Urgent and Emergency Care Review

Andy Burnham Excerpts

Tuesday 12th November 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will update the House on Professor Sir Bruce Keogh’s urgent and emergency care review following this morning’s briefing to the media.

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

In January this year, the board of NHS England launched a review of urgent and emergency care in England. Urgent and emergency care covers a range of areas, including accident and emergency departments, NHS 111 centres and other emergency telephone services, ambulances, minor injury units, and urgent care centres. The review is being led by Professor Sir Bruce Keogh, NHS England’s medical director. A report on phase 1 of the review is being published tomorrow, and it is embargoed until then. [Interruption.] This is an NHS England report, and NHS England is an independent body, accountable to me through the mandate. The report that will be published tomorrow is a preliminary one, setting out initial thinking. [Interruption.]

[Mr Hunt]

I should underline the fact that this morning’s briefing was under embargo, an embargo which, to my knowledge, has been respected. The final version will be published in the new year.

Sir Bruce has said that he will outline initial proposals and recommendations for the future of urgent and emergency care services in England, which have been informed by an engagement exercise that took place between June and August this year. There will be further consultation on the proposals through a number of channels, including commissioning guidance and demonstrator sites. Another progress report will be produced in the spring of 2014.

Decisions on changing services are made at a local level by commissioners and providers, in consultation with all interested parties. That is exactly as it should be, as only then can the system be responsive to local needs. It is vital to ensure that both urgent and emergency care and the wider health and care system remain sustainable and readily understandable to patients. A and E performance levels have largely been maintained, thanks to the expertise and dedication of NHS staff. A and E departments see 95% of patients within four hours, and the figure has not dropped below the 95% target since the end of April. However, urgent and emergency care is falling behind the public’s needs and expectations.

The number of people going to A and E departments has risen historically, not least because of an ageing population. A million more people are coming through the doors than in 2010. Winter inevitably challenges the system further, which is why we are supporting the most under-pressure A and Es with an additional £250 million. Planning has started earlier than ever this year, and the NHS has been extremely focused on preparing for additional pressure.

We will look at Sir Bruce’s report extremely carefully. Reform of the urgent and emergency care system may take years to complete, but that does not mean that it is not achievable. We are exceptionally fortunate in this country to have in the NHS one of the world’s great institutions. NHS staff are working tirelessly to ensure that the care that people need will continue to be available to them, wherever and whenever they need it.

[Andy Burnham]

Rarely has this House been treated to a more disrespectful and complacent reply. There are new reports today of 12,000 patients spending 12 hours or more on trolleys in A and E. A and E is in crisis according to the College of Emergency Medicine, and this is before the winter has even started. People are increasingly asking, “Where are the Government and what are they doing about it?” So far all they have heard is, “Crisis? What crisis?” But behind the scenes it is a different story. Such is the panic in Whitehall, the Prime Minister has apparently taken personal charge and this morning the media were given a private briefing on a major review of emergency care. What is going on and why is the Secretary of State running scared, blaming NHS England and trying to keep this House in the dark? It should not be for us to drag the Secretary of State here to give Members information already passed to journalists.

Let me remind the House what the Secretary of State said at Health questions in July. He said that Bruce Keogh’s review

“will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter”.—[Official Report, 13 July 2013; Vol. 566, c. 902.]

To hear him now, it was all about the long term. Let me ask him: what are those lessons, and what immediate action is he now taking ahead of winter?

Weekend briefings suggested Sir Bruce emphasises alternatives to A and E, such as walk-in centres and 111, but Monitor reported yesterday that one in four walk-in centres have been closed and others are today under threat of closure. We need a clear answer. Will the Secretary of State stop further closures of walk-in centres? Does he now accept that his 111 helpline is flawed, and will he put nurses back on the end of the phone, rather than call handlers? And what of the recruitment crisis in A and E? There is a shortage of senior A and E doctors and, according to the Royal College of Nursing, 20,000 too few nurses. Will the Secretary of State give a clear commitment to bring all A and Es back up to safe staffing levels?

Last week, a complacent Prime Minister stood there, told us everything was fine, and even claimed that the average waiting time in A and E had gone down to 50 minutes, but that is not true. I have here a written reply from the public health Minister telling us it has gone up to over two and half hours. When are the Government going to show this House and the country some respect, cut the spin, and give us the real picture about a crisis that is happening right now?

[Mr Hunt]

Mr Speaker, I will tell the right hon. Gentleman what complacency is: it is refusing to have a public inquiry into Mid Staffs, where staff in A and E departments were bullied and harassed when they tried to speak out. He did not think it was worth having a public inquiry into the poor care that his Government swept under the carpet and which we are doing something about. There is one figure that he refused to mention: the A and E performance figures published last week of 96.4%—hitting the target, higher than the previous week, higher than this time last year. That sums it up: in a good week he wants to run down the performance of hard-working staff whereas this Government are backing them.

Why are we having an A and E review? It is to clear up the mess and confusion caused by 13 years of Labour mismanagement of our emergency services. The right hon. Gentleman talks about walk-in centres. Why were they introduced? Because of the disastrous mistake over the GP contract. The brave thing for his Government to have done would have been to admit they got that wrong and reverse it, but they did not. They introduced a whole new raft of services, which confused the public: A and E, walk-in centres, GP surgeries, telephone helplines. Tomorrow we will sort out those problems. Yes there are difficult decisions, but they are decisions his Government ducked and left the public exposed as a result.

Before the right hon. Gentleman runs down our A and E services, let me just gently remind him that he talked about a recruitment crisis, but we have 300 more A and E consultants than when he was Health Secretary, we have nearly 2,000 more people—[Interruption.] I am sorry that this is difficult for those on the Opposition Front Bench to listen to. We have nearly 2,000 more people being seen within four hours every single day than when the right hon. Gentleman was Health Secretary —that is some 700,000 more people every year. We have more hospital doctors, more hospital nurses, more treatments and fewer long waits than when he was Health Secretary, and he should celebrate that improvement in our NHS’s performance, instead of trying to run down the people on the front line.

I will tell the right hon. Gentleman something else we are doing. We are tackling the long-term causes of pressure in A and E that his Government absolutely failed to do: not just the GP contract but also the integration of the health and social care system, the lack of which means that hospitals are not able to discharge people from their beds on time, causing huge pressure. Today, the shadow Health Secretary has shown his true colours. The man whose Government made so many wrong decisions about A and E is exposed as trying to make political capital while this Government sort out his mess.

Changes to Health Services in London

Andy Burnham Excerpts

Wednesday 30th October 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

People at home will have listened carefully to what the Secretary of State has just said, and they will have one simple question in their mind: why is this man trying to close so many A and Es when we are in the middle of an A and E crisis? At least seven A and Es across the capital are under threat, at a time when all London A and Es are working flat out and are full to capacity. As we stand here, thousands of people are waiting to be seen, stuck on trolleys or held in the back of ambulances that are queuing outside A and E. When the A and Es we have are struggling to cope, how on earth can it be safe to close or downgrade so many?

That brings me to what I see as the major flaw in what the Secretary of State has announced. These plans have been in development for four years, as he said. Four years ago, A and E was not in the crisis that it faces today. The reality on the ground in London has changed. In 2013, A and Es in London have been getting worse and worse and worse. Across London, 200,000 people have waited in A and E for longer than four hours in the past 12 months. Here is the statistic that should make people stop and think: taking all its major A and E units together, London has missed the Government’s A and E target in 48 of the last 52 weeks.

Any further changes to this fragile and overburdened system must proceed with the utmost caution. Will the Secretary of State give me a categorical assurance that he personally gave in-depth consideration to the latest evidence of the pressure on London A and Es and to the changed reality that 2013 has brought before making his decision? I understand how tough such decisions are. Sometimes, difficult changes need to be made, as I found when I reorganised stroke services in London before the last election. When he does the right thing, based on a clear clinical case that lives will be saved, we will support him, as we did on children’s heart surgery. The problem with the closure programme, as managers admitted to Members of the House at the outset, is that it is primarily about saving money, not saving lives.

Even though the Secretary of State has made some minor concessions today, he is still performing pretty brutal surgery on west London’s NHS. It is the single biggest hospital closure programme the NHS has ever seen. Has he considered the impact of the changes on people in those communities who are on low incomes? They will face much greater costs and journey times in getting to hospital.

Will the Secretary of State be straight with us on the much-loved Charing Cross and Ealing hospitals? I listened carefully to what he said. What is the “further work” that he referred to? He spoke of their A and Es being of a different size and shape. Is that not spin for saying that the units will be downgraded and become urgent care centres? Alternatively, is he giving those units a permanent reprieve today? If he cannot answer those questions directly, local people in those areas will take what he has said as weasel words.

The Secretary of State said that there will be investment in communities before the changes go ahead. He said that to the hon. Member for Enfield North (Nick de Bois) in respect of Chase Farm hospital, but he is closing that unit next month. What guarantee do people have that he will follow through on this promise, when he broke the promise that he made to his hon. Friend?

The Secretary of State has made a statement on London health services. People will not have missed the fact that he has failed to mention Lewisham hospital and what happened at the Court of Appeal yesterday. Is that not a staggering omission? The victory that was won by the people of Lewisham will give hope to people who are disappointed by today’s announcement.

The humiliation of the Secretary of State in court again raises major questions about his judgment and his ability to manage such important decisions. In the summer, we explicitly warned him to accept the first court ruling. Instead, he ploughed on, throwing around taxpayers’ money in a cavalier fashion, to protect his pride and defend the indefensible. I have a simple question: how much has he spent on appealing that decision? When he decided to appeal, did the official legal advice from the Government recommend an appeal or did he overrule it? Will he confirm today to this House and to the people of Lewisham that there will be no further appeal against the court’s ruling? Will he give the people of Lewisham and the staff who work at Lewisham hospital a commitment that their A and E and maternity services will be protected? Finally, will he apologise to the people of Lewisham for the unnecessary distress and worry he has put them through?

It will not have escaped people’s notice that the Secretary of State is trying to put powers through the House quite soon to grab further powers for himself and drive through financial closures of A and Es without proper consultation, so that in effect he can do what he tried to do to Lewisham to every community in England. That will send a chill wind through those communities that fear to lose their A and Es, and that is why we will oppose those powers when they are considered by the House.

In conclusion, the Government have come a long way since the Prime Minister stood outside Chase Farm hospital days after the last general election and promised a moratorium on all hospital changes. Local people in west London will not have forgotten the Prime Minister standing outside Ealing and Central Middlesex hospitals and promising the same. People are seeing through a Prime Minister whose broken promises on the NHS are catching up with him. Has it ever been clearer than it is today that people simply cannot trust the Tories with the NHS?

[Mr Hunt]

I am afraid the right hon. Gentleman is sounding more and more desperate. Today the Government have taken a difficult decision that will improve services for patients. It was a moment for him to show that he understood the challenges facing the NHS, but that was not to be. He said that we should not proceed with the changes given winter pressures on A and Es, but he should read the document. The proposals are for more emergency care doctors, more critical care doctors, and more psychiatric liaison support that helps A and E departments, and they are supported by the medical directors of all nine trusts affected. He said that if evidence can be produced to show that the proposals will save lives, Labour will support them. What more evidence does he want? He should be shouting from the rooftops to support the proposals, but instead he is putting politics before patients.

The right hon. Gentleman mentioned A and E performance, and I am happy to tell him about that. On average a person now waits 50 minutes in A and E before they are seen; when he was Health Secretary it was 71 minutes. The number of patients seen in less than four hours every day is 57,000—nearly 2,000 more than when the right hon. Gentleman was Health Secretary. Our hospitals are performing extremely well under a great deal of pressure because we are taking difficult decisions of the kind that we are talking about today.

The right hon. Gentleman also talked about hospital closures. Again, he should read the proposals: a brand new trauma centre at St Mary’s hospital in Paddington; two brand new elective care centres at Ealing and Charing Cross; seven-day NHS care that will save lives; 24/7 obstetric care; 16 paediatric care centres. Those are big improvements in hospital care—[Interruption.] I will come on to Lewisham. I am acting to end uncertainty because I made the decision today that whatever the outcome of further discussions that the Independent Reconfiguration Panel recommends, there will remain an A and E at Ealing and Charing Cross. That is the best thing I can do for those residents.

The right hon. Gentleman mentioned Lewisham, but let us remember that the problem started because his Government saddled South London Healthcare NHS Trust with £150 million in private finance initiative costs. I judged that the right thing for patients was to sort out a problem that was diverting £1 million every week from the front line. Yes it is difficult, but I would rather lose a battle with the courts trying to do the right thing for patients than not try at all.

Finally, these are difficult decisions, but the party that really has NHS interests at heart is the one that is prepared to grip those decisions. We are gripping the problems in A and E, and in terms of hospital reconfigurations. That is why the NHS is safe in our hands and not safe in those of the Labour party.

Hepatitis C (Haemophiliacs)

Andy Burnham Excerpts

Tuesday 29th October 2013 Westminster Hall

[Paul Goggins]

I am grateful to my hon. Friend for that intervention. He makes precisely the point I was moving on to. I welcome the new Minister, the hon. Member for Battersea (Jane Ellison), to the debate and to her new responsibilities. Whatever else she achieves in her time as a Minister—and I hope she achieves a great deal—nothing would be more important than bringing a measure of justice to those who have suffered from such injustice over so many years. Lord Winston described it as the worst treatment disaster in the history of the NHS.

I am delighted that we are joined this morning by so many hon. Members from both sides of the House—particularly the hon. Member for North East Bedfordshire (Alistair Burt), who raised the issue again with the Prime Minister in a clear and determined way a few days ago. I am also pleased that my right hon. Friend the Member for Leigh (Andy Burnham) is in attendance for the start of the debate. It is unusual for a Secretary of State, or shadow Secretary of State, to attend an Adjournment debate in Westminster Hall. His attendance is appreciated; he is keeping a promise made earlier this year. My constituents have asked me to thank him this morning for his willingness to listen—not only now in opposition, but when he was the Secretary of State.

[Andy Burnham (Leigh) (Lab)]

I apologise, Mr Dobbin, for the fact that I cannot stay for the whole debate. I am here to show solidarity with my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins), who has represented his constituents outstandingly, and with Peter Mossman and Fred and Eleanor Bates, whom I met in my office with my right hon. Friend when I was Health Secretary.

I want my right hon. Friend and his constituents to understand that the commitment I gave to them was not a one-off, convenient commitment, but a permanent one. If I were to find myself back in government, that commitment would remain. Does my right hon. Friend agree that there needs to be a further process of truth and reconciliation, so that those concerned have all the answers for which they are still looking?

[Paul Goggins]

I am grateful to my right hon. Friend and I agree with him entirely. There needs to be not only a review of the current financial arrangements, but a deeper search for the truth, to bring justice, an explanation and a profound apology to those who have suffered. I will make some remarks about that later.

I will not dwell this morning on the long history of the injustice, other than to remind the House that of the 4,670 people with haemophilia who were infected with hepatitis C or HIV, at least 1,757 have died from the effects of the viruses; I say “at least” because the number is almost certainly higher than that. Although it was recognised at the time that the use of imported blood products carried a very high risk, treatment continued and patients were simply kept in the dark. As people tried to get to the truth, they were met with a lack of honesty and deep disrespect. Their dogged persistence is remarkable.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Mr Hunt]

I am happy to do so. I want to make it clear to my hon. Friend that I am keen to ensure we have a structure inside the NHS that makes it easy for high-performing hospitals that want to work more closely together and share services to do so, if it is in the interests of patients. We need to do more work in this area.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State has been in post for a year, and in that time we have got used to his style: everything is always someone else’s fault, be it lazy GPs, uncaring nurses or the last Government. And today we see more diversion tactics—now immigration is to blame. But there is an inconvenient truth that gets clearer day by day and which he cannot spin away: A and E is getting worse and worse and worse on his watch. We have had ambulance queues, a treatment tent in a car park and now police cars doubling as ambulances, with a patient dying on the backseat. The NHS stands on the brink of a dangerous winter. Will he today set out in detail what he personally is doing to avert a crisis?

[Mr Hunt]

I welcome the right hon. Gentleman back to his place. It is a great pleasure to see him there, even if it is not entirely what the Labour leader wanted.

If the right hon. Gentleman is shocked that I breached the A and E target for one quarter last year, he will want to make a full apology for the fact that he breached it for two quarters when he was Health Secretary.

[Andy Burnham]

This complacent spin is no good to the NHS. If he wants to compare records, let us do that. Under me, 98 per cent. of people were seen within four hours; under him, over 1 million people in the last year waited more than four hours in A and E—not only a winter crisis, but the first summer A and E crisis in living memory. Today it gets worse. New figures this morning show a further 450 nursing jobs have been cut, taking the total close to 6,000 under this Government. But what were they doing last night? They were voting in the Lords against safe staffing levels. Will he now listen to the experts, stop the job cuts and take immediate action to ensure that all A and Es have enough staff to provide safe care this winter?

[Mr Hunt]

We will listen to no one on the Opposition Benches when it comes to safe care for patients in the NHS. They presided over a system where whistleblowers were bullied, patients were ignored and regulators felt leaned on if they tried to speak out about poor care. That is a record to be ashamed of.

Accident and Emergency Departments

Andy Burnham Excerpts

Tuesday 10th September 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on his plans to alleviate pressure on accident and emergency departments.

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

This morning I made a written ministerial statement outlining the Government’s plans for the winter and detailing how we are allocating £250 million of funding for NHS England. Working with Monitor and the NHS Trust Development Authority, NHS England will distribute this money in 2013-14 to the areas where it is needed most. This follows the announcement in August by my right hon. Friend the Prime Minister that A and E departments will be given an additional £500 million over the next two years to deal with seasonal pressures. Patients need to be able to rely on the NHS all year round, and especially when demand is at its greatest. Ensuring the NHS’s sustainability means identifying each of the challenges it faces and, where possible, alleviating the burden.

Flu is an avoidable pressure on the NHS. Every year, around 750,000 patients see their GP with flu symptoms and nearly 5,000 people die. While flu levels have been comparatively low in the last two years, it would be complacent to assume that they will not rise. Should this happen, it will increase pressure on A and Es, which have already seen a rise in admissions of 32% in the last decade.

The best way to protect oneself and other people from flu is to get the flu vaccine, so, for the first time, children aged two and three will be offered the innovative nasal spray vaccine. Young children’s close contact with others makes them more likely to transmit flu to vulnerable groups including infants and the elderly.

Around 27,000 people spend time in hospital with flu every year, so it is very important that NHS staff should do all they can to avoid getting, and passing on, flu. Less than half of front-line NHS staff get vaccinated against flu. In some hospitals, that drops to fewer than one in five. The Government want to boost significantly the number of health care workers getting the flu vaccine. Trusts will not be eligible to receive a portion of the money in future years if they do not achieve a staff vaccination rate of 75%, except in exceptional circumstances.

This funding will be targeted in the following way: £15 million will go towards securing a reliable NHS 111 service throughout the winter period; subject to completion of current scrutiny of plans, a total provisional amount of £221 million will go to the 53 highest-risk systems; and a small contingency of £14 million will be used for final settlements, for trusts to use in the winter. My written ministerial statement outlines the indicative amounts that have been allocated to specific trusts. The additional allocation will require an increase to the revenue budget for NHS England for 2013-14, as had been specified in the mandate, and the revision to the mandate will be laid before Parliament in due course.

I recognise, however, that we need more radical change to reduce pressures on A and E departments over the longer term. I am currently consulting on my plans to provide improved care for vulnerable older people, to keep them out of hospital through better, more proactive care in their community. This will include better joint-working between the health and care systems; personalised, proactive care overseen by a named, accountable GP; and the sharing of GP records across different organisations, including out-of-hours GP services and the ambulance service.

NHS staff are working harder than ever before, and the British public rely on the NHS just as much as they have always done, and on a year-round basis. The plans outlined in this announcement will improve patient safety levels and help to reduce avoidable pressure on the NHS in the winter months ahead.

[Andy Burnham]

This Secretary of State has been in office for one year—the worst year in A and E in a decade: close to 1 million people waiting more than four hours, and on his watch, the first summer A and E crisis in living memory. But with this Government it is always someone else’s fault: GPs, nurses, patients, the weather, immigration, bank holidays—nothing to do with him, Mr Speaker, he is just a member of the public, as he is fond of saying. Well, I have got news for him: he is the Secretary of State, and it is time he started acting like it. All year we have warned him about the growing A and E crisis. First, he ignored those warnings, leaving A and E ill-prepared on the brink of a dangerous winter, as the NHS Confederation has warned. Now, in panic, he briefs out half-baked plans, without coming to this House. This is too little, too late. It is not good enough that we have had to drag him here on an issue of huge importance to our constituents. With his spin about the GP contract, he neglects the real causes.

First, on staffing, we learn today of the shocking shortage of doctors covering A and Es overnight, and we heard at the weekend reports of A and Es up and down the land without enough staff. More than 5,000 nursing jobs have been lost on the Government’s watch—and counting. Enough is enough. When will the Secretary of State stop the job cuts and ensure that all A and Es have enough staff to provide safe care?

Secondly, on GP opening hours, the Secretary of State tries to blame the 2004 contract but conveniently ignores the fact that A and E performance improved between 2004 and 2010. The truth is that it is the Government who have let GP practices stop evening and weekend surgeries, and it is the Government who ended the guarantee of appointments within 48 hours. What is he doing to restore patient access to GPs?

Thirdly, on social care, in the first two years of this Government there was an appalling 66% increase in the number of people aged over 90 coming into A and E via a blue-light ambulance—that is more than 100,000 very frail and frightened people in the backs of ambulances speeding through our cities and towns. That is a scandal, and it is more to do with social care cuts than anything else. I do not know how many more times I am going to have to ask the Secretary of State this: when will he do something to stop the collapse of social care in England?

All the while the Secretary of State blames a contract signed 10 years ago for today’s pressure he neglects the real causes of his A and E crisis. That is dangerous and it cannot carry on. Patients and staff cannot go through another year in A and E like the one we have just had. He should cut the spin, get a grip or go.

Managing Risk in the NHS

Andy Burnham Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andrew Percy (Brigg and Goole) (Con)]

Will the right hon. Gentleman way?

[Andy Burnham]

I will give way to the hon. Gentleman, but I hope he will respond to what he has just heard.

[Andrew Percy]

If a few more of the shadow Secretary of State’s colleagues had turned up to this debate, they would be able to respond to those points for him.

If I may take him back to his comments about the challenges in A and E, which have been severe this Christmas and winter, does he accept that one of the things that he and his party got wrong in government was to cut beds and close wards before putting in place proper intermediate care services? People in my constituency could not get into their local hospitals this year because of the beds that were cut when his party was in government.

[Andy Burnham]

The hon. Gentleman is doing what the Conservatives have been doing for quite a few weeks now, which is rewriting history. Does he recall the general chaos in A and E before 1997? Does he remember people waiting for hours on trolleys before they were seen or people spending a day in A and E departments? When we left government, 98% of trusts across the country were meeting the four-hour target. Sadly, we cannot say the same about the NHS on his Government’s watch.

What I have just given to the House was a warning of all warnings not to proceed with a reckless reorganisation at a time when the NHS was facing the biggest financial challenge in its history. Senior civil servants gave those warnings; the Government ploughed on regardless. That was a monumental mistake, combining the biggest ever financial challenge with the biggest ever reorganisation. Eyes were taken off the ball at the worst possible moment.

[Mr Dave Watts (St Helens North) (Lab)]

Does my right hon. Friend know when the Secretary of State last visited an accident and emergency unit? May I suggest, through my right hon. Friend, that he comes with me to my accident and emergency unit and sees the chaos he has created?

[Andy Burnham]

Promises were made before the reorganisation to my hon. Friend and his colleagues in St Helens, Knowsley and Halton about the future of the hospital, because there was concern that certain commitments would not be honoured by the new organisations. And it came to pass: they were not honoured. My hon. Friend asked whether the Secretary of State had been to an A and E. We know that he did not turn up at one until April, yet he had already stood up and criticised hospitals for “coasting”. How on earth could he make such comments when he had not bothered to get his feet on the ground to see what was happening in the NHS? Unbelievable.

The Government took a huge gamble when they proceeded with the reorganisation at a time of financial stress and in the teeth of opposition from the public and the professions. If the Secretary of State truly believes, as he said yesterday, that transparency is a disinfectant—he is nodding—and if he wants to show leadership from the front from today onwards, should he not now commit to publishing the risk register that accompanied the Government’s reorganisation of the NHS? [Interruption.] He claims again that this was all about the last Government, but let me explain the difference to him. This Government withheld the risk register in defiance of the Information Rights Tribunal and the Appeal Court. Is he proud of that? What message does he think that that sends to the boards of those NHS organisations that he is now asking to act with maximum transparency? I am afraid that it sends absolutely the wrong message. He will not foster the right culture in risk management in the NHS if there is one rule for the Department and another for everybody else.

[Andrew Selous (South West Bedfordshire) (Con)]

What is the right hon. Gentleman’s view of the previous culture of secret board-to-board meetings, at which the boards of a local trust and a strategic health authority met in private to try to deal with issues? In retrospect, does he agree that that was probably not the best way to deal with serious issues, because the very people who were responsible would perhaps not get the blame?

[Andy Burnham]

Let me give the hon. Gentleman a direct answer. One of the things that shocked me most when I received the Francis report, which I commissioned under the previous Government, was the revelation that on receiving foundation trust status, the board of Mid Staffordshire NHS Foundation Trust had begun to hold its meetings in private, rather than in public. It had taken the freedoms, yet decided to become more secretive. That was fundamentally unacceptable, and I made that point loud and clear to the NHS when I received that report. I do not think that there is any difference between us on this. I believe in openness and transparency too. Ours was the Government who brought in the Freedom of Information Act and independent regulation for the NHS. On that matter, we can make common cause.

[Several hon. Members]

rose—

[Andy Burnham]

I want to make some progress, but I will give way again later.

People have a right to know whether any of the recent pressure that we have seen in the NHS was predicted and made known to Ministers before they proceeded with their reorganisation, which has led to thousands of good, experienced, committed people leaving the NHS. It left in charge less experienced people, who had never seen an A and E winter crisis and who did not know what to do. It led to millions in large redundancy payments being handed to people who were then re-employed by a new NHS organisation. Overall, £3 billion was siphoned out of the NHS front line to pay for this upheaval. Managers got six-figure pay-offs, and 4,000 nurses got P45s. It is no wonder that morale among staff is at rock bottom.

[Alun Cairns (Vale of Glamorgan) (Con)]

rose—

[Andy Burnham]

I will give way to the hon. Gentleman, but I hope that his intervention will not be about Wales. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I want to hear Mr Cairns.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Mr Cairns, do not take advantage of the situation; it is not fair to other Members who also want to intervene. We want this debate to be heard in the best possible way.

[Andy Burnham]

This is debate is about the NHS in England, and if the hon. Gentleman has concerns about the NHS in Wales, why does he not have a word with his right hon. Friend the Chancellor of the Exchequer and get a better deal for the Welsh Assembly so that a bit more money could be put back into the Welsh national health service?

As I was saying, the Government have put staff morale at rock bottom, and where are the promised benefits of this reorganisation? Clinical commissioning groups are not, as we were promised, the powerhouse of the new NHS; they are embryonic at best and anonymous at worst. Members of all parties, I am sure, write letters to CCGs that get passed to NHS England, which then either does not provide a proper answer or passes them on again. [Interruption.] I hear the public health Minister saying it is dreadful that Members do not get proper answers. When my hon. Friend the Member for Easington (Grahame M. Morris) wrote to her about cancer services in his constituency, she also brushed it off to NHS England. Is this proper accountability? No.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

rose—

[Andy Burnham]

I hope the Minister is going to deliver some accountability now.

[Anna Soubry]

Will the right hon. Gentleman please agree and accept that I have not only answered his letters, but met him on at least one occasion? It is right under the new system for such letters to go to NHS England, but that does not stop me making representations. We have introduced a much better system than we used to have under his Administration.

[Andy Burnham]

We have just heard it; this is what the NHS has been reduced to. The Minister has to make representations to NHS England about cancer services of all things. My goodness, if Ministers are not responsible for cancer services, what are they responsible for? Who is making the decisions and who is responsible for what? Even now, confusion reigns.

What precisely is the role of the Secretary of State in this new world? He has cast himself in a new role as a detached commentator on the sidelines, magnifying all of the NHS’s failings and accepting none of the responsibility to fix them. I assume that that is all for NHS England, too. With the NHS already laid low by cuts and reorganisation, the Secretary of State has opened up a new front on staff: nurses repeatedly blamed for not caring enough; hospitals blamed for coasting, as I have said; GPs blamed for causing the A and E crisis. Everything is someone else’s fault.

Then we get to this weekend. The Keogh report rightly exposed poor care standards, which should never be tolerated; we support action to tackle to them. The report, however, exposed something else, too—a Government who are now actively spinning against the NHS for which they are responsible, generating misleading or, in Sir Bruce’s words, “reckless” headlines about 14 already troubled hospitals. What chance do they have of improving when the man supposedly in charge is actively doing them down?

[Derek Twigg (Halton) (Lab)]

My right hon. Friend mentions the Keogh report and we are talking about the present day. Keogh says in the report that he found

“frequent examples of inadequate numbers of nursing staff in some ward areas…The reported data did not provide a true picture of the numbers of staff actually working on the wards.”

There we have it: it is this Government who are not making sure that our hospitals are properly staffed.

[Andy Burnham]

I am grateful to my hon. Friend and I will come to that precise point, as one would think that that was a responsibility of a Secretary of State. Who knows, though, what their responsibilities are now. Presumably that is a matter for NHS England as well. We shall return to the point in a few moments.

[Penny Mordaunt (Portsmouth North) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I want to make some more progress.

As I said a moment ago, what chance do these hospitals have when they get these misleading headlines running them down when they are trying and struggling to make progress, alarming staff, alarming patients, demoralising staff and casually trading figures—[Interruption.] No. I will not give way. [Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. If the right hon. Member wants to give way, he will give way. We do not need people standing up, shouting and bawling. I want to hear what the shadow Secretary of State has to say, just as I want to hear what the Secretary of State has to say. Let us have a little more courtesy from everyone.

[Andy Burnham]

Thank you, Mr Deputy Speaker.

Alarming patients, demoralising staff and casually trading figures about deaths in the pursuit of political advantage is no way to run the NHS, and those are not the actions of a responsible Government. Today people are asking what kind of Government this is, if they are willing to cause further damage to fragile hospitals for their own self-serving political ends. Yesterday the Secretary of State told the BBC that he had no idea who had put the 13,000 figure in the public domain. Does he seriously expect us to believe that?

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

Yes.

[Andy Burnham]

He seriously expects us to believe it? Why are we being told that those responsible were representatives of Conservative Central Office? [Interruption.] Yes, that is what is being said. The Secretary of State should go back and check his facts. If he does not have control of his advisers, it will not be the first time, will it? We have heard this before, have we not? “I do not know what the advisers are doing.”

The “my adviser is out of control” defence may have worked for the Secretary of State once, but it will not work for him twice. He must take responsibility for his own advisers, and for the advisers at Conservative headquarters. We were told explicitly that that is where the briefings came from, and the Secretary of State owes the House a full answer. He owes it to the House to put that on the record. [Interruption.] I will not put the name in the public domain, but I have a name. I will send it to the Secretary of State immediately after the debate, and he must come straight back to me, having asked that person whether or not he briefed the press. If the Secretary of State agrees to that, let us leave it there. I have a name, and I will put it to him straight after the debate. He must take responsibility.

[Mr Kevan Jones (North Durham) (Lab)]

If there was no organised briefing over the weekend, there must have been a coming together of some extraordinary fiction. The Keogh report itself states:

“It is important to understand that mortality in… NHS hospitals has been falling over the last decade: overall mortality has fallen by…30%”.

Keogh says that that is an improvement, even given

“the increasing complexity of patients being treated”.

Those who read the headlines, and the spin from the Conservative party, would not think that our investment over 13 years had made any difference to mortality rates.

[Andy Burnham]

My hon. Friend has made an extremely important point. The conclusion to which he has referred may well have been missed by many people up and down the country yesterday, but it is worth repeating and putting centre stage in today’s debate, because the Government certainly will not make any reference to it.

NHS hospitals in England, including the 14 covered by the review, have reduced mortality by 30% in recent years. That is an incredible achievement, which we should surely be celebrating. Of course the NHS is not perfect. It does fail people, and when it does, we are truly sorry for the effect on their families. The fact is, however, that the NHS and its hospitals have improved over the past decade, and that needs to be repeated and repeated to counter the scare stories that are emanating from the Conservatives and the fears that they are stoking among people about going into hospital.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

I wonder whether the right hon. Gentleman is aware of the work of Professor Sheena Asthana, who has studied hospitals with higher mortality rates and found a correspondence between hospitals serving clinical commissioning groups—formerly primary care trusts—in areas with older populations which are receiving lower funding allocations than those with younger populations. She believes that funding allocations could be one of the causes of higher mortality across the system.

[Andy Burnham]

I would not close my mind to that suggestion, but I think it important also to take account of what Keogh said about other similarities between those hospitals—and, probably, between them and Mid Staffordshire. What they have in common is geographic isolation. Hospitals serving smaller market towns are not supported by the same clinical networks as others, and may find it more difficult to attract qualified staff. I agree with the hon. Gentleman that there are a number of important issues that need to be considered.

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

My right hon. Friend knows well, and knows personally, that in the past two months there has been a marked change in the coalition Government’s approach on the national health service. It started with the absurd argument that the problems in accident and emergency departments were the result of the 2004 GP contract. Is it not more likely that what is happening is that Mr Lynton Crosby is telling Government Members to squeeze the lead that Labour has had over the Conservative party for many decades on the NHS, and attacking NHS workers, scaring patients and attacking the Opposition is what they are trying to do? They ought to be ashamed of themselves for being involved in it.

[Andy Burnham]

It used to be, “We love the NHS”—the Prime Minister said, “I love the NHS”—but now it is about running down the NHS. I say to the Secretary of State, in all sincerity, that he will not improve patient care by continually blaming doctors and nurses. As I have said before, the NHS is fragile right now because of his reorganisation, and it cannot keep taking these knocks on a daily basis. The blame game is destructive and polarising, and it has to end. He is in real danger of losing any remaining good will in the NHS work force, and none of us and, more importantly, none of our constituents can afford to see those crucial staff become fed up, lose heart and walk away. Government Members can throw whatever they like at me, because that is politics, but I will not allow the NHS and its staff to become collateral damage in this orchestrated political campaign.

[Penny Mordaunt]

The right hon. Gentleman is making some important points about accountability, responsibility and the grip the Secretary of State should have on his Department. In that vein, can the right hon. Gentleman please tell the House how many of the 400 warnings about United Lincolnshire, 300 warnings about Blackpool and more than 200 warnings about Basildon went across his desk?

[Andy Burnham]

This is all part of the spin in which Government Members have been engaging in recent days. [Interruption.] Okay, so let me answer and then the same test will apply to the Secretary of State as the hon. Lady is applying to me. She is referring to letters sent by members of the public to the Department of Health. I am sure that this has not changed with the change of Government; contrary to what she has just said, those letters do not come across Ministers’ desks. They are not formal warnings to Ministers, and it is very important to be precise with language here. This Secretary of State will have received many, many hundreds of letters about hospitals up and down the country that he will not have seen, and it is not right for the hon. Lady to come along, again, with slurs and half truths to try to muddy the waters.

[Charlie Elphicke (Dover) (Con)]

With respect, I do not think the right hon. Gentleman’s answer to my hon. Friend the Member for Portsmouth North (Penny Mordaunt) is good enough and convincing enough. We have heard too much about concern for hospitals and for hospital staff from the right hon. Gentleman, but not enough about concern for patients and for patient care.

[Andy Burnham]

If the hon. Gentleman was listening, I said just a few seconds ago that the Secretary of State will not improve care for patients if he continually blames nurses and doctors. It is not one or the other, although Government Members seem to think they can attack the health unions for somehow being the enemy of patients. Ordinary people do not see it that way. They know that the staff are there for them day in, day out. We support the staff to help the patients. If staff are rewarded properly and have good working conditions, they will provide better care to patients. These are not opposites; the two go together, and the Conservative party would do well to remember that.

[Mr Jim Cunningham (Coventry South) (Lab)]

Some of us were here during the time of the previous Conservative Government, and I can remember that one of the hospitals in Coventry badly needed repair. After 1997, we got a new hospital. More importantly, one thing that Government Members always boast about is that they have increased the number of trainee doctors. It takes seven years to train a doctor. This Government are in their third year, so the credit goes to us.

[Andy Burnham]

As so often with the spin that we hear from Government Members, it is our achievements they are trying to claim credit for. I left behind the plans for the training of those doctors, but we do not hear much credit coming in this direction, do we? Government Members are happy to take the credit and then they try to cast off all the blame for everything else. My point is that criticism must be fair and made with care. We all have a duty to point out the failings of the NHS, in our own constituencies and nationally, and that is what I did when I did the Secretary of State’s job. However, we have to do that responsibly and fairly, especially for hospitals and those who manage them.

Hospitals are not the architects of all the problems we read about. For example, they are all struggling with the fallout of severe cuts to social care budgets, the appalling cost of which I recently revealed: a 66% increase over two years in the number of over-90s coming into A and E via blue-light ambulances. In human terms, more than 100,000 very frail and frightened people have been speeding through the streets of our communities in the back of ambulances. Hospitals have to absorb that extra pressure and also struggle with longer delays in getting people back home. We are in real danger of asking too much of our hospitals by allowing them to be the last resort for people who would be better supported elsewhere. Without a greater understanding of that situation in the current debate, and if the trend towards the vilification of NHS managers continues, who will take on the job of running our acute trusts? Good people will walk away and no one will want to do the job. Again, the NHS simply cannot afford that.

This crude blame game is an election strategy with two components: run down the NHS; and pin all the failings on the previous Government. The NHS cannot take 20 months of that until May 2015. It has been destabilised and demoralised already; if the Government are not careful, they will push it over the edge.

The Secretary of State needs to change course and find a way of bringing people back together, so the purpose of the debate is to put forward two constructive proposals to manage risk in the NHS—one for now, the other for the long term. First, I turn to the immediate proposal. It is clear that the best way to draw a line under recent events and unify people would be for the House to embrace today the analysis and main recommendations of the Francis report. The motion highlights the three most significant recommendations: benchmarks on safe staffing; a duty of candour on individual NHS staff; and the regulation of health care assistants. If all parties endorsed those proposals, it would send staff a message of support and recognition of the pressure that they are under, while the patients who have suffered poor care would receive the positive message that the parties are working together to prevent that from happening to others.

Given the tragic events that lie behind them, public inquiries should, when possible, produce consensus. It is extraordinary that, having commissioned a three-year public inquiry, the Government have slowly been distancing themselves from the Francis report’s analysis and conclusions ever since its publication. It is hard not to conclude that the report did not deliver what the Government wanted and that they have spent the past five months rewriting it. They have come up with their own recommendations on chief inspectors for hospitals, general practice and social care, yet dragged their feet on the actual recommendations. They have substituted the verdict of Francis on Ministers in the previous Government with that of the kangaroo court of Lynton Crosby. We do not oppose chief inspectors, but if the Government believe that ever-tougher central regulation will bring about the culture change locally that everyone agrees is necessary, they are mistaken. We need change that will have an immediate effect on the ground, and that will support staff and improve care for patients.

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

My right hon. Friend has probably been in the Chamber on most of the occasions when I have raised the question of safe staffing with the Secretary of State. It was cited in the Francis and Keogh reviews, and the Care Quality Commission tells us that one in 10 hospitals has unsafe staffing levels. The Secretary of State dances around the issue again and again, but he will not take action. Yesterday, I asked him to introduce transparency to the process so that hospitals do not have wards with ratios of two staff to 29 patients, but he refused to answer my question. Does my right hon. Friend agree that if hospitals were transparent about their ratios, that would be the way forward, because we would know where we were?

[Andy Burnham]

The Keogh report exposes alarming ratios at my hon. Friend’s hospital and others. We have been warning the Government for months—years, in fact—about cuts to nursing numbers. It is neither right nor fair to criticise nurses for being uncaring when too many of them are unsupported and are working in conditions in which they have to make compromises that they would rather avoid.

Staffing emerged as the main concern arising from the Keogh report, but the problems go way beyond 14 trusts. The CQC says that one in 10 trusts in England does not have adequate staffing levels. Can we agree today that the staffing in all hospitals must urgently be brought back up to adequate levels, as defined by the commission, with clear benchmarks set for the future? [Interruption.] I am pleased if the Secretary of State is agreeing, because that represents progress, so I look forward to finding out how his plan will be delivered.

[Andrew George (St Ives) (LD)]

The right hon. Gentleman will remember that yesterday I drew attention to the fact that all but one of the 14 hospitals Keogh reviewed had staffing and skill mix issues that needed to be dealt with, but it would be quite wrong to suggest that that has happened only in recent years. Graham Pink drew attention to the problem in the early ’90s, and it also happened during Labour’s years in government. I think that it would be good for this debate if the right hon. Gentleman at least acknowledged that it has been going on for more than three years.

[Andy Burnham]

I will acknowledge that. A moment ago, I mentioned the Francis report, which I commissioned, which revealed the dangerous cuts to front-line staffing that the hospital pursued as the primary cause. I accept what the hon. Gentleman has just said. Rather than always pursuing central regulation as the solution, if local communities had identifiable benchmarks that they could use to check up on their local hospitals, surely that would be progress we could all get behind.

On the duty of candour, the Government are legislating for a duty on organisations, but not on individuals. I think that we all agree that changing the culture of NHS organisations is essential if we are to move forward. The Francis recommendation is a necessary part of bringing about that culture change. Rather than being a threat to staff, as some have argued, it would protect them when they make known any concerns. Will the Government look at that again and legislate for the full Francis recommendation in the Care Bill? That is incredibly important in the light of yesterday’s report by Sir Bruce Keogh. He revealed—this will shock anyone who has not spotted it yet—that some trusts were telling members of staff what they could and could not say to his review. Surely we can all agree that is fundamentally unacceptable.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

I am glad that the Secretary of State nods. Does that not make the case, however, for a duty of candour on individuals, which would have allowed staff to say to management, “No, I’m going to speak to the Keogh review and I won’t face action afterwards because it is my duty to do so”?

[Mr Brian Binley (Northampton South) (Con)]

It is generally accepted that there were some serious management breakdowns. The Secretary of State at the time was the chief executive of the organisation. In my business, I would want to know what was happening. Does the right hon. Gentleman accept that he should have known what was happening?

[Andy Burnham]

I always took action when anything was brought to me. When mortality data on Basildon hospital were published, I immediately ordered an in-depth review of all hospitals in England, which led to warnings on five of the trusts on the Keogh list. Those warnings were inherited by the hon. Gentleman’s Government, but Ministers allowed those trusts to carry on cutting staff, and the same was true for the hospital in the constituency of my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), even though it was subject to a warning about patient care. I think that Government Members have to look at themselves before making claims.

On the duty of candour, the final recommendation that we need to see progress on relates to the regulation of health care assistants, which is long overdue. If the Secretary of State took these three sensible measures, he would provide support to staff and reassurance to the public, but they are not in themselves the answer to the structural challenge the NHS faces. That brings me to my final point on the longer-term solution. I have thought long and hard about what happened at Stafford hospital and why we hear recurrent echoes of the same elsewhere in the NHS, with older people lost on acute hospital wards, disorientated and dehydrated. I believe that the problem goes far deeper than any regulatory solution. Governments of all colours have underinvested in social care over many years, and in the end we get what we pay for: a malnourished, minimum wage system that dishes out care in 15-minute slots, which is barely time to make a cup of tea, let alone exchange a meaningful word.

Looking after someone else’s parents should be the highest calling that any young person can answer. However, if we are honest with ourselves, the effect of decisions taken here in this House over many years means that the signal we are currently sending is that it is the lowest calling that a young person can answer. Some 307,000 care staff in England—20% of the work force—are on zero-hours contracts. That is an appalling figure. This situation cannot carry on. Good care cannot be provided on a zero-hours, here-today-gone-tomorrow basis.

The collapse of decent social care in England means that too many elderly people are drifting unnecessarily towards hospital. Our hospitals are becoming increasingly full of very frail, very elderly people, and that is not sustainable in either human or financial terms. That is why I have proposed—

[Jeremy Lefroy (Stafford) (Con)]

I understand what the right hon. Gentleman is saying about the situation of care assistants—their low pay and so on—but in Stafford some of the highest-paid people in the organisation showed the least compassion. It is not all about money, although money may come into it. Compassion does not have any regard to income.

[Andy Burnham]

I agree with the hon. Gentleman, and I respect the way in which he continues to pursue the issues arising from what happened in his constituency. Yes, it is not all about money, but it is about the message we send to the people working in our care system. If somebody does not have certainty about the money that they will bring into the family home from one week to the next because they do not know how many hours they will be working, how can we expect them to pass on a sense of security to those they care for? We will not get the care that we all want for everybody’s parents if we carry on with a system that is working as it is. I lay the blame with no one Government; as I said, all Governments have brought this situation about.

That is why I have proposed the full integration of health and social care with one service looking after the whole person and all their needs, physical, mental and social. I hear the Government increasingly borrowing our ideas and our language, and I have no objection to that. However, here is my challenge to the Minister of State, who has been roused by that statement: he cannot speak the language of integration while legislating for fragmentation and competition. We are hearing reports from across the country of sensible collaboration between secondary, primary and social care being blocked by the competition provisions of the Health and Social Care Act 2012. Torbay, the beacon of integrated care, fears that any qualified provider may break up its celebrated model. That has led the Minister to suggest in the Health Service Journal that his integrated care pilot area might be offered exemptions from the Act’s competition provisions. Surely that is the clearest admission from the Government that the Act they passed is a barrier to the change that the NHS needs. Collaboration or competition? Integration or fragmentation? In the end, they have to make a choice; they cannot have it both ways. If the Minister is serious about this, the last offer I make is that we will work with him to fast-track repeal of the competition provisions of the Health and Social Care Act.

Today I have made some positive suggestions about a way forward for the NHS. It is now up to the Government to decide what they want to do. In the past few days, we have seen a glimpse of a Government prepared to run down the NHS, still the country’s best-loved institution, for their own political ends. If, from here on in, they intend to continue with that approach, they will be pursuing a very dangerous path. It will cement an impression in the country that some people have already formed—that the Secretary of State is running down the NHS to erode public confidence in it and to soften it up for privatisation. People suspect that that is the real agenda. Only today, we learned of six NHS trusts preparing for a major expansion in private work under privatisation freedoms given to them by this Government.

Nye Bevan said that there will be an NHS for

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

I can tell all Government Members that they have not knocked the fight out of me, and I suspect there are millions out there ready to rally to the same cause. People rely on an NHS that puts patients before profit, and Labour will always defend that. This week the Government have revealed their hand and it is nasty. They should pull back or get ready for the fight of their lives.

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

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“welcomes the Government’s swift action in response to the Francis Report; notes the rapid establishment of reviews on key components of the Report’s findings, including the Cavendish review on healthcare assistants, the Clwyd-Hart review on complaints and the Berwick review on patient safety; further notes the drive to improve standards through the appointment of a Chief Inspector of Hospitals, the introduction of Ofsted-style ratings and the recruitment of specialist hospital inspectors; regrets the Opposition’s continued refusal to support these practical measures to expose and improve poor care; welcomes the watershed decision to expose and investigate 14 hospitals with high death rates through the recent Keogh review; further notes the Government’s decisive action to drive improvements in these hospitals by placing 11 hospitals in special measures; and applauds the Government’s wide-ranging efforts to introduce greater transparency and accountability in the NHS.”

I am honoured to see you, Mr Speaker, in your place for my speech. The right hon. Member for Leigh (Andy Burnham) talked about yesterday, and I for one hope that he has had a chance to reflect on Labour’s shockingly inappropriate behaviour. Let me give him one fact to think about: on a day when a review described appalling failings at 14 hospitals, my speech mentioned patients 19 times—his mentioned them just twice. Does that not say it all about Labour’s attitude to the NHS?

[Andy Burnham]

I listened carefully to what the Health Secretary just said about our speeches. Does he think it appropriate for a Secretary of State introducing a report on mortality rates in the NHS to begin, within seconds of getting to his feet, by making political attacks on the previous Government? On reflection, was that the right thing to do?

[Mr Hunt]

It is funny how the Labour party decided to make the NHS its main campaigning issue for the past three years, yet the moment people start to scrutinise its own record on the NHS it says the NHS is being used as a political football. What does that say about Labour’s approach to the NHS?

I want to consider the specifics of the motion before looking at the wider issue of risk. The motion mentions the Francis inquiry. One of this Government’s first acts on coming to power was to set up the full public inquiry into Mid Staffs that families had been denied by the right hon. Gentleman’s Government for too long. We are implementing it, and fast. That is why a new chief inspector of hospitals started work yesterday, just five months after the report was published. [Interruption.] The right hon. Gentleman says that a chief inspector of hospitals is not in the report, but how are we going to make sure that the report’s recommendations are implemented throughout all 266 NHS trusts? That will be done because we will have independent inspection of hospitals, which has not been done before because the situation was so undermined by the previous Government. That is how we are going to make sure that Francis actually happens.

We intend to implement the spirit of everything that Robert Francis proposed, even if the details may vary in places from his 290 recommendations. Francis himself endorsed that approach when that he said that the Government have indicated their

“determination to make positive changes to the culture of the NHS, in part by adopting some of my recommendations and in part through other initiatives.”

Francis talked about five themes, so let us look at the progress being made on them. First, on information and transparency, yesterday showed that this Government are determined to root out, once and for all, an NHS culture of solving problems behind closed doors. This is about not just the decision to hold a public inquiry into Mid Staffs, which the right hon. Member for Leigh and his colleagues rejected doing 81 times, but the Keogh review, which reported yesterday that 14 hospital trusts have excess mortality rates. This is the first time the NHS has ever conducted such a review. We have also published individual surgeon outcomes—the first country in the world to do so across an entire health system. The independent rating of hospitals will start this autumn, so for the first time people will know how good their local hospital is, just as they do for their local school.

Francis also mentioned standards. The new chief inspector of hospitals—a position that Labour still refuses to support—began work yesterday. In Professor Sir Mike Richards, we have a new whistleblower-in-chief whose sole job is to drive up standards and root out poor care. He will be supported by a team of expert inspectors, in stark contrast to the generalist inspection model set out by the right hon. Gentleman’s Government in 2009. That is plain common sense. We have put it right. The work of the inspectors will be informed by the independent review of hospital safety that is being conducted by Professor Don Berwick, who will advise on how to embed a culture of patient safety throughout the NHS. He will report back later this summer.

--- Later in debate ---

[Mr Hunt]

I am going to make some progress. The Francis report also talked about leadership.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Hunt]

I will give way in a moment.

The right hon. Member for Leigh talked about leadership. I want our NHS to attract the brightest and best leaders that this country has to offer. I have asked the NHS leadership academy to develop a new leadership programme to support clinicians to become clinical chief executives and to fast-track professionals from outside the NHS into leadership roles. We urgently need more talented managers in our NHS, and that will make a big difference.

[Mr Hunt]

My hon. Friend makes an important point.

I say to the shadow Secretary of State that it is a question not just of whether he responded to the warnings that he received, but of whether he received the warnings that he should have received in the first place because the inspection system might not have been up to scratch.

[Andy Burnham]

I mentioned a moment ago that when I saw the mortality data in late 2009, action was taken at Basildon and a review was ordered of all hospitals in England, so I did respond.

The Secretary of State needs to correct for the record something that he said a moment ago. He implied that the mortality ratio had not come down at the 14 hospitals. If I have got him wrong, he needs to be clear about it. Yesterday, a group of Back-Bench MPs was informed by Sir Bruce that mortality ratios at the 14 hospitals had fallen since 2005 by between 30% and 50%, but that they were still above the average for England. Overall, the mortality rate is down at all hospitals, but the 14 hospitals have rates that are above the average. Will he correct that point because it is incredibly important?

[Mr Hunt]

Let me help the right hon. Gentleman out. Those 14 hospitals were investigated by Professor Keogh because they had excess mortality rates that go right the way back to 2005. Labour cannot be in denial. Professor Brian Jarman said that under Labour, there was “total denial” in the Department of Health over the issue of excess mortality—

--- Later in debate ---

[Charlotte Leslie (Bristol North West) (Con)]

The Opposition often say that we need to learn lessons—in many ways, I agree with them—and so I intend to go through some of the lessons we can learn. I note that on the 65th anniversary of the NHS, Labour made cupcakes saying, “We love the NHS”, which prompts an interesting question: do we love the NHS—the institution—or do we love, care for and want to protect the patients it serves and respect the professionals who work in it?

I was also very perturbed yesterday by the venom in the denial of some—not all—Opposition Members. As I said then, it reminded me that Julie Bailey faced the same venom and aggressive denial in response to her mission to try to expose some of the truths at Mid Staffs. I am equally perturbed and disturbed that a lot of that venom is coming from two Labour party members locally, Diana Smith, who used to work for David Kidney, and Steve Walker. I would very much like to know whether the Labour party will formally condemn those actions.

The shadow Secretary of State mentioned rewriting history, and I am also slightly concerned that there was a little rewriting of history or confusion in that state of denial. I remind him that it was not him who commissioned Francis 2. He commissioned Francis 1, which was an inquiry of far more limited scope where evidence was given behind closed doors. He had every opportunity to commission Francis 2, and if he had done so the lessons he is now saying we must implement more quickly—and I appreciate speed is always of the essence—could have been implemented some time ago.

[Andy Burnham]

I would like just mildly to correct what the hon. Lady said. When I commissioned Francis 1, I said to Robert Francis that if he did not think he was receiving enough co-operation from witnesses in the first-stage inquiry and he came back to me wanting me to give him powers to compel, I would be glad to give him those powers. The second point the hon. Lady needs to bear in mind is that when he delivered his first report I told this House, in February 2010, that I would be commissioning a second stage report looking at the wider regulatory issues.

[Charlotte Leslie]

That is very encouraging to hear post-event, but unfortunately it still leaves some questions as to why the Cure the NHS group was not able to go along and formally deliver the case studies of Bella Bailey at the Department of Health but instead had to go and see the former Secretary of State outside his constituency office—and for those who want to deny yet more evidence, that is on YouTube.

We have to ask why this review was not commissioned at the time if there were, through 81 requests, serious concerns raised. What did people have to hide? In 2009 the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) said fairly clearly that Mid Staffs was a one-off, but unfortunately we know from the Labour “lines to take”—which are in the inquiry so are in the public domain—that Labour knew there were 12 hospitals with equal or even worse mortality rates. That was denied, but, tellingly, that brief says Labour should try to avoid naming them. That stands in stark contrast to the approach taken in the Keogh report, which has been transparent in naming those trusts where there are problems. Unlike Labour, I do not think being honest about the situation prevents improvement; actually, I think it helps improvement.

--- Later in debate ---

[Charlotte Leslie]

I am terribly sorry. I will make progress.

I would also like to set the record straight on who knew what about hospital trusts. The right hon. Member for Leigh says that he took astute action. He knows, because I have the e-mails, as he does, that he was written to by Professor Sir Brian Jarman about 25 trusts about which he had concerns. He said he was concerned that the CQC was not doing its job. Seven of those were investigated by Sir Bruce Keogh. Fifteen of those trusts were in marginal seats and one, as he will know, was in the constituency of the right hon. Member for Leigh.

[Andy Burnham]

That list, when Brian Jarman gave it to me, was immediately referred to the CQC. Within weeks, six of the trusts, I think, on that list were registered with conditions before the general election.

[Charlotte Leslie]

The fact that the very same trusts appear in the Keogh report and have not resolved their problems proves that we have suffered a legacy issue. Those reports are still relevant.

The then Secretary of State referred those trusts to the CQC, which we now know he was leaning heavily on. We know that people were saying that the aim of the CQC’s operation was that no bad news should come out. The lessons that we need to learn about how to avert risk and to care for patients is to return to the specialist, honest medical analysis and inspection of hospitals that will give all Governments some uncomfortable truths. This party wants to hear uncomfortable truths. We do not want to smother them.

Labour has presided over a culture of bullying, threatening and aggressive denial, which we sometimes see in the Chamber. We will not be bullied now. The truth is out. Finally, patients and professionals struggling to care for those patients will not be stifled under a saccharine sickly-sweet cupcake icing which says, “We love the NHS”. We have seen in so many tragic cases that that love has been lethal.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

What my hon. Friend says is incredibly important. We must have a culture of openness and transparency inside the NHS, which means that people at the front line feel empowered to speak up if they think there is a problem. That has not happened in the past, and we are going to put it right.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State will make a statement shortly about the Keogh review. Two of the hospitals investigated are Basildon and Tameside. The previous Government left a warning in place on both trusts about patient safety. This Government have ignored those warnings and allowed both trusts to make severe cuts to front-line staff. Tameside has cut 128 nursing posts and Basildon an unbelievable 345. Given the warnings he inherited, why on earth has he allowed that to happen?

[Mr Hunt]

I am very surprised that the right hon. Gentleman wants to mention what happened at Tameside. Tameside had high death rates for eight years under Labour. The previous Government ignored a whistleblower in 2005, warnings to Parliament in 2006, a coroner’s report in 2006 and warnings from my predecessor in 2009. To cap it all, in 2009 the hospital was given a “good” rating by the Care Quality Commission. How bad is that?

[Andy Burnham]

I am afraid the Secretary of State is simply wrong. At the instigation of my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), I ordered unannounced inspections into Tameside. The Secretary of State should get his facts straight before he comes to this Dispatch Box. He did not answer on staffing, and it gets worse, Mr Speaker. Seven of the 14 hospitals in the Keogh review have between them cut a shocking 1,117 nursing jobs on this Government’s watch. Unsurprisingly, A and E performance has plummeted at all seven. All 14 hospitals were meeting the A and E target in my time in office; none of them are meeting it under the Secretary of State. Is not the right response to the Keogh review to stop dithering and act now on safe staffing levels?

[Mr Hunt]

I am surprised that the right hon. Gentleman wants to talk about the Keogh review before we have made our statement. I am particularly surprised because the Keogh review is the review that Labour never wanted to have, with high death rates in all those hospitals stretching back to 2005 and a record of inaction by Labour. As former—[Interruption.] I think the House might be interested to hear this. as former Labour councillor and Mid Staffs campaigner Ken Lownds said today:

“Can you imagine a Keogh review under Andy Burnham or any Labour Health Secretary? Not a chance.”

Hospital Mortality Rates

Andy Burnham Excerpts

Tuesday 16th July 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

First, let me join the Secretary of State in thanking Sir Bruce Keogh and his team for this important review. Having worked closely with Sir Bruce, I know him well and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, we accept the findings of this report in full.

The statement we have just heard, however—the partisan statement—was not worthy of the excellent report that Sir Bruce has delivered today. The Health Secretary claimed at Health questions that this was a historical report, all about the past and the last Government. Well, I have got news for him: it is not. Trusts were identified on the basis of mortality data for 2011 and 2012. This report is about the right hon. Gentleman’s Government and failings that are happening now on this Government’s watch.

Anyone who supports the NHS must always be prepared to shine a spotlight on its failings, so it can face up to them and improve. In so doing, we must be fair to staff and the NHS as a whole. I am pleased to say that Sir Bruce is fair in his report. He says early in the report that the failings of the 14 hospitals must be put in context, stating that mortality in “all NHS hospitals” has been falling over the last decade by about 30%. He rightly reminds us of

“decades of neglect in the NHS in the 1980s and 1990s”,

and he speaks of the challenge facing the last Government in their early days. The key issue, he said,

“was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

The last Labour Government dealt with that issue; I am proud of it and we are proud of our record on the NHS.

The balanced picture presented in this report is not recognisable from the Government briefing appearing in the weekend newspapers. In fact, this report exposes one of the more cynical spin operations of recent times. Nowhere in this report does the claim of 13,000 avoidable deaths appear. Sir Bruce is clear, so let me quote him directly:

“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”,

but that is precisely what this Government chose to do in advance of this report. They made unfounded claims, which will have alarmed people in the areas served by the 14 hospitals, and they have questioned the integrity of the staff working in those hospitals in difficult circumstances—and all for their own self-serving political ends. That is simply unworthy of any responsible Government. On reading this review, the diversionary spin operation now makes sense because it reveals evidence of deterioration at all 14 hospitals on their watch.

Let me turn to one of Sir Bruce’s central findings—unsafe staffing. One of the report’s major concerns is that trusts have allowed staffing levels to drop to dangerously low levels. It says:

“When the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas.”

Already, the review team has had to intervene on staffing levels in three trusts to protect patient safety.

The Secretary of State claimed in his comments that the Care Quality Commission had failed to spot any problems. Working with the CQC during the last Government, I left in place warnings about five of these hospitals. The Secretary of State claims that we were covering up, so let me answer on the question of Ministers’ integrity and cite the Francis report, which said that there was no evidence that any Minister received or ignored advice that would have led to safe outcomes. Let me quote to him from a letter sent by Baroness Young to the Prime Minister yesterday:

“CQC was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures.”

It is outrageous for the Secretary of State to come to the House today and repeat those concerns without a shred of evidence to back them up.

Five of the trusts examined by Keogh had warnings in place, and it is shocking that they have been allowed to cut staff to unsafe levels on this Government’s watch. Overall, seven of the trusts in the review have cut front-line staff by a shocking 1,117. The great sadness is that it appears Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified “dangerous cuts” to the front line as a primary cause of care failures. Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Is it not the case that the Secretary of State can no longer ignore these authoritative calls, and will he take urgent action on safe staffing levels in these 14 trusts and across the NHS? Will he accept that the loss of over 4,000 nursing jobs that has now been laid bare under this Government is a monumental mistake, while £3 billion has been siphoned out of the NHS front line to pay for reorganisation that nobody wanted and nobody voted for?

Let me turn to A and E performance, the barometer of the health service and a wider indication of problems across hospitals. The report highlights major failings in A and E at many of the trusts and we know that the NHS has just come through the worst winter for a decade. At the end of last year, all 14 trusts were in breach of the Government’s A and E target—when, under the previous Government, all 14 were meeting the A and E target.

Sir Bruce is clear that urgent action is needed to improve A and E. Let me quote the report:

“We have established that one of the primary causes of high mortality in these hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients…All trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellation of operations due to bed shortages and difficulty meeting waiting time targets.”

Will the Secretary of State now take immediate action, working with the whole health economy in these 14 areas, to bring each trust back up to the national standards on A and E that his Government have set? Will he accept that it is not fair to these hospitals to blame them alone, as the devastating cuts to social care are a major driver of pressure in hospitals?

Finally, on what happens next, the simple truth is that people watching will want solutions rather than point scoring. Surely the right response to the Keogh review is now to accept the Francis recommendations in full, particularly on minimum staffing. A duty of candour on individuals will help bring the culture change we need at local level and, of course, we need to see the regulation of health care assistants. Will the Secretary of State work with us now on early implementation of the Francis recommendations? He spoke earlier of a new era of transparency. If he means what he says, will he now publish the NHS risk register? For all we know, it might well have predicted some of the failings we are reading about today.

It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What matters is how the NHS responds. Rather than pulling down the shutters and pushing people away, it is right that we should hold a mirror up to the NHS so that it can act on its failings. We must also be fair to people working in the NHS by ensuring that an accurate picture is presented. Sir Bruce has had to take the extraordinary step already of distancing himself from the Government briefings that appeared at the weekend. I hope the Government will learn a painful lesson from this: you should not play politics with people’s lives and you should not play politics with the NHS, on which all people depend.

[Mr Hunt]

Mr Speaker, it is hard for a serving Health Secretary to admit that things can go wrong in the NHS, but we know today that it is even harder for a former Health Secretary. We have heard nothing but shameful denial. The right hon. Gentleman—[Interruption.]

Health Services (North-West)

Andy Burnham Excerpts

Thursday 11th July 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement on matters that are of major significance to the NHS in the north-west of England, but I am not the only north-west MP taken by surprise this morning by the lack of advance notice. My hon. Friend the Member for Stretford and Urmston (Kate Green), in whose constituency Trafford hospital lies, was heading home, but had to abandon her journey at Stoke and is now heading back down to try to get here. This is not just a major discourtesy to her and the House, Mr Speaker; it is an insult to the people of Trafford, and it is no way to treat people who have campaigned to save their A and E, and who should have rightly been able to expect that their voice be heard in this House today through their elected Member of Parliament.

It says a lot about this Secretary of State. His advisers could find time to get texts sent to the Murdochs with market-sensitive information before an earlier statement he made, but he could not find time to give a local MP advance notice of a statement about the closure of her accident and emergency department: disgraceful.

This is not just any A and E: 65 years and six days after Nye Bevan opened the NHS at Trafford hospital, we have the spectacle of this Secretary of State scurrying to the House to rush out an announcement without the scrutiny of local MPs about a major downgrade of the hospital. What clearer symbol could we have of a Government who disrespect and disregard the views of NHS staff, patients and local people?

My hon. Friend the Member for Stretford and Urmston is trusting that the west coast main line will get her back before the close of this statement, and I hope you will allow her to contribute, Mr Speaker, even though she has clearly missed the opening of this statement.

Let me now turn to the substance of what the Secretary of State has said. He is right to say that the IRP provides excellent support and advice to Ministers. It did so to me and my predecessors in the last Government, and I am sure it is doing the same for the current Government. Where it can be shown that changes will save lives and reduce disability, in my view all Members of this House have a moral obligation to support them. Changes to vascular services in Cumbria and Lancashire clearly fall into that category. The concentration of this highly specialised surgery on three sites will save and improve lives, but given the geography it is essential that people are supported with travel. The Secretary of State made a vague commitment, but can he be more specific about the support that will be made available to patients, particularly in the sparsely populated northern part of our region, who will now have to travel much further to receive this life-saving surgery?

Although we support the Secretary of State’s decision on Lancashire and Cumbria, we have much greater concerns about the process that has led to the decisions today about Trafford hospital. While the IRP has undoubtedly done what it has been asked to do, I wrote to the Secretary of State in November last year to express serious reservations about the Trafford review proceeding ahead of Healthier Together, a much wider review of acute and emergency services across Greater Manchester. Speaking as a Greater Manchester MP, I cannot see why it makes sense to pick off Trafford hospital ahead of this review without looking at things in the round. It does not feel to me that this is part of a coherent plan for the NHS in our city region, and I ask the Secretary of State today why his decision is justified, given that the wider considerations affecting health services in Greater Manchester have not yet been completed.

The Secretary of State claims that the patients affected by the closure of Trafford can be easily and safely absorbed by the neighbouring A and Es. How can he say that when all the A and Es that will now have to absorb extra patients missed his own A and E target for at least four months during the worst winter in the NHS for a decade? Have the Secretary of State and the IRP made their decision looking at the very latest evidence of growing pressure on A and E departments in Greater Manchester? He mentions extra funding for Wythenshawe, which is welcome, as the hospital was built for 70,000 patients a year and is currently seeing almost 100,000, but will other affected A and Es also receive additional funding?

Finally, Mr Speaker, the appalling mishandling of this statement today, which has left the people affected unable to put the Secretary of State under scrutiny, is just the latest example of the wider mishandling of hospital reconfiguration under the coalition, which has seriously damaged public trust in our ability to make changes to hospitals. Picking off Trafford ahead of a wider review broke the illusory moratorium on hospital changes announced just days after the general election outside Chase Farm hospital by the Secretary of State’s predecessor and the Prime Minister—incidentally, that hospital is also now downgraded.

Sir David Nicholson has today said:

“If a political manifesto does not say that service change is absolutely essential and that you need to concentrate and centralise services—it will not be being straight forward with the British people.”

Might he just have had the last Conservative manifesto in mind when he made that statement? Will the Secretary of State today admit that this false moratorium was a cynical and dishonest policy designed to win votes in marginal seats, and will he commit never to repeat it?

Worse still, the Secretary of State’s officials have been in court in the past few days trying to justify the indefensible: a decision to rob a local community in south London of a successful A and E to solve problems in another trust that were not of its making. Is all this not causing severe damage to trust in how these decisions are made? Will he give a commitment to the House today that if the court finds against him, he will abandon his plans to downgrade Lewisham A and E? Labour Members will support changes where they are clinically justified, but where communities are picked off unfairly by this arrogant Government we will stand with them and fight for fairness.

[Mr Hunt]

Many members of the public are understandably concerned about these decisions, but from someone who was Health Secretary and who argued the case many times for changing services what we have heard today is not sensible argument, but political opportunism.

Let us examine what the right hon. Gentleman said only last week in Hastings. He said that people like him have a moral imperative to support the doctors who are making these decisions. Well, these changes are supported by the Trafford clinical commissioning group, Greater Manchester critical care network, the Royal College of Surgeons and many other doctors. How many doctors does he need to support this decision before he actually does what he said he would do last Friday, which is support doctors making difficult decisions? On the very day that NHS England is talking about the need to protect services for patients by facing up to difficult decisions, his approach is more than inconsistent—it is irresponsible, and he knows it. Let us examine what he said about changes in Trafford when he was Health Secretary—

[Andy Burnham]

Answer the questions.

[Mr Speaker]

Order. We must have order from those on the Opposition Front Bench, and I know that the Secretary of State will want to respond to the questions asked of him. I just remind the House that it is not a generalised debate; it is a statement and a response to questions.

--- Later in debate ---

[Mr Hunt]

The process has taken a long time because we have consulted extensively with the local community and local Members. There have been debates in the House about it, and Members have regularly asked about it during oral questions. I asked for hon. Members to be given advance notice of today’s statement. Consultation is important, and we asked for advice from the Independent Reconfiguration Panel—

[Andy Burnham]

No; wrong. You did not give advance notice.

Care Quality Commission (Morecambe Bay Hospitals)

Andy Burnham Excerpts

Wednesday 19th June 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for early sight of it, and I welcome what he has just said. Today’s report will have left people stunned. The Secretary of State began with an apology and we on the Opposition side echo it. It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What is never acceptable is when people or organisations try to hide those mistakes. As Professor Sir Liam Donaldson, the former chief medical officer, says:

“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Sadly, that is precisely what appears to have happened in this case.

The report covers a four-year period from autumn 2008 to autumn 2012. It details failures in regulation, but also subsequent attempts at a cover-up. It was published only because of the efforts of James Titcombe and his family. Like the Secretary of State, I pay tribute to them today, as does my hon. Friend the Member for Barrow and Furness (John Woodcock), who has supported the family. As he rightly said, that family’s suffering has been intensified by the actions of the NHS—something that should never happen. It is now essential that they and all the other Cumbria and Lancashire families affected get all the answers they are looking for—and I fully commit the Opposition to making sure that happens.

The most shocking revelation in this report is that, in March 2012, an instruction was given by a member of senior management at the CQC to “delete” the findings of a critical internal review. Let me remind the House of the context in which that March 2012 instruction was given. At that time, we were midway through a major public inquiry into the terrible failings at Mid Staffs. This was two years after the completion of an earlier independent inquiry—also led by Robert Francis, QC—following which all parts of the NHS had committed to full openness and transparency. It also came after failings at other trusts—most notably Basildon and Thurrock—which led me to request an in-depth look at all hospitals so that problems could be flushed out and a system put in place to ensure that people had a comprehensive picture of local standards. That was the context in which this instruction was given, and it explains why today’s revelations beggar belief and are hard to comprehend. The report raises questions for the CQC and the Department; I will take each in turn.

The new chief executive, David Behan, commissioned this report and we pay tribute to him for doing so. The chair has said today that he now wants to draw a line under this issue, but does the Secretary of State agree that it will be possible to do that only when further questions raised by this report are answered?

On hospital regulation, there is a recognition on all sides that it has not been good enough for too long. While we note the important work of Don Berwick, should we not also be getting on with the job of implementing the recommendations of the three-year Francis report in this regard? The Secretary of State mentioned a duty of candour on providers, but he will know that Robert Francis recommended that that should extend to individual clinicians, too. Will the right hon. Gentleman work with the Opposition to implement that recommendation as soon as possible?

On the cover-up, paragraph 1.17 of today’s report says that the order to delete

“may constitute a broader and on-going cover-up.”

Will the Secretary of State address that point directly and tell the House whether he is confident that this cover-up is no longer happening? Is he satisfied that the CQC has taken all appropriate steps, and does he have full confidence in it going forward, or does he believe a further process of investigation is necessary?

More specifically, is anybody who was involved in the decision to delete still working at the CQC or elsewhere in the NHS? If they are, people will find that hard to accept and they will want answers on that specific point. Given that accountability is essential, does the Secretary of State agree that people will find it hard to accept if data protection laws stand in the way of that accountability, and will he therefore review the decision to shield the identities of those involved? Today’s report makes it clear that the “deleted” report still exists. Should it not now be published?

Now let me turn to the Department of Health. Was the decision to delete taken solely by senior management at the CQC or is there evidence that anyone outside the CQC was either involved in the decision or aware of it? Was anyone in the Department of Health aware of the internal report being produced, and did any contact take place between the CQC and the Department running up to the decision to delete it?

Unfortunately, this matter does not end with deletion of the report. The Prime Minister said earlier that there should always be support for whistleblowers, and he was right, but there are serious doubts about whether that has happened in this case. Concerns about the CQC were raised by an internal whistleblower who was on the board. We know there was an attempt to remove her from the board and to question her character. Has the Secretary of State looked into these issues and considered whether appropriate support was provided—by both the CQC and the Department—to the individual who raised these concerns? The same whistleblower told the CQC today that she had raised issues internally first, then within the Department and then directly with the former Secretary of State in a meeting. Will the Secretary of State provide details of that meeting and publish a minute of it? What actions were taken by Ministers subsequent to that meeting? Were Ministers consulted about the decision to remove her from the CQC board, and did they support that decision?

Finally, the only real answer to all of these deep-rooted problems that go back a long way is for both sides of the House to recommit to full openness and transparency in the national health service. Will the Secretary of State join me today in restating that commitment and together sending the clearest and most unambiguous signal we can to the rest of the NHS?

In conclusion, there are difficult questions here for people at every level of the system. If we are to restore confidence, it is essential that they are answered and that people are held accountable for their actions. Learning from this failure and others, this House must a deliver a regulator that the public can trust, one that puts patients before its own interests. We will support the Government in that process and not stop until it is completed.

[Mr Hunt]

I welcome much of what the right hon. Gentleman says, but let me say this: he talks about getting on with implementing the Francis report, and that is exactly what has been happening. The report came to the House on 6 February. A new chief inspector of hospitals was appointed by 31 May, and the new inspections will start towards the end of this year. That will mean that many of the things talked about in the Francis report as being fundamentally important will start to be looked at independently and rigorously for the very first time.

I can confirm that there will be a duty of candour in the new Care Bill. We are looking at the extent to which it should apply to individuals, but we want to wait until Professor Berwick produces his report, because it is important to create a culture of openness, and we do not want to pass a measure that might inadvertently mean people clam up when they see a potential safety breach. We need to encourage an atmosphere where everyone talks openly about any concerns they have.

David Prior will be looking in his response to today’s independent report at whether anyone still working in the NHS, or, indeed, the CQC, may have been responsible for some of the shocking things that have been revealed. He will pass that report to me within the next two months. As I said in my statement, there will be full consideration of any sanctions or appropriate disciplinary procedures. In our response to the Francis report, we have said we want to introduce a new barring scheme to make sure that managers who have been found guilty of behaving in a bad way do not get jobs in another part of the NHS.

With respect to what the right hon. Gentleman said about my colleague, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), I gently say to him that it was not my right hon. Friend or myself or this Government’s Ministers who rejected 81 requests for a public inquiry into what happened at Mid Staffs. My right hon. Friend was the person who called the public inquiry into Mid Staffs. He is the person who changed the management of the CQC. He is the person who put clinicians in charge of budgets in the NHS, precisely to make sure these kinds of safety issues do not arise.

Finally, the right hon. Gentleman talks about accountability. If the Opposition really wanted to give confidence that they take the issues raised today seriously, they would recognise that it was fundamentally wrong to set up an inspection regime that was not carried out by specialists, and where the same person was inspecting a dental clinic, a slimming clinic, a hospital or a GP practice, perhaps in the same month. That may have contributed to the CQC’s decision in 2009 not to investigate the maternity deaths at Morecambe Bay, and to its decision in April 2010 to register the hospital without conditions.

When it comes to accountability, the right hon. Gentleman needs to explain to the House why the former head of the CQC, Barbara Young, said in her evidence to the Francis inquiry:

“We were under more pressure…when Andy Burnham became minister, from the politics.”

Is it the case that the head of the CQC felt under pressure not to speak out about care issues?

On the substantive policy point, the right hon. Gentleman continues to criticise the appointment of a chief inspector of hospitals and continues to criticise me when I single out hospital management who coast when it comes to raising standards. Just how much evidence will it take for the right hon. Gentleman and the Labour party to realise that when it comes to NHS policies, they really need to change?