NHS Services (Access)

David T C Davies Excerpts

Wednesday 15th October 2014 Commons Chamber

[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.

[David T. C. Davies (Monmouth) (Con)]

The right hon. Gentleman is making some emotional points here. Does he support the policies of his colleagues in Wales, and does he endorse the way in which they have dealt with the NHS in Wales?

[Andy Burnham]

I do get emotional about the NHS, because I believe in it, unlike the hon. Gentleman. That is fine, I do not mind—it does animate me. Let us have a look at Wales and, as I am about to come on to cancer care. In England, only 84% of patients receive treatment within 62 days. That is not good enough, and Wales has better figures on cancer care. The analysis of the four home nations’ health care systems found that there is good and bad in all of them and this Tory attack on the national health service in Wales has to stop.

I will move on to cancer and I will go back to the letter that I was quoting. It said:

“Thousands of patients are facing longer and even unacceptable waits to find out whether or not they have cancer, because services are under extreme pressure and referral targets are being missed.”

In 2014, 10,000 people in England had to wait longer than the recommended 62 days to start their cancer treatment. The number of patients waiting longer than six weeks for diagnostic tests has doubled in the past year—doubled, for cancer tests. That is simply not acceptable. We need to hear today what the Secretary of State is going to do about it and may I suggest that the very first thing he should do is stop the cuts to cancer care? A parliamentary question shows that expenditure on cancer services has fallen by £800 million in real terms since 2009-10; the information comes from his Department and I will send it to him. That is why the NHS has missed the cancer treatment target for two quarters running, the first time that it has ever done that.

The evidence is indisputable. The NHS has gone downhill on this Government’s watch and the question follows of what they are doing to bring GP, A and E and cancer services back up to national standards. That is what our motion and, more importantly, patients demand to know from the Secretary of State today, but they will also want to know why the NHS has gone from being a successful service four years ago to being at breaking point today. The front page of The Times on Monday offered us an answer. It quoted a senior Cabinet Minister who said:

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

The Secretary of State is conveniently looking down and avoiding my eye at this point, but I am sure he has found out who that was. I am sure he knows. I know that he is avoiding looking at me, but is he prepared to tell us who it was or is he going to carry on with his head buried and avoiding—[Interruption.] He is blushing. I see that he has the good grace to do that, at least. It is an embarrassing comment, it really is, from a senior Cabinet Minister, but what use is it to people now, when people such as the hon. Member for St Ives (Andrew George) and I were pleading with the Government to stop the process, to admit that it was all a mistake? It is an embarrassing situation for the Secretary of State to deal with, but at least we have from the very top of this arrogant Government the first admission that their reorganisation was a major mistake.

The article goes on to quote an ally of the Chancellor, who says:

“George kicks himself for not having spotted it and stopped it.”

Not having spotted it? This was famously the reorganisation so big we could see it from space. Not spotted it? What planet was the Chancellor living on? The truth is that the Government could have and should have stopped the reorganisation for the simple reason that they were elected on a promise of no top-down reorganisation and did not have the permission of a single person in this land to carry it out. That is why Thursday 7 May 2015 will be their day of reckoning on the national health service.

If this private apology now is designed to bring people back on board, it will not work. Doctors and nurses lined up to plead with the Government to call the reorganisation off, but they ploughed on. In the words of Mark Porter, chairman of the British Medical Association:

“The damage done to the NHS has been profound and intense”.

Let me focus on just one example of that damage, staffing costs, as the Secretary of State was talking about them this week. The staff census shows very clearly that in the early years of this Parliament, when spending on back-office restructuring was at its peak, front-line nursing posts were cut by about 7,000. At the same time, the reorganisation threw nurse training into chaos. Training places were cut and have never recovered, down from 21,000 a year to 18,000 today.

The NHS has been recruiting more staff in the wake of the Francis report, but this is where the damage done by the reorganisation is hitting NHS trusts. They are being forced to recruit overseas or to turn to agency staff because there are simply not enough nurses coming through the training system.

I have been contacted by a whistleblower from a trust in Liverpool who says that it is now common for staff to receive text messages from agencies such as Pulse offering huge fees—up to £1,000—to work weekends in London or the north-east, with all travel and accommodation costs paid. That is now the norm, and it is happening on this Secretary of State’s watch. Some nurses are literally taking off one uniform on a Friday night and putting on another for the weekend. That is why the agency bill is out of control, and it is happening on his watch.

In 2013-14 the NHS spent £2.6 billion on agency staff. For foundation trusts that is a staggering 162% over what was planned. That helps to explain why trust deficits are mounting. Does not this mismanagement of the staffing budget explain why the Government are now reneging on their promise to pay nurses a meagre 1% pay rise? Is not that the real reason? I wonder how the Secretary of State thinks those nurses will feel when they read this week that senior mangers’ pay has increased by 13.8% on this Government’s watch, while their pay has gone up by only 5%. I am told that he has refused to meet the unions even to discuss it. It is not good enough. He should get to the negotiating table tomorrow and start treating the staff of our national health service with the respect they deserve.

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[Mr Hunt]

First, let me just correct for the record what the right hon. Gentleman has said. The Prime Minister’s commitment was not just a continuation of the ring fence; he has committed to continue to increase funding in real terms for the NHS. If the right hon. Gentleman looks at the record of this Government, he will see that we have increased spending on the NHS by more, in real terms, than Labour’s promises at its conference. The point about promises is whether the people making them are credible. Which party will deliver the strong economy that can fund the NHS?

[David T. C. Davies]

Will my right hon. Friend confirm that this Government have increased spending on the NHS in real terms by 3%? In Wales, where Labour is in control, there has been an 8% cut in real terms. How can we possibly trust a word Labour says on funding for the NHS?

[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.

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[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.

[David T. C. Davies (Monmouth) (Con)]

The Secretary of State and his Ministers will know that I have had cause to write to them, to e-mail them and even to meet them on numerous occasions to discuss the absolutely appalling second-rate NHS treatment that patients in my constituency are receiving. They are receiving such treatment from an NHS that is run entirely by the Labour party, which is enacting precisely the policies that Opposition Members wish to enact here. Those patients include Mariana Robinson, whom the Secretary of State was good enough to meet recently. She has waited months for diagnostic treatment for an illness that could well be cancer; she does not know what it is. She wants to be treated in England by the coalition-run national health service.

Those patients also include Mr Christmas in Abergavenny, a war veteran who is in his 80s. He had constant chronic pain in his tooth that was keeping him awake at night, but he was told that, despite his age and his war service, he would have to wait nine months for any form of treatment. In the end, he was forced to use his meagre savings to go private. Ann Wilkinson also wants to be treated in England. She has stated very publicly that she has cancer, but there is no cancer drugs fund in Wales and she wants to have access to Avastin. I believe that she will shortly present a petition in Parliament and in the Welsh Assembly demanding the same high standards in Wales that this coalition Government are already delivering in England.

Some Opposition Members, including the hon. Member for North Durham (Mr Jones), wanted to quote statistics.

[Andy Burnham]

The hon. Gentleman mentions access to cancer services. He might have heard me say earlier that the NHS here is missing its national cancer target, with more people waiting longer than 62 days. In England, only 84% of patients start to receive treatment within 62 days. Does he acknowledge that 90% of patients in Wales start their treatment within 62 days?

[David T. C. Davies]

When they have been diagnosed. The right hon. Gentleman has failed to point out that while only 2% of patients wait more than six weeks for diagnostic treatment in England, 33% of patients do so in Wales. That is absolutely disgraceful. If a situation in which 2% of patients are waiting more than six weeks is bad, what on earth are we to make of a situation in which 33%—one in three, or so—are waiting that long? I hope the hon. Gentleman would agree that that is a disgraceful situation.

The hon. Member for North Durham talked about ambulance response times and gave the House some interesting examples. However, the recent Nuffield report demonstrated that the worst ambulance response times in the United Kingdom were in Wales. We have accident and emergency targets, for those in Wales who are lucky enough make it into a hospital, but those targets have not been met since 2009. We have waiting list targets of 26 weeks, as opposed to the 18-week targets that apply in England. One in seven of the population in Wales is on a waiting list. That is what lies in store for people if they vote Labour at the next general election.

It was interesting that the hon. Member for Worsley and Eccles South (Barbara Keeley) was unwilling to say what she thought voters should do about people who wanted to cut NHS budgets. Despite all the Opposition rhetoric, this coalition Government have kept their promise and continued to fund the NHS. In real terms, we have increased its budget, whereas Labour—where it is in office—has cut NHS funding in real terms by about 8%. It cannot escape any of the blame for this. We heard about reorganisations earlier, and we have had several in Wales. We went from having five health boards to having 22 and then back to having seven. Not only has Labour been in power constantly, either completely or as the dominant party, ever since the Welsh Assembly was set up in 1999, but it has rammed those health boards full of Labour party supporters, failed parliamentary candidates, ex-Assembly Members, local councillors and the like. In one case, Labour put in a former general secretary of the TUC, who, I am guessing, is probably not a supporter of the Conservative party. Labour has politicised the health boards and it must therefore take complete responsibility for the shambles that has led to so many people wanting to be treated not in Wales but in England, by the coalition-run NHS.

No more damning example of all this can be given than the recent antics with the OECD, which is trying to carry out a comparison on NHS systems across the whole of the United Kingdom. The coalition Government are keen for that study to go ahead and are delighted with the opportunity to have themselves compared with Wales, and they should be; they have every reason to look forward to that. But of course the reaction in the Welsh Assembly has been one of absolute horror. I am told by very reliable sources that the Welsh Assembly Government cancelled the visit by OECD officials because they were so desperate to try to ensure that no report comes out before the general election. Of course, people watching this debate do not have to take the word of anyone in this room; they simply have to Google “Wales NHS waiting lists” or something similar to see story after story about people who have been badly treated by the NHS in Wales and want to be treated by the NHS run by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is sitting on the Front Bench.

I could suggest much that would improve things. Ideally, I would like to see the power taken away from the Welsh Assembly, because it has simply made such a mess, but that is never going to happen. If Opposition Members are confident that they could do a good job with the NHS, they should support the OECD report, and get their colleagues in Wales to get behind it and bring it out as quickly as possible. They should allow funding to follow patients, so that where a patient from Wales wants to be treated in England, that should be able to happen, with the money simply deducted from the Welsh Assembly block grant. Of course, the same should apply vice versa; any patients from England who want to be treated in Wales should be allowed to have that chance—I do not see many doing that.

One of the more irritating bits of propaganda coming out of the Labour party is that it says that lots of people from England are being treated in Wales. That is true, as historically there have been people with Welsh GPs who have to be treated in Wales even though they live in England. However, these people have set up an action group called Action4OurCare and are trying to take legal action on this. These are normal patients, not party activists, who want to be treated by the coalition-run NHS.

About the only good thing that comes from all this is that Labour apparently wants to make the NHS one of the main planks of its election campaign. I say bring it on, because I cannot wait to debate the NHS with Labour party members all over the United Kingdom. I will ask them about Wales and the cuts to the budget, the lack of a cancer drugs fund, the long hospital waiting lists and the fact that its ambulance response times are the worst in the United Kingdom. I shall remind them that people are already voting with their feet—they are voting to get out of the Labour-run NHS in Wales and get into the coalition-run NHS in England. They will shortly have the opportunity to vote not with their feet but in the ballot, and I very much look forward to seeing them have the opportunity to do so.

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[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to close today’s debate and to follow my hon. Friend the Member for Luton South (Gavin Shuker), who spoke very powerfully. In fact, hon. Members on both sides of the House have spoken with great passion and commitment about the NHS and the vital role it plays in their constituents’ lives and in their families’ lives. Many hon. Members, including the hon. Members for South West Devon (Mr Streeter), for Bosworth (David Tredinnick) and for Morecambe and Lunesdale (David Morris), have rightly praised NHS staff for working tirelessly to deliver good quality services despite all the challenges they face.

However, we have also heard countless examples of what the Alzheimer’s Society, the Multiple Sclerosis Society, the Royal College of Nursing, the Royal College of Midwives, the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Paediatrics and Child Health, the British Medical Association and many others said in their letter to The Independent last week. It stated that

“Signs of a system buckling...are everywhere…The NHS and our social care services are at breaking point and things cannot go on like this.”

We heard from my hon. Friends the Members for Corby (Andy Sawford) and for Worsley and Eccles South (Barbara Keeley) about how more and more people are struggling to get an appointment with their GP, with one in four waiting at least a week and thousands waiting more than two weeks.

Hon. Members, including my hon. Friend the Member for Nottingham South (Lilian Greenwood), spoke about how the huge cuts to local council care budgets mean half a million fewer older and disabled people, some of the most vulnerable people in society, are getting vital services, such as home care visits or home adaptations. This is leaving their families struggling to cope and to pick up the pieces.

Fewer services in the community mean that increasing numbers of frail, elderly people end up ringing 999, going to A and E and getting stuck in hospital when they do not need to be there, causing them and their families distress and costing the taxpayer far more. Ambulance services are under huge pressure, as my hon. Friend the Member for North Durham (Mr Jones) said. Hospital A and Es have now failed to meet the Government’s lower four-hour waiting target for 63 weeks in a row. A and E performance over the summer has been worse even than at the height of last winter. Delayed discharges from hospital are at a record high and cost more than £250 million in the last 12 months alone—money that could have paid for a year’s home care for 37,000 older or disabled people. Where on earth is the sense in that?

Rising emergency admissions and delayed hospital discharges mean planned operations are going backwards, too. More than 3 million people are now on the waiting list. The 18-week maximum wait target has been missed for the last two months in a row, and the NHS has missed the 62-day wait for vital cancer treatment—

[David T. C. Davies]

Will the hon. Lady give way?

[Liz Kendall]

I will not. [Interruption.] If the hon. Gentleman is going to talk about Wales, 90% of patients get their treatment within that target, compared with 84% here, so let me save him some time and bother.

The Government’s failure to keep people out of hospital and keep waiting lists under control, means the NHS is facing a looming financial crisis, too. Two-thirds of all acute hospitals are already in deficit to the tune of £500 million. They predict they will end the year £1 billion in the red, piling on the pressure for even greater service cuts and worse standards of care in future.

The tragedy is that it did not have to be this way. After 13 years of investment and reform, the previous Labour Government left the NHS with the highest ever patient satisfaction rates and the lowest ever patient treatment waits. But we were not complacent. We understood that the NHS had to face up to even bigger challenges: our ageing population, the increase in long-term conditions and huge medical advances, at a time when there is far less money around. For that reason, we had a plan in every region to reform front-line services, through Lord Ara Darzi’s NHS next stage review, by delivering some services in specialist centres so that patients got expert treatment 24/7 and by shifting other services out of hospitals and into the community. It was a move towards prevention joined up with social care to help people stay living at home. Instead of going ahead with our reforms, however, the Government scrapped them and forced through the biggest backroom reorganisation in the history of the NHS, wasting three years of time, effort and energy, and £3 billion of taxpayers’ money that should have gone on patient care.

The Health Secretary told the House today, and said on the “Today” programme, that the Government had saved £1 billion.