NHS Funding

Norman Lamb Excerpts

Wednesday 12th December 2012 Commons Chamber

[Mr Kevin Barron (Rother Valley) (Lab)]

I am sorry that the Secretary of State is leaving because, before going on to discuss what is happening in my local health community and local hospital, I want to pick up on a couple of the things that have been said. First, I am pleased that this very dry motion has been tabled because I hope that it will concentrate our minds on what is happening in the national health service and, in particular, to spending.

The Secretary of State said that spending is related to budgets. He did not respond to the point posed by my right hon. Friend the Member for Leigh (Andy Burnham) that in 2010-11, there was a £1.9 billion underspend in the national health service budget. No use was made of the budget exchange scheme, so none of that money was moved into the following financial year. We can assume that £1.9 billion went back to the Treasury.

In the following year, 2011-12, the underspend was £1.4 billion, and £316 million was carried over into 2012-13. An underspend in the region of £3 billion from the first two years of this Government—including the year they won the general election—has gone back to the Treasury. Those are the facts; I do not know if any Front Bench Member wishes to dispute them.

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

Does the right hon. Gentleman also acknowledge that the average underspend in the last four years of the Labour Government was £1.9 billion?

[Mr Barron]

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

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

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[Mr Barron]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Norman Lamb]

Does that not demonstrate a complete failure at local level to address the real problems that we are trying to grapple with? There is therefore a case for a changed system whereby a health and wellbeing board brings all the parts of the system together to debate such issues.

[Mr Barron]

The events of the past two months suggest to me that the people in whom the Minister has faith to reorganise health care in Rotherham do not know what they are doing. They have brought in new systems and produced a report inside the hospital, which I understand was given to the trade unions. It ended up on the front page of a local newspaper and was countered by a press release by the hospital itself. Where is the debate about improving health care for my constituents and others? It is absent.

I say to the Minister that it was wholly wrong for the previous and current Secretaries of State—he is not the Secretary of State himself, but we never know, he may be one day—to say “These are not matters for Ministers”. I have not been consulted about them. The three local MPs had an appointment with the chief executive of the trust about two weeks ago, but it was cancelled because he had announced his retirement the week before. That is not acceptable.

The hard reality on the ground is that no matter what we would like to happen in health care, trusts are charging into cutting budgets. They are cutting jobs, because that is where the major expenditure is in health care, and that is creating the chaos that I have described. It is not acceptable. My constituents pay their taxes to pay for health care—it does not come out of the budget down here in Westminster—and they deserve better than what they are getting at the moment.

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[Andy Sawford (Corby) (Lab/Co-op)]

I am grateful for the opportunity to speak in a debate that is incredibly important to my constituents. I thank my right hon. Friend the Member for Leigh (Andy Burnham) for opening the debate. He is aware of my grave concerns about the future of hospital services that serve people in Corby and east Northamptonshire.

It has long been the ambition of people in Corby—a large, important town that is growing—to have their own hospital. I hope that in future we can realise that ambition. For a long time, however—and for the foreseeable future—we will be served by Kettering general hospital for most of our hospital needs. At Kettering general hospital there are 650 beds and more than 3,000 staff. The hospital is more than 115 years old, and received massive investment, including under the Labour Government. I make that point not so much politically point but as a local person who remembers driving down Hospital hill in Kettering and seeing the fundraising barometer outside the hospital and wondering why we relied on car-boot sales to fund vital hospital services.

My right hon. Friend the Member for Leigh, a former Health Secretary, and his predecessors began to put that right, and there was huge investment. Kettering general hospital now has 17 operating theatres and an obstetrics unit that delivers more than 3,500 babies a year. It has something that serves only a few of my constituents but is incredibly important to all of us—a neonatal intensive care unit, or special care baby unit. My own family has had cause to be grateful to that unit and its brilliant staff.

Kettering general hospital offers a 24-hour accident and emergency service, with level 2 trauma services, which sees more than 2,000 trauma patients a year. There are concerns, however, and I have agreed with the hospital and local people to champion certain issues in the House as the local Member of Parliament, including per capita funding of Kettering general hospital, which we believe is inadequate and lower than average compared with other areas. With a growing population and growing health needs, that must be addressed.

Recently, a report on the hospital by Monitor raised serious concerns, particularly about accident and emergency. I have met the hospital chief executive and the chair of the trust to discuss those concerns, and to assure them that I will seek to do whatever I can, including making sure that a case for adequate funding for the hospital is made, so that those concerns are addressed.

The big issue that causes us all concern locally is a major review of health services—the kind of review that other Members have experienced in their areas. In Kettering, the Healthier Together review of five hospitals has already cost more than £2 million; that was the figure in the summer, and I have no doubt that it is rising rapidly. The review has also taken a great deal of time and effort. In early September, together with local nurses and others, I met the people leading that review, as a public member of the trust, and I was incredibly worried about what I heard, both as a user of the services, and as a representative of local people.

The Healthier Together team gave us a pledge card telling us about their plans and giving us some assurances. The context was also set. We were told that the review was driven by a desire for the best clinical outcomes, by expertise, and by research on how local people could be provided with the best health care. We were told that there were considerations to do with more services being provided in the community, and a shift to prevention, which are things I recognise it is important for our local hospital and its partners—the clinical commissioning group and the other hospitals—to consider.

It was slide 2 that really got to the heart of the problem. It told us that the five hospitals face a combined funding gap of £48 million, and that my local hospital, Kettering general hospital, faces a future funding gap of £6 million a year. I have no doubt that the comments that Andrew Dilnot recently made about the real-terms reduction in funding are very much connected to that, but I do not want to make that wider political point again; it has already been made eloquently by my right hon. Friend the shadow Secretary of State. I simply say that all local people recognise that resources are getting tighter and tighter at the hospital.

[Norman Lamb]

Does the hon. Gentleman share my view that in many local health economies, private finance initiatives are causing a massive strain on resources?

[Andy Sawford]

I want to keep my remarks to Kettering general hospital, and I do not think that PFI is the issue there.

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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.

[Nigel Adams]

May I appeal to the Minister to ensure that rural areas such as North Yorkshire are given a fairer funding formula when the Secretary of State reassesses the formula shortly?

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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—

[Ms Rosie Winterton (Doncaster Central) (Lab)]

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Main Question accordingly put.