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National Health Service

Opposition Day — [4th Allotted Day] – in the House of Commons at 5:14 pm on 16th July 2012.

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Votes in this debate

  • Division number 54
    A majority of MPs voted against asking the Government to take action to prevent rationing by cost in the NHS and against calling on the Government to honour its pledge to increase health spending in real terms each year.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health 5:14 pm, 16th July 2012

I beg to move

That this House
regrets the growing gap between Ministers’
statements and what is happening in the NHS;
notes mounting evidence of rationing of treatments and services by cost, despite Ministers’
claims to have prevented it;
further regrets the increasing number of cost-driven reconfigurations of hospital services, despite the Coalition Agreement’s promise of a moratorium on changes to hospital services;
further notes growing private sector involvement in both the commissioning and provision of NHS services, contradicting Ministers’
claims that the NHS reorganisation would not increase levels of privatisation;
recognises that, according to the Government’s Public Expenditure Statistical Analyses figures, actual Government spending on the NHS in 2011-12 fell by £26 million, the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office, in breach of the commitment in the Coalition Agreement;
believes the Government’s decision to reorganise the NHS has distracted its focus from the financial challenge, with seven out of 10 acute hospital trusts in England missing savings targets in the first half of 2011-12;
calls on the Government to take action to prevent rationing by cost in the NHS, based on the evidence presented;
and further calls on the Government to honour pledges on NHS spending in the Coalition Agreement, and the commitment that future savings will be reinvested into the NHS front line, and to return at least half of the underspend to the Department of Health budget.

The year 2011 was the first full year of the coalition Government and the year of the biggest ever fall in public satisfaction with the national health service. As I shall set out, those two facts are not unconnected. The NHS in England is reeling from the Government’s catastrophic decision to reorganise it at a time of huge financial pressure. Warnings by Opposition Members and others during the passage of the Health and Social Care Act 2012 of a postcode lottery, of destabilised hospitals and of increasing privatisation are, sadly, beginning to materialise.

For the coalition, attention has moved to other battles—more pressing priorities—but for the NHS the moment of greatest danger is now, as the unstoppable force of reorganisation hits the immovable object of the financial challenge. That is why the Opposition make no apology for introducing this debate, or for bringing the House’s attention back to where it should be: our country’s most important public service and the struggle it faces.

I am grateful for the Secretary of State’s letter—[ Interruption. ] I can hear him mumbling away on the Government Front Bench. I would have thought the debate would justify his attention, as it justifies that of the Minister of State, Mr Burns. The Opposition have introduced this debate to support NHS staff. We thank them for what they do. They have a huge capacity to deal with whatever is thrown at them, but they have been set mission impossible by the Government. One can only wonder how they felt on hearing the news that the Deputy Prime Minister had the chance to stop this reorganisation but chose to prioritise House of Lords reform. A million hearts will have sunk.

It was not just the Government’s decision to reorganise that was wrong; the way they have gone about it was wrong as well.

Photo of Graham Stuart Graham Stuart Chair, Education Committee, Chair, Education Committee

The right hon. Gentleman will know that the Chair of the Public Accounts Committee said that productivity fell continuously for a decade under the previous Government. Does he regret that and recognise that radical change is required to get the productivity improvements this country desperately needs if we are to be able to afford the NHS we all want?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I am afraid the hon. Gentleman is out of date, because the figures cited by the Government are wrong. NHS productivity was improving by the time Labour left office. The independent and authoritative Commonwealth Fund pronounced the NHS the most efficient health care system in the world in June 2010. That was the legacy of the Labour Government, which the Conservative party is putting at risk.

As I have said, it was not just the decision to reorganise that was wrong; the way the Government have gone about it is also wrong. Before the ink was dry on their White Paper, Ministers set about dismantling existing NHS structures before the new ones were in place. That is a dangerous move at any time, but disastrous at a moment of financial crisis.

We have therefore had drift in the NHS: a loss of focus at local level and a loss of grip on the money just when it was most needed. At a stroke, the Government demoralised the very work force who would be crucial to managing the transition, with primary care trust managers dismissed as worthless. Experienced people left in droves. Those who stayed hoping for jobs in the new world were issued with scorched earth instructions: “Get on and do the unpopular stuff now—the rationing and the reconfiguration—so the new clinical commissioning groups don’t have to.”

We can now see the consequences across England: brutal, cost-driven plans for hospital reconfiguration being railroaded through on an impossible timetable without adequate consultation; walk-in centres being closed left, right and centre; and people left in pain and discomfort, or facing charges for treatment, as PCTs introduce restrictions on 125 separate treatments and services.

Photo of Andrew Slaughter Andrew Slaughter Shadow Minister (Justice)

On the subject of brutal closures, did my right hon. Friend have a chance to look at the authoritative report by David Rose in The Mail On Sunday yesterday about the “Beeching-style” closure of major casualty units? Four out of nine of the units to be closed are in west London, leaving my constituents and 2 million people in west London without adequate health cover.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I have no idea how Ministers expect west London to cope with service reductions on that scale, nor do I know how they square them with the moratorium on hospital closures and changes which they promised at the last election. Perhaps we will hear some justification later today, although I will turn to reconfigurations shortly.

Photo of Steve Pound Steve Pound Shadow Minister (Northern Ireland)

Further to the previous question, Angie Bray has said that this is all about finance, and she may well be right. However, bearing in mind the fact that Ealing hospital not only came in under budget but produced an operating surplus last year, what possible justification can there be for ripping this crucial and much needed service from the heart of our community?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

My hon. Friend makes his point powerfully. With some reconfigurations there is a clinical case supporting change, such as the changes I introduced in London before the last election to improve stroke services. We reduced the number of centres from 12 to eight. That was a difficult decision for many London Members at the time, but it was the right thing to do because lives are being saved. However, there is a world of difference between those changes and the crude, cost-driven reconfigurations in the NHS that those on the Government Benches said they would not allow.

I spent my weekend reading a very entertaining book entitled “Never Again? The story of the Health and Social Care Act 2012: A study in coalition government and policy making”. It is a very interesting book and offers a new, detailed account, by Nick Timmins, of the Government’s NHS reorganisation—or, as it says on the blurb, the inside story of a “car crash”. I particularly enjoyed the quotation from the Minister of State—I gather that he has not read it, but there he is, up in lights at the very beginning of the book. He made this comment about the then Bill, which the author thought worthy of special attention:

“You cannot encapsulate in one or two sentences the main thrust of this.”

He should know that better than anybody, as he toured more media studios than anybody, and used more sentences than anyone, in a vain attempt to sell the technocratic and dense plans that made sense to his boss and nobody else.

Photo of Anne Main Anne Main Conservative, St Albans

Given that the biggest strain on most health authorities is staff pay, does the right hon. Gentleman regret the fact that Labour doubled the remuneration of GPs, allowing them to opt out and thus putting huge stresses on many health care authorities, which then had to buy in additional services? Does Labour not regret allowing doctors to be paid more for doing less?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I am interested in the argument that the hon. Lady is beginning to develop, which is that she wants to deliver pay cuts to NHS staff across her constituency. Presumably she wants the same as people in the south-west are getting. Is that what she is calling for? It is an interesting argument, and I would be interested to hear her expand on it later.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

In a moment.

What I found most useful about the book is that it answered a question that has been nagging away in my mind for some time. As a former Health Secretary, I remember clearly the warnings I received from senior civil servants about the sheer scale of the £20 billion efficiency challenge. “It would be a major undertaking,” they said. “The NHS would need to focus all its energy on that alone. To be negotiated safely, new policy initiatives would have to be put on hold.” Over the months that have followed, I have often had cause to recall those words, as I watch the Secretary of State add to the financial challenge with the biggest ever reorganisation in NHS history. Did the same civil servants issue the same apocalyptic warnings to the incoming Secretary of State as they did to me? Finally I have my answer, in a quotation in the book from an unnamed senior civil servant:

“The biggest challenge was trying to get the secretary of state to focus on the money—the £20 billion and the sheer scale of the financial challenge”.

According to that civil servant, however, the Secretary of State’s attitude was:

“I am going to do these reforms anyway, irrespective of whether there are any financial issues. I am not going to let the mere matter of the financial context stop me getting on with this”.

Another civil servant is quoted as saying:

“We did point out to him that his plans were written before the big financial challenge, and didn’t that change things? He completely did not see that at all. He completely ignored it”.

Then the question is asked: was the Secretary of State presented by the Department with alternatives to inflicting legislative upheaval on the NHS? A senior civil servant said that

“it was clear that having posed the question of did he want to see other options, that Andrew was not very interested at all in us presenting alternatives.”

A picture is emerging of a Secretary of State with an inability to listen, take advice or heed warnings, who is going to have his Bill regardless of the upheaval that it will cause to the national health service.

Photo of Barry Gardiner Barry Gardiner Labour, Brent North

I am grateful to my right hon. Friend for giving way, although I fear that the moment might have passed. I simply wanted to ask him to reflect on the challenges that Mrs Main issued to him about doctors and pay. Does he agree that those doctors are now the very people who are in charge of commissioning the services of which they are also the providers? I wonder whether the hon. Lady thinks that that is a good thing or a bad thing.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

At the heart of the defective legislation that the Government rammed through the House of Commons is an unresolved conflict of interest, in which commissioners can also be providers who can remove services from hospitals and then provide them themselves. Under pressure in the other place, the Government came up with a requirement for a statement of such interests, but without introducing any mechanism for enforcement to ensure that decisions in the NHS are being made for the right reasons. I fear that that conflict of interest will return to haunt the Government.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

The right hon. Gentleman knows that I share his critique of the Health and Social Care Act 2012. He mentioned the fact that civil servants had given him warnings and cautioned him about the consequences of his decisions during his time in office.

Was he warned about the changes in regulations that have resulted in the decision of the south-west consortium to suggest changes to the terms and conditions and pay of staff in that area? That was a direct result of regulations brought in by his Government.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

No, it was not. Agenda for Change was one of the proudest achievements of our Government, and we always staunchly defended national pay arrangements. The hon. Gentleman talks about warnings, but I have just read out the explicit warning that was given to the current Secretary of State that this was the wrong time to reorganise the NHS. It was unforgivable to proceed in those circumstances. This was the single most reckless gamble ever taken with the NHS, and patients and staff are already proving to be the biggest losers.

Photo of Steve Brine Steve Brine Conservative, Winchester

I was not reading the book that the right hon. Gentleman has mentioned at the weekend, but I was listening to Radio 4 last night while I was doing the washing up, as I do. I heard one of his colleagues, Lisa Nandy, say that Labour was committed to repealing the Health and Social Care Act in its entirety. Will the shadow Secretary of State tell me whether, when I am in Winchester over the summer recess, I should tell the clinical commissioning groups that are getting on with their work that all that work would be undone, and that the Hampshire primary care trust and the South Central strategic health authority would be recreated if Labour were to form the next Government?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

In the light of what the right hon. Gentleman has just said, will he clear up this confusion? His leader, 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.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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, 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.

Photo of Stephen Dorrell Stephen Dorrell Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

A moment ago, the right hon. Gentleman told my hon. Friend 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?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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.

Photo of George Howarth George Howarth Labour, Knowsley

Last week I was at Whiston hospital, which, as my right hon. Friend will know, covers Knowsley and St Helens. The net effect of all the changes is that its staff, particularly the nursing staff, are thoroughly demoralised. Does my right hon. Friend accept that any commitment that he makes to changing the system will be welcomed by NHS staff?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I will give way to the Minister one more time, and then to my hon. Friend Clive Efford, but after that I must make some progress.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

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?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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.

Photo of Clive Efford Clive Efford Shadow Minister (Culture, Media and Sport)

Clinicians in south-east London presented proposals for the reorganisation of our health care provision in “A picture of health”. It was all agreed by local commissioners, but when the Tories took office, they imposed a two-year delay that cost our health care trust £16 million a year—and that is the same trust that the Secretary of State has just put into administration.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

This is what happened: when they came into government, they had a cynical policy of a moratorium, and they went up to Chase Farm hospital to announce it, saying, “There will be no cuts and no closures at this hospital.” They traded and touted for votes in that constituency for years on the back of that issue, and now that hospital is going to close. They delayed the reconfiguration and then they delayed the savings that came to the NHS. It was disgraceful, and people will have seen through it.

Photo of Dave Watts Dave Watts Labour, St Helens North

I wish my right hon. Friend well in trying to hold this Government to account. The NHS is paying consultancy fees all around the country: hundreds of thousands of pounds are being wasted, and the Government are refusing to publish the information. They are also bullying many of the trusts. How are we going to get the information out when the Government are doing this?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

My hon. Friend is absolutely right about the waste of money the Government have brought into the NHS through this reorganisation. The total is over £3 billion. That is simply unjustifiable at this time. Staff who had been working in primary care trusts are either being re-employed as consultants or are going into clinical commissioning groups. This is such a waste of money at a time when the NHS needed every penny to maintain standards of patient care.

I was talking about rationing, and let me focus on cataract surgery. GP magazine has found limits on cataract surgery in 66% of PCTs. The Royal National Institute of Blind People found that 58% of PCTs are using visual acuity thresholds to restrict surgery. This is the evidence, so the Secretary of State had better start listening. What has happened since those restrictions on cataract operations have been introduced? Unsurprisingly, the number of cataract operations in England fell by over 12,000 between 2010 and 2011. That is a direct result of the new restrictions. There is no less need, however. Thousands of older people need such procedures, but they are now being forced to live with very poor sight.

This is truly a false economy. Cataract surgery is one of the most cost-effective procedures carried out by the NHS. It helps people live independently and have a quality of life, and research has shown that in the last two years poor vision has been a factor in 270,000 falls by people aged 60 or over. This is the rationing by cost that Ministers have repeatedly denied is happening. So let me ask the Secretary of State again: does he agree with these restrictions on cataract surgery? If he does not, will he take immediate action to lift them?

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras

Will my right hon. Friend confirm that under the last Labour Government the number of cataract operations carried out by the NHS rose from 160,000 a year to 310,000 a year, as a result of the commitment of the staff? What will the staff in the south-west think about all this if they have their pay cut?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

For staff who are trying to hold things together through the chaos the Government have brought about, what a kick in the teeth it must have been to read in the Sunday newspapers that unless they accept pay cuts, they will be made redundant. My right hon. Friend says the staff made those improvements, but so did he. As the incoming Secretary of State, he made improvements to waiting times for cataract surgery, which, if I remember rightly, were commonly about a year in the late-1990s. We brought those waiting times right down. Now what do we hear? We hear that under this crowd people with two cataracts are being told, “You can have one done, but not both.” That is what the NHS has been reduced to under this Government. The Secretary of State has promised action, and I have given him the evidence. He now must take action.

The second area on which the Government need to be challenged is privatisation. As the debate on the Bill drew to a close, the Secretary of State made this clear statement:

“The legislation is absolutely clear that it does not lead to privatisation, it does not promote privatisation, it does not permit privatisation and it does not allow any increase in charges in the NHS.”—[Hansard, 27 March 2012; Vol. 542, c. 1335.]

It is hard to know where to start, but how about the NHS walk-in centre in Sheffield, which is managed by a private company and has just started charging patients with whiplash injuries £25 for treatment, or the NHS hospitals now marketing private treatments for in vitro fertilisation, cancer screening or bone screening since the cap was lifted? How about the letter sent to all PCTs requiring them to identify three or more services for tendering under the “any qualified provider” measure in 2012-13? How about the 100 or so tenders for a range of services that have been offered to the private sector on this Secretary of State’s watch, with a total value of more than £4 billion? So let me ask the Minister and the Secretary of State today: will they now at least be honest about their true intentions for the level of private sector involvement in the NHS?

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Education)

Is my right hon. Friend as concerned as I am about the exponential rise in the number of private health care ads that we see on our television screens and in our newspapers every day? These ads had almost disappeared under the previous Government. Advertisers advertise only when they know that there is a market.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

This is really important; it is where all of what the Government are doing comes together. They have put in place restrictions in treatments— 125 separate treatments, as I have just mentioned— and at the same time they have given a 49% cap to NHS hospitals to do more private work. So as the NHS decommissions services, hospitals are then free to start offering those services. That is why my hon. Friend is beginning to see the changes that she is noticing, and this is the clear agenda of the Conservative party.

Photo of Huw Irranca-Davies Huw Irranca-Davies Shadow Minister (Environment, Food and Rural Affairs)

Does not the fragmentation that my right hon. Friend is describing raise the crucial question about when the national health service ceases being a national health service under this Government?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

The Bill that the Government brought through is an attack on the N in the NHS; that is what it was designed to do. It was designed to break national standards; to break national pay; to break waiting time standards; and to allow primary care trusts to introduce random rationing across the system. That was the intention of the Bill that they brought through; they wanted an unfettered market in the health service, and my hon. Friend is absolutely right. That is why we are saying that we will repeal this Act and restore the N in NHS at the earliest opportunity.

Photo of Andrew Percy Andrew Percy Conservative, Brigg and Goole

On 28 June, in response to misinformation put out by Labour councillors, the medical director of my local hospital trust, a doctor of 30 years, wrote an article in my local paper under the headline “NHS faces greatest challenge”. She talked about staff costs, treatment costs and the 2008 Nicholson challenge. She said that the trust’s problems date “back to 2008”, and she continued:

“Having been a doctor for nearly 30 years, the 2008 Nicholson challenge is, by far, the greatest challenge the NHS has ever faced”.

What should we believe: the picture being presented by the right hon. Gentleman or this article?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

The hon. Gentleman is making my point; if he was listening to what I said at the start of my speech, he would have heard me say clearly that the £20 billion Nicholson challenge, which I set, was always going to be a mountain to climb for the NHS. Let us be clear that it was. What was unforgiveable was combining that Nicholson challenge with the biggest ever top-down reorganisation in history, when the whole thing was turned upside down, managers were being moved or made redundant and nobody was in charge of the money. That was what was so wrong, and that is what the hon. Gentleman should not be defending if he is defending staff in the NHS.

The third area where we need action from Ministers is on protection for staff. The Deputy Prime Minister said recently:

“There is going to be no regional pay system. That is not going to happen.”

But we heard yesterday that a breakaway group of 19 NHS trusts in the south-west has joined together to drive through regional pay, in open defiance of the Deputy Prime Minister. They are looking at changes to force staff to take a pay cut of 5%; to end overtime payments for working nights, weekends and bank holidays; to reduce holiday time; and to introduce longer shifts. We even hear that if staff will not accept this, they are going to be made redundant and re-employed on the new terms. So let us ask the Secretary of State and the Minister to answer this today: do the Government support regional pay in the NHS and the other moves planned by trusts in the south-west? If they do not, will they today send a clear message to NHS staff in the south-west that they are prepared to overrule NHS managers?

Fourthly, I shall deal with reconfigurations. The House will recall the promise of a moratorium on changes to hospitals and the Prime Minister’s threat of a “bare-knuckle fight” to resist closure plans. In 2010, the Secretary of State set out four tests that all proposed reconfigurations had to pass. They related to support from general practitioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice. He said:

“Without all those elements, reconfigurations cannot proceed.”

So let me ask the Minister: does he think that the A and E units closing at Ealing, Hammersmith, Charing Cross and Central Middlesex pass that test? How about St Helier, King George, Newark and Rugby? Is it not clear to everyone that the Prime Minister’s bare-knuckle fight never materialised? Is it not also clear that no one told the Foreign Secretary, the Work and Pensions Secretary or even the Minister of State, Department of Health, Paul Burstow, who is responsible for care and older people and who has launched a campaign against his own Department? What clearer sign could there be of the chaos in the Department of Health and of the chaos engulfing the NHS? Will the Secretary of State now take action to stop reconfigurations on the grounds of cost alone?

That brings me to my fifth and final area for action, which is NHS spending. The coalition agreement said:

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

That is health spending, not the health allocation. Official Government figures show that actual spending has fallen for two years running and the underspend has been clawed back by the Treasury. Of all the promises the coalition has broken, people will surely find that one the hardest to understand given that the Prime Minister appeared on every billboard in the land, on practically every street in the land, promising to do the opposite just two years ago.

Photo of Gordon Birtwistle Gordon Birtwistle Liberal Democrat, Burnley

Will the right hon. Gentleman advise me who he consulted with before he closed the A and E unit in Burnley?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I was prepared to make difficult decisions and be honest about them. I am not proposing the reversal of that decision and I note that clinicians in his area recently said how it had improved outcomes for his constituents. What I will not do—what I will never do—is go to marginal constituencies, as the Secretary of State did, and make false promises that I will reopen such units. The Secretary of State did that before the last election; no wonder he is looking shifty in his seat right now. He went to the hon. Gentleman’s constituency and said that he would reopen that unit. Has he done that? I do not believe that he has.

Photo of Clive Efford Clive Efford Shadow Minister (Culture, Media and Sport)

On that very point about turning up in constituencies just before general elections promising to save A and E services, the Tories pledged to save 999 services at my local hospital, Queen Mary’s, Sidcup. They pledged to keep that A and E open—the Secretary of State did so himself. Where is the A and E?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I do not know how the Secretary of State justifies what has been done. Even in my own patch, Greater Manchester was going through a children’s and maternity services review and some constituencies were benefiting from the changes—Bolton, for example, was getting a bigger maternity unit—but some were not and this Secretary of State went both to Bury, where he said that he would defend the maternity unit, and to Bolton, for a photo call celebrating the new investment. If anything illustrates the sheer opportunism of the Secretary of State in opposition, surely that is the example that does.

Several hon. Members:

rose —

Photo of Sarah Wollaston Sarah Wollaston Conservative, Totnes

I hope that in his conclusion, the right hon. Gentleman will address a point raised by the King’s Fund. It said that the greatest policy failure of the previous Administration was the failure to tackle health inequalities. He says that he wishes to repeal the whole of the Health and Social Care Act 2012, but does he accept that shifting public health back to local authorities gives us one of the greatest opportunities to tackle health inequalities? Will he seriously put public health back where it was before and, by so doing, continue to fail to address health inequalities?

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

The hon. Lady mentions the Act, and I seem to remember that she called the Bill a hand grenade thrown into the health service. She seems to have changed her tune since then. We made huge progress on tackling smoking and improving the public health of this country, progress of which we are very proud. We can always say that we could have done more, but

I remember putting through measures on smoking towards the end of our time in government that were opposed by those on the Government Front Bench. I am not sure how she could justify that.

The budget cut combined with the distraction of reorganisation means that six out of 10 hospitals in England are now off target for their efficiency savings. That brings me back to where we started: this is the wrong time to reorganise the national health service. In conclusion, the House cannot reverse tonight the damage of the NHS re-organisation, but we are not powerless. There are things we can do to help the NHS at one of the most dangerous moments it has faced. Our constituents will expect us to hold Ministers to account for promises made on rationing and reconfigurations. They will want us to do the right thing by NHS staff facing pay cuts and redundancy. Our constituents have a right to expect that one of the central pledges in the coalition agreement—not to cut the NHS—will be honoured. That is the simple call of our motion this evening which, we hope, can unite all sides of the House. A vote tonight for the motion would be a positive vote for an NHS under siege and a message of appreciation for NHS staff facing uncertain times. I commend the motion to the House.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health 5:50 pm, 16th July 2012

The motion that we are debating today is typical of the Opposition. Rather than praising the NHS in a year of change, they seek to denigrate it. Rather than commending the hard work and dedication of NHS staff, they undermine their efforts and belittle their results. Rather than supporting the parts of the NHS that are dealing with long-term financial challenges—challenges that were partly of the own making of Andy Burnham—they attempt to scaremonger.

In truth, this has been a year that has tested the NHS, which has dealt with significant financial pressures as well as the transition to the new system, but it is also a year in which the NHS has proven its mettle. Far from the meltdown that some gleefully predicted, we have seen a robust and resilient NHS delivering better care for patients.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

In a minute.

I know that waiting times mean a great deal to the right hon. Member for Leigh, so let us have a look at the numbers. Despite what he peddles around the country, waiting times remain low and stable—in fact, below where they were at the last general election. In May 2010 more than 18,000 people waited more than a year for treatment. Today that figure is just 4,317. Today 55,335 people wait more than six months for treatment—almost half the figure of 100,979 at the last general election. There are 149,912 people now waiting more than 18 weeks, compared to 209,411 in May 2010. The median wait for admitted patients has fallen in that time from 8.4 weeks to 8 weeks, and for non-admitted patients from 4.3 weeks to 4 weeks. Across the country, all NHS waiting time standards for diagnostic tests and cancer treatment have been met.

Photo of Andrew Slaughter Andrew Slaughter Shadow Minister (Justice)

The Minister talks about scaremongering. For seven years my constituents put up with scaremongering from his party that Charing Cross hospital was going to close. The services there expanded. After two years of his Government, the hospital, 500 beds, and the accident and emergency department are closing and being replaced by an urgent care centre, which will treat only minor injuries. What will that do to his statistics?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I am slightly surprised that the hon. Gentleman made that intervention because it rather proves my point about scaremongering. He said that is going to happen. The truth is that the local NHS has determined locally what it believes is the best reconfiguration of services. That is going out to public consultation and so far no decisions have been taken because the consultation process has only just started. It will last for 14 weeks and then the results of that consultation will be considered.

Several hon. Members:

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Photo of Simon Burns Simon Burns The Minister of State, Department of Health

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.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

Yes; 96% of patients wait for fewer than four hours in A and E, and as the right hon. Gentleman knows, the percentile is 95%.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I shall make a little more progress.

Let us not stop at waiting times. The £600 million cancer drugs fund that has helped more than 12,500 patients to access the drugs previously denied to them, the screening programmes for breast and bowel cancer, potentially saving an extra 1,100 lives every year by 2015, the world-leading telehealth and telecare whole systems demonstrator programme, which saw a stunning 45% fall in mortality and is set to transform of 3 million people with long-term conditions over the next five years—

Several hon. Members:

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Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I will give way to my hon. Friend Henry Smith, then I will give way to Mr Howarth and Valerie Vaz, then I will stop giving way for a time to make progress.

Photo of Henry Smith Henry Smith Conservative, Crawley

Earlier this year I was delighted to be able to open a new digital mammography unit at Crawley hospital, a hospital which under the previous Government saw its accident and emergency unit closed down. Does my right hon. Friend find it odd that the Opposition refuse to match the spending commitments on the NHS that this Government are delivering?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

My hon. Friend is right. As he would probably expect, I shall deal with that issue later in my speech. While I am responding to his intervention, let me say that not only was his hospital fortunate in having that fantastic equipment to look after his constituents, but I had the pleasure last week to be in his constituency to visit Elekta and Varian, which are world leaders in making equipment to help with radiotherapy.

Photo of Valerie Vaz Valerie Vaz Labour, Walsall South

The Minister is very fond of statistics. Can he say whether GP referrals have gone up, and whether A and E admissions have gone up or down?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

The hon. Lady will know that GP referrals have gone down slightly, but the referrals to A and E have risen slightly.

Photo of George Howarth George Howarth Labour, Knowsley

The Minister said in his opening remarks that Opposition Members are denigrating NHS staff and their achievements. Does he accept that if he has any conversations with NHS staff, he will find the reverse—they feel that they are being denigrated by this Government and their reforms?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I do not like to contradict the right hon. Gentleman, but I will. What I said was slightly different from what he accused me of saying. What I said was that rather than praising the NHS in a year of change, the Opposition denigrate it. That is slightly different.

To pick up on a point that the right hon. Member for Leigh mentioned from a sedentary position, GP referrals for 2011-12 were 1% lower than in the previous year, but outpatient referrals were, as I said, slightly higher.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

If my hon. Friend will allow me, I would like to make some progress. If the opportunity arises, I will give way to him then.

I could stop after reporting all that good news, but I do not see why I should when there is so much more to praise the NHS for. It gets little praise for its performance from the Opposition. I want to praise the fact that patients are reporting better outcomes for hip and knee replacements and for hernias, and the fact that the latest GP patient survey showed that 88% of patients rated their GP practice as good or very good. MORI’s independent public perceptions of the NHS survey shows satisfaction with the NHS remaining high at 70%.

In the patient experience survey, 92% of patients who had used the NHS in the past year rated their care as good, very good or excellent. Mixed-sex accommodation breaches are down an incredible 96% since we came to power, although of course the Opposition often claimed to have eradicated that problem—not so, alas. MRSA infections are down 24% in the year, and C. difficile infections down 17%. More than a million more people have an NHS dentist. No reasonable person could look at the performance of the NHS over what has been a challenging year with anything but admiration and pride. I, too, would like to take this opportunity to praise NHS staff for their hard work and dedication and the excellent results they are delivering for patients.

Photo of Andrew Percy Andrew Percy Conservative, Brigg and Goole

Will the Minister condemn Labour party representatives in Goole who, despite the fact that under Labour we saw ward closures and mental health in-patient beds go, recently gave the media incorrect waiting list times, and will he confirm that in north Lincolnshire 93% of patients are seen within 18 weeks, which is far ahead of the national target? The Labour party needs to stop talking down our local hospital.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I am extremely grateful to my hon. Friend and certainly condemn any misrepresentation, misinformation or talking down of the NHS in any of my hon. Friends’ constituencies.

Several hon. Members:

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Photo of Simon Burns Simon Burns The Minister of State, Department of Health

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.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

What I was saying that the right hon. Gentleman—[ Interruption. ] He must wait one minute, because I will answer him. What I said, which is correct, is that, in keeping with our commitments, we have increased funding on the NHS in real terms—

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

Just wait. But, as he has said, and as I have said about the £26 million—[ Interruption. ]—there was an underspend in the NHS and that money, as he will know, because of the financial arrangements his party put in place for the NHS in 2004, will be ploughed back into the NHS over the next three or four years as extra spending. We will put in more money for front-line clinical staff, including more than 4,000 doctors—more money for doctors and treatments and for improving patient outcomes. Spending on front-line NHS services has increased by £3.4 billion in cash terms, or 3.5%, compared to last year.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

Not at the moment.

The motion states that seven out of every 10 acute hospital trusts in England missed their savings targets for the first half of 2011-12, referring to their cost improvement plans. Not only did the right hon. Gentleman use out-of-date figures—figures for the whole year are now available—but he again misrepresented what they mean for the performance of the NHS. Across the NHS, acute NHS trusts plan to save £1.3 billion during 2011-12. In the end, they saved £1.2 billion. More than half—57%—of the shortfall was concentrated in just 10 NHS trusts in significant financial difficulties— 10 NHS trusts that he ignored when he was Health Secretary but that we are getting to grips with. I would point him instead to the £4.3 billion of efficiency savings made in 2010-11 and the further £5.8 billion of efficiency savings made in 2011-12. Primary care trusts and strategic health authorities have reported a surplus of £1.6 billion in 2011-12, money that is being carried forward and made available for 2012-13 and thereafter.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

No, I will not.

Unlike the right hon. Member for Leigh, who championed cuts to the NHS, this Government are investing more in the NHS, more in front-line care, more in staff and more in treatments.

Photo of Angie Bray Angie Bray Conservative, Ealing Central and Acton

As my right hon. Friend is aware, the proposal is to downgrade four accident and emergency departments across London that are all right beside my constituency. Does he agree with my constituents that losing four accident and emergency departments is disproportionate and will mean a significant loss of service for them locally?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

What I will say to my hon. Friend is similar to what I said to Mr Slaughter: that is a reconfiguration that is in progress and has been put together locally by the local NHS. It has just gone out to consultation and, obviously, when the process is complete the responses will be considered before any final decisions are made on the best way to provide care for her constituents and those of Opposition Members so that they can get the quality of care and the relevant care in their area. At the moment, when there is a consultation process going on, it would wrong of me to comment on a local decision, but I certainly urge my hon. Friend, her constituents and others to get involved in the consultation so that all views can be considered.

Several hon. Members:

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Photo of Simon Burns Simon Burns The Minister of State, Department of Health

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.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I will give way to the right hon. Gentleman and then to my hon. Friend, but then I will make some progress.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

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?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

What the right hon. Gentleman rather cunningly does not mention—[ Interruption. ] I am answering the question, if 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.

Photo of Graham Stuart Graham Stuart Chair, Education Committee, Chair, Education Committee

Is my right hon. Friend as confused as I am by the Labour party’s policy? Andy Burnham could not explain where public health would go; he wants to repeal the Health and Social Care Act 2012, although he wants the services to be shaped as the Act says; and on funding he said in June 2010:

“It is irresponsible to increase NHS spending in real terms”.

That is the Labour party’s policy: it is chaotic and makes no sense. Can my right hon. Friend please tell us whether he sees more sense in it than I do?

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I am afraid that I cannot help my hon. Friend, because the policy is contradictory and does not make sense.

The right hon. Gentleman talks about repealing the 2012 Act, which includes the clinical commissioning groups, but if he abolishes them there will be no other mechanism from 1 April next year to commission care for patients, so there will be no one available to commission care for patients, which seems stunning.

The right hon. Gentleman talks about funding, and his quotations—my hon. Friend Mr Stuart mentions one—are quite clear: he disapproves of giving real-terms increases in funding to the NHS. In Wales, the Welsh Labour Government have taken him at his word and are cutting spending, which we are not very enthralled by.

Several hon. Members:

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Photo of Simon Burns Simon Burns The Minister of State, Department of Health

I will now make progress.

Treatments available on the NHS are based on clinical need. There should never be any arbitrary rationing based on cost either locally or nationally—[ Interruption. ] The right hon. Member for Leigh shouts from a sedentary position, “There is”, and waves a piece of paper a little like Chamberlain on his way back from Munich, but if the piece of paper that the right hon. Gentleman is waving is his NHS health check, which officials in my Department have looked at, it is as worthless as the piece of paper that Chamberlain brought back from Munich.

If the right hon. Gentleman has any genuine evidence based on the cost of care, I and the Department of Health will certainly investigate it. Such practices are totally unacceptable, and we will take them very seriously indeed, but until then, although the motion talks about “the evidence presented”, the truth is that there is none.

The right hon. Gentleman claims that the number of cataract operations has fallen significantly since we came to power, but the reason for the fall is that clinicians have advised that the surgery is inappropriate in many cases—on clinical grounds. Surgery is available, however, for those patients who are clinically eligible, and they will receive it when there is a clinical reason.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

No, I am making progress.

The motion notes the growing involvement of the private sector, insisting that it represents evidence of growing privatisation. Not only is that unadulterated tosh, but I personally find it offensive to be accused of seeking to privatise the NHS, when in my political philosophy one of my core beliefs is in an NHS free at the point of use for all those eligible to use it.

Not only does the right hon. Gentleman have some difficulty understanding the meaning of “privatisation”, but he forgets his own record in government. The only plan to increase the private provision of NHS services came under the previous Government when he was Minister, when his hon. Friend Liz Kendall was the special adviser and when Patricia Hewitt was Health Secretary. In May 2007, the right hon. Gentleman said:

“Now the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”

Those are his words. It was his Government who saw private companies paid 11% more than NHS providers for doing the same work, and who wasted £297 million on operations that never happened at independent sector treatment centres. Given that he may have forgotten, I must tell him that the Labour party manifesto in 2010, when he was the Secretary of State for Health, stated:

“Foundation trusts will be given the freedom to expand their provision into primary and community care, and to increase their private services—where these are consistent with NHS values”.

That suggests that, as Secretary of State, he was prepared to have in his own party’s manifesto a policy allowing and encouraging foundation trusts to attract more work from the private sector.

This Government’s Health and Social Care Act 2012 specifically prohibits the Secretary of State, Monitor or the NHS Commissioning Board from favouring any type of provider, be they from the NHS, the charitable sector or the independent sector. It does so because this Government understand something that the right hon. Gentleman’s never did—it is not the nature of the provider, but the quality of the outcomes that matters most to patients.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

No, I will not.

The motion speaks of the

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

The reconfiguration of NHS services must always be led by a desire to improve patient care and patient outcomes. As lifestyles change, as needs and expectations grow and as technology develops, the NHS must respond. This Government are very clear that the reconfiguration of services is a matter for the local NHS, and that the best decisions are those taken closest to the front line and tailored to the needs of the local population. But, when making those decisions, it is imperative that the NHS carries the support of local people, patients, carers and clinicians.

The principle is enshrined in the four tests that my right hon. Friend the Secretary of State set out in 2010: all local reconfiguration plans must demonstrate support from clinical commissioners, strengthened public and patient engagement, clear clinical evidence and support for patient choice.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

The right hon. Member for Leigh equates the coalition agreement’s promise of a temporary moratorium on changes to hospital services, with a commitment to hold the NHS in a permanent state of suspended animation. The moratorium was needed to put a stop to the arbitrary reconfigurations that his Government instigated—reconfigurations that lacked the support of local clinicians, lacked a clinical evidence base and lacked basic democratic legitimacy. This Government and the Secretary of State have put that right.

Now I turn to another issue that the right hon. Gentleman raised and which is of considerable importance, given what has—

Photo of Lindsay Hoyle Lindsay Hoyle Deputy Speaker and Chairman of Ways and Means, Chair, Panel of Chairs, Chairman of Ways and Means, Chair, Panel of Chairs

Order. Hon. Gentlemen, the Minister has given way quite a bit, and I am sure that if he wishes to give way he will let you know. You do not need to keep standing and hovering for so long.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

Thank you, Mr Deputy Speaker. Because I want to make progress so that other people can contribute, I will not accept any more interventions.

On the South West Pay Consortium—[ Interruption ] an issue on which I hope the right hon. Member for Leigh will listen, given that during his speech he seemed keen to hear the Government’s response—the Government’s position is clear: it is for employers, not for the Government, to lead negotiations on the terms and conditions of their staff, and to do so with the agreement of staff.

This Government are committed to the principles of “Agenda for Change”, a national framework. The ongoing negotiations on “Agenda for Change” are about ensuring that patients and taxpayers get the maximum value for money from every penny spent on the NHS, and that it is spent efficiently and effectively. The negotiations are not about a pay cut, and we would not support one.

The Health Act 2006, brought in by the previous Government when the right hon. Gentleman was the Minister of State in the Department of Health, gives NHS trusts the power to set their own terms and conditions. Although they are free to opt out of the national pay framework, they cannot do so unilaterally; they must consult and seek agreement with their staff and representatives.

Almost all trusts have until now chosen to stay on national terms and conditions. I believe that most still want to, but that has to be fit for purpose and fit for the future. Only one trust—Southend—has opted out of “Agenda for Change”. [Interruption.] Tom Blenkinsop may be a Whip, but he is rather foolish to fall into the trap that I have just set. That trust opted out of “Agenda for Change” under the last Labour Government. Perhaps he would like to apologise.

Pay is the largest element of NHS costs, and pay systems must evolve. The trusts in the south-west wish to work and negotiate with the trade unions to agree changes, not to dismiss and re-engage staff.

Photo of Simon Burns Simon Burns The Minister of State, Department of Health

The hon. Lady only recently walked in. She has not been here from the beginning.

I call on the unions to respond positively to the issue and the national discussions on “Agenda for Change”. I also hope that the Opposition will support the policies that they put in place when in government.

The Opposition have used this debate to make yet another sorry attempt to paint a distorted picture of the NHS. That is wrong. The shadow Secretary of State pours scorn on the performance of the NHS, while we admire the excellence of the staff; he belittles their achievement while we laud them; he scaremongers, while we present the truth more transparently than at any other time in the history of the NHS.

The accusations in the motion are simply wrong, and I ask my right hon. and hon. Friends to join me in the Division Lobby at the end of the debate to defeat the motion.

Several hon. Members:

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Photo of Grahame Morris Grahame Morris Labour, Easington 6:21 pm, 16th July 2012

Thank you for calling me early, Mr Deputy Speaker. I am delighted to be able to participate in this important debate just before the recess.

I refer hon. Members to part of the Opposition motion:

“That this House regrets the growing gap between Ministers’ statements and what is happening in the NHS; notes mounting evidence of rationing of treatments and services by cost, despite Ministers’ claims to have prevented it”.

I would like to highlight one specific example. The Minister, who is not paying attention at the moment, may wish to make note of the issue, because it matters to cancer patients in my area and across the country. I am talking about the lack of access to advanced radiotherapy.

By way of background, I should say that the national cancer action team told NHS commissioners that radiotherapy is involved in 40% of cases in which cancer is cured. Furthermore, radiotherapy by itself now cures 16% of cancer patients. By contrast, cancer drugs are the main cure of only 2% of cancer patients. We can draw the conclusion that I hope the Department of Health and Ministers would accept: radiotherapy cures far more cancer patients than drugs. They should issue instructions to commissioners to reflect that and make money available for radiotherapy.

The current allocations are inadequate and arguably paltry. The radiotherapy budget for the current year is just £350 million, while the cancer drug budget is close to £1.5 billion. Within that sits the Government’s flagship cancer drugs fund, which, according to information that I have received, was underspent by £150 million. Despite that underspend, an additional £200 million is going into the cancer drugs fund. My concern is that that money is not for cancer patients but for cancer drug companies.

The whole idea is becoming discredited—so much so that, as has been reported in the newspapers, even Mr Clive Stone, the Prime Minister’s constituent who originally inspired the fund, has asked for less money to be put into the fund. Why? He now needs advanced radiotherapy for his cancer and there is no money available for him.

The cancer drugs fund cannot be used to fund advanced radiotherapy, and that is a real concern. I have no doubt that during the winding-up speeches we will be told that the Government are putting in an extra £150 million into new radiotherapy treatments over the next four years. The Minister of State, Paul Burstow, keeps telling us that, but when I ask him where the first and second year allocations—£13 million and £22 million—are being spent, he tells us that he does not know.

I thought I would try to help out the Minister, so I sent freedom of information requests to every strategic health authority asking how much of the money they had received and how their PCTs had spent it. I have good news for the Minister, who is not in his place. It is that he is not the only one who is in the dark when it comes to that £13 million and £22 million; the SHAs do not know either. I have the replies with me. I was going to read them out, but unfortunately I do not have time.

The stark truth is that under this Government no new money is going into providing the latest radiotherapy technologies for the NHS. In March last year, the Secretary of State commended some of the new facilities, including the new CyberKnife system at St Bartholomew’s hospital in London. Members, some of whom have also been to see the system, are concerned that charities are having to be used to raise money to buy that vital equipment. When I raised that issue in this Chamber, the Minister disputed that, but I have furnished him with a list of areas where it is happening. The Minister should accept his responsibility, get a grip on the situation and ensure that cancer patients needing advanced radiotherapy have access to the service that they need. I support the motion.

Photo of Stephen Dorrell Stephen Dorrell Chair, Health and Social Care Committee, Chair, Health and Social Care Committee 6:26 pm, 16th July 2012

It is a pleasure to follow Grahame M. Morris, who is a member of the Health Committee. I hope he will forgive me if I do not follow him down the specialist course of radiotherapy services.

I want to address my remarks primarily to the shadow Health Secretary and to begin with an echo from a different era. When I first came to the House, there used to be something called “Whitelaw’s law”, which, obviously, referred to the late Willie Whitelaw. “The more he blusters,” we used to say, “the less he believes it.” The shadow Health Secretary gave us an Olympic-class demonstration of the principle of Whitelaw’s law. He blustered from the Dispatch Box and got himself into several dead ends. It became clear that he did not really believe that he had answers for the challenges facing the NHS.

I refer the right hon. Gentleman to a point that he made and which I agree with. The most important statement about the current state of the health service was not made by him as Secretary of State—and, with great respect to my right hon. Friend the Secretary of State, it was not made by him either. It was made by

Sir David Nicholson in his annual report to the national health service in May 2009, and it was endorsed by the right hon. Gentleman. Sir David said, looking forward to the period of this Parliament:

“we must be prepared for a range of scenarios, including the possibility that investment will be frozen for a time. We should also plan on the assumption that we will need to release unprecedented levels of efficiency savings between 2011 and 2014—between £15 billion and £20 billion across the service over the three years.”

I agreed with what the shadow Secretary of State said about the importance of what we, in the Health Committee, dubbed “the Nicholson challenge”. I believe that that is the central challenge facing the national health service. The sadness in this debate was that the right hon. Gentleman gave us no hint as to how he believes the health service should address that central challenge about which he and I agree.

Photo of Graham Stuart Graham Stuart Chair, Education Committee, Chair, Education Committee

Meeting that challenge, and dealing with the challenges in the NHS generally, would be all the more difficult if one believed, as Andy Burnham does, that real-terms increases in investment in the NHS are irresponsible.

Photo of Stephen Dorrell Stephen Dorrell Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

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—

Photo of Stephen Dorrell Stephen Dorrell Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

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. ] 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.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras

Would the right hon. Gentleman care to confirm for the House that in the last year when he was Secretary of State, NHS hospitals carried out 5.7 million operations and at the end of the Labour Government’s period in office it was carrying out 9.7 million operations?

Photo of Stephen Dorrell Stephen Dorrell Chair, Health and Social Care Committee, Chair, Health and Social Care Committee

I am grateful to the right hon. Gentleman for drawing attention to the fact that throughout the history of the health service, under Governments of all political complexions, there has been a growth in the level of services, and improvement in the quality of services, provided to patients. It happened under the Tory Government of whom I was a member and under the Government of whom he was a member. Of course, that is delivered not by the politicians but by the doctors and nurses who work in the health service.

The challenge faced by the current generation of policy makers, including the shadow Health Secretary, is how to meet the rising demands and the requirement for improved quality in much more constrained financial circumstances than I or he faced as Secretaries of State. He signally failed to meet that challenge today.

Photo of Nick Raynsford Nick Raynsford Labour, Greenwich and Woolwich 6:34 pm, 16th July 2012

This debate comes less than a week after the Secretary of State’s announcement that he is putting South London Healthcare NHS trust into administration. He will therefore not be surprised, and nor will the House, that I intend to focus on that issue.

Not surprisingly, this announcement has caused massive alarm and concern across south-east London. Staff working for the NHS in all three affected boroughs—Greenwich, Bromley and Bexley—are all worried about whether they will continue to have a job. Patients and their relatives are worried that the NHS services on which they have depended for years may no longer be available, as rumours abound about potential cuts and closures affecting hospital services. What is most regrettable is that all this is utterly unnecessary. Indeed, there is a strong suspicion that the whole process of putting South London Healthcare into administration is driven by politics—by the Government’s wish to send a message about being tough with trusts in deficit rather than by a rational assessment of what is most likely to help the trust to improve its clinical and financial performance.

Let us look at the facts. At the time when the Secretary of State made his announcement, briefings appeared in the media about South London Healthcare being a failing trust with poor standards of clinical care. On the contrary, the trust has shown significant improvement in clinical performance. It is one of the top five trusts in the UK in terms of low mortality, hospital infection rates are three times lower than the national average, and the four-hour target for A and E patients has been met month on month since February. For those of us who have been working with South London Healthcare to raise its performance, it is particularly galling to see the Secretary of State dismissing those achievements and incorrectly claiming, as he did on 28 June in a communication to MPs, that patients at the trust

“experience some of the longest waits for treatment”.

That is simply not true of South London Healthcare today. It may have been true a year ago, but, as I said, there has been improvement, and the Secretary of State has ignored that. Indeed, he himself appears to realise that his criticisms were wide of the mark, as just one week after he made that statement I received a letter from him, as did many other London MPs, starting with the following memorable words:

“Dear Colleague,

I wanted to write to you with a summary of the excellent performance of the NHS in your area”.

You couldn’t make it up; talk about the left hand not knowing what the right hand is doing.

What about the deficit? Yes, there is a deficit—about £70 million last year—but South London Healthcare has been implementing a series of service changes designed to reduce it over the next four years while at the same time improving the standards of health care. Ironically, its task has been made much more difficult by the Secretary of State, who knows only too well that two years ago, in summer 2010, he intervened to halt the implementation of a clinically led plan to reconfigure services in south-east London entitled “A picture of health”, which, after six months’ delay and a review that he imposed, was judged to meet all four of the necessary tests. His intervention merely delayed a reconfiguration process that was going to improve services and save money. Now, after a wholly unnecessary and costly delay, the plan is proceeding, with the consolidation of A and E services on two, rather than three, sites and similar moves to concentrate specialisms: stroke at Bromley; elective surgery at Queen Mary’s, Sidcup; and maternity at Queen Elizabeth, Woolwich. All those changes have helped to improve performance and have made savings. Ironically, the same Secretary of State who delayed the implementation of these improvements is now blaming the trust for the deficit without acknowledging his own part in the process.

South London Healthcare has been in existence for just three years. It came into being as a merger of three trusts, all of which faced deficits and needed support and help to get out of their problems. As the trust’s ex-acting chair, who was removed from office today, said in his letter to the Secretary of State on 9 July,

“We have been prepared to take strong action—we are the only Trust in London to successfully close an A and E department and move maternity services…What we have not been prepared to do is to promise more than is within our capacity to deliver; nor to mask structural issues that need to be addressed.”

It is a tragedy that, rather than supporting the trust in its really good work in improving patient care and reducing the deficit, the Secretary of State has acted in an arbitrary and unfair way and is trying to blame the trust for a problem for which he has a large measure of responsibility.

Photo of Karen Lumley Karen Lumley Conservative, Redditch 6:39 pm, 16th July 2012

I want to highlight some of the issues that people in Worcestershire are facing. Like many parts of the country, we are facing a joint services review of our acute trust.

For those who do not know Worcestershire, it has three hospitals, including a private finance initiative hospital, which is costing 5% of the total health spend in the county. The PFI deal was made under the Labour Government, who have admitted that there is a case for saying that they were poor at negotiating PFI contracts from the outset. In Worcestershire, not only were they poor at negotiating the contract; they also put the hospital in the wrong place. Our PFI hospital is in the south of the county, which is all very well for people who live there, but for the 200,000-plus people who live in the north of the county, it is extremely difficult to get to. For somebody who lives in Redditch, it is far easier to get to a hospital in Birmingham than to one in Worcester.

We are now undertaking yet another review. Once again, people in Redditch see that their hospital and their services, including A and E, maternity and children’s services, are under threat. I say once again because six years ago we were in the same position. I know that spending in our health economy has been increasing, but we in Worcestershire are paying for the overspends of the past few years and need to save money.

I put it on the record that the people of Redditch want to retain their A and E. As their Member of Parliament, I totally agree with them. We are in the early stages of the consultation, but I urge Ministers to look closely at this matter. The Secretary of State has visited the Alexandra hospital and seen for himself what a good hospital it is. Importantly, it was paid for and is owned by the NHS. I will be asking for a cross-party meeting in due course, which I hope my right hon. Friend will agree to, because the people of Redditch are once again working together. Apart from the Labour parliamentary candidate, people have put party politics aside to work together to save our A and E.

I know that many other Members want to speak in this debate. I just wanted to put the marker down that we in Redditch want our A and E and that I intend to fight for it.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras 6:41 pm, 16th July 2012

We all know that the massive top-down reorganisation of the national health service that the Government have pushed through had not a jot of public support, that no one voted for it and that it was not mentioned in the famous coalition agreement. Nevertheless, it was proceeded with.

We are now faced with something that was not in the election manifesto of either of the Government parties. Nor, I suspect, was it in any of the election literature of any of the MPs from those parties in the south-west. I do not think that any of them said, to use the phrase of the Minister of State, Department of Health, Mr Burns, “We admire you people in the health service so much that we have decided that you will have to pay more for your pension and work longer, and that your pension will be smaller.” I do not think that any of the Lib Dem or Tory candidates in the south-west put in their leaflets, “We admire you people in the national health service so much that we intend to reduce your pay.” None of them said, “We admire you so much that we are going to reduce your entitlement to leave.” None of them has said, at a time when there is rightly increasing concern about the standard of care in hospitals at the weekend, “We intend to reduce or get rid of your overtime pay at weekends.” I would not wish to be admired by a Health Minister, because something nasty would clearly appear shortly afterwards.

People in the national health service are sick to death of this massive reorganisation, of thousands of their colleagues being made redundant, of people having to reapply for their own jobs, and of being expected to do their day job while falling into line with the preposterous ideas in the major health legislation that went through this House. On top of that, they are now being told that they cannot be paid what they used to be paid. Apparently, people in the south-west say, “Pay down here tends to be lower, so let’s reduce the higher pay of people in the public sector, such as those in the hospitals, to the miserable levels that the private sector pays people here.” It is not likely that giving people even lower pay, which is always associated with poor health, will improve the public health of people in the south-west, which Dr Wollaston, who is herself a GP in the south-west, has talked about.

What the Government have done is disgraceful and is in clear breach of their manifesto commitments. They are now attacking people in the national health service. I laud and admire people who work in the national health service. There may be some bad ’uns—there are bad ’uns everywhere—but most of them work very hard and brilliantly on our behalf, none more so than those at University College hospital in my constituency and at the Kentish Town health centre, which I was happy be at recently with Alan Bennett for the ceremony to celebrate 125 years of the Wigg practice, which serves people brilliantly. Believe me: when I talk to people at those two institutions, the main people who are denigrated are the Tory Ministers who have wished all this upon them. I join in that denigration.

Photo of Stuart Andrew Stuart Andrew Conservative, Pudsey 6:45 pm, 16th July 2012

I am extremely grateful for the opportunity to speak in this debate. The NHS is clearly important to all of us. I have seen it personally because I have had a number of operations and through my working life in the hospice movement, where I saw how the care that is provided is so important to the families we were looking after. Clearly, the dedication of the staff is great and I pay tribute to them.

Listening to the Opposition today, it is hard to take them seriously. We can see what they would do with the NHS if they were in power by their actions in Wales. They have cut the budget, resulting in an increase of 51% in the number of patients waiting to start treatment and an increase of 156% in the number of those waiting for more than 26 weeks. All the bad news from the Opposition is therefore difficult to swallow.

I will give a couple of examples from my area. I recently met some GPs and clinicians to talk about the work they are doing to redesign musculoskeletal services. They have brought in innovative ways of ensuring that the patient knows exactly what will happen to them. Clinicians across primary care, community services and secondary care are working together to ensure that the patient has a clear understanding of the care that they will receive. They use map displays, which show a clear pathway, offer educational content for GPs to ensure that patients get the highest standard of care, and ensure that information is available for the patient.

I am proud to say that on Friday, one of the surgeries in my constituency will open a new well-being centre, which will provide a place where health care, social care and the third sector can come together to provide better ways to improve health and well-being in the town.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights)

Does the hon. Gentleman share the concerns of many Members, as I believe he does, over the closure of surgical units for children in the middle counties of England? If so, what is he doing to prevent it in his constituency?

Photo of Stuart Andrew Stuart Andrew Conservative, Pudsey

The hon. Gentleman pre-empts the next part of my speech and I am grateful to him for that.

As this is a health debate, I am sure that my right hon. Friend the Secretary of State would expect me to talk about the safe and sustainable review of children’s heart units. Like other Members, I have received a number of e-mails from various organisations today. One of them said that some MPs should seek to reignite the debate and that I should think about the children because if I had children, I would move heaven and earth to ensure that the service was the very best. Frankly, throughout the campaign on children’s heart units, I have only ever thought about the children. Of course I want the very best service for them, as do the right hon. and hon. Members from all parts of the House who have worked on the campaign. I have always accepted that there is a need for change. That is why I want to discuss a few related points this evening. I know that I will have an opportunity to raise it in greater detail tomorrow, but it is important that I speak about it tonight.

Access and travel times are incredibly important to the families who use children’s heart services. Logical health planning surely dictates that services should be based according to where the population lies. The British Congenital Cardiac Association states:

“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”

Photo of Andrew Percy Andrew Percy Conservative, Brigg and Goole

That is exactly the point that Members who represent Yorkshire and northern Lincolnshire are concerned about. The proposals will mean that patients will have to travel, and expecting families in northern Lincolnshire to get to Newcastle is simply not acceptable.

Photo of Stuart Andrew Stuart Andrew Conservative, Pudsey

I thank my hon. Friend, who brings me on to my next point. Independent analysis of patient flows showed that the majority of people in the Doncaster, Leeds, Sheffield and Wakefield area would not go to Newcastle; they would probably choose centres in Liverpool, Birmingham or even London. The NHS constitution states that patients have the right to make choices about their NHS care, yet the joint committee of primary care trusts has asserted that Newcastle could reach the minimum number of procedures if parents were “properly managed”. That flies in the face of patient choice.

Furthermore, the review has ignored the views of the people. I do not think there has ever been a petition as large as the one from Yorkshire, with more than 600,000 people’s signatures, but it counted as only one representation in the meeting at which the decision was made. I will raise a number of issues tomorrow to do with the scoring process that was used in the review, but I believe that the change will provide a poorer quality of service for Yorkshire and Humber families. Clinical experts from the BCCA, the Bristol inquiry, the Paediatric Intensive Care Society and the Association of Cardiothoracic Anaesthetists say that paediatric services should all be under one roof. In Leeds, we have a dedicated children’s hospital with all the services under one roof, so it is ready-made.

I urge Ministers to look into the process of the review and see whether they believe it was properly run. Given the closeness of the scores for Leeds and Newcastle, and considering the outcry that has come from Yorkshire and the Humber, I hope that they will give both centres an opportunity, until April 2014, to demonstrate that they can comply with all the standards that the clinicians on the safe and sustainable steering group have recommended. If one or both centres fail to meet any of those standards, the decision should be reviewed.

This is a very important issue for my constituents. The number of letters that I and my colleagues from around Yorkshire and the Humber are receiving shows how strongly people feel about it, and I urge Ministers to listen to our concerns.

Photo of Virendra Sharma Virendra Sharma Labour, Ealing, Southall 6:52 pm, 16th July 2012

Thank you for giving me the opportunity to speak in this important debate, Mr Speaker. I wish to bring to the House’s attention some of the realities on the ground.

NHS North West London is currently conducting a flawed consultation, which is cynically being held during the Olympics and the summer months, on proposals for the reconfiguration of acute hospital services. The proposals would mean the closure of four out of nine accident and emergency departments, including Ealing’s, and the effective closure of Ealing hospital, my local hospital. My right hon. Friend the shadow Secretary of State recently described those shocking proposals, accurately, as “butchery”, not reconfiguration.

The proposals are put forward as clinically led, but that is far from the truth. At a recent meeting convened to discuss them, consultants at Ealing hospital and GPs from right across the London borough of Ealing voted unanimously against the proposal to close Ealing hospital. Other clinicians from right across north-west London are also opposed to the changes, and Angie Bray, who has just left the Chamber, has rightly said that they are financially driven. I take this opportunity to congratulate and thank the staff at Ealing hospital, who are working hard to provide services to patients during this time of uncertainty.

The Nicholson challenge means that across the country, £20 billion of savings must be found in the NHS by 2014, and £1 billion of those is earmarked to come from north-west London. It is clear that this is a top-down restructuring of hospital services, driven totally by financial considerations. The proposals are being railroaded through by the remnants of the old PCTs before they are abolished next April and replaced with clinical commissioning groups. That is a top-down reorganisation of local hospitals by an unaccountable body that, after making these major decisions, will no longer exist. That flies in the face of what the Prime Minister said to me at Prime Minister’s questions—that such a decision should have the support of local doctors and patients. Local GPs and patients are overwhelmingly against the proposals, so they should be withdrawn immediately. The Prime Minister has also repeatedly told me that there are no plans to close Ealing hospital. Given that after his visit to Ealing he said that he liked what he saw, I expect him to join me, local doctors, patients and all political parties in opposing the plans.

The Secretary of State, too, is on record as saying that there were no plans to close Ealing hospital’s A and E, and as asking where all the people who use it would go. Approximately 100,000 people a year attend there, of whom 55,000 use the urgent care centre and 45,000 are treated in the full A and E department. Where will all those people go for treatment if Ealing’s A and E is closed? Other A and E departments that are not proposed for closure are already under pressure from their own population and would not be able to cope with the extra numbers. Services would suffer, and waiting times would become intolerable.

The preferred option being consulted on also includes the closure of the Central Middlesex, Hammersmith and Charing Cross A and Es. That would be reckless and dangerous, and would leave a large swathe of west London without adequate A and E cover. Three London boroughs—Ealing, Brent and Hammersmith—would be left without any A and E. What would happen if there were a major incident similar to the Southall rail crash in Ealing or elsewhere in west London, or, God forbid, an air crash or terrorist incident?

The plan is opposed by clinicians, patients, politicians of all parties and members of the public, and it should be scrapped immediately. I will support the motion this evening.

Photo of Andrew George Andrew George Liberal Democrat, St Ives 6:57 pm, 16th July 2012

It is a pleasure to follow Mr Sharma, a fellow member of the Health Committee. He makes a strong case on behalf of his constituents, and one hopes that any reconfiguration will be evidence-based and, above all, based on clinical governance and clinical safety.

This is an important debate—indeed, we cannot debate the future of the NHS enough, because it concerns many Members and their constituents. It draws passion and a great deal of interest, because it affects everyone’s lives. I therefore congratulate the Opposition on giving us the opportunity to debate it this evening.

I apologise to the Minister of State, my right hon. Friend Mr Burns, for not having heard his speech. I had to attend an urgent meeting with a Minister to discuss the closure of a Remploy factory in my constituency. My hon. Friend John Pugh gave me a précis of the Minister’s wise remarks as best he could—without, of course, being able to convey fully his panache and oratorical dexterity. I understand that the Minister made a number of important remarks about one issue that I want to discuss, as a Member representing west Cornwall and the Isles of Scilly, which, apart from being the centre of the world, are in the far south-west. That issue is pay and conditions for staff. As I understand it, he emphasised the point that no such independent review of pay, conditions and the salaries of staff in such an area can proceed without the full involvement and support of the unions, and their engagement in the final decisions.

Photo of Alison Seabeck Alison Seabeck Shadow Minister (Defence)

It is absolutely right that the trade unions should be involved, because this is an enormous issue, particularly for staff morale in the south-west. Does the hon. Gentleman not share my concern that thus far the consortium has shown no great desire to undertake that consultation in the south-west? That really has to change.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

The hon. Lady makes an important point. Lezli Boswell, the chief executive of the Royal Cornwall Hospitals Trust, wrote to me on behalf of the consortium about concerns that have been raised, including by the unions, saying that once the national pay review has concluded under “Agenda for Change” it would then be appropriate, if it is at all appropriate, for any further local discussions to proceed. Without union involvement in the work of the consortium, I agree with the hon. Lady that the proposal is irrelevant and potentially disruptive and dangerous, given its impact on staff morale throughout the NHS in the south-west. My hon. Friends will be listening closely to this debate, and to the concerns that have been raised by many Members and, indeed, by staff across the south-west about the consequences for staff morale and the impact on NHS services. I certainly hope that the Secretary of State will address those issues when he concludes the debate.

A key issue is one that dare not speak its name—it affected staff morale under the previous Government as well—but it is the increasing pressure on front-line NHS staff. The staffing levels at the coal face have never been sufficient to provide a safe staff to patient ratio. Many people have been critical of nursing and care standards in the NHS, but they often overlook staffing ratios.

I have also expressed concerns about the out-of-hours service in Cornwall—I know that we will not have time to discuss that—and the Care Quality Commission will produce a report as a result of those concerns, which were also voiced by Sarah Newton.

On pay for staff in the south-west, the chief executive of the Royal Cornwall Hospitals Trust said to me in a letter:

“In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement initiatives). Monitor…has also estimated that NHS organisations with a turnover of around £200m will need to produce savings of around £9m a year for each year until 2016/17 to remain in financial health.”

She goes on to say that the consortium, which consists of 20 organisations in the south-west,

“is looking at how pay costs may be reduced, whilst maintaining a transparent and fair system that is better able to reward high performance, incentivise the workforce and support the continued delivery of high quality healthcare.”

Does the Secretary of State agree with that, and how does he intend that that should proceed? How will he protect staff and staff morale, because the consequences will, I fear, derail national negotiations on “Agenda for Change” and drive down pay and morale, particularly in an area of very low wages? I hope that he is listening.

Photo of Barry Gardiner Barry Gardiner Labour, Brent North 7:04 pm, 16th July 2012

Thank you, Sir. I shall try to respect your advice.

In November 2011, the following announcement appeared on the Central Middlesex hospital website:

“A and E at Central Middx Hospital is temporarily closing overnight between 7 pm and 8 am starting from Monday 14 November 2011.

The urgent care centre next to A and E will remain open 24 hrs a day 7 days a week to treat patients with minor injuries and illness.

We are making this temporary change to ensure we continue to provide a safe service to patients during the winter months.”

In those three paragraphs, we hear twice over that that overnight closure is temporary, which gave minimal comfort to my constituents in Brent who used the facility. The overnight closure is indeed temporary. On 2 July, a consultation entitled “Shaping a healthier future” was launched in north-west London, and residents can submit their views until 8 October this year. The consultation, promoted by a transitional body called NHS North West London, aims to centralise and rationalise hospital services in the area. Each proposal outlined in the consultation includes the closure of the A and E at Central Middlesex—not overnight provision, but the 24-hour facility—for good.

The motion speaks of

“the growing gap between Ministers’ statements and what is happening in the NHS”.

I may have trouble agreeing with that, because it depends on which Minister and which statements. The Minister of State, Department for Education, Sarah Teather, received an e-mail from me today advising her that, if called to speak, I would quote her in this evening’s debate. I wanted to do so, because she made the following three statements. First:

“The Tories would be a disaster for the NHS, they plan a part privatised service”.

The second quotation:

“These cuts will hit the poorest and most vulnerable hardest”.

The third quotation:

“The government must take urgent steps to safeguard our local NHS”.

Those three quotes date respectively from 2003, 2007 and 2007, when the hon. Lady was campaigning to keep open the accident and emergency centre at Central Middlesex hospital—campaigning for something which she, in her government, is now closing. No wonder her latest comment is:

“This flawed consultation, which does not allow residents to say that they want to save the A and E, is a kick in the teeth for all local people.”

I do not speak Parseltongue—I do not understand it—but I deplore the pretence of opposing a policy that you are pushing through in government. That is really disgraceful.

Photo of Alex Cunningham Alex Cunningham Labour, Stockton North 7:07 pm, 16th July 2012

Thank you, Mr Deputy Speaker.

Patients in my constituency of Stockton North are already feeling the pain from the Tories’ policies. The number of admitted patients who have waited longer than 18 weeks for an operation rose by a staggering 49% between May 2010 and November 2011, and I have no doubt that the figure is much higher now.

The North Tees and Hartlepool NHS Foundation Trust faces a drastic cut to its budget of £40 million over three years. Chief executive Alan Foster has said that that is the most difficult financial position the he has ever faced and has acknowledged that the cuts will undoubtedly lead to unpopular decisions to keep the trust afloat. The trust is trying very hard, and it has even resorted to car boot sales to try to balance the books. Some of those cuts could be achieved if the Government got behind the trust and did something to ensure that the two North Tees and Hartlepool university hospitals are replaced by one midway between the two communities.

My fear is that there will be no new hospital and the trust will be forced to close one of the existing hospitals if it is to have any chance at all of delivering £40 million cuts in the next few years. We could end up without any of the benefits of a new hospital, and the targets might still not be achievable. Such a cut would almost certainly cause irreparable damage to the trust’s ability to maintain the excellent range of high- quality services of which it is justly proud. It will undermine all the good work that has gone on in the trust over the past 10 years.

I know that the trust will keep patient safety, quality and performance at the top of its agenda as it goes through this difficult period, but it will not be easy to deliver services to the 350,000 people who depend on them, as they have in the past. The north-east already experiences far greater levels of poor health than the national average. It must be due to the heavy industries and resultant poor environment, as our region mined coal, built ships and made chemicals and steel. The budget cuts will only worsen this position.

The last Labour Government worked hard to reduce the kind of health inequality faced in my constituency, where men can expect to live 14.8 years less in one part of the constituency than in another. Real progress was made to close the gap, but even so, it has proved painstakingly slow, as much work requires huge resources, which are now being denied. I feel the gap growing, even though I know that Stockton borough council has recently appointed a high-calibre person to head up public health. We will not be able to make the progress everyone wants if he and the NHS are starved of resources.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health) 7:10 pm, 16th July 2012

We have had a good debate, albeit one slightly curtailed by statements. We have heard 10 speeches from Back-Bench Members and I would especially like to commend my right hon. Friends the Members for Greenwich and Woolwich (Mr Raynsford) and for Holborn and St Pancras (Frank Dobson) and my hon. Friends the Members for Easington (Grahame M. Morris), for Ealing, Southall (Mr Sharma), for Brent North (Barry Gardiner) and for Stockton North (Alex Cunningham) for their contributions. I also rightly want to pay tribute to the many thousands who work in our national health service, doing a tremendous job in often challenging and difficult circumstances.

As we have heard in the debate today, there are growing problems in the national health service. We know that two thirds of NHS acute trusts—65%—are reported to have fallen behind on their efficiency targets. As we have heard from right hon. and hon. Members, we are starting to see temporary ward and accident and emergency closures, while a quarter of walk-in centres are closing across England. Despite the “Through the Looking Glass” world of Ministers—one where the Secretary of State for Health closes a debate—we now have growing rationing across the national health service, with treatments—including cataracts, hip and knee replacements—being restricted or stopped altogether by one primary care trust or another.

Photo of John Pugh John Pugh Liberal Democrat, Southport

Does the hon. Gentleman not acknowledge that the real weakness of this debate, as specified by the Select Committee Chairman, is that the Labour party has at no point spelled out how it would meet the £20 billion Nicholson challenge? Will he tell us?

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health)

We set out the Nicholson challenge, but I notice that the hon. Gentleman does not defend the decisions being taken by his Government to restrict or stop these treatments.

It is becoming increasingly clear that there is a gap between Ministers’ statements on the NHS and people’s real experience of it on the ground. In opening, the Minister of State, Department of Health, Mr Burns incorrectly said that GP referrals have gone down. Figures published by the Department of Health on 13 July 2012 show that GP referrals are up by 1.9% year on year. Those are statistics from the Minister’s own Department’s. He is out of touch. Furthermore, the Minister said that NHS Hull is not restricting procedures on ganglia, but a freedom of information request we received says:

“NHS Hull will not routinely commission excision of ganglia”.

That was in April 2012, and it is a fact, again showing that Ministers are out of touch. The Secretary of State claimed that there is no such evidence of treatments being restricted or decommissioned.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health)

I will not, as I do not have time now.

In the Secretary of State’s annual report to Parliament, he dismissed restrictions on bariatric surgery as “meaningless” and continued to say:

“Time and again, he says”— that is my right hon. Friend Andy Burnham

‘“Oh, they are rationing.’ They are not”.—[Hansard, 4 July 2012; Vol. 547, c. 923.]

But Opposition Members all know the truth. Aside from the evidence presented by the Labour party and the “GP Magazine”, verified by Full Fact, primary care trusts acknowledge that they are restricting access to bariatric surgery. The National Institute for Health and Clinical Excellence recommends surgery for anyone with a body mass index of 40 or a BMI of 35 and co-morbidity. Many PCTs, including NHS Stockport in my own constituency of Denton and Reddish, impose additional restrictions.

Recent freedom of information requests of PCTs and shadow clinical commissioning groups across England have revealed that 149 separate treatments, previously provided for free by the NHS, have been either restricted or stopped altogether in the last two years, with 41 of those being entirely stopped in some parts of the country. This provides the clearest evidence yet of random rationing across the NHS and of an accelerating postcode lottery, which appears to be part of a co-ordinated drive to shrink the level of NHS free provision. From our study, it is clear that many patients are facing difficulties in accessing routine treatments that were previously readily available, and there is evidence that some patients are being forced to consider private services in areas where the NHS has entirely stopped providing the treatment.

Of course, there has been a real reduction in the number of nurses working in the NHS. The Government have claimed that there are only 450 fewer nurses, and at Health questions last month, the Minister, the right hon. Member for Chelmsford said that the figure was “nowhere near 4,000”. But now we all know the truth: figures for the NHS work force in March 2012 showed clearly that there are 3,904 fewer nurses than in May 2010. We have seen broken promise after broken promise, including on reconfigurations.

It was this Government who, when in opposition, spent millions of pounds during the general election putting up posters throughout the country reassuring the electorate that under the Conservatives there would be a moratorium on hospital and A and E closures. Indeed, in opposition, they pledged to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.

It is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011, this Secretary of

State accepted the recommendations and approved the downgrading and closure of services at Chase Farm. And there are several others, such as the Hartlepool, the King George hospital in Ilford, the East London, the Trafford General, the North London, the St Cross in Rugby and, as we have heard today, the West London, too, that have either closed or are set to close. What is becoming clear is that when it comes to reconfiguration, Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished structures for the forthcoming closures.

In the brief time remaining, I want to deal with Government spending on the health service. As we have learned, actual Government spending on the NHS in 2011-12 fell by £26 million.

Photo of Andrew Gwynne Andrew Gwynne Shadow Minister (Health)

No, I will not.

This was the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office. This is in clear breach of the commitment given by the Conservatives and Liberal Democrats in their coalition agreement.

Of course, a long line of professionals have come, one after the other, to express their concern about the damage that will be done to the health service if hospital is pitted against hospital, and doctor against doctor. That is where we start. The Health and Social Care Act 2012 now allows hospitals completely to change character over time. The Government have essentially set everybody on their own. Hospitals are being told, “You’re on your own. There’s no support from the centre any more; no more bail-outs.”

We know that there are problems with the NHS meeting efficiency targets. Indeed, a survey of NHS chief executives and chairmen found that one in four believe that the current financial pressures are the

“worst they have ever experienced”,

with a further 46% saying they were “very serious”. More than half of foundation trusts missed their savings plan targets, according to Monitor’s review of the last financial year.

Ministers have said that every penny saved will be a penny reinvested to the benefit of patient care, but in reality £1.4 billion of the £1.7 billion not spent by the Department of Health has been returned to the Treasury—more broken promises. It is therefore clear for all to see that there is an increasing gap between what the Government are saying and what is going on in the NHS, and the experience of ordinary patients on the ground.

The Government have increasingly broken their promises on the NHS. They promised no top-down reorganisation and a moratorium on hospital closures and they promised to maintain spending levels in the NHS. They have broken all those promises—they are the three biggest broken promises in the history of the NHS. There is clearly a yawning gap between what the Prime Minister and others say and the reality of patients’ experience.

During the general election, the Prime Minister said:

“I’ll cut the deficit, not the NHS.”

It is now clear that the Government are cutting our NHS. The NHS is important for the people of our country, and they deserve better. I commend the motion to the House.

Photo of Andrew Lansley Andrew Lansley The Secretary of State for Health 7:20 pm, 16th July 2012

I was rather disappointed by the speech of Andrew Gwynne. Like the motion, the hon. Gentleman failed to say anything about NHS staff, or to reflect the admiration and respect we have for them. The motion and his speech were just another occasion for Labour to use the NHS as a political football, fuelled by nothing but distortions, inaccuracies and myths.

I always welcome such debates, because they give hon. Members an opportunity to raise constituency issues. Many did—I will respond to the points they made—but Andy Burnham, the shadow Secretary of State, did not. When the Conservative Opposition raised debates on the NHS before the election, as we often did, we had an alternative policy to express and arguments to put forward. Like the motion, his speech was empty of argument and of fact, and he and the Labour party are empty of policy.

The right hon. Gentleman told us only that he wants to abolish the Health and Social Care Act 2012. If that happened, there would be no clinical commissioning in the NHS. In fact, nobody would be responsible for commissioning. He would abolish local authorities’ responsibilities for public health in their area, which they are embracing and acting on. He would abolish health and wellbeing boards, which are integrating health and social care more effectively. He would abolish the duties in the legislation for NHS bodies to act to reduce health inequalities, which rose under a Labour Government.

Let me address some of the points—

Photo of Andrew Lansley Andrew Lansley The Secretary of State for Health

No. I will address the points made in hon. Members’ speeches, including his. He was the first Back-Bencher to speak in the debate. He talked about more support for radiotherapy. He must recognise that we committed to £150 million additional support for radiotherapy in the cancer outcomes strategy. That will be available. He mentioned CyberKnife, which is a brand name for stereotactic beam therapy. That form of therapy is available in the NHS and will continue to be available. He neglected to mention that I announced during the past few months new plans for the establishment of two major centres for proton beam therapy in this country, which will mean that patients no longer have to go abroad to access it.

Photo of Andrew Lansley Andrew Lansley The Secretary of State for Health

No.

My right hon. Friend Mr Dorrell made an important point on the Nicholson challenge, which a number of Opposition Members mentioned. At least one or two of them had the good grace to recognise that David Nicholson’s proposals were set out in May 2009, under, and endorsed by, a Labour Government. Labour Members now want nothing to do with the consequences of meeting that financial challenge. They fail to recognise, as my right hon. Friend said, that the challenge was against the background of an expectation that a Labour Government would not increase the NHS budget, and that the challenge would have to be achieved within three years. The Conservative Government have increased the budget for the NHS. Over the course of this Parliament, it will go up by £12.5 billion, which represents a 1.8% increase in real terms. The right hon. Member for Leigh and his party were against that.

No Opposition Member recognised in the debate the simple fact that, in the first year of this Parliament, £4.3 billion of efficiency savings were achieved, and performance improved, across the NHS. That was not even in the time frame for the Nicholson challenge. We have now had one year of the challenge. The target was £5.9 billion of efficiency savings, and we achieved, across the NHS, £5.8 billion. Things are on track, which completely refutes the shadow Secretary of State’s argument that we cannot have reform and deliver on the financial challenge at the same time. Actually, we can do both, and in addition improve performance in the NHS.

Mr Raynsford completely contradicted Clive Efford on the South London Healthcare NHS trust. The latter said he was against changes at Queen Mary’s, Sidcup, but the former said that I did not get on with the changes soon enough. The hon. Member for Denton and Reddish complains from the Opposition Front Bench that I did not have a moratorium, but the right hon. Member for Greenwich and Woolwich complains because I did have one.

Let me be clear about this: I did introduce a moratorium, and the four tests. Reconfigurations that meet the four tests should go ahead, because they will improve clinical outcomes for patients, meet the needs of the people of that area, deliver on the intentions of local commissioners, and be in line with the views of the local public. If they meet the four tests, they should go ahead; if they do not, as my hon. Friend Karen Lumley made clear in respect of Worcestershire, they should not go ahead. That much is clear.

My hon. Friend Stuart Andrew made good points on how clinical commissioning is bringing improvements in musculoskeletal services. He also rightly made it clear, as the right hon. Member for Leigh did not, that Wales does not meet anything like the same standards as England and is cutting its NHS budget by 8.4%. We are increasing resources for the NHS in England and improving it. It is expected that, by the end of this Parliament, expenditure per head for the NHS in Wales will be below that of England. That is what we get from a Labour Government.

Let me reiterate to Mr Sharma and my hon. Friend Angie Bray a point I made a moment ago. The hon. Member for Ealing, Southall should admit that the plans being looked at in north-west London are entirely the same ones considered under a Labour Government before the election. I will insist that the plans are subjected to the four tests I have described. If they meet those four tests, they can go ahead; if not, they will not. I advise him to continue making speeches in the House, but also to ask the general practitioners and clinical commissioners in Ealing what they think is in the best interests of their patients—his constituents. That is a good basis to start with.

My hon. Friend Andrew George, Frank Dobson, and a number of other hon. Members, asked about the south-west pay consortium. When I went to the NHS pay review body just a couple of months or so ago, I made it very clear that the Government believe we should do everything we can to support NHS employers to have the flexibilities in the pay framework that are necessary for them to recruit, retain and motivate staff.

Photo of Frank Dobson Frank Dobson Labour, Holborn and St Pancras

Meaning: pay staff less in the south-west.

Photo of Andrew Lansley Andrew Lansley The Secretary of State for Health

The right hon. Gentleman should not interrupt from a sedentary position. I am answering the question. Members are interested in this. When I went to the pay review body, I made it clear that, in my view, we could achieve that through negotiations on the “Agenda for Change”. That continues to be my view, and the south-west pay consortium makes it clear in its documentation that it supports such a negotiation. It is right to pursue such a negotiation nationally and for local pay flexibilities to be used in the national pay framework. That is what most NHS employers do, with the exception of Southend.

I have made it clear, as the Minister of State, Department of Health, my right hon. Friend Mr Burns has, that we are not proposing any reductions in pay as a consequence. I do not believe they are necessary or desirable in achieving the efficiency challenge.

Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health

I have a simple question for the Secretary of State. Is he therefore overruling the south-west consortium?

Photo of Andrew Lansley Andrew Lansley The Secretary of State for Health

No, because the south-west consortium has made no such proposal. Its document is clear: it wants the “Agenda for Change” national pay framework to give it the necessary flexibilities. My view is that we should do that, and I hope that the Opposition, along with the trade unions and the staff side, will support it. As a consequence, no proposal for the reduction of pay or the dismissal and re-engagement of staff is, in my view, desirable or necessary. Indeed, when I went to the pay review body, I made the point that I did not believe reduction of pay in the NHS to be necessary.

Let me conclude. There was a lot that those of us in the Chamber did not hear from Opposition Members. Much of it was in the annual report that I published just two weeks ago—waiting times below what they were at the time of the last election; the number of people waiting beyond 18 weeks cut by 50,000; the number waiting beyond a year reduced by nearly two thirds; infection rates in hospitals at their lowest ever level; cancer waiting times met; ambulance trusts all meeting the category A8 standard; 95.8% of patients seen, treated and discharged from A and E within four hours; 92% of in-patients and 95% of out-patients saying that their care was good, very good or excellent; and patients across the NHS saying that they support the NHS and believe the care they received to have been excellent. On that basis, the House should reject the motion as unfair in its characterisation of the NHS and wrong in its denigration of the NHS.

Question put .

The House divided:

Ayes 228, Noes 303.

Division number 54 National Health Service — Health Spending and Rationing by Cost

A majority of MPs voted against asking the Government to take action to prevent rationing by cost in the NHS and against calling on the Government to honour its pledge to increase health spending in real terms each year.

Aye: 228 MPs

No: 303 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

Absent: 115 MPs

Absents: A-Z by last name

Question accordingly negatived.