Care Bill [Lords]

Debate between Stephen Dorrell and Andy Burnham

Tuesday 11th March 2014 Commons Chamber

[Mr Dorrell]

rose—

[Andy Burnham]

I give way to the Chairman of the Health Committee.

[Mr Dorrell]

I ask the right hon. Gentleman to reflect on what he has just said. Does he really believe that we can make the changes that are necessary, whether in an individual health institution or in a whole health economy, by looking purely at the finances, without looking at the effect that changing the financial structure needs to have on the structure of care delivery, particularly through the delivery of more integrated care, which he and I so often talk about?

[Andy Burnham]

This is where the right hon. Gentleman and I differ. I believe that we need to begin by asking whether there is a clinical case for change and build from there. Clause 119 seeks to turn things around. It starts with the financial case for change and the clinical issues come second. The previous Government established a very clear policy, advised by Sir Ian Carruthers, that the clinical case must be front and centre, and that we must build from there. Clause 119 completely subverts that.

Care Bill [Lords]

Debate between Stephen Dorrell and Andy Burnham

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

I was proposing a fundamentally different policy in a national care service. I ask the Secretary of State politely whether it is about time he stopped trying to say that everything is about the past? Why did he not stand there, explain and justify his own policy? Would that have been a good thing for him to have done today, instead of leaving it to me to explain what he is proposing?

[Mr Stephen Dorrell (Charnwood) (Con)]

In the interests of explaining his policy, will the right hon. Gentleman confirm that the answer to the question posed by the Secretary of State and the Minister was, “Yes”?

[Andy Burnham]

I say again, with all respect to the Chair of the Health Committee, that I was proposing a fundamentally different scheme to that in the Bill. I was proposing a universal all-in scheme, and several steps were put forward to get us to that. The right hon. Gentleman knows that because the Conservative party and those on the Government Front Bench put posters up about that scheme before the last election. Does he remember that? [Interruption.] He nods, right—that was my proposal, but it is not the Government’s proposal, which is different. I proposed various steps to get to my scheme. Is it about time the Government started answering for their proposal, rather than for mine?

--- Later in debate ---

[Mr Dorrell]

Of course I accept that if we have more money, we can do more, but I do not think that that exempts us, particularly given the public finances we inherited in 2010, from the obligation to see how we can get more for the £125 billion of taxpayers’ money that is already committed to health and social care in England.

That brings me to clause 3. The only way to deliver person-centred care and early intervention to prevent avoidable cases, is to reinvent care on a much more integrated model between the national health service and the social care authorities. That is why there is the obligation in clause 3 to consider integrating health and care. In that way we will not think of the NHS as one bureaucracy and social care as another, but instead think of it, as Mike Farrar said when he was at the NHS Confederation, as a care system that provides medical support when necessary, rather than as a medical system that provides care support when it has got the money—that is how not to do it.

[Andy Burnham]

The right hon. Gentleman will recall that the NHS chief executive stood before him and his Committee saying that the competition legislation was the biggest barrier to achieving the vision he is rightly describing; he and I agree about the vision of person-centred services in the home. If the NHS is saying that before his Committee, why does he say that the competition regime is irrelevant? Is it not fragmenting care, rather than integrating it?

[Mr Dorrell]

I did not say it was irrelevant; I said it was not germane to this Bill—and in the seven minutes remaining to me, I am not going to cover that. All I will say to the right hon. Gentleman is that the difficulty with competition policy that the NHS chief executive talked about is a difficulty that health care systems around the world—in north America and in continental Europe—are finding as well. I agree with the right hon. Gentleman, however, that we need to look at how competition policy can be aligned with the policy prescriptions I am describing.

I now want to list the fourth key premise upon which this Bill is based; in what must be a short speech, I can list only four. It is around the well-being of individuals; it is around early intervention and prevention; it is around integration; it is also, critically, for the first time in statutory form, around doing needs assessments that take account of the needs not just of the individual person, but of their carer and social context as well. In that way, the support that is provided to individuals takes account of the context in which they live, rather than treats them as individuals divorced from the carers and people who care for them when the statutory social worker is not there.

The Opposition spokesman said this is an enormously ambitious set of objectives, and I entirely agree that the objective of redefining the delivery of health and social care in a way that matches the aims set out in the first three clauses and clause 10 around carers is ambitious. The objective is to re-imagine care so that we think of the health and care system not as being primarily around acute hospitals, but as a system designed to meet the needs of that majority of people who are the main focus of those who work in the service—people who primarily have a care need with an occasional medical or clinical requirement. In other words, this is about thinking about the system from the front end rather than viewing it from the top of the bureaucracy. I commend this Bill because I believe it sets that framework in statute.

I also commend the Government because they are not just setting out these aspirations as commitments in law. It is one thing to change the law. It is another thing to change the way the service is actually delivered on the ground. The most effective step the Government have taken to achieve this re-imagination of care is the £3.8 billion that my right hon. Friend the Secretary of State talked about. That is £3.8 billion voted into the NHS but available only if the service at local level delivers the joined-up, person-centred care that is set out in the first three clauses of the Bill. So this is not just a set of wordy aspirations; it is a set of aspirations supported by the resources necessary to deliver the change in the care model that the Bill describes. The £3.8 billion is the catalyst that will allow us to deliver the objectives.

With respect to those on the Opposition Front Bench, it is wrong to say that it is only £3.8 billion out of £125 billion. The £3.8 billion is the minimum that the law will require to deliver integrated care within a locality, through the health and wellbeing boards that are much beloved of the right hon. Member for Leigh (Andy Burnham) and which were legislated for by the Government. This is an important step forward. If the health and wellbeing board in a locality can see a way to use health resources to deliver a changed model of care that puts more focus on prevention and on individuals through the delivery of more joined-up services, there is no constraint in the legislation, as I understand it, to prevent more than £3.8 billion from being used for the delivery of that objective.

Resources are important in this regard. This is partly about the £3.8 billion from the taxpayer, but it is also about individual resources. It is about individual users having their right set out in the Bill to engage with their personal budgets and with direct payments, enabling them to make real choices about how joined-up, person-centred care will work best for them. It is the curse of these health debates to imagine that we can gather 650 people together in this Chamber and work out how we are going to deliver £125 billion-worth of care in a way that will work for an individual old lady in her own home. That is nonsense; we need to engage the people themselves in the decisions on how the resources are used. We also need to assure them that they will not be exposed to catastrophic personal losses by making their own contributions to their care. That is why I welcome the fact that, despite what the right hon. Member for Leigh says, the Bill gives effect to the basic propositions set out in the Dilnot report.

The Bill sets out the vision of person-centred, joined-up, integrated care, and the Government have set out plans to commit resources to turn those fine words into deeds. Also, through the establishment of an independent Care Quality Commission, the Bill will provide independent assurance about the quality of care that is provided right across the health and care system. The right hon. Gentleman claims credit, as he is entitled to do so, for the fact that the previous Government took the first faltering steps down the road to introducing proper regulation of health and care provision, but he cannot possibly believe that the Care Quality Commission that he bequeathed was fit for purpose. If he does, he is the only man in the kingdom to do so. I welcome the fact that this Government are putting in place new management and, importantly, a new statutory framework so that the aspirations that might have motivated the Labour Government to set up the CQC will now be delivered in reality.

Accident and Emergency Waiting Times

Debate between Stephen Dorrell and Andy Burnham

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

Oh dear, Mr Deputy Speaker. It is hard for this Government, who have decimated social care, to lecture us about it. Between 2005 and 2010, A and E waits fell. That was after the GP contract was signed. Let us have some facts. We did much to support social care and to deliver an NHS with the lowest ever waiting lists and the highest ever patient satisfaction.

The second point in our A and E rescue plan concerns safe staffing levels—another aspect that we have raised repeatedly with the Secretary of State.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way to the right hon. Gentleman in a moment.

All over the country, NHS staff are saying that there are not enough people on the ward to deal safely with the pressure that they are under. The College of Emergency Medicine has warned of a “workforce crisis” in A and E and of

“a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care.”

More than 4,000 nursing posts have been lost since May 2010 and the Care Quality Commission says that one in 10 hospitals in England is understaffed. It emerged last week that the problem is set to get worse. A survey of NHS HR directors by the Health Service Journal found that 27% of trusts were planning to cut nursing jobs in the coming year, that 20% were planning to cut doctors and that one in three was not confident that they had enough staff to meet demand.

As I have said before, all parties in this House, including my own, need to learn the lessons of the failures in care at Mid Staffs and of the Francis report. The primary cause of those failures was dangerous cuts to front-line staffing. There is a clear risk that the NHS is repeating that mistake. I therefore call on the Secretary of State to intervene in the further round of job cuts and to ensure that all hospitals in England have safe staffing levels.

[Mr Dorrell]

May I bring the right hon. Gentleman back to the interface between social care and health care? He knows that I have a lot of sympathy for the points that he made about the importance of making that interface work more smoothly than it has done for a long time. Is the House to interpret his remark that an additional £1.2 billion ought to be made available for social care as a spending commitment that has the consent of the shadow Chancellor, on the day when the Labour party has said that it will not make good the child benefit changes that it opposed earlier in the Parliament?

[Andy Burnham]

It is important for me to answer the Chairman of the Health Committee. Those of us who are in the club of former Secretaries of State understand that the health and social care systems are interconnected and must be seen as one system, because the failure of social care lands on the doorstep of the NHS.

To answer the right hon. Gentleman’s point directly, the money that I was talking about would come from the underspend. It is part of the allocated budget that his Government gave to the Department of Health for 2012-13. The Department did not spend the whole budget so there was a £2.2 billion underspend. As he knows, the practice has been that Departments can take forward that resource to meet new pressures in later years. I am asking the Secretary of State please to ask for access to that money to relieve the pressure on social care. Simply handing it back to the Treasury when there is an A and E crisis and social care is collapsing is not good enough.

The third point I want to address is out-of-hours advice and the introduction of the 111 service. Last week’s summit heard worrying evidence that the problems of 111 are not just teething problems, as the Secretary of State has claimed. We were told that the problems were more structural and were a result of how 111 has been set up—a feature of the cost-driven contracts that have replaced the successful and trusted NHS Direct. Contracts have gone to the lowest bidder, and they are saving money by having inexperienced call handlers working to a computer algorithm that too often results in the advice “Go to A and E”. There has also been a huge reduction in nurse-led call back, which was the norm with NHS Direct.

--- Later in debate ---

[Mr Dorrell]

I have four minutes, or with two interventions, six minutes, so if the hon. Gentleman will forgive me, I shall not go off into a discussion about immigration policy.

I want to focus on the changing needs that the health service has to meet. I sometimes wonder whether people talking about rising demand on the health service and rising demand for emergency care have ever sat in a GP’s surgery. Have they noticed around them in a GP’s surgery the kind of people who present in a surgery and the conditions that bring them there—dementia, diabetes and drug and alcohol abuse? How can we expect a service that was designed to meet the needs of patients, inasmuch as it was designed at all, in the 1950s, 1960s and 1970s to meet the needs of today’s increasingly elderly and dependent patients, without rethinking the way care is delivered?

This is—I come back to my core point—a shared analysis. It is not a subject of party political debate. It is a shared analysis between the two Front Benches, and what is even more surprising is that not only is the analysis shared, but the conclusions about the right policy response are shared.

[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Dorrell]

Forgive me. I have a minute and a half and I want to develop what I think is an important point.

When I make the case for greater urgency about integration between the different parts of the health and care system, I am often told that I am supporting Andy Burnham’s plan. I am quite happy to support Andy Burnham’s plan. Actually, I gently claim credit for the fact that the Health Committee on a cross-party basis has been advancing this analysis from the beginning of this Parliament, and with due deference to the right hon. Gentleman and to my colleagues on the Select Committee I will also point out that part of the answer that the right hon. Gentleman is—rightly, I think—advancing builds on health and wellbeing boards, which are the creation not of me or of him, but of my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), the former Secretary of State for Health and now the Leader of the House of Commons.

The right hon. Member for Holborn and St Pancras (Frank Dobson) talked about a duty of candour. Could we not have a duty of candour about agreement in the House of Commons—agreement that what needs to happen is not to find artificial divisions, but to build on the need for urgent change to meet the needs of today’s patients?

NHS Funding

Debate between Stephen Dorrell and Andy Burnham

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

Mr Dilnot may be watching; the Minister needs to be careful what she says.

That promise was carried into the coalition agreement, which said:

“We will guarantee”—

guarantee, mind—

“that health spending increases in real terms in each year of the Parliament”.

The Secretary of State has stopped nodding; he was nodding earlier. [Interruption.] I will be interested to hear how the Conservatives make those claims stack up, because week after week, Ministers from the Prime Minister downwards have stood at the Dispatch Box and claimed that that is exactly what they have delivered.

Until recently, this appeared prominently on the Conservative party website:

“We have increased the NHS budget in real terms in each of the last two years”.

Then, on 23 October, the Secretary of State said to the House:

“Real-terms spending on the NHS has increased across the country.”—[Official Report, 23 October 2012; Vol. 551, c. 815.]

[Interruption.] “It has”, he says again today. Okay, but this is where the story changes, because last week, he received a letter from the chair of the UK Statistics Authority, Andrew Dilnot CBE. Let me quote the key sentence, which puts Mr Dilnot and the Secretary of State at odds, if I heard the Secretary of State correctly a moment ago:

“On the basis of these figures, we would conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10.”

[Interruption.] I am coming on to it all. In other words, NHS spending is lower, in real terms, after the first two years of the coalition, than when Labour left office.

[Mr Stephen Dorrell (Charnwood) (Con)]

Can the right hon. Gentleman confirm that the next sentence says:

“Given the small size of the changes and the uncertainties associated with them, it might also be fair to say that real terms expenditure had changed little over this period”?

[Andy Burnham]

Let me say to the Chair of the Health Committee that today I am challenging the veracity of ministerial statements made at the Dispatch Box. I am sure that as a former Secretary of State with many years’ experience of the House, he will know that when Ministers are at the Dispatch Box, they have to be accurate; they have to say the truth. A moment ago, the Secretary of State for Health said that he and the Conservative party were right to say that NHS spending had increased in real terms. That directly contradicts the letter that the Secretary of State had just been sent. Is it any wonder that the public are losing trust in the Government if that is the kind of arrogant spin that comes from those on the Government Benches, week after week?

[Mr Dorrell]

rose—

[Andy Burnham]

I give way to the right hon. Gentleman once more, but then I will make some progress.

[Mr Dorrell]

Is it fair to characterise the letter as saying that

“real terms expenditure had changed little over this period”?

[Andy Burnham]

That is what the letter says, but it is a cut; that is what the letter says. The right hon. Gentleman might say that, in the context of the NHS budget, £1.9 billion is not very much, but it is still a change, and it is a cut. He stood for election on a manifesto promising a real-terms increase. He has just acknowledged that there has been a real-terms cut. Does he acknowledge that there has been a real-terms cut? I think he will have to. I am amazed; the Conservatives come here today to try to con the public, yet again, into thinking that they are fulfilling their promise.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

You challenged us earlier, Mr Deputy Speaker, to introduce a little Christmas good will to the debate, and I want to try to do that in two ways. First, I want to respond to the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), who spoke from the perspective of the local constituency and community interest in Lewisham. The challenges that she described repeat themselves many times over in the health care system, and it is those challenges that I want to address.

Secondly, I want to surprise the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), by welcoming the fact that his motion, although I do not endorse it, refocuses the health debate on the core challenge facing the health service, and the health and care system more broadly, as it thinks about how we meet demand—in truth, there is bipartisan agreement on this—in the more challenging resource environment in which we now live.

Although we were not able to detect it in the right hon. Gentleman’s speech, the fact is that he, as Secretary of State, introduced the changed resource outlook within which the health and care system now operates. It was in May 2009—not on election day in May 2010—that Sir David Nicholson issued his annual report on the challenges facing the national health service. He made it clear that the system has to meet demand against the background of a resource outlook that is not only unrecognisably different from that during the generous funding of the Labour years between 1997 and 2010, but that has fundamentally changed from the one that the NHS has experienced throughout its whole history since 1948.

[Andy Burnham]

I agree with the right hon. Gentleman that I had to give the NHS that reality check and set the Nicholson challenge. With that in mind, does he agree that the Nicholson challenge should have been the only show in town after 2010, and that it was catastrophic to combine it with the biggest ever reorganisation that the NHS has ever seen?

[Mr Dorrell]

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

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

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

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

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

Regional Pay (NHS)

Debate between Stephen Dorrell and Andy Burnham

Wednesday 7th November 2012 Commons Chamber

[Andy Burnham]

I am here to talk about the NHS in England. I will come on to the Conservative Government’s record on funding the NHS in England, so I would not be so smug if I were the hon. Gentleman.

The drive to turn collaboration into competition depends on breaking national standards—breaking the “N” in NHS. The former Health Secretary’s request to the pay review body to consider the case for “market-facing pay” needs to be seen alongside his Health and Social Care Act 2012. Breaking national pay in the NHS is an essential step towards creating the free market in health that many in the Conservative party have long wanted, and which the Liberals now seem willing to let them have.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman confirm that the direction towards market-facing pay should also be seen in the context of the statement in the Budget presented by the previous Government in 2003 committing them to increase regional and local flexibility in public service pay systems? Did he support that when he was Secretary of State?

[Andy Burnham]

The Labour Government did introduce some flexibility, but let me tell the right hon. Gentleman my record: I spoke up, at every opportunity, for the principle of national pay underpinning a national health service. We hear nothing similar from Government Front Benchers. We built a progressive system of pay for the NHS in “Agenda for Change”, which brought fairness and stability to the system. By the time we left office, not one trust had opted out of that national system of pay, and only one, Southend, paid an increment on top.

[Mr Dorrell]

Will the right hon. Gentleman give way?

[Andy Burnham]

No, I will make some progress.

Breaking national pay is what the Government want to do, and that springs from an entirely different philosophy from the one that forged the NHS in the first place. The Government are rejecting the “one NHS” approach, whereby hospitals collaborate and the unpredictable pressures of any health service are balanced across the system. Instead, they have a vision of hospitals as stand-alone small businesses, on their own in the marketplace, with no bail-outs and free to earn up to 49% of their income from the treatment of private patients, but—as we are seeing in south-east London—finding little mercy in a private-sector-style administration process if the sums do not add up. That is a very different vision of the NHS, and it is not one to which the British people have ever given their consent in a general election.

National Health Service

Debate between Stephen Dorrell and Andy Burnham

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

There is a simple answer: yes, we will repeal the Act. It is a defective, sub-optimal piece of legislation and it is saddling the NHS with a complicated mess. The hon. Gentleman should listen to the chair of the NHS Commissioning Board, whom his Secretary of State appointed. He has called the legislation “unintelligible”. In those circumstances, it would be irresponsible to leave it in place.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[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.

--- Later in debate ---

[Andy Burnham]

One of the great tragedies in this book is the Secretary of State’s admission, during a statement in the House in which he announced the “pause”, that he could have done most of what he wanted to do without legislation. The former Secretary of State, the right hon. Member for Charnwood (Mr Dorrell), is quoted as muttering to a colleague, “Why on earth are we doing it, then?” Well, why on earth did he do it? Because he wanted his Bill, regardless of other people.

[Mr Dorrell]

A moment ago, the right hon. Gentleman told my hon. Friend the Member for Winchester (Steve Brine) that Labour was committed to repealing the Act in its entirety. Does that not mean that an incoming Labour Government would be committed to precisely the kind of pre-cooked reorganisation of which he has just accused my right hon. Friend the Secretary of State?

[Andy Burnham]

No, it does not. This is what Government Members do not understand. It is not about the organisations, but about the services that they provide. The existing organisations can be asked to work differently, and I would ask them to work differently. I do not want NHS organisations to be in outright competition, hospital versus hospital; I want them to work collaboratively. So yes, we will repeal the Act, but no, there will not be a pointless top-down reorganisation of the kind that we have seen the Secretary of State inflict on the NHS.

This complacency is dangerous, and it cannot be allowed to continue. We had two clear purposes in initiating today’s debate. First, although we cannot stop the Government’s reorganisation, we can hold them to account for promises that they made to get their Bill through. I shall shortly identify five such promises in respect of which we are asking Ministers to live up to their words. Secondly, we wanted to give the House a chance to help the NHS by voting to hold the Government to account and enforcing the coalition agreement’s commitments on NHS spending.

Let me first deal with Ministers’ claim that there is no evidence of rationing of treatments by cost. They have promised to act if any evidence is presented. In fact the evidence is plentiful, and it is simply not credible for Ministers to deny it. The postcode lottery of which we warned is now running riot through the NHS. We have identified 125 separate treatments that have been stopped or restricted in the past two years, in some cases in direct contradiction of guidance from the National Institute for Health and Clinical Excellence.

--- Later in debate ---

[Mr Dorrell]

I agree with my hon. Friend, but let us not go down that route. At the time when Sir David Nicholson was writing, the Labour Government were contemplating the possibility not of a real-terms freeze, which is in effect what is planned under the coalition, but of a cash freeze, which would have been substantially more difficult to achieve.

The main issue now is how we deliver services that meet the demands placed on the system against the background of a resource allocation to the health service that was always going to be dramatically less generous than it was during the earlier years of the Labour Government. We heard from the right hon. Gentleman a commitment that an incoming Labour Government would go through a clean-sheet-of-paper redrawing of the map—

[Andy Burnham]

indicated dissent.

[Mr Dorrell]

The right hon. Gentleman shakes his head, but he said that he would repeal the Health and Social Care Act 2012, the result of which would be to commit the health service to precisely the kind of reorganisation—or re-disorganisation—that he accuses the Government of introducing.

The challenge for the Opposition is to show that they are willing to map a future for the health service, in much more constrained financial circumstances, that allows it to meet the demand for services that is going to be placed on it and to fulfil the aspirations that we all have for improved quality of service. That becomes increasingly difficult in the light of motions such as the one that the right hon. Gentleman has put down for the House to consider. He invites us to regret

“the increasing number of cost-driven reconfigurations of hospital services”

and

“growing private sector involvement in both the commissioning and provision of NHS services”.

Yet when he was Secretary of State and bore my right hon. Friend’s responsibilities for meeting this challenge, he made it clear that service reconfiguration was precisely how the health service needed to meet the challenges that it faced, and that the private sector had an important role—of course, not an exclusive role—in introducing the solutions to the challenge that Sir David Nicholson articulated in May 2009. The same approach was taken in the Labour party’s manifesto for the 2010 general election.

The challenge that the right hon. Gentleman has to address if he is to discharge his responsibilities as shadow Health Secretary is to move on from party political ding-dongs, of which we have had too many. [Interruption.] The right hon. Member for Holborn and St Pancras (Frank Dobson) is commenting from a sedentary position. I have always been aware that he, at least, does not agree with the commissioner-provider split that the shadow Health Secretary operated as Secretary of State and has always said that he is in favour of considering.

Health and Social Care Bill

Debate between Stephen Dorrell and Andy Burnham

Tuesday 20th March 2012 Commons Chamber

[Andy Burnham]

I am grateful to the hon. Lady for her point. The Liberal Democrats once derided the Freedom of Information Act as too weak. Today they cower behind it, trying to use any scrap of protection they can find within it to prevent the publication of the information that patients and the public deserve to have. That says everything that people need to know about today’s Liberal Democrat party.

[Mr Stephen Dorrell (Charnwood) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will not give way. I will now bring my remarks to a close.

We are clear that the risks in the Bill arise not just from the organisational turbulence that the Secretary of State is inflicting on the NHS, but from the specific policies in the Bill. Today we table a package of amendments in a last-ditch attempt to provide the necessary safeguards that the Liberal Democrats failed to secure in another place—

[Mr Dorrell]

On that point, will the right hon. Gentleman give way?

[Andy Burnham]

They are safeguards in light of the huge potential for the conflict of interests in the award of contracts under the “any qualified provider” provisions, which will not be addressed by a simple register of interests, and safeguards on a stronger local HealthWatch—the Government have watered that down since the Bill left this House of Commons. There are safeguards too—

[Mr Dorrell]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will give way for one last time.

[Mr Dorrell]

I am grateful to the right hon. Gentleman. Will he just clarify one issue of principle for the House? Are Labour Front Benchers now arguing that every Government Department should publish its strategic risk register? If not, can he justify his proposition that the Department of Health should do so uniquely?

[Andy Burnham]

I refer the right hon. Gentleman to the Information Commissioner’s ruling on the decision about a third runway at Heathrow. That is the precedent his Government should be following, but instead they have chosen to defy the commissioner. It was the Labour party that published the decision on a third runway at Heathrow, and I refer him to the ruling from the Information Rights Tribunal, which made a clear distinction between the strategic risk register, which covers all the uncontrollable risks that any Department will face, and the transition risk register, which deals specifically with the effects of Ministers’ decisions, in this case on the NHS. There is a real difference between the two. The tribunal said that the transition register should be published. His Government should respect the law and publish today.

We will table amendments to provide safeguards today, but in future it will not just be the cover-up of the risk register that we will have to worry about—that is just a taste of things to come in the new NHS. Members will have to get used to the words “commercial confidentiality” when inquiring about local services, because that is what they will find in the NHS that Ministers are creating. Let us look at the risks inherent in the proposed relaxation of the private patient income cap. One risk assessment that Ministers have published—the revised impact assessment—states that

“there is a risk that private patients may be prioritised above NHS patients, resulting in a growth in waiting times for NHS patients.”

That is all they have told us, but that alone is reason enough to oppose the Bill.

The only hope I can give people worried about the future of the NHS is that this might be the end of the Bill, but it is just the beginning of our campaign. The NHS will find a way of working around these changes and will not deteriorate overnight. We will be working to mitigate the worst effects of the Bill. This is the eleventh hour; our only hope would be a change of heart from the Liberal Democrats. We will call a vote on this motion and ask people to vote against it to show that we have not had enough time to debate these important issues.

I respect those Liberal Democrat Members who have had the courage to defy their orange book leadership, and I respect their grass-roots members who did the same at their spring conference, but the truth is that from today the Liberal Democrats will be remembered not only for tuition fees, but as the party that stole people’s votes in May 2012 in order to secure jobs for themselves and sell out the national health service. They could have stood up to the Prime Minister and enforced the coalition agreement, but they chose not to do so.

That brings us back to where we started: a Bill that nobody voted for, rammed through this place tonight in the teeth of near-universal professional opposition and in defiance of a major legal ruling; a Bill about which no Member of this House can look their constituents in the eye and say they have a mandate to support. Tonight Government Members will inflict this Bill on the NHS without knowing the potential damage it can do to the health service in their constituencies. They have made their choice; I have made ours. Although on a day like today it is hard for me to give any encouragement to people worried about what the Government are doing, I can at least say this: we will repeal this legislation at the first opportunity and restore the N in NHS. We have given this fight everything that we had. All I can say is that our fight will go on to protect and restore the Labour party’s finest achievement.

Health and Social Care Bill

Debate between Stephen Dorrell and Andy Burnham

Tuesday 13th March 2012 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the right hon. Member for South Shields (David Miliband) and it was notable that his hon. and right hon. Friends were listening to his words, rapt, possibly reflecting on what they had missed out on. The kernel of his argument for this side of the House appeared to be the offering of advice to us about where our party advantage lay. He will forgive me if I say that I think we should look elsewhere for advice about where our party advantage lies.

The right hon. Gentleman was raising a voice for Blairite reform of the NHS, and that is a theme to which I want to return. Some opponents of the Bill can claim the virtue of consistency. Some opponents of the Bill can claim that they always opposed the development of structures in the health services that encouraged flexibility and encouraged a focus on the patient voice and on general practitioners and the wider clinical community as an effective voice for patients in the health service.

Some can claim that they have always opposed having a health service open to private and independent sector provision alongside the national health service provision—that they have always preferred a centrally planned, state-provided service. The right hon. Member for Holborn and St Pancras (Frank Dobson), who is not in his place, can claim the virtue of consistency on that argument, but the shadow Health Secretary cannot claim that consistency because he, like the right hon. Member for South Shields, was once a Blairite. As my right hon. Friend the Secretary of State has shown with the quotations he gave from the shadow Health Secretary when he was at the Department, the shadow Health Secretary used to be an advocate of the policies that underlie this Bill. The Bill will deliver effective practice-based commissioning —a policy that the shadow Secretary of State used to espouse.

[Andy Burnham]

If this Bill simply continues our policy, why does it rewrite the entire legal structure of the national health service over 500 pages?

[Mr Dorrell]

The right hon. Gentleman knows that there is room for more than one view about the extent to which there is a need to rewrite the full statutory basis of the Bill, but that is not the issue now. The question is how, if we went down his route, had a summit and talked for another 12 months about what the institutional structure of the health service should be, that would serve the policy objective that he seeks to espouse, of greater clinical engagement in commissioning. How would it serve the policy objective of which he says he is in favour, of engaging local authorities and the wider political community in decisions that shape the future of the health service?

One issue that the right hon. Gentleman did not mention in his speech is the shift of public health out of the relatively narrow interpretation that is implicit when it is located in the national health service. Instead, public health can properly be understood as being part of the wider range of local government. Those changes do not justify some of the more ambitious rhetoric being used in support of the Bill but they certainly do not come close to justifying the rhetoric being used against it. If half the things being said about the Bill by Opposition Members were true, I and most of my right hon. and hon. Friends, and certainly my right hon. Friend the Secretary of State, would not support it.

NHS (Private Sector)

Debate between Stephen Dorrell and Andy Burnham

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

I agree that the cap varied according to historical levels of private sector activity within the different trusts. The hon. Gentleman is absolutely right about that, but he must agree that it was clearly defined in respect of every individual NHS hospital. They had a clear number and local people were able to hold them to account for that number. Where hospitals had large numbers, the cap froze their level of activity at the level when the cap was introduced.

[Mr Stephen Dorrell (Charnwood) (Con)]

Just to be clear, could the right hon. Gentleman explain why it is in the interests of NHS patients in a particular hospital for that hospital’s capacity to generate additional revenue from the private sector to be limited by a cap?

[Andy Burnham]

I will explain that very clearly. I am sure the right hon. Gentleman will have read the impact assessment to the Bill, which warns of the risk of lengthening NHS waiting lists if existing capacity is made available to private patients. It says that if additional capacity is provided, there might be no effect on NHS waiting lists. That is why this is dangerous, because all the progress that Labour made on reducing long NHS waits would be put at risk by the careless and cavalier policy of simply abandoning the principle of the cap, which has stood us in good stead.

[Mr Dorrell]

rose—

[Mr Simon Burns]

rose—

[Andy Burnham]

I shall give way to the Chairman of the Select Committee on Health once more and then to the Minister.

[Mr Dorrell]

I apologise to my right hon. Friend on the Front Bench. Could the right hon. Gentleman explain more clearly than he has so far why a hospital should reduce capacity at the same time as it is increasing revenue?

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

It is a pleasure to follow the hon. Member for Easington (Grahame M. Morris). He and I are both members of the Health Committee and, surprisingly perhaps, we more often find ourselves in agreement about the objectives that we are trying to deliver than is obvious from the nature of the debates across the Floor of the House.

I shall focus my remarks on the speech by the shadow Health Secretary. I have some quite good news for him—he was a far better Secretary of State than he himself appears now to believe. As Secretary of State, he did not allow himself to fall victim to the kind of prejudices that have been ventilated this evening. Tonight, he fell into the old trap of eliding two concepts and pretending that they are the same. The two concepts are, on the one hand, privatising the health service, and on the other, involving the private sector in the improvement of care available to patients. As Secretary of State, he was well able to distinguish between those two concepts and pursued policies of involving the private and voluntary sector when there were opportunities to improve care for patients. He now prefers to forget the fact that during his time as a Minister we not only heard plans for involving the private sector in improving the care delivered to patients but saw an open-minded attempt to bring in the private sector to improve the process of commissioning in the health service. That was what world-class commissioning was designed to deliver. We are now asked to turn our mind away from all those ideas.

I, like my right hon. Friend the Secretary of State, am in favour of tax-funded care for patients. I am in favour of equitable access to high-quality care, like my right hon. Friend the Secretary of State and like the shadow Health Secretary. I am also, however, in favour of plural provision, looking for the best solution for patients and the best value for taxpayers. In that respect, I am, as the shadow Health Secretary used to be but apparently no longer is, a straightforward Blairite. This was the breakthrough that Tony Blair taught the Labour party that it now appears to have forgotten. It was Tony Blair who advocated the introduction of private hospitals into the delivery of care and Tony Blair who stressed the importance of the third sector in finding new ways of improving care for patients, yet it is now my right hon. Friend the Secretary of State who has to pick up the Blairite torch that has been so unceremoniously dropped by the shadow Health Secretary.

It is worth reflecting, is it not, on whether this Blairite consensus is the inevitable consequence of the principle of commissioning—

[Andy Burnham]

Will the right hon. Gentleman give way?

--- Later in debate ---

[Mr Dorrell]

I would be delighted to.

[Andy Burnham]

If the policy that the Secretary of State is pursuing is a continuation of our policy in government, why do the Government need many hundreds of pages of legislation and a new Bill?

[Mr Dorrell]

The right hon. Gentleman is in danger of creating another consensus. Indeed, there is a debate about whether the Bill moves things forward as far as the rhetoric suggests. I am on the record many times saying that the claims made for the Bill by, if I am honest, both the Government and the Opposition spokesmen are grossly overstated. It introduces greater engagement by clinicians in commissioning and greater engagement by local authorities in commissioning through the health and wellbeing boards, and those are good things. I agree, however, with the tone of the right hon. Gentleman’s last intervention: the new world is not quite as far removed from the old as he sometimes likes to suggest and as he suggested in his speech.

Let us focus for a second on what it means to have commissioners in the health service. When the shadow Secretary of State has more time one day, I would like to hear him talk us through the process, which he would, on occasion at least, advocate, of turning down a good idea that is brought to a commissioner to improve care for patients and good value for taxpayers because that idea comes from the private sector. I hold no brief for the private or public sector in the delivery of care; I hold a brief for tax-funded equitable access to higher quality care from whomsoever provides that care. That is what I mean when I say that I am a straightforward Blairite and I look forward to welcoming the shadow Health Secretary back into the fold.