National Health Service Debate
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Simon Burns
Main Page: Simon Burns (Conservative - Chelmsford)Department Debates - View all Simon Burns's debates with the Department of Health and Social Care
(12 years, 5 months ago)
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Andy Burnham
I will give way to the Chair of the Select Committee in a moment.
Wherever we look, we see warnings of an NHS in increasing financial distress, yet according to Ministers everything is fine. The gap between their complacent statements and people’s real experience of the NHS gets wider every week. They are in denial about the effects of their reorganisation on the real world. That dangerous complacency cannot be allowed to continue.
The Minister of State, Department of Health (Mr Simon Burns)
In the light of what the right hon. Gentleman has just said, will he clear up this confusion? His leader, the right hon. Member for Doncaster North (Edward Miliband), has said that he would keep clinical commissioning, yet the shadow Secretary of State has just said that he would repeal the Act in toto, which would include the provisions on clinical commissioning.
Andy Burnham
I have heard the same from staff throughout the system. Morale has never been lower. People have been badly let down by a Government who promised them no top-down reorganisation, a moratorium on hospital changes, and real-terms increases. None of those things has been delivered. During the run-up to the general election the Conservatives cynically used the NHS to try to gain votes, and they will pay a heavy price for breaking the promises that they made then.
Andy Burnham
I will give way to the Minister one more time, and then to my hon. Friend the Member for Eltham (Clive Efford), but after that I must make some progress.
Mr Burns
I am grateful to the right hon. Gentleman. Although he did not answer the question that I asked him earlier, he did spread more confusion. If he were ever in a position to repeal the entire Act and did so, given that the strategic health authorities and the primary care trusts will have long since gone, how does he envisage care being commissioned for patients?
Andy Burnham
The Minister seems to equate removal of the Act with bringing back PCTs and SHAs. I do not have a problem with clinical commissioning, and I said as much during the Bill’s passage. I introduced it myself. I do not have a problem with clinical commissioning groups; my problem is with the job that they are asked to do, and the legal context in which they are asked to operate. We reject the Secretary of State’s market, and that is why we will repeal his Act.
The Minister of State, Department of Health (Mr Simon Burns)
The motion that we are debating today is typical of the Opposition. Rather than praising the NHS in a year of change, they seek to denigrate it. Rather than commending the hard work and dedication of NHS staff, they undermine their efforts and belittle their results. Rather than supporting the parts of the NHS that are dealing with long-term financial challenges—challenges that were partly of the own making of the right hon. Member for Leigh (Andy Burnham)—they attempt to scaremonger.
In truth, this has been a year that has tested the NHS, which has dealt with significant financial pressures as well as the transition to the new system, but it is also a year in which the NHS has proven its mettle. Far from the meltdown that some gleefully predicted, we have seen a robust and resilient NHS delivering better care for patients.
Mr Burns
In a minute.
I know that waiting times mean a great deal to the right hon. Member for Leigh, so let us have a look at the numbers. Despite what he peddles around the country, waiting times remain low and stable—in fact, below where they were at the last general election. In May 2010 more than 18,000 people waited more than a year for treatment. Today that figure is just 4,317. Today 55,335 people wait more than six months for treatment—almost half the figure of 100,979 at the last general election. There are 149,912 people now waiting more than 18 weeks, compared with 209,411 in May 2010. The median wait for admitted patients has fallen in that time from 8.4 weeks to 8 weeks, and for non-admitted patients from 4.3 weeks to 4 weeks. Across the country, all NHS waiting time standards for diagnostic tests and cancer treatment have been met.
Mr Slaughter
The Minister talks about scaremongering. For seven years my constituents put up with scaremongering from his party that Charing Cross hospital was going to close. The services there expanded. After two years of his Government, the hospital, 500 beds, and the accident and emergency department are closing and being replaced by an urgent care centre, which will treat only minor injuries. What will that do to his statistics?
Mr Burns
I am slightly surprised that the hon. Gentleman made that intervention because it rather proves my point about scaremongering. He said that is going to happen. The truth is that the local NHS has determined locally what it believes is the best reconfiguration of services. That is going out to public consultation and so far no decisions have been taken because the consultation process has only just started. It will last for 14 weeks and then the results of that consultation will be considered.
Mr Burns
I will now make progress.
To return to waiting times and the record as a fact, rather than the fiction that Opposition politicians like to peddle, 96% of patients wait for fewer than four hours in accident and emergency, and every ambulance trust in England meets its core response times.
Andy Burnham
On accident and emergency waiting times, let us be clear. In the 2013 year to date, has the NHS met the 95% target or not?
Mr Burns
I shall make a little more progress.
Let us not stop at waiting times. The £600 million cancer drugs fund that has helped more than 12,500 patients to access the drugs previously denied to them, the screening programmes for breast and bowel cancer, potentially saving an extra 1,100 lives every year by 2015, the world-leading telehealth and telecare whole systems demonstrator programme, which saw a stunning 45% fall in mortality and is set to transform of 3 million people with long-term conditions over the next five years—
Henry Smith (Crawley) (Con)
Earlier this year I was delighted to be able to open a new digital mammography unit at Crawley hospital, a hospital which under the previous Government saw its accident and emergency unit closed down. Does my right hon. Friend find it odd that the Opposition refuse to match the spending commitments on the NHS that this Government are delivering?
Mr Burns
My hon. Friend is right. As he would probably expect, I shall deal with that issue later in my speech. While I am responding to his intervention, let me say that not only was his hospital fortunate in having that fantastic equipment to look after his constituents, but I had the pleasure last week to be in his constituency to visit Elekta and Varian, which are world leaders in making equipment to help with radiotherapy.
Valerie Vaz
The Minister is very fond of statistics. Can he say whether GP referrals have gone up, and whether A and E admissions have gone up or down?
Mr George Howarth
The Minister said in his opening remarks that Opposition Members are denigrating NHS staff and their achievements. Does he accept that if he has any conversations with NHS staff, he will find the reverse—they feel that they are being denigrated by this Government and their reforms?
Mr Burns
I do not like to contradict the right hon. Gentleman, but I will. What I said was slightly different from what he accused me of saying. What I said was that rather than praising the NHS in a year of change, the Opposition denigrate it. That is slightly different.
To pick up on a point that the right hon. Member for Leigh mentioned from a sedentary position, GP referrals for 2011-12 were 1% lower than in the previous year, but outpatient referrals were, as I said, slightly higher.
Mr Burns
If my hon. Friend will allow me, I would like to make some progress. If the opportunity arises, I will give way to him then.
I could stop after reporting all that good news, but I do not see why I should when there is so much more to praise the NHS for. It gets little praise for its performance from the Opposition. I want to praise the fact that patients are reporting better outcomes for hip and knee replacements and for hernias, and the fact that the latest GP patient survey showed that 88% of patients rated their GP practice as good or very good. MORI’s independent public perceptions of the NHS survey shows satisfaction with the NHS remaining high at 70%.
In the patient experience survey, 92% of patients who had used the NHS in the past year rated their care as good, very good or excellent. Mixed-sex accommodation breaches are down an incredible 96% since we came to power, although of course the Opposition often claimed to have eradicated that problem—not so, alas. MRSA infections are down 24% in the year, and C. difficile infections down 17%. More than a million more people have an NHS dentist. No reasonable person could look at the performance of the NHS over what has been a challenging year with anything but admiration and pride. I, too, would like to take this opportunity to praise NHS staff for their hard work and dedication and the excellent results they are delivering for patients.
Angie Bray (Ealing Central and Acton) (Con)
Will my right hon. Friend give way?
Andrew Percy
Will the Minister condemn Labour party representatives in Goole who, despite the fact that under Labour we saw ward closures and mental health in-patient beds go, recently gave the media incorrect waiting list times, and will he confirm that in North Lincolnshire 93% of patients are seen within 18 weeks, which is far ahead of the national target? The Labour party needs to stop talking down our local hospital.
Mr Burns
If hon. Gentlemen and Ladies will bear with me, I would like to make some progress, because this is a short debate and many hon. Members would like to participate, but I will give way later.
The motion, like the right hon. Member for Leigh, mentions a fall in spending on the NHS of £26 million in 2011-12. I will give him one statistic: £12.5 billion. There will be £12.5 billion extra for the NHS in this Parliament, £12.5 billion that would never have been made available had he had his way, as he said that to do so would be irresponsible. That is exactly what his party is doing in Wales, where it is in control of the NHS. It is cutting the NHS budget in Wales by 6.5% in real terms from 2011-12 to 2014-15. His motion talks about a £26 million underspend, but what he does not understand is that there has been a real-terms increase in funding for the NHS this year. Because we are no longer wasting hundreds of millions of pounds on a bloated bureaucracy and the national programme for IT, we have been able to save an extra £1.1 billion in real terms from the back office and put it into front-line care.
Andy Burnham
So that there is no confusion, because this is a very important matter, I will quote from a Department of Health press release of Friday 6 July:
“PESA figures released today show that in real terms NHS spending has reduced slightly by 0.02%.”
For the record, will the Minister say whether NHS spending rose or fell over the last financial year?
Mr Burns
Just wait. But, as he has said, and as I have said about the £26 million—[Interruption]—there was an underspend in the NHS and that money, as he will know, because of the financial arrangements his party put in place for the NHS in 2004, will be ploughed back into the NHS over the next three or four years as extra spending. We will put in more money for front-line clinical staff, including more than 4,000 doctors—more money for doctors and treatments and for improving patient outcomes. Spending on front-line NHS services has increased by £3.4 billion in cash terms, or 3.5%, compared with last year.
Mr Burns
Not at the moment.
The motion states that seven out of every 10 acute hospital trusts in England missed their savings targets for the first half of 2011-12, referring to their cost improvement plans. Not only did the right hon. Gentleman use out-of-date figures—figures for the whole year are now available—but he again misrepresented what they mean for the performance of the NHS. Across the NHS, acute NHS trusts plan to save £1.3 billion during 2011-12. In the end, they saved £1.2 billion. More than half—57%—of the shortfall was concentrated in just 10 NHS trusts in significant financial difficulties— 10 NHS trusts that he ignored when he was Health Secretary but that we are getting to grips with. I would point him instead to the £4.3 billion of efficiency savings made in 2010-11 and the further £5.8 billion of efficiency savings made in 2011-12. Primary care trusts and strategic health authorities have reported a surplus of £1.6 billion in 2011-12, money that is being carried forward and made available for 2012-13 and thereafter.
Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab)
Will the Minister give way?
Angie Bray
As my right hon. Friend is aware, the proposal is to downgrade four accident and emergency departments across London that are all right beside my constituency. Does he agree with my constituents that losing four accident and emergency departments is disproportionate and will mean a significant loss of service for them locally?
Mr Burns
What I will say to my hon. Friend is similar to what I said to the hon. Member for Hammersmith (Mr Slaughter): that is a reconfiguration that is in progress and has been put together locally by the local NHS. It has just gone out to consultation and, obviously, when the process is complete the responses will be considered before any final decisions are made on the best way to provide care for her constituents and those of Opposition Members so that they can get the quality of care and the relevant care in their area. At the moment, when there is a consultation process going on, it would wrong of me to comment on a local decision, but I certainly urge my hon. Friend, her constituents and others to get involved in the consultation so that all views can be considered.
Mr Burns
I will now make some progress.
The motion seeks to give the impression that NHS care is being rationed. That is worse than inaccurate: it is scurrilous nonsense and scaremongering on a grand and somewhat desperate scale. [Interruption.] I will come to cataracts in a moment. We did some rudimentary checking of our own into the veracity of those claims, which were originally made as part of the Labour party’s NHS health check. It was not long before it became abundantly clear that that was not worth the press notice it was printed on. It claimed that there was a blanket ban by NHS Hull on the removal of risk ganglia. We spoke with NHS Hull and found that there is no such ban. It claimed that 11 out of 100 PCT clinical commissioning groups restrict laser revision surgery for scars, but such cosmetic surgery has never been routinely available on the NHS, under either this Government or the previous Government, when the right hon. Member for Leigh was Secretary of State. It claimed that weight-loss treatment is restricted, stating that
“patients generally have to be over 18 and have a BMI over a certain level to receive weight loss surgery”.
Amazing—people actually have to be overweight to be entitled to weight-loss surgery. I would have thought that that was startlingly obvious, but obviously the right hon. Gentleman does not think so.
Andy Burnham
Is the Minister aware that the National Institute for Health and Clinical Excellence guidance recommends that bariatric surgery should be offered only to people with a BMI of 40? Is he also aware that numerous PCTs all over the country are restricting access to that surgery by introducing their own arbitrary limits? That is evidence of the rationing I am talking about. He will know that the NHS constitution guarantees people access to NICE-approved treatments, so why does he not take action on those PCTs that are standing outwith the NICE guidance?
Mr Burns
What the right hon. Gentleman rather cunningly does not mention—[Interruption.] I am answering the question, if the hon. Member for Copeland (Mr Reed) can just keep quiet for a second. The right hon. Gentleman says that the NICE guideline refers to a BMI of 40, and that is absolutely correct, but I point him in the direction of one area in central London that does not go by that guideline, because it uses a BMI of 35, which is lower.
Mr Graham Stuart
Is my right hon. Friend as confused as I am by the Labour party’s policy? The right hon. Member for Leigh (Andy Burnham) could not explain where public health would go; he wants to repeal the Health and Social Care Act 2012, although he wants the services to be shaped as the Act says; and on funding he said in June 2010:
“It is irresponsible to increase NHS spending in real terms”.
That is the Labour party’s policy: it is chaotic and makes no sense. Can my right hon. Friend please tell us whether he sees more sense in it than I do?
Mr Burns
I am afraid that I cannot help my hon. Friend, because the policy is contradictory and does not make sense.
The right hon. Gentleman talks about repealing the 2012 Act, which includes the clinical commissioning groups, but if he abolishes them there will be no other mechanism from 1 April next year to commission care for patients, so there will be no one available to commission care for patients, which seems stunning.
The right hon. Gentleman talks about funding, and his quotations—my hon. Friend the Member for Beverley and Holderness (Mr Stuart) mentions one—are quite clear: he disapproves of giving real-terms increases in funding to the NHS. In Wales, the Welsh Labour Government have taken him at his word and are cutting spending, which we are not very enthralled by.
Mr Burns
I will now make progress.
Treatments available on the NHS are based on clinical need. There should never be any arbitrary rationing based on cost either locally or nationally—[Interruption.] The right hon. Member for Leigh shouts from a sedentary position, “There is”, and waves a piece of paper a little like Chamberlain on his way back from Munich, but if the piece of paper that the right hon. Gentleman is waving is his NHS health check, which officials in my Department have looked at, it is as worthless as the piece of paper that Chamberlain brought back from Munich.
If the right hon. Gentleman has any genuine evidence based on the cost of care, I and the Department of Health will certainly investigate it. Such practices are totally unacceptable, and we will take them very seriously indeed, but until then, although the motion talks about “the evidence presented”, the truth is that there is none.
The right hon. Gentleman claims that the number of cataract operations has fallen significantly since we came to power, but the reason for the fall is that clinicians have advised that the surgery is inappropriate in many cases—on clinical grounds. Surgery is available, however, for those patients who are clinically eligible, and they will receive it when there is a clinical reason.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will the Minister give way?
Mr Burns
No, I am making progress.
The motion notes the growing involvement of the private sector, insisting that it represents evidence of growing privatisation. Not only is that unadulterated tosh, but I personally find it offensive to be accused of seeking to privatise the NHS, when in my political philosophy one of my core beliefs is in an NHS free at the point of use for all those eligible to use it.
Not only does the right hon. Gentleman have some difficulty understanding the meaning of “privatisation”, but he forgets his own record in government. The only plan to increase the private provision of NHS services came under the previous Government when he was Minister, when his hon. Friend the Member for Leicester West (Liz Kendall) was the special adviser and when Patricia Hewitt was Health Secretary. In May 2007, the right hon. Gentleman said:
“Now the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”
Those are his words. It was his Government who saw private companies paid 11% more than NHS providers for doing the same work, and who wasted £297 million on operations that never happened at independent sector treatment centres. Given that he may have forgotten, I must tell him that the Labour party manifesto in 2010, when he was the Secretary of State for Health, stated:
“Foundation trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values”.
That suggests that, as Secretary of State, he was prepared to have in his own party’s manifesto a policy allowing and encouraging foundation trusts to attract more work from the private sector.
This Government’s Health and Social Care Act 2012 specifically prohibits the Secretary of State, Monitor or the NHS Commissioning Board from favouring any type of provider, be they from the NHS, the charitable sector or the independent sector. It does so because this Government understand something that the right hon. Gentleman’s never did—it is not the nature of the provider, but the quality of the outcomes that matters most to patients.
Mr Burns
No, I will not.
The motion speaks of the
“increasing number of cost-driven reconfigurations of hospital services”.
The reconfiguration of NHS services must always be led by a desire to improve patient care and patient outcomes. As lifestyles change, as needs and expectations grow and as technology develops, the NHS must respond. This Government are very clear that the reconfiguration of services is a matter for the local NHS, and that the best decisions are those taken closest to the front line and tailored to the needs of the local population. But, when making those decisions, it is imperative that the NHS carries the support of local people, patients, carers and clinicians.
The principle is enshrined in the four tests that my right hon. Friend the Secretary of State set out in 2010: all local reconfiguration plans must demonstrate support from clinical commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice.
Mr Burns
The right hon. Member for Leigh equates the coalition agreement’s promise of a temporary moratorium on changes to hospital services, with a commitment to hold the NHS in a permanent state of suspended animation. The moratorium was needed to put a stop to the arbitrary reconfigurations that his Government instigated—reconfigurations that lacked the support of local clinicians, lacked a clinical evidence base and lacked basic democratic legitimacy. This Government and the Secretary of State have put that right.
Now I turn to another issue that the right hon. Gentleman raised and which is of considerable importance, given what has—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Hon. Gentlemen, the Minister has given way quite a bit, and I am sure that if he wishes to give way he will let you know. You do not need to keep standing and hovering for so long.
Mr Burns
Thank you, Mr Deputy Speaker. Because I want to make progress so that other people can contribute, I will not accept any more interventions.
On the South West Pay Consortium—[Interruption]—an issue on which I hope the right hon. Member for Leigh will listen, given that during his speech he seemed keen to hear the Government’s response—the Government’s position is clear: it is for employers, not for the Government, to lead negotiations on the terms and conditions of their staff, and to do so with the agreement of staff.
This Government are committed to the principles of “Agenda for Change”, a national framework. The ongoing negotiations on “Agenda for Change” are about ensuring that patients and taxpayers get the maximum value for money from every penny spent on the NHS, and that it is spent efficiently and effectively. The negotiations are not about a pay cut, and we would not support one.
The Health Act 2006, brought in by the previous Government when the right hon. Gentleman was the Minister of State in the Department of Health, gives NHS trusts the power to set their own terms and conditions. Although they are free to opt out of the national pay framework, they cannot do so unilaterally; they must consult and seek agreement with their staff and representatives.
Almost all trusts have until now chosen to stay on national terms and conditions. I believe that most still want to, but that has to be fit for purpose and fit for the future. Only one trust—Southend—has opted out of “Agenda for Change”. [Interruption.] The hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) may be a Whip, but he is rather foolish to fall into the trap that I have just set. That trust opted out of “Agenda for Change” under the last Labour Government. Perhaps he would like to apologise.
Pay is the largest element of NHS costs, and pay systems must evolve. The trusts in the south-west wish to work and negotiate with the trade unions to agree changes, not to dismiss and re-engage staff.
Mr Burns
The hon. Lady only recently walked in. She has not been here from the beginning.
I call on the unions to respond positively to the issue and the national discussions on “Agenda for Change”. I also hope that the Opposition will support the policies that they put in place when in government.
The Opposition have used this debate to make yet another sorry attempt to paint a distorted picture of the NHS. That is wrong. The shadow Secretary of State pours scorn on the performance of the NHS, while we admire the excellence of the staff; he belittles their achievement while we laud them; he scaremongers, while we present the truth more transparently than at any other time in the history of the NHS.
The accusations in the motion are simply wrong, and I ask my right hon. and hon. Friends to join me in the Division Lobby at the end of the debate to defeat the motion.