Maternity Services (Morecambe Bay)

Debate between Jeremy Hunt and Andy Burnham

Tuesday 3rd March 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his well-judged statement, and echo entirely the sentiments he expressed. Families in Barrow and the wider Cumbria area were badly let down by their local hospital and by the NHS as a whole. The Secretary of State was right to apologise to them on behalf of the Government and the NHS, and today I do the same on behalf of the previous Government.

It is hard to imagine what it must be like to lose a child or partner in such circumstances, but to have that suffering intensified by the actions of the NHS is inexcusable. Bereaved families should never again have to fight in the way that these families have had to fight to get answers. The fact that they have found the strength and courage to do so will benefit others in years to come, and I pay tribute to them all, and particularly to James Titcombe.

This report finally gives the families the answers that they should have received many years ago. It explains in detail what went wrong, the appalling scale of the failings and, as the Secretary of State said, the opportunities missed to identify those failings and put them right.

I echo the Secretary of State’s praise for Dr Bill Kirkup, his investigation team and the panel that assisted them. The report’s analysis is thorough, and its recommendations are powerful but proportionate. The Opposition support all the recommendations made today. I understand that the Secretary of State will want to take time to consider each individually, but he can rely on our full support in introducing them at the earliest opportunity.

People’s first concern will be whether local services are safe today. The report identifies the root cause of the failures as a dysfunctional local culture and a failure to follow national clinical guidance. There are suggestions in the report that that culture has not entirely disappeared. The report finds:

“we…heard from some of the long-standing clinicians that relations with midwives had not improved and had possibly deteriorated over the last two to three years…we saw and heard evidence that untoward incidents with worryingly similar features to those seen previously had occurred as recently as mid-2014.”

I am sure the fact that problems have been acknowledged means that there has already been significant improvement, but will the Secretary of State say more about those findings, and about what steps he is taking to ensure that the trust now has the right staff and safety culture?

After safety, people will rightly want accountability, as the Secretary of State said, not just for the care failings, but for the fact that the problem was kept hidden from the regulators and the public for so long. When information came to light, it was not acted on. Lessons were not learned, and problems were not corrected. The investigation recommends that the trust formally apologises to those affected. The whole House will endorse that call, and will want it done both appropriately and immediately. Further, will the Secretary of State ensure that any further referrals to the GMC and NMC are made without delay? Will he also ensure that any managerial or administrative staff found guilty of wrongdoing are subject to appropriate action? A number of staff have left the trust in recent years, many with pay-offs. Will he review those decisions in the light of the report and take whatever steps he can to ensure that those who have failed are not rewarded?

One of the central findings of the investigation is on the challenges faced by geographically remote and isolated communities in providing health services. The investigation warns of the risks of a closed clinical culture in which

“practice can ‘drift’ away from standards and procedures found elsewhere”.

Is not the report right to recommend a national review of maternity care and paediatrics in rural and isolated areas, and will the Secretary of State take that forward? Alongside that, there are concerns about the sustainability of the Cumbrian health economy. My hon. Friend the Member for Copeland (Mr Reed) has today written to the chief executive of NHS England to call for a review of the specific challenges it faces. I hope the Secretary of State will be sympathetic to that call.

On the CQC, the role of the regulator has always been to oppose poor care and challenge practice, but it is clear that it failed in its duty in this case. Given what was known, the decision to register the trust without conditions in April 2010 was inexplicable, as was the decision to award foundation trust status later in 2010, as was the decision to inspect emergency care pathways but not maternity services—in so doing, it failed to act on specific warnings. As the report states, there was and remains confusion in the system over who has overall responsibility for monitoring standards, with overlapping regulatory responsibilities. The Opposition support moves to make the CQC more independent, but does the Secretary of State agree that the journey of improvement at the regulator needs to continue, and that there is a need for further reform? Will he ensure that NHS England draws up the recommended protocol on the roles and responsibilities for all parts of the oversight system without delay, and does he agree that the CQC should take prime responsibility?

I want to close by focusing on two proposals that I believe get to the heart of the matter before us. I have thought carefully about how we truly do justice to the families’ campaign and learn the lessons of both this investigation and the Francis report. In my view, the answer is a much more rigorous system of the review of all deaths in the community and in hospitals than currently exists.

First, is the reform of death certification and the introduction of a new system of independent medical examination well overdue? The Kirkup report echoes findings that go back as far as Dame Janet Smith’s inquiry into the Shipman murders, which were repeated recently by Sir Robert Francis in his two reports on Mid Staffordshire. The previous Government legislated for those reforms and made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to a coroner. That has been piloted and proven to be effective. The investigation says that those reforms could have raised concerns at Morecambe Bay before they eventually became evident.

The second point is that we need a better system for scrutinising deaths in hospital. The report recommends mandatory reporting and investigation of serious incidents of all maternal deaths, stillbirths and unexpected neonatal deaths. Is there not a case to go further, including by looking at moving to a mandatory review of case notes for every death in hospital, and at how we can use a standardised system of case note review to support learning and improvement at every trust?

To help to guide the Opposition’s new approach to quality improvement, Professor Nick Black has agreed to advise us and inform the review, which will be concluded by the end of the month. In our view, that reform is much needed, because rather than looking at a sample of deaths to avoid harm, we would look at every single death to learn lessons, which means that every single person matters. Ideally, the review should be cross-party. I hope the Secretary of State feels able to endorse the review I have announced, which will make recommendations that the next Government can act on immediately. Is that not the best way to do justice to the issues that the families have fought to raise, and to ensure that the legacy of their campaign is to ensure that no others go through what they have gone through?

[Mr Hunt]

I thank the right hon. Gentleman for his measured tone. I am sure he is absolutely sincere in wanting to learn from this tragedy. I thank him for his moving words and for his apology. He will understand that there is nervousness among the families because, in the past, when the Government have talked about rooting out poor care, we have been accused of running down the NHS. We have had a different tone today, and I welcome it.

To answer the right hon. Gentleman’s specific points on the quality of care at the hospital currently, the best person and people to make that judgment are the new CQC and chief inspector of hospitals, Professor Sir Mike Richards. He has said that, in his view, the care at the maternity unity in Furness general hospital is good, and indeed safe—it is more than safe; it is good. That should reassure many people who are using the hospital. He is also very clear that there are many, many improvements to make, and his overall rating for the trust is not good. The report highlights many areas that still need to be addressed, but it is important to give that reassurance.

On death certification, I assure the right hon. Gentleman that we fully support that policy. As he knows, it was recommended in January 2005, so it has taken a long time for both Governments to address. We fully support the policy and have had successful trials. We are committed to introducing it as soon as possible and we want to go further. There may be some common ground, because we, too, have been talking to Professor Nick Black about case note reviews. The latest advice I have had is that it would be technically very difficult to review the case notes of all the 250,000 deaths every year in NHS hospitals, because of the resource implications and the doctors’ time it would take. I asked whether it would be possible to do that. I was advised that, if we looked at case notes hospital by hospital, there would be a risk of trusts getting into big disputes about whether or not a death was avoidable. I asked Professor Black to help me to devise a methodology so that we can assess the level of avoidable deaths by hospital trust. We would be the first health economy in the world to do that. I hope we will have his full support as we take that forward.

On the decision to give the trust foundation trust status, the report makes it clear that Ministers were advised that they had no locus to intervene, because the process had already been set in train—the decision had been deferred but not stopped, so they were not able to intervene. It is clear that the level of knowledge in the Department of Health, as in the rest of the system, was wholly inadequate given what was happening in that hospital.

I should like to make one other point, on a comment made by Labour this morning that the report would say that the failings were very localised. In fact, the report says the opposite. I want to read what Dr Kirkup says in the introduction to the report:

“It is vital that the lessons, now plain to see, are learnt and acted upon, not least by other Trusts, which must not believe that ‘it could not happen here’.”

It is important that we take that lesson from the report extremely seriously.

I would like to finish on a note of consensus. I appreciate that it is not always easy for Oppositions to support the Government publicly as they put right policy mistakes that they have inherited, but I think there is one thing where we can make common ground: the need for culture change in the NHS. Policies can be changed over one Parliament, but culture change takes a generation. What the families who have suffered so much want to know more than anything else is that Members on all sides of the House are committed to that, so that we never again go back to the closed ranks and institutional self-defence that piled agony on to their tragedies, and that, once and for all, we all make the commitment that patients will always come first.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

We do understand those concerns. It is absolutely essential that CCGs make sure that they have the right bed capacity to deal with the pressures of winters.

[Andy Burnham (Leigh) (Lab)]

Let me take the Secretary of State back to a subject he likes to avoid—NHS privatisation. He tries to deny that it is happening on his watch, but we heard earlier about the ideological privatisation of cancer scanning in Cheshire and Staffordshire, despite its being more expensive than the NHS bid—and now it could get much worse. On the Friday before the recess, the Government sneaked out the public contracts regulations, which require NHS contracts worth over €750,000 to be opened up to full EU competition. Will the Secretary of State confirm that that is indeed the case in these regulations, and can he explain what mandate he has from the public to open up the NHS to private bidders across Europe?

[Mr Hunt]

Since the last time the right hon. Gentleman and I met, the King’s Fund has published its assessment of the NHS reforms over the past few years, and its words were:

“Claims of mass NHS privatisation were and are exaggerated”.

He knows perfectly well that outsourcing grew at double the rate under the previous Labour Government than it has grown under this Government.

[Andy Burnham]

The King’s Fund report said that as a result of the Secretary of State’s reforms there is

“greater marketisation of the NHS”.

People will notice that he failed to answer my question. That is because he wants to sneak these plans through under the radar. I serve notice on him today that we will fight him all the way, right to the very last day of this Parliament. If passed, these regulations will mean that almost every NHS contract will be forced to be advertised across Europe, shattering the promise he made to protect the NHS from EU competition law. Is it not now abundantly clear that he has forfeited the public’s trust on the NHS, and that five more years of this Government will lead to huge acceleration in NHS privatisation?

[Mr Hunt]

I repeat:

“Claims of mass NHS privatisation were and are exaggerated”.

If the right hon. Gentleman does not like the reforms, let us look at a country that did not have them—Wales. The number of people waiting too long for A and E is nearly double that in England, the number of people waiting too long for urgent ambulances is nearly double that in England, and the number of people waiting for operations is 10 times that in England. That is our record—it is a record of success.

Francis Report: Update and Response

Debate between Jeremy Hunt and Andy Burnham

Wednesday 11th February 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I welcome the Secretary of State’s statement and his obvious commitment to improve the culture of tackling poor care in the NHS; there is plenty of common ground between us. We endorse the principles laid out in Sir Robert Francis’s new report and we will work with the Secretary of State to get new safeguards on the statute book in the remainder of this Parliament, as he requested.

It was the Labour Government who, in 1998, introduced the first legal protection for whistleblowers in the Public Interest Disclosure Act 1998, reinforced in the NHS constitution in 2008. Sir Robert’s new principles build on those foundations. We thank him and the review team for their work and praise every whistleblower who has had the courage to come forward.

Our shared aim must be to create a climate in which every NHS worker feels able to raise concerns and feels confident that they will be listened to, that appropriate action will be taken and that they will not face mistreatment as a result. Sir Robert’s report will help achieve that. We particularly welcome the call for whistleblowers worried about losing their jobs to be offered alternative employment and for training in whistleblowing for all staff. Those measures are overdue. Will the Secretary of State say more about how Sir Robert’s principles will be enforced across the NHS and about the timetable for implementation? Will he confirm that they will apply equally to all providers of NHS services, including voluntary and private providers?

That brings me to an issue of major substance not covered in Sir Robert’s report. As he points out, his remit did not apply to any form of social care. That is a major concern, given that it could be argued that some of the poorest care provided in England today is in social care settings or in people’s own homes. Only at the weekend, a BBC investigation found that one in five care homes for older people is failing to meet standards for safety. Should we not today, across this House, establish the firm principle that Sir Robert’s recommendations should apply equally to all places where people receive care?

Let me turn to the recommendation for an external organisation that staff can approach for advice and support. In response to the first Francis report in February 2010, I established an expert group to update whistleblowing guidance. It reported in June 2010, and the Secretary of State’s predecessor announced plans for a “safe and independent authority” to which staff could turn when their organisations were not acting on concerns. Will the Health Secretary say why that has not progressed since then and assure us that there will be no further delays now that Sir Robert has reinforced that recommendation?

Although I believe that the Secretary of State’s commitment to improve the culture in the NHS is genuine, he will no doubt be concerned by Sir Robert’s findings that it might have got worse in recent years. In his report, he said about the cases he examined:

“Many were relatively recent or current. This is not about a small number of historic high profile cases from a time when organisations might argue the culture was different. We had a significant number of contributions about cases in 2014.”

The report specifically references figures from the latest NHS staff survey, which shows that reports of bullying have increased from 14% of staff in 2011 to 22% in 2013. Over the same period, the percentage of staff who feel able to speak out about poor care or to report errors or near misses has fallen from 98% in 2011 to 94% in 2013. Those figures suggest that things are getting worse, not better. Will the Secretary of State explain why he thinks that is and whether he will investigate the reasons further? That underlines the importance of any moves to improve the culture being introduced in the right spirit and being supportive rather than punitive, so that they do not reinforce the wrong culture and have the opposite effect to that which the Secretary of State is obviously trying to achieve.

At the weekend, the Secretary of State proposed fines and jail sentences for failure to be open about poor care. Although we support his zero-tolerance approach, is he certain that how this is perceived on the ground will not create a climate of fear and have the opposite effect?

Those concerns also apply to the new inspection regime introduced since the Francis report. In advance of today, I was contacted by a whistleblower who works in a hospital about a Care Quality Commission inspection planned for later this month and about the growing practice of hospitals running mock inspection days in advance of the CQC’s arrival, as schools have come to do with Ofsted. The whistleblower’s letter states:

“I enclose a document that invites us for a mock inspection to show us what to do and say when the CQC comes. Is this the correct thing to do? I think not. I cannot reveal my name as I would be instantly dismissed. Can you help?”

I am sure that the Secretary of State will be as concerned as I am to hear that and I will forward the information to him this afternoon.

I turn now to the Secretary of State’s update on the Francis report on Mid Staffordshire. Both sides of this House supported Sir Robert’s original recommendations and we give credit to the Secretary of State for making significant progress with their introduction, but gaps remain where progress has not been made and that is a concern when standards overall in the NHS are recorded to be falling, not rising.

In particular, there is a long-standing need to reform the system of death certification which goes back to Dame Janet Smith’s inquiry into the Harold Shipman murders. I took a personal interest in that as a Minister on the back of concerns raised by my hon. Friend the Member for Denton and Reddish (Andrew Gwynne)and James Purnell, the former Member for Stalybridge and Hyde. I legislated for reforms of death certification in the Coroners and Justice Act 2009, which made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to the coroner.

Following successful pilots, Sir Robert Francis reinforced Dame Janet Smith’s recommendation. Dr Suzy Lishman, the president of the Royal College of Pathologists, says that introducing these reforms will

“improve patient care whilst reducing harm and saving money”.

It will therefore be a cause of great concern to a great many people, not least the families of the victims of Harold Shipman, that those reforms appear to be stuck in the long grass. Chris Bird, whose mother Violet was one of those victims, recently told the “Today” programme that

“it is criminal that the Government is stalling on implementing something like this that could save lives.”

I have been informed by senior officials in the Secretary of State’s own Department that he personally is holding up this reform. Can he say whether that is true, and if so why? If it is not true, which I am prepared to accept, will he today set out a clear timetable for the introduction of this vital reform?

Alongside that, we need better arrangements in hospitals for reviewing case notes when patients have died, as the Secretary of State mentioned in his statement. Over the weekend, the Government announced plans to introduce an annual review from a sample of patients. Although that will help us to develop a more accurate measure of avoidable deaths than mortality rates, does the Secretary of State think it goes far enough? Should not the NHS learn from all serious failings? Will he give consideration to our suggestion that every death in hospital should be subject to an appropriate level of review?

We welcome the renewed focus on staff numbers since the Francis report, but we also remind the House that in the first three years of this Parliament almost 6,000 nurses were lost and, with record numbers of people in hospital, nurse-patient ratios have not kept pace with demand and there are fewer nurses per head of population now than in 2009-10. One of the problems with having made so many permanent staff redundant is that, post Francis, recruitment has been heavily reliant on agency staff. As Robert Francis warns today, that has made it even harder to get the culture right. We welcome the Secretary of State’s recent focus on nurse numbers, but will he concede that it was a mistake to cut staff so heavily? Will he back Labour’s plan to bring down the agency bill by recruiting 20,000 more nurses?

We welcome the progress made at some hospitals in special measures, but may I caution the Secretary of State on his use of statistics? Is he aware of the graph on page 8 of the Dr Foster report, which shows that mortality rates at the Keogh trusts fell faster between 2006 and 2010 than between 2010 and 2014? There was never a tolerance or denial of high mortality, as he seemed to suggest in his statement.

On openness and transparency more broadly, the Secretary of State will be aware that the King’s Fund delivered a damning verdict on the Government’s reorganisation, concluding that it had damaged patient care. That is consistent with a survey of NHS staff, which found that 69% said the reorganisation had harmed patient care, with only 3% saying it had improved. It is suggested that the Government’s own risk register on the reorganisation warned that reorganising the NHS at a time of financial stress would damage front-line care. So that any future Government can learn the lessons of the past few years, will the Secretary of State publish the risk register, as recommended by Sir Robert Francis?

In conclusion, as I have always said, the lessons from Mid Staffordshire need to continue to be learned if the NHS is to be what we all want it to be: the safest and best health care system in the world. The Secretary of State has today taken some important steps towards that goal, but I hope he will respond fully to the serious questions I have raised.

[Mr Hunt]

I welcome the broadly constructive tone that we have heard today. May I say, in that spirit, that I hope that that represents a change in substance from some of the other exchanges we have had on these topics? The right hon. Gentleman tried to vote down the legislation that set up the new chief inspectors and he opposed the holding of a public inquiry into Mid Staffs. If we are to have constructive agreement across the House, I do think we need to agree on substance as well as on tone. Let me just take the individual points he mentioned.

We are completely committed to death certification. That was recommended in the wake of the Shipman inquiry. The right hon. Gentleman’s Government took a very long time to do anything on this and we have been trying hard to do it. It is a complicated thing to get right. On the question of looking properly at avoidable deaths, I just want to say this. It is very difficult, when one looks at case notes, to work out whether a death was avoidable or not, but we think we have a methodology to do that. It is more difficult to relate that to individual trusts, but we want to try to achieve that as well. I was disappointed at the weekend that when we announced that, his response was that it was unambitious. Two weeks earlier, he had published Labour’s 10-year plan for the NHS, which did not actually mention reducing avoidable deaths at all. What we are proposing is the most ambitious thing that any health care system has proposed anywhere in the world, and I hope it will have his full support.

On the right hon. Gentleman’s comments about not generating a climate of fear, he is absolutely right; it is really important, in getting the culture right, to make sure that people are supported to speak out and that there is not, as an unintended consequence, the kind of bullying and intimidation that Sir Robert says is all too common today. I suggest to him that one of the reasons for that climate of fear has been over-dependence on top-down targets as a way of running the NHS. That is what has created the fear in managers that sometimes has led them to treat their staff in the wrong way. What would be very constructive would be a recognition from Labour that that top-down targets culture did go too far, and that we need to rely on transparency as a way of improving performance as a much better tool than endless new targets.

In anything we do—this is something else where I agree with the right hon. Gentleman—we must look very closely at making sure that we learn these lessons in the social care sector as well. That is particularly clear when we look at the scandal of what happened in Rotherham. That is why, when we introduced the new CQC inspection regime following the original Francis public inquiry, we did not just set up a chief inspector for hospitals but set up a chief inspector for general practice and for adult social care. We are now getting the same Ofsted-style transparent rankings of how good care is in care homes, and indeed in domiciliary care. I know that he, like me, is concerned about 15-minute care visits. I think those inspections will help to root out those problems.

With respect to nurse numbers, I really do think that is something on which, if the right hon. Gentleman wants to be constructive, he should commend the Government’s efforts. We have 8,000 more nurses in our hospital wards than we had four years ago. Of course, as a short-term response a lot of hospitals are employing nurses through agencies. That must only be a short-term response. We need proper long-term commitment to institutions, which we do not get with agency staff, but I commend hospitals that have said, “While we try and get enough staff in place for the long term we are not going to wait, because we need to make sure that patients are safe today.” They want to do what it takes to do that.

Finally, on the risk register, I simply remind the right hon. Gentleman that when he was Secretary of State he blocked the publication of the risk register. As a Minister, he said:

“This would inhibit the free and frank exchange of views about significant risks and…management, and inhibit the provision of advice to Ministers.”—[Official Report, 23 March 2007; Vol. 458, c. 1192W.]

More broadly, I just want to say this. There are many patients and whistleblowers looking at today’s exchanges and wanting to see constructive agreement on the way forward. I think we can get a measure of that. What they say they want is not just words, but actions.

As we put staff and patients first in England, will Labour do the same for patients in Wales and today commit to a Keogh review of high mortality hospitals, commit to a chief inspector of Welsh hospitals and commit to protect staff who speak out in Wales, as we want to do in England? Will he commit to putting right a top-down culture that prioritised the needs of the system over the needs of individuals? Will he, as we do, recognise that that is always the danger of treating the NHS as a political possession and not as a service for patients? Patients must always come first. Staff who want to do the right thing for patients should always be heard. Our NHS deserves nothing less.

NHS Major Incidents

Debate between Jeremy Hunt and Andy Burnham

Wednesday 28th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what guidance has been issued by NHS England on declaring a major incident.

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

As you know, Mr Speaker, I am always happy to come to the House to discuss the NHS, but today we have been brought here to discuss a local operational issue that, regrettably, the Opposition have tried to spin as part of their policy to “weaponise the NHS.”

As I said to the House earlier this month, a major incident is part of the established escalation process for the NHS, and has been since 2005. It enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally, and there is no national definition. We must trust the managers and clinicians in our local NHS to make these decisions and support them in doing so by ensuring that there is sufficient financial support available to help them to deal with additional pressures. The document that has been questioned this morning by the Opposition Health spokesman was issued by the local NHS in the west midlands. That was done to help its clinical commissioning groups to work with local NHS organisations to deal with the unprecedented pressures they have been facing this winter. The chief operating officer of NHS England, Dame Barbara Hakin, has said this morning that this was a local decision and neither the responsibility of Ministers nor the result of pressure by Ministers.

Let me finish by praising the NHS for coping well with the unprecedented pressures. Performance against the A and E standard improved to 92.4% last week, which is testament to hard-working staff, and this Government will support them, not try to turn their efforts into a political football.

[Andy Burnham]

In the first week of January, at least 14 trusts across England declared major incidents, including three in the west midlands. Official figures show that pressure continued into the second and third weeks of January, with only seven A and Es out of 140 meeting the Government’s target. There were ambulance diverts, and even an A and E closure, but no further major incidents were declared. On 7 January, when the Health Secretary was called to the House to answer an urgent question, he said:

“The decision to declare a major incident is taken locally—there is no national definition”—[Official Report, 7 January 2015; Vol. 590, c. 273.]

He has just repeated that now, and called this a “local operational issue”, but that does not appear to be entirely accurate. Let me quote from the guidance that was sent in the middle of January. It is headed “NHS England” and it states:

“Major incidents should be agreed with…the Director on call for NHS England”.

Will the Secretary of State now withdraw his earlier statement to the House and confirm that this decision is not purely local, in that it has to be approved by NHS England?

Let me turn to the impact that this has had on trusts. There are 17 enhanced criteria set out, including requirements that may cause serious time delays for trusts in an emergency. For instance, there is a requirement on the on-call CCG manager to visit the trust and undertake a review. Let me tell the Secretary of State how those new rules were perceived by senior managers. I shall quote from an e-mail sent by the head of operations at one trust, who said that the requirement had been

“introduced by NHS England to effectively stop trusts from calling a major incident…Our hands will be tied in most cases if they wish to call a major incident for capacity reasons”.

Is the Secretary of State confident that the new enhanced criteria are not unduly burdensome and will not cause unnecessary delays for a trust in an emergency situation? Is he satisfied that this guidance is consistent with good practice at national level and safe to be left in place?

The Secretary of State has used the word “local” many times today, and spoken of the only consideration being relieving pressure on hospitals facing severe demand. However, his claim that this matter is purely local is called into serious question right now by this 86-page document headed “NHS England”—[Interruption.] He says it is from the local team, but this is a regional function of the national body, NHS England. The local claim will not wash, I am afraid.

I will tell the Secretary of State what the guidance tells trusts to take into account. He says that it concerns only operational matters, but section 7.2.3 is headed “Politics”, and subsection (a) asks:

“Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?”

Subsection (c) asks:

“Is there a risk of reputational damage?”

Does not this muddy the waters hugely? Will it not distract doctors whose sole focus should be on the emergency situation, and not on media and political considerations that should form no part of their judgment? If the Secretary of State agrees with me on that, will he today instruct NHS England to withdraw this guidance and issue more appropriate instructions to the NHS in the region? The NHS remains under serious pressure, and it needs the clearest of instructions based on what is best for patients. Will he act today, so as to leave the NHS in no doubt that that must be its paramount and only concern at all times?

[Mr Hunt]

In the right hon. Gentleman’s desperate desire to weaponise the NHS, I am afraid that Labour has sunk to new depths today. He said in the media this morning that the Government had put news management over patient safety. That is ironic coming from him, given that so many officials testified to Francis about the pressure they were put under not to come out with bad news when he was Health Secretary. Even the head of the Care Quality Commission was roasted because she wanted to publish details of the problems that were happening in the NHS under Labour and he did not want that to happen when he was Health Secretary. That news management stopped the moment he walked out the door, and those days are over.

As confirmed by NHS England this morning, this was an operational decision; it was nothing to do with Ministers. This was the local NHS doing its best to get good guidelines out in a tough winter. [Interruption.] It is a local decision. The right hon. Gentleman is the man who talks—he did not deliver this in office—a lot about integration. It is absolutely right that a local hospital should talk to the rest of the local NHS to check about the impact of any decision it makes on major incidents, to make sure that patients are treated safely—is he now saying to this House that local hospitals should not talk to the rest of the NHS? That is what these guidelines say. This was a period when we had 16 major incidents, but that number has gone right down because performance on accident and emergency is significantly—[Interruption.] This is the underlying point, because the reason we have fewer major incidents is that A and E performance has got better. This is the week when we discovered that public satisfaction with the NHS jumped five points last year. This is the week when NHS unions have put patients first by suspending their strike, and Labour focuses not on patients, but on politics. On patients, he did not want to talk about the Welsh ambulance service publishing its worst ever figures, although the Labour leader says that we should be looking at what is going on in Wales.

Let us be clear: where Labour runs the NHS we have double the number of people waiting at A and E; double the number of people waiting too long for ambulances; and 10 times the number of people waiting for their operations. We have seen Labour today in Wales and Labour before covering up around Mid Staffs, ignoring patients and weaponising the NHS for political advantage—has the right hon. Gentleman not proved today that Labour is still not fit to run the NHS?

--- Later in debate ---

[Mr Hunt]

My hon. Friend eloquently points out the great irony in what we have heard from the Opposition Front Bench. We do not want an NHS in which every single operational decision is made from behind the Secretary of State’s desk. We want to trust people on the ground. Why do we want to do that?

[Andy Burnham]

Politics.

National Health Service

Debate between Jeremy Hunt and Andy Burnham

Wednesday 21st January 2015 Commons Chamber

[Mr Hunt]

I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.

Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.

Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.

It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.

[Andy Burnham]

I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?

[Mr Hunt]

Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.

I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.

What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.

While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!

--- Later in debate ---

[Mr Hunt]

Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.

[Andy Burnham]

Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.

The Secretary of State reeled off a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.

[Mr Hunt]

If the right hon. Gentleman did such a wonderful job and wants to talk about Mid Staffs, why are patient campaigners so outraged by his comments and feel that he did everything he could to brush those problems under the carpet?

[Mr Hunt]

I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.

[Andy Burnham]

It’s not working.

[Mr Hunt]

But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.

The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members, poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point about the way targets are set up. It is possible for ambulance services to hit their targets while not delivering a satisfactory service to the most rural areas, and we have discussed that issue a number of times. Because we are in the middle of a challenging winter, we do not think that now is the right time to review the issue, but he should rest assured that we are keeping it under review.

[Andy Burnham (Leigh) (Lab)]

Although focus has been on A and E, it is becoming clear that the knock-on crisis in the ambulance service is more serious than people realise. Evidence is emerging of services unilaterally abandoning national standards and putting patients at risk. We know of one ambulance service that left patients at the door of A and E without handing them over to A and E staff, and last night East of England ambulance service was forced to release an internal report on the downgrading of thousands of 999 calls, including calls made by terminally ill patients. The report covered only a sample, but it showed that at least 57 of those patients died after a decision was taken not to send an ambulance. Withholding ambulances from terminally ill people is the most cruel form of rationing imaginable. Will the Secretary of State today order a full, independent investigation into how that happened, and into every death or adverse incident?

[Mr Hunt]

We investigate deaths and adverse incidents carefully, and the East of England ambulance service got £3.6 million of extra support to help it this winter. Let us look at what is happening in the ambulance service. Year on year, the number of the most serious category A calls—those that need to be answered within eight minutes—has increased by 26% over one year, and the number of ambulances dispatched within eight minutes has increased by 22%. That is 1,900 extra ambulance journeys arriving within eight minutes, which is a record of an ambulance service doing well under a lot of pressure. The right hon. Gentleman should be getting behind the paramedics and ambulance services, not trying to politicise the issue.

[Andy Burnham]

I raised a very serious issue, which came to light last night, regarding 57 terminally ill patients. As that was only a sample, it is not the whole story. I am surprised that the Secretary of State did not answer the very specific question about a serious failure in the East of England ambulance service. The truth is that this is not confined to the ambulance service in the east of England. Last year, we heard of a 77-year-old great-grandfather from Bolton who waited for more than four hours on a freezing pavement and a 92-year-old grandmother who tragically died after waiting for five hours in agony on the floor of her home in Muswell Hill.

Whatever the Secretary of State says, those are not isolated cases. New figures last week showed that in November a staggering 17,000 critically ill patients who were classified as needing an urgent category A 999 response waited longer than 19 minutes for an ambulance to arrive. Will the Secretary of State agree that this chaos is now putting lives at risk and cannot carry on? Will he tell the House what precise steps the Government are taking to bring responses to 999 calls back up to acceptable standards?

[Mr Hunt]

But we are taking measures. That is why we have 2,000 more doctors and 5,000 more nurses compared with a year ago. Frankly, the last thing those doctors and nurses on the front line want is scaremongering by the right hon. Gentleman—posters saying that the NHS might cease to exist under this Government; and leaflets like the one I have here from Lancaster saying that the local hospital might close. We are backing the NHS with more doctors, more nurses, more resources and a long-term plan. Will he now back the NHS by disowning this kind of scaremongering and stop trying to weaponise the NHS?

A and E (Major Incidents)

Debate between Jeremy Hunt and Andy Burnham

Wednesday 7th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the major incidents that have been declared at a number of hospitals and on A and E performance in England.

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

Mr Speaker, I welcome this opportunity to come to the House and make a statement on accident and emergency services.

First, we must recognise the context. The NHS always faces significant pressures during the winter months, but, with an ageing population, we now have 350,000 more over-75s than just four years ago. As a result, we are seeing more people turning up at our A and Es, with 279,000 more attendances in quarter three of this year as compared with last, and a greater level of sickness among those who do arrive, leading to an increase in emergency admissions of nearly 6% on last year. This picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland all missing key performance standards as a result.

A number of hospitals have declared major incidents over the past few days, in what is traditionally a particularly busy time in A and E. A major incident is part of the established escalation process for the NHS, and has been since 2005. This enables trusts to deal with significant demands, putting in place a command and control structure to allow them to bring in additional staff and increase capacity. It is a temporary measure taken to ensure that the most urgent and serious cases get the safe, high-quality care they need.

The decision to declare a major incident is taken locally—there is no national definition—and we must trust the managers and clinicians in our local NHS to make these decisions, and support them in doing so by making sure there is sufficient financial support available to help deal with additional pressures.

I chaired my first meeting to discuss that support on 17 March last year. On 13 June, we gave the NHS an additional £400 million for winter pressures, topped up in the autumn by £300 million to a record total of £700 million, ensuring local services had the certainty of additional money and time to plan how best to use it.

The NHS started this winter with 1,900 more doctors and 4,800 more hospital nurses than a year ago. This planning and funding has been widely welcomed by experts in the system, including NHS England, NHS Providers, the College of Emergency Medicine and the NHS Confederation. The funding the Government have put in, which is on top of the year-on-year real-terms increases in funding, is made possible by a strong economy, and will pay for the equivalent of 1,000 more doctors, 2,000 more nurses and 2,000 other NHS and care staff including physiotherapists and social workers. It will fund up to 2,500 additional beds, both in the acute and community sectors, and also provide £50 million to support ambulance services.

But the NHS also needs longer-term solutions to these pressures. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, with over 4 million already benefiting. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. And we have funded the NHS’s own plan to deal with these pressures, the five-year forward view, with an additional £1.7 billion for the NHS in 2015-16 and £1 billion of capital over the next four years to improve primary care facilities.

Mr Speaker, let me finish by thanking hard-working NHS staff across the country for the outstanding care they continue to deliver under a great deal of operational pressure.

[Andy Burnham]

All over England, the NHS is stretched to the limit—and in places is at breaking point. Staff are working flat-out and we thank each and every one of them for all they are doing, but the situation is now serious and getting worse. Right now, too many vulnerable people are exposed to too much risk, waiting hours for ambulances to arrive, and held in the back of them outside A and E or on trolleys in corridors. This cannot be allowed to carry on. Patients and staff deserve better answers than they have had to date about what is being done to address this issue, and that is why, faced with this complacency, we have again had to force the Secretary of State to come here today.

Fourteen hospitals have declared major incidents. Will the right hon. Gentleman explain clearly what this means for services in those areas? What is the official advice to people living in those areas? Is he providing any central support and advice to those hospitals? If a number of major incidents are declared in the same area at the same time, what contingency plans will be put into place to protect the public? More broadly, what new measures does he have under active consideration to ease pressure at all hospitals?

The Secretary of State mentioned resources. When he allocated additional resources for winter pressure, what assessment was used to determine how much was needed? Clearly, it is not working. Does he now plan to reassess the situation and perhaps allocate more? Ministers keep blaming unprecedented demand, but the question is this: why is there such unprecedented demand? Could it have anything to do with the difficulty in getting a GP appointment, the closure of walk-in centres or the cuts to social care?

Let me turn to ambulance services. There are alarming reports of people waiting hours for ambulances to arrive. This is because ambulances are trapped in queues outside A and E departments. We are hearing that at least one service has implemented a policy of leaving patients at the door of A and E without handing them over to A and E staff. Is the Secretary of State aware of this practice, and is he satisfied that it is not putting patient safety and care at risk?

The last time we had to drag the Secretary of State here, he failed to inform the House that he had approved a proposal to relax 999 response times. So will he today tell the House what the current status of those plans is and whether they are still going ahead this winter? I have real concerns, which I have relayed to ambulance leaders, about making any such change without proper consultation and evidence. There are also reports of police and fire vehicles being used to carry people to A and E. What discussions has he had with police and fire service leaders about this practice? What training or advice has been given to front-line police and fire staff? Is he fully satisfied that patient safety is not being compromised?

Finally, cuts to social care are a root cause of the pressure on hospitals. A record number of elderly people are trapped in hospital beds, and any solution to this crisis must involve councils and a solution for social care. So will the Secretary of State now act on our constructive proposal to hold an urgent summit of all the public services affected—councils, police and fire services—and to develop a co-ordinated plan to ease this crisis? NHS staff deserve it. Safe patient care demands it. When will he deliver it?

[Mr Hunt]

First, let me thank the right hon. Gentleman for this opportunity once again to go through the plans that we have in place to support the NHS and to reiterate the gratitude of the whole House to NHS staff for what they are doing under huge pressure at the moment. Let me start by telling him where I agree with him. I agree that what happens in the social care system is closely linked to what happens in the NHS. That is why, from June last year, meetings have been happening in 140 local authority areas between the local NHS and local authorities to work out how best to plan for winter. The result of that planning process, which is funded by £700 million of Government support, is extra doctors, extra nurses, extra beds and new plans in every area. I am absolutely satisfied that that money is making a difference. Every day in our A and E departments, 2,500 more people are being seen within four hours than was the case four years ago when the right hon. Gentleman was Health Secretary. The local structures worked last year, and they are working now. Now is the time to get behind them and to support the local NHS.

In a letter that the right hon. Gentleman wrote to me yesterday, he talked about Government failure. This is not the time to play politics—[Interruption.] Perhaps Opposition Members will listen to this. The head of NHS England, Simon Stevens, a former Labour special adviser, said yesterday

“the NHS, the Department of Health and local clinicians have done everything that could reasonably be expected”

to put in place plans over the last weeks. If the right hon. Gentleman will not listen to that, perhaps he will listen to Rob Webster, who runs the NHS Confederation, a representative body of all NHS organisations. He says that we should be grateful for the huge effort NHS staff have put in over the past few weeks and that it is not the time to play political football.

The right hon. Gentleman talked about ambulances, where we are putting in £50 million of support this winter, and some changes proposed by the Association of Ambulance Chief Executives, which he was informed about three months earlier than they came to public light. This is what the AACE said:

“We have been surprised by some of the reaction today given that over the last three months the principles of what we are proposing…have been shared with Labour…and we have received no negative feedback”.

What did the right hon. Gentleman say? He said it was a panic decision to relax 999 standards. There was no panic, no decision, no relaxation of 999 standards; I did what any Health Secretary should do: I simply asked for clinical advice on what would be best for patients. He chose to frighten the public, to scaremonger for party political purpose. Is it not time the Labour party, for once, thought about the impact on patients of the kind of things it is saying in the press?

The right hon. Gentleman then talked, and the Leader of the Opposition has talked, about the causes of these challenges being the reforms this Government introduced in this Parliament. Let me say to him that the one part of the UK that introduced these reforms, England, happens to have the best A and E performance and the one part of the UK that has most set its face against these forms, Labour-run Wales, has one of the worst performances. If he wants to do something about A and E pressures, instead of trying to make political capital in England, he should be getting Labour to turn things round in the one place it does run the health service—Wales. He should be backing this Government’s support for the NHS in a difficult period that has meant more doctors, more nurses, more people being seen quickly, more operations, long-term support and a plan for our NHS; it should not be politics and scaremongering ahead of an election.

UK Ebola Preparedness

Debate between Jeremy Hunt and Andy Burnham

Monday 5th January 2015 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Over the break, there have been a number of reports suggesting that the Ebola outbreak is far from under control and we saw, as the Secretary of State has said, the first case diagnosed here in the UK. Concerns are rising and that is why the Secretary of State was right to give his informative update to the House at the very first opportunity.

May I echo the tribute he paid to all the NHS staff, members of the armed forces and aid workers who are showing immense courage in the most difficult of circumstances? In particular, we echo his moving words and good wishes for Pauline Cafferkey. Our thoughts are with her and her family right now, and we know she could not be in better hands than those of the team at the Royal Free.

On the substance of the Secretary of State’s statement, we welcome what he had to say and the action he is taking. As I said the last time he updated the House, we will play a constructive part in helping the Government to minimise the risk to the public. That remains the case and the questions I will put to him—some of which will cover areas he has not mentioned, particularly treatment and vaccine—will be asked in that constructive spirit.

Let me begin with the circumstances surrounding the case. The Secretary of State mentioned the Save the Children review of how Pauline caught the disease. Are the Government part of that review and/or are they carrying out their own, and when will the results be known? He did not mention when it would be published, but that is important as the next group of NHS volunteers will leave for west Africa in the coming weeks. They will want to know whether procedures and guidance for medical staff working out in west Africa will be reviewed in the light of this case.

I would also be grateful if the Secretary of State could tell us whether he is satisfied with current guidance to NHS staff here on handling Ebola patients. He will be aware that the US Centres for Disease Control and Prevention have recently strengthened their infection control guidance, and on the last occasion he updated the House he said he would follow their lead. What revisions, if any, have been made to those protocols following the CDC’s changes?

Let me turn to screening. We know that Pauline travelled to Glasgow via London Heathrow and despite informing screening staff at Heathrow that she felt unwell she was still allowed to fly home. I welcome what the Secretary of State has just said about reviewing procedures for future passengers in a similar position, but there are broader concerns. Martin Deahl, who was part of the same volunteer group as Pauline and sat next to her on the plane home, said:

“The precautions and checks at the airport were shambolic. There seemed to be too few staff and too few rooms or places to put us in. We were crowded into a small reception area where we waited for an hour or more. I had a higher temperature so they wanted to put me in a room by myself—but they could not find one because they were using every inch of space.”

I welcome the Secretary of State’s commitment to keep the arrangements under review, but may I ask him to look into the specific concerns raised by Mr Deahl and to rectify any problems as a matter of urgency, and certainly before the return of the next group of volunteers?

More broadly, is the Secretary of State satisfied that the screening procedure is adequate in terms of the medical checks that are carried out—are more checks needed than just temperature checks—and, indeed, is he satisfied that staff have had sufficient training? Were the Scottish NHS, the Scottish Government and, crucially, Glasgow airport informed that Miss Cafferkey had warned officials that she felt unwell? In the light of this case, should screening checks be expanded to cover more ports? I would be interested in the Secretary of State’s views on those points. I am sure he would agree that maintaining public confidence in the screening procedure is crucial, and I hope he will continue to keep all those questions under review, as he has said he would.

Let me turn to post-arrival monitoring. A number of states in America have introduced it for all travellers returning from an affected country, whereas only those showing symptoms on return are actively monitored here. Given that symptoms of Ebola can emerge up to 21 days after exposure, is there a case for strengthening post-arrival monitoring in line with other countries?

On treatment, we understand that Pauline is receiving an experimental drug, not ZMapp, owing to a worldwide shortage. When the Secretary of State last updated the House, I asked him whether plans were in hand to increase supplies of ZMapp, so the latest news is a matter of concern. Are any efforts under way to increase manufacturing capacity for ZMapp and/or any other potential treatments? Of course, what would give most confidence to people in the countries affected and further afield is the development of an effective vaccine. Will he say something about the timetable for that, and about the Government’s role in trying to expedite it?

More broadly, will the Secretary of State give the House his latest view on the adequacy of the international response to Ebola. We hear that the health system in Sierra Leone is in danger of collapse, immunisation programmes have come to a halt and people are not going to the hospitals or clinics because they are frightened of catching Ebola, and that might lead to the spread of other diseases. Over Christmas, William Pooley said:

“This is a global problem and it will take the world to fix it.”

Does the Secretary of State share that sentiment, and what are the Government doing to bring about a better global response than we have seen to date?

In conclusion, it is clear that Ebola will remain a threat for the foreseeable future, and it will not be easy to meet that challenge. We join the Secretary of State in sending our best wishes to Pauline and her family, and we will continue to work with him and the Government to minimise the risk to others.

[Mr Hunt]

May I first thank the right hon. Gentleman for the constructive tone of his comments and the official Opposition’s willingness to work closely with us on this very important issue? Let me cover some of the important points that he made.

The right hon. Gentleman is right that the disease is continuing to progress in those countries. We now have a total of 7,905 reported deaths, and there are 20,206 reported cases, which is likely to be an underestimate. There are some early—I stress, early—signs that the rate at which the disease is reproducing itself is beginning to fall to about the level where it is stabilising. However, those are early signs, and the truth is that we still need to do a huge amount of work to bring the disease under control.

We think that it is absolutely vital to proceed as quickly as possible with the vaccine that the right hon. Gentleman mentioned, and I can tell him that we currently have three vaccines in the first phase of clinical trials. We have made some changes to speed up the process by which they can be used in the field, and DFID has put in £1.34 million to establish a joint research fund with the Wellcome Trust, so we are making progress on that front.

It has been impossible to get supplies of ZMapp—the drug given to the other Ebola patient treated in the UK, Will Pooley—because it is grown using genetically modified tobacco plants, so there is a time constraint. Clinically, we do not yet know whether it was significant in Will Pooley’s recovery. We have tried other experimental treatments on Pauline Cafferkey, including using some of the plasma from Will Pooley, and we hope that will have an effect.

The review by Save the Children is being conducted in conjunction with Public Health England staff in Sierra Leone, and I hope that it will report in the next few days. We are obviously keen for them to report as quickly as possible, but we do not want to put them under pressure not to do a thorough report. I am satisfied with current protective arrangements on the basis of our clinical evidence, but as we saw with the screening arrangements, with a disease such as Ebola we must constantly keep an open mind about the best ways of dealing with things, and we will look carefully at what Save the Children recommends. I am satisfied with the protections in place for NHS workers in the UK on the basis of advice from the chief medical officer, and we will obviously also look at what happened in the US. At the moment we do not believe that the personal protective equipment suits have been breached, but we must keep an open mind and see what other evidence comes forward.

On the screening procedure, our clinical protocols were followed when Pauline Cafferkey arrived, but organisationally I do not think that it was as smooth as it needed to be. There were a lot of people to deal with, and because it was over the Christmas period we probably did not have as many people to do that as we needed, which meant that those coming for screening needed to wait longer than we would have liked. However, on the basis of revised protocols, and to ensure that we do not repeat this situation—nine more volunteers are coming back this Sunday and 60 more the following Sunday—the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), and the chief medical officer have been to inspect what is happening, to ensure that we learn the necessary lessons. Other volunteers have said that they think the screening procedure is working smoothly. This was a relatively isolated incident, but we must learn the lessons.

On expanding screening to other airports, I will look into whether Glasgow airport was informed and let the right hon. Gentleman know, but we have obviously learned from this event the importance of close working with the Scottish Government, and that has worked very well.

Finally, the right hon. Gentleman mentioned the active monitoring of people who come back, and I think that we have the best system. We are not only actively monitoring those who have been tested for having contracted the disease, but actively monitoring anyone in the high-risk groups. Of the 2,495 people who have been screened since we set up the process, 54 have been identified as having had direct contact with Ebola patients and as being in the high-risk group, and we have an enhanced monitoring process for them. Everyone else is informed exactly what to do if they develop feverish symptoms, which is what happened with Pauline Cafferkey.

I again thank the right hon. Gentleman for his constructive approach to this issue.

A and E and Ambulance Services

Debate between Jeremy Hunt and Andy Burnham

Thursday 18th December 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the performance of accident and emergency departments and ambulance services, and what plans are in place to help them cope with winter pressures.

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

I welcome this opportunity to come to the House and confirm NHS plans to support A and E and ambulance services over the challenging winter period. First, we must recognise the context. The NHS always faces significant pressures during the winter months, and with an ageing population we have 350,000 more over-75s than four years ago. As a result, more people are turning up at our A and Es, with attendances up 5% on last year, and a greater level of sickness among those who turn up has led to an increase in emergency admissions of nearly 6% on last year. That picture is reflected across the home nations, with A and Es in Wales, Scotland and Northern Ireland, as well as England, missing key performance standards as a result.

In England, where performance has been relatively better than in other home nations, we have been preparing for this winter for more than nine months—indeed, I chaired my first meeting to discuss the issue on 17 March. On 13 June we gave the NHS an additional £400 million for winter pressures. That was topped up in autumn by £300 million, making a total of £700 million to ensure that local services had the certainty of additional money and time to plan how it should best be used. That funding was provided earlier than ever before in NHS history, and was possible because a strong economy has allowed us to make year-on-year real-term increases in NHS spending. That funding will pay for the equivalent of 1,000 more doctors, 2,000 more nurses, and 2,000 other NHS and care staff, including physiotherapists and social workers. It will fund up to 2,500 additional beds in the acute and community sectors, and provide £50 million to support ambulance services.

We are also progressing with a long-term plan to reduce pressures on A and E. We are providing £150 million through the Prime Minister’s challenge fund to make evening and weekend GP appointments available for 10 million people, and more than 4 million people are already benefiting from that. Our better care programme integrates, for the first time ever, health and social care services in 151 local authority areas, with plans starting in April to reduce, on average, emergency admissions to hospitals by 3%. The Five Year Forward View is funded by an additional £2 billion of new money announced in the autumn statement—we have a long-term plan for our NHS, just as we do for the economy.

The winter will be tough, but a number of changes made over the last four years will put us in a much stronger position. Since 2010, the NHS has nearly 1,200 more A and E doctors, including 400 more consultants, almost 600 more registrars, 1,700 more paramedics and 17,200 more clinical staff overall. Our A and E departments are seeing and treating around 2,000 more people within four hours every day, and our ambulances are making nearly 2,000 additional emergency journeys every day. The Care Quality Commission has confirmed that compassionate care in A and Es has improved over the last two years, and according to patients the NHS is getting record scores for the safety of care, and for treating people with dignity and compassion.

I will conclude by thanking hard-working NHS staff across the country for the outstanding care that they continue to deliver under a great deal of operational pressure. On behalf of the whole House I also thank the 70 NHS front-line volunteers who will be making this country safer by spending their Christmas in Sierra Leone on the front line in the fight against Ebola. They are the bravest of the brave and make our entire country proud.

[Andy Burnham]

I thank the Secretary of State for his statement. I of course echo the sentiments he expressed about NHS staff and volunteers fighting Ebola.

I have to say, however, that I heard a good deal of misplaced complacency in what he had to say. Winter has not begun in earnest, but there are already signs of A and Es and ambulance services being stretched to the limit. Last week, a record number of people waited more than four hours in A and E and on trolleys. Ambulance response times are getting worse across England, with some 999 calls taking hours. Overnight, news has emerged of an 82-year-old man who waited more than three hours for an ambulance to arrive at his nursing home. He then waited a further 19 hours on a trolley in a corridor. That is appalling, and there are fears that things will get worse when the House is in recess.

Given that, it should not be for me to drag the Secretary of State here today to explain what he is doing to prevent a full winter crisis in the NHS. The question he did not answer, but must answer today, is this: does he have a winter plan? If he does, will he publish it? People working in the NHS need to know what is in it. [Interruption.] He seems to suggest that he has one, but let me quote Dr Mark Porter, chair of the British Medical Association. He criticises what he calls the

“total failure by government to come up with a meaningful plan”.

The Secretary of State will have to reassure Dr Porter.

The Secretary of State mentions money, but is it not the case that £300 million of it was allocated only in November? Does he really think that that gave the service enough time to plan? Dr Clifford Mann, chair of the College of Emergency Medicine, does not think so. He says:

“Had these funds been used back in summer and early autumn we might have more resilience in the system now.”

Dr Mann also questions where this money has gone, saying “very little” has been seen by front-line A and E staff, and instead

“a lot of it has gone to shoring up balance sheets in acute trusts”.

Is that true? Will the Secretary of State provide of full breakdown of how that money was allocated and has been spent to date? Were any conditions attached? I am sure he will claim the money has been used properly, but, if that is the case, why is the NHS already under so much pressure?

Over the break, hon. Members will want to monitor the situation in their local hospitals very closely. However, we have learnt that from tomorrow the publication of data on A and E will be suspended for three weeks over the crucial Christmas period. That is simply unacceptable. Given that we know the figures are still being collected, there is absolutely no reason why they should not be published. The Secretary of State rightly puts a premium on transparency. Will he today order an end to the news blackout and instruct NHS England to maintain weekly reports?

I have visited a number of acute trusts in recent days and they all say that the pressure on A and E is critically linked to the severe shortage of places in nursing and residential homes and cuts to social care. The sad truth is that today a record number of older people are trapped in hospital. They are well enough to go home, but do not have the support to do so. When are the Government going to wake up to the very real crisis in social care and the fact that it is dragging down the NHS?

Finally, no one can predict what this winter will hold, but the warning signs are there and the NHS needs to plan for all eventualities. What discussions has the Secretary of State held with other Departments, and do the Government have a wider contingency plan for the NHS?

This is a serious situation. If patients and staff are to have confidence, they need better answers than they have had so far. I hope the Secretary of State will start providing them now.

[Mr Hunt]

First, may I thank the shadow Health Secretary for bringing this matter to the attention of the House? As a former Health Secretary, he knows that operational pressures are one of the biggest challenges facing any Health Secretary. Indeed, he had many examples of very, very poor care on his own watch and he is absolutely right to give the House a chance to hear more about our plans for winter.

The shadow Secretary of State asks whether we have a plan. It seems to me that he prepared his comments before he listened to the statement. We have put in more money than ever before. Plans were announced in June. NHS England had a press conference in which it went through the plans relating not just to the £400 million, but the extra £300 million that was agreed in September and allocated through October. That is a record amount. Let us consider what is happening in his own constituency. In Wigan borough, since 2010, because of spending that he opposed, Wrightington, Wigan and Leigh NHS Foundation Trust has taken on 78 more doctors, 149 more nurses and 209 more clinical—[Interruption.] He says, “Does this help?” These are extra doctors and nurses on the front line, helping patients in his own constituency.

The right hon. Gentleman talked about care homes. The £3.3 million going to help his own constituents with winter pressures is to monitor the mental and physical health of patients in care homes and to help reduce the number of emergency admissions. We have a winter plan that is working in his own constituency to help improve the lot of his constituents. He needs to acknowledge that.

The right hon. Gentleman talked about the publication of figures over Christmas. We have never published figures over the Christmas period because it would mean forcing NHS staff to work over Christmas, whereas, where possible, we would like them to be able to go home for Christmas, just like Members of this House. When he was Health Secretary, did he publish performance or weekly A and E figures over Christmas? He did not. He did not publish them at Christmas or Easter; he did not publish any weekly A and E figures at all, so to come to the House and call it a news blackout says to me that he is more interested in political opportunism than in care for patients.

It is disappointing that the right hon. Gentleman did not take this opportunity to disown his own leader’s instructions to weaponise the NHS. The NHS is not, and never should be, a political weapon. This is what third parties say. Dr Mann, president of the College of Emergency Medicine, whom the shadow Secretary of State mentioned, said yesterday that

“the system is under pressure but it’s working pretty well”.

The Foundation Trust Network said:

“NHS providers prepared for this Winter earlier and more fully than ever before”

and that—he should listen to this bit—the

“NHS needs support not criticism”

please. The NHS Confederation said the NHS was pulling out all the stops on urgent care and A and E, and that earlier planning and extra money were helping.

The right hon. Gentleman wants to draw comparisons. Nine out of 10 people are being seen within four hours in this country, which is a higher proportion than in any country anywhere in the world that measures A and E performance—faster than Australia, New Zealand, Canada, Scotland, Northern Ireland and, yes, faster than Labour-run Wales. Eight people out of every 100 wait more than four hours in A and E in England; in Wales, that figure is 15 hours. He should concentrate on saving the NHS in Wales, rather than running it down in England, where it is doing so much better.

Finally, if the right hon. Gentleman is worried about poor care, why is he still saying it was wrong to have a public inquiry into Mid Staffs? This is what Julie Bailey, the Mid Staffs campaigner, said this week about his comments:

“It is very worrying, because if he becomes Health Secretary again at the election it is clear we would go straight back to the old days of covering up.”

The NHS is performing well under great pressure. He should commend the efforts being made by front-line staff, not undermine them by trying to turn the NHS into a political football.

NHS (Five Year Forward View)

Debate between Jeremy Hunt and Andy Burnham

Monday 1st December 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

This weekend a 16-year-old girl in need of a hospital bed was held for two days in a police cell because there was not a single bed available for her anywhere in the country. As we have warned before, this is by no means an isolated example: the BBC reported on Friday that seven other people had died recently waiting for mental health beds. But it is not just mental health: last week I told the House of a stroke patient ferried to hospital by police on a makeshift stretcher made from blinds in his house. That patient later died. This is one of a number of alarming reports of people waiting hours in pain and distress for ambulances to arrive.

Listening to the Secretary of State for over 10 minutes today, one would have no idea that any of that was happening in the NHS right now—and that is the problem: nothing he has said today will address those pressures ahead of this winter. On mental health, does he not accept that there is an undeniable need to open more beds urgently —right now, this week—to stop appalling cases like the one we heard about at the weekend? What assessment has he made of the ability of the ambulance service to cope this winter? Is there a case for emergency support, on top of what has already been announced?

This statement offers no help now to an NHS on the brink of its worst winter in years, but there is another major problem with it. The weekend headlines promised £2 billion extra for the NHS, but the small print revealed that it is nothing of the sort. I note that the Secretary of State did not use the figure of £2 billion once in his statement, but that is what the NHS was led to believe it was getting. False promises and cheques that bounce one day after they are written are of no use to doctors and nurses struggling to keep services going. We all remember the omnishambles Budget unravelling the day after it was given, but an autumn statement unravelling three days before it has been delivered is a first even for this Government.

Will the Secretary of State confirm that £700 million of the £1.7 billion he talked about is not new money, but already in his departmental budget? A few weeks ago his Department told the Public Accounts Committee that it expects to overspend this year by half a billion pounds. His Department is in deficit right now. If that is the case, would he care to tell us where this £700 million is coming from and what services he will be cutting to pay for it? He mentioned research. At the weekend we exposed NHS England’s plans to cut the funding for clinical trials, which would have affected thousands of very poorly patients. Was that one of his planned central cuts to pay for this funding? Will he now guarantee that funding for research and clinical trials will not be cut?

But it gets worse. Not only is £700 million recycled; we gather that the other £1 billion will be funded by cuts to other Departments. The Institute for Fiscal Studies has warned of “staggeringly big cuts” to local government in the next Parliament. The NHS Confederation has said:

“If additional NHS funding comes at the expense of tough cuts to local government budgets, this will be a false economy as costs in the NHS will rise.”

Have the Government not learnt the lessons of this Parliament: that the NHS cannot be seen in isolation from other services, particularly local government, and that cutting social care only leads to extra costs for the NHS? Figures released on Friday revealed record numbers of older people trapped in hospital because the care was not there for them at home. That is happening on the Secretary of State’s watch.

This is the human consequence of the severe cuts to social care in this Parliament, and it is clear that this Government are preparing to do the same again in the next Parliament if they are re-elected. This is why hospital A and Es have missed the right hon. Gentleman’s own target for 71 weeks running. We also have cancer patients waiting longer for treatment to start, and everyone is finding it harder and harder to see a GP.

Is it not the case that most of what the Secretary of State has announced will go to patching up the problems he has created, leaving less than a quarter for the new models of care outlined in the “Forward View”? Let me remind him that policies such as a year of care for vulnerable patients and having accountable care organisations were developed by the Opposition, and for him to stand there today and lecture us about reorganisations of the NHS—well, I did not think that even he would have the nerve to do that.

The truth is that what the Secretary of State has announced provides nothing for the NHS now and is not what it seems, and because of that it will not be enough to prevent the NHS from tipping into full-blown crisis if the Tories are re-elected next year. They will not be able to find any more money for the NHS than this, because they have prioritised tax cuts for higher earners and have not yet found the money to pay for them. That explains their desperate attempts to inflate these figures and make them sound more than they are. Is it not the case that to deliver the “Five Year Forward View”, the NHS needs truly additional money on the scale proposed by Labour—an extra £2.5 billion over and above everything the Secretary of State has promised today, and an ambitious plan for the full integration of health and social care.

They said they would be the Government who cut the deficit, not the NHS, but it is the Health Secretary who has created a deficit in the NHS. It is because of that deficit that cancer patients are waiting longer, A and E is in crisis and children are being held in police cells, not hospital beds. He had nothing to say to those people today. They deserve better than a Chancellor fiddling the figures and a Health Secretary spinning the facts.

[Mr Hunt]

This is the day on which Labour’s attacks on the NHS have been shown up for what they are—every bit as shallow as their attacks on the economy. The country knows that we are addressing the squeeze on NHS funding caused by Labour’s wrecking of the British economy.

The right hon. Gentleman called today’s announcement “patching up the problems”. If growing the economy so that we can put more money into the NHS is patching up problems, how would he describe shrinking the economy and then cutting the NHS budget, as he wanted to do? He said that £2 billion of new money was a false promise. It was not a false promise: it was the truth—£1 billion of additional funding from the Treasury and £1 billion from the forex fines. That is £2 billion of new money, which has been welcomed by the King’s Fund today as a big step forward, and by the NHS Confederation, the Foundation Trust Network and Simon Stevens, the head of NHS England and former Labour No. 10 health adviser. This is a very significant moment when, after years of taking painful decisions to get the economy back on track, we can at last put more money into the NHS. The right hon. Gentleman should welcome it, not scorn it.

The right hon. Gentleman talked about deficits in the NHS. We will take no lessons on deficits from the Labour party—the party that left the country its biggest level of unfunded spending commitments in peacetime history. The truth is that now, with a strong economy that Labour could never deliver, we are putting things right.

The right hon. Gentleman talked about problems with care in the NHS, and the one thing that no one ever says about me is that I am a Health Secretary who shies away from those problems. The trouble is that every time I talk about problems with care in the NHS, he says it is running down the NHS. It is not running down the NHS to confront the problems of poor care. He also talked about the issue of police cells, but we are on track to reduce the number of mental health patients using them by 50% over the next few months.

As for pressures on the NHS front line, it is not that all Health Secretaries do not have to confront them; it is whether or not we sort them out. When it comes to poor care in hospitals such as the Medway and hospitals in Colchester, Basildon and Burton, this Government are sorting out those problems, while the previous Government swept them under the carpet. The right hon. Gentleman used the word “spin”, but he might like to reflect on the massive harm done to patients when under a Labour Government poor care was covered up by Labour spin—surely it was Labour’s darkest period ever when it came to running the NHS.

Government Members have a long-term plan for the economy, and a long-term plan for the NHS. By contrast—[Interruption.] Opposition Members might listen to the truth about the NHS. By contrast, the Labour leader said recently that he wanted to “weaponise” the NHS. He wanted to turn the NHS into a weapon—a weapon to get Labour votes. No, Mr Speaker, the NHS is not a weapon for political parties. It is there to help patients and to save lives, not to save political spins. Under this Government, it will always be there for patients: that is what this Government will deliver.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 25th November 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Two weeks ago, news emerged of serious problems at Colchester hospital. People there still do not know the precise details, as Ministers have not made a statement and the Care Quality Commission has not published its report. But Colchester is not the only hospital in difficulty; we have learnt that hospitals in Scunthorpe, Middlesbrough and King’s Lynn have been turning patients away and others are already on black alert, and that is before winter has even begun. We do not have an accurate picture of what is happening in the NHS right now, because NHS England was due to begin publishing weekly reports on 14 November but has failed to do so. Why has that information not been published, and will the Secretary of State today instruct NHS England to do so without delay?

[Mr Hunt]

That information is published at the decision of NHS England—[Interruption.] It has said that it will publish it in a fortnight’s time. Let me just say to the right hon. Gentleman that it was this Government who decided to publish that information on a weekly basis, something he never did when he was Health Secretary.

[Andy Burnham]

I am afraid that is just not good enough. Who is in charge here? It is not just A and Es that are under pressure; there is a knock-on effect on ambulance services. Reports are now surfacing of serious failures in patient care. Last month, a six-year-old girl from Sunderland was left for three hours with a suspected broken back despite five 999 calls. At the weekend, it was reported that a 56-year-old stroke patient from Huyton was taken to A and E by police on a makeshift stretcher made from window blinds from the man’s home, and he later died. Yesterday, it emerged that a 57-year-old cancer patient from Bishop Auckland died after three ambulances were diverted to other calls. Is it not clear that the situation in the NHS right now is far more serious than the Government have acknowledged, and should not the Secretary of State now make an urgent statement to Parliament setting out what he is doing to reduce the risk of harm to patients this winter?

[Mr Hunt]

There are huge pressures in the NHS. That is why we have put a record £700 million into the NHS to help it to get through this winter. May I gently suggest to the right hon. Gentleman that he should not try to politicise every single operational problem? When the NHS is all about politics, patients get forgotten—as he should know, because that is what happened when he was Health Secretary. Whether in Medway, Colchester, Burton or George Eliot, patients were forgotten because for Labour it was politics before patients every time.

Five Year Forward View

Debate between Jeremy Hunt and Andy Burnham

Thursday 23rd October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the “Five Year Forward View” for the national health service.

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

NHS England, along with other NHS organisations, has today published its independent “Five Year Forward View”, which sets out its view of how the health service needs to change over the coming years. It is a report that recognises the real challenges facing the NHS, but it is essentially positive and optimistic. It says that continuing with a comprehensive tax-funded NHS is intrinsically do-able, and that there are

“viable options for sustaining and improving the NHS over the next five years.”

The report says that the challenges of an ageing population can be met by a combination of increased real-terms funding, efficiencies and changing the models of care delivered. It also says that

“decisions on these options will need to be taken in the context of how the UK economy overall is performing.”

In other words, a strong NHS needs a strong economy.

The report proposes detailed new models of care, putting out-of-hospital services front and centre of the solution, delivered through greater integration between primary, community and specialised tertiary sectors alongside national urgent and emergency networks. These can help to reduce demand significantly for hospital services and give older people in particular the personal care that we would all want for our own parents and grandparents.

The report talks about continued opportunities for efficiency savings driven by innovation and new technology, and suggests that they could be increased above the long-term run rate of efficiency savings in the NHS. It talks about reducing variation in the quality of care, in the wake of the tragedy in Mid Staffs, and about how the new Care Quality Commission inspection regime is designed to drive up standards across the system. It says that to do this we will need to move to much greater transparency in outcomes across the health and social care system. Finally, the report makes important points about better integrating the public health agenda into broader NHS activity, with a particular focus on continued reductions in smoking and obesity rates.

The Government warmly welcome the report as a blueprint for the direction of travel needed for the NHS. We will be responding to its contents in detail in due course, but we think it is an important contribution to the debate. We are proud of how the NHS has coped with the pressures of financial constraint and an ageing population in the last four years, but we also know that to sustain the levels of service that people want, the NHS needs to face up to change—not structural change, but a change in the culture of the way we care for people.

Given that the report has been welcomed on both sides of the House, I also hope that this can be the start of a more measured debate about the future of the NHS in which those from all parties in the House recognise our shared commitment to its future and focus on the best way to achieve the strong and successful NHS that the whole country desires.

[Andy Burnham]

A five-year forward view for the NHS, involving more than £550 billion of public spending, briefed to the media but not to Parliament—what clearer illustration could there be of the serious loss of public accountability arising from the Government’s reorganisation? The Secretary of State is in his place today only because he was dragged here by us. I do not know who runs the NHS these days, but I do know that it is certainly not him. We know why he wants to distance himself from this report: because it endorses key planks of Labour’s plan and leaves him with big questions to answer.

First, on GP services, does the Secretary of State agree with the report that primary care has been under-resourced and that people are struggling to get appointments? Will he accept its recommendation to stop his cuts to the GP budget, stabilise funding and match Labour’s plans to recruit 8,000 more GPs?

Secondly, on cancer, the report makes it clear that “faster diagnosis” is needed—we agree. So why did the Prime Minister yesterday dismiss Labour’s proposals for one-week cancer tests?

On integration, the report endorses Labour’s vision for new models of care, including hospitals evolving into integrated care organisations with more salaried GPs. Can the Secretary of State tell the House why he has spent the last few weeks attacking that plan, and is he now prepared to drop his opposition? On public health, is the report not right that the time has come for radical action on obesity, and will he now concede that his voluntary responsibility deal is simply not working?

It will not have escaped people’s notice that the report does not give one mention to competition—that is because it creates fragmentation, when the future demands integration. So will the Secretary of State commit to reviewing his competition rules and vote with Labour in four weeks’ time to repeal them?

Finally, on funding, the report could not be clearer: simply protecting the NHS budget in the next Parliament, as the Conservatives propose, will not prevent it from tipping into a full-blown crisis. As the hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, has said, current Tory funding plans raise the spectre of rationing, longer waits and charges. Will he now drop them and match Labour’s plans for more money for the NHS? Labour has set out its plan, and today the NHS endorses that plan. The big question people are asking is: where on earth is his?

[Mr Hunt]

I talked about having a more measured debate, but I think I was speaking a trifle too soon, judging by what we have just heard. The right hon. Gentleman obviously was not listening to what I actually said, so let me just repeat to him that the Government warmly welcome this report. I talked about it as a “blueprint” for the future. He did not agree with setting up NHS England, and I do not think he agreed with the appointment of Simon Stevens as the chief executive, but we did that so that we would have a body that would think strategically about the long-term future of the NHS at arm’s length from the Government. That is what it has done, and the report is excellent.

The right hon. Gentleman and I have a sometimes slightly fractious relationship, but I would like to congratulate him this morning on his Houdini-like spin in the way he is approaching this report. He has been constantly telling this House that the NHS is on the point of collapse, but the chief executive of NHS England says that the NHS has been “remarkably successful” in weathering the pressures of recent years. The right hon. Gentleman has told this House constantly that the biggest threat to the NHS is privatisation and competition. This report, a five-year forward view, by bodies at arm’s length from the Government, contains not one mention of competition and privatisation as a threat, yet he says this report endorses Labour’s plans.

The right hon. Gentleman says, as has his leader, that the first thing he would do in government is repeal the Health and Social Care Act 2012 and strip clinical commissioning groups of their powers. He really should read the report carefully on that. He now says he welcomes the report, but it begs him not to carry out further big structural changes; it does not call for the repeal of the 2012 Act, and this is the report which he warmly welcomes today.

Then we need to consider money. The right hon. Gentleman told this House repeatedly that it was irresponsible to increase spending on the NHS, but now we have a report that says that the NHS needs real-terms increases, along the lines that this Government have been delivering in this Parliament. What does he say? He says, “It is great to have our plans endorsed by NHS England.” This report does not endorse Labour’s narrative; it exposes it for the shallow party politicking that we have had from him.

Let me say to the right hon. Gentleman that the really important message of this report is something we can agree on, and he should be talking about that. We both agree about the integration of health and social care, which is now happening. We both agree about improving investment in primary care. We both agree that we need more GPs. We both agree that we need more care closer to home. I think the public would say that we would have a more measured, intelligent and sensible debate—the kind of debate they want to hear—if we started talking about the things we agree on a bit more instead of constantly pretending there are vast disagreements.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 21st October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

At their conference, the Tory party promised flat funding for the NHS in the next Parliament, but experts say that the service is at breaking point now and that the funding promised is not enough. Now, the Secretary of State’s own side are saying the same thing. The Chair of the Health Committee said last night:

“The Chancellor is going to have to write a bigger cheque”

or we will

“see reductions in services or waiting times increase”

and

“go down the route of top-ups and charges”.

Does the Secretary of State agree with her, and will he concede that a flat budget for the NHS in the next Parliament will not stop it tipping into a full-blown crisis?

[Mr Jeremy Hunt]

I am afraid that the shadow Health Secretary is misrepresenting what was said at the Conservative party conference. We promised not just to protect the NHS budget but to protect and continue to increase the NHS budget in real terms. I gently say to him that we have increased the NHS budget spend this Parliament by double the amount that Labour promised at its conference. We did that because on this side of the House we understand a simple truth: a strong NHS needs a strong economy.

[Andy Burnham]

The House will have noticed that the Secretary of State did not answer my question. There is a very simple reason why the Secretary of State cannot answer my question: his party has prioritised unfunded tax cuts for higher earners, leaving a large black hole in the public finances. There will be nothing left for the NHS if the Tories are re-elected. We on the Labour Benches, in contrast, have promised £2.5 billion over and above what they are committed to. Does that not make the choice on the NHS now clear: under Labour, more money for the NHS; under the Tories, tax cuts for some but an NHS crisis for all?

[Mr Hunt]

The right hon. Gentleman cannot have it both ways. The tax cuts the Government have prioritised are for lower-paid people, many of whom work in the NHS. When we had a strike last week, he was criticising the Government for not being more generous, but we have been generous—with the tax cuts he is now criticising. The NHS is facing the biggest financial squeeze in its history partly because of an ageing population but partly because the last Labour Government forgot about the deficit.

NHS Services (Access)

Debate between Jeremy Hunt and Andy Burnham

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.

--- Later in debate ---

[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?

--- Later in debate ---

[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.

--- Later in debate ---

[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 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.

Ebola

Debate between Jeremy Hunt and Andy Burnham

Monday 13th October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for the advance copy of his statement and commend him for making it at the first opportunity.

We have all been horrified by the devastating scenes from west Africa and our hearts go out to the communities that are confronting this threat on a daily basis. Public concern about Ebola is rising here and it is important that people have reliable facts and regular updates.

There are parallels between the current situation and the 2009 swine flu pandemic with which I dealt. I was grateful for the helpful approach of the then Opposition, particularly the right hon. Member for South Cambridgeshire (Mr Lansley), and I aim to provide the Secretary of State with the same approach. However, we do have a role in scrutinising the Government’s approach and I will do that today in a constructive spirit.

I echo the Secretary of State’s tribute to the many NHS staff, Public Health England staff and members of the armed forces who have helped on the ground in west Africa. We have a duty to protect them in any way we can. I want to start with the advice that is given to those who are treating people with the disease. People will be worried by the reports of a second case of Ebola in a health worker, this time in Dallas. We have seen protests in Spain by clinical staff who feel that a colleague has been unfairly exposed to infection. In the light of that, will the Secretary of State say whether he has confidence in the official advice that is being given to those who are treating the disease, and whether it needs to be reviewed?

Let me turn to the risk to the public here. The Secretary of State says that it remains low and the chief medical officer predicts a handful of cases. A handful is not a very scientific term. Will he be more precise and give the House the full range of figures that the advisory group has considered, including the worst case scenario? I recall agonising over whether to publish the official predictions for swine flu and about the risk of worrying the public unnecessarily. However, I think that the public interest lies in openness. Will the Secretary of State confirm that he is planning for the worst case scenario, so that there is no sense of complacency?

Let me turn to our preparedness to deal with an outbreak. There has been confusion about screening at point of entry. Last Thursday, the Department of Health said:

“Entry screening in the UK is not recommended by the World Health Organization, and there are no plans to introduce entry screening for Ebola in the UK.”

Screening was also ruled out by the Secretary of State for Defence. However, just 24 hours later, we were told that screening was to be introduced. Will the right hon. Gentleman say what prompted that about-turn? What official advice has he received from the chief medical officer and Public Health England on entry screening? Based on the science, do they think that it is necessary? Do the arrangements he has announced for temperature checks fully comply with that advice?

As there are currently no direct flights from the affected countries, will the Secretary of State say exactly who will be screened? Will it be all arrivals from those countries? How many people a day or week do we expect that to be, and how will they be identified? Have front-line Border Force staff been properly briefed about what is expected of them, and are they being trained in what to look for and in screening procedures? Why is there only partial coverage of ports of entry? What about sea ports and other UK airports? Will he say where the checks will take place on Eurostar, given that it stops at a number of places en route to London?

On the exercise this weekend, as the Secretary of State will know, a patient was transferred from Newcastle where there are beds in negative pressure isolation units to the Royal Free hospital, which has Trexler isolators. Do the Government believe that Ebola is better handled in Trexler beds, and is the Secretary of State satisfied that the two NHS beds—both at the Royal Free—are sufficient? Given that in addition to the two Trexler beds there are already 24 negative pressure isolation beds, which make up the 26 beds he referred to, will he say what he means by “surge Ebola bed capacity”? If it becomes necessary to treat Ebola cases more widely in isolation beds, is he satisfied that there is adequate provision across England? Is he satisfied that all relevant NHS staff, including GPs, ambulance and 111 staff, know how to identify Ebola, the precautions to take in any potential presentation, and the protocols for handling it? He mentioned symptoms a few times in his statement. For the public watching this statement, will he tell the House simply what those symptoms are?

On treatment, the British nurse who was successfully treated here was offered and took an experimental medication called ZMapp. Will it be standard practice to offer all affected patients ZMapp, and if so, are there sufficient supplies in the NHS to do that? The Secretary of State rightly focused on a vaccine, which would of course be the best reassurance we could give the public. During the swine flu pandemic, huge effort went into compressing the timetable for the development of a vaccine. Is he confident that everything that can be done is being done to speed that up?

Finally, as the Secretary of State said, the best way to protect people here is to stop Ebola at source. The UK has rightly pledged £125 million to assist Sierra Leone, but with cases doubling every three to four weeks there is wide agreement that the response of the wider international community has been slow and inadequate. The window to halt Ebola before it runs out of control altogether is closing fast. What assessment has been made of the resilience of neighbouring countries such as Guinea and Liberia, and what help is being offered to them? The International Development Committee report was clear that the lack of proper health coverage allowed the outbreak to grow unchecked for so long. Does the right hon. Gentleman accept that improving global health systems is the best way to prevent these outbreaks, or at least ensure that they are caught before they get out of control? Many countries support placing universal health coverage at the centre of global development, yet the UK is currently opposing such plans at the UN. Will he say a little more about the Government’s position on that, and whether they are prepared to reconsider it in the light of recent events? Knowing from my experience how difficult these situations are, I assure the Secretary of State that the offer of help is genuine, but on behalf of the House I ask him for regular updates and maximum openness in the weeks and months to come.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. That is totally appropriate and I am grateful. I will start with the point on which he finished, because the most crucial thing we can do to protect the UK population is deal with the disease at source and contain it in west Africa. That is why I am working extremely closely with the International Development Secretary, and she is working closely with me because the role of NHS volunteers is important. The right hon. Gentleman is absolutely right: the initial international response has focused on taking the three worst affected countries and giving them a partner country in the developed world to help them—we are helping Sierra Leone, America is helping Liberia, and France is helping Guinea.

That has worked up to a point, but we need more help from the rest of the international community. I had a conversation earlier today with US Health Secretary Burwell. We talked about a co-ordinated international response for the whole of west Africa, because we will not defeat this disease if we operate in silos. We need to recognise that this disease does not recognise international boundaries; the right hon. Gentleman was absolutely right to make that point.

Let me try to give the right hon. Gentleman some of the information he requested. First, he is absolutely right to raise the issue of the protection of health workers. That has to be our No. 1 priority both here in the UK and abroad. That is why we are building a dedicated 12-bed facility in Sierra Leone that will give the highest standards of care, equivalent to NHS standards of care, for health care workers taking part in the international effort to contain the disease there. That is also very relevant to health care workers here: events in both Spain and the US will have caused great concern.

I am satisfied that the official advice to health care workers is correct. The Centers for Disease Control and Prevention in the US, the US equivalent of Public Health England, believes that breaches in protocol led to the infection of the US nurse—the case we have seen in the media recently—but it is investigating that. The advice is always kept under review and if that advice changes we would, of course, respect that. It is important that we follow the scientific advice we have, but that the scientists themselves keep an open mind on the basis of new evidence as it emerges. I know that they are doing that.

The right hon. Gentleman talked about the full range of figures. He is absolutely right to say that we will maintain public confidence in the handling of this by being totally open about what we know. The reason we have stuck carefully to the formula of “a handful of cases” is because it is genuinely very difficult to predict an accurate exact number. Let me say this: we would not have used the formula of “a handful of cases” if we thought that the number of cases over the next three months would reach double figures. However, it is also important to say that that was a current assessment. That assessment may change on the basis of the evidence. I will, of course, keep the House informed if it does change.

The right hon. Gentleman talked about screening. It is important to deal with a misunderstanding. Why did the policy change on Thursday? The answer is that it changed because the clinical advice from the chief medical officer changed on Thursday. Her advice changed not on the basis that the risk level in the UK had changed—she still considers it to be low—but because she said that we should prepare for the risk level going up. That is why we started to put in place measures, but they are not measures primarily intended to pick up people arriving in the UK who are displaying symptoms of Ebola. We think that most of those people should be prevented from flying in the first place. The measures are designed to identify people who may be at risk within the incubation period of developing the disease, so that we can track them and make sure they get access to the right medical care quickly.

As I mentioned, we think we will reach 89% of people arriving in the UK from the affected countries. We will continue to review that. If the numbers increase and the risk level justifies it, we have contingency plans to expand the screening, for example to Birmingham and Manchester. The reason we have included Eurostar at this early stage is because there are direct flights from those three countries to Paris and Brussels, from where it is easy to connect to Eurostar. We will use the tracking system for people who are ticketed directly through to the UK in order to identify, where we can, people who then independently get a Eurostar ticket. It is important to say that because they are changing the mode of transport in Paris and Brussels, tracking is not as robust as it would be for people taking a direct flight to the UK. We will not be able to identify everyone, which is why we need to win the support of people arriving in the UK from those countries, so that they self-present, in their own interest, to give us the best possible chance of helping them if they start contracting symptoms.

I am satisfied that the Trexler beds and the negative isolation rooms are safe both for health care workers and in preventing onward transmission. They use different systems—one of them is a tented system and the other is based on people wearing personal protective equipment —but I am satisfied that both of them are safe. I will continue to take advice on that. It is very important that ambulance staff know that someone is a potential Ebola case, so that they wear the PP equipment.

As we will not be able to identify everyone who comes from the affected countries, it is important that the 111 service knows to ask people exhibiting the symptoms of Ebola whether they have travelled to those affected areas. The right hon. Gentleman asked what those symptoms are. They are essentially flu-like symptoms, but they are not dissimilar to the symptoms someone might exhibit if they had, for example, malaria. That is why it is important to ask for people’s travel history and whether they have had or may have had contact with people who have had Ebola, in order to identify the risk level.

We would like to continue using ZMapp for people in the UK who contract the disease, but that is subject to international availability. It might not be possible to get it for everyone, because there is such high international demand, but we will certainly try.

In terms of the development of a vaccine, we are doing everything we can to work with GSK to bring forward the date when a vaccine is available. Indeed, we are considering potentially giving indemnities if the full clinical trials have not been conducted.

Special Measures Regime

Debate between Jeremy Hunt and Andy Burnham

Wednesday 16th July 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Anyone who supports the NHS must always be prepared to shine a light on its failings so that it can face up to them and improve. Therefore, I welcome much of what the Secretary of State has said today, and I join him in thanking Sir Mike Richards and Sir Bruce Keogh. Their work builds on foundations laid by the previous Government, and I do not think the Secretary of State helps his case today by continuing to make assertions not supported by the facts. Let me once again gently remind him of the broader context.

It was following care failures in the 1980s and 1990s that independent regulation of the NHS was introduced for the first time by the previous Government. It was that independent regulator that, as Sir Bruce Keogh said, helped reduce mortality in all NHS hospitals over the past decade and then uncovered problems at Mid Staffs.

The Secretary of State was right to say that Mid Staffs needed to be a moment of change for the NHS. The central lesson of the first Francis report, which I commissioned, was that staffing levels were critical to safe care. The big question that arises is for this Government to answer: why, following that report, did they fail to learn the lesson and allow staffing to fall across the NHS in the first three years of this Parliament? Nurse numbers were cut by almost 6,000 in the three years between July 2010 and July 2013, but the cuts fell particularly hard on some of the 11 trusts that we are considering today. North Cumbria cut 148 nursing posts, United Lincolnshire cut 179 and Basildon cut 345. When the Health Secretary was forced to put those trusts into special measures, it was because they were getting worse on his watch.

The Health Secretary mentioned Basildon—like him, I congratulate the trust and its staff on its improvement—but I left a clear warning in place about Basildon in 2010, following a statement I made to the House. Why on earth was it allowed to cut so many staff in the following three years when Francis had already warned of the dangers of doing so? I have an answer to a parliamentary question that shows that Ministers did not hold a single meeting about Basildon up to its being placed in special measures, presumably because they were distracted with their reorganisation. Will the Health Secretary now admit that it was an error to cut so many nursing staff, and will he today accept the National Institute for Health and Care Excellence recommendations on safe staffing levels?

Let me turn to the special measures regime. We welcome the improvements at some of the 11 hospitals and pay tribute to the staff, but it is a concern that four are showing only limited signs of improvement. One trust, Medway, has barely shown any, but how can that be after a year in special measures? Does it not raise questions about whether the regime is providing enough support to improve? A CQC inspection published last week found a catalogue of concerns at Medway—patients on trolleys overnight without appropriate nursing assessment, medication given without appropriate identification of patients, and insufficient nursing levels with an over-reliance on agency staff. The Secretary of State claims that all the problems are long-standing ones, but the CQC found that happening right now. The trust has been in special measures for one year. How can there have been no improvement, what is he doing to help Medway to improve, and given its worrying lack of progress, will he report back to the House at the first opportunity?

There are also questions about the inspection regime. Last week, it was revealed that in 2012 the CQC employed as inspectors 134 applicants who had failed competency tests, of whom 121 are still in place. Again, how was that allowed to happen? Is the Health Secretary confident in the ability of those inspectors, and if not, what is he doing about it?

Three of Cumbria’s four largest hospitals are in special measures. General practitioners are under severe pressure, and my hon. Friend the Member for Copeland (Mr Reed) relayed their warnings to the House yesterday. Is there not a much wider failure in the health economy, as he warned, and with an overly hospital-focused inspection programme, is there not a risk that wider problems in the heath economy are being missed? Is it not the case that hospitals are often dealing with pressures and problems not of their own making—but due to cuts to primary care, social care or mental health—and to be truly effective, should not the Health Secretary’s inspection regime take a much wider view of the whole health economy?

That brings me to social care, about which the Health Secretary is right to say that we have seen appalling failures in recent years at Winterbourne View, Orchid View and Oban Court. We welcome the extension of the special measures regime to care homes, but I must say that it sounds like a U-turn. Only recently, he legislated to remove the CQC’s role in assessing whether councils commission care effectively. Is he conceding that that was a mistake, and does he accept that it must be reversed if we are to have truly effective care inspection?

Local authority commissioning can be the root cause of care failures, but so can the impossible budget cuts that many providers now have to absorb. Is that not the real reason why we have such problems in our malnourished social care system today? New House of Commons Library analysis—we are publishing it today—shows that £3.7 billion has been cut from adult social care since 2009-10. That is not sustainable. How does the Health Secretary think that older and disabled people will ever get the standards of care to which he aspires with cuts on this scale?

The truth is that the collapse of social care is in danger of dragging down hospitals, which are becoming dangerously full of older people and struggling to function. The Health Secretary will not like to admit it, but in the year to the day since he stood at the Dispatch Box and made his first statement on the Keogh report, hospital accident and emergency departments have missed his own lowered A and E target in every single one of those 52 weeks. Does that not tell us more clearly than anything that it is not just a small number of trusts that have got worse on his watch, but the whole NHS? The cancer treatment target has been missed for the first time ever, it is harder to see a GP, and waiting lists have hit a six-year high. He does not just need a plan for some trusts; he urgently needs a credible plan to get the whole NHS back on track.

[Mr Hunt]

I had hoped for a little more consensus on the issue of dealing with poor care. I am afraid that what we had from the right hon. Gentleman was a set-piece speech. However, let me go through the points that he raised.

First, the right hon. Gentleman spoke about nursing numbers. Let us look at the number of nurses since the Government took office. We have 6,200 more nurses on our wards than when he was Secretary of State for Health. Why is that? It is because we took the difficult decision, which he opposed every step of the way, to get rid of the bureaucracy, the primary care trusts and the strategic health authorities—19,000 administrators—so that we could afford more nurses, more doctors, more paramedics and more front-line staff. It is time that he admitted that he was wrong to oppose those important reforms.

The right hon. Gentleman then talked about trusts missing A and E targets. Despite the fact that we are doing better on A and E than he did as Health Secretary, he has missed the point about targets. It was an obsession with targets under Labour that led to the problems in Mid Staffs and many of the trusts that are in special measures today. Let us just take one example. [Interruption.] The Opposition should listen to this example because it provides an important lesson about targets that the Labour party has still not learned. Buckinghamshire had a terrible tragedy in 2004 and 2005, when more than 30 pensioners died in a clostridium difficile outbreak. Why did that happen? The independent report said that the trust was too focused on Government targets.

That is the dividing line. The Opposition want an NHS that is obsessed with targets. The Government recognise that targets matter, but that treating people with dignity, respect and compassionate care matters. Is it not extraordinary that the party that founded the NHS has got itself into a position where it does not care how people are treated in the NHS?

The right hon. Gentleman talked about social care. If he wants more funding for social care, why has he called for the better care fund to be halted, when it will put an extra £1.9 billion at the disposal of the people who commission adult social care?

Let us look at some of the examples that the right hon. Gentleman raised. He talked about Basildon. When he was Health Secretary, the CQC sat on a report about that trust for six months that talked about bloodstains on the carpets, blood on the floors and vital safety measures being ignored. When the reason why the report was not published for so long was looked into, people at the CQC said that they were afraid to publish something that could embarrass the Government of the day. Is it not time that he admitted that the way the Labour Government ran the CQC was wrong? We now have an independent inspections regime, which is a big step forward.

The right hon. Gentleman talked about Cumbria. There are real issues in some of the hospitals in Cumbria. However, when Labour was in office, somebody in one of those hospitals—North Cumbria—was paid £3.6 million because they were disabled for life. Should that not have been a warning sign? There were also issues at Morecambe Bay involving children.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

I know that discussions are going on on that very topic and the CCGs are very interested in putting a hyper-acute stroke service at Southend hospital, which I know has excellent stroke services. We still need further improvements in the ambulance services for the east of England if we are going to do that and that is what we are currently discussing.

[Andy Burnham (Leigh) (Lab)]

I shall begin by congratulating the Health Secretary on surviving the massacre of the moderates. This was no real surprise for those of us on the Opposition Benches, however, because we know that his real views on the NHS are anything but moderate. On his watch, there has been more privatisation and now there is an accelerating postcode lottery. Today, the Royal College of Surgeons has revealed that some people waiting for hip replacements are being denied treatment that is available elsewhere because of arbitrary pain thresholds that are so harsh in places that people must be in severe debilitating pain before they can be treated. This is in direct contravention of National Institute for Health and Care Excellence guidance. Will the Secretary of State today condemn the fact that people are being denied treatment in that way, and act immediately to end the practice?

[Mr Hunt]

Of course it is absolutely right that people should follow NICE guidance, including all clinical commissioning groups, but if the right hon. Gentleman looks at what has happened over the past four years, he will see that we are treating more people, not fewer, with 6,000 more people getting their knees replaced and 9,000 more getting their hips replaced every year. That is possible only because we have 7,000 more doctors in the NHS because we took the difficult decision to get rid of the primary care trusts. Will he now accept that he was wrong to oppose those reforms and wrong to put politics before patients?

[Andy Burnham]

The Secretary of State says that CCGs should be following NICE guidance, but they are not. Seven out of 10 are not following that guidance, and people who are waiting for operations today will be left in pain because he is not acting. The truth is that the reorganisation has resulted in a postcode lottery writ large, and it is worse than we thought, because there is now a proposal in one area to end the provision of hearing aids on the national health service. That is totally unacceptable. Action on Hearing Loss warns that that would set a dangerous national precedent, leaving millions unable to live their lives. So, no ifs, no buts—will he condemn that proposal now and guarantee that patients will not be forced to pay for hearing aids on his watch?

[Mr Hunt]

I make it absolutely clear that everyone should follow NICE guidance. As the right hon. Gentleman has talked about the reorganisation, will he please accept that we are now doing 850,000 more operations on the NHS every single year? That means that more people are getting help with their hearing, their hips and their knees, and with all the other things that they need. He bitterly opposed that reorganisation, but he must now realise that he was wrong to oppose it then and he is wrong to oppose it now.

NHS Investigations (Jimmy Savile)

Debate between Jeremy Hunt and Andy Burnham

Thursday 26th June 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for notice and sight of his statement. I commend him for the way he introduced it to the House and welcome everything he said. The reports published today are truly disturbing, and as sickening as any ever presented to the House. How a celebrity DJ and predatory sex offender came to have unfettered access to vulnerable patients across the NHS, and gold-plated keys to its highest security hospital, surely ranks as one of the worst failures of patient and public protection our country has ever seen. It raises questions of the most profound kind about how victims of abuse are treated, how systems for protecting vulnerable children and adults work and the nature of celebrity and society’s relationship with it.

The Secretary of State was right to begin with an apology—I support him in making it—to the hundreds of people who were appallingly failed and whose lives have been haunted ever since. Our first thought must be with them today. They had a right to look to the NHS as a place of safety and sanctuary, but they were cruelly let down by the very institutions that were meant to offer protection. As one of Savile’s victims put it:

“It was like another insult. I’m in a top security hospital and someone has got to me again. When does it stop?”

Today’s statement will have evoked memories of the most painful kind for them, so will the Secretary of State ensure that all Savile’s victims have full and direct access to all the counselling and other support they will need?

One of the main purposes of this process of inquiry should have been to give all the victims the opportunity to be heard, but the Secretary of State might know that there are reports today in the Yorkshire Post that one person who tried to come forward was at first ignored in October 2012. Will he assure us that all reasonable steps have been taken by those preparing these reports to help victims come forward and tell their story, including those who might have been ignored when they first tried?

Many of Savile’s victims have suffered severe financial loss as a result of the challenges they have faced. I understand that claims for compensation will in the first instance draw on Jimmy Savile’s estate. Has there been an assessment of whether the estate’s funds will be sufficient to meet all claims? Given what has been revealed today and the abject failures of public bodies, should not the Government now consider allocating public funds to ensure that all the people damaged by Savile are properly compensated and supported?

Reading the report, it is not at all clear to me that a proper process has yet been put in place to hold people who failed in their public duties to account. If evidence is revealed in any of these reports that shows that any person still working in the NHS or the Department of Health knowingly facilitated these crimes, will the Secretary of State assure us that they will now face the full weight of the law and that those who were negligent in respect of their public duties will also be held fully to account?

It is incomprehensible how this could have been allowed to happen over 55 years. Although it relates to a different era, there are serious lessons that we can learn, given that abuse continues in our health and care system today. Let me turn to those. The first area of concern relates to how victims of abuse are treated, particularly young people or people in the mental health care system. Sadly, there are still far too many instances of abuse in our care system and in mental health settings, and the real figure is likely to be higher because of under-reporting. Will the Secretary of State consider what more needs to be done to give people the confidence to come forward and the reassurance that they will be listened to? Is there a case for more training for staff in dealing with allegations of abuse?

The second area of concern relates to how public bodies carry out vetting and barring arrangements, make public appointments and manage their relationship with celebrity. Hospitals across the country have increasingly sophisticated fundraising operations and links with celebrity endorsers. Will the Secretary of State accept the Broadmoor report’s recommendation that no celebrity should be appointed to an executive position or given privileged access to a hospital or its patients and that they should be fully vetted if appointed to a non-executive position? More broadly, is there now a case for a code of conduct setting out the appropriate relationship that the NHS should have with celebrity or business backers?

On vetting and barring, figures obtained by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) show that the number of people barred from working with children as a result of committing a sexual offence against a child has dropped by 10,000, or 75%, in the past three years. These extremely worrying figures have come about as a result of changes to the vetting and barring arrangements. This raises the concern that there are people working in our health and care system now who may pose a risk to children. Will the Secretary of State look again at this issue, consult the Home Secretary, and urgently report back to the House on why these figures have dropped by so much in such a short space of time, and on whether they believe that the current child protection regime is strong enough?

The question arises of whether this process of inquiry is a sufficient response to the scale of these atrocious crimes. It is hard to draw a clear picture and consistent recommendations from 28 separate reports and all the other inquiries that are still ongoing in schools, care homes, the BBC and the police. I, too, pay tribute to the work of Kate Lampard in assuring the quality of the reports published today, and we wait for her second phase of work, but questions remain about their independence given that each hospital has, in effect, investigated itself. There is also a question of whether this needs to be more independent of Government.

The Broadmoor report raises serious questions about the conduct of civil servants and Ministers in the Department of Health in how Savile came to be appointed to the Broadmoor taskforce. In evidence to the inquiry, the then Minister describes the main objective of Savile’s appointment as follows:

“The principal question was can Government break this hold that the Prison Officers Association has on the hospital.”

She went on to say:

“This task force was dreamed up and seemed like a very good idea and step forward Jimmy Savile who knew the place backwards and was more than happy to volunteer his time to do this. And we were happy to do it.”

That paints a picture of chaos in the Department and a complete absence of due process for such a serious appointment. This is an extraordinary revelation. Although there is no suggestion that any Minister knew of any sexual misconduct, it points to the need for a further process of independent inquiry so that we all, as Ministers and former Ministers, can learn the lessons of what happened, but also draw together the threads of the multiple ongoing inquiries. It simply cannot be left for Savile’s victims to try to pull together the details of these investigations.

As the shadow Home Secretary, my right hon. Friend the Member for Normanton, Pontefract and Castleford (Yvette Cooper), has said, there is now a clear case for a proper, overarching, independent review led by child protection experts into why there was such large-scale institutional failure to stop these abhorrent crimes. I would be grateful if the Secretary of State gave this proposal careful consideration. I finish by assuring him of our full support in helping him to establish the full truth of why abuse on this scale was allowed to happen for so long.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive tone of his comments. Many of the suggestions he has made are very sensible. We will take them away and look at them, but I will go through a number of them now. First, we will indeed make sure that all Savile’s victims get the counselling they need. I think that it has been made available to them, but it is absolutely right to double-check that they are getting every bit of help they need and that we are taking all reasonable steps.

I hope that what has happened today will be, in its own way, another landmark for all victims of sexual abuse in giving them the confidence that we are changing, not just as an NHS but as a society, into being much better at listening when people come forward with these very serious allegations. It hits you time and again when reading these reports how many people did not speak up at the time because they thought that no one would believe them. We are not going to change that culture overnight, but we have to be a society that listens to the small person—the person who might get forgotten and does not feel they are important in the system.

On the claims for compensation, the right hon. Gentleman is absolutely right to say that the first draw for those claims will come from the Savile estate. I hope I can reassure him, however, that, as we have said, the Government will underwrite this so that if there are any claims that are not able to be met by the estate we finance them from the public purse. We think it is important that we should do that, although Savile’s estate is the first place to start, for obvious reasons.

The right hon. Gentleman is right to say that if there is evidence that people have criminally neglected claims that were made at the time or behaved inappropriately—even if it is not a matter for the law and they behaved in a way that could make them subject to disciplinary procedures in NHS organisations—that should be addressed. We will urge all NHS organisations to look carefully at anyone who is mentioned in the reports. Of course, the police will, naturally, look at the evidence against any individuals, who of course have the right to due process, which everyone in the House would accept.

On the specific point about the behaviour of one Minister and what it suggested about the motivation for Savile’s approval for his job at Broadmoor, my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke), who was Secretary of State at the time, has said that that behaviour would be indefensible now and that it would have been indefensible at the time. I agree with him. Everyone must be held accountable for the actions they took.

We are doing a great deal to make sure that all NHS staff are trained to feel more confident about speaking out. The Mid Staffs whistleblower Helene Donnelly is now working with Health Education England to see what needs to change in the training of NHS staff in order to change that culture.

On the new disclosure and barring scheme, we are already doing work to examine the reason for the drop in the number of people who are being barred from working with children. The Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) is looking into that. I have given this a lot of thought and it is important to say that in the current environment, were we to have another Savile, it is likely that the disclosure and barring scheme would bar him from working with children and in trusts, but that is not certain because he was never convicted of a crime. The Criminal Records Bureau checks would not have stopped that, but it is possible for the disclosure and barring scheme to prevent people from working with children and vulnerable adults even if they have not committed a crime. For example, their employment track record may show that they were dismissed for doing things that raised suspicions. It is also important to make the point—I think everyone in the House will understand this—that it is not possible to legislate to stop all criminal vile activity. What we depend on for the disclosure and barring scheme to work is a culture in which the public and patients feel able to speak out and staff listen when they do so, in order that these things surface much more quickly.

Finally, the question of whether any further inquiries are necessary will, of course, be considered. The first step is to let Kate Lampard do her full report. At this stage, she has not drawn together all the different inquiries and tried to draw lessons from the system as a whole. I asked her to do two things. The first was to verify independently that the reports of NHS organisations were of the necessary quality, and I think she has done that superbly. The second stage of her work is to see what lessons can be drawn from the system as a whole. We need to hear what she has to say about that and, indeed, what the Department for Education and the BBC learn from their reports, and then we will come to a conclusion about whether any further investigations are needed.

Patient Safety

Debate between Jeremy Hunt and Andy Burnham

Tuesday 24th June 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on his announcement on patient safety.

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

Mr Speaker, I would like to make a statement to the House about a package of measures that I have announced today to boost safety, transparency and openness in our NHS. It follows my earlier written ministerial statement.

Just last week, the independent Commonwealth Fund said that under this Government the NHS has risen to be the top-rated health care system in the world. Despite many challenges in our NHS, it is therefore clear that we have much to be proud of. However, it is also clear that there is more to do. It is estimated that for 12,000 deaths a year in hospitals there was a 50% or greater chance of their being prevented. Figures released by NHS England today tell us that there were 32 never events in the past two months, including cases of a throat pack and a hypodermic needle being left inside patients post-surgery. These are shocking statistics.

In the Government’s response to Sir Robert Francis’s landmark public inquiry on the poor standards of care at Mid Staffordshire NHS Foundation Trust, I made clear our determination to make the NHS the safest and most open health care system in the world. Today, all hospital trusts around the country will therefore receive an invitation to the Sign up to Safety campaign, which is led by Sir David Dalton, the inspirational chief executive of Salford Royal. The campaign will help us to achieve our ambition of halving avoidable harm, thereby potentially saving 6,000 lives. Trusts will be asked to devise and deliver a safety plan, and may receive a financial incentive from the NHS Litigation Authority to support implementation.

We are fulfilling the pledge that we made in our response to Francis to create a hospital safety website for patients. As of today, the NHS Choices website will tell us how all hospital trusts are performing across a range of seven key safety indicators, including one for open and honest reporting. For the first time, the website will let patients and the public see whether a hospital has achieved its planned levels for nursing hours. Indeed, I am pleased to inform the House that the latest work force statistics, published today, show us that we have 5,900 more nurses in our hospital wards since our response to Francis just over a year ago.

Finally, I am pleased to announce today that Sir Robert Francis QC will chair an independent review on creating an open and honest reporting culture in the NHS. The review will provide advice and recommendations to ensure that NHS workers can speak up without fear of retribution. It will also look at how we can ensure that where NHS whistleblowers have been mistreated, there are appropriate remedies for staff and there is accountability for those who have mistreated them.

I am confident that the package of measures announced today will shine a light on poor care so that lessons can be learned, action can be taken and harm to patients can be prevented. In the process, we will support front-line staff to help the best health care system in the world blaze a trail on issues of safety, transparency and compassionate care.

--- Later in debate ---

[Andy Burnham]

The Health Secretary rightly calls for openness, transparency and accountability. It is a pity that that does not extend to his dealings with this House. He spent the morning touring TV studios, but could not find the time to come to the Chamber. Is that because he has signed away day-to-day control of the NHS, as his public health Minister—the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison)—let slip, or is it because he did not want to face questions on the damning criticism of him from the outgoing president of the Royal College of Psychiatrists, who says that he is ignoring the “car crash” in mental health? Either way, it should not be left to us to drag the Secretary of State to the House.

An open, learning culture in all parts of the NHS is an ambition shared across this House and it builds on the work of the last Government following care scandals in the 1990s. More information is welcome, but how will the Secretary of State guard against the risk, as expressed this morning by Martin Bromiley, of creating a “naming, shaming and blaming” culture? He has just told the House that a fifth of hospitals are failing to report properly. Why is that and how will he correct it?

The Secretary of State mentions the Commonwealth Fund and I join him in celebrating the standing of the NHS. He implies that it has all been achieved in the past four years. That is pure spin. I remind him that the NHS first came top in 2007 and that this year’s report specifically traces the NHS’s recent success to reforms implemented by the last Labour Government and to the Darzi report, which it says led to

“an increased emphasis on improving the quality of care provided by the NHS.”

Perhaps the Secretary of State will reflect that analysis in any future statement on the previous Government’s record.

The Secretary of State promises new data on infection—one area where the Commonwealth Fund found cause for concern compared with 2010, with the NHS now ranked worst in the world for patients reporting infection in hospital or shortly after. What is he doing to turn that worrying trend around? On staffing, will he commit to publishing figures on how many of the nurses he mentioned are agency nurses? Is the NHS not now spending a fortune on agency staff—£1.4 billion, 162% higher than planned—because, in the first four years of this Parliament, the Government and the then Secretary of State, who is now the Leader of the House and sitting on the Front Bench, cut nurse training places by 10,000?

The Secretary of State talks about his new target to save 6,000 lives over three years. Can he explain how that will be achieved when people are now waiting longer to start treatment for cancer, when NHS waiting lists have hit a six-year high and when ambulance response times are getting longer? Is not that the real reason he was afraid to come here today? The NHS is getting worse on his watch and the Government have surrendered their power to do anything about it.

[Mr Hunt]

We talk about many things and there will always be political differences between Opposition and Government Members, but I would have thought that on patient safety, on saving patients’ lives, on dealing with the issue that once a week in the NHS we operate on the wrong part of someone’s body and on other terrible issues, there might be a degree of consensus. It is incredibly disappointing that, again, the right hon. Gentleman has chosen to make a political football out of something that should be above party politics.

Let me go through the right hon. Gentleman’s points. This morning in the radio studios, I talked about fulfilling a pledge that I made to the House in my response to Francis—that we would publish staffing data, something that he never did when he was in power. We have done that for 6,700 wards throughout the country, because we want to end the scandal of short staffing that happened on his watch and directly led to Mid Staffs.

I am delighted to come to the House. I have made a written ministerial statement. I often come to the House and I am delighted that the right hon. Gentleman has raised this issue. As he has raised some specific points, I need to address them. He quoted what the outgoing president of the Royal College of Psychiatrists said, but he failed to mention what the incoming president said this morning, which was to praise the remarkable work done by this Secretary of State and his Ministers to raise the issue of mental health.

The right hon. Gentleman talked about the Commonwealth Fund. Let us look at that. When he was Secretary of State, we fell from being top-rated in the world to being second. We are now back on top. He has spent the past four years saying that under the coalition Government the NHS is going to rack and ruin. Someone who is independent has now looked at it and said that we are the best in the world. The right hon. Gentleman should reflect on that before he starts to criticise and run down the NHS.

Let us talk about agency nurses. I am very proud of the fact that, in just over a year, we have 5,900 more nurses on our wards. That is an increase of 4,000 nurses across the system compared with when Labour was in power. Why is that? It is because we are doing something about the issue of safety and compassionate care—issues that the right hon. Gentleman repeatedly swept under the carpet when he was Health Secretary.

Finally, let me make this point. We are doing something that is a world first today: we are publishing staffing data on a hospital-by-hospital, ward-by-ward basis. Yes, we are also publishing which hospitals do not have an open and transparent reporting culture. Creating transparency about failures has, I am afraid, become one of the biggest dividing lines in this House. I think it is a very great shame that every time I raise the issue of poor care in the NHS, the right hon. Gentleman accuses me of running down the NHS and softening it up for privatisation, when what I am actually doing is standing up for patients, which is what he should have done when he was Health Secretary.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

Actually, I agree with the hon. Gentleman. I think that we do have a problem. We have some fantastically good GP surgeries and some brilliant GPs, but we have not in the past had structures in place to make sure that we deal quickly with underperforming GP surgeries and, indeed, underperforming GPs. We need to have much more transparency of data so that we can see where the problems are. We have introduced a rigorous new inspection regime, with a new chief inspector of general practice, and I hope that that will go some way to addressing the issues he raises.

[Andy Burnham (Leigh) (Lab)]

People ringing their surgery this morning only to be told that no appointments are available for days will be listening to the Secretary of State’s answers today and thinking that he is living in a different world. People’s real experience is that it is getting harder and harder to get a GP appointment under this Government, but for some it could get much worse. I recently visited a practice in east London that faces closure in October because of this Health Secretary’s changes to GP funding. NHS England says that 97 other practices are in the same position, affecting thousands of patients. Will he today give a guarantee that no practice will have to close?

[Mr Hunt]

Let us address this issue head on. The right hon. Gentleman knows perfectly well that it is totally wrong to have a system in which two neighbouring GP practices can be paid different sums of money for doing the same amount of work. We must have an equitable funding formula for GP practices, which is why we are phasing out the minimum practice income guarantee. That is a sensible decision. We are also taking measures to ensure that we do not affect patient care in the process. Of course we are looking at the individual cases carefully, but I am sure that he would agree that we have to fund GP practices equitably.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is right, and I am grateful to him for mentioning how proud we are of the HPV vaccination programme for girls and women. It is one of the best in the world, and we are getting an 86% take-up rate among eligible 12 to 13-year-old girls. He is also right to say that we now need to look at whether the programme should be extended to men and boys. A decision was taken at the time that it did not need to be, but we are now reviewing that decision. We will shortly be getting advice from the Joint Committee on Vaccination and Immunisation—which, as he will know, gives us independent advice on these matters—and we will take its advice seriously.

[Andy Burnham (Leigh) (Lab)]

I am sure that, like me, the Secretary of State will have been shocked to the core by the serious case review into the Orchid View care home. It spoke of institutionalised abuse and of residents dying of sheer neglect. This is just the latest case of appalling abuse in care homes, following that of Winterbourne View and the recent “Panorama” programme on Oban House. People are asking how many more times we must see abuse of this kind in our care homes before we take decisive action to stop it. Will the Secretary of State give serious consideration to the central finding of yesterday’s review, which was that the same principles of patient safety that apply in the NHS should now be applied to the care home sector?

Health

Debate between Jeremy Hunt and Andy Burnham

Monday 9th June 2014 Commons Chamber

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

The legislative programme presented to Parliament last week by Her Majesty the Queen builds on four years in which we have not shirked our duty to the British people to restore confidence in disastrous public finances; to lead the country from the deepest recession since the second world war to the strongest growth in the G7; and to implement a plan that secures our long-term economic future. As part of that programme, we have been following a long-term plan to transform our NHS and help it to meet the challenges of an ageing population. However, we must remember that without the difficult decisions made to restore faith in our public finances, the NHS would have been in a very different position.

In Ireland, the health pay bill was slashed by 16% because it ran out of money. In Greece, health spending was cut by 20%. In Portugal, the public were asked to double their personal contribution to the cost of health care, but in England difficult decisions meant that we were able to protect the NHS budget, unlike the Labour party, which plans to cut it in England, and did indeed cut it by 8% in Wales, with disastrous consequences. Labour made the wrong call on the economy and the wrong call on NHS finances. Because we made the right call, the NHS is now doing extremely well in very challenging circumstances.

Later, Members will hear the right hon. Member for Leigh (Andy Burnham) talk about operational pressures facing the NHS. He is right: it is tough out there. This week, we will announce new measures to help the service to meet the challenges that it faces. We will no doubt also hear attempts to politicise what are essentially operational pressures, but what we will not hear is how much better the NHS is doing than it ever did when he was Health Secretary. The facts speak for themselves. Every single day—[Interruption.] This is difficult for Labour Members to listen to, but they would do well to listen. Compared with when he was Health Secretary, every single day we are referring 1,000 more people with suspected cancers to specialists. We are transporting 1,000 more patients—

[Andy Burnham (Leigh) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress and then give way. The right hon. Gentleman needs to listen. We are doing much more now compared with what was done when he was Health Secretary. If he listens, he might learn something.

This is what is happening every single day: 1,000 people with suspected cancers are being referred, and 1,000 more patients are being transported in ambulances in emergencies. Every day we are performing 2,000 more badly needed operations, we are seeing 3,000 more vulnerable people in A and E departments, and every day we are providing around 6,000 more GP consultations for members of the public and 10,000 more vital diagnostic tests. At the same time, MRSA rates have almost halved, mixed-sex wards have been virtually eliminated, and fewer people are waiting for 18 or more weeks for their operation.

[Andy Burnham]

The Health Secretary is standing there claiming everything is fine and giving a litany of successes. Let us just consider cancer care. He said the NHS was worse when we were in government. So that we are absolutely clear, will he confirm that the last set of figures show that the NHS is now for the first time missing its standard of treating cancer patients within 62 days?

[Mr Hunt]

The right hon. Gentleman should have listened to what I said: I said he was right to say it is tough out there, and I also said that this week we will be announcing measures to help the NHS deal with operational pressures. He talks about how long people are waiting for operations, so let us look at one particular statistic that sums up what I am saying: the number of people waiting not 18 weeks but a whole year for a vital operation. Shockingly, when the right hon. Gentleman was Health Secretary, nearly 18,500 people were waiting over a year, and I am proud that we have reduced that to just 500 people. Those results would not be possible without the hard work and dedication of front-line NHS staff, and whatever the political disagreements today, the whole House will want to pay tribute to their magnificent efforts.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

Last week, the Secretary of State told the NHS Confederation that patient safety was crucial to the future sustainability of the NHS. Let me begin on a note of agreement. The Health Secretary is right to continue to send the clearest message to the NHS that patient safety must be its top priority. He knows that he has our support in introducing measures to implement the Francis report and, indeed, learning all the lessons from the terrible failings at Stafford hospital. A question arises that is perhaps more for the Government to answer than the right hon. Gentleman: why is the Secretary of State’s important priority not reflected in the Gracious Speech? It is approaching 18 months since the publication of the Francis report, yet many of its recommendations are still to be implemented. The failure to make progress in this legislative programme undermines the Secretary of State’s message today.

The Francis report recommended new legislation to modernise the regulation of doctors and nurses and speed up the handling of complaints. The regulatory bodies said that progress is urgently needed, and they were expecting a Bill in the Gracious Speech to implement those reforms. Not surprisingly, both reacted negatively to the decision to drop it. Niall Dickson, chief executive and registrar of the General Medical Council, said:

“We are disappointed that the government has not taken this opportunity to improve patient safety”,

and Jackie Smith, chief executive and registrar of the Nursing and Midwifery Council, said:

“Both the NMC and the public it protects now continue to be left, indefinitely, with a framework that does not best serve to protect the public.”

I hope the Secretary of State will explain why that Bill was dropped and answer the concerns of Jackie Smith and Niall Dickson.

[Mr Hunt]

The right hon. Gentleman said he would start on a note of consensus on the Francis report, so does he now retract his comments last week that what happened at Mid Staffs was “a local failure” and that the Government were exaggerating its significance for the rest of the NHS? That was a very damaging thing to have said.

[Andy Burnham]

The Francis report found that the failing at Stafford hospital was principally a failure of the local board. I served in the previous Government, who inherited problems from the preceding one—care failings at Bristol royal infirmary and Alder Hey, and the Shipman murders. Contrary to what the Secretary of State said today, we acted on those failures to bring more transparency to the NHS. We introduced independent regulation to the NHS. He needs to look at the statements that he has made over the past year and consider whether his response has always been appropriate. He has used language such as

“Cruelty became normal in our NHS”—[Official Report, 19 November 2013; Vol. 570, c. 1097.]

Does he stand by such statements and does he think that is fair to the thousands of NHS staff who give their all every day, doing their best to serve patients?

[Mr Hunt]

rose—

[Andy Burnham]

I will give way to the right hon. Gentleman once more, but he needs to answer those concerns of staff, who feel that he has been running down the NHS.

[Mr Hunt]

Let me be absolutely clear. I have never blamed NHS staff for what happened at Mid Staffs. I blame the policy failures of the right hon. Gentleman’s Government. It is not just I who say so. Robert Francis said in his report:

“Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated”

in the rest of the NHS. He continued:

“The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction.”

Will the right hon. Gentleman now retract his comment that this was “a local failure” whose impact has been exaggerated?

[Andy Burnham]

I am quite clear in what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.

The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.

So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that

“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.

I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”

I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 1st April 2014 Commons Chamber

[Mr Hunt]

PFI debt is costing the NHS more than £1 billion every year. In some cases that money was well spent, but it was often very poorly spent. My hon. Friend is absolutely right: we want the money to be spent on front-line care, which is why we have drawn a line under the appalling deals negotiated by the last Government. We are spending money where it should be spent, in order to help patients.

[Andy Burnham (Leigh) (Lab)]

It is a year to the day since the Government’s reorganisation took effect, and now that the dust has settled, we can see the full scale of its folly. There are 163 more NHS organisations than there were before, four times more managers are being paid the very highest salaries than the Government planned for, and 4,000 staff received redundancy payments only to be rehired by the new organisations that the Government had created. Is not the reason why the NHS is the only public service that cannot honour a 1% pay increase for its hard-working staff the fact that these Ministers lost control of their own reorganisation, and it has now wasted billions of pounds?

[Mr Hunt]

I think that the right hon. Gentleman needs to look at the figures. The reorganisation, which he opposed through thick and thin, means that the NHS is spending less on administration and bureaucracy. If he questions that, may I ask how he thinks we found the money to pay for 8,000 more doctors and 15,000 more clinicians, if it was not by getting rid of primary care trusts and strategic health authorities? That is why there are now 2.5 million more diagnostic tests and 4 million more out-patient appointments every year. We are doing more for patients than was ever done when the right hon. Gentleman was Secretary of State.

[Andy Burnham]

I know that it is April fool’s day, and the Secretary of State certainly seems to be getting into the spirit of it with that answer, but his fantasy figures will be laughed at by anyone who works in the NHS. It is not just in relation to bureaucracy that the Government have broken promises. They said that the reorganisation would improve patient care, but 70% of NHS staff say that it has got worse. The first full year of the reorganised NHS has been the worst year for a decade in A and E. It is harder to get a GP appointment than it was before, and cancer patients are waiting longer to start treatment. Is it not now clear that the Government’s reorganisation has been a disaster on every level for patients and taxpayers who never voted for it, and who were promised that it would never happen?

[Mr Hunt]

I will tell the right hon. Gentleman what is not an April fool—the appalling care at Mid Staffs on his watch. If he is talking about how the NHS is doing, perhaps, for once, Labour Members should look at what patients are saying. I know that it is difficult, but if we look at what patients say, we see that since the election, there has been a 5% increase in those who think that their NHS care is safe, and a 10% increase in those who think that they will be treated with dignity and respect in the NHS under the coalition. We are proud of that, because we are putting patients before politics, which the right hon. Gentleman never does.

Care Bill [Lords]

Debate between Jeremy Hunt and Andy Burnham

Tuesday 11th March 2014 Commons Chamber

[Andy Burnham]

My hon. Friend’s intervention brings me to my second reason for thinking that the Bill is not what it seems. The changes in eligibility for social care expose more people to social care charges than was the case before the present Government came to office, and, as has been demonstrated by my hon. Friend the Member for Leicester West, those charges are increasing above inflation. More people are paying care charges, and paying them at a higher level. The care cap is not what it seems. In fact, as my hon. Friend has consistently argued, it is a care con. The Secretary of State said today that the Bill would give people certainty about what they would pay—

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State says yes, but I am afraid that it will not. The £72,000 cap is based on a local authority average, not on the actual amount that people will pay for care. So no, the Bill will not give them that certainty. The Secretary of State also said that people would not lose everything to pay for care. Let us take him at his word, and assume that £72,000 is the maximum that a person can pay, and £144,000 is the maximum for a couple. In my constituency, that would indeed mean people losing everything that they had worked for, although it might not mean that in the Secretary of State’s constituency or in other parts of the country. The Secretary of State needs to be honest with people. That is why we are saying that the Bill is not what it seems.

--- Later in debate ---

[Andy Burnham]

No I will not, as the hon. Gentleman has not been here all afternoon.

The third area is the claims that the Bill will improve regulation. Let me ask a direct question: if this is about improving the quality of services, why remove from the CQC the responsibility to provide oversight of local authority commissioning? Why do that if this Bill is about improving regulation? Why leave local government free to do what they like at a local level—to commission for 15-minute visits or for staff on zero-hours contracts—when we have seen the failures at Winterbourne View and other places? Why remove that important role from the CQC?

[Mr Jeremy Hunt]

rose—

[Andy Burnham]

We have never had a proper answer to that. I hope we are about to get one.

[Mr Hunt]

Let me tell the right hon. Gentleman what this Bill does: it introduces the proper expert-led inspection of social care provision that was scrapped by his Government, so that we actually know when there are care problems and we sort them out.

[Andy Burnham]

The right hon. Gentleman has not answered the question. There was a responsibility on the CQC to provide oversight of local authority commissioning. This Bill removes it. Why does it do that? It is a backward step in my view.

The fourth area is that, in respect of the care data scheme, the Bill fails to provide the assurances the Government tried to herald in the press a few days ago—to borrow the Secretary of State’s words today, a “rock-solid assurance” that data could never be passed to commercial insurance companies. I do not believe it is possible to claim that new clause 34, which has now been added to the Bill, does that. It just has general aims around the promotion of health. That does not stop data being passed to private health insurance companies. Again, I do not think the Bill does what the Secretary of State claims it does.

The fifth area I want to challenge the Government on is the whole question we have just been debating. This goes to the heart of where the coalition began, which was that local people would be in the driving seat and local GPs would be in control. The coalition agreement said the Government would end centrally dictated closures. Well, they have ripped all that up this afternoon by passing clause 119 and keeping it in the Bill. They claimed they were just doing what we left behind. That is not the case, because the High Court told them otherwise. The High Court told them they had gone beyond the powers I had created in 2009. The Secretary of State was unable to answer that. He said everything was our fault—it is never their fault or his fault. Well, how about him listening to the Court? How about him reading the clause that we passed before he tried to close or downgrade Lewisham’s A and E? Would that not have been a good thing to do? He did not do that, however. He tried to plough on and downgrade a successful A and E in the teeth of opposition and he got found out. Yet he comes back here today and just thinks arrogantly he can ram the same powers back through this Parliament.

What we have seen today from the right hon. Member for Sutton and Cheam (Paul Burstow), who positioned himself as though he was going to make a stand for local involvement in the NHS, is the worst kind of collusion and sell-out of our national health service. Just as the Liberal Democrats voted for the Health and Social Care Act, again they have backed tonight the break-up of the NHS. In the last few days the right hon. Gentleman has been asking for all these signatures from all over the country—148,000 people to sign his petition—just so, it seems, that he could get a new job working within the coalition. I am not sure they are going to feel well represented this evening.

[Mr Hunt]

The shadow Secretary of State is bandying around some big words like “arrogant” so will he now show some humility and recognise that every single one of the 14 hospitals in special measures had warning signs when Labour was in office and Labour failed to sort out those problems?

[Andy Burnham]

We took action to address care standards in the NHS. The right hon. Gentleman is trying to politicise care failure. The Labour Government inherited the Bristol Royal infirmary scandal from the previous Conservative Government, along with the scandal at Alder Hey and the Shipman murders, but we did not try to politicise those failings. The Secretary of State is trying to politicise such failings today, however.

The Lib Dems have shown again tonight that they simply cannot be trusted to stand up for the national health service. There is only one party in this House that will do that, and that is the Labour party represented on these Benches. The next Labour Government will repeal the Health and Social Care Act and restore the right values to the heart of the NHS. In so doing, we will also repeal clause 119 of this Bill. We will take the powers that the Secretary of State has taken for himself today and hand them back to local people.

We will not get the care that we want until we are able to face up to the care crisis that this country now has. Our argument is that the full integration of health and care is the only way to reshape services around the person. That is the only way to go, and we will give a full green light to NHS organisations to collaborate and integrate, instead of working with the market regime that this Government have introduced. We have had the ludicrous spectacle of the Competition Commission telling two hospitals that wanted to collaborate that they could not do so because it would be anti-competitive. That is the reality of the NHS that this Government have created. That is the nonsense that people are facing on the ground. Only when we repeal the Health and Social Care Act and get rid of the powers that the Secretary of State has taken for himself today will we put the NHS back on the right path, away from the path towards fragmentation and privatisation, and begin to build a 21st-century NHS.

Francis Report

Debate between Jeremy Hunt and Andy Burnham

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

This debate is a welcome opportunity to review progress on the Francis report one year after its publication. That publication completed a long process of independent inquiry into the terrible failings at Stafford hospital, and it began in July 2009 with my appointment of Robert Francis, QC. Ever since, the onus has been on us all to learn the important lessons and implement all the recommendations of the Francis report.

First, however, I will say a word about the previous Government’s record. It was the previous Labour Government who introduced for the first time independent regulation to the national health service, following the scandals of the 1990s at Bristol Royal infirmary, Alder Hey and, of course, the Shipman murders. It was that independent regulator which uncovered the problems at Mid Staffs. To listen to the Secretary of State, one would not believe that those were the facts—

[Mr Jeremy Hunt]

rose—

[Andy Burnham]

I want to make some points at the beginning and then I will give way to the Secretary of State.

Those were the actions of the last Government in dealing with the issues that we inherited. It was the last Government who left the national health service with the lowest ever waiting lists and the highest ever public satisfaction, and no attempt by the Conservatives to rewrite history can take away that fundamental strength in the NHS which the last Government left behind.

[Mr Hunt]

I agree with the right hon. Gentleman that his predecessors deserve credit for introducing an inspection regime into the NHS, but would he now agree that it was a big mistake to allow expert-led inspections—the kind of really thorough inspections that could have uncovered what happened at Mid Staffs—to be abolished in favour of generalist inspections, which meant that the same people inspected dental clinics, GP practices and big London teaching hospitals? That was a profoundly important mistake that this Government are right to correct.

[Andy Burnham]

It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.

We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.

Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out.

Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS. If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.

To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.

--- Later in debate ---

[Andy Burnham]

In a moment.

On all measures, this winter has been just as bad as the last, with some patients waiting hours on trolleys, or held at the door of A and E or in the back of ambulances. A and E is the barometer of the whole health and care system, and that barometer is warning of severe storms ahead.

[Mr Jeremy Hunt]

As it happens, waiting times for A and E departments are now half what they were when the right hon. Gentleman was Health Secretary, but may I gently suggest that rather than trying to turn this debate into a discussion about who had the better A and E performance, he should return to the Francis report, which is what the debate is about and which deals with something that happened on his watch? The country wants to know what his party, and he personally, have learned from the mistakes that were made that allowed Mid Staffs to happen.

[Andy Burnham]

Pressure on hospitals, and how we relieve it so that they can care for people properly, is the core of this debate. What we have seen under this Government is an ever-increasing number of frail, elderly people coming into hospital via A and E. The Secretary of State shakes his head, but Francis made specific recommendations on the care of older people in hospital. The point I am making is that under him the number of older people admitted to hospitals as emergency admissions has gone up significantly, and that goes to the heart of the issues raised by the Francis report.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

I will do that, and NHS England was absolutely right to have a pause so that we ensure that we give people such reassurance—[Interruption.] When we had a pause before, the result was the very good Health and Social Care Act, which is doing good things for patients throughout the NHS. This programme is too important to get wrong, and while I think that there is understanding on both sides of the House about the benefits of using anonymised data properly, the process must be carried out in a way that reassures the public.

[Andy Burnham (Leigh) (Lab)]

When he was appointed, the Health Secretary declared it his personal mission to have a “data revolution” in the NHS, but what he has presided over is a spectacular collapse in public confidence in the use of patient data. The only revolution he has created is a growing public revolt against his care.data scheme. Coming after his NHS 111 shambles and the court humiliation over Lewisham hospital, it cements a reputation for incompetence. When was he first warned about problems with care.data and what action did he take?

[Mr Hunt]

The shadow Secretary of State searches for NHS crises with about as much success as George Bush searching for weapons of mass destruction. My first contact with that programme, when I was told about it, was to decide to do something that he never did as Health Secretary: to say that every single NHS patient should have a right to opt out of having their data used in anonymised scientific research. I think that was the right thing to do. Of course we are having a difficult debate, but its purpose is to carry the public with us so that we can go on to make important scientific discoveries.

[Andy Burnham]

Again, the right hon. Gentleman never takes responsibility—it is always somebody else’s fault. Even by this Government’s standards, this is a master-class in incompetence. First, we have this useless glossy leaflet. He said that it has gone to every home, but that is not true, because homes that have opted out of junk mail have not received it. Many people report that they still have not had it through their letterbox. Secondly, when people cannot even get through to their GP practice on the phone, as we heard earlier, or get an appointment, he has made it almost impossible to opt out of the scheme. Has this cavalier approach not built an impression that the Government are taking patient confidentiality for granted in trying to force through the scheme, increasing public mistrust and putting the important scheme at risk?

[Mr Hunt]

It is intriguing that the shadow Secretary of State has chosen not to talk about a winter crisis, because it has not happened, despite the fact that he predicted it time after time. Let me tell him what was cavalier: the previous Labour Government’s refusal to give patients a right to opt out of giving their data to this programme, even though it was going on for their whole time in office. We believe that we should have a data revolution, but to do that we need to carry the public with us, which is why we need to have this important debate and give people the reassurance they deserve.

--- Later in debate ---

[Mr Hunt]

I reassure my hon. Friend that I have looked into Ben Foy’s case, and NHS England has confirmed that it is responsible for commissioning his care. The particular drug that my hon. Friend mentioned is not recommended by the manufacturer for use by children and adolescents, but I am happy to arrange for him to meet NHS England and get to the bottom of the issue.

[Andy Burnham (Leigh) (Lab)]

I want to return to care.data—an important scheme that needs to be saved from the incompetence of this clownish coalition. The Secretary of State said earlier that I was in search of a crisis, but now I will offer him a solution. If the Government work with us to introduce a series of tough new safeguards to protect patients, we will work with the Secretary of State to help rescue this failing plan. Those safeguards include tougher penalties for the misuse of data, Secretary of State sign-off on any application to access data, full transparency on organisations granted access, and new opt-out arrangements by phone or online. Will he meet me to discuss changes to the Care Bill to put that important scheme back on track?

[Mr Hunt]

The right hon. Gentleman has still not addressed the fundamental question of why he did not introduce an opt-out for the use of personal data, which this Government are doing. We have taken more steps than his Government ever did, and we will continue to work hard to ensure that this important scheme goes ahead. The right hon. Gentleman should know better.

NHS

Debate between Jeremy Hunt and Andy Burnham

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

My hon. Friend is right. For the very first time in the history of the NHS, competition intervenes to block sensible collaboration between two hospitals seeking to improve care and make savings. Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit. That is what has happened. That is not just what I say; listen to what the chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS:

“I think we’ve got a problem, we may need legislative change…What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it”—

that is, the law. That is from the chief executive of NHS England.

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

That was Labour’s law.

[Andy Burnham]

No, it was your law, your Government’s law, the Health and Social Care Act 2012—the same law against which his own care Minister, the hon. Member for North Norfolk (Norman Lamb), has recently been speaking out. He recently told the King’s Fund:

“I have a problem with the OFT being involved in all of these procurement issues… I think that’s got to change… In my view I think it should be scrapped in the future… That might happen at some future date… we’ve got to look at the barriers and address them and sort them out.”

Is that just his view, or the view of the whole Government? [Interruption.] He voted to let the OFT into the NHS. Why is he now changing his tune?

The former care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), said the same:

“The one area I have my concerns about is the way”—

the 2012 Act—

“opened up the role of the OFT.”

Yes, but did we not tell him that two years ago when he voted for the Act and when his hon. Friend the Member for St Ives (Andrew George), who is sitting next to him, joined us in the Lobby to oppose it? This is exactly what we warned them about. We warned them that it would let the market run riot through the NHS, but they would not listen, and that is why we are where we are today.

It is not just Ministers who are saying it; the comments by the chair of the Care Quality Commission at the weekend show the utter confusion in Government policy on competition in the NHS:

“We need more competition…more entrants into the market from private-sector companies”.

Will the Secretary of State clarify? Is that a statement of official Government policy? Is it his policy to get more private sector companies and more competition into the NHS? Is that what he wants? If that happens, it will mean more enforced competition leading to the fragmentation of care, and it will load extra costs on to the NHS at the worst possible time.

--- Later in debate ---

[Mr Hunt]

That is exactly what is happening in so much of the country. Despite a lot of pressure, our A and E departments are holding up extremely well. I wonder how the staff in that hospital would feel about the constant running down of the NHS that we get from the Opposition.

Let us look at the figures that the right hon. Member for Leigh quoted in more detail. How does he get the number he quoted for the worst winter for a decade?

[Andy Burnham]

Let us have a proper debate. I did not say the worst winter for a decade; I said the worst year in A and E for a decade. Let us get it straight. The Secretary of State should not redefine the question at the beginning of his speech. I am talking about the last 12 months, from this day today back to February 2013. Let us get that absolutely clear and let him answer for the last year, during which he has missed the A and E target 44 times out of 52.

[Mr Hunt]

Let us be absolutely clear. Why has Labour decided to remove the word “crisis” from the motion it submitted to the House this afternoon? It does not mention the word “crisis” at all, because the winter crisis that the right hon. Gentleman has been predicting for over six months now has simply not materialised.

Let us look—this is important—at how the right hon. Gentleman has been manipulating the statistics. He knows perfectly well that there is no A and E target for single categories of A and E; rather, the target applies to all A and Es. He gets his numbers by singling out the biggest A and E departments, type 1s, which are extremely important. How did type 1s—the most important and biggest A and Es—perform during the winter when he was Health Secretary? Let me tell the House: they missed their target every single week up until this point in the year. There are indeed pressures on A and E departments, but why does he think the country will listen to him, when by his own yardstick he failed to deliver every single week up until this point in the year?

The right hon. Gentleman has been predicting a winter crisis for months, and we are still waiting. For him, these debates are not about the reality on the ground; they are about hyperbole and spin. As someone who has been Health Secretary, he must know—this is a serious point—the effect that lurid headlines based on dubious statistics have on morale for staff and those using the NHS, but still we get the same cracked record, because for him, politics always matters more than patients.

It is not just A and E performance; under this Government—[Interruption.] It might not be comfortable for the Opposition, but let us look at the figures. Under this Government, MRSA rates have virtually halved, mixed-sex wards have nearly been eliminated and when it comes to elective care, more than 35,000 fewer people are waiting more than 18 weeks. That is thanks to the efforts of hard-working front-line staff. Our NHS is doing 800,000 more operations year in, year out than it did under Labour—something we can be immensely proud of.

--- Later in debate ---

[Mr Hunt]

I will give way in a minute, but this is an Opposition day debate, so I want to return to the central motion. Let me remind the right hon. Member for Leigh that he told this House—in fact, he had an Opposition day debate to do it—that the NHS budget had been cut in real terms. It had not: it rose. He also claimed that the number of nurses was being cut, when actually it went up. His attempts to talk up a winter crisis have been disproved time and again. That is important, because we have not had a proper apology to this House in relation to the letter he received from the chief executive of the south-western ambulance trust complaining about his spinning, which stated:

“information provided to your office in response to a Freedom of Information request…has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain.”

The right hon. Gentleman should not be playing politics with the pressures in A and E; he should be getting behind front-line staff, who are working extremely hard and who find that kind of tactic extremely demoralising.

[Andy Burnham]

For the record, I am afraid that the letter the Secretary of State quotes had its facts wrong. The information provided by the south-western ambulance service that I quoted was accurate. I wrote to the service the day it wrote to me to put it straight, and I am afraid it has not come back since and said that I was wrong; so again, let us get the facts straight. We have had enough spin from the Secretary of State; he needs to start dealing in a bit of fact.

[Mr Hunt]

I will tell the right hon. Gentleman exactly what the facts are. The other word I heard him use several times in his speech was “complacency”. I will tell him what complacency is: it is complaining about an English NHS that is hitting its A and E targets and completely ignoring Labour-controlled Wales, where the NHS has been missing its A and E targets since 2009. Something else that is complacent is this idea Labour has that, almost a year after the Francis report, the lessons of Mid Staffs stop at the border of England and Wales—that Wales has nothing to learn and does not need to do a Keogh report into excess mortality rates, which the Welsh Labour Government have consistently refused to do. People in Welsh hospitals are suffering because the Welsh NHS has refused to bite the bullet on excess mortality rates.

--- Later in debate ---

[Mr Hunt]

Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.

If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.

Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.

[Andy Burnham]

If everything is exactly the same, why did the Government legislate? Why did they need a 300-page Bill if they were doing everything that the previous Government had done? Let the Secretary of State answer this question directly. There was a huge debate in the House about section 75 of the Health and Social Care Act, and his Minister had to withdraw the regulations and rewrite them, but the view of the entire NHS is that section 75 requires services to be put out to open tender, and does not leave discretion with GPs. GPs cannot decide, as the Secretary of State has claimed. Services are being forced out to open tender. Is that the correct position, or is it not?

[Mr Hunt]

Let me make the position absolutely clear.

[Andy Burnham]

Answer!

[Mr Hunt]

I am about to answer, if the right hon. Gentleman will be a little bit patient. The Act does not change the procurement requirements under which PCTs operated. It does not change the locus of the Competition Commission or the OFT under the Enterprise Act.

While we are correcting some facts, the right hon. Gentleman may be interested to know—as would my hon. Friend the Member for Taunton Deane (Mr Browne), but he is no longer in the Chamber—that we have the figures for the number of people admitted to the NHS with scurvy in 2011-12 and in 2012-13. In 2011-12, the number of admissions not just to A and E departments but in total—[Interruption.] Yes, including A and E departments. In 2011-12, eight people were admitted—[Interruption.] This was the right hon. Gentleman’s big argument about why A and E departments are under so much pressure. In 2012-13, 18 people were admitted. With the greatest respect, I think that the right hon. Gentleman is building his house on sand.

Accident and Emergency

Debate between Jeremy Hunt and Andy Burnham

Wednesday 18th December 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress.

I want to talk about what is happening in England, because the right hon. Gentleman wanted to know the truth. These are the statistics he did not want to tell the House about the comparison with his time in power, which he said was so good: 1.2 million more people are going through A and E every year, and more than 2,000 are being seen within four hours every single day, compared with when he was Health Secretary. The average wait to be seen is now 33 minutes compared with 77 minutes when he was Health Secretary—that is 44 more minutes longer, on average, to be seen under Labour than under this Government. For treatment, the average wait is now 75 minutes compared with 102 minutes when he was in office.

[Andy Burnham]

Will the Secretary of State give a straight answer to this simple question: is there or is there not a crisis in A and E?

[Mr Hunt]

I refer the right hon. Gentleman to the people who know about this at the College of Emergency Medicine, which says today on its website:

“There is now cause for optimism that the crisis is behind us.”

He should listen to that before whipping up fears of a crisis that the College of Emergency Medicine says is not happening.

Care Bill [Lords]

Debate between Jeremy Hunt and Andy Burnham

Monday 16th December 2013 Commons Chamber

[Mr Hunt]

The reason I am talking about this is that the hon. Lady’s party has decided to oppose the Bill. Let us look at the measures in the Bill that Labour is opposing.

[Andy Burnham (Leigh) (Lab)]

Will the Minister give way?

[Mr Hunt]

I will make some progress, then I will give way.

Labour will today vote against measures that will help to implement 61 of the most important recommendations made by Robert Francis. Many of these will be policed by the new chief inspector of hospitals, appointed to be the nation’s whistleblower in chief, whose duties will be enshrined in today’s legislation, which Labour are voting against.

[Andy Burnham]

How can it be appropriate to introduce a debate on such fundamentally important issues as the way we care for older people with such narrow, petty, partisan, point scoring efforts? May I just say to the Secretary of State that he should not stand there and misrepresent the position of the Opposition? We will not oppose the Second Reading—we have tabled a reasoned amendment, because we do not believe his proposals for a cap are what they seem, but we will not oppose the Second Reading of this Bill. He should get his facts straight before he comes to that Dispatch Box.

[Mr Hunt]

The right hon. Gentleman needs to read his own amendment, because it says that he “declines to give” the Bill “a Second Reading”. If he is changing his position now, that is the fastest U-turn in history.

Let me go on to say why it is so important that the Labour party supports today’s Bill and does not, as the amendment says, decline to give the Bill a Second Reading.

[Mr Hunt]

I am going to make some progress. The new chief inspector of hospitals will act as Ofsted does with schools and, as with Ofsted, will inspect and rate hospitals using simple language that the public can understand: “Is my local hospital safe? Is it caring? Is it responsive? Is it clinically effective? Is it well led?” We will also make sure that the same scrutiny is directed at services outside hospitals, so the Bill makes provision for a chief inspector of social care and a chief inspector of general practice.

Ministers in the previous Government were repeatedly asked to strengthen the regulatory system and repeatedly ignored those requests. [Interruption.] The right hon. Gentleman says, from a sedentary position, that that is rubbish, but this is what Barbara Young, the chair of the Care Quality Commission at the time and now a Labour peer, told the Francis inquiry about the inspection system that the right hon. Gentleman introduced:

“The annual health check was so flawed in so many ways that I went and saw the Secretary of State. It was nonsense. And having argued that with the Secretary of State, I was told firmly that we weren’t permitted to change it. I was very unhappy about that.”

Well, today—

[Andy Burnham]

rose—

[Mr Hunt]

No, I am going to make some progress. Today he had a chance to show that he had learned how wrong—

[Andy Burnham]

On a point of order, Mr Speaker. Is it in order for the Secretary of State to misrepresent the views of the previous Government and previous Ministers, and refuse to take interventions? He has just said that I refused to change and strengthen the regulation system of hospitals in England—that is factually incorrect. I brought forward a new system for the registration of all hospitals in England in autumn 2009, on the back of recommendations from the CQC. Again, he should get his facts straight at that Dispatch Box.

[Mr Speaker]

I am grateful to the right hon. Gentleman for his point of order, and I make two points in response. First, every Member and every Minister must be responsible for his or her comments in the Chamber—the accuracy and appropriateness thereof. I am afraid that, however angry people feel, on either side of the argument, these are matters of debate. Secondly, the situation would be greatly helped if the Secretary of State now, immediately, turned his mind to the presentation of the argument in support of the introduction of the Bill, which is, ordinarily, the matter upon which one anticipates a Secretary of State will focus his remarks. This is not an occasion for a historical legerdemain; it is an occasion for the presentation of the case for a Bill, to which I know that, without delay, the Secretary of State will turn his mind.

--- Later in debate ---

[Mr Hunt]

I am going to make some progress.

Thanks to our reversal of Labour’s 2004 GP contract, vulnerable people over 75 will have an accountable, named GP responsible for making sure they get the wraparound care they require.

The collapse of Southern Cross showed the risks to people’s care when providers fail, so through the Bill we are introducing provisions to help ensure that people do not go without care if their provider fails, even if they pay for their own care. The CQC will monitor the financial position of the most difficult-to-replace providers in England to help local authorities provide continuity of care in a way that minimises anxiety for people receiving care.

We also need to improve the training of health care assistants and social care support workers. For the first time, health care assistants will have a new care certificate to ensure they get training in compassionate care and the Bill allows us to appoint a body to set the standards for that training. That means that the public can be assured that no one will be assigned to give personal care to their loved ones without appropriate training or skills. My hon. Friend the Minister of State, who is responsible for care and support, will have more to say on those elements of the Bill when he closes the debate and I thank him for his outstanding work on raising standards in that area.

We also need to address the funding of care. At the moment, people fear being saddled with catastrophic costs and even having to sell their home at the worst possible time to pay for their care. The Care Bill significantly reforms the funding of care and support, introducing a duty on local authorities to offer a deferred payments scheme so that people will not be forced to sell their homes in their lifetime to pay for residential care.

We will also introduce a cap on people’s social care costs, raising the means test at which support from the state is made possible and delivering on the recommendation of the independent Dilnot commission.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make some progress.

Some 100,000 older people will benefit financially and everyone will be protected from the catastrophic cost of care.

--- Later in debate ---

[Mr Hunt]

My hon. Friend is right. We followed the recommendations of Andrew Dilnot, who did not think that the cap should apply to hotel costs, and, indeed, the policy that the Opposition followed in their national care service White Paper. We think that it is reasonable to cap the care costs. There is a cost issue—we would like to be more generous, but by the end of the next Parliament this proposal will cost nearly £2 billion. People who would like a more generous system must be obliged to tell us where they will get the extra funding.

[Andy Burnham]

rose—

[Mr Hunt]

The right hon. Gentleman will have a chance to speak later.

We want to be one of the first countries in the world where it is as normal to save for one’s social care costs as it is for one’s pension, and this Bill’s provisions make that possible. The deferred payments scheme, with a threshold of £23,250, on which we openly consulted, excludes only the wealthiest 15% of people entering residential care. How extraordinary it is that Labour should play politics by feigning concern for the richest in society, when they failed to do anything for the poorest over 13 years when they had the chance to do so.

--- Later in debate ---

[Andy Burnham]

Those are the facts. The councils that are still trying to provide support to people with moderate needs are not all, but by and large, Labour councils. They are still trying to do that, but they have lost significantly more per head under this Government than councils elsewhere. The situation is about to get a lot worse, because NHS England will meet tomorrow to consider a major change to the NHS resource allocation formula, which will reduce the weighting given to health inequality and increase the weighting given to age. That will have the effect of taking more money out of Salford and Wigan and giving more money to areas where healthy life expectancy is already the longest. The Government are making it impossible for people who want to do the right thing.

[Mr Jeremy Hunt]

Local authority budgets were indeed cut to deal with the deficit, so will the right hon. Gentleman tell the House whether he would reverse those cuts—yes or no?

--- Later in debate ---

[Andy Burnham]

I am not sure that I agree with the hon. Lady. Some older people in my constituency probably do not have as good a quality of life in later life as some in her area, because there are ex-miners with chronic obstructive pulmonary disease and other things, who have very extensive needs caused by the dangers they were exposed to during their working life, and that places a burden on our health service. Of course, people are more likely to be living with chronic disease in more deprived areas, and both those things have to be recognised in the funding formula. If the change goes ahead, it will cause great volatility and move a lot of money around the system, but it will not allow areas such as the one I represent to invest in the home-based, high-quality, integrated services that the Secretary of State said he wanted.

To return to the costs of care charged by councils, let us call the hikes in charges what they are—stealthy dementia taxes that seek out the most vulnerable people in our society. The more vulnerable someone is and the greater their need, the more they pay. People who are paying more for care under the current Government and often receiving a worse service will not be convinced by the Secretary of State’s claims for his Bill today. It will feel like a con, and that feeling will only intensify when people understand more about the proposed cap.

Although we welcome the principle of a cap, this one is not what it seems. It is set at £72,000, despite Dilnot warning that a cap above £50,000 would not provide adequate protection for people with low incomes and low wealth. The Health Secretary has repeatedly said that people will not have to pay more than £72,000 for care.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding, but I hope he will be honest enough to admit today that that is simply not the case. In reality, the average pensioner could pay more than £150,000 for their actual residential care home bill—£300,000 for a couple—before they hit the so-called cap. I will explain why. It is because the cap will be based on the standard rate that local authorities pay for a care home place, not the actual amount that self-funders are charged, which is often much higher than the council rate. It is estimated that in 2016-17, when the cap is due to start, the average council rate for residential care will be £522 a week, and the average price of a care home place will be £610 a week. That is because self-funders pay more than councils. However, that will not be taken into account when the cap is calculated.

--- Later in debate ---

[Andy Burnham]

They are offering a similar scheme but at the moment they are not allowed to charge interest on it. That brings me to the next part of what is wrong with these proposals. What the Health Secretary has not said today is that interest will be charged on his proposed deferred payment scheme, which is not universal because it is not available to everybody. A loan to cover the average length of stay in a care home—two and a half years—would clock up extra costs of £3,500 in interest alone. That interest would not be included in the cap but would be outside it. Again, people will not feel that what they are paying is related to a cap.

[Mr Jeremy Hunt]

rose—

[Andy Burnham]

I noticed that the Secretary of State was not very good at giving way, and I hope in future he will bear that in mind.

[Mr Hunt]

I am most grateful. Will the right hon. Gentleman confirm that the impact assessment for his policy stated that interest would be charged under his own plans?

[Andy Burnham]

I was proposing a fundamentally different policy in a national care service. I ask the Secretary of State politely whether it is about time he stopped trying to say that everything is about the past? Why did he not stand there, explain and justify his own policy? Would that have been a good thing for him to have done today, instead of leaving it to me to explain what he is proposing?

--- Later in debate ---

[Andy Burnham]

That illustrates the confusion that is currently at the heart of the NHS. No one knows who is in charge of anything. What if CCGs and the boards of foundation trusts disagree with the conclusions of the TSA? How will that be resolved? Were we not told that doctors were sovereign? Were they not supposed to decide everything? Was that not the big call when the Government introduced their Bill? It seems that that is no longer the case: everything can be done “top down” by the Secretary of State. It takes power away from every Member and could be used as a back-door way to railroad through unpopular changes.

The real danger of the proposal comes when it is seen in the context of the competition regime created by the Health and Social Care Act 2012. Of course, it is sometimes necessary to make changes to local health services beyond just a failing trust. That is best done through partnership and collaboration, but such sensible changes are now being blocked by the market madness imposed by the Act. We recently saw the ludicrous spectacle of the Competition Commission intervening in the NHS for the first time to stop the sensible collaboration between Bournemouth and Poole. Since when did competition lawyers decide what was best for patients?

[Mr Jeremy Hunt]

What has that got to do with the Care Bill?

[Andy Burnham]

One reason the Lewisham clause is so worrying is that simple collaboration between hospitals to solve financial problems is no longer an option to ease financial pressures. That is what it has got to do with the Care Bill. The Government are making a case for all hospitals standing or falling on their own, and in that context, the weakest can be picked off by the Secretary of State and closed without consultation. Given the financial pressures on many organisations, this special administration process is likely to be used on an increasing basis, putting more hospitals at risk. That should send a shiver though every community represented in the House today.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

My hon. Friend has taken a great interest in this topic, and he is absolutely right to do so, because if we are to give integrated, joined-up care, in which people deal with NHS professionals who know about them, their medical history, their allergies and all the other important things, it is vital that, if they give their consent, their medical record can be accessed. That needs to be from GP surgery to hospital to social care system. Under the named GP policy that we have announced, there is a big opportunity for care homes to access GP records and keep them updated daily, so that GPs are kept in daily contact with how some of the most vulnerable people are doing.

[Andy Burnham (Leigh) (Lab)]

Today I want to put to the Secretary of State new evidence that the A and E crisis is deepening, and having a serious knock-on effect on ambulance services. Information from police forces reveals that cases in which police cars have to ferry patients to A and E are far more widespread than people realise; in some areas, it happens on a daily basis. One ambulance service is now using retained firefighters to attend calls, and—this is how bad things have got—another ambulance service has seen a 350% increase in the number of 999 calls attended by taxis. Does the Secretary of State think that it is ever acceptable that when a patient dials 999, a taxi turns up?

[Mr Hunt]

I am afraid that that is utterly irresponsible. We are hitting our A and E target, and we are hitting our ambulance standard. When the right hon. Gentleman was Health Secretary he missed the ambulance standard for October, November, December and January. He is trying to talk up a crisis that is not happening. He should think about people on the front line and, just for once, put patients before politics.

[Andy Burnham]

The country will have heard the complacency from the Secretary of State. He needs to explain why he spent Friday afternoon making panicked phone calls to hospitals up and down the country that were missing their A and E target. He did not condemn the use of taxis, which is unacceptable but is happening on his watch because ambulances are trapped at A and E, unable to hand over patients. That means that 999 response times have got worse and large swathes of the country, right now, are without adequate ambulance cover. Is it not time that the Secretary of State was honest with the public and admitted the scale of the crisis facing the NHS this winter, and took action now to prevent it from engulfing other emergency services?

[Mr Hunt]

We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.

Mid Staffordshire NHS Foundation Trust

Debate between Jeremy Hunt and Andy Burnham

Tuesday 19th November 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

What happened at Mid Staffs was a betrayal of the NHS and its values. The previous Government rightly apologised, but now is the time to back our words with action. That is why, although I welcome much of what the Secretary of State has just said, it is my job to press him on where we feel he could have gone further and to question why, of the 290 Francis recommendations, 86 are not being implemented in full.

First, let me, too, pay tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd), Professor Tricia Hart, Professor Sir Bruce Keogh, Camilla Cavendish, Professor Don Berwick and, of course, Robert Francis. Between them, they have given us proposals that will help to prevent a repeat but, more importantly, as the Secretary of State said, change the whole of the NHS for the better.

Both Francis reports found three primary and fundamental causes of what went wrong: a failure to listen to patients; a lack of properly trained staff; and a dysfunctional culture. I shall take each of those issues in turn.

First, I am sure the Secretary of State agrees with me that patients and their families must always, as Francis recommends, be the first priority for the NHS. That principle unites this House and it must also unite the NHS. Is not Robert Francis right to recommend that the NHS constitution, and the ethos it sets out, should be required reading for all NHS staff? I congratulate the right hon. Gentleman on agreeing to implement the Clywd review in full and change the way the NHS handles complaints.

Secondly, on the issue of staffing numbers and training, the first Francis report found that Mid Staffs made dangerous cuts to front-line staffing over a short period. I welcome the Government’s new focus on this issue, but is it not the case that nurse-patient ratios across the NHS have got significantly worse in the past three years, with 5,890 fewer nurses, more older patients in hospital and bed occupancy running at record levels? It is encouraging that the NHS has plans to recruit more nurses this year, and is introducing more monitoring. The Secretary of State says “things are already changing for the better”, but is he aware that Monitor has warned that trusts are planning major nurse redundancies in the 2014-16 period, far outweighing any increases this year? Will he intervene now to stop that? Further, can he explain why he stopped short of requiring safe staffing levels? Is he further aware that nurse training places have been severely cut in recent years and trusts are being forced to recruit overseas?

Alongside nursing, more action is needed to raise standards across the caring work force. As Robert Francis has said, it is unacceptable that the security guard at the door of the hospital is more regulated, and subject to professional sanctions, than the health care assistant attending to an elderly patient. The development of the care certificate as proposed by Camilla Cavendish is a step forward, but will it not work only alongside a register of those who hold it and an ability to remove it if they fall short? Was not Robert Francis right to recommend a system of regulation for health care assistants and, going forward, will the Government reconsider their decision to rule this out? Overall, although there is progress on staffing today, it does not go far enough and we will continue to challenge the Government on it.

Thirdly, on culture change, Francis’s central proposal is a new duty of candour on organisations and individuals. Extending the duty to organisations is a step forward, but patient groups are disappointed today that it will cover only the most serious incidents. Can the right hon. Gentleman say why it has not been extended to all incidents of harm? Further, it is not clear how an organisational duty alone will help individuals challenge an organisation where there is a dysfunctional culture. Is it not the case that an individual duty as proposed by Francis is essential? This point comes over clearly from the evidence given to Francis from a senior, soon to be retired consultant. He said:

“I took the path of least resistance . . . here were also veiled threats at the time, that I should not rock the boat at my stage in life.”

It is only when an individual is both required to speak out, and protected in doing so, that this House can say it has done enough to safeguard patients.

The duty of openness and transparency should apply equally to all organisations providing NHS services including, as Francis rightly recommends, contractors providing outsourced services. Given that this Government are bringing into the NHS more outside providers, patients will need reassurance that we do not have an uneven playing field where private providers face less scrutiny. So will the Secretary of State extend the duty of candour to all health care organisations, as Francis proposed? His amendments to the Care Bill do not make that clear. And should not he now commit to extending freedom of information law to any provider of NHS services?

On openness, Francis made a direct call on the Government to set an example to the rest of the NHS. He said that

“risk assessments should be made public, and debated publicly, before a proposal for any major structural change to the healthcare system is accepted.”

Given that the Government claim today to be accepting this, should they not show now that they mean what they say by finally publishing the risk register on the current reorganisation of the NHS?

Finally, on openness, the NHS would be more accountable to families with a proper system of death certification. The House will remember that this was a recommendation of the Dame Janet Smith inquiry into the Shipman murders. The report today says that the Francis recommendations on this are not accepted in full. If we fail to act now, might people be justified in thinking that this House has not learned the lessons of tragedies that have gone before? If the Secretary of State brings forward proposals, we will work with him on a cross-party basis to implement them.

In conclusion, I do not believe that cruelty has become normal in the NHS, but there is a much deeper question for us all and that is how, in the century of the ageing society, we do a better job of caring for older people. We should not accept the situation where, as Cavendish says, people are paid less than the national minimum wage. Should we not all set much higher ambitions for the care of older people and, in so doing, learn the most fundamental lesson of all from what happened at Mid Staffs?

[Mr Hunt]

Let me take the right hon. Gentleman’s points in turn. First, he will know, because this is what happened after the Bristol inquiry and the Shipman inquiry under the previous Government, that Governments do not always accept every single recommendation. What I have said today is that we accept all the principles behind every single one of Robert Francis’s recommendations. We are implementing 204 in full, and in respect of the 86 that we are not implementing exactly as he said, we are doing everything we can to make sure that we implement the spirit behind them, but we need to make sure that everything we do is workable in practice. Francis himself has said that it is a “carefully considered” response that is a “comprehensive collection of measures”.

On staffing numbers, which is an essential part of what we have to consider, if the right hon. Gentleman looks at the nursing hours per bed, he will find that they have gone up since 2010, not down. We recognise the crucial importance of front-line staff, which is why I gently say to him that we made some reforms to the NHS that meant that there are 5,500 more doctors on the front line and 8,000 fewer managers. What we also need is more nurses. That is why it is so encouraging that in response to what Robert Francis has said and the recognition throughout the NHS of the importance of compassionate care, we are getting a reaction from NHS trusts—not as a result of a direct ministerial decision, but because trusts themselves are recognising the importance of compassionate care. We think that is a very encouraging sign.

With respect to whether staffing levels should be mandatory, we agree that there are minimum recommended staffing levels, but they are not the same for every ward in every hospital. The minimum level might be one in six for an acute medical unit, one in four for a general medical unit, and one on one for intensive care. We took extensive advice on whether it would be appropriate to set a national minimum mandatory number. Not only is the chief nurse and leading nurses from across the country against this; the King’s Fund and the British Medical Association are against it. The BMA said something today in a statement which I never thought I would read in my lifetime—it said that the “Government is right” on this issue.

The right hon. Gentleman also opposed mandatory staffing levels back in 2011, although it is fair to say that in the House his position on this has changed. The important thing is that we allow local discretion to make sure that nursing levels are adequate, and that where they are not, that is exposed quickly so that there is no repetition of what happened at Mid Staffs.

On the regulation of health care assistants, every health care assistant will have to have a care certificate. Effectively, there will be a database which allows employers to check whether someone has such a certificate. That is a kind of register. The other reason for people talking about the regulation of health care assistants is that they want to make sure that if someone fails in their duty of care, they are not able to appear somewhere else in the country. That is why we have a vetting and barring scheme to make sure that that does not happen.

On the individual duty of candour, let us be clear: we want total candour about all avoidable harm, at every stage that it happens, anywhere in the NHS. We decided after much discussion that extending the statutory duty of candour to individual front-line clinicians would be likely to create a huge amount of bureaucracy and damage the culture of openness that we are trying to create, because everyone would constantly be worried about whether or not they were breaking the law. We decided that the right way to achieve the objective is through a professional duty of candour, which is much stronger than the current professional duty states. Critically—this is a key change—we decided to make sure that, just as airline pilots have protection if they speak out, if front-line NHS employees speak out, they too will get protection if there is a professional conduct case, and that openness at an early stage will be treated as a mitigating factor. That is really important in terms of changing the culture.

Finally, we absolutely do need to resolve the issue of death certificates. It is important that we have an independent view to certify deaths. It is a question of finding a practical way to make sure that we do that, but we very much accept the spirit of what Robert Francis said.

Today I hope that we will find a way forward on all the problems that Robert Francis addressed in his response and that we have been thinking hard about. I urge the shadow Secretary of State to join Government Members in saying that this is a moment when the NHS can once again reach forward and aim to be the very best in the world, because the kind of measures that we are talking about are not happening anywhere else, and that is something of which we can all be very proud.

Urgent and Emergency Care Review

Debate between Jeremy Hunt and Andy Burnham

Tuesday 12th November 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will update the House on Professor Sir Bruce Keogh’s urgent and emergency care review following this morning’s briefing to the media.

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

In January this year, the board of NHS England launched a review of urgent and emergency care in England. Urgent and emergency care covers a range of areas, including accident and emergency departments, NHS 111 centres and other emergency telephone services, ambulances, minor injury units, and urgent care centres. The review is being led by Professor Sir Bruce Keogh, NHS England’s medical director. A report on phase 1 of the review is being published tomorrow, and it is embargoed until then. [Interruption.] This is an NHS England report, and NHS England is an independent body, accountable to me through the mandate. The report that will be published tomorrow is a preliminary one, setting out initial thinking. [Interruption.]

[Mr Hunt]

I should underline the fact that this morning’s briefing was under embargo, an embargo which, to my knowledge, has been respected. The final version will be published in the new year.

Sir Bruce has said that he will outline initial proposals and recommendations for the future of urgent and emergency care services in England, which have been informed by an engagement exercise that took place between June and August this year. There will be further consultation on the proposals through a number of channels, including commissioning guidance and demonstrator sites. Another progress report will be produced in the spring of 2014.

Decisions on changing services are made at a local level by commissioners and providers, in consultation with all interested parties. That is exactly as it should be, as only then can the system be responsive to local needs. It is vital to ensure that both urgent and emergency care and the wider health and care system remain sustainable and readily understandable to patients. A and E performance levels have largely been maintained, thanks to the expertise and dedication of NHS staff. A and E departments see 95% of patients within four hours, and the figure has not dropped below the 95% target since the end of April. However, urgent and emergency care is falling behind the public’s needs and expectations.

The number of people going to A and E departments has risen historically, not least because of an ageing population. A million more people are coming through the doors than in 2010. Winter inevitably challenges the system further, which is why we are supporting the most under-pressure A and Es with an additional £250 million. Planning has started earlier than ever this year, and the NHS has been extremely focused on preparing for additional pressure.

We will look at Sir Bruce’s report extremely carefully. Reform of the urgent and emergency care system may take years to complete, but that does not mean that it is not achievable. We are exceptionally fortunate in this country to have in the NHS one of the world’s great institutions. NHS staff are working tirelessly to ensure that the care that people need will continue to be available to them, wherever and whenever they need it.

[Andy Burnham]

Rarely has this House been treated to a more disrespectful and complacent reply. There are new reports today of 12,000 patients spending 12 hours or more on trolleys in A and E. A and E is in crisis according to the College of Emergency Medicine, and this is before the winter has even started. People are increasingly asking, “Where are the Government and what are they doing about it?” So far all they have heard is, “Crisis? What crisis?” But behind the scenes it is a different story. Such is the panic in Whitehall, the Prime Minister has apparently taken personal charge and this morning the media were given a private briefing on a major review of emergency care. What is going on and why is the Secretary of State running scared, blaming NHS England and trying to keep this House in the dark? It should not be for us to drag the Secretary of State here to give Members information already passed to journalists.

Let me remind the House what the Secretary of State said at Health questions in July. He said that Bruce Keogh’s review

“will report this autumn, precisely so that we can make sure we learn any lessons we need to learn for this winter”.—[Official Report, 13 July 2013; Vol. 566, c. 902.]

To hear him now, it was all about the long term. Let me ask him: what are those lessons, and what immediate action is he now taking ahead of winter?

Weekend briefings suggested Sir Bruce emphasises alternatives to A and E, such as walk-in centres and 111, but Monitor reported yesterday that one in four walk-in centres have been closed and others are today under threat of closure. We need a clear answer. Will the Secretary of State stop further closures of walk-in centres? Does he now accept that his 111 helpline is flawed, and will he put nurses back on the end of the phone, rather than call handlers? And what of the recruitment crisis in A and E? There is a shortage of senior A and E doctors and, according to the Royal College of Nursing, 20,000 too few nurses. Will the Secretary of State give a clear commitment to bring all A and Es back up to safe staffing levels?

Last week, a complacent Prime Minister stood there, told us everything was fine, and even claimed that the average waiting time in A and E had gone down to 50 minutes, but that is not true. I have here a written reply from the public health Minister telling us it has gone up to over two and half hours. When are the Government going to show this House and the country some respect, cut the spin, and give us the real picture about a crisis that is happening right now?

[Mr Hunt]

Mr Speaker, I will tell the right hon. Gentleman what complacency is: it is refusing to have a public inquiry into Mid Staffs, where staff in A and E departments were bullied and harassed when they tried to speak out. He did not think it was worth having a public inquiry into the poor care that his Government swept under the carpet and which we are doing something about. There is one figure that he refused to mention: the A and E performance figures published last week of 96.4%—hitting the target, higher than the previous week, higher than this time last year. That sums it up: in a good week he wants to run down the performance of hard-working staff whereas this Government are backing them.

Why are we having an A and E review? It is to clear up the mess and confusion caused by 13 years of Labour mismanagement of our emergency services. The right hon. Gentleman talks about walk-in centres. Why were they introduced? Because of the disastrous mistake over the GP contract. The brave thing for his Government to have done would have been to admit they got that wrong and reverse it, but they did not. They introduced a whole new raft of services, which confused the public: A and E, walk-in centres, GP surgeries, telephone helplines. Tomorrow we will sort out those problems. Yes there are difficult decisions, but they are decisions his Government ducked and left the public exposed as a result.

Before the right hon. Gentleman runs down our A and E services, let me just gently remind him that he talked about a recruitment crisis, but we have 300 more A and E consultants than when he was Health Secretary, we have nearly 2,000 more people—[Interruption.] I am sorry that this is difficult for those on the Opposition Front Bench to listen to. We have nearly 2,000 more people being seen within four hours every single day than when the right hon. Gentleman was Health Secretary —that is some 700,000 more people every year. We have more hospital doctors, more hospital nurses, more treatments and fewer long waits than when he was Health Secretary, and he should celebrate that improvement in our NHS’s performance, instead of trying to run down the people on the front line.

I will tell the right hon. Gentleman something else we are doing. We are tackling the long-term causes of pressure in A and E that his Government absolutely failed to do: not just the GP contract but also the integration of the health and social care system, the lack of which means that hospitals are not able to discharge people from their beds on time, causing huge pressure. Today, the shadow Health Secretary has shown his true colours. The man whose Government made so many wrong decisions about A and E is exposed as trying to make political capital while this Government sort out his mess.

Changes to Health Services in London

Debate between Jeremy Hunt and Andy Burnham

Wednesday 30th October 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

People at home will have listened carefully to what the Secretary of State has just said, and they will have one simple question in their mind: why is this man trying to close so many A and Es when we are in the middle of an A and E crisis? At least seven A and Es across the capital are under threat, at a time when all London A and Es are working flat out and are full to capacity. As we stand here, thousands of people are waiting to be seen, stuck on trolleys or held in the back of ambulances that are queuing outside A and E. When the A and Es we have are struggling to cope, how on earth can it be safe to close or downgrade so many?

That brings me to what I see as the major flaw in what the Secretary of State has announced. These plans have been in development for four years, as he said. Four years ago, A and E was not in the crisis that it faces today. The reality on the ground in London has changed. In 2013, A and Es in London have been getting worse and worse and worse. Across London, 200,000 people have waited in A and E for longer than four hours in the past 12 months. Here is the statistic that should make people stop and think: taking all its major A and E units together, London has missed the Government’s A and E target in 48 of the last 52 weeks.

Any further changes to this fragile and overburdened system must proceed with the utmost caution. Will the Secretary of State give me a categorical assurance that he personally gave in-depth consideration to the latest evidence of the pressure on London A and Es and to the changed reality that 2013 has brought before making his decision? I understand how tough such decisions are. Sometimes, difficult changes need to be made, as I found when I reorganised stroke services in London before the last election. When he does the right thing, based on a clear clinical case that lives will be saved, we will support him, as we did on children’s heart surgery. The problem with the closure programme, as managers admitted to Members of the House at the outset, is that it is primarily about saving money, not saving lives.

Even though the Secretary of State has made some minor concessions today, he is still performing pretty brutal surgery on west London’s NHS. It is the single biggest hospital closure programme the NHS has ever seen. Has he considered the impact of the changes on people in those communities who are on low incomes? They will face much greater costs and journey times in getting to hospital.

Will the Secretary of State be straight with us on the much-loved Charing Cross and Ealing hospitals? I listened carefully to what he said. What is the “further work” that he referred to? He spoke of their A and Es being of a different size and shape. Is that not spin for saying that the units will be downgraded and become urgent care centres? Alternatively, is he giving those units a permanent reprieve today? If he cannot answer those questions directly, local people in those areas will take what he has said as weasel words.

The Secretary of State said that there will be investment in communities before the changes go ahead. He said that to the hon. Member for Enfield North (Nick de Bois) in respect of Chase Farm hospital, but he is closing that unit next month. What guarantee do people have that he will follow through on this promise, when he broke the promise that he made to his hon. Friend?

The Secretary of State has made a statement on London health services. People will not have missed the fact that he has failed to mention Lewisham hospital and what happened at the Court of Appeal yesterday. Is that not a staggering omission? The victory that was won by the people of Lewisham will give hope to people who are disappointed by today’s announcement.

The humiliation of the Secretary of State in court again raises major questions about his judgment and his ability to manage such important decisions. In the summer, we explicitly warned him to accept the first court ruling. Instead, he ploughed on, throwing around taxpayers’ money in a cavalier fashion, to protect his pride and defend the indefensible. I have a simple question: how much has he spent on appealing that decision? When he decided to appeal, did the official legal advice from the Government recommend an appeal or did he overrule it? Will he confirm today to this House and to the people of Lewisham that there will be no further appeal against the court’s ruling? Will he give the people of Lewisham and the staff who work at Lewisham hospital a commitment that their A and E and maternity services will be protected? Finally, will he apologise to the people of Lewisham for the unnecessary distress and worry he has put them through?

It will not have escaped people’s notice that the Secretary of State is trying to put powers through the House quite soon to grab further powers for himself and drive through financial closures of A and Es without proper consultation, so that in effect he can do what he tried to do to Lewisham to every community in England. That will send a chill wind through those communities that fear to lose their A and Es, and that is why we will oppose those powers when they are considered by the House.

In conclusion, the Government have come a long way since the Prime Minister stood outside Chase Farm hospital days after the last general election and promised a moratorium on all hospital changes. Local people in west London will not have forgotten the Prime Minister standing outside Ealing and Central Middlesex hospitals and promising the same. People are seeing through a Prime Minister whose broken promises on the NHS are catching up with him. Has it ever been clearer than it is today that people simply cannot trust the Tories with the NHS?

[Mr Hunt]

I am afraid the right hon. Gentleman is sounding more and more desperate. Today the Government have taken a difficult decision that will improve services for patients. It was a moment for him to show that he understood the challenges facing the NHS, but that was not to be. He said that we should not proceed with the changes given winter pressures on A and Es, but he should read the document. The proposals are for more emergency care doctors, more critical care doctors, and more psychiatric liaison support that helps A and E departments, and they are supported by the medical directors of all nine trusts affected. He said that if evidence can be produced to show that the proposals will save lives, Labour will support them. What more evidence does he want? He should be shouting from the rooftops to support the proposals, but instead he is putting politics before patients.

The right hon. Gentleman mentioned A and E performance, and I am happy to tell him about that. On average a person now waits 50 minutes in A and E before they are seen; when he was Health Secretary it was 71 minutes. The number of patients seen in less than four hours every day is 57,000—nearly 2,000 more than when the right hon. Gentleman was Health Secretary. Our hospitals are performing extremely well under a great deal of pressure because we are taking difficult decisions of the kind that we are talking about today.

The right hon. Gentleman also talked about hospital closures. Again, he should read the proposals: a brand new trauma centre at St Mary’s hospital in Paddington; two brand new elective care centres at Ealing and Charing Cross; seven-day NHS care that will save lives; 24/7 obstetric care; 16 paediatric care centres. Those are big improvements in hospital care—[Interruption.] I will come on to Lewisham. I am acting to end uncertainty because I made the decision today that whatever the outcome of further discussions that the Independent Reconfiguration Panel recommends, there will remain an A and E at Ealing and Charing Cross. That is the best thing I can do for those residents.

The right hon. Gentleman mentioned Lewisham, but let us remember that the problem started because his Government saddled South London Healthcare NHS Trust with £150 million in private finance initiative costs. I judged that the right thing for patients was to sort out a problem that was diverting £1 million every week from the front line. Yes it is difficult, but I would rather lose a battle with the courts trying to do the right thing for patients than not try at all.

Finally, these are difficult decisions, but the party that really has NHS interests at heart is the one that is prepared to grip those decisions. We are gripping the problems in A and E, and in terms of hospital reconfigurations. That is why the NHS is safe in our hands and not safe in those of the Labour party.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 22nd October 2013 Commons Chamber

[Mr Hunt]

I am happy to do so. I want to make it clear to my hon. Friend that I am keen to ensure we have a structure inside the NHS that makes it easy for high-performing hospitals that want to work more closely together and share services to do so, if it is in the interests of patients. We need to do more work in this area.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State has been in post for a year, and in that time we have got used to his style: everything is always someone else’s fault, be it lazy GPs, uncaring nurses or the last Government. And today we see more diversion tactics—now immigration is to blame. But there is an inconvenient truth that gets clearer day by day and which he cannot spin away: A and E is getting worse and worse and worse on his watch. We have had ambulance queues, a treatment tent in a car park and now police cars doubling as ambulances, with a patient dying on the backseat. The NHS stands on the brink of a dangerous winter. Will he today set out in detail what he personally is doing to avert a crisis?

[Mr Hunt]

I welcome the right hon. Gentleman back to his place. It is a great pleasure to see him there, even if it is not entirely what the Labour leader wanted.

If the right hon. Gentleman is shocked that I breached the A and E target for one quarter last year, he will want to make a full apology for the fact that he breached it for two quarters when he was Health Secretary.

[Andy Burnham]

This complacent spin is no good to the NHS. If he wants to compare records, let us do that. Under me, 98 per cent. of people were seen within four hours; under him, over 1 million people in the last year waited more than four hours in A and E—not only a winter crisis, but the first summer A and E crisis in living memory. Today it gets worse. New figures this morning show a further 450 nursing jobs have been cut, taking the total close to 6,000 under this Government. But what were they doing last night? They were voting in the Lords against safe staffing levels. Will he now listen to the experts, stop the job cuts and take immediate action to ensure that all A and Es have enough staff to provide safe care this winter?

[Mr Hunt]

We will listen to no one on the Opposition Benches when it comes to safe care for patients in the NHS. They presided over a system where whistleblowers were bullied, patients were ignored and regulators felt leaned on if they tried to speak out about poor care. That is a record to be ashamed of.

Accident and Emergency Departments

Debate between Jeremy Hunt and Andy Burnham

Tuesday 10th September 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on his plans to alleviate pressure on accident and emergency departments.

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

This morning I made a written ministerial statement outlining the Government’s plans for the winter and detailing how we are allocating £250 million of funding for NHS England. Working with Monitor and the NHS Trust Development Authority, NHS England will distribute this money in 2013-14 to the areas where it is needed most. This follows the announcement in August by my right hon. Friend the Prime Minister that A and E departments will be given an additional £500 million over the next two years to deal with seasonal pressures. Patients need to be able to rely on the NHS all year round, and especially when demand is at its greatest. Ensuring the NHS’s sustainability means identifying each of the challenges it faces and, where possible, alleviating the burden.

Flu is an avoidable pressure on the NHS. Every year, around 750,000 patients see their GP with flu symptoms and nearly 5,000 people die. While flu levels have been comparatively low in the last two years, it would be complacent to assume that they will not rise. Should this happen, it will increase pressure on A and Es, which have already seen a rise in admissions of 32% in the last decade.

The best way to protect oneself and other people from flu is to get the flu vaccine, so, for the first time, children aged two and three will be offered the innovative nasal spray vaccine. Young children’s close contact with others makes them more likely to transmit flu to vulnerable groups including infants and the elderly.

Around 27,000 people spend time in hospital with flu every year, so it is very important that NHS staff should do all they can to avoid getting, and passing on, flu. Less than half of front-line NHS staff get vaccinated against flu. In some hospitals, that drops to fewer than one in five. The Government want to boost significantly the number of health care workers getting the flu vaccine. Trusts will not be eligible to receive a portion of the money in future years if they do not achieve a staff vaccination rate of 75%, except in exceptional circumstances.

This funding will be targeted in the following way: £15 million will go towards securing a reliable NHS 111 service throughout the winter period; subject to completion of current scrutiny of plans, a total provisional amount of £221 million will go to the 53 highest-risk systems; and a small contingency of £14 million will be used for final settlements, for trusts to use in the winter. My written ministerial statement outlines the indicative amounts that have been allocated to specific trusts. The additional allocation will require an increase to the revenue budget for NHS England for 2013-14, as had been specified in the mandate, and the revision to the mandate will be laid before Parliament in due course.

I recognise, however, that we need more radical change to reduce pressures on A and E departments over the longer term. I am currently consulting on my plans to provide improved care for vulnerable older people, to keep them out of hospital through better, more proactive care in their community. This will include better joint-working between the health and care systems; personalised, proactive care overseen by a named, accountable GP; and the sharing of GP records across different organisations, including out-of-hours GP services and the ambulance service.

NHS staff are working harder than ever before, and the British public rely on the NHS just as much as they have always done, and on a year-round basis. The plans outlined in this announcement will improve patient safety levels and help to reduce avoidable pressure on the NHS in the winter months ahead.

[Andy Burnham]

This Secretary of State has been in office for one year—the worst year in A and E in a decade: close to 1 million people waiting more than four hours, and on his watch, the first summer A and E crisis in living memory. But with this Government it is always someone else’s fault: GPs, nurses, patients, the weather, immigration, bank holidays—nothing to do with him, Mr Speaker, he is just a member of the public, as he is fond of saying. Well, I have got news for him: he is the Secretary of State, and it is time he started acting like it. All year we have warned him about the growing A and E crisis. First, he ignored those warnings, leaving A and E ill-prepared on the brink of a dangerous winter, as the NHS Confederation has warned. Now, in panic, he briefs out half-baked plans, without coming to this House. This is too little, too late. It is not good enough that we have had to drag him here on an issue of huge importance to our constituents. With his spin about the GP contract, he neglects the real causes.

First, on staffing, we learn today of the shocking shortage of doctors covering A and Es overnight, and we heard at the weekend reports of A and Es up and down the land without enough staff. More than 5,000 nursing jobs have been lost on the Government’s watch—and counting. Enough is enough. When will the Secretary of State stop the job cuts and ensure that all A and Es have enough staff to provide safe care?

Secondly, on GP opening hours, the Secretary of State tries to blame the 2004 contract but conveniently ignores the fact that A and E performance improved between 2004 and 2010. The truth is that it is the Government who have let GP practices stop evening and weekend surgeries, and it is the Government who ended the guarantee of appointments within 48 hours. What is he doing to restore patient access to GPs?

Thirdly, on social care, in the first two years of this Government there was an appalling 66% increase in the number of people aged over 90 coming into A and E via a blue-light ambulance—that is more than 100,000 very frail and frightened people in the backs of ambulances speeding through our cities and towns. That is a scandal, and it is more to do with social care cuts than anything else. I do not know how many more times I am going to have to ask the Secretary of State this: when will he do something to stop the collapse of social care in England?

All the while the Secretary of State blames a contract signed 10 years ago for today’s pressure he neglects the real causes of his A and E crisis. That is dangerous and it cannot carry on. Patients and staff cannot go through another year in A and E like the one we have just had. He should cut the spin, get a grip or go.

Managing Risk in the NHS

Debate between Jeremy Hunt and Andy Burnham

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

Thank you, Mr Deputy Speaker.

Alarming patients, demoralising staff and casually trading figures about deaths in the pursuit of political advantage is no way to run the NHS, and those are not the actions of a responsible Government. Today people are asking what kind of Government this is, if they are willing to cause further damage to fragile hospitals for their own self-serving political ends. Yesterday the Secretary of State told the BBC that he had no idea who had put the 13,000 figure in the public domain. Does he seriously expect us to believe that?

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

Yes.

[Andy Burnham]

He seriously expects us to believe it? Why are we being told that those responsible were representatives of Conservative Central Office? [Interruption.] Yes, that is what is being said. The Secretary of State should go back and check his facts. If he does not have control of his advisers, it will not be the first time, will it? We have heard this before, have we not? “I do not know what the advisers are doing.”

The “my adviser is out of control” defence may have worked for the Secretary of State once, but it will not work for him twice. He must take responsibility for his own advisers, and for the advisers at Conservative headquarters. We were told explicitly that that is where the briefings came from, and the Secretary of State owes the House a full answer. He owes it to the House to put that on the record. [Interruption.] I will not put the name in the public domain, but I have a name. I will send it to the Secretary of State immediately after the debate, and he must come straight back to me, having asked that person whether or not he briefed the press. If the Secretary of State agrees to that, let us leave it there. I have a name, and I will put it to him straight after the debate. He must take responsibility.

--- Later in debate ---

[Andy Burnham]

I will acknowledge that. A moment ago, I mentioned the Francis report, which I commissioned, which revealed the dangerous cuts to front-line staffing that the hospital pursued as the primary cause. I accept what the hon. Gentleman has just said. Rather than always pursuing central regulation as the solution, if local communities had identifiable benchmarks that they could use to check up on their local hospitals, surely that would be progress we could all get behind.

On the duty of candour, the Government are legislating for a duty on organisations, but not on individuals. I think that we all agree that changing the culture of NHS organisations is essential if we are to move forward. The Francis recommendation is a necessary part of bringing about that culture change. Rather than being a threat to staff, as some have argued, it would protect them when they make known any concerns. Will the Government look at that again and legislate for the full Francis recommendation in the Care Bill? That is incredibly important in the light of yesterday’s report by Sir Bruce Keogh. He revealed—this will shock anyone who has not spotted it yet—that some trusts were telling members of staff what they could and could not say to his review. Surely we can all agree that is fundamentally unacceptable.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

I am glad that the Secretary of State nods. Does that not make the case, however, for a duty of candour on individuals, which would have allowed staff to say to management, “No, I’m going to speak to the Keogh review and I won’t face action afterwards because it is my duty to do so”?

--- Later in debate ---

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

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“welcomes the Government’s swift action in response to the Francis Report; notes the rapid establishment of reviews on key components of the Report’s findings, including the Cavendish review on healthcare assistants, the Clwyd-Hart review on complaints and the Berwick review on patient safety; further notes the drive to improve standards through the appointment of a Chief Inspector of Hospitals, the introduction of Ofsted-style ratings and the recruitment of specialist hospital inspectors; regrets the Opposition’s continued refusal to support these practical measures to expose and improve poor care; welcomes the watershed decision to expose and investigate 14 hospitals with high death rates through the recent Keogh review; further notes the Government’s decisive action to drive improvements in these hospitals by placing 11 hospitals in special measures; and applauds the Government’s wide-ranging efforts to introduce greater transparency and accountability in the NHS.”

I am honoured to see you, Mr Speaker, in your place for my speech. The right hon. Member for Leigh (Andy Burnham) talked about yesterday, and I for one hope that he has had a chance to reflect on Labour’s shockingly inappropriate behaviour. Let me give him one fact to think about: on a day when a review described appalling failings at 14 hospitals, my speech mentioned patients 19 times—his mentioned them just twice. Does that not say it all about Labour’s attitude to the NHS?

[Andy Burnham]

I listened carefully to what the Health Secretary just said about our speeches. Does he think it appropriate for a Secretary of State introducing a report on mortality rates in the NHS to begin, within seconds of getting to his feet, by making political attacks on the previous Government? On reflection, was that the right thing to do?

[Mr Hunt]

It is funny how the Labour party decided to make the NHS its main campaigning issue for the past three years, yet the moment people start to scrutinise its own record on the NHS it says the NHS is being used as a political football. What does that say about Labour’s approach to the NHS?

I want to consider the specifics of the motion before looking at the wider issue of risk. The motion mentions the Francis inquiry. One of this Government’s first acts on coming to power was to set up the full public inquiry into Mid Staffs that families had been denied by the right hon. Gentleman’s Government for too long. We are implementing it, and fast. That is why a new chief inspector of hospitals started work yesterday, just five months after the report was published. [Interruption.] The right hon. Gentleman says that a chief inspector of hospitals is not in the report, but how are we going to make sure that the report’s recommendations are implemented throughout all 266 NHS trusts? That will be done because we will have independent inspection of hospitals, which has not been done before because the situation was so undermined by the previous Government. That is how we are going to make sure that Francis actually happens.

We intend to implement the spirit of everything that Robert Francis proposed, even if the details may vary in places from his 290 recommendations. Francis himself endorsed that approach when that he said that the Government have indicated their

“determination to make positive changes to the culture of the NHS, in part by adopting some of my recommendations and in part through other initiatives.”

Francis talked about five themes, so let us look at the progress being made on them. First, on information and transparency, yesterday showed that this Government are determined to root out, once and for all, an NHS culture of solving problems behind closed doors. This is about not just the decision to hold a public inquiry into Mid Staffs, which the right hon. Member for Leigh and his colleagues rejected doing 81 times, but the Keogh review, which reported yesterday that 14 hospital trusts have excess mortality rates. This is the first time the NHS has ever conducted such a review. We have also published individual surgeon outcomes—the first country in the world to do so across an entire health system. The independent rating of hospitals will start this autumn, so for the first time people will know how good their local hospital is, just as they do for their local school.

Francis also mentioned standards. The new chief inspector of hospitals—a position that Labour still refuses to support—began work yesterday. In Professor Sir Mike Richards, we have a new whistleblower-in-chief whose sole job is to drive up standards and root out poor care. He will be supported by a team of expert inspectors, in stark contrast to the generalist inspection model set out by the right hon. Gentleman’s Government in 2009. That is plain common sense. We have put it right. The work of the inspectors will be informed by the independent review of hospital safety that is being conducted by Professor Don Berwick, who will advise on how to embed a culture of patient safety throughout the NHS. He will report back later this summer.

--- Later in debate ---

[Mr Hunt]

I am going to make some progress. The Francis report also talked about leadership.

[Andy Burnham]

Will the Secretary of State give way?

[Mr Hunt]

I will give way in a moment.

The right hon. Member for Leigh talked about leadership. I want our NHS to attract the brightest and best leaders that this country has to offer. I have asked the NHS leadership academy to develop a new leadership programme to support clinicians to become clinical chief executives and to fast-track professionals from outside the NHS into leadership roles. We urgently need more talented managers in our NHS, and that will make a big difference.

[Mr Hunt]

My hon. Friend makes an important point.

I say to the shadow Secretary of State that it is a question not just of whether he responded to the warnings that he received, but of whether he received the warnings that he should have received in the first place because the inspection system might not have been up to scratch.

[Andy Burnham]

I mentioned a moment ago that when I saw the mortality data in late 2009, action was taken at Basildon and a review was ordered of all hospitals in England, so I did respond.

The Secretary of State needs to correct for the record something that he said a moment ago. He implied that the mortality ratio had not come down at the 14 hospitals. If I have got him wrong, he needs to be clear about it. Yesterday, a group of Back-Bench MPs was informed by Sir Bruce that mortality ratios at the 14 hospitals had fallen since 2005 by between 30% and 50%, but that they were still above the average for England. Overall, the mortality rate is down at all hospitals, but the 14 hospitals have rates that are above the average. Will he correct that point because it is incredibly important?

[Mr Hunt]

Let me help the right hon. Gentleman out. Those 14 hospitals were investigated by Professor Keogh because they had excess mortality rates that go right the way back to 2005. Labour cannot be in denial. Professor Brian Jarman said that under Labour, there was “total denial” in the Department of Health over the issue of excess mortality—

Hospital Mortality Rates

Debate between Jeremy Hunt and Andy Burnham

Tuesday 16th July 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

First, let me join the Secretary of State in thanking Sir Bruce Keogh and his team for this important review. Having worked closely with Sir Bruce, I know him well and have the utmost respect for him. His review presents a challenging but accurate picture of care standards and failings at the 14 trusts. As with both Francis reports, we accept the findings of this report in full.

The statement we have just heard, however—the partisan statement—was not worthy of the excellent report that Sir Bruce has delivered today. The Health Secretary claimed at Health questions that this was a historical report, all about the past and the last Government. Well, I have got news for him: it is not. Trusts were identified on the basis of mortality data for 2011 and 2012. This report is about the right hon. Gentleman’s Government and failings that are happening now on this Government’s watch.

Anyone who supports the NHS must always be prepared to shine a spotlight on its failings, so it can face up to them and improve. In so doing, we must be fair to staff and the NHS as a whole. I am pleased to say that Sir Bruce is fair in his report. He says early in the report that the failings of the 14 hospitals must be put in context, stating that mortality in “all NHS hospitals” has been falling over the last decade by about 30%. He rightly reminds us of

“decades of neglect in the NHS in the 1980s and 1990s”,

and he speaks of the challenge facing the last Government in their early days. The key issue, he said,

“was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment.”

The last Labour Government dealt with that issue; I am proud of it and we are proud of our record on the NHS.

The balanced picture presented in this report is not recognisable from the Government briefing appearing in the weekend newspapers. In fact, this report exposes one of the more cynical spin operations of recent times. Nowhere in this report does the claim of 13,000 avoidable deaths appear. Sir Bruce is clear, so let me quote him directly:

“However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”,

but that is precisely what this Government chose to do in advance of this report. They made unfounded claims, which will have alarmed people in the areas served by the 14 hospitals, and they have questioned the integrity of the staff working in those hospitals in difficult circumstances—and all for their own self-serving political ends. That is simply unworthy of any responsible Government. On reading this review, the diversionary spin operation now makes sense because it reveals evidence of deterioration at all 14 hospitals on their watch.

Let me turn to one of Sir Bruce’s central findings—unsafe staffing. One of the report’s major concerns is that trusts have allowed staffing levels to drop to dangerously low levels. It says:

“When the review teams visited the hospitals, they found frequent examples of inadequate numbers of nursing staff in some ward areas.”

Already, the review team has had to intervene on staffing levels in three trusts to protect patient safety.

The Secretary of State claimed in his comments that the Care Quality Commission had failed to spot any problems. Working with the CQC during the last Government, I left in place warnings about five of these hospitals. The Secretary of State claims that we were covering up, so let me answer on the question of Ministers’ integrity and cite the Francis report, which said that there was no evidence that any Minister received or ignored advice that would have led to safe outcomes. Let me quote to him from a letter sent by Baroness Young to the Prime Minister yesterday:

“CQC was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures.”

It is outrageous for the Secretary of State to come to the House today and repeat those concerns without a shred of evidence to back them up.

Five of the trusts examined by Keogh had warnings in place, and it is shocking that they have been allowed to cut staff to unsafe levels on this Government’s watch. Overall, seven of the trusts in the review have cut front-line staff by a shocking 1,117. The great sadness is that it appears Ministers are in danger of forgetting the lessons of Stafford, where Robert Francis identified “dangerous cuts” to the front line as a primary cause of care failures. Like Robert Francis, Sir Bruce makes recommendations on appropriate staffing levels. Is it not the case that the Secretary of State can no longer ignore these authoritative calls, and will he take urgent action on safe staffing levels in these 14 trusts and across the NHS? Will he accept that the loss of over 4,000 nursing jobs that has now been laid bare under this Government is a monumental mistake, while £3 billion has been siphoned out of the NHS front line to pay for reorganisation that nobody wanted and nobody voted for?

Let me turn to A and E performance, the barometer of the health service and a wider indication of problems across hospitals. The report highlights major failings in A and E at many of the trusts and we know that the NHS has just come through the worst winter for a decade. At the end of last year, all 14 trusts were in breach of the Government’s A and E target—when, under the previous Government, all 14 were meeting the A and E target.

Sir Bruce is clear that urgent action is needed to improve A and E. Let me quote the report:

“We have established that one of the primary causes of high mortality in these hospitals are found primarily in urgent and emergency care, and particularly in care for frail and elderly patients…All trusts were functioning at high levels of capacity in the urgent care pathway. This frequently led to challenges in A&E and, as a consequence, cancellation of operations due to bed shortages and difficulty meeting waiting time targets.”

Will the Secretary of State now take immediate action, working with the whole health economy in these 14 areas, to bring each trust back up to the national standards on A and E that his Government have set? Will he accept that it is not fair to these hospitals to blame them alone, as the devastating cuts to social care are a major driver of pressure in hospitals?

Finally, on what happens next, the simple truth is that people watching will want solutions rather than point scoring. Surely the right response to the Keogh review is now to accept the Francis recommendations in full, particularly on minimum staffing. A duty of candour on individuals will help bring the culture change we need at local level and, of course, we need to see the regulation of health care assistants. Will the Secretary of State work with us now on early implementation of the Francis recommendations? He spoke earlier of a new era of transparency. If he means what he says, will he now publish the NHS risk register? For all we know, it might well have predicted some of the failings we are reading about today.

It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What matters is how the NHS responds. Rather than pulling down the shutters and pushing people away, it is right that we should hold a mirror up to the NHS so that it can act on its failings. We must also be fair to people working in the NHS by ensuring that an accurate picture is presented. Sir Bruce has had to take the extraordinary step already of distancing himself from the Government briefings that appeared at the weekend. I hope the Government will learn a painful lesson from this: you should not play politics with people’s lives and you should not play politics with the NHS, on which all people depend.

[Mr Hunt]

Mr Speaker, it is hard for a serving Health Secretary to admit that things can go wrong in the NHS, but we know today that it is even harder for a former Health Secretary. We have heard nothing but shameful denial. The right hon. Gentleman—[Interruption.]

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

What my hon. Friend says is incredibly important. We must have a culture of openness and transparency inside the NHS, which means that people at the front line feel empowered to speak up if they think there is a problem. That has not happened in the past, and we are going to put it right.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State will make a statement shortly about the Keogh review. Two of the hospitals investigated are Basildon and Tameside. The previous Government left a warning in place on both trusts about patient safety. This Government have ignored those warnings and allowed both trusts to make severe cuts to front-line staff. Tameside has cut 128 nursing posts and Basildon an unbelievable 345. Given the warnings he inherited, why on earth has he allowed that to happen?

[Mr Hunt]

I am very surprised that the right hon. Gentleman wants to mention what happened at Tameside. Tameside had high death rates for eight years under Labour. The previous Government ignored a whistleblower in 2005, warnings to Parliament in 2006, a coroner’s report in 2006 and warnings from my predecessor in 2009. To cap it all, in 2009 the hospital was given a “good” rating by the Care Quality Commission. How bad is that?

[Andy Burnham]

I am afraid the Secretary of State is simply wrong. At the instigation of my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), I ordered unannounced inspections into Tameside. The Secretary of State should get his facts straight before he comes to this Dispatch Box. He did not answer on staffing, and it gets worse, Mr Speaker. Seven of the 14 hospitals in the Keogh review have between them cut a shocking 1,117 nursing jobs on this Government’s watch. Unsurprisingly, A and E performance has plummeted at all seven. All 14 hospitals were meeting the A and E target in my time in office; none of them are meeting it under the Secretary of State. Is not the right response to the Keogh review to stop dithering and act now on safe staffing levels?

[Mr Hunt]

I am surprised that the right hon. Gentleman wants to talk about the Keogh review before we have made our statement. I am particularly surprised because the Keogh review is the review that Labour never wanted to have, with high death rates in all those hospitals stretching back to 2005 and a record of inaction by Labour. As former—[Interruption.] I think the House might be interested to hear this. as former Labour councillor and Mid Staffs campaigner Ken Lownds said today:

“Can you imagine a Keogh review under Andy Burnham or any Labour Health Secretary? Not a chance.”

Health Services (North-West)

Debate between Jeremy Hunt and Andy Burnham

Thursday 11th July 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement on matters that are of major significance to the NHS in the north-west of England, but I am not the only north-west MP taken by surprise this morning by the lack of advance notice. My hon. Friend the Member for Stretford and Urmston (Kate Green), in whose constituency Trafford hospital lies, was heading home, but had to abandon her journey at Stoke and is now heading back down to try to get here. This is not just a major discourtesy to her and the House, Mr Speaker; it is an insult to the people of Trafford, and it is no way to treat people who have campaigned to save their A and E, and who should have rightly been able to expect that their voice be heard in this House today through their elected Member of Parliament.

It says a lot about this Secretary of State. His advisers could find time to get texts sent to the Murdochs with market-sensitive information before an earlier statement he made, but he could not find time to give a local MP advance notice of a statement about the closure of her accident and emergency department: disgraceful.

This is not just any A and E: 65 years and six days after Nye Bevan opened the NHS at Trafford hospital, we have the spectacle of this Secretary of State scurrying to the House to rush out an announcement without the scrutiny of local MPs about a major downgrade of the hospital. What clearer symbol could we have of a Government who disrespect and disregard the views of NHS staff, patients and local people?

My hon. Friend the Member for Stretford and Urmston is trusting that the west coast main line will get her back before the close of this statement, and I hope you will allow her to contribute, Mr Speaker, even though she has clearly missed the opening of this statement.

Let me now turn to the substance of what the Secretary of State has said. He is right to say that the IRP provides excellent support and advice to Ministers. It did so to me and my predecessors in the last Government, and I am sure it is doing the same for the current Government. Where it can be shown that changes will save lives and reduce disability, in my view all Members of this House have a moral obligation to support them. Changes to vascular services in Cumbria and Lancashire clearly fall into that category. The concentration of this highly specialised surgery on three sites will save and improve lives, but given the geography it is essential that people are supported with travel. The Secretary of State made a vague commitment, but can he be more specific about the support that will be made available to patients, particularly in the sparsely populated northern part of our region, who will now have to travel much further to receive this life-saving surgery?

Although we support the Secretary of State’s decision on Lancashire and Cumbria, we have much greater concerns about the process that has led to the decisions today about Trafford hospital. While the IRP has undoubtedly done what it has been asked to do, I wrote to the Secretary of State in November last year to express serious reservations about the Trafford review proceeding ahead of Healthier Together, a much wider review of acute and emergency services across Greater Manchester. Speaking as a Greater Manchester MP, I cannot see why it makes sense to pick off Trafford hospital ahead of this review without looking at things in the round. It does not feel to me that this is part of a coherent plan for the NHS in our city region, and I ask the Secretary of State today why his decision is justified, given that the wider considerations affecting health services in Greater Manchester have not yet been completed.

The Secretary of State claims that the patients affected by the closure of Trafford can be easily and safely absorbed by the neighbouring A and Es. How can he say that when all the A and Es that will now have to absorb extra patients missed his own A and E target for at least four months during the worst winter in the NHS for a decade? Have the Secretary of State and the IRP made their decision looking at the very latest evidence of growing pressure on A and E departments in Greater Manchester? He mentions extra funding for Wythenshawe, which is welcome, as the hospital was built for 70,000 patients a year and is currently seeing almost 100,000, but will other affected A and Es also receive additional funding?

Finally, Mr Speaker, the appalling mishandling of this statement today, which has left the people affected unable to put the Secretary of State under scrutiny, is just the latest example of the wider mishandling of hospital reconfiguration under the coalition, which has seriously damaged public trust in our ability to make changes to hospitals. Picking off Trafford ahead of a wider review broke the illusory moratorium on hospital changes announced just days after the general election outside Chase Farm hospital by the Secretary of State’s predecessor and the Prime Minister—incidentally, that hospital is also now downgraded.

Sir David Nicholson has today said:

“If a political manifesto does not say that service change is absolutely essential and that you need to concentrate and centralise services—it will not be being straight forward with the British people.”

Might he just have had the last Conservative manifesto in mind when he made that statement? Will the Secretary of State today admit that this false moratorium was a cynical and dishonest policy designed to win votes in marginal seats, and will he commit never to repeat it?

Worse still, the Secretary of State’s officials have been in court in the past few days trying to justify the indefensible: a decision to rob a local community in south London of a successful A and E to solve problems in another trust that were not of its making. Is all this not causing severe damage to trust in how these decisions are made? Will he give a commitment to the House today that if the court finds against him, he will abandon his plans to downgrade Lewisham A and E? Labour Members will support changes where they are clinically justified, but where communities are picked off unfairly by this arrogant Government we will stand with them and fight for fairness.

[Mr Hunt]

Many members of the public are understandably concerned about these decisions, but from someone who was Health Secretary and who argued the case many times for changing services what we have heard today is not sensible argument, but political opportunism.

Let us examine what the right hon. Gentleman said only last week in Hastings. He said that people like him have a moral imperative to support the doctors who are making these decisions. Well, these changes are supported by the Trafford clinical commissioning group, Greater Manchester critical care network, the Royal College of Surgeons and many other doctors. How many doctors does he need to support this decision before he actually does what he said he would do last Friday, which is support doctors making difficult decisions? On the very day that NHS England is talking about the need to protect services for patients by facing up to difficult decisions, his approach is more than inconsistent—it is irresponsible, and he knows it. Let us examine what he said about changes in Trafford when he was Health Secretary—

[Andy Burnham]

Answer the questions.

[Mr Speaker]

Order. We must have order from those on the Opposition Front Bench, and I know that the Secretary of State will want to respond to the questions asked of him. I just remind the House that it is not a generalised debate; it is a statement and a response to questions.

--- Later in debate ---

[Mr Hunt]

The process has taken a long time because we have consulted extensively with the local community and local Members. There have been debates in the House about it, and Members have regularly asked about it during oral questions. I asked for hon. Members to be given advance notice of today’s statement. Consultation is important, and we asked for advice from the Independent Reconfiguration Panel—

[Andy Burnham]

No; wrong. You did not give advance notice.

Care Quality Commission (Morecambe Bay Hospitals)

Debate between Jeremy Hunt and Andy Burnham

Wednesday 19th June 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for early sight of it, and I welcome what he has just said. Today’s report will have left people stunned. The Secretary of State began with an apology and we on the Opposition side echo it. It is a sad fact that mistakes will be made in any walk of life, even in the NHS. What is never acceptable is when people or organisations try to hide those mistakes. As Professor Sir Liam Donaldson, the former chief medical officer, says:

“To err is human, to cover up is unforgivable, and to fail to learn is inexcusable.”

Sadly, that is precisely what appears to have happened in this case.

The report covers a four-year period from autumn 2008 to autumn 2012. It details failures in regulation, but also subsequent attempts at a cover-up. It was published only because of the efforts of James Titcombe and his family. Like the Secretary of State, I pay tribute to them today, as does my hon. Friend the Member for Barrow and Furness (John Woodcock), who has supported the family. As he rightly said, that family’s suffering has been intensified by the actions of the NHS—something that should never happen. It is now essential that they and all the other Cumbria and Lancashire families affected get all the answers they are looking for—and I fully commit the Opposition to making sure that happens.

The most shocking revelation in this report is that, in March 2012, an instruction was given by a member of senior management at the CQC to “delete” the findings of a critical internal review. Let me remind the House of the context in which that March 2012 instruction was given. At that time, we were midway through a major public inquiry into the terrible failings at Mid Staffs. This was two years after the completion of an earlier independent inquiry—also led by Robert Francis, QC—following which all parts of the NHS had committed to full openness and transparency. It also came after failings at other trusts—most notably Basildon and Thurrock—which led me to request an in-depth look at all hospitals so that problems could be flushed out and a system put in place to ensure that people had a comprehensive picture of local standards. That was the context in which this instruction was given, and it explains why today’s revelations beggar belief and are hard to comprehend. The report raises questions for the CQC and the Department; I will take each in turn.

The new chief executive, David Behan, commissioned this report and we pay tribute to him for doing so. The chair has said today that he now wants to draw a line under this issue, but does the Secretary of State agree that it will be possible to do that only when further questions raised by this report are answered?

On hospital regulation, there is a recognition on all sides that it has not been good enough for too long. While we note the important work of Don Berwick, should we not also be getting on with the job of implementing the recommendations of the three-year Francis report in this regard? The Secretary of State mentioned a duty of candour on providers, but he will know that Robert Francis recommended that that should extend to individual clinicians, too. Will the right hon. Gentleman work with the Opposition to implement that recommendation as soon as possible?

On the cover-up, paragraph 1.17 of today’s report says that the order to delete

“may constitute a broader and on-going cover-up.”

Will the Secretary of State address that point directly and tell the House whether he is confident that this cover-up is no longer happening? Is he satisfied that the CQC has taken all appropriate steps, and does he have full confidence in it going forward, or does he believe a further process of investigation is necessary?

More specifically, is anybody who was involved in the decision to delete still working at the CQC or elsewhere in the NHS? If they are, people will find that hard to accept and they will want answers on that specific point. Given that accountability is essential, does the Secretary of State agree that people will find it hard to accept if data protection laws stand in the way of that accountability, and will he therefore review the decision to shield the identities of those involved? Today’s report makes it clear that the “deleted” report still exists. Should it not now be published?

Now let me turn to the Department of Health. Was the decision to delete taken solely by senior management at the CQC or is there evidence that anyone outside the CQC was either involved in the decision or aware of it? Was anyone in the Department of Health aware of the internal report being produced, and did any contact take place between the CQC and the Department running up to the decision to delete it?

Unfortunately, this matter does not end with deletion of the report. The Prime Minister said earlier that there should always be support for whistleblowers, and he was right, but there are serious doubts about whether that has happened in this case. Concerns about the CQC were raised by an internal whistleblower who was on the board. We know there was an attempt to remove her from the board and to question her character. Has the Secretary of State looked into these issues and considered whether appropriate support was provided—by both the CQC and the Department—to the individual who raised these concerns? The same whistleblower told the CQC today that she had raised issues internally first, then within the Department and then directly with the former Secretary of State in a meeting. Will the Secretary of State provide details of that meeting and publish a minute of it? What actions were taken by Ministers subsequent to that meeting? Were Ministers consulted about the decision to remove her from the CQC board, and did they support that decision?

Finally, the only real answer to all of these deep-rooted problems that go back a long way is for both sides of the House to recommit to full openness and transparency in the national health service. Will the Secretary of State join me today in restating that commitment and together sending the clearest and most unambiguous signal we can to the rest of the NHS?

In conclusion, there are difficult questions here for people at every level of the system. If we are to restore confidence, it is essential that they are answered and that people are held accountable for their actions. Learning from this failure and others, this House must a deliver a regulator that the public can trust, one that puts patients before its own interests. We will support the Government in that process and not stop until it is completed.

[Mr Hunt]

I welcome much of what the right hon. Gentleman says, but let me say this: he talks about getting on with implementing the Francis report, and that is exactly what has been happening. The report came to the House on 6 February. A new chief inspector of hospitals was appointed by 31 May, and the new inspections will start towards the end of this year. That will mean that many of the things talked about in the Francis report as being fundamentally important will start to be looked at independently and rigorously for the very first time.

I can confirm that there will be a duty of candour in the new Care Bill. We are looking at the extent to which it should apply to individuals, but we want to wait until Professor Berwick produces his report, because it is important to create a culture of openness, and we do not want to pass a measure that might inadvertently mean people clam up when they see a potential safety breach. We need to encourage an atmosphere where everyone talks openly about any concerns they have.

David Prior will be looking in his response to today’s independent report at whether anyone still working in the NHS, or, indeed, the CQC, may have been responsible for some of the shocking things that have been revealed. He will pass that report to me within the next two months. As I said in my statement, there will be full consideration of any sanctions or appropriate disciplinary procedures. In our response to the Francis report, we have said we want to introduce a new barring scheme to make sure that managers who have been found guilty of behaving in a bad way do not get jobs in another part of the NHS.

With respect to what the right hon. Gentleman said about my colleague, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), I gently say to him that it was not my right hon. Friend or myself or this Government’s Ministers who rejected 81 requests for a public inquiry into what happened at Mid Staffs. My right hon. Friend was the person who called the public inquiry into Mid Staffs. He is the person who changed the management of the CQC. He is the person who put clinicians in charge of budgets in the NHS, precisely to make sure these kinds of safety issues do not arise.

Finally, the right hon. Gentleman talks about accountability. If the Opposition really wanted to give confidence that they take the issues raised today seriously, they would recognise that it was fundamentally wrong to set up an inspection regime that was not carried out by specialists, and where the same person was inspecting a dental clinic, a slimming clinic, a hospital or a GP practice, perhaps in the same month. That may have contributed to the CQC’s decision in 2009 not to investigate the maternity deaths at Morecambe Bay, and to its decision in April 2010 to register the hospital without conditions.

When it comes to accountability, the right hon. Gentleman needs to explain to the House why the former head of the CQC, Barbara Young, said in her evidence to the Francis inquiry:

“We were under more pressure…when Andy Burnham became minister, from the politics.”

Is it the case that the head of the CQC felt under pressure not to speak out about care issues?

On the substantive policy point, the right hon. Gentleman continues to criticise the appointment of a chief inspector of hospitals and continues to criticise me when I single out hospital management who coast when it comes to raising standards. Just how much evidence will it take for the right hon. Gentleman and the Labour party to realise that when it comes to NHS policies, they really need to change?

Children’s Heart Surgery

Debate between Jeremy Hunt and Andy Burnham

Wednesday 12th June 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for giving me early sight of his statement. He was right to begin by reminding the House of the events that led to the Safe and Sustainable review. Terrible failings in the care of very sick children at the Bristol royal infirmary in the 1980s and 1990s led Sir Ian Kennedy to call for expertise to be concentrated in fewer surgical sites—a call supported by more recent events, including those at the John Radcliffe hospital in 2010. Since Bristol, Sir Ian’s important conclusion has had the full support of the health professions and of those on both sides of this House. As we digest what the Secretary of State has just said, two considerations must remain at the forefront of our minds. First, that this issue must continue to transcend party politics. Secondly, that the complexity it presents should not derail our determination to deliver the safest possible care for children in England.

That said, changes of this magnitude must be able to command public confidence and consensus, but that has not emerged since the decision on site selection by the Joint Committee. I fully support the reduction in sites, but when the decision was published I expressed concern about the distribution of the seven sites, which was skewed towards the western half of England and left a large swath of the east, from Newcastle to London, without a surgical centre. For a family in Hull or Lincoln, already at their wits’ end with worry, the wrench of leaving home to travel hundreds of miles, along with the cost of accommodation and time off work, would add to high levels of stress and anxiety. That is why the issue has aroused such strength of feeling, particularly across Yorkshire, the Humber and the east midlands—a concern well voiced and represented by Members throughout the House.

Although clinical safety must predominate, does the Secretary of State agree that the NHS needs to give more consideration to public access and travel times when reconfiguring services? The truth is that the NHS has a habit of minimising these concerns in all reconfigurations—in this case, as the IRP report points out, the Joint Committee considered access the least important factor. The IRP concluded, surely rightly, that

“the decision used a flawed and incomplete analysis of accessibility”.

Going forward, will the Secretary of State ensure that this is corrected and that access is made a significant factor in any future decision?

Turning to the review itself, the Secretary of State will know that one of the main concerns has been that the mortality data were not given enough weight. Although decisions of this kind cannot be based on death rates alone, we agree with John Deanfield, director of the National Institute for Cardiovascular Outcomes Research, who wrote in his letter to NHS England in April:

“Mortality is only one measure of quality, but currently is the most…available outcome.”

Will the right hon. Gentleman confirm that these data will feature more prominently in the further process of review announced today?

My main concern with what the Secretary of State has just announced is the proposal to link the children’s review with the review of adult heart services, and the implications that might have for the timetable. The Secretary of State will know that there are around 30 centres across England carrying out adult heart surgery. The seven selected children’s centres are not all co-located with adult heart surgery and, indeed, a number of them are on specialist children sites, so the link between children’s and adult heart surgery is not clear. Is there not a real danger that by linking the review with adult heart surgery, the Secretary of State is introducing more complexity and, potentially, controversy, risking a loss of focus and more delay? By broadening out in this way, is there not a danger that we will lose the consensus that has already been gained over the future of children’s heart surgery? I would be grateful if the right hon. Gentleman would say more on those points.

This decision will also have implications for the timetable of the children’s review and it will not have escaped the House’s notice that that Secretary of State has not announced a clear timetable. Can he set out more precisely a timetable for the decision making that will now follow? He says that the review will be concluded by the autumn. What people will want to know is when the decisions will be made and implemented. Can he say more about that? The statement sets out a major role for NHS England and questions may be asked about the independence of the review he has announced. What guarantees can he give that NHS England will operate independently of vested interests linked to the 10 sites?

Finally, I am sure the right hon. Gentleman will agree that we cannot risk any loss of confidence in the process, damaging confidence in all 10 existing sites. Will he say more about what he will do in the interim to support all existing units and ensure that there is no loss of expertise?

In conclusion, it is, of course, essential that the public have confidence in the process and the final decision. Balanced against that, however, is the fact that unnecessary delay will not bring the best results for the children who most need our help. The Secretary of State is right to say that we need a process that is seen to be fair by all concerned, but, equally, a point will come when decisions must be made. In the end, I want to assure the Secretary of State that when he comes to face up to those difficult decisions, he will have our support in doing so.

[Mr Hunt]

I thank the right hon. Gentleman for the tone of his comments and the bipartisan way in which he has approached these issues. I particularly welcome his last point. We have many debates in this House, but this is one issue where we are completely at one. If there is a difficult decision to be made that will save children’s lives, we must have the courage to take it. I am grateful for the right hon. Gentleman’s support on that.

I think that the right hon. Gentleman will also agree with me that while this issue transcends party politics, it is one from which all of us—on both sides of the House, throughout the NHS and indeed in local authorities—have things to learn. I think that the biggest issue for us all to consider is the sheer amount of time that it has taken. The original concerns about what happened in Bristol were raised in 1989. I am pleased to say that they have been dealt with, but there are broader, system-wide lessons to be learnt. It took until 2001 for Sir Ian Kennedy’s report to be completed, it took until 2008 for the Safe and Sustainable review to begin, and now, in 2013, we are having to suspend the process yet again. What has happened is not the right outcome for children, and we must all learn the lessons from that.

The right hon. Gentleman mentioned site selection. I consider that to be one of the most crucial areas in which the process was flawed. Whether we should involve adult heart services is a difficult question, but one of the key recommendations in the IRP’s report is that they should be taken into account. I think that we should pay attention to that recommendation, because the panel thought about it very carefully. The reason for its view was that the same surgeons often operate on children and on adults. Adults also have congenital heart conditions that require operations. The panel also says that if the best outcomes are to be achieved for children, services must be concentrated in teams that have four full-time surgeons, provide specialist training, and conduct research. The knock-on impact of what is happening in adult heart services is relevant.

I agree with the thrust of what the right hon. Gentleman said about mortality data, but I know that he will also understand the difficulty of publishing such data on a very small number of cases when they may not be statistically significant. That was one of the great debates that we had over the temporary suspension of services at Leeds. We must be careful not to publish data that could lead the public to make the wrong conclusions. In principle, however, transparency is the most important thing for us to bring about.

I entirely agree with the right hon. Gentleman about the timetable. I think that we must get on with this process: I do not want to delay it any more than is necessary. I have talked extensively to NHS England about how it should be approached. NHS England—along with all the stakeholders involved—needs time in which to digest the contents of the IRP report, which was published only today. I consider that the minimum period that I need to allow it to come up with the timetable is until the end of next month. I appreciate that that is six weeks, but I think that it is a sensible period. I certainly want to be able to publish an indicative timetable by then, so that people can understand how the process will continue and how we will learn the lessons.

I also agree with the right hon. Gentleman that nothing in my statement should undermine the public’s confidence in the brilliant work being done by heart surgeons all over the country for adults and children. Our heart surgery survival rates have improved so much that they are now some of the best in Europe, and we can be very proud of the work that those surgeons do, day in, day out. However, that does not mean that we cannot strive to be even better.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 11th June 2013 Commons Chamber

[Mr Hunt]

As I said, I share my hon. Friend’s concerns about the way funding works at the moment. We are in a very difficult situation because if we were to move closer to the formula proposed by ACRA—I am sure he would agree with me that it is right that it is done independently of Ministers, and in this case it is done under NHS England—it would mean cuts in real terms for the budgets in other areas. Given the pressures overall in the NHS, that was obviously a decision that NHS England was very reluctant to make.

[Andy Burnham (Leigh) (Lab)]

The last Government matched health funding to health need and reduced the gap in male life expectancy and infant mortality, but this Government have reduced the weighting for health inequalities. The Secretary of State’s public health allocations mean that the areas he has identified today with the biggest health challenges do not get a fair share. The area with longest male life expectancy, Kensington and Chelsea, gets £133 per head, but Liverpool gets £89, Manchester £86, Luton £61, and Slough just £37. If he really wants to do something about health inequalities, should he not match his words with deeds and give more to the areas with the greatest challenges?

[Mr Hunt]

The right hon. Gentleman really cannot have it both ways. The budget for public health is also decided by an independent body, and we gave everyone a real-terms increase and then used any remaining money to even out the differences, to get everyone as close as possible to the independent formula. But if we are talking about spending, I think the right hon. Gentleman needs to say precisely whether he stands by his assertion that Governments should cut spending on the NHS by £600 million—[Interruption.] He says he has never said it before, but actually, up till now he has always said that it was irresponsible for the Government to increase spending in real terms. We have increased it; we have increased it by £600 million. He needs to come clean on whether he still wants to cut the NHS budget.

Accident and Emergency Waiting Times

Debate between Jeremy Hunt and Andy Burnham

Wednesday 5th June 2013 Commons Chamber

[Mr Hunt]

I will give way to the shadow Health Secretary in a minute. One patient there had a cardiac arrest in the eye-examination room as there was no room in the resuscitation bay, and 24 to 36-hour waits for beds are now common in Wales. One patient spent a full three days in a Welsh emergency department. So let me give him a chance finally to condemn what is happening in Wales.

[Andy Burnham]

People watching this debate will be wondering why the Secretary of State is talking about something that is not his responsibility; nor is it mine. He is not responsible for the NHS in Wales; nor am I. I have put to him today serious questions about the NHS in England right now. He is the Secretary of State for the NHS in England, so will he now address the questions I put to him?

[Mr Hunt]

So there we are. Labour totally fails again to condemn the appalling shambles in the part of the country where it runs the NHS. I will tell the right hon. Gentleman why what is happening in Wales is completely relevant to the debate in England.

--- Later in debate ---

[Mr Hunt]

I will give way to the hon. Gentleman, if he will just take his place for a moment while I make my point. I will also give way to my hon. Friend the Member for Enfield North (Nick de Bois)—[Interruption.] I will reflect on whether I want to give way to the hon. Member for Rhondda (Chris Bryant), but I will certainly give way to the hon. Member for Caerphilly (Wayne David).

What is happening in Wales is directly relevant to what is happening in England, because in England the NHS budget has increased in real terms and NHS spending has increased in real terms. If we did not increase them both, that would mean fewer doctors, fewer nurses and longer waits for operations—[Interruption.] The shadow Secretary of State shouts from a sedentary position that the NHS—

[Andy Burnham]

On a point of order, Mr Deputy Speaker. The Secretary of State has just said at the Dispatch Box that the budget for the NHS has increased in real terms. In December, I referred the Secretary of State’s comments to the UK Statistics Authority and I received a letter back saying that they were incorrect. Will you ask the Secretary of State to correct the parliamentary record and ensure that when the statistics commissioner makes a ruling it is adhered to by the Secretary of State?

[Mr Deputy Speaker]

That is not a point of order, but the right hon. Gentleman has certainly made his clarification for the record.

A and E Departments

Debate between Jeremy Hunt and Andy Burnham

Tuesday 21st May 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on what evidence he has to show how his plans to change GP services will solve the current crisis in accident and emergency departments.

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

A and E departments are under great pressure, and the whole House will want to pay tribute to the thousands of doctors, nurses and health care assistants who work extraordinary hours in very challenging conditions. They are there for us when we need them, and we owe them a great debt.

More than 1 million more people visit A and E every year compared with just three years ago—those are additional numbers—and the simple fact is that if growth continues at that rate it will be unsustainable. It also means that when there are short-term pressures on the system, such as a very cold winter, teething problems with NHS 111 or bank holidays, the system cannot cope as well as it needs to and the quality of care is affected.

Let us be clear: A and Es are currently hitting the 95% target. The latest figures show that 96.3% of patients are seen within four hours, and people are waiting on average 55 minutes for treatment. However, if A and E services are to be sustainable, we need both short-term and long-term measures to address the underlying causes of the pressure they are under.

Last week, NHS England announced that it would change the basis on which tariff money for certain A and E cases is spent. For the first time, hospitals will have a say in how money is spent to alleviate demand when that money is withheld for numbers exceeding the 2009 baseline. We also need to address more fundamental issues, which is why I announced to the House on 13 May that the Government will publish in the autumn a vulnerable older people’s plan that will tackle those long-term underlying causes of pressure in our A and Es, particularly for the frail elderly who are the heart of many of the issues we face in both quality of care and service performance.

The changes the Labour Government made to the GP contract took responsibility for out-of-hours care away from GPs. [[Interruption.] Labour Members may not like to hear the facts about the consequences of those changes, but let us go through them—they asked the question. Since those changes, 90% of GPs have opted out of providing out-of-hours care, and they got a pay rise in addition. As a result of those disastrous changes to the GP contract, we have seen a significant rise in attendances at A and E—4 million more people are using A and E every year than when the contract was changed. As researchers from the university of Nottingham found, to give just one example, a reduction in out-of-hours services provided by patients’ usual family doctors is a direct cause of increased A and E attendance by children.

There are other issues too, including the lack of integration with social care, and vulnerable patients being discharged from hospital with no one co-ordinating proper health and social care to support them in their own homes. That lack of integration was something else that the previous Government failed to address over 13 long years.

Then there are the problems inside A and E departments caused by the disastrous failure of Labour’s IT contract. When people are admitted to A and E departments, the departments are unable to see their medical records, which could have an enormous impact—[Interruption.]

[Mr Hunt]

We will address those problems inside A and Es and the system-wide issues. It is not all about the GP contract, but that is a significant part of it, because confidence in primary care alternatives is a key driver in decisions on whether to go to A and E. We will take responsibility for sorting out those problems, but the Labour party must take responsibility for creating a number of them.

[Andy Burnham]

The Secretary of State could brief the newspapers last night, but he could not give a straight answer to my question today. He has not outlined his plans to change GP services.

The facts are that A and Es are under severe pressure and people are waiting hours on trolleys in corridors or in the back of queuing ambulances to be seen. Last week, a third of major A and Es missed the Government’s lowered targets—some were seriously adrift. At University Hospitals of Leicester, 78% of patients were seen within four hours. Seventy-nine per cent. of patients were seen within four hours in Portsmouth. Things have taken a more serious turn today, with news that 20 senior A and E doctors say they are unable to guarantee patient safety.

For weeks, the Opposition have warned the Secretary of State to get a grip. His only substantive response was to tour the TV studios to blame the 2004 GP contract. We today read that his answer is yet another costly NHS reorganisation, this time of GP services. Where is the evidence to support his contention that that will solve the A and E crisis? Why did he not outline his plans to the House—he has already given the news to newspapers?

This morning, the chief executive of the NHS Confederation told the Select Committee on Health that there is no link between today’s pressures on A and E and the 2004 contract, echoing expert analysis from the King’s Fund. If the GP contract is the root cause, as the Secretary of State claims, will he explain why 98% of people were seen within four hours in 2009, five years after the contract was signed? That figure has deteriorated sharply under his Government, and mainly on his watch. Major A and Es have missed the target in 33 of the 35 weeks when he has been Health Secretary. His complacency is dangerous. Is it not time he stopped blaming GPs to divert attention from a mess of the Government’s own making and addressed the real causes?

Two weeks ago, NHS England told the Secretary of State what those causes were. He needs to provide convincing answers on each. What steps is he taking to prevent the collapse of adult social care in England? What is he doing to ensure that all A and Es in England have enough doctors and nurses to provide safe care? Will he update the House on the status of his plans to cobble together a £400 million A and E crisis fund, news of which was leaked a fortnight ago? Will he halt the closure of NHS walk-in centres and personally review all planned A and E closures? What is he doing to sort out the failing 111 service? Did he not speed up implementation against official advice?

The truth is that this is a mess of the Government’s own making. It will not be solved by the Secretary of State’s spin or by blaming GPs. He has been found playing politics when he should be dealing with the real causes of today’s chaos. Faced with a real crisis, he has been found wanting. He needs to cut the spin and get a grip.

[Mr Hunt]

What the right hon. Gentleman says would have some credibility if he looked at the facts. Fact: under this Government, we hit the A and E target for last year. Fact: Wales, where Labour is in control, has not hit the A and E target since 2009.

[Andy Burnham]

Forget Wales!

[Mr Hunt]

The right hon. Gentleman says, “Forget Wales,” but why has he never once been prepared to condemn the appalling failures in A and E in Wales, caused by the Welsh Labour Government’s decision to cut NHS spending by 8%? What he says would have some credibility were he at least prepared to condemn what has happened in Wales, but he never does.

The right hon. Gentleman asks for the evidence, and I will tell him. Patrick Cadigan of the Royal College of Physicians says that the pressures on A and E are caused because many people assume that, after 5 pm, the lights in the NHS go out everywhere except A and E departments—a direct consequence of those disastrous 2004 changes to the contract. Nottingham university conducted an independent study, and last year’s GP patient survey found that only 58% of patients know how to contact their local out-of-hours service, 20% find it difficult to contact their out-of-hours service, and 37% feel that the service is too slow—problems that we are trying to address. Perhaps he should visit some A and E departments and talk to consultants, doctors and nurses, because they will tell him that the changes to the GP contract, which he says have nothing to do with the pressures on A and E, have had a huge and devastating impact.

He talks about taking responsibility for these problems. Let us see if he is prepared to take responsibility. Is he prepared to take responsibility for the target-at-any-cost culture in some parts of the NHS under Labour, which led to the disaster of Mid-Staffs? Is he prepared to take responsibility for the IT failures that mean that A and E departments cannot access GP records? Will he nod his head if he is prepared to take responsibility? [Interruption.] He is not prepared. Is he prepared to take responsibility—

Health and Social Care

Debate between Jeremy Hunt and Andy Burnham

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I will make some progress.

Even worse, when signs of how the targets policy was going wrong became clear, Labour’s response was to ignore or cover up the findings.

[Andy Burnham (Leigh) (Lab)]

Rubbish!

[Mr Hunt]

The right hon. Gentleman says “rubbish” from a sedentary position, but the Francis report—if he read it—mentioned 50 warning signs that were missed by his Government about Mid Staffs. He himself rejected 81 separate requests for a public inquiry into what happened. The Labour party created a lame duck Care Quality Commission, unable to speak out or force change, and an NHS where too often the system was more important than the individual.

[Andy Burnham]

At the outset, will the Secretary of State correct the record and remind the House that it was my decision, two months after being appointed Secretary of State in June 2009, to appoint Robert Francis to conduct an independent inquiry?

[Mr Hunt]

The right hon. Gentleman’s decision not to have a public inquiry that revealed extremely important information has meant that we are finally addressing the issue that his Government failed to address.

The Care Bill will include a vital element of our response to the Francis report, including regulatory clarity on who is responsible for identifying problems, driving up standards, and operating a single failure regime when urgent changes are not made.

--- Later in debate ---

[Mr Hunt]

I am going to make some progress.

Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

[Andy Burnham]

I am grateful to the Secretary of State for giving way, but the trouble with him is that, often, there is a huge gap between the rhetoric he comes out with at the Dispatch Box and the reality on the ground. He says he is promoting integrated care, but what does he say about the pioneers of integrated care in Torbay, who are threatening to take legal action because of the requirement for compulsory competitive tendering of services? Under this Government, are not the beacons of integration being demolished by his free market?

[Mr Hunt]

It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

--- Later in debate ---

[Andy Burnham]

My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

[Mr Jeremy Hunt]

indicated dissent.

[Andy Burnham]

That is what this Government are doing. A cap is ineffective without long-term funding for the future of social care, and the failure to face up to the crisis in adult social care budgets that Conservative councillors are talking about will leave people with the impression that this Health Secretary is fiddling while Rome burns. The social care system in England is close to collapse, and the reality behind the Government spin is that, under this Government, people’s savings are being washed away more quickly than ever before.

I want to turn now to our accident and emergency services. The crisis in social care is the predominant driver of what we are now seeing in our accident and emergency departments. If people’s services are withdrawn, or if they cannot afford to pay for them, they are more likely to struggle and fall ill at home and to end up in hospital. That is bad for them, and it costs the NHS more. Also, NHS staff are finding that people who are ready to leave hospital cannot be discharged because the necessary support cannot be put in place. Beds are not being freed up on the wards, and A and E therefore cannot admit people to the wards because there is no space. A and E then becomes full, which results in ambulances queuing up outside because they cannot hand over patients. The system is now backing up right through A and E.

[Mr Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding; he should do something about it. This is happening on his watch. Across the country, hospitals are operating at levels way beyond safe bed occupancy—[Interruption.] He nods, but I am saying, “Do something. Don’t just nod!” We need action from the Secretary of State.

Let me return to the quote that I mentioned earlier. People love to say that I would have cut the NHS. For the record, I have never said that I would cut the NHS. At the last election, I promised real-terms protection for the NHS. The Conservatives promised real-terms increases, which have never been delivered. Let me read that quote in full:

“It is irresponsible to increase NHS spending if the effect is that it is damaging, in a serious way, the ability of other services to cope…that are intimately linked to the NHS. The health service needs functioning day care, and housing”

and meals on wheels.

That warning has now come true.

[Mr Hunt]

rose—

[Andy Burnham]

I will give way to the Secretary of State, but I ask him to address this point. He has paid for the so-called ring fence on the NHS by ransacking local government funding, and that makes no sense whatever.

--- Later in debate ---

[Mr Hunt]

If the right hon. Gentleman looks at the figures, he will see that real-terms spending on the NHS has gone up since Labour was in power. Given that he thinks it irresponsible to increase the NHS budget, does he agree that if he were to follow his own policy, he would now need to cut that budget from its current level? That is Labour policy.

[Andy Burnham]

I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.

--- Later in debate ---

[Andy Burnham]

The former Secretary of State said that it was full steam ahead and that is what they would do. This Secretary of State comes in and says nothing about the issue. Then, a right-wing Australian lobbyist arrives, and all of a sudden no one mentions it at all. Has the Secretary of State ever met Lynton Crosby and discussed this issue with him? I think we have a right to know. [Interruption.] He nods; I should be interested to know the substance—[Interruption.] He has not met him to discuss the issue. He looks very uncomfortable all of a sudden.

[Mr Jeremy Hunt]

Just to put the right hon. Gentleman out of his misery, I have not discussed this matter on any occasion with Lynton Crosby.

[Andy Burnham]

We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 16th April 2013 Commons Chamber

[Mr Hunt]

I absolutely agree with my hon. Friend. What Andrew Wakefield said had no scientific basis and caused huge damage and worry to many thousands of parents. It is very important to reiterate that the scientific way to prevent measles, which can be a horrible and even a fatal disease, is to make sure that children have had two doses of MMR. Parents of children of any age who have not had those doses should contact their GP, particularly in the current circumstances.

[Andy Burnham (Leigh) (Lab)]

Accident and emergency departments across England are being closed, even though all are under intense pressure. For 11 weeks running, the NHS has missed the Government’s national A and E target. Last week, in places, one in three patients waited more than four hours in scenes not seen since the bad old days of the mid-1990s. What clearer symbol of the growing crisis in A and E is there than a tent as a makeshift ward in the car park at Norwich? The Secretary of State’s failure to address that cannot continue. Nursing jobs have been lost, ambulances are queuing outside A and E and patients are being treated in car parks. When will he get a grip?

[Mr Hunt]

The statistic that the right hon. Gentleman will not give the House is that for the year as a whole, which ended last March, the Government hit our A and E target. Furthermore, he still will not tell the House about the disaster that is happening in Labour-controlled Wales, where the A and E target has not been hit since 2009. He still refuses to condemn what is happening there. There is a lot of pressure on A and E, because 1 million more people are using A and E every year, compared with just two years ago. What are the root causes? They are poor primary care alternatives that date directly to the disastrous GP contract negotiated by his Government, since when more than 4 million additional people have been using A and E every year, social care and hospital sectors that are not joined up—Labour had 13 years to sort that out but did nothing—and problems in recruitment that have been made a great deal worse by his disastrous decision to implement the working time directive. It is time he sorted out his own issues before trying to criticise the Government for sorting them out.

Mid Staffordshire NHS Foundation Trust

Debate between Jeremy Hunt and Andy Burnham

Tuesday 26th March 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for the measured way in which he introduced it.

The NHS is 65 this year, and if it is to be ready for the challenges of this century, it must learn from the darkest hours of its past. The NHS was founded on compassion and, as the Secretary of State said, what happened at Stafford was a betrayal of that. Rightly, apologies have been given, but it is now time to act and make this a moment of change.

Robert Francis delivered 290 careful recommendations after a three-year public inquiry and, like the Secretary of State, I pay tribute to him today. In response, the Prime Minister promised a detailed response to each recommendation by the end of this month. Although the Opposition welcome much of what the Secretary of State has said today, his statement falls short of that promised full response and contains serious omissions on which I would like to press him, in particular, on four of Robert Francis’s flagship recommendations, which I shall take in turn.

First, we welcome the move to place a duty of candour on health care providers and believe it could help bring about the culture change the NHS needs. The Francis report, however, goes further and recommends a duty of candour on individual members of staff. Will the Secretary of State say more about why he has only accepted this recommendation in part and not applied it to staff? Has he ruled that out or is he prepared to give it further consideration?

Will the Secretary of State assure the House that the duty will apply equally to all providers of NHS services, including private providers? His statement was a little vague on that point. More generally, with more private providers coming into the NHS, is it not the case that we will not get the transparency we need unless the provisions of freedom of information apply fully to all holders of NHS contracts and information cannot be withheld under commercial confidentiality?

Secondly, on patient voice, the Government have announced new chief inspectors of hospitals and social care. Those were not Francis recommendations and, while we give them a cautious welcome, I am sure that the Secretary of State will agree that regulation alone will not be enough to prevent another Mid Staffs. Instead, we need a powerful patient voice in every community that is able to sound the alarm if things are going wrong. Rather than pulling down the shutters, as the NHS has a tendency to do, complaints should be embraced as opportunities to learn and improve.

It is just a matter of days until the new NHS comes into being and the concern is that patient voice has not been embedded at the heart of the new system. A third of councils say that their local healthwatch will not be up and running by the 1 April deadline, and there are wide variations in both structure and membership. Will the Government accept Robert Francis’s recommendation of a consistent basic structure for healthwatch programmes throughout the country before it is too late and they go their separate ways?

Thirdly, on regulation and training, Robert Francis has made a very clear case for a new system of regulation of health care assistants to improve basic standards—a case that we made during the passage of the Health and Social Care Act 2012—yet it did not feature in the Secretary of State’s statement. Have the Government accepted in principle the regulation of health care assistants?

We support moves to rebalance nurse training and to include more hands-on experience, but student nurses already spend 50% of their time in clinical practice and face significant financial barriers when completing their training. Will the Secretary of State assure the House that requiring a year on the ward will not increase the financial barriers to young people entering nursing and, if more trainees are to be on the wards, will he ensure that there are enough staff with the time to train the extra students?

That takes me to my fourth point and the most glaring omission from the Secretary of State’s statement, namely safe staffing levels. We will never get the right culture on our wards if they are understaffed and over-stretched, but there is evidence that things are going in the wrong direction and the Secretary of State was silent on the issue today.

The CQC has recently reported that one in 10 hospitals in England do not have adequate staffing levels. Just last week, work force figures showed that there had been a reduction of 843 nurses between November and December last year. Does that not sound the clearest of alarm bells that some parts of the NHS are already in danger of forgetting the lessons of its recent past by cutting the front line too far? Do not communities need a clear, objective benchmark so that they can challenge staffing levels on wards, and would it not be a great help to them for the Francis recommendation on staff-patient ratios to be accepted? We learned last week that the Department has handed £2.2 billion from last year’s budget back to the Treasury. Surely that money would have been better invested in the front line and in bringing all hospitals in England back up to safe staffing levels.

Finally, I want to turn to Stafford hospital itself, which Monitor has recommended should be placed in administration. This doubt about the hospital’s future will be causing real concern to the people of Stafford. After all they have been through, I think we can all agree that they deserve a safe and sustainable hospital, and I hope the Secretary of State will soon set out a plan to achieve that.

Learning the lessons of Stafford cannot be done overnight. We all have to play our part. The Government have made a start today, but much more needs to be done and we will hold them to that.

[Mr Hunt]

The right hon. Gentleman talks about glaring omissions in the Government’s response, but there were glaring omissions in his response too. Where was the apology for Labour’s targets culture that led to so many of the problems; the apology for failing to set up a regulatory structure that had proper safeguards; and the apology for missing all those warning signs? This was not just the darkest day in NHS history, but the darkest day in Labour’s management of the NHS. It is time the Labour party recognised the policy mistakes it made.

Let me go through what the right hon. Gentleman says are omissions. First, on the duty of candour, we accept the principle of the duty of candour when it applies to hospital boards, but we want to be absolutely sure that there are not unintended consequences of applying it to hospital staff, because another part of the Francis report is on the importance of a culture of openness and transparency, and we do not want a culture of fear. We have therefore not ruled out criminal sanctions for hospital employees who breach a duty of candour—they already have a contractual duty of candour —but, as I said in my statement, we want to wait for the result of Don Berwick’s report on zero harm to ensure that we do not take any measure that impedes the openness we need in hospitals.

The inspection regime will apply to all providers. It is important that it should, but I remind the right hon. Gentleman, who mentioned private providers, that the problems happened at an NHS hospital. Trying to turn this into a debate on privatisation tells people that Labour is missing the point in the response to Francis.

We will not introduce statutory regulation of health care assistants, but we will introduce minimum standards of training for them. We will not introduce statutory regulation because we believe there is a risk that a database of 0.5 million to 1.5 million people could end up being a box-ticking exercise that fails to raise standards in the way we need. We believe we have another way to achieve the same end, which is what we will implement.

On nurse training, we believe it is important that nurses have hands-on experience of the front line, because nurses, when they are properly qualified, will be managing health care assistants. It is therefore important that nurses understand what it is like to be a health care assistant. We will be very careful in how we implement that to ensure that we do not create financial barriers because, obviously, we want to attract the best people into nursing, regardless of income.

On staffing levels and nursing numbers, I remind the right hon. Gentleman that the problems at Mid Staffs happened when Labour was in power, when budgets were going up quite significantly, and when numbers were going up. To distil the problem to one of numbers is, again, to miss the point. This is about the values of the people on the ward. If he wants to talk about numbers, he must accept that, because this Government have protected the NHS budget, which he wants to cut from its current levels, there are 6,000 more clinical staff in the NHS today than there were at the time of the last election.

On Stafford hospital, it is extremely important that, when we have problems such as the ones at Mid Staffs, we create a structure that makes it impossible not to deal with them. That is a difficult process. We are announcing today a time-limited process to ensure that Ministers and the system cannot duck difficult decisions when we have a failing hospital. Obviously, we will follow the Monitor trust special administrators’ recommendations and look at them carefully, but it is important to address the issues. The wrong thing to do would be to fail to do so, because that would lead to clinical failure.

I welcome the fact that the right hon. Gentleman broadly accepts the Francis recommendations. He asked whether we would respond to all of them. The inquiry was a public inquiry, which he refused to set up. As a result of that detailed public inquiry, there are 290 recommendations. It takes time to go through all of them in detail, but I thought it was right to come to the House today with our initial response so that we can get cracking with the important things right away.

Immigrants (NHS Treatment)

Debate between Jeremy Hunt and Andy Burnham

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

What my right hon. Friend says bears very careful consideration. He is absolutely right that primary care is a critical access point, and we need to look at that. We also need to look at the burdens we place on GPs. I think that ultimately the easy way we will do that is through proper digital patient records, which will allow NHS professionals to find out about the medical history of people accessing the NHS at any point, including whether they are likely to be eligible for free treatment.

With regard to hospitals, my right hon. Friend makes a very interesting point about an overseas visitors manager. One of the problems we have is that the incentives in the system positively disincentivise hospitals from declaring foreign users of the NHS. If they declare someone not to be entitled to free NHS care, they have to collect the money from that person themselves, whereas if they do not declare the person not to be entitled to free NHS care, they get paid automatically by their primary care trust or clinical commissioning group. The incentives in the system have acted to suggest that this is a much smaller problem than I believe it is.

[Andy Burnham (Leigh) (Lab)]

The NHS must not be open to abuse. Where people do not have entitlement to free treatment, steps should always be taken to recover the costs from individuals and Governments. That clear principle is shared by Members across this House.

For some time, hospitals have rightly had a legal duty to recover any charges owed from overseas patients. The previous Government proposed a number of further steps, including amending immigration rules so that anyone with substantial medical debts is not allowed back into the country. We welcome efforts to build on that, while always guarding against overblown rhetoric, which does not help the immigration debate. We therefore need more precision and clarity from the Secretary of State. First, on the scale of the problem, as ever with this Government’s announcements, there is already confusion to clear up. Earlier today, the Prime Minister’s spokesperson put the cost to the NHS of health tourism at £10 million to £20 million. On “World at One” this lunchtime, the Secretary of State said that he thinks it is more like £200 million. So which is it? Will the Secretary of State publish the evidence he has to support his claim?

Secondly, we need more detail on what the Government are proposing. Has the Secretary of State consulted those in Scotland, Wales and Northern Ireland on any proposed changes? There are practical questions on which health professionals will need reassurance. We have heard in the news today about the problems in the UK Border Agency. What assurances can the Secretary of State give to health professionals that they will not be used to plug the gaps that have been created by the Government’s severe cuts to the front line of the UK Border Force? Will they be given a simple way of checking eligibility and not be burdened by extra bureaucracy? Will these changes apply equally to planned and emergency care? If so, that could put health professionals in a difficult ethical position. Does the Secretary of State agree that care should always be provided in life-threatening situations, and will he take this opportunity to reassure health professionals on that important point?

Finally, the Secretary of State told “World at One” that one of the main reasons he was doing this was to relieve pressure on accident and emergency departments, particularly in London. While we commend moves to prevent abuse of the system, could he not better achieve his aim if he was not planning to close so many A and Es in London?

The Government have made a lot of assertions, but there is a real lack of policy clarity and evidence. Unless the Secretary of State can provide convincing answers to my questions, the House will be left with the distinct whiff of a cooked-up a story to suit the Government’s political purposes rather than a real drive to protect the NHS from abuse.

[Mr Hunt]

The Government are not going to take any lessons in overblown rhetoric when Labour Members talked about this problem for 13 years and did absolutely nothing about it. What was missing from the right hon. Gentleman’s remarks was a proper apology for Labour’s total failure to control our borders during a period in office that saw a quadrupling of net migration. We do not know how many people are residing in this country illegally, but in January the London School of Economics published a report stating that it could be nearly 900,000 people, in which case the cost will not be a few millions but many, many times that. In 13 years, Labour did not change eligibility for access to free NHS services and did nothing to improve the collection of proper dues from people coming from outside the European Union.

The £20 million figure that the Prime Minister’s spokesman used this morning is the amount of uncollected debt that is owed to the NHS by foreign nationals. If the right hon. Gentleman had listened to my response, he would know that we believe—of course it is impossible to get exact figures on this because of the total mess that the previous Government created—that we identify less than half the people who should be paying for NHS care and collect less than half the money that should be collected.

Of course we will work with very closely with Scotland, Wales and Northern Ireland to ensure a co-ordinated approach. If the right hon. Gentleman had listened to what I said, he would have heard that the exemption for emergency care and for public health issues will remain in place, which is extremely important.

Let me finish by talking about A and E issues. The reality is that the LSE estimates that about 70% of those living illegally in the UK live in London, where A and Es happen to face some of the biggest pressures. University College London Hospitals NHS Foundation Trust opened a new A and E only in the past few years and it was built for a capacity of 65,000 people a year, but it is now seeing 120,000 a year. If the right hon. Gentleman’s Government had done something about this rather than talk about it, A and Es across London would not be facing the pressure they are now facing.

Accountability and Transparency in the NHS

Debate between Jeremy Hunt and Andy Burnham

Thursday 14th March 2013 Commons Chamber

[Mr Hunt]

I will make some progress and then I will take interventions from both sides of the House.

Sir David Nicholson told the Health Committee last week that in the NHS as a whole, patients were not the centre of the way the system operated. Which party was in power when that culture was allowed to operate? If Sir David has been held to account, so too must the Labour party be held to account. The Francis report rightly states that Ministers were not personally responsible for what happened at Mid Staffs, and I have no doubt that no Labour Minister would have condoned, knowingly allowed or wanted the events at Mid Staffs to happen. We also know from the report that the pursuit of targets at any cost was a central driver of what went wrong. As the report set out, above all Mid Staffordshire NHS Foundation Trust failed to tackle an “insidious negative culture” involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. It went on:

“This failure was in part the consequence of allowing a focus on reaching national access targets,”.

Ministers, not civil servants, are ultimately responsible for the culture of the NHS, and it is clear that during that period a culture of neglect was allowed to take root in which the pursuit of targets at any cost compromised the quality of care that patients received, and made it harder for front-line staff to treat people with dignity and compassion.

[Andy Burnham]

I am listening carefully to the Secretary of State but it is not fair to people in the NHS for him to say that Stafford equals everywhere in the NHS, and that we can take one failing—a terrible failing, as I said in my speech—in a locality and apply it to the whole NHS. He must acknowledge that NHS staff did an incredible job to end the situation when people were spending months and years on waiting lists, and even dying on them.

[Mr Hunt]

I acknowledge the brilliant work done by NHS staff and, contrary to what the right hon. Gentleman says, I do that in every speech that I make on these matters. I will not, however, accept the complacency that says that problems at Stafford hospital were localised and happened only in one place. If we are to sort out those problems, we have a duty to root them out anywhere in the NHS that they occur.

The right hon. Gentleman talked about waiting times targets. Let us be clear: there is an important role for targets in a large organisation such as the NHS. Without the four-hour A and E target, or the 18-week elective waiting time target, access to NHS services would not have been transferred and I accept that the previous Government deserve credit for that. It was right to increase spending on the NHS, although it is curious that Labour now wants to cut the NHS budget. Labour did however—this is where Labour Members should listen rather than barrack—make three huge policy mistakes, and the right hon. Gentleman must accept that it is not simply a question of Government policy not being implemented in every corner of the NHS. Those three mistakes contributed to the culture of neglect that we are now dealing with.

The first mistake—a huge mistake—was that Labour failed to put in place safeguards to stop weak, inexperienced or bad managers pursuing not only bureaucratic targets but targets at any cost. That is exactly what happened at Mid Staffs, where patient safety and care were compromised in a blind rush to achieve foundation trust status. Secondly, Labour failed to set up proper, independent, peer-led inspections of hospital quality and safety that told the public how good and safe their local hospital was. Instead of a zero-harm attitude to patient safety, we have a culture of compliance and the bureaucratic morass that is the current Care Quality Commission. Thirdly, Labour failed to spot clear warnings when things went wrong. The Francis report lays out a timeline of 50 key warning signs between 2001 and 2009. Why did Ministers not act sooner? If those warnings were not being brought to the attention of Ministers, why did they not build a system in which they were? Instead, there was a climate in which NHS employees who spoke out about poor care were ignored, intimidated or bullied.

--- Later in debate ---

[Mr Hunt]

I am going to make some progress.

This debate is about accountability. I have been doing this job for six months, and in nearly every exchange on the Floor of the House, the Opposition have avoided engaging in substance, preferring instead to make baseless allegations about the Government’s motives in respect of the NHS. I put it to the House that we have shown our commitment to the NHS time and again through a protection of the budget; a willingness to face up to big challenges, whether in clinical commissioning, the funding of social care or the need to ensure that care is prioritised throughout the system—

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Hunt]

No, the right hon. Gentleman needs to listen to my point. If Labour is truly committed to the NHS, it, too, has to show that it has learned. I did not hear that in his speech. Labour Members need to accept that they made some terrible policy mistakes that led to a culture of neglect. They must recognise that the party that claims to speak for the most vulnerable in society betrayed many vulnerable people, with tragic consequences. Only then will the public know that the lessons of Mid Staffs have been learnt—not just by the NHS, not just by civil servants, not just by Government, but by all sides of this House.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 26th February 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I am sure that, like me, the Secretary of State has spent recent weeks absorbing the Francis report and its recommendations; there are lessons for everyone at every level, particularly on staffing. New analysis to be published later today will show that the NHS is set to lose 12,000 nurses over the course of this Parliament, raising doubts about its ability to respond to Robert Francis’s recommendations on staffing. Will the Government say today whether they accept those recommendations and the principle of a minimum staff-to-patient ratio?

[Mr Jeremy Hunt]

If the right hon. Gentleman had read the Francis report carefully he would have, first, observed that the appalling tragedies covered in that report happened between 2005 and 2009, when nursing numbers were going up. So to say that this is an issue about nursing numbers is to miss the point completely. This is not an issue where there is a quick fix; it is an issue about the NHS having become dominated for far too long by a culture of targets at any cost. Unpicking that culture is the biggest challenge we face if we are to return a culture of compassionate care to the NHS.

[Andy Burnham]

I have read both Francis reports, and I think it is essential that everybody learns the lessons—that is what I said—including Labour Members. It is also important that we do not repeat the mistakes, and the first Francis report said that the problems were caused because the trust cut staff to dangerously low levels. The most worrying thing from the analysis that will be published today is that four in 10 of the jobs being lost come directly from services linked to the care of older people. Does the Secretary of State therefore agree that there is a danger that the NHS is already failing to learn the lessons of the recent past? Will he join me in sending a message to the NHS that care of older people should be a priority for improvement, not an easy target for cuts?

[Mr Hunt]

If we are to learn the lessons of the Francis report and admit to our mistakes, perhaps the right hon. Gentleman will reflect on the fact that, because we decided to protect the NHS budget, there are 8,000 more clinical staff in the NHS today, yet he still wants to cut the NHS budget from its current levels, as he confirmed only last December.

Social Care Funding

Debate between Jeremy Hunt and Andy Burnham

Monday 11th February 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement, and for early sight of it. I agree with him that our current social care system in England is the worst of all possible worlds: a cruel lottery whereby people go into later life with everything for which they have worked on the roulette table, and the most vulnerable are always the biggest losers. That needs to change.

The Secretary of State has tabled a modest plan that will make the system fairer than it is today, and we congratulate him on that. We welcome elements of what he has announced today. A cap of £75,000 will protect people from the catastrophic costs of care, and raising the means-test threshold will help more people on lower incomes to obtain some help with care charges. This is a step forward, but it is a faltering one. The House has been presented with a flawed prospectus today. Vulnerable people will still face rising care charges and homes will still be lost, notwithstanding valiant attempts to put the best possible spin on things in the weekend media. Yesterday the Deputy Prime Minister made the big claim that the Government were going to “crack” the care “conundrum”. Today, when we are faced with this meek package, that sounds suspiciously like overselling. Stephen Burke, the director of United for All Ages, has described the cap as

“the dampest of damp squibs”.

Yesterday, on The Andrew Marr Show, the Secretary of State said:

“I've been hauled before the Speaker before and I wouldn’t want that to happen again and so I don’t want to go into the details.”

Now that we have heard the details, perhaps the Secretary of State could explain on which part of his statement the media had not been pre-briefed. It is disappointing that the media rather than the House were briefed first on a statement that was of such importance to so many people. It is also disappointing that the Government have abandoned any effort to build a cross-party consensus before rushing to announce its proposals, and that they have chosen to rewrite the Dilnot report with figures of its own, breaking its careful logic.

More specifically, there are four problems with what has been announced today, and I will address each in turn. First, it fails the fairness test. We will only have a durable solution if it can answer this question: will it help every person and every couple to protect what they have worked for, whatever their wealth and savings? I am afraid that the answer is no. According to Demos, a £35,000 cap would benefit about 3.2 million pensioners. A per-person cap of £75,000 will benefit just 1.4 million. For the average couple, the cap is £150,000. That might be enough to protect detached houses, but it will not protect the average semi-detached home in large parts of England.

As Andrew Dilnot said today, the cap

“is higher than we would have wanted —£11,000 higher than the top end of our range—and I regret that”.

Will the Secretary of State confirm that people with modest to average homes and savings are not protected under his plan? Is this not a plan for the few and not the many, and further proof that we are not all in it together?

The Secretary of State claims that insurance companies will step in with new products to help more people to protect their assets, but in evidence to the Health Committee, the Association of British Insurers said that it did not believe that the capped cost model would result in a market for pre-funded care insurance. So what further confidence can the Secretary of State give the House today that such a market will in fact emerge?

Secondly, the plan is at best a partial solution. With this decision, the Government have prioritised the funding of a cap on care costs with new money, over and above addressing the crisis in council care budgets. Will the Secretary of State confirm that this was against the advice of Andrew Dilnot to the cross-party talks? In practice, it will mean that vulnerable people will continue to face rising charges, as councils put up fees to cope with the growing shortfall in their budgets, making it more likely that those people will, in time, have to pay right up to the new £75,000 cap. To many people, that will not feel like progress.

More than £1.3 billion has been cut from local council budgets for older people’s care since the coalition came to power. Care charges are rising above inflation, and councils are warning that, by 2024, they will be overwhelmed by the costs of care. Does the Secretary of State accept that forecast, and if he does, how will the plans he has announced today help to address it? If he fails to face up to the current crisis in council funding, is it not the case that, with care charges rising, today’s announcement will feel like a con? It is true that the Government have raised the capital threshold, and I have said that we welcome that, but can the Secretary of State give the House any confidence that the extra support that people receive through a more generous means test will not be more than offset by increasing care charges caused by collapsing council budgets?

What people might not know is that the cap reflects not what people actually pay for care but a local authority average, and that it does not include accommodation costs. That was not mentioned in the Secretary of State’s statement. Will not people feel conned if the Government do not make that clearer?

The third problem is that this package disguises yet another coalition U-turn, this time on inheritance tax—[Interruption.] It is ironic, I must say. In 2007, a flagship pledge was made to increase the inheritance tax threshold to £1 million. Just eight weeks ago, the Chancellor said that he would increase the threshold in two years’ time. What has happened in the past two months to make him change his mind? Is not this the quickest coalition U-turn yet? The irony will not be lost on people that the Government are now increasing death taxes to pay for their plan. The Secretary of State has also said the rest will be made up from national insurance. Does he think it is fair to ask the working age population to pay for something else, rather than older people?

Finally, the proposal fails to meet the scale of the challenge of the ageing society. It will not lead to more integration of care. Instead, it will entrench the separation between two separate systems: a free-at-the-point-of-use NHS and charged-for social care. Would it not have made more sense, rather than developing these piecemeal plans in isolation, to have set them out as part of a single vision for a sustainable health and care system in the 21st century? The Secretary of State has made progress, but he has missed an opportunity to produce a long-term plan that is fair to everyone and built on cross-party consensus. He has settled for a timid solution when what older people needed was a far bigger and bolder response.

[Mr Hunt]

Really! The right hon. Gentleman talked about a flawed prospectus, but what we had from the Labour Government during their 13 years in power was no prospectus whatever. This was in Labour’s manifesto in 1997, then the Government had a royal commission in 1999. There was a Green Paper in 2005, followed by the Wanless review in 2006. The problem was going to be solved in the comprehensive spending review of 2007, but then we had another Green Paper in 2009. Let us compare that with a coalition that commissioned a report the moment it came into office, said after a year that it accepted the principles of the report, and has now, just two years later, announced how it will implement it and pay for that implementation.

Let me go through some of the things that the shadow Secretary of State has said. He quoted one stakeholder, Stephen Burke, but let us look at what some of the others have been saying. The Joseph Rowntree Foundation has said that

“the cap and threshold are welcome measures, and a welcome sign that the government is taking responsibility for addressing care funding.”

Andrew Dilnot said today:

“I recognise the public finances are in a pretty tricky state and it doesn’t seem to me that”—

what the Government are proposing is—

“so different from what we wanted”.

Or we could talk about Age UK, which says it

“has always supported the principle of a cap”

and welcomes the fact that we are increasing what it describes as

“the current miserly upper means test threshold”.

A lot of stakeholders welcome today’s announcement, but recognise that we are in extremely difficult financial circumstances and that that is why we have to be responsible with public finances.

The right hon. Gentleman talked about the cap of £75,000, which is indeed higher than the upper limit proposed by Andrew Dilnot, but to describe this as only helping people on higher incomes is fundamentally to misunderstand how a cap works. First, potentially more than 70% of the £1 billion a year that this will cost the Government by the end of the next Parliament is going to socially disadvantaged families. This is a highly progressive measure, and as well as increasing the cap we are increasing the threshold above which people do not get any help, from £23,000 to £123,000—exactly the kind of thing that some of the most disadvantaged families on the lowest of incomes will benefit from most.

The right hon. Gentleman talks about the Association of British Insurers—he needs to get up to date. It describes this as

“potentially another positive step forward in tackling the challenges of an ageing society.”

[Interruption.] If he wants some more quotes, let us look at what financial services companies are saying. Aegon UK says it

“welcomes today’s announcement and the clarity it brings on state support.”

Legal & General says it is

“pleased the Government has decided to move forward with Andrew Dilnot’s proposals.”

As for local authority budgets—the shocking state of which, by the way, we inherited from the last Labour Government—the Government said in the spending review that the NHS health budget would give £7.2 billion of support for health-related needs to local authorities during the course of this Parliament.

On inheritance tax, what the right hon. Gentleman does not understand about today’s measures is that fundamentally, they are helping people to protect their inheritance from the lottery of social care costs. The randomness of someone not knowing whether they will be the one in 10 who suffers over £100,000 in care costs is eliminated by a proposal that allows everyone to plan and prepare for their own social care costs.

The right hon. Gentleman describes this as a modest plan and says we have neglected the scale of the problem. Of course, in dealing with an ageing population many other issues need to be dealt with. He talked about the problem of integration, which we are solving by devolving power to clinical commissioning groups on the front line, a reform that Labour opposed, and by integrating technology, a reform on which Labour failed. Also, Labour did nothing about dementia, leaving us with less than half the people with dementia being diagnosed. We are now tackling that problem. We saw last week the issues of treating older people with dignity and respect. We are tackling that problem—Labour left it for far too long.

The problem is not that our solution is too small, but that it was too big for Labour to solve when they were in office. When it comes to making Britain a better country to grow old in, this Government are taking action where the last Government failed.

South London Healthcare NHS Trust

Debate between Jeremy Hunt and Andy Burnham

Thursday 31st January 2013 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Just when we thought this Government’s mismanagement of the national health service could not get any worse, it just has. Let us be clear about what the Secretary of State has announced today. He has at last accepted recommendations that were agreed by the previous Government but then delayed by his predecessor’s moratorium, thereby deepening the financial problems of South London Healthcare NHS Trust. And he has rejected an outrageous proposal that Lewisham hospital should lose its accident and emergency department—a proposal that never should have been made in the first place, but which has cost more than £5 million of precious NHS cash on accountants in the process, enough to give some of the 5,000 nurses who were sacked their jobs back.

But the Secretary of State has accepted the principle that a successful local hospital can have its services downgraded to pay for the failures of another trust. That takes the NHS into new territory. The Secretary of State has just crossed a line and set dangerous precedents—namely, that in his new market-driven NHS, finance takes precedence and any hospital, no matter how successful, is vulnerable to changes through backdoor reconfiguration, that success can be punished and failure rewarded, and that a community can see its A and E and maternity services downgraded without proper consultation and without clinical justification.

There will be no cheers for the statement in Lewisham and it will send a chill wind through any community worried about its hospital services. There is now utter confusion about the Government’s policy on hospital reconfiguration. In three years, they have gone from moratorium to pandemonium. Across the country, half-baked cost-driven proposals to close A and Es and maternity units are being foisted on local communities without evidence of how that can be done safely and without putting lives at risk, yet at the same time, A and Es everywhere are under severe pressure. Thousands more patients are waiting for more than four hours to be seen and there are queues of ambulances lined up outside.

In that context, it is simply not tenable to downgrade any A and E department without first establishing a clear clinical case for how it can be done without compromising patient safety, but that is what the Government are doing here. They have set up a financially driven process and thrown together a clinical justification that is not independent but drawn up in his own Department, leaving the Secretary of State’s so-called four tests in tatters. Let me remind him that the fourth test is that any proposal for change must have “demonstrable support from commissioners”. Let me quote to him the chair of the Lewisham clinical commissioning group, Dr Helen Tattersfield, who has said:

“If the TSA proceeds as currently planned it is my belief that not only will this result in a reduction of quality and provision of health services for Lewisham residents with huge risks to health outcomes but also the effective end of clinical commissioning in Lewisham.”

It is clearly the case that the proposals that the Secretary of State has announced today will lead, in Dr Tattersfield’s words, to a reduction of quality and provision in Lewisham. These changes are opposed by the doctors he promised to put in charge of the NHS, and therefore clearly fail the fourth test that he has set out.

Furthermore, is the Secretary of State confident that what he has announced today is legal? We warned him that he was going beyond the powers in the Health Act 2009. He said that he would commission fresh legal advice. Will he publish it today so that there can be a proper debate on the legal position? He mentioned PFI, but is it not the case that the schemes he mentioned were initiated and negotiated under the Major Government? He said that he had consulted South London Healthcare NHS Trust, but is it not a fact that it found out about this process from the media?

This decision will damage fragile trust in the way that the NHS manages changes to hospitals. The Government need to get back to first principles. Will the Secretary of State confirm, learning from this debacle, that in future no proposal to downgrade or close A and E and maternity services will ever get out of the starting blocks if it does not have a proper clinical case to support it?

Will the Secretary of State today issue an apology to the people of Lewisham? How on earth are they expected to have confidence in the figures he has announced from a clinical review thrown together—cobbled together —in his Department in a matter of days? He has caused huge distress to them but he has also failed to listen to them. Thousands of people have put their lives on hold to fundraise, to lobby, to campaign: 52,000 names on a petition; 25,000 people on a march. This community have rallied together to defend their local hospital, led by the fantastic efforts of the local MPs, but more than that, they have fought valiantly for every community worried about this Government’s cavalier approach to our country’s most valued institution. This community have stood up to an out-of-touch Government who think they can treat some of more deprived parts of our country with utter disdain. This community have achieved something today, but I am certain that they will continue the fight—and let me say that they will have our support. Will the Secretary of State confirm that what he has just announced takes away their right of appeal to the Independent Reconfiguration Panel? If that is the case, are they not justified in continuing the fight to stop this Government riding roughshod over the people of Lewisham and south London?

What we have seen here today is the first glimpse of the new market-driven NHS that the Government have created, where the moneymen and not the medics are calling the shots. We have seen another chapter in the unfolding omnishambles that is this Government—this one, sadly, could be entitled the Lewishambles. We have seen a scandalous waste of money on a solution that will not be acceptable to people in Lewisham—and it is not acceptable to people anywhere. The Secretary of State is asking this House to accept the unacceptable. We will not do that for Lewisham and we will not do it for anywhere else.

[Mr Hunt]

I am afraid that the shadow Health Secretary clearly wrote his response before he read my statement. Listening to him this morning, he has never sounded further away from being part of the Government-in-waiting that he aspires to be.

Let me say this to the right hon. Gentleman: the apology over what is happening in South London Healthcare NHS Trust needs to come from Labour Members, because they were the people who failed to resolve this problem over very many years. It was their party that set up two PFI deals, signed in 1998, which have been incredibly dangerous. It was their party that created a financial situation that means that £1 million every week is being bled from front-line patient care in order to fund a deficit, and that 100 lives every year are not being saved that could be saved in Lewisham and the whole of south-east London.

What I did not hear from the right hon. Gentleman was any contrition about the fact that this incredibly difficult problem was something that his Government and, indeed, he as Health Secretary totally failed to resolve. Let me remind him that the legislation that I followed actually came from the Labour party, which passed it when it was in government. He asked me to confirm that the people of Lewisham have no right of appeal to the IRP against this decision, but who was it who stripped them of that right to appeal? It was him when his Government passed the legislation. Nothing that he has said has contained a single alternative proposal to deal with this problem. If he was being responsible as shadow Health Secretary, he would have come up with just one proposal, but he did not come up with a single one or tell the House about any of his ideas.

The right hon. Gentleman talked about the pressure on A and E, but we will take no lessons from him. We met our A and E targets last year, whereas in Wales, where the Labour party is cutting the NHS budget by 8%, the A and E targets have not been met since 2009.

I am afraid that what we have heard—I hope that other contributors will strike a different tone—is a very disappointing response from the Labour party. The shadow Health Minister, the hon. Member for Leicester West (Liz Kendall), who is not on the Opposition Front Bench today—perhaps this will explain why—has said that Labour would not do what she called the “easy politics” of opposing every single reconfiguration, but what we have heard this morning is easy politics from a party that closed at least 12 A and Es and at least nine maternity units while it was in office. The right hon. Gentleman needs to recognise that the responsible thing for a Health Secretary to do is that which will save the most lives, and that is what I have announced this morning.

South London Healthcare NHS Trust

Debate between Jeremy Hunt and Andy Burnham

Tuesday 8th January 2013 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for again speaking up for his constituents, as indeed I have done as a constituency MP on many occasions. I want to reassure him that the four tests we have outlined for any major changes to health care services would indeed apply to the Beckenham Beacon and that, were there to be any changes, we would need to be satisfied that they would have strong, local, clinical support, that his constituents had been properly consulted and that there was clear evidence that change would be beneficial.

[Andy Burnham (Leigh) (Lab)]

I apologise for missing the start of proceedings on this urgent question.

It has long been accepted that difficult decisions are needed to secure the sustainability of health services in south-east London. That is why recommendations from the review, “A Picture of Health”, were agreed under the previous Government. The trust special administrator has adopted many of those proposals, which we welcome.

However, the review presented today goes way beyond that and takes the NHS into new territory. It uses powers passed by the previous Government in a way that was never intended and, in so doing, sets a worrying precedent whereby normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services are pushed through. The Health Act 2009, which I took through this House, states that

“the administrator must provide to the Secretary of State and publish a draft report stating the action which the administrator recommends the Secretary of State should take in relation to the trust.”

In making recommendations that have a major impact on another trust, is the Secretary of State not going beyond the powers this House has given to him? He has acknowledged that he needs to commission fresh legal advice, which suggests to me that the legality of the process is in doubt. Will he publish all the legal advice he has been given so far and give a commitment that any new legal advice he commissions will be made available?

As this is a financially driven process, the people of Lewisham have justifiable concerns about whether it is safe to close their A and E and downgrade the maternity services. Is the Secretary of State satisfied that a clinical case has been established behind these major changes? Given that all A and E departments in south London are currently overstretched and operating at full capacity, people will need to be convinced that these changes will not put lives at risk.

Finally, will the Secretary of State give a guarantee today to the people of Lewisham that, if he accepts the TSA’s recommendations, they will have the full consultation rights that come with any hospital reconfiguration, including the ability to challenge the clinical case and, if necessary, to refer it to the Independent Reconfiguration Panel? This process is attempting to rewrite the rules on making changes to hospital services, bypassing the intention of the House. It will send a shiver through any communities without a foundation trust, as it raises the prospect that their hospital will be able to be used as a pawn to solve problems in another.

People in Lewisham feel a huge sense of unfairness and I am sure that that will be shared by people across the House. The onus is on the Secretary of State to justify the changes and ensure that rules governing hospital changes are fair and respect the essential rights of all communities to be fully consulted and involved in any decision affecting their services.

[Mr Hunt]

We have followed to the letter the processes laid down in the law that the right hon. Gentleman’s Government passed. We followed the procedure extremely carefully. This is the first time that the procedure has been invoked, so we have taken extra legal advice to make sure that the processes followed strictly adhere to the letter of the law. I will continue to take legal advice, because I want to make sure that we absolutely follow the wishes of the House in how we carry out the procedure.

Unlike the right hon. Gentleman’s Government, we have introduced new safeguards for any major changes made to NHS services. Those safeguards did not exist when the right hon. Gentleman was Health Secretary. We have said that we will not accept any changes unless there is proper consultation of the local population, clear evidence and clear local clinical support. We made that commitment in the four tests, which did not exist under his Government.

I will not accept any of the changes that the special administrator proposes unless I am satisfied that all four tests have been met. They include proper local consultation, because I consider that to be extremely important.

NHS Funding

Debate between Jeremy Hunt and Andy Burnham

Wednesday 12th December 2012 Commons Chamber

[Mr Hunt]

I said that I would make a little progress, if that is all right.

I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:

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

So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?

[Andy Burnham]

Yes, I do. I said in my speech that the NHS should be protected in real terms at the front line. That is what the Secretary of State has not done. I cannot believe that he is contradicting the contents of the letter from Andrew Dilnot. He really needs to tread very carefully before he goes any further.

[Mr Hunt]

Let me say very gently to the right hon. Gentleman that he can hardly come to this House criticising us for an alleged cut in NHS spending if his own plans would have led not to higher but to lower NHS spending. We are increasing spending by £12.5 billion, and he thinks that that is irresponsible.

--- Later in debate ---

[Mr Hunt]

I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.

Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.

While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?

[Andy Burnham]

indicated assent.

[Mr Hunt]

He does support it—well, there we are. So now we have it. Labour policy in Wales is to cut the NHS budget, and that is supported by Labour Front Benchers.

--- Later in debate ---

[Mr Hunt]

I assure my hon. Friend that I am aware of the concerns that he raises, which are frequently raised with me by the Minister of State, my hon. Friend the Member for North Norfolk (Norman Lamb), who has a constituency in the east of England. I follow that situation carefully.

Let me now deal with the substance of the motion. I have always talked about spending going up from the first year of the comprehensive spending review—the first year when this Government had full control of the budget and were responsible for setting the spending plans. In 2011-12—[Interruption.] The shadow Secretary of State should listen to the facts. He tabled the motion, so he probably should hear the answer, although I know it is not what he wants. In 2011-12, spending went up by £2.5 billion in cash terms—0.1% in real terms—on 2010-11. This year, 2012-13, it will go up again, as it will in every year of the Parliament.

[Andy Burnham]

Would the Secretary of State care to remind the House of the commitment in the coalition agreement? Could he read that out for us?

[Mr Hunt]

I have just said that spending will go up in every year of the Parliament. Let me point out to the right hon. Gentleman that these are small real-terms increases, albeit ones that he bitterly opposed. That is why, given the uncertainties around GDP deflators, Andrew Dilnot’s letter says, in the sentence that the right hon. Gentleman did not want to read out, that

“it might also be fair to say real terms expenditure has changed little over this period.”

There it is, exposed for all to see: a bogus Labour motion trying to paint a picture of cuts to the NHS budget when even the head of the UK Statistics Authority says that the broad picture of NHS spending is that it has been protected in real terms—something that almost certainly would not have happened had Labour been in power.

[Andy Burnham]

I am struggling to believe what I am hearing. The Secretary of State is saying that Andrew Dilnot agreed with him that there had been real-terms increases in every year of this Parliament—[Interruption.] That is what he just said at the Dispatch Box. Let me quote Andrew Dilnot again, for the sake of accuracy. He said that

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

How can the Secretary of State square what he has just told the House of Commons with what is in Andrew Dilnot’s letter? Is he saying that Andrew Dilnot is wrong?

[Mr Hunt]

Some politicians walk into the same trap not once but twice. Let me give the right hon. Gentleman the sentence that comes straight after that, which he did not want to quote. It says that

“it might also be fair to say that real-terms expenditure had changed little over this period.”

That is what Andrew Dilnot is saying, which is why the motion is so completely bogus.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 27th November 2012 Commons Chamber

[Mr Hunt]

I have some sympathy with what my hon. Friend is saying, although it is important to recognise, as we have this debate about nursing, that the vast majority of nurses in the NHS do an outstanding job and we are very lucky to have them giving their lives to the NHS. Next week, at the chief nursing officer’s conference, we are launching a new vision for nursing, which will put compassion and the patient at the heart of what nurses do. I hope that will address some of her concerns.

[Andy Burnham (Leigh) (Lab)]

Last week, official statistics revealed that 7,134 nursing jobs had been lost under the coalition—almost 1,000 of them in the last month on the Secretary of State’s watch. The very next day, the Care Quality Commission warned that 16% of hospitals in England are not meeting the CQC standard for adequate staffing levels. Is this not prima facie evidence that the NHS and patients are not safe in his hands? Will he urgently intervene to stop the job losses?

[Mr Hunt]

The reason why the CQC undertook its shocking investigation into the state of care in our country was that this Government introduced dignity and nutrition inspections, which never happened when the right hon. Gentleman was Secretary of State. He talked about numbers employed in the NHS, so let us look at them. Yes, there has been a 2% decline in the number of nurses, but there has been an increase in the nurse-to-bed ratio. There has been a 4% increase in the number of midwives, a 5% increase in the number of doctors and an increase of more than 50% in the number of health visitors—their number went down when he was in office. How much worse would those numbers have been if we had had the cut in NHS funding that he wanted?

NHS Commissioning Board (Mandate)

Debate between Jeremy Hunt and Andy Burnham

Tuesday 13th November 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

The Secretary of State has just reeled off an impressive wish list, but people across the NHS will be asking a simple question: how on earth can he ask the NHS to do more, when we learn today that 61,000 jobs have been lost or are at risk in the NHS? His statements are dangerously at odds with the reality on the ground and risk raising unrealistic expectations. Across England, services are under severe pressure with ambulances queuing outside A and E, patients left on trolleys in corridors for hours on end, and increasing numbers of A and E and ward closures. No wonder nurses’ leaders today warn that the NHS is “sleepwalking into a crisis.” To listen to the Secretary of State, however, it is as if none of that is happening.

A toxic mix of reorganisation and real-terms cuts risks plunging the NHS into a tailspin. Today, people will have been hoping for a mandate for common sense to restore sanity to an NHS that is in danger of losing the plot, and for instructions to protect the front line. Well, they will have been disappointed.

The Secretary of State glosses over finance, but let me give the House the facts. He and his predecessor promised to reinvest all efficiency savings in the NHS front line—[Interruption.] Yes, they say, yet we learn that £3 billion of NHS money has been swiped back by the Treasury. When will the Secretary of State stand up to the Treasury and keep promises that the Government have made to the NHS? While the NHS front line takes a battering, the Government keep throwing money at a back-office reorganisation that nobody wanted. A full £1 billion has been spent on redundancy packages for managers, more than 1,000 of whom have received six-figure payouts while 6,000 nurses get P45s. That is the scandalous reality of the coalition Government NHS.

Will the Secretary of State confirm that a single payoff of £324,000 was made to the former chief executive of NHS Bolton? How would he care to justify that to NHS staff in Bolton who are losing their jobs? There could be no clearer illustration of a Government whose priorities are completely wrong.

Let me turn to some of the specific points set out by the Secretary of State. First, he makes welcome commitments on care for older people. If that is his priority, however, why are there no instructions in this mandate to stop commissioners from imposing restrictions on essential operations for older people? Last year, there were 12,000 fewer cataract operations than in 2009-10. Older people were told that they could have an operation in one eye but not in two. The Government boast about shorter waiting lists, but that is because people cannot get on those lists in the first place. A postcode lottery is running riot and there is nothing in this mandate to stop it.

The Secretary of State’s promises on dementia will be nothing more than hollow words until he faces up to the crisis in council budgets for adult social care. Across England, older people and carers are facing a desperate struggle as council services such as home helps are cut to the bone. Millions of people are facing ever higher care charges—cruel coalition dementia taxes—as councils are forced to put up the cost of meals on wheels and other services. If the Secretary of State really wants to help people with dementia, when will he act to stop this scandal?

Let me turn to mortality rates. Over the past decade, the deaths from heart attacks fell by 50% in men and 53% in women, and the NHS achieved the biggest drop in cancer deaths among the 10 most developed nations. It is widely accepted that the clinical networks established by the previous Government played a significant role in that success. Indeed, the NHS medical director, Professor Sir Bruce Keogh, called them “an NHS success story”. Why, then, is the Secretary of State proceeding with brutal cuts to cancer, heart and stroke networks? Surely the best way to meet the ambitions he has set out is to build on that track record of success, not destroy it.

The Secretary of State promises to implement the Labour amendment to the Health and Social Care Act 2012 to ensure “parity of esteem” between physical and mental health. However, the opposite is happening as the NHS reverts to its default position and places mental health services first in line for cuts. Will he confirm that mental health spending was cut in real terms last year, and what will he do to reverse that? He says he wants a transparency revolution, but across the country local people are being shut out of crucial decisions affecting local NHS services. If he believes in “No decision about me without me,” will he today commit to consult Greater Manchester patients with long-term conditions on whether they want ambulance services to be run by a bus company? Will he act to stop details of contracts under his “any qualified provider” regime from being kept secret from local people under “commercial confidentiality”? The truth is that patients are being shut out as his friends in the private sector fill their boots.

In the weekend’s papers, this mandate was called the first contract with the NHS—the new language of the coalition NHS, in which competition and contracts replace care and compassion. Yes, the Secretary of State has today published a new mandate, but we needed a change of direction. The Government have put the NHS on a fast track to fragmentation. Today, they have unfairly and unrealistically raised expectations on a battered NHS, thinking they have cleverly contracted out responsibility to the national Commissioning Board. I have news for them. The chaos in the NHS starts and ends with the guilty men and women on the Government Benches. We will hound them and hold them to account for the damage they are doing.

[Mr Hunt]

This is an incredibly important document for the NHS, and I think that we were all expecting a bit more than the same old hollow rhetoric from the right hon. Gentleman.

There could be no greater commitment to the NHS than to protect its budget at a time of unprecedented austerity. This Government have protected the NHS budget; the right hon. Gentleman said that that would be irresponsible. The Government take action; he uses words. The picture he paints of the NHS in crisis is not the picture recognised by thousands of doctors and nurses up and down the country. Of course, with an ageing population, the NHS is doing more than ever before. Nearly 1 million more people every year are in A and E than when he was Health Secretary, but it is meeting all its waiting times targets and has virtually eliminated mixed-sex wards, and hospital-acquired infections are going down. This NHS is performing exceptionally well.

Let me address some of the points that the right hon. Gentleman made. On finance, in the figures he gave, I think he was alluding to the fact that, in the first year the coalition was in power, it worked to Labour’s NHS budgets. There was an underspend in that year, as there was in each of the last four years that Labour was in control. In three of those four years, the underspend was higher than it was when my right hon. Friend the Leader of the House was Health Secretary. Let us talk about redundancy payments. The reforms introduced by my right hon. Friend will save the NHS—[Interruption.]

Regional Pay (NHS)

Debate between Jeremy Hunt and Andy Burnham

Wednesday 7th November 2012 Commons Chamber

[Andy Burnham]

These are the same staff whom we were celebrating during the Olympic games, just a few months ago, for everything that they contribute to the NHS and to the care of others, but Ministers sit there and do absolutely nothing. It is disgraceful that any staff in the NHS should be treated in such a way.

This is no academic threat. These are the panic moves of an NHS that is experiencing increasing distress, in which control has been lost because it is facing the biggest financial challenge in its history. After the election, the £20 billion Nicholson challenge should have been the only show in town, but the previous Secretary of State was allowed to proceed with his vanity reorganisation of the NHS. Instead of focusing on saving money, the NHS has been busy wasting it: £1.6 billion, and rising. A full £1 billion has been spent on redundancies—1,300 people have received six-figure payouts, and l73 have received more than £200,000—while 6,000 nurses are losing their jobs. That is scandalous.

As unforgiveable is the Conservative party’s repeated inaccurate boast on NHS funding. I checked on the Conservative party website today, and in the “Where we stand” section it says this:

“We have increased the NHS budget in real terms in each of the last two years.”

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

indicated assent.

[Andy Burnham]

The Secretary of State nods, because he has made similar statements. I want to know whether he stands by those words as a truthful and accurate statement.

[Mr Hunt]

Absolutely.

[Andy Burnham]

He says he does, so let me refer him to table 1.8 of the Treasury’s “Public Expenditure Statistical Analyses 2012”. On NHS spending it shows the following: for 2010-11, a 0.6% real-terms cut; for 2011-12, a 0.1% cut. Those are the facts. How on earth can the Secretary of State say today that he stands by—[Interruption.] The figures are there in black and white. There have been two years of real-terms cuts in the NHS. If anyone does not believe my analysis, a Department of Health press release from July 2012 confirms what I have said:

“PESA figures released today show that in real terms NHS spending has reduced.”

So I ask the Secretary of State this: will he today remove that untrue statement from the Conservative party website? It is giving a false impression of what is happening in the NHS. Perhaps it is designed to give the impression that the drastic moves on pay are a local matter not of Ministers’ making. This is the real picture, however: the Government have forced the NHS to fund a £1.6 billion reorganisation it did not want—even though they promised that would not happen—from a falling budget which they still claim is increasing.

All trusts have been put in a difficult position by this Government, but that is no excuse for some taking the easy way out by taking it out on staff. If they are allowed to do that, they will damage something that serves the wider good.

The “Agenda for Change” system introduced by the last Government represented a significant step forward, and I want to set out the compelling economic, social and health policy arguments in its favour. First, it brings stability to the service. Unlike other areas of economic activity, health care depends upon certainty and predictability. As an essential emergency service, it needs to be there for people day in, day out. Volatility helps no one. All communities need a full complement of clinical grades and professions. Local or regional pay is not conducive to stable services. If one area starts seeking to poach staff from another, no one wins, as we will get instability and, over time, an inflationary pressure that is hard to control at local level.

That brings me to the second reason in favour of national pay. All the evidence suggests that a national approach to pay and conditions helps to reduce costs and risks to the NHS. Market-based systems tend to cost more, not less.

There is also the hassle and distraction factor of every individual NHS employer or regional group going through the annual process of pay negotiation and setting. Trusts rushing to break away from the national pay system forget that. They are also forgetting the risks of the pre-“Agenda for Change” days, when individual trusts would bear the full legal exposure of failure to implement equal pay legislation. It would seem that there are a few short memories in the NHS. People are forgetting that the advent of a national pay system has insulated the NHS from those risks, which have impacted on other parts of the public sector, such as by bringing more turbulence in recruitment and retention.

I do not think the 32 trusts involved in the breakaway have fully thought through the consequences of their position. For instance, national pay is reflected in the calculation of the tariff under the payment by results system, so are these trusts expecting to be paid at national tariff rates by commissioners while paying staff regional rates? I find it hard to see how that could be justified. So, in effect, they are not only pulling down the system of national pay that helps to give stability for everyone; they will also end up pulling down the national tariff system.

The third health policy reason for national pay is the most compelling. National pay helps with the recruitment of staff in the areas where they are most needed. If we follow through the logic of the argument of proponents of a broken down system of regional or local pay, it will end in a proposal to pay people less in areas where unemployment is highest and wages are lowest. The problem with that argument is that those areas are also the most deprived parts of our country where the health challenges are greatest. It is often much harder to work on the NHS front line in areas of higher health need and deprivation. We need to work hard to attract the most motivated staff to those areas, and I simply do not see how that will happen if the offer to work in the areas where the pressure is greatest includes being paid 15% less.

In the end, care is a people business and this race-to-the-bottom approach simply does not deliver the quality people are looking for. We have seen that approach in social care: a crude race to the bottom and a cut-price, minimum-wage business. That simply does not work.

It is true that pressures vary from place to place and the job is not the same everywhere, but the principle that a health visitor, a physiotherapist or a midwife should be paid broadly the same for doing a similar job is a good one. It is fair to staff, and we should stick with it.

That brings me on to the fourth reason: the social and economic case. All the evidence points to regional pay in public services causing damage to the regional economies of England. Rather than stimulate the south-west economy, it has been estimated that regional pay would take £140 million out of it.

It is not just the public sector making that argument. Some 60 academics wrote to The Times to say that, and businesses in the north-east have written to the Chancellor raising their concerns. They said:

“Now is the time for the country to unite and focus on growth, not risk a divisive and harmful policy such as this.”

They are right. An NHS with national pay is a one-nation policy. What is happening in the NHS risks cementing the regional divides and creating an unequal Britain.

Taken together, those four reasons stack up a compelling case for keeping a system of national pay in the NHS. Losing it will be bad for the NHS, bad for the economy and bad for society.

I know that the force of that argument is not only felt on the Opposition Benches. Debates such as this one usually divide Members along tribal lines, but there are Members in all parties who represent areas where the jargon of “market-facing pay” means one thing: crude pay cuts for the staff who work so hard to serve their constituents day in, day out. What I find encouraging is that Members on both sides of the House whose constituencies would be affected by these changes have had the courage to speak out against them.

It is not just Liberal Democrat Members who are doing so. I am encouraged by the fact that a number of Conservative Members have expressed serious concerns. The hon. Members for Brigg and Goole (Andrew Percy), for Stafford (Jeremy Lefroy), for Carlisle (John Stevenson) and for Hexham (Guy Opperman) have all spoken out, and I can do no better than repeat the words of the hon. and learned Member for Torridge and West Devon (Mr Cox):

“I am extremely cautious about any change that might further depress incomes in our area or that might act as a disincentive to those in the medical profession to work here.”

The Government Front-Bench team would do well to listen to those concerns, as I suspect they are widely held across this House.

The Government’s amendment does absolutely nothing for the 88,000 NHS staff in the south-west who are worried about the future. It does nothing for the businesses worried about regional divides. It ducks the issue, and lets local and regional pay creep in through the back door. If the Secretary of State has any belief in a national health service, he must step in tonight, stop the breakaway and uphold the principle of national pay in the NHS. I commend the motion to the House.

--- Later in debate ---

[Mr Hunt]

Let me remind the hon. Gentleman that he supported the 2003 Act, which gave foundation trusts the power to set their own terms and conditions. Let me also remind him that this Government have increased the NHS budget in real terms—something that the right hon. Member for Leigh said was “irresponsible”. Let me say clearly that we are not changing the allocation of resources to different parts of the country, but we are allowing the flexibilities that the Labour Government introduced for local NHS managers to make sure that they get the benefit. If the hon. Member for York Central (Hugh Bayley) listened to what I said about a million more people being treated in accident and emergency, one and a half million more diagnostic tests being carried out, and about half a million more out-patient appointments being dealt with, he would understand that all our constituents are benefiting from that. That is because we have the flexibilities that that Government introduced.

[Andy Burnham]

The Secretary of State said again that in 2010-11 and 2011-12 the NHS budget increased in real terms. Is he saying that Her Majesty’s Treasury has got its figures wrong?

[Mr Hunt]

No. Let me just remind the right hon. Gentleman that the budget increase in the NHS that this Government committed to and that this Government announced was something that he said would be “irresponsible”. We have ignored that, and I have been completely clear that the NHS budget went up.

We support recruitment and retention pay—an amount that can be as much as 30% of a person’s salary, and which the Opposition, if they were consistent in their opposition to regional pay, would presumably wish to abolish. We support the London weighting, which is, again, a form of regional pay that we would be planning to abolish if we listened to the Opposition’s arguments today.

--- Later in debate ---

[Mr Hunt]

All we are doing is supporting what the hon. Gentleman’s Government did, which was to introduce flexibilities for the people who run foundation trusts to set pay and conditions in order to get the best health care in their areas, including in his constituency, in that of the right hon. Member for Leigh and in mine. The previous Labour Government did not just support that; they legislated to require it. They introduced foundation trusts—

[Andy Burnham]

rose—

[Mr Hunt]

I am going to make some progress now. The previous Labour Government introduced foundation trusts in 2003, giving them the power to set their own terms and conditions, just like NHS trusts. Indeed that Government went further, removing the remaining powers of the Secretary of State to intervene. Then, in 2004, the right hon. Gentleman’s Government included regional pay as a firm principle of “Agenda for Change”. Then they legislated to confirm these principles in the Health Act 2006. Who was the Health Minister then? It was the right hon. Gentleman.

The right hon. Gentleman recently referred to this flexibility as a “loophole”. It is not a loophole; it was one of the central planks of that Government’s policy. Let us consider the following:

“The challenge now must be to genuinely free the very best NHS hospitals from direct Whitehall control.

We plan to do this…by removing the Secretary of State's powers of direction over NHS Foundation Trusts…

Exercising these freedoms will give NHS Foundation Trusts precisely the sort of autonomy that is commonplace for hospitals elsewhere in Europe.”

Those are not my words, but those of his colleague and former Health Secretary, Alan Milburn, when he introduced foundation trusts.

The question that the right hon. Gentleman has to answer—he has completely failed to do so—is why, as Health Minister, he legislated for these powers if he disagreed with them. If he disagrees with them, why did he not overturn them when he had a chance to do so as Health Secretary? Either he has changed his mind or the unions which bankroll his party have changed it for him. Whichever is the case, it is a pretty sorry state of affairs for a party that claims to aspire to power.

[Andy Burnham]

The Secretary of State has misrepresented the former Government’s position twice, and on NHS spending. Let me just ask him about regional pay. He said he is building on what we did. When we left office not a single NHS trust in this country had opted out of the national “Agenda for Change” system—that is a fact—because we defended the principle of national pay. He has just said to my right hon. Friend the Member for Exeter (Mr Bradshaw) that he will not condemn the cartel in the south-west, and that he wants trusts to choose whether to opt in to national pay or regional pay. Should he not tell Liberal Democrat Members and the people sitting behind him that he supports local and regional pay in the NHS?

[Mr Hunt]

That is a funny way of defending the principle of national pay: legislating to give foundation trusts the ability, for the first time ever, to set their own terms and conditions. I do not know how the right hon. Gentleman defines it, but that does not seem to me to be in any way logical.

Mental Health (Approval Functions) Bill

Debate between Jeremy Hunt and Andy Burnham

Tuesday 30th October 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

Detaining people under the Mental Health Act raises fundamental questions of individual liberty and public safety, requiring the most careful consideration. I am sure that there is general agreement across the House that the circumstances in which we find ourselves today are far from ideal. Members on all sides will want to use the time we have to satisfy themselves that the measures that the Government are asking the House to approve today are justified.

Emergency legislation tends to be forward looking in its scope, so the retrospective nature of the Bill before us is unusual and potentially troubling for Members. As I said yesterday, we will need to be sure that this is the only real course of action available and that it is not setting a precedent whereby emergency legislation can be used as a convenient means of correcting administrative failings, which could in itself breed a culture of complacency in public administration.

In asking those legitimate questions, however, we must have at the forefront of our minds the simple fact that the uncertainty which has arisen in the past week affects thousands of highly vulnerable people and their families, as well as having serious implications for patients and public safety. If we leave that uncertainty hanging, it will have the potential to cause real harm to the individuals concerned, and to damage public trust in our systems of individual and public protection.

The Secretary of State was right to act quickly, and to come to the House yesterday to make his exceptional and urgent request for legislation. I am surprised that he did not make the case for that legislation to the House in person today, but the Opposition have nevertheless concluded that, on balance, the public interest is best served by our supporting the Government in the swift action that they propose, and we will ensure as far as possible that that pragmatic approach is reflected in the other place.

In reaching our judgment, I think we can take some comfort from the fact that the main mental health organisations, as well as the Royal College of Psychiatrists, are, for now, supporting the Government’s course. However, concerns and questions have already been raised today—not least by my right hon. Friend the Member for Oxford East (Mr Smith)—which have not been fully answered. I must say to the Government that it is vital for the fullest possible answers to be given to the House today before any approval is given to this exceptional retrospective measure. I shall be seeking answers not just to the questions that I am about to ask, but to questions that the Secretary of State did not answer yesterday. There are matters of detail here, but matters of principle also arise, and I want to cover both in my speech.

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

May I clarify something? I had intended to make the Second Reading speech earlier, but I will be winding up the debate, and during that speech I shall seek to address any points raised by the right hon. Gentleman—and, indeed, any outstanding points raised by other Members.

[Andy Burnham]

I thank the Secretary of State for his intervention. We understand that these are urgent matters, and I am sure that he is receiving briefings from the Department, but I think that there is a sense among Opposition Members that that is not good enough, and that he should have been here to answer the questions that were asked. We appreciate that he will be winding up the debate, but I hope he will take careful note of all the questions that are asked, and will give every Member present the fullest possible answer.

First things first: let us begin with the detail. I think it would help the House to know more about the extent of the checks that have been carried out on the 4,000 to 5,000 cases involved. The very fact that the number remains vague suggests that there has not yet been a thorough case-by-case review. Does the Minister—or, indeed, the Secretary of State—agree that it is essential to conduct such a review, and to put a precise number on the extent of the problem? I asked yesterday whether the Department could tell us how many of the people concerned were in high-security hospitals. I think that that is an important aspect of the issue, and I should be grateful if the information could be given to us at some point this afternoon. Without detailed case-by-case checks, how can we be sure that this procedural defect was the only technical irregularity in the process that was operating in the four SHAs concerned? We need to be reassured that there are no further problems that will need to be corrected at a later date.

That brings me to another question that was not answered yesterday. Families of the people involved will have heard yesterday’s news, and will no doubt have been unsettled by it. Does the Secretary of State agree that it is important for the Government to make arrangements, urgently, for direct communication to take place with the families who have been directly affected so that the issue can be explained to them more fully, and in isolation from some media coverage that may not give them the reassurance and support that they seek? Have such arrangements been made, and has any facility been provided enabling questions to be answered so that people can be given that reassurance and support?

That, in turn, brings me to another important point. If the Government were to leave a vacuum in terms of advice and communication, it could of course be filled by less scrupulous elements of the legal profession seeking to initiate compensation claims. We have already read warnings today that efforts may be made to encourage patients to sue for £500 or £600 a day, the amount that a prisoner would receive in compensation for unlawful detention. I am sure the Secretary of State agrees that any such activities would be highly unsettling, and would amount to the potential exploitation of vulnerable people. I hope he will join me in sending the clearest of messages to the legal profession that that would not be at all welcome. On the other hand, we would not want to see any curtailment of individuals’ legitimate right to challenge the decisions made affecting their liberty as a result of the Bill.

[Andy Burnham]

That is a good point. So many cases are involved that challenges may have already been in progress before this technical problem arose. There may have been complaints about the nature of the decision-making process, the number of professionals involved, or any matter relating to the process by which the decision was made.

I hope that it will reassure the hon. Gentleman to learn that I have been given access to Government lawyers—the Secretary of State promised that yesterday, and I am grateful to him for arranging it—and I have been assured that the Bill will not wipe away an individual’s right to issue a legal challenge on a different point of process. That is a fundamentally important point, and I am glad that the hon. Gentleman has given me an opportunity to put it on the record. We would certainly not support the Bill if it were intended to wipe away an individual’s rights retrospectively, and I am sure that the hon. Gentleman would not either. We are grateful for that reassurance from the Government.

Along with the urgent steps that are being taken to correct the legal position, we need a review of how this came about in the first place. If it had happened in a single SHA, the explanation might have been easier to ascertain and understand, but the fact that it happened in four SHAs points to a more widespread issue of concern. It raises the question whether the problem arose from historical practice among clinicians and NHS bodies in the four regions concerned, or whether a piece of Department of Health guidance that was circulated in the past may have been responsible. I hope that the Minister or the Secretary of State will be able to enlighten the House further.

We want the Harris review—which I support—to cover all the technical issues surrounding mental health, so that the House and the public can be absolutely certain that no other technical failures or breaches of regulation have been identified. Let me make two appeals to the Secretary of State. First, I ask him to consider widening the remit of the review, and ensuring that in future it can take the broadest possible view of arrangements for sections under the Mental Health Act 1983. Secondly, I ask for the review to be conducted as swiftly as possible, so that it can inform the current reorganisation of the NHS.

It seems to me that the crux of the issue is the interrelationship between the 1983 Act and the potential for reorganisations of the NHS to disturb important existing arrangements and procedures for the carrying out of these essential public functions. That is the crux of the matter. I accept that a problem may have arisen as a result of the introduction of SHAs and PCTs in 2003, and we will have to wait and see whether that was the case. Regardless of the answer to that, however, the Government still have to face a relevant and current issue: they have to be absolutely sure that the changes they are proposing—and which the Opposition continue to believe are unnecessary and highly disruptive to an NHS that is functioning well for the vast majority of people—will not run the risk of causing further confusion.

We have not had anywhere near enough clarity from the Secretary of State—or his predecessor, the right hon. Member for South Cambridgeshire (Mr Lansley), who has just left the Chamber—on how some of the essential functions of NHS bodies to do with safeguarding and public protection are to be handled in the new NHS structure. Many months have passed since the publication of the Government’s first White Paper, yet there are still doubts in the minds of clinicians and others practitioners on the ground. That is an indictment, and shows the confusion the reorganisation has created. We are seeing the emergence of myriad new bodies in the NHS whose functions are not yet fully understood or specified by the Government. This crowded landscape has the potential to cause for further uncertainty. I therefore today ask for more clarity on this matter.

As things currently stand, what will the NHS arrangements be for sectioning people under the mental health provisions to be introduced from April 2013? I do not yet know with confidence what those arrangements are, and if I do not know there is a good chance that the wider public and many people working in the NHS have no idea. The Government need to answer these questions.

There is a further specific question the Department needs to answer, and it goes to the heart of the issues under discussion. I am sure I heard the Secretary of State say yesterday that the secondary approval function that SHAs are meant to carry out will come back to the Department of Health following the Government’s current reorganisation of the NHS.

[Mr Jeremy Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding from a sedentary position, so I assume that is correct. Surely, therefore, a concern arises that the SHA part of the process is no more than a rubber-stamping exercise. The Department will be entirely remote from the local situation on the ground relating to the individuals involved and the clinicians and institutions making the judgments. If this process is taken up to the national level, will that not give rise to more concerns that mistakes might be made in the future, because of the distance between the process of approval and the individual cases on the ground? Has the Secretary of State had discussions with mental health organisations about whether they believe those arrangements are acceptable? I must say that I have serious concerns about them.

--- Later in debate ---

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

I start by apologising to any Members who had hoped to intervene on me at the start of the debate, but I hope that I will now be able to give a fuller answer not just to any interventions, but to speeches made by right hon. and hon. Members. I thank the Opposition and the whole House for the very responsible attitude that they have taken towards this extremely sensitive and difficult issue. I intend to respond fully to all the points made by right hon. and hon. Members about the need to act so fast and retrospectively. Those are important issues that deserve the fullest attention.

It is important to record our appreciation at this stage for the invaluable help and advice that we received from partners outside the House, such as Mind, Rethink and the Royal College of Psychiatrists. Their primary concern is naturally those whom they represent so ably, but we are genuinely grateful for the mature and calm way in which they have responded. Everyone in the House has shared the same ultimate objective—to do what is best for the patients directly affected by a technical error.

Let me go through the points raised in the debate. I shall try to respond as fully as I can. With respect to the devolved Administrations, I have spoken to Health Ministers in Wales and Northern Ireland today, and I spoke to the Advocate-General for Scotland yesterday. They have been extremely supportive of the position that the Government and the whole House have taken, and they understand the need for speed. In Wales it is a sensitive matter because the Welsh Assembly is in recess, but I managed to speak to the Health Minister and go through the issues involved.

A number of Members asked about the extent to which we will be communicating with patients. We are working closely with the Royal College of Psychiatrists as to the best way to do this. That also extends to the families and carers of patients. Sir David Nicholson, the chief executive of the NHS, is writing to all strategic health authorities, stressing the need to communicate broadly across all mental health organisations, including patients and their families, and including, as has been mentioned, not just the patients who are directly affected, but potentially other patients who have been detained under the Mental Health Act, who may also have concerns. We have not been able to complete that communication exercise at this stage, because of the speed necessary to pass the Bill, but we will need to make sure that it proceeds as a matter of urgency.

[Andy Burnham]

We welcome the exercise being carried out by the NHS chief executive, but it is not the same as a personal communication to the individuals directly affected, so will the Secretary of State address the specific point of whether or not they will receive explanatory information from him or the Department?

[Mr Hunt]

Yes. What Sir David Nicholson is doing is ensuring that all SHAs have a proper communication process in place, but we want to follow clinical advice on the appropriateness of individual communications with individual patients. Where we are advised that is clinically sensible, we must ensure that it happens, but we want to listen to the advice carefully because of the vulnerability of some of the patients involved. The right hon. Gentleman makes an extremely important point. We must do this properly but, as I know he will agree, we must proceed with extreme care and caution.

I will start with some of the issues that the right hon. Gentleman raised, particularly the role of the review being conducted by Dr Geoff Harris. He is absolutely right that it needs to be done speedily because of the changes being introduced by the Health and Social Care Act 2012. I want to reassure him that Dr Harris’s review will not be simply a retrospective review; he will not just be asking, “Why did this happen?” He will also be stepping back and asking, “Where might this happen again and are our governance procedures sufficient to ensure that it does not?” In particular, he will look at the new structures that will be put in place over the next few months to give us good and independent advice on whether we have the safeguards in place to prevent this from happening again. That is an important point.

With regard to how many people are affected, the figure is up to 5,000. We think that the number includes all the patients at Rampton and 57 patients at Ashworth, but we are still verifying the exact numbers. I will keep the right hon. Gentleman informed as more information becomes available.

The right hon. Gentleman’s other point was about the new arrangements that are being put in place. He wondered, legitimately, whether, as the powers are returning to the Department of Health following the abolition of the SHAs—he was correct to pick that up from my comments yesterday—there is a danger that the process could be more remote for local areas. We will keep him informed of our plans in that regard, but we do not intend to have a single national panel doing this. We intend to have a structure that draws on local and regional expertise to help us to make the right decision on the suitability of doctors for the role. That is also something we hope Dr Harris will advise us on when he conducts his review.

I will move on to some of the comments made by the right hon. Member for Oxford East (Mr Smith). Independent oversight is also something we will ask Dr Harris to look at. He is independent and he is looking at it. We will also ask him to look at the general issue of independent oversight and whether it has been missing in the structures we have had to date and, therefore, whether it contributed to the concerns that we are now addressing.

The right hon. Gentleman and the hon. Member for Wolverhampton North East (Emma Reynolds) raised another issue: the wording we have been using, the fact that we believe there are good arguments for saying that the detentions that happened as a result of approvals made by the doctors in the four SHAs were and are legal and, therefore, why we feel the need for emergency retrospective legislation. It is a reasonable question. The answer is that we believe that there is legal precedent for why, in so sensitive a situation, a court, in deciding whether a detention was lawful or unlawful, would consider what the will of Parliament was when it passed the original law. Therefore, we believe that we have a good argument for why a court should rule that these detentions were and are lawful.

However, because of the technical irregularity in the process of approving some of the doctors who made the decisions in the four SHAs, that argument could be challenged. That is also an important part of the advice we have received. It is because it is so important to put the decisions beyond doubt, with respect to this narrow and technical issue, that the Bill is so incredibly important. However—this might help to address some of the concerns raised during the Opposition winding-up speech—this piece of retrospective legislation refers only to that narrow and technical issue. If people question the grounds for their sectioning under the Mental Health Act on clinical grounds and claim that the wrong clinical judgment had been reached, for example, or if they do not agree with what the panels have said, the Bill will not affect their right to challenge the decision and, if the court upholds the challenge, to get compensation if they have been detained. The Bill relates only to the very narrow issue of the technicality.

[Mr Hunt]

The right hon. Gentleman makes an extremely important point. I am pleased to reassure him that that has happened. That was one of the first things that happened, and it was completed yesterday, so all the doctors who are currently making these approvals in the four SHAs were approved using the correct process. We are confident that the problem will not arise in future, but we still have the issue of the decisions they took when the technical process had not been followed.

We have taken a number of actions to deliver parity of esteem for mental health services. I wholeheartedly agree with the concerns that have been raised about mental health issues having been for too long the poor relative in a number of areas. The right hon. Member for Leigh (Andy Burnham) will know that in July we published the implementation framework for our mental health strategy, “No health without mental health”. We have legislated, with his party’s support, for parity of esteem. The operating framework for the NHS expands access to psychological therapies, which is one of the key things we can do. The number of people accessing psychological therapies has increased to 528,000 people this year, which is more than double the figure for last year, and the amount of money going into it has increased from £364 million to £386 million. Those therapies have a very good success rate of about 45%, and we think that we can get it up to 50%. I want to reassure right hon. and hon. Members that we note the general view of the House that more emphasis needs to be put on mental health services.

[Andy Burnham]

But overall there has been a significant real-terms reduction in spending on mental health, as the figures given by the right hon. Gentleman’s colleague in the House of Lords a few weeks ago indicate, which suggests that the NHS is making disproportionately more redundancies in the field of mental health than in other areas and that it is reverting to that default position. Therefore, although I appreciate the Secretary of State’s words at the Dispatch Box today, the reality on the ground suggests that, as ever, mental health is bearing the brunt of some of the reductions and redundancies taking place and that the capacity of people to deal with these kinds of issues will perhaps be reduced. What will he say about safeguarding against that?

[Mr Hunt]

The right hon. Gentleman makes an important point. I believe that in actual terms the spending on mental health has increased slightly, but when we take inflation into account it might have gone down slightly in real terms. I do not think that it is a significant drop, but overall, as he knows, the NHS budget has been protected. I would be extremely disappointed if, as we go through a process of finding important efficiency savings in order to meet the increased demand on the NHS, the picture that he paints were to be the case, but I will be watching the situation very carefully. I will expect him to hold me to account for my commitment to ensuring that mental health services are properly addressed.

Crucially, it is not just about what we say but about what we deliver, particularly as regards the progress that we make towards improving access to mental health services, which were never included in the waiting times targets that were introduced by the previous Government. There are obviously financial implications in doing that, but we are working on it. Parity of esteem needs to include access to mental health services and not just the availability of those services.

Mental Health Act 1983

Debate between Jeremy Hunt and Andy Burnham

Monday 29th October 2012 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I thank the Secretary of State for his statement and for notice of it. Detaining people under the Mental Health Act raises the most serious issues of fundamental rights and of patient and public safety. Any reported failure will therefore always be a matter of the highest concern. I know this House will want to get to the bottom of the unacceptable breaches of procedure that we have just heard about. However, I am sure I speak for both sides in saying that the House will have been reassured by the Secretary of State today on three crucial points: first, that no patient has been wrongly detained, received care that was not clinically appropriate or will see their legal rights restricted by the legislation; secondly, that no doctor was unqualified to make decisions; and, thirdly, that urgent action is being taken to correct the situation and bring the clarity that is so essential.

Let me now turn to the serious questions that need to be answered. Will the Secretary of State say more about the events that brought this issue to light last week? Was it discovered in one SHA first, and by what process did the Department establish that it extended to three more? When exactly was the Department made aware, when was the Secretary of State informed and what action has been taken to establish the full extent of the problem? Have extensive checks been undertaken in all 10 SHA areas, and is he absolutely confident that no more patients and families are affected than the 4,000 to 5,000 he has mentioned?

I want to press the Secretary of State for more information on the people affected. Will he say whether he has any plans for direct communication with the patients and families affected? Are the patients living not only in the four regions mentioned but in all parts of the country? How many are in high-secure hospitals, and how many could pose a risk to the public?

We understand and support the Secretary of State’s wish to remove any doubt about the legal status of the patients concerned, but that must be set against the undesirability of asking the House to legislate tomorrow on an issue that it has found out about only today. Over the next 24 hours, will he ensure that Members have access to the fullest possible information, including a summary of the legal advice he has received?

There will be concerns about precedent. This is the first time that the House has been presented with emergency legislation in this area that will affect people’s rights. The public will want to know that it is being used in exceptional circumstances as a last resort, and not as a convenient means of correcting administrative failures. Will the Secretary of State therefore explain precisely what alternatives to legislation were considered, and why it was decided that they were not acceptable in these circumstances?

Let me turn to the investigation. We support the review under Dr Harris that will try to get to the facts and ensure that lessons are properly learned. We do not want to prejudge it, but is the Secretary of State in a position to confirm today whether the review is already proceeding on the basis that this is a failure of policy implementation rather than a defect in the original legislation? That is important, as practitioners working in this field will not want any unnecessary question marks hanging over the Mental Health Act 1983.

We also need clarity about the future. This area is currently the responsibility of SHAs, which are due to be abolished next April. So, as well as establishing the historical facts, will the Secretary of State ask his review to consider whether the new arrangements for sections, following the Government’s reorganisation of the NHS, are sufficiently well understood? Will he also ask the review to advise on how any danger of further confusion arising from the process of transition can be prevented?

I commend the Secretary of State for the pragmatic approach he is taking to this difficult issue. His request of the House is exceptional, but failure to act could cause unnecessary distress and uncertainty to many thousands of vulnerable patients and their families, and present risks to public safety. We will press him for answers in the areas that I have outlined, but we believe that his action is justified. He will have our support in removing any uncertainty.

[Mr Hunt]

First, I thank the right hon. Gentleman for the co-operation that he has shown to me and my Department over the weekend. There are occasionally moments when issues of public safety and patient well-being transcend the normal political divides, and I greatly appreciate his co-operation on this matter.

Let me deal with the important questions that the right hon. Gentleman has asked. The issue arose when a challenge was made to the authorisation of one doctor in Yorkshire and Humberside and, in dealing with that challenge, the irregularity in the way in which all authorisations had happened became apparent. Following further investigation, we discovered that this had happened in four other SHAs. We found out about this early last week, and I was informed towards the end of last week. Immediate action was taken to ensure proper validation last week of all the doctors who are currently taking section 12 decisions under the Mental Health Act, and that was completed as of today.

We have done exhaustive checks on the other SHAs, which is part of the reason why we asked all the SHA bosses to write to Sir David Nicholson—which they have all done today—to confirm that their processes in this area are in order. We do not believe that this issue affects any patients other than the ones we have talked about, to date. However, because people move and are moved to different hospitals and places of detention, it might be happening in other parts of the country beyond the four SHAs in which the irregularities in authorisation happened.

The right hon. Gentleman will understand that it is not the practice for Governments to publish legal advice because we want to continue to be able to receive frank legal advice in the future. However, I am happy to answer any questions about the legal advice and, as he knows, I am happy for him to talk to my Department’s legal advisers to satisfy himself on the precise legal situation.

Let me move on to the really important point about the alternatives that we considered, as it is highly exceptional to bring in emergency legislation. The right hon. Gentleman will know that authorities are allowed to detain someone under the Mental Health Act for 72 hours while the correct processes are followed to section them. Although, as I mentioned, we believe we have good arguments to show why these detentions were lawful, we did not know what a court might have decided if the detentions were challenged. We could have faced literally having to redo the entire process for 4,000 to 5,000 patients within 72 hours. Given the high level of vulnerability of many of them, we could not find a means of doing that in an orderly way that protected their well-being. I received clear medical advice from the NHS medical director, Professor Sir Bruce Keogh that that would not be an appropriate course of action. We looked at the position carefully and because we were trying to explore other alternatives we did not come to the decision to introduce emergency legislation until this weekend.

I can confirm that we do not believe that this has highlighted a defect in the legislation. We are not seeking in the emergency draft Bill to change the Mental Health Act. This is purely retrospective legislation dealing with some specific procedures under that Act; it will have no impact as this goes forward.

The right hon. Gentleman is absolutely right that we must be sure to minimise the confusion as we move towards the new structures. Under them, the problem would have been resolved, with the power reverting from strategic health authorities to the Department of Health. I do not want to be complacent: if this problem happened in one area, we want to be sure that it cannot happen in others.

Oral Answers to Questions

Debate between Jeremy Hunt and Andy Burnham

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

I would be delighted to see the innovative things that are happening at the Kent Health Commission. Looking at how we deal with people with long-term conditions—that is 30% of the population, and the proportion is growing with the ageing population—will be a vital priority for the NHS over the coming years.

[Andy Burnham (Leigh) (Lab)]

May I welcome the Secretary of State and his new team to their positions? As the only other person to have made the jump from Culture to Health, I am sure that he will find me a constant source of useful advice.

The Secretary of State has not said much since his appointment, but he did set out his mission in The Spectator:

“I would like to be the person who safeguards Andrew Lansley’s legacy”.

Let us talk about that legacy. Just last week, the Secretary of State slipped out figures on the latest costs of NHS reorganisation. Would he care to update the House on the current estimates?

[Mr Hunt]

Let me tell the right hon. Gentleman that Andrew Lansley’s legacy is—

--- Later in debate ---

[Mr Hunt]

First, may I say how delighted I am that the right hon. Gentleman and I once again have the same brief? I look forward to having a constructive relationship with him, not with total optimism, but I will try my best.

The right hon. Gentleman talked about my predecessor’s reforms and legacy. One of the finest things about my predecessor’s legacy is that he safeguarded the NHS budget—indeed, he increased it during this Parliament by £12 billion—when the right hon. Gentleman said that it would be irresponsible to increase it.

[Andy Burnham]

Look at the figures: the previous Secretary of State gave the budget a real-terms cut for two years running. Let me give the exact figures, which the Secretary of State did not give the House. The costs of the reorganisation are up by 33% or £400 million, making the total £1.6 billion and rising. And what is that money being spent on? A full £1 billion is being spent on redundancy packages for managers: 1,300 have got six-figure pay-offs and there are 173 pay-offs of more than £200,000. Scandalously, that news comes as we learn today that the number of nurse redundancies has risen to more than 6,100. Six-figure pay-outs for managers, P45s for nurses and the NHS in chaos—is that the legacy that the Secretary of State is so proud of?

[Mr Hunt]

Let us look at some of the facts. The number of clinical staff in the NHS has gone up since the coalition came to power. The right hon. Gentleman talked about the cost of the reforms, which is about £1.6 billion. Thanks to those reforms, we will save £1.5 billion every single year from 2014 and the total savings in this Parliament will be £5.5 billion. Let me remind him that he left the NHS with £73 billion of private finance initiative debt, which costs the NHS £1.6 billion every single year. That money cannot be spent on patient care. He should be ashamed of that.