NHS Funding

Graham Stuart Excerpts

Wednesday 12th December 2012 Commons Chamber

[Mr Hunt]

I am going to make a little progress, if I may.

The right hon. Member for Leigh rather helpfully spelled out the difference between his position and our position when he admitted in the New Statesman that we are spending more than he wanted to spend on the NHS. He said of the NHS budget:

“They’re not ring-fencing it. They’re increasing it.”

In respect of NHS spending, he said:

“Cameron’s been saying it every week in the Commons: ‘Oh, the shadow health secretary wants to spend less on health than us’…it is true, but that’s my point.”

It was a good point, because we are spending more and he would have spent less. So why on earth call an Alice in Wonderland Opposition day debate condemning levels of spending in the NHS when he has so clearly put it on the record that he wanted that spending to be less?

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

Does my right hon. Friend agree that it is disingenuous, should it be allowed by the Deputy Speaker to say that, of the shadow Secretary of State and Labour Members—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. We are not going to be disingenuous, are we? We are going to be friends together, and I am sure that a good experienced Member like you, Mr Stuart, could word it better.

[Mr Stuart]

Thank you, Mr Deputy Speaker, for that correction, which I required. Obviously, it is an inadvertent tendency towards disingenuousness on the subject. I would like to apologise for pointing out, on behalf of patients right across the country, that for the Opposition to have a debate on health funding, when they were proposing to cut it—when they are actually cutting it in Wales—and when productivity fell, is the height of hypocrisy.

[Mr Deputy Speaker]

Order. I do not think we can have “hypocrisy” either, so we will have the Secretary of State instead.

--- Later in debate ---

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

Today’s debate centres on the Prime Minister’s broken promise to protect the NHS, which was expressed as a commitment to increase spending on the NHS year on year. That is not the only promise that he made. In opposition, he spoke passionately about retaining essential local services and named my local hospital, Lewisham, as one of the 29 hospitals that he would personally defend. Today we can offer him and the Secretary of State for Health that opportunity. The bottom line for NHS spending has to be the provision of safe, quality health care that meets the needs of the local population and is free at the point of need. Nothing is more important to the vast majority of our people.

The four tests that the Government have set for any local reorganisation proposals are: that they should have the support of local GPs; that they should have strong public and patient engagement; that they should be backed by sound clinical evidence; and that they should provide support for patient choice. Not one of those criteria has been met by the current proposals for Lewisham hospital by the trust special administrator.

[Mr Graham Stuart]

The right hon. Lady is speaking movingly about local services. Does she welcome, as I do, the £12.5 billion increase proposed for the NHS budget during this Parliament? Does she disagree with the right hon. Member for Leigh (Andy Burnham), who believes that such increases are irresponsible?

[Dame Joan Ruddock]

If the hon. Gentleman will be patient, he will discover that I find it impossible to see the increase. What I see on the ground are cuts, cuts, cuts. That is what I want to speak about today.

As I was saying, not one of those criteria is met by the trust special administrator’s proposals for Lewisham hospital. The TSA was appointed in July by the Secretary of State for Health to sort out the considerable financial problems of the neighbouring South London Healthcare NHS Trust. His remit required him to find tens of millions of pounds of savings from the services provided by the trust’s hospitals in Woolwich, Farnborough and Sidcup. That could not be done, so the TSA’s response was to grab a successful, solvent and highly regarded hospital, Lewisham, and propose to destroy it to raise money from the sale of two thirds of the site currently occupied by the hospital, a fact that was not even mentioned in the consultation document.

--- Later in debate ---

[Mr Dorrell]

I agree completely with the hon. Gentleman’s characterisation of the challenge. I was looking forward to him congratulating the Government on taking a step in the right direction, although it is not a total solution, by investing in prevention some of the resources in the health care. [Interruption.] The hon. Gentleman indicates that it is only a little and that it should be more.

We need to look across the statutory divide that reflects history, but not the demands of today’s generation of patients. The key thing that we must recognise in the debate about health and care is that we have inherited a system, which all of us have supported through most of its history, that is built on the assumption that the typical patient will be restored to good health. In Bevan’s day, that was true of the typical patient in the health and care system, but it is not true of the typical patient in today’s system. The majority of the resources in today’s health and care system go towards delivering care to people who will not be restored to full health. That, not surprisingly, requires a different set of institutions, shaped in a different way from the institutions that we have inherited from history.

The challenge that faces all of us in this House who care about the health and care system is not to protect the different bits of the system as though they were listed buildings, but to change the system so that it uses today’s technologies to meet the needs of today’s patients. That is the core challenge that faces my right hon. Friend the Secretary of State and his colleagues and, if I may say so, the right hon. Member for Leigh and his shadow ministerial colleagues.

[Mr Graham Stuart]

Will my right hon. Friend give way?

[Mr Dorrell]

If my hon. Friend will forgive me, I will not.

For the second half of this Parliament, we could have a reprise of the first half and we could trade party political slogans about a system that increasingly thinks that the political debate has nothing to do with it, or we could engage with the people who understand what real life feels like on the front line of the system, which has been described by one or two Opposition Members, and we could show that we in this House support the need for change in order to use taxpayers’ resources to meet taxpayers’ health and care needs. That is the real challenge that faces the House this evening.

--- Later in debate ---

[Mr Barron]

I recognise that there has been underspend, but I take this debate, and the debate we had running up to the general election, a bit more seriously. The chairman of the UK Statistics Authority said that there had been an underspend, and what we have just heard is not true. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the Conservative party manifesto stated:

“We will increase health spending in real terms every year.”

[Mr Graham Stuart]

Will the right hon. Gentleman give way?

[Mr Barron]

I will give way in a few minutes. When the Conservative party was in opposition, the current Prime Minister said in 2009:

“With the Conservatives there will no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.”

I want to keep reminding hon. Members of that because, as my right hon. Friend the Member for Leigh pointed out, we may be able to take £20 billion out of a budget over four years—that is a big ask and has never been done anywhere in the public or private sector—but to do it while we are also having mass reorganisation is creating chaos in the health service. I will refer to what is happening in my local health service in a few minutes.

In 2007 the right hon. Member for South Cambridgeshire (Mr Lansley) was shadow Secretary of State for Health, although he has now moved to Leader of the House. He said that the NHS needed

“no more top-down reorganisations.”

Indeed, in terms of expenditure the coalition agreement stated:

“We will guarantee that health spending increases in real terms, in each year of the Parliament, while recognising the impact this decision will have on other departments.”

It also stated:

“We will stop the top-down re-organisations of the NHS”

so we can take that with a pinch of salt as well.

[Mr Graham Stuart]

rose—

[Mr Barron]

I will give way to the hon. Gentleman before I move on to what is happening to the NHS in the real world.

[Mr Stuart]

Like my right hon. Friend the Member for Charnwood (Mr Dorrell), the right hon. Member for Rother Valley (Mr Barron) is a former distinguished Chairman of the Health Committee. My right hon. Friend rightly said that spending on the NHS is broadly flat, and that the most important question we should be debating, rather than scoring points over 0.1% of spend, is how to use the money most effectively. Does the right hon. Gentleman agree with that, and that we must look at the allocation of spend around the country? I represent a rural area and it does not seem as if funds are fairly allocated now.

[Mr Barron]

The issue of allocation has been looked at by many Select Committees, including by the Health Committee when I chaired it in the last Parliament. We did not find the level of unfairness that people, particularly those from rural areas, used to say there was. We looked for it but we did not find it.

Let us look at what is happening in the real world. My local Rotherham hospital foundation trust is not a bad hospital trust in any way and scores quite well in many areas. It received foundation trust status a number of years ago, and when this Government took office, it is fair to say that the efficiency factor was there already. On 16 March 2011 the trust announced that more than 60 jobs were to be axed at Rotherham general hospital, and confirmed a potential reduction of 62 posts in medical and surgical areas. Earlier this year on 6 March 2012, the local BBC announced that more than 70 NHS staff were facing the threat of redundancy, and the trust is seeking to save about £4 million. On 26 October 2012, an internal report given to the local media stated that the trust now intends to cut 750 jobs—about 20% of its work force—by 2015.

The NHS trust said that it needed a smaller hospital with substantially fewer beds and a smaller work force to save £50 million over the next four years. The internal report—aptly named, “Creating Certainty in an Uncertain World”—said that it was necessary to save £50 million from the £220 million budget before 2015 to meet Government targets. That was confirmed by the trust in a press release.

On 5 November 2012, the chief executive of the trust said that it would show staff the plans and invite them to come back with alternative views on how things might be done differently. The trust stated:

“We’ve made it very clear that there may have to be redundancies, but to be honest with you until we have gone through the process, I don’t know how many we will be able to lose through natural turnover and how many will have to be made redundant.”

What type of planning is there in any of this when we have such a situation in a district general hospital on which about 80% of my constituents rely if they have to go into secondary care?

On 20 November 2012, the chief executive announced his retirement. On 3 December 2012, the hospital announced that staff will be informed about the decision to postpone the formal consultation launch into work force restructuring. It went on:

“We realise this an anxious time for all members of staff, but it is imperative that we do what is right for the Trust, our staff and our patients. This means that we need to take more time to ensure our workforce proposal is exactly what the Trust requires and we anticipate the launch to take place later in the month.”

On 7 December 2012—last Friday—a headline in the local newspaper stated that the trust had recently engaged the services of a director of transformation on a time-limited basis. The acting chief executive said:

“It is important that the trust acts quickly to take the action required to safeguard the future clinical and financial sustainability of the Trust. This appointment, which was made after a competitive process, is required to provide additional expertise and impetus to the changes we need to make, whilst allowing others to remain focused on delivering the healthcare services that the people of Rotherham need and deserve.”

I do not stand here and support the way the NHS has been structured now or in the past, and I have been critical about many areas of that. I agree with the chief executive of the NHS, David Nicholson, who said at the NHS confederation conference this year:

“We need to change the model of care to one which supports patients and focuses more on preventing ill health from happening in the first place...and move away from the default position of getting someone into a hospital bed.”

At the same conference the then Health Secretary said that closure decisions were not an issue for national politicians, and my right hon. Friend the Member for Leigh said that the current Health Secretary said very much the same thing—“It’s nothing to do with me, guv.”

Let me say to the Minister, and other hon. Members who have made relevant interventions, that if changes and reconfigurations inside the national health service are getting better care to more patients, that is fine. However, the chaos in my local health service is about cutting back and saving money. I have played an active role in health care in my constituency over many years and, as far as I know, there has been no debate with local Members of Parliament, patients, patient groups, local doctors or people engaged in health provision in Rotherham. There have been no discussions whatever about reconfiguring the district general hospital to improve the position of patients and of the people of Rotherham and the surrounding area. Instead there is a drive to save money, which is creating chaos in my local health service.

--- Later in debate ---

[Andy Sawford]

Will the hon. Gentleman accept, though, in the interests of being transparent with the public, last week’s letter from Andrew Dilnot, the chair of the UK Statistics Authority?

[Mr Graham Stuart]

Move on.

[Andy Sawford]

The letter stated unequivocally that

“we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

Until both Government parties acknowledge that truth, which independent experts have told us about, they will not have any credibility in health debates.