National Health Service
Debate between Simon Burns and Andy Burnham(9 years, 11 months ago)
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Mr Burns
No, I will not, because I only have eight minutes.
What I decry, however, is when, in the generality, the health service is used to attack a political party, whether the Government or whatever, simply to try to score cheap party political points. That does a grave disservice to the NHS. As the right hon. Member for Manchester, Gorton said, people in this country love the health service. They believe in it, free at the point of use for all those who are eligible to use it. I, like I imagine millions and millions of taxpayers, have no objection to paying our taxes to have a free health service. To appropriate the four freedoms of Franklin Roosevelt, there is a fifth freedom: the freedom from fear of a medical bill dropping on one’s mat and financially ruining one’s family.
Where I see the greatest and, to my mind, the most disgraceful attack is in the accusation, which is not new—it was being made in 1979, and, I suspect, before then, but fortunately I am a bit too young to remember exactly—that the Conservative party wants to privatise the health service. We do not and we never have done. As long as I am a politician, and my right hon. Friend the Prime Minister is, we never will. I find it extremely aggravating and hurtful when this cheap shot is made.
One of the examples of privatisation given is the use of the private sector to improve and enhance the health care of our constituents. Let me just explain something. Over Christmas, I read an extremely good new book, which I strongly recommend to the right hon. Member for Leigh (Andy Burnham), if he has not already come across it. “Nye”, by Nicklaus Thomas-Symonds, is the new biography of Nye Bevan. It is a fascinating book, particularly the part about when he was the Minister for Health from 1945 to July 1948 and putting together and negotiating the creation of the NHS. It sets out the arguments he had with the medical profession and others, and the compromises he had to make to establish the NHS. Many people do not realise that even to this day, as a result of those compromises, 95% of GP practices are private small businesses. I do not decry that, because they are treating patients, under the national health service, free of charge.
Historically, a lot of mental health care has been free of charge, but provided by the private sector. In the 1990s, when I was a Health Minister, I remember John Major using the private sector to bring down waiting lists and waiting times for operations. My constituents had no problem whatever with that, providing it was free and kept to the core principle of the NHS. The last Labour Government, the Blair-Brown Government, were quite happy to use the private sector providing it was benefiting NHS patients.
The shadow Secretary of State kindly mentioned—albeit in passing—Chelmsford walk-in centre and suggested it was a great political scandal and the next bandwagon he was going to jump on. May I point something out to him? The walk-in centre was created from the dying embers of his stewardship of the NHS, in March 2010, to be run by a private company. I have no problem with that, if it is serving NHS patients. However, its sole purpose was to reduce pressures on A and E at the local hospital, and I am afraid it has singularly failed to do that. The use of A and E at Broomfield hospital, just down the road, has increased inexorably and, in that respect, the walk-in centre has failed.
Andy Burnham
I am listening carefully to the right hon. Gentleman. As he knows, I have huge respect and affection for him, but he is arguing that NHS privatisation is a myth and that our accusation is wrong. If he does not mind, I will quote what he said during the Committee stage of the Health and Social Care Act 2012:
“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”—[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]
Why, then, is it a myth that he and his Government have exposed the NHS to a greater risk of commercialisation, marketisation and, indeed, privatisation?
Mr Burns
First, competition was introduced on the current scale by the Blair-Brown Government, and secondly, there is nothing wrong, per se, with competition to get the best providers providing the best care for patients, so long as they keep to the sole ethos of the NHS, which is that that good care be provided free at the point of use for NHS patients. We saw that under his Government and under the Major Government, and this Government have used the private sector to ensure that patients are treated more quickly. We want them to be treated as quickly as possible, and if there is not enough capacity in the NHS, and if a private provider can provide the capacity, I see nothing wrong with that, and neither do most people in this country, if they are treated more quickly.
Returning to the walk-in centre, there were 40,000 attendances last year, 10,000 of which were by people beyond the Mid Essex CCG area. Of the remaining attendances, one third should have been self-caring or using their community pharmacy or 111, which the CCG is paying for, and another third should have been using their community pharmacy or GP, which the NHS is paying for. The CCG was therefore paying twice for the same care for the same patients, which is an utter waste of money. That money should be being used to care for more patients quicker, which is why the CCG has taken the decision it has. It is a rational decision, because the centre is failing to meet the aims it was set up for and instead ensuring that the NHS pays twice for the same patient to be treated. In place of the walk-in centre, there will now be an urgent care service at the local hospital for those people who should be going there. Sometimes, politicians have to do the right thing, regardless of political point scoring. Where it is in the interest of patients and the configuration of services, they should take the right decision, be reasonable and responsible and explain why it is the case.
In conclusion, I am delighted to see the hon. Member for Hackney North and Stoke Newington (Ms Abbott) in her place. I am fascinated to note that the nub of the motion is a call for an extra £2.5 billion for the NHS, which I am sure she strongly supports. What worries and concerns me—she may have a problem when it comes to voting at 7 o’clock tonight—is that the motion goes on to say that it is going to be
“funded by measures including a tax on properties worth over £2 million”.
Given the battle the hon. Lady had on the radio with a member—a right hon. Member— of her party from a southern Scottish constituency, I imagine that she is in turmoil, wondering how to justify that funding from that source.
Care Bill [Lords]
Debate between Simon Burns and Andy Burnham(10 years, 9 months ago)
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Mr Simon Burns (Chelmsford) (Con)
It is a pleasure to follow the hon. Member for Hayes and Harlington (John McDonnell). He said at the beginning of his remarks, and he kept to his pledge, that he was going to speak without party rancour. I, too, would like to do that because I think there is very little difference between my views on the health service and those of the right hon. Member for Leigh (Andy Burnham). We may perhaps have a divergence of view on how to achieve what we both passionately believe in, as does my right hon. Friend the Secretary of State, which is the finest health service for the provision of care for all people in this country, but on the core principle of a national health service, free at the point of use for all those eligible to use it, there is not one iota of difference, despite the speech I heard from the endearing hon. Member for Easington (Grahame M. Morris). I almost felt I had woken up from a nightmare. Having listened to the same speech in 39 of the 40 sittings of the Health and Social Care Bill Committee, I regarded it as my good fortune that during the 40th sitting, my right hon. Friend the then Secretary of State was giving evidence to the Health Committee which prevented the hon. Gentleman being in our Committee.
The point I want to make is this: the national health service has from day one constantly evolved in the delivery of health care, partly because of changing medical science, partly because of changes in the diseases that people have suffered from owing to improved and enhanced preventive care, and partly because many conditions that in the past one would stay in hospital for no longer need to be treated in hospital but can be treated in a GP surgery or elsewhere. We all—politicians, medical practitioners and others—have to recognise that the NHS is constantly evolving and revolving, and we have to adjust to those changes and meet those challenges.
I passionately believe that decisions within the NHS should be taken locally. I supported the Health and Social Care Bill so strongly because it devolved powers and decision making to the people who I think are best qualified to take commissioning decisions on behalf of patients—local GPs. I also welcome the fact that my right hon. Friend the Secretary of State is no longer micro-managing the running of the NHS on a day-to-day basis. However much admiration I have for my right hon. Friend, or even for the shadow Secretary of State when he was in post, I do not think he is best qualified to be running the health service on a day-to-day basis.
If we are going to evolve and meet the challenges, difficult decisions will have to be taken, and politicians in particular—politicians of all political parties; this does not apply simply to Opposition Members of Parliament or to Conservative Members or to Liberal Democrats—have got to be braver. When there is any consideration of a reconfiguration to meet new challenges or address problems, the knee-jerk reaction is to take the populist, easy route, say no and oppose for opposition’s sake, rather than look at the reasons behind any reconfiguration.
Andy Burnham
The right hon. Gentleman knows I have huge regard for him and I do not disagree that change needs to be made. The question, however, is how we make that change. I remember that when the earlier Bill was going through, he repeatedly said in this House and in TV studios that the principle behind it—if it had a principle—was to put local doctors in charge. Does he think that clause 119 is consistent with the argument he made when the earlier Bill went through?
Mr Burns
I am grateful to my right hon.—or, rather, the right hon. Gentleman; I nearly made a Freudian slip—for that question. I can unequivocally say to him that I believe it as strongly and firmly today as I did when I was one of the Ministers taking the Health and Social Care Bill through this House three years ago. And I shall tell the right hon. Gentleman why I believe it.
I was saying that politicians of all parties must strengthen their backbone and be prepared to look at each case of reconfiguration on its merits, and then take difficult decisions if they are in the best interests of patients. I believe that reconfigurations should initially be determined at local level—[Interruption.] If the right hon. Member for Leigh will wait, I will get to his point. They should be determined by local commissioners in consultation with local people and with the health and wellbeing boards, which play a vital part in keeping local communities and local health interests plugged in and represented, and in ensuring the delivery of the necessary services locally.
However—this is where I get to the right hon. Gentleman’s point—there will be a few rare and exceptional circumstances in which a TSA will have to be appointed. That is what happened in the case of South London. At that time, I happened to be privy to all the discussions that led up to what was, if I remember correctly, the unprecedented decision taken by the then Secretary of State, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley).
Mr Burns
The short answer to the hon. Gentleman, because I have the freedom of the Back Benches, is that I do not share that view. I was privy to the discussions that led to South London being put into special measures. That was done because there were real and significant problems to which it was impossible at a local level, within NHS London and elsewhere, to find a coherent—[Interruption.] The right hon. Member for Leigh says no. He was in opposition at the time these conversations were taking place.
Andy Burnham
It is wrong. The right hon. Gentleman will know that when he arrived at the Department of Health in May 2010, there was a plan in place called “A Picture of Health”—[Interruption.] My hon. Friend the Member for Lewisham West and Penge (Jim Dowd) agrees. The plan, which had been extensively debated and consulted on at local level, was to make difficult changes to the health service in south-east London. That plan was shelved because of the right hon. Gentleman’s moratorium, and precious time to make changes was therefore lost. The financial problems in those health service organisations increased because the plan was shelved, and they were left with the option of having to bring forward a more brutal administration process. Please do not rewrite history in a debate as important as this.
Mr Burns
I agree with the right hon. Gentleman that this is a very important debate. I have the benefit of having attended the meetings and having seen what was happening in South London. In one respect the right hon. Gentleman is absolutely right: there was a moratorium. The country wanted a moratorium to start with because of some of the closures that were causing problems, and people wanted a re-examination of the situation to check that the right decisions were being taken. Work was still going on to find a solution to South London, and my right hon. Friend the Member for South Cambridgeshire reluctantly came to the conclusion that he had to take the exceptional power that was available to him.
Oral Answers to Questions
Debate between Simon Burns and Andy Burnham(12 years, 5 months ago)
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Andy Burnham (Leigh) (Lab)
I shall give the Secretary of State one last chance on rationing.
Andy Burnham
The right hon. Gentleman needs to listen carefully to what I am about to say. Yesterday, he promised action to stop the restricting of cataract operations for financial reasons, if given evidence. How about this example? NHS Sussex has imposed severe restrictions that contradict the Department’s own guidance, “Action on Cataracts”, and this has seen the number of operations in Sussex fall from 5,646 in 2010 to 4,215 in 2011. Does the Secretary of State consider that fair to older people, and will he now take the action his Department has promised?
National Health Service
Debate between Simon Burns and Andy Burnham(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.
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
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
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.
Health Transition Risk Register
Debate between Simon Burns and Andy Burnham(12 years, 7 months ago)
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Andy Burnham (Leigh) (Lab)
Back in the rose garden, the talk was of the most open and transparent Government ever. Today, those words are as worthless as “no rise in tuition fees” and “no top-down re-organisation of the NHS”. We have heard self-serving rubbish today from a Secretary of State who does not want patients and the public to know the whole truth about his NHS re-organisation, but he has been brought here by the sheer tenacity of my right hon. Friend the Member for Wentworth and Dearne (John Healey).
My right hon. Friend has been completely vindicated by the Information Rights Tribunal, which was scathing about the way in which the Government have conducted their re-organisation of the NHS, their failure to give an indication of their wide-ranging plans before their hastily drawn-up White Paper, and their decision to implement them on the ground before a Bill had been presented to the House.
After last Thursday, in interviews following the local election results, Government Members all promised to listen, but what is the first thing that they do? They take this unanimous ruling from a judge-led legal tribunal and tear it in two with trademark arrogance—a Government who believe that they are born to rule and above the law. In doing so, they have made a major departure from the established policy on freedom of information, and from the precedent set by the previous Government.
Hitherto, the ministerial veto has been used on only three occasions, all related to Cabinet discussions; applying the veto to operational matters of domestic policy breaks that precedent. As such, it is a major step backwards towards secrecy and closed government. Is there not now a real risk that other Departments will cite this shoddy decision as a precedent and seek to withhold public information that, in the spirit of policy intention of the Freedom of Information Act, should be placed in the public domain?
Where does this decision leave the Information Commissioner and, indeed, the Information Tribunal? Have they not been completely undermined by the Cabinet’s decision? The truth is that there is confusion in government about the decision, and the Secretary of State has failed to clear it up today. In his statement on Tuesday he said clearly that the risk register would not be published following Cabinet agreement and that it was a “final decision” by the Secretary of State, but just hours later on the “Today” programme the Health Minister Earl Howe said:
“We have every intention of publishing the risk register in due course, when we think the time is right”.
I have a simple question: will it be published or not? Was the Secretary of State’s Minister speaking for him and his Department when he made that statement, and if so will the Secretary of State tell us what his Minister means by “when…the time is right”? Most people, including those on the tribunal, felt that the time was right when the Bill was going through the House of Commons—before the right hon. Gentleman shamelessly rammed it on to the statute book.
The shambles is not just in the Department of Health, however; it is right across government. The shadow Leader of the House has just left the Chamber, but in a blog post earlier this week he said—
The Minister of State, Department of Health (Mr Simon Burns)
The Deputy Leader of the House.
Andy Burnham
The Deputy Leader of the House said that
“it would also be right to publish as much of what is contained in the risk register as possible”.
He said that this week—that the risk register should have been published. How many more Ministers and coalition MPs do not agree with the Cabinet’s decision?
Most worrying, however, is the confusion over freedom of information policy. The Secretary of State, in his statement earlier this week, said:
“If such risk registers were regularly disclosed, it is likely that their form and content would change”.
But later in the same statement he said that this was an “exceptional case”. Which is it? Do the Government now have a blanket ban on the publication of any risk register, even if ordered to do so by a judge, or was this an exceptional case? If it was the latter, how did it meet the exceptional criteria that Government rules require? We need answers, as again this Government are breaking the precedent set by the last Government. Following a ruling from the Information Commissioner, we released the Heathrow third runway risk register. We never called for the publication of all risk registers, but said that each case should be judged on its merits. Inconveniently for the Minister and the Conservative party, that ruling makes a clear differentiation between the strategic risk register on the one hand and the transition risk register on the other, as I have argued all the way through this discussion.
The Secretary of State’s argument today hinges on the “safe space” argument—he says that if we did not have a safe space, it may change future risk registers. Is he aware that the tribunal considered that point in detail but concluded that there was no evidence presented to us that the release of the Heathrow risk register had a chilling effect on their use by Government? Was the Secretary of State’s argument not tested in court and did it not fail in court? Is he not now showing a blatant disregard for the law? He said today that it “is a matter of principle and not a matter of law”, but it is a matter of principle and of law—freedom of information is the principle and the Freedom of Information Act is the law. He should be following the law that enacts that principle, but he has taken a step away from it today.
The Treasury website still has this statement on risk policy:
“Government will make available its assessments of risks that affect the public, how it has reached its decisions, and how it will handle the risk. It will also do so where the development of new policies poses a potential risk to the public.”
I ask again: if that is no longer the Government’s policy on risk management, when will it be removed from the Treasury’s website?
In conclusion, the Government are in disarray on many fronts. The NHS belongs to the people of this country, not Ministers. If Ministers cannot be open about the risks that they are taking with the NHS, they should not be taking those risks. That is a simple principle.
The truth is that this has been a cowardly decision from a Government on the run who are now too frightened to face up to the consequences of their own incompetence. The real reason for the veto is that publication would have shown that the warnings from doctors, nurses, midwives and patients were echoed in private by civil servants but the Government just ignored them. This is a Cabinet cover-up of epic proportions—a Government closing ranks and covering each other’s backs because they know that the public would never forgive them if they could see the scale of the risks that the Government are taking with the national health service.
Oral Answers to Questions
Debate between Simon Burns and Andy Burnham(12 years, 8 months ago)
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Andy Burnham (Leigh) (Lab)
Last week in the emergency debate, the Secretary of State said:
“Risk registers…are not a prediction of the future. They set out a worst-case scenario”.—[Official Report, 20 March 2012; Vol. 542, c. 676.]
I now have an early version of the risk register that civil servants gave him in September 2010. Risk No. 7 of his reorganisation was that “Financial control is lost.” That was red rated and, according to the document, likely to happen with major consequences. Is it not clear that last week the Secretary of State gave an inaccurate description of the risk registers he saw, and should he not now come to the Dispatch Box to correct the record?
Mr Burns
May I reassure you, Mr Speaker, if not so much the right hon. Gentleman, that my right hon. Friend did not mislead anyone? The answer to the right hon. Gentleman’s question is the same as he and his predecessors pursued under the last Labour Government—and was pursued under the Thatcher and Major Governments—which is that Ministers do not comment on leaked documents.
Andy Burnham
The rest of the world is, and we would be interested to hear the Government’s views on it. Here we have it in full colour. It is not the worst-case scenario, as the Secretary of State claimed, but 43 very real and predictable risks, 21 of which are red rated and 14 likely to happen with major consequences. They include:
“Emergencies…less well managed…more failures…GP consortia go bust or have to cut services…performance dips and key staff lost”.
Is it not now clear for all to see that the Secretary of State and his Ministers have knowingly taken major risks with the national health service, ignored warnings from civil servants and kept those risks secret from Parliament in order to get their unnecessary Bill through?
Mr Burns
I am not quite sure which word in my last answer the right hon. Gentleman did not understand, so I will repeat it. Like previous Governments, we do not comment on leaked documents. Instead of coming to the Dispatch Box and talking down the fantastic work that nurses and doctors do day in and day out, why does he not read the quarter, the latest copy of which is full of facts about how the NHS is improving its performance and delivering better quality care for patients throughout England?
Health and Social Care Bill
Debate between Simon Burns and Andy Burnham(12 years, 9 months ago)
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Andy Burnham
It is not rubbish. They can earn 49% of their income, according to this Bill, from the treatment of private patients. That is a fact, and why the hon. Lady shouts “rubbish” I have no idea.
Andy Burnham
Non-foundation trusts were managed by the Department, and the Department’s policy, during our time in government, was to have a tight cap—[Interruption]. There was a tight cap on the income that trusts could earn, so the very fact of foundation trusts’ creation gave rise to the question of whether there should be a cap. The Minister is effectively abolishing that cap with his Bill.
Andy Burnham
I have answered the right hon. Gentleman’s question. It was an entirely different situation altogether.
On the suggestion that we are setting our face against reform, we have not said that, and I as Secretary of State initiated a review of the private patient cap, because the issue came up before the election. I was prepared to allow a modest relaxation of the cap if it could be demonstrated to benefit private patients, but I was talking about single percentage points: 1% or 2% becoming 2% or 3%. I was not in any way conceiving the possibility that 49% of a trust’s income might be made from the treatment of private patients—that half their theatre time, beds and car parking spaces could be turned over to the treatment of private patients.
Health and Social Care Bill
Debate between Simon Burns and Andy Burnham(12 years, 9 months ago)
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Andy Burnham
Dr Chand is not an adviser to the Labour party, and the Secretary of State, in seeking to inject that party political note so early on in today’s debate and to claim that the petition of 170,000 people is a political petition, continues, it suggests to me, to misread the mood of this country on his unnecessary Bill.
The Minister of State, Department of Health (Mr Simon Burns)
Will the right hon. Gentleman give way?
Andy Burnham
No, I will not.
We have arrived at a dangerous moment, not only for the NHS but for our democracy. To recap, this is a Bill for which nobody voted at the general election and which does not have a mandate, a Bill ruled out by the coalition agreement, and a Bill that has been so heavily amended in another place that in effect the unelected Chamber has written a new legal structure for the national health service that we are being asked to rubber-stamp. Yet despite all that, it could be rammed through this House in just seven days’ time, in defiance of an outstanding legal ruling from the Information Tribunal and in the teeth of overwhelming professional and public opposition.
This is an intolerable situation, and it is no way to treat our country’s most valued institution. Far-ranging changes to the NHS of the kind proposed by the Secretary of State can be made only by public consent and professional consensus, and it is plain for all to see that the Government have achieved neither of those things.
The Minister of State, Department of Health (Mr Simon Burns)
I agree with my hon. Friend the Member for Witham (Priti Patel), who observed in her vigorous and punchy speech that there was an element of déjà vu in the debate.
I was delighted to listen to the speech of the right hon. Member for South Shields (David Miliband). As I listened to it, and to the speech of the right hon. Member for Leigh (Andy Burnham), I reflected on how odd changes in political fortunes are. Those two were the über-Blair reformers, but it was clear from their speeches—both thoughtful in their different ways—that they had turned away from their reforming zeal. I can only put that down to “what a difference a leadership election makes”.
I congratulate my right hon. Friend the Member for Charnwood (Mr Dorrell) on another good and compelling contribution. I also congratulate my hon. Friends the Members for Kingswood (Chris Skidmore), for South West Bedfordshire (Andrew Selous), for Loughborough (Nicky Morgan) and for Witham, as well as the hon. Member for Burnley (Gordon Birtwistle). It seems that in his part of the world they call a spade a spade.
I must also mention the speech of the hon. Member for Walsall South (Valerie Vaz), which was at times fanciful, that of the hon. Member for Stoke-on-Trent North (Joan Walley), that of the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), which was passionate but, I fear, misguided, and that of the hon. Member for Stallybridge—[Hon. Members: “Stalybridge!”] I mean the hon. Member for Stalybridge and Hyde (Jonathan Reynolds). I am afraid that I am from the south. I was disappointed that the hon. Gentleman did not answer my question about the political allegiance of Dr Chand, whom he prayed in aid, given that Dr Chand has had aspirations to become a Labour candidate. Indeed, I think he even had aspirations to fight the seat that the hon. Gentleman fought, so it was very generous of the hon. Gentleman to mention him.
Let me make clear to the House that no party has a monopoly on caring for the NHS. We all care for the NHS passionately, and I find it distressing when Opposition Members seek to misrepresent the position by accusing us of trying to privatise it. Let me tell them that this party, my party—this Government, the coalition Government—will never privatise the NHS, and let me tell my hon. Friends to reinforce that message. Clause 1 of the Bill gives the Secretary of State a duty to provide a comprehensive health service, and subsection (3) gives a commitment—just as Nye Bevan did in his original Act—that it will be free at the point of use.
Let me tell Opposition Members that what they are saying is scaremongering, that it is unfair, and that it is a gross distortion of the facts. Let me also tell them that shroud-waving does not do them any credit. Pulling out examples that have no basis in proof and are simply intended to misguide and mislead the public is a disgrace—
Mr Burns
No, because I have no time. I have only five minutes.
The right hon. Gentleman was seductive in his speech. He came across as trying to be eminently reasonable by saying that he did not want this to be a party political football. I must say to him, however, that it is he and his friends who have turned the NHS into a party political football, and I must say to them that the NHS is too precious to be turned into a party political football simply for the purpose of trying to gain votes.
Our reforms will help to prepare the NHS for the future, making it more balanced and better suited to the demands of the 21st century so that it has a long and healthy life based on its founding principles. First, our reforms will give patients more choice, enabling them to choose where to go, see who they want to see, and influence the kind of services that they want in their communities. Secondly, they will give doctors more freedom to commission care for their patients, so that they can shape the NHS around the needs of their local communities. Thirdly, they will reduce bureaucracy so that money—£4.5 billion of it between now and 2015—can be saved and reinvested in front-line services. Those are the basic premises and that is the basic ethos of the Bill.
Not once during the speech of the shadow Secretary of State, and not once during the speeches of any of his right hon. and hon. Friends, did we hear a single answer to the question of what they would do. I do not know how many Members saw the right hon. Gentleman being interviewed on “Newsnight” by Jeremy Paxman two weeks ago. Some of us live in fear of that experience, while some of us come to enjoy it. Five times during that brief one-to-one interview, Mr Paxman asked the right hon. Gentleman “What would you do?” and answer came there none. That was because the right hon. Gentleman is prepared to criticise and try to scare people in order to win votes, but he is not prepared to confront, in a realistic and meaningful way, the challenges facing the NHS and the way in which it must move forward.
What we need is less carping, less criticism, and more constructive engagement. When the right hon. Gentleman says in his flowery way that he is prepared to engage in all-party discussions there is a hollowness in his claim, because he has no policies to discuss, and can identify no positive way in which to resolve the problems of the NHS and enable it to evolve to meet the pressures to which it is subject.
This Bill, which has been discussed at length in this House and in another place, is the Bill that will move the NHS forward and enable it to meet the challenges of an ageing population and an escalating drugs spend. I urge my hon. Friends to reject the motion and to reject the Liberal Democrats’ amendment if it is pressed to a vote, because neither is in the interests of the health service or those of the country.
Question put, That the amendment be made.
Adult Social Care
Debate between Simon Burns and Andy Burnham(12 years, 9 months ago)
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Andy Burnham (Leigh) (Lab)
I, too, congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on bringing this important debate to the House. They make an impressive and persuasive double act for this most important of causes, and are right to challenge both Front-Bench teams as this is without doubt the biggest unresolved public policy challenge facing the country. So far, between us, Parliament has failed to face up to it, and as others have said the result is a developing care crisis in England.
We must all bear our share of the responsibility for allowing that to happen, but the best response is to resolve to find lasting solutions. This century of the ageing society demands it, and the earlier we do it, the better. If we do not, to Beveridge’s five giants of the last century we might add a sixth for the 21st century: fear of old age. We cannot let that happen, and people are looking to us all to put point scoring aside and to work constructively to find a solution. In that spirit, I welcome much of what the Minister said.
I commit the Opposition to doing the same, and as a sign of our intent, the Leader of the Opposition has appointed a member of the shadow Cabinet with specific responsibility for these matters. I refer to my hon. Friend the Member for Leicester West (Liz Kendall). The House might have noticed that she is not here today. I send her apologies. [Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), is absolutely right. She has a good excuse: she is in Leicester with Her Majesty the Queen at the commencement of the diamond jubilee celebrations; otherwise of course she would have been here. I hope that I am an acceptable substitute.
Andy Burnham
Thank you.
I wish to demonstrate today Labour’s commitment to this issue. The House might remember, as my hon. Friend the Member for Worsley and Eccles South said, that I made reforming social care my top priority as Health Secretary, and I did that for a very personal reason: I have never forgotten my grandmother’s dispiriting journey through England’s care system and the battles that my mum fought to preserve her dignity. The day I visited her in a nursing home near where I lived to find that her engagement ring had been wrenched off her finger and stolen was the day that I knew something was seriously amiss with how we looked after our older people.
We all have our own personal experiences, and we all know that we have to do much better. Looking after other people’s relatives, particularly the most vulnerable in our society, should be one of the most highly valued and respected callings there is, but sadly the reverse is the case. England’s care provision is too often low status and low wage, with about 70% of the work force having no qualifications and many earning at or around the national minimum wage.
With every year that passes and every year that we do not achieve a lasting and better solution to the funding of adult social care, the cruel unfairness in the system gets worse and the quality of service diminishes even further. People are paying higher charges, and the most vulnerable, as the Minister said, are losing everything. Families are being wiped out physically, emotionally and financially by the situation, carers are under intolerable pressure and councils are struggling to cope with the demographic pressures.
But there is hope. I did not think that the White Paper and cross-party talks that I led before the election achieved as much as they might, but perhaps I was wrong, because they might have prompted the Government to establish the Dilnot commission, on which we congratulate them. We also congratulate Andrew Dilnot and his commission on the intelligent way they addressed their brief and delivered a solution that politicians on all sides can work with. It provides a basis for progress, and we should take it.
Since then, we have also had the Health Select Committee’s excellent report on social care, which made a persuasive case for integration. At present, the social care debate is happening in isolation from the debate about NHS reform, which is unhelpful. We are looking at a Bill called the Health and Social Care Bill, but there is not much about social care in it. Indeed, it is slightly odd that a Bill of this name is going through Parliament, yet a social care White Paper is not due until May, as my hon. Friend the Member for Worsley and Eccles South said. It is essential that we start viewing reform of social care and the NHS as two sides of the same challenge—how to provide integrated, people-centred and preventive care in the century of the ageing society.
The Committee’s recommendation of a single commissioner for older people was an important one, and I was pleased to hear the hon. Member for Truro and Falmouth endorse it. I do, too, not least because it was precisely what I would have done had I returned to the Department of Health as Health Secretary had we secured a different result at the general election. However, I am worried that this vision, which we share, is made more difficult by the Health and Social Care Bill and the new landscape that is developing.
Those are the issues that the Government need to address in the White Paper. We are grateful for the opportunity that the Minister and the Secretary of State have extended to us to take part in cross-party talks and to influence that debate, as well as the crucial issue of how to fund the Dilnot proposals. Speaking for the Opposition, I can assure the House that we will play a constructive and responsible role in those talks. However, I would also like to take this opportunity to place three caveats on the table. First, we need to make it clear to people that although the Dilnot package is an important step forward, it is only that. It is not the whole answer to the challenges that the country faces. Its introduction would make the system fairer than it is today and would deal with the catastrophic costs of care that the most vulnerable people face. However, people would still be liable for high charges, with the vulnerable paying the most.
Secondly, there has to be a recognition from all parties in the House that progress will come only with difficult decisions and nettles being grasped. We need to have a mature discussion with the public about those difficult options, rather than using them for point-scoring purposes. What stands in the way of progress is not the complexity of the issues—they are not over-complex—but the political will to advance a difficult argument. That is what has prevented us from making more progress than we should have. To push things along and give our talks some impetus, it would help if the Government committed to introduce legislation in this Parliament to implement whatever has been agreed. That would bring a useful focus to the cross-party talks. Thirdly, we believe that there is a genuine danger that the debate might focus only on funding the Dilnot recommendations, and not on the existing pressures in the system. That must be avoided at all costs, as my hon. Friend the Member for Worsley and Eccles South said. As one care charity told me yesterday,
“We can’t have jam tomorrow if we have no bread today”.
I, too, was concerned by the comments that the Minister made before the Select Committee on Health, specifically when he said:
“We don’t accept the position that there is a gap. We have closed that gap in the spending review. On the issue of unmet need, I am yet to find any agreement among academics on a definition of unmet need.”
Many councils would struggle to reconcile that statement with the reality of what is happening on the ground. Council budgets are being cut by more than a third over the course of this Parliament, and as we know, adult social care makes up the largest part of those budgets, at around 40%.
The Prime Minister is fond of quoting me on health funding at Prime Minister’s questions, but he only ever uses the bits that suit his purpose. If I may, I would like to give the House the full version of that quotation today, because what I was warning of was the danger of taking an unbalanced approach to public spending. Before the election, the Conservatives were saying that they would give the health service real-terms increases, over and above inflation—which have not, in fact, materialised—within a much reduced overall public spending envelope. My worry was that taking such an unbalanced approach could damage other public services, including those that are intrinsically linked to the health service. What I actually said was:
“It is irresponsible to increase NHS spending in real terms within the overall financial envelope that he, as chancellor, is setting. The effect is that he is damaging, in a serious way, the ability of other public services to cope: he will visit real damage on other services that are intimately linked to the NHS,”
such as social care. I believe that this is what we are seeing right now.
NHS Risk Register
Debate between Simon Burns and Andy Burnham(12 years, 10 months ago)
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Andy Burnham
Those on the Government Front Bench are laughing. They will not be laughing when I have finished my speech.
More than 150 experts in child health wrote to a newspaper last week to say that health inequalities among children will widen as a result of the Bill. Are Ministers listening? No. It is disgraceful that they behave as they do.
The Minister of State, Department of Health (Mr Simon Burns)
Will the Secretary of State confirm—sorry, the shadow Secretary of State—that in clause 3 of the Health and Social Care Bill for the first time in the history of the NHS reductions in inequalities in health have been put on the face of a Bill as a duty to achieve?
Andy Burnham
I confirm to the Minister that I am the shadow of my former self, but it sounds as though he would like to have me back. Expert opinion says that health inequalities will widen. Is he listening to that opinion? That is the question he should answer today.
Oral Answers to Questions
Debate between Simon Burns and Andy Burnham(12 years, 10 months ago)
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NHS (Private Sector)
Debate between Simon Burns and Andy Burnham(12 years, 11 months ago)
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Andy Burnham
No, I would not agree. I shall explain the policy that our Government adopted on the private sector and how different it was from that of the Government whom the right hon. Gentleman supports. In making our argument we will expose the terrifying gap between the Prime Minister’s rhetoric on the NHS and what he is doing in reality. People will recall the efforts that went into rebranding the nasty party. The Conservatives were at great pains to tell us that they would be pro-environment, a bit less tough on crime and pro-NHS going forward. Many photo calls were arranged to send those messages to the public, but it was poor old NHS staff who featured far more than huskies or hoodies in being brought in to promote hastily made political promises. We were told there would be real-terms increases for the NHS, a moratorium on accident and emergency department closures, thousands more midwives and, famously, no top-down reorganisation—four promises made in opposition: four promises broken in government. I still have not worked out how a Prime Minister can go from agreeing there should be no top-down reorganisation with his coalition partners after the election to bringing forward just weeks later the biggest top-down reorganisation ever in the history of the NHS. How does that work? Perhaps Lib Dem Members will enlighten us this evening.
Our evasive Prime Minister is the master of making statements that sound good at the time only to turn out to be meaningless in practice. Tonight we will focus on his most outrageous yet. On Monday 16 May last year, under pressure to reassure people about the Health and Social Care Bill and in the middle of the enforced pause, the Prime Minister said, in a speech:
“That’s why, when I think about what our NHS will look like in five years time, I don’t picture some space-age institution, a million miles away from what we have now. Let me make clear: there will be no privatisation”.
Those were his words—“no privatisation”.
Andy Burnham
The Minister of State says that is right, and he is free at any point to get up and challenge what I say or to prove how he can make that statement. I will give him the opportunity to do so soon.
The Prime Minister could not have been clearer—“no privatisation”. Similar statements were made during the pause by the Deputy Prime Minister. On the Marr programme on 8 May, he promised that safeguards would be brought forward in the health Bill. He said:
“What you will see in this legislation are clear guarantees that you are not going to have back-door privatisation of the NHS.”
He followed that up on 14 June with this promise:
“Patients, doctors and nurses have spoken. We have listened. Now we are improving our plans for the NHS. Yes to patient choice. No to privatisation. Yes to giving nurses, hospital doctors and family doctors more say in your care. No to the free market dogma that can fragment the NHS.”
Those statements from the Prime Minister and the Deputy Prime Minister were significant for two reasons. First, they revealed an understanding at the top of Government about how, more than anything else, fears about privatisation and the market in the NHS were driving professional disquiet about the Health and Social Care Bill—a Bill that was sold as putting doctors in charge but that had a hidden agenda of breaking up the structures of the national planned health system to allow a free market in health. Secondly, they implied that major changes to address those concerns would be made to the Bill and that there would be a return to the existing policy of the managed use of the private sector within a planned and publicly accountable health system.
Let me be clear. As our motion states, we believe that there is a role for the private sector in helping the NHS to deliver the best possible services to NHS patients, and that was the policy we pursued in government. Without the contribution of private providers, we would never have delivered NHS waiting lists and times at historically low levels, but let us put this in its proper context. Our policy was to use the private sector at the margins to support the public NHS. So, in 2009-10, 2.14% of all operations carried out in the NHS were carried out in the independent sector and spend in the private sector accounted for 7.4% of the total NHS budget. I would defend those figures, because that helped us to deliver the best health care to the people of this country.
Furthermore, we supported a system allowing foundation trusts to generate income at the margins of their activity from treating private patients but with a clearly defined cap to protect the interests of NHS patients at all times.
Andy Burnham
I shall give way to the Chairman of the Select Committee on Health once more and then to the Minister.
Andy Burnham
That is not what I said. I understand that the preferred policy was to have no caps or limits, but even if a generous and liberal cap was introduced there would be a major risk that hospitals under financial pressure would give beds, theatre time and appointments to private patients, enabling them to jump the queue and giving a much worse deal to NHS patients. That is the risk that the cap was designed to mitigate and that is why we support it.
Mr Simon Burns
Could the right hon. Gentleman explain the logic, under his Government, of having a cap on a minority of trusts—foundation trusts—while he as the Secretary of State and his Government did not impose a cap on the majority of trusts that were not foundation trusts?
Andy Burnham
There is a simple explanation. The right hon. Gentleman will remember, as I do, the debate on the foundation trust legislation. There were worries that if hospitals were made more independent and were not directly managed by the Department they would put the treatment of private patients before that of NHS patients. The cap was introduced to mitigate that risk. He will know that we had a policy that all trusts should become foundation trusts in time—a policy that his Government have adopted—so that the cap would apply to all NHS hospitals in time. I think that answers his question.
Andy Burnham
It did not, and I would expect a Minister not to make misleading statements like that in a debate of this kind. It did not propose the removal of the cap: it said that more freedom would be given to NHS hospitals with a modest loosening of the cap. That was my policy as Health Secretary. We did not propose removal of the private patient cap.
Andy Burnham
I remind the Health Secretary that he is the Secretary of State, not me. It is for him to bring forward proposals. Forty-nine per cent: in that proposal he is saying that NHS hospitals can give equal priority to the treatment of private patients—that it can be as legitimate an objective for an NHS facility, paid for by the taxpayers, to be used equally for the treatment of private and NHS patients. I put it to the hon. Member for Kingswood (Chris Skidmore) that I am not prepared to accept a cap on that scale. It could lead to an explosion of private sector work in NHS facilities and I do not think that is in the best interests of NHS patients. I would be prepared to accept the Government’s bringing forward proposals that fulfilled a modest loosening of the cap, to give the NHS more freedom at this difficult time, but I am talking in single figures. I am not talking about a doubt-digit, 50% cap—a recommendation that hospitals devote half their resources to private patients.
Mr Simon Burns
Will the shadow Secretary of State kindly answer the questions put by my right hon. and hon. Friends about what modest means? [Interruption.] If I might read it out, the 2010 Labour manifesto says:
“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, and provided they generate surpluses that are invested directly into the NHS.”
There was no mention of a modest increase; it was open-ended.
Andy Burnham
The Minister is not listening. I answered his question. I proposed a small increase in the cap—in single figures; a couple of per cent, as I am on record saying at the time, to give NHS hospitals more freedom to generate more income, to be put back into improving standards for NHS patients. Can the Minister honestly look me in the eye and tell me that 49% is not a world away from the NHS that he inherited from our Government?
Oral Answers to Questions
Debate between Simon Burns and Andy Burnham(12 years, 11 months ago)
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Mr Burns
My right hon. Friend is absolutely right; of course, when he was Secretary of State he did a considerable amount of work to lay the ground rules for the move towards greater integration, because that is the way forward. My right hon. Friend makes a very valid point: it is the way forward and we fully recognise that. We are deeply committed to achieving that aim, and that is why my right hon. Friend the Secretary of State has added an extra £150 million to the existing £300 million, to facilitate progress towards it.
Andy Burnham (Leigh) (Lab)
May I tell the Secretary of State and the Minister that he will receive more representations on his Bill later this week from two hospital doctors who, early this morning, began a 160 mile run to protest against his Bill, from Bevan’s statue in Cardiff to his Department? [Interruption.] The Secretary of State should listen. Let me remind him why people are so angry. Nobody voted for the Bill. It was ruled out by the coalition agreement, and it is now the unelected House deciding the future of the NHS, passing amendments that he was too scared to table in this House.
Will the Minister today have the courage to admit that it is now the Government’s intention to allow NHS hospitals to make 49% of their income, effectively devoting half of their beds, from the treatment of private patients?
Mr Burns
May I say a happy new year to the right hon. Gentleman as well? I believe that his analysis of the support for the Bill is flawed, because there are a number of areas where a number of organisations warmly welcome its contents. For example, the BMA voted in favour of GP commissioning at its special general meeting last year.
On the question of 49%, the shadow Secretary of State has been uncharacteristically forgetful, because of course he will appreciate that the cap applies only to foundation trusts, not to non-foundation trusts, and that is no different today from what it will be after the modernisation—and it was a policy that his Government brought in.
Andy Burnham
No, it was not. That policy would never, ever have come forward under a Labour Government—and I know that the right hon. Gentleman has not denied it. We, the Opposition, will now make it our business to tell every single patient in England about his plans for the NHS. People can finally see the Bill for what it is: a privatisation plan for the NHS. England’s hospitals will never be the same again if the Bill gets through: an explosion of private work; longer waits for NHS patients; profits before patient care. Will not the only choice on offer for patients be the old Tory choice in the NHS: wait longer or pay to go private?
Mr Burns
I am afraid that the shadow Secretary of State is just totally wrong. This Government have no intention to and will not privatise the national health service. We want to improve patient outcomes and the patient experience. The right hon. Gentleman should look again at the 49% that he talks about, because we are not changing the situation, particularly because it does not apply to trusts at the moment; it is only for foundation trusts.
Oral Answers to Questions
Debate between Simon Burns and Andy Burnham(13 years, 1 month ago)
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Mr Burns
If the hon. Gentleman had read it, he would know that the important aspect—[Interruption.] He says that he cannot read it, but if he listens for a minute, he will hear that the important parts that are relevant to the Health and Social Care Bill were published in January and September this year in the impact assessment for the Bill.
Andy Burnham (Leigh) (Lab)
May I first commend the Health Secretary on his ingenious new approach to cutting delayed discharges? If his appearance on continuous loop on hospital TV does not cut length of stay, I do not know what will. One area where he has been noticeably less forthcoming is on the recent ruling by the Information Commissioner, which could not be clearer: Parliament and the public have the right to know what extra risks and threats his Department expects the NHS to face as a result of this top-down reorganisation. Let us give him one more chance to give us a clear commitment: will he live up to the Prime Minister’s words on transparency and openness and publish the report in full without delay?
Mr Burns
The right hon. Gentleman may not have been listening to the response I gave to his hon. Friend, which was that the relevant aspects of the risk assessment have been incorporated into the impact assessments published in January and September. [Interruption.] Before he, too, gets too pious, may I remind him that it was he himself who, in September 2009, blocked the publication of his Department’s risk assessment?
Andy Burnham
I would happily have paid £5 to opt out of that particular pre-scripted loop message. Unlike the Minister and his fellow Front Benchers, I was not subject to a ruling from the Information Commissioner. People watching this today will be left wondering what he and the Secretary of State are so desperate to hide. He can hide the report, but he cannot hide the growing warning signs we are seeing in our NHS: waiting lists up, delayed discharges up, and nurses made redundant. The truth is that he has placed the NHS in the danger zone, with a destabilising and demoralising reorganisation when it most needed stability. He says he wants feedback, so why does he not listen to patients and staff, put the NHS first and drop his dangerous Bill?
Mr Burns
It is marvellous how the right hon. Gentleman repeats his soundbite every time he discusses the NHS. I have to tell him that he is wrong. He knows that the NHS has to evolve. He knows that we have to improve and enhance patient care. I think he does himself a disservice by simply joining the ranks of organisations such as 38 Degrees, which is frightening people and getting them, almost zombie-like, to send in e-mails.
National Health Service
Debate between Simon Burns and Andy Burnham(13 years, 1 month ago)
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The Minister of State, Department of Health (Mr Simon Burns)
It has been an interesting experience listening to the range of contributions that have been made over the past few hours. Having studied the shadow Secretary of State’s tweets yesterday afternoon heralding today’s debate, one would have expected this to be an action-packed afternoon. One remembers the grand old Duke of York marching his troops up to the top of the hill and then down to the bottom, but the grand old Duke of York had 10,000 men. For most of this debate, apart from the wind-ups, the shadow Secretary of State has barely managed to get more than six Opposition Back Benchers here, which is fewer than the Government have had, so on that point I fear that he has failed.
Let me turn to some of the speeches that I had to listen to. It was a delight to hear the hon. Member for Easington (Grahame M. Morris) again, after a break from the Committee stage of the Health and Social Care Bill. Broken record his speech may have been—it was the same story—but it was worth listening to, even though the accuracy gained nothing in the telling.
My hon. Friend the Member for Kingswood (Chris Skidmore) made an excellent speech, as did my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who spoke fluently and knowledgably, on the basis of his intense and intimate experience of working in the NHS and his insights into the challenges we face in social care and improving the integration of care.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) made an interesting contribution, although at times I began to think that she might be the only person who believed what she was saying. None the less, it was interesting.
The hon. Member for Ealing North (Stephen Pound)—as always, a jokester in our midst—put forward a serious message in a jocular way. From my experience of the NHS, both personal and professional, however, I felt that a lot of what he said bore little relation to reality. I can assure him that Government Members share the core principles of the NHS. I was also interested to hear the comments of my hon. Friend the Member for Stafford (Jeremy Lefroy). Anyone who represents that part of the country will have a deep understanding of the problems, as well as the successes, of the local health service. He was right in what he said about the future of accident and emergency services and about the critical issue of training.
I am saddened by the fact that the Opposition have once again shown themselves to be more interested in trying to revive their own political fortunes than in improving the outcomes of patients. Once again, they prefer to scaremonger and blindly attack, rather than put forward any policies of their own. They have been a policy-free zone in this debate. Once again, they reveal themselves to be on the back foot when it comes to securing the future of the NHS, as well as wrong-headed.
The Opposition claim that the Government are cutting NHS spending, which is not only nonsense but outrageous. Surprisingly, only last summer, the right hon. Member for Leigh said—this has been quoted before, but I will repeat it—that it would be
“irresponsible to increase NHS spending in real terms”.
Ironically, that is not a view that I share. I fundamental disagree with it, because I believe that we should increase the funding of the NHS in real terms. [Interruption.] I do not care how much the right hon. Gentleman says it; if he looks at the—
Mr Burns
I will in one minute, just to disprove what the hon. Member for Leicester West (Liz Kendall) says.
If the right hon. Gentleman does not want to believe what I say, he can look at the chart produced by the Wales Audit Office, an independent body, which shows, if one cares to read it, real-terms spending increases in each year in the English NHS. Ironically, it also shows such increases in Northern Ireland and Scotland, but if we look at the red parts of the chart, we can see that there are certainly no increases in Labour-controlled Wales.
Andy Burnham
The Minister says that the Government are providing real-terms increases, but he does not take into account inflation or the £1 billion transfer to social care. Will he accept the figures that I have here? They are the total departmental expenditure limits published by the Treasury in July 2011. They show that, in 2009-10, £102 billion was spent on the NHS. The figure for 2010-11 was £101 billion. I invite him to tell me that those figures are not correct.
Mr Burns
One minute. The right hon. Gentleman wants a reply, so he must hold his horses.
It is the gross domestic product deflator that determines how one increases in real terms the funding of the NHS. The right hon. Gentleman has once again scored an own goal in reading out those figures, because they are based on the Labour Government’s spending for the year in which they were leaving power.
Mr Burns
No, I said that I would give way once. I must now make progress.
We are increasing funding for the NHS in real terms over this Parliament, and stripping out unnecessary bureaucracy to focus precious resources on the front line and not the back office. So in place of management-led primary care trusts and strategic health authorities, we are introducing clinically led clinical commissioning groups, to put money and power in the hands of front-line doctors and nurses. That is why we are driving through the plans to make the NHS more efficient by focusing on prevention, on innovation, on productivity and on driving up the quality of care. A fact that Labour Members appear rapidly to have forgotten is that better care is very often less expensive care, and less expensive care means there is more money to spend on the health service.
Oral Answers to Questions
Debate between Simon Burns and Andy Burnham(14 years, 5 months ago)
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Mr Speaker
Order. May I gently ask the Minister to face the House? I am sure that Opposition Members will want to see his face.
Andy Burnham (Leigh) (Lab)
We do, Mr Speaker, very much; we want to see him squirm.
First, let me say that we welcome the Minister back to the Department of Health; he was a Minister in the Department 13 years ago. As I have said before, we trust that he finds the NHS in much better condition than when he left office. Last week we had an independent verdict on those 13 years. The independent and respected Commonwealth Fund said that the NHS was one of the best health care systems in the world, and, indeed, that it was top on efficiency: a ringing endorsement of Labour’s stewardship of the national health service. That verdict reflects the huge progress on waiting times that has been made over those 13 years. So does not the abolition of the 18-week target, which the Minister announced last week, put all that progress at risk? Will he today give us a straight answer to this question: can he guarantee that waiting times will not rise, and that patients will still be treated within 18 weeks?
Mr Burns
I thank the right hon. Gentleman for the kind comments at the beginning of his remarks; things went downhill thereafter, but that is politics.
The right hon. Gentleman needs to understand that patients have to come first in a national health service, and the trouble with the approach he took was that he wanted politicians and bureaucrats to micro-manage it from the top down, rather than having a bottom-up system that listened to local people. One of the key aims is to ensure that people get the finest and best treatment possible, and I am afraid that his approach—a straitjacket of targets in certain areas—did not work then, and will not work now.
Andy Burnham
I shall take that as a no, because the Minister did not answer the question; he could not give that guarantee. He says that we must put people and patients first, yet at a stroke he has taken power away from patients and handed it back to the system, turning the clock back to the bad old days of the Tory NHS. Let me quote some comments by Jill Watts, chair of the NHS Partners Network, which represents private providers. In the Financial Times on 18 May, she is reported as saying the following about the loss of targets:
“Waiting times will go up and if people want a procedure they have a choice: they can wait or they can look to pay”.
Is that not always the Tory choice on the NHS: wait or pay?
Mr Burns
The right hon. Gentleman is not right. We have not taken that attitude; we never have taken that attitude. We want to have a system whereby the health service is not in a straitjacket of targets that disrupt and distort clinical decisions. We want to empower clinicians and GPs to take decisions about who should be treated when according to their clinical judgment.