NHS Funding

Lucy Powell Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

The two guilty men here have a list of broken promises as long as their arm. The previous Secretary of State toured marginal seats before the election, promising the earth—“Burnley A and E? Oh, we’ll re-open that. Whatever you want. Chase Farm? That won’t close.” It was unbelievably cynical politics. It was all self-serving politics for their own ends and it had nothing to do with the reality in the NHS, but the problem for the present Secretary of State is that he has presented this false version of events to the House. On 13 November he said that

“there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans.”—[Official Report, 13 November 2012; Vol. 553, c. 188.]

[Interruption.] He says there has been. I ask for your help, Mr Deputy Speaker. How can Ministers deny the facts—deny what the watchdog is telling them? What do we do in such circumstances, when they have the sheer nerve and brass neck to carry on making these false statements?

Based on what we know, there is no way the Secretary of State can back up that claim, and I ask him to withdraw it today. It is an inaccurate claim. He made it at the Dispatch Box; the onus is on him to withdraw it. We know that he is taking time to come to terms with his brief, but he is in danger of developing a credibility problem with his utterances in the House. Take this from last month’s Health questions:

“Cancer networks are here to stay and their budget has been protected.”—[Official Report, 27 November 2012; Vol. 554, c. 127.]

But again the truth emerges, and it is somewhat different from the version of events presented to us by the Secretary of State. On Monday, responding to excellent research by my hon. Friend the Member for Leicester West (Liz Kendall), the national cancer director conceded that in future cancer networks would have to live with a smaller budget. What are we to do? Who are we to believe? We have a Secretary of State who is making statements that contradict his national cancer director. It is shameless.

[Lucy Powell (Manchester Central) (Lab/Co-op)]

Even the north-west regional centre for cancer treatment, the Christie hospital, recently announced that 213 posts will go. I do not know how it stacks up with the Secretary of State’s claim that the NHS budget is going up, when we see cancer patients getting a reduced service at the Christie hospital.

[Andy Burnham]

The priorities are all wrong. The Government are spending the money on a reorganisation that none of us wanted in the north-west, and as my hon. Friend says, cancer networks are being cut and are shedding staff. As my hon. Friend the Member for Leicester West revealed this week, they are cutting back on the vital work that they do—and there could be no more vital work. Yet we continue to have a false version of events given to us. Ministers must think we are daft, but we are telling the facts to the country today and people will judge for themselves.

When we put the whole picture together, what we see is a tissue of obfuscation and misrepresentation of the real position on NHS spending. The hon. Member for Mid Bedfordshire (Nadine Dorries), who is, sadly, not in the House today, once made some interesting observations about those on the Government Front Bench, but it is not just that they

“don’t know the price of pint of milk”.

The arrogance of which she spoke seems to give them a feeling that they can claim that black is white and expect everyone to believe it. If they say it is so, then it must be so. Well no, actually. The intelligence of the House need not be—

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[Andy Burnham]

Inadvertent claims are being thrown around the House all the time.

Fourthly, and finally, cuts and reorganisation are resulting in a crude drive to privatise services, prioritising cost over clinical quality. Across England, deals have been signed to open up 396 community services to open tender under any qualified provider, but those deals are not subject to proper public scrutiny because they are held back under commercial confidentiality. In Greater Manchester, plans are advanced to hand over patient transport services to Arriva, despite the fact that an in-house bid scored higher on quality and despite the fact that the CQC recently found serious shortcomings with the same provider in Leicestershire. The trouble is that nobody has asked the people of Greater Manchester, or more importantly the patients who rely on that service, whether they want that change.

[Lucy Powell]

My right hon. Friend might not be aware of another point. The patients who use the Greater Manchester passenger transport service are coming to me regularly and crying their eyes out in distress at this decision—[Interruption.] The hon. Member for Beverley and Holderness (Mr Stuart) says “Aaah”, but those are poor and vulnerable people who rely on that service to take them to and from hospital. It is an absolute disgrace that the contract has been given to Arriva bus service, so don’t patronise them or me. I thank my right hon. Friend for giving way.

[Andy Burnham]

Thank God my hon. Friend got up to deliver that to Government Members, because they need to hear a bit more of it. They say “Aaah,” but we are talking about people who desperately need that service, trust it and like it the way it is. The Government have not even bothered to consult them about the changes they are making. That is what is so wrong.

“Any qualified provider” is turning into the NHS version of compulsory competitive tendering, a race to the bottom and a rush to go for the cheapest bid, regardless of the effect on patients and services. What clearer symbol could there be of a privatised, cut-price coalition NHS than the decision to award patient transport in Greater Manchester to a bus company?

Let me remind the Secretary of State of the rights of patients and staff as set out in the NHS constitution:

“You have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services.”

If the people whom my hon. Friend the Member for Manchester Central (Lucy Powell) referred to sought to enforce those rights by bringing a legal action against the North West ambulance service, can the Secretary of State confirm that there would be a fair chance that it would have to halt its plans? If so, why does he not just press that pause button and ask people whether they want their ambulance services run by a bus company?

The first line of the NHS constitution states:

“The NHS belongs to the people.”

But it will not when this Government have finished with it. We are losing the NHS, and that is why we will keep stepping up the fight for it. People will remember the personal promises the Prime Minister made on the NHS in order to win office, promises that it now seems had more to do with his desire to detoxify the Tory brand than with any genuine regard for the NHS. He promised no top-down reorganisation of the NHS; that was broken. He promised a moratorium on hospital changes; that was broken. He promised real-terms increases in every year of this Parliament; that was broken. They can now see the chaos that the breaking of those promises is visiting on the NHS: nurse numbers cut, health visitors cut, mental health cut, cancer networks cut, and cataract operations cut. He is the man who cut the NHS, not the deficit. The House cannot vote tonight to stop the damage, but it can put down a marker against an arrogant and incompetent Government who need to show the NHS, its patients and staff a little more respect. I commend the motion to the House.

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[Mr Dorrell]

The right hon. Gentleman knows that I agree that the prime focus of health policy since 2010 should have been on how we can change the way that care is delivered in the health care system and the social care system to ensure that we can meet demand against the very different resource outlook that I have described. However, I say to the right hon. Gentleman, as I have done many times in this Chamber, that he shares some of the responsibility for the two-year trip down memory lane that we have had. It has been comfortable for the Labour party to say that the Tory party does not believe in the health service. We have been reminded numerous times that Tory MPs—all of whom are now dead and most of whom died before most of the current Members of the House of Commons were born—voted against the establishment of the national health service in 1946. We have had reminders from Government Members that the Labour party voted against the establishment of NHS trusts and then went ahead with the policy in office. The Labour party says that it is against choice and competition, but it was that party that established the choice and competition panel to ensure that those influences were brought to bear in health care policy.

We have had a two-year trip down memory lane, in which we have engaged in party political arguments that have avoided the issue that the right hon. Gentleman articulated as Secretary of State: how can we meet rising demand for health and care services against the background of a budget that, as the Select Committee has said repeatedly, is flatlining in real terms? That is why I was so keen earlier to read out the sentence from the Dilnot letter that states that it is

“fair to say that real terms expenditure had changed little over this period.”

The way that I prefer to put it is that if the decimal points are knocked out, real-terms expenditure is running at zero. The question is how to act against the background of a very small growth in resources, which is what the Government are committed to.

What the right hon. Gentleman did not cover in his speech is that the revenue expenditure of the NHS, which is what actually treats patients on a day-by-day basis, has grown modestly in real terms since his last year as Secretary of State. In my view, it will continue to grow modestly in real terms. He is frowning, but it is there in the arithmetic that there has been modest real-terms growth in the revenue expenditure, which is another definition of front-line services. That is the expenditure that funds the delivery of services to patients on a day-by-day basis and that is where the pressure is felt.

[Lucy Powell]

In addition to the point that the right hon. Gentleman is making, has he considered the chronic pressure that is being put on the NHS, which will get much worse from next April with the cuts to adult social care and the desperate cuts to local government? The conversation that we are having has to take into account what the money has to be spent on. The service will decline dramatically from next April.

[Mr Dorrell]

I have made the point more than once that we should look across the traditional divide between the national health service and the social care system towards a health and care system. The only way of responding to the efficiency challenge that the right hon. Member for Leigh was the first Secretary of State to set out—what the Select Committee has described as the Nicholson challenge—is to rethink the way in which services are delivered across the health and social care divide. The National Audit Office, another independent body, has stated that 30% of non-emergency hospital admissions are avoidable—not unnecessary, but avoidable. We need decent community-based services that meet the demand early in the development of the condition to avoid the unnecessary development of acute cases that have to be treated though hospital admission.

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[The Minister of State, Department of Health (Norman Lamb)]

I start by acknowledging the moving contribution of the right hon. Member for Cynon Valley (Ann Clwyd). Her testimony was shocking and should force the whole system to recognise that such experiences are utterly intolerable and have no place in a modern health system in which kindness and compassion must always take first place. My right hon. Friend the Secretary of State is absolutely right to put that at the top of his agenda. The hon. Member for Strangford (Jim Shannon) also spoke about that point.

I have sat in this Chamber for many debates on the NHS; I have spoken in many of them too. I have heard many arguments about a lot of different things, but unfortunately this is one of the most misguided motions I have ever seen. I get on well with the right hon. Member for Leigh (Andy Burnham), but on this occasion he is completely wrong. As my right hon. Friend the Member for Charnwood (Mr Dorrell) said, the debate should be about the massive challenge we face in caring for people with long-term chronic conditions.

The right hon. Gentleman blames us for his spending plans when he was in office—plans that he signed off when he was in government. Let us have a quick reality check. The coalition’s spending plans kicked in in 2011-12, not before, and in that year there was an increase in real-terms spending. However, hon. Members should not take my word for it: they should ask Andrew Dilnot, the chair of the UK Statistics Authority and a highly respected and eminent economist. He confirmed that in 2011-12, NHS spending increased in real terms compared with the previous year by 0.1%. It says it all that the right hon. Gentleman refused to complete the sentence from Andrew Dilnot’s letter and give the complete picture. Spending will carry on going up for years to come, despite the legacy of financial irresponsibility left us by the last Government—the billions frittered away on a failed IT programme; the vice-like grip of PFI schemes mortgaging—

[Lucy Powell]

Will the Minister give way?

[Norman Lamb]

I have very little time.

Seventy-three billion pounds outstanding on PFI projects, mortgaging the NHS’s future and causing a massive strain on local health economies—that was something alluded to by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Members for Lewisham East (Heidi Alexander) and for Corby (Andy Sawford). The problems of PFI are massive. Labour also had 25,000 people working in health quangos. That is Labour’s legacy, but now, under the coalition, over the four years to 2014-15 the NHS budget will rise by more than £12.5 billion.

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[Norman Lamb]

I understand the concern about rural areas and I will write to my hon. Friend about that. That £12.5 billion will go into improving services, hiring staff and keeping people well. That money will help to protect our health even as the age of the population goes up.

[Lucy Powell]

I thank the Minister for giving way. [Interruption.] Let me tell the Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry) that I am not going to read anything out. After such a long and lively debate, I just want to know whether the Minister will now clarify the matter that is before the House. Was NHS expenditure, in Dilnot’s words, lower in 2011-12 than it was in 2009-10? Yes or no?

[Norman Lamb]

The letter from Andrew Dilnot—the part that the right hon. Member for Leigh did not read out—also said that

“it might also be fair to say that real-terms expenditure had changed little over this period.”

In 2011-12, it went up according to Andrew Dilnot.

My right hon. Friend the Secretary of State for Health has already gone through the numbers outlining what is happening in the NHS today. He has already mentioned all those areas where the NHS is now healthier than under Labour—60,000 fewer people waiting longer than 18 weeks than under Labour; a determination to give access rights to those with mental health problems, as well as those with physical health problems, which was something bizarrely left out by Labour; more than 3 million more out-patient appointments every year than under Labour; more clinical staff, including 5,000 more doctors; and better access to drugs than ever before, including £600 million for the cancer drugs fund. On the cancer networks, the budget for networks as a whole is going up by 27%, which includes dementia and maternity—something that was also left out by Labour. Had the Labour party had its way and cut NHS spending, what would have happened to the networks in those circumstances?

Here is the important point, a point that Labour Members have unsurprisingly chosen not to mention throughout the length of this debate—that money would not be there under Labour. I have no doubt that they will protest, but it is there in black and white, immortalised in Hansard and in the press: for years, they have consistently advocated spending less than us on the NHS. In 2010, the right hon. Member for Leigh, in an interview with the New Statesman, said:

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

The interviewer fired back:

“Which is true, isn’t it?”,

and the right hon. Gentleman admitted ,“Yes, it’s true”. In the same year, as reported in The Guardian, the right hon. Gentleman said:

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

Yet it goes even further than that. A year before those interviews, in 2009, he could not even promise that the NHS would be protected from cuts. The chief economist from the King’s Fund agrees. Commenting on Labour’s plans, he said that the implication of the overall budget for the NHS was that it would be cut in real terms from between a very small amount to up to 5% over two years. That is what would have happened, had Labour won the election. It will fool no one: it will not fool the public, patients, the professionals or this House. We all know that the coalition is moving heaven and earth to protect the proud heritage of the NHS and drive up standards for everyone—whoever they are and wherever they live.

As my right hon. Friend the Member for Charnwood rightly says, the challenge is how we rethink how services are delivered across the health and social care divide to prevent crises from occurring. Prevention is what we should be doing, as the right hon. Member for Rother Valley (Mr Barron) rightly pointed out. If Labour Members do not like our plans, it is up to them, but if they think the NHS would be doing better with less money, more mixed-sex wards, longer waiting times and fewer clinical staff, they are more than welcome to that position. They can cling on to that as long as they wish, but what is unforgivable is for them to try to hoodwink the public into belittling an NHS that is getting better and better all the time. We have an NHS that is treating more people than ever better than ever, an NHS that is preparing itself for new challenges every day.

Let us compare that with Labour’s real NHS project in Wales, where we see cuts—cuts that have resulted in half a billion pounds taken out of the NHS in Wales by Labour. Waiting times are longer than in England and a higher proportion of patients is waiting for treatment. That is the true face of Labour on the NHS, and in England we should fight it as passionately as we can.

We have seen clearly today the desperation of the Labour party—a desperation that has led it to try to misinterpret inconvenient statistics. Frankly—