National Health Service

Debate between Paul Burstow and Andy Burnham

Wednesday 21st January 2015 Commons Chamber

[Paul Burstow]

I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.

In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?

[Andy Burnham]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will, unlike the right hon. Gentleman on many occasions earlier.

[Andy Burnham]

The right hon. Gentleman clearly was not listening to my speech. The central proposition is that what I described as the “root cause” of the A and E crisis was the imposition of devastating cuts in social care, which are leaving people unsupported in their own homes. Will the right hon. Gentleman now say—because he was there—that it was wrong of him and his colleagues to allow social care to be cut in that way, given that the cuts are now presenting the NHS with an enormous productivity and efficiency problem?

[Paul Burstow]

The right hon. Gentleman is right to raise that question. I wanted to ask him a question that relates directly to his point, and, indeed, answers it. I hope that he will agree with me—and, indeed, with the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb)—that we need a fundamental review of NHS and care spending, in the round, and that finances in that area need to be addressed before the spending review that any Government will carry out later in the year. We need to ensure that we are clear about the level of investment that will go into our health and social care system. So far, I have heard no clear indication from the right hon. Gentleman of his relative spending priorities when it comes to health and social care, and they need to be made clear if we are to establish a consensus.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will give way once more, but then I must make rapid progress.

[Andy Burnham]

My answer to the right hon. Gentleman’s question is that I want a single service: a single service for the whole person. I want a national health and care service. We should no longer have two budgets; we should have a single budget, and we should then use the money as best we can to support people, starting in their own homes—and we are going to invest an extra £2.5 billion.

The right hon. Gentleman did not answer the question that I asked him. I asked him whether he and his Government colleagues, in those early days, made a mistake in allowing social care to be cut to the bone? Every week I am accused of saying that it is irresponsible to give real-terms increases. The right hon. Gentleman allowed social care to be raided. Should we not receive an apology for that today?

Care Bill [Lords]

Debate between Paul Burstow and Andy Burnham

Tuesday 11th March 2014 Commons Chamber

[Paul Burstow]

I think the hon. Lady will find some sympathy for that view.

Local commissioners and trusts should be responsible for sorting out difficulties that could lead to a failure. Again, it needs to be clearer what happens at the pre-failure stage, and Ministers need to work with NHS England and Monitor to set out the pre-failure regime so that it is crystal clear what needs to happen to avoid triggering the TSA process. It might be argued, as Labour did in 2009, that when an NHS trust fails, there needs to be a fast way of making decisions about its future. Those decisions might have knock-on effects, but that should not mean that one trust’s failure triggers a wholesale re-engineering of local health services without proper checks and balances and accountability. Decisions about local health services should be taken by clinical commissioning groups.

I have tabled new clause 16 because I believe that two principles established by the Health and Social Care Act 2012 deserve to be protected. The first principle is—

[Andy Burnham]

Will the right hon. Gentleman give way?

[Paul Burstow]

If I may develop my point, I shall be happy to give way to the right hon. Gentleman.

The first principle is that, in the absence of failure in the arrangements set up by local commissioners, decisions about what services should be provided at an NHS trust or an NHS foundation trust should be taken by local commissioners working within their local health economies, and should not be foisted on the local NHS from outside. This autonomy principle is reflected in the absence of any general right for the Secretary of State or NHS England to direct local commissioners about the discharge of their functions. The previous position under the Labour Government was that the Secretary of State could issue directions to primary care trusts. We did not replicate that in the 2012 Act.

[Andy Burnham]

The right hon. Gentleman has made an outstanding contribution to proceedings over the past couple of days and I pay tribute to him for that. He was centrally involved in the development of coalition health policy after the last election. Does he agree with us that clause 119 represents a major departure from some of the statements that were being made by him and by others in this House when the Health and Social Care Act was going through?

[Paul Burstow]

I am grateful for that intervention. As I develop my argument, I think the right hon. Gentleman will hear where I sit on the spectrum of viewpoints. He may be interested in what I am about to say.

The second principle is that commissioners who have successfully managed the quality and demand in their area should not have decision making taken away from them. Decision making can be removed from the trusts that are failing, and this may mean that commissioners of such bodies have to accept unwelcome changes. But local decision making should remain in place where a local commissioner and provider are working successfully together. Thus the first purpose of my new clause is to seek to place with the commissioners of services at NHS foundation trusts and NHS trusts that are not in special administration the same decision-making powers as are given to commissioners of services of NHS trusts that have been found to fail and are in special administration.

At present the Bill creates two classes of commissioner. Where there is a trust in special administration, the clause provides that commissioners of services at that trust are able to define the services that the failing trust should continue to provide. The commissioners are thus entitled to ring-fence certain services that they feel must be preserved for the benefit of local patients. They are, in effect, given a veto on the extent of changes that can be made to a troubled trust because of the statutory objectives set for the administrator. The commissioners are thus able to act to preserve local services.

However, the present text of section 65DA does not give the same rights to the commissioners of adjoining trusts. They are relegated to second-class status. Clause 119 as drafted envisages that a special administrator is entitled to make recommendations for changes at trusts other than the trust in special administration which are not approved by local commissioners. In its present form clause 119 does not provide that the commissioners of the services at trusts other than the trust in special administration enjoy the same veto over the extent of any changes as the commissioners of a trust in special administration. There is a fundamental lack of parity of esteem between the different organisations and the different commissioners in a locality. It is that inequality that I am seeking to change.

--- Later in debate ---

[Andy Burnham]

I begin by thanking my shadow team, particularly my hon. Friends the Members for Leicester West (Liz Kendall) and for Copeland (Mr Reed), who have spent many hours trying to make sense of this unwieldy piece of legislation. I, too, want to thank members of the Public Bill Committee for their work, as well as the officials, Officers and staff of the House who enabled the Committee’s work to take place.

It is right also to pay tribute at this point to the Care and Support Alliance, a very important association of organisations working to be advocates and champions for some of the most vulnerable people in our society. The alliance worked with the previous Government and is working with this Government; indeed it works with all sides of the House. It can take some credit for some of the steps forward that are coming as a result of the Bill, and it is fair to say that there are some steps towards a better social care system.

I would argue that the Bill builds on the work of the previous Labour Government in that regard, particularly in the overdue recognition of carers. We welcome stronger legal recognition and rights for carers. We welcome better access to information and advice, which will make a difference to some people using the care system. The idea of portability—that if people move from one place to another, their entitlement to care goes with them—is a good principle and one that I put forward. We welcome the fact that it has been carried into the Bill. The principle of a cap on what people should pay for social care is in itself an important step forward. I recognise that but, as I will go on to say, we do not believe that all is at it seems.

There are measures in the Bill, as the Secretary of State said, to implement parts of the Francis report, such as the organisational duty of candour and moves to strengthen regulation. We welcome these steps but we would have encouraged the Government to go further.

The big problem with the Bill is the gap between what Ministers claim it does and what it actually does. It is not what it seems and it will not deliver on the claims made for it. Worse, it is no answer to the problems posed by an ageing society, and it is not equal to the scale and urgency of the care crisis that the country faces.

[Paul Burstow]

The right hon. Gentleman expresses concern about the care crisis. Why did he abstain in yesterday’s vote on the Local Government Association’s proposal that there should simply be an assessment of the adequacy of funding?

[Andy Burnham]

I do not think that the right hon. Gentleman is in a very strong position to talk about Members’ abstaining in votes on amendments. I shall say more about that shortly.

Let me now list three reasons for our argument that the Bill is not what it seems. First, as I have said, it is no answer to the care crisis. It proposes that a cap should be paid for by the restriction of eligibility for care, and the removal of care from some people who are already receiving it. Last week we heard from Age Concern that 800,000 people who had previously received support no longer received it. The problem is that local authorities are being asked to implement the system with no additional resources, and are therefore having to move funding from preventive social care to the administration and funding of the cap and the deferred payment scheme. Rather than taking from one area of social care to give to another, the Government should have put new resources into social care.

NHS

Debate between Paul Burstow and Andy Burnham

Wednesday 5th February 2014 Commons Chamber

[Paul Burstow]

The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.

[Andy Burnham]

The right hon. Gentleman seems to be arguing that the Health and Social Care Act 2012 is perfect—[Interruption.] It was his Act; he was a Minister. I quoted him in my speech as saying that it now needs to be amended. Will he be straight with the House this afternoon: does it need to be amended to remove the role of the OFT?

[Paul Burstow]

The right hon. Gentleman must be reading my notes as that was my very next point. One thing about our politics is that it is very difficult for people to admit their mistakes, so let me do just that today. I regret that we included in the 2012 Act a provision for the OFT to deal with the specific issue of mergers. At the time, the argument was that the OFT had the expertise, but it clearly did not. Monitor should have that role. I want to address that issue either through agreement—the Secretary of State has suggested how that might happen—or by amending the legislation. That is my view based on how things have developed over time, and one cannot be more straightforward than that.

[Andy Burnham]

Fair enough.

[Paul Burstow]

I thank the right hon. Gentleman.

The right hon. Gentleman spoke about Hinchingbrooke hospital and the franchising arrangement. The process started and was two thirds of the way through by the time the previous Government left office. There were only private sector providers in the competition when the previous Government left office—

[Andy Burnham]

indicated dissent.

[Paul Burstow]

I hope the right hon. Gentleman has had the opportunity to go and see what is happening at Hinchingbrooke, because it is doing fantastically well. It is being led by clinicians and is making a huge difference as a result. We should take heart from that.

Let me end by drawing out one point about A and E pressures. The situation is complex and driven by a multifactoral set of problems. There are seasonal changes, with high-volume, less complex A and E attendance in the spring and summer, and a pattern of fewer but more complex cases in the autumn and winter that often drive up admissions. It is also important to note that it is a question not just of an ageing society but of a rise in co-morbidity, which drives the pressures in our A and E departments. There are also changes in behaviour as people regard A and E as the first point of access for any ailment, driven by the fact that nine out of 10 GPs opted out.

In conclusion, the motion is flawed and does not celebrate the successes of this Government, not least in driving integration in a way that the previous Administration failed to do. For that reason and many others besides, it should not be supported and the Government amendment should be supported instead.

Accident and Emergency

Debate between Paul Burstow and Andy Burnham

Wednesday 18th December 2013 Commons Chamber

[Paul Burstow]

My hon. Friend is absolutely right. One of the good things that came out of the work by Keith Willett and Sir Bruce Keogh is the more coherent, communicable and understandable way in which emergency care can and should be organised. Indeed, in some cases there are also staffing pressures. Those are not helped by some of the unintended consequences of changing medical careers, as that has had an impact on the supply of medical doctors.

Labour’s answer seems to be that we should go back to the good old days—whatever they were—of a 48-hour target, but that target was flawed. When it was removed by the Government, the British Medical Association welcomed the change, which it said would give GPs greater flexibility to organise their appointments. Today we have heard—quite rightly—from the chair of the BMA, Dr Maureen Baker, who said the proposal was ill thought out and a knee-jerk response to long-term problems, and that it would make a bad situation worse.

[Andy Burnham]

Do not the views of patients matter most? The right hon. Gentleman is quoting the professionals, but perhaps it is sometimes inconvenient for them to have to do things. Surely the point is that people are ringing surgeries and cannot get appointments. If he does not like the 48-hour target, surely he and the coalition Government should put forward their alternative so that people can get to see their doctor.

[Paul Burstow]

With all due respect to the shadow Secretary of State, when presenting arguments in support of his motion he set out a range of professional expertise and opinions for why there should be a 48-hour target. It is therefore not unreasonable for me to quote other professional opinion on why that would not be good for patients. I will come to some of the alternatives that I think are relevant to addressing the A and E problem, because I do not think that simply addressing it through a 48-hour target makes any sense at all.

The changes the Government are making to the GP contract will help—not least having a named person co-ordinating care for the over-75s. I hope the welcome focus on frailty and multi-morbidity will be extended to more people on the basis of their need, not simply their age. Figures show that the average number of diagnosed conditions for patients admitted from A and E has increased over the past five years. In other words, the medical needs of people attending A and E are getting more complex, and that impacts on the amount of time people spend in A and E departments. Therefore, the answer is not one simple solution but must be a combination of actions. Much of that needs to be centred in primary and social care, as well as mental health services. In primary care we must recognise that it is not just about GP services and that we need best practice around the country, for example in engaging pharmacies as first care centres or getting them to play a key role in managing long-term conditions—a big driver of pressure on A and E departments, particularly in winter.

We need concrete action to drive the integration of health and social care—that may be mentioned in the motion, but the Government are delivering it, not least with the £3.8 billion first steps for a better care fund, which is bringing health and social care together in a practical and unprecedented way that has not been achieved before. That must be welcomed as a first step which I hope will grow as more resources are pooled across the system. It is essential to delivering the integrated, co-ordinated care that people want.

Mental health was neglected by Labour, under which there were no access standards or targets for people suffering a mental health crisis. In fact, under Labour two thirds of people suffering from a mental health crisis waited for more than four hours to be seen. I applaud what the Minister is doing to improve that situation significantly by setting standards for the first time to drive improvement in that area.

I conclude with a quote from Dr Clifford Mann, president of the College of Emergency Medicine:

“While this winter will be tough for the NHS and A and E departments in particular—”

I think we should acknowledge that—

“I believe there is now cause for optimism and that the crisis is behind us.”

Yes, there have been problems, but the Government have been addressing them in a comprehensive way. That is why this debate is mis-timed, wrong, and does our constituents no good whatsoever. It does not identify the real problem, although this Government are getting on with sorting the issue out.

Care Bill [Lords]

Debate between Paul Burstow and Andy Burnham

Monday 16th December 2013 Commons Chamber

[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.

[Paul Burstow (Sutton and Cheam) (LD)]

Will the shadow Secretary of State confirm to the House that the use of notional costs, which he is describing, was not a Government proposal but one of the Dilnot commission’s recommendations?

[Andy Burnham]

I remember that the right hon. Gentleman showed a good deal of support for the Dilnot proposals, as did we, but they worked as a clever package. They were carefully constructed to ensure that the system would work, be progressive and provide support to everybody. They have now been pulled apart and different figures have been introduced.

[Paul Burstow]

indicated dissent.

Health and Social Care

Debate between Paul Burstow and Andy Burnham

Monday 13th May 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I want to concentrate my remarks on social care, because all too often in debates entitled “Health and Social Care” we tend to spend most of our time debating health, and yet our social care system is absolutely vital in regulating health care costs and delivering a better-quality health service. The Bill announced in the Queen’s Speech—it was indeed published on Friday—goes a long way towards laying some important foundations for a better social care system.

The Care Bill attempts to address a number of long-standing flaws in the system that have developed over the past 60 years through a series of piecemeal measures enacted by successive Governments. It is essential that in considering this over the next few months we make sure that we get it right, because legislation in the social care sphere comes to the House very infrequently. Our care and support system is of key importance because the rapid age shift that is taking place in our population is profoundly changing the nature of the demands on the system. It is important to note that this is not just about ageing; it is about the complex co-morbidities of long-term health conditions, both physical and mental, that are at the heart of the serious pressures on our whole system.

Our social care system has a number of features that need to change. It is too oriented around crisis and stutters into life when things have already gone wrong. It does not enable people to plan successfully for future care needs or, indeed, to prevent and postpone them. It does not provide adequate signposting, information, advice and advocacy for people to secure what they need from it, making it feel too much like a fight to get what is necessary. There is a lack of recognition of, and support for, family carers. Quality is variable around the country. We have heard announcements today about co-ordination of care and continuity, which is clearly a problem too. The costs of care are a lottery, and that needs to be addressed.

The Bill is taking all this forward. It focuses on early intervention and prevention, with a new responsibility for that to be up front in the way that local authorities plan their services. There are new duties on information and advice. I welcome the fact that the Government have agreed that the Bill should specifically refer to financial advice as being part of the legal obligations. There are new rights for adult carers—I will talk about young carers in a moment—with a lower threshold of eligibility for services. That is very welcome. A new rating system is being established to assist with quality of care and to help providers themselves to benchmark their performance.

[Andy Burnham]

I know that the right hon. Gentleman is very knowledgeable on this subject, but does he believe that councils have sufficient resources to consider new rights, given that we hear that care is collapsing all over the country and the Local Government Association says that if nothing else happens councils will be overwhelmed by the costs of care in less than 10 years?

[Paul Burstow]

I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.

The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.

I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill, which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.

The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

Adult Social Care

Debate between Paul Burstow and Andy Burnham

Monday 16th July 2012 Commons Chamber

[Paul Burstow]

I am not certain which thing the hon. Gentleman is inviting me to support. Many measures were introduced by the coalition Government in Scotland over a number of years to reform the social services system in Scotland, not least some relating to adult safeguarding which this Government are now making progress on.

[Andy Burnham (Leigh) (Lab)]

I think that the Minister has unfairly misrepresented the process we went through in the last Parliament. We did not just have a White Paper before the general election. We had a Green Paper in the summer of 2009, and the whole process was kicked off in the 2007 spending review. Upon a request from the then shadow Health Secretary, I agreed to cross-party talks. So the Minister is unfair in saying that nothing was done and then a rabbit was produced from the hat. May I say to him that the White Paper that I produced before the election addressed both service reform and funding? I am afraid that the same could not be said of the White Paper that emerged last week.

[Paul Burstow]

That is interesting, because the White Paper that was published seven days before the general election was called carried no details on who should pay, what they should pay or when they should pay. It contained no details of that sort, and I urge people to read it and compare it with the White Paper, draft Bill and other details that we published just last week. In 13 years, when the money was available, the Labour Government did not do anything; they left it until the last seven days and even then did not come up with the details.

In the space of two years, this coalition Government have advanced further and faster than any in the previous 20 years on addressing a wide range of issues and challenges and backing that with tangible action. Unlike what happened with Labour’s royal commission, so firmly kicked into the long grass, this Government have accepted all the recommendations of the Dilnot commission as the basis for a reformed system. Many of those recommendations are translated into the legislation that we published last week. Crucially, the Government accept the principles of a capped cost system as the basis for protecting people from catastrophic costs. Labour’s motion seems to suggest that Labour does, too. I want to make it clear that we are keen, still, to engage with the official Opposition and other stakeholders in reaching a final settlement on this question of the boundary between the state’s responsibility and the individual family’s responsibilities for meeting care costs.

--- Later in debate ---

[Paul Burstow]

I am grateful to the hon. Lady for her question, because it allows me to talk about some of the points I think will directly address it. Reform of our care and support system is about more than just who pays for care; it is also about some other very important issues. A central proposition in the White Paper we published last week concerns the move from a service focused on managing crisis, and often not doing so very well, to one focused on supporting people’s well-being by concentrating on early intervention and prevention. That is why, alongside the White Paper, we published a draft Bill that will underpin the reforms we intend to make, consolidating, simplifying and modernising the legislation. The Bill sets out for the first time in statute some very clear governing principles about how decisions are made in social care, focusing on people’s well-being and living by the idea set out by our first White Paper in government of “No decision about me, without me”.

The Bill sets out a number of important changes that go to the heart of people being able to plan, prepare and have proper choice about the care available to them. First, it makes it a requirement for local authorities to ensure that there is a universal offer of information and advice so that people can plan and prepare. Secondly, it requires for the first time local authorities to focus on prevention. Thirdly, it requires a sufficiency of quality care so that choice is available to people locally. Fourthly, it requires integration and co-operation not just between the NHS and social care but between those agencies and housing.

The Bill will not only do that; it will simplify the point of entry into the state system. It will ensure consistent national eligibility and, for the first time in Government legislation, will ensure that there are rights for carers not just to an assessment of their needs but to support for those needs. It will also deal with the often mentioned issue of protection from disruption when people move from one part of the country to another or when a child moves from children’s services to adult services. It will guarantee continuity of services, which is not currently provided for.

Personal budgets, which were started by the Opposition but have not stuck well because of the legal framework, will for the first time be given a clear legal basis. I am delighted to say that whereas when this Government came to office in 2010 we inherited 168,000 people receiving personal budgets, by March of this year 432,000 people were benefiting from them. There will also be clear legal duties on the NHS, police and councils to safeguard people.

At the heart of our White Paper reforms is the notion that we need less variability on quality, to ensure that providers are responsible for driving up quality and accountable for doing just that, and to have more and open information about the quality of provision. That is why our provider quality profiles will provide that information in a way that will allow people to compare and rate providers for the first time and why we are putting an extra £32.5 million in to support those services.

[Andy Burnham]

The Minister is mentioning the things in the White Paper that he will ask councils to do. Can he give us a figure tonight for how much the Government have estimated that the cost to councils will be of providing all those things and tell us how councils will pay for it?

[Paul Burstow]

I will come on to give a specific figure in a moment, so the right hon. Gentleman will have to be patient.

I wanted to pick up again on the point about the White Paper ruling out crude contracting by the minute—a culture of clock-watching which has been allowed to grow up for years in too many places and which is not good for dignity, respect or quality. Under the Labour Government there were years and years of delay and dither when it came to addressing the quality of care workers and health care assistants. This Government are putting in place a code of conduct and national minimum training standards, and will double the number of people able to access apprenticeships in the care sector to 100,000.

Mental Health

Debate between Paul Burstow and Andy Burnham

Thursday 14th June 2012 Commons Chamber

[Andy Burnham]

We must. Perhaps I am about to make more of a political point, but as has been mentioned so eloquently today by my hon. Friend the Member for North Durham, as well as the hon. Member for Strangford (Jim Shannon), although the trend is upwards—that is happening come what may: I mentioned the financial crisis, during which the rate has jumped up, including in our time in government—the cumulative effect of some of the benefits changes on some of the most vulnerable members of society, coupled with the withdrawal of social care support by councils, means that, right now, some people out there are suffering very badly indeed. That is part of the explanation for the worrying figures that my hon. Friend has just given the House. The Government need to have a look at what is happening out there and whether or not some people are struggling with mental health problems because of the extra stress that other factors, particularly financial, are putting upon them.

I welcome the Minister’s commitment to the improving access to psychological therapies programme, but I hear that waiting times for it are increasing in parts of the country where GPs face much longer referral times. Indeed, a Mind survey of 2011 said that 30% of GPs were unaware of services to which they could refer patients, beyond medication. That tells us that we still have quite a long way to go. IAPT needs protecting and nurturing; it needs to come with a national direction in the operating framework. In the new and changing NHS world, we cannot allow it to be simply whittled away. More broadly, we need to look carefully at commissioning and find out whether GPs have the right skills to commission properly for mental health. We need to consider what the precise commissioning arrangements for mental health are, as there is still some confusion out there about them.

[Paul Burstow]

One of the key aspects of the NHS Commissioning Board’s work in authorising clinical commissioning groups will be to assess their capacity to commission in mental health. As I am sure the right hon. Gentleman knows, the Royal College of General Practitioners is currently exploring what the extra year of education and training will involve, as we move forward to ensuring that mental health is part of it. I think it is a very important innovation.

Health and Social Care Bill

Debate between Paul Burstow and Andy Burnham

Tuesday 20th March 2012 Commons Chamber

[Andy Burnham]

I am not going to debate that now. The right hon. Gentleman is going to have to defend himself on whether he has his facts right. I do not think that he has.

We need to put firmly on the record that there are real flaws in the Liberal Democrats’ proposal. They say that it is a safeguard to state, “The governors will decide and it is better done at a local level,” but the governors are going to be under pressure from the management of the hospital because of the pressure on the hospital’s finances. If they make a decision that is in the interests of that hospital, it does not mean that it is in the interests of everybody and of NHS patients.

[Paul Burstow]

The model that the right hon. Gentleman describes is one that he was only too happy to go through the Lobby and support during the introduction of foundation trusts in the first place. He has omitted to mention Monitor’s role in overseeing the situation through its powers of intervention to ensure the safeguarding of a comprehensive health service, and to mention the guidance that the Secretary of State will give Monitor in order to do just that.

[Andy Burnham]

I am afraid that I am not at all reassured by that, or in fact by anything the Minister says. The letter that we have from the Deputy Prime Minister spoke of insulating the NHS from European competition law, but I am still waiting to see the amendment that delivers that. As I understand it, one of the Minister’s noble Friends tabled an amendment and then withdrew it, because they did not have the courage to press it to a vote, and accepted a statement on the record instead. This is different from what the Minister keeps saying that we did in government, because he is envisaging a huge expansion of the role of any qualified provider and the putting out to tender of commissioning support units. He has overseen a situation in which three community services have been compulsorily tendered.

The truth is that the Clegg-Williams letter, with the amendments that followed, does not only fail to deliver but sells out the national health service, as does so much of what the Liberal Democrats have agreed to. Our amendments, particularly amendment (b), would provide a measure of systems regulation in the best interests of the NHS, and that is why we will seek to press amendment (b) to a vote.

--- Later in debate ---

[Andy Burnham]

rose—

[Paul Burstow]

rose—

Adult Social Care

Debate between Paul Burstow and Andy Burnham

Thursday 8th March 2012 Commons Chamber

[Paul Burstow]

The right hon. Gentleman made those remarks ahead of the spending review in 2010. The spending review also gave the Government the opportunity to make announcements about social care spending, and it is when we committed £7.2 billion extra for social care support. We have to challenge local authorities to use those resources wisely. Indeed, I hope that he will join me in challenging local authorities to commit to spend the resources that the Government have allocated for social care on social care.

[Andy Burnham]

Yes, I will. There is no difference between us on that, but there is a difference between us on the funding position that the Minister has set out. The King’s Fund and others have identified that there is a £1 billion funding gap in adult social care in England, not just because of the money but because of the demographic pressures, which we cannot get away from.

The Government’s commitment was to give more money to the health service, but we have produced figures showing a real-terms cut in outturn last year, and we also notice that transfers—indeed, recent transfers—have had to be made to the social care system, which implies that the Government have left it short, and that there is an emergency propping-up of the system, revealing the flaw in their position.

Oral Answers to Questions

Debate between Paul Burstow and Andy Burnham

Tuesday 21st February 2012 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

My hon. Friend is right about the need to invest in early intervention and prevention. In addition to the £7.2 billion that we will invest this Parliament, this January we announced an extra £120 million for the remainder of the year to support care services. Furthermore, we are funding, jointly with the Local Government Association, work to support councils in delivering improved productivity and sharing best practice to ensure that they deliver improvements to services, and not just cuts.

[Andy Burnham (Leigh) (Lab)]

The Secretary of State said that he would listen to doctors and nurses but yesterday shut the door of No. 10 Downing street in their faces. But now things take a sinister turn. Let me quote from a letter from an NHS director received last week by a respected clinician of many years’ standing:

“I understand that you are a signatory to a letter which highlights your personal concerns about the Health Bill. It is inappropriate for individuals to raise their personal concerns about the proposed Government reforms. You are therefore required to attend a meeting with the Chief Executive to explain and account for the actions you have recently taken.”

Will he confirm that it is now his policy to threaten NHS staff with disciplinary action if they speak out against his reorganisation?

National Health Service

Debate between Paul Burstow and Andy Burnham

Wednesday 26th October 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

indicated dissent.

[Andy Burnham]

Ministers are shaking their heads, but I will read them the Treasury figures published in July this year, and let them tell me then that what I have just said is not true. The public expenditure statistical analyses from this year provide official confirmation of what I have just said. They show that in 2009-10 health spending was £102,751 million. That was in the last year of the Labour Government. In 2010-11, health spending was £101,985 million. There we have it in black and white—the first real-terms cut in health spending for 14 years. In fact, it is the first real-terms cut since the last year of the last Tory Government in 1996-97.

Oral Answers to Questions

Debate between Paul Burstow and Andy Burnham

Tuesday 18th October 2011 Commons Chamber

[Paul Burstow]

If the hon. Gentleman would care to write to me setting out where he believes there are inaccuracies, we will examine them.

[Andy Burnham (Leigh) (Lab)]

It is good to be back. I see that in my absence, the Secretary of State has at last made some progress with his plans for a US-style health care system.

I have a letter sent by the practice that my hon. Friend the Member for Warrington North (Helen Jones) mentioned a moment ago, in which it wrote that

“we can no longer offer your procedure as one of our NHS services…I am writing to make you aware of some of the options that you have to have the procedure completed as a private patient.”

Helpfully, it enclosed a leaflet announcing the practice’s new private minor operations service. Can the Minister point me to any part of the Health and Social Care Bill that will prevent that practice in future?

[Paul Burstow]

I wonder whether the right hon. Gentleman could have pointed me to any such arrangements in current legislation. There is none. However, Dr David Geddes, the medical director of NHS North Yorkshire and York, has stated:

“We have some concerns about the activities of the Haxby and Wigginton health centre in York and we will be discussing these issues with them directly as a matter of urgency. These concerns are around possible breaches of the Data Protection Act and the accuracy of the information sent to patients. For example, of the eight procedures they list, three are routinely funded by NHS North Yorkshire and York”.

Let us be clear that when he was Secretary of State, that PCT was in a worse financial state.

[Andy Burnham]

That is total bluster, because that vision is precisely what the Government want to do to our NHS. As my hon. Friend the Member for Warrington North said, it is a terrifying glimpse of a Tory NHS in future—not a national health service but a postcode lottery writ large, in which, as we read today, random rationing is taking place around the country. The NHS is in chaos because the Secretary of State made the mistake of combining a £2.5 billion reorganisation, at a time when every ounce of energy should be focused on the NHS front line. This Secretary of State has placed our national health service in the danger zone, and he has lost the confidence of GPs, nurses and midwives. Is it not time that he stopped digging in, listened to NHS staff and dropped this damaging Bill?

[Paul Burstow]

That was a good example of bluster—perhaps that is what we will see from the Opposition under the right hon. Gentleman’s stewardship.

The right hon. Gentleman ought to be aware, because it happened on his watch, that primary care trusts and strategic health authorities have seen their management costs increase by more than £1 billion. There was a 120% increase from 2002 to when this Government took office. That is why we are determined to cut overhead costs in the NHS, so that we can reinvest every penny in the front line.