Care Bill [Lords]
Andy Burnham Excerpts(10 years, 4 months ago)
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Jeremy Lefroy
I am grateful to the hon. Member for Stoke-on-Trent North (Joan Walley) for playing an extremely important and constructive role in this whole matter. She has been very supportive, and she makes some extremely important points. We need to look at the whole issue of administration, to which I will come in a few moments.
The Secretary of State’s decision to introduce the addition has given me considerable comfort about new clause 6, which I tabled before his decision, not being necessary. He does not seem to consider himself entirely constrained by the law into only accepting or rejecting Monitor’s recommendations in full; there is clearly room for proposing changes to details while still accepting the main thrust about the dissolution of a trust.
We shall of course need to see the results of the NHS review of consultant-led maternity services. If, as I hope, they are retained as a vital part of the regional health service—together with the level 1 special care baby unit, which serves a much wider area—it is important that finances are put in place to ensure that they are sustainable. I would therefore welcome clarification from the Minister about how the Department of Health now interprets the law.
If the Secretary of State’s decision on Mid Staffordshire demonstrates that the law allows for positive changes to the details of recommendations without Monitor having to go through another lengthy and legalistic process at a time when, as in the case of Stafford, a hospital is in a very fragile state, I welcome that fact, and new clause 6 will be unnecessary. However, if the Minister wants confirmation of the flexibility set out in the new clause, I would be happy for the Government to accept it or something similar.
Finally, to return to the question of trust special administrations, I believe that they are the right way to dissolve the legal entity of a foundation trust, but they are most certainly not the right way to redesign clinical services. That is not to criticise Monitor generally or the trust special administrators in the case of Mid Staffordshire—I believe that they acted within the remit given to them by this House—but we as a House did not get it right either in 2006 or in 2012. I urge a complete rethink, starting today.
Andy Burnham (Leigh) (Lab)
I rise to speak to my amendment 30. When the coalition came to office, it made a series of grand promises about future changes to hospital services. The coalition agreement proclaimed:
“We will stop the centrally dictated closure of A&E and maternity wards, so that people have better access to local services.”
GPs were to be put in the driving seat and given the power to shape local services. That was then; now we have a Secretary of State who has not just failed to stop centrally dictated closures but wants to legislate to make them much easier. What a difference four years make.
Clause 119 allows a hospital to be closed or downgraded simply because it happens to be near a failing one. It denies local people a meaningful say in those life and death decisions. It creates an entirely new route for hospital reconfiguration—top-down and finance-led. It subverts the established process in the NHS, which requires that any changes to hospitals should first and foremost be about saving lives, rather than saving money. It puts management consultants, not medical consultants or GPs, in the driving seat. By any reckoning, it represents a major change of policy from the one originally set out by the coalition.
Dr Poulter
If the right hon. Gentleman is so concerned about issues of financial failure, why did the Health Act 2009, through which the previous Labour Government introduced the regime, allow trust special administrators to consider only financial failure, not care failure, a fact which we are changing in the Bill?
Andy Burnham
The Minister anticipates me—he has hit the nail on the head. It was a different vehicle. It was a vehicle for financial and administrative reconfiguration, not service reconfiguration. In our view, those important decisions cannot be imposed on people, but should follow an established process. It should begin with local consultation, with local elected members involved in overview and scrutiny having the chance to make challenges, and then it should be referred for independent reconfiguration. That was the previous Government’s established policy, and in my view it is the right way to make changes in the NHS. As I shall explain, that is why I believe that he and his colleagues are spectacularly wrong.
Caroline Lucas
Does the right hon. Gentleman agree that as well as being profoundly undemocratic, the measure is likely to be incredibly counter-productive? Any Government who try to use a trust special administration to impose sweeping change without proper local public engagement will face a barrage of opposition because, as he says, change should be driven by clinical arguments, not imposed top-down.
Andy Burnham
The hon. Lady is absolutely right. The measure risks damaging, rather than building, public trust in the whole process of changing hospitals. In the end, that is probably the most powerful argument against what the Government are seeking to do.
By any reckoning, the proposal is a major change of policy from the one set out in the coalition agreement; yet there has been no Green Paper, no White Paper, no policy document, no statement to Parliament, no proper explanation of the Government’s intentions and no justification of the extreme measures sought. Instead, on the back of a court defeat, the Secretary of State has rammed a new clause into the Bill, asking the House to give him sweeping powers over the NHS in all our constituencies without even having the courtesy to come to the House to make the argument for the changes himself. How arrogant to expect us just to rubber-stamp the powers, without even coming to explain himself. That really shows the House a major discourtesy.
The fact is that the Secretary of State has not adequately made the case for what he wants to do. Instead, Members are asked to take a leap of faith and to trust him, but that is very hard to do when we see what happened to the people of Lewisham. In standing up to this Government, they won a victory for everyone; without them, we would not be debating clause 119 today. I pay tribute to my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) and my hon. Friends the Members for Lewisham West and Penge (Jim Dowd) and for Lewisham East (Heidi Alexander), who provided superb leadership when the people of Lewisham felt incredible outrage at their trusted and valued local hospital being prised out of their hands.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
I am most grateful to my right hon. Friend. He should also pay tribute to the efforts of all the clinicians, GPs and health workers. It was not just down to the leaders of the community; everybody was united. That was because the decision was not about clinical standards, but was an accountant’s solution to a different problem.
Andy Burnham
My right hon. Friend makes a very important point. The community came forward, with clinicians standing beside ordinary people on the streets of Lewisham, to say, “This is not acceptable.” My right hon. Friend and others gave voice to that concern and brought it to this House. That incredible campaign gave heart to campaigners everywhere. She was right to put that point on the record.
Heidi Alexander (Lewisham East) (Lab)
The Save Lewisham Hospital campaign was terrifically important, but there was also a protection written into law in relation to the trust special administration regime. Does my right hon. Friend agree that clause 119 will today remove that legal protection?
Andy Burnham
I agree with my hon. Friend. That is the point that the Minister revealed in his intervention. The original power was designed for something entirely different. It was designed to deal with financial failure in a trust. It put in place measures to dissolve and rescue that trust through administrative reconfiguration. It was never intended as a vehicle for back-door reconfiguration across a whole health economy. That is where the Government got themselves into trouble. The fact that they cannot see that now, after the court has told them that they went way beyond Parliament’s original intention, reflects badly on their ability to listen.
Mr Dorrell
I ask the right hon. Gentleman to reflect on what he has just said. Does he really believe that we can make the changes that are necessary, whether in an individual health institution or in a whole health economy, by looking purely at the finances, without looking at the effect that changing the financial structure needs to have on the structure of care delivery, particularly through the delivery of more integrated care, which he and I so often talk about?
Andy Burnham
This is where the right hon. Gentleman and I differ. I believe that we need to begin by asking whether there is a clinical case for change and build from there. Clause 119 seeks to turn things around. It starts with the financial case for change and the clinical issues come second. The previous Government established a very clear policy, advised by Sir Ian Carruthers, that the clinical case must be front and centre, and that we must build from there. Clause 119 completely subverts that.
Dr Poulter
The shadow Secretary of State is rewriting history. Under the TSA clause written by the Labour Government, only financial failure could be considered as part of a trust special administrator regime. That is not the case under the changes in the Bill, in which it is about patient care. The Care Quality Commission has a clear role in assuring that patient care. Will he now accept that?
Andy Burnham
The Minister makes my point again. The powers dealt only with financial failure. That is the point. The Government tried to misappropriate those powers and use them as a back-door route to impose reconfiguration on local communities. That is where they got into trouble. That is why the High Court said that they were acting beyond their powers and breaking Parliament’s original intention in the legislation. In his two interventions, he has made my fundamental case, which is that this is the wrong vehicle for making major changes to hospital services.
Jim Dowd
My right hon. Friend says that clause 119 is the result of defeat in the courts. That is true. However, the Government capitulated before the decision of the appeal court was known, just after the decision of the High Court in July. My contention—if I am able to catch your eye later, Madam Deputy Speaker, I would be happy to elaborate further—is that the Government knew from the outset that they had no legal power to do it and were just, in the way of all bullies, trying it on until somebody stopped them.
Andy Burnham
That is why I say, “Thank God for the people of Lewisham.” The Government may well have got away with it if they had picked on a community that does not know how to fight like my hon. Friend’s community. I say in all seriousness that they did a service for every community that is worried about its hospital services. That fight inspired everybody. He is right that the arrogance is breathtaking.
We have not had a White Paper or an explanation of why the Government have tried to misappropriate these powers. In the absence of information, mistrust is building about the Government’s intentions. Why are they doing this? It seems to many people that they would not be driving these powers through today if they did not have every intention of using them to the full. It will not have escaped people’s attention that financial problems are building in the NHS, with the King’s Fund predicting that more than one in five hospitals will end this year in deficit. The Labour party has today identified 32 communities where there are entrenched financial problems and that could be at risk of imposed change if clause 119 passes.
The Minister must answer a straight question: are any plans being worked up in the Department of Health, NHS England or Monitor to begin an administration process in any of those areas or in any other parts of the country if the clause passes? The hon. Member for Stafford (Jeremy Lefroy) made a similar point a moment ago. Indeed, he went further and said that there should not be a further administration process. I hope that the Minister will listen to that point. The House deserves an honest answer to that question today before it can be expected to give its consent.
Mr Crispin Blunt (Reigate) (Con)
As a constituency MP, I have seen hospitals that are well supported by their community, and which happen to be in Labour marginal seats, create powerful political forces. As a result, decisions were made by two of the right hon. Gentleman’s predecessors that materially damaged the delivery of secondary health care in my constituency. He will therefore understand why I am considerably happier with the arrangements in the Bill, which take both care and money into account. The Secretary of State will have the powers that he needs to make sense of the delivery of health care so that it is not at the mercy of the kind of decisions that his predecessors took.
Andy Burnham
Before the hon. Gentleman makes that argument, I suggest that he speaks to the people of Lewisham to see whether they think that the process was fair. I suggest that he goes and speaks to the people of Stafford to see whether they think that the process has been fair. I do not know how he can argue that the new process is better than the original process, whereby there was always local engagement and through which elected Members had a chance to refer matters to the Independent Reconfiguration Panel.
Andrew George (St Ives) (LD)
We often debate this matter in the House and we all agree in principle with the concept of reconfiguration, until it is the local hospital in our constituency that is affected. That is the conundrum. What facility does the right hon. Gentleman think the Secretary of State and the Department of Health need to overcome the fact that every MP will defend their local hospital, even though reconfigurations are clearly required?
Andy Burnham
The hon. Gentleman makes that argument as if there were no changes to hospitals under the previous Government. There was plenty of change, but there is a right way and a wrong way of doing things. I would argue, as I just have, that the previous way of doing things was a better way.
Andy Burnham
In a moment.
The previous Government made changes to stroke services in London just before the last election. The number of units went down from 12 to eight. That was based on a clinical case for change. We took that argument to local people and said, “Look, it will save lives if this goes through.” That is how the Department can take people with it—by building a case for changing hospital services. Clause 119 threatens to set that back, because it puts finance in the driving seat. That risks losing public trust in the case for change. That is why what we are being asked to endorse today is, in my view, fundamentally wrong.
Grahame M. Morris
My right hon. Friend has made his point powerfully. I was going to ask him for an example of how it is possible to make a reconfiguration that is clinically driven. He has given the example of stroke services in London. Another example is coronary services in the north-east, where an overwhelming clinical case was made by clinicians and accepted by the general public.
Andy Burnham
The difficult thing for me is that when I think back to some of the processes I was involved with—stroke services in London, child care and maternity services in Greater Manchester, changes to A and E across the country, Chase Farm hospital, and other places—those issues were cynically used by those on the Government Benches when they were in opposition, and it was a bare-knuckle fight to save every hospital in the land. That is what they said, whereas we made the case for change because it would improve patient safety. I would not change my tune if I was in opposition; I still believe that hospitals need to carry on changing, but as I said, I will not do that by imposing changes on local people. The right way is to explain why, and take people with us.
Dame Joan Ruddock
Let me give my right hon. Friend another example. I and my hon. Friend the Member for Lewisham West and Penge (Jim Dowd) both supported the closure of a local children’s hospital, and its services were moved to Lewisham hospital. When the trust special administrator looked at Lewisham hospital, children’s services were not even considered.
Andy Burnham
Government Members would do well to listen to my right hon. Friend because she followed that whole process in detail. If people listen carefully, she is saying that clinical evidence took second place, and the process was driven by management consultants, not by clinicians. Government Members told the House that doctors would be in charge from now on, but that was not the experience of my right hon. Friend or the hon. Member for Stafford. That is why this proposal should not be accepted by any Member of the House.
Frank Dobson (Holborn and St Pancras) (Lab)
My right hon. Friend says that the propositions were made by management consultants. He will be aware that those consultants were from PricewaterhouseCoopers, which was Northern Rock’s auditor and did not notice that it went broke, and KPMG, which was the auditor for Halifax Bank of Scotland and Bradford and Bingley, and did not know that they went broke. They are probably giving bad financial advice as well as clinical advice.
Andy Burnham
I am not sure there is much I can add to that. Why are management consultants better placed—my right hon. Friend makes the point that they are not—to make sweeping changes to hospitals in our constituencies than experts and clinicians?
Mr Brian H. Donohoe (Central Ayrshire) (Lab)
It is always dangerous to wander into territory that is not necessarily our own, but what happens—or is likely to happen—here today, has an awful habit of happening up in Scotland tomorrow. As a consequence of the fact that the Scottish Government are perhaps the most centralist and draw in all their powers, what representations, if any, has my right hon. Friend made to his equivalent in the Scottish Parliament to find out exactly how they would go about the same business?
Andy Burnham
I speak to my counterpart in the Scottish Parliament on a regular basis, and we are clear that this proposal is not the way to take people with us or build support for change in the NHS. This is a way to alienate people and damage public confidence, and that is why it is so dangerous.
Andy Burnham
I will make some progress but I will give way to the hon. Gentleman before the end of my speech.
Let me set out more of the background, because the Minister raised it a moment ago. In 2009 I took proposals through the House to create a process that could be used in extremis to deal with a trust that had got into serious financial problems. That was a financial and administrative vehicle, not a vehicle for widespread service change across the health economy. That is why the High Court was quite correct in upholding Parliament’s original intention when it accepted the case of the people of Lewisham against the Secretary of State, and threw out his plan to downgrade a much-loved and successful hospital. At that point, common decency would have suggested that the right response to the reverse in court would have been to listen to the court and bow down gracefully. Instead, it appears for all the world as if in a fit of pique, the Secretary of State is changing the law to get his way because he can. Imagine the outcry if someone caught breaking the law could simply come along and change it to their satisfaction. We would not accept that for burglars, and we should not accept it for politicians.
Dr Poulter
The right hon. Gentleman is being very generous in giving way. He makes the point that, during his time in office, the regime was very limited. In the interests of consistency, I point out that page 6 of his own impact assessment for the TSA regime in May 2009 states:
“NHS Trusts…are not free-floating, commercial organisations …State-owned providers are part of a wider NHS system.”
That directly contradicts what the right hon. Gentleman has just been saying.
Andy Burnham
Is the Minister listening to the debate and to what I am saying? I have explained to him carefully that that was a vehicle for financial and administrative reconfiguration. Yes, a neighbouring trust might have had to come and help with a solution to carry on with the administration and the running of that trust. That is the point, and that is what he has just read out. It was never a vehicle for service change—I do not know how many times I can make that point to the Minister before he actually listens.
Richard Fuller
For clarity, the shadow Secretary of State is talking about in extremis and financial failures. What policy did he put in place for in extremis care failures, and why is it not appropriate to have others help out in such circumstances?
Andy Burnham
I will come on to that point, but the CQC had existing powers on care failure, and powers to move more quickly than clause 119 provides for. Adequate powers were in place to deal with the point the hon. Gentleman has just made.
In truth, it is arrogance in the extreme for the Government to be coming along today—and worse, it seriously risks damaging public trust in how change in the NHS is made. That will be the real loss if the clause is accepted. It threatens to destroy any public faith in a sense of fair process governing these crucial decisions, and any prospect of cross-party consensus on a way to make changes to hospital services.
Making changes to those services is about the most difficult decision that politicians have to make, but the fact is that hospitals need to change if we are to make services safer and respond to the pressures of an ageing society. We did not shy away from that in government, and we do not say something different now. However, there is a right way and a wrong way of going about such things.
The Government’s answer—to use a brutal administration process to take decisions above the heads of local people—is a spectacularly wrong response to a very real problem, and precisely because those decisions arouse such strong emotions, we must find better ways of involving people, not shutting them out. If people suspect a stitch-up, and see solutions imposed from on high, they will understandably fight back hard. Does the spectacle of tens of thousands of people marching in Stafford or on the streets of Lewisham not give Ministers pause for thought that this new approach might seriously set back the goal of better public engagement in the NHS?
Andy Burnham
I will give way one final time, but I hope the hon. Gentleman will take on board the point that public engagement is essential if we are to have trust in the NHS.
Steve Baker
I am most grateful to the right hon. Gentleman and I have listened extremely carefully to what he has said. Wycombe lost its A and E under his Government. Does he seriously suggest that that change was not imposed on the people of Wycombe, or that they were listened to, engaged and approved of the change?
Andy Burnham
I am saying to the hon. Gentleman that the previous Government had a process at the end of which was an independent panel—the Independent Reconfiguration Panel—to take a decision on whether a proposal was right or wrong in the interests of patient safety, which was the driving principle. I will defend the changes we made to improve services. I have given him the example of stroke services in London. The Opposition are not against making change in the NHS, but we are emphatically in favour of local people in areas such as his having the ability to have their say in the process. Clause 119 seeks to drop solutions on local people from on high.
Our policy was set out in the Carruthers review, commissioned by Patricia Hewitt in 2006, which concludes:
“Reasons for change should be built on a clear evidence base of clinical and patient benefits.”
That principle guided the Darzi review towards the end of the previous Government, which put quality centre stage. The Darzi review influenced the plans for stroke services in London and others, and the difficult changes we planned to make in south-east London before the last election. A detailed consultation, “A Picture of Health”, had brought together a case for change to how services were delivered across the area. It was given formal approval before the election, but was subject to the Government’s moratorium after it.
In the space of a few years, Ministers have gone from campaigning outside hospitals to save services to campaigning for extra powers to close them down without debate. That will leave the NHS more top-down than ever before, with the patient and public voice utterly marginalised.
Jim Dowd
It is with some trepidation that I must disagree with my right hon. Friend. In fact, the figure was closer to two thirds of the estate. The scheme was so well engineered that they left the bit that we were keeping, allegedly, for whatever was going to be there—a glorified first aid post—completely landlocked. There was no access apart from via the River Ravensbourne, which is not the mode of transport favoured by most people using Lewisham hospital. Oh yes, it was all worked out well beforehand.
The public meetings following the publication of the draft report were, of course, rather more difficult to control. People were able to ask questions, although they did not receive many answers. Those who were presenting the case on behalf of the trust special administrator did not seem particularly receptive to what was being said, although on occasion, when they came up against a difficult objection, they would say “South London Healthcare NHS Trust is losing £1 million a week: £1 million that is not being spent on health care for patients.” We know that—it is self-evident—but when they were told “That is not the problem of Lewisham hospital”, and asked “Can you not understand that?” , the answer was no, they could not understand it.
That was followed by a little homily of the kind much beloved of some people: “If your domestic budget was being overspent week after week, you would need to take action, would you not?” Naturally everyone agreed, but a woman who attended the public meeting at Sydenham school said to Mr Kershaw, “If your domestic budget was being overspent, of course you would have to do something about it, but that would not include breaking into the house of the people next door and nicking all their stuff”—which is what was being proposed in south London by the special administrator.
After attending numerous meetings with Mr Kershaw and his associates, and at the other south London hospitals, I eventually concluded that—recognising that those who would be worst affected by their proposals were hardly likely to be very receptive to them—they automatically assumed that there would be opposition and hostility, and automatically factored in and discounted it, saying “Of course they are going to object to the changes, but we have a task and a mission to pursue.” The whole process was condescending, impenetrable and antagonistic. The special administrator and his acolytes and accomplices had a mission, given to them before they ever left Richmond House, which they were determined to deliver. They already knew the answer, and they were not going to bother to do anything other than go through the motions.
We owe thanks to Lewisham council, to the Save Lewisham Hospital campaign and, amazingly enough, to the High Court and the Appeal Court, whose three judges—Lords Justices Dyson, Underhill and Sullivan—within 24 hours unanimously overturned the Secretary of State’s case that he had the powers to do this. As I have said, the Secretary of State had already capitulated by then. The Government knew from the outset that this was legally questionable. They knew they did not have the powers to behave in the way they were behaving, but they basically just said, “Who’s going to stop us?” I will tell you who stopped them: the people of Lewisham and their supporters and the High Court. That is who stopped them.
This clause will make occurrences like that more, not less, likely. More communities across the country are going to be threatened and will come under the tender mercies of the TSA process.
Andy Burnham
My hon. Friend is absolutely right. More communities could face this threat, but is not the point that those communities would not have the ability to fight it in the way that Lewisham was able to fight and defeat it?
Jim Dowd
My right hon. Friend is right; that is precisely the point and that is precisely what this Government intend. I have absolutely no doubt about that; their writ will run whether people want it or not.
After all that, what is the current position of South London Healthcare NHS Trust—after that £5 million? Princess Royal in Orpington is now an adjunct of King’s College hospital. The TSA was quite happy to say the whole thing should be passed lock, stock and barrel to King’s. There was a rather unseemly squabble about the size of the bung King’s should get for taking on Princess Royal, but there was no specification about the services that should be provided there or anywhere else; that was entirely up to King’s. Queen Mary’s, which of course is not a fully functioning district general hospital, is now being managed by Oxleas NHS Foundation Trust, the primary care trust in that part of the world. Again, the TSA made no recommendations about what services, or what range of services, should be provided there.
Queen Elizabeth, which, of course, is the biggest problem in what was South London Healthcare NHS Trust, has now merged with Lewisham university hospital in the Lewisham and Greenwich NHS Trust. It is now managing a very difficult proposition; I do not dispute that for a moment. I have my doubts about whether that is the best move for the people of Lewisham, but I understand why it has been done. Yet, the board at university hospital Lewisham was prepared to enter into that agreement before the TSA even set foot in the area. So what we have now in south-east London was entirely possible by rational argument and reasoned consent without the need for the TSA and all the disruption, anguish and distress he and his acolytes have caused. I say to Members voting on this tonight, “Remember; you may not want to visit a TSA and I don’t blame you, but that won’t prevent them from visiting you if this clause goes through.”
Paul Burstow
I think the hon. Lady will find some sympathy for that view.
Local commissioners and trusts should be responsible for sorting out difficulties that could lead to a failure. Again, it needs to be clearer what happens at the pre-failure stage, and Ministers need to work with NHS England and Monitor to set out the pre-failure regime so that it is crystal clear what needs to happen to avoid triggering the TSA process. It might be argued, as Labour did in 2009, that when an NHS trust fails, there needs to be a fast way of making decisions about its future. Those decisions might have knock-on effects, but that should not mean that one trust’s failure triggers a wholesale re-engineering of local health services without proper checks and balances and accountability. Decisions about local health services should be taken by clinical commissioning groups.
I have tabled new clause 16 because I believe that two principles established by the Health and Social Care Act 2012 deserve to be protected. The first principle is—
Paul Burstow
If I may develop my point, I shall be happy to give way to the right hon. Gentleman.
The first principle is that, in the absence of failure in the arrangements set up by local commissioners, decisions about what services should be provided at an NHS trust or an NHS foundation trust should be taken by local commissioners working within their local health economies, and should not be foisted on the local NHS from outside. This autonomy principle is reflected in the absence of any general right for the Secretary of State or NHS England to direct local commissioners about the discharge of their functions. The previous position under the Labour Government was that the Secretary of State could issue directions to primary care trusts. We did not replicate that in the 2012 Act.
Andy Burnham
The right hon. Gentleman has made an outstanding contribution to proceedings over the past couple of days and I pay tribute to him for that. He was centrally involved in the development of coalition health policy after the last election. Does he agree with us that clause 119 represents a major departure from some of the statements that were being made by him and by others in this House when the Health and Social Care Act was going through?
Paul Burstow
I am grateful for that intervention. As I develop my argument, I think the right hon. Gentleman will hear where I sit on the spectrum of viewpoints. He may be interested in what I am about to say.
The second principle is that commissioners who have successfully managed the quality and demand in their area should not have decision making taken away from them. Decision making can be removed from the trusts that are failing, and this may mean that commissioners of such bodies have to accept unwelcome changes. But local decision making should remain in place where a local commissioner and provider are working successfully together. Thus the first purpose of my new clause is to seek to place with the commissioners of services at NHS foundation trusts and NHS trusts that are not in special administration the same decision-making powers as are given to commissioners of services of NHS trusts that have been found to fail and are in special administration.
At present the Bill creates two classes of commissioner. Where there is a trust in special administration, the clause provides that commissioners of services at that trust are able to define the services that the failing trust should continue to provide. The commissioners are thus entitled to ring-fence certain services that they feel must be preserved for the benefit of local patients. They are, in effect, given a veto on the extent of changes that can be made to a troubled trust because of the statutory objectives set for the administrator. The commissioners are thus able to act to preserve local services.
However, the present text of section 65DA does not give the same rights to the commissioners of adjoining trusts. They are relegated to second-class status. Clause 119 as drafted envisages that a special administrator is entitled to make recommendations for changes at trusts other than the trust in special administration which are not approved by local commissioners. In its present form clause 119 does not provide that the commissioners of the services at trusts other than the trust in special administration enjoy the same veto over the extent of any changes as the commissioners of a trust in special administration. There is a fundamental lack of parity of esteem between the different organisations and the different commissioners in a locality. It is that inequality that I am seeking to change.
Andy Burnham
Given that clause 119 is a dramatic extension of the Secretary of State’s powers, as my hon. Friend is rightly saying, does he agree that it is astonishing that the Secretary of State is not in the House this afternoon to make the case in person, to ask for the powers and to justify the idea that we should entrust the future of our hospitals to him?
Grahame M. Morris
I am absolutely amazed. I share my right hon. Friend’s incredulity that the Secretary of State is not here. In my view, clause 119 is one power too many for a Secretary of State who apparently believes the NHS to be a 60-year-old mistake. [Interruption.] That is a direct quotation from the Secretary of State before he took office.
The Secretary of State’s increased power and Monitor’s expanded role directly contradict the Government’s earlier promise that local commissioners would no longer be subject to central diktat. That represents a reversal of the vision that was presented during the consideration of the Health and Social Care Act 2012. Clause 119 supports none of the preconditions for a legitimate reorganisation of a local health economy and will allow trust special administrators to overrule any concerned parties.
If clause 119 becomes law, the Secretary of State will be granted the power to issue directions to require foundation trusts and clinical commissioning groups to take steps that they do not want to take. Any Member who wants to prevent the Secretary of State’s axe from falling arbitrarily on their own hospitals without clinical justification should seek to remove the clause from the Bill. I therefore urge right hon. and hon. Members to support Labour’s amendment 30 and new clause 16, which is a compromise measure to ameliorate the worst aspects of clause 119.
Mr Simon Burns (Chelmsford) (Con)
It is a pleasure to follow the hon. Member for Hayes and Harlington (John McDonnell). He said at the beginning of his remarks, and he kept to his pledge, that he was going to speak without party rancour. I, too, would like to do that because I think there is very little difference between my views on the health service and those of the right hon. Member for Leigh (Andy Burnham). We may perhaps have a divergence of view on how to achieve what we both passionately believe in, as does my right hon. Friend the Secretary of State, which is the finest health service for the provision of care for all people in this country, but on the core principle of a national health service, free at the point of use for all those eligible to use it, there is not one iota of difference, despite the speech I heard from the endearing hon. Member for Easington (Grahame M. Morris). I almost felt I had woken up from a nightmare. Having listened to the same speech in 39 of the 40 sittings of the Health and Social Care Bill Committee, I regarded it as my good fortune that during the 40th sitting, my right hon. Friend the then Secretary of State was giving evidence to the Health Committee which prevented the hon. Gentleman being in our Committee.
The point I want to make is this: the national health service has from day one constantly evolved in the delivery of health care, partly because of changing medical science, partly because of changes in the diseases that people have suffered from owing to improved and enhanced preventive care, and partly because many conditions that in the past one would stay in hospital for no longer need to be treated in hospital but can be treated in a GP surgery or elsewhere. We all—politicians, medical practitioners and others—have to recognise that the NHS is constantly evolving and revolving, and we have to adjust to those changes and meet those challenges.
I passionately believe that decisions within the NHS should be taken locally. I supported the Health and Social Care Bill so strongly because it devolved powers and decision making to the people who I think are best qualified to take commissioning decisions on behalf of patients—local GPs. I also welcome the fact that my right hon. Friend the Secretary of State is no longer micro-managing the running of the NHS on a day-to-day basis. However much admiration I have for my right hon. Friend, or even for the shadow Secretary of State when he was in post, I do not think he is best qualified to be running the health service on a day-to-day basis.
If we are going to evolve and meet the challenges, difficult decisions will have to be taken, and politicians in particular—politicians of all political parties; this does not apply simply to Opposition Members of Parliament or to Conservative Members or to Liberal Democrats—have got to be braver. When there is any consideration of a reconfiguration to meet new challenges or address problems, the knee-jerk reaction is to take the populist, easy route, say no and oppose for opposition’s sake, rather than look at the reasons behind any reconfiguration.
Andy Burnham
The right hon. Gentleman knows I have huge regard for him and I do not disagree that change needs to be made. The question, however, is how we make that change. I remember that when the earlier Bill was going through, he repeatedly said in this House and in TV studios that the principle behind it—if it had a principle—was to put local doctors in charge. Does he think that clause 119 is consistent with the argument he made when the earlier Bill went through?
Mr Burns
I am grateful to my right hon.—or, rather, the right hon. Gentleman; I nearly made a Freudian slip—for that question. I can unequivocally say to him that I believe it as strongly and firmly today as I did when I was one of the Ministers taking the Health and Social Care Bill through this House three years ago. And I shall tell the right hon. Gentleman why I believe it.
I was saying that politicians of all parties must strengthen their backbone and be prepared to look at each case of reconfiguration on its merits, and then take difficult decisions if they are in the best interests of patients. I believe that reconfigurations should initially be determined at local level—[Interruption.] If the right hon. Member for Leigh will wait, I will get to his point. They should be determined by local commissioners in consultation with local people and with the health and wellbeing boards, which play a vital part in keeping local communities and local health interests plugged in and represented, and in ensuring the delivery of the necessary services locally.
However—this is where I get to the right hon. Gentleman’s point—there will be a few rare and exceptional circumstances in which a TSA will have to be appointed. That is what happened in the case of South London. At that time, I happened to be privy to all the discussions that led up to what was, if I remember correctly, the unprecedented decision taken by the then Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).
Mr Burns
The short answer to the hon. Gentleman, because I have the freedom of the Back Benches, is that I do not share that view. I was privy to the discussions that led to South London being put into special measures. That was done because there were real and significant problems to which it was impossible at a local level, within NHS London and elsewhere, to find a coherent—[Interruption.] The right hon. Member for Leigh says no. He was in opposition at the time these conversations were taking place.
Andy Burnham
It is wrong. The right hon. Gentleman will know that when he arrived at the Department of Health in May 2010, there was a plan in place called “A Picture of Health”—[Interruption.] My hon. Friend the Member for Lewisham West and Penge (Jim Dowd) agrees. The plan, which had been extensively debated and consulted on at local level, was to make difficult changes to the health service in south-east London. That plan was shelved because of the right hon. Gentleman’s moratorium, and precious time to make changes was therefore lost. The financial problems in those health service organisations increased because the plan was shelved, and they were left with the option of having to bring forward a more brutal administration process. Please do not rewrite history in a debate as important as this.
Mr Burns
I agree with the right hon. Gentleman that this is a very important debate. I have the benefit of having attended the meetings and having seen what was happening in South London. In one respect the right hon. Gentleman is absolutely right: there was a moratorium. The country wanted a moratorium to start with because of some of the closures that were causing problems, and people wanted a re-examination of the situation to check that the right decisions were being taken. Work was still going on to find a solution to South London, and my right hon. Friend the Member for South Cambridgeshire reluctantly came to the conclusion that he had to take the exceptional power that was available to him.
Dr Poulter
That is absolutely the case. It is absolutely wrong to conflate the fact—as Opposition Members are trying to do—that from time to time even good hospitals occasionally run deficits with the TSA regime. This is a power of last resort; it is not a power that is routinely used. Local measures are in place to support hospitals to get their finances in order and to ensure that where there are care quality problems, they are addressed promptly to the benefit of patients.
Andy Burnham
The Minister was saying that all other measures should be explored first, in particular co-operation—buddying, he said—between hospitals. If that is the case, why did the Competition Commission step in to prevent sensible collaboration between two hospitals on the south coast, Bournemouth and Poole? How is what he has just said consistent with the Health and Social Care Act 2012, which requires hospitals to compete, not to collaborate?
Dr Poulter
As part of our changes in the wake of the Mid Staffordshire inquiry—changes the right hon. Gentleman would be wise to heed and learn lessons from, if he should be lucky enough ever to be on the Government Benches again—we have made it clear that we need to ensure that where there are care quality failures, hospitals learn to put such problems right much more promptly than they have done in the past. That is why we put in place buddying mechanisms and why we put trusts in special measures, to deal with issues quickly and effectively to ensure that hospital services are put back on track and patients can be properly protected.
Dr Poulter
I may give way in a few moments, but I need to make a bit of progress. The clause would extend the remit of a TSA to make recommendations that may apply to services beyond the confines of the trust in administration. The Secretary of State or, in the case of foundation trusts, Monitor, will be able to make decisions based on those wider powers. Where severe and prolonged problems exist, an administrator must be able to recommend a solution in the best interests of local patients. Only then can we resolve the situation in a sensible, holistic way and ensure safe and sustainable patient care. That is what the impact assessment said of the 2009 TSA regime, and something the Government are ensuring that we deliver, even though the previous Government failed to deliver it.
Andy Burnham
The Minister is being generous. He has made the argument all afternoon that he is doing what I was doing; he is just using the powers that I created. That is the crux of his argument. If that is the case, why did three judges rule that this Government had broken Parliament’s original intention when they passed those powers?
Dr Poulter
Quite frankly, it was because the right hon. Gentleman’s legislation was not worded effectively enough—[Interruption.]
Andy Burnham
I begin by thanking my shadow team, particularly my hon. Friends the Members for Leicester West (Liz Kendall) and for Copeland (Mr Reed), who have spent many hours trying to make sense of this unwieldy piece of legislation. I, too, want to thank members of the Public Bill Committee for their work, as well as the officials, Officers and staff of the House who enabled the Committee’s work to take place.
It is right also to pay tribute at this point to the Care and Support Alliance, a very important association of organisations working to be advocates and champions for some of the most vulnerable people in our society. The alliance worked with the previous Government and is working with this Government; indeed it works with all sides of the House. It can take some credit for some of the steps forward that are coming as a result of the Bill, and it is fair to say that there are some steps towards a better social care system.
I would argue that the Bill builds on the work of the previous Labour Government in that regard, particularly in the overdue recognition of carers. We welcome stronger legal recognition and rights for carers. We welcome better access to information and advice, which will make a difference to some people using the care system. The idea of portability—that if people move from one place to another, their entitlement to care goes with them—is a good principle and one that I put forward. We welcome the fact that it has been carried into the Bill. The principle of a cap on what people should pay for social care is in itself an important step forward. I recognise that but, as I will go on to say, we do not believe that all is at it seems.
There are measures in the Bill, as the Secretary of State said, to implement parts of the Francis report, such as the organisational duty of candour and moves to strengthen regulation. We welcome these steps but we would have encouraged the Government to go further.
The big problem with the Bill is the gap between what Ministers claim it does and what it actually does. It is not what it seems and it will not deliver on the claims made for it. Worse, it is no answer to the problems posed by an ageing society, and it is not equal to the scale and urgency of the care crisis that the country faces.
Paul Burstow
The right hon. Gentleman expresses concern about the care crisis. Why did he abstain in yesterday’s vote on the Local Government Association’s proposal that there should simply be an assessment of the adequacy of funding?
Andy Burnham
I do not think that the right hon. Gentleman is in a very strong position to talk about Members’ abstaining in votes on amendments. I shall say more about that shortly.
Let me now list three reasons for our argument that the Bill is not what it seems. First, as I have said, it is no answer to the care crisis. It proposes that a cap should be paid for by the restriction of eligibility for care, and the removal of care from some people who are already receiving it. Last week we heard from Age Concern that 800,000 people who had previously received support no longer received it. The problem is that local authorities are being asked to implement the system with no additional resources, and are therefore having to move funding from preventive social care to the administration and funding of the cap and the deferred payment scheme. Rather than taking from one area of social care to give to another, the Government should have put new resources into social care.
The Minister of State, Department of Health (Norman Lamb)
The right hon. Gentleman said a moment ago that the Bill removed care from some people by restricting eligibility criteria. Does he accept that although there is a national eligibility criterion—which is long overdue—any councils that choose to be more generous can do so, just as they can now?
Andy Burnham
If the Minister gave councils budgets that enabled them to be more generous, they might have a chance, but drastic cuts mean that they cannot provide care that is worthy of the name. He will know of the fears of organisations that represent disabled adults of working age. The Royal National Institute of Blind People, for instance, fears that the move to retrench eligibility criteria to cover only substantial and critical needs will remove care from people with moderate needs whose support currently enables them to continue to work.
Barbara Keeley
I understand that the Minister is to visit Salford tomorrow. Perhaps he would like to talk to Salford city council, whose budget has been cut by £100 million over the last three years, about how it might be more generous. I am glad that my right hon. Friend has mentioned carers and their new rights, but how hollow do those new rights seem to carers in Salford, given that 1,000 people will lose their care packages this year and 400 will not qualify for them? That is a direct result of what the Government have done.
Andy Burnham
My hon. Friend’s intervention brings me to my second reason for thinking that the Bill is not what it seems. The changes in eligibility for social care expose more people to social care charges than was the case before the present Government came to office, and, as has been demonstrated by my hon. Friend the Member for Leicester West, those charges are increasing above inflation. More people are paying care charges, and paying them at a higher level. The care cap is not what it seems. In fact, as my hon. Friend has consistently argued, it is a care con. The Secretary of State said today that the Bill would give people certainty about what they would pay—
Andy Burnham
The Secretary of State says yes, but I am afraid that it will not. The £72,000 cap is based on a local authority average, not on the actual amount that people will pay for care. So no, the Bill will not give them that certainty. The Secretary of State also said that people would not lose everything to pay for care. Let us take him at his word, and assume that £72,000 is the maximum that a person can pay, and £144,000 is the maximum for a couple. In my constituency, that would indeed mean people losing everything that they had worked for, although it might not mean that in the Secretary of State’s constituency or in other parts of the country. The Secretary of State needs to be honest with people. That is why we are saying that the Bill is not what it seems.
Andy Burnham
I will, but I think that the Minister should take account of that point, because it is quite important.
Norman Lamb
The right hon. Gentleman says that he would like the eligibility criteria to be more generous. Is he now committing himself to funding that?
Andy Burnham
I am not writing a budget at the Dispatch Box this evening. I will stand by our record of giving real-terms increases to local government. I warned at the start of this Parliament that if the effect of the Government’s promise of real-terms increases for the NHS—which have actually never materialised—was a raid on local government, that would be a short-term policy. It would mean more older people ending up in hospital and who then could not be discharged because there was not the care at home. That is exactly what is happening. It is a false economy. That is what we warned them about and they failed to listen.
Andrew Percy (Brigg and Goole) (Con)
Will the right hon. Gentleman give way?
Andy Burnham
No I will not, as the hon. Gentleman has not been here all afternoon.
The third area is the claims that the Bill will improve regulation. Let me ask a direct question: if this is about improving the quality of services, why remove from the CQC the responsibility to provide oversight of local authority commissioning? Why do that if this Bill is about improving regulation? Why leave local government free to do what they like at a local level—to commission for 15-minute visits or for staff on zero-hours contracts—when we have seen the failures at Winterbourne View and other places? Why remove that important role from the CQC?
Andy Burnham
We have never had a proper answer to that. I hope we are about to get one.
Andy Burnham
The right hon. Gentleman has not answered the question. There was a responsibility on the CQC to provide oversight of local authority commissioning. This Bill removes it. Why does it do that? It is a backward step in my view.
The fourth area is that, in respect of the care data scheme, the Bill fails to provide the assurances the Government tried to herald in the press a few days ago—to borrow the Secretary of State’s words today, a “rock-solid assurance” that data could never be passed to commercial insurance companies. I do not believe it is possible to claim that new clause 34, which has now been added to the Bill, does that. It just has general aims around the promotion of health. That does not stop data being passed to private health insurance companies. Again, I do not think the Bill does what the Secretary of State claims it does.
The fifth area I want to challenge the Government on is the whole question we have just been debating. This goes to the heart of where the coalition began, which was that local people would be in the driving seat and local GPs would be in control. The coalition agreement said the Government would end centrally dictated closures. Well, they have ripped all that up this afternoon by passing clause 119 and keeping it in the Bill. They claimed they were just doing what we left behind. That is not the case, because the High Court told them otherwise. The High Court told them they had gone beyond the powers I had created in 2009. The Secretary of State was unable to answer that. He said everything was our fault—it is never their fault or his fault. Well, how about him listening to the Court? How about him reading the clause that we passed before he tried to close or downgrade Lewisham’s A and E? Would that not have been a good thing to do? He did not do that, however. He tried to plough on and downgrade a successful A and E in the teeth of opposition and he got found out. Yet he comes back here today and just thinks arrogantly he can ram the same powers back through this Parliament.
What we have seen today from the right hon. Member for Sutton and Cheam (Paul Burstow), who positioned himself as though he was going to make a stand for local involvement in the NHS, is the worst kind of collusion and sell-out of our national health service. Just as the Liberal Democrats voted for the Health and Social Care Act, again they have backed tonight the break-up of the NHS. In the last few days the right hon. Gentleman has been asking for all these signatures from all over the country—148,000 people to sign his petition—just so, it seems, that he could get a new job working within the coalition. I am not sure they are going to feel well represented this evening.
Mr Hunt
The shadow Secretary of State is bandying around some big words like “arrogant” so will he now show some humility and recognise that every single one of the 14 hospitals in special measures had warning signs when Labour was in office and Labour failed to sort out those problems?
Andy Burnham
We took action to address care standards in the NHS. The right hon. Gentleman is trying to politicise care failure. The Labour Government inherited the Bristol Royal infirmary scandal from the previous Conservative Government, along with the scandal at Alder Hey and the Shipman murders, but we did not try to politicise those failings. The Secretary of State is trying to politicise such failings today, however.
The Lib Dems have shown again tonight that they simply cannot be trusted to stand up for the national health service. There is only one party in this House that will do that, and that is the Labour party represented on these Benches. The next Labour Government will repeal the Health and Social Care Act and restore the right values to the heart of the NHS. In so doing, we will also repeal clause 119 of this Bill. We will take the powers that the Secretary of State has taken for himself today and hand them back to local people.
We will not get the care that we want until we are able to face up to the care crisis that this country now has. Our argument is that the full integration of health and care is the only way to reshape services around the person. That is the only way to go, and we will give a full green light to NHS organisations to collaborate and integrate, instead of working with the market regime that this Government have introduced. We have had the ludicrous spectacle of the Competition Commission telling two hospitals that wanted to collaborate that they could not do so because it would be anti-competitive. That is the reality of the NHS that this Government have created. That is the nonsense that people are facing on the ground. Only when we repeal the Health and Social Care Act and get rid of the powers that the Secretary of State has taken for himself today will we put the NHS back on the right path, away from the path towards fragmentation and privatisation, and begin to build a 21st-century NHS.
Care Bill [Lords]
Andy Burnham Excerpts(10 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham (Leigh) (Lab)
Where in the new clause does it say that? Nowhere does it say that the data cannot be passed to private health insurance companies. Proposed new subsection 1A states that such information could be passed on
“for the purposes of…the provision of health care or adult social care”.
This is a very wide provision, and I see no clarity in it that delivers on the commitment that the Minister is giving to the House.
Dr Poulter
Hopefully, if I am allowed to make some progress and address the points that have been raised, I will give further reassurances a little later. It would be useful—[Interruption.] I will answer the question a little later, so there is no point in heckling or being abusive. If the right hon. Gentleman will wait, I will talk him through the Government’s amendments so that he can gain a better understanding —
Dr Poulter
No, I am not afraid to give way. The hon. Gentleman should sit down, because he often has quite enough to say, and it is not always a very valuable contribution. In this context, he may do well to listen to some of the purposes of the amendments. As I have already outlined, there are strong safeguards set out in the 2012 Act on how data can be used. Data can be used only for the benefit of the health and care system. In order to reassure the public, we have tabled amendments to clarify further how data may be used.
Speaking to a great many people in recent days, as well as considering amendments tabled by other Members, has prompted the Government to re-table the new clause in order to clarify that these kinds of data may also be disseminated for other wider public health purposes, such as research into environmental factors associated with asthma, or for healthy eating. We have ensured that those other kinds of research can benefit from the data by changing the wording in the new clause to make it clear that information may be disseminated for the purposes of
“the provision of health care or adult social care”
or “the promotion of health”. I am sure that the House will agree that it is essential that that valuable data resource is available to support a broad range of health research.
New clause 34 clarifies that in disseminating information, and indeed in carrying out any of its functions, the Health and Social Care Information Centre must have regard to the need to promote and respect the privacy of those receiving health services and adult social care in England. It also requires the HSCIC to take into account advice from the advisory committee that the Health Research Authority is required to appoint under paragraph 8 of schedule 7 to the Bill. The advice from that committee, known as the confidentiality advisory group, will provide a new level of independent scrutiny of the HSCIC’s decisions to publish or disseminate information.
Amendment 17 would also enable the confidentiality advisory group to advise the HSCIC on the exercise of functions conferred in regulations under section 251 of the National Health Service Act 2006, or more generally on decisions to disseminate information that could be used to identify individual patients. For example, when new regulations are made under section 251 of the 2006 Act that confer functions on the HSCIC, the confidentiality advisory group could advise the HSCIC on proposals to release data. New clause 34 requires the HSCIC to have regard to that external advice on its exercise of any function under the 2012 Act of publishing or otherwise disseminating information.
Amendment 18 gives the Secretary of State regulation-making powers to set out the specific criteria that the confidentiality advisory group will be required to take into account in giving advice to the Secretary of State, the Health Research Authority or the HSCIC in carrying out their duties. That provision is intended to enable regulations which would require that the confidentiality advisory group considers: that the purpose for which the data will be used should be in the public interest and for the provision of health and care services; that any approved processing must respect and promote the privacy of patients and care service users; that the purpose cannot be achieved using suitably anonymised data, rather than identifiable data; that it is not reasonably possible to gain explicit patient consent to achieve that purpose; and that the applicant requesting the data has not misused those kinds of data in the past.
That last criterion would effectively introduce a new “one strike and you’re out” deterrent. Potentially, for some organisations, the risk of no longer being able to access those kinds of data may prove a more effective sanction than the current maximum monetary penalty of £500,000 that can be imposed under the Data Protection Act 1998. Taken together, those measures provide an additional level of scrutiny and assurance to the processes of the HSCIC in publishing or disseminating information. The Government’s amendments—new clause 34 and amendments 17 and 18—provide robust assurance that those kinds of data cannot be disseminated for purposes such as commercial insurance or for assessing an individual’s mortgage application.
Andy Burnham
Before the Minister sits down, I would be very appreciative if he could direct me to the precise part of new clause 34 that prevents a private health insurance company accessing data.
Grahame M. Morris
That is a perfect example and an important question that the Minister and the Government should answer. If we are to ensure that we have public trust in the data and who will use them, such questions must be answered and people be given the opportunity to consider what the Government propose.
It has become clear in recent months that the public lack confidence that the implementation of the care.data scheme as currently proposed would protect the data from inappropriate use, not least because of the point that my hon. Friend has just made. I am sure she would recall that we recently had a Health Committee session on this issue—in fact, the Minister was present—and certain assurances were given, not by the Minister but by one of his officials, that companies outside the United Kingdom would not have access to such data. The thought ran through my mind that many private health companies are global in their operations.
Andy Burnham
To add to the theme that my hon. Friend is developing, is not one of the problems with care.data that we have had so many statements from Ministers and officials that have not in the end come to be true? At the last Health questions, the Secretary of State said that a leaflet would be sent to every home in the land to explain what was happening. That also was not true. Does my hon. Friend agree that this is bringing the whole scheme into disrepute?
Grahame M. Morris
My right hon. Friend has hit the nail on the head, because there has been a catalogue of mismanagement. What we need to do if we believe in the importance of such a database is to ensure that we rebuild public trust. The Government have an opportunity to do that, but it will not be a simple matter. We have to look carefully at the implications of what the Government propose and give the necessary assurances.
The assurance that the official gave to the Health Committee had a gap that a coach and horses could be driven through. Several multinational companies could get round it by establishing a subsidiary based in the UK that would have access to the data, if that were the only safeguard.
Francis Report
Andy Burnham Excerpts(10 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham (Leigh) (Lab)
This debate is a welcome opportunity to review progress on the Francis report one year after its publication. That publication completed a long process of independent inquiry into the terrible failings at Stafford hospital, and it began in July 2009 with my appointment of Robert Francis, QC. Ever since, the onus has been on us all to learn the important lessons and implement all the recommendations of the Francis report.
First, however, I will say a word about the previous Government’s record. It was the previous Labour Government who introduced for the first time independent regulation to the national health service, following the scandals of the 1990s at Bristol Royal infirmary, Alder Hey and, of course, the Shipman murders. It was that independent regulator which uncovered the problems at Mid Staffs. To listen to the Secretary of State, one would not believe that those were the facts—
Andy Burnham
I want to make some points at the beginning and then I will give way to the Secretary of State.
Those were the actions of the last Government in dealing with the issues that we inherited. It was the last Government who left the national health service with the lowest ever waiting lists and the highest ever public satisfaction, and no attempt by the Conservatives to rewrite history can take away that fundamental strength in the NHS which the last Government left behind.
Mr Hunt
I agree with the right hon. Gentleman that his predecessors deserve credit for introducing an inspection regime into the NHS, but would he now agree that it was a big mistake to allow expert-led inspections—the kind of really thorough inspections that could have uncovered what happened at Mid Staffs—to be abolished in favour of generalist inspections, which meant that the same people inspected dental clinics, GP practices and big London teaching hospitals? That was a profoundly important mistake that this Government are right to correct.
Andy Burnham
It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.
We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.
Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out.
Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS. If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.
To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.
Grahame M. Morris (Easington) (Lab)
Does my hon. Friend also recognise the growing problems in the mental health sector, as illustrated by evidence given to the Health Committee only earlier this week? We have seen the loss of 1,700 mental health beds over the last two years.
Andy Burnham
My hon. Friend anticipates me, as I will come on to that subject. My point that the NHS has gone downhill is no better illustrated than by the crisis that is developing in mental health provision.
Alun Cairns (Vale of Glamorgan) (Con)
Will the right hon. Gentleman give way?
Andy Burnham
In a moment.
On all measures, this winter has been just as bad as the last, with some patients waiting hours on trolleys, or held at the door of A and E or in the back of ambulances. A and E is the barometer of the whole health and care system, and that barometer is warning of severe storms ahead.
Mr Jeremy Hunt
As it happens, waiting times for A and E departments are now half what they were when the right hon. Gentleman was Health Secretary, but may I gently suggest that rather than trying to turn this debate into a discussion about who had the better A and E performance, he should return to the Francis report, which is what the debate is about and which deals with something that happened on his watch? The country wants to know what his party, and he personally, have learned from the mistakes that were made that allowed Mid Staffs to happen.
Andy Burnham
Pressure on hospitals, and how we relieve it so that they can care for people properly, is the core of this debate. What we have seen under this Government is an ever-increasing number of frail, elderly people coming into hospital via A and E. The Secretary of State shakes his head, but Francis made specific recommendations on the care of older people in hospital. The point I am making is that under him the number of older people admitted to hospitals as emergency admissions has gone up significantly, and that goes to the heart of the issues raised by the Francis report.
Barbara Keeley (Worsley and Eccles South) (Lab)
We have an excellent hospital in Salford—it is one of the best in the country—but we also have 1,000 people who are losing their care packages this year. We have pressure on Salford because Trafford has been downgraded and lost its A and E, and we are short of two A and E consultants—even Salford has a problem recruiting A and E consultants. Those are real concerns for people in Salford despite having one of the best hospitals in the country.
Andy Burnham
I hope that the Secretary of State was listening to my hon. Friend. The point I was making—he did not like it—was that there is plentiful evidence that the NHS has gone downhill in the 12 months since the publication of the Francis report. The chaos in A and E has increased, and pressure on mental health services has reached almost intolerable levels.
Trusts face great difficulties in recruiting sufficient A and E doctors—a central issue in the Francis report, as it addresses safe staffing numbers.
Alex Cunningham (Stockton North) (Lab)
I agree that this is a debate about the whole NHS, and the 111 service is failing people. On Saturday night, I had direct experience of that with my six-month-old grandchild. I phoned the 111 service, but nobody could tell me when I could speak to a doctor. What did I do? I went to A and E.
Andy Burnham
That is the problem. The Government’s focus is on hospitals. All the while, alternatives to A and E are being degraded and taken away. It is an undeniable fact that it has become much harder to get a GP appointment under this Government. The Patients Association warns that it may soon be the norm to have to wait for up to a week. [Interruption.] The Secretary of State says, “Nonsense.” He should get out and speak to people. The people I speak to tell me they are getting up in the morning and ringing the surgery at 8 am or 9 am, only to be told there is nothing available for weeks. As my hon. Friend the Member for Stockton North (Alex Cunningham) said, they ring 111 and the advice given is to go to A and E.
The Government have created the situation that the Secretary of State will not address. He wants to put it all in his own terms, but this is the reality in the NHS right now and this is what has happened since the publication of the Francis report. He has put more pressure on hospitals, because he has made it harder for people to get a GP appointment, and hospitals today face greater difficulty in meeting their targets. Indeed, as I just said, in the 12 months since the Francis report, hospital A and Es have missed the target 32 times running. These issues go to the heart of what we are debating today.
Robert Flello (Stoke-on-Trent South) (Lab)
Constituents across the country will be really concerned that the Secretary of State was shaking his head when my right hon. Friend noted the fact that hospitals are under pressure and that that will have an adverse impact. Macmillan Cancer Support notes that four in 10 people are leaving hospital without enough support from health and social services. That shows there is a crisis across the entirety of the NHS, not just in A and E.
Andy Burnham
That is what I am saying: A and E is the barometer of the whole system. If there is pressure anywhere, in the end it shows up in A and E. Hospitals become jammed: they cannot admit people from A and E to the ward because people in the ward cannot be discharged home. This is what we are seeing. The Secretary of State is in denial, basically. He is shaking his head and saying that this is nothing to do with the issues raised by the Francis report. I am afraid that this is the real experience of people—staff and patients—up and down the country, and the sooner he wakes up to it the better for us all. If he thinks the situation with regard to getting a GP appointment is acceptable at the moment that is up to him, but those of us on the Opposition Benches find it completely unacceptable. It is simply not good enough and the sooner he pulls his finger out and does something about it the better.
The Secretary of State’s failure even to acknowledge these issues today is a matter of some amazement, given that he could find time to talk on an area that is not his responsibility—the NHS in Wales. There are, of course, important issues that the Welsh Assembly needs to address, but voters in England might appreciate it if he spent a bit more time sorting out problems here rather than pointing the finger over there.
Mr Harper
The NHS in Wales is relevant. Thousands of constituents in England have to use the NHS in Wales—the point I made to the Secretary of State—because of the Labour party’s ill-thought-out devolution settlement. Thousands of patients in Wales cross the border to use the NHS in England, too. What lessons should this House draw from the Labour party’s performance in running the NHS in Wales, if the shadow Secretary of State is ever back in my right hon. Friend’s chair at the Department of Health?
Andy Burnham
I, as part of the previous Government, left the lowest waiting times in the history of the NHS, and A and E was performing much better at the end of the previous Government than it is now. Hospital A and Es have dropped right down, so we do not need to take lessons from the hon. Gentleman.
Let us return to the issue of England and Wales. The mantra or script of Government Members is almost to deny that there are problems in England. Last week, 16 major A and Es in England were below the Welsh average on waits in A and E. Some trusts are seriously struggling, such as in Leicester, in the constituency of my hon. Friend the Member for Leicester West (Liz Kendall), and Great Western Hospitals NHS Trust and North West London Hospitals NHS Trust, where one in four patients were waiting more than four hours.
Another trust below the Welsh average was Barking, Havering and Redbridge, which includes Queen’s hospital, Romford. May I recommend to the Secretary of State that instead of sitting there mumbling away, he read an article on The Guardian website today by Saleyha Ahsan, an A and E consultant who has worked at Queen’s hospital, Romford? She writes:
“Being a doctor in accident and emergency has at times resembled being a medic in a war zone.”
May I remind him that this is the English NHS she is talking about—the one he is supposed to be responsible for? She goes on to say that the severe shortage of A and E doctors is a result of his predecessor’s failure to listen to the warnings from the College of Emergency Medicine about the looming recruitment crisis, because it was obsessed by its reorganisation. Dr Clifford Mann said he felt like
“John the Baptist crying in the wilderness”
because the Government’s reorganisation brought “decision-making paralysis” to the NHS. What does Dr Mann say now? He says that even after the reorganisation these issues cannot be dealt with, because
“there are now a lot of semi-detached organisations to deal with”.
Government Members do not like hearing it, but the fact is that the reorganisation by the right hon. Member for South Cambridgeshire (Mr Lansley) damaged front-line care in the NHS. May I remind the Secretary of State that just 12% of people think standards in the NHS have got better under the coalition, while 47% think they have got worse? Rather than pointing the finger at Wales, the Government need to spend a bit more time sorting out the problems they have created in England.
As my hon. Friend the Member for Easington (Grahame M. Morris) says, an urgent area that needs to be addressed is mental health. Some 1,700 mental health care beds have been cut over the past two years because these Ministers have allowed the first real-terms cut in mental health spending for a decade. As a result, alarming stories are emerging of very vulnerable children and adults being held in inappropriate accommodation, such as police cells. According to Mind, many trusts are reporting more than 100% bed occupancy. One trust in London has had to turn office space into temporary wards with camp beds.
We are also hearing of children being sent hundreds of miles to find an available bed. In a constituency case, my hon. Friend the Member for Leicester West found that there was simply no bed available in the public or private sector anywhere in England on a day when a very vulnerable child needed support. A recent freedom of information request by Community Care found that in 2013-14 10 trusts sent children to young people’s units more than 150 miles away. The furthest distance was 275 miles, from Sussex to Bury. A 12-year-old girl from Hull was sent 130 miles away to a unit in Stafford. Her child and adolescent mental health services team were searching for a bed for two days, and were told that the Stafford bed was the only one available in the country.
George Freeman
On a point of order, Madam Deputy Speaker. I came to have a debate on the Francis report. The shadow Secretary of State is not mentioning the Francis report; he is launching a criticism of the Government’s record since the report, which has nothing to do with it.
Madam Deputy Speaker (Dawn Primarolo)
Frankly, that is my business and I do not require any help to decide what is in order. The shadow Secretary of State is remaining in order, as the Secretary of State remained in order. I think it is best that we continue with the Front-Bench opening speeches to make sure that we can get in all the Back Benchers who wish to speak in this important debate.
Andy Burnham
It is interesting that Government Members do not like it, but this is the reality in the NHS right now, 12 months after the Francis report. Patient care is being compromised in the mental health care system. If the hon. Member for Mid Norfolk (George Freeman) does not think that that is relevant, let me quote Professor Sue Bailey, the President of the Royal College of Psychiatrists. She said that mental health units are
“heading for a Mid Staffs scandal”.
If that is not relevant, what is?
Mr Cash
Just to put the record straight and to give the shadow Secretary of State the opportunity to rectify something he was responsible for at the time, I accept that there was a Francis report before the inquiry under the Inquiries Act 2005 took place. In the light of the fact that he has himself acknowledged many of the recommendations of the Francis report, will he now accept that it was a grave mistake not to have a public inquiry under the 2005 Act on his watch that of his predecessors as Secretaries of State?
Andy Burnham
I am pleased that the hon. Gentleman has acknowledged that it was I who appointed Robert Francis to begin the process of an independent inquiry into what went wrong. I shall say more in a moment about what I did, why I did it, and why I stand by what I did, because in my view what I did was help to get to the truth while also helping Stafford hospital to recover.
Steve Rotheram (Liverpool, Walton) (Lab)
As my right hon. Friend knows, my wife is a community psychiatric nurse who sees mental health services at the sharp end. Does he agree that the coalition seems to view mental health as a Cinderella service rather than an integral part of the NHS?
Andy Burnham
My hon. Friend is right: it is the poor relation that has always been on the fringes of the system, and is always the first service to be targeted for cuts. That has happened again in these difficult times. The Government are cutting mental health services more deeply than the rest of the NHS, and that has led to all the problems that I have been describing.
I went to Stafford recently to meet campaigners who are working to support the hospital. One of them told me that because of the lack of available mental health beds, beds had had to be found in the hospital for people who were experiencing serious mental health crises. That is what begins to happen when we do not have adequate capacity on the ground. Government Members say that this is not relevant, but it is directly relevant to all the matters that we are discussing today.
Andrew George
As the right hon. Gentleman knows, I was critical of the last Labour Government for rather bizarrely rolling out the red carpet for the private sector and, indeed, allowing financial targets to distort clinical priorities to an extent which, I think, created the circumstances that led to the Mid Staffs difficulties. He has mentioned integration of care. Does the Labour party propose full integration in terms of the pooling of budgets, and does he support the campaign for a fundamental safety standard in respect of the ratio of registered nurses to patients on acute hospital wards?
Andy Burnham
I do support that campaign, because I think that we need transparency so that local people can see whether their hospitals have enough staff. I also support the full integration of health and social care into a single service—an even deeper integration than a pooled budget—because I believe that that is the only way in which we will build a service based on the individual. We need a system in which all the needs of one person are clear and the service can start in the home, rather than this fragmented world in which care in the home is being cut and older people are being left at ever greater risk of hospitalisation.
I find it worrying that Government Members seem to be in denial about what I have been saying, and that brings me to the central point that I want to make. I believe that the Government have mishandled their response to the Francis report, and I shall cite three examples in support of my claim. First and most obviously, the Government have failed fully to implement 88 of the report’s recommendations, as they have themselves acknowledged. Secondly, Stafford hospital has, in my view, been hung out to dry. Thirdly, by overtly politicising the whole issue of care failure, the Government have created a climate of fear throughout the NHS—the worst possible response to what Francis said.
It seems to me that the Government have missed the entire point of the Francis report. If we distil the report into a few words, it called for a culture change. A range of measures were proposed with the aim of achieving that change, including a duty of candour for individuals and organisations, regulation of health care assistants, and, crucially, moves to strengthen the patient voice at local level by giving Healthwatch more protection and prominence. Francis recommended that local authorities be required to pass centrally provided funds to local Healthwatch groups, but that recommendation was not accepted. Of the £43 million allocated by the Department last year, HealthWatch groups have received only £33 million, which leaves £10 million unaccounted for. The Patients Association has said that
“vital recommendations have not been accepted and…patient care could suffer as a result.”
We support measures that the Government are introducing in the Care Bill on the appointment of chief inspectors, but let us be clear: they were not recommendations of the Francis report, and, if we are not careful, they will risk reinforcing a much more top-down approach to regulation. The position is not helped, I might add, by the Secretary of State’s new habit of calling hospital chief executives directly himself. Indeed, one of the great ironies of the Government’s reorganisation is that it has left the NHS a more top-down organisation than it was before, with clinical commissioning groups yet to find their voice and NHS England calling all the shots.
Let me quote from the Nuffield Trust’s report, entitled “The Francis Report: one year on”. In his foreword to the report, Francis himself says:
“Perhaps of most concern are the reports suggesting a persistence of somewhat oppressive reactions to reports of problems in meeting financial and other corporate requirements. It is vital that national bodies exemplify in their own practice the change of cultural values which all seem to agree is needed in the health service.”
Robert Francis himself says that national bodies are still behaving in a top-down fashion—one year on.
Rosie Cooper (West Lancashire) (Lab)
What with NHS England, the NHS Trust Development Authority, the Care Quality Commission, Monitor, clinical commissioning groups and the Department of Health, is the NHS not in danger of having no clear lines of responsibility? There appears to be no clarity when it comes to who is enforcing good quality of care across the NHS. Is not the use of human resources practice to bully staff one example of something that may fall through the gaps between those various organisations?
Andy Burnham
My hon. Friend has raised an important point. People are confused about the new NHS, and confused about who has responsibility for what. The Government have created more organisations, not fewer; the NHS is more top-down than it was before; and that is not changing the culture. Robert Francis himself has said that the culture is not changing. The Government are utterly complacent if they think that they have got everything sorted out.
Andy Burnham
Time is against us, I am afraid.
The Secretary of State is wrong if he thinks that top-down regulation is the only answer. It cannot prevent things from going wrong in the first place. The Secretary of State should accept all the recommendations of the Francis report, including the recommendations that are designed to change the culture at a local level.
Let me now turn to the future of Stafford hospital, and address the point made by the hon. Member for Stone (Mr Cash). If there was one thing that the people of Stafford deserved after what had been a long and painful process, it was the legitimate expectation that, at the end of that process, they would see a fully functioning local hospital that was both safe and sustainable. That is why I believe that the conclusion of the trust special administrator process is both wrong and unfair on them. It will result in a significant downgrade of the hospital, and there is still no clarity in regard to important services such as maternity.
The issue of the future of Stafford hospital goes to the heart of the handling of the inquiry and the decisions made about it. When I arrived at the Department of Health in June 2009, the official advice that I received was that I should not hold any further inquiry into what had gone wrong, because it would distract the hospital from the essential task of making immediate improvements. I could not accept that advice, because I believed that we needed to get to the full truth of what had gone wrong. That is why I appointed Robert Francis to conduct an independent inquiry. However, I stopped short of a full public inquiry because I had been warned that such an inquiry could destabilise the hospital and prevent it from making improvements. The Secretary of State nods.
That is the advice that I was given, but I told Robert Francis that he could come back to me and ask for powers to compel witnesses to appear before him if he felt that that was necessary. He came back to me to say that he felt that he had had all the co-operation that he needed. Indeed, he had had more, because of the nature of the inquiry that I had set up.
As the Secretary of State will recall, after the first Francis report I commissioned a second-stage inquiry into regulatory systems. I did not disagree with the coalition’s decision to upgrade it to a full public inquiry, as that was always a finely balanced judgment, but I did warn at the time that the hospital would need further support, given what a full public inquiry would entail. I do not believe that it has been given that support. Worse, the administration process that it has undergone has been brutal. I do not believe that there is a district general hospital in the land that could survive a three-year public inquiry followed by financial administration. The Labour party’s view—informed by the Lewisham and Stafford examples—is that the Government are misusing the administration powers created by the last Government to drive through reconfiguration on cost rather than clinical grounds, and we will therefore move to delete those powers from the Care Bill next week.
Dr Phillip Lee (Bracknell) (Con)
The right hon. Gentleman has alluded to the sustainability of district hospitals. In the light of the Francis report and the dreadful care failings at Mid Staffs, I would suggest—and I am sure that others would agree with me—that part of the problem was that we were trying to offer care over two sites to a relatively small population. The right hon. Gentleman agrees with me that reconfiguration of acute care in particular is on the horizon. Does he also agree that, in view of the political difficulties of acute reconfiguration and the ultimate closures of departments, a cross-party approach is long overdue?
Andy Burnham
The hon. Gentleman makes a very important call, and I think he is right: hospitals are going to have to change, and the sooner we all wake up to that fact, the better. I would also say to him, though, that hospitals cannot be changed top-down, as I believe his Government are trying to do with clause 119 of the Care Bill: a power to drive through financially driven reconfiguration and create a twin-track route outside of the normal, established process. The normal process creates local oversight and scrutiny at democratic level, and independent judgment on changes from the Independent Reconfiguration Panel. That is the established route and it should not be bypassed. I say that while agreeing with the hon. Gentleman that we do need a cross-party approach.
I believe we owe it to the people of Stafford to support their hospital and maintain as many services there as possible. If the Secretary of State were to visit Stafford and sit down with people on the Support Stafford Hospital group, as I have done, he would hear a real sense of injustice from them that their hospital has been dragged down by a barrage of negative publicity. Will the Secretary of State confirm today whether Stafford hospital will continue to have a maternity service? Rumours and nods and winks are no good; people need to know. What will he do to ensure that the people of Stafford do not have to travel miles to get basic services? I can tell the House that I will continue to argue for the fullest range of safe services at Stafford, as that has been my consistent aim throughout this entire process.
Perhaps the most unseemly aspect of the last year has been an attempt by some to politicise the failing at Stafford. That has created a climate of fear in the NHS that may make it even less likely that doctors and nurses feel able to report mistakes or poor care and achieve the culture change that the Francis report advocated. I would like to remind those on the Government Benches that this stands in stark contrast to the way the previous Government handled the care failures they inherited from the Government before them at Bristol and Alder Hey, and also the Shipman murders. At Bristol, doctors raised concerns but were not listened to. Parents whose children had died or suffered brain damage were ignored. For a long time nothing was done. It was in 1997 that the General Medical Council finally started to investigate what had gone wrong at Bristol. I say to those on the Government Benches, for goodness’ sake please remember and take the long view on these issues. Let us all use these moments by making them a catalyst for change in the NHS.
NHS staff report to me that they now feel a climate of fear and an intensification of the blame culture, with the talk of uncaring nurses, lazy GPs and coasting hospitals. We have seen HSMR—hospital standardised mortality ratio—figures misused by Government spin doctors to generate misleading headlines that have damaged struggling hospitals. It even got to the point where a group of senior clinicians and managers felt compelled to write to The Guardian at the end of last year, calling on the Government to call off the attack dogs. They feel that there is an attempt to magnify the failings of the NHS and run it down, and that it is linked to a drive towards more privatisation.
What the NHS needs to address some of the major issues that the Francis report raised is the ability to collaborate and integrate. The great sadness is that the Health and Social Care Act has placed it on the opposite path, towards competition and fragmentation. We now have the unbelievable spectacle of the Competition Commission intervening for the first time to prevent sensible collaboration between hospitals. The logical consequence of “any qualified provider” is more and more providers dealing with one person’s care. This is a recipe for cost, complexity and fragmentation.
I am clear that the market is not the answer to 21st century care. Instead, we need services based around the individual, starting in the home, with all barriers to integration are removed. That is essential if we are to rethink the care of older people as the Francis report invites us to do, and this shows the big difference between those on this side of the House and those on the Government Benches. They talk about integration but have instead legislated for fragmentation. Only by repealing the Health and Social Care Act will we put that right, put the right values back at the heart of the NHS and build an NHS ready for the 21st century.
Mr Aidan Burley (Cannock Chase) (Con)
It is a pleasure to follow the right hon. Member for Cynon Valley (Ann Clwyd). I, too, pay tribute to her work in championing patients. The calm silence with which the House listened to her speech speaks volumes, as do the many nods of heads of colleagues around the Chamber.
I declare an interest, as my local hospital, Cannock Chase, is the other hospital in the Mid Staffs trust, so my constituents, like those of my hon. Friend the Member for Stafford (Jeremy Lefroy), have been deeply affected by the fall-out from Mid Staffs and the Francis report. I echo some the comments that have been made: I would not wish a public inquiry or trust special administration on any Member of Parliament, as it is an horrendously long drawn-out process and incredibly stressful for everyone involved, not least the patients who use the hospitals affected and the staff who work in them. However, the outcome is worth it, as today’s debate shows it was, if we learn the right lessons,.
I praise the staff at both Stafford and Cannock Chase hospitals for getting on with the job even when they are not sure what the future will be. I urge the Minister once more to move to the new organisational structure, with Royal Wolverhampton Hospitals NHS Trust running Cannock Chase and University Hospital of North Staffordshire NHS Trust running Stafford, as soon as possible to end the insecurity that the staff at both hospitals have suffered for too long.
Andy Burnham
I am grateful to the hon. Gentleman for giving way so early in his speech, to which I am listening carefully. He says that the TSA process was worth it. May I press him on that? Does he really think that that was ever going to deliver a fair outcome for his local hospital, given that it followed a three-year public inquiry and the hospital lost patients and staff as a result? In the spirit of the call made by the hon. Member for Stafford (Jeremy Lefroy), should we not all unite to recognise the exceptional circumstances that the local trust has been through? Is it not the case that a TSA process could never capture the exceptional nature of what has happened to the local health economy and, in fact, it looked narrowly at the trust’s finances and sustainability? Should we not call on the Government to look at that?
Mr Burley
The right hon. Gentleman asks a number of questions. I am still not clear about his position and whether he thinks that the public inquiry was the right decision or not. The inquiry led to recommendations and the improvements we have seen. To answer his question about whether “the TSA process was worth it”—that was the phrase he used—as we speak in the Chamber today, my local hospital is 50% empty. Cannock Chase hospital was run down by the management of Mid Staffs to near closure, and half of it lies empty. Any building that is half empty has a sword of Damocles hanging over it, and no one from the Opposition complained locally as services were slowly stripped out by stealth over the past 10 years. As a result of the TSA process, Royal Wolverhampton Hospitals NHS Trust will take over running of Cannock hospital, increase utilisation from 50% to 100%, and invest £20 million in refurbishing it. That shows that the TSA process has been fantastic from a Cannock Chase perspective, even though it has been a stressful and drawn-out process.
I praise my hon. Friend the Member for Stafford for his tireless work on this issue and for his technical and clinical knowledge of local services, which is second to none in the House. His campaigning has led us a long way from the point at which A and E, maternity and paediatrics would all be closed, which is a hell of a legacy of public service to the people of Stafford who, I am sure, will return him at the next election for a second term—one which I hope is not dominated by the issue of Stafford hospital, as his first term has been.
As we know, the Government introduced measures in the Care Bill as their legislative response to the Francis inquiry. Those measures include the introduction of Ofsted-style ratings for hospitals and care homes, creating a single regime to deal with financial and care failures at NHS hospitals, introducing a duty of candour, and making it a criminal offence for care providers to give false and misleading information about their performance. It may surprise many that those measures do not already exist. Local parents in my constituency send their children to schools in Cannock that have an Ofsted rating, and they can speak to teachers about any documented problems in the school. Those same parents take their elderly relatives to Stafford hospital and are surprised when they receive appalling care—indeed, some even die suddenly—because there is simply no clear ranking of how that hospital is performing as there is for their children’s school.
Worse still, nursing management and staff had actively been covering up the problems. As we have seen locally, the events at Mid Staffs clearly demonstrate that a culture had been allowed to develop in the NHS in which defensiveness and secrecy were put ahead of patient care. Think about that for a moment: they were put ahead of patient care. In the 21st century, is that not a damning indictment of an institution that was set up to improve the health of its people, but has been encouraged over the years to protect itself and its reputation more than the people it exists to serve? I think that all Members should reflect on that before rushing to defend the reputation of the NHS. We should remember why the NHS exists: to serve the patients, not itself or any political party.
In the time available, I want to talk about two things: prioritising the patient experience and the TSA process. Before doing so, I think that it is worth remembering how we got to this point today. Macmillan Cancer Support’s briefing for this debate, which the hon. Member for Stoke-on-Trent South (Robert Flello) has already quoted, gets it spot on:
“The failure at Mid Staffordshire NHS Foundation Trust to put patients and their priorities at the centre of their work was a key finding from Robert Francis’ report… In particular, the report found that the trust prioritised its finances and Foundation Trust application over providing a high quality of care that put patients first.”
To quote a source that we on the Government side of the House all read regularly, the World Socialist Web Site:
“Under the 1997-2010 Labour government, Stafford was pressured to transform into a Foundation Trust—an initiative aimed at making hospitals semi-independent of the Department of Health by ‘freeing’ them to find private funding sources. In the process, £10 million was cut from the Trust’s budget and 150 jobs lost, leading to nursing staff shortages, overwork and the inability to provide a high-quality service to vulnerable patients. Any excess deaths at the hospital must be attributed to this shift.”
Andy Burnham
I thoroughly agree with the Minister about collecting data on mental health so that we can make proper judgments about the quality of services, but why has the Department of Health scrapped the annual survey of expenditure on adult mental health services?
Dr Poulter
It is very difficult for me to stand at the Dispatch Box and take any lessons from the right hon. Gentleman and the previous Government on mental health issues. Only this Government have taken serious steps to improve parity of esteem and enshrine it in law, and only this Government are investing in mental health on the ground, with £450 million that is particularly focused on talking therapies. If the previous Government had any interest in mental health, they had 13 years to make investments and to improve data collection to drive better commissioning, but they took no steps towards doing that, and I am afraid that their record on mental health was abysmal and very poor. Unfortunately, patients paid the price for that.
We are very proud of our record on mental health, but it will take several years to turn around the fact that there was no parity of esteem in the past. Investment is now going in on the ground and things are being put in better order. My right hon. Friend the Member for Sutton and Cheam played his part in that, and the 2012 Act was a huge step forward in delivering those improvements.
I will try not to get drawn away from the topic of the Francis inquiry, Mr Deputy Speaker—we are talking about the broader health and care service—but I mentioned mental health, which we can be proud of, because it was mentioned by Francis in his report.
It is also important to talk about some of the wider lessons that can be drawn from the Francis inquiry. The right hon. Member for Cynon Valley (Ann Clwyd) and my hon. Friend the Member for Vale of Glamorgan (Alun Cairns) spoke particularly about the need, apolitically, to make sure that the whole of the United Kingdom draws such lessons. I have had very productive meetings with counterparts in Scotland, and Wales can also learn lessons about the importance of transparency and openness, and about recognising potential areas of poor care.
I hope that shadow Ministers will take up those matters with their counterparts in Wales, because such a situation can only be to the detriment of patients there. That is not a political point, but one about good care. It is important for us to deliver that in the system at the moment. It is also important because English patients are treated in Welsh hospitals. My right hon. Friend the Secretary of State is very excited about that point, which is why he is a very strong advocate of the needs of English patients and why he takes a particular and important interest in what happens in Wales, quite rightly drawing comparisons between the two systems.
Robert Francis found, as we have discussed, that individuals and organisations at every level of our health service let down the patients and families whom they were there to care for and protect. That was a systemic failure on the part of everyone concerned and cultural change was needed throughout the system. To prevent the same thing from ever happening again, the Government are changing the culture by requiring transparency and openness, by empowering staff and supporting strong leadership, and by embedding the patient voice and listening when something goes wrong.
Oral Answers to Questions
Andy Burnham Excerpts(10 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
I will do that, and NHS England was absolutely right to have a pause so that we ensure that we give people such reassurance—[Interruption.] When we had a pause before, the result was the very good Health and Social Care Act, which is doing good things for patients throughout the NHS. This programme is too important to get wrong, and while I think that there is understanding on both sides of the House about the benefits of using anonymised data properly, the process must be carried out in a way that reassures the public.
Andy Burnham (Leigh) (Lab)
When he was appointed, the Health Secretary declared it his personal mission to have a “data revolution” in the NHS, but what he has presided over is a spectacular collapse in public confidence in the use of patient data. The only revolution he has created is a growing public revolt against his care.data scheme. Coming after his NHS 111 shambles and the court humiliation over Lewisham hospital, it cements a reputation for incompetence. When was he first warned about problems with care.data and what action did he take?
Mr Hunt
The shadow Secretary of State searches for NHS crises with about as much success as George Bush searching for weapons of mass destruction. My first contact with that programme, when I was told about it, was to decide to do something that he never did as Health Secretary: to say that every single NHS patient should have a right to opt out of having their data used in anonymised scientific research. I think that was the right thing to do. Of course we are having a difficult debate, but its purpose is to carry the public with us so that we can go on to make important scientific discoveries.
Andy Burnham
Again, the right hon. Gentleman never takes responsibility—it is always somebody else’s fault. Even by this Government’s standards, this is a master-class in incompetence. First, we have this useless glossy leaflet. He said that it has gone to every home, but that is not true, because homes that have opted out of junk mail have not received it. Many people report that they still have not had it through their letterbox. Secondly, when people cannot even get through to their GP practice on the phone, as we heard earlier, or get an appointment, he has made it almost impossible to opt out of the scheme. Has this cavalier approach not built an impression that the Government are taking patient confidentiality for granted in trying to force through the scheme, increasing public mistrust and putting the important scheme at risk?
Mr Hunt
It is intriguing that the shadow Secretary of State has chosen not to talk about a winter crisis, because it has not happened, despite the fact that he predicted it time after time. Let me tell him what was cavalier: the previous Labour Government’s refusal to give patients a right to opt out of giving their data to this programme, even though it was going on for their whole time in office. We believe that we should have a data revolution, but to do that we need to carry the public with us, which is why we need to have this important debate and give people the reassurance they deserve.
Mr Hunt
I reassure my hon. Friend that I have looked into Ben Foy’s case, and NHS England has confirmed that it is responsible for commissioning his care. The particular drug that my hon. Friend mentioned is not recommended by the manufacturer for use by children and adolescents, but I am happy to arrange for him to meet NHS England and get to the bottom of the issue.
Andy Burnham (Leigh) (Lab)
I want to return to care.data—an important scheme that needs to be saved from the incompetence of this clownish coalition. The Secretary of State said earlier that I was in search of a crisis, but now I will offer him a solution. If the Government work with us to introduce a series of tough new safeguards to protect patients, we will work with the Secretary of State to help rescue this failing plan. Those safeguards include tougher penalties for the misuse of data, Secretary of State sign-off on any application to access data, full transparency on organisations granted access, and new opt-out arrangements by phone or online. Will he meet me to discuss changes to the Care Bill to put that important scheme back on track?
Mr Hunt
The right hon. Gentleman has still not addressed the fundamental question of why he did not introduce an opt-out for the use of personal data, which this Government are doing. We have taken more steps than his Government ever did, and we will continue to work hard to ensure that this important scheme goes ahead. The right hon. Gentleman should know better.
NHS
Andy Burnham Excerpts(10 years, 5 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham (Leigh) (Lab)
I beg to move,
That this House is concerned about recent pressure in Accident and Emergency departments and the increase in the number of people attending hospital A&Es since 2009-10; notes a recent report by the Care Quality Commission which found that more than half a million people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in the last year; believes that better integration to improve care in the home or community can relieve pressure on A&E; notes comments made by the Chief Executive of NHS England in oral evidence to the Health Select Committee on 5 November 2013, that the NHS is getting bogged down in a morass of competition law, that this is causing significant cost and that to make integration happen there may need to be legislative change; is further concerned that the competition aspects of the Health and Social Care Act 2012 are causing increased costs in the NHS at a time when there is a shortage of A&E doctors; and calls on the Government to reverse its changes to NHS competition policy that are holding back the integration needed to help solve the A&E crisis and diverting resources which should be better spent on improving patient care.
Our purpose in calling this debate is twofold. First, we want to help the House to develop a more sophisticated understanding of the underlying reasons for the sustained pressure in accident and emergency departments throughout England. Secondly, we want to remove what we see as the major barrier to a lasting solution in A and E.
What has been happening in A and E over recent years? Between 2007 and 2010, attendances at A and E were fairly stable, although they rose slightly. Over those three years, attendances at hospital A and E departments increased by 16,000. Between 2010 and 2013, something changed. In the first three years of this Government, attendances at A and E increased by a staggering 633,000.
What is going on? It is all too easy to reach for simplistic answers. In truth, the picture is complex and a range of factors has contributed to the rise. However, it is possible to point to underlying causes. One of those is clearly the general economic climate. People have been living under greater pressure and are struggling with the cost of living. A and E has become the last resort for people who are not able to cope for a range of reasons. If Members speak to A and E staff, they will be told that there has been a rise in people arriving at A and E who have a range of problems linked to their living circumstances, from people who have severe dental pain because they cannot afford to see the dentist, to people who are suffering a breakdown or who are in crisis, to people who cannot afford to keep warm and are suffering a range of cold-related conditions.
Stephen Mosley (City of Chester) (Con)
The right hon. Gentleman is explaining why there is increased pressure on A and E. Does he not accept that A and E performance has improved since the general election? The average waiting time is down from 77 minutes under the last Government to 30 minutes.
Andy Burnham
No, I do not accept that. This has been the worst year in a decade in A and E departments. Almost 1 million people have waited more than four hours to be seen. In my year as Secretary of State for Health, the figure was 350,000. There has been a big increase in the number of people who are waiting a long time. I was going to come on to the average waiting time, but since the hon. Gentleman mentions it, let me make the situation clear now. The figure that he is talking about and which appears in the Government amendment relates to the waiting time until an initial assessment, not the total waiting time in A and E. [Interruption.] The Secretary of State is nodding because, as ever with him, it is all about the spin. That figure does not mean anything to the public. They want to know how long they will spend waiting in A and E in total. We need to have a bit of truth in this debate.
Kate Green (Stretford and Urmston) (Lab)
My right hon. Friend was making a point about the wider economic pressures that are leading to greater pressure within A and E. Was he as shocked as I was to read in the Manchester Evening News last year that people in our area are presenting at A and E as a result of malnutrition? Is it not an appalling indictment of the Government that they have allowed that to happen in the 21st century? It is putting huge pressure on A and E departments across the north-west, including those at Wythenshawe hospital and Manchester Royal infirmary.
Andy Burnham
That is an indictment of the Government. They have made it harder for people to afford a good basic diet. We have seen a rise in hypothermia, rickets and scurvy. Sadly, we have also seen the rise of food banks under this Government. That is why I am beginning my speech by saying that there is a range of reasons for the sustained pressure on A and E.
Andy Burnham
I will make a little progress and then I will give way.
There have been record levels of hypothermia this year and thousands of over-75s have been treated in hospital for respiratory or circulatory diseases. That brings me to the second underlying cause of the increase in attendances at A and E. The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.
We all need to face up to the uncomfortable fact that our hospitals are increasingly full of extremely frail elderly people. Too many older people are in hospital who ought not to have ended up there or who are trapped there because they cannot get the right support to go home. That situation is unacceptable and it has to be addressed.
Margot James
Does the right hon. Gentleman not accept that the emergence of older people visiting A and E in far greater numbers has been coming on for a long time? I know that he does not like to be reminded of the 2004 GP contract, but surely he agrees that it is a factor, because older people have not been able to get the necessary support over a long period. The Government are putting that right by integrating health and social care far better.
Andy Burnham
The hon. Lady wants me to answer that question, but I direct her to her right hon. Friend, the Chairman of the Health Committee, who has dismissed the self-serving spin from the Government that says that these problem are all to do with a contract that was signed 10 years ago. I began my speech by citing figures that show an exponential rise in the number of people attending A and E since 2010. Many of those people are very frail older people. That is the issue before the House, so it does not help the debate for the hon. Lady to stand up and make a spurious political point.
Yasmin Qureshi
Is not one of the reasons why more elderly and frail people are going to hospital that there has been a £1.8 billion cut in adult social services and support? Those people are ending up in hospital because they are not receiving the care that they need at home.
Andy Burnham
My hon. Friend is absolutely right. I will come on to say that the single most important underlying cause of the A and E crisis is the severe cuts that we have seen to adult social care. That has created a situation in which older people are trapped on the ward and cannot go home because there is not adequate support at home. That means that A and E cannot admit to the ward because the beds are full. Hospitals are operating way beyond safe occupancy levels. Because of that, the whole hospital begins to jam up and the pressure backs up through A and E. When A and E cannot admit to the ward it becomes full, so ambulances queue up outside because they cannot hand people over to A and E.
That is exactly what is happening in our NHS at the moment. A and E is the barometer of the whole health and care system. If there is a problem anywhere in the system, it will be seen eventually as pressure in A and E. That is what is happening. The simplistic spin from the Conservative party, which says that it is all to do with a GP contract from 10 years ago, is discounted by expert after expert.
Helen Jones (Warrington North) (Lab)
My right hon. Friend rightly said that back-ups in A and E cause problems elsewhere. May I draw his attention to the fact that over the past 18 months, more than 1,600 people have waited more than 20 minutes in ambulances outside Warrington hospital before they could even get to A and E and the clock starts ticking? North West Ambulance service says that it cannot be accurate about the waiting time for hundreds of incidents. Does that show that waiting times may be even worse than first thought?
Andy Burnham
I fear my hon. Friend is absolutely right. I know Warrington hospital well and the pressures that have been on it, and I agree that ambulance response times have increased across the country because so many ambulances have been held in queues outside A and E, unable to hand over patients to A and E staff because it is full. That has left large swathes of the country—particularly in rural areas—without adequate ambulance cover, and very serious incidents have taken place across the country, not least in the Minister’s area of Norfolk where people have not received ambulances on time. That is the consequence of the pressure on A and E not being addressed, and it is threatening to drag down the rest of the NHS.
Catherine McKinnell (Newcastle upon Tyne North) (Lab)
My right hon. Friend is making an incredibly powerful speech that goes to the very heart of our NHS and the staff who work in it. North East Ambulance Service is one of the highest performing services in the country and reaches 80% of most seriously ill or injured patients within eight minutes. Last week, however, it had to hold an emergency summit because staff morale is at an all-time low. Assaults on staff are increasing dramatically, and the stress and pressure of waiting outside A and E to admit patients is having a deeply damaging impact on the wider NHS. Does my right hon. Friend agree that that is not what the Prime Minister meant when he said that the NHS was safe in his hands?
Andy Burnham
My hon. Friend’s point was also made powerfully by ambulance staff at an A and E summit held by the shadow Front-Bench team in Parliament before Christmas when a paramedic spoke of the phenomenon she has just described. He mentioned an occasion when staff were at the door of A and E waiting to hand over a patient to A and E staff, when the patient had a heart attack. The staff did not know what to do and had to go back to the ambulance to try to stabilise the patient. Those sorts of joining points or disconnects in the system are leading to real pressure on staff who do not know what to do in those difficult circumstances. The system is in danger of being overwhelmed, and the pressure on staff must be addressed urgently.
The Minister of State, Department of Health (Norman Lamb)
I share the right hon. Gentleman’s view that delays in handover at A and E are not acceptable, and I remember well that last decade, under the previous Government, ambulances were stacking up outside the A and E at the Norfolk and Norwich hospital. Does he welcome the fact that this winter, delays of longer than 30 minutes are down by more than 30% compared with last year?
Andy Burnham
Yes, there has always been pressure on the ambulance service at this time of year, but if the Minister wants me to join in with his complacency, I am afraid I will not. The past 12 months have been the worst in A and E in a decade, and there are reports of ambulances across the country held in queues. Is the Minister satisfied with the performance of the ambulance service in his region of east England? Was he satisfied with the way the case I mentioned was handled? I do not believe he was or that his complacency at the Dispatch Box will be appreciated by his constituents.
George Freeman (Mid Norfolk) (Con)
As a Norfolk MP I assure the right hon. Gentleman that we are on the case regarding ambulances, and the Minister is leading the charge. I am interested in the facts. Is not the truth that we are treating 2,000 more patients every day in under four hours in A and E, and that we have 350 more A and E consultants? In Norfolk and Norwich hospital, people tell us that it was under Labour, with the IT issues, integration, GP contracts and working time directive that A and E became chaotic. The right hon. Gentleman’s attack is unfair, ill-judged and overly partisan.
Andy Burnham
I acknowledged that there is always pressure in A and E, but the fact is that it performed better in every month when I was Health Secretary than it has under the current Health Secretary. The hon. Gentleman mentions Norfolk again. We have been looking at the Minister’s website, which makes us wonder whether he considers himself a Minister or an observer of events in the NHS. Under the headline “Norman Lamb’s North Norfolk Ambulance Survey” he states:
“I have been campaigning over the last year to improve unacceptable ambulance response times in rural Norfolk.”
My God, this is the Minister! He is campaigning against his own Government.
Steve Rotheram (Liverpool, Walton) (Lab)
I wonder whether the Minister will write to the Minister about that problem. The spin from those on the Government Front Bench may kid some of their Back Benchers, and it has certainly kidded some Liberal Democrats who I have been speaking to across the Chamber, but it will not kid patients who go to A and E and see people on trolleys, camp beds or blocked in ambulances.
Andy Burnham
My hon. Friend is absolutely right, and I would love the Government to explain that everything is fine and that there is no problem at all to more than 100,000 people who have waited more than four hours on a trolley this year, or almost 1 million people who have waited more than four hours in A and E. The complacency is not justified, and if those people were to read the Government’s motion, I am afraid, quite frankly, they would be astonished.
Mr Andy Slaughter (Hammersmith) (Lab)
Perhaps I may help my right hon. Friend by saying that the campaign in North Norfolk began on the Minister’s website after the excellent campaign run by the Labour prospective parliamentary candidate, Denise Burke, who pointed out how deficient local services were—[Interruption.]
Mr Slaughter
Will my right hon. Friend join me in condemning the Government for still classing A and Es as such when, like the one at Charing Cross, they are in practice closing and turning into GP-run clinics? The Government are still calling them A and Es, and people are misled. That will lead them to go to the GP-run centres when they should be going to properly staffed A and Es, and we will get tragedies such as the one at Chase Farm.
Andy Burnham
I am afraid that under the coalition, NHS treatment for “Gove-itis” is being rationed, like everything else, unfortunately. As my hon. Friend said, the Government claim they are keeping A and Es and call them “local” A and Es, but they are actually downgrading A and E units all over the country. How can it make sense to close and downgrade A and Es in the midst of an A and E crisis? In west London, as my hon. Friend knows, incredible changes are being introduced without proper regard for the evidence I am presenting to the House today of a change in A and E and of sustained pressure on A and E units. The Government must go back and consider their plans for my hon. Friend’s constituency and the rest of London.
Andrew George (St Ives) (LD)
I totally agree with the right hon. Gentleman that the last thing the health service requires is complacency, but synthetic rage does not help either. He must remember that when he was Health Secretary, and indeed a Health Minister, up to seven ambulances were queuing outside Treliske hospital in Cornwall. That problem happens from time to time and it would be better for parties to co-operate and to come together to try to find a solution, rather than simply trying to score political points and ignoring the past.
Andy Burnham
I will put forward a solution that the hon. Gentleman might support. I think he supported the campaign to oppose the Government’s Health and Social Care Bill, and I pay credit to him for that as we worked across party lines on that issue. It is my job to hold the Government to account where there are problems in the national health service, and if the Minister is saying to me that there are no problems in the health service right now, I am afraid I do not agree with him. Emergency services are under intense pressure. If he looks back to our time in government, as he invited me to do, he will see that the winter crisis was a regular feature at the turn of the millennium and the early years of the last decade, although it got progressively better and better and we did not see the annual winter crisis. Now it is back with a vengeance, although it is different. The winter/spring crisis has become a summer/autumn crisis too. The pressure is relentless and it needs a proper, lasting solution.
John Glen (Salisbury) (Con)
Would the right hon. Gentleman care to reflect on the fact that we now have 350 more A and E consultants in the NHS? Given his commitment to cut the NHS at the last election, if he is going to offer a sensible improvement, where will the money come from? How will he pay for it? That is what the people out there want to understand.
Andy Burnham
First, I would be grateful if the hon. Gentleman did not continue to misrepresent what I said on the NHS. I have never said, “Cut the NHS”. I stood at the last election on a commitment to protect the NHS budget in real terms. He stood on a manifesto promising real-terms increases for the NHS. I said that if there were to be increases for the NHS, they should be given to social care instead, and that would have relieved some of the pressures on A and E. Let us have the facts straight.
Secondly, the hon. Gentleman boasts about having enough A and E doctors. Perhaps he should speak to people from the College of Emergency Medicine and hear what they have to say on that subject. They talk of warning the Government of a recruitment crisis in A and E about two or three years ago. They said that they could not get through to Ministers who were obsessed with structural reorganisation. They were left feeling like John the Baptist crying in the wilderness—their words. Perhaps before the hon. Gentleman shouts the odds in the House, he should speak to the people who know about these things and who warned his Government —who failed to act.
One of the major problems with the pressure on A and E is the number of older people trapped in hospital. This is a product of demographic pressure and the ageing society. Nursing staff talk of how, when they first qualified, it was rare to see someone in their 90s on the ward. Now they are there in great numbers and that makes the task of meeting their needs much more complex. When people reach an advanced age it is simply not possible to separate out their physical, social and mental needs. Need becomes a blur of all three. Our hospitals are not geared up to provide the additional mental and social support that very frail elderly people often need.
Andy Burnham
I have given way to the hon. Lady once: I want to make some progress.
Some, but not all, of the needs of older people are met in an acute hospital environment, which explains why their condition often drops like a stone. It is a phenomenon that was accurately identified by Robert Francis QC in his report, published a year ago this week. He called for an overhaul of the way in which older people are cared for in acute hospitals. He was right to do so, and while I applaud some of the steps the Secretary of State has taken in that regard, such as the move towards a named consultant, I do not believe it will tackle the root cause of the problem, which is the arrival of far too many older people in hospital in the first place. Only when that is tackled will we begin to address the underlying causes of the A and E crisis.
Mr Jeremy Browne (Taunton Deane) (LD)
I am grateful to the former Secretary of State for giving way, because I am concerned—especially as we are talking about not distorting the facts—by his initial analysis. He attributed part of the pressure on A and E to an outbreak of scurvy and rickets cases. I do not want anybody in my constituency or elsewhere to be unduly alarmed, so can he please put on the record what proportion of people reporting to A and E, including those who are not seen within four hours, are doing so because they have scurvy? He can give the numbers in absolute figures or percentages, but it is important that the House not be misled and that we are given the unvarnished truth.
Andy Burnham
The hon. Gentleman should climb off his high horse for a moment. In answer to an important point made by my hon. Friend the Member for Stretford and Urmston (Kate Green), I pointed to the increase in cases of scurvy, rickets and malnutrition. If he wants—[Interruption.] If he wants to deny that that is the case, that is up to him—[Interruption.] If he speaks to A and E staff, he will hear that people who are not eating properly are turning up in ever greater numbers—[Interruption.] I have answered his point and I will now make some progress.
It is the case that too many older people are arriving at hospital in the first place. A recent Care Quality Commission report found avoidable emergency admissions for pensioners topping 500,000 for the first time—[Interruption.]
Mr Speaker
Order. The exchange between the hon. Member for Liverpool, Walton (Steve Rotheram) and the hon. Member for Taunton Deane is most unseemly. I remind the latter that he is a distinguished former member of Her Majesty’s Government and he should comport himself with appropriate dignity. That is what we look for in an hon. Member who aspires to be a statesman.
Mr Speaker
Order. I am not dismissing the statesmanlike potential of the hon. Member for Taunton Deane, but I think his journey has some way to go.
Andy Burnham
The beard is certainly helping. I suggest that the hon. Member for Taunton Deane (Mr Browne) visit Liverpool Walton, because he will see more food banks there than anywhere else in the country. He will meet families who cannot afford to put enough food on the table to give their kids a decent diet. He will see the direct effects of some of his Government’s policies on some of the most deprived communities in the country.
Steve Rotheram
If people who turn up to A and E have malnutrition, it plays havoc with their medication. If they are not eating properly, they can be violently ill from their medication. Does my right hon. Friend agree that that is a growing problem?
Andy Burnham
I agree, and the last time we had a debate on this issue I quoted a well-known GP who said that she has taken to asking her patients whether they are eating properly, because many are presenting with unexplained symptoms that she cannot identify. People on several prescription medicines who are not eating properly are putting themselves at risk—
Andy Burnham
I will give way once more, but I hope the hon. Gentleman makes a legitimate and reasonable point.
Mr Browne
I am grateful to the right hon. Gentleman for giving way. I do not dispute that there are people who live on a small amount of money or that some of those who go to see doctors are not eating adequately. But he attributed the pressures on A and E in part—he raised the issue, not me—to an increase in the number of people who are reporting to A and E with scurvy and rickets. He made that point with all the authority of a former Secretary of State, so he should tell the House how much of the extra pressure on A and E is attributable to people who have scurvy or rickets. If he does not know, why did he raise the issue in the first place?
Andy Burnham
I began by saying that the reasons for the rise in A and E attendances were complex. I did not say—if the hon. Gentleman was listening—that there were any simplistic reasons. I did say that there had been a rise in malnutrition and diseases linked to it. If hon. Members on the other side of the House want to dispute that fact, I will have that debate any time they wish. They seek to suggest that malnutrition is not a problem, but they are confirming how out of touch they are.
As I was saying, the number of emergency admissions of pensioners has topped 500,000 for the first time. It is rising faster than the increase in the ageing population. There were 65,000 more emergency admissions in the last 12 months compared to the previous 12 months, a clear sign of more frail, elderly people ending up in A and E. Hospitals are operating way beyond safe recommended bed occupancy levels, with increasing numbers of frail, elderly people on the wards. That means that A and E finds it increasingly difficult to admit people, and pressure backs up through A and E.
The Government’s amendment seems to have been written in a parallel universe. Let us get this clear: the last 12 months have been the worst in A and E for a decade. Hospital A and Es have missed the Government’s target in 44 out of the last 52 weeks. How can that equate to A and E performing strongly, as the amendment suggests? It serves only to confirm an impression that has been building about this Secretary of State since he took office: that he seems to spend more time paying attention to spin doctors than he does to real doctors.
Julie Hilling (Bolton West) (Lab)
One problem my food bank has reported to me is that people are reducing the number of drugs they are taking because they cannot afford to buy them. There is a queue in A and E departments to register. Not only are people waiting in ambulances outside, but there are queues of people, as happened in a hospital very close to this place, waiting to be registered.
Andy Burnham
My hon. Friend is absolutely right. She knows the pressure people are under in our area. What we have heard from the Government is denial that this is the reality in many parts of the country. [Interruption.] We can hear them shouting now, claiming that it is a myth that people are using food banks and not eating properly, and that they cannot afford to heat their homes because of the rise in fuel bills under this Government. All of that is placing extra pressure on A and E, and people are waiting longer and longer to be seen.
Margot James
I thank the right hon. Gentleman for giving way; he is being very generous. As he is widening the debate out to the wider economy, does he not accept that, although there are many reasons for increased A and E consultations and some of the issues relating to nutrition are valid, the point made by the hon. Member for Bolton West (Julie Hilling) about people not being able to afford prescriptions must be fallacious? They will receive free prescriptions if they have a very low income and are attending food banks. There are many more reasons than the right hon. Gentleman is giving credit for.
Andy Burnham
Not for the first time, Government Members are showing how out of touch they are with what is happening. The hon. Lady says that she is not aware that any family is unable to afford a prescription item. Let me put her straight: that is what many families are facing at the moment, particularly those who are in work, who do not get free prescriptions. They are facing difficult choices about whether they can afford to buy their prescriptions. If she is saying she does not recognise that problem, then I am afraid she really needs to get out of this place a bit more.
Huw Irranca-Davies (Ogmore) (Lab)
I did not intend to intervene, but I should say to the House and to the hon. Member for Stourbridge (Margot James) that I met recently representatives from community pharmacy associations and others who said to me, explicitly and clearly, that people from what one would assume to be relatively well-off families—middle class and relatively affluent—who are prescribed multiple prescriptions are now choosing not to pay for them because of the cost of living and the squeeze on their finances. They are choosing to go without, and that is apparent at pharmacy counters.
Andy Burnham
My hon. Friend puts his finger on it. There are families who are choosing between eating, heating or other essentials, such as prescriptions. That is the reality for many families and it is having an impact on their health. For those on the Government Benches not to recognise that that is the reality of life for many people, I fear for the state that we are in. They have been shouting at me for the past few minutes about scurvy. I can tell the hon. Member for Taunton Deane (Mr Browne) that the number of admissions has doubled. There are a relatively small number of cases, but they are on the rise. He really should not sit there barracking and dismissing the whole problem. He would do well to look at the facts.
Today, the Secretary of State says that the NHS got better in the past year. He should say that to the 131,000 people left waiting on trolleys for more than four hours. He should say that to the people finding it harder to get a GP appointment under his Government, left ringing the surgery at 9 am to be told that nothing is available. He should tell that to the families of children who have suffered a mental health crisis, but are told that there are no beds available anywhere in the country and end up being held in police cells. The truth is that the Government have failed to get the A and E crisis under control and it is threatening to drag down the rest of the NHS. In the past 12 months trolley waits are up, waiting times are up, emergency admissions are up, cancelled operations are up and delayed discharges are up, too. That is the reality of what is happening in the NHS.
One of the main reasons for the intense pressure on A and E is the collapse of social care in England. In December, a report from the Personal Social Services Research Unit found that, due to local government cuts, social care support in the home has been withdrawn from about 500,000 older and vulnerable people. These are people who were receiving support in the home, but are no longer getting any help. Even for those people still receiving some support, we continue to hear stories of corners being cut: slapdash 15-minute visits where staff have to choose between helping people wash or helping people eat. If we carry on like this, our hospitals will become more and more full of older people. A and E will be overwhelmed by the pressure and that really is no answer to the ageing society. That brings me to the second part of our debate today: the solution.
What is clear to most people is that there will not be a solution to the sustained pressure on A and E without better integration of hospital services with social care, primary care and more collaboration between the two. What is also clear is that there is now great frustration among people working in the NHS that they are being prevented from developing solutions to the A and E crisis by a large barrier standing in their way: the Health and Social Care Act 2012. This Government like to talk about integration, but the fact is that they have legislated for fragmentation. Under this Government, market madness has run riot throughout the NHS and is now holding back solutions to the care that older people need.
Guy Opperman (Hexham) (Con)
Will the right hon. Gentleman welcome the exact example that he so urgently seeks: Haltwhistle hospital in Northumberland? It is currently being built and I have been around it. It is integrated, with the local authority on the top floor and the NHS on the bottom floor. That is surely the model and the way forward.
Andy Burnham
I agree with the hon. Gentleman. There are examples of good practice out there, but I suggest that he speaks to chief executives of clinical commissioning groups and trusts. They are telling me that the competition regime introduced by his Government is a barrier to that kind of sensible collaboration. The chief executive of a large NHS trust near here says that he tried to create a partnership with GP practices and social care, but was told by his lawyers that he could not because it was anti-competitive. Does the hon. Gentleman support that? Is that what he thought he was legislating for when he voted for the Health and Social Care Act? People are being held back from doing the right thing for fear of breaking this Government’s competition rules.
Recently, we heard of two CCGs in Blackpool that have been referred to Monitor for failing to send enough patients to a private hospital. The CCG says that there is a good reason for that: patients can be treated better in the community, avoiding costly unnecessary hospital visits. That is not good enough for the new NHS, however, so the CCG has had to hire an administrator to collect thousands of documents, tracking every referral from GPs and spending valuable resources that could have been spent on the front line.
Yasmin Qureshi
My right hon. Friend might be aware that recently the trust in Bournemouth wanted to merge with neighbouring Poole trust, but the competition rules stopped the merger taking place.
Andy Burnham
My hon. Friend is right. For the very first time in the history of the NHS, competition intervenes to block sensible collaboration between two hospitals seeking to improve care and make savings. Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit. That is what has happened. That is not just what I say; listen to what the chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS:
“I think we’ve got a problem, we may need legislative change…What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it”—
that is, the law. That is from the chief executive of NHS England.
Andy Burnham
No, it was your law, your Government’s law, the Health and Social Care Act 2012—the same law against which his own care Minister, the hon. Member for North Norfolk (Norman Lamb), has recently been speaking out. He recently told the King’s Fund:
“I have a problem with the OFT being involved in all of these procurement issues… I think that’s got to change… In my view I think it should be scrapped in the future… That might happen at some future date… we’ve got to look at the barriers and address them and sort them out.”
Is that just his view, or the view of the whole Government? [Interruption.] He voted to let the OFT into the NHS. Why is he now changing his tune?
The former care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), said the same:
“The one area I have my concerns about is the way”—
the 2012 Act—
“opened up the role of the OFT.”
Yes, but did we not tell him that two years ago when he voted for the Act and when his hon. Friend the Member for St Ives (Andrew George), who is sitting next to him, joined us in the Lobby to oppose it? This is exactly what we warned them about. We warned them that it would let the market run riot through the NHS, but they would not listen, and that is why we are where we are today.
It is not just Ministers who are saying it; the comments by the chair of the Care Quality Commission at the weekend show the utter confusion in Government policy on competition in the NHS:
“We need more competition…more entrants into the market from private-sector companies”.
Will the Secretary of State clarify? Is that a statement of official Government policy? Is it his policy to get more private sector companies and more competition into the NHS? Is that what he wants? If that happens, it will mean more enforced competition leading to the fragmentation of care, and it will load extra costs on to the NHS at the worst possible time.
Grahame M. Morris (Easington) (Lab)
My right hon. Friend is making some positive points about the privatisation of the NHS, but does he share my concern that Monitor’s board is packed with executives who have come from private health sector companies?
Andy Burnham
We are seeing this across the NHS. We have also seen contracts going to companies whose shareholders are Tory party donors. The closeness of the links between the Tory party and private health care is worrying.
Since April, when their Act came in, seven out of the 10 contracts let have gone outside the NHS. That is the clearest of all wake-up calls about what is happening to the NHS under this Government: it is being broken up and sold off. Under section 75 of the Act, clinicians have to put services out to tender, regardless of whether they are performing well, and that is the big difference between this Government and the last one. They are enforcing competition and marketisation in the NHS, but nobody voted for it.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Why, when the right hon. Gentleman was Secretary of State, were the previous Government prepared to pay private sector providers 11% more than NHS providers?
Andy Burnham
Let me explain the difference to the Minister. When we were in government we used the private sector in a supporting role to help bring down NHS waiting times; he is using the private sector to replace the public NHS. There is a very big difference. He might remember that as Secretary of State I introduced the NHS preferred provider policy. At the time, his party complained—it said it was wrong—but I did it because I believed in the public NHS. I believe in what it stands for, unlike him and his party.
Dr Poulter
I remind the right hon. Gentleman that, unlike him, I have worked for the NHS and understand what it is like to work on its front line. Will he confirm that the previous Government introduced private sector provision into the NHS and paid 11% more to private sector providers than to NHS providers? This Government will not allow that.
Andy Burnham
The Minister looks pleased with himself, but I am afraid he has got his facts wrong. We did not introduce the private sector into the NHS; it has always worked with the private sector to relieve pressure on waiting lists. As a doctor, he should know that. He might also know that waiting lists and times came right down under the last Government, because the private sector supported the NHS, and I am proud of how we brought waiting lists down, but he is using the private sector to replace the public NHS. He is saying that any qualified provider can provide NHS contracts. I had a policy of designating the NHS as the preferred provider. So let us get the facts straight. There is a major difference between the two positions.
Mr Marcus Jones (Nuneaton) (Con)
If the right hon. Gentleman is so anti private sector involvement in the NHS, why did he allow an NHS hospital to be managed by the private sector?
Andy Burnham
I think the hon. Gentleman is referring to Hinchingbrooke, the contract for which, he will recall, was signed under his Government. If he comes to the House, he should at least have the decency to get his facts straight. A procurement exercise began under the NHS preferred provider policy that I introduced, but he will find that his Government changed that to any qualified provider, and then appointed Circle health, whose shareholders also happen to be major donors to the Conservative party, to run the hospital.
The Government are spending millions of pounds on competition advice under the regime introduced by the 2012 Act. Since last April, CCGs, have spent £5 million on external competition legal advice. How can that be justifiable at a time when we have a shortage of A and E doctors? Around the world, we see that competition not only costs more, not less, than a planned system such as the NHS, but results in more fragmentation. It will never be an answer to the pressures in A and E. We need an approach where clinicians can collaborate and develop integrated solutions to relieve pressure. How can we possibly achieve integrated care when there are several different providers, each providing a different part of the same patient pathway?
The A and E crisis will be permanent, unless the Government accept its root causes and remove the barriers to its solution. The answer is in the motion before the House. The House can vote to reverse the competition policy introduced by the Government in the 2012 Act and to remove the market madness now holding back the NHS, and it could all be done because it would be consistent with the coalition agreement. The simple fact is that nobody voted for the NHS to be broken up in this way. Who gave this Prime Minister and Government permission to put the NHS up for sale? Nobody. They said there would be no top-down reorganisation. In the fullness of time, “No top-down reorganisation of the NHS” will be to this Prime Minister what, “No rise in tuition fees” is to the Deputy Prime Minister.
The choice on the NHS in 2015 is becoming clear: it can stay on the fast track to fragmentation or it can return to its values of putting integration over fragmentation, collaboration over competition, and people before profits. That is what the Opposition believe in. Let us have that debate so that we can save our NHS for future generations.
Paul Uppal (Wolverhampton South West) (Con)
On a point of order, Madam Deputy Speaker. In response to yesterday’s sensitive statement on Sri Harmandir Sahib, the shadow Foreign Secretary, the right hon. Member for Paisley and Renfrewshire South (Mr Alexander), made a point about documents pertaining to Lady Thatcher not being released. In fact, they were released back in January. I would appreciate your guidance, Madam Deputy Speaker, as this is a very sensitive matter, and I would hate to see it politicised.
Mr Hunt
That is exactly what is happening in so much of the country. Despite a lot of pressure, our A and E departments are holding up extremely well. I wonder how the staff in that hospital would feel about the constant running down of the NHS that we get from the Opposition.
Let us look at the figures that the right hon. Member for Leigh quoted in more detail. How does he get the number he quoted for the worst winter for a decade?
Andy Burnham
Let us have a proper debate. I did not say the worst winter for a decade; I said the worst year in A and E for a decade. Let us get it straight. The Secretary of State should not redefine the question at the beginning of his speech. I am talking about the last 12 months, from this day today back to February 2013. Let us get that absolutely clear and let him answer for the last year, during which he has missed the A and E target 44 times out of 52.
Mr Hunt
Let us be absolutely clear. Why has Labour decided to remove the word “crisis” from the motion it submitted to the House this afternoon? It does not mention the word “crisis” at all, because the winter crisis that the right hon. Gentleman has been predicting for over six months now has simply not materialised.
Let us look—this is important—at how the right hon. Gentleman has been manipulating the statistics. He knows perfectly well that there is no A and E target for single categories of A and E; rather, the target applies to all A and Es. He gets his numbers by singling out the biggest A and E departments, type 1s, which are extremely important. How did type 1s—the most important and biggest A and Es—perform during the winter when he was Health Secretary? Let me tell the House: they missed their target every single week up until this point in the year. There are indeed pressures on A and E departments, but why does he think the country will listen to him, when by his own yardstick he failed to deliver every single week up until this point in the year?
The right hon. Gentleman has been predicting a winter crisis for months, and we are still waiting. For him, these debates are not about the reality on the ground; they are about hyperbole and spin. As someone who has been Health Secretary, he must know—this is a serious point—the effect that lurid headlines based on dubious statistics have on morale for staff and those using the NHS, but still we get the same cracked record, because for him, politics always matters more than patients.
It is not just A and E performance; under this Government—[Interruption.] It might not be comfortable for the Opposition, but let us look at the figures. Under this Government, MRSA rates have virtually halved, mixed-sex wards have nearly been eliminated and when it comes to elective care, more than 35,000 fewer people are waiting more than 18 weeks. That is thanks to the efforts of hard-working front-line staff. Our NHS is doing 800,000 more operations year in, year out than it did under Labour—something we can be immensely proud of.
Mr Hunt
I will give way in a minute, but this is an Opposition day debate, so I want to return to the central motion. Let me remind the right hon. Member for Leigh that he told this House—in fact, he had an Opposition day debate to do it—that the NHS budget had been cut in real terms. It had not: it rose. He also claimed that the number of nurses was being cut, when actually it went up. His attempts to talk up a winter crisis have been disproved time and again. That is important, because we have not had a proper apology to this House in relation to the letter he received from the chief executive of the south-western ambulance trust complaining about his spinning, which stated:
“information provided to your office in response to a Freedom of Information request…has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain.”
The right hon. Gentleman should not be playing politics with the pressures in A and E; he should be getting behind front-line staff, who are working extremely hard and who find that kind of tactic extremely demoralising.
Andy Burnham
For the record, I am afraid that the letter the Secretary of State quotes had its facts wrong. The information provided by the south-western ambulance service that I quoted was accurate. I wrote to the service the day it wrote to me to put it straight, and I am afraid it has not come back since and said that I was wrong; so again, let us get the facts straight. We have had enough spin from the Secretary of State; he needs to start dealing in a bit of fact.
Mr Hunt
I will tell the right hon. Gentleman exactly what the facts are. The other word I heard him use several times in his speech was “complacency”. I will tell him what complacency is: it is complaining about an English NHS that is hitting its A and E targets and completely ignoring Labour-controlled Wales, where the NHS has been missing its A and E targets since 2009. Something else that is complacent is this idea Labour has that, almost a year after the Francis report, the lessons of Mid Staffs stop at the border of England and Wales—that Wales has nothing to learn and does not need to do a Keogh report into excess mortality rates, which the Welsh Labour Government have consistently refused to do. People in Welsh hospitals are suffering because the Welsh NHS has refused to bite the bullet on excess mortality rates.
Mr Hunt
Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.
If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.
Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.
Andy Burnham
If everything is exactly the same, why did the Government legislate? Why did they need a 300-page Bill if they were doing everything that the previous Government had done? Let the Secretary of State answer this question directly. There was a huge debate in the House about section 75 of the Health and Social Care Act, and his Minister had to withdraw the regulations and rewrite them, but the view of the entire NHS is that section 75 requires services to be put out to open tender, and does not leave discretion with GPs. GPs cannot decide, as the Secretary of State has claimed. Services are being forced out to open tender. Is that the correct position, or is it not?
Mr Hunt
I am about to answer, if the right hon. Gentleman will be a little bit patient. The Act does not change the procurement requirements under which PCTs operated. It does not change the locus of the Competition Commission or the OFT under the Enterprise Act.
While we are correcting some facts, the right hon. Gentleman may be interested to know—as would my hon. Friend the Member for Taunton Deane (Mr Browne), but he is no longer in the Chamber—that we have the figures for the number of people admitted to the NHS with scurvy in 2011-12 and in 2012-13. In 2011-12, the number of admissions not just to A and E departments but in total—[Interruption.] Yes, including A and E departments. In 2011-12, eight people were admitted—[Interruption.] This was the right hon. Gentleman’s big argument about why A and E departments are under so much pressure. In 2012-13, 18 people were admitted. With the greatest respect, I think that the right hon. Gentleman is building his house on sand.
Paul Burstow
The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.
Andy Burnham
The right hon. Gentleman seems to be arguing that the Health and Social Care Act 2012 is perfect—[Interruption.] It was his Act; he was a Minister. I quoted him in my speech as saying that it now needs to be amended. Will he be straight with the House this afternoon: does it need to be amended to remove the role of the OFT?
Paul Burstow
The right hon. Gentleman must be reading my notes as that was my very next point. One thing about our politics is that it is very difficult for people to admit their mistakes, so let me do just that today. I regret that we included in the 2012 Act a provision for the OFT to deal with the specific issue of mergers. At the time, the argument was that the OFT had the expertise, but it clearly did not. Monitor should have that role. I want to address that issue either through agreement—the Secretary of State has suggested how that might happen—or by amending the legislation. That is my view based on how things have developed over time, and one cannot be more straightforward than that.
Paul Burstow
I thank the right hon. Gentleman.
The right hon. Gentleman spoke about Hinchingbrooke hospital and the franchising arrangement. The process started and was two thirds of the way through by the time the previous Government left office. There were only private sector providers in the competition when the previous Government left office—
Paul Burstow
I hope the right hon. Gentleman has had the opportunity to go and see what is happening at Hinchingbrooke, because it is doing fantastically well. It is being led by clinicians and is making a huge difference as a result. We should take heart from that.
Let me end by drawing out one point about A and E pressures. The situation is complex and driven by a multifactoral set of problems. There are seasonal changes, with high-volume, less complex A and E attendance in the spring and summer, and a pattern of fewer but more complex cases in the autumn and winter that often drive up admissions. It is also important to note that it is a question not just of an ageing society but of a rise in co-morbidity, which drives the pressures in our A and E departments. There are also changes in behaviour as people regard A and E as the first point of access for any ailment, driven by the fact that nine out of 10 GPs opted out.
In conclusion, the motion is flawed and does not celebrate the successes of this Government, not least in driving integration in a way that the previous Administration failed to do. For that reason and many others besides, it should not be supported and the Government amendment should be supported instead.
Kate Green (Stretford and Urmston) (Lab)
It is a great pleasure to follow the hon. Member for Suffolk Coastal (Dr Coffey) and to speak in this debate.
I have spoken several times about the experience in my area, where in recent months we have been undergoing a major reconfiguration of hospital services, particularly accident and emergency. I have to report that, whatever the metrics or the resourcing may be demonstrating, the patient experience as reported to me, particularly regarding our A and E departments at Manchester Royal infirmary and at Wythenshawe hospital, is that there is a great deal of pressure and strain in the system. People are reporting long waits in very pressured environments, and there is a genuine sense of unhappiness about the atmosphere in which they feel emergency care is being provided because of the stretched services. A whole range of pressures are coinciding. There is rising demand due to some of the social reasons that right hon. and hon. Members have mentioned, including individuals’ behaviour; public health crises; pressures on resourcing in the NHS; and the pressures brought about by reconfiguration itself. It is hard to disentangle which of those different pressures is contributing to so much stress in the system.
I would like to highlight a few key points that I hope the Minister will take on board. There is no doubt that more change is coming in the NHS and we are learning quite a lot in my area as we go along. First, the reconfiguration of accident and emergency services and their downgrading to an urgent care centre at Trafford general hospital has immediately been followed by rising numbers at neighbouring A and E departments. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) mentioned the huge rise, in percentage terms, at Salford Royal hospital. That is also the case at Wythenshawe, in particular, as we are discovering on the doorsteps in Wythenshawe and Sale East. My colleague Mike Kane, who I hope will very soon be an hon. Friend in this House, has been talking to hundreds of local people, and we know that Wythenshawe hospital is experiencing very great pressure.
On 10 out of 13 days in January, Manchester Royal infirmary’s A and E department failed to meet the four-hour waiting time target, as did Wythenshawe on 11 out of 13 days, and four Manchester trusts failed to meet the target in quarter 3. It is difficult to disentangle whether that is attributable wholly or in part to the reconfiguration of services. None the less, there are real pressures in our A and E departments in Greater Manchester. Particularly in the immediate aftermath of the reconfiguration at Trafford, there have been reports of long ambulance queues, especially at Wythenshawe. That is not surprising, because the reconfiguration has inevitably created significant numbers of additional ambulance journeys as people are presenting at what is now an urgent care centre but may have to be transferred elsewhere for specialist care. I understand that there have been 100 extra ambulance journeys in the immediate aftermath of the reconfiguration. People are also going to what are, in effect, their own places. I think that is understandable, because, as the hon. Member for Stafford (Jeremy Lefroy)—who is no longer in his place—has said, the picture is confusing.
Local road signs used to say, “A&E”, but now they say, “A&E not 24 hours”, following the reconfiguration at Trafford. To be frank, that is an utterly meaningless piece of information for somebody driving to an A and E department, because it gives them no idea of when during those 24 hours the service will not be open. There is also real confusion about what is or is not available at the urgent care centre and whether it is safe to go there.
Local people tell me that the reason they do not go to Trafford is that they do not believe they are any longer allowed to go there. That was not the clinicians’ planning assumption when the urgent care centre was introduced, but that is what patients believe. As the hon. Member for Stafford said—Sir Bruce Keogh has put his finger on this, too—it is really important that patients are given clarity about what is available, where to go and when. We have to pay much more attention to educating the public about that.
Another difficulty that we discovered very quickly is that the decision tree used by North West ambulance service has resulted in its taking cases to Wythenshawe and to Salford Royal and Manchester Royal infirmary which should, under the original plan, have gone to Trafford urgent care centre. We are learning a lot from what is going on in the aftermath of the reconfiguration. It would be interesting to hear from the Minister how the lessons will be taken on board and distributed.
Pressure is also being created in a wider context. My right hon. Friend the Member for Leigh (Andy Burnham) mentioned in particular the pressure of rising poverty, which is, without question, leading to higher levels of need and people presenting at our hospitals. The number of hospital admittances as a result of malnutrition nearly doubled—it went up from 3,161 to 5,499—between 2008-09 and 2011-12. They did not all present at A and E, but they did all present at a hospital and that is of real concern.
Andy Burnham
Was as my hon. Friend as surprised as I was at some of the sneering from Government Members when she intervened on me to point out that the number of malnutrition cases has gone up significantly? All we got from them was sneering abuse, but the facts speak for themselves.
Kate Green
When the Manchester Evening News published a report about the shocking rise in malnutrition in our region, people were horrified and commented voluntarily on how disgraceful and shameful it was that, in such a rich economy, we could be in such a situation. There is no doubt that that is partly because of pressure on family incomes.
I want to highlight the position of disabled people in particular, who face extra costs for special diets, aids and adaptations, prescription charges and continence pads. All of those costs have to be met by disability benefits that are of dwindling value. There is also further pressure on the services on which they rely, including day services, respite care, access to mobility aids and care at home, which is under great pressure because of social care budget cuts.
In conclusion, against a backdrop of great pressure—some of it to do with changes to the NHS, some with rising remand and some with wider environmental factors—change and further reconfiguration may be necessary, but it is very difficult to do it. I want to finish by making three points to the Minister about what we are learning from the situation in Trafford, where we are integrating health and social care. First, it is not a quick fix. Secondly, it is not possible to remove services from our hospitals before the care and provision is available in the community—that is of real concern at a time when budgets are pressed. Thirdly, there is a huge piece of work to be done—the Government have not embarked on it—on educating the public and driving up public understanding. The public in my local area are extremely confused about what the NHS is able to provide to them and where they should go to get it. I am sure we are not unique. The situation is undoubtedly creating additional pressure for hospitals and other NHS providers, and I hope the Minister and his colleagues will address it.
The Minister of State, Department of Health (Norman Lamb)
This afternoon, we have been presented with more of the same from the Labour party—the same scaremongering, the same misinformation, the same unwillingness to offer solutions. In short, it is the same old Labour party.
Earlier this week, we heard from the right hon. Member for Leigh (Andy Burnham) that the N was being wrenched off the NHS and that it was being sold to any company, but in reality only 6% of expenditure in the NHS goes to private providers. He talks about “market madness running riot through the NHS”, but listen to the facts: between 2006 and 2010, under Labour, total spending on the independent and private sector more than doubled; and between 2007-08 and 2010-11, under Labour, the number of operations conducted by the independent sector tripled. Since then, the figure has been around 46%.
Labour is desperately trying to make the public believe that its skewed vision is the reality of the NHS, but this view is of course total nonsense, and I am happy to try to set the record straight.
Andy Burnham
I think the Minister was in the Chamber when his predecessor as care Minister held his hands up and admitted he got it wrong on competition when the Health and Social Care Bill went through the House. He has given hints to newspapers that he feels the same way. Would he care to step into the confessional and admit that the Liberal Democrats got it wrong on competition in the NHS?
Norman Lamb
I certainly think we have to avoid any repeat of what happened in Bournemouth. It is absolutely right for politicians to make that clear.
The Labour party has tried to paint a picture of crisis in A and E. We know that there is more pressure on this vital service.
Oral Answers to Questions
Andy Burnham Excerpts(10 years, 6 months ago)
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Dr Poulter
I will certainly do that and write to my hon. Friend to reassure her, although members of staff who work part time often put tremendous effort into their work, and we often get well rewarded by the broader experience they bring as a result of being part time, so there are benefits to having part-time staff in the NHS.
Andy Burnham (Leigh) (Lab)
Figures out today show a staggering 60% rise in spending on locum A and E doctors under this Government—in some trusts, 20 times more—because they cannot recruit staff. It has now come to light that Ministers were warned about this problem three years ago. Dr Clifford Mann, president of the College of Emergency Medicine, said that when he tried to raise this issue, he was left feeling like
“John the Baptist crying in the wilderness”.
Why did Ministers ignore an explicit warning in 2011 from the top A and E doctor in the country?
Mr Speaker
Order. I do not wish to be unkind to the hon. Gentleman, but his answers almost invariably suffer from the failing of being far too long. It is nothing to be smug about; he really has to improve.
Andy Burnham
Mr Speaker, sometimes it takes a long time to rewrite history, which was what the Minister was just doing. The first warnings did not come in 2004. Dr Mann said:
“The first warning signs were three years ago when we failed to recruit 50% of our posts. Those concerns were raised at the time.”
Why does he believe his concerns were ignored? He blames “decision-making paralysis” caused by a top-down reorganisation no one wanted and nobody voted for. Ministers dismantled work force planning structures, making redundant the very people who could have done something to stop the locum bill spiralling out of control. Will he now concede that breaking the coalition agreement promise of no top-down reorganisation has weakened the NHS and made the A and E crisis worse—[Interruption.]
Accident and Emergency
Andy Burnham Excerpts(10 years, 7 months ago)
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Andy Burnham (Leigh) (Lab)
I beg to move,
That this House is concerned about recent Government statements on Accident and Emergency (A&E) and Government claims that it is not in crisis; notes that last week, 79 A&Es and the NHS overall missed the Government’s A&E target; further notes that attendances at hospital A&Es have increased three times faster since 2009-10 than in the period from 2004-05 to 2009-10, and that in the last 12 months more than one million people have waited more than four hours; believes there are a range of reasons for the current pressure on Accident and Emergency but that difficulty in accessing GP services is one of the primary causes; regrets the Government’s decision to cut funding for evening and weekend GP opening and scrap the guarantee of a GP appointment within 48 hours; and, to ease the pressure in Accident and Emergency, calls on the Government to reverse for winter 2013 its scrapping of the 48-hour appointment guarantee.
As we approach the end of 2013, it is becoming clear that this has been the worst year in accident and emergency for at least a decade. All year, the pressure has been relentless. It is not just a winter crisis, but a spring, summer and autumn crisis. Across the 12 months, more than 1 million people have waited more than four hours to be seen, which is a threefold increase since 2010. For the past 22 weeks, hospital accident and emergency departments have missed this Government’s target. Last week, the target was missed by the NHS as a whole, which is a warning sign that winter has now arrived and things are getting even worse.
Accident and emergency is the barometer of the whole health and care system. All year, that barometer has been warning us of severe storms ahead, and yet, three weeks ago, the Secretary of State stood at that Dispatch Box and claimed that this was
“a crisis that is not happening”.—[Official Report, 26 November 2013; Vol. 571, c. 155.]
He should try telling that to the families of people left waiting for hours on trolleys in corridors; to the people who have been ferried to hospital in police cars and taxis because ambulances are trapped in queues at accident and emergency; and to the A and E sister who attended our A and E summit here in Parliament last week and said:
“It feels like we’re fire fighting. It’s crisis management.”
David Wright (Telford) (Lab)
Is this problem not compounded by the fact that in many places such as Telford and Wrekin and the wider Shropshire area, the future of full A and E services at many hospitals is in doubt? That situation is bad for morale, and it compounds the other problems such as waiting times. People want some reassurance about the future of their A and E services.
Andy Burnham
That is a question for the Secretary of State. How can it make sense to close so many A and E departments in the middle of an A and E crisis? This year, the facts on the ground have changed. As I have said, it has been the worst year for a decade. Any proposal to change A and E in areas such as that of my hon. Friend needs to be considered in the light of that new evidence. We need to consider whether it is safe to proceed. As the A and E sister said, it is crisis management. That is the view from the real world. In here, it is a different story. It is, “Crisis, what crisis?”
My purpose in holding this debate is to cut through the spin. I want to bring into our debate today the voices of those A and E nurses, occupational therapists, paramedics, community nurses, and NHS 111 staff and mental health professionals who came to our summit. For instance, there is the paramedic who told us of his worries about ambulance response times getting longer because ambulances are trapped at A and E; and of the time when a patient who was held a long time at the door of a busy A and E suffered a heart attack and had to be rushed back to the ambulance. Another paramedic told us about being at the scene of a serious incident in a city centre. After calling for back-up, he was joined by a private ambulance which did not appear to have adequately trained staff to take patients to hospital. A community nurse spoke of her frustration at spending an hour and a half on the phone trying to get a GP appointment for a frail patient. An A and E-based occupational therapist said that she was now regularly diagnosing dementia for the first time in older patients who had ended up in A and E. Surely we can do better than that.
Grahame M. Morris (Easington) (Lab)
My right hon. Friend is giving an excellent argument as to why we are in this crisis. Is it not completely predictable given the response that we have just had on the local government grant settlement? Increased pressures on the system will be felt by old people and in deprived areas.
Andy Burnham
I agree. The Government have made grave mistakes. I warned them—they misquote me every week—that it would be irresponsible to give increases to the NHS, which is what they were promising, if they had to ransack local government, particularly social care budgets, to pay for them. That is a false economy. It means that older people have support withdrawn from the home, and they drift towards A and E in ever greater numbers. That is what is happening today on this Secretary of State’s watch.
Steve Rotheram (Liverpool, Walton) (Lab)
Given that we have just heard that Liverpool will face 62% reductions in local government settlements, does my right hon. Friend agree that the obvious consequence will be to put additional pressures on A and E in Liverpool hospitals?
Andy Burnham
The Government are tearing up the social fabric of England’s most deprived city. This is a city in which people struggle to feed their kids and to make ends meet. Council services are utterly crucial in helping people to cope. The Government do not understand, or they do not care, and they just rip up the fabric of an entire city. It is disgraceful.
Caroline Lucas (Brighton, Pavilion) (Green)
Does the right hon. Gentleman share my concern about the impact of the fines that are being levied as a result of delays in ambulance handovers? Many hard-working staff at the Brighton hospital say they are incredibly demoralising because they punish A and E for a problem that is actually hospital-wide, and it is hospital-wide because of cuts to the national tariff and because of the top-down reorganisation that nobody wants and that is hugely costly.
Andy Burnham
As the hon. Lady says, ambulance services and A and E are often now not working well together. I mentioned the paramedic held at the door, and we are hearing of queues at A and E. What we cannot have are perverse incentives in the system. The Secretary of State needs to look at the issue that she raises.
Andy Burnham
I will make some progress because I am conscious that many Members want to speak in both debates.
The picture that emerged from our summit was of a health service on the edge, creaking at the seams, with corners being cut and A and E as the last resort for people failed by other services—people who, in an ideal world, ought not to have been there. We heard of people with severe mental health problems in A and E because of a lack of crisis beds, people with severe dental pain who could not afford treatment, disorientated older people with dementia and, perhaps saddest of all, palliative patients in A and E waiting areas.
It is clear that the cost of living crisis and this Government’s failure to support people through it might also be driving people to A and E. The House is soon to debate the scourge of food poverty that now blights our land. Food banks are growing at an exponential rate. Indeed, we now read that it is Government policy to ask councils to set up more, even though they have just cut the funding of the councils with the most food banks. It is unbelievable. It suggests to me that they expect food poverty to be with us for some time to come and have no real intention of tackling it. People will go on having to choose between eating properly and putting the heating on—[Interruption.] The Secretary of State chunters, but he has no idea what it is like to do that, has he?
People are making other impossible choices that might damage their health. I am told of the growing number of people now taking prescription medicines on an empty stomach because they cannot afford to eat properly. Dr Ellie Cannon, a GP who also writes for The Mail on Sunday, recently tweeted:
“I’m sad to say that at my NHS practice if we have a patient who has unexplained symptoms, we have started asking if they can afford to eat”.
How can that possibly be right in England in 2013? Has the Secretary of State considered reviewing the effect on people’s health of the growing problem of food poverty and has he discussed the effects of benefits policy on people’s health with the Secretary of State for Work and Pensions? If he has not, I suggest that he does so immediately.
Barry Gardiner (Brent North) (Lab)
As my right hon. Friend is talking about general practitioners, does he agree that the Government’s failure to honour the guarantee that we gave that people could see a GP within 48 hours means that more and more people are going directly to A and E?
Andy Burnham
That is the central point of my speech: the removal of the guarantee that patients could get an appointment within two working days. The Government removed it in June 2010 and, as a result, we all hear stories, do we not, of people saying that they are getting up and ringing the surgery at 8 or 9 o’clock in the morning and are being told that there is nothing available for days. That is a result of the Government’s decision to remove the two-day guarantee. That is why people are facing that frustration. I shall explain that in more detail—[Interruption.] Government Members say that the guarantee did not work, but in 2005 nine out of 10 people said that they could get an appointment within two days. Have those Members checked the figures recently? There is falling satisfaction with GP services and it is happening on their watch.
I asked the Secretary of State whether he had spoken to the Work and Pensions Secretary, and he needs to do so urgently. The truth is that pressure has been growing all year on A and E and he has been ignoring the warnings, sticking to his usual line of blaming everyone else. His original line was to blame the 2004 GP contract, but that was undermined by the Chair of the Select Committee on Health and the inconvenient fact that there was no winter crisis in 2005, 2006, 2007, 2008 or, indeed, 2009.
Having seen his original spin dismissed, the Secretary of State changed tack. In a message to NHS staff on 6 December he said:
“Our ageing society has meant 1.2 million more people in A&E every year compared to 3 years ago”.
Finally we have an admission that the pressure has built on his watch, but as ever, it is nothing to do with the Government. It is nothing to do with the break-up of NHS Direct and its replacement with the disastrous NHS 111, nothing to do with the closure of a quarter of NHS walk-in centres, nothing to do with the severe cuts to social care and the removal of home care from vulnerable people, nothing to do with the loss of 6,000 nursing jobs and nothing to do with the reorganisation that no one wanted and no one voted for that threw the entire NHS into chaos just when it needed stability and that has led to precious NHS money being spent on redundancy payments only for those people to be re-employed by new NHS bodies. No, it is now all the fault of the ageing society. You could not make it up, Madam Deputy Speaker.
Ms Margaret Ritchie (South Down) (SDLP)
My right hon. Friend is making a compelling case about the problems in accident and emergency. Is he aware that they extend to Northern Ireland? Although devolved arrangements are responsible, we are told that the problems are down to the shortage of doctors, which emanates from Whitehall and the Department of Health. It is no longer a compulsory part of GP training for doctors to do a component in A and E and that is causing a problem.
Andy Burnham
I mentioned the reorganisation, through which we saw the complete disruption of training arrangements in the NHS. The Government’s eye was taken completely off the ball of the growing problem of recruitment, not just of GPs but of A and E doctors. That is a real problem around the country. We now have fewer GPs per 1,000 of population than we had a few years ago, so my hon. Friend is absolutely right to raise that issue.
The new spin is that the Secretary of State admits that A and E has got worse on the Government’s watch, but it is not his fault and it is not a crisis. That is the public line, at least. In private, it is a different story. This is the Secretary of State who has taken up ringing hospital chief executives who are not meeting their A and E targets. I have heard from two senior sources that the Secretary of State has discussed within government whether Cobra should be convened to discuss the A and E crisis. Can he confirm or deny whether that is the case? I have no way of knowing, but he needs to give a straight answer.
The longer we see the Secretary of State in this job, the more familiar we become with his style: spin before substance. That is the real danger when someone holds a job as important as his. If they use spin to distract people from the real causes of the problems, they end up neglecting those problems and precious time is lost.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
I know that the right hon. Gentleman is passionate about the NHS, but he seems to ignore the history. In the last year of the Labour Government, the average wait in A and E was 77 minutes. It is now 33. The Labour-run Welsh NHS has missed every target since 2009. Frankly, I am proud that our Government are putting the patient at the heart of the NHS by tackling the issues in hospitals and in our ambulance services.
Andy Burnham
Last week, the NHS missed its A and E target—the hon. Lady’s A and E target—which is a lowered target. If she is going to maintain that complacency through the winter, I suggest that it might well backfire on her.
Mr Gareth Thomas (Harrow West) (Lab/Co-op)
My right hon. Friend’s description of rising waiting times in A and E and ambulances queuing outside A and E will be recognisable to my constituents who use Northwick Park hospital. What is his view of the Government’s proposed new funding formula, which, I hear, might mean that £20 million will be cut from Harrow’s NHS budget?
Andy Burnham
Since the change of Government, the previous Secretary of State and this one have talked about a formula based predominantly on need, not deprivation. The worrying thing about that is that it means that we have a formula based on the use of NHS services as opposed to the need to improve health. NHS England has been debating that issue this week and I hope that it has taken heed of what has been said in this House, because to do this to the NHS alongside the local government cuts mentioned by my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) will be catastrophic for the communities in this country with the greatest need.
Mr David Lammy (Tottenham) (Lab)
Does my right hon. Friend recognise the perversity of our having a debate about airport expansion, with the London population rising to 10 million, while at the same time closing A and Es in west London, experiencing problems at St Helier in south London, closing Chase Farm and making changes in the east? Does that make sense with a rising population? Will it not lead to chaos?
Andy Burnham
The Secretary of State really needs to answer for the cuts to London’s A and E departments, particularly at a time of unprecedented pressure, and for the desire to bring forward closures supported by a financial case, rather than a clinical one, as in Lewisham.
I want to set the record straight about the 2004 contract and dismiss the myths that have been put about. The fact is that it gave the public much quicker and more convenient access to GPs and relieved the pressure on A and E. Let me explain the changes it made. First, it created the ability to add an incentive to allow patients to book an appointment several days ahead. Members might recall Tony Blair being challenged on that very point during a live TV debate before the 2005 general election. As a result, he brought forward a new measure to give people that ability to plan ahead. Secondly, it created incentives for GPs to offer evening and weekend opening. Thirdly, it allowed the previous Government to offer people a new guarantee of a GP appointment within two working days. And it worked. In 1997 only half of patients could get an appointment within 48 hours, but by 2005 nine out of 10 patients could do so. As a result, A and E was performing much better than it had been in 1997.
What has happened since? This Government have scrapped all those measures to improve patient access and convenience. They removed the right set out in the NHS constitution to an appointment within two days, stating that it was no longer a priority. It might not be a priority for them, but let me tell them that it remains a high priority for my constituents and those of my hon. Friends. This is the simple truth that they do not like to admit: it has got harder to get a GP appointment under this Prime Minister and this Government. People who call their surgery early in the morning only to be told that nothing is available now know why.
There are now 854 fewer GP practices in England offering evening and weekend openings than there were in July 2009. The Patients Association has found that six out of 10 people said they could not see a GP for at least two days and four out of 10 said they could not book an appointment for at least two days in advance. All that is leading to some people turning straight to A and E and others getting sicker while they wait and then arriving in A and E as a more serious case.
The Government have tried to blame GPs for the problem, but that is unfair, because this Government have cut the funding for general practice, cut the funding for delivering better patient access and convenience and, I have already said, cut the number of GPs per thousand of the population. The analysis could not be clearer. The question is where do we go from here.
The House has got used to the Secretary of State’s stock speech, which takes no responsibility for what is happening now in the NHS and seeks to blame the previous Government for everything that is going wrong. Well I have news for him: that will not work today. A and E is getting worse on his watch. He has presided over the worst year in A and E for a decade. People need an honest assessment of the situation, and of the urgency and the NHS’s ability to cope this winter. Does he accept that there is a crisis in A and E? He has gone quiet, but we will hear from him in a moment. Or does he still maintain that it is not happening? We need to know.
With January just around the corner, people want practical answers to straight questions and some proposals to make things better. First, will he consider making urgent changes to NHS 111 and putting nurses and clinicians back on the other end of the phone line? Evidence from across the NHS tells us that the cut-price model of call handlers with computer algorithms simply does not work. Too often the computer says, “Call an ambulance or go to A and E.” The sensible change back to an NHS Direct-style system was recommended by Sir Bruce Keogh in his report and should be made right now ahead of the winter.
Secondly—this is the centrepiece of what I want to say today—given the evidence to show that the 48-hour guarantee worked to divert people from A and E, there is a clear case for reintroducing it this winter. It is true that GPs might not be so keen on it, but it was valued by patients, and that is the most important thing. The Secretary of State needs to listen to what people are saying about their difficulties in getting an appointment in office hours, not in out-of-office hours. He must do something to address that. Will he divert some of the funding that he has made available to meet A and E pressures to that purpose, or indeed will he reclaim some of the funding he has handed back to the Treasury? It is so important that people can get appointments when they need them.
Those are two practical suggestions that I hope the Government will consider and accept. If the Secretary of State will not accept them, he needs to put forward other suggestions of his own to help people get access to good advice via a GP or over the phone and to avoid A and E this winter. If he refuses to do that, is he really saying that everything possible has been done to ensure that things do not get worse in the months ahead?
In conclusion, the NHS today stands on the brink of its most dangerous winter in years. It is a serious situation and people are looking for straight answers from the Secretary of State. It has got harder to get a GP appointment on his watch and people want to know what he is going to do about it. A and E is getting worse and worse on his watch and people want to know how he plans to turn things around and ensure that all A and E departments and ambulance services can get safely through the winter. He now needs to put away his stock speech, cut the spin and get a grip, and fast.
Mr Hunt
I am going to make some progress.
I want to talk about what is happening in England, because the right hon. Gentleman wanted to know the truth. These are the statistics he did not want to tell the House about the comparison with his time in power, which he said was so good: 1.2 million more people are going through A and E every year, and more than 2,000 are being seen within four hours every single day, compared with when he was Health Secretary. The average wait to be seen is now 33 minutes compared with 77 minutes when he was Health Secretary—that is 44 more minutes longer, on average, to be seen under Labour than under this Government. For treatment, the average wait is now 75 minutes compared with 102 minutes when he was in office.
Andy Burnham
Will the Secretary of State give a straight answer to this simple question: is there or is there not a crisis in A and E?
Mr Hunt
I refer the right hon. Gentleman to the people who know about this at the College of Emergency Medicine, which says today on its website:
“There is now cause for optimism that the crisis is behind us.”
He should listen to that before whipping up fears of a crisis that the College of Emergency Medicine says is not happening.
Paul Burstow
My hon. Friend is absolutely right. One of the good things that came out of the work by Keith Willett and Sir Bruce Keogh is the more coherent, communicable and understandable way in which emergency care can and should be organised. Indeed, in some cases there are also staffing pressures. Those are not helped by some of the unintended consequences of changing medical careers, as that has had an impact on the supply of medical doctors.
Labour’s answer seems to be that we should go back to the good old days—whatever they were—of a 48-hour target, but that target was flawed. When it was removed by the Government, the British Medical Association welcomed the change, which it said would give GPs greater flexibility to organise their appointments. Today we have heard—quite rightly—from the chair of the BMA, Dr Maureen Baker, who said the proposal was ill thought out and a knee-jerk response to long-term problems, and that it would make a bad situation worse.
Andy Burnham
Do not the views of patients matter most? The right hon. Gentleman is quoting the professionals, but perhaps it is sometimes inconvenient for them to have to do things. Surely the point is that people are ringing surgeries and cannot get appointments. If he does not like the 48-hour target, surely he and the coalition Government should put forward their alternative so that people can get to see their doctor.
Paul Burstow
With all due respect to the shadow Secretary of State, when presenting arguments in support of his motion he set out a range of professional expertise and opinions for why there should be a 48-hour target. It is therefore not unreasonable for me to quote other professional opinion on why that would not be good for patients. I will come to some of the alternatives that I think are relevant to addressing the A and E problem, because I do not think that simply addressing it through a 48-hour target makes any sense at all.
The changes the Government are making to the GP contract will help—not least having a named person co-ordinating care for the over-75s. I hope the welcome focus on frailty and multi-morbidity will be extended to more people on the basis of their need, not simply their age. Figures show that the average number of diagnosed conditions for patients admitted from A and E has increased over the past five years. In other words, the medical needs of people attending A and E are getting more complex, and that impacts on the amount of time people spend in A and E departments. Therefore, the answer is not one simple solution but must be a combination of actions. Much of that needs to be centred in primary and social care, as well as mental health services. In primary care we must recognise that it is not just about GP services and that we need best practice around the country, for example in engaging pharmacies as first care centres or getting them to play a key role in managing long-term conditions—a big driver of pressure on A and E departments, particularly in winter.
We need concrete action to drive the integration of health and social care—that may be mentioned in the motion, but the Government are delivering it, not least with the £3.8 billion first steps for a better care fund, which is bringing health and social care together in a practical and unprecedented way that has not been achieved before. That must be welcomed as a first step which I hope will grow as more resources are pooled across the system. It is essential to delivering the integrated, co-ordinated care that people want.
Mental health was neglected by Labour, under which there were no access standards or targets for people suffering a mental health crisis. In fact, under Labour two thirds of people suffering from a mental health crisis waited for more than four hours to be seen. I applaud what the Minister is doing to improve that situation significantly by setting standards for the first time to drive improvement in that area.
I conclude with a quote from Dr Clifford Mann, president of the College of Emergency Medicine:
“While this winter will be tough for the NHS and A and E departments in particular—”
I think we should acknowledge that—
“I believe there is now cause for optimism and that the crisis is behind us.”
Yes, there have been problems, but the Government have been addressing them in a comprehensive way. That is why this debate is mis-timed, wrong, and does our constituents no good whatsoever. It does not identify the real problem, although this Government are getting on with sorting the issue out.
Care Bill [Lords]
Andy Burnham Excerpts(10 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
I will make some progress, then I will give way.
Labour will today vote against measures that will help to implement 61 of the most important recommendations made by Robert Francis. Many of these will be policed by the new chief inspector of hospitals, appointed to be the nation’s whistleblower in chief, whose duties will be enshrined in today’s legislation, which Labour are voting against.
Andy Burnham
How can it be appropriate to introduce a debate on such fundamentally important issues as the way we care for older people with such narrow, petty, partisan, point scoring efforts? May I just say to the Secretary of State that he should not stand there and misrepresent the position of the Opposition? We will not oppose the Second Reading—we have tabled a reasoned amendment, because we do not believe his proposals for a cap are what they seem, but we will not oppose the Second Reading of this Bill. He should get his facts straight before he comes to that Dispatch Box.
Mr Hunt
The right hon. Gentleman needs to read his own amendment, because it says that he “declines to give” the Bill “a Second Reading”. If he is changing his position now, that is the fastest U-turn in history.
Let me go on to say why it is so important that the Labour party supports today’s Bill and does not, as the amendment says, decline to give the Bill a Second Reading.
Mr Hunt
I am going to make some progress. The new chief inspector of hospitals will act as Ofsted does with schools and, as with Ofsted, will inspect and rate hospitals using simple language that the public can understand: “Is my local hospital safe? Is it caring? Is it responsive? Is it clinically effective? Is it well led?” We will also make sure that the same scrutiny is directed at services outside hospitals, so the Bill makes provision for a chief inspector of social care and a chief inspector of general practice.
Ministers in the previous Government were repeatedly asked to strengthen the regulatory system and repeatedly ignored those requests. [Interruption.] The right hon. Gentleman says, from a sedentary position, that that is rubbish, but this is what Barbara Young, the chair of the Care Quality Commission at the time and now a Labour peer, told the Francis inquiry about the inspection system that the right hon. Gentleman introduced:
“The annual health check was so flawed in so many ways that I went and saw the Secretary of State. It was nonsense. And having argued that with the Secretary of State, I was told firmly that we weren’t permitted to change it. I was very unhappy about that.”
Well, today—
Andy Burnham
On a point of order, Mr Speaker. Is it in order for the Secretary of State to misrepresent the views of the previous Government and previous Ministers, and refuse to take interventions? He has just said that I refused to change and strengthen the regulation system of hospitals in England—that is factually incorrect. I brought forward a new system for the registration of all hospitals in England in autumn 2009, on the back of recommendations from the CQC. Again, he should get his facts straight at that Dispatch Box.
Mr Speaker
I am grateful to the right hon. Gentleman for his point of order, and I make two points in response. First, every Member and every Minister must be responsible for his or her comments in the Chamber—the accuracy and appropriateness thereof. I am afraid that, however angry people feel, on either side of the argument, these are matters of debate. Secondly, the situation would be greatly helped if the Secretary of State now, immediately, turned his mind to the presentation of the argument in support of the introduction of the Bill, which is, ordinarily, the matter upon which one anticipates a Secretary of State will focus his remarks. This is not an occasion for a historical legerdemain; it is an occasion for the presentation of the case for a Bill, to which I know that, without delay, the Secretary of State will turn his mind.
Mr Hunt
I am going to make some progress.
Thanks to our reversal of Labour’s 2004 GP contract, vulnerable people over 75 will have an accountable, named GP responsible for making sure they get the wraparound care they require.
The collapse of Southern Cross showed the risks to people’s care when providers fail, so through the Bill we are introducing provisions to help ensure that people do not go without care if their provider fails, even if they pay for their own care. The CQC will monitor the financial position of the most difficult-to-replace providers in England to help local authorities provide continuity of care in a way that minimises anxiety for people receiving care.
We also need to improve the training of health care assistants and social care support workers. For the first time, health care assistants will have a new care certificate to ensure they get training in compassionate care and the Bill allows us to appoint a body to set the standards for that training. That means that the public can be assured that no one will be assigned to give personal care to their loved ones without appropriate training or skills. My hon. Friend the Minister of State, who is responsible for care and support, will have more to say on those elements of the Bill when he closes the debate and I thank him for his outstanding work on raising standards in that area.
We also need to address the funding of care. At the moment, people fear being saddled with catastrophic costs and even having to sell their home at the worst possible time to pay for their care. The Care Bill significantly reforms the funding of care and support, introducing a duty on local authorities to offer a deferred payments scheme so that people will not be forced to sell their homes in their lifetime to pay for residential care.
We will also introduce a cap on people’s social care costs, raising the means test at which support from the state is made possible and delivering on the recommendation of the independent Dilnot commission.
Mr Hunt
My hon. Friend is right. We followed the recommendations of Andrew Dilnot, who did not think that the cap should apply to hotel costs, and, indeed, the policy that the Opposition followed in their national care service White Paper. We think that it is reasonable to cap the care costs. There is a cost issue—we would like to be more generous, but by the end of the next Parliament this proposal will cost nearly £2 billion. People who would like a more generous system must be obliged to tell us where they will get the extra funding.
Mr Hunt
The right hon. Gentleman will have a chance to speak later.
We want to be one of the first countries in the world where it is as normal to save for one’s social care costs as it is for one’s pension, and this Bill’s provisions make that possible. The deferred payments scheme, with a threshold of £23,250, on which we openly consulted, excludes only the wealthiest 15% of people entering residential care. How extraordinary it is that Labour should play politics by feigning concern for the richest in society, when they failed to do anything for the poorest over 13 years when they had the chance to do so.
Andy Burnham (Leigh) (Lab)
I beg to move
That this House, whilst affirming its belief that the Care Bill [Lords] is a modest step towards a better social care system that protects some people from catastrophic costs, and welcoming the new rights for users and carers that the former Labour Government initiated, notes that the Bill’s deferred payment scheme will result in people continuing to have to sell their homes to pay for care; disagrees with the Government’s assertion that their proposals will cap care costs at £72,000 given that self-funders will face far higher bills; further notes that it includes provisions which could put NHS hospitals at risk of having services reconfigured without adequate consultation and without clinical support; further notes that the Bill fails to include measures to address the current crisis in care and meet the needs of the UK’s ageing population, including a genuinely integrated NHS and social care system; and therefore declines to give a Second Reading to the Care Bill [Lords] because it is an inadequate response to the scale of the challenge facing social care and fails fully to implement the recommendations of the Francis Report.
The Bill began as a response to the Dilnot report and a reform of social care, but has since taken in major new measures on the NHS. It deals with issues that matter greatly to millions—issues to which that very thin speech we have just heard did not do justice. Worse, it was an inappropriate attempt to turn an occasion such as this into the latest stage of the Secretary of State’s political smear campaign. I refuse to sink to his level, and instead will deal with the important issues before the House today. For clarity, I will take the issues separately—social care, then health.
Providing good care for all older and disabled people and finding a fair way to pay for it is the greatest unresolved public policy challenge of our times. The failure of successive Parliaments to face up to it has left in place today a care system in England which is underfunded, overstretched—[Interruption]—and in danger of being overwhelmed—a malnourished, minimum wage service where care is given in 15-minute slots, with barely time to make a cup of tea, let alone have a meaningful conversation or make someone comfortable.
Alison McGovern (Wirral South) (Lab)
Members can hardly say “Ah!” after the performance that we just saw at the Dispatch Box. On the important issue of social care that my right hon. Friend is coming to, he knows that 100 or more of my constituents turned up on a Friday evening to talk to me about that. They want to hear from us today what we are going to do to fix the culture of low pay and poor conditions in social care, so will he say what he thinks local authorities can do, especially given the level of cuts that they face from this Government?
Andy Burnham
The issues are huge. They affect every family in this country and the worries they have about how they will look after their mum and dad in later life. They did not hear any answers from the Government this afternoon. I hope my hon. Friend will hear a few from me. I know that she has campaigned on the use of zero-hours contracts in our care system. Is it not a sad reflection on both sides of the House that today in England around 300,000 care staff are working on zero-hours contracts? They do not have the security of knowing what they will earn from one week to the next, so how can we expect them to pass on a sense of security to those they care for? Is not the message that we are sending to people who work in our care service, particularly young people coming into the service, that looking after someone else’s mum or dad is the lowest calling they can answer, when really it should be the very highest?
Julie Hilling
Would my right hon. Friend have been as shocked as I was yesterday when I met the carer of a woman who will be 99 next week and discovered that she has a five-minute call at tea time and a 10-minute call at bed time?
Andy Burnham
I would like to say that I would have been shocked, but I know that the system just gets worse and worse each year as the pressure builds and corners have to be cut, and it is older people and their families who are paying the price. How can any “care” be given in five minutes? Of course it cannot. It does not make financial sense in the long run, because we have a care system that does not provide people with support in their own homes, buts leaves them to drift towards hospital, leaving our acute hospitals increasingly and unsustainably full of frail older people.
Richard Graham (Gloucester) (Con)
I am slightly confused, because we have been called to the House today to debate the amendment tabled by the right hon. Gentleman, which states that this House
“declines to give a Second Reading to the Care Bill”,
but I thought I heard him tell the Secretary of State for Health earlier that he is not opposing the Bill’s Second Reading. Will he please clarify that?
Andy Burnham
I would have thought that the hon. Gentleman had been here long enough to know the difference by now. We will not oppose the Bill, in the sense that we will not vote against it on Second Reading, but it contains measures to which we simply cannot give a clear endorsement, as I will go on to explain. That is the purpose of our reasoned amendment. We will not oppose the Bill’s passage on Second Reading, which is why I objected to the Secretary of State misrepresenting my position.
Andrew George
I was going to make a similar point. Is it wise to bring forward an amendment of the type the right hon. Gentleman has tabled, bearing in mind the rather partisan nature of the debate we have had so far? What we really wanted was a debate on the Bill’s contents. Does he not now regret having brought forward such an amendment, because it has precipitated our going down into the gutter of partisan politics?
Andy Burnham
I agree with the hon. Gentleman, which is why I am not opportunistically opposing the Bill. I have tabled a reasoned amendment to put on the record the very serious concerns people have about funding for local authority care in England, the way the new cap will work and, in particular, the proposed clause on hospital reconfiguration—the Lewisham clause. I cannot let those concerns pass without making clear our position on them from the Dispatch Box. That is why we have taken that stand. That is why I am seeking to introduce my remarks in a non-partisan way.
Jacob Rees-Mogg (North East Somerset) (Con)
Will the right hon. Gentleman give way?
Andy Burnham
No, I want to make some progress.
I described the care system we have in England. Surely we can do better. In the last Parliament, the previous Government began a serious attempt at reform. I give this Government credit for continuing some of that work. The Bill contains many proposals originally put forward in my White Paper “Building the National Care Service”, published in February 2010. What most people will remember from the pre-election period was the clash between the parties on funding solutions, but what they might not have realised is that beneath the rhetoric there was much common ground on other matters. I hope that people will welcome that, just as we welcome some of the measures that are carried forward into the Bill.
First, stronger legal rights and recognition for carers are well overdue. For far too long, informal and family carers have been invisible to the system and taken for granted. That simply cannot go on. If statutory services are to be sustainable in the 21st century, they must learn to value informal care and carers and help them do more to help their loved ones. Secondly, we welcome efforts to simplify the social care system. Better information and advice will make a difference to some people. Unifying social care legislation in line with the recommendations of the Law Commission review initiated under the previous Government is sensible and overdue. Thirdly, the idea of a cap on the overall costs of care that individuals can face establishes the important principle that people should not lose everything they have worked for because of their vulnerability in later life.
I am happy to say that those are all important steps forward that we would not seek to oppose. However, let me be clear—this answers the points raised by Government Members—that this Bill is not equal to the scale and the urgency of the care crisis in England. It fails to implement the Dilnot report and does not provide a lasting solution. It does little or nothing to improve care services now or to reduce the costs of care for most people; in fact, it is likely to make things even worse. That is why we have tabled a reasoned amendment to draw the House’s attention to two major problems with the Government’s approach. First, prioritising funding a cap over and above protecting existing council budgets means that the care system will continue to go backwards and get worse, not better. In short, the Government are promising future help instead of helping people right now. Secondly, the proposed £72,000 cap is not what it seems; it is a care con.
On funding priorities, the Government are failing to face up to the scale of the funding crisis facing councils right now. In the cross-party talks on the Dilnot report, Labour stated a clear principle that the cap and the council baseline must be considered together as equal priorities. That was supported by Andrew Dilnot himself, as the right hon. Member for Sutton and Cheam (Paul Burstow) may remember, because he was also party to those talks. As a first step, we called on the Government to use some of last year’s NHS underspend to tackle the care crisis—and, by extension, to ease pressure on A and E—instead of handing the money back to the Treasury. The Government have not listened to that, and this Bill makes matters worse for local authorities by placing new, unfunded and uncosted burdens on them. The fact that it restricts the eligibility of those in substantial or critical need of support is, in itself, a clear admission on the Government’s part that the support system overall is being scaled back.
Mrs Madeleine Moon (Bridgend) (Lab)
I spent 30 years making assessments of people who were in care and addressing the care that they needed, often while working in hospitals to get them discharged. After 30 years, the same problem exists: there is not enough money in local government to pay for the care to get people home early to have the rehabilitation they need at home, with the quality of care to make sure that they do not deteriorate further and end up back in the hospital system. This Bill will not tackle that fundamental underlying problem.
Andy Burnham
My hon. Friend is absolutely right. This Bill promises far-off help for people while services are getting worse right now, because the Government have failed to address the crisis in local government’s ability to fund social care.
Andy Burnham
I shall in a moment.
What are the direct and practical effects of those cuts to council budgets? First, councils have cut eligibility criteria, so more people are exposed to care charges in a way that they were not before. Secondly, those care charges are now rising above inflation year on year, so more people are exposed to higher charges. This means that they are now more likely to pay right up to the new cap that the Government are introducing. That will not feel like progress to the public, and that is why we are making our reasoned objection to the Bill.
The Minister of State, Department of Health (Norman Lamb)
I am sure the right hon. Gentleman agrees it is important that we are accurate about these matters. He suggested that the Bill “restricts”—that is the word he used—eligibility for substantial or critical care. Does he accept that it does not do that, and that any council that wants to have more generous eligibility can continue to do so?
Andy Burnham
I do not disagree with the approach of setting national eligibility criteria and taking a national view, so I agree with the Minister on that. The problem, however, is that if the Government legislate for just critical and substantial levels, they are sending a very clear message to local government that they believe they can only afford to fund it at those levels. Surely the criteria would have been set higher if they were funding local government better.
The truth is that when this Government came to office, many more councils in England were providing social care at “moderate” level. That has been slowly cut back and now only about 23 councils are still providing support to people with moderate needs. It is a fair bet that those councils will soon be unable to provide moderate care and shrink back to providing only critical and substantial care.
Norman Lamb
Does the right hon. Gentleman accept that more than 100 councils were setting the eligibility criteria at “substantial” when his party left office? Is he saying that a future Labour Government would fund eligibility criteria at moderate level? If so, how would he fund it?
Andy Burnham
That is a political point; let me deal with it. When we left government, 38 councils were providing some free care to people with either low or moderate needs. I correct the figure I gave a moment ago: it is, in fact, 15 councils that are now doing that. The care system is being scaled back. Therefore, people are more liable to charges and are more likely to have to pay them, because support is being withdrawn from people in the home.
Andy Burnham
I was about to explain that those charges are increasing quite quickly, but first I will give way to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has done so much to raise these issues.
Barbara Keeley
I thank my right hon. Friend for giving way and I am surprised and disappointed that the Secretary of State would not give way.
My local council, Salford local authority, is one of the many that are reluctantly having to cut their eligibility criteria this year. Salford tried to stick with the moderate level and this is the third year of cuts. The council has lost £100 million over the past three years and it will lose another £75 million before the Bill’s reforms are implemented. That is a 20% cut in adult social care. How can any of the Health Ministers, whose southern local authorities are not affected in the same way, think that our northern councils can afford this?
Andy Burnham
Those are the facts. The councils that are still trying to provide support to people with moderate needs are not all, but by and large, Labour councils. They are still trying to do that, but they have lost significantly more per head under this Government than councils elsewhere. The situation is about to get a lot worse, because NHS England will meet tomorrow to consider a major change to the NHS resource allocation formula, which will reduce the weighting given to health inequality and increase the weighting given to age. That will have the effect of taking more money out of Salford and Wigan and giving more money to areas where healthy life expectancy is already the longest. The Government are making it impossible for people who want to do the right thing.
Mr Jeremy Hunt
Local authority budgets were indeed cut to deal with the deficit, so will the right hon. Gentleman tell the House whether he would reverse those cuts—yes or no?
Andy Burnham
The Secretary of State may remember that when he came into government he stood on a manifesto promising real-terms increases. He and the Prime Minister have stood at the Dispatch Box every week since the election saying that I said that we would cut the NHS, but that is not the case: I stood on a manifesto promising protection for the NHS in real terms. I said that if there were to be real-terms increases they should be given to social care instead, because it would be “irresponsible”—that was the quote—if the Government overfunded the NHS only to let social care services collapse: it would be a false economy, because it would push more and more older people into hospitals, and hospitals would stop functioning.
Do you know what? That is happening right now. The Secretary of State’s cuts to social care are forcing more and more older people into hospital. That is why he has an A and E crisis—because hospitals are full. On his watch there has been a 66% increase in people aged over 90 going into A and E via blue-light ambulances. If he is proud of that, that is up to him, but I certainly would not be.
Mr Andy Slaughter (Hammersmith) (Lab)
I am not surprised that the Secretary of State wants to change the subject, because if that decision is confirmed tomorrow my clinical commissioning group will lose £29 million—13% of its budget for hospital care. It has some of the poorest health outcomes, but that money will go to places where life expectancy and health outcomes are much better—in other words, Tory-controlled areas. That is a disgrace, coming on top of the closure of fine hospitals such as Charing Cross and emergency hospitals. That is the truth about what this Secretary of State is doing and I am afraid that all we have heard today is political spin.
Andy Burnham
The Secretary of State began by quoting the principles of the NHS. I was always led to believe that one of the principles is that the NHS should respect need—that funds should follow those in greatest need. [Interruption.] The Secretary of State says, “Absolutely.” In constituencies in parts of London, the midlands, the north-west, Yorkshire and the north-east, male life expectancy is 10 years lower than in other parts of the county. There is real need in those communities, but they will be the biggest losers if the change goes ahead. I believe that it is immoral to take money out of those communities to hand it to areas where life expectancy is already longer.
I hope that NHS England is listening to this debate. Quite apart from the morality of whether the change should be made, how is it that a quango can distribute about £80 billion of public money to our constituencies while we seemingly have no locus whatever in such a decision? Should not the Secretary of State be at the Dispatch Box either to defend changes that he makes or to say that such changes will not go ahead, so being accountable to this House? Instead, a quango—the biggest in the world—seems to be about to take money out of some of the most deprived parts of the country.
Kate Green
I was very disappointed that the Secretary of State would not give way to me, because he did not once mention the position of disabled people in his opening remarks. Does my right hon. Friend not agree that councils being forced to raise the threshold to “substantial” or “critical” will pile up costs for disabled people and their isolation? They cannot get access to moderate levels of care, go out to work or volunteer in their communities, but are shut at home unable to participate. That is bad for them, and it is a false economy.
Andy Burnham
I could not agree more. I would guess that disabled people listening to the debate today will be very worried about what they are hearing. The change will restrict support for them, and it is a false economy. If they cannot go out to work, how on earth does that help them or, indeed, anybody? The change will have an impact on disabled people, with some losing their support.
I was going on to make the point that disabled people and older people are already paying much more for care as a result of changes in recent years. As research by my hon. Friend the Member for Leicester West (Liz Kendall) has shown, they are paying almost £740 more a year for vital home case services compared with 2010, up on average by almost £50 a month. That is a hidden cost of living crisis, because who sees that older people have to pay more out of their bank accounts? It goes unnoticed by the media and large parts of society, but the most vulnerable people in society are bearing the brunt.
Dr Sarah Wollaston (Totnes) (Con)
I am glad that the right hon. Gentleman has mentioned older people. Does he accept that although health inequalities are very important in setting funding formulas, age is one of the greatest predictors for establishing need? It is absolutely vital to include such factors as age and rurality in deciding funding formulas, and it is precisely to remove the politicisation of such decisions that we are handing them over to another body.
Andy Burnham
The hon. Lady must have misunderstood me. I am not saying that age is unimportant; I am saying that age is important, but so is need. In my view, those two must have equal weighting in the system, as they do at the moment. As I understand it, the proposal is to deprioritise need or deprivation as part of the funding formula, which will have the effect of removing funding from communities in which the expectancy for a healthy life is already shortest. I do not believe that that is defensible, and I would be surprised if she found that it was.
Dr Wollaston
The right hon. Gentleman is being generous in giving way. The point is that we are discussing the Care Bill and how need relating to age is the single greatest predictor of someone’s need. I accept that health inequality is a very important factor, but the formula currently does not take enough note of age-based need and multiple long-term conditions.
Andy Burnham
I am not sure that I agree with the hon. Lady. Some older people in my constituency probably do not have as good a quality of life in later life as some in her area, because there are ex-miners with chronic obstructive pulmonary disease and other things, who have very extensive needs caused by the dangers they were exposed to during their working life, and that places a burden on our health service. Of course, people are more likely to be living with chronic disease in more deprived areas, and both those things have to be recognised in the funding formula. If the change goes ahead, it will cause great volatility and move a lot of money around the system, but it will not allow areas such as the one I represent to invest in the home-based, high-quality, integrated services that the Secretary of State said he wanted.
To return to the costs of care charged by councils, let us call the hikes in charges what they are—stealthy dementia taxes that seek out the most vulnerable people in our society. The more vulnerable someone is and the greater their need, the more they pay. People who are paying more for care under the current Government and often receiving a worse service will not be convinced by the Secretary of State’s claims for his Bill today. It will feel like a con, and that feeling will only intensify when people understand more about the proposed cap.
Although we welcome the principle of a cap, this one is not what it seems. It is set at £72,000, despite Dilnot warning that a cap above £50,000 would not provide adequate protection for people with low incomes and low wealth. The Health Secretary has repeatedly said that people will not have to pay more than £72,000 for care.
Andy Burnham
The Secretary of State is nodding, but I hope he will be honest enough to admit today that that is simply not the case. In reality, the average pensioner could pay more than £150,000 for their actual residential care home bill—£300,000 for a couple—before they hit the so-called cap. I will explain why. It is because the cap will be based on the standard rate that local authorities pay for a care home place, not the actual amount that self-funders are charged, which is often much higher than the council rate. It is estimated that in 2016-17, when the cap is due to start, the average council rate for residential care will be £522 a week, and the average price of a care home place will be £610 a week. That is because self-funders pay more than councils. However, that will not be taken into account when the cap is calculated.
Paul Burstow (Sutton and Cheam) (LD)
Will the shadow Secretary of State confirm to the House that the use of notional costs, which he is describing, was not a Government proposal but one of the Dilnot commission’s recommendations?
Andy Burnham
I remember that the right hon. Gentleman showed a good deal of support for the Dilnot proposals, as did we, but they worked as a clever package. They were carefully constructed to ensure that the system would work, be progressive and provide support to everybody. They have now been pulled apart and different figures have been introduced.
Andy Burnham
The right hon. Gentleman shakes his head, but a £72,000 cap is not what Dilnot recommended. That is the Government’s problem. As I said before, the cap will not cover hotel and accommodation costs, either. When both factors are taken into account, an average person in England will take almost five years to hit the so-called cap. Based on average stays in care homes, that means that six out of seven elderly people will have died before they reach it.
If that were not bad enough, people are about to find out that the promises that they will not have to sell their home are also a con. The ability to defer payment for care was one of Andrew Dilnot’s central proposals designed to stop people worrying about selling their home while they were alive. He said that old people would be able to borrow from the local council and repay care bills from what they left behind. The Government initially said that they would implement that proposal and introduce what they called a universal deferred payments scheme. I remember when they used to call that type of proposal a death tax, but things have seemingly moved on for the better.
However, on the day when Parliament rose for the summer recess, the Department sneaked out a consultation document saying that pensioners would not qualify for any help under the universal deferred payment scheme until their savings and other assets, such as valuable possessions, had been run down to below £23,250. That new condition will prevent almost half of those who would otherwise have been able to take advantage of that apparently universal scheme from accessing it.
Norman Lamb
Does the right hon. Gentleman accept that that was exactly the same proposal as his party’s Government put forward just before they left office?
Andy Burnham
Just as the Government’s proposal is not the Dilnot report, it is not my national care service proposal. I had a range of different proposals, and that one has to be considered in that context.
As the Minister knows, I proposed a universal approach in which everybody would contribute on the NHS principle—I seem to remember that he and I were in some agreement about that. That was a deferred payment, but this proposal is different. The Government are talking about a universal deferred payment scheme in which people will pay from what they leave behind, but—and this is the point—it will not be available to everybody. That was the promise the Minister has broken.
Grahame M. Morris
My right hon. Friend is making excellent points. On deferred payments, this proposal has been presented as something new, but is it not the case that about 90% or 95% of local authorities currently offer a similar scheme?
Andy Burnham
They are offering a similar scheme but at the moment they are not allowed to charge interest on it. That brings me to the next part of what is wrong with these proposals. What the Health Secretary has not said today is that interest will be charged on his proposed deferred payment scheme, which is not universal because it is not available to everybody. A loan to cover the average length of stay in a care home—two and a half years—would clock up extra costs of £3,500 in interest alone. That interest would not be included in the cap but would be outside it. Again, people will not feel that what they are paying is related to a cap.
Andy Burnham
I noticed that the Secretary of State was not very good at giving way, and I hope in future he will bear that in mind.
Andy Burnham
I was proposing a fundamentally different policy in a national care service. I ask the Secretary of State politely whether it is about time he stopped trying to say that everything is about the past? Why did he not stand there, explain and justify his own policy? Would that have been a good thing for him to have done today, instead of leaving it to me to explain what he is proposing?
Mr Stephen Dorrell (Charnwood) (Con)
In the interests of explaining his policy, will the right hon. Gentleman confirm that the answer to the question posed by the Secretary of State and the Minister was, “Yes”?
Andy Burnham
I say again, with all respect to the Chair of the Health Committee, that I was proposing a fundamentally different scheme to that in the Bill. I was proposing a universal all-in scheme, and several steps were put forward to get us to that. The right hon. Gentleman knows that because the Conservative party and those on the Government Front Bench put posters up about that scheme before the last election. Does he remember that? [Interruption.] He nods, right—that was my proposal, but it is not the Government’s proposal, which is different. I proposed various steps to get to my scheme. Is it about time the Government started answering for their proposal, rather than for mine?
Barbara Keeley
My right hon. Friend is being generous in giving way, and I guess we ought to move on shortly. There is all this harking back to our policies, but I understand—I was here—that steps were taken towards Labour’s national care service, including the Personal Care at Home Act 2010 that would have helped 400,000 people, not the 100,000 who will be helped by this Bill—if, indeed, it ends up being 100,000. Is my right hon. Friend, like everybody else, totally disappointed with the Government’s lack of ambition to help people?
Andy Burnham
I completely agree, and it is unfair that older people have not been given a full picture. People need proper information to plan for the future, and they have not been getting that today. People need the facts. Spin is of absolutely no use to them whatsoever, but that is all that is on offer from this Secretary of State. The truth is that in the end, the Bill will not stop catastrophic care costs that run into hundreds of thousands of pounds, or stop people losing their homes. It will not improve services now as it promises only a vague review of the practice of 15-minute visits, and strips the Care Quality Commission of its responsibility to inspect local authority commissioning, which is often responsible for such things.
Andy Burnham
I will make some progress and turn to part 2 of the Bill and measures related to the NHS. It would help to get a few facts clear. The Secretary of State seeks to denigrate Labour’s record at every opportunity, but let me remind him that the Labour party left an NHS rebuilt with the lowest ever waiting lists and highest ever public satisfaction. The previous Labour Government introduced independent regulation of NHS hospitals for the first time, prompted by previous scandals at Bristol, Alder Hey and the Shipman murders. The Secretary of State should cast his mind back a little further before coming to the House and making unfounded allegations.
As Robert Francis rightly acknowledged in his report, there was no system of independent regulation before 1997. It was the independent regulator that first uncovered the failings at Mid Staffs and, later, at Basildon. As the party that introduced independent regulation in the NHS, Labour has no problem with strengthening it and providing legislative backing for the appointment of chief inspectors for hospitals, general practice and social care, but let us be clear: those were not recommendations of the Francis report.
The Secretary of State accused us of not supporting the Francis report. We do support the report; it is the Government who are not implementing its recommendations. Just as part 1 of the Bill fails to implement the Dilnot report, part 2 fails to implement the Francis report. One of the report’s central recommendations was for a statutory duty of candour for individuals, but the Government are proposing that it should apply only to organisations. How will an organisational duty help individuals to challenge an organisation where there is a dysfunctional culture? It will not, and we urge Ministers to think again. They also need to clarify whether the duty will cover the most serious incidents, and whether it will apply to all organisations that provide NHS services, including outsourced services.
My main objection to part 2, however, is that it embodies the huge contradiction that now sits at the heart of Government health policy. The Secretary of State talks of independence for the Care Quality Commission in the same way as the Health and Social Care Act supposedly legislated for the independence of the NHS, but this is the Secretary of State who has taken to ringing up hospital chief executives who are not meeting their A and E targets. The Secretary of State nods, but that is not “independence of the NHS”. This is the Secretary of State who holds weekly meetings with the supposedly independent CQC, Monitor and NHS England. What precisely is the Government’s policy on independence? People are becoming confused. Clause 118 makes it clear that the Secretary of State wants more control: he wants sweeping powers to close hospitals without proper consultation and clinical support.
Dame Joan Ruddock
Does my right hon. Friend recall that in the case of the failing South London Healthcare NHS Trust, the trust special administrator got his financial projections wrong? He massively overspent his own budget, and failed to point out the consequences for the solvent Lewisham hospital, which was in a different trust and which, as a result, did not consult on them. Does my right hon. Friend imagine that there is any way in which such a consultation could take place and produce good outcomes in just 100 days?
Andy Burnham
I pay tribute to my right hon. Friend. She and the people of her community stood up to an arrogant Government, and won a victory for every community that was worried about the future of its hospital. One would have thought that, following humiliation in the courts, the Government would have backed off gracefully, but no: here comes the Secretary of State again today, like someone who, having been caught breaking in through the back door, has the brass neck to return and try to force his way in through the front. Well, we will not let him get away with it. We give him notice that clause 118 is wrong, that it is an affront to democracy, and that we will oppose it every step of the way.
Hospital reconfiguration should always be driven by a clinical case first and foremost, but clause 118 paves the way for a new round of financially driven closures. It rips up established rules of consultation and the clinical case for change. It allows the Secretary of State to reconfigure services across an entire region for financial reasons alone, which means that no hospital, however successful, is safe. The House needs to stand up to this audacious power grab by the Executive.
Joan Walley (Stoke-on-Trent North) (Lab)
The clause introduced in the House of Lords gives extra powers to the trust special administrator. Are we not now faced with a complete contradiction? Rather than clinical commissioning groups commissioning services, the TSA will commission long-term services, and there has been no proper consultation. In Mid Staffordshire and North Staffordshire, for example, we have had a consultation procedure that has taken no account whatsoever of services in North Staffordshire.
Andy Burnham
That illustrates the confusion that is currently at the heart of the NHS. No one knows who is in charge of anything. What if CCGs and the boards of foundation trusts disagree with the conclusions of the TSA? How will that be resolved? Were we not told that doctors were sovereign? Were they not supposed to decide everything? Was that not the big call when the Government introduced their Bill? It seems that that is no longer the case: everything can be done “top down” by the Secretary of State. It takes power away from every Member and could be used as a back-door way to railroad through unpopular changes.
The real danger of the proposal comes when it is seen in the context of the competition regime created by the Health and Social Care Act 2012. Of course, it is sometimes necessary to make changes to local health services beyond just a failing trust. That is best done through partnership and collaboration, but such sensible changes are now being blocked by the market madness imposed by the Act. We recently saw the ludicrous spectacle of the Competition Commission intervening in the NHS for the first time to stop the sensible collaboration between Bournemouth and Poole. Since when did competition lawyers decide what was best for patients?
Andy Burnham
One reason the Lewisham clause is so worrying is that simple collaboration between hospitals to solve financial problems is no longer an option to ease financial pressures. That is what it has got to do with the Care Bill. The Government are making a case for all hospitals standing or falling on their own, and in that context, the weakest can be picked off by the Secretary of State and closed without consultation. Given the financial pressures on many organisations, this special administration process is likely to be used on an increasing basis, putting more hospitals at risk. That should send a shiver though every community represented in the House today.
Mr Jim Cunningham (Coventry South) (Lab)
Does my right hon. Friend agree that the Government seem to have adopted a drip, drip, drip strategy to discredit the NHS? I can remember him proposing a national care service some months before we left office, but the Conservatives rejected it.
Andy Burnham
They did, and they put those posters up at the election to try to scare older people—I do not know how they thought that was appropriate, in the same way I do not know how their contributions today have been appropriate.
What my hon. Friend the Member for Coventry South (Mr Cunningham) says is exactly what is happening. People are not daft. They can see what is going on. They saw a Government legislate to place the market at the heart of the NHS in a way that means we now have the Competition Commission making decisions and forcing services out to open tender. We also have a Secretary of State who does not waste a day running down the NHS—“uncaring nurses”, “lazy GPs”, “coasting hospitals”; everything undermined, everything wrong—rather than celebrating good care. That is the agenda. They are softening the NHS up for more privatisation.
That will be the big choice come the next election. The Secretary of State can spin whatever lines he wants from that Dispatch Box, but that is the choice: a public, proud NHS under Labour, or a fragmented market under the Conservative party. I know which side of the debate I am on, and that is the choice we will put to people.
Charlotte Leslie (Bristol North West) (Con)
Independent sector treatment centres—the right hon. Gentleman’s party started competition!
Andy Burnham
Across the NHS, people are spending millions on competition lawyers thanks to the Bill that the hon. Member for Bristol North West (Charlotte Leslie) and others passed. That is being cited as the major barrier to the integration that the Secretary of State claims he wants. Let me quote the NHS chief executive to back up that point. He recently told the Health Select Committee:
“What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost in the system and great frustration for people in the service about making change happen… In which case, to make integration happen we will need to change it”.
By which he meant the Health and Social Care Act. It could not be clearer. It is the biggest barrier to the integration of care and support for older people. That is understood across the NHS, but the Bill does nothing about it.
Instead, the Government have left an NHS bogged down in competition law. How did it come to that? Who voted for that change? Who gave this Prime Minister and this Health Secretary permission to do something that Margaret Thatcher never dared—put the NHS up for sale? The answer is no one. Ministers talk the talk about integration, but they have legislated for fragmentation and privatisation, and the Bill does not change that. Only Labour will repeal the Health and Social Care Act, and that will be the big choice, as I say. We will bring health and care together, creating a public service working for the whole person. That is the only way we can reshape health and care services around individuals in their own homes.
In conclusion, the Bill makes some sensible changes that we will not oppose, but as our reasoned amendment makes clear, it falls far short of the durable solution that England needs. Social care in England is getting worse, not better, and the Bill does nothing to change that. It will not stop people having to lose their homes and savings to pay for care, and in the end it deceives older people about the amount they might have to pay for care, which is fundamentally wrong. Older people deserve better, and it will fall to Labour to have the courage to deliver it.
Mr Dorrell
Of course I accept that if we have more money, we can do more, but I do not think that that exempts us, particularly given the public finances we inherited in 2010, from the obligation to see how we can get more for the £125 billion of taxpayers’ money that is already committed to health and social care in England.
That brings me to clause 3. The only way to deliver person-centred care and early intervention to prevent avoidable cases, is to reinvent care on a much more integrated model between the national health service and the social care authorities. That is why there is the obligation in clause 3 to consider integrating health and care. In that way we will not think of the NHS as one bureaucracy and social care as another, but instead think of it, as Mike Farrar said when he was at the NHS Confederation, as a care system that provides medical support when necessary, rather than as a medical system that provides care support when it has got the money—that is how not to do it.
Andy Burnham
The right hon. Gentleman will recall that the NHS chief executive stood before him and his Committee saying that the competition legislation was the biggest barrier to achieving the vision he is rightly describing; he and I agree about the vision of person-centred services in the home. If the NHS is saying that before his Committee, why does he say that the competition regime is irrelevant? Is it not fragmenting care, rather than integrating it?
Mr Dorrell
I did not say it was irrelevant; I said it was not germane to this Bill—and in the seven minutes remaining to me, I am not going to cover that. All I will say to the right hon. Gentleman is that the difficulty with competition policy that the NHS chief executive talked about is a difficulty that health care systems around the world—in north America and in continental Europe—are finding as well. I agree with the right hon. Gentleman, however, that we need to look at how competition policy can be aligned with the policy prescriptions I am describing.
I now want to list the fourth key premise upon which this Bill is based; in what must be a short speech, I can list only four. It is around the well-being of individuals; it is around early intervention and prevention; it is around integration; it is also, critically, for the first time in statutory form, around doing needs assessments that take account of the needs not just of the individual person, but of their carer and social context as well. In that way, the support that is provided to individuals takes account of the context in which they live, rather than treats them as individuals divorced from the carers and people who care for them when the statutory social worker is not there.
The Opposition spokesman said this is an enormously ambitious set of objectives, and I entirely agree that the objective of redefining the delivery of health and social care in a way that matches the aims set out in the first three clauses and clause 10 around carers is ambitious. The objective is to re-imagine care so that we think of the health and care system not as being primarily around acute hospitals, but as a system designed to meet the needs of that majority of people who are the main focus of those who work in the service—people who primarily have a care need with an occasional medical or clinical requirement. In other words, this is about thinking about the system from the front end rather than viewing it from the top of the bureaucracy. I commend this Bill because I believe it sets that framework in statute.
I also commend the Government because they are not just setting out these aspirations as commitments in law. It is one thing to change the law. It is another thing to change the way the service is actually delivered on the ground. The most effective step the Government have taken to achieve this re-imagination of care is the £3.8 billion that my right hon. Friend the Secretary of State talked about. That is £3.8 billion voted into the NHS but available only if the service at local level delivers the joined-up, person-centred care that is set out in the first three clauses of the Bill. So this is not just a set of wordy aspirations; it is a set of aspirations supported by the resources necessary to deliver the change in the care model that the Bill describes. The £3.8 billion is the catalyst that will allow us to deliver the objectives.
With respect to those on the Opposition Front Bench, it is wrong to say that it is only £3.8 billion out of £125 billion. The £3.8 billion is the minimum that the law will require to deliver integrated care within a locality, through the health and wellbeing boards that are much beloved of the right hon. Member for Leigh (Andy Burnham) and which were legislated for by the Government. This is an important step forward. If the health and wellbeing board in a locality can see a way to use health resources to deliver a changed model of care that puts more focus on prevention and on individuals through the delivery of more joined-up services, there is no constraint in the legislation, as I understand it, to prevent more than £3.8 billion from being used for the delivery of that objective.
Resources are important in this regard. This is partly about the £3.8 billion from the taxpayer, but it is also about individual resources. It is about individual users having their right set out in the Bill to engage with their personal budgets and with direct payments, enabling them to make real choices about how joined-up, person-centred care will work best for them. It is the curse of these health debates to imagine that we can gather 650 people together in this Chamber and work out how we are going to deliver £125 billion-worth of care in a way that will work for an individual old lady in her own home. That is nonsense; we need to engage the people themselves in the decisions on how the resources are used. We also need to assure them that they will not be exposed to catastrophic personal losses by making their own contributions to their care. That is why I welcome the fact that, despite what the right hon. Member for Leigh says, the Bill gives effect to the basic propositions set out in the Dilnot report.
The Bill sets out the vision of person-centred, joined-up, integrated care, and the Government have set out plans to commit resources to turn those fine words into deeds. Also, through the establishment of an independent Care Quality Commission, the Bill will provide independent assurance about the quality of care that is provided right across the health and care system. The right hon. Gentleman claims credit, as he is entitled to do so, for the fact that the previous Government took the first faltering steps down the road to introducing proper regulation of health and care provision, but he cannot possibly believe that the Care Quality Commission that he bequeathed was fit for purpose. If he does, he is the only man in the kingdom to do so. I welcome the fact that this Government are putting in place new management and, importantly, a new statutory framework so that the aspirations that might have motivated the Labour Government to set up the CQC will now be delivered in reality.
Norman Lamb
I note the position in Salford, and I recognise that finances in local government are tight. However, the Opposition have not recognised that 108 councils were already providing social care with substantial need as the eligibility criterion before the general election. They never mention that, but it is the truth.
Baroness Campbell has called the continuity of care provisions a “landmark reform”. Although we have heard the suggestion that we have somehow moved away from what Andrew Dilnot suggested, he has said:
“For the first time you don’t have to be terrified of the consequences of needing care…this system will radically reduce anxiety…It doesn’t seem to me that it’s so different from what we wanted.”
Several references have been made to the funding of social care, and as I have said, I fully recognise the tough financial settlement that local government has faced. However, that has been necessary because of the dire state of the public finances that we inherited from the Labour Government, and we have sought to protect social care. Despite what the hon. Member for Easington (Grahame M. Morris) and others have said, a recent budget survey by the Association of Directors of Adult Social Services showed that most of the savings that local councils have made have come through efficiency changes, and that services have largely been protected. [Interruption.] Well, that is what the survey showed.
As the population continues to age, our health needs become more complex, and it is essential that we continue to adapt. We need to ensure that the care and support system is sustainable, and the Bill lays the foundation for that sustainable system. At the top of the agenda has been the issue of how we pay for care. The current system simply does not work and is not fit for the 21st century. Too many people have faced catastrophic care costs and had to make impossible financial decisions at a time of huge personal crisis. It is deeply unfair. If someone who has worked hard all their life and budgeted carefully is unlucky enough to be diagnosed with dementia or some other condition, they lose pretty much everything they have ever worked for.
Through the Bill, we are putting an end to that unfair system. We have addressed how people can plan and pay for their care, following on from Andrew Dilnot’s recommendations. We have listened carefully to what he and his colleagues have said, and we have been absolutely consistent about how these reforms will support people to plan for their future effectively. From April 2016, extending the means-test support to £118,000 will immediately result in 35,000 more elderly people receiving financial help with their care costs. That figure will rise to 100,000 people getting extra help by 2024-25.
Andy Burnham
Can the Minister guarantee to older people listening to the debate this evening that nobody will pay more than £72,000 for their care—yes or no?
Norman Lamb
Of course we have made it clear that people can choose to spend more, but I can say absolutely that by 2024-25, far more people—100,000 people—will be getting more financial support than under the system we inherited from the Labour Government. Everyone will be protected from catastrophic costs through the reassurance provided by the cap on care costs.
Oral Answers to Questions
Andy Burnham Excerpts(10 years, 7 months ago)
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Mr Hunt
My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.
Andy Burnham (Leigh) (Lab)
Today I want to put to the Secretary of State new evidence that the A and E crisis is deepening, and having a serious knock-on effect on ambulance services. Information from police forces reveals that cases in which police cars have to ferry patients to A and E are far more widespread than people realise; in some areas, it happens on a daily basis. One ambulance service is now using retained firefighters to attend calls, and—this is how bad things have got—another ambulance service has seen a 350% increase in the number of 999 calls attended by taxis. Does the Secretary of State think that it is ever acceptable that when a patient dials 999, a taxi turns up?
Mr Hunt
I am afraid that that is utterly irresponsible. We are hitting our A and E target, and we are hitting our ambulance standard. When the right hon. Gentleman was Health Secretary he missed the ambulance standard for October, November, December and January. He is trying to talk up a crisis that is not happening. He should think about people on the front line and, just for once, put patients before politics.
Andy Burnham
The country will have heard the complacency from the Secretary of State. He needs to explain why he spent Friday afternoon making panicked phone calls to hospitals up and down the country that were missing their A and E target. He did not condemn the use of taxis, which is unacceptable but is happening on his watch because ambulances are trapped at A and E, unable to hand over patients. That means that 999 response times have got worse and large swathes of the country, right now, are without adequate ambulance cover. Is it not time that the Secretary of State was honest with the public and admitted the scale of the crisis facing the NHS this winter, and took action now to prevent it from engulfing other emergency services?
Mr Hunt
We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.
Mid Staffordshire NHS Foundation Trust
Andy Burnham Excerpts(10 years, 8 months ago)
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Andy Burnham (Leigh) (Lab)
What happened at Mid Staffs was a betrayal of the NHS and its values. The previous Government rightly apologised, but now is the time to back our words with action. That is why, although I welcome much of what the Secretary of State has just said, it is my job to press him on where we feel he could have gone further and to question why, of the 290 Francis recommendations, 86 are not being implemented in full.
First, let me, too, pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), Professor Tricia Hart, Professor Sir Bruce Keogh, Camilla Cavendish, Professor Don Berwick and, of course, Robert Francis. Between them, they have given us proposals that will help to prevent a repeat but, more importantly, as the Secretary of State said, change the whole of the NHS for the better.
Both Francis reports found three primary and fundamental causes of what went wrong: a failure to listen to patients; a lack of properly trained staff; and a dysfunctional culture. I shall take each of those issues in turn.
First, I am sure the Secretary of State agrees with me that patients and their families must always, as Francis recommends, be the first priority for the NHS. That principle unites this House and it must also unite the NHS. Is not Robert Francis right to recommend that the NHS constitution, and the ethos it sets out, should be required reading for all NHS staff? I congratulate the right hon. Gentleman on agreeing to implement the Clywd review in full and change the way the NHS handles complaints.
Secondly, on the issue of staffing numbers and training, the first Francis report found that Mid Staffs made dangerous cuts to front-line staffing over a short period. I welcome the Government’s new focus on this issue, but is it not the case that nurse-patient ratios across the NHS have got significantly worse in the past three years, with 5,890 fewer nurses, more older patients in hospital and bed occupancy running at record levels? It is encouraging that the NHS has plans to recruit more nurses this year, and is introducing more monitoring. The Secretary of State says “things are already changing for the better”, but is he aware that Monitor has warned that trusts are planning major nurse redundancies in the 2014-16 period, far outweighing any increases this year? Will he intervene now to stop that? Further, can he explain why he stopped short of requiring safe staffing levels? Is he further aware that nurse training places have been severely cut in recent years and trusts are being forced to recruit overseas?
Alongside nursing, more action is needed to raise standards across the caring work force. As Robert Francis has said, it is unacceptable that the security guard at the door of the hospital is more regulated, and subject to professional sanctions, than the health care assistant attending to an elderly patient. The development of the care certificate as proposed by Camilla Cavendish is a step forward, but will it not work only alongside a register of those who hold it and an ability to remove it if they fall short? Was not Robert Francis right to recommend a system of regulation for health care assistants and, going forward, will the Government reconsider their decision to rule this out? Overall, although there is progress on staffing today, it does not go far enough and we will continue to challenge the Government on it.
Thirdly, on culture change, Francis’s central proposal is a new duty of candour on organisations and individuals. Extending the duty to organisations is a step forward, but patient groups are disappointed today that it will cover only the most serious incidents. Can the right hon. Gentleman say why it has not been extended to all incidents of harm? Further, it is not clear how an organisational duty alone will help individuals challenge an organisation where there is a dysfunctional culture. Is it not the case that an individual duty as proposed by Francis is essential? This point comes over clearly from the evidence given to Francis from a senior, soon to be retired consultant. He said:
“I took the path of least resistance . . . here were also veiled threats at the time, that I should not rock the boat at my stage in life.”
It is only when an individual is both required to speak out, and protected in doing so, that this House can say it has done enough to safeguard patients.
The duty of openness and transparency should apply equally to all organisations providing NHS services including, as Francis rightly recommends, contractors providing outsourced services. Given that this Government are bringing into the NHS more outside providers, patients will need reassurance that we do not have an uneven playing field where private providers face less scrutiny. So will the Secretary of State extend the duty of candour to all health care organisations, as Francis proposed? His amendments to the Care Bill do not make that clear. And should not he now commit to extending freedom of information law to any provider of NHS services?
On openness, Francis made a direct call on the Government to set an example to the rest of the NHS. He said that
“risk assessments should be made public, and debated publicly, before a proposal for any major structural change to the healthcare system is accepted.”
Given that the Government claim today to be accepting this, should they not show now that they mean what they say by finally publishing the risk register on the current reorganisation of the NHS?
Finally, on openness, the NHS would be more accountable to families with a proper system of death certification. The House will remember that this was a recommendation of the Dame Janet Smith inquiry into the Shipman murders. The report today says that the Francis recommendations on this are not accepted in full. If we fail to act now, might people be justified in thinking that this House has not learned the lessons of tragedies that have gone before? If the Secretary of State brings forward proposals, we will work with him on a cross-party basis to implement them.
In conclusion, I do not believe that cruelty has become normal in the NHS, but there is a much deeper question for us all and that is how, in the century of the ageing society, we do a better job of caring for older people. We should not accept the situation where, as Cavendish says, people are paid less than the national minimum wage. Should we not all set much higher ambitions for the care of older people and, in so doing, learn the most fundamental lesson of all from what happened at Mid Staffs?
Mr Hunt
Let me take the right hon. Gentleman’s points in turn. First, he will know, because this is what happened after the Bristol inquiry and the Shipman inquiry under the previous Government, that Governments do not always accept every single recommendation. What I have said today is that we accept all the principles behind every single one of Robert Francis’s recommendations. We are implementing 204 in full, and in respect of the 86 that we are not implementing exactly as he said, we are doing everything we can to make sure that we implement the spirit behind them, but we need to make sure that everything we do is workable in practice. Francis himself has said that it is a “carefully considered” response that is a “comprehensive collection of measures”.
On staffing numbers, which is an essential part of what we have to consider, if the right hon. Gentleman looks at the nursing hours per bed, he will find that they have gone up since 2010, not down. We recognise the crucial importance of front-line staff, which is why I gently say to him that we made some reforms to the NHS that meant that there are 5,500 more doctors on the front line and 8,000 fewer managers. What we also need is more nurses. That is why it is so encouraging that in response to what Robert Francis has said and the recognition throughout the NHS of the importance of compassionate care, we are getting a reaction from NHS trusts—not as a result of a direct ministerial decision, but because trusts themselves are recognising the importance of compassionate care. We think that is a very encouraging sign.
With respect to whether staffing levels should be mandatory, we agree that there are minimum recommended staffing levels, but they are not the same for every ward in every hospital. The minimum level might be one in six for an acute medical unit, one in four for a general medical unit, and one on one for intensive care. We took extensive advice on whether it would be appropriate to set a national minimum mandatory number. Not only is the chief nurse and leading nurses from across the country against this; the King’s Fund and the British Medical Association are against it. The BMA said something today in a statement which I never thought I would read in my lifetime—it said that the “Government is right” on this issue.
The right hon. Gentleman also opposed mandatory staffing levels back in 2011, although it is fair to say that in the House his position on this has changed. The important thing is that we allow local discretion to make sure that nursing levels are adequate, and that where they are not, that is exposed quickly so that there is no repetition of what happened at Mid Staffs.
On the regulation of health care assistants, every health care assistant will have to have a care certificate. Effectively, there will be a database which allows employers to check whether someone has such a certificate. That is a kind of register. The other reason for people talking about the regulation of health care assistants is that they want to make sure that if someone fails in their duty of care, they are not able to appear somewhere else in the country. That is why we have a vetting and barring scheme to make sure that that does not happen.
On the individual duty of candour, let us be clear: we want total candour about all avoidable harm, at every stage that it happens, anywhere in the NHS. We decided after much discussion that extending the statutory duty of candour to individual front-line clinicians would be likely to create a huge amount of bureaucracy and damage the culture of openness that we are trying to create, because everyone would constantly be worried about whether or not they were breaking the law. We decided that the right way to achieve the objective is through a professional duty of candour, which is much stronger than the current professional duty states. Critically—this is a key change—we decided to make sure that, just as airline pilots have protection if they speak out, if front-line NHS employees speak out, they too will get protection if there is a professional conduct case, and that openness at an early stage will be treated as a mitigating factor. That is really important in terms of changing the culture.
Finally, we absolutely do need to resolve the issue of death certificates. It is important that we have an independent view to certify deaths. It is a question of finding a practical way to make sure that we do that, but we very much accept the spirit of what Robert Francis said.
Today I hope that we will find a way forward on all the problems that Robert Francis addressed in his response and that we have been thinking hard about. I urge the shadow Secretary of State to join Government Members in saying that this is a moment when the NHS can once again reach forward and aim to be the very best in the world, because the kind of measures that we are talking about are not happening anywhere else, and that is something of which we can all be very proud.