NHS Services (Access)

Baroness Keeley Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

I am interested to see this new friendship that my hon. Friend has struck up with the hon. Member for Clacton (Douglas Carswell) on the Front Bench. My hon. Friend is absolutely right. The promise was that there would be no top-down reorganisation. We told the Government that it would be a major mistake to break that promise. They broke that promise and now they are admitting it in private to newspapers. I will come to that point a bit later.

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

It is worth saying to my right hon. Friend and to the hon. Member for St Ives (Andrew George) that all of us on the Health Committee were very concerned yesterday when we spoke to people in Staffordshire and Stoke, because they were talking about what seemed to be the privatisation of cancer and end-of-life care services. That seems to be going on much to the consternation of clinicians and radiologists who were not consulted; much to the consternation of NHS staff and of an awful lot of patients and people who live in that area. It is very concerning indeed that we find ourselves in that situation. That could be one of the biggest mistakes that is made in the NHS.

[Andy Burnham]

I am glad that my hon. Friend raised that point, as again it highlights the major difference between us and the Government. They were saying that we brought in private providers. Yes, that is true, but that was to bring down waiting lists for planned operations, such as hip and knee operations. As she has just rightly said, the Government are putting out to tender cancer services. That is a very different thing. The Government are presiding over a major increase in private ambulances providing blue light 999 services. That is a massively different policy from the one they inherited, which is why the points they have made simply do not hold water.

--- Later in debate ---

[Mr Hunt]

I will give way in a moment, but I want to make some progress.

I want to go through the arguments of the right hon. Member for Leigh in detail, but let me start with the elephant in the room: the massive financial pressure facing the NHS if it is to meet our expectations in the face of an ageing population. There are now nearly 1 million more people over 65 than when this Government came to office. Our economy then was nearly bankrupt. Despite those extraordinary challenges, this Government have been able to increase spending on our NHS—including on Leigh infirmary in the right hon. Gentleman’s constituency—because of our difficult decisions, which were opposed at every stage by the Labour party. Government Members know one simple truth: a strong NHS needs a strong economy.

On the day that unemployment fell below 2 million and the claimant count fell below 1 million, there was nothing in the right hon. Gentleman’s speech about the need for a strong economy to support our NHS and nothing about learning from the Labour Government’s disastrous mistakes, which were so bad that they were in fact planning to cut the NHS budget had they won the election. We should remember that countries that forgot about the deficit ended up cutting their health budgets—Greece by 14% and Portugal by 17%. [Interruption.] Well, these are the facts. We must never again in this country allow the poor economic decisions that have been the hallmark of every Labour Government in history.

[Barbara Keeley]

It is interesting that the Secretary of State is claiming credit for things where the data are based on Labour’s achievements with the NHS, while anything else is our fault. He talked about older people and the demographics of an ageing population, but what good does he think he is doing to that section of the population with £3.7 billion of cuts to social care? Particularly as we move to integration, how does he think that will help those people? In my local area, 1,000 people will lose their care package this year. How does he think that will help the NHS in Salford?

[Mr Hunt]

I will tell the hon. Lady what we are doing: we are integrating the health and social care systems through the Better Care fund—a £3.9 billion programme—which is something that Labour could have done in 13 years in office but failed to do. That will make a massive difference to the social care system. Let us move on to some of the detailed arguments.

--- Later in debate ---

[Mr Hunt]

That is the point. We get all sorts of rhetoric from Labour, but when we look at its record of running the NHS—whether its disastrous record in England previously, or its disastrous record in Wales today—we see the real face of Labour policies on the NHS, and no one should ever be allowed to forget it.

There has been a lot of discussion about reorganisation. The right hon. Gentleman criticised reorganisation as if it were the last thing in the world that a Labour Government would do, but the previous Labour Government had nine reorganisations in just 13 years. Following the conference season, we know that Labour wants to have yet another one by effectively abolishing clinical commissioning groups in all but name and making GPs work for hospitals. There is widespread opposition to that policy across the NHS.

The right hon. Gentleman has repeatedly claimed that the reforms have cost £3 billion, but the audited accounts show that the reforms will save nearly £5 billion in this Parliament and £1.5 billion a year thereafter. These are the words of the National Audit Office—[Interruption.] He should listen to this, because this is about an independent audit that relates to a key part of his case. These are the words of the National Audit Office in its 2013 report:

“The estimated administration cost savings outweigh the costs of the reforms, and are contributing to the efficiency savings that the NHS needs to make.”

Will he publicly correct the record and accept what the National Audit Office has said, which is that the reforms saved money? The man who is never short of a word is suddenly silent. I have the National Audit Office report here, so he can see for himself. The reforms saved money.

If the right hon. Gentleman wants to talk about wasting money, I am happy to do so. The management pay bill doubled under Labour, compared with a 16% drop under this Government. The private finance initiative schemes left the NHS with £79 billion of debt. The IT fiasco wasted £12 billion. We will take no lectures on wasting money from the party that was so good at wasting it that it nearly bankrupted the country, let alone the NHS.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress.

The right hon. Gentleman said that the reforms have made it harder to access NHS services. The opposite is true. Scrapping the primary care trusts and strategic health authorities meant the introduction of clinical leadership, which he wants to abolish, and allowed the NHS to hire 6,100 more doctors and 3,300 more nurses. Those members of staff are helping the NHS to do 850,000 more operations every single year compared with when he was in office. How can he possibly stand before the House and say that access to NHS services is getting worse, when nearly 1 million more people are getting operations every year compared with when he was Health Secretary?

--- Later in debate ---

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

The Government argued that the current NHS reforms—their NHS reforms—would result in major savings to the NHS, making our system more “responsible, efficient and affordable.” I am sure that many Labour Members will agree that reforms under the Health and Social Care Act 2012 have failed to deliver a single one of these aims. The NHS is costing more and delivering less, the quality of care it provides has declined and hard-working staff, particularly GPs, nurses and staff in A and E, are bearing the brunt of the Government's misguided and irresponsible measures.

It seems that senior Cabinet Ministers may think the same as Opposition Members. As we have heard, The Times quoted one as having said:

“We’ve made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.”

I think that it is about time Government Members owned up to their mistakes, and started to share their opinions openly with the House.

The reorganisation caused upheaval in every part of the NHS. Primary care trusts and strategic health authorities were abolished, and commissioning responsibility was transferred to NHS England as well as to clinical commissioning groups. The chair of a health and wellbeing board told me last Friday: “I am left more confused by the NHS England role than by anything I have seen over decades of involvement with the NHS.” More than 440 new organisations have been created, but all the evidence now shows that that has been done at a heavy economic and social cost. Some £3 billion has been wasted on altering the structure of the NHS rather than being spent on front-line patient care, and the reforms have consistently failed to be delivered within budget. In July last year, the National Audit Office stated that the cost of their implementation had been 15% more than originally expected.

Of course, we hear counter-claims from Ministers. When I tried to intervene on the Secretary of State, he would not take an intervention on the issue of management and reorganisation costs. It was interesting to hear what was said yesterday by Kieran Walshe, professor of health policy and management at Manchester business school, on Radio 4 about the savings claimed by the Secretary of State. He said that the Government had under-counted the costs of reorganisation, even to the extent of accepting nil returns from some strategic health authorities. Most tellingly, he said that the best way in which to test the facts was to talk to people in the NHS who had lived through the reorganisation. He said that he had not talked to anyone who thought that the reorganisation had made the NHS more efficient and more productive. He had not talked to anyone who thought that the trauma of total reorganisation and redesign was worth while. None of us understands why PCTs were replaced by CCGs, or why NHS England was created. He also said:

“I don’t think you will find anyone who thinks the new system costs less to run”.

We know that the financial difficulties of the NHS have worsened, not improved. For the first time, foundation trusts have found themselves in deficit, along with trusts that are not foundation trusts. Figures from Monitor showed that 86 out of 147 trusts were in the red, and that there had been a deficit of £167 million in the first quarter of 2014-2015. Alongside that, not surprisingly, we are seeing a decline in patient care. In all areas of the NHS, pressures are mounting and the quality of care is declining. The number of people waiting more than a week for an appointment with a GP is up. A survey of patients in Salford for our CCG showed that a third of the patients who responded had had to wait for days for an appointment, and one in seven Salford patients had had to wait for a week or more. That is better than the national picture, but it is not good enough. For the first time, the NHS has missed its cancer treatment target; and NHS workers have felt the need to go on strike—the largest strike of its kind in over 30 years. We have an NHS in crisis.

As we know, there are many challenges in addition to the damage that has been inflicted by the Health and Social Care Act 2012. We have heard about the mounting demographic pressure on health services. However, despite the increase in the number of people aged over 80, the Government have slashed local authorities’ budgets, causing them, in turn, to change eligibility for social care. I believe that that is one of the most serious failings. My city council in Salford has been subjected to savage cuts of £100 million, and—I mentioned this earlier, and I shall keep on mentioning it—1,000 people in Salford will either lose care packages or not qualify for care this year.

[David T. C. Davies]

Does the hon. Lady think that members of the public should vote against any members of any political party who have imposed a cut on the NHS anywhere in the United Kingdom?

[Barbara Keeley]

I am not going to answer hypothetical questions like that. I am talking about local authority budget cuts, and the parlous state in which social care will find itself after £3.7 billion has been taken away from it.

Constituents have told me about care staff working locally who have been allocated too little time to devote to the people in their care. That is a scandal. I have been told that a single care worker was sent out when two were needed to care safely. I have also been told about patients in nursing homes who have not been properly changed or helped to eat by care staff who are rushing to manage their work load. That is the reality, and it is not the way in which to create a sustainable health and social care system. I therefore wholeheartedly support Labour’s alternative plans. We must create an NHS with the time to care.

I agree with my right hon. Friend the Member for Leigh (Andy Burnham) that we must repeal the Health and Social Care Act 2012 before it causes any additional lasting damage to a health system of which people in this country are rightly proud, although they will not be for much longer. I shall be here on 21 November to vote for the private Member’s Bill. We must find ways of providing the resources to cope with the challenges that the NHS will face. As my right hon. Friend said, Labour has pledged to raise £2.5 billion for the NHS Time to Care fund, which will provide 20,000 new nurses, 8,000 more GPs, 5,000 new homecare workers and 3,000 more midwives. And do we need them? Yes we do.

We must also move towards an integrated model of health and social care. That integration in itself will not solve the financial problems the NHS faces, but moving to a model that allows for equal consideration of all a patient’s health and care needs can improve services and should reduce duplication. Above all, we must place patients and carers back where they belong, at the heart of a health and social care system that works for them and puts their needs before those of the providers and the ridiculous and convoluted commissioning structures that we have been arguing about in the debate today.