NHS Services (Access)

Jeremy Hunt Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham]

My hon. Friend puts it very well. If mental health is the poor relation of the NHS, then child and adolescent mental health services are the poor relation of the poor relation. How can that be the case when we are talking about children who need the best possible support—the most vulnerable children—being denied the services that they need? My hon. Friend the Member for Leicester West (Liz Kendall) discussed at a shadow health team meeting a constituency case where a family were trying to find a bed for a child who was in a crisis and not one bed was available for that child in the whole country—not one bed. She is nodding. That is the reality. I wish that Government Members would focus on that rather than making complacent statements.

No amount of spin from the Government can disguise the fact that the NHS is heading for the rocks and urgently needs turning around, so the question is how we get it back on track. I have two positive proposals to put before the House on policy direction and on funding. Let me take each in turn. Instead of just admitting privately that the reorganisation was a mistake, the Government should be actively working with us to begin to put it right—and they will soon have a chance to do so. In five weeks, my hon. Friend the Member for Eltham (Clive Efford) will bring a Bill before this House to repeal the worst aspects of the Health and Social Care Act 2012. When the Government’s reorganisation was going through, their mantra was “Doctors will decide.” The Prime Minister repeated this in his “Today” programme interview during the Conservative party conference when he said:

“there’s nothing we’ve done which makes it more likely there’ll be private provision in the NHS”.

[The Secretary of State for Health (Mr Jeremy Hunt)]

That is true.

[Andy Burnham]

The Secretary of State says that it is true, but that is not how people see it in the real world. Doctor after doctor tells me that their legal advice under section 75 of the Act mandates them to run open tenders for services. Today we see the evidence of how the NHS is changing under that regime. The BBC reports that more than half of contracts awarded by clinical commissioning groups are going outside the NHS. Why is this a problem? Because it is wasting NHS resources on tenders and leading to fragmentation of care when the future demands integration. We need Government Members to tell us today whether they will vote with us on 21 November to repeal mandatory tendering and thus be true to what they originally said they wanted to do, which was to let doctors decide how services are provided.

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[The Secretary of State for Health (Mr Jeremy Hunt)]

I do not think I have ever heard such a misuse of statistics and facts in this House as we have heard today.

I am delighted to debate the NHS, which has been independently rated—[Interruption.] Labour Members do not like to hear this. The NHS has been independently rated by the Commonwealth Fund this year as having become, under this Government, the best out of 11 industrialised countries. It is a better health care system than those in France, Germany and Australia. [Interruption.] Labour Members do not like to hear this, but the independent experts in Washington have said that the NHS has become the best in the world under this Government. The most uncomfortable thing of all for the Labour party is that the NHS has become better than it ever was under the previous Labour Government, when the right hon. Member for Leigh (Andy Burnham) was Health Secretary.

If the right hon. Gentleman wants to talk about Government mistakes, we will do so, but he will find that, on Mid Staffs, the private finance initiative, botched IT projects, a disastrous GP contract, unsafe hospitals, low cancer survival rates and little action on dementia, it is the Labour party, not this Government, that must be held accountable for mistakes in running the NHS. Indeed, after years of mismanagement it is this Government who are finally putting high-quality patient care back at the heart of what the NHS stands for.

[Steve Rotheram]

rose—

[Mr Hunt]

I will give way in a moment, but I want to make some progress.

I want to go through the arguments of the right hon. Member for Leigh in detail, but let me start with the elephant in the room: the massive financial pressure facing the NHS if it is to meet our expectations in the face of an ageing population. There are now nearly 1 million more people over 65 than when this Government came to office. Our economy then was nearly bankrupt. Despite those extraordinary challenges, this Government have been able to increase spending on our NHS—including on Leigh infirmary in the right hon. Gentleman’s constituency—because of our difficult decisions, which were opposed at every stage by the Labour party. Government Members know one simple truth: a strong NHS needs a strong economy.

On the day that unemployment fell below 2 million and the claimant count fell below 1 million, there was nothing in the right hon. Gentleman’s speech about the need for a strong economy to support our NHS and nothing about learning from the Labour Government’s disastrous mistakes, which were so bad that they were in fact planning to cut the NHS budget had they won the election. We should remember that countries that forgot about the deficit ended up cutting their health budgets—Greece by 14% and Portugal by 17%. [Interruption.] Well, these are the facts. We must never again in this country allow the poor economic decisions that have been the hallmark of every Labour Government in history.

[Barbara Keeley]

It is interesting that the Secretary of State is claiming credit for things where the data are based on Labour’s achievements with the NHS, while anything else is our fault. He talked about older people and the demographics of an ageing population, but what good does he think he is doing to that section of the population with £3.7 billion of cuts to social care? Particularly as we move to integration, how does he think that will help those people? In my local area, 1,000 people will lose their care package this year. How does he think that will help the NHS in Salford?

[Mr Hunt]

I will tell the hon. Lady what we are doing: we are integrating the health and social care systems through the Better Care fund—a £3.9 billion programme—which is something that Labour could have done in 13 years in office but failed to do. That will make a massive difference to the social care system. Let us move on to some of the detailed arguments.

[Steve Rotheram]

Will the Secretary of State give way?

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[Mr Hunt]

I will make some progress first.

[Andy Burnham]

rose—

[Mr Hunt]

I am very happy to give way to the right hon. Gentleman.

[Andy Burnham]

This is the most important part of the debate. The Secretary of State is right about the elephant in the room. This is the thing that people in the NHS will pay most attention to today. He has gone through his record in this Parliament, but the problems in the next Parliament will be large, as I am sure he would agree. He needs to say today whether he thinks the ring fence will be sufficient, or does he think that the NHS will need more money over and above the ring fence if it is to avoid crisis in the next Parliament?

[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.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Hunt]

I will make some progress.

The right hon. Gentleman said that the reforms have made it harder to access NHS services. The opposite is true. Scrapping the primary care trusts and strategic health authorities meant the introduction of clinical leadership, which he wants to abolish, and allowed the NHS to hire 6,100 more doctors and 3,300 more nurses. Those members of staff are helping the NHS to do 850,000 more operations every single year compared with when he was in office. How can he possibly stand before the House and say that access to NHS services is getting worse, when nearly 1 million more people are getting operations every year compared with when he was Health Secretary?

[John Glen (Salisbury) (Con)]

What is more, the evidence from Labour’s last years in office shows that the number of managers was increasing at three times the recruitment rate for nurses. What does that say about Labour’s priorities in office?

[Mr Hunt]

My hon. Friend is absolutely right. That is why the management pay bill doubled under Labour and why we took the difficult decision, which the Opposition bitterly opposed, to get rid of 19,000 administrators and managers so that we could recruit the extra doctors and nurses. I notice that Opposition Front Benchers are very quiet on that point because they cannot answer the simple question of how they would pay for those extra doctors and nurses if the Health and Social Care Act 2012 was reversed. [Interruption.] Ah! They would pay for the extra doctors and nurses by bringing in new taxes that the country is not paying at the moment.

The right hon. Gentleman talked about structural reforms. We ought to discuss the structural reforms that he chose not to talk about, such as making the Care Quality Commission independent, with new chief inspectors for hospitals, adult social care and general practice. He tried to vote down that legislation in this House. So far—[Interruption.] I know that this is uncomfortable for Labour Members, but they should listen, because the new inspection regime has put 18 hospitals into special measures. Five of them have been turned around completely and have exited special measures, and important improvements are being made at the others.

The motion talks about Government mistakes, so will the right hon. Gentleman finally accept the catastrophic mistakes that he made as Health Secretary, such as failing to sort out the problems at those hospitals, even though there were warning signs at every single one of them? Does he accept that because Labour ignored those warning signs, patients were harmed and lives lost? Will he finally apologise to the relatives of patients at Mid Staffs whom he made wait outside in the cold because he refused to meet them and hear their concerns? Will he make that apology now? He has not apologised and it is clear that he does not want to do so today.

The right hon. Gentleman talked about A and E. Just as when he was Health Secretary, there have been weeks when the target has not been met. What he did not tell the House is that, thanks to our reforms, we have 800 more A and E doctors than four years ago and nearly 2,000 more people are being treated within four hours every single day than when he was Health Secretary.

As the motion refers to Government mistakes, perhaps the right hon. Gentleman might like to acknowledge some of his own mistakes on A and E, such as the 2004 GP contract that removed personal responsibility for patients from GPs, making it more likely that people would end up in A and E, or the failure over 13 years to integrate the health and social care systems, meaning that many vulnerable older people continue to end up in A and E unnecessarily—something that we are putting right through the Better Care programme.

When the right hon. Gentleman spoke about NHS performance, he talked repeatedly about missed targets. That is a really important issue and is perhaps the biggest dividing line between his approach to the NHS and mine. Of course targets matter in any large organisation, but not targets at any cost. That is why the Government have been careful to ensure that in the new inspection regime, waiting time targets are assessed not on their own, but alongside the quality and safety of care.

[Andy Burnham]

The Secretary of State makes an important point, and as Health Secretary, I said that over-reliance on targets was not right. I accept that point, but he now needs to answer a question of mine. He has not removed our targets for A and E or for cancer. Does he consider it acceptable that the NHS is missing the national cancer target? If not, what will he say to reassure families that that will get better soon?

[Mr Hunt]

Let us deal with the cancer target. When the right hon. Gentleman left office—[Interruption.] I am dealing with the cancer target. When he left office, we had the worst cancer survival—

[Andy Burnham]

Forget that—I am asking about now.

[Mr Hunt]

The right hon. Gentleman may want to forget that, when he left office, we had the worst cancer survival rate in western Europe, but why did we have that? We had the worst cancer survival rate in western Europe because we were not diagnosing cancers quickly enough. Under this Government—this is the inconvenient truth for the Labour party—we have treated for cancer nearly three quarters of a million more people than in the last Parliament. We have done that because, as the Prime Minister said, we are referring 50% more people. Access to cancer care has dramatically improved under this Government, and we are starting to climb back up the European league tables.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Hunt]

Let me finish my point about targets because it is important. The NHS over which the right hon. Gentleman’s Government presided was, as the former NHS chief executive Sir David Nicholson said, an NHS where

“patients were not the centre of the way the system operated.”

Labour’s NHS was obsessed with targets, and we have still not had an apology for the policy mistakes that led to Mid Staffs. We have got rid of a number of targets; we are happy to keep a few benchmark targets, but we will not be obsessed with targets at any cost.

May I gently suggest that the Labour party re-read the Francis report? These are Sir Robert’s words about the culture during the Mid Staffs period, when the right hon. Gentleman was a Minister. He described an

“insidious negative culture involving a tolerance of poor standards”

resulting from

“a focus on reaching national access targets”.

If the right hon. Gentleman does not want to listen to Sir Robert, will he listen to families who suffered in Mid Staffs, Morecambe Bay, Basildon and countless other hospitals, all of whom are simply incredulous that Labour wants to put him back in charge of the NHS, while he refuses to acknowledge the terrible problems caused by Labour’s NHS target culture?

The right hon. Gentleman also talked about privatisation. That may hit the spot for his trade union supporters, but it does not stand up to scrutiny. He knows that the use of the private sector for secondary care has grown more slowly under this Government than it grew under Labour. He knows that the biggest single privatisation decision in NHS history—the decision to contract out a whole district general hospital to the private sector—was allowed not by me, but by him when he was Heath Secretary. Let us set the record straight, because he tried to give the impression to my hon. Friend the Member for Selby and Ainsty (Nigel Adams) that that decision was not taken—[Interruption.] Let me make my point, and then I will give way. The right hon. Gentleman approved a shortlist for Hinchingbrooke hospital, which had on it two private sector providers and an NHS provider. He did not tell my hon. Friend that the NHS provider then pulled out, and that he accepted the continuation of that process with an all-private shortlist—[Interruption.] That is what happened, and if he wants to deny it, I will give way to him now.

[Andy Burnham]

The question is: when was that contract signed? Will the Secretary of State answer that question?

[Mr Hunt]

Actually, the question is: when did it become an all-private shortlist, and why did the right hon. Gentleman allow that to happen if he is now saying that the privatised running of hospitals is such a bad thing? I think that we have found him out, and he will want to correct the record and the impression that he gave to my hon. Friend the Member for Selby and Ainsty.

[Mr Simon Burns (Chelmsford) (Con)]

Will my right hon. Friend confirm that in March 2010, when the right hon. Member for Leigh (Andy Burnham) was Secretary of State, the number of bidders for Hinchingbrooke hospital—a process that took place under legislation passed by the previous Labour Government—went from five to three? Two of those bidders were private companies; the third bidder was a private company in conjunction with an NHS trust, but at a later stage as the process developed—as my right hon. Friend said—it went down to one bidder. The right hon. Gentleman said in response to my hon. Friend the Member for Selby and Ainsty (Nigel Adams) that there was a preferred bidder and that it was not a private company but the NHS. It was not the NHS; it was an NHS trust in conjunction with a private company.

[Mr Hunt]

I am grateful to my right hon. Friend because he makes it clear that, when the right hon. Member for Leigh was Health Secretary, he accepted an all-private shortlist. He will want to correct the record on that point.

[Andy Burnham]

The right hon. Member for Chelmsford (Mr Burns) has contradicted the Secretary of State. The right hon. Gentleman said that the bidder withdrew at a later stage, but the Secretary of State said that the bidder withdrew earlier. The Secretary of State cannot have it both ways. The right hon. Gentleman flatly contradicts him.

[Mr Hunt]

The right hon. Gentleman is quite wrong. My right hon. Friend said that there was a list of three providers, all with private provision involved. When the right hon. Gentleman was Health Secretary, he accepted that all-private shortlist for the Hinchingbrooke decision. In other words, the biggest privatisation in NHS history happened because of a decision taken by the shadow Health Secretary.

Government Members are not ideological. We believe there are times when we can learn from the independent sector, but, normally, people use the private sector when they are looking for innovation or better value. Only a Labour Government would sign deals with the private sector, paying 11% more than the NHS rate, and ending up paying more than £200 million for operations that never happened. What a shocking waste of money. When the right hon. Gentleman next talks about privatisation, instead of inventing a privatisation agenda that does not exist, will he apologise for a botched one that existed when Labour was in office?

Finally, there is a comparison that Labour never wants to make when talking about NHS performance: what happens over the border in Wales. That is where the policies that the right hon. Gentleman supports are put into practice. Let us see the difference. A record one in every seven Welsh people find themselves sitting on an NHS waiting list, compared with just one in 17 people in England. The urgent cancer waiting time target has not been met once since 2008 in Wales, but it has been missed in England in only two quarters in the whole period. A and E waiting times have been met every year in England, but they have not been met since 2008 in Wales.

[Lilian Greenwood]

Will the Secretary of State give way?

[Mr Hunt]

No, I will finish this point.

The British Medical Association, no friend of the Conservative party, described the NHS in Wales as being in a state of imminent meltdown. The point is that the NHS in England, like the NHS in Wales, faces huge pressure, but politicising operational problems in England, while denying much greater failings in Wales, is the worst kind of opportunism. For Labour Members, good headlines for Labour matter more than poor care on Labour’s watch. They are playing politics with our NHS. That not only scares people in England, but betrays people in Wales.

I shall conclude—

[Lilian Greenwood]

Will the Secretary of State give way?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The right hon. Gentleman is not giving way. He must be allowed to speak.

[Mr Hunt]

The Government are proud of our record on the NHS in England: more operations for more people; three quarters of a million more people getting the cancer treatment they need; record numbers being seen promptly in A and E; record numbers getting treatment for dementia; and the first ever introduction of maximum waiting times for mental health conditions. It is an NHS under pressure, yes, but it is an NHS preparing for the future, with higher-quality care in hospitals, integrated health and social care, and personal care driven by a much bigger role for GPs.

Some of those changes need money, and we have delivered that, but some of them need a change in culture, different ways of working, more transparency and a more patient-centred approach. That can mean challenging the system, which the right hon. Member for Leigh has never been prepared to do, but which this Government will always do if it is right for patients. We want an NHS building for the long term and an NHS with the confidence of a strong economy behind it. Under this Government, the NHS is independently rated as the best in the world. I oppose the motion.

[Several hon. Members]

rose—

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[Kevin Barron]

I will give way to the right hon. Gentleman in a bit, because I may mention him, as he was a Minister at the time. This Government came to office and passed a Bill through Parliament that was going to introduce competition into the national health service and mean a massive reorganisation, and billions of pounds were going to be spent in doing that—billions of pounds that could have been spent elsewhere—and the case for the defence is, “We’ll make a billion pounds a year in this Parliament.” Well, it is not there yet, Ministers.

It was not just the reorganisation of the national health service that was mentioned. The Government also told us at the same time that they had got to make efficiency savings of 4% a year, something that the health service had never done, and something the public sector had never done. Indeed, people said at the time that the private sector had never done it either.

That is the situation we had when that Bill went through Parliament. They were warned about the consequences of that not just by politicians in the House, but by people who gave evidence to the Public Bill Committee. I served on it. The Bill was stalled and came back in again. Evidence after evidence came in saying what has happened was going to happen.

We have had massive reorganisation. I just wonder if the Secretary of State—if he is prepared to listen—will tell us how many of the 4,000 NHS staff who were laid off and paid redundancy were then re-employed by the NHS, some of them on massive six-figure sums. How much did that cost the NHS? How much did that take away from mental health services or other services that our constituents rely on? None of this is in the debate at all, and Ministers all know perfectly well what the situation is.

Week after week, we hear these platitudes from Ministers. The Secretary of State said not too long ago, “When you go into hospital, you’ll get a named consultant,” but what does having a named consultant matter to most people? Are they going to work seven days a week, 24 hours a day so we can phone and say, “Can we come and see you?” No one has mentioned the latest one we have had, which I thought was wonderful—

[Mr Hunt]

rose—

[Kevin Barron]

The Secretary of State can come in in a minute. This latest one is a consequence of a speech made by the Prime Minister: we are going to be able to see GPs seven days a week. Well, the Royal College of GPs does not think so. I say this to the Secretary of State: “We could see a GP, not far from this place, seven days a week until you lot got in.” We could do so in the Victoria NHS walk-in centre, and I used to go in there, as my GP is elsewhere, but it closed years ago.

We put in walk-in centres—sometimes in the face of opposition from GPs, I have to say. A GP objected to them in my constituency, as I raised in the House at the time, so some of them were saying they did not want them. They gave seven days a week access to GPs.

I understand that my time is up, Madam Deputy Speaker, but I want to finish by saying this: whatever happened at Hinchingbrooke or anywhere else, we never ever had to have competition law on the statute book. We have now. Do not tell me or anybody else out there that the Secretary of State has not got plans to privatise properly the national health service, because I am convinced that he has.

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[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.

[Mr Jeremy Hunt]

The NAO said it.

[Liz Kendall]

I actually picked up the copy of the report he left behind, and I found his highlight. It reads:

“The estimated administration cost savings outweigh the costs of the reforms”,

but it does not mention the £1 billion figure. In fact, paragraph 4.10, on the reliability of the Department of Health, states “we found…limited assurance” in the figures. It also states that

“strategic health authority staff did not verify the figures submitted to them by primary care trusts”

and that it

“saw no evidence that the”

Government

“challenged these figures.”

Far from being independently verified, as the Health Secretary claims, they have been made up on the back of an envelope. [Interruption.]

Government Members can complain, but we have constantly argued that the NHS reorganisation has been the single biggest mistake made by the Government, and now we find out that members of the Cabinet agree. An ally of the Chancellor told The Times:

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

A former No. 10 adviser says that

“no one apart from Lansley had a clue what he was really embarking on—certainly not the prime minister”.

So we have a Chancellor, who is meant to safeguard public money, failing to stop billions of pounds of waste and a Prime Minister who claimed the NHS was his top priority, but was too confused or complacent to bother to understand his own plans. The Conservative party still does not get it. One Downing street adviser is quoted as saying:

“A lot of work had gone into persuading people that David Cameron believed in the NHS, had personal experience and cared about it. Then the Conservatives came in and forgot all about reassurance. Lansley managed to alienate all the professional people in Britain who were trusted on the NHS.”

The Government’s NHS reorganisation was not just terrible politics; it is terrible in practice for patients, taxpayers and NHS staff. I remind hon. Members that the Health and Social Care Act 2012 did not just create 221 CCGs, 152 health and wellbeing boards, NHS England, Public Health England and Health Education England; it also created four regional NHS England teams, 27 local area NHS England teams, 16 specialist commissioning units—well, there were 19, but at least two have already been merged—and 10 specialist commissioning units. That is on top of Monitor and the Care Quality Commission. It is a system so chaotic and confusing that no one knows who is responsible or accountable for leading the changes patients want and taxpayers need.

And now, just when we thought it could not get any worse, another major new reorganisation is under way. NHS England was commissioning primary care and specialist services, but in May it announced it wanted to give primary and specialist commissioning back to CCGs to try and patch up the fragmentation created by the Government's own plans. How much will this second reorganisation cost patients and staff?

Patients, staff and taxpayers cannot afford another seven months, let alone another five years, of this Government. They need a clear plan to restore care standards and restore care services so that they are fit for the future. Opposition Members would use the savings from scrapping the cost of competition in the NHS to guarantee new rights for patients to see their GP at a time that is convenient for them. We would raise £2.5 billion from a mansion tax, clamping down on tax avoidance and a levy on the tobacco companies to fund more GPs, nurses, midwives and homecare workers to transform services, particularly in the community. We will support carers with new duties on the NHS to identify family carers, a single point of contact for information and services and ring-fenced funding for carers’ breaks. Our plan for whole-person care would ensure the full integration of physical and mental health and social care services into one service with one team to meet all of a person’s needs.

At the next election, there will be a real choice on the NHS: a choice between care going backwards and money wasted under the Conservatives or Labour’s plans to fully join up services to get the best results for patients and the best value for money. It will be a choice between the Conservatives who have broken their promises to protect the NHS, throwing the system into chaos and blaming staff, or Labour who will make the real reforms we need so that people get personalised care in the right place at the right time. It will be a choice between the Conservatives’ unfunded plans to cut taxes for the wealthiest or Labour’s fully funded plans to reform the NHS and care services on which we all rely. I commend the motion to the House.