NHS (Government Spending)

Chris Leslie Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie (Nottingham East) (Lab/Co-op)]

I beg to move,

That this House notes comments from leading doctors and nurses that the NHS is in crisis under this Government, which has wasted £3 billion on a reckless reorganisation; believes an extra £2.5 billion a year should be invested in the health service, including to fund an additional 20,000 nurses and 8,000 GPs, by raising additional revenue from closing tax loopholes, a levy on tobacco companies and a tax on properties worth over £2 million; further notes that the Office for Budget Responsibility has said that the Government’s spending plans in the Autumn Statement would return public spending to a share of national income last seen in the late 1930s, before there was an NHS, and a level which is incompatible with the Government’s claims to be able to protect the NHS; recognises that only four OECD countries have total government expenditure at 35 per cent or less of GDP and that all of these countries have significantly higher charging as a share of overall national health spending than in the UK; and calls on the Government to reconsider the plans set out in the Autumn Statement for even deeper spending cuts, which the head of the Institute for Fiscal Studies has said could involve a fundamental reimagining of the role of the state.

We have discussed already today some of the issues facing the NHS, but when will the Government realise that our health service faces such unprecedented pressures that it is in intensive care and in need of urgent attention if we are to avoid reaching the point of no return?

I want at the outset to set the context for this debate, because it is important that we look at this Administration’s record so far. We know that the numbers of people waiting for more than four hours in the accident and emergency departments of our hospitals throughout the country have grown and grown, but in 2014 almost 1.25 million people waited for longer than four hours. It is true that the number of people going to A and E has been increasing: in the last four years of the last Government, it was rising by about 60,000 a year, but in the last four years it has gone up by 600,000 a year. This is a rapid escalation in the level of strain on our NHS infrastructure, which has a series of causes that fall at the Government’s door.

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

It gets worse. At University hospital in Coventry, we are now back to the bed-blocking of previous Tory Governments as a result of cuts to local government funding for social workers, which means that people cannot be discharged. That is back to the future, as it were.

[Chris Leslie]

The accident and emergency situation is a barometer of a series of failures across the health and social care infrastructure. I shall certainly deal with some of those questions, as will my hon. Friends.

[Mr Simon Burns (Chelmsford) (Con)]

Will the hon. Gentleman give way?

[Chris Leslie]

I will give way to the right hon. Gentleman in a moment. My hon. Friend talked about Coventry; last Friday in my constituency in Nottingham I attended a summit with health chief executives, the local authority and others. At the A and E department at Queen’s medical centre more than one in four patients waited for more than four hours in the first few weeks in January—a totally unacceptable situation. This is not something that affects only my constituency; it affects those of all my hon. Friends, and probably even that of the right hon. Gentleman, to whom I will be happy to give way.

[Mr Burns]

I read the motion carefully. It is about the NHS and spending on it, as the hon. Gentleman has illustrated in his remarks so far. Will he explain something that puzzles me? I know that the shadow Secretary of State’s interview with Kirsty Wark on “Newsnight” last night was a car crash, but why is he not opening this debate? He has never been reticent in the past in coming forward to try to weaponise the NHS. Is it because his leader has wrapped him up in cotton wool to keep him away from the public gaze?

[Chris Leslie]

The right hon. Gentleman raises a number of issues there. He has plenty to puzzle over, and he will always be a puzzled individual. The bigger question is where is the Secretary of State for Health when we are talking about these particular issues? [Hon. Members: “There!”] There he is. He is so anonymous he just did not make any impact on me whatever. I am delighted that he has walked in. He is quite unforgettable, isn’t he?

The NHS has experienced problems not just in accident and emergency departments, as has been said, but across a series of services: missed cancer treatment targets for three successive quarters—15,000 people having to wait longer than the recommended 62 days to start their cancer treatment in the past year. It has not always been like this.

[Charlie Elphicke (Dover) (Con)]

rose—

[Chris Leslie]

The Government inherited a situation in which 98% of patients were seen in accident and emergency departments within four hours. While one in four patients is now waiting a week to see their GP, when Labour left office the vast majority were seen within 48 hours. In January, we know that 14 NHS trusts declared major incident status. [Interruption.] The urgent question today did not really provide the opportunity to clarify the exact words in the NHS England document, so I want to take this opportunity to do so on behalf of my right hon. Friend the shadow Secretary of State.

[Charlie Elphicke]

rose—

[Mr Speaker]

Order. Members shouting, and then expecting to intervene, do not display great wisdom. The hon. Gentleman can probably do better, and he should certainly try to do so, within the limits of his capacity.

[Chris Leslie]

I am very grateful, Mr Speaker.

In urgent questions, there is obviously a time limit on our ability to read out quotes from NHS England documents, but there is no such time limit in an Opposition day debate, so let us take the opportunity to spell something out clearly for the record. The Secretary of State is here now. I apologise for not noticing him as he came into the Chamber, but he is here now, and that is good, because I can hold this document up and show it to him—it says “NHS England” on the front. He is nodding; he has accepted that point. I turn to page 21, where in paragraph 7.2.3, under the heading—[Interruption.] Government Members want to shout me down. If the Under-Secretary of State, the hon. Member for Battersea (Jane Ellison), is patient I will read out the full quote from the NHS England document. It refers to principles for considering escalation and the responses to be had. Paragraph 7.2.3, under the heading “Politics”, says:

“(a) Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?

(b) Is there a requirement to bolster or assure public confidence?

(c) Is there a risk of reputational damage?”

I do not understand why an NHS document contains those exact words. The Secretary of State can probably read them from there, across the Table—he is nodding again. Yet only a few minutes ago he denied that NHS England had such a document. What am I holding up—a mythical piece of paper? We can now at least establish that NHS England has been issuing documents suggesting that reputational damage and politics need to be taken into account when preventing major incidents. We have now at least had the opportunity to read into the record, as Hansard will reflect, the full text of that NHS England document.

This is the set of situations and circumstances that the NHS faces: pressures on A and E departments, pressures on cancer treatment, and pressures on the major incidents as we have seen. Why are things in such a fragile and critical state? The Government took £3 billion out of elderly social care and wasted it on a £3 billion reorganisation of the NHS that nobody voted for and nobody wanted. They are cutting corners and rushing the care that is needed to help the frail elderly to stay out of hospital. What greater example of a false economy could there be?

[Mr Marcus Jones (Nuneaton) (Con)]

Given the hon. Gentleman’s comments about the adult social care budget and the Opposition’s complaints about the money that has been taken from local authorities, will he commit to giving the money that he says has been taken from local authorities back to them in the next Parliament, should we have the misfortune to have a Labour Government?

[Chris Leslie]

That was a very helpful intervention. I thank the hon. Gentleman, who has only a number of months to go in his current job. We have explained how we can hire a further 5,000 home care workers, a further 3,000 midwives, a further 20,000 nurses and a further 8,000 GPs through the time to care fund—the £2.5 billion a year that is fully costed and fully funded. I will methodically go through the detail of how we pay for that—he need not worry about that.

[Stella Creasy (Walthamstow) (Lab/Co-op)]

Let us take this debate back to the people we care about most—the patients, such as the mum who got in touch with me today who had rung her local GP 28 times to try to get through to get an appointment for her daughter, and whose friend had been told, “Don’t risk it—go to A and E because we simply cannot see our doctors.” Does my hon. Friend agree that the fragmentation of the NHS has made it much harder to hold to account our local health care services such as the Royal Free trust?

[Chris Leslie]

I am glad that my hon. Friend mentions the situation with GP numbers, which is another factor in the NHS infrastructure being under such pressure.

Let us look at what has been happening with GP numbers, which are not keeping up with demand in the rising population. In 2009, there were 62 GPs for every 100,000 people; that has now fallen to 59 and a half GPs per 100,000 people. We have also seen cuts to GP training. It is no wonder that the Government ditched the 48-hour guarantee for people to be able to see a GP.

[Charlie Elphicke]

rose—

[Chris Leslie]

I will give way to the hon. Gentleman if he can explain why the Government dropped the pledge that patients, including his constituents in Dover, should be able to see their GP within 48 hours.

[Charlie Elphicke]

Can the hon. Gentleman explain why he, rather than the shadow Health Secretary, is leading this debate? Is it because the shadow Health Secretary is reported to be clinging to his job, without any guarantees from the Leader of the Opposition?

[Chris Leslie]

There you have it, Madam Deputy Speaker. Government Members are not concerned in any way about the state of the NHS or about GPs, but only about asking questions about procedure and process. I am here today because the shadow Treasury team, like every shadow departmental team on the Labour Front Bench, is committed to supporting our NHS and to making sure that we get the investment that is needed.

Why is the situation so fragile? The Government scrapped NHS Direct and fragmented it into 46 separate, cut-price 111 contracts, which does not ensure that 60% of calls are dealt with by medical staff. That figure is now down to 20%. It is no wonder patients are so quickly being driven back to—[Interruption.]

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Minister, I heard what you said to your Back Benchers and it is out of order. The hon. Member for Wyre Forest (Mark Garnier) will disregard the advice from the Minister. I will not embarrass the Minister by saying exactly what it was, but I will not hear him say it again.

[Chris Leslie]

That is rather curious, Madam Deputy Speaker. I would be quite interested to know what the Minister was saying. Perhaps the hon. Member for Wyre Forest (Mark Garnier) heard it. What did the Minister say to him?

[Mark Garnier (Wyre Forest) (Con)]

I have to confess that I did not hear it—I do apologise—but it would have been very sound advice.

I am curious. As we have a shadow Treasury Minister here, perhaps this is an opportunity for him to explain to my constituents what he proposes to do to help them. It is important to remember that one of the very first things the Labour Government did when they came to power was to close the A and E department at Kidderminster hospital and downscale that hospital. As a result, Labour policies were so massively hated by my constituents that they voted in an Independent, Dr Richard Taylor. That demonstrated just how unpopular Labour’s NHS policies really are.

[Chris Leslie]

Labour Members are absolutely committed to saving the national health service from the fate that would befall it should the hon. Gentleman’s party have a further five years in office. We will absolutely not apologise for fighting tooth and nail to do what we can about, for instance, the staffing crisis that the NHS also faces.

[Dr Sarah Wollaston (Totnes) (Con)]

rose—

[Chris Leslie]

Before I give way to the hon. Lady, I shall tell her what is happening with staffing in the NHS. The NHS is now spending a further £500 million a year on agency nurses. Six thousand nurses who were trained in the UK have left the country and gone elsewhere, and 4,000 nurses are coming from overseas to try to back-fill some of those places. We are spending a fortune, day after day—far more than we ought to be—on these more expensive agency nursing staff. I know that as Chair of the Health Committee, the hon. Lady has a view on agency nursing within the NHS. Is she really content with the situation?

[Dr Wollaston]

I will write to the hon. Gentleman on that point, which is very important, but I wanted to respond to his question to my hon. Friend the Member for Dover (Charlie Elphicke) about why we dropped Labour’s policy of 48-hour access. I will tell him why, as a former GP who was there at the time: it was because patients could not get advance appointments. It caused enormous distortion of clinical priorities, and it was absolutely right that it was dropped, as called for by the profession. It was a ridiculous policy and it is absolutely right that it has been dropped.

[Chris Leslie]

The hon. Lady should know that there were provisions for advance appointments in the system that we had. Given that we have these pressures, with GPs being totally overstretched and having more and more people to deal with, and the shrinking number of GPs per head of population, she should not be surprised that we are in this situation. We have to do more to recruit and train more GPs. That is part of the way in which we would save the NHS from the situation that it is facing.

When all these different factors are combined with the high levels of winter flu and the growing population, we have an NHS in crisis—but there is an alternative. Yes, we have to repeal the competition-driven Tory changes, but we also have to deliver a sustained increase in resources and a fund designed urgently to alleviate the pressures. That is why, as shadow Chief Secretary, I want to take the time to talk about our £2.5 billion fund.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I am grateful to the shadow Chief Secretary, because I have sat quietly and listened to 16 minutes of his speech trashing the NHS. Will he take the opportunity to congratulate staff at Worthing hospital who, in very difficult circumstances, have met waiting times targets in above 98% of cases? Will he congratulate the staff who have cut hospital-acquired infections by 50% since 2010? Will he congratulate NHS staff who have reduced the number of people in mixed-sex wards from 11,802 in 2010 to 170? May we hear some good news about the staff who are doing a really good job?

[Chris Leslie]

We will hear this time and again from the Conservatives. They want to gag us when we dare to criticise their record on the NHS. We are not going to be quiet about it. We are going to fight for the future of the NHS. I would tell the hon. Gentleman that we do not have any criticisms of the staff in the NHS, or even of the managers who are trying their best in very difficult circumstances to keep the NHS on an even keel. He should know about the BUPA contracts in his West Sussex hospital—

[Tim Loughton]

indicated assent.

[Chris Leslie]

The hon. Gentleman nods. Those contracts have greatly destabilised his local hospital. He voted for that in the then Health and Social Care Bill, which was designed to drive competition all the way through the NHS by stealth, and what a mess it has created in his own patch. I am happy to give way to him if he wants to apologise to patients in West Sussex for the waste and distraction the BUPA contractual arrangement has caused there. Will he apologise?

[Tim Loughton]

I am delighted to intervene because the shadow Secretary of State, who has now appeared, mentioned that in his car crash interview last night. I do not know if the shadow Chief Secretary has been to Worthing or has looked at the contract, but it made no difference in money terms. As it happens, I opposed the contract, as did my hon. Friend the Member for Worthing West (Sir Peter Bottomley), because there was no impact study. As a result, we will now get a better service—run by the hospital—that is more seamless for patients. Will the shadow Chief Secretary apologise?

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Interventions must be brief. Mr Leslie, get back to your speech.

[Chris Leslie]

I think we got the gist of the intervention. The hon. Member for East Worthing and Shoreham (Tim Loughton) opposed such competition, but I think he voted for it in the Health and Social Care Bill. He has his own demons to worry about on that.

[Grahame M. Morris (Easington) (Lab)]

I, too, served on the Health and Social Care Bill Committee. Does my hon. Friend agree that one of the great problems we face with work force planning, as Government Members have highlighted, is that private sector providers by and large are not training the doctors and the range of staff we need to deliver an integrated health service?

[Chris Leslie]

My hon. Friend is right. That is the crucial difference between those on the two sides of the Chamber: Government Members are not interested in having private or voluntary sector supplements where there is need in the NHS; their agenda is to replace provision across the NHS and to contract out across the board.

[Several hon. Members]

rose—

[Chris Leslie]

If my hon. Friends will allow me, I want to make a little progress, but I will certainly give way again in a moment.

As a member of the shadow Treasury team, I want meticulously to explain the alternative course by which we will deal with the requirement for 20,000 additional nurses and 8,000 additional GPs, and the time to care fund of £2.5 billion. First, we would raise £1.2 billion from the levy on ultra-high-value properties—those worth more than £2 million—the so-called mansion tax.

Secondly, we would raise least £1.15 billion by closing three tax loopholes. The first is that hedge funds are avoiding stamp duty by getting tax-exempt investment banks to buy shares for them. At least £500 million is lost through that tax loophole, and we must close it. The second is that many large corporations, including some of the water utilities, are shifting profits out of the UK by borrowing large sums at high interest rates via their owners’ subsidiary companies through offshore stock exchanges. That is known as the quoted eurobond exemption. The third is that many employment agencies sign up workers to umbrella companies almost at random, and exploit tax reliefs on travel and subsistence without passing them on to the work force. Between £300 million and £600 million is lost to the Exchequer in that way. Those three tax loopholes must be closed.

Thirdly, we need to take £150 million a year from a new levy on tobacco company profits. That levy has worked in the United States, and we believe it is now appropriate in this country.

The sum of £2.5 billion is a significant investment that our NHS needs. It will also provide the time to care for the patients who deserve much more than the 15-minute chunks they have been getting recently.

[Margot James (Stourbridge) (Con)]

Leaving aside the fact that the previous Government were not much good at closing tax loopholes, I am sorry to hear that the Labour party has lost faith with one of the fundamental principles of the NHS, which is that it should be based on need and funded through general taxation. That is the most stable basis for funding our NHS, and the Labour party is taking a great risk with NHS finances by proposing otherwise.

[Chris Leslie]

That is rather interesting. The hon. Lady would criticise us if we said that we would do this through general taxation, but when we show where the money will come from—pound for pound—she criticises that as well. I want to hear the Conservatives say where they will get the extra money from for the NHS. I will come to that in a moment, but I will first give way to my hon. Friend.

[Lilian Greenwood (Nottingham South) (Lab)]

A moment ago, my hon. Friend was talking about the risks of privatisation. I know he shares my concerns about health services in Nottingham. What advice does he have for the voters of Nottingham who, as a result of the outsourcing of our hospital’s world-renowned dermatology department, which was then broken up, can no longer access acute dermatology services locally? How should our constituents vote on 7 May? [Interruption.]

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Mr Garnier, I am not going to tell you again. You are on a warning now. You make lots of interventions. Members show you respect, and I expect you to show it to others when they make their points.

[Chris Leslie]

That is so unlike the hon. Member for Wyre Forest (Mark Garnier), and very out of character.

My hon. Friend the Member for Nottingham South (Lilian Greenwood) is a doughty fighter for NHS patients in our city of Nottingham. She knows very well that we have been trying our best, in working with local trusts, to press them to ensure that such services are safeguarded. Ultimately, when our constituents see the Government passing legislation encouraging trusts to move a private income level of 2% to potentially 49%, and when they see the pressure trusts are under, they are not surprised that many such problems are occurring in our area. It is only through making sure that we find resources and channel them towards investment for the care needs in our NHS that we will deal with those pressures.

[Andy Sawford (Corby) (Lab/Co-op)]

Does my hon. Friend agree that, as well as ensuring there are finances at national level, we must ensure they are fairly distributed across the country? NHS England has a target funding allocation for Corby, but the National Audit Office and the Public Accounts Committee say that my local health authority is the worst funded in the country. Will shadow Ministers commit to fairness of funding when in government?

[Chris Leslie]

We know that the Conservative party has tried to distort funding formulas across the country by stealth. In fact, they have not done it stealthily; it has been pretty bleeding obvious. Given how local government funding formulas have been skewed—away from areas of need, and in a gerrymandering fashion—I certainly agree that such a situation must be reviewed.

[Several hon. Members]

rose—

[Chris Leslie]

If my hon. Friends will allow me, I will give way in a moment. I want to pick up the point made by the hon. Member for Stourbridge (Margot James), when she implied that the Conservative party somehow has plans to support additional investment in the NHS. The Chancellor of the Exchequer alluded to the fact that the Government might be able to cobble together £2 billion of additional funding. According to page 65 of the Treasury Green Book—“Autumn Statement 2014”— £1.2 billion was supposed to come from reserves or underspends for the NHS, but there is absolutely no commitment for any additional money beyond 2015-16. I will give way to the Minister if he will explain where his party has identified resources to meet that commitment beyond 2015-16. Will he spell that out? [Interruption.] I do not think that he wants to. My hon. Friends will ensure that he explains later, as he has just promised, because the public need to know where the money will come from to meet the pressures we face.

The Conservatives also wanted to switch £750 million out of Public Health England and Health Education England as some kind of sticking plaster for the NHS. However, we must think about the impact switching money away from preventive systems such as inoculations and vaccinations would have. [Interruption.] The Liberal Democrat Minister of State thinks that that is a good idea, but it is not a sustainable way to provide funding for our NHS. He has to do his sums again, make tough decisions and find the additional resources. Of course, the Liberal Democrats have said that growth will somehow magic up the money for the NHS, which shows their lack of credibility.

It is no wonder that the Institute for Fiscal Studies has said that Labour is the most cautious party in ensuring that it fully funds its pledges. It is no wonder that the Government parties do not want the Office for Budget Responsibility to go anywhere near the costings for the promises of political parties.

[Caroline Lucas (Brighton, Pavilion) (Green)]

Does the hon. Gentleman agree that when Government Members ask us to congratulate NHS staff, which we do, it seems a bit hollow when they will not even pay nurses a decent wage? Does he further agree that privatisation is fragmenting the NHS, making it much harder to deliver a good service for patients?

[Chris Leslie]

We have to do far more to create a joined-up health service and social care system. That is very much part of the 10-year plan for the NHS that we announced yesterday. Yes, this is a debate about resources and getting the investment in, but we have to do more than that.

I question why the Conservatives are not putting their plans for funding the NHS on the record. Is it that they do not have any plans to pay for it or, which is more likely, that they are committed to shrinking public service investment in this country? The Conservatives and the Liberal Democrats have signed off on projections that would shrink public services to just 35% of GDP by the end of the coming Parliament. [Interruption.] I say to the hon. Member for Daventry (Chris Heaton-Harris) that there was nothing in the charter for budget responsibility about shrinking the state to 35% of GDP. That is his plan. Public services have not been at that level since the late 1930s—before the NHS even existed.

That is the Conservatives’ vision, but what would it mean for the NHS? We are fortunate in this country that charging makes up just 10% of a patient’s out-of-pocket expenses. That includes prescriptions, optical services and dental services. Let us just look at how it works in those countries where public services form just 35% or less of GDP. There are four such countries across the OECD. In Switzerland, where public services make up 32.8% of GDP, more than a quarter of a patient’s income goes towards the cost of treatments. It has an insurance system in which the patient effectively pays an excess: as with a car insurance system, the patient has to pay the first amount and it is deducted from the total bill. Patients in Switzerland typically pay £1,800 out of their own pockets. In Mexico, charging makes up 44% of out-of-pocket expenses, in Chile it is 32% and in Korea it is 36%. Korea has a co-payment system, which means that up to half the hospital costs have to be borne by the patient.

Such things happen in every country where less than 35% of GDP goes towards public services. The Conservatives want to head us in the direction of such pressures. An NHS free at the point of use is not sustainable under the Conservative plans, and the risk that charges will be introduced is great.

The Conservatives have form on this issue, because their 2005 manifesto, which the Prime Minister and the Chancellor authored, encouraged people to go private. They wanted a patient passport that would have introduced charges for people who wanted to jump the queue. I wonder whether my hon. Friends recall that. The Prime Minister and the Chancellor wanted such charges for basic medical treatments. I have another question for the Minister and, again, I will give way to him. Would the Conservative party still introduce those plans in the dreadful event that they won the next general election? I will give way to the Minister if he wants to say that that is categorically not part of his party’s plans.

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

I am sure that the hon. Gentleman can be patient. I will reply to him in a few moments when he finishes his speech.

[Chris Leslie]

It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.

What else can we expect from the Conservatives? More privatisation and more market-based changes.

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

I, too, serve on the Health Committee. Alongside the things that we have heard about today and the concerns expressed by Opposition Members following the Health and Social Care Act 2012, is it not a really worrying development that £1.2 billion of cancer services and end-of-life care services in Staffordshire and Stoke— a wide geographical area—are being tendered out in a 10-year contract? That is a risky thing to do and it has never been done before for a single disease. Will all patients with cancer who are at the end of their lives be able to rely on those services, given that the majority of those tendering are private companies? Is that not the big issue? Will the Minister answer that point?

[Chris Leslie]

That is the sort of ideological stain that has pervaded the NHS policies of recent years. We must recognise that, should the Conservatives win the general election, we will see more of the same. That is the course the NHS will pursue. Not just that, but the Government breach the NHS constitution time and again on safeguards, waiting times, ambulance responses and cancelled operations. The squeeze on resources will force patients increasingly to pay for private treatment.

It fell to the generation after the second world war to build the NHS. It fell to Labour in 1997, after 18 years of Conservative neglect, to save the NHS. Today, it once more falls to Labour to rescue the NHS and rebuild it for the 21st century. The choice is stark: a tangible and fully funded 10-year plan to boost investment in our NHS with Labour, versus more decline and more of the same from the Tories, as they dismantle the NHS by stealth. It is beyond doubt that the NHS as we know it cannot survive another five years under the Tories, because once the NHS is gone, we will never get it back.

--- Later in debate ---

[Dr Poulter]

My hon. Friend makes a very good point. The mansion tax, which is alluded to as a major plank of the Opposition’s funding plans for the NHS, has already been spent three times—that is economic incompetence if nothing else.

[Chris Leslie]

The Minister claims to be spending NHS resources effectively. Let us put to one side the £3 billion that he wasted on the NHS reorganisation—difficult though that is to do—and address the issue of clinical negligence in the NHS. My understanding is that it was at about 0.8% of NHS expenditure, but it has now gone up to an astonishing 1.1%. More than £20 billion has been set aside for clinical negligence provision because clinicians do not have the time they need to do the job and stop problems occurring. Should not the Minister apologise for that?

[Dr Poulter]

That is frankly not true and a misrepresentation of the facts. We have a very safe health service, and that was recognised by the Commonwealth Fund. We also know that even in a very safe health service bad things sometimes happen. This is not a controversial point: it is a sensible and important point. In some areas, such as obstetrics, we have very safe care in the main, but sometimes there can be a very high quantum of claims, such as £7 million for a lifetime of care in one case. We have to make sure that in the rare cases when things go wrong we look after people properly. That is uncontroversial.

The projected future trajectory for the litigation bill spend was exactly the same under the previous Government as it is now, and we are looking at dealing with lower value claims to save money on litigation in the future and removing the sometimes adversarial nature of litigation, which is much more beneficial for patients and their families.

[Chris Leslie]

To focus on the detail and take the politics out of this issue, I think that the Minister said that the clinical negligence bills have not gone up under this Government compared with those under the previous Administration. If he wishes to repeat those words, I am sure that his officials and others will correct him. Does he really think that there are no further clinical negligence liabilities under his watch?

[Dr Poulter]

The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means a greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.

As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under the right hon. Member for Leigh (Andy Burnham), the number of managers in the NHS went up six times as fast as the number of nurses.

--- Later in debate ---

[Dr Poulter]

Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.

We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.

At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.

The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.

[Chris Leslie]

Because I’m a doctor.