I beg to move,
That this House
notes comments from leading doctors and nurses that the NHS is in crisis under this Government, which has wasted £3 billion on a reckless reorganisation;
believes an extra £2.5 billion a year should be invested in the health service, including to fund an additional 20,000 nurses and 8,000 GPs, by raising additional revenue from closing tax loopholes, a levy on tobacco companies and a tax on properties worth over £2 million;
further notes that the Office for Budget Responsibility has said that the Government’s spending plans in the Autumn Statement would return public spending to a share of national income last seen in the late 1930s, before there was an NHS, and a level which is incompatible with the Government’s claims to be able to protect the NHS;
recognises that only four OECD countries have total government expenditure at 35 per cent or less of GDP and that all of these countries have significantly higher charging as a share of overall national health spending than in the UK;
and calls on the Government to reconsider the plans set out in the Autumn Statement for even deeper spending cuts, which the head of the Institute for Fiscal Studies has said could involve a fundamental reimagining of the role of the state.
We have discussed already today some of the issues facing the NHS, but when will the Government realise that our health service faces such unprecedented pressures that it is in intensive care and in need of urgent attention if we are to avoid reaching the point of no return?
I want at the outset to set the context for this debate, because it is important that we look at this Administration’s record so far. We know that the numbers of people waiting for more than four hours in the accident and emergency departments of our hospitals throughout the country have grown and grown, but in 2014 almost 1.25 million people waited for longer than four hours. It is true that the number of people going to A and E has been increasing: in the last four years of the last Government, it was rising by about 60,000 a year, but in the last four years it has gone up by 600,000 a year. This is a rapid escalation in the level of strain on our NHS infrastructure, which has a series of causes that fall at the Government’s door.
It gets worse. At University hospital in Coventry, we are now back to the bed-blocking of previous Tory Governments as a result of cuts to local government funding for social workers, which means that people cannot be discharged. That is back to the future, as it were.
The accident and emergency situation is a barometer of a series of failures across the health and social care infrastructure. I shall certainly deal with some of those questions, as will my hon. Friends.
I will give way to the right hon. Gentleman in a moment. My hon. Friend talked about Coventry; last Friday in my constituency in Nottingham I attended a summit with health chief executives, the local authority and others. At the A and E department at Queen’s medical centre more than one in four patients waited for more than four hours in the first few weeks in January—a totally unacceptable situation. This is not something that affects only my constituency; it affects those of all my hon. Friends, and probably even that of the right hon. Gentleman, whom I will be happy to give way to.
I read the motion carefully. It is about the NHS and spending on it, as the hon. Gentleman has illustrated in his remarks so far. Will he explain something that puzzles me? I know that the shadow Secretary of State’s interview with Kirsty Wark on “Newsnight” last night was a car crash, but why is he not opening this debate? He has never been reticent in the past in coming forward to try to weaponise the NHS. Is it because his leader has wrapped him up in cotton wool to keep him away from the public gaze?
The right hon. Gentleman raises a number of issues there. He has plenty to puzzle over, and he will always be a puzzled individual. The bigger question is where is the Secretary of State for Health when we are talking about these particular issues? [Hon. Members: “There!”] There he is. He is so anonymous he just did not make any impact on me whatever. I am delighted that he has walked in. He is quite unforgettable, isn’t he?
The NHS has experienced problems not just in accident and emergency departments, as has been said, but across a series of services: missed cancer treatment targets for three successive quarters—15,000 people having to wait longer than the recommended 62 days to start their cancer treatment in the past year. It has not always been like this.
The Government inherited a situation in which 98% of patients were seen in accident and emergency departments within four hours. While one in four patients is now waiting a week to see their GP, when Labour left office the vast majority were seen within 48 hours. In January, we know that 14 NHS trusts declared major incident status. [Interruption.] The urgent question today did not really provide the opportunity to clarify the exact words in the NHS England document, so I want to take this opportunity to do so on behalf of my right hon. Friend the shadow Secretary of State.
Order. Members shouting, and then expecting to intervene, do not display great wisdom. The hon. Gentleman can probably do better, and he should certainly try to do so, within the limits of his capacity.
I am very grateful, Mr Speaker.
In urgent questions, there is obviously a time limit on our ability to read out quotes from NHS England documents, but there is no such time limit in an Opposition day debate, so let us take the opportunity to spell something out clearly for the record. The Secretary of
State is here now. I apologise for not noticing him as he came into the Chamber, but he is here now, and that is good, because I can hold this document up and show it to him—it says “NHS England” on the front. He is nodding; he has accepted that point. I turn to page 21, where in paragraph 7.2.3, under the heading—
Government Members want to shout me down. If the Under-Secretary of State, Jane Ellison, is patient I will read out the full quote from the NHS England document. It refers to principles for considering escalation and the responses to be had. Paragraph 7.2.3, under the heading “Politics”, says:
“(a) Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?
(b) Is there a requirement to bolster or assure public confidence?
(c) Is there a risk of reputational damage?”
I do not understand why an NHS document contains those exact words. The Secretary of State can probably read them from there, across the Table—he is nodding again. Yet only a few minutes ago he denied that NHS England had such a document. What am I holding up—a mythical piece of paper? We can now at least establish that NHS England has been issuing documents suggesting that reputational damage and politics need to be taken into account when preventing major incidents. We have now at least had the opportunity to read into the record, as Hansard will reflect, the full text of that NHS England document.
This is the set of situations and circumstances that the NHS faces: pressures on A and E departments, pressures on cancer treatment, and pressures on the major incidents as we have seen. Why are things in such a fragile and critical state? The Government took £3 billion out of elderly social care and wasted it on a £3 billion reorganisation of the NHS that nobody voted for and nobody wanted. They are cutting corners and rushing the care that is needed to help the frail elderly to stay out of hospital. What greater example of a false economy could there be?
Given the hon. Gentleman’s comments about the adult social care budget and the Opposition’s complaints about the money that has been taken from local authorities, will he commit to giving the money that he says has been taken from local authorities back to them in the next Parliament, should we have the misfortune to have a Labour Government?
That was a very helpful intervention. I thank the hon. Gentleman, who has only a number of months to go in his current job. We have explained how we can hire a further 5,000 home care workers, a further 3,000 midwives, a further 20,000 nurses and a further 8,000 GPs through the time to care fund—the £2.5 billion a year that is fully costed and fully funded. I will methodically go through the detail of how we pay for that—he need not worry about that.
Let us take this debate back to the people we care about most—the patients, such as the mum who got in touch with me today who had rung her local GP 28 times to try to get through to get an appointment for her daughter, and whose friend had been told, “Don’t risk it—go to A and E because we simply cannot see our doctors.”
Does my hon. Friend agree that the fragmentation of the NHS has made it much harder to hold to account our local health care services such as the Royal Free trust?
I am glad that my hon. Friend mentions the situation with GP numbers, which is another factor in the NHS infrastructure being under such pressure.
Let us look at what has been happening with GP numbers, which are not keeping up with demand in the rising population. In 2009, there were 62 GPs for every 100,000 people; that has now fallen to 59 and a half GPs per 100,000 people. We have also seen cuts to GP training. It is no wonder that the Government ditched the 48-hour guarantee for people to be able to see a GP.
I will give way to the hon. Gentleman if he can explain why the Government dropped the pledge that patients, including his constituents in Dover, should be able to see their GP within 48 hours.
There you have it, Madam Deputy Speaker. Government Members are not concerned in any way about the state of the NHS or about GPs, but only about asking questions about procedure and process. I am here today because the shadow Treasury team, like every shadow departmental team on the Labour Front Bench, is committed to supporting our NHS and to making sure that we get the investment that is needed.
Why is the situation so fragile? The Government scrapped NHS Direct and fragmented it into 46 separate, cut-price 111 contracts, which does not ensure that 60% of calls are dealt with by medical staff. That figure is now down to 20%. It is no wonder patients are so quickly being driven back to—[Interruption.]
I have to confess that I did not hear it—I do apologise—but it would have been very sound advice.
I am curious. As we have a shadow Treasury Minister here, perhaps this is an opportunity for him to explain to my constituents what he proposes to do to help them. It is important to remember that one of the very first things the Labour Government did when they came to power was to close the A and E department at Kidderminster hospital and downscale that hospital. As a result, Labour policies were so massively hated by my constituents that they voted in an Independent, Dr Richard Taylor. That demonstrated just how unpopular Labour’s NHS policies really are.
Labour Members are absolutely committed to saving the national health service from the fate that would befall it should the hon. Gentleman’s party have a further five years in office. We will absolutely not apologise for fighting tooth and nail to do what we can about, for instance, the staffing crisis that the NHS also faces.
Before I give way to the hon. Lady, I shall tell her what is happening with staffing in the NHS. The NHS is now spending a further £500 million a year on agency nurses. Six thousand nurses who were trained in the UK have left the country and gone elsewhere, and 4,000 nurses are coming from overseas to try to back-fill some of those places. We are spending a fortune, day after day—far more than we ought to be—on these more expensive agency nursing staff. I know that as Chair of the Health Committee, the hon. Lady has a view on agency nursing within the NHS. Is she really content with the situation?
I will write to the hon. Gentleman on that point, which is very important, but I wanted to respond to his question to my hon. Friend Charlie Elphicke about why we dropped Labour’s policy of 48-hour access. I will tell him why, as a former GP who was there at the time: it was because patients could not get advance appointments. It caused enormous distortion of clinical priorities, and it was absolutely right that it was dropped, as called for by the profession. It was a ridiculous policy and it is absolutely right that it has been dropped.
The hon. Lady should know that there were provisions for advance appointments in the system that we had. Given that we have these pressures, with GPs being totally overstretched and having more and more people to deal with, and the shrinking number of GPs per head of population, she should not be surprised that we are in this situation. We have to do more to recruit and train more GPs. That is part of the way in which we would save the NHS from the situation that it is facing.
When all these different factors are combined with the high levels of winter flu and the growing population, we have an NHS in crisis—but there is an alternative. Yes, we have to repeal the competition-driven Tory changes, but we also have to deliver a sustained increase in resources and a fund designed urgently to alleviate the pressures. That is why, as shadow Chief Secretary, I want to take the time to talk about our £2.5 billion fund.
I am grateful to the shadow Chief Secretary, because I have sat quietly and listened to 16 minutes of his speech trashing the NHS. Will he take the opportunity to congratulate staff at Worthing hospital who, in very difficult circumstances, have met waiting times targets in above 98% of cases? Will he congratulate the staff who have cut hospital-acquired infections by 50% since 2010? Will he congratulate NHS staff who have reduced the number of people in mixed-sex wards from 11,802 in 2010 to 170? May we hear some good news about the staff who are doing a really good job?
We will hear this time and again from the Conservatives. They want to gag us when we dare to criticise their record on the NHS. We are not going to be quiet about it. We are going to fight for the future of the NHS. I would tell the hon. Gentleman that we do not have any criticisms of the staff in the NHS, or even of the managers who are trying their best in very difficult circumstances to keep the NHS on an even keel. He should know about the BUPA contracts in his West Sussex hospital—
The hon. Gentleman nods. Those contracts have greatly destabilised his local hospital. He voted for that in the then Health and Social Care Bill, which was designed to drive competition all the way through the NHS by stealth, and what a mess it has created in his own patch. I am happy to give way to him if he wants to apologise to patients in West Sussex for the waste and distraction the BUPA contractual arrangement has caused there. Will he apologise?
I am delighted to intervene because the shadow Secretary of State, who has now appeared, mentioned that in his car crash interview last night. I do not know if the shadow Chief Secretary has been to Worthing or has looked at the contract, but it made no difference in money terms. As it happens, I opposed the contract, as did my hon. Friend Sir Peter Bottomley, because there was no impact study. As a result, we will now get a better service—run by the hospital—that is more seamless for patients. Will the shadow Chief Secretary apologise?
I, too, served on the Health and Social Care Bill Committee. Does my hon. Friend agree that one of the great problems we face with work force planning, as Government Members have highlighted, is that private sector providers by and large are not training the doctors and the range of staff we need to deliver an integrated health service?
My hon. Friend is right. That is the crucial difference between those on the two sides of the Chamber: Government Members are not interested in having private or voluntary sector supplements where there is need in the NHS; their agenda is to replace provision across the NHS and to contract out across the board.
If my hon. Friends will allow me, I want to make a little progress, but I will certainly give way again in a moment.
As a member of the shadow Treasury team, I want meticulously to explain the alternative course by which we will deal with the requirement for 20,000 additional nurses and 8,000 additional GPs, and the time to care fund of £2.5 billion. First, we would raise £1.2 billion from the levy on ultra-high-value properties—those worth more than £2 million—the so-called mansion tax.
Secondly, we would raise least £1.15 billion by closing three tax loopholes. The first is that hedge funds are avoiding stamp duty by getting tax-exempt investment banks to buy shares for them. At least £500 million is lost through that tax loophole, and we must close it. The second is that many large corporations, including some of the water utilities, are shifting profits out of the UK by borrowing large sums at high interest rates via their owners’ subsidiary companies through offshore stock exchanges. That is known as the quoted eurobond exemption. The third is that many employment agencies sign up workers to umbrella companies almost at random, and exploit tax reliefs on travel and subsistence without passing them on to the work force. Between £300 million and £600 million is lost to the Exchequer in that way. Those three tax loopholes must be closed.
Thirdly, we need to take £150 million a year from a new levy on tobacco company profits. That levy has worked in the United States, and we believe it is now appropriate in this country.
The sum of £2.5 billion is a significant investment that our NHS needs. It will also provide the time to care for the patients who deserve much more than the 15-minute chunks they have been getting recently.
Leaving aside the fact that the previous Government were not much good at closing tax loopholes, I am sorry to hear that the Labour party has lost faith with one of the fundamental principles of the NHS, which is that it should be based on need and funded through general taxation. That is the most stable basis for funding our NHS, and the Labour party is taking a great risk with NHS finances by proposing otherwise.
That is rather interesting. The hon. Lady would criticise us if we said that we would do this through general taxation, but when we show where the money will come from—pound for pound—she criticises that as well. I want to hear the Conservatives say where they will get the extra money from for the NHS. I will come to that in a moment, but I will first give way to my hon. Friend.
A moment ago, my hon. Friend was talking about the risks of privatisation. I know he shares my concerns about health services in Nottingham. What advice does he have for the voters of Nottingham who, as a result of the outsourcing of our hospital’s world-renowned dermatology department, which was then broken up, can no longer access acute dermatology services locally? How should our constituents vote on
Order. Mr Garnier, I am not going to tell you again. You are on a warning now. You make lots of interventions. Members show you respect, and I expect you to show it to others when they make their points.
That is so unlike Mark Garnier, and very out of character.
My hon. Friend Lilian Greenwood is a doughty fighter for NHS patients in our city of Nottingham. She knows very well that we have been trying our best, in working with local trusts, to press them to ensure that such services are safeguarded. Ultimately, when our constituents see the Government passing legislation encouraging trusts to move a private income level of 2% to potentially 49%, and when they see the pressure trusts are under, they are not surprised that many such problems are occurring in our area. It is only through making sure that we find resources and channel them towards investment for the care needs in our NHS that we will deal with those pressures.
Does my hon. Friend agree that, as well as ensuring there are finances at national level, we must ensure they are fairly distributed across the country? NHS England has a target funding allocation for Corby, but the National Audit Office and the Public Accounts Committee say that my local health authority is the worst funded in the country. Will shadow Ministers commit to fairness of funding when in government?
We know that the Conservative party has tried to distort funding formulas across the country by stealth. In fact, they have not done it stealthily; it has been pretty bleeding obvious. Given how local government funding formulas have been skewed—away from areas of need, and in a gerrymandering fashion—I certainly agree that such a situation must be reviewed.
If my hon. Friends will allow me, I will give way in a moment. I want to pick up the point made by Margot James, when she implied that the Conservative party somehow has plans to support additional investment in the NHS. The Chancellor of the Exchequer alluded to the fact that the Government might be able to cobble together £2 billion of additional funding. According to page 65 of the Treasury Green Book—“Autumn Statement 2014”— £1.2 billion was supposed to come from reserves or underspends for the NHS, but there is absolutely no commitment for any additional money beyond 2015-16. I will give way to the Minister if he will explain where his party has identified resources to meet that commitment beyond 2015-16. Will he spell that out? [Interruption.] I do not think that he wants to. My hon. Friends will ensure that he explains later, as he has just promised, because the public need to know where the money will come from to meet the pressures we face.
The Conservatives also wanted to switch £750 million out of Public Health England and Health Education England as some kind of sticking plaster for the NHS. However, we must think about the impact switching money away from preventive systems such as inoculations and vaccinations would have. [Interruption.] The Liberal Democrat Minister of State thinks that that is a good idea, but it is not a sustainable way to provide funding for our NHS. He has to do his sums again, make tough decisions and find the additional resources. Of course, the Liberal Democrats have said that growth will somehow magic up the money for the NHS, which shows their lack of credibility.
It is no wonder that the Institute for Fiscal Studies has said that Labour is the most cautious party in ensuring that it fully funds its pledges. It is no wonder that the Government parties do not want the Office for Budget Responsibility to go anywhere near the costings for the promises of political parties.
Does the hon. Gentleman agree that when Government Members ask us to congratulate NHS staff, which we do, it seems a bit hollow when they will not even pay nurses a decent wage? Does he further agree that privatisation is fragmenting the NHS, making it much harder to deliver a good service for patients?
We have to do far more to create a joined-up health service and social care system. That is very much part of the 10-year plan for the NHS that we announced yesterday. Yes, this is a debate about resources and getting the investment in, but we have to do more than that.
I question why the Conservatives are not putting their plans for funding the NHS on the record. Is it that they do not have any plans to pay for it or, which is more likely, that they are committed to shrinking public service investment in this country? The Conservatives and the Liberal Democrats have signed off on projections that would shrink public services to just 35% of GDP by the end of the coming Parliament. [Interruption.] I say to Chris Heaton-Harris that there was nothing in the charter for budget responsibility about shrinking the state to 35% of GDP. That is his plan. Public services have not been at that level since the late 1930s—before the NHS even existed.
That is the Conservatives’ vision, but what would it mean for the NHS? We are fortunate in this country that charging makes up just 10% of a patient’s out-of-pocket expenses. That includes prescriptions, optical services and dental services. Let us just look at how it works in those countries where public services form just 35% or less of GDP. There are four such countries across the OECD. In Switzerland, where public services make up 32.8% of GDP, more than a quarter of a patient’s income goes towards the cost of treatments. It has an insurance system in which the patient effectively pays an excess: as with a car insurance system, the patient has to pay the first amount and it is deducted from the total bill. Patients in Switzerland typically pay £1,800 out of their own pockets. In Mexico, charging makes up 44% of out-of-pocket expenses, in Chile it is 32% and in Korea it is 36%. Korea has a co-payment system, which means that up to half the hospital costs have to be borne by the patient.
Such things happen in every country where less than 35% of GDP goes towards public services. The Conservatives want to head us in the direction of such pressures. An NHS free at the point of use is not sustainable under the Conservative plans, and the risk that charges will be introduced is great.
The Conservatives have form on this issue, because their 2005 manifesto, which the Prime Minister and the Chancellor authored, encouraged people to go private. They wanted a patient passport that would have introduced charges for people who wanted to jump the queue. I wonder whether my hon. Friends recall that. The Prime Minister and the Chancellor wanted such charges for basic medical treatments. I have another question for the Minister and, again, I will give way to him. Would the Conservative party still introduce those plans in the dreadful event that they won the next general election? I will give way to the Minister if he wants to say that that is categorically not part of his party’s plans.
It was quite a simple question. The Minister could have dealt with it there and then, and pushed the matter to one side. I half expected him to do so. But no, that is not the answer he gave. Perhaps we are seeing the return of Michael Howard. The patient passport rears its head again.
What else can we expect from the Conservatives? More privatisation and more market-based changes.
I, too, serve on the Health Committee. Alongside the things that we have heard about today and the concerns expressed by Opposition Members following the Health and Social Care Act 2012, is it not a really worrying development that £1.2 billion of cancer services and end-of-life care services in Staffordshire and Stoke— a wide geographical area—are being tendered out in a 10-year contract? That is a risky thing to do and it has never been done before for a single disease. Will all patients with cancer who are at the end of their lives be able to rely on those services, given that the majority of those tendering are private companies? Is that not the big issue? Will the Minister answer that point?
That is the sort of ideological stain that has pervaded the NHS policies of recent years. We must recognise that, should the Conservatives win the general election, we will see more of the same. That is the course the NHS will pursue. Not just that, but the Government breach the NHS constitution time and again on safeguards, waiting times, ambulance responses and cancelled operations. The squeeze on resources will force patients increasingly to pay for private treatment.
It fell to the generation after the second world war to build the NHS. It fell to Labour in 1997, after 18 years of Conservative neglect, to save the NHS. Today, it once more falls to Labour to rescue the NHS and rebuild it for the 21st century. The choice is stark: a tangible and fully funded 10-year plan to boost investment in our
NHS with Labour, versus more decline and more of the same from the Tories, as they dismantle the NHS by stealth. It is beyond doubt that the NHS as we know it cannot survive another five years under the Tories, because once the NHS is gone, we will never get it back.
I welcome this opportunity to discuss the NHS. In answer to the question from Chris Leslie, I reconfirm the Government’s commitment to an NHS free at the point of need and free at the point of delivery. Only with a strong economy can we afford to pay for our NHS.
It would be wrong to open my remarks without commenting on the Labour party’s increasingly regrettable approach of weaponising the NHS. I still work as an NHS hospital doctor. There are a lot of professional politicians on the Opposition Front Bench. In my capacity as a local MP, I have been out on the front line with the East of England ambulance service during night shifts over this busy winter period. Front-line NHS staff do not appreciate the way in which the Labour party is trying to run down our NHS. There are a lot of staff working incredibly hard over this busy winter period and they should be congratulated on the effort and dedication that they put into front-line patient care. I hope that the hon. Member for Nottingham East and the Leader of the Opposition will reflect on that.
As this is an economic motion, it is appropriate in my opening remarks to address the economic situation our country was in when we came into government. We inherited the worst economic record of any new Government since the 1930s. Labour’s record of economic incompetence and profligate spending meant that the annual deficit was £134 billion and that we were paying back £367 million each and every day in debt interest alone. I believe that the hon. Member for Nottingham East was a special adviser who advised on that profligacy and incompetence. Labour left Britain with its largest deficit since the second world war. One pound in every four that was spent by the Government came from borrowing. Labour’s outgoing Chief Secretary to the Treasury, Mr Byrne, summed it up in his note to his successor with the words, “Good luck. There’s no money left.” There we have it—Labour’s record of economic incompetence. Britain was bankrupted by the last Labour Government, but thanks to our long-term economic plan things have changed for the better and Britain is back on track. There are now 2.16 million more private sector jobs since the coalition came to power, and 2 million more people have started an apprenticeship. The Government are giving more young people a chance in life and the opportunity to take home a pay packet.
May I just point out one of the lessons from history? When the NHS was established after the second world war, the country was tasked with rebuilding and its debt and deficit were considerable. But the Labour politicians of the day had the strength of character and the will to make that investment in the interests of the health of the nation. Should we not do that now?
To take the intervention in the spirit in which it was intended, I recognise that the hon. Gentleman is committed to our NHS, as are Members on this side of the House. That commitment to and investment in the NHS has been made clear by the fact that we have increased NHS spending by £12.7 billion during this Parliament.
Opposition Members have also incorrectly asserted that our long-term economic plan is taking Britain back to the 1930s, but the latest forecast from the independent Office for Budget Responsibility shows that our plans would reduce total Government spending as a share of GDP from some 40% today to 35.2% by the end of the next Parliament in 2020—the same levels of public spending as were proposed under Labour in 2002, when the right hon. Members for Doncaster North (Edward Miliband) and for Morley and Outwood (Ed Balls) were in the Treasury. If it was appropriate to set public spending at that level under Labour when they were in government, they need to explain why it is somehow wrong for a Conservative-led or coalition Government to plan for a similar level of public expenditure in the future—something that the Labour party has completely failed to do to date.
Just before I came into this debate I met a 10-year-old constituent, Margot, and her mother, who works for the NHS. She works all hours and still struggles to put enough food on the table. Can the Minister explain why the Prime Minister does not care about NHS workers? That is what Margot wants to know and that is what the rest of the country wants to know.
I am familiar with the hon. Lady’s constituency, having worked as a doctor at a hospital in the area. Her question is very disingenuous when we have increased the number of front-line clinical staff working in our NHS, investing in more staff to treat patients. We have also recently agreed with the unions a pay deal that will see the majority of NHS staff receiving a substantial increase in pay, thanks largely to their increments. Other staff will receive 1%.
My hon. Friend makes a very good point. On this side of the House we believe that when we spend public money we should do so efficiently and effectively. We have also made Government spending much more efficient—
Rather than heckling, Luciana Berger might do well to listen to what I am about to say, because efficient public spending should be a priority for any Government, although it certainly was not for the previous Government. Cabinet Office figures, endorsed by the National Audit Office, show that £14.3 billion of savings, relative to 2009-10, have been made across many areas of expenditure, including procurement, work force, major projects and transformation. That is £850 for every working household saved by this Government, and clearly shows that we are spending public money much more efficiently and wisely than Labour ever did when in office.
Does the Minister agree that money can be spent only once? Labours say it wants to invest £2.5 billion from the mansion tax in the NHS, but it has already promised that to deficit reduction and introducing a 10p tax rate. That is nonsense.
My hon. Friend makes a very good point. The mansion tax, which is alluded to as a major plank of the Opposition’s funding plans for the NHS, has already been spent three times—that is economic incompetence if nothing else.
The Minister claims to be spending NHS resources effectively. Let us put to one side the £3 billion that he wasted on the NHS reorganisation—difficult though that is to do—and address the issue of clinical negligence in the NHS. My understanding is that it was at about 0.8% of NHS expenditure, but it has now gone up to an astonishing 1.1%. More than £20 billion has been set aside for clinical negligence provision because clinicians do not have the time they need to do the job and stop problems occurring. Should not the Minister apologise for that?
That is frankly not true and a misrepresentation of the facts. We have a very safe health service, and that was recognised by the Commonwealth Fund. We also know that even in a very safe health service bad things sometimes happen. This is not a controversial point: it is a sensible and important point. In some areas, such as obstetrics, we have very safe care in the main, but sometimes there can be a very high quantum of claims, such as £7 million for a lifetime of care in one case. We have to make sure that in the rare cases when things go wrong we look after people properly. That is uncontroversial.
The projected future trajectory for the litigation bill spend was exactly the same under the previous Government as it is now, and we are looking at dealing with lower value claims to save money on litigation in the future and removing the sometimes adversarial nature of litigation, which is much more beneficial for patients and their families.
To focus on the detail and take the politics out of this issue, I think that the Minister said that the clinical negligence bills have not gone up under this Government compared with those under the previous Administration. If he wishes to repeat those words, I am sure that his officials and others will correct him. Does he really think that there are no further clinical negligence liabilities under his watch?
The point is that the figures for the expected trajectory of clinical negligence were the same under the previous Government as under this Government. We know that even though the NHS and its front-line staff deliver safe and effective care in the main, the costs of looking after people—who may not previously have survived into adulthood, but do so now because care has improved—are now much greater. As a result, the quantum of settlements is sometimes greater than it used to be because our NHS is doing better at helping people, who previously might have died in childhood, to live longer. That means greater lifetime of care costs, which the previous Government would have been familiar with when they looked at future litigation spending. We are, rightly, asking where we can save money on NHS litigation and we will announce soon the results of work on reducing the adversarial nature of low quantum claims, which will also benefit NHS finances.
As senior figures in the Labour party made clear this week, if the previous Labour Government had delivered efficiencies on the scale that we have delivered in our NHS, £40 billion more would have been available for front-line patient care. Let us remember that it was under Labour that £10 billion was wasted on a failed NHS IT contract; that hospitals were crippled by eye-watering PFI repayments, which currently total £2 billion a year; and that the pay bill for NHS managers doubled. Indeed, in the last year under Andy Burnham, the number of managers in the NHS went up six times as fast as the number of nurses.
I have just told the right hon. Gentleman very clearly that the cost of NHS managers doubled under the previous Labour Government, a profligate record of spending that has taken money away from front-line patient care.
The Minister missed one thing from the list. A written parliamentary question revealed to me in 2010 that the Labour party spent £250 million paying private providers to do precisely nothing.
My hon. Friend makes a very important point. We could stand here all day talking about the inefficiencies and profligacy in running the NHS finances by the previous Labour Government. He is also right to highlight—
I am going to make some progress. I will give way to the right hon. Gentleman later. I have been very generous and I need to make some progress. I remind him that under the previous Labour Government, as my hon. Friend the Member for St Austell and
Newquay (Stephen Gilbert) highlighted quite rightly, NHS providers were paid less than private sector providers. The right hon. Gentleman and the previous Labour Government paid the private sector 11% more than the NHS for performing the same NHS operations—something we have clearly outlawed under our legislation.
If we needed a further reminder of what Labour does when it runs the health service we need only look at Wales today, where almost every indicator of NHS performance shows that the Welsh NHS, run by Labour, is performing poorly when compared with the NHS in England. While we protected and increased our NHS budget in England, Labour in Wales has cut the NHS budget and patients are paying the price. Thanks to Labour in Wales, people have to wait about 100 days longer than patients in England for knee and hip operations. On finances and on care, Labour has let down our hard-working NHS staff and patients in Wales by its lack of investment in front-line services.
I am sure the Minister would agree that the shadow Health Secretary could have opened this debate, rather than trying to intervene now in a desperate way. Does my hon. Friend also recall the shadow Secretary of State, when he was Health Secretary in 2009, saying that we can
“move beyond the polarising debates of the last decade over private or public sector provision”?
That is what he said then. What does he say these days?
If the right hon. Gentleman wanted to contribute to the debate in such a meaningful way, why did he not have the courage to stand here and speak in this debate? I have been very generous in giving way. I know he does not like to be reminded of his record in office. Frankly, on NHS finances his record is abysmal, just like the previous Labour Government’s record of running our economy. If he wants to contribute he should speak in the debate. I will give way generously again later, but I want to make some progress.
On the Government Benches, we know that we cannot have a strong NHS without a strong economy. In spite of the profoundly challenging financial position we inherited from Labour, I am proud that this Government have increased NHS funding in each year of this Parliament. As a result of the additional funding announced in the autumn statement for 2015-16, funding will be £16 billion higher in cash terms in 2015-16 than it was in 2010-11. That equates to an increase of £6.8 billion in real terms for our national health service under this Government.
Our NHS is also on track to deliver up to £20 billion of efficiency savings this Parliament, having reported about £15 billion of efficiencies in the first three years. All of that has, or will be, reinvested into front-line patient care. Our commitment to our NHS has meant that, since the last election in 2010, there are now more than 17,200 more professionally qualified clinical staff, including over 9,000 more doctors, enabling 850,000 more people to have operations than 2010, and over 3,300 more nurses, midwives and health visitors. Fewer patients are waiting to start treatment, and hospital infections have virtually halved. Mixed-sex wards, a great scandal of the previous Government, have largely become a thing of the past. I could, and will, go on in a moment.
The Minister talks about more nurses. Derriford hospital in Plymouth has had to fill more than 60 vacancies with nurses from overseas. Morale is so low among nurses in the UK—plus we are not training them—it cannot fill those vacancies. He spoke earlier about a substantial pay rise. Would he like to explain to the nurses in my constituency exactly how substantial that pay rise is, because they do not think they have had a substantial pay rise?
Through the “Agenda for Change” settlement, many nurses will receive an incremental pay rise worth an average, I think, of between 3.2% and 3.4%. On top of that, we have come to an agreement with the unions to give a 1% rise, particularly to the lower paid NHS staff. That is something I hope the hon. Lady welcomes. It is worth highlighting that one of the biggest things that supports front-line staff is increasing numbers. In Plymouth Hospitals NHS Trust, the number of hospital doctors since 2010 has increased by 25 and the number of nurses by 62. That shows that the investment we are making at national level is paying dividends at local level in her trust.
I am going to make some progress and I am sure I will give way to the hon. Lady later on.
The investment we are making in the NHS also means that our NHS is caring for more patients than it has ever done before. Last year, compared with Labour’s last year in office, there were 1.2 million more episodes of in-patient care, including 850,000 more operations, 6.1 million more out-patient appointments, 3.6 million more diagnostic tests and almost 460,000 more GP referrals seen by a specialist for suspected cancer, meaning that under this Government more patients are receiving early referral for important care. We have also reduced the number of administrators in our NHS by 20,000. That is freeing up more cash to be reinvested in the front line of patient care.
While we are talking about future resources for the NHS, may I commend the Government for what they have done to move towards parity of esteem in mental health and investment in talking therapies? Is it not important, when we consider future NHS resources, to consider the balance of the £14 billion that we currently spend on mental health services and how we can further invest in mental health services over the next Parliament?
My hon. Friend makes an important point. We have made considerable progress under this Government in improving the funding in the past year—£302 million more for mental health services—and in making sure that from this year, for the first time, there will be genuine parity between mental and physical health when we introduce access targets. They will ensure that patients are seen in a more timely manner when they suffer from mental illness and need specialist care and referral. Our record in office on mental health is something I think we can be very proud of. We have for the first time in many years reset the debate. There is now becoming a genuine parity of esteem between mental and physical health.
It is always important to hear the Government talk about parity of esteem. In practice, however, we have seen many examples in the past year where that has not actually applied, whether that is NHS England’s decision to apply a cut to a mental health trust that is 20% higher than for all other trusts, or the figures we saw this year showing that child and adolescent mental health services have been cut by £15 million. Is it not just warm words to talk about parity of esteem, when in reality people have to travel hundreds of miles to access in-patient care or not get any treatment at all?
Frankly, the previous Government’s record on investing in mental health was woeful. To reassure the hon. Lady—I think it would perhaps be worth her noting the points I have raised—we have increased the mental health budget this year by £302 million. I will talk a little more about support for children with mental ill health later in my remarks.
We have also put a lot of investment and support into tackling perinatal mental health. By 2017, for the first time, mums will have specially qualified and trained staff in every birthing unit to provide support for perinatal mental health. [Interruption.] The hon. Lady says that is not treatment. I am a doctor. I work in maternity. It is absolutely right that we put in place the right support for perinatal mental health. I am sorry, but frankly that is misunderstanding the clinical reality of what it is like to look after patients. It does the hon. Lady—and those on the Opposition Front Bench—a great disservice.
At a time of continued pressure on the public finances, the additional funding announced by the Chancellor in the autumn statement further highlights the priority the Government place on our NHS. The extra money we have provided will enable our NHS to continue to meet significant and rapidly rising patient expectations and demands in the short term, while allowing us to make important investment in new models of community-based care in order to realise the vision set out in NHS England’s “Five Year Forward View”.
The Government’s commitment to our NHS is clear. By ensuring a strong economy, we will also ensure that our NHS remains sustainable in the long term as a health service that is free at the point of need and of use—the health service we all believe in.
Well, I am a doctor. It is a pity there are so many professional politicians in the Labour party. Had they experience of real life, they might be able to make a more valuable contribution to debates in this place.
In 2015-16, funding for front-line NHS services in England will be £2 billion higher. Of this additional funding, £1.5 billion will go to local NHS services to meet the ever-growing demand for services and to provide better care for the frail elderly and people with long-term medical conditions, such as heart disease and dementia. In addition, £200 million will go towards piloting new care models set out in NHS England’s “Five Year Forward View”; £250 million will provide the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities; and about £30 million will go to the NHS to develop the best approaches to caring for young people with eating disorders in both in-patient and community settings—which further answers the question from the hon. Member for Liverpool, Wavertree by confirming this Government’s commitment to providing better care for people with mental illnesses.
I thank the Minister for giving way, particularly as he is a doctor. He never took into account my real-life experience in IT when we debated care.data, so he wants to be careful about saying that people do not have real-life experience—several of us have real-life experience in different industries, but he does not take that into account.
Order. Mr Heaton-Harris, will you allow the intervention to take place? I am sure you will have a chance to join the debate when you catch my eye later. However, I do not want interventions to be overlong either, because we do not have much time left in the debate. Barbara Keeley, will you therefore please be brief?
Will the Minister address the issue of delayed discharges and the impact of cutting community resources? We have touched on social care in general practice, funding for which has really been cut, but the big issue that comes up again and again before the Health Select Committee concerns the loss of thousands of district nurses. I heard yesterday that in the north-west agencies do not even have supply district nurses. Will he address the matter of those community resources? He is talking about community care for the elderly and vulnerable. What will be done about district nurses?
As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care, which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.
Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.
It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.
Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.
No, on this occasion, the hon. Gentleman will have to forgive me.
Our capital investment in maternity services, which, as I said, is the biggest for decades, is making a big difference to mums, dads and new families. Thanks to our investment in the midwifery work force, we now have the highest ever number of midwives working in our NHS—about 2,000 more than in 2010—providing more personalised care and support for women and new mums. However, we must all recognise the challenges facing our health and care system in the months and years ahead. NHS England’s “Five Year Forward View” argued that we needed to do more to tackle the root causes of ill health through a radical upgrade in prevention and public health; to give patients more control over their own care, including through the option of combining health and social care, and new support for carers and volunteers; to ensure the NHS changes to meet the needs of a population that lives longer; and to develop and deliver new models of care, local flexibility and more investment in our work force, technology and innovation, some of which I have already outlined.
That is why the Government have provided additional funding for NHS front-line services in 2015-16, including £200 million to pilot new care models and £250 million for the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities to support our GPs and primary and community care work force in the important work they do. In community care, we are committed to undoing the terrible mistake that was Labour’s 2004 GP contract, which left so many people, particularly the frail elderly, without the GP care they needed at evenings and weekends. Our investment will support GPs to provide care for patients seven days a week so that patients will once more be properly supported during evenings and weekends. We are also training an extra 5,000 GPs, in addition to the 5,000 extra we have already seen under this Government, to provide that care.
We are clear, however, that if the NHS is to meet the challenge of increasing patient demand and expectations, it cannot stand still. By 2018, 3 million people in our country will have three or more long-term conditions, so we must continually adapt and change how we deliver care to support patients, families and carers, and deliver more care in people’s homes and communities. For our part, and as part of our plan for our NHS, not only are we delivering a strong economy so that we can protect our NHS budget, but we will continue to be ruthless in delivering greater efficiencies in estate management and procurement and in reducing back-office costs so that we can reinvest that money in front-line patient care. Furthermore, we will continue to back front-line staff with the training, equipment and new technology they need to do their job and provide high-quality patient care, which is why we have already made available an additional £2 billion down payment to deliver NHS England’s “Five Year Forward View” and why the Prime Minister has committed to continuing to protect our NHS and ensuring that it has the additional money it needs to deliver first-class patient care in the months and years ahead.
In conclusion, I would like to thank the dedicated NHS staff working incredibly hard to keep us well looked after and safe in this busy winter period. As a practising doctor—I know Labour does not like it, given its dearth of real-life experience and the number of former special advisers on its Front Bench—I know how hard our NHS staff work and how dedicated they are to delivering the highest-quality patient care. I remind the House that we have been able to increase the money available to our NHS only because we have the growing economy to pay for it; because our long-term economic plan is working; and because, under this Conservative-led Government, there are more people in work than there were under Labour. Anybody who does not have an economic plan for the economy—and Labour has no plan for our economy, as has certainly been clear in today’s debate—does not have a plan for the future of our NHS. Through economic policies and by creating growth and jobs, we have been able to announce additional NHS funding for 2015-16 without having to raise taxes, including on people’s homes, as Labour would like to. This gives our NHS the funding it needs to begin implementing the plan set out in NHS England’s “Five Year Forward View”, so that it can continue to be a world-class, sustainable health service, delivered free at the point of need.
When we came into power, we took two big strategic decisions with our NHS: to increase funding and to cut bureaucracy and waste, and to reinvest that money in more doctors, nurses and front-line staff and to improve front-line patient care. That is exactly what we have done, so the choice on
I remind Members that there is a seven-minute speaking limit. We should get everybody in, unless there are interventions, in which case we may have to change it.
Let me begin by thanking the Minister for his contribution today—particularly as he is a doctor. I also thank him for helping those of us with our Tory NHS debate bingo cards to show that he has used all the words we were expecting—“weaponise”, “Wales”, “long-term economic plan”—and for the additional benefit of sharing his understanding of the international banking crash, which is that it was Mr Brown shovelling money out of the back windows at Lehman Brothers that caused the entire world economy to crash.
Let me move on to perhaps a much more important point. How are we going to fund the national health service in the future? What the Minister did not address—which is a grave disappointment—were some of the matters in the motion that we are supposed to be debating. My constituents prioritise the NHS probably over everything else. For them, it is all about our working together as one community and looking after everyone: no one is more important than anyone else; we all stick together; we pay our taxes and support the weakest; and all of us should be able to get world-class health care. We are very proud of the national health service, which has delivered that. However, my constituents are profoundly concerned about what is going to happen in the future. Can the national health service survive another five years of a Tory Government? The answer they come to very rapidly is no.
The question is a simple one. How can the Prime Minister stand up at the Tory party conference and say, “We’re going to make £7 billion worth of tax cuts,” and not tell us where the money is coming from? How can the Prime Minister or the Chancellor of the Exchequer say that state spending is going to decline to the level it was in the 1930s, when in the 1930s we did not have a national health service? How does that work? How do we square that circle? Without answers to profoundly important questions such as those, the public simply say, “We don’t trust you with the most precious thing we have as part of our British identity. We want to be able to have a national health service that will hold us together.” How can the NHS be safe in the hands of this Government?
The hon. Lady will of course be aware that our plans for public spending will only put it back to the level it was in 2002, under the previous Labour Government, which is hardly the bleak picture she paints. At the same time, we will be able to invest money in our NHS.
I still do not understand why, therefore, the Office for Budget Responsibility says that the percentage of state spending will be at the level it was in the 1930s. In the end, although the Minister is a doctor, I would prefer to take the word of the Office for Budget Responsibility. Indeed, I urge the Minister to speak again to his party leader and say to him, “When we come to make manifesto commitments, let’s run them past the Office for Budget Responsibility,” so that the public know whom they can trust on money and particularly on the NHS.
I remember serving on the Health and Social Care Bill Committee for many, many weeks—months, in fact; indeed, I believe it was almost a year of life. I remember my hon. Friend Liz Kendall and I pleading with the Government not to go ahead—not to waste time and money on a top-down reorganisation; not to waste people’s heart and soul on a reorganisation of the national health service in a way that was unnecessary. We said, “All you’re doing is opening the door to privatisation. What you are doing is wrong for the national health service. You must stop. You must think again.” And there was indeed a pause—a pause for an awful lot of spinning—but the Government still forced through a profound reorganisation of the national health service that has allowed the market to come into the NHS and wasted £3 billion.
We also said that if we needed to look again—and we did—at making our national health service appropriate for the 21st century, we should look at how to bring social care and health together. It is difficult, because social care is largely provided by local authorities. Very often it is means-tested and provided locally, with local accountability, whereas the national health service was much more nationally accountable, had much better funds and was not means-tested. However, without those two things moving and working together, we cannot have proper health care in our country, because—and we all know this—most people who use the national health service are elderly. They come to A and E in crisis, and once they are in they are unable to get out again. It is demeaning. It is humiliating. It is something that all of us in the Chamber will face unless something is done.
People must be supported in the community so that they are able to live their lives as healthily as possible—yes, fighting off three or four long-term conditions, but still as healthily as possible. However, while this Government have been cutting the money to local authorities—it is being shovelled out the back door by Eric Pickles—the Health team have been saying, “Oh, it’s all right: we’re giving more money to social care.” But the Government know—and all of us who have friends, relatives or constituents who are using social care know—that there is not enough of it around. Old ladies are getting up and being taken out of bed and are sitting in their chair three hours later than they were before. They are getting visits of 15 minutes. They are not being looked after properly. They have the choice between having a bath and having a meal. In the 21st century, in one of the richest countries in the world, that is a disgrace. How can we really be looking properly at the future of the health service and allowing that to happen? Of course, if people are kept in bed until 11 o’clock in the morning and then being put back to bed at 5 o’clock in the evening, they will become unhealthy. They will end up in A and E in crisis and they will not be able to get out again.
More and more local authorities are cutting back on social care and are giving social care only to those in the most acute need. In the time I have left—I do not have very long, so I am going to rattle through—I want to say what Islington does. Despite having the sixth-worst levels of child poverty in the entire country and one of the worst mental health records in the country, Islington provides social care on a level of which we should be proud. It provides social care at moderate levels. It is working with Whittington Health. The hospital in my constituency is working with the local authority, providing health in the community. The hospital sends people out; we have GPs working in the hospital. It is a model on which I hope the next Government’s—ours—model for proper health and social care will be based: the idea of people working together, looking at the whole person, giving the health service time to care and look after people properly, and giving people the right to die at home with dignity and support.
I want to use the 30 seconds I have left to give due credit to Camden health services for allowing my father-in-law to die at home with true dignity and proper palliative care. It gave him the choice to die in his bed, next to his wife, for which I am profoundly grateful. I know that he was very privileged in being allowed to do that, because up and down the country that is not being allowed. It saved money, gave him what he wanted and gave him pride. Why are we not dealing with problems like that, instead of introducing the private market into our precious national health service?
It is a pleasure to follow Emily Thornberry.
It is a little sad, to be honest, to be having this debate today, because we could approach this issue in a much more mature way as politicians. Clearly there are enormous challenges facing our health service and our adult social care services, not only for this Government or the next, but for the two Governments after them. As politicians, we owe it to our constituents to have a mature debate about how we are going to avert the demographic time bomb that is heading our way. Frankly, we all have an interest in that. Just like the hon. Member for Nottingham
East (Chris Leslie), we are probably going to need those services at some point. I hope I will not find myself in a bed next to him, but we could end up on the same ward.
It is worth saying that every Labour party election leaflet for the last 50 years has said, “You can’t trust the Tories with the NHS.” [Interruption.] Yet we have had countless Conservative Governments over that period, and the NHS continues to thrive, to look after people and to offer its services.
The hon. Gentleman is saying that the NHS is safe in Conservative hands, but let me remind him that in 1997, when Labour came to power, there had been 18 years—a considerable length of time—of under-investment. Expenditure on the NHS was increased 300% by the Labour Government: from £30 billion to over £100 billion. Every accident and emergency unit was rebuilt and many hospitals were rebuilt, too.
That is where the hon. Gentleman’s party falls down. Labour Members obsess about cash and forget about clinical operation. That is why we ended up with crises such as that at Mid Staffs hospital, with people dying in their beds because of bureaucracy, target setting and obsession with process rather than the care of patients.
The Opposition also have an obsession with the private sector. My father had to have a new knee, unfortunately. He went to the local hospital, which happens to be the one that the constituents of the hon. Member for Nottingham East attend. Rather than being treated in the NHS Queen’s medical centre, he was sent to a hospital in Sherwood in his constituency, which looked after him very well. It was a private hospital and this was in 2008—under the previous Government. The NHS was making use of private services back then. It was very efficient and well delivered. I do not understand this obsession with the private sector. We need to remember that private companies make the drugs that the NHS uses; private companies make all the crutches and the ambulances; and GPs are, in effect, private companies. It works very well. As long as we can deliver a service that is free at the point of use and run in the most efficient way but with the highest levels of care and consideration, I think that is the right place to be.
Let me return to my earlier point. Would the hon. Gentleman be comfortable if his constituents with cancer or those at the end of their lives had to contend with a totally privatised service? That is what we might have to contend with, because we might be faced with a 10-year contract to privatise all those services. It has never been done before, and it is highly risky—and the oncologists were not even consulted about it. We are not talking about supplementing; we are talking about private services replacing the NHS.
I thank the hon. Lady for that intervention. What my constituents who are in the unfortunate position of suffering from cancer care about is whether they are going to get better. Is the service going to deliver a service that makes them better and gets them over the disease? Frankly, if it does not cost constituents any money, and if the level of care and service is the highest, I think that is what really matters to them.
It is easy to stand here and talk. Politicians talk—they will always talk—but we have to look at what politicians do. This Government, to their credit, have in this Parliament put in an extra £12.7 billion. Let us compare that with how politicians have operated in Wales, where the budget has been cut by 8%. I think it says a lot to our constituents about how the NHS is going to be managed in future and how much we genuinely care about and want to support the NHS system.
Of course, I am the first to admit that there is financial pressure within the system. The previous Government borrowed enormous amounts of money and ran up an enormous deficit. Any Government coming in at that time would have had to take difficult decisions, but the simple fact is that spending in England has gone up under this Government, while spending in Wales under the control of the hon. Lady’s party has gone down. There are some 850,000 extra operations a year taking place in our NHS by comparison with 2010.
The issue that upsets me most and has brought me to attend this debate is the state of my own Sherwood Forest Hospitals NHS Foundation Trust. It “benefited” from a PFI deal signed under the previous Government, which now costs the trust £40 million a year out of its budget. That is where we went wrong under the previous Government. Let us spin that out: we were fortunate enough to invest £320 million in a new hospital, but it will cost £2 billion in repayments. I put it to Members that they would get a better interest rate from Wonga than they would out of that PFI deal. If we look at what happened nationally, we find that £11 billion-worth of investment through PFI matches up with £55 billion-worth of repayments. That means £44 billion being taken out of the NHS because of the shocking PFI deals signed by the previous Government.
Labour Members talk about the cost of our reorganisation being £3 billion, but that is frankly nothing by comparison with £44 billion. It is an enormous amount of cash that could be spent on doctors, nurses, cancer patients and putting our NHS services in the right place.
I am very fortunate that the Secretary of State has agreed to meet me and my hon. Friend Robert Jenrick to try to help Sherwood Forest hospital trust out of the hole that the previous Government put it in. Hopefully, we can assist in dealing with the £40 million a year being sucked out of the trust.
I am conscious that other Members want to speak, so I shall end there. I am grateful for having had the opportunity to speak.
I am pleased to follow Mr Spencer. Last Saturday, I sat with my constituent Joanna Redfearn, who is a mother of four. Her 11-year-old daughter, Kelsie, has complex medical needs, including epilepsy. Joanna was telling me about the increasing difficulty she experiences in getting an ambulance to come when her child has a fit. She has been subject to waits of between an hour and two hours—clearly, that is totally unacceptable, because it is extremely dangerous for her child.
A recent low point was when a paramedic turned up, who was told that a St John ambulance—not an NHS ambulance—was about to come. The paramedic rang the North East Ambulance Service to say, “Sorry, that will not do. They are not equipped to deal with this child’s needs. We need a proper ambulance.” My constituent is so desperate that she is considering moving house to be nearer to the hospital.
This is part of a pattern in my constituency. When an elderly woman fell out of her wheelchair outdoors last summer, her husband, whose hearing is very bad, rang the ambulance service. The people on the other end of the phone began to challenge him and ask him a series of questions, but he could not answer them because he could not hear them. He could phone up and say, “I need an ambulance now”, but he could not hear well enough to engage in a long conversation with the ambulance service.
After three phone calls a paramedic turned up, who then called a proper ambulance. The old man had to stand, propping his wife up for over an hour while the paramedics gave her the medical support she needed. It was fully two and a half hours before the proper ambulance came to collect her and take her to A and E. The worst case, however, is the one I raised with the Secretary of State a few days ago: that of Violet Alliston. Her partner rang 999 several times, but the ambulance arrived so late that she died.
Everyone knows that the North East Ambulance Service is in crisis. The patients know, the GPs know and the paramedics know. The only people who do not seem to know are the Ministers. It is a shame that the doctor is no longer with us, because he made a number of comments, and it is unfortunate that he will not hear my response to them. He challenged what had been written by the independent Office for Budget Responsibility, which was set up by the Government to audit their public spending plans. It was the OBR that said that the Government’s plans would reduce spending to 1930s levels, and reduce by 1 million the number of public service jobs. It would be nice if the Minister responding to the debate told us which NHS staff will be included in that 1 million.
Government Members seem to think that this is just a rhetorical device, and that none of us on the Opposition Benches have any such personal experience. That is not true. In the 1930s, my grandmother used to collect for an ambulance friendly society. What happened in the 1930s, under a 1930s system, was that if people did not pay, they did not get an ambulance. No one wants to return to that system.
The problems I have described obviously have knock-on effects in hospital A and E departments. County Durham and Darlington NHS Foundation Trust met the four-hour waiting time standard on only 74% of occasions. Furthermore, services are constantly being removed from Bishop Auckland general hospital. The latest service the trust wants to remove is the maternity unit. Again, I am sorry that the doctor is not here to respond to my account of the problems we are experiencing. We have been told that maternity services are not safe because if something goes wrong during labour, the trust cannot guarantee that an ambulance will arrive to transfer the patient, even though the ambulance station is right next to the hospital. Of course the ambulance service is not working.
I said to representatives of the hospital trust, “You are still dealing with home births. Surely the problems involved in collecting people from Bishop Auckland hospital by ambulance are exactly the same as those involved in collecting people if a home birth goes wrong.” They replied, “It is true that home births are risky, but people expect to be safer in a hospital.” In other words, what they are really bothered about is not health outcomes, but the risk of litigation. That is no way to run the health service.
What the health service needs is a proper, well-funded plan, and that is what Labour’s motion sets out. We need to see changes in the culture, in the resources and in the management. Labour’s plan is honest, truthful, transparent and clear, and it is what the British people want.
Let me begin by reminding the House of a few facts. This Government have presided over an additional £12.7 billion of public spending on the NHS, which amounts to a real-terms increase of 4%. That is a singular achievement, given that there have been cuts in every other area of public spending bar two—cuts forced on us by the Labour Government’s appalling management of the public finances.
The public will judge as they find. Anyone who lives anywhere near the Welsh border will know that additional pressures on hospital services have arisen from the exodus of Welsh people in search of decent care. As Government Members have already pointed out, the Labour-run Welsh Assembly Government have cut the NHS in Wales by 8%. That contrasts very unfavourably with this Government’s 4% increase in spending on the English NHS. As I have said, the public will judge as they find.
I want to say a little about our spending on health services in comparison with that of other countries. We are doing quite well at the moment. The European Union average is 8.7% of GDP; the United Kingdom figure is 9.2%, 0.5% higher, and is identical to the Australian figure. We also get a very efficient return on our spending. I applaud the NHS, certainly in my area, for all that it does with that money. Our system is considerably more efficient than the United States’, which is a privatised system based on private insurance. It costs a great deal more to run, and health outcomes are poorer because of the under-treatment of people who are underinsured, and the over-treatment of people who are insured properly. The administrative costs of the American system are also excessive compared with those of the publicly funded NHS.
That is one of the reasons why I am so enraged by Labour’s lies and smears about our position on the NHS. We have no wish to privatise the NHS, even if we thought that was a good idea from an ideological point of view. I am an ex-business person, and if I took over the NHS, the last thing I would want to do is privatise it and create a system that would cost more to run and deliver worse outcomes.
I am sorry to interrupt the hon. Lady’s flow, but I want to defend the land of my fathers, Wales. I do not know whether the hon. Lady was present for the urgent question. We often measure the stress on the system according to the declaration of emergency and major incident plans. There have been 15 in England but, as far as I am aware, none in Wales.
I do not want to cast aspersions relating to cover-ups and the like on some of the NHS management in Wales, but I think that some members of the hon. Gentleman’s own party have some salutary tales to tell on that front.
However, as was pointed out by my hon. Friend Mr Spencer, this is not just about spending; it is about how we control the budget and what we get for the money that we spend. I appeal to those who rate the Labour party on the basis of its health policies to reflect on its record. They should remember how much Labour was borrowing when it was running the NHS, and that it was spending money as though it were going out of fashion.
Under the last Government, the number of managers increased three times as fast as the number of nurses, and managers’ pay increased far faster than nurses’ pay. The management pay bill more than doubled under the last Government, but we have reduced it by nearly a fifth. There was absolutely no integration of health and social care under the last Government, although they had 13 years in which to put that right. Despite severe financial constraints, our record has been so much better than theirs, and that is the position I will put to my electorate when the time comes. We have produced 13,000 more doctors and nurses, and 21,000 fewer administrators and managers. That is what the public want to see. They know that this Government have the right priorities. In my area, that has translated to 353 more nurses and 84 more doctors in my hospital since this Government came to power. I congratulate our health ministerial team on not caving in all the time to producer interests—another facet of the last Government, with their command and control culture.
I want to mention a few of the things I am proud this Government have achieved within severe spending constraints. We have ended the indignity of mixed sex-wards. We have reduced infection rates dramatically. C. difficile infection rates have come down by a staggering 63%. The last Government grappled with this issue for 13 years, leaving a disaster when they left office. They had an appalling record. Another great innovation—one of many; I have not got time to mention them all—is the Cancer Drugs Fund, which has helped many of my constituents to get the treatment they were denied under the last Government, with all their spending largesse. That has also flowed through to the hospital sector—imaging and radiodiagnostic tests have increased by 34%. All these benefits have been achieved with very small real-terms increases in spend. That is what this Government have been able to do: deliver more with less.
Under the previous Government, all the in-patient wards in one of my local hospitals, Rowley Regis, were closed, but during the last four and a half years they have reopened, and there has been lots of innovation and new services coming into that hospital.
That is a good example, and I know how hard my hon. Friend has worked in his constituency to assist in bringing about that improvement.
The polls clearly show that the public have very little confidence in Labour’s proposals to manage the economy. However, I want to make sure I do everything I can to get the public to cast a weather-eye over the Opposition’s plans for the NHS, and to remember which party introduced privatisation into the NHS, and why. I remember calling on an elderly lady who had been waiting almost two years for a cataract operation on both eyes. That was what the previous Government presided over, and in desperation they called in the private sector to reduce those waiting times. They could not bring about change within the NHS because of their target-driven management culture and their command and control-driven philosophy, so they had to bring in the private sector.
What we are seeing now is a tiny increase: the whole of the private sector accounts for less than 7% of total NHS activity, so we are talking about a small element that the Opposition are blowing up out of all proportion.
I am sorry, but I am running out of time.
Labour’s record in government, when the producer interest held sway, stands as a salutary lesson which I hope people will remember.
No wonder there are serious divisions within the Opposition about their health policy, as was reported in the press only today. One Labour Front Bencher was anonymously quoted as saying that it would be a “fatal mistake” to increase the health budget without reforming it. I know there are some people with common sense on the Opposition Benches, but it is a shame they are not in control of health policy.
I have the real-life experience of having worked for the NHS for 33 years, and I am not a doctor.
I have seen the NHS go through many changes, but I have never seen such industrial unrest and poor staff morale as has developed under this Government. This Government claim to have employed more doctors and more nurses, yet they are not talking about the cuts to other services and other staff, and the redundancies and the outsourcing of work to the private sector.
This Government like to claim that all is wonderful in today’s NHS, but those of us who work, or have worked, within it know that that is not the case. The NHS still operates to a large extent on the good will of the staff. This Government have been withholding a pay review body-recommended rise of just 1% to all NHS staff. Only now that an election is looming has the Secretary of State finally agreed to meet the trade unions, and now that meaningful negotiation appears to have finally commenced and the strike that was planned for tomorrow has been suspended the Government are claiming that as some kind of victory. There is no victory, and this Government need to remember that they have presided over a series of strikes and industrial unrest on their watch and only now that there is an election on the horizon do they see fit to address these issues.
I welcome this motion which proposes to invest £2.5 billion into our NHS. Staff have seen £3 billion being wasted on a costly reorganisation which nobody wanted, which was not necessary and which was in neither the Tory nor the Lib Dem manifestos. NHS departments such as the one I used to work in, pathology, have been making so-called efficiency savings for the last four and a half years, to the extent that if someone resigns from a post a business case has to be made for them to be replaced. In today’s NHS, decisions are being made not on clinical grounds, but on financial ones.
It is an absolute disgrace that this Government’s spending plans will return our public spending as a share of national income to levels last seen in the 1930s, before we had an NHS. The Tories assert that they will protect the NHS yet propose to cut spending on services to levels seen in countries where almost half the health service is privately funded.
The Government even deny that the NHS is being privatised on their watch, yet the evidence is of piecemeal privatisation of services. In my own area of the north-west, ambulance services have been privatised and are now run by Arriva transport, a bus company. This service is a source of constant complaints from my constituents, with patients being left to wait and being unable to get hospital for important medical tests. Medical staff tell me they struggle to get through Arriva’s complicated system of questions and answers—to which my hon. Friend Helen Goodman, who is no longer present, has already referred—in order to secure patient transport.
My hon. Friend is making a great case and is absolutely right about Arriva and its patient transport service in Manchester. Is she aware that many of the hospital trusts in Greater Manchester are now having to put in their own arrangements, which is costing the public purse even more, because of Arriva’s failure?
I thank my hon. Friend for his intervention, and yes I am aware of that shocking fact. This contract needs to be looked at as a matter of urgency. The private sector is not providing the service that was commissioned.
Medical staff have trouble getting the Arriva ambulance service to come out. If medical staff have difficulty getting through the question and answer system, imagine how patients must feel, and how they manage when they try to get patient transport from home to take them to hospital for urgent tests that need to be done in order to secure the treatment they need.
My constituents also complain to me about GP appointments. A lot of them are unable to get GP appointments within a week, and this is supported by the results of the GP patient survey. If this Government are allowed to carry on as they have been, more and more people will end up waiting a week or more to see a
GP or even be unable to get to see one at all. Labour will guarantee a GP appointment within 48 hours, and on the same day for those who need it, funded by our time to care fund, as opposed to suggestions made from the Opposition Benches such as “People with chronic illnesses like diabetes and thyroid disorders should be charged for their drugs”, or “Patients should be issued with receipts for the costs of GP and A and E appointments.”
The NHS is not safe under this Government, and most NHS staff are aware of that. Only Labour can reverse the damage currently being done to our NHS.
It is a pleasure to follow Liz McInnes. I know that she cares passionately about our national health service, as well as having considerable experience of it. I want to start by mentioning some massive positives and some points of agreement with the Opposition. Everyone in this place knows that the NHS at all levels gives their constituents incredible care. Yes, some people occasionally complain when things go slightly wrong, but they are relatively small in number compared with the quantum of folk who come through the NHS’s doors every day.
Yes, I am going to make the points that every Conservative and coalition Member will make about the NHS budget going up by around £12.7 billion in cash terms over the course of this Parliament, about the fact that we have had 850,000 more operations being delivered each year compared with 2010 and about the fact that the number of MRSA bloodstream infections and incidences of clostridium difficile are at an all-time low. I am also going to make the point that more than 1.3 million more people have access to an NHS dentist. When we came into office, that was really difficult for people to do. We all remember the bad old days.
Given our excellent track record, I am surprised that the Opposition want to talk about the NHS quite so much, especially when their plans include extra spending that they simply cannot account for or that they have already spent several times over. I should not be surprised, however, because although I am sure that every individual Labour MP truly does love the NHS, they are complicit in their leader’s bizarre plan to weaponise it. They want to forget about the NHS caring for people and instead use it for political advantage.
Alas, I have seen such weaponisation locally in my county, where Labour has deliberately tried to scare vulnerable people by saying that hospitals or services are going to close. During the Corby by-election campaign—I informed Andy Sawford that I was going to mention him and his constituency—Labour ran a petition against the closure of Kettering general hospital. The hospital is not in the Corby constituency, and it was not going to close. During the campaign, I went to the Lakelands hospice in Corby, where I met a lovely elderly lady. She told me how afraid she was that the hospital that she was going to was closing. Just in case hon. Members think I am making this up, that exchange was witnessed by a local BBC television crew. I know that the hon. Member for Corby has learned from that experience and that he is now working with my hon. Friends the
Members for Wellingborough (Mr Bone) and for Kettering (Mr Hollobone) to get better services from Kettering hospital.
The Opposition have even tried to scare people by using that disgusting tactic in my own constituency. Last week, I received an e-mail from a local Labour activist who told me that Danetre hospital would close if my party won the next election. That is a common theme among Labour party members when they talk to the public in my constituency. Danetre hospital is a fantastic NHS resource in the town of Daventry, but it remains under-used by the hospital trust that controls it. However, the trust is looking into using it better, and I have met its chief executive, Dr Sonia Swart, to talk about the plans for the hospital. It has two operating theatres and 28 beds. It also has free parking—a phenomenal thing in our NHS. I have been assured by everyone that Danetre hospital is here to stay, but I knew that anyway. How did I know? Because it has 22 years remaining on an amazingly expensive private finance initiative deal that costs about £3 million a year to fund.
Perhaps now is the time for those on the Opposition Front Bench to apologise for what they are allowing to happen in their name. But they will not, because they are weaponising the NHS, and they have a track record of doing that nationally. I seem to remember a national campaign in March 2012 about there being 24 hours to save the NHS. At 3 pm today, 25,047 hours will have passed since that campaign was launched, yet the NHS is still serving millions of people in our country.
The Opposition criticise the private elements involved in the NHS but they will not tell us how much private sector involvement is acceptable to them. It was introduced on scale by the Labour Government and went up to 4.4% on their watch. It is now nearly 6%. What percentage is acceptable to those on the Opposition Front Bench? Perhaps they would limit the areas in which the private sector could operate. Maybe there would be no more private cancer care—we heard that mentioned earlier. It would be interesting to tell that to someone suffering from cancer who might be getting better treatment at the moment. Perhaps the Opposition would put an end to hip replacements and MRI scans being performed outside the NHS. Which private sector involvement do they think is bad?
Yes, there are issues with NHS finances. Demand is massive; it is higher than ever before, and the NHS is treating more people than ever before. I sit on the Public Accounts Committee, and we have looked at many NHS projects and items. Perhaps an Opposition Member would like to stand up now and say how proud they are of the 2004 GP contracts, of the consultants’ contracts or of the NHS IT contract that cost the NHS and the country £10 billion in waste. Some salaries in the NHS seem very high. The chief clinical commissioning officer for the Vale of Glamorgan CCG is paid £185,000 a year, with pension and benefits, despite the fact that NHS England recommends a pay band of up to £100,000. NHS finances are safe only when our national economy is strong and growing. They are safe only under this party’s leadership.
I have a great deal of affection for Chris Heaton-Harris, but I have to say to him that the only people who are using that word are those on the Government Benches, because they apparently have nothing to say about the future of the NHS under the stewardship of a Conservative Government—God forbid—or about the real crisis that our accident and emergency services are suffering across the country. I should like to hear a little more from them about what they actually plan to do, rather than hearing this ridiculous nonsense.
We all know that the national health service faces major funding challenges in the years to come. NHS England has set that out clearly, and we have put forward concrete proposals to raise the extra money that our NHS needs. That will involve increased funding and, I have to say, radical reform. The merging of health and social care is a major undertaking that will unlock huge efficiencies and deal with one of the major pinch points of inefficiency that is wasting billions of pounds as well as creating great difficulties in people’s lives. Families simply do not know where to turn at the moment.
That scale of ambition has not been matched by the Government. In fact, at the very moment that they should be encouraging front-line workers to innovate and work together from the bottom up to come up with the new ideas necessary to take the NHS to a new level, they are tying them up with the red tape of compulsory competitive tendering. That is the last thing those people need at a time when a radical new approach to delivering services is needed.
I want to focus on the specific funding situation in the University Hospitals of Morecambe Bay NHS Foundation Trust. It is regrettable that the Under-Secretary of State for Health, Dr Poulter, who is a doctor, refused to take my intervention on the subject of maternity services. He must know, given that we have been talking about my maternity unit and maternity services across the Morecambe Bay area for some years now, that the situation is now critical. It will be the subject of a major report in the next couple of weeks, and there are real funding issues involved.
I shall run briefly through the trust’s recent funding history. In 2011, the University Hospitals of Morecambe Bay NHS Foundation Trust announced that it was facing a cut of £15 million—around 4% of its annual budget—as a result of the efficiencies and cuts to hospital funding being required by the Government. At that stage, it managed to avoid reductions in front-line staffing and facilities. The required additional spending resulting from the clinical and staffing failures found by the serious Care Quality Commission reports led to the trust’s finances falling into deficit by about £25 million annually. Ministers are still insisting that that must be eliminated.
The Better Care Together reconfiguration plan was submitted to NHS England and Monitor by the trust last July. It set out a scheme that would allow for up to £18 million of annual savings achieved over a five-year period. The trust, NHS England and the Department have been going backwards and forwards on the details of this plan, but it has boiled down to this basic point: innovative changes in approach and some difficult decisions mean that local health care experts are proposing to reduce the trust’s deficit by a full 70%, but—this is the key point—our whole area is clear that the unique combination of geographical isolation, poor transport links and severe health needs in pockets of some of the worst urban deprivation in the country in Barrow makes this a unique case, meaning we cannot go further than that 70% proposed reduction without cutting deeply into vital services across our hospitals.
It is a shame that the hon. Members who represent the Royal Lancaster infirmary, which is part of Morecambe Bay’s trust, are again not here to make this case. However, I want to ask the Minister something, and she can rise now or deal with this in her summing up. Will she follow the lead of the shadow Secretary of State, recognise our unique case and pledge to bridge the gap? Until we get that promise I will keep working with anyone in our community across Morecambe Bay who will join us in demanding the funding deal our hospitals desperately need.
The hon. Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Morecambe and Lunesdale (David Morris) are not here to stand up for their hospital today, so I will be out at the weekend with the people who will replace them as MPs: our brilliant candidates Amina Lone and Cat Smith. We will not stop until our hospitals are secure. The Government are proving themselves to be not up to this job, so they should get out of the way.
When I was first campaigning in Dover and Deal, I found that the previous Government’s legacy was that they had run down the much-loved Buckland hospital in Dover. Wards had been axed one by one; services had been withdrawn one by one; and the hospital had been decimated for more than a decade. There had been talk of plans to build a new hospital, but they had gone nowhere for the better part of a decade. It was a total disgrace; we did not get a fair share of health care in Dover and Deal.
In addition, an agreement appeared to have been made by the hospital trust in 2006 to take away the out-patient services at Deal’s hospital. There were claims of a consultation with the then MP and the then elected representatives to withdraw those out-patient services. So when I was elected I faced a situation where the hospital trust wanted to axe out-patient services and people were very concerned that Deal’s hospital was so undermined that it would be lost altogether. That was unacceptable.
What did the Conservatives do about it? Thanks to our funding of the NHS—the amount of money we have put in and the increase in spending in real terms—we managed to get a new hospital being built and it opens in March. That is a real achievement, ensuring that we will have a fairer share of health care back in Dover. After the years of going backwards, we will go forwards, and people in our community will be able to be seen and cared for in our community. Rather than have Deal’s hospital being run down and closed, as people feared, because Labour left it teetering on the edge, we campaigned hard. I undertook a large survey across the whole of Deal and I listened to people’s views. Thousands responded and we had hundreds in a meeting in a church to listen to the doctors and put the case for keeping the hospital, and now the clinical commissioning group, using its new funding powers, is ensuring that that hospital is safeguarded for the future. In that way, under the Conservatives, we have safeguarded Deal’s hospital and we are getting a new Dover hospital.
We also had difficult times in our local hospital trust—the East Kent Hospitals University NHS Foundation Trust had the CQC come in and investigate. In the past there would have been a cover-up and things would all have been swept under the carpet, just as they were in Staffordshire. That was the disgrace under the previous Government; the shadow Health Secretary oversaw that shameful episode. This Government have been open, honest and frank about the situation, and have ensured that special measures are taken and that we will have more nurses, more investment and better health care as a result. That is an important milestone. It shows not only that we have a new Dover hospital and that we have safeguarded Deal’s hospital, but that we have a better trust thanks to the reforms the Government have put in place.
But I think we should go further. I want to see five-star health care in Dover and Deal, so that rather than the cold wards of old, we should have new individual care and recovery suites, which can enable flexibility. People could be there for short-time observation; for step-down care for a week or two, rather than blocking up the acute hospital; for re-ambulation over a two to three-month period; or for much longer-term palliative care or perhaps end-of-life care. I am working with Kent county council, the local CCG and other health stakeholders to examine how we can bring forward that sort of innovative proposal. It will help with NHS funding because it will save money lost through bed-blocking; it will save money because its beds will be less expensive than elsewhere in the NHS; and it will provide a better experience for patients because they will be able to get better and recover within the community.
We need to rethink A and E more generally, by having more local emergency centres. My plan is that at the new Dover Buckland hospital, which opens in March, we should see a local emergency centre being used as an out-of-hours base for the doctors and CCG. It should be beefed up so that it has a much more emergency flavour to it, rather than a minor injuries one, so that more people use it, more people have trust and confidence in it and fewer people will inappropriately admit themselves to A and E down the road in Ashford. In that way, we will be able to get the right kind of cascading, the right level of treatment and the right places, given how our health system works. Such an approach would allow simpler stuff to be carried out more locally in our communities, whereas the more complicated accident and emergency problems would be dealt with in a more centralised A and E unit. That kind of modernisation in how we deal with out-of-hours care and A and E-type care is something I hope we will think about and see more of in future. I do not see this as a left/right issue, just as I do not see community hospitals, which I believe in, as a left/right issue. I see it as being about people who are concerned about localism, and the localisation of health care and bringing it closer to the patient and to the community. That is the way we should be building the future of our NHS. It is a great shame we have seen so much politicisation and weaponisation of this—
I am pleased to follow Charlie Elphicke. I wish to make it clear that I have chosen to be here in the Chamber today to participate in this important debate rather than attend the Health Committee, which is also considering important matters, because I feel that we need to set out our view of the direction of the health service.
I was very interested in some of the hon. Gentleman’s views about fair funding. Having experienced NHS funding under the Conservatives and Liberal Democrats, I must say that my view is rather different. After the general election in 2010, the funding for a brand new hospital that would have served my constituency—it was to be funded not through the private finance initiative scheme but by NHS capital—was cancelled by the present Government. It is an absolute disgrace that we still do not have modern facilities to serve my constituents and those of neighbouring constituencies. It prompts us to ask whether fair funding or some kind of gerrymandering is being applied.
The hon. Gentleman was talking about opening urgent treatment centres. That is a revelation to me because the two centres that opened in my constituency under the previous Labour Government are now threatened with closure. We have neither a modern hospital nor modern facilities.
I am proud to say that, although I am not a doctor, I did work in the health service. Like my hon. Friend Liz McInnes, I worked in a pathology laboratory, doing some important diagnostic work. I am proud of the people who deliver that service; I think they deserve enormous credit.
The creation of the NHS is Labour’s proudest achievement. More than anything else—more than football or cricket—it is what binds us together as a nation. The principle of a free national health service, which is free at the point of use, has huge popular support among the general public.
When the Prime Minister said that his priorities could be summarised in three letters—NHS—we might have been forgiven for thinking that the Conservatives had been transformed and had come to cherish the NHS as much as the British people do. But, with fewer than 100 days to the general election, it is apparent that his words were nothing more than a smokescreen. It is clear that the Government knew that they could never go into a general election stating their true intentions. Now, we have been accused of weaponising the NHS.
I would rather weaponise it than privatise it, which is what I accuse the Government of doing. That would not have been possible without the active support of the Liberal Democrat party—talking of which, Ian Swales has just taken his place in the Chamber. I feel bitter about what has happened. The hon. Gentleman and I both served on the Health and Social Care Bill, which has now been enacted. The lead advocates were the right hon. Members for Chelmsford (Mr Burns) and for Sutton and Cheam (Paul Burstow). That Act was a really dangerous move, because part 3 opened up our national health service to the full force of competition. Conservatives may say that the difference is only marginal, but the truth is that that Act allows hospital trusts to have up to 49% of their income come from private patients.
I know that we are desperately short of time, but I want to set out some political dividing lines. Labour and the Conservatives are making very different offerings for the NHS. Labour’s offering is that it will provide more nurses and GPs, and I think it will find favour. In the next general election—
I have been a Member of Parliament for nearly 10 years and I have never had so many complaints about the NHS as I have received in recent months. In a recent survey that I carried out, more than 35% of people who responded had had to wait more than a week to see a GP. I have seen many parents who are concerned about the length of time they have waited for their children to receive a diagnosis of autism, or to get an appointment with child and adolescent mental health services. Our four hour-target rate at A and E in Hull stands at about 74.9%, which is one of the lowest in the country. We also have very high levels of cancelled operations.
We now have a new chief executive, who is doing his very best, with a dedicated team of front-line staff, to deal with the pressures on A and E, and I want to pay tribute to them for their work. However, what I really wish to focus on in this short contribution is a report on financial irregularities, which has been published on the front page of my local newspaper today. It concerns the regime that existed under the former chief executive of Hull Royal Infirmary, Phil Morley, who left the hospital very suddenly last April, just before the publication of a very damning report by the Care Quality Commission, which outlined concerns about bullying, staff shortages and the care that was being provided at the hospital. Within a few months of his leaving and the damning report, he turned up as a chief executive at the Princess Alexandra hospital in Harlow, earning—I found out from a freedom of information request—£170,000. The report published this morning is a leaked report, but I want to read this out, because I am sure that all hon. Members will be concerned to learn what has happened to NHS money:
“In a draft report leaked” to the Hull Daily Mail
“external auditors KPMG, called in to investigate financial concerns, said there was ‘an undeclared conflict of interest’ between Mr Morley and chief operating officer Amanda Pye. The NHS watchdog for hospital trusts was asked to consider calling in a team involved in examining financial irregularities and suspicions of fraud ‘due to the seniority of staff involved and potential conflicts of interest’.”
That included—I am sure that hon. Members will be concerned about this—payment for a sunset cruise on a luxury yacht in 2012 for Mr Morley and senior members of his management team in Florida. It also says:
“Mr Morley amended draft minutes from a committee set up to approve salaries and additional payments to staff”.
This includes a payment made for a relocation allowance, when there was no relocation, and the person ended up having to pay £8,000 back to the trust. As I have said, there was a conflict of interest between Mr Morley and a senior member of his team.
This has all come to light as a result of the investigative journalism by Allison Coggan at the Hull Daily Mail and by Vicky Johnson at the local BBC. I think it is shocking that the chair of the audit committee, when asked on television by Vicky Johnson why she had not challenged what the chief executive was doing, said that she was scared to challenge him. This is NHS money, and we know that every penny counts. I have raised this on the Floor of the House with the Secretary of State. Initially, he said that there was nothing he could do about it, so I wrote to him and received a letter from the Under-Secretary of State for Health, Dr Poulter, saying that there was nothing that could be done. Finally, we had a meeting with the Secretary of State, who has arranged for the Trust Development Authority to investigate what was going on in that trust.
It is of concern to many hon. Members and to me that where there are financial irregularities in the NHS, it seems that chief executives can move from one trust, having made a mess of things, straight into another job. It seems as if they are protected, which it is fundamentally wrong when it is NHS money—public money. My constituents will certainly be worried about the story on the front page of today’s Hull Daily Mail, and the fact that this individual is still in a post paid for by the NHS in another part of the country earning a lot of money. I hope that the Minister can reassure me that the TDA will do a thorough and proper investigation into what went on in that trust, because it is not acceptable that this man still holds a chief executive position.
I apologise for not being in the Chamber for the beginning of the debate.
The issues raised in today’s debate about the challenges of providing health care for a population that is ageing and living longer with complex health conditions in a context of fiscal austerity and rising costs are some of the most pressing ones facing us as policy makers. We all acknowledge that it is difficult and there is no easy sound-bite solution to the long-term challenges, but I do not believe that those challenges are insurmountable if we are prepared to prioritise health spending and address pressure points in the system.
It is interesting that the hon. Lady was talking about the costs of an ageing population. Is she aware of Monday’s report by Action on Hearing Loss, which showed that as a result of budget cuts and rising demand two out of five audiology departments offer patients a reduced service? The chief executive of Action on Hearing Loss described that as having a cruel and senseless impact on people with hearing loss. Should the Government not respond to that?
I was not aware of that report, so I am grateful to the hon. Lady for pointing it out.
We all know that we do not have one NHS in the UK—we have national health services in each of the home nations that operate independently of one another and are accountable to the devolved institutions—but it is worth noting that in recent years our distinct national health services have gone down divergent policy paths. Those of us who remain committed to comprehensive health care, available free at the point of need, understand that the model is under ideological threat. I have been horrified by the NHS reforms in England that have removed the statutory duty of care, and that, as we speak, are enabling the creeping privatisation of services. For the sake of the peoples of these islands, those reforms need to be reversed, because the reality of devolution is that Westminster still holds the purse strings. The funding formula by which the devolved Governments receive their block grants is directly related to budget decisions made for England in devolved policy areas, so decisions to cut spending in NHS England, or to privatise services, have a direct knock-on effect on the money made available to the Scottish Government.
There has been a 10% cut in Scotland’s fiscal resource budget since 2010, and a 26% real-terms cut in Scotland’s capital budget. Nevertheless, the Scottish Government have increased the health resource budget by 4.6% in real terms, and every penny of additional budget consequentials accruing from health spending has been spent on health. This coming year, health spending in Scotland will break the £12 billion barrier for the first time.
The practical consequences of increased health spending in Scotland can be seen in record staffing levels—up 6.5% overall, with record numbers of consultants, over 1,700 more nurses and a 7% increase in GPs. We have cleaner hospitals—cases of MRSA are down 88%, and C. diff is down 81% in elderly patients since 2007. Our waiting times for in-patients and out-patients have improved dramatically. More than 97% of in-patients were treated within the 12-week target in the last quarter, and 90% of patients are now being seen and treated within 18 weeks of initial referral. Perhaps most telling of all, there has been a drop in the hospital standardised mortality ratios of almost 16% since 2008 and a sizeable reduction in premature deaths in the most deprived areas. And we have honoured our pay commitments to our NHS staff.
The Minister and other Members have today made many comparisons between the NHS in England and the NHS in Wales, but there have been no comparisons with the NHS in Scotland. That is because across a range of indicators the Scottish NHS is outperforming the NHS elsewhere, precisely because we have not gone down the privatisation route.
Just yesterday the brand-new Southern general was handed over to the NHS—an NHS hospital, paid for without the use of discredited private finance initiative or public-private partnership schemes that have been an atrocious waste of public money and are still costing NHS Scotland over £225 million a year. In the north-east, anyone visiting Foresterhill can see all the building work that is going on to improve facilities. Under previous Governments, NHS Grampian was severely short-changed by the funding formula, but the SNP Government have been closing that gap and next year will put in an additional £49 million, a 6% funding increase to bring it into line with other health boards.
We cannot be complacent about the pressures on our NHS. Despite the best efforts and commitment of staff, our NHS is under strain and it does not always get it right. As MPs we often see when things go wrong, but we need to see that against a background of increasing patient satisfaction overall and continuing improvement in patient care, despite enormous pressures. We heard earlier today that some of the pressure on A and E emergency care is a consequence of people having problems accessing primary care. Another area where pressure in one part of the NHS has extensive knock-on impacts is in relation to delayed discharge, which puts tremendous strain on patients, whether they are stuck in hospital desperate to get home, or stuck at home desperate to get into hospital for treatment, because no beds are available.
The Scottish Health Secretary announced an additional £100 million earlier this month to address delayed discharges, but the underlying issues are not just for the NHS. Back in 2010 the report of the Christie commission highlighted, among other things, the need for joined-up services between health boards, local authorities and others, and preventive early interventions to meet the challenges of rising costs and changing demographics in the context of tight public finances. In Scotland, much progress has been made since then, but nobody would pretend that there is not a lot still left to do, or that the process is straightforward. However, we just need to look at how the non-means-tested free personal care has enabled thousands of people to live at home to see the human benefits of what is increasingly being recognised as a cost effective-policy.
It is precisely those efforts to join up health and social care that are threatened by the austerity agenda and the promises of further cuts that both Front-Bench teams seem to have shackled themselves to. Local authority budgets are already under pressure, and further cuts to the public services that they provide, including social care and preventive early intervention work, risk driving up still further the acute pressures on our NHS. Our NHS is precious. Most of us depend upon it. We need to prioritise it and provide the resources that it needs to meet changing demands on it.
It is a pleasure to close the debate. There have been some passionate speeches from Members on both sides of the House who are really standing up for care for their constituents. My hon. Friend Emily Thornberry talked about the excellent joined-up care provided by the Whittington hospital, which I was privileged to visit, and the excellent work of Islington council, which is still funding social care for people with moderate needs and ensuring that all its home care staff are paid the London living wage, including for travel time.
My hon. Friend Helen Goodman talked about the terrible problems with long ambulance service waits, and my hon. Friend Liz McInnes talked about the difficulties with the Arriva patient transport service, a problem I have in my constituency, where there have been some appalling lapses in the quality of care.
My hon. Friend John Woodcock talked about the huge financial problems facing his trust, and made a powerful case for its uniqueness in terms of its geographical position and transport links, such that it needs to be looked at seriously in future. My hon. Friend Diana Johnson expressed concern about financial irregularities in her trust, which I hope we can get to the bottom of. My hon. Friend Grahame M. Morris did not get much time to speak, but I agree with him that the NHS, perhaps more than football or cricket, is what makes us proud to be British.
Our NHS faces huge challenges: our ageing population; the increase in people living with long-term conditions; drugs and medical technologies advancing at incredible speed; and public expectations changing rapidly too. Meeting these demands, when the NHS faces the tightest financial settlement of its life, requires a Government who are laser focused on ensuring that all our services get the best results for patients and offer the best value for taxpayers’ money.
In practice, we know that this means that some services must be provided in specialist centres, so that patients get expert treatment 24/7. Others must be shifted out of hospital into the community and towards prevention, to help people stay living at home. All services—physical, mental and social, across hospitals and in the community—must be properly joined up and personalised, so that people have the right care, at the right time, in the right place. We also need bold action on public health to prevent long-term illnesses such as diabetes, obesity and heart disease from developing in the first place and to ensure that the NHS is sustainable in future.
In the light of those huge challenges, what did the Government do when they took office in 2010? They focused not on reforming front-line care, but on forcing through the biggest backroom reorganisation in the history of the NHS, wasting three years and £3 billion of taxpayers’ money. Ministers promised that they would cut bureaucracy, but instead they created 440 new organisations—not just NHS England, 221 clinical commissioning groups and 152 health and wellbeing boards, but four regional NHS England teams, 27 local area teams, 19 specialist commissioning units, Public Health England and Health Education England, and that is obviously alongside Monitor and the Care Quality Commission. It is a system so confusing that no one knows who is responsible or accountable for leading the changes that patients want and taxpayers need to ensure that the NHS is fit for the future.
Ministers promised that their reorganisation would save money, but £1.4 billion has been spent on redundancy payments alone, and more than 4,000 people who were made redundant have since been re-hired elsewhere in the system. They promised to cut the costs of management consultancy—indeed, Mr Lansley specifically promised that those costs would be reduced by 46% by 2014. Instead, these costs have soared as hospitals and CCGs spend good money after bad to try to make sense of the new system. Last month, the British Medical Journal revealed that NHS spending on management consultancy has not been cut by 46%; it has increased by 100% to £640 million. That is enough to run three medium-sized hospitals or employ 20,000 extra nurses.
But the Government’s disastrous reorganisation does not even stop there. It is still going on. Primary care is being reorganised again because NHS England has finally realised that it cannot commission effective local GP services at a national level—just as Labour warned.
Specialist commissioning is under review because NHS England has lost grip of the budget and realised that patients need specialist services that are joined up with local care—just as Labour warned. Support for GPs in their commissioning role is being reorganised too, with commissioning support units forced to merge and then—get this!—bid to be on a list of approved organisations, including private companies, that are allowed to sell their services back to the NHS. It is a Kafkaesque nightmare of incompetence and chaos written by the Conservatives and signed by the Liberal Democrats.
As if all this was not bad enough, Ministers have made the pressures on the NHS even worse by cutting the services that help to keep people out of hospital and living at home. They shut one in four walk-in centres, scrapped the 48-hour GP waiting target, and removed Labour’s incentives for evening and weekend surgery appointments, so more people are forced to turn to A and E. They slashed social care budgets by £3.5 billion, so fewer older and disabled people get vital help to stay living at home. They cut over 2,000 district and community nurses, who help elderly people get back home from hospital and prevent people with long-term illnesses from ending up there in the first place.
What is the result? More sick, elderly people in A and E, and more patients stuck in hospital, often for weeks or months at a time, when they could be cared for back at home. Over the past 12 months, delayed discharges from hospitals have cost the NHS £280 million. This could have paid for 6,500 nurses or a year of decent home care for 40,000 people. Where on earth is the sense in that? More patients are stuck in hospital, more people are forced to wait longer for treatment, and more planned operations are being cancelled. Patients are in distress, families are struggling, and staff are under intolerable pressure.
Patients, staff and taxpayers cannot afford another 99 days of this Government, let alone another five years. They need Labour’s long-term plan for investment and reform, with an extra £2.5 billion a year, on top of this Government’s plans, to get the doctors, nurses, midwives and home care workers we need. We will join up physical, mental and social care services from home to hospital, with one team and one point of contact, to get families the support they need. We will introduce a year of care budget to create a powerful incentive for better home and community services, to keep people out of hospital, and to tackle the scandal of 15-minute home care visits. We will give more power and control to patients, with new rights to swifter cancer tests, better GP access, talking therapies and care at home. We will end the zero-hours contracts that exploit social care workers, so that elderly people finally know who is coming through their front door every morning and staff can properly plan their lives.
At the next election there will be a real choice on the NHS. It will be a choice between care going backwards, services fragmented and money wasted under the Conservatives, or Labour’s plans to fully integrate services to get the best results for patients and the best value for taxpayers’ money. It will be a choice between the Conservatives, whose Prime Minister has broken his promise to protect the NHS and thrown the system into chaos, or Labour, who will make the real investment and reforms the NHS needs to meet the challenges of the future. It will be a choice between the Conservatives’ unfunded plans to cut taxes for the wealthiest and make even deeper cuts to social care, or Labour’s fully funded proposals and 10-year plan to ensure that the NHS is sustainable for the future. I commend the motion to the House.
It is a pleasure to follow Liz Kendall. In truth, I think we have heard a great deal more consensus about the future of our health services than the Opposition sometimes like to pretend. It has been obvious that Members in all parts of the House care passionately about their local services. They have spoken up clearly on behalf of local staff who are working so hard through this winter. I thank all hon. Members for their contributions.
All Members speaking up for their constituencies are doing so because they care about their local health services. They also accept the challenge that the NHS and the whole health service in England is facing but is collectively rising to meet. Hard-working NHS staff do not need to hear the endless politically driven scaremongering that we hear all too often from Opposition Members. That was highlighted by my hon. Friend Chris Heaton-Harris and by many colleagues who have come here with scaremongering leaflets from their constituencies saying the very opposite of what is true. Far too much of that is going on. It must be absolutely demoralising for staff who are working hard in the face of winter pressures.
Despite the huge financial pressures we were faced with when we came to office, such as the need to reduce the deficit we inherited, which was, as Members have said, the worst peacetime—
I will make some progress; the hon. Gentleman has made a contribution.
Not only has NHS funding in England been protected; it has risen in every year of this Parliament. That is an indisputable fact that flies in the face of the Opposition’s financial scaremongering. As a result of the additional £2 billion funding for 2015-16 the Chancellor announced in the autumn statement, funding in 2015-16 will be £16 billion higher in cash terms than in 2010-11. Those are the facts. That equates to an increase of £6.8 billion in real terms. That additional investment is a down-payment on the NHS’s own plan, which was set out in the “Five Year Forward View”. The chief executive of NHS England, Simon Stevens, has said that the autumn statement gives the NHS what it needs for next year.
Winter is always challenging for the NHS. This year, it comes on top of a significant increase in A and E attendances, which have been higher than in any year since 2010. On average, 3,000 more patients each day are being seen and treated in under four hours than under Labour. As my hon. Friend Margot James set out clearly in going back over the past few years, the additional funding the Government have put in emphasises the priority we place on the NHS. That makes utter nonsense of the claim that we are going back to 1930s levels of funding.
That is ludicrous, and Opposition Members parroting that because they have been told to insults the intelligence of every Member of the House. It is nonsense.
I remind all Opposition Members of their predictions about employment at the beginning of this Parliament. If any of them wants to remind us of those, they can be my guest.
We recognise the significant and continuing pressure on services in the short term and the need to invest in new ways of providing care for the future.
This Government have put more performance data in the public domain and have put an unprecedented emphasis on transparency. Indeed, some of the statistics Members quote in these debates are in the public domain only because the Government have put such an emphasis on transparency. Transparency is one of the key drivers of safety in our system.
As public health Minister, I welcome the focus on prevention in the “Five Year Forward View”. I think this is common ground across the parties. Prevention has to be a key part of the NHS’s plans. When we keep people healthy and out of hospital, it is a win for them and a win for the NHS. Mention has been made of the national diabetes prevention programme. We will be the first country in the world to implement such a programme at scale to help prevent the onset of the disease and reduce demand on the NHS. Investing in the NHS with a focus on prevention is one of the keys to a sustainable footing for the NHS in the long term.
Thanks to the work of NHS staff and the funding protection provided by the Government, the NHS is treating more patients than ever. Again, that flies in the face of all the dire threats about its peril. There are 9,000 more doctors and 3,300 more nurses. The additional funding announced by the Chancellor in the autumn statement will enable the NHS to continue to meet the rapidly rising demand in the short term, while making investments in new services and facilities to transform care for patients and ensure that the NHS is sustainable in the long term.
The Minister mentioned an increase in the number of nurses, but there is no increase in the number of district nurses, of whom we have lost thousands. Week in, week out, the Health Committee keeps being told how serious that is for all aspects of care in the community.
I am sure that, like me, the hon. Lady will welcome the 589 new nurses in her trust.
The more sensible Opposition Front Benchers have made it clear in interviews that the link between reform and investment is important. I want to pay tribute to the NHS, which is well on track to make up to £20 billion of efficiency savings to be reinvested in front-line care. For example, the NHS is securing savings of £2 billion a year as a result of the drive to tackle waste and improve procurement. Tough decisions were taken at the beginning of this Parliament to protect the NHS budget—against the advice of the Labour party—that have allowed us to strengthen family doctoring and reform out-of-hospital care. We all agree that integrating health and social care is important, and that is exactly why the Government have the £5 billion better care fund. It is an area on which—despite what Opposition Members say—there is significant consensus. They should support that fund instead of, as I recall, inviting us to put it on pause.
We have heard about how Labour plans to raise more money for the NHS, but in 2015-16 it would raise nothing. The Government are already consulting on a tobacco levy. The tax on family homes, by the Opposition’s own admission, would not start until 2016-17 and has already been spent three times—paying down the deficit, funding the NHS, getting rid of the 10p rate. As a London MP, I have to say that the chance of the homes tax surviving Labour’s London mayoral candidate race is minimal, given the raining down of ire on it from Labour MPs in London. On top of that, Labour plans to spend an extra £5 billion, including more than £2 billion on committing equal resource to physical and mental health and more than £1 billion on GP access—it just does not stack up.
We came into government with a long-term economic plan to reduce the deficit and build a stronger economy, with a commitment to protect and safeguard the NHS. We have kept that important promise on the NHS and we kept our promise on the success of our economic plan. We recognise that the NHS still faces significant challenges, both short and long term, as Liz Kendall laid out—rising demand, an ageing population and growing expectations—but it is only through sticking to our long-term economic plan that we are able to put the investment in. We are making a down-payment of £2 billion on the NHS’s five-year forward view and we fully support the long-term vision for the NHS, by the NHS—by the most senior and experienced clinicians in our country. The Government have committed to put more resources in now and in the future to give all our constituents a better service, free at the point of use and fit for the future.