NHS Services (Access)

Opposition Day — [6th Allotted Day] – in the House of Commons at 4:15 pm on 15th October 2014.

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Photo of Andy Burnham Andy Burnham Shadow Secretary of State for Health 4:15 pm, 15th October 2014

I beg to move,

That this House
notes comments from leading experts that the NHS and social care services are at breaking point;
believes that this is linked to the Government’s decision to reorganise the NHS;
further notes that one senior Cabinet minister has said that reorganising the NHS was the Government’s biggest mistake;
further believes that the NHS reorganisation has wasted money which could have been spent on frontline care;
further believes that access to NHS services is now deteriorating and that staff numbers are not keeping pace with demand;
notes the report by the Nuffield Trust, entitled Cause for Concern: Quality Watch annual statement 2014, published in October 2014, which found that it is now becoming harder to access care in many settings, with some people facing extreme waits;
calls on the Government to act swiftly to reverse the deterioration in accident and emergency, cancer and referral to treatment waiting times;
further calls on the Government to publish its independent evidence on the costs of reorganising the NHS;
and further calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion to invest in building the NHS workforce of the future.

Back in 1997, people were waiting months and years, and even dying, on NHS waiting lists. The last Labour Government brought that scandal to an end. Following the Wanless report we increased investment in the NHS, although that was opposed at the time by the Tories. Slowly, over the course of the past decade, the NHS rose up the international league table to the point where, in June 2010, it was judged by the Commonwealth Fund to be one of the best—if not the best—health services in the world. Of course it was not perfect, and there were terrible failings at Mid-Staffs, but the legacy inherited by this Government included the lowest-ever waiting lists and the highest-ever public satisfaction. That was Labour’s record: a massive turnaround in the fortunes of the NHS from the crumbling service that we inherited.

So where, after four and a half years of the coalition Government, does the NHS stand in 2014? It is at “breaking point”—[Interruption.] Hon. Members laugh, but those are not my words but those of the seven medical royal colleges and trusted organisations, including the Royal National Institute of Blind People, the Multiple Sclerosis Society, Anthony Nolan and the Alzheimer’s Society, which wrote an open letter last week to all the political parties. They said that

“staff feel undervalued and demoralised…things cannot go on like this.”

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

I want to make some progress.

The letter identifies six areas of major concern, and I shall focus on three of them today. The first is GP services. The letter states:

“A shortage of GPs means that patients are struggling to get an appointment to see their doctor.”

Paul Turner-Mitchell got in touch with me today to say that getting a GP appointment is now like trying to get sought-after concert tickets with the phone stuck on redial. I am sure that a lot of people watching this debate today will know exactly what he means. It is becoming the norm for people to ring the surgery early in the morning only to be told that there is nothing available for days. This year, 13 million people have either waited a week or more for a GP appointment or could not get one at all. That figure has gone up by 2.5 million since 2011.

Why is this happening? It is happening because the GP budget has been repeatedly cut under this Government, because Labour’s 48-hour appointment guarantee has been axed and because the Government—in the words of their own GP taskforce—have presided over a “GP workforce crisis”. The number of GPs per 100,000 population increased from 54 in 1995 to 62 in 2009. However, the figure has now gone back down to 59.5.

At Prime Minister’s questions today, the Prime Minister tried to claim that there were 1,000 more GPs in the NHS than under the last Government. This is simply not true. I wonder what we can do about it, Madam Deputy Speaker. We have a Prime Minister who regularly abuses statistics at that Dispatch Box, and even when he has been found out, as he has on many occasions—

d

WHAT ABOUT PRACTICES THAT HAVE NO DOCTORS AVAILABLE ON HALF DAY `TRAINING DAYS`.

Always closed at weekends with no Dr available

and have Doctors who only work 4 days or less [eg Monday Wednesday Thursday and Friday ] Take a training afternoon out and that might be 3 1/2 days.

There are reports of Doctors only in 2 days a week ......

Submitted by david GREGORY

Photo of Dawn Primarolo Dawn Primarolo Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. I am going to request that the right hon. Gentleman rephrases the point he just made about the use of the statistics, as he made an accusation against the Prime Minister and I do not think it is acceptable for him to say that. Will he rephrase it, please?

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

I will rephrase it, Madam Deputy Speaker, but we have had rulings from the Office for National Statistics in respect of these things. I shall say that the Prime Minister has misused statistics at that Dispatch Box and there is plentiful evidence that that is the case. Statistics have been misused, and I wish to give this example from today. Figures from the 2009-10 census—this was the final year of the previous Government —show that there were 32,426 GPs then. The most recent figures report 32,201 GPs, which is 226 fewer. So let us get some facts on the record.

The second area highlighted by the letter is accident and emergency, the classic barometer of the whole health and care system. The letter states:

“Major accident and emergency departments in England have failed to meet their waiting times targets for an entire year.”

An entire year! What have Ministers been doing? In fact, it is longer than a year, as the target has been missed for 63 weeks running. We must remember that we are talking about this Government’s own, lowered A and E target. Before the Secretary of State says that that is not the figure for the whole NHS because it excludes minor injury units and walk-in centres, I can tell the House that the NHS as a whole has missed the A and E waiting time target for five out of the past six weeks. Almost 95,000 people waited longer than four hours in A and E in September 2014, which compares with 70,000 in September 2013. So there has been a dramatic deterioration. A and E performance over the past six weeks has been worse than it was last winter. Loud alarm bells should be ringing in the Department about this coming winter, but instead of having a plan it seems that Ministers have given up on ever meeting their own target again. The annual winter A and E crisis is now a permanent spring, summer and autumn crisis, too.

Photo of Helen Jones Helen Jones Shadow Minister (Home Affairs)

My right hon. Friend is rightly outlining this Government’s failures on health. Is he aware that towns such as Warrington face a triple whammy, whereby the number of full-time equivalent GPs is down, ambulance response times are up and yet while this Government last year gave £10 million to Cheshire West and Chester to deal with winter pressures, they gave absolutely nothing to the hospital in my constituency? Does he think that decision was politically rather than health based?

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

Many questions are raised by that decision. Areas of the country where services were being run well would say that they did not get money and instead the money was given to areas where things were not working properly. The situation my hon. Friend describes is what is happening across the NHS in England. The Government have cut the GP budget, the mental health budget and the social care budget, and all that has led to increased pressure on hospitals. There are too many people in hospitals right now in England. The wards are full and people cannot be sent back home because the social care is not there. So the wards do not become free, and A and E cannot admit people to the wards because no beds are available. A and E therefore becomes blocked. Ambulances cannot hand patients over to A and E so they end up queuing outside, meaning that ambulance response times get worse. That is the knock-on effect of the Government’s policies across the NHS, and the deteriorations she is seeing for her constituents are mirrored right across the country.

Photo of Helen Goodman Helen Goodman Shadow Minister (Culture, Media and Sport)

My right hon. Friend describes it brilliantly. Does he agree that he is describing a system that shows exactly why privatisation and competition is completely inappropriate in the NHS?

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

All the evidence from around the world tells us that more market-based health systems cost more than systems such as the NHS, and are more complex and fragmented. The clear conclusion I draw is that the market is not the answer to 21st-century health and care. The Government believe it is, which is why they must be defeated if we are to protect our national health service.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

I hear what the right hon. Gentleman is saying. If he is concerned about other providers in the health service, will he explain why the previous Labour Government were happy to pay private sector providers 11% more than NHS providers for providing NHS services?

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

We brought in other providers in a supporting role to add capacity to bring down NHS waiting lists to the lowest-ever level. That is what the previous Government did. By contrast, this Government are doing something different. It is mandating tendering on GP commissioners, requiring people to compete, wasting money on running tenders and privatising the national health service, which is why they must be stopped.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

It is fair to say that the previous Labour Government did introduce the private sector to many areas of the NHS. They also introduced a requirement for the tendering of many NHS services. If we follow the logic of Lord Warner, who is setting out the general direction of Labour party policy, we will find that that is clearly where the heart of Labour party policy has been and probably will go.

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

May I remind the hon. Gentleman, for whom I have a lot of respect, that I, as Health Secretary in 2009, introduced to the national health service a policy of NHS preferred provider? That is because I am not neutral about the NHS. I believe in the public NHS and what it represents, which is people before profits. Any policy that I develop will always be based on that principle. I was attacked at the time by the Conservative party for introducing such a policy, but I make no apology for it. We used the private sector in a supporting role, but the Government want to use it in a replacement role, and there is a very big difference between the two things. If they were continuing what we had done, why did they need a 300-page Bill to rewrite the whole legal basis of the national health service?

Photo of Steve Rotheram Steve Rotheram Labour, Liverpool, Walton

Is my right hon. Friend aware that even the Chancellor agrees that the disastrous top-down reorganisation of the NHS was a huge strategic error? Does he agree that those on the Government Benches, including Andrew George, should apologise—I include in that the newly elected hon. Member for Clacton (Douglas Carswell) who has somehow found his way on to the front Bench on the Opposition side, but hopefully not for long—and support the private Member’s Bill of my hon. Friend Clive Efford when it comes before the House on 21 November?

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

I am interested to see this new friendship that my hon. Friend has struck up with Douglas Carswell on the Front Bench. My hon. Friend is absolutely right. The promise was that there would be no top-down reorganisation. We told the Government that it would be a major mistake to break that promise. They broke that promise and now they are admitting it in private to newspapers. I will come to that point a bit later.

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South

It is worth saying to my right hon. Friend and to Andrew George that all of us on the Health Committee were very concerned yesterday when we spoke to people in Staffordshire and Stoke, because they were talking about what seemed to be the privatisation of cancer and end-of-life care services. That seems to be going on much to the consternation of clinicians and radiologists who were not consulted; much to the consternation of NHS staff and of an awful lot of patients and people who live in that area. It is very concerning indeed that we find ourselves in that situation. That could be one of the biggest mistakes that is made in the NHS.

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

I am glad that my hon. Friend raised that point, as again it highlights the major difference between us and the Government. They were saying that we brought in private providers. Yes, that is true, but that was to bring down waiting lists for planned operations, such as hip and knee operations. As she has just rightly said, the Government are putting out to tender cancer services. That is a very different thing. The Government are presiding over a major increase in private ambulances providing blue light 999 services. That is a massively different policy from the one they inherited, which is why the points they have made simply do not hold water.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

The right hon. Gentleman is making some emotional points here. Does he support the policies of his colleagues in Wales, and does he endorse the way in which they have dealt with the NHS in Wales?

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

I do get emotional about the NHS, because I believe in it, unlike the hon. Gentleman. That is fine, I do not mind—it does animate me. Let us have a look at Wales and, as I am about to come on to cancer care, let us have a look at that. In England, only 84% of patients receive treatment within 62 days. That is not good enough, and Wales has better figures on cancer care. The analysis of the four home nations’ health care systems found that there is good and bad in all of them and this Tory attack on the national health service in Wales has to stop.

I will move on to cancer and I will go back to the letter that I was quoting. It said:

“Thousands of patients are facing longer and even unacceptable waits to find out whether or not they have cancer, because services are under extreme pressure and referral targets are being missed.”

In 2014, 10,000 people in England had to wait longer than the recommended 62 days to start their cancer treatment. The number of patients waiting longer than six weeks for diagnostic tests has doubled in the past year—doubled, for cancer tests. That is simply not acceptable. We need to hear today what the Secretary of State is going to do about it and may I suggest that the very first thing he should do is stop the cuts to cancer care? A parliamentary question shows that expenditure on cancer services has fallen by £800 million in real terms since 2009-10; the information comes from his Department and I will send it to him. That is why the NHS has missed the cancer treatment target for two quarters running, the first time that it has ever done that.

The evidence is indisputable. The NHS has gone downhill on this Government’s watch and the question follows of what they are doing to bring GP, A and E and cancer services back up to national standards. That is what our motion and, more importantly, patients demand to know from the Secretary of State today, but they will also want to know why the NHS has gone from being a successful service four years ago to being at breaking point today. The front page of The Times on Monday offered us an answer. It quoted a senior Cabinet Minister who said:

“We’ve made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.”

The Secretary of State is conveniently looking down and avoiding my eye at this point, but I am sure he has found out who that was. I am sure he knows. I know that he is avoiding looking at me, but is he prepared to tell us who it was or is he going to carry on with his head buried and avoiding—[Interruption.] He is blushing. I see that he has the good grace to do that, at least. It is an embarrassing comment, it really is, from a senior Cabinet Minister, but what use is it to people now, when people such as Andrew George and I were pleading with the Government to stop the process, to admit that it was all a mistake? It is an embarrassing situation for the Secretary of State to deal with, but at least we have from the very top of this arrogant Government the first admission that their reorganisation was a major mistake.

The article goes on to quote an ally of the Chancellor, who says:

“George kicks himself for not having spotted it and stopped it.”

Not having spotted it? This was famously the reorganisation so big we could see it from space. Not spotted it? What planet was the Chancellor living on? The truth is that the Government could have and should have stopped the reorganisation for the simple reason that they were elected on a promise of no top-down reorganisation and did not have the permission of a single person in this land to carry it out. That is why Thursday 7 May 2015 will be their day of reckoning on the national health service.

If this private apology now is designed to bring people back on board, it will not work. Doctors and nurses lined up to plead with the Government to call the reorganisation off, but they ploughed on. In the words of Mark Porter, chairman of the British Medical Association:

“The damage done to the NHS has been profound and intense”.

Let me focus on just one example of that damage, staffing costs, as the Secretary of State was talking about them this week. The staff census shows very clearly that in the early years of this Parliament, when spending on back-office restructuring was at its peak, front-line nursing posts were cut by about 7,000. At the same time, the reorganisation threw nurse training into chaos. Training places were cut and have never recovered, down from 21,000 a year to 18,000 today.

The NHS has been recruiting more staff in the wake of the Francis report, but this is where the damage done by the reorganisation is hitting NHS trusts. They are being forced to recruit overseas or to turn to agency staff because there are simply not enough nurses coming through the training system.

I have been contacted by a whistleblower from a trust in Liverpool who says that it is now common for staff to receive text messages from agencies such as Pulse offering huge fees—up to £1,000—to work weekends in London or the north-east, with all travel and accommodation costs paid. That is now the norm, and it is happening on this Secretary of State’s watch. Some nurses are literally taking off one uniform on a Friday night and putting on another for the weekend. That is why the agency bill is out of control, and it is happening on his watch.

In 2013-14 the NHS spent £2.6 billion on agency staff. For foundation trusts that is a staggering 162% over what was planned. That helps to explain why trust deficits are mounting. Does not this mismanagement of the staffing budget explain why the Government are now reneging on their promise to pay nurses a meagre 1% pay rise? Is not that the real reason? I wonder how the Secretary of State thinks those nurses will feel when they read this week that senior mangers’ pay has increased by 13.8% on this Government’s watch, while their pay has gone up by only 5%. I am told that he has refused to meet the unions even to discuss it. It is not good enough. He should get to the negotiating table tomorrow and start treating the staff of our national health service with the respect they deserve.

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

I will not.

The Secretary of State now claims that his reorganisation is saving £1 billion a year, but the truth is that that is a fantasy figure. The reorganisation, which cost £3 billion and counting, turned the 163 NHS organisations into 440 separate administrations with their own running costs. It introduced a new competition regime that is eating up tens of millions of pounds of NHS money. Perhaps that is why Kieran Walshe, professor of health policy at Manchester business school, said:

“I haven’t found anybody who thinks that this reorganisation has made the NHS more efficient and more productive… and I don’t think you find many people who think that the new system costs any less to run.”

The Secretary of State needs to clear this up today. Either he publishes the independent analysis that he claims supports his figure of £1 billion, or he stops making a claim that is simply not credible.

Photo of James Morris James Morris Conservative, Halesowen and Rowley Regis

I thought that this debate was about access to services. One thing that the right hon. Gentleman has not mentioned is mental health services. One of this Government’s achievements is that 100,000 more people are getting access to psychological therapies than under the previous Government, and last week the Government announced for the first time access standards and waiting time targets for mental health services, which were never in place in the 13 years of the Labour Government.

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

I am afraid that the hon. Gentleman is wrong, because I mentioned the cuts to mental health services earlier in answer to my hon. Friend Helen Jones. The talking therapies he mentioned were introduced by the previous Government —indeed by me—and in some places they are not being cut, which I am pleased about, but in others they are. The letter I referred to from the royal colleges and other organisations talked about a crisis in mental health. They say that people are being ferried hundreds of miles to find emergency beds. That is the reality on this Government’s watch. I think that a little less complacency and a little more focus on these problems would not go amiss.

Photo of Kevan Jones Kevan Jones Shadow Minister (Defence)

My right hon. Friend should be congratulated, along with my right hon. Friend Alan Johnson, who brought in the IAPT—improving access to psychological therapies—programme. It was a revolutionary system for dealing with access to mental health services. Is not it the case that this Government, even though they obviously think that there are votes in championing mental health, are cutting not only the number of in-patient beds, but the mental health budget across the country?

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

My hon. Friend is right. We heard the commitment that the Deputy Prime Minister gave last week, and I am sure that he means it, but people will ask why they have not done anything about it in this Parliament. It is lip service. We introduced talking therapies and many other things. The key point is that they cut it faster than they cut the rest of the NHS. Worse still, they introduced a tariff decision this year that will cut it even further and make the problems even worse. It was Labour that proposed parity of esteem between mental and physical health in law. The Government accepted it, but they have done absolutely nothing about it.

Photo of Lilian Greenwood Lilian Greenwood Shadow Minister (Transport)

One of the groups most affected by cuts to mental health services is children. On this Government’s watch we have seen increasing numbers of children with mental health difficulties treated on adult psychiatric wards. Is that not completely unacceptable?

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

My hon. Friend puts it very well. If mental health is the poor relation of the NHS, then child and adolescent mental health services are the poor relation of the poor relation. How can that be the case when we are talking about children who need the best possible support—the most vulnerable children—being denied the services that they need? My hon. Friend Liz Kendall discussed at a shadow health team meeting a constituency case where a family were trying to find a bed for a child who was in a crisis and not one bed was available for that child in the whole country—not one bed. She is nodding. That is the reality. I wish that Government Members would focus on that rather than making complacent statements.

No amount of spin from the Government can disguise the fact that the NHS is heading for the rocks and urgently needs turning around, so the question is how we get it back on track. I have two positive proposals to put before the House on policy direction and on funding. Let me take each in turn. Instead of just admitting privately that the reorganisation was a mistake, the Government should be actively working with us to begin to put it right—and they will soon have a chance to do so. In five weeks, my hon. Friend Clive Efford will bring a Bill before this House to repeal the worst aspects of the Health and Social Care Act 2012. When the Government’s reorganisation was going through, their mantra was “Doctors will decide.” The Prime Minister repeated this in his “Today” programme interview during the Conservative party conference when he said:

“there’s nothing we’ve done which makes it more likely there’ll be private provision in the NHS”.

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

The Secretary of State says that it is true, but that is not how people see it in the real world. Doctor after doctor tells me that their legal advice under section 75 of the Act mandates them to run open tenders for services. Today we see the evidence of how the NHS is changing under that regime. The BBC reports that more than half of contracts awarded by clinical commissioning groups are going outside the NHS. Why is this a problem? Because it is wasting NHS resources on tenders and leading to fragmentation of care when the future demands integration. We need Government Members to tell us today whether they will vote with us on 21 November to repeal mandatory tendering and thus be true to what they originally said they wanted to do, which was to let doctors decide how services are provided.

Photo of Nigel Adams Nigel Adams Conservative, Selby and Ainsty

I want to take the shadow Health Secretary back to his words earlier when he seemed to be concerned that private operators are in danger of putting profits before patients. Why, when he was Health Secretary, did he personally sign off on a private-only shortlist for the Hinchingbrooke hospital franchise?

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

That is inaccurate, because it was not a private-only shortlist—there was an NHS bidder in the frame at the time. The hon. Gentleman needs to keep his facts straight. As I said earlier, I introduced the NHS preferred provider principle, and that is my policy. [Interruption.] If he wants to dispute that, then the facts will speak for themselves. The shortlist had public and private on it.

Photo of Nicola Blackwood Nicola Blackwood Conservative, Oxford West and Abingdon

The shadow Secretary of State is being very generous, and I hope that he will respond to me in a non-partisan way. I speak as the daughter of two NHS workers and as somebody who has recently had a very close family member survive an emergency operation for a life-threatening illness. Will he clarify Labour’s position on what it would do in government about a reorganisation, because the difference between a restructuring and a reorganisation is not clear to me? The British Medical Association and GP leaders have been very concerned about exactly what the policy is and what it would mean, so will he make that clear? He has been criticising certain policies, and I would like to understand what his policy would be.

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

I am glad that the hon. Lady asked that—it is a very fair question. I imagine that a reorganisation is the last thing that people in the NHS would want right now. My definition of a structural reorganisation is where we stand down a whole set of organisations and then create a whole set of new ones. I have been very clear that I will not do what Mr Lansley did. I will work with the organisations that I inherit. I will work with CCGs, and with health and wellbeing boards, in particular. Health and wellbeing boards were one of the few good things that came out of the Act, because they are a partnership between local government and the NHS, and that is something I can work with. She asked a fair question and I hope I have given her a fair answer. A structural reorganisation where we make everybody redundant again and recreate organisations will not help anybody. In fact, if the Government wanted GP-led commissioning, they should simply have put doctors in charge of the old primary care trusts. If they had done that, they would have saved a lot of money and a lot of heartache in the process.

I am going to finish on NHS funding. The letter I mentioned at the beginning called for a long-term spending plan for the NHS. The NHS Confederation has put that at £2 billion a year. At the Conservative party conference, the Prime Minister committed to maintaining the ring fence for health in the next Parliament, but experts are clear that that will not be enough to prevent the NHS from tipping into a full-blown crisis. Indeed, the Chair of the Health Committee, Dr Wollaston, has said:

“Maintaining the ring-fence on health spending is not enough.”

I am sure the hon. Lady is right, but her problem—and the problem for everyone on the Conservative Benches—is that they have chosen a different spending priority. They have given a commitment to tax cuts for higher earners, which will cost an unfunded £7 billion. What that means in reality is that if the Tories get back in, any spare money will go towards filling that black hole and there will be nothing left for the NHS, so the outlook for the NHS under the Tories in the next Parliament is very bleak indeed. Given current policy direction on competition and the funding plans they have announced, the NHS is looking at a toxic combination of cuts and privatisation under a re-elected Tory Government.

By contrast, Labour’s priority is not tax cuts for some, but a strong NHS for all. We have found an extra £2.5 billion a year—that is not spin; it is money we have committed to—to build the NHS of the future, and the question before the House tonight is whether it should call on the Government to match it.

Labour’s plan is for a national health and care service—full integration of health and social care, starting in the home and building one team around the person. We will do that by recruiting 20,000 more nurses, 3,000 more midwives, 8,000 more GPs and 5,000 extra home care workers by the end of the next Parliament—a new generation work force in the NHS, working from home to hospital, transforming the delivery of care. Social care is prevention, and by uniting it with the NHS we can turn the financial tide around and place the system on a path towards financial sustainability.

Labour has a credible plan for the NHS and the money to back it up. This House needs to decide tonight whether it agrees and whether it is prepared to match the money needed to turn the NHS around. The decision we make tonight will clarify the decision before the country next May. Will our top priority be, as the PM used to say, those three letters: NHS? Or will it be tax cuts for some, but an NHS crisis for all? That is the choice. We have made ours and our choice is the NHS.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health 4:47 pm, 15th October 2014

I do not think I have ever heard such a misuse of statistics and facts in this House as we have heard today.

I am delighted to debate the NHS, which has been independently rated—[Interruption.] Labour Members do not like to hear this. The NHS has been independently rated by the Commonwealth Fund this year as having become, under this Government, the best out of 11 industrialised countries. It is a better health care system than those in France, Germany and Australia. [Interruption.] Labour Members do not like to hear this, but the independent experts in Washington have said that the NHS has become the best in the world under this Government. The most uncomfortable thing of all for the Labour party is that the NHS has become better than it ever was under the previous Labour Government, when Andy Burnham was Health Secretary.

If the right hon. Gentleman wants to talk about Government mistakes, we will do so, but he will find that, on Mid Staffs, the private finance initiative, botched IT projects, a disastrous GP contract, unsafe hospitals, low cancer survival rates and little action on dementia, it is the Labour party, not this Government, that must be held accountable for mistakes in running the NHS. Indeed, after years of mismanagement it is this Government who are finally putting high-quality patient care back at the heart of what the NHS stands for.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will give way in a moment, but I want to make some progress.

I want to go through the arguments of the right hon. Member for Leigh in detail, but let me start with the elephant in the room: the massive financial pressure facing the NHS if it is to meet our expectations in the face of an ageing population. There are now nearly 1 million more people over 65 than when this Government came to office. Our economy then was nearly bankrupt. Despite those extraordinary challenges, this Government have been able to increase spending on our NHS—including on Leigh infirmary in the right hon. Gentleman’s constituency—because of our difficult decisions, which were opposed at every stage by the Labour party. Government Members know one simple truth: a strong NHS needs a strong economy.

On the day that unemployment fell below 2 million and the claimant count fell below 1 million, there was nothing in the right hon. Gentleman’s speech about the need for a strong economy to support our NHS and nothing about learning from the Labour Government’s disastrous mistakes, which were so bad that they were in fact planning to cut the NHS budget had they won the election. We should remember that countries that forgot about the deficit ended up cutting their health budgets—Greece by 14% and Portugal by 17%. [Interruption.] Well, these are the facts. We must never again in this country allow the poor economic decisions that have been the hallmark of every Labour Government in history.

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South

It is interesting that the Secretary of State is claiming credit for things where the data are based on Labour’s achievements with the NHS, while anything else is our fault. He talked about older people and the demographics of an ageing population, but what good does he think he is doing to that section of the population with £3.7 billion of cuts to social care? Particularly as we move to integration, how does he think that will help those people? In my local area, 1,000 people will lose their care package this year. How does he think that will help the NHS in Salford?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will tell the hon. Lady what we are doing: we are integrating the health and social care systems through the Better Care fund—a £3.9 billion programme—which is something that Labour could have done in 13 years in office but failed to do. That will make a massive difference to the social care system. Let us move on to some of the detailed arguments.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will make some progress first.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I am very happy to give way to the right hon. Gentleman.

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

This is the most important part of the debate. The Secretary of State is right about the elephant in the room. This is the thing that people in the NHS will pay most attention to today. He has gone through his record in this Parliament, but the problems in the next Parliament will be large, as I am sure he would agree. He needs to say today whether he thinks the ring fence will be sufficient, or does he think that the NHS will need more money over and above the ring fence if it is to avoid crisis in the next Parliament?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

First, let me just correct for the record what the right hon. Gentleman has said. The Prime Minister’s commitment was not just a continuation of the ring fence; he has committed to continue to increase funding in real terms for the NHS. If the right hon. Gentleman looks at the record of this Government, he will see that we have increased spending on the NHS by more, in real terms, than Labour’s promises at its conference. The point about promises is whether the people making them are credible. Which party will deliver the strong economy that can fund the NHS?

Photo of David Davies David Davies Chair, Welsh Affairs Committee

Will my right hon. Friend confirm that this Government have increased spending on the NHS in real terms by 3%? In Wales, where Labour is in control, there has been an 8% cut in real terms. How can we possibly trust a word Labour says on funding for the NHS?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is the point. We get all sorts of rhetoric from Labour, but when we look at its record of running the NHS—whether its disastrous record in England previously, or its disastrous record in Wales today—we see the real face of Labour policies on the NHS, and no one should ever be allowed to forget it.

There has been a lot of discussion about reorganisation. The right hon. Gentleman criticised reorganisation as if it were the last thing in the world that a Labour Government would do, but the previous Labour Government had nine reorganisations in just 13 years. Following the conference season, we know that Labour wants to have yet another one by effectively abolishing clinical commissioning groups in all but name and making GPs work for hospitals. There is widespread opposition to that policy across the NHS.

The right hon. Gentleman has repeatedly claimed that the reforms have cost £3 billion, but the audited accounts show that the reforms will save nearly £5 billion in this Parliament and £1.5 billion a year thereafter. These are the words of the National Audit Office[Interruption.] He should listen to this, because this is about an independent audit that relates to a key part of his case. These are the words of the National Audit Office in its 2013 report:

“The estimated administration cost savings outweigh the costs of the reforms, and are contributing to the efficiency savings that the NHS needs to make.”

Will he publicly correct the record and accept what the National Audit Office has said, which is that the reforms saved money? The man who is never short of a word is suddenly silent. I have the National Audit Office report here, so he can see for himself. The reforms saved money.

If the right hon. Gentleman wants to talk about wasting money, I am happy to do so. The management pay bill doubled under Labour, compared with a 16% drop under this Government. The private finance initiative schemes left the NHS with £79 billion of debt. The IT fiasco wasted £12 billion. We will take no lectures on wasting money from the party that was so good at wasting it that it nearly bankrupted the country, let alone the NHS.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will make some progress.

The right hon. Gentleman said that the reforms have made it harder to access NHS services. The opposite is true. Scrapping the primary care trusts and strategic health authorities meant the introduction of clinical leadership, which he wants to abolish, and allowed the NHS to hire 6,100 more doctors and 3,300 more nurses. Those members of staff are helping the NHS to do 850,000 more operations every single year compared with when he was in office. How can he possibly stand before the House and say that access to NHS services is getting worse, when nearly 1 million more people are getting operations every year compared with when he was Health Secretary?

Photo of John Glen John Glen Conservative, Salisbury

What is more, the evidence from Labour’s last years in office shows that the number of managers was increasing at three times the recruitment rate for nurses. What does that say about Labour’s priorities in office?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is absolutely right. That is why the management pay bill doubled under Labour and why we took the difficult decision, which the Opposition bitterly opposed, to get rid of 19,000 administrators and managers so that we could recruit the extra doctors and nurses. I notice that Opposition Front Benchers are very quiet on that point because they cannot answer the simple question of how they would pay for those extra doctors and nurses if the Health and Social Care Act 2012 was reversed. [Interruption.] Ah! They would pay for the extra doctors and nurses by bringing in new taxes that the country is not paying at the moment.

The right hon. Gentleman talked about structural reforms. We ought to discuss the structural reforms that he chose not to talk about, such as making the Care Quality Commission independent, with new chief inspectors for hospitals, adult social care and general practice. He tried to vote down that legislation in this House. So far—[Interruption.] I know that this is uncomfortable for Labour Members, but they should listen, because the new inspection regime has put 18 hospitals into special measures. Five of them have been turned around completely and have exited special measures, and important improvements are being made at the others.

The motion talks about Government mistakes, so will the right hon. Gentleman finally accept the catastrophic mistakes that he made as Health Secretary, such as failing to sort out the problems at those hospitals, even though there were warning signs at every single one of them? Will he accept that because Labour ignored those warning signs, patients were harmed and lives lost? Will he finally apologise to the relatives of patients at Mid Staffs whom he made wait outside in the cold because he refused to meet them and hear their concerns? Will he make that apology now? He has not apologised and it is clear that he does not want to do so today.

The right hon. Gentleman talked about A and E. Just as when he was Health Secretary, there have been weeks when the target has not been met. What he did not tell the House is that, thanks to our reforms, we have 800 more A and E doctors than four years ago and nearly 2,000 more people are being treated within four hours every single day than when he was Health Secretary.

As the motion refers to Government mistakes, perhaps the right hon. Gentleman might like to acknowledge some of his own mistakes on A and E, such as the 2004 GP contract that removed personal responsibility for patients from GPs, making it more likely that people would end up in A and E, or the failure over 13 years to integrate the health and social care systems, meaning that many vulnerable older people continue to end up in A and E unnecessarily—something that we are putting right through the Better Care programme.

When the right hon. Gentleman spoke about NHS performance, he talked repeatedly about missed targets. That is a really important issue and is perhaps the biggest dividing line between his approach to the NHS and mine. Of course targets matter in any large organisation, but not targets at any cost. That is why the Government have been careful to ensure that in the new inspection regime, waiting time targets are assessed not on their own, but alongside the quality and safety of care.

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

The Secretary of State makes an important point, and as Health Secretary, I said that over-reliance on targets was not right. I accept that point, but he now needs to answer a question of mine. He has not removed our targets for A and E or for cancer. Does he consider it acceptable that the NHS is missing the national cancer target? If not, what will he say to reassure families that that will get better soon?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Let us deal with the cancer target. When the right hon. Gentleman left office—[Interruption.] I am dealing with the cancer target. When he left office, we had the worst cancer survival—

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

Forget that—I am asking about now.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The right hon. Gentleman may want to forget that, when he left office, we had the worst cancer survival rate in western Europe, but why did we have that? We had the worst cancer survival rate in western Europe because we were not diagnosing cancers quickly enough. Under this Government—this is the inconvenient truth for the Labour party—we have treated for cancer nearly three quarters of a million more people than in the last Parliament. We have done that because, as the Prime Minister said, we are referring 50% more people. Access to cancer care has dramatically improved under this Government, and we are starting to climb back up the European league tables.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Let me finish my point about targets because it is important. The NHS over which the right hon. Gentleman’s Government presided was, as the former NHS chief executive Sir David Nicholson said, an NHS where

“patients were not the centre of the way the system operated.”

Labour’s NHS was obsessed with targets, and we have still not had an apology for the policy mistakes that led to Mid Staffs. We have got rid of a number of targets; we are happy to keep a few benchmark targets, but we will not be obsessed with targets at any cost.

May I gently suggest that the Labour party re-read the Francis report? These are Sir Robert’s words about the culture during the Mid Staffs period, when the right hon. Gentleman was a Minister. He described an

“insidious negative culture involving a tolerance of poor standards” resulting from

“a focus on reaching national access targets”.

If the right hon. Gentleman does not want to listen to Sir Robert, will he listen to families who suffered in Mid Staffs, Morecambe Bay, Basildon and countless other hospitals, all of whom are simply incredulous that Labour wants to put him back in charge of the NHS, while he refuses to acknowledge the terrible problems caused by Labour’s NHS target culture?

The right hon. Gentleman also talked about privatisation. That may hit the spot for his trade union supporters, but it does not stand up to scrutiny. He knows that the use of the private sector for secondary care has grown more slowly under this Government than it grew under Labour. He knows that the biggest single privatisation decision in NHS history—the decision to contract out a whole district general hospital to the private sector—was allowed not by me, but by him when he was Heath Secretary. Let us set the record straight, because he tried to give the impression to my hon. Friend Nigel Adams that that decision was not taken—[Interruption.] Let me make my point, and then I will give way. The right hon. Gentleman approved a shortlist for Hinchingbrooke hospital, which had on it two private sector providers and an NHS provider. He did not tell my hon. Friend that the NHS provider then pulled out, and that he accepted the continuation of that process with an all-private shortlist—[Interruption.] That is what happened, and if he wants to deny it, I will give way to him now.

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

The question is: when was that contract signed? Will the Secretary of State answer that question?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Actually, the question is: when did it become an all-private shortlist, and why did the right hon. Gentleman allow that to happen if he is now saying that the privatised running of hospitals is such a bad thing? I think that we have found him out, and he will want to correct the record and the impression that he gave to my hon. Friend the Member for Selby and Ainsty.

Photo of Simon Burns Simon Burns Conservative, Chelmsford

Will my right hon. Friend confirm that in March 2010, when Andy Burnham was Secretary of State, the number of bidders for Hinchingbrooke hospital—a process that took place under legislation passed by the previous Labour Government—went from five to three? Two of those bidders were private companies; the third bidder was a private company in conjunction with an NHS trust, but at a later stage as the process developed—as my right hon. Friend said—it went down to one bidder. The right hon. Gentleman said in response to my hon. Friend Nigel Adams that there was a preferred bidder and that it was not a private company but the NHS. It was not the NHS; it was an NHS trust in conjunction with a private company.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I am grateful to my right hon. Friend because he makes it clear that, when the right hon. Member for Leigh was Health Secretary, he accepted an all-private shortlist. He will want to correct the record on that point.

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

Mr Burns has contradicted the Secretary of State. The right hon. Gentleman said that the bidder withdrew at a later stage, but the Secretary of State said that the bidder withdrew earlier. The Secretary of State cannot have it both ways. The right hon. Gentleman flatly contradicts him.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The right hon. Gentleman is quite wrong. My right hon. Friend said that there was a list of three providers, all with private provision involved. When the right hon. Gentleman was Health Secretary, he accepted that all-private shortlist for the Hinchingbrooke decision. In other words, the biggest privatisation in NHS history happened because of a decision taken by the shadow Health Secretary.

Government Members are not ideological. We believe there are times when we can learn from the independent sector, but, normally, people use the private sector when they are looking for innovation or better value. Only a Labour Government would sign deals with the private sector, paying 11% more than the NHS rate, and ending up paying more than £200 million for operations that never happened. What a shocking waste of money. When the right hon. Gentleman next talks about privatisation, instead of inventing a privatisation agenda that does not exist, will he apologise for a botched one that existed when Labour was in office?

Finally, there is a comparison that Labour never wants to make when talking about NHS performance: what happens over the border in Wales. That is where the policies that the right hon. Gentleman supports are put into practice. Let us see the difference. A record one in every seven Welsh people find themselves sitting on an NHS waiting list, compared with just one in 17 people in England. The urgent cancer waiting time target has not been met once since 2008 in Wales, but it has been missed in England in only two quarters in the whole period. A and E waiting times have been met every year in England, but they have not been met since 2008 in Wales.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

No, I will finish this point.

The British Medical Association, no friend of the Conservative party, described the NHS in Wales as being in a state of imminent meltdown. The point is that the NHS in England, like the NHS in Wales, faces huge pressure, but politicising operational problems in England, while denying much greater failings in Wales, is the worst kind of opportunism. For Labour Members, good headlines for Labour matter more than poor care on Labour’s watch. They are playing politics with our NHS. That not only scares people in England, but betrays people in Wales.

I shall conclude—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means), First Deputy Chairman of Ways and Means

Order. The right hon. Gentleman is not giving way. He must be allowed to speak.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

The Government are proud of our record on the NHS in England: more operations for more people; three quarters of a million more people getting the cancer treatment they need; record numbers being seen promptly in A and E; record numbers getting treatment for dementia; and the first ever introduction of maximum waiting times for mental health conditions. It is an NHS under pressure, yes, but it is an NHS preparing for the future, with higher-quality care in hospitals, integrated health and social care, and personal care driven by a much bigger role for GPs.

Some of those changes need money, and we have delivered that, but some of them need a change in culture, different ways of working, more transparency and a more patient-centred approach. That can mean challenging the system, which the right hon. Member for Leigh has never been prepared to do, but which this Government will always do if it is right for patients. We want an NHS building for the long term and an NHS with the confidence of a strong economy behind it. Under this Government, the NHS is independently rated as the best in the world. I oppose the motion.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing Deputy Speaker (First Deputy Chairman of Ways and Means), First Deputy Chairman of Ways and Means

Order. The House will be aware that a great many hon. Members have indicated they wish to speak and that there is limited time available for their speeches. With my apologies for my inability to articulate—I did not catch my sore throat from the Leader of the Opposition—I have to set a time limit of six minutes.

Photo of Kevin Barron Kevin Barron Chair, Committee on Privileges, Chair, Committee on Standards 5:09 pm, 15th October 2014

We are here in the Chamber today in a week when we have seen health service workers on the picket lines for the first time in 30 years, and we have seen midwives out on strike for the first time in their history—we have had midwives working in the health care system in this country for 150 years, I think—yet most of the spat we have listened to up until now this afternoon has been about who bid what for Hinchingbrooke hospital and so forth. I wonder what people outside—not just people who work in the health service, but those who rely on it and do not have the option to go elsewhere, into the private sector—think about this situation.

We have a Government—if they had been a different Government, I would probably be saying the same thing—where the case for the defence we heard from the Secretary of State this morning about how well our health service is doing comes from independent experts in Washington. I have never in my 30 years in here heard someone doing that. Philadelphia lawyers are presumably the people saying that; I thought it might be a reference to Washington, County Durham, but, no, I assume it is Washington in the USA where people are saying we have got a good health service, not the British Medical Association or the royal colleges of nurses, GPs and everything else who constantly e-mail Members on both sides of this House about the state of health care in this country and the demoralisation of the staff—hence the first picket lines for 30 years. Here we have a Secretary of State who seems to think he can find somebody to defend him who is an independent expert from Washington DC. I think that it is shameful that the Secretary of State comes to the Dispatch Box and uses arguments like that.

Let me tell the Secretary of State—although he is not listening; he is engaged in other things—that everybody knew what was going to happen when this Government came to office in 2010.

Photo of Kevin Barron Kevin Barron Chair, Committee on Privileges, Chair, Committee on Standards

I will give way to the right hon. Gentleman in a bit, because I may mention him, as he was a Minister at the time. This Government came to office and passed a Bill through Parliament that was going to introduce competition into the national health service and mean a massive reorganisation, and billions of pounds were going to be spent in doing that—billions of pounds that could have been spent elsewhere—and the case for the defence is, “We’ll make a billion pounds a year in this Parliament.” Well, it is not there yet, Ministers.

It was not just the reorganisation of the national health service that was mentioned. The Government also told us at the same time that they had got to make efficiency savings of 4% a year, something that the health service had never done, and something the public sector had never done. Indeed, people said at the time that the private sector had never done it either.

That is the situation we had when that Bill went through Parliament. They were warned about the consequences of that not just by politicians in the House, but by people who gave evidence to the Public Bill Committee. I served on it. The Bill was stalled and came back in again. Evidence after evidence came in saying what has happened was going to happen.

We have had massive reorganisation. I just wonder if the Secretary of State—if he is prepared to listen—will tell us how many of the 4,000 NHS staff who were laid off and paid redundancy were then re-employed by the NHS, some of them on massive six-figure sums. How much did that cost the NHS? How much did that take away from mental health services or other services that our constituents rely on? None of this is in the debate at all, and Ministers all know perfectly well what the situation is.

Week after week, we hear these platitudes from Ministers. The Secretary of State said not too long ago, “When you go into hospital, you’ll get a named consultant,” but what does having a named consultant matter to most people? Are they going to work seven days a week, 24 hours a day so we can phone and say, “Can we come and see you?” No one has mentioned the latest one we have had, which I thought was wonderful—

Photo of Kevin Barron Kevin Barron Chair, Committee on Privileges, Chair, Committee on Standards

The Secretary of State can come in in a minute. This latest one is a consequence of a speech made by the Prime Minister: we are going to be able to see GPs seven days a week. Well, the Royal College of GPs does not think so. I say this to the Secretary of State: “We could see a GP, not far from this place, seven days a week until you lot got in.” We could do so in the Victoria NHS walk-in centre, and I used to go in there, as my GP is elsewhere, but it closed years ago.

We put in walk-in centres—sometimes in the face of opposition from GPs, I have to say. A GP objected to them in my constituency, as I raised in the House at the time, so some of them were saying they did not want them. They gave seven days a week access to GPs.

I understand that my time is up, Madam Deputy Speaker, but I want to finish by saying this: whatever happened at Hinchingbrooke or anywhere else, we never ever had to have competition law on the statute book. We have now. Do not tell me or anybody else out there that the Secretary of State has not got plans to privatise properly the national health service, because I am convinced that he has.

Photo of Gary Streeter Gary Streeter Conservative, South West Devon 5:15 pm, 15th October 2014

Thank you, Madam Deputy Speaker. I love your husky voice.

In June, I spoke to a conference of orthopaedic surgeons from the south-west, including the NHS consultant who carried out my own hip replacement very successfully in 2012. They had asked me to speak about the future of the NHS and to be as bold and as honest as I could be. When we came to questions, I was amazed at how all the doctors said basically the same thing. It might be paraphrased thus: “When will you politicians realise that the NHS is creaking at the seams and come up with new, more radical policies and a brand-new model more suitable to the 21st century that is able to cope with the demands we now face?” They said they were grateful for the extra money this Government have put in and they recognised the competing pressures on the public purse, but they believed passionately that it was not just about money going in at the top. They wanted us to be more radical in addressing the problems now facing the NHS and, in particular, in finding new service delivery vehicles.

I explained that one of the weaknesses of modern-day politics is that as soon as anyone starts to grapple with innovation and change in the NHS, we hear the voices Opposition Members—we have just heard them—who immediately shriek privatisation, and the debate grinds to a halt, especially in the run-up to an election. I find it extremely disappointing that this has all happened again today. The audience of doctors recognised this depressing reality, but none the less urged us to be bolder in addressing the pressure under which they work day in, day out in an institution that was designed 70 years ago.

I listened to the shadow Secretary of State this evening and the complaint seems to be that doctors are now under an obligation, in their commissioning groups, to buy in the best services to provide the very best health care for our constituents. That is surely a good thing. The motion before us today is an example of this immature debate. It seeks to lay the blame for the pressure under which the NHS operates today on the reorganisation that took place earlier in this Parliament. That is an absurd claim. Let us look at some of the statistics.

Between 2009 and 2013, the number of general and acute in-patient admissions rose by more than 10%. In 2003, there were just over 77,000 hip operations. By 2013, these had increased by 43% to 110,000 hip operations, of which mine was one. In 2003, there were approximately 46,000 knee replacements. That number rose sharply by 71% by 2013 to more than 79,500 knee replacements. All this has to be funded. Total attendance at accident and emergency departments in 2013 was almost 22 million, representing an increase of 11% since 2003. There were around 9.1 million emergency calls in 2013, up from 4.9 million in 2003—an increase of 85% in just 10 years.

In Derriford hospital in Plymouth, every day 75% of the patients are over 65. In the 10 years between 2003 and 2013, the actual number of people over 75 who completed episodes of admitted patient care in NHS hospitals rose by 61%. Life expectancy in the UK is increasing significantly. One in three children born today is expected to celebrate their 100th birthday. The fact that people are living longer is a wonderful success story, but it is having a significant impact on the NHS. Average NHS spend on retired households is nearly double that for non-retired households.

As everybody in the country knows, the primary source of NHS pressure today is the demographic success we have seen in recent years of people living longer—more of us getting older and needing more health care. That is why we were right to ring-fence the health budget in 2010, which has resulted in an £12.7 billion extra pumped in in this Parliament. That is why it is right that the Prime Minister has committed the next Conservative Government to continuing to increase health spending over and above inflation every year for the next Parliament. I hope we will also be bold and find new models of delivering health care, still free at the point of use, to meet the demands of a growing and ageing population.

On the subject of new models and structures, I see signs that the new commissioning groups in my area are having a positive impact. My constituency is part of the West Devon clinical commissioning group, and my discussions with the GPs who serve on it give me great hope that they are beginning to improve the nature and scope of their commissioning, helping better to meet the health care needs of my constituents. It is right that doctors, not bureaucrats, be in charge of commissioning, and we were right to deconstruct the bloated PCTs. Our PCT in Plymouth was so cumbersome that I gave up attending the regular MP briefing meetings because I could not cope with the bureaucratic culture. I am glad it has been replaced by a more streamlined, doctor-led commissioning group. This is a step in the right direction. I do not suppose for a second that the reforms were perfect—nothing ever is that Governments do—but I can see progress in the commissioning of acute services.

I say one thing to my colleagues on the Front Bench: in the west country, it used to be extremely easy to recruit GPs, but it is getting tougher by the year. I hope in the winding-up speech to hear some reassurance that in places such as Devon—a splendid place to live and work—which are having difficulty recruiting GPs of the highest quality, steps and policies will be put in place to set this right over the next two years. Nevertheless, I support the reforms; the NHS is improving all the time.

Photo of Kevan Jones Kevan Jones Shadow Minister (Defence) 5:21 pm, 15th October 2014

I wish to discuss the crisis in the North East ambulance service. To do this, I will give some of the examples I have come across and others that have been backed up by the police and other agencies. But first I must pay tribute to the hard work of the staff of the ambulance service. It is not their fault they are under pressure; they are dedicated individuals who wish to do their best for my constituents and others in the north-east.

I wish to give two of many examples—other north-east parliamentary colleagues have complaints as well. The first comes from Carole Hampson, who lives in Quaking Houses, in my constituency. On 20 June, her son Christopher rang 111, the non-emergency number, because his 10-month-old son had drunk bleach. He was told, “No problem. We’ll get an ambulance to you straightaway. Don’t do anything.” An hour later, an ambulance had still not turned up. His mother then rang back and said, “Forget it. I’m taking him in a car.” The pressure and worry for both him and his grandmother must have been tremendous. Luckily, the youngster was fine. On 4 July, she again rang the ambulance service because her son was critically ill with a diabetes-related condition. She rang 999 and the operator said, “Is he still conscious?” She said, “Yes”. The operator said, “Okay, we’ll get there as soon as possible.” An hour and 20 minutes later, an ambulance turned up.

It is not just Carole Hampson’s family who have been affected. On 11 July, she was driving through Stanley in my constituency when she saw an old gentleman fall into the road and break his head on the pavement. The police arrived and she and other bystanders came by. She rang 999 for an ambulance. While they were waiting—for 30-odd minutes—blue light ambulances were going past. The police rang the ambulance service, but no response was forthcoming. In the end, the police took the old gentleman home, where an ambulance later attended. I have another constituent, who I will not name because I have not asked her permission, whose husband had an angina attack. She rang her GP, who recommended she ring 999. The operator said, “We’ll get a paramedic to you”, which she did, but three hours later the ambulance arrived to take him to hospital.

It is not just individual constituents saying there is a crisis in the North East ambulance service; there is evidence from the police. Over a six-month period this year, there were 675 incidents in which the police had to step in following the failure of ambulances to attend. I shall give just a few examples. On 2 September, the police attended a road traffic accident and asked for an ambulance to attend. Thirty minutes later, an ambulance arrived.

On 5 September, the police requested an ambulance because an individual had been assaulted and had waited 75 minutes for an ambulance to attend. On 7 September, the police transported to hospital a male patient with head injuries because the North East ambulance controller said that no ambulance was available and that there were 39 outstanding instances. On 19 September, the police requested an ambulance to attend a female patient with severe facial injuries; an hour and a half later an ambulance had not attended, so the family had to take care of the individual themselves. On 20 September, the ambulance controller told the local police that the ambulance service was in a critical situation. This needs sorting out.

There are two problems facing the NHS North East ambulance service. One is A and E. Ambulances are backing up at A and E. The other day, an ambulance driver told me that he had been directed from Chester-le-Street to Carlisle on the other side of the country. Then there is the 111 service brought in by this Government, which is failing. The system is not being managed by professionals with any background. It is a tick-box system that is leading to instances in which ambulances that are not needed have been sent out, clogging up the system. This service is in crisis, and what is the North East ambulance service that is responsible for it going to do? It is carrying out a review. It has appointed Deloitte to carry out a review into its operation, but my constituents do not want management consultants to sort it out.

Photo of Mike Kane Mike Kane Labour, Wythenshawe and Sale East

I thank my hon. Friend for giving way and compliment him on his excellent contribution. Does he agree that this situation is being exacerbated where we are privatising ambulance services? That is what happened in Greater Manchester where in last year alone, half the journeys failed to get patients to their appointments on time.

Photo of Kevan Jones Kevan Jones Shadow Minister (Defence)

That is right. This is what is picking up the slack.

My constituents do not want management consultants to sort the problems out; they want health care professionals to do so. If we in the north-east do not do something about this soon, people are going to die. Because of what is happening, people do not accept this system. The delays are causing a huge amount of angst to individuals and are putting huge pressure on other services such as the police and fire and rescue. In desperate situations, where people in road traffic and other accidents need urgent medical care, they are unable to get it. It is a failure in 2014 that my constituents and those of other north-east Members cannot get basic medical care.

I ask the Minister—I see he is busy talking at the moment and I would like him to pay attention—urgently to intervene in the North East ambulance service because it faces a critical situation. Management consultants are not the answer, and I have no faith in the management to sort this out, as has been said by other emergency services, local authorities and their own staff. Unless there is some central direction and intervention to put this right, people’s lives in the north-east of England will be lost.

Photo of David Tredinnick David Tredinnick Conservative, Bosworth 5:28 pm, 15th October 2014

May I say how sorry I am to hear that you are suffering from a throat affliction, Madam Deputy Speaker, and how sorry I was to hear of the throat problems of the Leader of the

Opposition during Question Time today. I was reflecting on whether, if he visited his doctor, he would be taking antibiotics. One of the great crises in health care at the moment, of course, is the increase in the use of antibiotics—an issue that the Science and Technology Committee, of which I am a member, has looked at. I hope that we will address this issue with great sincerity and seriousness. The 25% increase in recent years is quite terrifying.

I do not accept any of the arguments I heard from the shadow Health Secretary. I would like to share some experiences of the Hinkley and Bosworth health and wellbeing board, which has had a very positive impact in my area. The very fact that we have together in one room on a regular basis the clinical commissioning groups, NHS England, the borough council, healthwatch and the director of public health for Leicestershire has made a tremendous difference. We heard recently that NHS England was working with GPs to increase capacity in Barwell and Earl Shilton. The clinical commissioning group was discussing new links with paramedics to provide in-home care seven days a week and also about increased sports activity in the borough. Healthwatch is conducting surveys on patients’ concerns about A and E access, dental services and repeat prescriptions. It is perhaps not surprising that the West Leicestershire NHS team has been shortlisted in the primary care innovation category for a national award from the Health Service Journal, and everyone in our area can be proud of that.

I have always felt that the health reforms are only two legs of a stool. Health and social care were brought together in the massive Health and Social Care Act 2012, but allopathic medical services were not integrated with complementary and alternative medicine. My right hon. Friend the Secretary of State for Health should look at this with great care, because estimates I have received show that making greater use of acupuncture, herbal medicine, chiropractic and osteopathy reduce the cost of medical care by about 5%.

The Impact Integrated Medicine Partnership in Nottingham is a social enterprise that provides acupuncture, chiropractic and homeopathy in primary care settings. It combines the best of conventional and complementary medicine and has proved to be flexible, with lasting, sustainable improvements. Comprehensive evaluations of the service in 2006 and 2010 demonstrated the effectiveness of those interventions, and patients—I ask the Minister please to listen to this—who completed treatments subsequently visited their GP less often, reported taking less medication and had less need for referral to secondary care, thus saving NHS resources. The partnership is a shining example of what can be done if the complementary field is brought into the mainstream, reducing costs and burdens on doctors and providing a more efficient and more patient friendly health service.

Altogether Better, Wakefield has supported individuals in the community to become volunteer community health champions. It has trained 17,000 community health champions and a recent social return on investment study by York Health Economics Consortium showed a positive return of about £1 for every £1 invested. That is £1 more for the health service to spend.

There are many other examples, such as the Kensington and Chelsea beating back pain service and the Royal London Hospital for Integrated Medicine, which has

13 care pathways. They assist with the problems that doctors face with almost intractable conditions such as chronic fatigue syndrome, chronic low back pain, chronic headache, knee pain, hay fever, non-organic insomnia, perennial allergic rhinitis, irritable bowel syndrome and weight loss.

Finally, I am concerned about antibiotics. My right hon. Friend the Secretary of State should address this with the greatest possible speed and care.

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South 5:33 pm, 15th October 2014

The Government argued that the current NHS reforms—their NHS reforms—would result in major savings to the NHS, making our system more “responsible, efficient and affordable.” I am sure that many Labour Members will agree that reforms under the Health and Social Care Act 2012 have failed to deliver a single one of these aims. The NHS is costing more and delivering less, the quality of care it provides has declined and hard-working staff, particularly GPs, nurses and staff in A and E, are bearing the brunt of the Government's misguided and irresponsible measures.

It seems that senior Cabinet Ministers may think the same as Opposition Members. As we have heard, The Times quoted one as having said:

“We’ve made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.”

I think that it is about time Government Members owned up to their mistakes, and started to share their opinions openly with the House.

The reorganisation caused upheaval in every part of the NHS. Primary care trusts and strategic health authorities were abolished, and commissioning responsibility was transferred to NHS England as well as to clinical commissioning groups. The chair of a health and wellbeing board told me last Friday: “I am left more confused by the NHS England role than by anything I have seen over decades of involvement with the NHS.” More than 440 new organisations have been created, but all the evidence now shows that that has been done at a heavy economic and social cost. Some £3 billion has been wasted on altering the structure of the NHS rather than being spent on front-line patient care, and the reforms have consistently failed to be delivered within budget. In July last year, the National Audit Office stated that the cost of their implementation had been 15% more than originally expected.

Of course, we hear counter-claims from Ministers. When I tried to intervene on the Secretary of State, he would not take an intervention on the issue of management and reorganisation costs. It was interesting to hear what was said yesterday by Kieran Walshe, professor of health policy and management at Manchester business school, on Radio 4 about the savings claimed by the Secretary of State. He said that the Government had under-counted the costs of reorganisation, even to the extent of accepting nil returns from some strategic health authorities. Most tellingly, he said that the best way in which to test the facts was to talk to people in the NHS who had lived through the reorganisation. He said that he had not talked to anyone who thought that the reorganisation had made the NHS more efficient and more productive. He had not talked to anyone who thought that the trauma of total reorganisation and redesign was worthwhile. None of us understands why PCTs were replaced by CCGs, or why NHS England was created. He also said:

“I don’t think you will find anyone who thinks the new system costs less to run”.

We know that the financial difficulties of the NHS have worsened, not improved. For the first time, foundation trusts have found themselves in deficit, along with trusts that are not foundation trusts. Figures from Monitor showed that 86 out of 147 trusts were in the red, and that there had been a deficit of £167 million in the first quarter of 2014-2015. Alongside that, not surprisingly, we are seeing a decline in patient care. In all areas of the NHS, pressures are mounting and the quality of care is declining. The number of people waiting more than a week for an appointment with a GP is up. A survey of patients in Salford for our CCG showed that a third of the patients who responded had had to wait for days for an appointment, and one in seven Salford patients had had to wait for a week or more. That is better than the national picture, but it is not good enough. For the first time, the NHS has missed its cancer treatment target; and NHS workers have felt the need to go on strike—the largest strike of its kind in over 30 years. We have an NHS in crisis.

As we know, there are many challenges in addition to the damage that has been inflicted by the Health and Social Care Act 2012. We have heard about the mounting demographic pressure on health services. However, despite the increase in the number of people aged over 80, the Government have slashed local authorities’ budgets, causing them, in turn, to change eligibility for social care. I believe that that is one of the most serious failings. My city council in Salford has been subjected to savage cuts of £100 million, and—I mentioned this earlier, and I shall keep on mentioning it—1,000 people in Salford will either lose care packages or not qualify for care this year.

Photo of David Davies David Davies Chair, Welsh Affairs Committee

Does the hon. Lady think that members of the public should vote against any members of any political party who have imposed a cut on the NHS anywhere in the United Kingdom?

Photo of Barbara Keeley Barbara Keeley Labour, Worsley and Eccles South

I am not going to answer hypothetical questions like that. I am talking about local authority budget cuts, and the parlous state in which social care will find itself after £3.7 billion has been taken away from it.

Constituents have told me about care staff working locally who have been allocated too little time to devote to the people in their care. That is a scandal. I have been told that a single care worker was sent out when two were needed to care safely. I have also been told about patients in nursing homes who have not been properly changed or helped to eat by care staff who are rushing to manage their work load. That is the reality, and it is not the way in which to create a sustainable health and social care system. I therefore wholeheartedly support Labour’s alternative plans. We must create an NHS with the time to care.

I agree with my right hon. Friend Andy Burnham that we must repeal the Health and Social Care Act 2012 before it causes any additional lasting damage to a health system of which people in this country are rightly proud, although they will not be for much longer. I shall be here on 21 November to vote for the private Member’s Bill. We must find ways of providing the resources to cope with the challenges that the NHS will face. As my right hon. Friend said, Labour has pledged to raise £2.5 billion for the NHS Time to Care fund, which will provide 20,000 new nurses, 8,000 more GPs, 5,000 new homecare workers and 3,000 more midwives. And do we need them? Yes we do.

We must also move towards an integrated model of health and social care. That integration in itself will not solve the financial problems the NHS faces, but moving to a model that allows for equal consideration of all a patient’s health and care needs can improve services and should reduce duplication. Above all, we must place patients and carers back where they belong, at the heart of a health and social care system that works for them and puts their needs before those of the providers and the ridiculous and convoluted commissioning structures that we have been arguing about in the debate today.

Photo of David Davies David Davies Chair, Welsh Affairs Committee 5:40 pm, 15th October 2014

The Secretary of State and his Ministers will know that I have had cause to write to them, to e-mail them and even to meet them on numerous occasions to discuss the absolutely appalling second-rate NHS treatment that patients in my constituency are receiving. They are receiving such treatment from an NHS that is run entirely by the Labour party, which is enacting precisely the policies that Opposition Members wish to enact here. Those patients include Mariana Robinson, whom the Secretary of State was good enough to meet recently. She has waited months for diagnostic treatment for an illness that could well be cancer; she does not know what it is. She wants to be treated in England by the coalition-run national health service.

Those patients also include Mr Christmas in Abergavenny, a war veteran who is in his 80s. He had constant chronic pain in his tooth that was keeping him awake at night, but he was told that, despite his age and his war service, he would have to wait nine months for any form of treatment. In the end, he was forced to use his meagre savings to go private. Ann Wilkinson also wants to be treated in England. She has stated very publicly that she has cancer, but there is no cancer drugs fund in Wales and she wants to have access to Avastin. I believe that she will shortly present a petition in Parliament and in the Welsh Assembly demanding the same high standards in Wales that this coalition Government are already delivering in England.

Some Opposition Members, including Mr Jones, wanted to quote statistics.

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

The hon. Gentleman mentions access to cancer services. He might have heard me say earlier that the NHS here is missing its national cancer target, with more people waiting longer than 62 days. In England, only 84% of patients start to receive treatment within 62 days. Does he acknowledge that 90% of patients in Wales start their treatment within 62 days?

Photo of David Davies David Davies Chair, Welsh Affairs Committee

When they have been diagnosed. The right hon. Gentleman has failed to point out that while only 2% of patients wait more than six weeks for diagnostic treatment in England, 33% of patients do so in Wales. That is absolutely disgraceful. If a situation in which 2% of patients are waiting more than six weeks is bad, what on earth are we to make of a situation in which 33%—one in three, or so—are waiting that long? I hope the hon. Gentleman would agree that that is a disgraceful situation.

The hon. Member for North Durham talked about ambulance response times and gave the House some interesting examples. However, the recent Nuffield report demonstrated that the worst ambulance response times in the United Kingdom were in Wales. We have accident and emergency targets, for those in Wales who are lucky enough make it into a hospital, but those targets have not been met since 2009. We have waiting list targets of 26 weeks, as opposed to the 18-week targets that apply in England. One in seven of the population in Wales is on a waiting list. That is what lies in store for people if they vote Labour at the next general election.

It was interesting that Barbara Keeley was unwilling to say what she thought voters should do about people who wanted to cut NHS budgets. Despite all the Opposition rhetoric, this coalition Government have kept their promise and continued to fund the NHS. In real terms, we have increased its budget, whereas Labour—where it is in office—has cut NHS funding in real terms by about 8%. It cannot escape any of the blame for this. We heard about reorganisations earlier, and we have had several in Wales. We went from having five health boards to having 22 and then back to having seven. Not only has Labour been in power constantly, either completely or as the dominant party, ever since the Welsh Assembly was set up in 1999, but it has rammed those health boards full of Labour party supporters, failed parliamentary candidates, ex-Assembly Members, local councillors and the like. In one case, Labour put in a former general secretary of the TUC, who, I am guessing, is probably not a supporter of the Conservative party. Labour has politicised the health boards and it must therefore take complete responsibility for the shambles that has led to so many people wanting to be treated not in Wales but in England, by the coalition-run NHS.

No more damning example of all this can be given than the recent antics with the OECD, which is trying to carry out a comparison on NHS systems across the whole of the United Kingdom. The coalition Government are keen for that study to go ahead and are delighted with the opportunity to have themselves compared with Wales, and they should be; they have every reason to look forward to that. But of course the reaction in the Welsh Assembly has been one of absolute horror. I am told by very reliable sources that the Welsh Assembly Government cancelled the visit by OECD officials because they were so desperate to try to ensure that no report comes out before the general election. Of course, people watching this debate do not have to take the word of anyone in this room; they simply have to Google “Wales NHS waiting lists” or something similar to see story after story about people who have been badly treated by the NHS in Wales and want to be treated by the NHS run by the Under-Secretary of State for Health, my hon. Friend Dr Poulter, who is sitting on the Front Bench.

I could suggest much that would improve things. Ideally, I would like to see the power taken away from the Welsh Assembly, because it has simply made such a mess, but that is never going to happen. If Opposition Members are confident that they could do a good job with the NHS, they should support the OECD report, and get their colleagues in Wales to get behind it and bring it out as quickly as possible. They should allow funding to follow patients, so that where a patient from Wales wants to be treated in England, that should be able to happen, with the money simply deducted from the Welsh Assembly block grant. Of course, the same should apply vice versa; any patients from England who want to be treated in Wales should be allowed to have that chance—I do not see many doing that.

One of the more irritating bits of propaganda coming out of the Labour party is that it says that lots of people from England are being treated in Wales. That is true, as historically there have been people with Welsh GPs who have to be treated in Wales even though they live in England. However, these people have set up an action group called Action4OurCare and are trying to take legal action on this. These are normal patients, not party activists, who want to be treated by the coalition-run NHS.

About the only good thing that comes from all this is that Labour apparently wants to make the NHS one of the main planks of its election campaign. I say bring it on, because I cannot wait to debate the NHS with Labour party members all over the United Kingdom. I will ask them about Wales and the cuts to the budget, the lack of a cancer drugs fund, the long hospital waiting lists and the fact that its ambulance response times are the worst in the United Kingdom. I shall remind them that people are already voting with their feet—they are voting to get out of the Labour-run NHS in Wales and get into the coalition-run NHS in England. They will shortly have the opportunity to vote not with their feet but in the ballot, and I very much look forward to seeing them have the opportunity to do so.

Photo of Lilian Greenwood Lilian Greenwood Shadow Minister (Transport) 5:48 pm, 15th October 2014

Earlier today, my hon. Friend Jenny Chapman asked the Prime Minister about the mothers from her constituency who marched 300 miles this summer to show their anger at this Government’s wasteful mismanagement of the health service. He dodged her question of course, because he has no answer to it. Is it reassuring that members of the Cabinet have finally realised what the rest of us have known for four years—that reorganising the NHS was a big mistake? I do not think so. There is disgust and anger out there, but not surprise. I was proud to walk alongside the Darlo Mums when their long march passed through Nottingham. The T-shirt I wore that day has a slogan on it. Sadly, I am not allowed to wear it here. It says, “Never trust a Tory with your NHS”. That is good advice.

We all remember what the Prime Minister promised before the election—no more top-down reorganisations. That promise did not last long. The reason I am angry is not just because that was not true, but because the reorganisation was the wrong policy at the worst possible time. We know that the finances are difficult. With both an ageing population and increasingly complex and expensive treatments available, the NHS faces unprecedented challenges. But instead of focusing on achieving the best possible outcomes for people with the resources available, the Prime Minister caused chaos: 4,000 staff were laid off and rehired; nurse numbers have not kept pace with demand; training places were cut; there are not enough GPs; training has been scaled back; hospitals are tied up in competition law; and savage cuts have been made to local authorities, leading to a crisis in social care and so pushing more and more elderly people into A and E when they should be getting the care they need at home. It is no wonder that morale is low when half of nurses say that their wards are dangerously understaffed; Ministers undermine the independent pay review body; and managers are being rehired after having six-figure pay-offs. But what makes me really angry is the impact that this wasteful reorganisation has had on my own constituents. I am proud of the NHS in Nottingham—whether in primary care, mental health services or our two acute hospitals. I know that we have great staff working incredibly hard for the people who need them, but at every level they face unbelievable pressure, and, in places, they are really struggling to cope.

The chief executive of Nottingham University Hospitals NHS Trust was very blunt when he met local MPs a couple of weeks ago. He told us that the trust faces the toughest ever cost-reduction plan, that this year he is planning for a deficit of £19.1 million—the first time the trust has been in that position—and that targets are being missed.

The accident and emergency department at Queen’s has missed the four-hour waiting target every month since August last year, and it reached its worst performance this June, in the middle of summer. I know our local hospital is planning for winter, but the crisis is already here. The reasons for the crisis are not simple, but it is clear that patient flow, both through and out of the hospital, is creating particular problems. Hundreds of patients who are well enough to be discharged or who should be receiving care and support at home or in residential care are still in hospital because their discharge is delayed. That is because, despite a commitment to joint working, social services cannot cope. The deep cuts to social care are having a real and direct impact on the NHS in Nottinghamshire and on my constituents.

NHS privatisation is now taking hold as commissioners are forced to put services out to the market. Let me tell the House about patient transport and my constituent, Jean. Jean is 84 years old and very unwell. She needs four hours of dialysis three times a week. Since a private company took over patient transport, she has been late for appointments, and had to wait for hours to be taken home. Such poor service has a knock-on impact on other patients in our city’s hospitals and the clinical commissioning group tells me that Jean’s experience is typical of feedback from other patients.

Last week, the chair of the hospitals trust described meeting a patient at 10 o’clock at night. That patient had been waiting since 10 o’clock in the morning to go home where his wife was waiting for him. Patients deserve so much better. Next May, they will have a chance to vote on the service, because Labour has a plan for the NHS. We will raise £2.5 billion for an NHS “time to care” fund. The money will come not from ordinary working people, but from ensuring that hedge funds and other tax avoiders play by the rules, and from asking those at the top to pay more and introducing fees on tobacco companies. The £2.5 billion will be used to employ enough doctors and nurses with the time to care for patients—20,000 more nurses to ensure that we get the basics right with safe staffing; 8,000 more GPs to help people stay healthy outside hospital; and 5,000 new home care workers and 3,000 more midwives. We will ensure better access and guarantee GP appointments in 48 hours or on the same day for those who need it. We will repeal the Tories’ NHS changes that put private profit before patients, so that our health service does the things that it should, such as care for patients and not argue about competition law. We will give patients and the public a real say over local services, and bring together physical health, mental health and social care into a single service to meet all of a person’s care needs —whole person care.

The message from the Darlo Mums to the Government was clear—hands off our NHS. It might not fit on a T-shirt, but my message today is equally clear. Labour built the NHS, Labour will save the NHS, and only Labour can transform it for the future.

Photo of Andrew George Andrew George Liberal Democrat, St Ives 5:53 pm, 15th October 2014

It was in fact the Liberals who were the architects of the NHS, but perhaps that might be lost from history. The fact is that we have yet another occasion when the nation will be looking down and counting their shirt buttons as Members on the two Front Benches trade dodgy statistics and rewrite history. I am talking about the nature of the rather tribal debate that we had in the opening exchanges. My fear is that that is the biggest risk to the NHS—too much tribalism and not enough time spent addressing the serious issues of the NHS.

Andy Burnham is absolutely right that there are serious issues in the NHS that need to be addressed. What usually happens on these occasions is that the Secretary of State beats the right hon. Gentleman around the head with a report from Mid Staffs. I am pleased that on this occasion he did not, because that is often done in very bad taste and rather inappropriately.

Equally, I have to say to the right hon. Member for Leigh that, as the Secretary of State reasonably pointed out, he failed to acknowledge that Labour cannot ignore the fact that it ushered in and rolled out the red carpet for the private sector. The arrangements for the tendering for Hinchingbrooke hospital happened under a system set up by the then Labour Government. No matter at which stage various companies or NHS trusts fell out of or withdrew from the process, the course had been set by Labour. Unless he is telling us that he was going to preordain the outcome of a proper and open tendering process, which would of course be anti-competitive, he must have known that one of the options—this is what happened—was that a private company would take over the running of the hospital.

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

I am grateful to the hon. Gentleman for giving way, as I want him to be absolutely clear about how I operated that process. It followed the NHS preferred provider principle, which I introduced, and I began by asking the officials in the Department to see whether a local NHS trust was prepared to come in and take over. Addenbrooke’s was the trust I had in mind, but for some reason it was not prepared to do so at that point so we had to find a runner. I said that we had to go out more broadly, but my intention was clear: I wanted an NHS provider. That was where things had got to. The former Minister, Mr Burns, mentioned March, but things were going into purdah at that point. That was where the process was when we left government and I want the hon. Gentleman to be clear on that point.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

I am grateful to the right hon. Gentleman and, of course, he has now had the opportunity to put that point on the record. However, he must recognise that as others have said—indeed, I made this point when I intervened on him—the Labour Government rolled out the red carpet with the policy of independent treatment centres, walk-in centres and other services, where the taxpayer paid dearly for services that were not delivered.

The right hon. Gentleman knows that I did not support the Health and Social Care Act 2012. I saw it as a missed opportunity to address a large number of issues and it engaged in a top-down reorganisation that was not necessary. I fear that both the Conservative party and the Labour party appear to have been beguiled by a set of PowerPoint-wielding management consultants who have persuaded them that changing how the system works is an easy solution when, as a number of Members have mentioned, more than anything else the NHS needs much more integration of services—certainly not fragmentation—and for standards within it to be addressed.

The House knows that I always look to make a constructive contribution to such debates, so, as the Minister knows, I have been championing the case for safe staffing levels. The campaign of the Safe Staffing Alliance has argued for no more than eight acutely ill patients for every registered nurse, excluding the nurse in charge, on acute hospital wards. We need to establish a floor below which standards cannot fall, because services are often engaged in a race to the bottom because of financial pressures. That is very important. It is encouraging that that issue is now being taken seriously and I hope that the Government will consider the recommendations from other bodies to advance the cause.

With regard to the integration of health and social care in the wider community, there has always been the mantra that we need fewer hospital beds, and that certainly happened under Labour. That has resulted in many of our acute hospitals being on red alert and unable to manage the situation, with patients on inappropriate wards or stuck in ambulances queuing outside. That was clearly predicted by many people, not least me, when the policy was being pursued.

What we need to do is front-load the system to ensure that we can discharge patients from hospitals safely. We do not have the facilities for that, either in the community or in primary care. Of course, having that system of discharge and avoiding unnecessary admissions depends on having adequate services at home. Ultimately, that falls on the shoulders of home care workers, who themselves face a race to the bottom, as they are often paid the minimum wage and their travel times and costs are not properly covered. We therefore need a new benchmark that puts a floor in the system by paying those workers a living wage, covering their travel times and expenses, and protecting them so that we do not end up with the race to the bottom that I fear we are seeing in the system.

We need to ensure that we have safe services. Ultimately, we need to address care standards in our hospital wards and press for, rather than simply talk about, the integration of health and social care in order to address the fundamental challenges that the NHS faces.

Photo of Andy Sawford Andy Sawford Shadow Minister (Communities and Local Government) 6:01 pm, 15th October 2014

In the time available, I want to make the case for fair funding for health services in my constituency. My right hon. Friend Andy Burnham set out powerfully the charge sheet against this Government: a costly reorganisation that nobody wanted; a push to privatisation that nobody wanted, except perhaps some of the Tory donors; and fragmentation where we need integration—nowhere more so than in health and social care, because of the massive cuts to care budgets.

In my constituency there are brilliant health care workers struggling to deliver the best possible care for patients against the backdrop of all this disruption and undermining of the NHS. I was elected on a promise to fight for our local hospital services. A project called “Healthier Together” proposed reducing the number of beds at Kettering general hospital by 500, taking away proper maternity and children’s provision and downgrading accident and emergency services. The Prime Minister claimed that the threat was not real, but when the evidence came into the public domain—Mr Hollobone stood up to his own Whips and raised it on the Floor of the House—the proposals were ditched.

Some 6,000 people had signed my petition. We continued that cross-party working locally, with councillors from all parties, and the hon. Member for Kettering and I worked with commissioners in the hospital on a plan for major investment. A bid will soon be submitted. We met the partners last week and are seeking a meeting with the Minister soon. Our plan is to really develop the innovative integrated urgent and emergency care approach being pioneered in north Northamptonshire so that more people can be treated more quickly and effectively, whether in primary, urgent or emergency care.

I have to tell the Minister that although there is a real will and a proven ability to innovate and do the best they can with resources, our local health services are severely hampered by a lack of resources. The midwives I met this week told me that they are being asked to work harder for longer and with increasingly stretched resources. That is a pattern across the NHS work force. Ambulance workers trying to improve response times are working longer shifts with increasingly outdated equipment. I was out in a paramedic vehicle with East Midlands ambulance service workers over the summer—a car that had done 300,000 miles without a working phone. That is what our health care workers are struggling with.

Our community health services are struggling. Older people are suffering from the withdrawal of podiatry services. Mental health services have been slashed, with people waiting and waiting for the therapy and treatment they need. Mental health nurses in my area are being made redundant and vital voluntary organisations that have been supported by public funding, such as Safe Haven in Corby, have been severely cut. Children are being sent to the other end of the country because care is not available for them locally, despite their being particularly vulnerable. Doctors’ surgeries are struggling— some more than others, but particularly in our small towns and rural areas. When I met residents in Stanwick the other day, they told me of their concern that, with plans to continue the growth of their village, the doctor’s services simply will not be able to cope.

I recently surveyed hundreds of my constituents about local health services. They told me that they support our cross-party campaign but are deeply worried about access to out-of-hours services, the difficulties of finding a GP surgery appointment and the increased privatisation of services. Specifically, they wanted me to put on record their concerns about the transatlantic trade and investment partnership and the impact that it could have on our national health services.

All these issues are being addressed in a context where we have the worst-funded health service in the country. A report published in September by the National Audit Office bears this out. It is called “Funding healthcare: Making allocations to local areas”. The NAO says that Corby is the worst-funded area of England for health care, receiving £186 less per person per year than the allocation that the NHS says it needs. Each year, the Department of Health and NHS England make these allocations to local commissioning groups, aggregating funding for local primary care, hospital, community and mental health services. The NAO’s analysis suggests that in Corby we are 12.8% below the target that is needed to meet local health needs. That compares with £508 per person above target in the highest-funded area in west London. The head of the NAO, speaking about the report, said:

“Funding allocations have reflected, among other factors, a desire not to upset local health economies by taking funding away or even increasing it by less than inflation. This has significantly slowed progress towards a fair distribution where funding fully reflects needs across the country. The Department and NHS England need to consider carefully whether this approach is fast-moving enough to sustain hard-pressed local areas in the next few years.”

It is totally wrong that health services in Corby are being starved of funds. How can it be right that people in Chelsea or in Kensington are allocated £694 per person extra per year for health funding? Corby’s health care service is doing a good job of managing with these limited funds. The new urgent care centre, for example, is a beacon, but other services are having to be cut back. The NAO found that the unfair distribution is taking place because many decisions are based on individual civil service judgments instead of evidence. The report’s detail and recommendations really stand up the charge that the Government’s policy is not based on evidence.

The NAO found that the problem is exacerbated because proper account is not taken of population growth. My area has the highest birth rate in England; it is one of the fastest-growing towns in the country. This creates a real double whammy for our local services. It is a basic question of fairness that Corby should be funded according to needs. Therefore, in the coming months, I will be asking local people to join my campaign for fair health funding. Together, we will demand that the Government listen and end the injustice of filling the coffers of health commissioners in wealthy areas of the country at the expense of my constituents in Corby.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale 6:07 pm, 15th October 2014

It is an absolute pleasure to serve under your guidance, Mr Speaker, in this debate about access to services.

I share one thing in common with Andy Burnham, which is that I am from Leigh, as we both know. I am still under a specialist in Leigh, whom I have seen on many occasions. I have never had to wait and it has always been on time. I have seen specialists across at Tommy’s—St Thomas’s—without ever having to wait and always on time. I have also seen specialists in Lancaster without ever having to wait and always on time. I have heard all the stories about waiting lists and delays, but I personally have not experienced that. My family in the right hon. Gentleman’s constituency, where they still live, have not experienced it either. When my mother was leaving this world—shall we say?—she had exemplary care from the local health trust. There was never any talk among the health professionals of cuts. They did not know who I was; I was just another person who was losing their mother.

I do not like to be tribal. The right hon. Gentleman and I have had terse words in the past, but I will say this on the record in the House: he is a good man and an honourable gentleman. I have friends who have voted for him. He is very well-regarded in his constituency. But what upsets me—I do not want to change the tone of this debate—is that in my constituency the Labour party is campaigning on the basis of an erroneous agenda of cuts, hospital closures and A and E closures that have never happened and are not going to happen. I received an e-mail today from a constituent who is absolutely terrified that the local Royal Lancaster infirmary is going to close, but it is not. There is no suggestion of it closing. In fact, I have spoken to the chief executive and she said, “I don’t know where this has come from.”

We are in the run-up to a general election and it is the silly season—that is evident to everyone inside and outside the Chamber—but it does no service to anybody in the political world, never mind the Opposition, if candidates up and down the country are going to fight about cuts and closures to the health service that are not even happening in certain areas. That will certainly not play into the hands of an incoming Government.

In my constituency of Morecambe and Lunesdale, £25 million has been spent recently on a new health centre. The Under-Secretary of State for Health, my hon. Friend Dr Poulter opened a walk-in centre recently. We have been allocated £150 million to improve the local trust, most of which will be spent on the Royal Lancaster infirmary, which has four new hospital wards, and we have just received £2 million for GP access at the weekend. Two weeks ago, I opened a new mental health facility in my constituency.

Morecambe and Lunesdale has never seen so much investment in the NHS, yet the Labour party in my area says that everything is going to hell in a handcart and the hospital is closing down, but that is wrong. The RLI is not going to close, and neither was the hospital serving Corby, which Andy Sawford campaigned on.

Photo of James Morris James Morris Conservative, Halesowen and Rowley Regis

My hon. Friend is making a powerful case. In my constituency, there has been millions of pounds of new investment in the Rowley Regis hospital, which was under threat under the previous Government when all its in-patient wards were closed. The recent sign-off on a £350 million new integrated hospital in Smethwick in Sandwell, one of the most deprived areas in the country, will substantially benefit the population’s health care and also help regenerate the economy.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale

I thank my hon. Friend and namesake for making that point.

I am passionate about the NHS and I know that the Opposition and the right hon. Member for Leigh are also passionate about it, but we should get a grip on reality. Campaigns are saying that £25 million is being cut from the local trust when £150 million has been invested in it, so the maths do not stack up. As my hon. Friend Andrew George has said, we have been horse-trading figures, but we have to look at the reality of the situation. Scaremongering is not the way forward, because all it does is alienate the electorate, my constituents and the people we all live with across the nation and put fear into the services that we are trying to protect.

I am facing a third erroneous campaign on health cuts in my constituency, and my mail box is always full every time there is such a campaign. All it seeks to do is frighten the electorate, but it does not frighten me, because the electorate know the truth.

Photo of David Ward David Ward Liberal Democrat, Bradford East

I was not going to intervene on the hon. Gentleman, but I sympathise with him, because Labour activists in my area have been campaigning against the closure of a treatment centre when all that happened, in fact, was that the contract came to an end. Hard work is now going on to make sure that the provision continues in another form. The big campaign was that this was about cuts and closing a treatment centre, but it was never going to close.

Photo of David Morris David Morris Conservative, Morecambe and Lunesdale

I share my hon. Friend’s sentiments.

My hospital in Lancaster, in my neighbouring constituency, is not going to close. Like everyone else in the Chamber, I care about the NHS, but I appeal not just to the Opposition, but to all political parties that have the honour to serve here and speak: let us get a grip on reality, stop scaremongering and work towards making a better NHS. It has been an absolute pleasure to speak in this debate.

Photo of Andrew Slaughter Andrew Slaughter Shadow Minister (Justice) 6:14 pm, 15th October 2014

I make no apologies for addressing my comments to the latest developments in the “Shaping a healthier future” programme, the comprehensive reorganisation of health services that is affecting 2 million people in west and north-west London. It constitutes the biggest hospital services closure programme in the history of the NHS, and I believe that it will be the prototype for similarly draconian cuts if the current Government are, by some misfortune, re-elected.

The programme was two years in planning—in secret—and was announced in June 2012. It involves the closure of four of the nine accident and emergency departments in the area, and the closure, effectively, of two major hospitals. It affects both A and Es in my constituency and, indeed, the complete demolition of Charing Cross hospital, one of London’s major hospitals. At the time, all but 3% of the land on which that hospital stood was to be sold off.

There followed two years of confusion, phoney consultation, buck passing and false information, and decisions were taken by primary care trusts that were then abolished the following month. The original scheme was so incompetent that the business case was delayed for more than a year. It emerged last month, and now requires 50% of the Charing Cross land to be sold, as well as 50% of the land at St Mary’s, Paddington. However, it still requires £400 million of borrowing to be approved by the Treasury, despite the fact that the trust—Imperial College Healthcare NHS Trust—cannot manage its finances from one month to the next.

Exactly a year ago, the Secretary of State announced in the House that the Hammersmith hospital and Central Middlesex hospital A and Es should close as soon as was practicable, and that in fact happened on 10 September this year. Two A and E departments closed in one day, with people who attended them being told to go to Northwick Park and St Mary’s hospitals. Four days later, The Mail on Sunday reported in relation to Northwick Park:

“An accident and emergency unit criticised in an official report for being unsafe and unable to cope with demand is set to be swamped with thousands of extra patients—thanks to emergency department closures elsewhere. The Chief Inspector of Hospitals painted a picture of chaos at ‘very busy’ Northwick Park Hospital in Harrow, North-West London, after a recent visit. But its A&E will soon have to deal with at least 8,000 more patients a year due to the controversial closure of two London units last week.”

How that can be said to be a practicable and safe decision, I do not know. At the trust’s annual general meeting two weeks later, the chief executive—newly arrived from Australia—told people that they should not rely so much on A and E departments. Well, they do not have a great deal of choice in my constituency.

Is closing two neighbouring A and E departments enough? Clearly not, despite the fact that GP and community services are also being cut—I wish I had the time to go into that in more detail—because the closure of Charing Cross hospital A and E is being persisted with. That hospital is still due for demolition and downgrading. The current plan is for it to lose all but 24 of its 360 in-patient beds, its emergency surgery unit, its intensive therapy unit, its stroke unit and of course its A and E, which will leave only primary care treatment and day surgery on site.

Photo of Gavin Shuker Gavin Shuker Shadow Minister (International Development)

My hon. Friend, alongside his local party, has mounted a truly impressive campaign to protect those services. Government Members say that they are the defenders of the NHS. What action has been taken locally by other political parties to support him?

Photo of Andrew Slaughter Andrew Slaughter Shadow Minister (Justice)

The Conservative party fully supports the closures of the A and E departments. When it ran the local authority—fortunately, it no longer does so—it simply put out disinformation about whether the service closures would or would not take place. It is only because of the actions of local residents that my constituents know exactly what is happening.

Worse than that, on 15 May the Prime Minister came to my constituency for one purpose and one purpose only—to go into the basement of the Conservative party offices and give an interview to a local journalist, in which he said that Charing Cross hospital would retain its A and E and other services, and he then left.

That was of course one week before the local elections. On 7 September,

The Mail on Sunday

, which I now regard as the paper of record on this issue and which has fought a strong campaign on behalf of A and E departments, reported the following:

“A casualty unit that David Cameron personally promised would stay open is due to be closed, The Mail on Sunday can reveal. Days before council elections in May, the Prime Minister visited Hammersmith in London and stated that Charing Cross Hospital in nearby Fulham ‘will retain its A&E and services’. But the organisation that runs the hospital intends to close the department and replace it with an ‘urgent care centre’, NHS papers show. Urgent care centres can be run by GPs and nurses rather than A&E consultants, and have far fewer facilities to care for the seriously ill or injured.”

I do not think that I need to explain that any more. The Prime Minister, for the purely party political reason of supporting a Conservative local authority that he has described as his favourite, did not say what was factually correct.

If they were not so disingenuous and incompetent, I might have some sympathy for those at the trust because, under instruction from their political masters, they have to argue against themselves. On 7 October, they came to answer questions from the scrutiny committee of the local council. They were asked about Charing Cross hospital and said that, in future, it will have

“emergency services appropriate for a local hospital”.

They were cross-examined on that issue and could not amplify their position, so we are none the wiser. However, we do know that a hospital that has only primary care and treatment services cannot sustain an A and E department. In the interests of safety, as well as honesty, it would be better if that was admitted to my constituents.

I will end with the beginning of a letter that is in the Evening Standard today. It is from Anne Drinkell, who is the admirable secretary of the “Save our hospitals” campaign in Hammersmith and a former community matron. She says:

“You highlight the pressures that closing A&Es at Hammersmith and Central Middlesex hospitals put on surrounding emergency departments. God help us if plans to close Charing Cross A&E go ahead. Imperial NHS Trust’s management seems in chaos, with leaked internal memos detailing cuts in acute beds and a mounting deficit. It has been unable to provide a clear description of what future ‘emergency’ care at these sites would look like. A notice on the back door at Hammersmith still advises patients to take sick kids to the now-closed Central Middlesex A&E”.

She ends by saying:

“We ask North West London NHS for a moratorium on closures until they consult on plans for change based on clinical need, not budget cuts.”

Is that an unreasonable request?

Photo of Chloe Smith Chloe Smith Conservative, Norwich North 6:22 pm, 15th October 2014

I want to put on the record my view, which is shared by many in this House, that the NHS is an extraordinary, valuable, historic British institution. I pay tribute to its staff, who work particularly hard in the face of pressures. I also pay tribute to its many patients, who include my constituents and those of everybody else in this House. My substantive comments fall into two halves: those on the national pressures on the management of the NHS and those on the local issues that I wish to raise.

It is important to acknowledge that the NHS, however valuable, precious and emotive a subject it is, does not spring from nowhere. It springs from people’s money, which we collect in taxes to spend on their behalf. One of the most important decisions that the Government have taken was the decision at the beginning of the Parliament to ring-fence NHS spending. That has enabled me to communicate to my constituents the importance that we place on the NHS. I want that point to ring out from my contribution.

The other crucial thing that the Government have done is put the economy on a more secure footing at the same time. It is a strong economy that creates the means to have plans for any public services. I think that is a truth that we all acknowledge. By the way, I pay tribute to my hon. Friend David Morris for his very honourable speech in both tone and content about the honesty with which we should aspire to treat the NHS.

Of course, volumes are increasing in the NHS. The Secretary of State was honest in his opening speech in saying that there are pressures. Again, I applaud the staff on dealing with those pressures. Let me give a few examples of the increasing volumes in the NHS. Some 850,000 more operations are being delivered each year than in 2010; there are now 6.4 million more out-patient cases and 1.1 million more in-patient admissions; and more than 77,000 more people each year are being diagnosed with, and treated for, dementia. No wonder the NHS is under pressure when we see the demographic changes behind those figures, and the changes in demand. I applaud NHS staff for what they do, and note that the other key number this Government have delivered on is by having more than 13,500 more clinical staff, including more than 6,500 more doctors and 3,700 more nurses. That is something to praise.

My constituents know the value of a plan and the need to deal with pressures, and they know what they want out of a future NHS that stays within the budget available to it. Let me draw on three local points. The first is Norfolk and Norwich university hospital, and I am glad the Minister has agreed to visit Norwich and meet patients and staff, and to look at a few of the challenges we face. It has already been widely reported in our local press—it will not be strange news to him, a fellow East Anglian—that the Norfolk and Norwich university hospital faces pressures and a lack of beds. The point has been well made today that systemic pressures feed into the number of beds available at any one time, and I would like the Minister to support the NHS in Norwich, as I do as its local MP, and find a way through those pressures. The hospital did that last winter, and I am confident it can do so again.

Secondly, I wish to mention GP access—this is a debate about NHS services and access—and urge Norwich GPs to apply to the second access fund from next April. I understand that there were no applications from Norwich or Norfolk to the first access fund, and it is incredibly important to take every opportunity available in the system within which GPs work to make services more accessible to their patients. I regularly discuss with constituents the challenges they face in making an appointment with their GP, and one of the solutions to that problem is the access fund from this Government, which I applaud.

Thirdly, the Norwich walk-in centre is currently located in a shopping mall in the city centre. The landlord of those premises has terminated that contract which has, of course, created a need to change location. I have sought to be at the heart of those negotiations on behalf of my constituents because we need a quick solution to the problem. It is not acceptable for the NHS to fail to plan for what is needed for Norwich’s primary and urgent care, and I would welcome the Minister’s support for Norwich staff and patients.

Finally, I endorse the Conservatives’ proposed plan to continue to ring-fence and increase spending on the NHS in real terms. That will allow us to move to a 21st-century NHS, where, yes, there will be pressure, but we should fix that through a stronger economy, not through more borrowing and more debt.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Health), Shadow DUP Spokesperson (Transport), Shadow DUP Spokesperson (Human Rights) 6:28 pm, 15th October 2014

The motion is entitled “Access to NHS services” and I wish to comment on four categories of the NHS where services can be improved. Today we have heard one of the central themes of the next Westminster election on 7 May next year, because the battleground will clearly be the NHS. We have heard different opinions from both sides of the Chamber about the best way forward.

Parkinson’s disease is a progressive neurological condition that affects 127,000 people in the UK with an average age of 50 to 60. One person in every 500 has Parkinson’s disease, and there is no prospect of a person’s condition improving over time as there is currently no cure. Medication is the main treatment for the symptoms of Parkinson’s disease, and many people require multiple doses at specific times throughout the day. People with Parkinson’s who are admitted to hospitals are often prevented from managing their own medication, or are not given it in time. That leads to a deterioration in their condition, or even to permanent harm. It is clear that that costs the NHS some £20 million a year and that it is down to medication mismanagement in hospitals. It is a simple matter of receiving medication in time. What steps is the Minister taking to ensure that people with Parkinson’s always receive their medication on time in hospital, which in turn would mean that patients could return home sooner and that those costs could be greatly reduced? We talk about access to NHS services, but we need to know about funding, too.

Other hon. Members, including Chloe Smith, have referred to Alzheimer’s. The numbers are horrific. Some 856,000 people in the UK have it: 720,000 in England; 45,000 in Wales; 70,000 in Scotland; and 21,000 in Northern Ireland. It will cost the UK £26 billion a year. Yet again, the question is: can access to NHS services happen? The costs are astronomical. How does the Minister plan to prepare for providing the necessary services in the years to come, perhaps at a reduced cost, and ever mindful of the access to the NHS services we all wish to have?

My third concern is diabetes. It is great concern to many. It has been referred to in the Chamber and other places as a ticking time bomb that will cost the NHS the most money. It is also a question of access to services. I declare an interest as a type 2 diabetic—other hon. Members have the same problem. Diabetes UK says that, in this year alone, 280,000 people will be diagnosed with diabetes, which is the equivalent of the population of Newcastle—if we want to put the problem into perspective and relate it to a town or a city, that is the figure. The number of people living with type 1 and type 2 diabetes has increased throughout the UK: by 33% in Northern Ireland; by 25% in England; by 20% in Wales; and by 18% in Scotland. Some 738 people are diagnosed with type 2 diabetes per day.

The cost is significant. A report on diabetes in the NHS estimates a total cost of £3.5 billion per annum, or £9.6 million per day. An estimated 10% of the NHS budget is spent on diabetes, which is some £286 a second. The problem is funding and access to services. How do we ensure that people who are diabetic access NHS services?

A health survey in Northern Ireland—I am sure the figures are equivalent for the rest of the UK on the mainland—showed that some 62% of adults were classified as overweight or obese. The interesting thing that worries me a wee bit is children. Some 19% of children were reported to be overweight, and a further 6% were reported to be obese. When it comes to access to NHS treatment, what steps is the Minister taking to address childhood obesity and diet?

My final point is on cancer drugs. A central theme of the motion is cancer referrals and treatment waiting times. The problem impacts not only on those on the mainland, but on those of us in Northern Ireland and on our access to cancer drugs, despite Northern Ireland being an integral part of the United Kingdom and despite it being covered by the work of the National Institute for Health and Care Excellence, unlike Scotland, for example. Patients in Northern Ireland do not have access to 40 cancer drugs simply because of their postcodes.

In my discussions with Jim Wells, the Minister who has responsibility for health in Northern Ireland, he has referred to access in Northern Ireland to the individual funding request, whereby a consultant can submit an application for one of those 40 drugs on a patient’s behalf. However, there is a high hurdle, known as the “exceptionality test”, which is very hard to pass. Many consultants in Northern Ireland do not apply to use the IFR and know that the application will not pass. What discussions has the Minister had with the Minister in Northern Ireland on that? It is totally unfair. I am baffled and find it totally unacceptable that the access to treatments for my constituents who are diagnosed with cancer—they live in Northern Ireland and pay UK tax—is far more limited than it is for patients in the rest of the UK. With that in mind, I believe it is time for the provision of cancer drugs across the whole United Kingdom, and to the 331,487 people in the UK with cancer, irrespective of postcode.

Photo of Gavin Shuker Gavin Shuker Shadow Minister (International Development) 6:34 pm, 15th October 2014

Many hon. Members on both sides of the House have talked about their personal experiences of the NHS, and movingly about the care that they and others have received. It might not have escaped the House’s notice, but I am statistically one of the least likely Members to access NHS services, being under the age of 40—[Interruption.] I hear disparaging remarks about my size coming from my left, but I will ignore them.

I was extremely grateful to receive incredible care for my wife and child when Ruby, my daughter, was born last year, and got to see, incredibly and movingly, the dedication of NHS midwives, doctors and other staff as well.

I am hugely moved as well by the fact that locally in the seat I represent in Luton we receive fantastic NHS care. We have Luton and Dunstable hospital, and we were pleased to welcome the Darlington mums who had marched down to Whitehall to protest about the changes to the NHS when they came through Luton. They made many of the points I want to make today. They, as members of the general public, were able to articulate what I do not believe many Members across this House could: the depth of passion people feel for the NHS.

I would just say this. A number of different contributors today have talked at length about statistics and churned out figures, but for me there is one stand-out statistic from this Parliament: the level of patient satisfaction in the NHS. We can talk until we are blue in the face about which target should be met and which target should be missed, but it speaks volumes to me that the highest-ever level of patient satisfaction was in 2010 when this Government came to power and it has dropped since then. That should cause us to ask profound questions, because we understand that a new top-down reorganisation of the NHS can only do one thing, which is distract from patient care. That is the experience in this Parliament.

People forget that the NHS is not a series of services that can easily be bolted together. It is more a network or a system, and just as Beeching wielded his axe and chopped up different parts, compartmentalising and fragmenting the railways, so we must be aware of the lessons of history when it comes to fragmentation in our NHS system. It is the role of us in this Parliament not just to protect our own local services or seek to move forward with the amazing new treatments that exist now, but to protect the legacy of the NHS over the last 70 or 75 years.

Will this Government talk about the massive error that was the reorganisation of the NHS in this Parliament and allude to two others? The starvation of funds by the Tories in the ’80s and ’90s that had to be put right by a Labour Government in 1997, who saved the NHS, is the second, and opposing its creation in the first place was the Tories’ original sin on the NHS, but they seem not to have learned that lesson. They continue to make this mistake, and it has led to 440 new organisations in the NHS, tying up hospitals in competition law, with 4,000 staff laid off and then rehired. Is this not the waste we have talked about in our system—the waste that could be repurposed for better patient care, and a rise in patient satisfaction as well?

We need a clear plan for putting this system back on track, because of the many shortages and the rationing we have seen in the system. The first plank of that plan, advocated by my right hon. Friend Andy Burnham, is to be clear about our plans to repeal this damaging Tory NHS Act that has done so much damage in this Parliament. I am glad to hear that in five weeks each of us in this Parliament will be asked to cast our votes for the repeal of the most damaging aspects of this legislation, and I pledge to my constituents that I will not be found wanting when that comes. We must also exempt the NHS from the transatlantic trade and investment partnership, make sure the extension of competition law that has led to a massive acceleration in privatisation is curbed, increase NHS spending by £2.5 billion a year in a sustainable way to make sure the NHS has time to care, and hire 36,000 new nurses, doctors and midwives.

That is the expectation that will fall to us in the next Parliament, but in this Parliament there is also something that needs to be done. Government Members must admit publicly, not just privately, their error in going about this reorganisation, and commit to the funding that is going to be required. We all accept that there are no easy solutions, and politicians can sometimes get wound up in all sorts of knots trying to defend services that should be reconfigured. I fully accept that. But, fundamentally, we are the custodians and the guardians of the greatest mechanism against social inequality and the greatest mechanism to attack health inequality head on. The national health service is an institution rightly held in high regard by the people who believe they own it, not those who are asked to be its custodians. It is the crowning achievement of the 1945 Labour Government. It needs to be rescued by successive Labour Governments after Tory Administrations. The NHS demands nothing less.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People) 6:40 pm, 15th October 2014

It is a pleasure to close today’s debate and to follow my hon. Friend Gavin Shuker, who spoke very powerfully. In fact, hon. Members on both sides of the House have spoken with great passion and commitment about the NHS and the vital role it plays in their constituents’ lives and in their families’ lives. Many hon. Members, including the hon. Members for South West Devon (Mr Streeter), for Bosworth (David Tredinnick) and for Morecambe and Lunesdale (David Morris), have rightly praised NHS staff for working tirelessly to deliver good quality services despite all the challenges they face.

However, we have also heard countless examples of what the Alzheimer’s Society, the Multiple Sclerosis Society, the Royal College of Nursing, the Royal College of Midwives, the Royal College of General Practitioners, the Royal College of Physicians, the Royal College of Paediatrics and Child Health, the British Medical Association and many others said in their letter to The Independent last week. It stated that

“Signs of a system buckling...are everywhere…The NHS and our social care services are at breaking point and things cannot go on like this.”

We heard from my hon. Friends the Members for Corby (Andy Sawford) and for Worsley and Eccles South (Barbara Keeley) about how more and more people are struggling to get an appointment with their GP, with one in four waiting at least a week and thousands waiting more than two weeks.

Hon. Members, including my hon. Friend Lilian Greenwood, spoke about how the huge cuts to local council care budgets mean half a million fewer older and disabled people, some of the most vulnerable people in society, are getting vital services, such as home care visits or home adaptations. This is leaving their families struggling to cope and to pick up the pieces.

Fewer services in the community mean that increasing numbers of frail, elderly people end up ringing 999, going to A and E and getting stuck in hospital when they do not need to be there, causing them and their families distress and costing the taxpayer far more. Ambulance services are under huge pressure, as my hon. Friend Mr Jones said. Hospital A and Es have now failed to meet the Government’s lower four-hour waiting target for 63 weeks in a row. A and E performance over the summer has been worse even than at the height of last winter. Delayed discharges from hospital are at a record high and cost more than £250 million in the last 12 months alone—money that could have paid for a year’s home care for 37,000 older or disabled people. Where on earth is the sense in that?

Rising emergency admissions and delayed hospital discharges mean planned operations are going backwards, too. More than 3 million people are now on the waiting list. The 18-week maximum wait target has been missed for the last two months in a row, and the NHS has missed the 62-day wait for vital cancer treatment—

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

I will not. [Interruption.] If the hon. Gentleman is going to talk about Wales, 90% of patients get their treatment within that target, compared with 84% here, so let me save him some time and bother.

The Government’s failure to keep people out of hospital and keep waiting lists under control, means the NHS is facing a looming financial crisis, too. Two-thirds of all acute hospitals are already in deficit to the tune of £500 million. They predict they will end the year £1 billion in the red, piling on the pressure for even greater service cuts and worse standards of care in future.

The tragedy is that it did not have to be this way. After 13 years of investment and reform, the previous Labour Government left the NHS with the highest ever patient satisfaction rates and the lowest ever patient treatment waits. But we were not complacent. We understood that the NHS had to face up to even bigger challenges: our ageing population, the increase in long-term conditions and huge medical advances, at a time when there is far less money around. For that reason, we had a plan in every region to reform front-line services, through Lord Ara Darzi’s NHS next stage review, by delivering some services in specialist centres so that patients got expert treatment 24/7 and by shifting other services out of hospitals and into the community. It was a move towards prevention joined up with social care to help people stay living at home. Instead of going ahead with our reforms, however, the Government scrapped them and forced through the biggest backroom reorganisation in the history of the NHS, wasting three years of time, effort and energy, and £3 billion of taxpayers’ money that should have gone on patient care.

The Health Secretary told the House today, and said on the “Today” programme, that the Government had saved £1 billion.

Photo of Liz Kendall Liz Kendall Shadow Minister (Health) (Care and Older People)

I actually picked up the copy of the report he left behind, and I found his highlight. It reads:

“The estimated administration cost savings outweigh the costs of the reforms”,

but it does not mention the £1 billion figure. In fact, paragraph 4.10, on the reliability of the Department of Health, states “we found…limited assurance” in the figures. It also states that

“strategic health authority staff did not verify the figures submitted to them by primary care trusts” and that it

“saw no evidence that the”

Government

“challenged these figures.”

Far from being independently verified, as the Health Secretary claims, they have been made up on the back of an envelope. [Interruption.]

Government Members can complain, but we have constantly argued that the NHS reorganisation has been the single biggest mistake made by the Government, and now we find out that members of the Cabinet agree. An ally of the Chancellor told The Times:

“George kicks himself for not having spotted it or stopped it”.

A former No. 10 adviser says that

“no one apart from Lansley had a clue what he was really embarking on—certainly not the prime minister”.

So we have a Chancellor, who is meant to safeguard public money, failing to stop billions of pounds of waste and a Prime Minister who claimed the NHS was his top priority, but was too confused or complacent to bother to understand his own plans. The Conservative party still does not get it. One Downing street adviser is quoted as saying:

“A lot of work had gone into persuading people that David Cameron believed in the NHS, had personal experience and cared about it. Then the Conservatives came in and forgot all about reassurance. Lansley managed to alienate all the professional people in Britain who were trusted on the NHS.”

The Government’s NHS reorganisation was not just terrible politics; it is terrible in practice for patients, taxpayers and NHS staff. I remind hon. Members that the Health and Social Care Act 2012 did not just create 221 CCGs, 152 health and wellbeing boards, NHS England, Public Health England and Health Education England; it also created four regional NHS England teams, 27 local area NHS England teams, 16 specialist commissioning units—well, there were 19, but at least two have already been merged—and 10 specialist commissioning units. That is on top of Monitor and the Care Quality Commission. It is a system so chaotic and confusing that no one knows who is responsible or accountable for leading the changes patients want and taxpayers need.

And now, just when we thought it could not get any worse, another major new reorganisation is under way. NHS England was commissioning primary care and specialist services, but in May it announced it wanted to give primary and specialist commissioning back to CCGs to try and patch up the fragmentation created by the Government's own plans. How much will this second reorganisation cost patients and staff?

Patients, staff and taxpayers cannot afford another seven months, let alone another five years, of this Government. They need a clear plan to restore care standards and restore care services so that they are fit for the future. Opposition Members would use the savings from scrapping the cost of competition in the NHS to guarantee new rights for patients to see their GP at a time that is convenient for them. We would raise £2.5 billion from a mansion tax, clamping down on tax avoidance and a levy on the tobacco companies to fund more GPs, nurses, midwives and homecare workers to transform services, particularly in the community. We will support carers with new duties on the NHS to identify family carers, a single point of contact for information and services and ring-fenced funding for carers’ breaks. Our plan for whole-person care would ensure the full integration of physical and mental health and social care services into one service with one team to meet all of a person’s needs.

At the next election, there will be a real choice on the NHS: a choice between care going backwards and money wasted under the Conservatives or Labour’s plans to fully join up services to get the best results for patients and the best value for money. It will be a choice between the Conservatives who have broken their promises to protect the NHS, throwing the system into chaos and blaming staff, or Labour who will make the real reforms we need so that people get personalised care in the right place at the right time. It will be a choice between the Conservatives’ unfunded plans to cut taxes for the wealthiest or Labour’s fully funded plans to reform the NHS and care services on which we all rely. I commend the motion to the House.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health 6:50 pm, 15th October 2014

It is a pleasure to conclude this debate and to speak to the contributions of hon. Friends and hon. Members. It is a pity that when we have NHS debates, they sometimes become unnecessarily tribal and partisan. Some Labour Members often seek to talk down the local NHS rather than to stand up for their hard-working NHS staff who deliver high-quality services on the ground.

I want to talk about some of the successes this Government have delivered for our NHS and then I shall address some of the points raised in the debate. We know that even in these difficult economic times, this Government have protected our NHS budget with £12.7 billion more during this Parliament. That was something that the shadow Secretary of State, Andy Burnham called “irresponsible”, but it is not irresponsible to make sure that we continue to support and protect the NHS front line. We have stripped out over £5 billion-worth of bureaucracy and reinvested that money into front-line patient care. That has been audited by the National Audit Office, but Liz Kendall did not choose to highlight that point in her remarks. It has been confirmed and we know it is true.

I make no apology for the fact that we as a Government have focused ruthlessly on having a more efficient health service that frees up as much money as possible for front-line patient care. We have reduced the number of administrative staff by around 20,000, increased front-line clinical staff by over 12,500 and set up a cancer drugs fund that has helped 55,000 people who would not have received cancer drugs to receive them. There has been an unrelenting focus on promoting a more joined-up approach to care, to help deliver more care in the community for people with long-term medical conditions, particularly the frail elderly.

Let me deal with some of the comments and contributions to the debate. I would like to reassure my hon. Friend the Member for Morecambe and Lunesdale

(David Morris) that the hospital in his constituency is, of course, not going to close and that any local scaremongering by the Labour party is wrong and misplaced. I would also like to reassure Mr Jones, who raised concerns about the north-east ambulance service, that the service has generally been performing well. In 2013-14, it met all its national targets. I urge the hon. Gentleman to write to me if he has any further concerns on behalf of local patients.

We heard strong contributions from my hon. Friend Chloe Smith, who made important remarks about the services delivered at the Norfolk and Norwich hospital, and I look forward to accepting her invitation to visit that hospital once again in the near future, and from my hon. Friend David Tredinnick who made one of his regular pleas for more alternative medicine in the NHS. Importantly, he talked about the benefits of clinically driven commissioning. Under this Government, we have put doctors and nurses in charge of our NHS to make sure that services are delivered at local level. Patient services are run by doctors and nurses, not by bureaucrats, which has been a tremendous step forward. My hon. Friend Andrew George made a considered contribution about the previous Government’s record on encouraging private sector providers in the NHS—a point to which I shall return.

Photo of Lilian Greenwood Lilian Greenwood Shadow Minister (Transport)

What does the Minister think about what happened to the clinical commissioning group in North Staffordshire, which decided not to allow people with mild to moderate hearing loss to have hearing aids, even though that was clearly not the view of the local health scrutiny committees or local patients? Is that not precisely putting in jeopardy preventive services, which would keep people in work and keep them active in the community rather than being isolated? It is stopping those people from participating.

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

If the hon. Lady has concerns about local commissioning decisions, she should take them up with local commissioners. Time forbids me from going into the rationing of services by the previous Labour Government. It is important that clinical services are now designed and delivered by front-line health care professionals, and if she is concerned about them, I am sure she will take that up with her local CCG.

Andy Burnham referred to a work force crisis in GP training. It is clear that under this Government 1,000 more GPs are now in training and working in the NHS than in 2010 when we came into government. If it is not accepted that that is good start, we have committed to training an extra 5,000 because we want more people working in general practice.

We have ensured that 1.3 million more people are being treated in A and E compared with the number in 2009-10. We have halved the time that people must wait to be assessed, and every day we are treating nearly 2,000 more people within the four-hour target compared with the number in 2010.

Competition was introduced into the NHS not by the Health and Social Care Act 2012 but by the previous Labour Government, in which the right hon. Member for Leigh was a Minister. The Labour Government opened the door to private sector providers when they opened the first independent sector treatment centres in 2003. The Labour Government gave £250 million to private companies and independent sector treatment centres, regardless of whether they delivered that care. Labour was more concerned about giving money to the private centres than about ensuring that quality care was delivered. Labour paid independent private sector providers 11% more to provide the same care as NHS providers. That is Labour’s record on the private sector in the NHS—a record that shows that it is more committed to the private sector than any previous Conservative Government.

Photo of Kevin Barron Kevin Barron Chair, Committee on Privileges, Chair, Committee on Standards

If that is the case, will the Minister—as a Back Bencher, he sat on the Health Committee—tell us why there were so many clauses in the Bill that introduced the Competition Commission and the Office of Fair Trading into our national health service?

Photo of Daniel Poulter Daniel Poulter The Parliamentary Under-Secretary of State for Health

The right hon. Member will be aware that Labour’s legislation, which gave the private sector the opportunity to tender for contracts, saw 5% of NHS activity—I believe that figure is correct—provided by the private sector at the end of the last Labour Government. In the Health and Social Care Bill, we wanted to stop the unregulated approach. We wanted greater emphasis on integration of health care services. It was not just about the private sector provider fixing someone’s hip and forgetting what sort of care was available when their hip had been repaired and they had gone home. It was about ensuring greater emphasis not just on competition and what was best for patients, but on integrated and joined-up services to ensure that people were properly looked after when they left a treatment centre. We stopped the cherry-picking of services that happened under Labour, and we are proud of that.

We will take no lessons from the Labour party on NHS finances. Labour was the party that crippled the finances of so many NHS trusts with PFI deals, and it was the party that during its final year in government saw the number of managers rise six times as fast as the number of nurses.

I am proud of this Government’s record on the NHS and I am proud of our record on integration. There will be a clear choice at the general election next year: a Conservative-led Government who have delivered for patients, a Conservative-led Government who have delivered on cancer services and a cancer drugs fund, and a Conservative-led Government who will continue to ensure better care for people with long-term medical conditions. We have a proud record on the NHS and I urge my right hon. and hon. Friends to oppose the motion.

Question put.

The House divided:

Ayes 222, Noes 300.

Division number 57

See full list of votes (From The Public Whip)

Aye

No

Question accordingly negatived.