NHS Commissioning Board

Andy Burnham Excerpts

Tuesday 5th March 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on comments by the deputy medical director of the NHS Commissioning Board on the regulations on procurement, patient choice and competition under section 75 of the Health and Social Care Act 2012.

[The Minister of State, Department of Health (Norman Lamb)]

I know that the right hon. Member for Leigh (Andy Burnham) and others have raised concerns about the effect of the regulations and I would like to address them in my response. First, however, I would like to make it absolutely clear that the regulations must be fully in line with the assurances given to the House during the passage of the Health and Social Care Bill. The former Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), said to clinical commissioning groups in 2012 that

“commissioners, not the Secretary of State and not the regulators, should decide when and how competition should be used to serve…patients interests”.

That must be the case. I made it clear in Health questions last week that we would review the regulations to ensure that that was the case and that they were not open to any misinterpretation.

The right hon. Member for Leigh himself gave guidance to primary care trusts which made this clear in 2010:

“Where there is only one capable provider for a particular bundle of services or the objective of the procurement is to secure services to meet an immediate interim clinical need there will be a case for Single Tender Action (i.e. uncontested procurement). By definition, an immediate or urgent scenario will be exceptional and likely to only arise on clinical safety grounds or for example, where existing services have been suspended following intervention by the Care Quality Commission.”

The next bit is very important.

“A decision to procure through single tender should always take account of the potential to secure better value by investing in a competitive process, as long as this is justified by the scale and importance of the opportunity (i.e. it has to be worth it).”

[Interruption.] Those were the comments of the right hon. Member for Leigh.

In the Government’s response to the Future Forum report, we committed to ensuring that the regulations would simply continue that approach. However, I fully recognise that the wording of the regulations has inadvertently created confusion and generated significant concerns about their effect. I have therefore listened to people’s concerns and my Department is acting quickly to improve the drafting so that there can be no doubt that the regulations go no further than the set of principles and rules that we inherited from the previous Labour Government. Following our commitment in response to the Future Forum report, the co-operation and competition panel has been transferred to Monitor. That will ensure consistency in the application of the rules.

Concerns have been raised that commissioners would need to tender all services. That is not our intention and we will amend the regulations to remove any doubt and to clarify that the position remains the same as at present and as stated in my right hon. Friend the former Secretary of State’s letter of 2012.

Concerns have been raised that Monitor would use the regulations to force commissioners to tender competitively. However, I recognise that the wording of the regulations has created uncertainty, so we will amend them to put this beyond doubt. Concerns have also been raised that competition would be allowed to trump integration and co-operation. The Future Forum recognised that competition and integration are not mutually exclusive. Competition, as the Government made clear during the passage of the Bill, can only be a means to improve services for patients—not an end in itself. What is important is what is in patients’ best interests. Where there is co-operation and integration, there would be nothing in the regulations to prevent this. Integration is a key tool that commissioners are under a duty to use to improve services for patients. We will amend the regulations to make that point absolutely clear.

[Andy Burnham]

In less than four weeks’ time, new GP commissioners take control, yet today there is complete confusion about the job they are being asked to do. Following comments by the deputy medical director of the NHS Commissioning Board and the statement we have just heard, coalition policy on competition in the NHS is in utter chaos. It beggars belief that almost three years after the White Paper introduced by the right hon. Member for South Cambridgeshire (Mr Lansley) and after all the upheaval he inflicted on the NHS, there is still no clarity on policy today. They are in this mess because the “doctors will decide” mantra was always a fig leaf for their true ideological purpose of driving competition and privatisation into the heart of the NHS.

We notice that the Secretary of State is not here today, but perhaps the Minister will remind him of the statement his predecessor made to GPs:

“I know many of you may have read that you will be forced to fragment services, or to put services out to tender. This is absolutely not the case.”

I am tempted to ask: if the aim is to revert to the position we held, why on earth bring forward a 300 page Bill to rewrite the entire legal basis of the national health service? The truth is that they have been found out trying to sneak through the back door privatisation proposals that the Minister’s predecessors were forced to rule out to save their discredited Bill. In that light, does the Minister accept that it will not be good enough to bring these proposals back with a few cosmetic changes? Will he give a categorical assurance that there will now be a fundamental rewrite to reflect to the letter commitments given to the House and to the professions?

More broadly, we now need urgent clarification, in a full and detailed statement, of what Government policy on competition actually is. Will the Minister today send the clearest message to clinicians that they will control whether or not to use competitive tenders, and will he fulfil the pledge by his leader to protect the NHS from the full glare of EU competition law? If the Government still want to argue for more private providers in the NHS, is he confident that this will not restrict whistleblowing as it has in other outsourced public services?

Will they also respond today to the research of the Nuffield Trust, which shows that more competition in the NHS has resulted in falling productivity? A quarter of a million people who signed the 38 Degrees petition have forced the Government into yet another humiliating U-turn, but there will be lingering distrust at the fact that they had the audacity even to attempt this. The simple truth is this: the British public have never given them permission to put the NHS up for sale. Until they acknowledge that, we will never tire of reminding them.

[Norman Lamb]

I sense that the right hon. Gentleman’s speech was written before he heard what I had to say. If he had listened to it, he would know that we recognise concerns about the drafting and whether it absolutely meets the commitments already made. We want to be certain that the commitments made in this place during the passage of the Bill are met. Indeed, when the Secretary of State wrote to clinical commissioning groups in 2012, he made it absolutely clear that those groups would not be forced to go out to tender. We will make sure that that is met. [Interruption.] If Opposition Members had simply listened to what I said, they would have avoided coming up with a set of questions that completely ignored my points.

The right hon. Gentleman referred to the question of quality of care. From my point of view, poor care should be condemned wherever it happens, and he needs to remember that the scandal of Mid Staffordshire hospital happened under his and his party’s watch. The poor quality of care uncovered in that NHS hospital is completely unacceptable—just as unacceptable as poor quality care from any private provider at all. Let us be clear about that.

There will be no privatisation of the NHS under this Government. Furthermore, there will be no special favours for the private sector, which were provided under the right hon. Gentleman’s Government. It was his Government who gave £250 million to private providers of independent sector treatment centres—whether or not they delivered care. There will be no special favours under this Government’s new rules. No clinical commissioning group will be forced into competitive tender. The rules will be absolutely clear, and we shall publish the amended regulations shortly.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 26th February 2013 Commons Chamber

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

I am grateful for that question, because my right hon. Friend has identified the fact that TB is a growing problem. We are exploring the effectiveness of an approach across health sectors for a national strategy on TB, while ensuring that we recognise the local variances. We need to improve in that area.

[Andy Burnham (Leigh) (Lab)]

I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?

[Mr Jeremy Hunt]

If the right hon. Gentleman had read the Francis report carefully he would have, first, observed that the appalling tragedies covered in that report happened between 2005 and 2009, when nursing numbers were going up. So to say that this is an issue about nursing numbers is to miss the point completely. This is not an issue where there is a quick fix; it is an issue about the NHS having become dominated for far too long by a culture of targets at any cost. Unpicking that culture is the biggest challenge we face if we are to return a culture of compassionate care to the NHS.

[Andy Burnham]

I have read both Francis reports, and I think it is essential that everybody learns the lessons—that is what I said—including Labour Members. It is also important that we do not repeat the mistakes, and the first Francis report said that the problems were caused because the trust cut staff to dangerously low levels. The most worrying thing from the analysis that will be published today is that four in 10 of the jobs being lost come directly from services linked to the care of older people. Does the Secretary of State therefore agree that there is a danger that the NHS is already failing to learn the lessons of the recent past? Will he join me in sending a message to the NHS that care of older people should be a priority for improvement, not an easy target for cuts?

[Mr Hunt]

If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.

Social Care Funding

Andy Burnham Excerpts

Monday 11th February 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement, and for early sight of it. I agree with him that our current social care system in England is the worst of all possible worlds: a cruel lottery whereby people go into later life with everything for which they have worked on the roulette table, and the most vulnerable are always the biggest losers. That needs to change.

The Secretary of State has tabled a modest plan that will make the system fairer than it is today, and we congratulate him on that. We welcome elements of what he has announced today. A cap of £75,000 will protect people from the catastrophic costs of care, and raising the means-test threshold will help more people on lower incomes to obtain some help with care charges. This is a step forward, but it is a faltering one. The House has been presented with a flawed prospectus today. Vulnerable people will still face rising care charges and homes will still be lost, notwithstanding valiant attempts to put the best possible spin on things in the weekend media. Yesterday the Deputy Prime Minister made the big claim that the Government were going to “crack” the care “conundrum”. Today, when we are faced with this meek package, that sounds suspiciously like overselling. Stephen Burke, the director of United for All Ages, has described the cap as

“the dampest of damp squibs”.

Yesterday, on The Andrew Marr Show, the Secretary of State said:

“I've been hauled before the Speaker before and I wouldn’t want that to happen again and so I don’t want to go into the details.”

Now that we have heard the details, perhaps the Secretary of State could explain on which part of his statement the media had not been pre-briefed. It is disappointing that the media rather than the House were briefed first on a statement that was of such importance to so many people. It is also disappointing that the Government have abandoned any effort to build a cross-party consensus before rushing to announce its proposals, and that they have chosen to rewrite the Dilnot report with figures of its own, breaking its careful logic.

More specifically, there are four problems with what has been announced today, and I will address each in turn. First, it fails the fairness test. We will only have a durable solution if it can answer this question: will it help every person and every couple to protect what they have worked for, whatever their wealth and savings? I am afraid that the answer is no. According to Demos, a £35,000 cap would benefit about 3.2 million pensioners. A per-person cap of £75,000 will benefit just 1.4 million. For the average couple, the cap is £150,000. That might be enough to protect detached houses, but it will not protect the average semi-detached home in large parts of England.

As Andrew Dilnot said today, the cap

“is higher than we would have wanted —£11,000 higher than the top end of our range—and I regret that”.

Will the Secretary of State confirm that people with modest to average homes and savings are not protected under his plan? Is this not a plan for the few and not the many, and further proof that we are not all in it together?

The Secretary of State claims that insurance companies will step in with new products to help more people to protect their assets, but in evidence to the Health Committee, the Association of British Insurers said that it did not believe that the capped cost model would result in a market for pre-funded care insurance. So what further confidence can the Secretary of State give the House today that such a market will in fact emerge?

Secondly, the plan is at best a partial solution. With this decision, the Government have prioritised the funding of a cap on care costs with new money, over and above addressing the crisis in council care budgets. Will the Secretary of State confirm that this was against the advice of Andrew Dilnot to the cross-party talks? In practice, it will mean that vulnerable people will continue to face rising charges, as councils put up fees to cope with the growing shortfall in their budgets, making it more likely that those people will, in time, have to pay right up to the new £75,000 cap. To many people, that will not feel like progress.

More than £1.3 billion has been cut from local council budgets for older people’s care since the coalition came to power. Care charges are rising above inflation, and councils are warning that, by 2024, they will be overwhelmed by the costs of care. Does the Secretary of State accept that forecast, and if he does, how will the plans he has announced today help to address it? If he fails to face up to the current crisis in council funding, is it not the case that, with care charges rising, today’s announcement will feel like a con? It is true that the Government have raised the capital threshold, and I have said that we welcome that, but can the Secretary of State give the House any confidence that the extra support that people receive through a more generous means test will not be more than offset by increasing care charges caused by collapsing council budgets?

What people might not know is that the cap reflects not what people actually pay for care but a local authority average, and that it does not include accommodation costs. That was not mentioned in the Secretary of State’s statement. Will not people feel conned if the Government do not make that clearer?

The third problem is that this package disguises yet another coalition U-turn, this time on inheritance tax—[Interruption.] It is ironic, I must say. In 2007, a flagship pledge was made to increase the inheritance tax threshold to £1 million. Just eight weeks ago, the Chancellor said that he would increase the threshold in two years’ time. What has happened in the past two months to make him change his mind? Is not this the quickest coalition U-turn yet? The irony will not be lost on people that the Government are now increasing death taxes to pay for their plan. The Secretary of State has also said the rest will be made up from national insurance. Does he think it is fair to ask the working age population to pay for something else, rather than older people?

Finally, the proposal fails to meet the scale of the challenge of the ageing society. It will not lead to more integration of care. Instead, it will entrench the separation between two separate systems: a free-at-the-point-of-use NHS and charged-for social care. Would it not have made more sense, rather than developing these piecemeal plans in isolation, to have set them out as part of a single vision for a sustainable health and care system in the 21st century? The Secretary of State has made progress, but he has missed an opportunity to produce a long-term plan that is fair to everyone and built on cross-party consensus. He has settled for a timid solution when what older people needed was a far bigger and bolder response.

[Mr Hunt]

Really! The right hon. Gentleman talked about a flawed prospectus, but what we had from the Labour Government during their 13 years in power was no prospectus whatever. This was in Labour’s manifesto in 1997, then the Government had a royal commission in 1999. There was a Green Paper in 2005, followed by the Wanless review in 2006. The problem was going to be solved in the comprehensive spending review of 2007, but then we had another Green Paper in 2009. Let us compare that with a coalition that commissioned a report the moment it came into office, said after a year that it accepted the principles of the report, and has now, just two years later, announced how it will implement it and pay for that implementation.

Let me go through some of the things that the shadow Secretary of State has said. He quoted one stakeholder, Stephen Burke, but let us look at what some of the others have been saying. The Joseph Rowntree Foundation has said that

“the cap and threshold are welcome measures, and a welcome sign that the government is taking responsibility for addressing care funding.”

Andrew Dilnot said today:

“I recognise the public finances are in a pretty tricky state and it doesn’t seem to me that”—

what the Government are proposing is—

“so different from what we wanted”.

Or we could talk about Age UK, which says it

“has always supported the principle of a cap”

and welcomes the fact that we are increasing what it describes as

“the current miserly upper means test threshold”.

A lot of stakeholders welcome today’s announcement, but recognise that we are in extremely difficult financial circumstances and that that is why we have to be responsible with public finances.

The right hon. Gentleman talked about the cap of £75,000, which is indeed higher than the upper limit proposed by Andrew Dilnot, but to describe this as only helping people on higher incomes is fundamentally to misunderstand how a cap works. First, potentially more than 70% of the £1 billion a year that this will cost the Government by the end of the next Parliament is going to socially disadvantaged families. This is a highly progressive measure, and as well as increasing the cap we are increasing the threshold above which people do not get any help, from £23,000 to £123,000—exactly the kind of thing that some of the most disadvantaged families on the lowest of incomes will benefit from most.

The right hon. Gentleman talks about the Association of British Insurers—he needs to get up to date. It describes this as

“potentially another positive step forward in tackling the challenges of an ageing society.”

[Interruption.] If he wants some more quotes, let us look at what financial services companies are saying. Aegon UK says it

“welcomes today’s announcement and the clarity it brings on state support.”

Legal & General says it is

“pleased the Government has decided to move forward with Andrew Dilnot’s proposals.”

As for local authority budgets—the shocking state of which, by the way, we inherited from the last Labour Government—the Government said in the spending review that the NHS health budget would give £7.2 billion of support for health-related needs to local authorities during the course of this Parliament.

On inheritance tax, what the right hon. Gentleman does not understand about today’s measures is that fundamentally, they are helping people to protect their inheritance from the lottery of social care costs. The randomness of someone not knowing whether they will be the one in 10 who suffers over £100,000 in care costs is eliminated by a proposal that allows everyone to plan and prepare for their own social care costs.

The right hon. Gentleman describes this as a modest plan and says we have neglected the scale of the problem. Of course, in dealing with an ageing population many other issues need to be dealt with. He talked about the problem of integration, which we are solving by devolving power to clinical commissioning groups on the front line, a reform that Labour opposed, and by integrating technology, a reform on which Labour failed. Also, Labour did nothing about dementia, leaving us with less than half the people with dementia being diagnosed. We are now tackling that problem. We saw last week the issues of treating older people with dignity and respect. We are tackling that problem—Labour left it for far too long.

The problem is not that our solution is too small, but that it was too big for Labour to solve when they were in office. When it comes to making Britain a better country to grow old in, this Government are taking action where the last Government failed.

South London Healthcare NHS Trust

Andy Burnham Excerpts

Thursday 31st January 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Just when we thought this Government’s mismanagement of the national health service could not get any worse, it just has. Let us be clear about what the Secretary of State has announced today. He has at last accepted recommendations that were agreed by the previous Government but then delayed by his predecessor’s moratorium, thereby deepening the financial problems of South London Healthcare NHS Trust. And he has rejected an outrageous proposal that Lewisham hospital should lose its accident and emergency department—a proposal that never should have been made in the first place, but which has cost more than £5 million of precious NHS cash on accountants in the process, enough to give some of the 5,000 nurses who were sacked their jobs back.

But the Secretary of State has accepted the principle that a successful local hospital can have its services downgraded to pay for the failures of another trust. That takes the NHS into new territory. The Secretary of State has just crossed a line and set dangerous precedents—namely, that in his new market-driven NHS, finance takes precedence and any hospital, no matter how successful, is vulnerable to changes through backdoor reconfiguration, that success can be punished and failure rewarded, and that a community can see its A and E and maternity services downgraded without proper consultation and without clinical justification.

There will be no cheers for the statement in Lewisham and it will send a chill wind through any community worried about its hospital services. There is now utter confusion about the Government’s policy on hospital reconfiguration. In three years, they have gone from moratorium to pandemonium. Across the country, half-baked cost-driven proposals to close A and Es and maternity units are being foisted on local communities without evidence of how that can be done safely and without putting lives at risk, yet at the same time, A and Es everywhere are under severe pressure. Thousands more patients are waiting for more than four hours to be seen and there are queues of ambulances lined up outside.

In that context, it is simply not tenable to downgrade any A and E department without first establishing a clear clinical case for how it can be done without compromising patient safety, but that is what the Government are doing here. They have set up a financially driven process and thrown together a clinical justification that is not independent but drawn up in his own Department, leaving the Secretary of State’s so-called four tests in tatters. Let me remind him that the fourth test is that any proposal for change must have “demonstrable support from commissioners”. Let me quote to him the chair of the Lewisham clinical commissioning group, Dr Helen Tattersfield, who has said:

“If the TSA proceeds as currently planned it is my belief that not only will this result in a reduction of quality and provision of health services for Lewisham residents with huge risks to health outcomes but also the effective end of clinical commissioning in Lewisham.”

It is clearly the case that the proposals that the Secretary of State has announced today will lead, in Dr Tattersfield’s words, to a reduction of quality and provision in Lewisham. These changes are opposed by the doctors he promised to put in charge of the NHS, and therefore clearly fail the fourth test that he has set out.

Furthermore, is the Secretary of State confident that what he has announced today is legal? We warned him that he was going beyond the powers in the Health Act 2009. He said that he would commission fresh legal advice. Will he publish it today so that there can be a proper debate on the legal position? He mentioned PFI, but is it not the case that the schemes he mentioned were initiated and negotiated under the Major Government? He said that he had consulted South London Healthcare NHS Trust, but is it not a fact that it found out about this process from the media?

This decision will damage fragile trust in the way that the NHS manages changes to hospitals. The Government need to get back to first principles. Will the Secretary of State confirm, learning from this debacle, that in future no proposal to downgrade or close A and E and maternity services will ever get out of the starting blocks if it does not have a proper clinical case to support it?

Will the Secretary of State today issue an apology to the people of Lewisham? How on earth are they expected to have confidence in the figures he has announced from a clinical review thrown together—cobbled together —in his Department in a matter of days? He has caused huge distress to them but he has also failed to listen to them. Thousands of people have put their lives on hold to fundraise, to lobby, to campaign: 52,000 names on a petition; 25,000 people on a march. This community have rallied together to defend their local hospital, led by the fantastic efforts of the local MPs, but more than that, they have fought valiantly for every community worried about this Government’s cavalier approach to our country’s most valued institution. This community have stood up to an out-of-touch Government who think they can treat some of more deprived parts of our country with utter disdain. This community have achieved something today, but I am certain that they will continue the fight—and let me say that they will have our support. Will the Secretary of State confirm that what he has just announced takes away their right of appeal to the Independent Reconfiguration Panel? If that is the case, are they not justified in continuing the fight to stop this Government riding roughshod over the people of Lewisham and south London?

What we have seen here today is the first glimpse of the new market-driven NHS that the Government have created, where the moneymen and not the medics are calling the shots. We have seen another chapter in the unfolding omnishambles that is this Government—this one, sadly, could be entitled the Lewishambles. We have seen a scandalous waste of money on a solution that will not be acceptable to people in Lewisham—and it is not acceptable to people anywhere. The Secretary of State is asking this House to accept the unacceptable. We will not do that for Lewisham and we will not do it for anywhere else.

[Mr Hunt]

I am afraid that the shadow Health Secretary clearly wrote his response before he read my statement. Listening to him this morning, he has never sounded further away from being part of the Government-in-waiting that he aspires to be.

Let me say this to the right hon. Gentleman: the apology over what is happening in South London Healthcare NHS Trust needs to come from Labour Members, because they were the people who failed to resolve this problem over very many years. It was their party that set up two PFI deals, signed in 1998, which have been incredibly dangerous. It was their party that created a financial situation that means that £1 million every week is being bled from front-line patient care in order to fund a deficit, and that 100 lives every year are not being saved that could be saved in Lewisham and the whole of south-east London.

What I did not hear from the right hon. Gentleman was any contrition about the fact that this incredibly difficult problem was something that his Government and, indeed, he as Health Secretary totally failed to resolve. Let me remind him that the legislation that I followed actually came from the Labour party, which passed it when it was in government. He asked me to confirm that the people of Lewisham have no right of appeal to the IRP against this decision, but who was it who stripped them of that right to appeal? It was him when his Government passed the legislation. Nothing that he has said has contained a single alternative proposal to deal with this problem. If he was being responsible as shadow Health Secretary, he would have come up with just one proposal, but he did not come up with a single one or tell the House about any of his ideas.

The right hon. Gentleman talked about the pressure on A and E, but we will take no lessons from him. We met our A and E targets last year, whereas in Wales, where the Labour party is cutting the NHS budget by 8%, the A and E targets have not been met since 2009.

I am afraid that what we have heard—I hope that other contributors will strike a different tone—is a very disappointing response from the Labour party. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), who is not on the Opposition Front Bench today—perhaps this will explain why—has said that Labour would not do what she called the “easy politics” of opposing every single reconfiguration, but what we have heard this morning is easy politics from a party that closed at least 12 A and Es and at least nine maternity units while it was in office. The right hon. Gentleman needs to recognise that the responsible thing for a Health Secretary to do is that which will save the most lives, and that is what I have announced this morning.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 15th January 2013 Commons Chamber

[Dr Poulter]

I am happy to inform the hon. Lady that we are meeting the 95% target nationally for the A and E wait. On the most recent figures available, 96% of patients were seen within that period—96 out of every 100 patients are seen within four hours in A and E. The key difference between this Government and the last Labour Government is that we trust clinicians to ensure that they prioritise those patients in greatest need ahead of purely meeting targets and ticking boxes.

[Andy Burnham (Leigh) (Lab)]

As winter bites, the NHS faces its toughest time of year, but there is mounting evidence that the Secretary of State has left it unprepared. For 105 of his 133 days in office, the Government have missed their own A and E target for major A and Es. Last week, for the first time, the figure fell below 90%. Right now in A and Es up and down England, ambulances are stuck in queues outside, patients are on trolleys in corridors, and people are waiting to be seen for hours on end. Does the Minister accept that there is a growing crisis in our A and Es, and if he does, what is he doing about it?

[Dr Poulter]

The right hon. Gentleman is good at putting across figures based on brief snapshots in the year. We know that on an annual basis we are meeting the target, and that 96% of patients are being seen on time in A and Es. We have made allowances for winter pressures, which we know are always difficult during the flu season every year, and we have put aside £330 million to ensure that we support the NHS during those winter pressures. Let me make it clear to the right hon. Gentleman that it is wrong to try and distort figures based on outcomes from a snapshot of just a few days or a week. It is important to put across the clear picture, which is that the Government are meeting targets in the NHS and patients are being treated in a much more timely manner than under the previous Government.

[Andy Burnham]

I suggest to the Minister that he needs to get out on the ground in the NHS a bit more. The figures I gave him were for major A and Es. If he got out more, he would realise that his complacency, which we have just seen at the Dispatch Box, is not justified. Let us look at Milton Keynes, which was identified by the Care Quality Commission as one of the 17 understaffed hospitals, and where last week just 72% of patients were seen within four hours. Milton Keynes is one of 15 trusts in England where A and E performance plummeted below 80%. These are the kind of figures that we have not seen in the NHS since the bad old days of the mid-1990s. Ministers like to blame nurses, but it is time they started accepting some responsibility. Will the Minister today ensure that all A and Es in England have enough staff to get safely through the winter?

South London Healthcare NHS Trust

Andy Burnham Excerpts

Tuesday 8th January 2013 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for again speaking up for his constituents, as indeed I have done as a constituency MP on many occasions. I want to reassure him that the four tests we have outlined for any major changes to health care services would indeed apply to the Beckenham Beacon and that, were there to be any changes, we would need to be satisfied that they would have strong, local, clinical support, that his constituents had been properly consulted and that there was clear evidence that change would be beneficial.

[Andy Burnham (Leigh) (Lab)]

I apologise for missing the start of proceedings on this urgent question.

It has long been accepted that difficult decisions are needed to secure the sustainability of health services in south-east London. That is why recommendations from the review, “A Picture of Health”, were agreed under the previous Government. The trust special administrator has adopted many of those proposals, which we welcome.

However, the review presented today goes way beyond that and takes the NHS into new territory. It uses powers passed by the previous Government in a way that was never intended and, in so doing, sets a worrying precedent whereby normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services are pushed through. The Health Act 2009, which I took through this House, states that

“the administrator must provide to the Secretary of State and publish a draft report stating the action which the administrator recommends the Secretary of State should take in relation to the trust.”

In making recommendations that have a major impact on another trust, is the Secretary of State not going beyond the powers this House has given to him? He has acknowledged that he needs to commission fresh legal advice, which suggests to me that the legality of the process is in doubt. Will he publish all the legal advice he has been given so far and give a commitment that any new legal advice he commissions will be made available?

As this is a financially driven process, the people of Lewisham have justifiable concerns about whether it is safe to close their A and E and downgrade the maternity services. Is the Secretary of State satisfied that a clinical case has been established behind these major changes? Given that all A and E departments in south London are currently overstretched and operating at full capacity, people will need to be convinced that these changes will not put lives at risk.

Finally, will the Secretary of State give a guarantee today to the people of Lewisham that, if he accepts the TSA’s recommendations, they will have the full consultation rights that come with any hospital reconfiguration, including the ability to challenge the clinical case and, if necessary, to refer it to the Independent Reconfiguration Panel? This process is attempting to rewrite the rules on making changes to hospital services, bypassing the intention of the House. It will send a shiver through any communities without a foundation trust, as it raises the prospect that their hospital will be able to be used as a pawn to solve problems in another.

People in Lewisham feel a huge sense of unfairness and I am sure that that will be shared by people across the House. The onus is on the Secretary of State to justify the changes and ensure that rules governing hospital changes are fair and respect the essential rights of all communities to be fully consulted and involved in any decision affecting their services.

[Mr Hunt]

We have followed to the letter the processes laid down in the law that the right hon. Gentleman’s Government passed. We followed the procedure extremely carefully. This is the first time that the procedure has been invoked, so we have taken extra legal advice to make sure that the processes followed strictly adhere to the letter of the law. I will continue to take legal advice, because I want to make sure that we absolutely follow the wishes of the House in how we carry out the procedure.

Unlike the right hon. Gentleman’s Government, we have introduced new safeguards for any major changes made to NHS services. Those safeguards did not exist when the right hon. Gentleman was Health Secretary. We have said that we will not accept any changes unless there is proper consultation of the local population, clear evidence and clear local clinical support. We made that commitment in the four tests, which did not exist under his Government.

I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met. They include proper local consultation, because I consider that to be extremely important.

NHS Funding

Andy Burnham Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House notes with concern the letter of 4 December 2012 from the Chair of the UK Statistics Authority, Andrew Dilnot CBE, to the Secretary of State for Health concerning public expenditure on health, further notes Mr Dilnot’s statement that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10; and calls on Ministers to reflect this position in their public statements.

Some people question whether Opposition days ever achieve anything, but not us. Last month, we brought to the House our concern about plans for regional pay in the national health service, which found an echo among Government Members. Within days, the plans of the previous Health Secretary for market-facing pay in the NHS were scuppered in the autumn statement. To some, that was just another day, another U-turn, in the life of this shambolic coalition—no big deal—but to thousands of NHS staff in the south-west facing pay cuts it was a real relief, although we are still waiting for the consortium formally to back down. We will be vigilant until it does so.

Fresh from that success, we set ourselves a more challenging task in today’s Opposition day debate to bring some much-needed honesty to the public debate on the NHS, particularly on NHS spending. Across the country, people can see the signs of an NHS in increasing distress: cataract operations are restricted; A and E departments and walk-in centres have been closed; hospitals are full to bursting, some struggling for survival; over 7,000 nursing jobs have been lost—[Interruption.] Government Members should listen to the facts before they shout out, because this is the reality and the chaos that the previous Secretary of State created on the ground. People can see that with their own eyes, but when they go home and switch on the television they see Ministers standing at the Dispatch Box making complacent boasts about “real-terms increases” that they have given the NHS and saying that everything is fine.

[John Glen (Salisbury) (Con)]

If the right hon. Gentleman wants to have integrity and demonstrate honesty in this debate, will he at the outset condemn the Labour party in Wales for the real cuts that everyone knows are being made in the Welsh health service? Will he level with the British people about that, rather than offer this empty political rhetoric that does not deal honestly with what is happening in Wales?

[Andy Burnham]

We are discussing the hon. Gentleman’s Government today, but let me deal with Wales. His Government have given the Welsh Assembly Government a real-terms £2.1 billion cut. The Welsh Assembly Government have done their best to protect health spending in that context: they have protected the NHS budget in cash terms. May I also point out to the hon. Gentleman that since 2010 there has been no real reduction in front-line staff, particularly nurses, in Wales, which is quite unlike the position under his Government? Before he appears a bit too cocky on these matters he should read up on the facts. The Welsh Assembly is doing the best that it can with the awful hand of cards that he and his Government dealt it.

There is a mismatch between ministerial rhetoric and the reality on the ground in the NHS, and it is in danger of causing confusion. If left unchallenged, it may lead to unfair claims that the problems in the NHS are all down to its staff and have nothing to do with the Government. Today we need a bit of accountability and a bit of honesty. Once and for all, we will nail the myths, spin and sheer misrepresentation of the facts that roll off the Government Benches week after week.

[Julian Smith (Skipton and Ripon) (Con)]

In North Yorkshire, we have some of the lowest spending per capita in Britain. Does the right hon. Gentleman regret the removal and reduction of health spending on old people and rural areas under his watch?

[Andy Burnham]

I think that the hon. Gentleman should withdraw that remark, because there was no reduction in health spending on my watch. I left plans for an increase, as I am about to explain. He illustrates the point that I am making: we are getting half-truths, spin and misrepresentation from Government Members on NHS spending. Indeed, we just got some more, and it is about time that we had a bit more accuracy in the House from them.

The story starts with the 2010 Conservative party manifesto. Let me quote from it:

“We will increase spending on health in real terms every year”.

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

Absolutely right.

[Andy Burnham]

Mr Dilnot may be watching; the Minister needs to be careful what she says.

That promise was carried into the coalition agreement, which said:

“We will guarantee”—

guarantee, mind—

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

The Secretary of State has stopped nodding; he was nodding earlier. [Interruption.] I will be interested to hear how the Conservatives make those claims stack up, because week after week, Ministers from the Prime Minister downwards have stood at the Dispatch Box and claimed that that is exactly what they have delivered.

Until recently, this appeared prominently on the Conservative party website:

“We have increased the NHS budget in real terms in each of the last two years”.

Then, on 23 October, the Secretary of State said to the House:

“Real-terms spending on the NHS has increased across the country.”—[Official Report, 23 October 2012; Vol. 551, c. 815.]

[Interruption.] “It has”, he says again today. Okay, but this is where the story changes, because last week, he received a letter from the chair of the UK Statistics Authority, Andrew Dilnot CBE. Let me quote the key sentence, which puts Mr Dilnot and the Secretary of State at odds, if I heard the Secretary of State correctly a moment ago:

“On the basis of these figures, we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

[Interruption.] I am coming on to it all. In other words, NHS spending is lower, in real terms, after the first two years of the coalition, than when Labour left office.

[Mr Stephen Dorrell (Charnwood) (Con)]

Can the right hon. Gentleman confirm that the next sentence says:

“Given the small size of the changes and the uncertainties associated with them, it might also be fair to say that real terms expenditure had changed little over this period”?

[Andy Burnham]

Let me say to the Chair of the Health Committee that today I am challenging the veracity of ministerial statements made at the Dispatch Box. I am sure that as a former Secretary of State with many years’ experience of the House, he will know that when Ministers are at the Dispatch Box, they have to be accurate; they have to say the truth. A moment ago, the Secretary of State for Health said that he and the Conservative party were right to say that NHS spending had increased in real terms. That directly contradicts the letter that the Secretary of State had just been sent. Is it any wonder that the public are losing trust in the Government if that is the kind of arrogant spin that comes from those on the Government Benches, week after week?

[Mr Dorrell]

rose—

[Andy Burnham]

I give way to the right hon. Gentleman once more, but then I will make some progress.

[Mr Dorrell]

Is it fair to characterise the letter as saying that

“real terms expenditure had changed little over this period”?

[Andy Burnham]

That is what the letter says, but it is a cut; that is what the letter says. The right hon. Gentleman might say that, in the context of the NHS budget, £1.9 billion is not very much, but it is still a change, and it is a cut. He stood for election on a manifesto promising a real-terms increase. He has just acknowledged that there has been a real-terms cut. Does he acknowledge that there has been a real-terms cut? I think he will have to. I am amazed; the Conservatives come here today to try to con the public, yet again, into thinking that they are fulfilling their promise.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I enjoy every moment in which a blow is landed on the Government; they squirm and try to come back. Will my right hon. Friend comment on how much of the budget is being thrown away and wasted on top-down reorganisation, redundancy payments and everything else that is going on?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

We need short interventions. There are a lot of Members who wish to speak. I am a little bothered by the comments made; I am sure that the right hon. Member for Leigh (Andy Burnham) did not want to suggest that the Prime Minister conned people.

[Andy Burnham]

I am coming to the point made by my hon. Friend the Member for Stoke-on-Trent South (Robert Flello), because the context is that £1.6 billion, on the Government’s own figures, was spent on the back office, and taken away from the front line. The Chair of the Select Committee says that the cut was a little one, as though that is okay—“It’s really an increase, because it’s only a little cut”—but one has to add £1.6 billion to that to see the full extent of the diversion of funds from the NHS front line.

As the chair of the UK Statistics Authority has established, NHS spending was lower in the first two years of this coalition than when Labour left office. [Interruption.] The Secretary of State says that it is the same. Let us have some honesty here. Mr Dilnot says that it was a cut; accept what he says, and get on with the job. If the Secretary of State starts being a bit more honest at the Dispatch Box, he might get a bit more respect from the public.

The Prime Minister has cut the NHS—fact; but just as he airbrushed his poster, he has tried to airbrush the statistics, and he has been found out. To be fair, the Conservatives admitted it and corrected the Tory party website, but the problem is that we have a long list of similarly false claims made in the House that, as of now, stand uncorrected. Today, we invite the Secretary of State to correct the parliamentary record in person.

I am not surprised to see a few sheepish looks on the Conservative Benches, because we have been checking Conservative Members’ websites, and we found that the hon. Members for South West Bedfordshire (Andrew Selous), for North Herefordshire (Bill Wiggin), and for Hendon (Dr Offord), the hon. and learned Member for Sleaford and North Hykeham (Stephen Phillips), and the hon. Member for Mid Derbyshire (Pauline Latham)—

[Anna Soubry]

They are sheep, are they?

[Andy Burnham]

They are certainly sheepish today; they need to get back to their offices pretty sharpish to amend their websites in light of the letter from the chair of the UK Statistics Authority.

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

The website of the Conservatives in Salford says, on the budget that was going to increase,

“we would see more investment in our local NHS”

under a Conservative Government, but in Salford Royal hospital, 750 jobs have been cut. Between them, all our local hospitals have had 3,100 jobs cut in the past couple of years, and two walk-in centres have closed. If the budget is the same, why all these cuts?

[Andy Burnham]

This is the reality on the ground, as my hon. Friend says. There is also the mental health budget cut. There has been a mismatch; people see all those things, yet they hear the statements from the Government, and it does not make any sense, but now the truth and the facts about our NHS are being told, and things will begin to make sense to people.

What I find most troubling about all this, and most revealing about the Government’s style and the way that they work, is that even when they are warned by an official watchdog, they just carry on—as they are doing today—as if nothing had happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? Labour left plans for a cut; that is what the Prime Minister said at the Dispatch Box last week. It is what the Secretary of State said in a letter replying to Mr Dilnot. Again, that is simply untrue.

According to Treasury statistics, Labour left plans for a 0.7% real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this Government who slowed spending in 2010-11, who allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the Secretary of State’s promise that all savings would be reinvested, and who still have published plans, issued by Her Majesty’s Treasury, for a further 0.3% cut to the NHS in 2013-14 and 2014-15, contrary to the new statement that the Conservatives have just put on their website. The Secretary of State has a lot of explaining to do.

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

I should be interested in the right hon. Gentleman’s comments on the statement by John Appleby, the chief economist of the King’s Fund, who said that before the general election, the former Chancellor left plans for 2011-12 and 2012-13 that would see a cut in real terms. What does the right hon. Gentleman say to that?

[Andy Burnham]

I have not seen the quote, but I did the deal with the former Chancellor of the Exchequer just months before the general election, protecting the NHS in real terms. A deal was done for schools and for the Home Office too. Those were the plans. At the election I was arguing for real-terms protection. The Secretary of State was on the hustings calling for real-terms increases. I said it would be irresponsible, yes, to give real-terms increases over and above real-terms protection because the only way he could pay for that would be taking it off councils, hollowing out the social care budget. That is what I said at the election, but the right hon. Gentleman has not even given real-terms protection. He has cut the NHS in real terms, so it beggars belief that he has the nerve to heckle and shout out from the Front Bench, when he has cut the NHS lower than the plans that I had left in place.

[Clive Efford (Eltham) (Lab)]

It is not just on the budget that the Government have let people down. They promised that they would not close accident and emergency departments. Before the general election the former Secretary of State went to Bexley and said he would not close the accident and emergency department at Queen Mary’s, Sidcup, and it closed after the general election. Now they are planning to close the A and E at Lewisham—another broken promise about the NHS. It just goes to show: you can never trust the Tories with the NHS.

[Andy Burnham]

The two guilty men here have a list of broken promises as long as their arm. The previous Secretary of State toured marginal seats before the election, promising the earth—“Burnley A and E? Oh, we’ll re-open that. Whatever you want. Chase Farm? That won’t close.” It was unbelievably cynical politics. It was all self-serving politics for their own ends and it had nothing to do with the reality in the NHS, but the problem for the present Secretary of State is that he has presented this false version of events to the House. On 13 November he said that

“there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans.”—[Official Report, 13 November 2012; Vol. 553, c. 188.]

[Interruption.] He says there has been. I ask for your help, Mr Deputy Speaker. How can Ministers deny the facts—deny what the watchdog is telling them? What do we do in such circumstances, when they have the sheer nerve and brass neck to carry on making these false statements?

Based on what we know, there is no way the Secretary of State can back up that claim, and I ask him to withdraw it today. It is an inaccurate claim. He made it at the Dispatch Box; the onus is on him to withdraw it. We know that he is taking time to come to terms with his brief, but he is in danger of developing a credibility problem with his utterances in the House. Take this from last month’s Health questions:

“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]

But again the truth emerges, and it is somewhat different from the version of events presented to us by the Secretary of State. On Monday, responding to excellent research by my hon. Friend the Member for Leicester West (Liz Kendall), the national cancer director conceded that in future cancer networks would have to live with a smaller budget. What are we to do? Who are we to believe? We have a Secretary of State who is making statements that contradict his national cancer director. It is shameless.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

Even the north-west regional centre for cancer treatment, the Christie hospital, recently announced that 213 posts will go. I do not know how it stacks up with the Secretary of State’s claim that the NHS budget is going up, when we see cancer patients getting a reduced service at the Christie hospital.

[Andy Burnham]

The priorities are all wrong. The Government are spending the money on a reorganisation that none of us wanted in the north-west, and as my hon. Friend says, cancer networks are being cut and are shedding staff. As my hon. Friend the Member for Leicester West revealed this week, they are cutting back on the vital work that they do—and there could be no more vital work. Yet we continue to have a false version of events given to us. Ministers must think we are daft, but we are telling the facts to the country today and people will judge for themselves.

When we put the whole picture together, what we see is a tissue of obfuscation and misrepresentation of the real position on NHS spending. The hon. Member for Mid Bedfordshire (Nadine Dorries), who is, sadly, not in the House today, once made some interesting observations about those on the Government Front Bench, but it is not just that they

“don’t know the price of pint of milk”.

The arrogance of which she spoke seems to give them a feeling that they can claim that black is white and expect everyone to believe it. If they say it is so, then it must be so. Well no, actually. The intelligence of the House need not be—

[Chris Skidmore (Kingswood) (Con)]

On a point of order, Mr Deputy Speaker. Has the right hon. Member for Leigh (Andy Burnham) informed the hon. Member for Mid Bedfordshire (Nadine Dorries) that he would be making comments about her in the debate today?

--- Later in debate ---

[Andy Burnham]

Yes, I have done so, Mr Deputy Speaker.

If in future any Minister mentions the NHS and real-terms increases in the same sentence at the Dispatch Box, Members on all sides will at least have the facts. Better still, by carrying our simple motion this evening, we can give the House the opportunity to make sure that Ministers take much more care than they have previously shown with their statements on NHS spending.

Let us look to the future. What does all this mean for the NHS and what effect is the Government’s cut to its budget having in the real world? In its briefing for today’s debate, the NHS Confederation refers to a survey of NHS leaders which found that a full 74% described the current financial position as “the worst they had ever experienced” or “very serious”. The reason why the Government’s cuts feel much deeper to people working in the NHS, as we heard a moment ago, is that they are contending with the added effect of a reorganisation that nobody wanted and that they pleaded with the former Secretary of State to stop.

Cuts and reorganisation are a toxic mix. According to the Government’s own figures, a full £1.6 billion has been diverted from patient care and the NHS front line and spent on back-office restructuring. Look at the waste already: a full £1 billion spent on managerial redundancies—1,300 six-figure pay-outs and, scandalously, 173 pay-outs over £200,000. [Interruption.] The Secretary of State chunters away. I am surprised he has the nerve even to be here. Such pay-outs are unforgivable and unjustifiable when patients are seeing treatment restricted and nurses laid off in their thousands. But it is not just the financial cost. It is the opportunity cost—the colossal distraction this has proved to be from having the focus where it should be—on the money.

After the election, the £20 billion Nicholson challenge should have been the only show in town. Instead, no one stood up in Cabinet to the previous Secretary of State, who was allowed to proceed with his vanity reorganisation of the NHS. The consequence has been two years of drift, where no one knows who is making the decisions. The danger of this unwieldy and unmanaged approach to the efficiency drive is that, as trusts start to panic about the future, increasingly drastic cuts are being offered up that could have serious consequences for patient care.

I want to end by focusing on four such consequences. First, let us look at staffing levels on the NHS front-line. For two years, we have had the mismatch of Ministers making boasts about rising spending while the number of staff was dropping at an alarming rate. A full 7,134 nursing posts have been lost since the coalition came in, with 943 in the past month alone. [Interruption.] Government Members keep mentioning doctors. We left those plans for doctors coming through. The Secretary of State has not done anything about the training of those doctors, but on his watch he has seen more than 7,000 nursing posts cut.

Training places are being been cut by 4.6% this year, after a 9.4% cut in 2011-12. No wonder the chief executive of the Royal College of Nursing warns that we are “sleepwalking” into a crisis. Peter Carter says:

“On a daily basis, nurses are telling us they do not have enough staff to deliver good quality care.”

The situation has taken a serious turn. In its annual report, the Care Quality Commission found that 16% of hospitals in England did not have adequate staffing levels. I am surprised that a warning of this seriousness has not received more attention. It cannot go ignored. It would seem that the NHS is failing to learn the lessons of the failure at Mid Staffordshire, where the first Francis inquiry found inadequate staffing levels to be one of the main reasons why care standards fell so low.

The Health Secretary tells the Health Service Journal today that he is not going to interfere with the day-to-day running of hospitals, but let me remind him that it is his responsibility to ensure that our hospitals are safe. He must develop an urgent plan to stop the job losses and protect the NHS front line. He should tell us which hospitals do not have enough staff and explain what action he is taking on the CQC’s warning to ensure that all hospitals in England have safe staffing levels.

The second consequence of Government cuts to the NHS is the growing number of restrictions on treatment. We have revealed how 125 separate treatments have been restricted or stopped altogether since 2010, including cataracts, knee replacement and varicose veins. Just as they make false boasts about increasing NHS spending, so we hear repeated claims about reducing waiting lists. But that is because people cannot get on the waiting list in the first place.

Figures from the House of Commons Library show the effect of those restrictions on patients. More than 50,000 patients are being denied treatment and kept off NHS waiting lists, and there have been big falls in operations for cataracts, varicose veins and carpal tunnel syndrome. Ministers have promised to stop cost-based rationing if they are given evidence of it, but we have presented them with the evidence on a number of occasions, so let us now see some action.

Thirdly, the lethal mix of cuts and reorganisation is destabilising our hospitals. They are the first to feel the full effects of the free-market ideology that the Government have unleashed on the NHS. There is no longer one NHS approach in which spending is managed across the system; there is a broken-down, market-based NHS. The Government’s message to England’s hospitals is this: “You’re on your own. There’ll be no bail-outs. Sink or swim. But if it helps, you can devote half your beds to treating private patients.” We see the signs of increasing panic as hospitals struggle to survive in this harsh new world. In Bolton, South Tees, and Maidstone and Tunbridge Wells, a large number of staff have been given 90-day redundancy notices, and we see half-baked plans coming forward to reconfigure services with efforts to short-circuit public consultation.

Will the Secretary of State today remove the immediate threat to Lewisham A and E by stating clearly that it is a straightforward breach of the administration process rules to solve the problems in one trust through the back-door reconfiguration of another? Will he ensure that the future of all A and E provision in Greater Manchester is considered in the round as part of a city-wide review, rather than allowing the A and E at Trafford to be picked off in advance. In St Helens and Knowsley Hospitals NHS Trust, will he reverse the comments of the previous Secretary of State, who told the clinical commissioning groups that they had no obligation to honour financial commitments to the hospitals entered into by the previous primary care trusts? It is chaos out there. The Secretary of State urgently needs—[Interruption.] In fact, all the Health Ministers urgently need to get a grip, not just the Secretary of State.

[Robert Flello]

Is my right hon. Friend aware that the West Midlands ambulance service only yesterday advised that there are about half a dozen hospitals in the west midlands whose A and E staffing situation is so critical that it is having a knock-on effect on their ambulance turnaround times?

[Andy Burnham]

I hear reports from ambulance services all over the country that they simply cannot hand over patients at the door of A and E departments and are having to queue outside. Consequently, large swathes of the country are being left without adequate ambulance cover. That is unacceptable, especially as we go into winter and temperatures drop. We need to see some evidence that the Government have a grip on these things. I have been told that large parts of my constituency have occasionally been left without adequate ambulance cover. We must have answers on these matters today.

[Dr Sarah Wollaston (Totnes) (Con)]

I am very disappointed to hear the right hon. Gentleman talk down the NHS. As he has just acknowledged, before the election the NHS knew that it was facing an unprecedented efficiency challenge. He will also know that under Labour productivity in the NHS fell continuously. I wonder whether—[Interruption.] Okay, but for almost every year—

[Dr Wollaston]

Will the right hon. Gentleman acknowledge the NHS’s achievement in making a productivity gain?

[Andy Burnham]

The hon. Lady just made another untrue statement. She talks about talking down the NHS, but productivity has not fallen. I am sorry, but let us have some honesty. We are not just going to sit here and take one statement after another—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

We all know that all Members are very honest in this House.

[Andy Burnham]

Inadvertent claims are being thrown around the House all the time.

Fourthly, and finally, cuts and reorganisation are resulting in a crude drive to privatise services, prioritising cost over clinical quality. Across England, deals have been signed to open up 396 community services to open tender under any qualified provider, but those deals are not subject to proper public scrutiny because they are held back under commercial confidentiality. In Greater Manchester, plans are advanced to hand over patient transport services to Arriva, despite the fact that an in-house bid scored higher on quality and despite the fact that the CQC recently found serious shortcomings with the same provider in Leicestershire. The trouble is that nobody has asked the people of Greater Manchester, or more importantly the patients who rely on that service, whether they want that change.

[Lucy Powell]

My right hon. Friend might not be aware of another point. The patients who use the Greater Manchester passenger transport service are coming to me regularly and crying their eyes out in distress at this decision—[Interruption.] The hon. Member for Beverley and Holderness (Mr Stuart) says “Aaah”, but those are poor and vulnerable people who rely on that service to take them to and from hospital. It is an absolute disgrace that the contract has been given to Arriva bus service, so don’t patronise them or me. I thank my right hon. Friend for giving way.

[Andy Burnham]

Thank God my hon. Friend got up to deliver that to Government Members, because they need to hear a bit more of it. They say “Aaah,” but we are talking about people who desperately need that service, trust it and like it the way it is. The Government have not even bothered to consult them about the changes they are making. That is what is so wrong.

“Any qualified provider” is turning into the NHS version of compulsory competitive tendering, a race to the bottom and a rush to go for the cheapest bid, regardless of the effect on patients and services. What clearer symbol could there be of a privatised, cut-price coalition NHS than the decision to award patient transport in Greater Manchester to a bus company?

Let me remind the Secretary of State of the rights of patients and staff as set out in the NHS constitution:

“You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.”

If the people whom my hon. Friend the Member for Manchester Central (Lucy Powell) referred to sought to enforce those rights by bringing a legal action against the North West ambulance service, can the Secretary of State confirm that there would be a fair chance that it would have to halt its plans? If so, why does he not just press that pause button and ask people whether they want their ambulance services run by a bus company?

The first line of the NHS constitution states:

“The NHS belongs to the people.”

But it will not when this Government have finished with it. We are losing the NHS, and that is why we will keep stepping up the fight for it. People will remember the personal promises the Prime Minister made on the NHS in order to win office, promises that it now seems had more to do with his desire to detoxify the Tory brand than with any genuine regard for the NHS. He promised no top-down reorganisation of the NHS; that was broken. He promised a moratorium on hospital changes; that was broken. He promised real-terms increases in every year of this Parliament; that was broken. They can now see the chaos that the breaking of those promises is visiting on the NHS: nurse numbers cut, health visitors cut, mental health cut, cancer networks cut, and cataract operations cut. He is the man who cut the NHS, not the deficit. The House cannot vote tonight to stop the damage, but it can put down a marker against an arrogant and incompetent Government who need to show the NHS, its patients and staff a little more respect. I commend the motion to the House.

--- Later in debate ---

[Mr Hunt]

I said that I would make a little progress, if that is all right.

I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:

“It is irresponsible to increase NHS spending in real terms”.

So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?

[Andy Burnham]

Yes, I do. I said in my speech that the NHS should be protected in real terms at the front line. That is what the Secretary of State has not done. I cannot believe that he is contradicting the contents of the letter from Andrew Dilnot. He really needs to tread very carefully before he goes any further.

[Mr Hunt]

Let me say very gently to the right hon. Gentleman that he can hardly come to this House criticising us for an alleged cut in NHS spending if his own plans would have led not to higher but to lower NHS spending. We are increasing spending by £12.5 billion, and he thinks that that is irresponsible.

--- Later in debate ---

[Mr Hunt]

I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.

Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.

While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?

[Andy Burnham]

indicated assent.

[Mr Hunt]

He does support it—well, there we are. So now we have it. Labour policy in Wales is to cut the NHS budget, and that is supported by Labour Front Benchers.

--- Later in debate ---

[Mr Hunt]

I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.

Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[Interruption.] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.

[Andy Burnham]

Would the Secretary of State care to remind the House of the commitment in the coalition agreement? Could he read that out for us?

[Mr Hunt]

I have just said that spending will go up in every year of the Parliament. Let me point out to the right hon. Gentleman that these are small real-terms increases, albeit ones that he bitterly opposed. That is why, given the uncertainties around GDP deflators, Andrew Dilnot’s letter says, in the sentence that the right hon. Gentleman did not want to read out, that

“it might also be fair to say real terms expenditure has changed little over this period.”

There it is, exposed for all to see: a bogus Labour motion trying to paint a picture of cuts to the NHS budget when even the head of the UK Statistics Authority says that the broad picture of NHS spending is that it has been protected in real terms—something that almost certainly would not have happened had Labour been in power.

[Andy Burnham]

I am struggling to believe what I am hearing. The Secretary of State is saying that Andrew Dilnot agreed with him that there had been real-terms increases in every year of this Parliament—[Interruption.] That is what he just said at the Dispatch Box. Let me quote Andrew Dilnot again, for the sake of accuracy. He said that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10”.

How can the Secretary of State square what he has just told the House of Commons with what is in Andrew Dilnot’s letter? Is he saying that Andrew Dilnot is wrong?

[Mr Hunt]

Some politicians walk into the same trap not once but twice. Let me give the right hon. Gentleman the sentence that comes straight after that, which he did not want to quote. It says that

“it might also be fair to say that real-terms expenditure had changed little over this period.”

That is what Andrew Dilnot is saying, which is why the motion is so completely bogus.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

You challenged us earlier, Mr Deputy Speaker, to introduce a little Christmas good will to the debate, and I want to try to do that in two ways. First, I want to respond to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who spoke from the perspective of the local constituency and community interest in Lewisham. The challenges that she described repeat themselves many times over in the health care system, and it is those challenges that I want to address.

Secondly, I want to surprise the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), by welcoming the fact that his motion, although I do not endorse it, refocuses the health debate on the core challenge facing the health service, and the health and care system more broadly, as it thinks about how we meet demand—in truth, there is bipartisan agreement on this—in the more challenging resource environment in which we now live.

Although we were not able to detect it in the right hon. Gentleman’s speech, the fact is that he, as Secretary of State, introduced the changed resource outlook within which the health and care system now operates. It was in May 2009—not on election day in May 2010—that Sir David Nicholson issued his annual report on the challenges facing the national health service. He made it clear that the system has to meet demand against the background of a resource outlook that is not only unrecognisably different from that during the generous funding of the Labour years between 1997 and 2010, but that has fundamentally changed from the one that the NHS has experienced throughout its whole history since 1948.

[Andy Burnham]

I agree with the right hon. Gentleman that I had to give the NHS that reality check and set the Nicholson challenge. With that in mind, does he agree that the Nicholson challenge should have been the only show in town after 2010, and that it was catastrophic to combine it with the biggest ever reorganisation that the NHS has ever seen?

[Mr Dorrell]

The right hon. Gentleman knows that I agree that the prime focus of health policy since 2010 should have been on how we can change the way that care is delivered in the health care system and the social care system to ensure that we can meet demand against the very different resource outlook that I have described. However, I say to the right hon. Gentleman, as I have done many times in this Chamber, that he shares some of the responsibility for the two-year trip down memory lane that we have had. It has been comfortable for the Labour party to say that the Tory party does not believe in the health service. We have been reminded numerous times that Tory MPs—all of whom are now dead and most of whom died before most of the current Members of the House of Commons were born—voted against the establishment of the national health service in 1946. We have had reminders from Government Members that the Labour party voted against the establishment of NHS trusts and then went ahead with the policy in office. The Labour party says that it is against choice and competition, but it was that party that established the choice and competition panel to ensure that those influences were brought to bear in health care policy.

We have had a two-year trip down memory lane, in which we have engaged in party political arguments that have avoided the issue that the right hon. Gentleman articulated as Secretary of State: how can we meet rising demand for health and care services against the background of a budget that, as the Select Committee has said repeatedly, is flatlining in real terms? That is why I was so keen earlier to read out the sentence from the Dilnot letter that states that it is

“fair to say that real terms expenditure had changed little over this period.”

The way that I prefer to put it is that if the decimal points are knocked out, real-terms expenditure is running at zero. The question is how to act against the background of a very small growth in resources, which is what the Government are committed to.

What the right hon. Gentleman did not cover in his speech is that the revenue expenditure of the NHS, which is what actually treats patients on a day-by-day basis, has grown modestly in real terms since his last year as Secretary of State. In my view, it will continue to grow modestly in real terms. He is frowning, but it is there in the arithmetic that there has been modest real-terms growth in the revenue expenditure, which is another definition of front-line services. That is the expenditure that funds the delivery of services to patients on a day-by-day basis and that is where the pressure is felt.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mr Hunt]

I have some sympathy with what my hon. Friend is saying, although it is important to recognise, as we have this debate about nursing, that the vast majority of nurses in the NHS do an outstanding job and we are very lucky to have them giving their lives to the NHS. Next week, at the chief nursing officer’s conference, we are launching a new vision for nursing, which will put compassion and the patient at the heart of what nurses do. I hope that will address some of her concerns.

[Andy Burnham (Leigh) (Lab)]

Last week, official statistics revealed that 7,134 nursing jobs had been lost under the coalition—almost 1,000 of them in the last month on the Secretary of State’s watch. The very next day, the Care Quality Commission warned that 16% of hospitals in England are not meeting the CQC standard for adequate staffing levels. Is this not prima facie evidence that the NHS and patients are not safe in his hands? Will he urgently intervene to stop the job losses?

[Mr Hunt]

The reason why the CQC undertook its shocking investigation into the state of care in our country was that this Government introduced dignity and nutrition inspections, which never happened when the right hon. Gentleman was Secretary of State. He talked about numbers employed in the NHS, so let us look at them. Yes, there has been a 2% decline in the number of nurses, but there has been an increase in the nurse-to-bed ratio. There has been a 4% increase in the number of midwives, a 5% increase in the number of doctors and an increase of more than 50% in the number of health visitors—their number went down when he was in office. How much worse would those numbers have been if we had had the cut in NHS funding that he wanted?

--- Later in debate ---

[Dr Poulter]

I thank my hon. Friend for his question. He is right to raise this, because it has been a very long-standing problem. I am sure that he would welcome, with me, the fact that under the current Government over 1.1 million more people are receiving access to NHS dentistry. However, this is a difficult case, and I am happy to meet him to discuss it further and see what I can do to help to unblock the problem.

[Andy Burnham (Leigh) (Lab)]

Ministers have repeatedly promised to ban rationing of treatment by cost in the NHS. If the Minister is presented with evidence that this is still continuing, will he today give the House a categorical assurance that he will act immediately to stop it?

[Dr Poulter]

It has been very clear in all the criteria for NHS commissioners set by the previous Government and by this Government that decisions about local health care treatment have to be based on clinical need, and that those decisions are for local commissioners. The difference is that this Government will make sure that doctors, nurses and health care professionals are in charge of budgets and setting health care priorities rather than the managers the previous Government chose to favour, who did not always have experience of front-line care and did not always understand some of the challenges that patients were facing.

[Andy Burnham]

I will take that as a yes. The Minister is going to have a busy day, because this afternoon he will have on his desk new evidence that I will send him showing that an estimated 52,000 patients in England are being denied treatment and kept off NHS waiting lists because of new restrictions imposed under his Government on cataracts, varicose veins, carpal tunnel syndrome, and other serious treatments. Ministers boast of lower waiting lists, but that is because they have stopped people getting on to the waiting lists in the first place. Patients in pain and discomfort, unable to work, are being forced to pay for treatment. How many more people will have to suffer before he finally acts?

NHS Commissioning Board (Mandate)

Andy Burnham Excerpts

Tuesday 13th November 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

The Secretary of State has just reeled off an impressive wish list, but people across the NHS will be asking a simple question: how on earth can he ask the NHS to do more, when we learn today that 61,000 jobs have been lost or are at risk in the NHS? His statements are dangerously at odds with the reality on the ground and risk raising unrealistic expectations. Across England, services are under severe pressure with ambulances queuing outside A and E, patients left on trolleys in corridors for hours on end, and increasing numbers of A and E and ward closures. No wonder nurses’ leaders today warn that the NHS is “sleepwalking into a crisis.” To listen to the Secretary of State, however, it is as if none of that is happening.

A toxic mix of reorganisation and real-terms cuts risks plunging the NHS into a tailspin. Today, people will have been hoping for a mandate for common sense to restore sanity to an NHS that is in danger of losing the plot, and for instructions to protect the front line. Well, they will have been disappointed.

The Secretary of State glosses over finance, but let me give the House the facts. He and his predecessor promised to reinvest all efficiency savings in the NHS front line—[Interruption.] Yes, they say, yet we learn that £3 billion of NHS money has been swiped back by the Treasury. When will the Secretary of State stand up to the Treasury and keep promises that the Government have made to the NHS? While the NHS front line takes a battering, the Government keep throwing money at a back-office reorganisation that nobody wanted. A full £1 billion has been spent on redundancy packages for managers, more than 1,000 of whom have received six-figure payouts while 6,000 nurses get P45s. That is the scandalous reality of the coalition Government NHS.

Will the Secretary of State confirm that a single payoff of £324,000 was made to the former chief executive of NHS Bolton? How would he care to justify that to NHS staff in Bolton who are losing their jobs? There could be no clearer illustration of a Government whose priorities are completely wrong.

Let me turn to some of the specific points set out by the Secretary of State. First, he makes welcome commitments on care for older people. If that is his priority, however, why are there no instructions in this mandate to stop commissioners from imposing restrictions on essential operations for older people? Last year, there were 12,000 fewer cataract operations than in 2009-10. Older people were told that they could have an operation in one eye but not in two. The Government boast about shorter waiting lists, but that is because people cannot get on those lists in the first place. A postcode lottery is running riot and there is nothing in this mandate to stop it.

The Secretary of State’s promises on dementia will be nothing more than hollow words until he faces up to the crisis in council budgets for adult social care. Across England, older people and carers are facing a desperate struggle as council services such as home helps are cut to the bone. Millions of people are facing ever higher care charges—cruel coalition dementia taxes—as councils are forced to put up the cost of meals on wheels and other services. If the Secretary of State really wants to help people with dementia, when will he act to stop this scandal?

Let me turn to mortality rates. Over the past decade, the deaths from heart attacks fell by 50% in men and 53% in women, and the NHS achieved the biggest drop in cancer deaths among the 10 most developed nations. It is widely accepted that the clinical networks established by the previous Government played a significant role in that success. Indeed, the NHS medical director, Professor Sir Bruce Keogh, called them “an NHS success story”. Why, then, is the Secretary of State proceeding with brutal cuts to cancer, heart and stroke networks? Surely the best way to meet the ambitions he has set out is to build on that track record of success, not destroy it.

The Secretary of State promises to implement the Labour amendment to the Health and Social Care Act 2012 to ensure “parity of esteem” between physical and mental health. However, the opposite is happening as the NHS reverts to its default position and places mental health services first in line for cuts. Will he confirm that mental health spending was cut in real terms last year, and what will he do to reverse that? He says he wants a transparency revolution, but across the country local people are being shut out of crucial decisions affecting local NHS services. If he believes in “No decision about me without me,” will he today commit to consult Greater Manchester patients with long-term conditions on whether they want ambulance services to be run by a bus company? Will he act to stop details of contracts under his “any qualified provider” regime from being kept secret from local people under “commercial confidentiality”? The truth is that patients are being shut out as his friends in the private sector fill their boots.

In the weekend’s papers, this mandate was called the first contract with the NHS—the new language of the coalition NHS, in which competition and contracts replace care and compassion. Yes, the Secretary of State has today published a new mandate, but we needed a change of direction. The Government have put the NHS on a fast track to fragmentation. Today, they have unfairly and unrealistically raised expectations on a battered NHS, thinking they have cleverly contracted out responsibility to the national Commissioning Board. I have news for them. The chaos in the NHS starts and ends with the guilty men and women on the Government Benches. We will hound them and hold them to account for the damage they are doing.

[Mr Hunt]

This is an incredibly important document for the NHS, and I think that we were all expecting a bit more than the same old hollow rhetoric from the right hon. Gentleman.

There could be no greater commitment to the NHS than to protect its budget at a time of unprecedented austerity. This Government have protected the NHS budget; the right hon. Gentleman said that that would be irresponsible. The Government take action; he uses words. The picture he paints of the NHS in crisis is not the picture recognised by thousands of doctors and nurses up and down the country. Of course, with an ageing population, the NHS is doing more than ever before. Nearly 1 million more people every year are in A and E than when he was Health Secretary, but it is meeting all its waiting times targets and has virtually eliminated mixed-sex wards, and hospital-acquired infections are going down. This NHS is performing exceptionally well.

Let me address some of the points that the right hon. Gentleman made. On finance, in the figures he gave, I think he was alluding to the fact that, in the first year the coalition was in power, it worked to Labour’s NHS budgets. There was an underspend in that year, as there was in each of the last four years that Labour was in control. In three of those four years, the underspend was higher than it was when my right hon. Friend the Leader of the House was Health Secretary. Let us talk about redundancy payments. The reforms introduced by my right hon. Friend will save the NHS—[Interruption.]

Regional Pay (NHS)

Andy Burnham Excerpts

Wednesday 7th November 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House believes national pay agreements are an important part of the infrastructure that underpins a national health service; notes reports of the statement by the Deputy Prime Minister that there is going to be no regional pay system; further notes with increasing concern attempts by 20 trusts in the South West of England to opt out of national agreements by reducing staff pay and changing terms and conditions; notes with concern that an additional 11 trusts across England are considering similar moves; and calls on the Government to intervene without delay and uphold the principle of national pay arrangements in the NHS.

My right hon. and hon. Friends and I have called this debate with a clear purpose: to build support across the House for a health service that remains national in character, and to send the clearest of signals to those threatening to break it apart. National pay is part of the glue that holds together a national health service. In turn, the NHS is part of what holds our country together: a one-nation service bridging the social and economic divides of our country, uniting east and west, north and south; a service with fairness at its heart, where, from Newcastle to Newquay, patients can walk through the door and expect to meet staff with the same values, the same motivations and the same level of commitment to their employer.

The debate is not a narrow argument about levels of pay. It is about the character of our health service and the cohesion of our country. Like the BBC, the NHS is one of the country’s great unifying forces—a service that sees no differences, treating people, patients and staff with the same respect, wherever they come from, whatever their background. The “N” in NHS should be cherished, but instead it is coming under ideological attack.

[Several hon. Members]

rose—

[Andy Burnham]

I know that many Members want to speak in the debate, so I shall give way once or twice, to ensure that there is time left for others to contribute.

[Henry Smith (Crawley) (Con)]

The right hon. Gentleman is right that it is a national health service that this country enjoys. Why, therefore, is a Labour Administration reducing funding to the health service in Wales?

[Andy Burnham]

I am here to talk about the NHS in England. I will come on to the Conservative Government’s record on funding the NHS in England, so I would not be so smug if I were the hon. Gentleman.

The drive to turn collaboration into competition depends on breaking national standards—breaking the “N” in NHS. The former Health Secretary’s request to the pay review body to consider the case for “market-facing pay” needs to be seen alongside his Health and Social Care Act 2012. Breaking national pay in the NHS is an essential step towards creating the free market in health that many in the Conservative party have long wanted, and which the Liberals now seem willing to let them have.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman confirm that the direction towards market-facing pay should also be seen in the context of the statement in the Budget presented by the previous Government in 2003 committing them to increase regional and local flexibility in public service pay systems? Did he support that when he was Secretary of State?

[Andy Burnham]

The Labour Government did introduce some flexibility, but let me tell the right hon. Gentleman my record: I spoke up, at every opportunity, for the principle of national pay underpinning a national health service. We hear nothing similar from Government Front Benchers. We built a progressive system of pay for the NHS in “Agenda for Change”, which brought fairness and stability to the system. By the time we left office, not one trust had opted out of that national system of pay, and only one, Southend, paid an increment on top.

[Mr Dorrell]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I will make some progress.

Breaking national pay is what the Government want to do, and that springs from an entirely different philosophy from the one that forged the NHS in the first place. The Government are rejecting the “one NHS” approach, whereby hospitals collaborate and the unpredictable pressures of any health service are balanced across the system. Instead, they have a vision of hospitals as stand-alone small businesses, on their own in the marketplace, with no bail-outs and free to earn up to 49% of their income from the treatment of private patients, but—as we are seeing in south-east London—finding little mercy in a private-sector-style administration process if the sums do not add up. That is a very different vision of the NHS, and it is not one to which the British people have ever given their consent in a general election.

[Andrew George (St Ives) (LD)]

I will join the right hon. Gentleman in the Lobbies on one reasonable condition: he acknowledges that the last Labour Government did not just introduce regional pay in the Courts Service, but introduced flexibilities for foundation trusts which, through employment law, could result in detriment to NHS employees. If he acknowledges that and apologises for his introductory remarks, I will certainly join him in the Lobbies.

[Andy Burnham]

I partly welcome what the hon. Gentleman has said. I have already acknowledged the flexibilities, and mentioned that only one trust in England ever sought to make use of them, because it wanted to add to the national floor that we had introduced. The flexibilities were there and I support them, but we left office with a national pay system in place. I look forward to his support later this afternoon.

We have a new Secretary of State, but those who expect a change of direction look set to be disappointed. In his first major interview, he described his mission thus:

“I would like to be the person who safeguards Andrew Lansley’s legacy”.

That must qualify as the shortest suicide note in political history. We have Lansley-lite—more of the same—but, in fact, it may be worse.

Looking at the Secretary of State’s past speeches, I could find nothing that conveyed any passion, belief or commitment to the NHS. On the contrary, I was worried when I read that he tried to remove Danny Boyle’s NHS tribute from the opening ceremony of the Olympic games. He is also one of the co-authors of a right-wing pamphlet entitled “Direct Democracy”. He may remember that pamphlet. It said:

“Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain.”

Is that still the Secretary of State’s view? He has gone quiet now, has he not?

You will understand, Mr. Speaker, why NHS supporters get nervous about the intentions of this Secretary of State, but today he has a chance to calm those nerves. He can come to the Dispatch Box and send the clearest of messages to NHS trusts seeking to break from national pay. What he will learn about his job is that, if he says something with sufficient force, the NHS will respond.

The developing pay crisis in the NHS is the Secretary of State’s first real test, but so far he is failing it. As we reveal today, on his watch, the 20 NHS trusts that were threatening to break away in the south-west have become 32 NHS trusts across England. That is creating real worry for thousands of NHS staff and uncertainty for businesses, which have raised their concerns with the Chancellor. But what do we get from the Government today? A “do nothing” amendment expressing no view on the south-west issue, and inviting Government Members to sit on the fence and wait for the conclusions of the pay review body’s review. That will not do.

As the Government do nothing, national pay is being unpicked and the NHS is fragmenting before our eyes, but perhaps that is all part of the plan—it is nothing to do with them; it is all due to a local decision. The idea is to hide behind a review while national pay slowly and conveniently unravels, region by region, trust by trust. Staff facing the threat of a pay cut deserve some straight answers, but rather than getting a straight answer to the question “Does the Secretary of State support regional pay in the NHS or not?”, they are hearing contradictory statements from this shambolic Government. Not for the first time, the coalition is not speaking with one voice. I understand that the Liberal Democrat conference passed a motion opposing regional pay and that the Deputy Prime Minister was captured on film voting for it—although, as we know, being photographed making pledges does not make him more likely to keep them.

The Deputy Prime Minister has also made the following unambiguous statement:

“There is going to be no regional pay system. That is not going to happen.”

The trouble is that it is happening, under the Deputy Prime Minister’s nose and by the back door. Twenty NHS trusts in the south-west are openly defying the authority of the Deputy Prime Minister. Some 88,000 NHS staff are being affected by a unilateral drive to set a new going rate of NHS pay in the regions, which would be up to 15% lower than national “Agenda for Change” rates. The trusts are proposing to end overtime payments for night, weekend and bank holiday working, and to reduce holiday leave. They are also proposing to force staff to work longer shifts, and to cut sick pay rates drastically. That is no idle threat. The silence from Ministers is clearly emboldening them. Despite concerns raised here and elsewhere, they have built a fighting fund, set up a website, and appointed lawyers to make all this happen.

[Mr Ben Bradshaw (Exeter) (Lab)]

My right hon. Friend may not have been able to catch up with this morning’s Adjournment debate in Westminster Hall, but it is more than “silence from Ministers”. The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), who responded to the debate, admitted that the Department had known about the south-west cartel when it happened, and that she supported it. [Interruption.]

[Andy Burnham]

This debate is flushing out the Government’s position, is it not? The Under-Secretary of State keeps heckling from the Front Bench, but we now know—[Interruption.]

[Mr Speaker]

Order. I ask the right hon. Gentleman to resume his seat. [Interruption.] Order. Let me say once and for all to the Under-Secretary of State, the hon. Member for Broxtowe (Anna Soubry), who has been conducting a running commentary since she sat down on the Front Bench at the start of the debate, “Stop it.” I do not wish to hear it, and neither does the House. The Secretary of State will respond in due course. If the hon. Lady is dissatisfied with what has been said, her right hon. Friend will have a chance to respond. I do not want the sedentary chuntering, the finger-wagging and all the rest of it. The hon. Lady can say “pooh” if she wants, but she will accept the ruling of the Chair, and either behave or get out of the Chamber. I do not mind which it is.

[Andy Burnham]

The Government’s position was indeed made clear in Westminster Hall this morning, and perhaps we shall hear it again from the Dispatch Box in a moment.

The south-west trusts’ initial document stated that the consortium would explore

“radical changes to terms and conditions of the workforce”.

It went on to say that this would not be a negotiation, and that

“trusts would be obliged to dismiss and re-engage staff to secure such changes”.

That is disgraceful, and it is simply not possible for the Government to have no view on it. It is provocative, destabilising and divisive. However, it gets worse. In the vacuum left by Ministers, the chaos is spreading. We have identified a further 12 trusts across England that are actively considering opting out of “Agenda for Change”. There are five in the north-east, which gives rise to fears of a second emerging pay cartel. North Tees and Hartlepool has issued 90-day notices to 5,452 staff as a precursor to forcing them to sign new non-“Agenda for Change” contracts—staff who refuse to sign by March 2013 are threatened with the sack—and South Tees is considering a similar move.

[Mr David Anderson (Blaydon) (Lab)]

Will my hon. Friend give way?

--- Later in debate ---

[Andy Burnham]

I will give way for the last time to my hon. Friend.

[Mr Anderson]

I support what my right hon. Friend is saying. In the north-east there is real anger among people who have devoted their lives to the health service, and who are now being told that they will effectively be forced to sign new contracts, because otherwise they could face the dole. Is that any way in which to treat people who are relied on to make what are literally life-or-death decisions? It is a disgrace.

[Andy Burnham]

These are the same staff whom we were celebrating during the Olympic games, just a few months ago, for everything that they contribute to the NHS and to the care of others, but Ministers sit there and do absolutely nothing. It is disgraceful that any staff in the NHS should be treated in such a way.

This is no academic threat. These are the panic moves of an NHS that is experiencing increasing distress, in which control has been lost because it is facing the biggest financial challenge in its history. After the election, the £20 billion Nicholson challenge should have been the only show in town, but the previous Secretary of State was allowed to proceed with his vanity reorganisation of the NHS. Instead of focusing on saving money, the NHS has been busy wasting it: £1.6 billion, and rising. A full £1 billion has been spent on redundancies—1,300 people have received six-figure payouts, and l73 have received more than £200,000—while 6,000 nurses are losing their jobs. That is scandalous.

As unforgiveable is the Conservative party’s repeated inaccurate boast on NHS funding. I checked on the Conservative party website today, and in the “Where we stand” section it says this:

“We have increased the NHS budget in real terms in each of the last two years.”

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

indicated assent.

[Andy Burnham]

The Secretary of State nods, because he has made similar statements. I want to know whether he stands by those words as a truthful and accurate statement.

[Mr Hunt]

Absolutely.

[Andy Burnham]

He says he does, so let me refer him to table 1.8 of the Treasury’s “Public Expenditure Statistical Analyses 2012”. On NHS spending it shows the following: for 2010-11, a 0.6% real-terms cut; for 2011-12, a 0.1% cut. Those are the facts. How on earth can the Secretary of State say today that he stands by—[Interruption.] The figures are there in black and white. There have been two years of real-terms cuts in the NHS. If anyone does not believe my analysis, a Department of Health press release from July 2012 confirms what I have said:

“PESA figures released today show that in real terms NHS spending has reduced.”

So I ask the Secretary of State this: will he today remove that untrue statement from the Conservative party website? It is giving a false impression of what is happening in the NHS. Perhaps it is designed to give the impression that the drastic moves on pay are a local matter not of Ministers’ making. This is the real picture, however: the Government have forced the NHS to fund a £1.6 billion reorganisation it did not want—even though they promised that would not happen—from a falling budget which they still claim is increasing.

All trusts have been put in a difficult position by this Government, but that is no excuse for some taking the easy way out by taking it out on staff. If they are allowed to do that, they will damage something that serves the wider good.

The “Agenda for Change” system introduced by the last Government represented a significant step forward, and I want to set out the compelling economic, social and health policy arguments in its favour. First, it brings stability to the service. Unlike other areas of economic activity, health care depends upon certainty and predictability. As an essential emergency service, it needs to be there for people day in, day out. Volatility helps no one. All communities need a full complement of clinical grades and professions. Local or regional pay is not conducive to stable services. If one area starts seeking to poach staff from another, no one wins, as we will get instability and, over time, an inflationary pressure that is hard to control at local level.

That brings me to the second reason in favour of national pay. All the evidence suggests that a national approach to pay and conditions helps to reduce costs and risks to the NHS. Market-based systems tend to cost more, not less.

There is also the hassle and distraction factor of every individual NHS employer or regional group going through the annual process of pay negotiation and setting. Trusts rushing to break away from the national pay system forget that. They are also forgetting the risks of the pre-“Agenda for Change” days, when individual trusts would bear the full legal exposure of failure to implement equal pay legislation. It would seem that there are a few short memories in the NHS. People are forgetting that the advent of a national pay system has insulated the NHS from those risks, which have impacted on other parts of the public sector, such as by bringing more turbulence in recruitment and retention.

I do not think the 32 trusts involved in the breakaway have fully thought through the consequences of their position. For instance, national pay is reflected in the calculation of the tariff under the payment by results system, so are these trusts expecting to be paid at national tariff rates by commissioners while paying staff regional rates? I find it hard to see how that could be justified. So, in effect, they are not only pulling down the system of national pay that helps to give stability for everyone; they will also end up pulling down the national tariff system.

The third health policy reason for national pay is the most compelling. National pay helps with the recruitment of staff in the areas where they are most needed. If we follow through the logic of the argument of proponents of a broken down system of regional or local pay, it will end in a proposal to pay people less in areas where unemployment is highest and wages are lowest. The problem with that argument is that those areas are also the most deprived parts of our country where the health challenges are greatest. It is often much harder to work on the NHS front line in areas of higher health need and deprivation. We need to work hard to attract the most motivated staff to those areas, and I simply do not see how that will happen if the offer to work in the areas where the pressure is greatest includes being paid 15% less.

In the end, care is a people business and this race-to-the-bottom approach simply does not deliver the quality people are looking for. We have seen that approach in social care: a crude race to the bottom and a cut-price, minimum-wage business. That simply does not work.

It is true that pressures vary from place to place and the job is not the same everywhere, but the principle that a health visitor, a physiotherapist or a midwife should be paid broadly the same for doing a similar job is a good one. It is fair to staff, and we should stick with it.

That brings me on to the fourth reason: the social and economic case. All the evidence points to regional pay in public services causing damage to the regional economies of England. Rather than stimulate the south-west economy, it has been estimated that regional pay would take £140 million out of it.

It is not just the public sector making that argument. Some 60 academics wrote to The Times to say that, and businesses in the north-east have written to the Chancellor raising their concerns. They said:

“Now is the time for the country to unite and focus on growth, not risk a divisive and harmful policy such as this.”

They are right. An NHS with national pay is a one-nation policy. What is happening in the NHS risks cementing the regional divides and creating an unequal Britain.

Taken together, those four reasons stack up a compelling case for keeping a system of national pay in the NHS. Losing it will be bad for the NHS, bad for the economy and bad for society.

I know that the force of that argument is not only felt on the Opposition Benches. Debates such as this one usually divide Members along tribal lines, but there are Members in all parties who represent areas where the jargon of “market-facing pay” means one thing: crude pay cuts for the staff who work so hard to serve their constituents day in, day out. What I find encouraging is that Members on both sides of the House whose constituencies would be affected by these changes have had the courage to speak out against them.

It is not just Liberal Democrat Members who are doing so. I am encouraged by the fact that a number of Conservative Members have expressed serious concerns. The hon. Members for Brigg and Goole (Andrew Percy), for Stafford (Jeremy Lefroy), for Carlisle (John Stevenson) and for Hexham (Guy Opperman) have all spoken out, and I can do no better than repeat the words of the hon. and learned Member for Torridge and West Devon (Mr Cox):

“I am extremely cautious about any change that might further depress incomes in our area or that might act as a disincentive to those in the medical profession to work here.”

The Government Front-Bench team would do well to listen to those concerns, as I suspect they are widely held across this House.

The Government’s amendment does absolutely nothing for the 88,000 NHS staff in the south-west who are worried about the future. It does nothing for the businesses worried about regional divides. It ducks the issue, and lets local and regional pay creep in through the back door. If the Secretary of State has any belief in a national health service, he must step in tonight, stop the breakaway and uphold the principle of national pay in the NHS. I commend the motion to the House.

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[Mr Hunt]

Let me remind the hon. Gentleman that he supported the 2003 Act, which gave foundation trusts the power to set their own terms and conditions. Let me also remind him that this Government have increased the NHS budget in real terms—something that the right hon. Member for Leigh said was “irresponsible”. Let me say clearly that we are not changing the allocation of resources to different parts of the country, but we are allowing the flexibilities that the Labour Government introduced for local NHS managers to make sure that they get the benefit. If the hon. Member for York Central (Hugh Bayley) listened to what I said about a million more people being treated in accident and emergency, one and a half million more diagnostic tests being carried out, and about half a million more out-patient appointments being dealt with, he would understand that all our constituents are benefiting from that. That is because we have the flexibilities that that Government introduced.

[Andy Burnham]

The Secretary of State said again that in 2010-11 and 2011-12 the NHS budget increased in real terms. Is he saying that Her Majesty’s Treasury has got its figures wrong?

[Mr Hunt]

No. Let me just remind the right hon. Gentleman that the budget increase in the NHS that this Government committed to and that this Government announced was something that he said would be “irresponsible”. We have ignored that, and I have been completely clear that the NHS budget went up.

We support recruitment and retention pay—an amount that can be as much as 30% of a person’s salary, and which the Opposition, if they were consistent in their opposition to regional pay, would presumably wish to abolish. We support the London weighting, which is, again, a form of regional pay that we would be planning to abolish if we listened to the Opposition’s arguments today.

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[Mr Hunt]

All we are doing is supporting what the hon. Gentleman’s Government did, which was to introduce flexibilities for the people who run foundation trusts to set pay and conditions in order to get the best health care in their areas, including in his constituency, in that of the right hon. Member for Leigh and in mine. The previous Labour Government did not just support that; they legislated to require it. They introduced foundation trusts—

[Andy Burnham]

rose—

[Mr Hunt]

I am going to make some progress now. The previous Labour Government introduced foundation trusts in 2003, giving them the power to set their own terms and conditions, just like NHS trusts. Indeed that Government went further, removing the remaining powers of the Secretary of State to intervene. Then, in 2004, the right hon. Gentleman’s Government included regional pay as a firm principle of “Agenda for Change”. Then they legislated to confirm these principles in the Health Act 2006. Who was the Health Minister then? It was the right hon. Gentleman.

The right hon. Gentleman recently referred to this flexibility as a “loophole”. It is not a loophole; it was one of the central planks of that Government’s policy. Let us consider the following:

“The challenge now must be to genuinely free the very best NHS hospitals from direct Whitehall control.

We plan to do this…by removing the Secretary of State's powers of direction over NHS Foundation Trusts…

Exercising these freedoms will give NHS Foundation Trusts precisely the sort of autonomy that is commonplace for hospitals elsewhere in Europe.”

Those are not my words, but those of his colleague and former Health Secretary, Alan Milburn, when he introduced foundation trusts.

The question that the right hon. Gentleman has to answer—he has completely failed to do so—is why, as Health Minister, he legislated for these powers if he disagreed with them. If he disagrees with them, why did he not overturn them when he had a chance to do so as Health Secretary? Either he has changed his mind or the unions which bankroll his party have changed it for him. Whichever is the case, it is a pretty sorry state of affairs for a party that claims to aspire to power.

[Andy Burnham]

The Secretary of State has misrepresented the former Government’s position twice, and on NHS spending. Let me just ask him about regional pay. He said he is building on what we did. When we left office not a single NHS trust in this country had opted out of the national “Agenda for Change” system—that is a fact—because we defended the principle of national pay. He has just said to my right hon. Friend the Member for Exeter (Mr Bradshaw) that he will not condemn the cartel in the south-west, and that he wants trusts to choose whether to opt in to national pay or regional pay. Should he not tell Liberal Democrat Members and the people sitting behind him that he supports local and regional pay in the NHS?

[Mr Hunt]

That is a funny way of defending the principle of national pay: legislating to give foundation trusts the ability, for the first time ever, to set their own terms and conditions. I do not know how the right hon. Gentleman defines it, but that does not seem to me to be in any way logical.

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[Andy Burnham]

The hon. Gentleman said that the Labour Government gave too much to nurses and midwives in pay—[Interruption.] He said that we spent too much on pay. He also said that the market rate of pay should apply in his area. I want to ask him a direct question. Does he think that his constituents who work in the NHS are overpaid?

[Chris Skidmore]

No, I think that the right hon. Gentleman is misrepresenting what I said. The fact is that we have got to the point—[Interruption.] Nurses, doctors and health care professionals should be paid according to their skills. They should be paid according to what the trusts can afford. The problem we have is that, with an ageing population—

[Andy Burnham]

So they should be paid less?

[Chris Skidmore]

No, they should not be paid less. The right hon. Gentleman should stop splitting hairs. If we want a health care service that is viable for the future, where will the money come from? Perhaps he can answer that. What would he do to be able pay for the future of the NHS, given the demographic challenge we face?

[Andy Burnham]

If the hon. Gentleman gets rid of national pay in the south-west, does he think that the trusts in the consortium, or cartel, should receive a national tariff that factors in a national rate of pay, or should they be paid less for the work they do?

[Chris Skidmore]

What I find so frustrating about this debate is that the right hon. Gentleman has thrown his principles out of the window. He once defended flexibility for foundation trusts, but he now no longer trusts professionals in the way he really should.

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[Andy Burnham]

We could have a debate about foundation trusts, their powers and their freedoms, and there is an argument that some of them have improved in recent times, especially the big city trusts, but that is for another day. Will the hon. Gentleman at least do me the courtesy of acknowledging that during our time in government not one NHS trust broke away from “Agenda for Change”, and only one sought to add an increment?

[Dan Rogerson]

Absolutely, and of course the process of trusts becoming foundation trusts was just under way—it has gathered pace over the last two years—and they were bedding down. It is likely—especially given the challenges of efficiency savings that his party would still have imposed if they had won the 2010 election—that the same set of circumstances would have prevailed. In fact the managers in those trusts who are taking those decisions are the same people who would have been in post had Labour won. It is nonsense to say that because the coalition is in power, those people woke up one day and made those decisions. Those things would have happened anyway. To be fair to the right hon. Gentleman, perhaps we should say that we cannot know what would have happened because we are not in that world. We are in the world in which his party lost the last general election. However, the NHS that he left behind is the one that is allowing this to happen, and it is the one that we have to deal with.

We have private providers next door to the NHS treatment centre I mentioned. Bodmin hospital is full of great staff. It was built under a PFI contract and is now staffed by Peninsula Community Health, a community interest company on the social enterprise model. It had to move those nurses into the private sector—or the social enterprise sector, depending on how one views that form of body—on the basis of the provider/commissioner split in the primary care trusts that was set up by the right hon. Gentleman’s Government.

We also have the issue of funding, which is the background to much of this debate. It is no accident that trusts in Cornwall are looking at this. I disagree with them, and I agree with the hon. Member for Plymouth, Moor View about the process they are engaged in, but one of the reasons they are doing it is that the “distance from target” for NHS funding was massive for trusts in the area under the last Government. I have to say that I am not satisfied that our coalition Government have tackled that problem either. The problem also existed under the previous Conservative Government—health funding in our region has been lower than it should have been for decades. Trusts such as the Royal Cornwall Hospitals Trust are having to deal with the problem of funding for those historic reasons. It is not something that has suddenly been invented.

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[Mr Cox]

To be blunt, I am not happy about what I am seeing in the south-west in relation to those 20 trusts, whom I encourage to engage with staff and the unions, as my hon. Friend the Member for North Cornwall (Dan Rogerson) said, and to engage in a process that tries to reach some form of consensual agreement.

To answer the right hon. Gentleman’s question, however, I suspect that those 20 trusts have joined together only out of desperation at the static and stagnating nature of the discussions at national level. They are desperate to manage their budgets. Many are in extremely difficult financial circumstances. I see my hon. Friend the Member for North Devon (Sir Nick Harvey) in the Chamber. I will be meeting the chief executive of Northern Devon health trust shortly, and I know the budgetary pressures that it is facing. He will tell me that it cannot wait for the slow convoy of the national negotiations to take place. I urge it to do so. I hope that we can re-engage at a national level and that there are serious and mature discussions going forward. The truth is—nobody can doubt it—that the pay bill in the national health service needs to be tackled. That is why I say again to the right hon. Member for Leigh that the position adopted by the party he represents is not responsible. What he should be doing is calling for national negotiations to take place as swiftly as possible.

[Andy Burnham]

But all the evidence says that a national pay system is more cost-effective because it does not lead to inflationary pressure around the system, so ours is not an irresponsible position. The hon. and learned Gentleman began with a very trenchant criticism of the foundation trust legislation, which has been echoed on the Liberal Democrat Benches. At the same time as that legislation was enacted, Labour was bringing forward the most ambitious ever programme to overhaul national pay in the NHS, called “Agenda for Change”. He needs to give us some credit for doing that.

[Mr Cox]

I hope I have been as balanced and fair as I can. I am not suggesting that the right hon. Gentleman has been stewarding the national health service while trusts have taken these actions; I am saying that, like the householder, he opened the door to the burglar. He cannot say now, when he has opened the door, that he deplores the fact that the burglar has gone in and robbed the property. The truth is that he presided over it when he opened the door, and he must have known that that would happen.

There are two things that the Labour party should do now. If the right hon. Gentleman left aside parliamentary games, which we all know he has engaged in, he could offer to try to tackle these grave problems at a national level by encouraging the unions to engage. He should not seek to exploit the situation by scoring political points in the way that he currently is. I say to him and to Ministers on my Front Bench that I very much hope that the outcome of the review will not be that regional pay is recommended as the way forward. I would oppose it. I cannot in conscience sit in this House, representing thousands of people on the edge of poverty in a rural economy that is sustained largely by expenditure that those on public sector salaries in the national health service receive, and preside over a situation where their incomes are further depressed.

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[Andrew George (St Ives) (LD)]

It is a pleasure to follow the hon. Member for Worsley and Eccles South (Barbara Keeley), a fellow member of the Health Committee. I endorse her comments. She, like many others, has emphasised the reason it is so important that the House rejects the concept of regional pay and urges unions and employers to accelerate the process in order to reach a speedy conclusion on national pay bargaining. This is a serious issue, and it deserves a serious response from all parties in the House. It should not become a subject to be kicked around the playground of an Opposition Day debate in an opportunistic manner, as has so often happened—before the election as well as after it, to be fair. A matter as serious as this should not be debated in that way.

I intervened on the right hon. Member for Leigh (Andy Burnham) to ask whether he would acknowledge that we are where we are today because of the freedoms the previous Government created for the cartel in the south-west, or in any other part of the country. We are aware that other trusts are looking closely at what is happening with that cartel. The previous Government should be applauded for introducing the “Agenda for Change” and attempting to introduce a rigorous and effective method for agreeing pay and conditions at national level, but they also legislated to introduce foundation trusts and the new freedoms that went with them. The Liberal Democrats opposed that legislation at the time.

[Andy Burnham]

rose—

[Andrew George]

I was going to go on to talk about employment law, but I am happy to give way to the right hon. Gentleman.

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[Andy Burnham]

This subject has featured a lot in today’s debate. I would encourage the hon. Gentleman to go back to the speeches made by Ministers when that legislation was being introduced. They were clearly saying that there could be occasions when flexibility would be needed at the margins to deal with a particular short-term pressure or problem. Such an arrangement was used once, in respect of Southend, to put pay up. It is important to understand that there was no suggestion that pay could be reduced across the board in a co-ordinated, orchestrated move to undercut the national pay system that was being brought in at the same time. That argument has been put today, but it simply does not hold water.

[Andrew George]

That might have been the stated intention, but the effect is being seen through the cartel’s actions. What is happening is not the result of any coalition Government legislation; it is the result of an opportunity having been made available under employment law. This is not within the parameters of “Agenda for Change”. It is a result of the freedom given to foundation trusts to step outside those agreements and to use employment law to seize the opportunity of certain flexibilities, to the detriment of the employees in their pay. That might not have been the intention behind the legislation, but it has been the effect of it, whether the previous Government appreciated that or not.

If the right hon. Gentleman is really so concerned about this, and given the fact that he can now see the effects of his legislation being played out by the cartel in the south-west, perhaps the shadow Minister, the hon. Member for Copeland (Mr Reed), will acknowledge, in summing up the debate, that that was not the intention behind the legislation. Will he, having noted what is now going on as a result of that legislation, commit to rescinding that element of it if Labour were to come to power, to put right the weaknesses of it? If so, we would know that Labour Members were genuine and sincere in their intent, and that they acknowledged that weakness, which they had not anticipated at the time but which is now being exploited.

I strongly support my hon. Friend the Member for Southport (John Pugh) and congratulate him on his characteristic breathtakingly brilliant contribution to the debate. He was most entertaining, and there was disappointment across the whole House when he resumed his seat without having used all the time available to him. He made many insightful comments about the situation we are in today, and the weaknesses of it.

I also thank my hon. Friend the Member for North Cornwall (Dan Rogerson) for pointing out the significant weaknesses in the legislation and the impact they are likely to have on NHS staff. I am pleased to see my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) in the Chamber today. We are all aware that the Royal Cornwall Hospitals Trust’s involvement in the cartel is creating deep concern across Cornwall. The hon. Member for Truro and Falmouth (Sarah Newton) made a telling intervention earlier when she said that Cornwall has some of the highest costs of living in the country, while perpetually being at the bottom of the earnings league table, pretty much since records began.

One of the drivers behind the problem is the cherry-picking in the NHS. The private sector is already offering the easiest procedures. A private provider in Cornwall carries out the easiest procedures for the fittest patients with low anaesthetic risk and those who are the least likely to suffer complications following orthopaedic procedures. It is now extending its services into areas such as cardiology, hernias, haemorrhoids and endoscopy. If any complications occur, it will simply pass the patient across to the Royal Cornwall Hospitals Trust to deal with any difficulties or emergencies. It therefore has no need to invest in all the facilities necessary to provide the kind of wrap-around service that we want the NHS to provide. The fact that such private sector companies are able to vary wages, terms and conditions for their staff is undermining the NHS. The foundation trusts are having to compete with those companies, and that is one of the pressures that is driving their agenda. All parties need to recognise that fact, and Ministers need to acknowledge that this continued cherry-picking by the private sector is fundamentally undermining the capacity and ability of the NHS to respond adequately.

We must also ask why we are in this situation in the south-west. In regard to resource allocation, only two years ago Cornwall was getting £56 million a year less than the Government said that it needed to provide the necessary services. If there is a significant gap between the funding actually provided for the local health community and the amount that the Government say is the target funding, it is no wonder that local trusts find themselves having to make extremely challenging decisions.

I urge the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), when he winds up the debate, to acknowledge that resource allocation still needs to be addressed. Members of Parliament from across the south-west and I have arranged to hold a meeting with him on this matter, and I hope that it will take place soon so that we can have an opportunity properly to address the issues.

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[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a great pleasure to respond to today’s debate. I am pleased to start on a consensual note, in that we have heard some genuine concerns expressed by Members on both sides of the House on behalf of our NHS staff. All hon. Members very much value the dedication and hard work of all staff who work in the NHS on a daily basis. They often go above and beyond the call of duty to look after patients, and I would like to echo the comments made in that regard.

We have heard good contributions from the hon. Members for Blaydon (Mr Anderson), for South Down (Ms Ritchie), for Bristol East (Kerry McCarthy), for Hartlepool (Mr Wright), for Plymouth, Moor View (Alison Seabeck), for York Central (Hugh Bayley), for Worsley and Eccles South (Barbara Keeley) and for Stockton North (Alex Cunningham); my hon. Friends the Members for Kingswood (Chris Skidmore), for Southport (John Pugh), for Aberconwy (Guto Bebb) and for North Cornwall (Dan Rogerson); my hon. and learned Friend the Member for Torridge and West Devon (Mr Cox); and my hon. Friends the Members for North Devon (Sir Nick Harvey) and for St Ives (Andrew George). The contributions from the hon. Member for York Central and my hon. and learned Friend the Member for Torridge and West Devon were particularly thoughtful, putting on the record their genuine concerns for the NHS staff who work in their constituencies. Those contributions encapsulated the support that all Members of this House wish to show for the hard work that NHS staff do every day.

However, I was disappointed by the intervention from the right hon. Member for Exeter (Mr Bradshaw). I have looked at the Hansard record, and it is worth picking up on this. I have here the details of the exchange involving the hon. Member for Bristol East (Kerry McCarthy), and I want to set the record straight for the House now. She asked:

“When did the Department of Health first find out about the formation of the consortium?”

The Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry), replied that she was not aware—the Department was not aware—but that she would

“make further inquiries of …officials…and write to the hon. Lady”

to clarify that. It is clear that my hon. Friend has been misrepresented in this debate. That is in Hansard, it is on the record clearly, and I hope that hon. Members will accept the correction and withdraw their remarks. I wish to make it very clear, for the record, that we were made aware of the south-west consortium’s plans when its project document was leaked. That is when the Department became aware of the plans. We did not encourage the consortium in any way and it has the freedoms in respect of its own employment conditions that were given to it by the previous Government under their legislation.

It is worth stressing that Opposition Members, particularly those on the Front Bench, have made many attempts to rewrite history. The speech made by the hon. Member for Copeland (Mr Reed) bore little resemblance to reality when he talked about the involvement of the private sector. The right hon. Member for Leigh (Andy Burnham) said that breaking national pay frameworks is the first step towards the marketisation of the NHS. Yet, as one of his colleagues said later, it was the previous Labour Government who introduced the private sector into the NHS in the first place, who paid the private sector more than NHS providers for providing the same services, and who allowed those private sector providers to cherry-pick the best services from the NHS, to the detriment of NHS patients. Through the Health and Social Care Act 2012, this Government will be stopping that by having more of an emphasis on joined-up and integrated care for all health care providers.

It was the Labour Government who introduced the pay structure about which Opposition Members are so concerned into the NHS. It was the Labour Government who introduced regional pay into the NHS through incentives and London weighting. It was the previous Labour Government who endorsed the flexibility of local employers to set their own terms and conditions. It was the Labour Government—the Government of the right hon. Member for Leigh—who gave greater freedoms to employers to set their own terms and conditions when they created foundation trusts.

Let me set the record straight and make things perfectly clear. We cannot rewrite history. The right hon. Member for Leigh wants a change of direction, but does he mean a change of direction from the pay flexibility that he and his Government gave to the NHS when they were in power? The Government recognise that in some parts of the country it is important to have pay flexibility in the NHS. We believe that it is right to reward London workers with a £6,000 London weighting because the cost of living is much higher. Does he want to withdraw that flexibility?

[Andy Burnham]

On our watch, no trust opted out of the national pay agreement in the NHS, but on the Government’s watch, 32 trusts are trying to undercut it. The hon. Gentleman is in the Government—what is he going to do about it?

[Dr Poulter]

The right hon. Gentleman cannot rewrite history. He cannot stand at the Dispatch Box and say that he no longer agrees with the pay flexibilities he gave local NHS employers or with the “Agenda for Change” document that his Government put in place. That document recognises that in parts of this country premiums of up to 30% need to be paid to employees. It also recognises that the cost of living in London is much higher and gives a £6,000 premium to NHS workers who work in the centre of London.

In our amendment, the Government are pleased to support the comments made to the GMB by my right hon. Friend the Chief Secretary to the Treasury. That highlights the Government’s support for NHS and public sector staff and recognises implicitly that in some parts of the country—as the previous Government’s “Agenda for Change” makes clear—we need pay flexibility to recognise when the cost of living is greater.

Importantly, the Government have also made clear our intention to retain national pay frameworks and national collective bargaining while they remain fit for purpose. That is why we are encouraging NHS employers and the trade unions to come together at the NHS Staff Council to negotiate a settlement that remains fit for purpose so that we can continue to endorse national pay frameworks. That is the stated position of the Government and it is a shame that the Opposition are attempting to politicise an issue of their own making.

It is worth putting it on record that despite the financial challenge faced by the whole public sector, we have put an extra £12.5 billion into the NHS during the life of this Parliament. That is not to say, however, that there is no financial pressure, and the Opposition were right to highlight the Nicholson challenge and the need to cut away bureaucracy and waste in the NHS in order to put more money into the front line. We endorse that. The Government are meeting the Nicholson challenge, and the NHS reforms we have put in place will put the NHS in a much better place to do that in the future.