, yes, faster than Labour-run Wales. Eight people out of every 100 wait more than four hours in A and E in England; in Wales, that figure is 15 hours. He should concentrate on saving the NHS in Wales, rather than running it down in England, where it is doing so much better.
Finally, if the right hon. Gentleman is worried about poor care, why is he still saying it was wrong to have a public inquiry into Mid Staffs? This is what Julie Bailey, the Mid Staffs campaigner, said this week about his comments:
“It is very worrying, because if he becomes Health Secretary again at the election it is clear we would go straight back to the old days of covering up.”
The NHS is performing well under great pressure. He should commend the efforts being made by front-line staff, not undermine them by trying to turn the NHS into a political football.
NHS (Five Year Forward View)
Andy Burnham Excerpts(9 years, 6 months ago)
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Andy Burnham (Leigh) (Lab)
This weekend a 16-year-old girl in need of a hospital bed was held for two days in a police cell because there was not a single bed available for her anywhere in the country. As we have warned before, this is by no means an isolated example: the BBC reported on Friday that seven other people had died recently waiting for mental health beds. But it is not just mental health: last week I told the House of a stroke patient ferried to hospital by police on a makeshift stretcher made from blinds in his house. That patient later died. This is one of a number of alarming reports of people waiting hours in pain and distress for ambulances to arrive.
Listening to the Secretary of State for over 10 minutes today, one would have no idea that any of that was happening in the NHS right now—and that is the problem: nothing he has said today will address those pressures ahead of this winter. On mental health, does he not accept that there is an undeniable need to open more beds urgently —right now, this week—to stop appalling cases like the one we heard about at the weekend? What assessment has he made of the ability of the ambulance service to cope this winter? Is there a case for emergency support, on top of what has already been announced?
This statement offers no help now to an NHS on the brink of its worst winter in years, but there is another major problem with it. The weekend headlines promised £2 billion extra for the NHS, but the small print revealed that it is nothing of the sort. I note that the Secretary of State did not use the figure of £2 billion once in his statement, but that is what the NHS was led to believe it was getting. False promises and cheques that bounce one day after they are written are of no use to doctors and nurses struggling to keep services going. We all remember the omnishambles Budget unravelling the day after it was given, but an autumn statement unravelling three days before it has been delivered is a first even for this Government.
Will the Secretary of State confirm that £700 million of the £1.7 billion he talked about is not new money, but already in his departmental budget? A few weeks ago his Department told the Public Accounts Committee that it expects to overspend this year by half a billion pounds. His Department is in deficit right now. If that is the case, would he care to tell us where this £700 million is coming from and what services he will be cutting to pay for it? He mentioned research. At the weekend we exposed NHS England’s plans to cut the funding for clinical trials, which would have affected thousands of very poorly patients. Was that one of his planned central cuts to pay for this funding? Will he now guarantee that funding for research and clinical trials will not be cut?
But it gets worse. Not only is £700 million recycled; we gather that the other £1 billion will be funded by cuts to other Departments. The Institute for Fiscal Studies has warned of “staggeringly big cuts” to local government in the next Parliament. The NHS Confederation has said:
“If additional NHS funding comes at the expense of tough cuts to local government budgets, this will be a false economy as costs in the NHS will rise.”
Have the Government not learnt the lessons of this Parliament: that the NHS cannot be seen in isolation from other services, particularly local government, and that cutting social care only leads to extra costs for the NHS? Figures released on Friday revealed record numbers of older people trapped in hospital because the care was not there for them at home. That is happening on the Secretary of State’s watch.
This is the human consequence of the severe cuts to social care in this Parliament, and it is clear that this Government are preparing to do the same again in the next Parliament if they are re-elected. This is why hospital A and Es have missed the right hon. Gentleman’s own target for 71 weeks running. We also have cancer patients waiting longer for treatment to start, and everyone is finding it harder and harder to see a GP.
Is it not the case that most of what the Secretary of State has announced will go to patching up the problems he has created, leaving less than a quarter for the new models of care outlined in the “Forward View”? Let me remind him that policies such as a year of care for vulnerable patients and having accountable care organisations were developed by the Opposition, and for him to stand there today and lecture us about reorganisations of the NHS—well, I did not think that even he would have the nerve to do that.
The truth is that what the Secretary of State has announced provides nothing for the NHS now and is not what it seems, and because of that it will not be enough to prevent the NHS from tipping into full-blown crisis if the Tories are re-elected next year. They will not be able to find any more money for the NHS than this, because they have prioritised tax cuts for higher earners and have not yet found the money to pay for them. That explains their desperate attempts to inflate these figures and make them sound more than they are. Is it not the case that to deliver the “Five Year Forward View”, the NHS needs truly additional money on the scale proposed by Labour—an extra £2.5 billion over and above everything the Secretary of State has promised today, and an ambitious plan for the full integration of health and social care.
They said they would be the Government who cut the deficit, not the NHS, but it is the Health Secretary who has created a deficit in the NHS. It is because of that deficit that cancer patients are waiting longer, A and E is in crisis and children are being held in police cells, not hospital beds. He had nothing to say to those people today. They deserve better than a Chancellor fiddling the figures and a Health Secretary spinning the facts.
Mr Hunt
This is the day on which Labour’s attacks on the NHS have been shown up for what they are—every bit as shallow as their attacks on the economy. The country knows that we are addressing the squeeze on NHS funding caused by Labour’s wrecking of the British economy.
The right hon. Gentleman called today’s announcement “patching up the problems”. If growing the economy so that we can put more money into the NHS is patching up problems, how would he describe shrinking the economy and then cutting the NHS budget, as he wanted to do? He said that £2 billion of new money was a false promise. It was not a false promise: it was the truth—£1 billion of additional funding from the Treasury and £1 billion from the forex fines. That is £2 billion of new money, which has been welcomed by the King’s Fund today as a big step forward, and by the NHS Confederation, the Foundation Trust Network and Simon Stevens, the head of NHS England and former Labour No. 10 health adviser. This is a very significant moment when, after years of taking painful decisions to get the economy back on track, we can at last put more money into the NHS. The right hon. Gentleman should welcome it, not scorn it.
The right hon. Gentleman talked about deficits in the NHS. We will take no lessons on deficits from the Labour party—the party that left the country its biggest level of unfunded spending commitments in peacetime history. The truth is that now, with a strong economy that Labour could never deliver, we are putting things right.
The right hon. Gentleman talked about problems with care in the NHS, and the one thing that no one ever says about me is that I am a Health Secretary who shies away from those problems. The trouble is that every time I talk about problems with care in the NHS, he says it is running down the NHS. It is not running down the NHS to confront the problems of poor care. He also talked about the issue of police cells, but we are on track to reduce the number of mental health patients using them by 50% over the next few months.
As for pressures on the NHS front line, it is not that all Health Secretaries do not have to confront them; it is whether or not we sort them out. When it comes to poor care in hospitals such as the Medway and hospitals in Colchester, Basildon and Burton, this Government are sorting out those problems, while the previous Government swept them under the carpet. The right hon. Gentleman used the word “spin”, but he might like to reflect on the massive harm done to patients when under a Labour Government poor care was covered up by Labour spin—surely it was Labour’s darkest period ever when it came to running the NHS.
Government Members have a long-term plan for the economy, and a long-term plan for the NHS. By contrast—[Interruption.] Opposition Members might listen to the truth about the NHS. By contrast, the Labour leader said recently that he wanted to “weaponise” the NHS. He wanted to turn the NHS into a weapon—a weapon to get Labour votes. No, Mr Speaker, the NHS is not a weapon for political parties. It is there to help patients and to save lives, not to save political spins. Under this Government, it will always be there for patients: that is what this Government will deliver.
Oral Answers to Questions
Andy Burnham Excerpts(9 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I commend my hon. Friend, who, as many of us know, has worked enormously hard on a whole range of health issues in her constituency. In particular, I know that she has helped deliver the Winter Wellness programme with a number of local organisations. It is important to highlight what help and advice is available for people who need it most in order to stay warm. The Government’s cold weather plan has a series of cost-effective and simple measures that people can take to reduce the harm caused by cold weather.
Andy Burnham (Leigh) (Lab)
Two weeks ago, news emerged of serious problems at Colchester hospital. People there still do not know the precise details, as Ministers have not made a statement and the Care Quality Commission has not published its report. But Colchester is not the only hospital in difficulty; we have learnt that hospitals in Scunthorpe, Middlesbrough and King’s Lynn have been turning patients away and others are already on black alert, and that is before winter has even begun. We do not have an accurate picture of what is happening in the NHS right now, because NHS England was due to begin publishing weekly reports on 14 November but has failed to do so. Why has that information not been published, and will the Secretary of State today instruct NHS England to do so without delay?
Mr Hunt
That information is published at the decision of NHS England—[Interruption.] It has said that it will publish it in a fortnight’s time. Let me just say to the right hon. Gentleman that it was this Government who decided to publish that information on a weekly basis, something he never did when he was Health Secretary.
Andy Burnham
I am afraid that is just not good enough. Who is in charge here? It is not just A and Es that are under pressure; there is a knock-on effect on ambulance services. Reports are now surfacing of serious failures in patient care. Last month, a six-year-old girl from Sunderland was left for three hours with a suspected broken back despite five 999 calls. At the weekend, it was reported that a 56-year-old stroke patient from Huyton was taken to A and E by police on a makeshift stretcher made from window blinds from the man’s home, and he later died. Yesterday, it emerged that a 57-year-old cancer patient from Bishop Auckland died after three ambulances were diverted to other calls. Is it not clear that the situation in the NHS right now is far more serious than the Government have acknowledged, and should not the Secretary of State now make an urgent statement to Parliament setting out what he is doing to reduce the risk of harm to patients this winter?
Mr Hunt
There are huge pressures in the NHS. That is why we have put a record £700 million into the NHS to help it to get through this winter. May I gently suggest to the right hon. Gentleman that he should not try to politicise every single operational problem? When the NHS is all about politics, patients get forgotten—as he should know, because that is what happened when he was Health Secretary. Whether in Medway, Colchester, Burton or George Eliot, patients were forgotten because for Labour it was politics before patients every time.
National Health Service (Amended Duties and Powers) Bill
Andy Burnham Excerpts(9 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Sir Tony Baldry
My hon. Friend makes a good point. I think the Labour party will regret signing up to every 38 Degrees campaign, because if 38 Degrees starts drafting the Labour party manifesto rather than the Labour party, the Labour party will never sort out whether it is new Labour, old Labour or any other sort of Labour, which is why it did so incredibly badly yesterday in the Rochester by-election.
Andy Burnham (Leigh) (Lab)
The right hon. Gentleman has just made a comment that cannot go unchallenged. He claims that the relationship that this Government have with the private sector is the same as that of the previous Government. That is absolute rubbish. When his Government’s legislation went through, he said that doctors would decide. Doctors throughout the country are now saying that they are mandated to put services out to the open market under section 75 of the Health and Social Care Act 2012—his Government’s legislation. That was not the case under the previous Government. If this Government are just doing the same as the previous Government, why did they need a 300-page Bill to rewrite the legal basis of the national health service?
Sir Tony Baldry
May I remind the right hon. Gentleman of a document published on 31 October 2000, under the last Labour Government? The printout that I have is entitled, “A Concordat with the Private and Voluntary Health Care Provider Sector”. It is headed, “Socialist Health Association—Promoting health and well-being through the application of socialist principles”. It was a concordat introduced by the previous Government with the private and voluntary health care sector. It says:
“Introduction. There should be no organisational or ideological barriers to the delivery of high quality healthcare free at the point of delivery to those who need it, when they need it. The Government”—
the last Labour Government—
“has entered into this concordat with the Independent Healthcare Association to set out the parameters for a partnership between the NHS and private and voluntary health care providers. It describes a partnership approach that enables NHS patients in England to be treated free in the private and voluntary health care sector.
The key tests for any relationship between the NHS and private and voluntary health care providers is that it must represent good value for money for the tax payer and assure high standards of care for the patient. The involvement of private and voluntary health care providers in the planning of local health care services at an early stage will enable the NHS to use a wider range of health facilities within their locality. To achieve this Health Authorities in their strategic leadership role will be expected to ensure that local private and voluntary health care providers are involved in the processes designed to develop the local Health Improvement Programme as appropriate.”
And it carries on. The document is headed, by the last Labour Government, “Socialist Health Association…A Concordat with the Private and Voluntary Health Care…Sector”. Indeed, the last Labour Secretary of State for Health signed a concordat with the Independent Healthcare Association on 31 October 2000.
The decision to make greater use of private sector facilities for NHS patients did not require new legislation and it was possible to undertake it within the existing legislation on the NHS, but for the avoidance of doubt let me quote the Labour party manifesto from 2001. In the chapter on NHS reform, Labour promised to
“work with the private sector to use spare capacity, where it makes sense, for NHS patients”
and to
“create a new type of hospital—specially built surgical units, managed by the NHS or the private sector—to guarantee shorter waiting times”.
In my constituency, we have an independent orthopaedic treatment centre run by the private sector and introduced under the Labour Government. We have a Darzi walk-in centre run by private GPs, which was also introduced during the time of the Labour Government.
Sir Tony Baldry
The hon. Gentleman misunderstands my point. The Act did not introduce competition into the NHS because that competition had already been introduced by the previous Labour Government, who introduced greater private sector involvement in the NHS. Labour made binding rules to manage the competition, and the Act continued that approach with an expert health sector regulator working in the best interests of patients. Removing Monitor as the health sector regulator would merely leave commissioners facing actions through the courts under Labour’s own 2006 procurement regulations, which I do not think would be in the best interests of patients.
Andy Burnham
I am afraid that the right hon. Gentleman has undermined his entire speech with the ignorance he has displayed in response to my hon. Friend the Member for Eltham (Clive Efford). For the first time in the history of the NHS, the Act gave a role to the competition authorities, under the Enterprise Act 2002, in taking precisely the kind of action that my hon. Friend referred to. I am very surprised the right hon. Gentleman does not know that; may I suggest that he does not know what he is talking about?
Sir Tony Baldry
We heard that argument during the passage of the Act, and it is simply wrong. It is wrong to suggest that somehow the Act opened the door to competition.
Andy Burnham (Leigh) (Lab)
Tuesday 20 March 2012 was a black day for the NHS and for this Parliament. A Bill with no mandate from the British people was allowed to pass through this House and to place market forces at the heart of our health service. It allowed this democratic House to be bypassed when it comes to decisions affecting the country’s most valued institution. In other words, it was a crime against democracy and the national health service. Ever since that dark day, the damage has been mounting: NHS services worth billions of pounds—including blue light 999 ambulance services and cancer services—forced out to open tender; millions of pounds thrown at competition lawyers and consultants to run those tenders; and NHS hospitals, freed to earn up to 49% of their income from treating private patients, doing just that and letting NHS waiting lists get longer.
Ian Lavery (Wansbeck) (Lab)
Is my right hon. Friend aware of the unique deal between Northumbria Healthcare NHS Trust and the Labour-led Northumberland county council in which the council bought out the PFI deal, which means a better deal for the taxpayers in Northumberland and a much better deal for the NHS trust and the patients?
Andy Burnham
Yes, I am aware of the deal, and it is a great example of how a Labour council, working with the NHS, can take steps to improve funding for front-line patient care. It happened because of the deal that was struck in the latter stages of the previous Labour Government.
As a result of the Health and Social Care Act 2012, NHS hospitals can earn more money from treating private patients, while NHS waiting lists get longer. Those same hospitals have now been told by competition authorities that they cannot collaborate any more because it is “anti-competitive.” How did it come to this? That is not the health service that we have known for 66 years. Every day that this illegitimate legislation remains in force is a day closer to the demise of the national health service.
Jonathan Edwards
In response to an FOI request, I was told by my local health board that between December last year and July this year, 373 ophthalmology patients, 90 pain management patients, 165 neurology patients and 264 orthopaedic patients were transferred to private sector providers at a cost of nearly £600,000. What is the right hon. Gentleman’s message to his Labour colleague, the Health Minister for Wales?
Andy Burnham
I will give the hon. Gentleman my message now: the Labour Government in England and in Wales have taken steps to bring down NHS waiting lists. When we left office, they were at the lowest ever level. I make no apology to him for those improvements.
The 2012 Act has put the NHS in danger, which is why it has to go. Back on that March day in 2012, I pledged that the party that created the NHS would repeal that Bill at the first opportunity, and today we honour that promise. The Bill before us, presented by my hon. Friend the Member for Eltham (Clive Efford), restores the right values at the heart of the NHS: collaboration over competition; integration over fragmentation; people before profits.
Angie Bray
Will the right hon. Gentleman care to comment on the letter in The Daily Telegraph today, signed by a number of doctors and led by the chairman of NHS Alliance, asking people not to support this Bill, as it would be a backward step for patients?
Andy Burnham
I am sure that Tory central office has been ringing around for a few days trying to find some doctors who are still in favour of the 2012 legislation, and they found 11. Well, I think that is probably about the limit for the number of people prepared to put their name to it. I can tell the hon. Lady that thousands of doctors lined up with the Opposition and pleaded with her party to call off its reorganisation, and that included the British Medical Association and the royal colleges, but it would not listen. The Government ploughed on regardless, and the NHS has gone downhill ever since.
That is why my hon. Friend the Member for Eltham gave a stirring speech of the kind this House needs to hear more, full of conviction and passion, standing up for the national health service that he believes in. He has brought before the House a Bill that reaffirms the words of Nye Bevan’s original National Health Service Act 1946 on the democratic accountability of the NHS to the Secretary of State and, by extension, to this House. The Bill abolishes the compulsory tendering of NHS services and removes market forces. It reduces the private patient income cap back down to single figures. Once and for all, it fully exempts the NHS from EU procurement and competition law, as is our right under the Lisbon treaty. It sends the Government an uncompromising message that the NHS will never be touched by any TTIP treaty.
In particular, I commend my hon. Friend for saying that it is about time this House regained full sovereignty over the national health service. They gave it away—the Eurosceptics sitting there on the Government Back Benches—when they mandated open tendering of services. By doing that, they placed the NHS in the full glare of European competition law. [Interruption.] They do not like to hear it, but that is what they did.
Sir Oliver Heald
Is the right hon. Gentleman the same man who used to talk about an end to the polarising debate on private and public sector provision? Is he the same man who, when Secretary of State, privatised the services for an entire hospital at Hinchingbrooke? What is he doing today? It is buff and blow party politics.
Andy Burnham
I told the hon. and learned Gentleman earlier that that was incorrect and that he should withdraw the suggestion, because I did not do that. The contract for Hinchingbrooke was awarded under his Government. I will tell him who this man is. This is the man who, when Secretary of State, introduced the concept of NHS preferred provider, because I believe in the public NHS and what it represents, unlike him. I believe in an NHS that puts people before profit, unlike him. That is the man he is talking to, and that is what I will always stand up for.
Dr Huppert
The right hon. Gentleman correctly says that the contract for Hinchingbrooke was let under this Government, but does he not accept that it was he who, when Health Secretary, reduced the list of bidders to five, none of which were NHS bidders, and then to three, all of which were private companies? Does he accept that he could have left NHS bidders in the process, rather than only private bidders? Then he complains when one of the providers that he shortlisted got the contract.
Andy Burnham
I am afraid that the hon. Gentleman has to get his facts right, because they are wrong. When I was Health Secretary and Hinchingbrooke needed to find a new operator, I asked local NHS trusts in his area to come forward, and at the time none of them wanted to do that, so we had to find an operator—
Sir Oliver Heald
On a point of order, Madam Deputy Speaker. I may have inadvertently said that the contract was let, but I do not believe that I did. The true position is that it was the right hon. Gentleman who took the decision to privatise the services in that hospital, and it is wrong for him to seek to deny it. [Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I appreciate that the hon. and learned Gentleman wishes to ensure that the record is set straight. He has attempted so to do, but it is not a point of order for me to deal with.
Andy Burnham
“Attempted” is the operative word, Madam Deputy Speaker. The hon. and learned Gentleman says that it was my decision, but it was the decision of his right hon. Friend the Member for South Cambridgeshire (Mr Lansley). He did it when their Government came in, and the hon. and learned Gentleman should have the good grace to withdraw what he said.
I was in the middle of answering the intervention from the hon. Member for Cambridge (Dr Huppert)—the hon. and learned Gentleman should listen to this, because he will get his answer. I said that the process should go forward under the NHS preferred provider principle, which I introduced—he seems not to understand that. To correct him, when the previous Government left office there were three bidders, one of which was an NHS provider, so he really needs to get his facts straight—
Andy Burnham
No. The hon. Gentleman needs to get his facts straight before he tries to shout the odds in my direction.
The Bill gives back to this House sovereignty over the national health service, which millions of people will welcome. The Bill means so much to so many people who are concerned about what is happening to the NHS right now under this Government.
Barry Gardiner (Brent North) (Lab)
My right hon. Friend says that the Bill will mean so much to so many people. He will recall that in 1997 the waiting lists at Northwick Park hospital were the highest in the country, with people having to wait for 21 hours on trolleys. He will also know that the people in Brent and Harrow who rely on that hospital today are now enduring the highest waiting lists in the country again. Waiting lists came down on his watch, but they are back up again. What message does that send to the people of Brent and Harrow?
Andy Burnham
My hon. Friend is right to remind the House that in 1997 people were spending years on NHS waiting lists, and even dying while still on them. As my hon. Friend the Member for Bolsover (Mr Skinner) said, we brought those waiting lists down, and by the time we left government in 2010 this country had the lowest ever NHS waiting lists and the highest ever level of public satisfaction in the NHS. That is Labour’s record, and we will not let the Government forget it.
What is happening now? NHS waiting lists are back at a six-year high. That is the result of the reorganisation that the Government ploughed through, which nobody wanted. The country did not want it. There are millions of people out there who are concerned about what the Government are doing. It will not have escaped their notice that scores of Government MPs have failed to turn up today to defend what was one of their flagship Bills. What a shower! There are people who kept a vigil outside the House last night, in cold temperatures, imploring Members to be here to pass this Bill because the issues it raises matter so much to them. Then we have the spineless MPs of a disintegrating Government, some loaded up to the eyeballs with links to private health care, who do not have the guts to come here today to argue for what they have done. Is it any wonder that people are losing faith in this place?
Dr Huppert
On a point of order, Madam Deputy Speaker. The right hon. Gentleman claimed earlier that one of the bidders at Hinchingbrooke was an NHS provider, but according to the National Audit Office there was Circle, Serco and Ramsay. Can he now either correct the record for the House, or let us know which of those three he believes is an NHS provider?
Madam Deputy Speaker (Mrs Eleanor Laing)
The hon. Gentleman makes a perfectly good point of debate, but it is not a point of order.
Andy Burnham
We have spineless Government MPs who will not come here today to argue for the Act.
I congratulate the hon. Member for Rochester and Strood (Mark Reckless) on his victory and on being here today, despite being up all night—I cannot imagine that he managed to get any sleep. His party leader has said that when the hon. Gentleman is tired he says things that he does not mean—I think that he just nodded there. Given that he has been up all night, I can only conclude that he does not actually believe what he said in the speech we just heard. In three days he has gone from being in favour of the repatriation of European citizens to being against the privatisation of the NHS. That is a pretty big political distance to cover in just three days.
Mark Reckless
I have only ever argued for European citizens to be able to stay; any other words came from others, not me. It is the right hon. Gentleman’s party that has reversed its position, having previously privatised the Darent Valley hospital and fragmented the Medway Foundation Trust, but it now seems to have a better policy, which I am happy to support.
Andy Burnham
The hon. Gentleman said that he could not understand Labour’s position, but surely he remembers 2012, when Opposition Members spoke with force against that legislation, which he then voted for in the Lobby. I know that it has been a long night, but he really should try to remember these things, because they are quite important.
Mr Anderson
Is it not also true that the hon. Gentleman went through the Lobby not once, but 18 times, despite being told time and again that what has now happened would happen? The people who had their finger on the pulse were telling us what would happen, but he ignored them.
Andy Burnham
It is a tiring business being an MP and it is possible to forget things, particularly when one drinks as many pints as UKIP Members do, but they should try to remember. Their party leader once said that he would give the NHS budget to insurance companies; apparently, he does not believe that now. The deputy leader, a Mr Nuttall, said that the right hon. Member for South Cambridgeshire was to be congratulated on bringing a whiff—just a whiff—of privatisation to the NHS, and the hon. Member for Clacton (Douglas Carswell), whom the Minister quoted earlier, described the Lansley reforms as “fairly modest”. He chided his Tory colleagues who were sniping against him at the time and said that the reforms must not be derailed. The party says it is anti-politics in the way things are done. This is sheer opportunism and dishonesty.
Mark Reckless
I recall much of what the right hon. Gentleman said from the Dispatch Box in 2012, and I would like to credit him because a lot of it has come to pass. He was perspicacious in much of what he said and many of the assurances that I was given from the Government Front Bench have been found wanting.
Andy Burnham
I appreciate what the hon. Gentleman says—it would be churlish for me to say otherwise—and I am grateful for the way he said it. The things Opposition Members were saying back then have happened, and we can see the effects of the Government’s reorganisation in the NHS. With the new figures that came out this morning, we see that A and E has missed the Government’s target for 70 weeks in a row. The A and E figures are the barometer of the health and care system. They are the best place to look if we want to see whether there are problems in the health and care system. The fact that the target has been missed for 70 weeks in a row tells us that severe storms are building over the NHS.
Mr Jim Cunningham
I am glad my right hon. Friend raised that. It takes us back to pre-1997, when people who could not get beds were lying on trolleys. I am sure he remembers that. I can remember a hospital in Coventry that was falling down. As a result of the Labour Government, we got a new hospital.
Andy Burnham
My hon. Friend is right. The Labour Government inherited a situation where almost three quarters of the NHS estate was built before 1948. We transformed that, as well as bringing those waiting lists down. He is right to remind us.
I cannot believe that Government Members have not had the guts to be here today to argue for their own policy on the NHS. Or is it that under the shambolic regime of their new Chief Whip, who is now inflicting the same chaos on the parliamentary Conservative party as he did on England’s schools, the Government did not think they could win the vote today, so they did not dare to bring their troops here to hold it? I do not know what the reason is, but they clearly do not believe in their own legislation and the catastrophic reorganisation that followed. An unnamed senior Cabinet Minister has been quoted in The Times as admitting that it was their single biggest mistake.
Mr Ronnie Campbell
Will my right hon. Friend touch on the fact that 71 coalition Members of Parliament are being paid by private companies involved with the national health service?
Andy Burnham
It is one of the biggest scandals of recent times that people in this House who have links to private health, and many more in the other place, put through legislation that did not have a mandate from the British people and from which they would benefit financially. The story of that will one day be told in full.
The reorganisation has dragged the NHS down and left it on the brink. A reorganisation that was meant to put GPs at the heart of the NHS has left patients waiting days or even weeks to get a GP appointment. This week, there was news that the NHS has missed its cancer standard for the third quarter, leaving thousands of cancer patients waiting more than two months for treatment to start. It is a reorganisation that has systematically run down the NHS and opened the door for it to be sold off.
Paul Farrelly (Newcastle-under-Lyme) (Lab)
The reorganisation was unnecessary. My right hon. Friend is no doubt aware that in Staffordshire a £1 billion cancer contract has been put out to tender. The newly rebuilt local hospital is concerned that that will destabilise its finances. Does he agree that we should be very careful about going down that route without proper consideration?
Andy Burnham
The example that my hon. Friend quotes is the best example of the fact that the Government see no limit at all on the scale or extent of privatisation in the NHS, both in terms of the monetary value— £1 billion—and the fact that they are prepared to put cancer services out on the open market.
Mark Durkan (Foyle) (SDLP)
Does my right hon. Friend recall that some of us supported his opposition to the Health and Social Care Bill, which purported to be England-only legislation? By its marketisation and altering of the public service ethic for the health service, it was going to be predictive legislation with severe implications for devolved services. For similar reasons we support the Bill today, because it offers a bulwark against TTIP hazards for devolved health services.
Andy Burnham
The Bill before us deals comprehensively with that threat from any proposed TTIP treaty. I am glad to see the hon. Gentleman in his place today.
Robert Flello
Is my right hon. Friend aware that the companies on the list of preferred bidders to provide cancer care in north Staffordshire include CSC computer services, which was responsible for the £10 billion IT failure, the Lorenzo system, and Interserve Investments, which was fined £11 million by the Office of Fair Trading for anti-competitive bid rigging? These are the sort of firms that our cancer services might go to.
Andy Burnham
Those examples will alarm people. In Greater Manchester, a bus company has been running ambulance services. We had news this week that an arms manufacturer is bidding for a GP contract. These are the things that are beginning to happen to the NHS. Nobody’s constituents have ever given their permission for any of this to happen.
We heard speeches from the hon. Member for Bosworth (David Tredinnick) and the right hon. Member for Banbury (Sir Tony Baldry), who said that nothing had changed and what was happening in the NHS now was just a continuation of what the previous Government were doing. No, it is not. The right hon. Member for South Cambridgeshire said in a speech on 9 July 2005:
“The time has come for pro-competitive reforms in…health”
and he help up the example of utilities and rail. That was the specific inspiration for his reorganisation. He sold his Bill on the basis that doctors would decide, but doctors tell us that they have no choice but to put services out to the market. Section 75 says that commissioners may not run a tender if there is only one available provider. That is never the case, which is why CCG lawyers conclude that they have no choice but to put services out to tender.
That is why we see, according to figures from the NHS Support Federation, that 865 contracts for NHS services, worth £18.3 billion, have been offered to the market. Some 67% of the contracts awarded so far have gone outside the NHS. It is this decision to mandate the tendering of services which places the NHS in the full glare of EU procurement and competition law. Because Ministers have refused to exempt the NHS from the TTIP treaty, we could soon have private US health care providers ringing up CCGs to challenge them on their commissioning decisions.
This Bill legislates to remove that threat. It repeals section 75 and it really does let doctors and local commissioners decide. It restores the role of the Secretary of State and brings much needed ministerial accountability back to this House. No longer will Ministers be told to write to NHS England when they have concerns. Instead, there will be answers from the Government Dispatch Box about the service that matters most to their constituents. It removes the role of the competition authorities that the Government’s Act introduced. It stops the ludicrous situation where hospitals such as Bournemouth and Poole are not allowed to collaborate. Importantly, it stops hospitals devoting half their beds and half their facilities to the treatment of private patients.
Mr Slaughter
Since Hammersmith and Central Middlesex A and E departments closed two months ago, we have had people waiting in ambulances and waiting rooms with every seat taken. We have even had people waiting on floors. The Government’s answer to that is to close two more A and E departments, those at Charing Cross and Ealing in west London. Is that not just preparing the NHS for failure and for privatisation?
Andy Burnham
What is happening in west London should send a shiver down the spine of every community in the country. The NHS is being torn apart, which is damaging patient care and leading to the consequences that my hon. Friend outlines.
This is how the character of the NHS is changing under this Government and before our eyes. With every year that the Health and Social Care Act stays on the statute book, the private sector will be more embedded in the NHS and the public NHS weakened as a result. The Government have undermined the “N” in NHS. They are letting our hospitals become part-privatised and they must be stopped. If the Government continue on their current course, in the next Parliament the NHS will be overwhelmed by a toxic mix of cuts and privatisation.
If the Government stop this Bill receiving Royal Assent, it will form the basis of the repeal Bill that the next Labour Government will lay before the House in May next year. But it will do more than that: it will remove the competition role to allow the full integration of health and care to build and lay the foundations for a 21st-century NHS.
One final thing needs to be said. Before we vote, there is a simple truth that all Members in all parts of the House must confront: nobody here has permission from their constituents to put the NHS up for sale. Today is their last chance to put that right before they face their constituents in six months’ time. The people of this country value and trust a public NHS that puts people before profits. This Bill restores that. The party that created the NHS is proud to support it, and I urge all Members to vote for it.
Dr Poulter
Thank you, Madam Deputy Speaker. I think the tone of that point of order made my point for me better than I could have done.
As my right hon. Friend the Member for Banbury said in what was one of the best speeches on the NHS I have heard in this Parliament, the Health and Social Care Act 2012 did not introduce competition into our NHS. To say that it did is factually incorrect, scaremongering and distracts the NHS from addressing the key issues it faces. It was the creation of a mixed health economy, implemented by the previous Labour Government, that exposed our NHS to competition law, not the introduction of the Health and Social Care Act.
Andy Burnham
That is a very important point that goes to the heart of this debate and that really needs to be cleared up for those listening and watching. The Minister said that the Act did not introduce competition. Will he confirm that it gave, for the first time, a role to the competition authorities under the Enterprise Act 2002 and that since then they have intervened, for the first time ever in the history of the NHS, in Bournemouth and Poole?
Dr Poulter
What I will confirm is that it is factually correct, as my right hon. Friend the Member for Banbury made clear, to say that it was the previous Labour Government—Tony Blair’s Government—who introduced competition into our NHS. At the end of Labour’s time in office, I believe that £6 billion a year was going to NHS providers. The right hon. Member for Leigh was quite happy to pay private sector providers 11% more than NHS providers for providing the same service. That was Labour’s commitment to the private sector, which we have cleared up and put right in the 2012 Act.
Let us remember what the Labour party said in its last general election manifesto. I am sure Labour Members will remember it well—the right hon. Gentleman may well have written it. It said:
“All hospitals will become Foundation Trusts…Foundation Trusts will be given the freedom to expand their provision…and community care, and to increase their private services”.
That is from the manifesto that every Labour Member stood on at the last election. The facts are clear: competition in our NHS was introduced well before this Parliament and well before this Government came into power. It was introduced by policies made by Members who now sit on the Opposition Benches—the policies of the previous Labour Government.
As my right hon. Friend the Member for Banbury reminded us, it was Labour that introduced the use of independent treatment centres in 2003, the “any willing provider” policy and the advent of patient choice in 2006, and it was Labour’s policies when in government that brought NHS commissioning under the scope of European competition law through the Public Contract Regulations 2006.
Five Year Forward View
Andy Burnham Excerpts(9 years, 8 months ago)
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Andy Burnham (Leigh) (Lab)
(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the “Five Year Forward View” for the national health service.
The Secretary of State for Health (Mr Jeremy Hunt)
NHS England, along with other NHS organisations, has today published its independent “Five Year Forward View”, which sets out its view of how the health service needs to change over the coming years. It is a report that recognises the real challenges facing the NHS, but it is essentially positive and optimistic. It says that continuing with a comprehensive tax-funded NHS is intrinsically do-able, and that there are
“viable options for sustaining and improving the NHS over the next five years.”
The report says that the challenges of an ageing population can be met by a combination of increased real-terms funding, efficiencies and changing the models of care delivered. It also says that
“decisions on these options will need to be taken in the context of how the UK economy overall is performing.”
In other words, a strong NHS needs a strong economy.
The report proposes detailed new models of care, putting out-of-hospital services front and centre of the solution, delivered through greater integration between primary, community and specialised tertiary sectors alongside national urgent and emergency networks. These can help to reduce demand significantly for hospital services and give older people in particular the personal care that we would all want for our own parents and grandparents.
The report talks about continued opportunities for efficiency savings driven by innovation and new technology, and suggests that they could be increased above the long-term run rate of efficiency savings in the NHS. It talks about reducing variation in the quality of care, in the wake of the tragedy in Mid Staffs, and about how the new Care Quality Commission inspection regime is designed to drive up standards across the system. It says that to do this we will need to move to much greater transparency in outcomes across the health and social care system. Finally, the report makes important points about better integrating the public health agenda into broader NHS activity, with a particular focus on continued reductions in smoking and obesity rates.
The Government warmly welcome the report as a blueprint for the direction of travel needed for the NHS. We will be responding to its contents in detail in due course, but we think it is an important contribution to the debate. We are proud of how the NHS has coped with the pressures of financial constraint and an ageing population in the last four years, but we also know that to sustain the levels of service that people want, the NHS needs to face up to change—not structural change, but a change in the culture of the way we care for people.
Given that the report has been welcomed on both sides of the House, I also hope that this can be the start of a more measured debate about the future of the NHS in which those from all parties in the House recognise our shared commitment to its future and focus on the best way to achieve the strong and successful NHS that the whole country desires.
Andy Burnham
A five-year forward view for the NHS, involving more than £550 billion of public spending, briefed to the media but not to Parliament—what clearer illustration could there be of the serious loss of public accountability arising from the Government’s reorganisation? The Secretary of State is in his place today only because he was dragged here by us. I do not know who runs the NHS these days, but I do know that it is certainly not him. We know why he wants to distance himself from this report: because it endorses key planks of Labour’s plan and leaves him with big questions to answer.
First, on GP services, does the Secretary of State agree with the report that primary care has been under-resourced and that people are struggling to get appointments? Will he accept its recommendation to stop his cuts to the GP budget, stabilise funding and match Labour’s plans to recruit 8,000 more GPs?
Secondly, on cancer, the report makes it clear that “faster diagnosis” is needed—we agree. So why did the Prime Minister yesterday dismiss Labour’s proposals for one-week cancer tests?
On integration, the report endorses Labour’s vision for new models of care, including hospitals evolving into integrated care organisations with more salaried GPs. Can the Secretary of State tell the House why he has spent the last few weeks attacking that plan, and is he now prepared to drop his opposition? On public health, is the report not right that the time has come for radical action on obesity, and will he now concede that his voluntary responsibility deal is simply not working?
It will not have escaped people’s notice that the report does not give one mention to competition—that is because it creates fragmentation, when the future demands integration. So will the Secretary of State commit to reviewing his competition rules and vote with Labour in four weeks’ time to repeal them?
Finally, on funding, the report could not be clearer: simply protecting the NHS budget in the next Parliament, as the Conservatives propose, will not prevent it from tipping into a full-blown crisis. As the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, has said, current Tory funding plans raise the spectre of rationing, longer waits and charges. Will he now drop them and match Labour’s plans for more money for the NHS? Labour has set out its plan, and today the NHS endorses that plan. The big question people are asking is: where on earth is his?
Mr Hunt
I talked about having a more measured debate, but I think I was speaking a trifle too soon, judging by what we have just heard. The right hon. Gentleman obviously was not listening to what I actually said, so let me just repeat to him that the Government warmly welcome this report. I talked about it as a “blueprint” for the future. He did not agree with setting up NHS England, and I do not think he agreed with the appointment of Simon Stevens as the chief executive, but we did that so that we would have a body that would think strategically about the long-term future of the NHS at arm’s length from the Government. That is what it has done, and the report is excellent.
The right hon. Gentleman and I have a sometimes slightly fractious relationship, but I would like to congratulate him this morning on his Houdini-like spin in the way he is approaching this report. He has been constantly telling this House that the NHS is on the point of collapse, but the chief executive of NHS England says that the NHS has been “remarkably successful” in weathering the pressures of recent years. The right hon. Gentleman has told this House constantly that the biggest threat to the NHS is privatisation and competition. This report, a five-year forward view, by bodies at arm’s length from the Government, contains not one mention of competition and privatisation as a threat, yet he says this report endorses Labour’s plans.
The right hon. Gentleman says, as has his leader, that the first thing he would do in government is repeal the Health and Social Care Act 2012 and strip clinical commissioning groups of their powers. He really should read the report carefully on that. He now says he welcomes the report, but it begs him not to carry out further big structural changes; it does not call for the repeal of the 2012 Act, and this is the report which he warmly welcomes today.
Then we need to consider money. The right hon. Gentleman told this House repeatedly that it was irresponsible to increase spending on the NHS, but now we have a report that says that the NHS needs real-terms increases, along the lines that this Government have been delivering in this Parliament. What does he say? He says, “It is great to have our plans endorsed by NHS England.” This report does not endorse Labour’s narrative; it exposes it for the shallow party politicking that we have had from him.
Let me say to the right hon. Gentleman that the really important message of this report is something we can agree on, and he should be talking about that. We both agree about the integration of health and social care, which is now happening. We both agree about improving investment in primary care. We both agree that we need more GPs. We both agree that we need more care closer to home. I think the public would say that we would have a more measured, intelligent and sensible debate—the kind of debate they want to hear—if we started talking about the things we agree on a bit more instead of constantly pretending there are vast disagreements.