National Health Service

Graham Stuart Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move

That this House regrets the growing gap between Ministers’ statements and what is happening in the NHS; notes mounting evidence of rationing of treatments and services by cost, despite Ministers’ claims to have prevented it; further regrets the increasing number of cost-driven reconfigurations of hospital services, despite the Coalition Agreement’s promise of a moratorium on changes to hospital services; further notes growing private sector involvement in both the commissioning and provision of NHS services, contradicting Ministers’ claims that the NHS reorganisation would not increase levels of privatisation; recognises that, according to the Government’s Public Expenditure Statistical Analyses figures, actual Government spending on the NHS in 2011-12 fell by £26 million, the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office, in breach of the commitment in the Coalition Agreement; believes the Government’s decision to reorganise the NHS has distracted its focus from the financial challenge, with seven out of 10 acute hospital trusts in England missing savings targets in the first half of 2011-12; calls on the Government to take action to prevent rationing by cost in the NHS, based on the evidence presented; and further calls on the Government to honour pledges on NHS spending in the Coalition Agreement, and the commitment that future savings will be reinvested into the NHS front line, and to return at least half of the underspend to the Department of Health budget.

The year 2011 was the first full year of the coalition Government and the year of the biggest ever fall in public satisfaction with the national health service. As I shall set out, those two facts are not unconnected. The NHS in England is reeling from the Government’s catastrophic decision to reorganise it at a time of huge financial pressure. Warnings by Opposition Members and others during the passage of the Health and Social Care Act 2012 of a postcode lottery, of destabilised hospitals and of increasing privatisation are, sadly, beginning to materialise.

For the coalition, attention has moved to other battles—more pressing priorities—but for the NHS the moment of greatest danger is now, as the unstoppable force of reorganisation hits the immovable object of the financial challenge. That is why the Opposition make no apology for introducing this debate, or for bringing the House’s attention back to where it should be: our country’s most important public service and the struggle it faces.

I am grateful for the Secretary of State’s letter—[Interruption.] I can hear him mumbling away on the Government Front Bench. I would have thought the debate would justify his attention, as it justifies that of the Minister of State, the right hon. Member for Chelmsford (Mr Burns). The Opposition have introduced this debate to support NHS staff. We thank them for what they do. They have a huge capacity to deal with whatever is thrown at them, but they have been set mission impossible by the Government. One can only wonder how they felt on hearing the news that the Deputy Prime Minister had the chance to stop this reorganisation but chose to prioritise House of Lords reform. A million hearts will have sunk.

It was not just the Government’s decision to reorganise that was wrong; the way they have gone about it was wrong as well.

[Mr Graham Stuart (Beverley and Holderness) (Con)]

The right hon. Gentleman will know that the Chair of the Public Accounts Committee said that productivity fell continuously for a decade under the previous Government. Does he regret that and recognise that radical change is required to get the productivity improvements this country desperately needs if we are to be able to afford the NHS we all want?

[Andy Burnham]

I am afraid the hon. Gentleman is out of date, because the figures cited by the Government are wrong. NHS productivity was improving by the time Labour left office. The independent and authoritative Commonwealth Fund pronounced the NHS the most efficient health care system in the world in June 2010. That was the legacy of the Labour Government, which the Conservative party is putting at risk.

As I have said, it was not just the decision to reorganise that was wrong; the way the Government have gone about it is also wrong. Before the ink was dry on their White Paper, Ministers set about dismantling existing NHS structures before the new ones were in place. That is a dangerous move at any time, but disastrous at a moment of financial crisis.

We have therefore had drift in the NHS: a loss of focus at local level and a loss of grip on the money just when it was most needed. At a stroke, the Government demoralised the very work force who would be crucial to managing the transition, with primary care trust managers dismissed as worthless. Experienced people left in droves. Those who stayed hoping for jobs in the new world were issued with scorched earth instructions: “Get on and do the unpopular stuff now—the rationing and the reconfiguration—so the new clinical commissioning groups don’t have to.”

We can now see the consequences across England: brutal, cost-driven plans for hospital reconfiguration being railroaded through on an impossible timetable without adequate consultation; walk-in centres being closed left, right and centre; and people left in pain and discomfort, or facing charges for treatment, as PCTs introduce restrictions on 125 separate treatments and services.

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[Andy Burnham]

rose—

[Mr Graham Stuart]

rose—

[Mr Burns]

I will give way to the right hon. Gentleman and then to my hon. Friend, but then I will make some progress.

[Mr Burns]

What the right hon. Gentleman rather cunningly does not mention—[Interruption.] I am answering the question, if the hon. Member for Copeland (Mr Reed) can just keep quiet for a second. The right hon. Gentleman says that the NICE guideline refers to a BMI of 40, and that is absolutely correct, but I point him in the direction of one area in central London that does not go by that guideline, because it uses a BMI of 35, which is lower.

[Mr Graham Stuart]

Is my right hon. Friend as confused as I am by the Labour party’s policy? The right hon. Member for Leigh (Andy Burnham) could not explain where public health would go; he wants to repeal the Health and Social Care Act 2012, although he wants the services to be shaped as the Act says; and on funding he said in June 2010:

“It is irresponsible to increase NHS spending in real terms”.

That is the Labour party’s policy: it is chaotic and makes no sense. Can my right hon. Friend please tell us whether he sees more sense in it than I do?

[Mr Burns]

I am afraid that I cannot help my hon. Friend, because the policy is contradictory and does not make sense.

The right hon. Gentleman talks about repealing the 2012 Act, which includes the clinical commissioning groups, but if he abolishes them there will be no other mechanism from 1 April next year to commission care for patients, so there will be no one available to commission care for patients, which seems stunning.

The right hon. Gentleman talks about funding, and his quotations—my hon. Friend the Member for Beverley and Holderness (Mr Stuart) mentions one—are quite clear: he disapproves of giving real-terms increases in funding to the NHS. In Wales, the Welsh Labour Government have taken him at his word and are cutting spending, which we are not very enthralled by.

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[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the hon. Member for Easington (Grahame M. Morris), who is a member of the Health Committee. I hope he will forgive me if I do not follow him down the specialist course of radiotherapy services.

I want to address my remarks primarily to the shadow Health Secretary and to begin with an echo from a different era. When I first came to the House, there used to be something called “Whitelaw’s law”, which, obviously, referred to the late Willie Whitelaw. “The more he blusters,” we used to say, “the less he believes it.” The shadow Health Secretary gave us an Olympic-class demonstration of the principle of Whitelaw’s law. He blustered from the Dispatch Box and got himself into several dead ends. It became clear that he did not really believe that he had answers for the challenges facing the NHS.

I refer the right hon. Gentleman to a point that he made and which I agree with. The most important statement about the current state of the health service was not made by him as Secretary of State—and, with great respect to my right hon. Friend the Secretary of State, it was not made by him either. It was made by Sir David Nicholson in his annual report to the national health service in May 2009, and it was endorsed by the right hon. Gentleman. Sir David said, looking forward to the period of this Parliament:

“we must be prepared for a range of scenarios, including the possibility that investment will be frozen for a time. We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over the three years.”

I agreed with what the shadow Secretary of State said about the importance of what we, in the Health Committee, dubbed “the Nicholson challenge”. I believe that that is the central challenge facing the national health service. The sadness in this debate was that the right hon. Gentleman gave us no hint as to how he believes the health service should address that central challenge about which he and I agree.

[Mr Graham Stuart]

Meeting that challenge, and dealing with the challenges in the NHS generally, would be all the more difficult if one believed, as the right hon. Member for Leigh (Andy Burnham) does, that real-terms increases in investment in the NHS are irresponsible.

[Mr Dorrell]

I agree with my hon. Friend, but let us not go down that route. At the time when Sir David Nicholson was writing, the Labour Government were contemplating the possibility not of a real-terms freeze, which is in effect what is planned under the coalition, but of a cash freeze, which would have been substantially more difficult to achieve.

The main issue now is how we deliver services that meet the demands placed on the system against the background of a resource allocation to the health service that was always going to be dramatically less generous than it was during the earlier years of the Labour Government. We heard from the right hon. Gentleman a commitment that an incoming Labour Government would go through a clean-sheet-of-paper redrawing of the map—

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[Andrew Gwynne]

I will not, as I do not have time now.

In the Secretary of State’s annual report to Parliament, he dismissed restrictions on bariatric surgery as “meaningless” and continued to say:

“Time and again, he says”—

that is my right hon. Friend the Member for Leigh (Andy Burnham)—

‘“Oh, they are rationing.’ They are not”.—[Official Report, 4 July 2012; Vol. 547, c. 923.]

But Opposition Members all know the truth. Aside from the evidence presented by the Labour party and the GP magazine, verified by Full Fact, primary care trusts acknowledge that they are restricting access to bariatric surgery. The National Institute for Health and Clinical Excellence recommends surgery for anyone with a body mass index of 40 or a BMI of 35 and co-morbidity. Many PCTs, including NHS Stockport in my own constituency of Denton and Reddish, impose additional restrictions.

Recent freedom of information requests of PCTs and shadow clinical commissioning groups across England have revealed that 149 separate treatments, previously provided for free by the NHS, have been either restricted or stopped altogether in the last two years, with 41 of those being entirely stopped in some parts of the country. This provides the clearest evidence yet of random rationing across the NHS and of an accelerating postcode lottery, which appears to be part of a co-ordinated drive to shrink the level of NHS free provision. From our study, it is clear that many patients are facing difficulties in accessing routine treatments that were previously readily available, and there is evidence that some patients are being forced to consider private services in areas where the NHS has entirely stopped providing the treatment.

Of course, there has been a real reduction in the number of nurses working in the NHS. The Government have claimed that there are only 450 fewer nurses, and at Health questions last month, the Minister, the right hon. Member for Chelmsford said that the figure was “nowhere near 4,000”. But now we all know the truth: figures for the NHS work force in March 2012 showed clearly that there are 3,904 fewer nurses than in May 2010. We have seen broken promise after broken promise, including on reconfigurations.

It was this Government who, when in opposition, spent millions of pounds during the general election putting up posters throughout the country reassuring the electorate that under the Conservatives there would be a moratorium on hospital and A and E closures. Indeed, in opposition, they pledged to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.

It is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011, this Secretary of State accepted the recommendations and approved the downgrading and closure of services at Chase Farm. And there are several others, such as the Hartlepool, the King George hospital in Ilford, the East London, the Trafford General, the North London, the St Cross in Rugby and, as we have heard today, the West London, too, that have either closed or are set to close. What is becoming clear is that when it comes to reconfiguration, Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished structures for the forthcoming closures.

In the brief time remaining, I want to deal with Government spending on the health service. As we have learned, actual Government spending on the NHS in 2011-12 fell by £26 million.

[Mr Graham Stuart]

Will the hon. Gentleman give way?

[Andrew Gwynne]

No, I will not.

This was the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office. This is in clear breach of the commitment given by the Conservatives and Liberal Democrats in their coalition agreement.

Of course, a long line of professionals have come, one after the other, to express their concern about the damage that will be done to the health service if hospital is pitted against hospital, and doctor against doctor. That is where we start. The Health and Social Care Act 2012 now allows hospitals completely to change character over time. The Government have essentially set everybody on their own. Hospitals are being told, “You’re on your own. There’s no support from the centre any more; no more bail-outs.”

We know that there are problems with the NHS meeting efficiency targets. Indeed, a survey of NHS chief executives and chairmen found that one in four believe that the current financial pressures are the

“worst they have ever experienced”,

with a further 46% saying they were “very serious”. More than half of foundation trusts missed their savings plan targets, according to Monitor’s review of the last financial year.

Ministers have said that every penny saved will be a penny reinvested to the benefit of patient care, but in reality £1.4 billion of the £1.7 billion not spent by the Department of Health has been returned to the Treasury—more broken promises. It is therefore clear for all to see that there is an increasing gap between what the Government are saying and what is going on in the NHS, and the experience of ordinary patients on the ground.

The Government have increasingly broken their promises on the NHS. They promised no top-down reorganisation and a moratorium on hospital closures and they promised to maintain spending levels in the NHS. They have broken all those promises—they are the three biggest broken promises in the history of the NHS. There is clearly a yawning gap between what the Prime Minister and others say and the reality of patients’ experience.

During the general election, the Prime Minister said:

“I’ll cut the deficit, not the NHS.”

It is now clear that the Government are cutting our NHS. The NHS is important for the people of our country, and they deserve better. I commend the motion to the House.