Care Bill [Lords]

Debate between Andy Burnham and Joan Walley

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I pay tribute to my right hon. Friend. She and the people of her community stood up to an arrogant Government, and won a victory for every community that was worried about the future of its hospital. One would have thought that, following humiliation in the courts, the Government would have backed off gracefully, but no: here comes the Secretary of State again today, like someone who, having been caught breaking in through the back door, has the brass neck to return and try to force his way in through the front. Well, we will not let him get away with it. We give him notice that clause 118 is wrong, that it is an affront to democracy, and that we will oppose it every step of the way.

Hospital reconfiguration should always be driven by a clinical case first and foremost, but clause 118 paves the way for a new round of financially driven closures. It rips up established rules of consultation and the clinical case for change. It allows the Secretary of State to reconfigure services across an entire region for financial reasons alone, which means that no hospital, however successful, is safe. The House needs to stand up to this audacious power grab by the Executive.

[Joan Walley (Stoke-on-Trent North) (Lab)]

The clause introduced in the House of Lords gives extra powers to the trust special administrator. Are we not now faced with a complete contradiction? Rather than clinical commissioning groups commissioning services, the TSA will commission long-term services, and there has been no proper consultation. In Mid Staffordshire and North Staffordshire, for example, we have had a consultation procedure that has taken no account whatsoever of services in North Staffordshire.

[Andy Burnham]

That illustrates the confusion that is currently at the heart of the NHS. No one knows who is in charge of anything. What if CCGs and the boards of foundation trusts disagree with the conclusions of the TSA? How will that be resolved? Were we not told that doctors were sovereign? Were they not supposed to decide everything? Was that not the big call when the Government introduced their Bill? It seems that that is no longer the case: everything can be done “top down” by the Secretary of State. It takes power away from every Member and could be used as a back-door way to railroad through unpopular changes.

The real danger of the proposal comes when it is seen in the context of the competition regime created by the Health and Social Care Act 2012. Of course, it is sometimes necessary to make changes to local health services beyond just a failing trust. That is best done through partnership and collaboration, but such sensible changes are now being blocked by the market madness imposed by the Act. We recently saw the ludicrous spectacle of the Competition Commission intervening in the NHS for the first time to stop the sensible collaboration between Bournemouth and Poole. Since when did competition lawyers decide what was best for patients?

NHS Risk Register

Debate between Andy Burnham and Joan Walley

Wednesday 22nd February 2012 Commons Chamber

[Andy Burnham]

Not for the moment.

The risk rating in that risk register was 16—extreme. Let me focus on the phrase, “statutory functions”, because it is important that the House fully appreciates what that involves. One of the statutory functions of the primary care trusts that have been wound down before new structures are in place is the safeguarding of children and vulnerable adults. What does the NHS London risk register say on this point? [Interruption.] Government Members do not want to listen. I am sorry if it is inconvenient for the Parliamentary Private Secretary, the hon. Member for Broxtowe (Anna Soubry), but she will listen. The risk register makes the chilling prediction that the huge loss of named or designated professionals from PCTs across London, and the subsequent damage to information sharing, may lead to “preventable harm to children”. That risk was rated at 20 pre-mitigation and 15 post mitigation.

It is not just NHS London that is saying this. Let me quote again from the NHS Northamptonshire and Milton Keynes risk register; this time I ask the House to listen very carefully. It warns of a

“failure to deliver statutory requirements which leads to the significant harm or fatalities of children and vulnerable adults”.

That was originally rated as an extreme risk and, even after mitigation measures, it is still rated as “very high” with the possible frequency of occurrence being “monthly”.

This is what the national health service is telling the Health Secretary and the Prime Minister about the potential effects of their reorganisation. It is appalling and shocking. They are taking unacceptable risks with children’s safety and people’s lives. If this is what the NHS has been telling Ministers for 20 months, since the White Paper was published, how can they possibly justify pressing on with this dangerous reorganisation? Has not what remained of any justification for carrying on just collapsed before us? If this is what is published in local risk registers, that prompts the question of what on earth they are trying to hide in the national assessment. The simple truth is that they cannot publish because if people knew the full facts, that would demolish any residual support that this reorganisation might have.

That brings me to my third point—the Government’s claim that it is safer to press on with reorganisation than to deliver GP commissioning through the existing legal structure of the NHS. The evidence that I have laid out comprehensively dismisses that argument. If the Government were to abandon the Bill and work with the existing legal structure of the NHS, that would bring immediate stability to the system and, as the British Medical Journal has calculated, save over £1 billion on the cost of reorganisation. The Government’s claim that it is safer to press on is rejected by the overwhelming majority of clinical and professional opinion in England. The royal colleges and other professional organisations have given careful consideration to the pros and cons of proceeding and abandoning. Some disruption comes with either course of action, but given the terrible mess that we are now in, those royal colleges have concluded, one by one, that the interests of patients are best served by working to stabilise the system through existing structures.

It is not difficult to do that. PCT clusters could be maintained and the emerging clinical commissioning groups could simply take charge of the existing legal structure that is the residual PCT, and indeed any buildings and staff that they may still have. The painful truth is that delivering GP-led commissioning, which is where the Health Secretary began, could have been delivered without this Bill. Let me say to him again today that my offer still stands. If he drops the Bill, I will work with him to introduce GP-led commissioning using his emerging clinical commissioning groups.

However, that must be done in the right way. The local NHS risk registers raise concerns not only about reorganisation but about fundamental flaws in the policies that the Health Secretary wants to take forward. NHS Lincolnshire warns of a

“conflict of interest in CCG commissioning and provision: perceived or actual conflicts of interest arising from GPs as both providers and commissioners may impair the reputation of the CGG and, if not managed, may result in legal challenge.”

That has a moderate likelihood of happening but a consequence rated as catastrophic. A GP surgery in West Sussex has written to all its patients offering them

“private screening for heart and stroke risk”

from Health Screen First, for which, in return, the surgery receives a nominal fee from Health Screen First. In Haxby, GPs tried to restrict minor operations that are currently free on the NHS and at the same time launch their own private minor operations service, sending patients a price list. More broadly, stories are emerging around the country of plans by clinical commissioning groups to stop purchasing services from local hospitals, such as dermatology in Southwark and out-patients in south London. There are also plans to remove services from Stafford hospital, which we talked about earlier.

This unstable market in health care could have a very real effect on the viability and critical mass of essential hospital services, resulting in full or partial hospital closures. I have never heard of any plans from the Government to mitigate these risks other than the simple statement, “The market will decide.”

[Joan Walley (Stoke-on-Trent North) (Lab)]

In view of what was said about Stafford hospital and the implications for patient care in North Staffordshire, may I say to my right hon. Friend and to the House that it is vital that we get the full information and full risk assessments that are required in order to be able to plan for the NHS that we need, and that this important debate is part of that?

[Andy Burnham]

What happened at Stafford gives us very important lessons about the dangers of autonomy, and this Bill is all about extolling the benefits of autonomy. As Health Secretary, I had to deal with that situation. In some ways, it was a legacy of problems with our own policy; I accept and acknowledge that before the House. Because of that situation, I proposed the power to de-authorise a foundation trust and brought it forward in the Health Act 2009. If a hospital gets into trouble, it cannot carry on being autonomous and unable to improve, but should be brought back and helped to improve. I proposed the duty of autonomy.

In fact, that duty was recommended by Robert Francis QC in the first stage inquiry that he delivered to me. I accepted his recommendation. The Health and Social Care Bill abolishes the power to de-authorise a foundation trust. A recommendation from Robert Francis is being abolished by the Bill before the Government even give him the courtesy of allowing him to report. I say again that I do not have a good answer to why they are legislating before hearing from his inquiry. As was said a moment ago, there are plans in Stafford for GPs to do more in the community. That might be a good idea, I do not know, but it might further destabilise that hospital. That should be a cause for concern.

Education Maintenance Allowance

Debate between Andy Burnham and Joan Walley

Wednesday 19th January 2011 Commons Chamber

[Caroline Lucas]

rose—

[Joan Walley (Stoke-on-Trent North) (Lab)]

rose—

[Andy Burnham]

I will give way to the hon. Member for Brighton, Pavilion (Caroline Lucas) and then to my hon. Friend the Member for Stoke-on-Trent North (Joan Walley).

[Andy Burnham]

The hon. Lady makes a point of such importance that it must be addressed by the Secretary of State. In going about his business, he is wiping away important initiatives that work and are providing real opportunity for young people, with no assessment of the damage that the policies will do and no real understanding of how they might set back social mobility and equality in our country. The Government seem to have dispensed with some of the norms of government that we took seriously, such as equality impact assessments and consultations on the major changes to educational provision. Instead, they promised to keep EMA, and then simply pull the plug when it suits them. It is not good enough.

[Joan Walley]

I am most grateful to my right hon. Friend for giving way. Education maintenance allowance was piloted in Stoke-on-Trent and other cities, because we needed to give additional help to students, such as those who have come down from Burslem and Tunstall today to make the point that they need that additional money. Our staying-on rates have improved from 56.3% to 80.5%. Will my right hon. Friend ask the Secretary of State how it can be that people who currently receive EMA will not get that money, when people in the areas of deprivation that we represent need it for their travel costs and everything else? If they do not get it, they will not be in higher education, they will not get jobs, and there will be no solution to youth unemployment.

[Andy Burnham]

My hon. Friend brings me back to the point that I was making: EMA is not just about participation, as the Government say, but about helping people to make the best of themselves when they are in education and bringing out their full potential. The Government’s one-sided argument about a 90% dead-weight cost fails to acknowledge that it helps young people with one of the biggest challenges in life—to shine academically. It is very hard to put a value on that. It might open doors that would otherwise have remained closed.

Crucially, EMA supports the important principle of student choice for all in post-16 education. It means that the best sixth-form colleges, which are often some distance away, particularly in rural areas, are within the reach of young people. In most places, they do not get help with travel and transport costs, so EMA means that the doors of those fantastic institutions are opened to young people from ordinary working-class backgrounds.