Managing Risk in the NHS

Debate between Andy Burnham and Lord Watts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

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

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

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

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

[Andy Burnham]

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

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

Health and Social Care

Debate between Andy Burnham and Lord Watts

Monday 13th May 2013 Commons Chamber

[Andy Burnham]

I could not agree more with my right hon. Friend. All over the country, we hear that A and E is under intense pressure. Such is the importance of these services to every community that changes should be made only if there is a compelling clinical case to support them. If clinicians can demonstrate that more lives will be saved and disability will be reduced by changing A and E services, I think every Member should have a moral obligation to support them, but when the changes are financially driven—my right hon. Friend knows this better than anybody, as the Secretary of State has downgraded a successful A and E in Lewisham to deal with problems in another trust—that simply will not do. A and E units in west London, for example, are being closed one after another. That is not good enough, and neither is it good enough in Greater Manchester, where huge changes are planned. These changes must be clinically driven, not driven by finance, which is what we are seeing under this Government.

[Mr Watts]

rose—

[Andy Burnham]

I will give way one last time, before making some progress.

[Mr Watts]

I am grateful to my right hon. Friend, who is rightly concentrating on A and E units and social care. Does he agree with me that many hospitals around the country are facing a financial crisis, too, where the Government are refusing to fund anything other than consultancies? In my area, that has meant spending hundreds of thousands of pounds to tell us what we already knew—namely, that my hospital is underfunded.

[Andy Burnham]

That is what happens when a market is set up in the NHS, pitting one hospital against another in open competition. That is what is beginning to take hold in the NHS, where the Government waste money on consultants and all the other things that come from bidding for contracts. That is a direct effect of the legislation they pushed through. This reorganisation and the budget cuts I mentioned a few moments ago are providing a toxic mix. This is why for 32 weeks running, the NHS in England has missed the Government’s own lowered A and E target for major units. It really is time that the Health Secretary got a grip on the issue. We hear that last week he was trying to hatch a panic plan to deal with the A and E crisis. That is the reality of what was going on behind this threadbare Queen’s Speech: the Health Secretary was trying to cobble together a plan to deal with the A and E problems, weeks after we had first raised the issue in the House.

We hear of an e-mail leaked by an NHS finance officer which said:

“The SoS would like to announce tomorrow that £300m-400m is being invested to solve the A&E problem. We have spent most of the day trying to hold him off doing this.”

The Health Secretary seems to have forgotten that his powers to intervene were given away by his predecessor. He no longer has the power to mandate the NHS to do what he wants; the NHS can now “hold him off”. I am afraid that he looks weak. He has no response to what is happening to A and E departments. And where is the “£300 to £400 million” plan? It has not materialised. That is proof that when the Government surrendered their powers of control over the NHS, the Health Secretary surrendered his ability to do anything about the problems that we now face.

It is just as bad when it comes to staffing. We hear that nurses’ posts continue to be lost. Nearly 5,000 have been lost since the Government came to power, and according to the findings of a survey published yesterday, nurses fear that further tragedies could happen as a result of staff losses. That should set alarm bells ringing throughout the Department of Health. The Care Quality Commission has said that one in 10 hospitals in England does not have adequate staffing levels. The Health Secretary nods. I am glad that he accepts that, but, again, what is he going to do about it?

I welcome the fact that the Care Bill will contain measures relating to the Francis report, and I will work with the Health Secretary on that, but let us get to the crux of the issue of safe staffing levels, because that is the most urgent problem facing the NHS. The Health Secretary nods again. Let me make him an offer. If he introduces a benchmark—if he specifies minimum staff to patient ratios—we will support him, and the measure will go straight through the House. I shall wait for him to respond to that offer, and to ensure that the recommendations of the Francis report are properly implemented.

I give a cautious welcome to some of the Health Secretary’s measures to deal with health tourism, but let me issue two caveats. First, it is important not to overstate the nature of the problem, and secondly, it is essential for health practitioners not to be turned into immigration officers. In March, when asked how much health tourism was costing the NHS, the Health Secretary said:

“I don’t want to speculate… but… we have heard… it’s £200 million.”

On the same day, the Prime Minister’s spokesman said he believed that the figure was more like £20 million. Perhaps the Health Secretary could account for the difference—or did he just add a zero?

Mental Health (Approval Functions) Bill

Debate between Andy Burnham and Lord Watts

Tuesday 30th October 2012 Commons Chamber

[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?

National Health Service

Debate between Andy Burnham and Lord Watts

Monday 16th July 2012 Commons Chamber

[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?

School Sports Funding

Debate between Andy Burnham and Lord Watts

Tuesday 30th November 2010 Commons Chamber

[Andy Burnham]

The Health Secretary was on the airwaves this morning saying that we need more sport played in schools. Well, yeah. I never agreed very much with the current Health Secretary—we had our differences—but he was right to speak up in Cabinet against the Education Secretary. He had the courage to say that. As always, we see this Secretary of State failing to carry people with his decisions. He rushes out to make a decision, but does not carry his Cabinet colleagues with him. The mismatch between what the Government are saying in the public health White Paper and what we are debating now demonstrates that.

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

Is it not clear that Ministers have no idea about sport? Looking at them across the Chamber, I think it is clear that none of them has played sport. I cannot see, for example, the Secretary of State joining the boxing club.

[Andy Burnham]

I shall turn to that issue in a moment.

Funding and Schools Reform

Debate between Andy Burnham and Lord Watts

Wednesday 17th November 2010 Commons Chamber

[Andy Burnham]

I do not know whether the hon. Gentleman has ever been to any of those schools, but if he has seen the transformation in those communities and the messages that the schools send to children in areas that have, frankly, been let down for decades, I am surprised that he rises to his feet to say that that investment is not worth making. Let us talk about his Government and the spending review arrangements that his Secretary of State has recently secured: minus 60%. Let us just think about that figure for a moment.

Just after the spending review, the Financial Times reported senior Whitehall figures chiding the Secretary of State for

“folding too early in negotiations over capital”

spending. The only shock for me on reading that was to learn that he had been negotiating at all. We know that he is courteous, and we like that about him, but minus 60%? I can almost hear him now, politely inviting George and Danny to fill their boots. Is 60% enough? Do they want more? I doubt that the Secretary of State has played much poker in his life—although he has his poker face on now—but, as with sport in schools, it gives a person certain life skills and I recommend it to him.

The average capital reduction across Whitehall was 30%. I would think that everyone in education could live with that. But double the punishment? How exactly does that minus 60% reduction meet the Secretary of State’s “schools protected” claim?

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

Is my right hon. Friend surprised at the Government’s announcements, given the fact that the previous Tory Government spent nothing on schools? There are those of us who can remember tumbling-down buildings that leaked and needed the massive repairs that were put in by the Labour Government.

[Andy Burnham]

In the 1980s, I had the misfortune to go to a comprehensive school in my hon. Friend’s constituency—a Merseyside comprehensive. It was not a great deal of fun. School sport had dried up and the buildings were appalling. It fills me with dread that my children will go to secondary school under a Tory Government. We on the Opposition Benches will campaign to ensure that another generation is not failed as others were.

--- Later in debate ---

[Andy Burnham]

I hope that the Government will take account of my hon. Friend’s point because there is good evidence to show that the policy has been a success and is helping many more young people stay on in education and achieve.

[Mr Watts]

Is my right hon. Friend as depressed as I am about the fact that the Government seem to be saying that financial assistance to families does not matter, the poor state of school buildings does not matter and the overall funding package for education does not matter? What seems to matter is that both the Liberals and the Conservatives are determined to cut education spending and push people back into deprivation.

[Andy Burnham]

That is the inference that people will draw. There is an obsession with structures, not with standards or with helping young people to be the best they can be. I would like to hear the Secretary of State talk a little more about that and a little less about free schools and whatever structural ideas he is dreaming up. Let us focus on standards and on the aspiration of kids from a working-class background. Let us give them some hope rather than introducing organisational reforms that may or may not offer them anything. That is the problem the Secretary of State is facing.