National Health Service

Grahame Morris Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

The hon. Gentleman nods, but I am afraid that that was not the Secretary of State’s policy.

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

I compliment my right hon. Friend on how he is moving the motion. What are his views on the impact of the reduction of funding for the NHS on the front line, and on the number of hospital trusts that are breaching the 18-week target?

[Andy Burnham]

I am grateful to my hon. Friend for those words and I shall come to precisely that point, but let us be clear about this one: the Prime Minister promised a real-terms increase, but he has delivered a real-terms cut. He stands at the Dispatch Box week after week boasting about increasing health funding when he has not. All the while, NHS staff deal with the reality on the ground of his NHS cuts. Does he not realise how hopelessly out of touch he sounds? Hospitals everywhere are making severe cuts to services, closing wards, reducing A and E hours and closing overnight, making nurses redundant, and cutting training places. Last week, The Guardian revealed the random rationing that is taking place across the country. There are cuts to pay for management services, one third of neo-natal units are reducing the number of nurses, and midwife places are being cut despite the Prime Minister’s promise to recruit 3,000 more.

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[Andy Burnham]

I said just a moment ago that I was the one who put my name to the Nicholson challenge, because that money was going to help the NHS respond to the new demands placed on it at this difficult time, so the hon. Gentleman need not lecture me about efficiency. He needs to tell me how placing a moratorium on change in the NHS helps it to respond and deliver those efficiencies. That is the contradiction of his position, and he stood for election on that policy, as did others.

[Grahame M. Morris]

rose—

[Andrew George (St Ives) (LD)]

rose—

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[Mr Lansley]

That is absolutely not true, because we ordered absolutely no cuts in the NHS budget in 2010-11 compared with the spending plans that we inherited. So that is a complete own goal on the right hon. Gentleman’s part. And in regard to all that stuff that he talked about the support that the NHS is giving to social care, I can tell him that, with the exception of the underspend in the departmental central budgets, because we cut back on all of its bureaucracy and its IT programme, we spent over £150 million, or whatever it was—

[Grahame M. Morris]

Will the Secretary of State give way?

[Mr Lansley]

Sit down for a minute. I am answering the shadow Secretary of State. As I was saying, more than £150 million was generated from underspends in the departmental central budget in the last three months of the last financial year, and it was spent with local authorities in supporting social care. The rest of the social care support is for 2011-12, so what the right hon. Gentleman said cannot be a reason for the underspend in 2010-11. The amount spent was all in PCT allocations; there was no mechanism by which the Department of Health could go out and ask PCTs to spend less—the money was allocated to them. The shadow Secretary of State shakes his head, but he knows it is true. The money was allocated to the PCTs and they were free to spend the money they had.

The first reason to reject the motion is that it is a spectacular own goal. The second reason to reject it—

[Mr Lansley]

I am sorry, but that is another spectacular own goal. Both before and after the election, the chief executive of the NHS set aside, as the right hon. Gentleman had planned before the election, £1.7 billion for non-recurrent expenditure for the costs of NHS reorganisation. It was done before the election; we never changed the figure. It is not a consequence of any of our plans, but a precise consequence of the right hon. Gentleman’s. He said he accepted the Nicholson challenge, and the £1.7 billion non-recurrent set aside in 2010-11 was to fund that challenge. That was set out before the election, not after it. I thought that one of the benefits of the former Secretary of State coming here to debate matters would be that we would be treated to a bit of knowledge of the NHS and of how it works, but that does not seem to be the case at all.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Lansley]

No, I want to make a bit of progress. Strictly speaking, I have not yet said anything I intended to say.

[Grahame M. Morris]

rose—

[Paul Farrelly]

rose—

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[Mr Lansley]

No. I have given way many times. I am answering the hon. Member for Edmonton (Mr Love). It was very clear that we could not proceed on that basis.

I have another point for the hon. Member for Edmonton about what I found in a number places. Although this was not true of the moratorium in Maidstone and Chase Farm, the moratorium has led to substantially improved outcomes for local services elsewhere, as with Burnley, Solihull, Sidcup, Ealing, the Whittington hospital and other places.

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Mr Lansley]

No. I am still answering a point raised in an earlier intervention. In all those places and others, the moratorium has led to better solutions.

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[Mr Lansley]

The right hon. Member for Leigh says from a sedentary position that he did not ignore the panel’s advice. I do not believe that a Secretary of State has directly sought to contradict the panel since its establishment, or has sought not to comply with its recommendations. After all, it is there for a reason. The point is that, as I have made clear, the panel should be involved in the application of those four tests, and in the past that has tended not to happen.

Let me explain why I am asking the House to reject the motion. I believe—and this was always my approach in opposition—that when we table such a motion, we ought at least to be clear about what our alternative solution would be, but there is no such solution in the motion. Let me remind the new, or recycled, shadow Secretary of State what his old friend James Purnell wrote last February:

“The Tories appear to have the centre ground. Labour need to take it back—by coming out in favour of free schools and GP commissioning”.

The right hon. Gentleman did not come out in favour of free schools. He now says that he is coming out in favour of GP commissioning. If he believed in GP commissioning, why did he do nothing about it? Why did everyone in the general practice community, throughout the length and breadth of the country, believe that practice-based commissioning had come to a virtual halt? Why did David Colin-Thomé, the right hon. Gentleman’s own national clinical director for primary care, effectively say that it had completely stalled and was not going anywhere?

I know that the right hon. Gentleman agreed with this at one time. Back in 2006, he said of GP commissioning:

“That change will put power in the hands of local GPs to drive improvements in their area, so it should give more power to their elbow than they have at present. That is what I would like to see”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]

If the right hon. Gentleman wants that to happen, he must support the Bill that will make it happen. The same applies to health improvement and public health leadership in local government, and to our finally arriving at a point when, as was the last Labour Government’s intention, all NHS trusts become foundation trusts. We are going to make those things happen, but in order to do so we must have a legislative structure that supports them. That is evolutionary, not revolutionary. However much the right hon. Gentleman rants about the changes being made in the Bill, the truth is that it will do—in what his predecessor, the right hon. Member for Wentworth and Dearne (John Healey) described as a “consistent, coherent and comprehensive” way—much of what was intended by our predecessors as Secretaries of State under the last Government. The fact that the right hon. Gentleman turned his back on that at the end of his time in office—mainly at the behest of the trade unions, which seem to be the dominant force in Labour politics—does not absolve him of his responsibility to accept that we are now delivering the reforms that he talked about.

[Grahame M. Morris]

The Secretary of State told my right hon. Friend the Member for Leigh (Andy Burnham) that there had been no cuts in the NHS budget. Does he recall cancelling the building project for a new hospital serving my constituents in south Easington as part of the comprehensive spending review?

[Mr Lansley]

On the occasion when the Chief Secretary to the Treasury told the House that we were supporting a number of hospital projects, we made it clear that the hon. Gentleman’s local trust was a foundation trust. As his colleagues should tell him, the point of a foundation trust is that it should take more responsibility for securing the resources—

[Grahame M. Morris]

rose—

[Mr Lansley]

I am answering the hon. Gentleman’s question. The point of a foundation trust is that it should take more responsibility for securing the resources enabling it to undertake its own building projects. Foundation trusts cannot walk into the Department of Health imagining that they will receive a capital grant of more than £400 million. That is simply not the way it works. It is to the credit of the hon. Gentleman’s local trust that it accepted that, and is working, as a foundation trust, on a better solution for the hon. Gentleman’s area.

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

Although the words “shocking legacy” are ringing in my ears, I find it difficult to believe them, given Labour’s legacy on the NHS compared with what it inherited in 1997. Expenditure was increased from £30 billion in 1997 to £103 billion when we left office, and we had record patient satisfaction ratings. It beggars belief that that can be considered a shocking legacy.

[Gareth Johnson (Dartford) (Con)]

rose—

[Grahame M. Morris]

If the hon. Gentleman does not mind, I will continue my introduction and give way in a moment.

I wish to recognise the contribution of the NHS staff, who are the source of great pride. They have done such a great job, and continue to do so, even in difficult circumstances, in delivering the very high levels of patient satisfaction reported in the recent surveys.

In November 2010, the Backbench Business Committee selected my application for a debate on the impact of the comprehensive spending review on the Department of Health, the NHS and public health. So many of the issues that have been raised are implanted in my mind, not least the loss of the funding for a new hospital that would have served many of my constituents in the south of Easington. I am concerned about the particular reference that has been made to that and I would be grateful if the Secretary of State or the Minister would deal with that in their closing remarks. A value-for-money assessment was made by both the Department of Health and the Treasury and it was found that the best way to take forward that proposal was with public funding, rather than through the private finance initiative route. The disingenuous position repeated by those on the Government Benches, including the charges laid against the Labour Opposition about our support for PFI, has been compounded. I remind right hon. and hon. Members on the Government Benches that in the case of the new hospital planned for my area we were directed to the PFI route, despite the criticism that has come from the Secretary of State and other Members on the Government Benches.

I am pleased that the motion focuses on the failed personal pledges of both the Prime Minister and the Secretary of State. A key promise was made to increase real-terms expenditure on the NHS, but it is another broken promise. It is probably the most fundamental one, as the NHS is such a beloved institution of the whole British public. Before the election, the Conservatives promised to protect the NHS and give it a real-terms budget increase year on year. The coalition document promised a 0.4% real-terms budget increase for the NHS over the spending review period.

I am sure that we all saw the expensive billboards before the election, to which my right hon. Friend the Member for Leigh (Andy Burnham) referred. They showed the Prime Minister, then Leader of the Opposition, saying:

“I’ll cut the deficit, not the NHS.”

That was not really about rebranding the NHS; it was more an exercise in conning the British public. Whereas Labour gave a guarantee to protect the front line of the NHS, the Health Secretary, then the shadow Health Secretary, saw a cynical opportunity to give a guarantee on spending. We now know from the Treasury’s own figures that that guarantee was false: it is a promise that has been broken. It was a guarantee that went against all the Tory mantra. We are constantly told by the Conservative party that public service delivery is not about how much we spend but about how we spend it—in fact, we heard that today from the Prime Minister in relation to police numbers. However, the Tory promise was never about protecting the NHS; it was about protecting the Tory brand.

Even the Tories’ biggest backers realise that the promise to increase funding on the NHS was a con. The Secretary of State cited James Purnell a little earlier, so perhaps I might cite Fraser Nelson, who is not a well-known socialist—he writes for The Spectator and is a right-wing commentator. He says:

“It has become clear now that there was a cynical competition to dupe the British public into believing that if they voted Tory at the General Election, the NHS would be safe.”

After 13 years of unprecedented rises in the NHS budget under Labour, and efficiency measures such as those on procurement—

[Henry Smith]

The hon. Gentleman is talking about the 13 years under the previous Labour Government. I do not know what happened in his constituency, but my constituency lost accident and emergency provision, and we lost maternity provision. That was the direct consequence of Labour’s Department of Health.

[Grahame M. Morris]

I think we saw an unprecedented period of growth with the building of new hospitals and new facilities. I have some sympathy with the hon. Member for Enfield North (Nick de Bois) and what he is going through with the Chase Farm downgrading, because in my area the Hartlepool accident and emergency facility is also being downgraded to an urgent treatment centre. That is a cause of consternation among the public.

[Mr Lansley]

That was a Labour plan.

[Grahame M. Morris]

Well, it is being done under the Secretary of State’s Administration when an impression was given that there would be a moratorium and that we would not face such downgrading and closures. That was clearly a con that was sold to the public, so I do not accept the contention that the hon. Member for Crawley (Henry Smith) has put forward.

Let me press on, because time is limited. The NHS is hurting under this Government and these reckless reforms. On the promises for a real-terms increase, we know that health inflation has surged and that the spending power of the NHS is going down, so will the Minister now admit that the NHS is receiving a real-terms cut? This is not just about the NHS being held hostage to inflation. It is facing real financial pressures on the front line—which Labour promised to protect—for a number of reasons including the Government’s decision to push through this latest reorganisation, which is the biggest the NHS has ever faced, at the same time as pushing through £20 billion-worth of efficiency savings. The figure of £1 billion a year is being taken from the NHS’s existing budgets to meet the growing and ever-increasing costs of social care. The Select Committee on Health is now looking into that issue and I hope that we are able to come forward with some positive ideas that the Minister will consider.

[Joan Ruddock]

My hon. Friend heard the Secretary of State’s responses to my questions. I know that my hon. Friend served on the Committee considering the Health and Social Care Bill. Will he confirm that competitiveness is still at the heart of that Bill and that the cap on private patients in the NHS is being removed from hospitals?

[Grahame M. Morris]

I am grateful for that intervention from my right hon. Friend and I should like to place on record, because the Secretary of State did not take the opportunity to do so, that the cap on private patient work, which had been set at 5%, is to be raised by the Bill. That must have a detrimental impact on the NHS in general, and on non-private patients, as resources are directed to the private sector and private patients.

[Dr Poulter]

Will the hon. Gentleman give way?

[Grahame M. Morris]

I shall not, if the hon. Gentleman does not mind, because I do not think I will get any injury time if I do so and I have rather a lot to get through.

I have mentioned the transfer of resources from the NHS budget to meet the growing costs of social care. We have also discovered, from evidence that was given to the Select Committee, that there has been an underspend of almost £2 billion—much of it from the capital budget, with some of it, presumably, being saved by cancelling the new hospital that was to serve my area. Meanwhile many NHS trusts are sitting on hundreds of millions of pounds of debt, and figures produced by the Department of Health show that six large NHS trusts in London are predicting year-end deficits of £170 million. The pressures on the system are enormous and will inevitably show through in reductions in services, having an impact on the front line.

The reductions in tariffs for operations and the further pressures in that area will also mean that foundation and NHS acute trusts will bear the brunt of financial pressures within the system. Again, that means that the buck and the spotlight of transparency are being passed away from the Secretary of State to the NHS Commissioning Board, although he might have to reconsider that after last night’s Lords amendments.

Another area of pressure in the NHS comes from the huge redundancy costs being incurred as a consequence of the premature closure of primary care trusts and strategic health authorities, which is estimated to cost the taxpayer more than £1 billion. The opening up of the NHS entirely to the private sector, and the prospect of the £103 billion NHS budget being taken out of the public sector and placed within the remit of shareholders in private health care companies, is anathema to the majority of the British public. The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) is cringing, but the majority of the British public are cringing at the thought of this proposal.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order.

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[Chris Skidmore]

The hon. Gentleman will regret his comments. We have to pay back £65 billion on PFI deals that were originally signed for £11 billion—that ain’t minutiae. Many constituents are concerned about the waste that took place under the previous Government.

In 1997, there were 23,400 managers. That has gone up to 42,500. We are making a genuine attempt to tackle the problem. I could go on, but I will put the party politics aside.

[Grahame M. Morris]

Would the hon. Gentleman care to comment on the National Audit Office report in relation to savings that could be made from NHS procurement? Does he think that fragmenting the NHS will assist that or hinder it?

[Chris Skidmore]

We are spending £1 billion more than we should on procurement because of the lack of consistency across the NHS, delivered principally by the previous Government. That is one area in which we could make vital savings. The NHS needs to change. Your boss, the Leader of the Opposition, said:

“To protect the NHS is to change it”

and we need to do so. The reforms that we are bringing in are essential if we are to deliver savings and also to ensure that the NHS survives when our ageing population means there will be twice as many 85-year-olds by 2030.

We need to reform the NHS and we do so in the spirit of what Tony Blair and new Labour put forward. Julian Le Grand, Tony Blair’s key adviser, said that the reforms were

“evolutionary, not revolutionary: a logical, sensible extension of those put in place by Tony Blair”.

When I asked him in the Health Committee whether this is what Blair would have done, he said: “Absolutely. Blair ‘would have tried’ to get these reforms through, but I imagine the left of his party may have prevented him from doing so.”