Mental Health (Approval Functions) Bill

Andy Burnham Excerpts

Tuesday 30th October 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Detaining people under the Mental Health Act raises fundamental questions of individual liberty and public safety, requiring the most careful consideration. I am sure that there is general agreement across the House that the circumstances in which we find ourselves today are far from ideal. Members on all sides will want to use the time we have to satisfy themselves that the measures that the Government are asking the House to approve today are justified.

Emergency legislation tends to be forward looking in its scope, so the retrospective nature of the Bill before us is unusual and potentially troubling for Members. As I said yesterday, we will need to be sure that this is the only real course of action available and that it is not setting a precedent whereby emergency legislation can be used as a convenient means of correcting administrative failings, which could in itself breed a culture of complacency in public administration.

In asking those legitimate questions, however, we must have at the forefront of our minds the simple fact that the uncertainty which has arisen in the past week affects thousands of highly vulnerable people and their families, as well as having serious implications for patients and public safety. If we leave that uncertainty hanging, it will have the potential to cause real harm to the individuals concerned, and to damage public trust in our systems of individual and public protection.

The Secretary of State was right to act quickly, and to come to the House yesterday to make his exceptional and urgent request for legislation. I am surprised that he did not make the case for that legislation to the House in person today, but the Opposition have nevertheless concluded that, on balance, the public interest is best served by our supporting the Government in the swift action that they propose, and we will ensure as far as possible that that pragmatic approach is reflected in the other place.

In reaching our judgment, I think we can take some comfort from the fact that the main mental health organisations, as well as the Royal College of Psychiatrists, are, for now, supporting the Government’s course. However, concerns and questions have already been raised today—not least by my right hon. Friend the Member for Oxford East (Mr Smith)—which have not been fully answered. I must say to the Government that it is vital for the fullest possible answers to be given to the House today before any approval is given to this exceptional retrospective measure. I shall be seeking answers not just to the questions that I am about to ask, but to questions that the Secretary of State did not answer yesterday. There are matters of detail here, but matters of principle also arise, and I want to cover both in my speech.

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

May I clarify something? I had intended to make the Second Reading speech earlier, but I will be winding up the debate, and during that speech I shall seek to address any points raised by the right hon. Gentleman—and, indeed, any outstanding points raised by other Members.

[Andy Burnham]

I thank the Secretary of State for his intervention. We understand that these are urgent matters, and I am sure that he is receiving briefings from the Department, but I think that there is a sense among Opposition Members that that is not good enough, and that he should have been here to answer the questions that were asked. We appreciate that he will be winding up the debate, but I hope he will take careful note of all the questions that are asked, and will give every Member present the fullest possible answer.

First things first: let us begin with the detail. I think it would help the House to know more about the extent of the checks that have been carried out on the 4,000 to 5,000 cases involved. The very fact that the number remains vague suggests that there has not yet been a thorough case-by-case review. Does the Minister—or, indeed, the Secretary of State—agree that it is essential to conduct such a review, and to put a precise number on the extent of the problem? I asked yesterday whether the Department could tell us how many of the people concerned were in high-security hospitals. I think that that is an important aspect of the issue, and I should be grateful if the information could be given to us at some point this afternoon. Without detailed case-by-case checks, how can we be sure that this procedural defect was the only technical irregularity in the process that was operating in the four SHAs concerned? We need to be reassured that there are no further problems that will need to be corrected at a later date.

That brings me to another question that was not answered yesterday. Families of the people involved will have heard yesterday’s news, and will no doubt have been unsettled by it. Does the Secretary of State agree that it is important for the Government to make arrangements, urgently, for direct communication to take place with the families who have been directly affected so that the issue can be explained to them more fully, and in isolation from some media coverage that may not give them the reassurance and support that they seek? Have such arrangements been made, and has any facility been provided enabling questions to be answered so that people can be given that reassurance and support?

That, in turn, brings me to another important point. If the Government were to leave a vacuum in terms of advice and communication, it could of course be filled by less scrupulous elements of the legal profession seeking to initiate compensation claims. We have already read warnings today that efforts may be made to encourage patients to sue for £500 or £600 a day, the amount that a prisoner would receive in compensation for unlawful detention. I am sure the Secretary of State agrees that any such activities would be highly unsettling, and would amount to the potential exploitation of vulnerable people. I hope he will join me in sending the clearest of messages to the legal profession that that would not be at all welcome. On the other hand, we would not want to see any curtailment of individuals’ legitimate right to challenge the decisions made affecting their liberty as a result of the Bill.

[Hywel Williams]

I am glad that the right hon. Gentleman has made that second point. The fact that some people are litigious, possibly as a result of their condition—of which that is a notorious aspect—should not detract from their right to pursue a case if they wish to do so.

[Andy Burnham]

That is a good point. So many cases are involved that challenges may have already been in progress before this technical problem arose. There may have been complaints about the nature of the decision-making process, the number of professionals involved, or any matter relating to the process by which the decision was made.

I hope that it will reassure the hon. Gentleman to learn that I have been given access to Government lawyers—the Secretary of State promised that yesterday, and I am grateful to him for arranging it—and I have been assured that the Bill will not wipe away an individual’s right to issue a legal challenge on a different point of process. That is a fundamentally important point, and I am glad that the hon. Gentleman has given me an opportunity to put it on the record. We would certainly not support the Bill if it were intended to wipe away an individual’s rights retrospectively, and I am sure that the hon. Gentleman would not either. We are grateful for that reassurance from the Government.

Along with the urgent steps that are being taken to correct the legal position, we need a review of how this came about in the first place. If it had happened in a single SHA, the explanation might have been easier to ascertain and understand, but the fact that it happened in four SHAs points to a more widespread issue of concern. It raises the question whether the problem arose from historical practice among clinicians and NHS bodies in the four regions concerned, or whether a piece of Department of Health guidance that was circulated in the past may have been responsible. I hope that the Minister or the Secretary of State will be able to enlighten the House further.

We want the Harris review—which I support—to cover all the technical issues surrounding mental health, so that the House and the public can be absolutely certain that no other technical failures or breaches of regulation have been identified. Let me make two appeals to the Secretary of State. First, I ask him to consider widening the remit of the review, and ensuring that in future it can take the broadest possible view of arrangements for sections under the Mental Health Act 1983. Secondly, I ask for the review to be conducted as swiftly as possible, so that it can inform the current reorganisation of the NHS.

It seems to me that the crux of the issue is the interrelationship between the 1983 Act and the potential for reorganisations of the NHS to disturb important existing arrangements and procedures for the carrying out of these essential public functions. That is the crux of the matter. I accept that a problem may have arisen as a result of the introduction of SHAs and PCTs in 2003, and we will have to wait and see whether that was the case. Regardless of the answer to that, however, the Government still have to face a relevant and current issue: they have to be absolutely sure that the changes they are proposing—and which the Opposition continue to believe are unnecessary and highly disruptive to an NHS that is functioning well for the vast majority of people—will not run the risk of causing further confusion.

We have not had anywhere near enough clarity from the Secretary of State—or his predecessor, the right hon. Member for South Cambridgeshire (Mr Lansley), who has just left the Chamber—on how some of the essential functions of NHS bodies to do with safeguarding and public protection are to be handled in the new NHS structure. Many months have passed since the publication of the Government’s first White Paper, yet there are still doubts in the minds of clinicians and others practitioners on the ground. That is an indictment, and shows the confusion the reorganisation has created. We are seeing the emergence of myriad new bodies in the NHS whose functions are not yet fully understood or specified by the Government. This crowded landscape has the potential to cause for further uncertainty. I therefore today ask for more clarity on this matter.

As things currently stand, what will the NHS arrangements be for sectioning people under the mental health provisions to be introduced from April 2013? I do not yet know with confidence what those arrangements are, and if I do not know there is a good chance that the wider public and many people working in the NHS have no idea. The Government need to answer these questions.

There is a further specific question the Department needs to answer, and it goes to the heart of the issues under discussion. I am sure I heard the Secretary of State say yesterday that the secondary approval function that SHAs are meant to carry out will come back to the Department of Health following the Government’s current reorganisation of the NHS.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding from a sedentary position, so I assume that is correct. Surely, therefore, a concern arises that the SHA part of the process is no more than a rubber-stamping exercise. The Department will be entirely remote from the local situation on the ground relating to the individuals involved and the clinicians and institutions making the judgments. If this process is taken up to the national level, will that not give rise to more concerns that mistakes might be made in the future, because of the distance between the process of approval and the individual cases on the ground? Has the Secretary of State had discussions with mental health organisations about whether they believe those arrangements are acceptable? I must say that I have serious concerns about them.

[Mr Andrew Smith]

That is a very important point. Following the logic of my right hon. Friend’s argument, does he agree that the Government would be well advised to ensure there is independent professional involvement in auditing and overseeing that process?

[Andy Burnham]

That is a tremendously important point. Over the years, in terms of crucial public functions such as those we are discussing—and, indeed, in wider considerations such as assessments of new treatments with the National Institute for Health and Clinical Excellence—there has been a trend towards independent decision making, so that people can feel that there is no political, or departmental, interference, such as through changing local resource decisions.

The taking of these powers, and the rubber-stamping of approvals to section people, up to the national level will give rise to concerns about whether the process is sufficiently independent and people’s rights are being properly considered. I hope Ministers have listened to the important point my right hon. Friend the Member for Oxford East has just made.

I will end by addressing a point of wider principle about mental health policy and the place of mental health within our society. I believe it is possible that this whole unfortunate episode is symptomatic of a wider cultural problem: that mental health simply does not get sufficient focus and resources in the NHS at both the local PCT level and the regional SHA level—and, indeed, within the Department of Health. Beyond that, I do not believe that mental health gets the consideration it needs in Government or in this place. We do not give sufficient consideration to the hugely important issues relating to mental health.

When I was Health Secretary, hundreds of submissions would come across my desk in the course of an average week, and it was unusual if just one of them related to mental health. It is very much seen as a fringe consideration, pushed to the edges of the system—a peripheral concern in PCTs and SHAs, and all the way up to the Department of Health. That situation must not be allowed to continue.

The culture of separateness in the way we consider mental health, as opposed to other NHS issues, has deep roots in our society. Mental health services have often been provided in buildings that are out of sight, out of mind and on the fringes of the mainstream health care system.

That has to change. In the 21st century, we demand it. In our lives, we are all now dealing with much greater levels of stress, change and upheaval, and sometimes we are all left reeling by the sheer pace of modern life. We are discussing today between 4,000 and 5,000 very vulnerable people as though they are somehow apart from the rest of us. They are not. Any family can suffer the terrible consequences of serious mental health issues. In such circumstances, we would all want to be assured that those affected are not forgotten and pushed to the fringes where proper procedures are not carried out because there is a somewhat out-of-sight, out-of-mind approach. These issues are central concerns because they go to the heart of 21st century living.

Mental health must no longer be left at the edges of our national debate about health and care policy. It has to come to the very centre of our health care system. The Health and Social Care Act 2012 includes one good measure at least: to create parity of esteem between physical and mental health. I must say that it was a Labour amendment in another place that introduced that improvement into the Act, but, to be fair to the Government, I should add that I am pleased that they accepted it.

Will the Secretary of State explain what parity of esteem means in practice? What action has the Department thus far taken to put parity of esteem into effect in the national health service, and what plans does it have for the future? We have learnt in recent days that the budget for mental health has been cut in the last financial year, which suggests to me that the NHS is reverting to its default position in tough times.

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

Does my right hon. Friend agree that role models in society could do a lot more to help to improve cultural attitudes to mental health issues?

[Andy Burnham]

My hon. Friend makes a very important point, and we have the seen the beginning of the kind of campaign he advocates with the work of the Time to Change group. There has also been incredible bravery from individuals such as the cricketer Marcus Trescothick, who spoke out very publicly about the difficulties he had faced, and just a few weeks ago in this House we witnessed some incredibly powerful contributions from Members on both sides of the Chamber: for the first time Members spoke personally and publicly about the difficulties they faced.

I think a change is under way, therefore. People who have been suffering alone will take great heart and encouragement from these developments. We are beginning to challenge the last taboo—the last form of acceptable discrimination in our society—but that does not come a moment too soon. My feeling is that Parliament is finally waking up to the full scale of the mental health challenge we face. A Bill before us at the moment will outlaw the discrimination that exists whereby somebody who has suffered a serious mental breakdown is unable to be a Member of Parliament, a company director, a juror or a school governor. It is so important to remove that discrimination from the statute book because it sends a message that recovery is not possible, and that if someone has a serious mental breakdown there is no possibility of their coming back and playing a full part in our society. The further problem with that legislation is that it prevents those people from being in leadership positions in those organisations—in schools, in Parliament and in companies—where they could develop a better understanding of mental health and what policies need to be put in place to support people who may experience those problems.

[Hywel Williams]

Does the right hon. Gentleman share my concern, and that of organisations such as Mind, that the rate of compulsory detention seems to be growing, as does the rate of detention in police cells?

[Andy Burnham]

We need to look carefully at those trends. I remember the moment when my thinking about mental health changed. It came when I was Secretary of State for Health and I received the Bradley report on mental ill health in the criminal justice system. I recall the moment when I read the statistic that seven out of 10 young people in the system have some form of undiagnosed or untreated mental health problem. My jaw dropped and at that moment I realised that we were seriously failing many thousands of people by failing to give them the support they needed when they needed it, and so they went into detention and down a path of failing to fulfil their potential. That is a terrible indictment of our life today. In addition, the level of prescribing of anti-depressants has almost doubled over the past decade. We are issuing almost 40 million prescriptions for anti-depressants, which suggests to me that insufficient alternatives to medication are available in our communities and people are being given very old-fashioned, outdated interventions by the authorities which are not meeting their needs. That is why we cannot allow this complacency any more and why we need a modern approach to good mental health care.

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

My right hon. Friend is absolutely right when he says that mental health has been the poor relation of the health service, but does he agree that, within that mental health service, children’s mental health services have often been the poor relation again? Does he hope that the Government will address specific services for children who need mental health services?

--- Later in debate ---

[Andy Burnham]

I will indeed, Madam Deputy Speaker. This is a Second Reading debate, so I was just taking a moment to speak more widely. However, I believe that this comes back to the central point I made: the reason why this situation has arisen and why it was undetected for so long—10 years—in the Department was because of this culture of failing to put sufficient focus on and give attention to mental health. The issue is still on the fringes of our system. My hon. Friend makes an incredibly important point. We hear that not only is the budget for adult mental health being cut, but the budget for children’s mental health is being cut even further. That brings me back to another point I was making: in tough times the NHS reverts to its default position, which is to focus on the mainstream and to ignore mental health. That is a worrying sign, so we press the Government to say what parity of esteem means in practice. What actions are the Government taking to change this culture to ensure that the resources and the focus are in place?

In conclusion, although the Opposition will give the Government the co-operation they need to get this measure through the House today, I say again that we need to have full answers to all the concerns I have outlined. That is the least the Government owe Opposition Members. One of the good things that we hope may come from this unfortunate episode is that it may jolt us out of our complacency on mental health, and that Parliament will begin truly to work for more parity of esteem between physical and mental health and ensure that finally mental health gets the resources and the focus it desperately needs.

--- Later in debate ---

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

I start by apologising to any Members who had hoped to intervene on me at the start of the debate, but I hope that I will now be able to give a fuller answer not just to any interventions, but to speeches made by right hon. and hon. Members. I thank the Opposition and the whole House for the very responsible attitude that they have taken towards this extremely sensitive and difficult issue. I intend to respond fully to all the points made by right hon. and hon. Members about the need to act so fast and retrospectively. Those are important issues that deserve the fullest attention.

It is important to record our appreciation at this stage for the invaluable help and advice that we received from partners outside the House, such as Mind, Rethink and the Royal College of Psychiatrists. Their primary concern is naturally those whom they represent so ably, but we are genuinely grateful for the mature and calm way in which they have responded. Everyone in the House has shared the same ultimate objective—to do what is best for the patients directly affected by a technical error.

Let me go through the points raised in the debate. I shall try to respond as fully as I can. With respect to the devolved Administrations, I have spoken to Health Ministers in Wales and Northern Ireland today, and I spoke to the Advocate-General for Scotland yesterday. They have been extremely supportive of the position that the Government and the whole House have taken, and they understand the need for speed. In Wales it is a sensitive matter because the Welsh Assembly is in recess, but I managed to speak to the Health Minister and go through the issues involved.

A number of Members asked about the extent to which we will be communicating with patients. We are working closely with the Royal College of Psychiatrists as to the best way to do this. That also extends to the families and carers of patients. Sir David Nicholson, the chief executive of the NHS, is writing to all strategic health authorities, stressing the need to communicate broadly across all mental health organisations, including patients and their families, and including, as has been mentioned, not just the patients who are directly affected, but potentially other patients who have been detained under the Mental Health Act, who may also have concerns. We have not been able to complete that communication exercise at this stage, because of the speed necessary to pass the Bill, but we will need to make sure that it proceeds as a matter of urgency.

[Andy Burnham]

We welcome the exercise being carried out by the NHS chief executive, but it is not the same as a personal communication to the individuals directly affected, so will the Secretary of State address the specific point of whether or not they will receive explanatory information from him or the Department?

[Mr Hunt]

Yes. What Sir David Nicholson is doing is ensuring that all SHAs have a proper communication process in place, but we want to follow clinical advice on the appropriateness of individual communications with individual patients. Where we are advised that is clinically sensible, we must ensure that it happens, but we want to listen to the advice carefully because of the vulnerability of some of the patients involved. The right hon. Gentleman makes an extremely important point. We must do this properly but, as I know he will agree, we must proceed with extreme care and caution.

I will start with some of the issues that the right hon. Gentleman raised, particularly the role of the review being conducted by Dr Geoff Harris. He is absolutely right that it needs to be done speedily because of the changes being introduced by the Health and Social Care Act 2012. I want to reassure him that Dr Harris’s review will not be simply a retrospective review; he will not just be asking, “Why did this happen?” He will also be stepping back and asking, “Where might this happen again and are our governance procedures sufficient to ensure that it does not?” In particular, he will look at the new structures that will be put in place over the next few months to give us good and independent advice on whether we have the safeguards in place to prevent this from happening again. That is an important point.

With regard to how many people are affected, the figure is up to 5,000. We think that the number includes all the patients at Rampton and 57 patients at Ashworth, but we are still verifying the exact numbers. I will keep the right hon. Gentleman informed as more information becomes available.

The right hon. Gentleman’s other point was about the new arrangements that are being put in place. He wondered, legitimately, whether, as the powers are returning to the Department of Health following the abolition of the SHAs—he was correct to pick that up from my comments yesterday—there is a danger that the process could be more remote for local areas. We will keep him informed of our plans in that regard, but we do not intend to have a single national panel doing this. We intend to have a structure that draws on local and regional expertise to help us to make the right decision on the suitability of doctors for the role. That is also something we hope Dr Harris will advise us on when he conducts his review.

I will move on to some of the comments made by the right hon. Member for Oxford East (Mr Smith). Independent oversight is also something we will ask Dr Harris to look at. He is independent and he is looking at it. We will also ask him to look at the general issue of independent oversight and whether it has been missing in the structures we have had to date and, therefore, whether it contributed to the concerns that we are now addressing.

The right hon. Gentleman and the hon. Member for Wolverhampton North East (Emma Reynolds) raised another issue: the wording we have been using, the fact that we believe there are good arguments for saying that the detentions that happened as a result of approvals made by the doctors in the four SHAs were and are legal and, therefore, why we feel the need for emergency retrospective legislation. It is a reasonable question. The answer is that we believe that there is legal precedent for why, in so sensitive a situation, a court, in deciding whether a detention was lawful or unlawful, would consider what the will of Parliament was when it passed the original law. Therefore, we believe that we have a good argument for why a court should rule that these detentions were and are lawful.

However, because of the technical irregularity in the process of approving some of the doctors who made the decisions in the four SHAs, that argument could be challenged. That is also an important part of the advice we have received. It is because it is so important to put the decisions beyond doubt, with respect to this narrow and technical issue, that the Bill is so incredibly important. However—this might help to address some of the concerns raised during the Opposition winding-up speech—this piece of retrospective legislation refers only to that narrow and technical issue. If people question the grounds for their sectioning under the Mental Health Act on clinical grounds and claim that the wrong clinical judgment had been reached, for example, or if they do not agree with what the panels have said, the Bill will not affect their right to challenge the decision and, if the court upholds the challenge, to get compensation if they have been detained. The Bill relates only to the very narrow issue of the technicality.

[Mr Hunt]

The right hon. Gentleman makes an extremely important point. I am pleased to reassure him that that has happened. That was one of the first things that happened, and it was completed yesterday, so all the doctors who are currently making these approvals in the four SHAs were approved using the correct process. We are confident that the problem will not arise in future, but we still have the issue of the decisions they took when the technical process had not been followed.

We have taken a number of actions to deliver parity of esteem for mental health services. I wholeheartedly agree with the concerns that have been raised about mental health issues having been for too long the poor relative in a number of areas. The right hon. Member for Leigh (Andy Burnham) will know that in July we published the implementation framework for our mental health strategy, “No health without mental health”. We have legislated, with his party’s support, for parity of esteem. The operating framework for the NHS expands access to psychological therapies, which is one of the key things we can do. The number of people accessing psychological therapies has increased to 528,000 people this year, which is more than double the figure for last year, and the amount of money going into it has increased from £364 million to £386 million. Those therapies have a very good success rate of about 45%, and we think that we can get it up to 50%. I want to reassure right hon. and hon. Members that we note the general view of the House that more emphasis needs to be put on mental health services.

[Andy Burnham]

But overall there has been a significant real-terms reduction in spending on mental health, as the figures given by the right hon. Gentleman’s colleague in the House of Lords a few weeks ago indicate, which suggests that the NHS is making disproportionately more redundancies in the field of mental health than in other areas and that it is reverting to that default position. Therefore, although I appreciate the Secretary of State’s words at the Dispatch Box today, the reality on the ground suggests that, as ever, mental health is bearing the brunt of some of the reductions and redundancies taking place and that the capacity of people to deal with these kinds of issues will perhaps be reduced. What will he say about safeguarding against that?

[Mr Hunt]

The right hon. Gentleman makes an important point. I believe that in actual terms the spending on mental health has increased slightly, but when we take inflation into account it might have gone down slightly in real terms. I do not think that it is a significant drop, but overall, as he knows, the NHS budget has been protected. I would be extremely disappointed if, as we go through a process of finding important efficiency savings in order to meet the increased demand on the NHS, the picture that he paints were to be the case, but I will be watching the situation very carefully. I will expect him to hold me to account for my commitment to ensuring that mental health services are properly addressed.

Crucially, it is not just about what we say but about what we deliver, particularly as regards the progress that we make towards improving access to mental health services, which were never included in the waiting times targets that were introduced by the previous Government. There are obviously financial implications in doing that, but we are working on it. Parity of esteem needs to include access to mental health services and not just the availability of those services.

Mental Health (Approval Functions) Bill

Andy Burnham Excerpts

Tuesday 30th October 2012 Commons Chamber

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

I will first set out what the clause seeks to do and then respond to the shadow Minister’s questions.

The clause directly addresses the issue that the Bill intends to resolve. Between 2002 and 2012, four strategic health authorities delegated to mental health trusts the function of approving doctors with responsibilities under the Mental Health Act 1983. The legal advice that we have obtained is that there are good arguments, as we have already discussed, that decisions to detain made by doctors who were approved in that irregular way are nevertheless lawful. The clause removes any doubt—that is its purpose. It clearly spells out that when mental health trusts gave approval in the past they are to be treated as having had the power to do so.

The clause has the effect of eliminating any irregularity from decisions made in complete good faith, and in the best interests of the patient, by doctors fully qualified to make them. It does so in a way that is fully consistent with the legal and clinical advice that we have received on the issue, and means that patients and their families do not have to undergo the process of assessment for detention under the Act again solely for the purpose of correcting a technical error made by a strategic health authority.

The hon. Lady asked why the clause was so broad as to refer to “Any person”. I understand her concern, but the point is that we do not yet know whether there were other issues before the establishment of the SHAs. Obviously, that is part of the work that the review will undertake, but to ensure that we resolve the problem absolutely and that all those patients have clarity the decision was made for the clause to refer to “Any person” in order to avoid any risk of our uncovering another problem that might need a separate resolution. This deals with the whole problem of the approval process for the doctors who made those decisions.

The hon. Lady then asked, correctly, whether decisions will be taken properly as we progress. I can confirm that all the doctors have already been re-approved according to a proper process, so every decision that is taken from hereon in cannot be challenged. As we have said, any patient who wants to question the clinical judgement can do so and their rights remain the same as they have always been. This simply addresses the technical issue that we have been debating today.

[Andy Burnham (Leigh) (Lab)]

The clause refers not only to “Any person” but one who

“has done anything in the purported exercise of an approval function”.

On both counts, it is incredibly widely drawn and could take us into the territory of other elements of the approval process that may have been defective. Will the Minister assure the Committee that the clause is as narrow as it needs to be? It seems to be uncomfortably wide and may well restrict somebody’s ability to challenge an element of their section other than the fact that the doctor was not approved by the SHA. It is very loose in its current form.

[Norman Lamb]

I am grateful to the shadow Secretary of State for that intervention. We have gone through a very careful process and have followed legal advice on what is necessary to regularise the position. This relates specifically to the approval function, which is defined in clause 1(2). As I have said, the legal advice is that this is the best way to regularise the issue that has been uncovered.

--- Later in debate ---

[Norman Lamb]

I absolutely take the right hon. Gentleman’s point, and I am grateful to him. We must be absolutely certain that everybody is now properly authorised to make decisions. We know that everybody outside the four affected SHAs has been properly authorised—that has been checked and confirmed by SHAs, which have undertaken a proper check of their procedures. We also know that the four affected SHAs have already regularised the position of all their authorised practising doctors. We therefore know that across the whole system, doctors who undertake sectioning from now onwards will be properly authorised in accordance with the Mental Health Act 1983. The Bill addresses the previous problems with the authorisation process, and we have addressed the problem for the future by ensuring that everybody is properly authorised. I hope that deals with that point.

[Andy Burnham]

rose—

[Norman Lamb]

It does not entirely seem to deal with it, so I give way to the shadow Secretary of State.

[Andy Burnham]

I am grateful. It is important to get clarity before we leave this clause.

I know that the Government have not yet undertaken a full case-by-case review of the up to 5,000 cases involved. That prompts the question how the Government can be sure that the whole team involved in each case was qualified to a suitable level, and that there were not some instances of under-qualified people making decisions. That gives rise to concern that we may be retrospectively approving processes that were defective.

[Norman Lamb]

I do not think there is any suggestion that any of the people who undertook sectioning were not medically qualified to do so. The issue is simply with the body that undertook the authorisation and the fact that SHAs delegated that responsibility to mental health trusts, which was not in accordance with the law. The Bill is intended to regularise the position of every clinician who was not properly authorised because of that flaw.

[Andy Burnham]

I do not want to detain the Committee unnecessarily, but because the clause is drawn so widely it will possibly take away some people’s right to challenge whether there was a deficiency in the process or whether someone involved in the sectioning decision was under-qualified. Given that the Government have not undertaken a case-by-case review, I wonder how we can have absolute confidence that the power in the Bill is not too widely drawn.

[Norman Lamb]

I am told that we have dealt, doctor by doctor, with all the doctors in question who are currently practising. The problem relates to the doctor, not the patient, because it is about their authorisation to undertake the duties in the 1983 Act. The only people who undertake the actions referred to in the clause are doctors, who were authorised but unfortunately by the wrong body. That is what we are seeking to regularise.

[Andy Burnham]

We must have absolute clarity about this. In that case, why does the Bill mention “Any person” rather than “any doctor”? Our understanding is that a broader team of people can be involved in a sectioning decision, such as a social worker. If it is only doctors, the Bill should just say “any doctor”, but it does not.

[Norman Lamb]

We are talking about the approval function. Subsection (2) mentions

“practitioners approved to give medical recommendations”,

so it clearly deals with practitioners who have already been authorised, but by the wrong body.

--- Later in debate ---

[Andy Burnham]

The Opposition thank the Secretary of State and the Minister for attempting to answer all the questions that colleagues have raised. We appreciate that they have acted in good faith in bringing this legislation before the House with such speed, but, as my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) rightly said, this takes us into unprecedented territory. We are legislating retrospectively on matters of fundamental importance concerning people’s basic rights and public safety, and it is therefore right for the House to pause for thought and consider those issues before giving its assent to the legislation.

We had an important exchange on the precise drafting of the legislation, and a concern arose during the course of that debate. Clause 1 essentially states that “any person” who has undertaken any activity

“had the power to do so”.

If I heard the Minister and the Secretary of State correctly, that is not carte blanche to justify anything—including something inappropriate—that may have happened over the course of a decision, but simply means that the person who made the decision had the power to do so. I hope that people outside this House will hear those words clearly and understand that that is the only permission the House is giving this afternoon on this exceptional basis. In doing so, we return to the point about balancing our concerns about the exceptional nature of this legislation with the fact that this issue affects thousands of the most vulnerable people in our society and their families. We do not want any further distress caused to those people, or for them to suffer any unsettling effect, and that is why the Opposition believe that the legislation is justified.

It is crucial that no legal doubt hangs over arrangements that are made for patients and public safety. This Bill removes that doubt, but we do not want to remove any of the rights held by the individuals concerned, and in particular the 5,000—or more—people who may currently be challenging their detention. Having made that point as clearly as I can, the Opposition give the Government their support. We will seek to ensure that co-operation is continued in another place so that the Bill can be put on the statute book, and any uncertainty removed.

Question put and agreed to.

Bill accordingly read the Third time and passed.

Mental Health Act 1983

Andy Burnham Excerpts

Monday 29th October 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for notice of it. Detaining people under the Mental Health Act raises the most serious issues of fundamental rights and of patient and public safety. Any reported failure will therefore always be a matter of the highest concern. I know this House will want to get to the bottom of the unacceptable breaches of procedure that we have just heard about. However, I am sure I speak for both sides in saying that the House will have been reassured by the Secretary of State today on three crucial points: first, that no patient has been wrongly detained, received care that was not clinically appropriate or will see their legal rights restricted by the legislation; secondly, that no doctor was unqualified to make decisions; and, thirdly, that urgent action is being taken to correct the situation and bring the clarity that is so essential.

Let me now turn to the serious questions that need to be answered. Will the Secretary of State say more about the events that brought this issue to light last week? Was it discovered in one SHA first, and by what process did the Department establish that it extended to three more? When exactly was the Department made aware, when was the Secretary of State informed and what action has been taken to establish the full extent of the problem? Have extensive checks been undertaken in all 10 SHA areas, and is he absolutely confident that no more patients and families are affected than the 4,000 to 5,000 he has mentioned?

I want to press the Secretary of State for more information on the people affected. Will he say whether he has any plans for direct communication with the patients and families affected? Are the patients living not only in the four regions mentioned but in all parts of the country? How many are in high-secure hospitals, and how many could pose a risk to the public?

We understand and support the Secretary of State’s wish to remove any doubt about the legal status of the patients concerned, but that must be set against the undesirability of asking the House to legislate tomorrow on an issue that it has found out about only today. Over the next 24 hours, will he ensure that Members have access to the fullest possible information, including a summary of the legal advice he has received?

There will be concerns about precedent. This is the first time that the House has been presented with emergency legislation in this area that will affect people’s rights. The public will want to know that it is being used in exceptional circumstances as a last resort, and not as a convenient means of correcting administrative failures. Will the Secretary of State therefore explain precisely what alternatives to legislation were considered, and why it was decided that they were not acceptable in these circumstances?

Let me turn to the investigation. We support the review under Dr Harris that will try to get to the facts and ensure that lessons are properly learned. We do not want to prejudge it, but is the Secretary of State in a position to confirm today whether the review is already proceeding on the basis that this is a failure of policy implementation rather than a defect in the original legislation? That is important, as practitioners working in this field will not want any unnecessary question marks hanging over the Mental Health Act 1983.

We also need clarity about the future. This area is currently the responsibility of SHAs, which are due to be abolished next April. So, as well as establishing the historical facts, will the Secretary of State ask his review to consider whether the new arrangements for sections, following the Government’s reorganisation of the NHS, are sufficiently well understood? Will he also ask the review to advise on how any danger of further confusion arising from the process of transition can be prevented?

I commend the Secretary of State for the pragmatic approach he is taking to this difficult issue. His request of the House is exceptional, but failure to act could cause unnecessary distress and uncertainty to many thousands of vulnerable patients and their families, and present risks to public safety. We will press him for answers in the areas that I have outlined, but we believe that his action is justified. He will have our support in removing any uncertainty.

[Mr Hunt]

First, I thank the right hon. Gentleman for the co-operation that he has shown to me and my Department over the weekend. There are occasionally moments when issues of public safety and patient well-being transcend the normal political divides, and I greatly appreciate his co-operation on this matter.

Let me deal with the important questions that the right hon. Gentleman has asked. The issue arose when a challenge was made to the authorisation of one doctor in Yorkshire and Humberside and, in dealing with that challenge, the irregularity in the way in which all authorisations had happened became apparent. Following further investigation, we discovered that this had happened in four other SHAs. We found out about this early last week, and I was informed towards the end of last week. Immediate action was taken to ensure proper validation last week of all the doctors who are currently taking section 12 decisions under the Mental Health Act, and that was completed as of today.

We have done exhaustive checks on the other SHAs, which is part of the reason why we asked all the SHA bosses to write to Sir David Nicholson—which they have all done today—to confirm that their processes in this area are in order. We do not believe that this issue affects any patients other than the ones we have talked about, to date. However, because people move and are moved to different hospitals and places of detention, it might be happening in other parts of the country beyond the four SHAs in which the irregularities in authorisation happened.

The right hon. Gentleman will understand that it is not the practice for Governments to publish legal advice because we want to continue to be able to receive frank legal advice in the future. However, I am happy to answer any questions about the legal advice and, as he knows, I am happy for him to talk to my Department’s legal advisers to satisfy himself on the precise legal situation.

Let me move on to the really important point about the alternatives that we considered, as it is highly exceptional to bring in emergency legislation. The right hon. Gentleman will know that authorities are allowed to detain someone under the Mental Health Act for 72 hours while the correct processes are followed to section them. Although, as I mentioned, we believe we have good arguments to show why these detentions were lawful, we did not know what a court might have decided if the detentions were challenged. We could have faced literally having to redo the entire process for 4,000 to 5,000 patients within 72 hours. Given the high level of vulnerability of many of them, we could not find a means of doing that in an orderly way that protected their well-being. I received clear medical advice from the NHS medical director, Professor Sir Bruce Keogh that that would not be an appropriate course of action. We looked at the position carefully and because we were trying to explore other alternatives we did not come to the decision to introduce emergency legislation until this weekend.

I can confirm that we do not believe that this has highlighted a defect in the legislation. We are not seeking in the emergency draft Bill to change the Mental Health Act. This is purely retrospective legislation dealing with some specific procedures under that Act; it will have no impact as this goes forward.

The right hon. Gentleman is absolutely right that we must be sure to minimise the confusion as we move towards the new structures. Under them, the problem would have been resolved, with the power reverting from strategic health authorities to the Department of Health. I do not want to be complacent: if this problem happened in one area, we want to be sure that it cannot happen in others.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

I would be delighted to see the innovative things that are happening at the Kent Health Commission. Looking at how we deal with people with long-term conditions—that is 30% of the population, and the proportion is growing with the ageing population—will be a vital priority for the NHS over the coming years.

[Andy Burnham (Leigh) (Lab)]

May I welcome the Secretary of State and his new team to their positions? As the only other person to have made the jump from Culture to Health, I am sure that he will find me a constant source of useful advice.

The Secretary of State has not said much since his appointment, but he did set out his mission in The Spectator:

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

Let us talk about that legacy. Just last week, the Secretary of State slipped out figures on the latest costs of NHS reorganisation. Would he care to update the House on the current estimates?

[Mr Hunt]

Let me tell the right hon. Gentleman that Andrew Lansley’s legacy is—

--- Later in debate ---

[Mr Hunt]

First, may I say how delighted I am that the right hon. Gentleman and I once again have the same brief? I look forward to having a constructive relationship with him, not with total optimism, but I will try my best.

The right hon. Gentleman talked about my predecessor’s reforms and legacy. One of the finest things about my predecessor’s legacy is that he safeguarded the NHS budget—indeed, he increased it during this Parliament by £12 billion—when the right hon. Gentleman said that it would be irresponsible to increase it.

[Andy Burnham]

Look at the figures: the previous Secretary of State gave the budget a real-terms cut for two years running. Let me give the exact figures, which the Secretary of State did not give the House. The costs of the reorganisation are up by 33% or £400 million, making the total £1.6 billion and rising. And what is that money being spent on? A full £1 billion is being spent on redundancy packages for managers: 1,300 have got six-figure pay-offs and there are 173 pay-offs of more than £200,000. Scandalously, that news comes as we learn today that the number of nurse redundancies has risen to more than 6,100. Six-figure pay-outs for managers, P45s for nurses and the NHS in chaos—is that the legacy that the Secretary of State is so proud of?

[Mr Hunt]

Let us look at some of the facts. The number of clinical staff in the NHS has gone up since the coalition came to power. The right hon. Gentleman talked about the cost of the reforms, which is about £1.6 billion. Thanks to those reforms, we will save £1.5 billion every single year from 2014 and the total savings in this Parliament will be £5.5 billion. Let me remind him that he left the NHS with £73 billion of private finance initiative debt, which costs the NHS £1.6 billion every single year. That money cannot be spent on patient care. He should be ashamed of that.

Oral Answers to Questions

Andy Burnham Excerpts

Tuesday 17th July 2012 Commons Chamber

[Mr Lansley]

I hope that my hon. Friend is aware that when I appointed the trust special administrator and set a timetable for his work, I specifically added 30 days on an exceptional basis to the timetable for the production of his first report, one of the exceptional reasons being that an accelerated consultation should take place locally on the future of Orpington hospital.

[Andy Burnham (Leigh) (Lab)]

I shall give the Secretary of State one last chance on rationing.

[The Minister of State, Department of Health (Mr Simon Burns)]

Ooh!

[Andy Burnham]

The right hon. Gentleman needs to listen carefully to what I am about to say. Yesterday, he promised action to stop the restricting of cataract operations for financial reasons, if given evidence. How about this example? NHS Sussex has imposed severe restrictions that contradict the Department’s own guidance, “Action on Cataracts”, and this has seen the number of operations in Sussex fall from 5,646 in 2010 to 4,215 in 2011. Does the Secretary of State consider that fair to older people, and will he now take the action his Department has promised?

[Mr Lansley]

I have made it clear to the right hon. Gentleman many times, as has the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), that it is not acceptable and we will not allow NHS commissioners to impose blanket bans. I will gladly take note of and investigate that example, but I have to say that the right hon. Gentleman wrote to me with a document that purported to contain a series of examples from across the country, most of which turned out to be fictional. I shall respond in writing about NHS Sussex and put a copy in the Library of the House, but, as I have made clear, we, unlike our predecessors, will not accept any blanket ban on treatment. Any treatment must be clinically determined in the interests of patients.

[Andy Burnham]

Well, the right hon. Gentleman is accepting it, and he continues to dispute my evidence, but what does he say to the president of the Royal College of Ophthalmologists, who said yesterday of cataract restrictions:

“They are arbitrary and are a response to financial pressures, not clinical needs”?

The reason for the Government’s denial is that the financial pressures are greater than they care to admit. The figures released by the Treasury yesterday confirmed that he and the Government have now cut the NHS budget for two years running, but they also reveal something else: another real-terms cut planned for 2013-14. Do not their flagship promises on NHS spending now lie in shreds, and will this Prime Minister not be for ever remembered as the man who cut the NHS, not the deficit?

[Mr Lansley]

It is staggering, isn’t it? In 2010-11, the NHS budget was set by the right hon. Gentleman, not by us. The final accounts for 2011-12 will not be published until the autumn. I wish he would just get up at the Dispatch Box and admit that over the course of this Parliament the coalition Government will increase the NHS budget in England by 1.8% in real terms, which is £12.5 billion in cash, whereas the Wales Audit Office has said that a Labour Government in Wales will cut the NHS budget over the same period by 10% in real terms.

National Health Service

Andy Burnham Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move

That this House regrets the growing gap between Ministers’ statements and what is happening in the NHS; notes mounting evidence of rationing of treatments and services by cost, despite Ministers’ claims to have prevented it; further regrets the increasing number of cost-driven reconfigurations of hospital services, despite the Coalition Agreement’s promise of a moratorium on changes to hospital services; further notes growing private sector involvement in both the commissioning and provision of NHS services, contradicting Ministers’ claims that the NHS reorganisation would not increase levels of privatisation; recognises that, according to the Government’s Public Expenditure Statistical Analyses figures, actual Government spending on the NHS in 2011-12 fell by £26 million, the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office, in breach of the commitment in the Coalition Agreement; believes the Government’s decision to reorganise the NHS has distracted its focus from the financial challenge, with seven out of 10 acute hospital trusts in England missing savings targets in the first half of 2011-12; calls on the Government to take action to prevent rationing by cost in the NHS, based on the evidence presented; and further calls on the Government to honour pledges on NHS spending in the Coalition Agreement, and the commitment that future savings will be reinvested into the NHS front line, and to return at least half of the underspend to the Department of Health budget.

The year 2011 was the first full year of the coalition Government and the year of the biggest ever fall in public satisfaction with the national health service. As I shall set out, those two facts are not unconnected. The NHS in England is reeling from the Government’s catastrophic decision to reorganise it at a time of huge financial pressure. Warnings by Opposition Members and others during the passage of the Health and Social Care Act 2012 of a postcode lottery, of destabilised hospitals and of increasing privatisation are, sadly, beginning to materialise.

For the coalition, attention has moved to other battles—more pressing priorities—but for the NHS the moment of greatest danger is now, as the unstoppable force of reorganisation hits the immovable object of the financial challenge. That is why the Opposition make no apology for introducing this debate, or for bringing the House’s attention back to where it should be: our country’s most important public service and the struggle it faces.

I am grateful for the Secretary of State’s letter—[Interruption.] I can hear him mumbling away on the Government Front Bench. I would have thought the debate would justify his attention, as it justifies that of the Minister of State, the right hon. Member for Chelmsford (Mr Burns). The Opposition have introduced this debate to support NHS staff. We thank them for what they do. They have a huge capacity to deal with whatever is thrown at them, but they have been set mission impossible by the Government. One can only wonder how they felt on hearing the news that the Deputy Prime Minister had the chance to stop this reorganisation but chose to prioritise House of Lords reform. A million hearts will have sunk.

It was not just the Government’s decision to reorganise that was wrong; the way they have gone about it was wrong as well.

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

The right hon. Gentleman will know that the Chair of the Public Accounts Committee said that productivity fell continuously for a decade under the previous Government. Does he regret that and recognise that radical change is required to get the productivity improvements this country desperately needs if we are to be able to afford the NHS we all want?

[Andy Burnham]

I am afraid the hon. Gentleman is out of date, because the figures cited by the Government are wrong. NHS productivity was improving by the time Labour left office. The independent and authoritative Commonwealth Fund pronounced the NHS the most efficient health care system in the world in June 2010. That was the legacy of the Labour Government, which the Conservative party is putting at risk.

As I have said, it was not just the decision to reorganise that was wrong; the way the Government have gone about it is also wrong. Before the ink was dry on their White Paper, Ministers set about dismantling existing NHS structures before the new ones were in place. That is a dangerous move at any time, but disastrous at a moment of financial crisis.

We have therefore had drift in the NHS: a loss of focus at local level and a loss of grip on the money just when it was most needed. At a stroke, the Government demoralised the very work force who would be crucial to managing the transition, with primary care trust managers dismissed as worthless. Experienced people left in droves. Those who stayed hoping for jobs in the new world were issued with scorched earth instructions: “Get on and do the unpopular stuff now—the rationing and the reconfiguration—so the new clinical commissioning groups don’t have to.”

We can now see the consequences across England: brutal, cost-driven plans for hospital reconfiguration being railroaded through on an impossible timetable without adequate consultation; walk-in centres being closed left, right and centre; and people left in pain and discomfort, or facing charges for treatment, as PCTs introduce restrictions on 125 separate treatments and services.

[Mr Andy Slaughter (Hammersmith) (Lab)]

On the subject of brutal closures, did my right hon. Friend have a chance to look at the authoritative report by David Rose in The Mail On Sunday yesterday about the “Beeching-style” closure of major casualty units? Four out of nine of the units to be closed are in west London, leaving my constituents and 2 million people in west London without adequate health cover.

[Andy Burnham]

I have no idea how Ministers expect west London to cope with service reductions on that scale, nor do I know how they square them with the moratorium on hospital closures and changes which they promised at the last election. Perhaps we will hear some justification later today, although I will turn to reconfigurations shortly.

[Stephen Pound (Ealing North) (Lab)]

Further to the previous question, the hon. Member for Ealing Central and Acton (Angie Bray) has said that this is all about finance, and she may well be right. However, bearing in mind the fact that Ealing hospital not only came in under budget but produced an operating surplus last year, what possible justification can there be for ripping this crucial and much-needed service from the heart of our community?

[Andy Burnham]

My hon. Friend makes his point powerfully. With some reconfigurations there is a clinical case supporting change, such as the changes I introduced in London before the last election to improve stroke services. We reduced the number of centres from 12 to eight. That was a difficult decision for many London Members at the time, but it was the right thing to do because lives are being saved. However, there is a world of difference between those changes and the crude, cost-driven reconfigurations in the NHS that those on the Government Benches said they would not allow.

I spent my weekend reading a very entertaining book entitled “Never Again? The story of the Health and Social Care Act 2012: A study in coalition government and policy making”. It is a very interesting book and offers a new, detailed account, by Nick Timmins, of the Government’s NHS reorganisation—or, as it says on the blurb, the inside story of a “car crash”. I particularly enjoyed the quotation from the Minister of State—I gather that he has not read it, but there he is, up in lights at the very beginning of the book. He made this comment about the then Bill, which the author thought worthy of special attention:

“You cannot encapsulate in one or two sentences the main thrust of this.”

He should know that better than anybody, as he toured more media studios than anybody, and used more sentences than anyone, in a vain attempt to sell the technocratic and dense plans that made sense to his boss and nobody else.

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

Given that the biggest strain on most health authorities is staff pay, does the right hon. Gentleman regret the fact that Labour doubled the remuneration of GPs, allowing them to opt out and thus putting huge stresses on many health care authorities, which then had to buy in additional services? Does Labour not regret allowing doctors to be paid more for doing less?

[Andy Burnham]

I am interested in the argument that the hon. Lady is beginning to develop, which is that she wants to deliver pay cuts to NHS staff across her constituency. Presumably she wants the same as people in the south-west are getting. Is that what she is calling for? It is an interesting argument, and I would be interested to hear her expand on it later.

[Barry Gardiner (Brent North) (Lab)]

Will my right hon. Friend give way?

[Andy Burnham]

In a moment.

What I found most useful about the book is that it answered a question that has been nagging away in my mind for some time. As a former Health Secretary, I remember clearly the warnings I received from senior civil servants about the sheer scale of the £20 billion efficiency challenge. “It would be a major undertaking,” they said. “The NHS would need to focus all its energy on that alone. To be negotiated safely, new policy initiatives would have to be put on hold.” Over the months that have followed, I have often had cause to recall those words, as I watch the Secretary of State add to the financial challenge with the biggest ever reorganisation in NHS history. Did the same civil servants issue the same apocalyptic warnings to the incoming Secretary of State as they did to me? Finally I have my answer, in a quotation in the book from an unnamed senior civil servant:

“The biggest challenge was trying to get the secretary of state to focus on the money—the £20 billion and the sheer scale of the financial challenge”.

According to that civil servant, however, the Secretary of State’s attitude was:

“I am going to do these reforms anyway, irrespective of whether there are any financial issues. I am not going to let the mere matter of the financial context stop me getting on with this”.

Another civil servant is quoted as saying:

“We did point out to him that his plans were written before the big financial challenge, and didn’t that change things? He completely did not see that at all. He completely ignored it”.

Then the question is asked: was the Secretary of State presented by the Department with alternatives to inflicting legislative upheaval on the NHS? A senior civil servant said that

“it was clear that having posed the question of did he want to see other options, that Andrew was not very interested at all in us presenting alternatives.”

A picture is emerging of a Secretary of State with an inability to listen, take advice or heed warnings, who is going to have his Bill regardless of the upheaval that it will cause to the national health service.

[Barry Gardiner]

I am grateful to my right hon. Friend for giving way, although I fear that the moment might have passed. I simply wanted to ask him to reflect on the challenges that the hon. Member for St Albans (Mrs Main) issued to him about doctors and pay. Does he agree that those doctors are now the very people who are in charge of commissioning the services of which they are also the providers? I wonder whether the hon. Lady thinks that that is a good thing or a bad thing.

[Andy Burnham]

At the heart of the defective legislation that the Government rammed through the House of Commons is an unresolved conflict of interest, in which commissioners can also be providers who can remove services from hospitals and then provide them themselves. Under pressure in the other place, the Government came up with a requirement for a statement of such interests, but without introducing any mechanism for enforcement to ensure that decisions in the NHS are being made for the right reasons. I fear that that conflict of interest will return to haunt the Government.

[Andrew George (St Ives) (LD)]

The right hon. Gentleman knows that I share his critique of the Health and Social Care Act 2012. He mentioned the fact that civil servants had given him warnings and cautioned him about the consequences of his decisions during his time in office. Was he warned about the changes in regulations that have resulted in the decision of the south-west consortium to suggest changes to the terms and conditions and pay of staff in that area? That was a direct result of regulations brought in by his Government.

[Andy Burnham]

No, it was not. Agenda for Change was one of the proudest achievements of our Government, and we always staunchly defended national pay arrangements. The hon. Gentleman talks about warnings, but I have just read out the explicit warning that was given to the current Secretary of State that this was the wrong time to reorganise the NHS. It was unforgivable to proceed in those circumstances. This was the single most reckless gamble ever taken with the NHS, and patients and staff are already proving to be the biggest losers.

[Steve Brine (Winchester) (Con)]

I was not reading the book that the right hon. Gentleman has mentioned at the weekend, but I was listening to Radio 4 last night while I was doing the washing up, as I do. I heard one of his colleagues, the hon. Member for Wigan (Lisa Nandy), say that Labour was committed to repealing the Health and Social Care Act in its entirety. Will the shadow Secretary of State tell me whether, when I am in Winchester over the summer recess, I should tell the clinical commissioning groups that are getting on with their work that all that work would be undone, and that the Hampshire primary care trust and the South Central strategic health authority would be recreated if Labour were to form the next Government?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We are short of time, so may I request short interventions, please?

[Andy Burnham]

There is a simple answer: yes, we will repeal the Act. It is a defective, sub-optimal piece of legislation and it is saddling the NHS with a complicated mess. The hon. Gentleman should listen to the chair of the NHS Commissioning Board, whom his Secretary of State appointed. He has called the legislation “unintelligible”. In those circumstances, it would be irresponsible to leave it in place.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way to the Chair of the Select Committee in a moment.

Wherever we look, we see warnings of an NHS in increasing financial distress, yet according to Ministers everything is fine. The gap between their complacent statements and people’s real experience of the NHS gets wider every week. They are in denial about the effects of their reorganisation on the real world. That dangerous complacency cannot be allowed to continue.

[The Minister of State, Department of Health (Mr Simon Burns)]

In the light of what the right hon. Gentleman has just said, will he clear up this confusion? His leader, the right hon. Member for Doncaster North (Edward Miliband), has said that he would keep clinical commissioning, yet the shadow Secretary of State has just said that he would repeal the Act in toto, which would include the provisions on clinical commissioning.

--- Later in debate ---

[Andy Burnham]

One of the great tragedies in this book is the Secretary of State’s admission, during a statement in the House in which he announced the “pause”, that he could have done most of what he wanted to do without legislation. The former Secretary of State, the right hon. Member for Charnwood (Mr Dorrell), is quoted as muttering to a colleague, “Why on earth are we doing it, then?” Well, why on earth did he do it? Because he wanted his Bill, regardless of other people.

[Mr Dorrell]

A moment ago, the right hon. Gentleman told my hon. Friend the Member for Winchester (Steve Brine) that Labour was committed to repealing the Act in its entirety. Does that not mean that an incoming Labour Government would be committed to precisely the kind of pre-cooked reorganisation of which he has just accused my right hon. Friend the Secretary of State?

[Andy Burnham]

No, it does not. This is what Government Members do not understand. It is not about the organisations, but about the services that they provide. The existing organisations can be asked to work differently, and I would ask them to work differently. I do not want NHS organisations to be in outright competition, hospital versus hospital; I want them to work collaboratively. So yes, we will repeal the Act, but no, there will not be a pointless top-down reorganisation of the kind that we have seen the Secretary of State inflict on the NHS.

This complacency is dangerous, and it cannot be allowed to continue. We had two clear purposes in initiating today’s debate. First, although we cannot stop the Government’s reorganisation, we can hold them to account for promises that they made to get their Bill through. I shall shortly identify five such promises in respect of which we are asking Ministers to live up to their words. Secondly, we wanted to give the House a chance to help the NHS by voting to hold the Government to account and enforcing the coalition agreement’s commitments on NHS spending.

Let me first deal with Ministers’ claim that there is no evidence of rationing of treatments by cost. They have promised to act if any evidence is presented. In fact the evidence is plentiful, and it is simply not credible for Ministers to deny it. The postcode lottery of which we warned is now running riot through the NHS. We have identified 125 separate treatments that have been stopped or restricted in the past two years, in some cases in direct contradiction of guidance from the National Institute for Health and Clinical Excellence.

[Mr George Howarth (Knowsley) (Lab)]

Last week I was at Whiston hospital, which, as my right hon. Friend will know, covers Knowsley and St Helens. The net effect of all the changes is that its staff, particularly the nursing staff, are thoroughly demoralised. Does my right hon. Friend accept that any commitment that he makes to changing the system will be welcomed by NHS staff?

[Andy Burnham]

I have heard the same from staff throughout the system. Morale has never been lower. People have been badly let down by a Government who promised them no top-down reorganisation, a moratorium on hospital changes, and real-terms increases. None of those things has been delivered. During the run-up to the general election the Conservatives cynically used the NHS to try to gain votes, and they will pay a heavy price for breaking the promises that they made then.

[Mr Simon Burns]

rose—

[Clive Efford (Eltham) (Lab)]

rose—

[Andy Burnham]

I will give way to the Minister one more time, and then to my hon. Friend the Member for Eltham (Clive Efford), but after that I must make some progress.

[Mr Burns]

I am grateful to the right hon. Gentleman. Although he did not answer the question that I asked him earlier, he did spread more confusion. If he were ever in a position to repeal the entire Act and did so, given that the strategic health authorities and the primary care trusts will have long since gone, how does he envisage care being commissioned for patients?

[Andy Burnham]

The Minister seems to equate removal of the Act with bringing back PCTs and SHAs. I do not have a problem with clinical commissioning, and I said as much during the Bill’s passage. I introduced it myself. I do not have a problem with clinical commissioning groups; my problem is with the job that they are asked to do, and the legal context in which they are asked to operate. We reject the Secretary of State’s market, and that is why we will repeal his Act.

[Clive Efford]

Clinicians in south-east London presented proposals for the reorganisation of our health care provision in “A picture of health”. It was all agreed by local commissioners, but when the Tories took office, they imposed a two-year delay that cost our health care trust £16 million a year—and that is the same trust that the Secretary of State has just put into administration.

[Andy Burnham]

This is what happened: when they came into government, they had a cynical policy of a moratorium, and they went up to Chase Farm hospital to announce it, saying, “There will be no cuts and no closures at this hospital.” They traded and touted for votes in that constituency for years on the back of that issue, and now that hospital is going to close. They delayed the reconfiguration and then they delayed the savings that came to the NHS. It was disgraceful, and people will have seen through it.

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

I wish my right hon. Friend well in trying to hold this Government to account. The NHS is paying consultancy fees all around the country: hundreds of thousands of pounds are being wasted, and the Government are refusing to publish the information. They are also bullying many of the trusts. How are we going to get the information out when the Government are doing this?

[Andy Burnham]

My hon. Friend is absolutely right about the waste of money the Government have brought into the NHS through this reorganisation. The total is over £3 billion. That is simply unjustifiable at this time. Staff who had been working in primary care trusts are either being re-employed as consultants or are going into clinical commissioning groups. This is such a waste of money at a time when the NHS needed every penny to maintain standards of patient care.

I was talking about rationing, and let me focus on cataract surgery. GP magazine has found limits on cataract surgery in 66% of PCTs. The Royal National Institute of Blind People found that 58% of PCTs are using visual acuity thresholds to restrict surgery. This is the evidence, so the Secretary of State had better start listening. What has happened since those restrictions on cataract operations have been introduced? Unsurprisingly, the number of cataract operations in England fell by over 12,000 between 2010 and 2011. That is a direct result of the new restrictions. There is no less need, however. Thousands of older people need such procedures, but they are now being forced to live with very poor sight.

This is truly a false economy. Cataract surgery is one of the most cost-effective procedures carried out by the NHS. It helps people live independently and have a quality of life, and research has shown that in the last two years poor vision has been a factor in 270,000 falls by people aged 60 or over. This is the rationing by cost that Ministers have repeatedly denied is happening. So let me ask the Secretary of State again: does he agree with these restrictions on cataract surgery? If he does not, will he take immediate action to lift them?

[Frank Dobson (Holborn and St Pancras) (Lab)]

Will my right hon. Friend confirm that under the last Labour Government the number of cataract operations carried out by the NHS rose from 160,000 a year to 310,000 a year, as a result of the commitment of the staff? What will the staff in the south-west think about all this if they have their pay cut?

[Andy Burnham]

For staff who are trying to hold things together through the chaos the Government have brought about, what a kick in the teeth it must have been to read in the Sunday newspapers that unless they accept pay cuts, they will be made redundant. My right hon. Friend says the staff made those improvements, but so did he. As the incoming Secretary of State, he made improvements to waiting times for cataract surgery, which, if I remember rightly, were commonly about a year in the late-1990s. We brought those waiting times right down. Now what do we hear? We hear that under this crowd people with two cataracts are being told, “You can have one done, but not both.” That is what the NHS has been reduced to under this Government. The Secretary of State has promised action, and I have given him the evidence. He now must take action.

The second area on which the Government need to be challenged is privatisation. As the debate on the Bill drew to a close, the Secretary of State made this clear statement:

“The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS.”—[Official Report, 27 March 2012; Vol. 542, c. 1335.]

It is hard to know where to start, but how about the NHS walk-in centre in Sheffield, which is managed by a private company and has just started charging patients with whiplash injuries £25 for treatment, or the NHS hospitals now marketing private treatments for in vitro fertilisation, cancer screening or bone screening since the cap was lifted? How about the letter sent to all PCTs requiring them to identify three or more services for tendering under the “any qualified provider” measure in 2012-13? How about the 100 or so tenders for a range of services that have been offered to the private sector on this Secretary of State’s watch, with a total value of more than £4 billion? So let me ask the Minister and the Secretary of State today: will they now at least be honest about their true intentions for the level of private sector involvement in the NHS?

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Is my right hon. Friend as concerned as I am about the exponential rise in the number of private health care ads that we see on our television screens and in our newspapers every day? These ads had almost disappeared under the previous Government. Advertisers advertise only when they know that there is a market.

[Andy Burnham]

This is really important; it is where all of what the Government are doing comes together. They have put in place restrictions in treatments— 125 separate treatments, as I have just mentioned— and at the same time they have given a 49% cap to NHS hospitals to do more private work. So as the NHS decommissions services, hospitals are then free to start offering those services. That is why my hon. Friend is beginning to see the changes that she is noticing, and this is the clear agenda of the Conservative party.

[Huw Irranca-Davies (Ogmore) (Lab)]

Does not the fragmentation that my right hon. Friend is describing raise the crucial question about when the national health service ceases being a national health service under this Government?

[Andy Burnham]

The Bill that the Government brought through is an attack on the N in the NHS; that is what it was designed to do. It was designed to break national standards; to break national pay; to break waiting time standards; and to allow primary care trusts to introduce random rationing across the system. That was the intention of the Bill that they brought through; they wanted an unfettered market in the health service, and my hon. Friend is absolutely right. That is why we are saying that we will repeal this Act and restore the N in NHS at the earliest opportunity.

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

On 28 June, in response to misinformation put out by Labour councillors, the medical director of my local hospital trust, a doctor of 30 years, wrote an article in my local paper under the headline “NHS faces greatest challenge”. She talked about staff costs, treatment costs and the 2008 Nicholson challenge. She said that the trust’s problems date “back to 2008”, and she continued:

“Having been a doctor for nearly 30 years, the 2008 Nicholson challenge is, by far, the greatest challenge the NHS has ever faced”.

What should we believe: the picture being presented by the right hon. Gentleman or this article?

[Andy Burnham]

The hon. Gentleman is making my point; if he was listening to what I said at the start of my speech, he would have heard me say clearly that the £20 billion Nicholson challenge, which I set, was always going to be a mountain to climb for the NHS. Let us be clear that it was. What was unforgiveable was combining that Nicholson challenge with the biggest ever top-down reorganisation in history, when the whole thing was turned upside down, managers were being moved or made redundant and nobody was in charge of the money. That was what was so wrong, and that is what the hon. Gentleman should not be defending if he is defending staff in the NHS.

The third area where we need action from Ministers is on protection for staff. The Deputy Prime Minister said recently:

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

But we heard yesterday that a breakaway group of 19 NHS trusts in the south-west has joined together to drive through regional pay, in open defiance of the Deputy Prime Minister. They are looking at changes to force staff to take a pay cut of 5%; to end overtime payments for working nights, weekends and bank holidays; to reduce holiday time; and to introduce longer shifts. We even hear that if staff will not accept this, they are going to be made redundant and re-employed on the new terms. So let us ask the Secretary of State and the Minister to answer this today: do the Government support regional pay in the NHS and the other moves planned by trusts in the south-west? If they do not, will they today send a clear message to NHS staff in the south-west that they are prepared to overrule NHS managers?

Fourthly, I shall deal with reconfigurations. The House will recall the promise of a moratorium on changes to hospitals and the Prime Minister’s threat of a “bare-knuckle fight” to resist closure plans. In 2010, the Secretary of State set out four tests that all proposed reconfigurations had to pass. They related to support from general practitioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. He said:

“Without all those elements, reconfigurations cannot proceed.”

So let me ask the Minister: does he think that the A and E units closing at Ealing, Hammersmith, Charing Cross and Central Middlesex pass that test? How about St Helier, King George, Newark and Rugby? Is it not clear to everyone that the Prime Minister’s bare-knuckle fight never materialised? Is it not also clear that no one told the Foreign Secretary, the Work and Pensions Secretary or even the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for care and older people and who has launched a campaign against his own Department? What clearer sign could there be of the chaos in the Department of Health and of the chaos engulfing the NHS? Will the Secretary of State now take action to stop reconfigurations on the grounds of cost alone?

That brings me to my fifth and final area for action, which is NHS spending. The coalition agreement said:

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

That is health spending, not the health allocation. Official Government figures show that actual spending has fallen for two years running and the underspend has been clawed back by the Treasury. Of all the promises the coalition has broken, people will surely find that one the hardest to understand given that the Prime Minister appeared on every billboard in the land, on practically every street in the land, promising to do the opposite just two years ago.

[Gordon Birtwistle (Burnley) (LD)]

Will the right hon. Gentleman advise me who he consulted before he closed the A and E unit in Burnley?

[Andy Burnham]

I was prepared to make difficult decisions and be honest about them. I am not proposing the reversal of that decision and I note that clinicians in his area recently said how it had improved outcomes for his constituents. What I will not do—what I will never do—is go to marginal constituencies, as the Secretary of State did, and make false promises that I will reopen such units. The Secretary of State did that before the last election; no wonder he is looking shifty in his seat right now. He went to the hon. Gentleman’s constituency and said that he would reopen that unit. Has he done that? I do not believe that he has.

[Clive Efford]

On that very point about turning up in constituencies just before general elections promising to save A and E services, the Tories pledged to save 999 services at my local hospital, Queen Mary’s, Sidcup. They pledged to keep that A and E open—the Secretary of State did so himself. Where is the A and E?

[Andy Burnham]

I do not know how the Secretary of State justifies what has been done. Even in my own patch, Greater Manchester was going through a children’s and maternity services review and some constituencies were benefiting from the changes—Bolton, for example, was getting a bigger maternity unit—but some were not and this Secretary of State went both to Bury, where he said that he would defend the maternity unit, and to Bolton, for a photo call celebrating the new investment. If anything illustrates the sheer opportunism of the Secretary of State in opposition, surely that is the example that does.

[Several hon. Members]

rose—

[Andy Burnham]

I will give way to the hon. Member for Totnes (Dr Wollaston) before I conclude.

[Dr Sarah Wollaston (Totnes) (Con)]

I hope that in his conclusion, the right hon. Gentleman will address a point raised by the King’s Fund. It said that the greatest policy failure of the previous Administration was the failure to tackle health inequalities. He says that he wishes to appeal the whole of the Health and Social Care Act 2012, but does he accept that shifting public health back to local authorities gives us one of the greatest opportunities to tackle health inequalities? Will he seriously put public health back where it was before and, by so doing, continue to fail to address health inequalities?

[Andy Burnham]

The hon. Lady mentions the Act, and I seem to remember that she called the Bill a hand grenade thrown into the health service. She seems to have changed her tune since then. We made huge progress on tackling smoking and improving the public health of this country, progress of which we are very proud. We can always say that we could have done more, but I remember putting through measures on smoking towards the end of our time in government that were opposed by those on the Government Front Bench. I am not sure how she could justify that.

The budget cut combined with the distraction of reorganisation means that six out of 10 hospitals in England are now off target for their efficiency savings. That brings me back to where we started: this is the wrong time to reorganise the national health service. In conclusion, the House cannot reverse tonight the damage of the NHS reorganisation, but we are not powerless. There are things we can do to help the NHS at one of the most dangerous moments it has faced. Our constituents will expect us to hold Ministers to account for promises made on rationing and reconfigurations. They will want us to do the right thing by NHS staff facing pay cuts and redundancy. Our constituents have a right to expect that one of the central pledges in the coalition agreement—not to cut the NHS—will be honoured. That is the simple call of our motion this evening which, we hope, can unite all sides of the House. A vote tonight for the motion would be a positive vote for an NHS under siege and a message of appreciation for NHS staff facing uncertain times. I commend the motion to the House.

--- Later in debate ---

[Mr Burns]

I will now make progress.

To return to waiting times and the record as a fact, rather than the fiction that Opposition politicians like to peddle, 96% of patients wait for fewer than four hours in accident and emergency, and every ambulance trust in England meets its core response times.

[Andy Burnham]

On accident and emergency waiting times, let us be clear. In the 2013 year to date, has the NHS met the 95% target or not?

[Mr Burns]

Yes; 96% of patients wait for fewer than four hours in A and E, and as the right hon. Gentleman knows, the percentile is 95%.

--- Later in debate ---

[Mr Burns]

If hon. Gentlemen and Ladies will bear with me, I would like to make some progress, because this is a short debate and many hon. Members would like to participate, but I will give way later.

The motion, like the right hon. Member for Leigh, mentions a fall in spending on the NHS of £26 million in 2011-12. I will give him one statistic: £12.5 billion. There will be £12.5 billion extra for the NHS in this Parliament, £12.5 billion that would never have been made available had he had his way, as he said that to do so would be irresponsible. That is exactly what his party is doing in Wales, where it is in control of the NHS. It is cutting the NHS budget in Wales by 6.5% in real terms from 2011-12 to 2014-15. His motion talks about a £26 million underspend, but what he does not understand is that there has been a real-terms increase in funding for the NHS this year. Because we are no longer wasting hundreds of millions of pounds on a bloated bureaucracy and the national programme for IT, we have been able to save an extra £1.1 billion in real terms from the back office and put it into front-line care.

[Andy Burnham]

So that there is no confusion, because this is a very important matter, I will quote from a Department of Health press release of Friday 6 July:

“PESA figures released today show that in real terms NHS spending has reduced slightly by 0.02%.”

For the record, will the Minister say whether NHS spending rose or fell over the last financial year?

[Mr Burns]

What I was saying that the right hon. Gentleman—[Interruption.] He must wait one minute, because I will answer him. What I said, which is correct, is that, in keeping with our commitments, we have increased funding on the NHS in real terms—

[Andy Burnham]

It is your press release.

--- Later in debate ---

[Mr Burns]

I will now make some progress.

The motion seeks to give the impression that NHS care is being rationed. That is worse than inaccurate: it is scurrilous nonsense and scaremongering on a grand and somewhat desperate scale. [Interruption.] I will come to cataracts in a moment. We did some rudimentary checking of our own into the veracity of those claims, which were originally made as part of the Labour party’s NHS health check. It was not long before it became abundantly clear that that was not worth the press notice it was printed on. It claimed that there was a blanket ban by NHS Hull on the removal of risk ganglia. We spoke with NHS Hull and found that there is no such ban. It claimed that 11 out of 100 PCT clinical commissioning groups restrict laser revision surgery for scars, but such cosmetic surgery has never been routinely available on the NHS, under either this Government or the previous Government, when the right hon. Member for Leigh was Secretary of State. It claimed that weight-loss treatment is restricted, stating that

“patients generally have to be over 18 and have a BMI over a certain level to receive weight loss surgery”.

Amazing—people actually have to be overweight to be entitled to weight-loss surgery. I would have thought that that was startlingly obvious, but obviously the right hon. Gentleman does not think so.

[Andy Burnham]

rose—

[Mr Graham Stuart]

rose—

[Mr Burns]

I will give way to the right hon. Gentleman and then to my hon. Friend, but then I will make some progress.

[Andy Burnham]

Is the Minister aware that the National Institute for Health and Clinical Excellence guidance recommends that bariatric surgery should be offered only to people with a BMI of 40? Is he also aware that numerous PCTs all over the country are restricting access to that surgery by introducing their own arbitrary limits? That is evidence of the rationing I am talking about. He will know that the NHS constitution guarantees people access to NICE-approved treatments, so why does he not take action on those PCTs that are standing outwith the NICE guidance?

[Mr Burns]

What the right hon. Gentleman rather cunningly does not mention—[Interruption.] I am answering the question, if the hon. Member for Copeland (Mr Reed) can just keep quiet for a second. The right hon. Gentleman says that the NICE guideline refers to a BMI of 40, and that is absolutely correct, but I point him in the direction of one area in central London that does not go by that guideline, because it uses a BMI of 35, which is lower.

--- Later in debate ---

[Mr Dorrell]

I agree with my hon. Friend, but let us not go down that route. At the time when Sir David Nicholson was writing, the Labour Government were contemplating the possibility not of a real-terms freeze, which is in effect what is planned under the coalition, but of a cash freeze, which would have been substantially more difficult to achieve.

The main issue now is how we deliver services that meet the demands placed on the system against the background of a resource allocation to the health service that was always going to be dramatically less generous than it was during the earlier years of the Labour Government. We heard from the right hon. Gentleman a commitment that an incoming Labour Government would go through a clean-sheet-of-paper redrawing of the map—

[Andy Burnham]

indicated dissent.

[Mr Dorrell]

The right hon. Gentleman shakes his head, but he said that he would repeal the Health and Social Care Act 2012, the result of which would be to commit the health service to precisely the kind of reorganisation—or re-disorganisation—that he accuses the Government of introducing.

The challenge for the Opposition is to show that they are willing to map a future for the health service, in much more constrained financial circumstances, that allows it to meet the demand for services that is going to be placed on it and to fulfil the aspirations that we all have for improved quality of service. That becomes increasingly difficult in the light of motions such as the one that the right hon. Gentleman has put down for the House to consider. He invites us to regret

“the increasing number of cost-driven reconfigurations of hospital services”

and

“growing private sector involvement in both the commissioning and provision of NHS services”.

Yet when he was Secretary of State and bore my right hon. Friend’s responsibilities for meeting this challenge, he made it clear that service reconfiguration was precisely how the health service needed to meet the challenges that it faced, and that the private sector had an important role—of course, not an exclusive role—in introducing the solutions to the challenge that Sir David Nicholson articulated in May 2009. The same approach was taken in the Labour party’s manifesto for the 2010 general election.

The challenge that the right hon. Gentleman has to address if he is to discharge his responsibilities as shadow Health Secretary is to move on from party political ding-dongs, of which we have had too many. [Interruption.] The right hon. Member for Holborn and St Pancras (Frank Dobson) is commenting from a sedentary position. I have always been aware that he, at least, does not agree with the commissioner-provider split that the shadow Health Secretary operated as Secretary of State and has always said that he is in favour of considering.

--- Later in debate ---

[Mr Lansley]

The right hon. Gentleman should not interrupt from a sedentary position. I am answering the question. Members are interested in this. When I went to the pay review body, I made it clear that, in my view, we could achieve that through negotiations on the “Agenda for Change”. That continues to be my view, and the south-west pay consortium makes it clear in its documentation that it supports such a negotiation. It is right to pursue such a negotiation nationally and for local pay flexibilities to be used in the national pay framework. That is what most NHS employers do, with the exception of Southend.

I have made it clear, as the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns) has, that we are not proposing any reductions in pay as a consequence. I do not believe they are necessary or desirable in achieving the efficiency challenge.

[Andy Burnham]

I have a simple question for the Secretary of State. Is he therefore overruling the south-west consortium?

[Mr Lansley]

No, because the south-west consortium has made no such proposal. Its document is clear: it wants the “Agenda for Change” national pay framework to give it the necessary flexibilities. My view is that we should do that, and I hope that the Opposition, along with the trade unions and the staff side, will support it. As a consequence, no proposal for the reduction of pay or the dismissal and re-engagement of staff is, in my view, desirable or necessary. Indeed, when I went to the pay review body, I made the point that I did not believe reduction of pay in the NHS to be necessary.

Let me conclude. There was a lot that those of us in the Chamber did not hear from Opposition Members. Much of it was in the annual report that I published just two weeks ago—waiting times below what they were at the time of the last election; the number of people waiting beyond 18 weeks cut by 50,000; the number waiting beyond a year reduced by nearly two thirds; infection rates in hospitals at their lowest ever level; cancer waiting times met; ambulance trusts all meeting the category A8 standard; 95.8% of patients seen, treated and discharged from A and E within four hours; 92% of in-patients and 95% of out-patients saying that their care was good, very good or excellent; and patients across the NHS saying that they support the NHS and believe the care they received to have been excellent. On that basis, the House should reject the motion as unfair in its characterisation of the NHS and wrong in its denigration of the NHS.

Question put.

Adult Social Care

Andy Burnham Excerpts

Monday 16th July 2012 Commons Chamber

[Paul Burstow]

I am not certain which thing the hon. Gentleman is inviting me to support. Many measures were introduced by the coalition Government in Scotland over a number of years to reform the social services system in Scotland, not least some relating to adult safeguarding which this Government are now making progress on.

[Andy Burnham (Leigh) (Lab)]

I think that the Minister has unfairly misrepresented the process we went through in the last Parliament. We did not just have a White Paper before the general election. We had a Green Paper in the summer of 2009, and the whole process was kicked off in the 2007 spending review. Upon a request from the then shadow Health Secretary, I agreed to cross-party talks. So the Minister is unfair in saying that nothing was done and then a rabbit was produced from the hat. May I say to him that the White Paper that I produced before the election addressed both service reform and funding? I am afraid that the same could not be said of the White Paper that emerged last week.

[Paul Burstow]

That is interesting, because the White Paper that was published seven days before the general election was called carried no details on who should pay, what they should pay or when they should pay. It contained no details of that sort, and I urge people to read it and compare it with the White Paper, draft Bill and other details that we published just last week. In 13 years, when the money was available, the Labour Government did not do anything; they left it until the last seven days and even then did not come up with the details.

In the space of two years, this coalition Government have advanced further and faster than any in the previous 20 years on addressing a wide range of issues and challenges and backing that with tangible action. Unlike what happened with Labour’s royal commission, so firmly kicked into the long grass, this Government have accepted all the recommendations of the Dilnot commission as the basis for a reformed system. Many of those recommendations are translated into the legislation that we published last week. Crucially, the Government accept the principles of a capped cost system as the basis for protecting people from catastrophic costs. Labour’s motion seems to suggest that Labour does, too. I want to make it clear that we are keen, still, to engage with the official Opposition and other stakeholders in reaching a final settlement on this question of the boundary between the state’s responsibility and the individual family’s responsibilities for meeting care costs.

--- Later in debate ---

[Paul Burstow]

I am grateful to the hon. Lady for her question, because it allows me to talk about some of the points I think will directly address it. Reform of our care and support system is about more than just who pays for care; it is also about some other very important issues. A central proposition in the White Paper we published last week concerns the move from a service focused on managing crisis, and often not doing so very well, to one focused on supporting people’s well-being by concentrating on early intervention and prevention. That is why, alongside the White Paper, we published a draft Bill that will underpin the reforms we intend to make, consolidating, simplifying and modernising the legislation. The Bill sets out for the first time in statute some very clear governing principles about how decisions are made in social care, focusing on people’s well-being and living by the idea set out by our first White Paper in government of “No decision about me, without me”.

The Bill sets out a number of important changes that go to the heart of people being able to plan, prepare and have proper choice about the care available to them. First, it makes it a requirement for local authorities to ensure that there is a universal offer of information and advice so that people can plan and prepare. Secondly, it requires for the first time local authorities to focus on prevention. Thirdly, it requires a sufficiency of quality care so that choice is available to people locally. Fourthly, it requires integration and co-operation not just between the NHS and social care but between those agencies and housing.

The Bill will not only do that; it will simplify the point of entry into the state system. It will ensure consistent national eligibility and, for the first time in Government legislation, will ensure that there are rights for carers not just to an assessment of their needs but to support for those needs. It will also deal with the often mentioned issue of protection from disruption when people move from one part of the country to another or when a child moves from children’s services to adult services. It will guarantee continuity of services, which is not currently provided for.

Personal budgets, which were started by the Opposition but have not stuck well because of the legal framework, will for the first time be given a clear legal basis. I am delighted to say that whereas when this Government came to office in 2010 we inherited 168,000 people receiving personal budgets, by March of this year 432,000 people were benefiting from them. There will also be clear legal duties on the NHS, police and councils to safeguard people.

At the heart of our White Paper reforms is the notion that we need less variability on quality, to ensure that providers are responsible for driving up quality and accountable for doing just that, and to have more and open information about the quality of provision. That is why our provider quality profiles will provide that information in a way that will allow people to compare and rate providers for the first time and why we are putting an extra £32.5 million in to support those services.

[Andy Burnham]

The Minister is mentioning the things in the White Paper that he will ask councils to do. Can he give us a figure tonight for how much the Government have estimated that the cost to councils will be of providing all those things and tell us how councils will pay for it?

[Paul Burstow]

I will come on to give a specific figure in a moment, so the right hon. Gentleman will have to be patient.

I wanted to pick up again on the point about the White Paper ruling out crude contracting by the minute—a culture of clock-watching which has been allowed to grow up for years in too many places and which is not good for dignity, respect or quality. Under the Labour Government there were years and years of delay and dither when it came to addressing the quality of care workers and health care assistants. This Government are putting in place a code of conduct and national minimum training standards, and will double the number of people able to access apprenticeships in the care sector to 100,000.

Care and Support

Andy Burnham Excerpts

Wednesday 11th July 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement—and, indeed, for the constructive cross-party discussions that we have held on these crucial matters.

First, let me say that we welcome many of the ideas in the White Paper that the right hon. Gentleman is publishing today. A universal deferred payment scheme would help to spare vulnerable people the agony of watching savings and assets being washed away. National standards on eligibility could help to bring some consistency to a care system in England that is today the ultimate postcode lottery. Stronger legal rights for carers are overdue, as are improvements to end-of-life care.

The proposals are important steps forward; they were also in my own White Paper, “Building the National Care Service”, which was published before the last election. I take the right hon. Gentleman’s decision to carry the proposals forward into his White Paper as a positive sign of the developing consensus between the parties, but there is one crucial difference between his White Paper and ours. Despite the obvious political risks of doing so, we faced up to the difficult issue of how to pay for care and support in the century of the ageing society. The Government have failed to do that.

With no answers on money, the White Paper fails the credibility test; it is half a plan. The proposals that the right hon. Gentleman has set out are in danger of appearing meaningless and may raise false hope among older people, their carers and families. The proposals have no answers to the immediate funding crisis that is engulfing councils and resulting in thousands of older people seeing support taken away or facing huge increases in charges for day care and meals on wheels—stealth taxes on the most vulnerable in our society. Furthermore, there are no answers on how we pay for a fairer care system in the long term. Let me take each of the two issues in turn. I shall start with council funding.

Today we have a promise of new standards, new services and new rights for councils to deliver. I fear that that will be greeted with sheer disbelief in town halls up and down England. Councils are already facing a major funding shortfall, estimated to be at least £1 billion. They cannot cope with what they already have to do, never mind their being burdened with additional unfunded pressures. What is the Government’s assessment of the extra costs that will fall to local authorities in England from the proposals in the White Paper? Will the Secretary of State tell us how and when he plans to pay for those costs, as well as make up the existing shortfall in council budgets?

There is simply no point in promising new ideas if they come on top of the crumbling foundations of inadequate care budgets. Councils need emergency support. The right hon. Gentleman has allocated just £100 million and £200 million today, but last week it was confirmed that the Treasury had clawed back £1.4 billion from the Department of Health budget. Surely it would have made sense to have reallocated at least half that clawback—£700 million—to council budgets, to relieve pressure on care. Does he not accept that such a move is needed if his plans are to have any credibility in local government circles?

Let me turn to the flagship proposal—the new duty on all councils to provide loans to older people so that people can pay care costs after they die. Before we judge that, we need more detail. Can the Secretary of State tell us what the upfront set-up costs will be to local authorities? Currently, there is a deferred payment scheme based on no interest, but we read that, when his scheme is up and running, councils will be able to charge interest so as not to lose money.

Will the Secretary of State confirm that that means that councils will have to charge close to commercial rates of interest? Does he not accept that, if that is the case, taking on such large amounts of debt might be very frightening for older people? Was it not for that very reason that the proposal really made sense only if it came as part of a package alongside a cap, as promised by the Dilnot commission? This is the problem with the Government’s White Paper: they are adopting a pick-and-mix approach to the Dilnot package, which was conceived as a coherent and complementary whole.

That brings me to my second issue. I hear talk only of a vague commitment in the progress report to the main principle of Dilnot, so are the Government not in danger of sliding back on their own independent commission, which had produced the best hope for years of a consensus between us? I know, perhaps more than anyone, how politically charged these issues are, but I also know that progress will never be achieved if politicians cannot put difficult options on the table for fear of being accused of political point scoring. That is why my right hon. Friend the Leader of the Opposition made a genuine offer of cross-party talks to give the coalition the political space to look at those difficult options. I thank the Secretary of State for the way in which he conducted those talks—indeed, I thank the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow), too—and I have welcomed his idea of producing a joint progress report on funding.

I do not doubt the Secretary of State’s personal commitment to making progress, but I suspect that he was thwarted by the Treasury and a Chancellor who is making one wrong judgment call after another. The Government’s decision to change course at the eleventh hour and produce their own progress report, without input from Labour Members, reflects a Treasury decision to try to close these issues down—a mistake and a missed opportunity. Let me say this to the Government: if they offer a genuine, two-way discussion on the funding of care, with honesty about existing pressures and the difficult options, we will play our part, but they cannot expect us to provide political cover for a failure to face up to the scale and urgency of the care crisis in England. To do so would be to fail the millions of older people, their carers and families who have already waited long enough for politicians to get their act together.

The truth is that the Government are ducking one of the biggest issues of our time, with a White Paper that has today been branded a “massive failure” by the Alzheimer’s Society. Today’s announcements are designed to create a false sense of momentum and to disguise a Government decision to kick the funding of care into the political long grass. They have made their choice—they have placed Lords reform at the top of the agenda and shunted the care of older people into “Any Other Business”. That is the clearest sign yet of a Government who are losing their way and have their priorities completely wrong.

NHS Annual Report and Care Objectives

Andy Burnham Excerpts

Wednesday 4th July 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

The Secretary of State today presents his first annual report—an annual report on a lost year in the NHS. Just when the NHS needed stability to focus all its energy on the money, what did he do? He pulled the rug from underneath it, with a reorganisation no one wanted and that this Prime Minister promised would never happen.

In fact, we have had not one, but two lost years in the NHS, as this Secretary of State has obsessed on structures and inflicted an ideological experiment on the NHS that made sense to him but, sadly, to no one else. It was his decision to allow the dismantling of existing structures before new ones were in place, which has led to a loss of financial grip at local level in the NHS. He mentioned QIPP savings. The truth is that two-thirds of NHS acute trusts—65%—are reported to have fallen behind on their efficiency targets. So we see temporary ward and accident and emergency closures, a quarter of walk-in centres closing across England, panic plans to close services sprouting up wherever we look, and crude, random rationing across the NHS, with 125 separate treatments—including cataracts, hip replacements and knees—being restricted or stopped altogether by one primary care trust or another. This is an NHS drifting dangerously towards trouble, or, in the words of the chief executive of the NHS Confederation,

“a supertanker heading for an iceberg”.

Let us remember that even before the added complexity of today’s mandate, the Secretary of State has already saddled his new board with an Act of Parliament that even the chair of that board, whom he appointed, calls “unintelligible”. Listening to the Secretary of State today, one could not but conclude that he cannot be looking at the same NHS as the head of the NHS Confederation. The statistics he just reeled off do not include the people who give up waiting in A and E, who have their operation cancelled, who cannot get a GP appointment for days or who cannot get into hospital in the first place because his Government are restricting access to operations. Perhaps that explains why the year that he hails as a great success was the same year that saw the biggest ever fall in public satisfaction with the national health service according to the British social attitudes survey.

Let me challenge the Secretary of State on this growing gap between Ministers’ statements and people’s real experience of the NHS. He has said that there will be no rationing by cost, but I have news for him: it is happening on his watch, right across the system, with a whole host of restrictions on important treatments and a postcode lottery running riot. Where is the instruction in the draft mandate to stop it and deliver on the promise that he and the Minister of State, the right hon. Member for Chelmsford (Mr Burns), made to patients? It is not there.

Let me turn to bureaucracy and targets. First, the Government said that they would scrap the four-hour A and E and 18-week targets; then they brought them back. Now they have gone further and adopted Labour’s guarantees, but they have gone even further today and have added a whole new complex web of outcomes and performance indicators for the NHS. The NHS needs simplicity and clarity, but what it has received today from this Secretary of State is a dense document with 60 outcome indicators grouped within five domains. I hope it is clear to him, because it will not be clear to anyone else. Will he treat the House again to his explanation of the difference between an outcome indicator and a target? The fact is there is not one and he is loading a whole new set of targets and burdens on to a NHS that is already struggling to cope with the challenges it is facing.

It will not have escaped people’s notice that today the Secretary of State was silent on the biggest issue of all: the unfolding crisis in adult social care. Out there in the real world, councils are not coping, services are collapsing and that is placing intolerable pressure on hospitals. He promised a White Paper soon on service change, but nothing on funding. Has he given up on the Dilnot proposals and the challenge of finding a fairer and more sustainable funding system?

Before we let the Secretary of State go today, the House needs to ask to whom this mandate is being given. We are witnessing the democratic responsibility and accountability to this House for the organisation that matters more to our constituents than any other being outsourced and handed over to an unelected and unaccountable board.

Another major announcement is taking place today on the review of the arrangements for children’s heart surgery. It will not have escaped people’s notice, however, that the Secretary of State did not mention that review in his statement. He said that Ministers are stepping back, and I think people in this House know what that means—it is now nothing to do with him. All these changes will take place and he will not be responsible.

What assurances can the Secretary of State give to right hon. and hon. Members that his new board will listen to their concerns? Who are the people on that board? With trademark catastrophic timing, we learn that he has given a leading role in the running of the NHS to—yes—the vice-chair of Barclays, none other than Mr Diamond’s right-hand man and someone who has given £106,000 in donations to the Conservative party. If that does not sum up this Government, I do not know what does.

We know the real mandate that the Secretary of State has given his new board—and that is a mandate for privatisation. He promised it would not happen, but it is happening with community services being outsourced. No wonder there is a crisis of leadership, with one third of directors of public health not planning to transfer to local authorities. Is it not the simple truth that the Secretary of State inherited a successful, self-confident NHS and, in just two years, has reduced it to a service that is demoralised, destabilised and fearful of the future? The man who promised to listen to doctors has completely ignored them, and now they are calling for his resignation. Despite all his claims today, the supertanker is still heading towards an iceberg. He gave us a new mandate when what we really needed was a change of direction and a change of personnel.

[Mr Lansley]

At no point did the shadow Secretary of State express any appreciation for what the staff of the NHS have achieved in the past year. A party political rant populated with most of his misconceptions and poorly based arguments does not get him anywhere.

The right hon. Gentleman went around the country trying to drum up something he could throw at us about things that he believed were going wrong in the NHS. Do you know what he ended up with, Mr Speaker? He ended up by saying the NHS was rationing care. What was the basis for that? That parts of the NHS have restrictions on weight-loss surgery, because people have to be obese before they have access to it. That is meaningless. I wrote to the shadow Secretary of State this morning, and went through his so-called health check. There is no such ban on surgery as he claims. Time and again, he says, “Oh, they are rationing.” They are not, because last year, the co-operation and competition panel produced a report that showed where there had been blanket bans on NHS services under a Labour Government. We introduced measures to ensure that that would not happen in future across the service. Not only is he not giving the NHS credit for the achievements that I listed in detail in my statement but he is now pretending that the NHS is somehow in chaos or financial trouble. It is complete nonsense. Across the NHS, only three primary care trusts out of 154 were in deficit at the end of the year. The cumulative surplus across all the PCTs and strategic health authorities is £1.6 billion carried forward into this financial year.

That means that the NHS begins 2012-13 in a stronger financial place than anyone had any right to expect, because it is delivering better services more effectively, with GP referrals reduced, and reduced growth in the number of patients attending emergency departments. The right hon. Gentleman asked, “What about patients who leave A and E without being seen?” Under the Labour Government, no one ever measured whether patients left A and E without being seen. For the first time, we are measuring that, and we publish the results in the A and E quality indicators. There was a variation between about 0.5% and 11% of patients leaving without being seen when we first published that, but since then the variation has reduced. The average number has gone down, and it is now at 3%, so he ought to know his facts before he stands up at the Dispatch Box and begins to make accusations. We published those facts for the first time.

I will not reiterate the A and E target, because I mentioned it in the statement, but 96% of patients are seen within four hours in A and E. The right hon. Gentleman should withdraw all those absurd propositions that the NHS is not delivering. He should get up when next he can and express appreciation to the NHS for what it is achieving. Patients do so: last year, 92% of in-patients and 95% of out-patients thought that they had good or excellent care from the NHS, which is as high as in any previous year. That is what patients feel. Staff should be proud of what they achieve in the NHS, and the Labour party should be ashamed of itself.

Mental Health

Andy Burnham Excerpts

Thursday 14th June 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I begin by giving my apologies to the hon. Member for Loughborough (Nicky Morgan) for missing the beginning of her speech, and by congratulating the Minister on his excellent and thoughtful speech, to which I can hopefully add something.

I have high hopes for the debate. I hope it will help us to confront a major paradox: how can a subject that is so central to the big public policy challenges we face as a country—the challenges are not just of public health provision, but of worklessness, benefits, the criminal justice system and addiction—still exist on the fringes of our national debate, getting so little airtime and attention? As other hon. Members have acknowledged, the House, sadly, rarely applies itself to mental health. Perhaps that reflects our national stiff-upper-lip tendency not to talk openly about mental health, which in turn might help to explain why our public services are designed for the 20th century rather than the 21st.

[John Pugh]

The right hon. Gentleman seems to be forgetting that we had appreciable mental health legislation in the last Parliament—the Mental Health Act 2007.

[Andy Burnham]

I am proud of the improvements we made in the last Parliament, but I did not come here today to say that everything the previous Government did was right and wonderful. I will talk a little about those improvements, but given my failure to sing about Labour achievements, I am grateful to the hon. Gentleman for doing so.

We are reticent to talk about mental health as much as we should. There is a complacency in the public debate—that is not to make a political point, because it involves hon. Members on both sides of the House. The complacency goes throughout the civil service and the Government. To reflect on my time in government—not just in the Department of Health, but in the Treasury and the Home Office—it is remarkable how few submissions or meetings I had relating to mental health, given that it underlies the spending of hundreds of millions of pounds of public money. Indeed, £105 billion is the estimated cost of the full burden of mental health to this country.

That complacency is not shared by everybody and I congratulate the hon. Lady on introducing this debate. We have heard two unbelievably powerful speeches, from my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker), to which I will turn at the end of my remarks. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), who leads on these matters for the shadow health team, has rightly pointed out how mental health lies under the whole public health challenge. We will soon introduce Labour’s public health review.

We are beginning to wake up from our complacency. I am leading the debate for the Opposition to show that that comes from the top. We see the mental health challenge as central to health policy. Indeed, I made a point of making my first speech on returning as shadow Health Secretary on the subject of rethinking mental health in the 21st century at the Centre for Social Justice.

I must be honest: I shared the complacency about the mental health debate, or perhaps did not give it enough attention, but two things changed that when I was a Health Minister. First, I spent a day work-shadowing an assertive outreach team in Easington. I will never forget what one of the team told me about the early ’90s, when the mines closed and GP referrals for support were piling up on clinic desks, but there simply was no support to offer people. She said that that lay behind the social collapse in those mining communities. People facing difficult times were given no help.

A second thing made me think differently. When I became Health Secretary in June 2009, I inherited Lord Bradley’s report into mental health problems and learning disabilities in the criminal justice system. I will never forget sitting in my office at Richmond house reading that about 70% of young people in the criminal justice system have an undiagnosed or untreated mental health problem. If that is not truly shocking to every Member and does not make us do something, frankly nothing will. That was the moment that changed how I thought, and I have tried to follow it through ever since.

I mentioned that we had a public service designed for the 20th century, rather than the 21st century, and I want to illustrate that point with reference to my own constituency. The world that gave birth to the NHS was a very different place. When the NHS was set up, Leigh, like Easington, was a physically dangerous place to live and work in. Working underground exposed people to coal dust, explosions and accidents, and people had no choice but to lock arms, look out for each other and face the dangers together—that is how it was—and that spirit of solidarity was carried over into the streets above.

Like many places in this country, then, Leigh in the ’50s was a physically dangerous place but emotionally secure, because people pulled together. In the 21st century, however, that has completely reversed. We now live in a physically safe society—our work does not generally expose us to dangers—but it is emotionally far less secure than it was for most of the last century. The 21st century has changed the modern condition. We are all living longer, more stressful and isolated lives, and have to learn to cope with huge and constant change. Twentieth-century living demands levels of emotional and mental resilience that our parents and grandparents never needed, yet the NHS does not reflect that new reality; essentially, it remains a post-war production-line model focused on episodic physical care—the stroke, the hip replacement, the cataract—rather than the whole person. That is the issue to confront.

The demands of this society and the ageing society require a change in how we provide health and social care. We need a whole-person approach that combines not only the physical but the mental and social, if we are to give people the quality of life that we desire for our own families. That one in four people will experience a serious mental health problem makes this an issue for all families and people in the country. It also means that mental health must move from the margins to the centre of the NHS.

I shall say a couple of things about that necessary culture change. How can it be that an issue that causes so much suffering and costs our society so much still accounts for only a fraction of the NHS budget? It cannot be right. We also have to consider the separateness of mental health within the NHS. This has deep social roots—the asylum, the separate place where people with mental health problems were treated, the accompanying stigma and suspicion about what went on behind those four walls. Essentially, we still have the same system in the NHS, with separate organisations—mental health trusts—providing services on separate premises. That maintains the sense of a divide between the two systems and raises a huge health inequalities issue.

The wonderful briefing that Mind, Rethink and others have prepared for this debate contains this startling statistic: on average, people with severe mental health problems die 20 years earlier than those without. What an unbelievable statistic! Why is that? It is partly—not completely—explained by the separateness within our system. If someone is labelled a mental health patient, they are treated in the mental health system, and consequently their physical health needs are neglected.

[Andrea Leadsom (South Northamptonshire) (Con)]

Is the right hon. Gentleman aware that, right from the very start, the way in which a baby’s brain develops—whether development is healthy, through a loving bond, or not—can have profound implications for future physical health, and therefore life expectancy? It starts as early as that.

[Andy Burnham]

I completely agree, and obviously that was one of the major conclusions of the Field report, which the hon. Lady’s Government commissioned. The problem is not just the separateness of the system, although that is one of the factors; rather, it starts much earlier. We need to take that broad view.

More co-location of acute care and mental health care within the same hospital would be a good thing to encourage. We heard on the radio this morning about the RAID—rapid assessment interface and discharge—service in Birmingham, which is an excellent example of that and something we need to follow. That is part of the culture change we need in the NHS. The other part of that change is that practitioners dealing with mental health, particularly GPs, at the primary care level, should not just reach first for medical interventions, rather than social or psychological interventions. However, I am afraid that that is what we do. Let us look at these, more startling statistics. In 2009, the NHS issued 39.1 million prescriptions for antidepressants—there was a big jump during the financial crisis, towards the end of the last decade. That figure represented a 95% increase on the decade, from the 20.2 million prescriptions issued in 1998. Were all of those 40 million prescriptions necessary? Of course they were not.

Prompted by my north-west colleague, the hon. Member for Southport (John Pugh), let me pick up the point about Labour’s successes. We did address some of these issues. The improving access to psychological therapies programme is something I am very proud of taking forward as Secretary of State, because it began to give GPs an alternative to antidepressants and medication to refer people towards. That was an important development, and—credit where it is due—it was Lord Richard Layard who made such an incredible change, by pushing so determinedly for that programme.

[Jeremy Corbyn]

My right hon. Friend is making an important point. Too often GPs reach for medicine when they should be reaching for counselling. They should be offering a more supportive environment, but when we get high-speed GPs with little time to talk to patients, they tend to prescribe medicines when they ought to be doing something else. Does my right hon. Friend agree that we need to go a lot further than we already have?

[Andy Burnham]

I completely agree. I do a lot of work shadowing, and I recently shadowed a GP. What amazed me was how many of the people coming through his door were the people who also come through our doors on a Friday and Saturday. They are not necessarily looking for something to take to the chemists; they are actually just crying out for help, in one way or another, with a problem they are struggling with. That GP was very good and did not prescribe, but referred lots of people to the IAPT service, as I sat there with him. However, he said that across Coventry, where he was based, many others were not doing the same.

[Chris Ruane (Vale of Clwyd) (Lab)]

The Minister mentioned the number of prescriptions that have been issued. I received a parliamentary answer a couple of days ago which said that in 1991 there were 9 million prescriptions. The Minister mentioned the figure of 42 million, but from 2010 to 2011 the number went up by 4 million. In the years before that the increase was usually 2 million a year, but in one year the figure increased by 10%, or 4 million. When I asked the Minister what his assessment was of the reason for those increases, there was no conclusive answer. We must get to the bottom of why these prescriptions are being issued and why they have gone up by 500% in a 20-year period.

[Andy Burnham]

We must. Perhaps I am about to make more of a political point, but as has been mentioned so eloquently today by my hon. Friend the Member for North Durham, as well as the hon. Member for Strangford (Jim Shannon), although the trend is upwards—that is happening come what may: I mentioned the financial crisis, during which the rate has jumped up, including in our time in government—the cumulative effect of some of the benefits changes on some of the most vulnerable members of society, coupled with the withdrawal of social care support by councils, means that, right now, some people out there are suffering very badly indeed. That is part of the explanation for the worrying figures that my hon. Friend has just given the House. The Government need to have a look at what is happening out there and whether or not some people are struggling with mental health problems because of the extra stress that other factors, particularly financial, are putting upon them.

I welcome the Minister’s commitment to the improving access to psychological therapies programme, but I hear that waiting times for it are increasing in parts of the country where GPs face much longer referral times. Indeed, a Mind survey of 2011 said that 30% of GPs were unaware of services to which they could refer patients, beyond medication. That tells us that we still have quite a long way to go. IAPT needs protecting and nurturing; it needs to come with a national direction in the operating framework. In the new and changing NHS world, we cannot allow it to be simply whittled away. More broadly, we need to look carefully at commissioning and find out whether GPs have the right skills to commission properly for mental health. We need to consider what the precise commissioning arrangements for mental health are, as there is still some confusion out there about them.

[Paul Burstow]

One of the key aspects of the NHS Commissioning Board’s work in authorising clinical commissioning groups will be to assess their capacity to commission in mental health. As I am sure the right hon. Gentleman knows, the Royal College of General Practitioners is currently exploring what the extra year of education and training will involve, as we move forward to ensuring that mental health is part of it. I think it is a very important innovation.

--- Later in debate ---

[Andy Burnham]

I welcome what the Minister has said, but I say clearly to him that we are going to be vigilant about this. We do not want to see things slipping backwards, as we fear they may well do under this NHS reorganisation.

The hon. Member for Strangford made an important point about service personnel. I would like to pay tribute to the organisation Combat Stress, which has done a wonderful job—voluntarily, I think, for many years—giving some help and hope to people who come back here only to find that the statutory services are not providing anything for them. We have to absorb what it has done and the changes it has made into the mainstream to provide much better support. It is beginning to happen, but there is further to go.

On benefits appeals, I echo a point made by my hon. Friend the Member for North Durham. As he said, the number of employment and support allowance cases going to appeal is ridiculous. In 2009-10, the first full year of the ESA regime, 70,535 cases went to appeal at a cost of £19.8 million. In 2010-11, there were 176,567 cases at a cost of £42.2 million. If the Government want to cut waste from the benefit system, they have to get a grip on that. What we find is that 38% of cases—almost four in 10—are overturned on appeal; those cases should not have to go to appeal. My hon. Friend also mentioned the human cost. The financial cost is bad enough, but the stress that people with mental health problems are put through as they go through that process is, in many cases, unbearable. The Minister really needs to talk to his Department for Work and Pensions colleagues to encourage them to get a grip on this important problem. The Atos system is simply not working; it is actually making life a lot harder for some of the most vulnerable people in our society. Ministers need to look urgently at it.

Let me conclude with a point about stigma. I have picked up from today’s debate the fact that the hon. Member for Croydon Central (Gavin Barwell) is bringing forward a private Member’s Bill along the lines of the Bill introduced in the other place by Lord Stevenson, to whom this House should pay tribute. It is wonderful to hear that the hon. Gentleman will introduce that private Member’s Bill. Currently, a person who has had a serious breakdown and has been sectioned under the Mental Health Act 1983 is barred from being an MP, a juror, a school governor or a company director. What message does that send out? It says that recovery is not possible—a message that we might have put out about cancer in the ’50s or ’60s: “Once you have had it, it is a black mark; that’s it, you’re finished.” We urgently need to change that. Today’s debate has probably achieved some change. The Minister indicated his full support for the private Member’s Bill and I can pledge the full support of the Opposition for it. We wish the hon. Gentleman all good luck with it.

I think that today’s debate can begin to change social attitudes in the broader debate on mental health in this country. For the reasons I have set out, I think our debate has been historic, but we have a long way to go. When the Norwegian Prime Minister, Kjell Magne Bondevik had to take some time off, he publicly admitted that it was for depression. That was the reason he gave. Imagine a Prime Minister doing that! But he did so, and he changed the culture in Norway. Moreover, he went on to be re-elected and to become Norway’s longest-serving non-Labour Prime Minister since the second world war. That constituted incredible bravery and political leadership, and I think that we have seen two more examples of those qualities today in the speeches of my hon. Friend the Member for North Durham and the hon. Member for Broxbourne. That is the kind of leadership that changes social attitudes to mental health. Both Members deserve enormous credit for what they have said today, and I think that both have taken a major step towards changing the political debate.

I believe that we must all go back to first principles. I mentioned the start of the NHS. In 1948, the World Health Organisation defined health as

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Whatever differences we may have about precisely how we should construct the NHS, I think that today Members in all parts of the House can unite behind that definition, with the emphasis on prevention and well-being. I think that we can all commit ourselves to making major changes in the way in which mental health is seen in the House of Commons, the Government and the country, and begin to create a system of care for the 21st century that recognises the difficult, stressful lives that people are leading and gives them support when they need it so that they can fulfil their potential.

[Several hon. Members]

rose—

--- Later in debate ---

[Sir Peter Bottomley (Worthing West) (Con)]

It is a delight to congratulate the hon. Member for Vale of Clwyd (Chris Ruane) on his speech. We are having a debate of which the previous speakers and the Backbench Business Committee should be proud. I missed out on a lunch the other day and went with my hon. Friends the Members for Broxbourne (Mr Walker) and for Loughborough (Nicky Morgan) and others to appear in front of the Committee. They were tough and they were clear. We made our point that the subject needed a debate, and the issue then was whether it should be in Westminster Hall or in the Chamber. I think that if it had been in Westminster Hall, the impact would not have been so great.

When I was first elected to the House of Commons, if a Member of Parliament was thought to have gone mad, the Speaker would refer them to two people nominated by the Royal College of Surgeons. One of my early interventions was to suggest that psychiatrists might be rather more useful. If the Bill taken up by my hon. Friend the Member for Croydon Central (Gavin Barwell) gets through, perhaps that approach will be thrown away in turn.

Again when I was first elected, The Times and The Daily Telegraph would report debates and pick up a good point from everyone’s speech. If that happened after today’s debate, people’s understanding of the experiences of the lack of mental health, and of more extreme, occasionally disabling mental illness would become greater, deeper and wider. That would give comfort to the hundreds of thousands of people who care for people who are experiencing the lack of mental health.

[Andy Burnham]

I apologise for interrupting the hon. Gentleman so early on, but he is making such an important broader point about media coverage of mental health. Would he want to pay tribute to the Sunday Express, which has led a campaign that was mentioned by the hon. Member for Loughborough (Nicky Morgan)? One would not necessarily expect a newspaper to run a mental health campaign, yet it has. That is precisely the kind of media leadership that we need to see on this issue.

[Sir Peter Bottomley]

I join the right hon. Gentleman in saying that. I was trying to say things that had not been said already, and there has already been a tribute to the Sunday Express. I would add that several journalists have been prepared to speak about their own medical conditions that have challenged their ability to live or to work effectively. I am not saying that we should all have to spend our time saying what our physical or mental experiences have been, but it does help if it is regarded as being as normal to talk about having had an episode of depression as of having had a basal carcinoma removed or having recovered from a broken hip.

I pay tribute to the hundreds of thousands of people who care for those experiencing the lack of mental health. I also pay tribute to the professionals, particularly to Lisa Rodrigues, who is chief executive of the Sussex Partnership Trust. She has spoken of the services it provides across East Sussex, West Sussex, Brighton and Hove and Hampshire, and the 27,000 young people with whom she and her colleagues come into contact each year. They are not all experiencing real disability, but some will.

When I became roads Minister, one of my ambitions was to try to get the number of road deaths down below the suicide rate. Young people’s suicides number about 900 each year. The total number of road deaths among adults and young people is 1,800. The road deaths figure has come down from 5,600 a year to 1,850. Would it not be good if we could do the same thing for self-destruction and the penalties that that imposes—not only the shortened life but the damage to those around the person who has died?

My wife was a psychiatric social worker before she became a Member of Parliament, a Health Minister, and then Secretary of State for Health, when she took mental health issues very seriously. She worked with those at the Maudsley Institute of Psychiatry where, with one of her colleagues, Peter Wilson, she ran a support service for teachers. If we are to start being concerned with young people, we need to make sure that those who are in contact with them—parents, and teachers in primary and secondary schools—have an understanding of what is normally unhealthy, if I can put it that way.

One young person in four experiences some kind of mental health episode. We need to know how much of that involves a relatively normal experience from which they will recover. We also need to identify the one in 10 who will probably need help from someone with experience or specialist qualifications, and the 2% or 3% for whom the experience will be disabling.

YoungMinds is an association with which Peter Wilson was associated—I think he might have created it. It has a manifesto in which young people say that if they can get help when they are young, many more of them could be kept out of prison and psychiatric hospital, and kept in work and leading the kind of life that contributes to society.

I once met someone who had had experience of schizophrenia. There was a fine mental health project just outside my former constituency, and he told me that he was glad to have got to know about it. He became a client of the project. Six months later, he became a volunteer. A year later he wrote to tell me that it was the proudest moment of his life, as he was now a taxpayer with a paid job. He was given the opportunity to take those steps forward, in an environment in which everyone knew what was happening and could share in it and give support when appropriate. Those opportunities matter.

Had there been more time, I would have been tempted to talk about a range of issues, giving a sentence or two to each, but I do not think that that will be possible. I would say, however, to those who suffer at times, or constantly, from depression, anxiety, obsessive compulsive disorder, phobias, bipolar disorder, schizophrenia or personality disorders—I could go on—that information on most of those conditions is available on the websites of the organisations that provide help.

About 31 years ago, I was appointed to the council of Mind, formerly the National Association for Mental Health. The reason for that was that the then Conservative Government wanted to give the organisation their support, and its then general secretary was thought to be left-wing; I was there to provide balance. I am not sure how my Whips would regard that decision today.

The Mental Health Foundation does good work, and I also pay tribute to the Samaritans for the help that they give to people about whom they are concerned. Their website contains information on how we can help someone, even if we are untrained. It suggests avoiding the “Why?” question, as that can be regarded as challenging. Instead, it suggests asking:

“When—‘When did you realise?’ Where—‘Where did that happen?’ What—‘What else happened?’ How—‘How did that feel?’ In an ideal world what would you like to happen next? Would you like me to come with you?”

Standing beside people in that way can be a pretty effective approach.

I want to give the House one or two examples from the weekly newsletter from Lisa Rodrigues of the Sussex Partnership Trust. I try to send it on to two or three other people each week, to whom some of the points might be relevant. One week she talked about cancer, describing how, in the 1950s, Sir Richard Doll and others had started to examine the causes of lung cancer, and to realise that asbestos could also have a serious effect on breathing. She wrote:

“So why am I talking about cancer? It is because today dementia is where cancer was all those years ago…Why Sussex? Because we have the highest percentage of old people in the country living here. And why me? Because specialist mental health services hold the key to unlocking the potential in primary care, acute hospitals, local authorities, the voluntary and nursing home sector to provide better treatment and care to people with dementia, and support for their families.”

Lisa Rodrigues also recently attended a conference on how to get the various groups to work together more effectively, which is vital for people and their families and carers. If only they could find a one-stop shop to refer them to a place where they could be embraced as a person, a household or a family unit. She said that if we could get our mental health services working more effectively, our physical health services would have far less to cope with. That point has also been developed by other hon. Members this afternoon. She also wrote in her newsletter:

“We have a dream. In our dream, our psychiatrists, nurses, social workers, psychologists, therapists, care staff, receptionists and anyone else who comes into contact with the 100,000 people we serve each year will have the best possible tools to do their jobs. This will include a small, lightweight…portable device via which they can access patient records”

and the background of all the people they are in contact with. Up to now, that has not been possible.

Lisa Rodrigues talks every two or three weeks about employees who have done something special. In one example, she talks about the staff who have worked on a clinical reception and their helpfulness to patients and other visitors. She goes on to mention a person whom I have not met called Jackie Efford, a nurse in the health team at Lewes prison, who

“works flexibly so that, when prisoners arrive late into the night, she comes in to assess them and respond to any urgent physical or mental needs. Imagine being a prisoner and what a difference it would make to have a meeting when you first arrived with a compassionate and effective nurse.”

Lisa Rodrigues also talks about the child and adolescent mental health services. She says that the name is

“no longer fit for purpose. The word adolescent has negative connotations. And young people don’t respond positively to the term mental health.”

We must find the right language, not for political correctness, but to help people more effectively.

It would be easy to say more on this issue. However, I want to end by saying that if we have to wait another year to develop these themes, Parliament will not be doing its job properly. We should not have to rely on the pleading and cajoling that we provided at the Backbench Business Committee. Debates on this matter ought to be built in, rather than bolted on.