I beg to move,
That this House recalls that the Prime Minister made a series of personal pledges on the NHS in the run up to the General Election which were carried over to the Coalition Agreement; believes it is now clear he has failed to honour three of the headline commitments in the Coalition Agreement; notes firstly that Treasury figures from July 2011 confirm that NHS spending fell in real terms in 2010-11, contrary to the guarantee that health spending will increase in real terms in each year of the Parliament; notes secondly recent central approval of changes to hospital services, in breach of a moratorium on such changes; notes thirdly the Prime Minister’s continuation, despite widespread opposition, with the Health and Social Care Bill, contrary to the pledge in the Coalition Agreement to stop top-down reorganisations of the NHS; believes there is mounting evidence that the combination of an unprecedented financial challenge combined with the biggest reorganisation in the history of the NHS is damaging patient care and leading to longer waiting times; is concerned that huge cuts to adult social care in England will further limit hospitals’ ability to cope with coming winter pressures; and calls on the Government to listen to GPs and NHS staff, drop the Bill and accept the offer of cross-party talks on reforming NHS commissioning.
We read today that the Government were in open retreat last night on their Health and Social Care Bill in the House of Lords. Given that, we thought it only right to bring the Secretary of State here today to be held to account by this elected House. He tried to shuffle off his responsibilities and dug in when the Bill was in this place, only to give in down there. That came just hours after he had to confirm that he would still take oral questions in this House, despite a claim to the contrary by his preferred candidate to take over the running of the NHS. The Secretary of State may be on the run, but we will not let him hide. Our NHS is too precious to too many people in this country to be carved up in dodgy coalition deals in the unelected House. His Bill is unravelling before his eyes, and coalition health policy is in chaos. Today, we hold him to account for that.
To be fair to the right hon. Gentleman, the responsibility is not all his. It goes right up to the door of No. 10 Downing street. People will remember only too well, in the run-up to the general election, the then Leader of the Opposition’s ostentatious shows of affection for the NHS, his airbrushed face on the posters and three very personal promises—real-terms increases in every year of this Parliament, no accident and emergency or maternity closures, and no top-down reorganisation of the NHS. He protested his love for the NHS, and at photo call after photo call on the wards he routinely wore his heart on his sleeve. As we now know, he was protesting a little too much, and today we expose the hollowness of his promises.
May I take this opportunity to congratulate the right hon. Gentleman on his new post? He is back where he once was, but on the other side of the House.
Last year, in The Guardian, the right hon. Gentleman stated that it was
“irresponsible to increase NHS spending in real terms”.
Does he still stand by that statement?
I am not sure whether I should thank the hon. Lady for reminding me that I am now a shadow of my former self, but I thank her for her words. I will come to the precise question that she asks. I did indeed say those words, and I will explain why in a moment.
I was talking about the three headline promises that the Prime Minister made on the wards. They were part of a calculated and self-serving political strategy to detoxify the Tory brand, not a genuine concern for the NHS. It was cynical because, as we will show today, those were cheques for the NHS that the Tories knew they could not cash, and promises that they had no real intention of keeping. Let us take the Prime Minister’s three personal promises in turn, starting with the one on NHS funding. It will be good to get to the bottom of that once and for all.
At the last election, Labour promised to guarantee to maintain NHS front-line funding in real terms. The now Prime Minister, by contrast, offered real-terms increases. How big those increases would be was undefined, but that did not matter. The important thing was that, according to the requirements of the detoxification strategy, it sounded as though the Tories were planning to spend more.
I remember well our resulting exchanges with the then shadow Health Secretary, now the Heath Secretary, on the hustings. Indeed, the Prime Minister has in recent weeks been quoting what I said then, as the hon. Member for Chatham and Aylesford (Tracey Crouch) did a moment ago. I did indeed say that it was cynical and irresponsible to make those promises, and I repeat that today.
Does the right hon. Gentleman consider “protecting the front line” to be the closure of many hospitals throughout the UK, mergers and the loss of vital cardiac services in such places as Ipswich? That was exactly what happened when he was Secretary of State.
The hon. Gentleman goes right to the heart of my speech today. We made those difficult decisions to get the NHS ready for the future. We grasped the nettle and took services out of hospitals and moved them into the community, because that is what has to happen if we are to have an NHS that is sustainable for the future. He stood on an election manifesto that promised the opposite. It was a dishonest pledge, and I will come to it in a moment.
I said a moment ago that it was irresponsible to promise real-terms increases. I say that because I completed a spending review of the NHS in March 2010 and knew the figures inside out. I had also been in detailed discussions with the Treasury on the funding of adult social care, in preparation for a White Paper. The implication of what the Conservatives featured on an election poster—cutting the deficit on an accelerated timetable while giving the NHS real-terms increases—could mean only one thing: unpalatable cuts to other public services, particularly adult social care, on which the NHS relies.
Despite that, the election pledge was carried over into the coalition agreement, which could not be clearer. It states:
“We will guarantee that health spending increases in real terms in each year of the Parliament”.
A year ago, at the time of the comprehensive spending review, the official figures claimed that that had been delivered, with a 0.1% settlement—essentially the same as Labour promised at the election.
Does the right hon. Gentleman recall that before the general election, when he was Secretary of State, he said in the now infamous King’s Fund speech that the state should always be the preferred provider, irrespective of the quality of care that it provided to patients? Does he stand by that statement today, or is he now trying to drive a patient-centric health service rather than putting political ideology above patient care?
I think I should refer the hon. Gentleman back to the King’s Fund speech, because I did not say the NHS should be the preferred provider regardless of the quality of care it provided. I believe that the public NHS should have the first chance to change, and that was the preferred provider policy. We did not want to pull the rug from under the public NHS with a policy of “any willing provider”. If the NHS needed to change, we wanted to tell it, “You have to rise to the challenge, and you have a chance to do so. If you cannot, other providers will get a chance to come in.” That was the preferred provider policy, and I would be grateful if he did not misrepresent it.
As I said, a year ago the Government provided a 0.1% increase—or that was the headline, but the fine print began to emerge and their case began to fall apart from day one. It soon became clear that for the years 2011-12 to 2014-15, that figure included an annual £1 billion transfer to local government, ostensibly for social care but not ring-fenced, so councils would be free to spend it as they saw fit. The health funding settlement therefore already went below a real-terms increase. That transfer turned the apparently minuscule real-terms increase into a real-terms cut.
That still leaves 2010-11. When the coalition came into government, it immediately required primary care trusts to cut spending by increasing waiting times and restricting access to treatment, to generate an underspend in 2010-11.
Ministers are shaking their heads, but I will read them the Treasury figures published in July this year, and let them tell me then that what I have just said is not true. The public expenditure statistical analyses from this year provide official confirmation of what I have just said. They show that in 2009-10 health spending was £102,751 million. That was in the last year of the Labour Government. In 2010-11, health spending was £101,985 million. There we have it in black and white—the first real-terms cut in health spending for 14 years. In fact, it is the first real-terms cut since the last year of the last Tory Government in 1996-97.
I am interested to hear how the right hon. Gentleman is trying to manipulate those figures. How does he reconcile what he is saying with what his party’s Administration is doing in Wales, where the health service has been cut and hospital infections and waiting times have risen?
The hon. Gentleman uses the word “manipulate”. May I say that I take great exception to that? I have read out the Treasury statistical analysis from this July. If he is telling me that I have misrepresented it, let him stand up again now and say so. If not, he should hold his peace. I remind him that his party’s Government delivered a much deeper cut to Wales than to Scotland or Northern Ireland. The Labour Administration are now dealing with the consequences of that.
The right hon. Gentleman’s figures depended on the lack of what he called a ring fence in the social care transfer of £1 billion. I can assure him that as far as Suffolk is concerned, there is absolutely no problem in trying to deal with the ring fence. In fact, the county council spends more than the amount that was previously ring-fenced, because of the pressure on social care.
The hon. Gentleman was not listening. The social care transfer comes in for the years 2011-12 to 2014-15, but I was talking about the year 2010-11 and, in the year ended, there was a real-terms cut to the NHS, as confirmed by Treasury figures. This debate is about that fact. He and his hon. Friends stood at the election, with those airbrushed posters all around them, promising that they would not cut the NHS, but in their first year in office, they delivered a real-terms cut to the NHS.
Is it not the case that, whatever Government Members say, 82% of councils offer social care only in critical and substantial cases, that thousands of people up and down the country are suffering the loss of their services, and that that will have a real hit on the NHS in years to come?
My hon. Friend makes a very important point. That was precisely why I said it was irresponsible for the Conservatives to promise increases to the NHS in the way that they did, on a much-reduced public spending envelope. That has led to precisely the consequences that she describes. Indeed, that hidden cut to adult social care has been quantified at £2 billion.
I remember well Conservative party claims before the election about death taxes, but what about the dementia taxes that the Conservatives have loaded on to vulnerable older people up and down this country, who are now paying more out of their own pockets to pay for the care that they desperately need? That is the effect of cutting adult social care and cutting council budgets in that way.
We today the nail the position once and for all. The real position is worse than the one I described because of spiralling inflation, which in effect means even deeper real-terms cuts for the NHS this year and in all the years that follow.
The right hon. Gentleman mentions that the £2 billion transfer from the NHS social care budget is not ring-fenced, but I am sure he is aware that ring-fencing can have the perverse effect of ensuring that local authorities do not spend existing budgets. Will he clarify his position? Is ring-fencing a good idea or not?
I disagree with the hon. Gentleman. I said that it was irresponsible to pledge the money for the health service in the way that the then Opposition did in the run-up to the election precisely because I realised that more would be needed for adult social care. However, if the NHS is to transfer money to local government for adult social care, we must be certain that it will pay for that and not for weekly bin collections or for whatever else he thinks is more important than supporting older, vulnerable people with the costs of care. He makes my point that that money should have been ring-fenced, so that adult social care could have been protected.
I compliment my right hon. Friend on how he is moving the motion. What are his views on the impact of the reduction of funding for the NHS on the front line, and on the number of hospital trusts that are breaching the 18-week target?
I am grateful to my hon. Friend for those words and I shall come to precisely that point, but let us be clear about this one: the Prime Minister promised a real-terms increase, but he has delivered a real-terms cut. He stands at the Dispatch Box week after week boasting about increasing health funding when he has not. All the while, NHS staff deal with the reality on the ground of his NHS cuts. Does he not realise how hopelessly out of touch he sounds? Hospitals everywhere are making severe cuts to services, closing wards, reducing A and E hours and closing overnight, making nurses redundant, and cutting training places. Last week, The Guardian revealed the random rationing that is taking place across the country. There are cuts to pay for management services, one third of neo-natal units are reducing the number of nurses, and midwife places are being cut despite the Prime Minister’s promise to recruit 3,000 more.
The right hon. Gentleman is making a great deal out of cuts. The Government have committed an extra £15 billion to the NHS over the lifetime of this Parliament, but the Opposition have consistently failed to agree to commit to any additional funding. Will he make that commitment now?
Is it fair to say that under his leadership of the NHS, Monitor suggested that it needed to make efficiency savings? Those are coming through now, but the right hon. Gentleman is trying to present them as cuts to front-line services.
No. Let me explain the position to the hon. Lady so that she understands it. It is correct that in the previous Parliament, not Monitor, but the chief executive of the NHS, suggested that the NHS would have to make around £20 billion of efficiency savings over the four years of this Parliament. That is called the Nicholson challenge, which I accepted. However, contrary to what the Prime Minister said at the Dispatch Box last week, it was intended that every penny of that money would go back into the NHS to help it to deal with the pressures that it faces. I am afraid that the Government are again misrepresenting my position.
My position is different from the Secretary of State’s because that challenge, on its own, would have been all-consuming for the NHS, meaning that it would have had to focus every ounce of its energy on rising to that challenge. The last thing in the world that the NHS needs is a huge reorganisation, because it will take its eye off the ball, meaning that it cannot rise to that challenge.
Is my right hon. Friend aware that during the so-called “pause for thought”, nothing was done to stop the NHS reorganising ahead of legislation that was yet to go through Parliament? Was that not contemptuous of both Parliament and of the genuinely held concerns of Liberal Democrat coalition partners?
Frankly, it is disgraceful that primary care trusts were allowed to disintegrate before Parliament had given its consent to those changes, leaving the NHS in limbo in most communities represented in the House. I have said that the Government have put the NHS in the danger zone, and I mean it. There is no capacity on the ground to help the NHS through these difficult times. It has lost the grip it would have needed to take us through the financial challenge, and I lay that charge directly at the Secretary of State’s door.
I will give way in a moment.
I mentioned that the Prime Minister is out of touch, and that he promised to recruit 3,000 more midwives and then handed out redundancy notices to them. However, if the Prime Minister is out of touch, I worry that the Secretary of State is in outright denial. On 11 October, when my hon. Friend the Member for West Lancashire (Rosie Cooper) asked him about the practice of hospitals re-grading or down-banding nursing posts to cut their costs, he replied:
“I am not aware—my colleagues may be—of…trusts…seeking to manage their costs by the downgrading of existing staff. If you are aware of that, then, by all means, tell us, but I was not aware.”
The very next day, that version of events was directly contradicted by Janet Davies of the Royal College of Nursing, who said that
“the Royal College of Nursing has raised the issue of downbanding with the Secretary of State on a number of occasions, alongside other concerns such as recruitment freezes and redundancies in the NHS…Our members’ survey released earlier this month also revealed that 7% of nurses expect to be downbanded in the next 12 months”.
If the Secretary of State would like to correct the evidence that he gave to the Select Committee on Health and confirm that he was aware of the practice of down-banding, he can be my guest right now.
The Secretary of State directly contradicts, on the record, a spokesperson from the Royal College of Nursing. If he stands by his evidence, will he publish the minutes of his meetings with the RCN in which it states that the issue of down-banding was specifically discussed?
My hon. Friend is nodding. Why has the Secretary of State not responded to the letter that my hon. Friend sent to him several weeks ago pointing out the discrepancy between his evidence and the statements from the RCN? If he wants to adopt a pious tone in the House, he needs to reply to his letters on time and put his facts on the record.
If the right hon. Gentleman is going to insult me, he ought at least to give way. I have seen no letter from the hon. Member for West Lancashire (Rosie Cooper). I have seen a letter from the Chairman of the Health Select Committee, to which I approved an answer.
Well, that is no good to me. We have not seen that answer. The right hon. Gentleman needs to reply to hon. Members’ correspondence in a timely fashion, especially when it relates to serious issues about discrepancies between his evidence and statements made by the RCN.
I would like to inform both my right hon. Friend and the Secretary of State that I did, in fact, write to you but have received no reply. In my letter, which I shall ensure gets to you again, I asked you to publish the minutes of that meeting. It was very clear. One or other of you have made a severe error.
It is clear that we will get to the bottom of this, because the Secretary of State has committed to publishing the minutes, and if he is suggesting that the RCN has been inaccurate, he needs to produce the evidence.
That takes me to the Prime Minister’s second personal promise on the NHS, which deals with hospital reconfiguration and the mythical moratorium.
I shall give way in a moment.
If we thought that the Conservative party’s promises on funding were bad enough, the sheer audacity of its claims on hospital closures is breathtaking. Before the last election, the right hon. Gentleman toured the country promising the earth to every Conservative candidate he met. I recall seeing his commitments—I have them here—pile up in the Ashcroft-funded glossy leaflets that landed on my desk in the Department of Health. He said that he would reopen the accident and emergency department in Burnley; he said that he would save and A and E in Hartlepool, but, scandalously, only if the town elected a Conservative MP; and I well remember the day he visited his hon. Friend—although, after this week, I doubt that the Government Front Bench team still consider him a friend—the hon. Member for Bury North (Mr Nuttall) and promised the people of Bury in the leaflets I have here:
“Vote Conservative and if there is a Conservative government the maternity department will be kept open.”
It could not be clearer. However, the maternity department at Fairfield hospital is scheduled to close next March. It is disgraceful. However, the Prime Minister’s most shameful politicking came in north London. I lost count of the number of times he promised to save the A and E department at Chase Farm hospital.
Order. I am grateful to the right hon. Gentleman for that clarification, but perhaps this is an opportunity for me to make the position clear. I am not cavilling at the hon. Member for Kingswood (Chris Skidmore), but the position is basically this: if a Member is going to impugn the integrity or attack the record of an individual hon. Member, the Member who is the subject of the criticism should be notified in advance. The fact that someone simply intends to refer to another Member and something that may or may not have happened in his constituency during an election campaign, or at any other time, is not something of which prior notification is required.
After that rude interruption from the hon. Member for Kingswood (Chris Skidmore), I shall get back to my script.
Just days after the election, the Prime Minister went to Chase Farm hospital, with the Secretary of State, to announce the coalition’s new policy of the moratorium and the following commitment in the coalition agreement:
“We will stop the centrally dictated closure of A&E and maternity wards.”
I have with me the photograph from that very visit of the Secretary of State holding up a placard stating his opposition to any changes to the A and E at Chase Farm hospital. However, he has recently failed to prevent those changes to the A and E department and maternity unit at Chase Farm hospital, leaving the new hon. Member for Enfield North writing a desperate letter to the Prime Minister stating that his constituents had been utterly let down by them both. I do not know whether the Prime Minister or the Secretary of State have the decency to feel embarrassed today, hearing these cynical promises repeated in the House. The proposed moratorium and opposition to closures were purely political and designed to help the Conservatives win votes in marginal seats. That is a fact.
I apologise for not having intervened quickly enough earlier, but the right hon. Gentleman says that he accepts the Nicholson challenge. Given that efficiency savings will have to be made in the NHS, where does he envisage those savings being made? It seems to me that every hospital trust will have to make efficiency savings somewhere, as a result of the Nicholson challenge.
The hon. Gentleman asks a very fair question. It is precisely such issues—about how to produce the savings—that are the important issues. Care has to be taken out of the hospital setting and we have to prevent too many elderly people, in particular, from going into hospital in the first place if we are to create an NHS that is able to face the future and that is financially and structurally sound. That is why I take such exception to the naked opportunism that we saw before the election, when I, as Health Secretary, was taking on some of those difficult challenges and grasping the nettle, including in my own backyard in Greater Manchester, where there was a difficult review of maternity and children services, involving the closure of four maternity units and shrinking their number to eight. We did that, we took on that debate, and yet the now Health Secretary was touring those marginal constituencies in Greater Manchester, saying that he would overturn our decision in office, but he has not done it. That is precisely the point that I am making to the House. We need a Health Secretary prepared to take those difficult decisions, if the NHS is to be able to make the savings that will sustain it in the long term.
I am grateful to my right hon. Friend for giving way, because like the hon. Member for Banbury (Tony Baldry), I missed the opportunity to intervene when efficiency savings were being discussed. Does my right hon. Friend agree that the key to this problem is proper discussion with the experts within the health service—with the nurses, doctors and all the people who administer our fantastic service? They are the ones who can give us ideas for efficiency savings. The hallmark of the Government is their failure to listen to the professionals.
My right hon. Friend makes an important point. When we were in government, we said that there had to be a clinical case for change, if changes to hospital services were to be made. I mentioned Greater Manchester a moment ago. There was a clinical case to support those reforms. The experts, to which she rightly pointed, said that about 50 babies’ lives would be saved every year by specialising care in fewer locations. In such circumstances, politicians have a moral obligation to listen to those experts and to make changes, no matter how politically difficult they are. That is why I say that it was sheer opportunism of the worst kind for the Government, when in opposition, to say that they would have a moratorium on any changes and to tour those marginal constituencies promising to overturn decisions, when in fact they had no intention of doing so. I put it to the House that the people of Bury, Burnley and Enfield have now clearly discovered what opportunism there is from those on the Conservative Front Bench.
Does the right hon. Gentleman therefore welcome one of the Government’s first actions, which was to change the NHS operating guidelines for reconfigurations to ensure categorically that clinicians and the communities they serve were in the driving seat for future reconfiguration of the NHS?
If that is the case and the people of Enfield are in control of the decision, would Chase Farm A and E be closing? What the hon. Lady describes is a complete and utter reinvention of the moratorium policy. She stood on an election manifesto that promised a moratorium. Where is it? It has not materialised. It is a mythical policy that was designed to win votes; it had nothing to do with the good stewardship of the national health service.
I thank my right hon. Friend for giving way, and yes, I do have an interest because constituents of mine have been affected by the decision at Chase Farm. Not only did the Secretary of State come to Chase Farm immediately after the election, but he announced the change in policy on reconfigurations. He introduced the so-called four tests, none of which has ever saved any unit, in any part of the country. The reality is that he seriously misled the people of Enfield, who are now bearing down on their Member of Parliament, who also misled them on this policy. It is an outrage and they feel badly let down by this Government on health service reform.
For the avoidance of doubt, let me address directly what my hon. Friend has said. A moment ago I mentioned a photograph of the Secretary of State on a visit to Chase Farm hospital just days after the election, when he announced his so-called moratorium—although no one has yet seen any evidence of it. He is holding up a placard in that photograph that says, “HANDS OFF! Chase Farm A & E”, underneath which are the words: “I oppose any cutbacks to our A & E,” and on the bottom we can see his signature. How on earth he can square that with the letter that he recently exchanged with his hon. Friend the Member for Enfield North, I do not know. I do not know how the Secretary of State can reconcile those two things in his mind or how he could look anyone in Enfield North in the eye, having promised them that he would save their accident and emergency department. It is quite scandalous. People across the country are discovering that the Prime Minister’s moratorium is utterly meaningless, as A and Es restrict opening hours and maternity wards close.
We now come to the third of the Prime Minister’s broken promises, on NHS reorganisation. Again, the coalition agreement could not have been clearer:
“We will stop the top-down reorganisations of the NHS”.
I have never understood how those in the coalition could possibly sign up to those words, when only weeks later they would bring forward a White Paper heralding the mother of all reorganisations, the biggest since 1948. I can see the cynical politics behind the Prime Minister’s first two pledges, but on this pledge at least he was right. A reorganisation is precisely the last thing that the NHS needs right now. I am clear: the abandonment of that pledge is the Prime Minister’s biggest mistake in office. If he ploughs on, he will ultimately pay a heavy price for it, because it is a catastrophic error of judgment to combine the biggest ever financial challenge in the NHS with the biggest ever reorganisation.
As Health Secretary, I was told by officials that rising to the financial challenge would require every ounce of our energy and focus. The NHS would need stability. Instead, this Government have picked up the pieces of the jigsaw and thrown them up in the air, distracting the service at the very moment it needed maximum focus. Grip has been lost; the NHS is drifting.
I said just a moment ago that I was the one who put my name to the Nicholson challenge, because that money was going to help the NHS respond to the new demands placed on it at this difficult time, so the hon. Gentleman need not lecture me about efficiency. He needs to tell me how placing a moratorium on change in the NHS helps it to respond and deliver those efficiencies. That is the contradiction of his position, and he stood for election on that policy, as did others.
I accept that the Health and Social Care Bill is the longest and most incoherent suicide note in NHS history. Indeed, I am robust on this issue: I have voted against the Bill and will continue to take that view. However, considering that the right hon. Gentleman was involved when preferential arrangements were provided for private sector providers coming into the NHS, is this debate not an opportunity for him to acknowledge that at the Dispatch Box and apologise to the House for what was a rather ridiculous and one-sided policy?
Let me first acknowledge the hon. Gentleman’s courage in standing up and voting against the Health and Social Care Bill. I just wish that more of his Liberal Democrat colleagues had similar conviction and principle, and could stand up to the Government on a Bill that he knows—and which, in their heart of hearts, many of them know—will seriously damage the NHS.
The hon. Gentleman also asked me about the introduction of private sector capacity. I will not apologise for that, because that additional capacity was brought in to bring down NHS waiting lists, something that benefited his constituents. By bringing in that extra capacity we brought down NHS waiting lists to an all-time low and delivered the 18-week target. I am not going to apologise for that. The reason the NHS commands such strong support in the country today is that people’s experience of it improved in those years. I mentioned the preferred provider policy a moment ago. I believe that the private sector has a role to play in delivering world-class care to patients, and I am happy to put that on record.
At the heart of the current Bill are the 98 clauses that introduce competition law into the national health service—something that the last Government did not pass even one clause to do. Is not the ideology lying at the heart of the Bill what will wreck our national health service?
My right hon. Friend makes an incredibly important point. Make no mistake: if the Bill passes, the NHS will never be the same again. The Bill will unpick the fabric of a public national health care system—a planned system—and turn it into a free-for-all, as he says. Indeed, it is unbelievable to see a letter in The Guardian today from senior Liberal Democrats—many of whom made the same argument a few weeks ago as my right hon. Friend—now saying that, because of a few tweaks to the Secretary of State’s powers, the time has come to abandon all their concerns about the provisions. That is a ridiculous statement to make. If they still have concerns about competition and privatisation, they should have the courage of their convictions and stand up against the Bill, instead of writing sanctimonious letters to The Guardian.
Grip has been lost; the NHS is drifting. However, the Government cannot say that they were not warned. Sir David Nicholson, the chief executive of the NHS, told the Public Accounts Committee that the reorganisation had increased the scale of the financial challenge:
“I’ll not sit here and tell you that the risks have not gone up. They have. The risks of delivering the totality of…the efficiency savings that we need over the next four years have gone up because of the big changes that are going on in the NHS as a whole.”
This has been a lost year in the NHS—a crucial year, when it needed to face up to the financial challenge—but things are not getting better. We face months of further uncertainty, as the Secretary of State battles on with his complicated and unwanted Bill. Four-hundred and ninety pages, 70-page letters to peers, amendments made on the hoof: it is a total mess. The NHS deserves better than this. Even the man the Secretary of State brought in to run his new NHS Commissioning Board describes his Bill as “completely unintelligible,” and went on to say:
“It is going to be messy as we go through a very complex transitional programme.”
And this from the Secretary of State’s friends.
The harsh truth is that the Secretary of State has comprehensively failed to build the consensus he needs behind his Bill. GPs do not want it; nurses do not want it; midwives do not want it; patients do not want it. I say to the Prime Minister and the Health Secretary today: stop digging in. Drop this Bill. If they do, my offer still stands, as our motion makes clear. We will work with the Secretary of State to reform NHS commissioning, giving GPs and other clinicians a bigger role. That can be achieved without legislation and a major structural upheaval of the entire NHS. It can be done through existing legal structures, giving immediate stability and saving millions.
We make our offer again today, as it is time for all politicians to put the NHS first. It is slipping backwards, and the warning signs are there for all to see. Waiting lists and waiting times are getting longer, with a 48% rise in the last year in the numbers of patients waiting more than 18 weeks. When patients are waiting longer, it is unforgivable that £2 billion to £3 billion has been set aside to pay for the costs of reorganisation. It is also unforgivable that £850 million is being spent on making people redundant who will end up being re-employed elsewhere in the system, in the new clinical commissioning groups.
We are witnessing a return to the bad old days of waiting longer or paying to go private. This is just a glimpse of the future. If the Bill passes, the NHS will never be the same again. We have all seen the adverts on television for the health lottery. Is this the right hon. Gentleman’s early marketing and his new brand name for our NHS?
Does the right hon. Gentleman not accept that one of the severe problems that the national health service is facing came about on his watch, when primary care trusts were allowed to build up huge deficits without making the economies and efficiencies that should have been made at that time, rather than on this Government’s watch?
I have never said that the NHS was perfect, or that there were no challenges during our time in government. But let me tell the hon. Gentleman what happened when the NHS was facing those deficits in 2006 and 2007. We took a grip at the centre and we brought those trusts back into financial balance, through hard work. There was a turnaround team in the Department, and we made sure that those difficulties were tackled at root. I do not see the same grip in the national health service right now. I see drift and lack of focus, and I see huge distraction as a result of this unwanted Bill.
The image that the right hon. Gentleman has just painted is totally inaccurate. The Royal Cornwall Hospitals NHS Trust is struggling with an enormous debt, which it incurred as a result of enormous reorganisations under Labour and a ridiculous accountancy measure that doubles the debt every year. I will not take comments like that from the right hon. Gentleman, because Cornwall has been left in a very difficult situation that this Government have been left to sort out.
I did not say that everything was perfect, but I said a moment ago that we took a grip on those problems and dealt with them from the centre. In the hon. Lady’s Government’s NHS, there will be—what are the words?—no bail-outs. Everyone will be left to fend for themselves. Does that mean that her hospital will be allowed to go bust? I do not know, but that is the implication of the Secretary of State’s White Paper and Bill, and she needs to direct her questions to him.
The fact is that we are now looking at a national postcode lottery, in which GPs are free to send letters to patients telling them that minor operations must now be paid for, and in which hospitals no longer have maximum waiting times for NHS patients and can devote the freed-up theatre time to private patients as there is no longer any cap on private work. The Government have placed the NHS in the danger zone. It has been placed there by a Prime Minister who said “Trust me” and has gone back on his word. He wrote cheques for the NHS in opposition that he knew he would not be able to cash when in government. He made promises that he knew he would be unable to keep, in order to win votes. This is the Prime Minister’s very own great NHS betrayal, and, far from detoxifying his party, he has proved once and for all that we really cannot trust the Tories with our NHS.
I ask the House to reject the motion. I am sorry about the tone of much of what the right hon. Member for Leigh (Andy Burnham) said. This was his first opportunity to make a speech about the NHS and I thought that he might take the trouble to thank NHS staff for what they have achieved over the past year, rather than disparage and denigrate everything they have been doing. I also thought that he might take the opportunity to approach the issues facing the NHS from the standpoint of patients, rather than simply playing politics with the service, but he did not. Insulting me was the least of the problems in his speech. It seemed like the Burnham memorial speech—clearly no hard feelings about losing the election, then. Having spent 13 years in the House in opposition, I shall—at the risk of patronising him—give him a few words of advice: do not keep fighting the election that you lost. It is not the way to win any future election, and it will carry absolutely no credibility in the NHS.
Equally, the right hon. Gentleman will carry no credibility by wandering around telling people that he was not planning to cut the NHS budget, given that he made it absolutely clear in The Guardian last year that that was exactly what he intended to do and that he told us, in the run-up to the spending review, that it would be irresponsible to increase the NHS budget in real terms. I searched the Labour manifesto for any commitment to funding the NHS in real terms, but there is none. In March 2010, he might have said that he knew all these things, but he did not tell the public about any of it—[Interruption.] Well, it is here in his manifesto. The only reference to any kind of investment in the NHS is a plan to
“refocus capital investment on primary and community services”.
In a moment.
We know what that meant, because when we opened the books on arriving in the Department we saw that Labour was planning to slash by more than half the capital budget of the NHS. Every Member of Parliament who has a major hospital building programme in their constituency would have been affected by that. That might include my hon. Friend the Member for Harrow East (Bob Blackman), who has the Royal National Orthopaedic hospital in his constituency, or Members from Liverpool, who have the rebuild of the Royal Liverpool and Broadgreen hospitals and, all being well, the rebuilding of Alder Hey. That might also include the hon. Member for Copeland (Mr Reed). The last Labour Government, before the election, cut the capital budget, and his project—the West Cumberland hospital at Whitehaven—could have been at risk as a consequence of that. [Interruption.]
I went with my colleagues; in fact, the Chief Secretary to the Treasury stood here at the Dispatch Box and reconfirmed support for that project, so I will not have any nonsense from the hon. Member for Copeland. [Interruption.] Withdraw that. I have not misled the House. The Chief Secretary to the Treasury came here and reconfirmed support for that project. I will not put up with being told from a sedentary position that I am misleading the House. I ask the hon. Gentleman to withdraw that accusation.
Order. I am sure that it was not intentional, and I am sure that the hon. Member for Copeland (Mr Reed) would not wish to leave it on the record. [Hon. Members: “Withdraw. The hon. Gentleman has been asked to withdraw.”] Order. I do not need any advice. I am sure that it was not intentional, and that the hon. Member for Copeland would not wish to leave it on the record.
One of the reasons that the House should reject the motion is that it is deeply flawed. Let me just take up the hon. Lady’s argument. What an own goal it is for Labour to say that NHS funding fell in 2010-11. That was the last year of the Labour Government’s spending plans, not ours. The amount available to the NHS in 2010-11—[Interruption.] I am answering the hon. Lady’s question. The amount available to the NHS in 2010-11 was exactly the same amount as the last Labour Government determined under their spending plans. So if Labour is accusing the NHS of having a reduction in real terms in 2010-11, that is a complete own goal, because it happened as a consequence of its decisions, not ours.
May I just explain to the Secretary of State the difference between projected budgets and out-turn figures, as published by the Treasury? Will he confirm that the figures published in the Treasury’s public expenditure statistical analysis will be the figures that go into the historical record, and that they will record a real-terms cut because of underspends that he ordered?
That is absolutely not true, because we ordered absolutely no cuts in the NHS budget in 2010-11 compared with the spending plans that we inherited. So that is a complete own goal on the right hon. Gentleman’s part. And in regard to all that stuff that he talked about the support that the NHS is giving to social care, I can tell him that, with the exception of the underspend in the departmental central budgets, because we cut back on all of its bureaucracy and its IT programme, we spent over £150 million, or whatever it was—
Sit down for a minute. I am answering the shadow Secretary of State. As I was saying, more than £150 million was generated from underspends in the departmental central budget in the last three months of the last financial year, and it was spent with local authorities in supporting social care. The rest of the social care support is for 2011-12, so what the right hon. Gentleman said cannot be a reason for the underspend in 2010-11. The amount spent was all in PCT allocations; there was no mechanism by which the Department of Health could go out and ask PCTs to spend less—the money was allocated to them. The shadow Secretary of State shakes his head, but he knows it is true. The money was allocated to the PCTs and they were free to spend the money they had.
The first reason to reject the motion is that it is a spectacular own goal. The second reason to reject it—
The right hon. Gentleman says it is not true that PCTs were asked to set aside funds and generate underspends, so may I remind him of a letter sent by the chief executive of the NHS shortly after the White Paper was published, telling primary care trusts to set aside funding for the cost of transition? That is clear; it is in black and white. He did ask PCTs to generate those funds to spend on the costs of his reorganisation.
I am sorry, but that is another spectacular own goal. Both before and after the election, the chief executive of the NHS set aside, as the right hon. Gentleman had planned before the election, £1.7 billion for non-recurrent expenditure for the costs of NHS reorganisation. It was done before the election; we never changed the figure. It is not a consequence of any of our plans, but a precise consequence of the right hon. Gentleman’s. He said he accepted the Nicholson challenge, and the £1.7 billion non-recurrent set aside in 2010-11 was to fund that challenge. That was set out before the election, not after it. I thought that one of the benefits of the former Secretary of State coming here to debate matters would be that we would be treated to a bit of knowledge of the NHS and of how it works, but that does not seem to be the case at all.
The second reason the House should reject the motion is that it fails to pay tribute to the hard-working staff of the NHS. I participated in many debates such as this when I was shadow Secretary of State and I thought that they provided an incredibly good opportunity for Members to raise issues relating to their own constituencies. I hope that that happens in this debate, as it is important. Every one of us has in our constituencies thousands of committed and hard-working NHS staff who want to know that we recognise it. I do not see any of that in the motion.
It is surprising that I am being embarrassed by so many interventions from the Labour Benches, because there are so few Labour Members here. I remember that before the election it was my recurrent experience that when we held Opposition day debates on the NHS, the Labour or Government Benches were nearly empty while our Benches were pretty full of Members who, because of our commitment to the NHS, were seeking to make points about it. Funnily enough, it does not seem to have happened in reverse. The Government Benches are still full while the Opposition Benches are nearly empty. [Interruption.]
Staff of the High Street medical practice at Newcastle-under-Lyme are dedicated and hard working, yet that practice, which has 5,000 patients, is being forced to close. The Secretary of State has written me a letter, from which it is quite clear that closing directly run GP practices with salaried doctors is NHS policy. It is also clear that the closures are pre-empting proposed legislation to abolish PCTs, which is yet to go through Parliament. If the Secretary of State believed in a patient-focused NHS, surely he would be trying to save such practices, not encouraging their closure.
I will not delay the House at length with further explanation of what I wrote in my letter, as the hon. Gentleman quite properly raised the matter with me at topical questions. It is our intention to move to more consistent commissioning of primary care across the country through the NHS Commissioning Board, but the driver for that is still local decisions about what GP services should be available in an area and which practices are involved. The hon. Gentleman knows from my letter that this is the view of the local primary care trust. In future, it will be for the health and wellbeing boards, not least the clinical commissioning groups, to look at whether primary medical services can be provided with or without the sort of facilities that the hon. Gentleman mentioned.
The Secretary of State asked for some examples of the impact on constituencies; I can give him two. First, the savings being forced on Salford PCT have led to the shutting of the NHS walk-in centre in one of our most deprived wards, which was serving 2,000 patients a month. Secondly, there is the serious issue of the closedown of active case management for long-term conditions. Patient services in Salford are being downgraded as a result of the savings and cuts that have to be made.
The hon. Lady will forgive me for not commenting in detail on that. If my memory serves, that has been the subject of a referral by the local authority to me, which I have sent to the independent reconfiguration panel for initial advice. It would be unhelpful and improper for me to prejudice that.
A year or 18 months into this Administration, does the right hon. Gentleman regret the announcement he made on the steps of Chase Farm hospital? Does he accept that the four tests have seriously misled local people about the future of the health service in their area? Does he recognise the demoralisation that that has caused in the local health service in Enfield, and what steps will he take to try to recover the situation and move forward?
The hon. Gentleman also intervened on the shadow Secretary of State. I am afraid that I do not recognise his description. I said before the election that we would have a moratorium on top-down and forced closure programmes affecting A and E and maternity services—and that is exactly what we did. A moratorium means what it says; it provides an opportunity to stop, to take stock and to subject something to the right tests. I set out for the first time the tests that needed to be met—that proposals needed to be consistent with prospective patient choice, consistent with the views of the local community, not least as expressed through the local authority, consistent with the views of the commissioners in the area, especially the developing clinical commissioning groups, and consistent with clinical evidence of safety.
In the context of Enfield and Chase Farm, the hon. Gentleman knows—because he was a participant in these discussions—that that moratorium was applied, that the opportunity was given to the local authority and the general practice community in Enfield to come forward with alternative solutions. We should also remember that among those four tests is the one about clinical evidence and safety. However, when those community groups came back and said, “We don’t have a specific alternative, but we just don’t want things to change”, I had to ask the independent reconfiguration panel to examine it. Its view was that that was not clinically sustainable.
No. I have given way many times. I am answering the hon. Member for Edmonton (Mr Love). It was very clear that we could not proceed on that basis.
I have another point for the hon. Member for Edmonton about what I found in a number places. Although this was not true of the moratorium in Maidstone and Chase Farm, the moratorium has led to substantially improved outcomes for local services elsewhere, as with Burnley, Solihull, Sidcup, Ealing, the Whittington hospital and other places.
No. I think that the moratorium has led to a better way forward even in Enfield. It is in the hands of the commissioners and the local authority in Enfield collectively, to make decisions for Enfield. Within two months I shall receive a report from NHS London advising whether it would be better organisationally for Chase Farm to be combined with North Middlesex rather than Barnet, and I should be interested to know the hon. Gentleman’s view on that. We continue to seek not top-down forced reconfigurations, but reconfigurations that consistently meet the four tests, and do so in the best interests of the NHS.
The right hon. Member for Leigh (Andy Burnham) implied that my right hon. Friend should have completely ignored the advice of the independent reconfiguration panel. Can my right hon. Friend tell us whether, when the right hon. Gentleman was Secretary of State for Health, there were any occasions on which he sought to ignore the panel’s advice?
The right hon. Member for Leigh says from a sedentary position that he did not ignore the panel’s advice. I do not believe that a Secretary of State has directly sought to contradict the panel since its establishment, or has sought not to comply with its recommendations. After all, it is there for a reason. The point is that, as I have made clear, the panel should be involved in the application of those four tests, and in the past that has tended not to happen.
Let me explain why I am asking the House to reject the motion. I believe—and this was always my approach in opposition—that when we table such a motion, we ought at least to be clear about what our alternative solution would be, but there is no such solution in the motion. Let me remind the new, or recycled, shadow Secretary of State what his old friend James Purnell wrote last February:
“The Tories appear to have the centre ground. Labour need to take it back—by coming out in favour of free schools and GP commissioning”.
The right hon. Gentleman did not come out in favour of free schools. He now says that he is coming out in favour of GP commissioning. If he believed in GP commissioning, why did he do nothing about it? Why did everyone in the general practice community, throughout the length and breadth of the country, believe that practice-based commissioning had come to a virtual halt? Why did David Colin-Thomé, the right hon. Gentleman’s own national clinical director for primary care, effectively say that it had completely stalled and was not going anywhere?
I know that the right hon. Gentleman agreed with this at one time. Back in 2006, he said of GP commissioning:
“That change will put power in the hands of local GPs to drive improvements in their area, so it should give more power to their elbow than they have at present. That is what I would like to see”.—[Official Report, 16 May 2006; Vol. 446, c. 861.]
If the right hon. Gentleman wants that to happen, he must support the Bill that will make it happen. The same applies to health improvement and public health leadership in local government, and to our finally arriving at a point when, as was the last Labour Government’s intention, all NHS trusts become foundation trusts. We are going to make those things happen, but in order to do so we must have a legislative structure that supports them. That is evolutionary, not revolutionary. However much the right hon. Gentleman rants about the changes being made in the Bill, the truth is that it will do—in what his predecessor, the right hon. Member for Wentworth and Dearne (John Healey) described as a “consistent, coherent and comprehensive” way—much of what was intended by our predecessors as Secretaries of State under the last Government. The fact that the right hon. Gentleman turned his back on that at the end of his time in office—mainly at the behest of the trade unions, which seem to be the dominant force in Labour politics—does not absolve him of his responsibility to accept that we are now delivering the reforms that he talked about.
The Secretary of State told my right hon. Friend the Member for Leigh (Andy Burnham) that there had been no cuts in the NHS budget. Does he recall cancelling the building project for a new hospital serving my constituents in south Easington as part of the comprehensive spending review?
On the occasion when the Chief Secretary to the Treasury told the House that we were supporting a number of hospital projects, we made it clear that the hon. Gentleman’s local trust was a foundation trust. As his colleagues should tell him, the point of a foundation trust is that it should take more responsibility for securing the resources—
I am answering the hon. Gentleman’s question. The point of a foundation trust is that it should take more responsibility for securing the resources enabling it to undertake its own building projects. Foundation trusts cannot walk into the Department of Health imagining that they will receive a capital grant of more than £400 million. That is simply not the way it works. It is to the credit of the hon. Gentleman’s local trust that it accepted that, and is working, as a foundation trust, on a better solution for the hon. Gentleman’s area.
No, because I have already given way to the right hon. Gentleman many times. Let me tell him this. If he was going to offer to try to work with others on GP commissioning, he ought at least to have demonstrated before the election that he was going to do something about it; and using a transparent political ploy to try and interfere with the passage of the legislation in another place carries no credibility with me or with anyone else. Labour’s tabling of a motion in the other place in an attempt to block the Bill completely showed no willingness to work together, and the fact that it was defeated by 134 votes ought to have given the right hon. Gentleman a reason—and sufficient humility—not to try to return to the subject by tabling today’s motion.
As I said earlier, I find it regrettable that neither the right hon. Gentleman’s motion nor his speech made any attempt to deal with what has happened in the NHS over the past year. Let me tell him, and the House—for I know my right hon. and hon. Friends will be interested as well—what has, in truth, happened during that time.
At the end of the last Labour Government, the average in-patient wait was 8.4 weeks. According to the latest available figures, that has fallen to 8.1 weeks. The average waiting time for out-patients was 4.3 weeks at the time of the last election; it is now 4.1 weeks. Over the last year, the number of MRSA bloodstream infections in hospitals has fallen by a third, and the number of clostridium difficile infections by 16%. Nearly three quarters of a million more people have access to NHS dentistry. Nearly 2 million people have access to the new 111 urgent care service, and the whole country will be covered within the next 18 months. When we came to office, I discovered that there had been talk about a 111 telephone system, but nothing had been done. It is now happening.
More than 75% of stroke patients now spend 90% or more of their hospital stay in a stroke unit. That is a 20% increase in two years. The Cancer Drugs Fund has given more than 5,000 patients access to the drugs that they desperately need, and which under the last Government’s regime would not have been available to them. We have embarked on an £800 million investment in translational research, increasing our financial support for it by 30%, to help to secure the United Kingdom as a world leader in health research.
The NHS is leading the way in the prevention of venous thromboembolism, with 86% of patients receiving an assessment for the condition. I believe that that constitutes an increase of some 30% in the last year. The bowel cancer screening programme is enabling many more patients and members of the public to be screened, there is more screening for diabetic retinopathy than ever before, and there were 188,000 more diagnostic tests in the three months to August than there were last year. Pathfinder clinical commissioning groups have been established virtually through England, and there are 138 health and wellbeing boards in local authorities, meeting and putting together their strategies to deliver population health gain across their areas.
In a single year, the year preceding the election, the right hon. Member for Leigh presided over a 32% increase in NHS management costs. That was the year after the banks had gone bust. It was the year when it was obvious that Government deficits were out of control. It was the year when the debt crisis was just about to crash over the whole public sector. What happened on the right hon. Gentleman’s watch? There was a 23% increase in management costs in a single year, to £350 million. In the year that followed, we reduced those costs to £329 million.
Can the Secretary of State tell us what the percentage of senior managers is, and how that compares with the percentage in the private sector?
Does the hon. Lady act as parliamentary private secretary to the shadow Secretary of State? Ah, she does. Well, she has the merit of consistency. I am reminded that in June 2006, when for a short period she was chair—I think—of Rochdale primary care trust, she resigned. She said that she resigned because the radical changes happening under the then Labour Government in 2006 would
“destroy the NHS as we know it.”
The hon. Lady has the merit of being consistent: she is against every Government and every change. She does not think that any steps will make the NHS into what it ought to be. I will not take any lectures from her, therefore.
I was explaining to the hon. Lady and the House what has been achieved. We have stripped out pointless bureaucracy. The number of managers more than doubled under Labour, but we have cut their number by more than 5,000, and we have increased the number of doctors in the NHS by more than 1,500. The Bill includes measures to abolish primary care trusts and strategic health authorities, but in the meantime we have clustered PCTs and SHAs together.
We are reducing the cost of bureaucracy in the NHS not only because it is necessary to do so. The transfer to clinically led commissioning in the NHS, for which there is a very good case of course, also involves reducing such costs. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), has frequently made clear, as part of the transfer process we will deliver £4.5 billion in savings in administration costs this year across the national health service. The transition itself involves costs of course, but they will be recovered by the end of 2012-13, and by the end of the Parliament we will have gone on to save more than £4.5 billion in total.
Productivity fell in every single year that Labour was in charge of the NHS. However, according to the Audit Commission, in the last year—2010-11—we saved £4.3 billion. As the deputy chief executive of the NHS has reported, PCTs are intending to save a further £5.9 billion in 2011-12. Contrary to what the right hon. Member for Leigh repeatedly said, the NHS is not failing to deliver on the quality, innovation, productivity and prevention challenge; it is on target to meet that challenge. The modernisation that is at the heart of the Bill and the White Paper is not about frustrating the NHS in that endeavour; it is about enabling it to meet the QIPP challenge.
Last summer, I announced that we would be measuring mixed-sex accommodation and then driving down the extent to which patients were put in such accommodation when they should not have been. The right hon. Gentleman said at the time:
“This hollow announcement is an attempt by Mr Lansley to claim credit for something Labour has done”.
That is absolutely wrong. The evidence showed that almost 150,000 patients a year were being placed in mixed-sex accommodation in breach of the rules. We ensured that figures were published for the very first time. The first set of results was published in December, and it showed that in that month alone there were well over 11,000 such patients. Since then, there has been a 91% reduction in the number of patients put into mixed-sex accommodation. The right hon. Gentleman was prepared to see issues of care, service and standards in the NHS covered up. We are determined to shine a light on where the NHS can, and should, improve its performance; we are determined to enable the NHS to do so and to challenge it wherever it is not doing so.
I will give way to the hon. Gentleman shortly.
If the public want to know how the NHS in England would have fared under Labour since the last general election, they should look across the border at what has happened in Wales—I am not sure whether any Members representing Welsh constituencies are present. We are protecting the NHS and increasing its budget in real terms. However, I have brought along to the Chamber a report by the Auditor General for Wales that was published just a few days ago, on 14 October 2011. If I could, I would enter it in evidence, but I can at least hold it up in order to show Members a series of bar charts. They demonstrate that in England there is real-terms growth in the NHS, in Northern Ireland there is small real-terms growth that is unevenly distributed across the years, in Scotland there is tiny real-terms growth, and in Wales there is a large downward curve, which shows the reduction in real-terms spending on the NHS in Wales. Wales is the only part of the UK that is run by Labour, and there are real-terms cuts in the NHS budget there.
The right hon. Gentleman must know that “real terms” means taking account of inflation. For the record, can he tell the House what the retail prices index was for the last month for which figures are available? That will give us a sense of what “real terms” ought to mean in this context.
The hon. Gentleman is a shadow Treasury Minister, so he must know that the expression “real terms” has consistently been used in relation to the GDP deflator, which is independently estimated by the Office for Budget Responsibility. That is the basis on which we do these calculations, so the Wales Audit Office will have calculated the real-terms changes in budgets in each of the countries of the United Kingdom on that basis. John Appleby from the King’s Fund has estimated an 8.3% real-terms cut in the NHS budget in Labour Wales.
The Secretary of State is, justifiably, giving a robust performance. He said that his job is to shine a light into the NHS to make sure there is a better service for patients. Can he assure us that the recent findings about the care of the elderly in our hospitals and the recommendations of the Cavendish report on that issue will receive the Department’s full attention, as that is one of the areas where the NHS often fails to fulfil the expectations of patients and their families?
I agree with my right hon. Friend, and I appreciated the opportunity to talk with Camilla Cavendish and to read much of what she has written.
In January, I asked the Care Quality Commission to undertake dignity and nutrition inspections. They were nurse-led, unannounced inspections across NHS hospitals. The reasons for doing so were clear. I do not say this to denigrate the NHS, but many of us were concerned about two issues. First, although patients admitted to hospitals might get very good clinical care, the standards of personal care were often not as good as they should be, and they were seriously deficient in some cases. Secondly, the last Labour Government had star ratings for hospitals, the net effect of which was as follows. On the Healthcare Commission website, there would be a green dot against a hospital, which was often taken to mean, “This hospital is fine.” However, we all knew that some hospitals had tremendous reputations and world-beating clinical care in some respects and some wards where care was fantastic, but that care in neighbouring wards could be seriously deficient. The dignity and nutrition inspections have addressed that.
The CQC will follow up wherever it has found concerns. In addition, it will undertake similar unannounced inspections of learning disability services and there will be 500 unannounced inspections of care homes, to seek out and expose poor performance or poor care in those areas—and, I hope, demonstrate where good care is provided. There will be an additional follow-up inspection of a further 50 NHS hospitals.
I am grateful to my right hon. Friend for his comments. May I raise a linked point? One of the issues most frequently raised with me both in my constituency and elsewhere is that families and patients often do not feel that they have consistent contact with just one person who is responsible for the management of the care in a hospital. Instead, there is a range of people whom they do not know, except for what is printed on their name badges. They know the consultant, but they do not know who is responsible on a day-to-day basis for the delivery of 24-hour care. Can my right hon. Friend assure me that that is also on his agenda?
I entirely agree with my right hon. Friend. That is not only the case in hospitals, where people can sometimes ask, “Under whose care is my husband?” It is also especially true in community care. I hope that there will be more integrated services in the community, but although there may be a range of providers, there must be an integrated service with a clear line of accountability.
No, as I need to conclude my speech. [Interruption.] I am sure what the hon. Lady says is true.
The NHS in Wales is not cutting its budget because everything is going well. Labour Members are fond of citing waiting times, but the latest figures on waiting times show that in England 90.4% of admitted patients and 97.3% of non-admitted patients were referred to treatment within 18 weeks, whereas the figures for Wales are 67.6% and only 74% respectively.
Let me tell the House about infection rates. In 2007, the clostridium difficile mortality rates in England and Wales were similar—in fact, the rate was slightly higher in England. However, in the latest year for which figures are available there were 23.4 deaths per million for men and 23.5 deaths per million for women in England, whereas the figures for Wales were 54.9 deaths per million for men and 59.5 deaths per million for women, so the level in Wales is more than twice that in England. In four years, the gap has widened to the point where Wales has double the number of deaths from C. diff infections relative to England. Less money, less innovation and less good care is what has been happening in Wales under a Labour Government.
I must make it clear that we are going to put patients at the heart of the NHS. We are going to focus on the NHS delivering excellent care every time. Labour focused on the targets and the averages, and never got to the place of really caring about the specifics. A patient about to go into hospital for knee replacement surgery does not want to know about the national figure; they want to know about their hospital, their ward and what will happen to them. The same is true for mixed-sex accommodation. Labour turned a blind eye to variation in performance. We are going to open it up to clinical and public scrutiny, so that we can reward and celebrate achievement and excellence across the service, and shine a light on poor performance.
Two weeks ago, I had an operation in Guy’s hospital. Because of possible complications, I had to ask my consultant directly, “Would you advise me to go ahead or not?” He advised me to do so, and I had complete trust in him. He was not thinking about whether he had to fulfil a quota, whether there was competitiveness in his hospital or his department, or whether a private patient would be preferred in the bed that I was to occupy. He was someone I could trust. In the health service that the Secretary of State proposes in his Bill, I could never have that confidence. I ask him please to abandon this Bill.
The right hon. Lady is simply wrong. There is nothing in the legislation that will do anything other than support clinicians to exercise their judgments in order to deliver the best care for their patients. It was under her Government, when people were told to pursue 18-week targets, that managers were literally walking in to speak to consultants who were about to do waiting lists and surgery lists and telling them that, because of the 18-week target, they had to treat a certain patient rather than another whose interests would mean that they would be seen first. So I will not take any lectures about that. We are going to put clinicians at the heart of delivering care and put patients at the heart of the service that is delivered.
The Labour motion does not reflect reality. It is based on a misleading set of interpretations and representations. Labour Members have a very short memory, but I am afraid that they have left us a shocking legacy. The motion contains no appreciation of the challenges the NHS faces, no appreciation of the care the NHS has provided to patients day in, day out over the past year, and no vision of how the NHS can be better in the future. Modernisation of the NHS will deliver an NHS that we can rely on for future generations, that is based on need, not ability to pay, and that is able to deliver the best outcomes for patients. I urge the House to reject the motion.
Although the words “shocking legacy” are ringing in my ears, I find it difficult to believe them, given Labour’s legacy on the NHS compared with what it inherited in 1997. Expenditure was increased from £30 billion in 1997 to £103 billion when we left office, and we had record patient satisfaction ratings. It beggars belief that that can be considered a shocking legacy.
If the hon. Gentleman does not mind, I will continue my introduction and give way in a moment.
I wish to recognise the contribution of the NHS staff, who are the source of great pride. They have done such a great job, and continue to do so, even in difficult circumstances, in delivering the very high levels of patient satisfaction reported in the recent surveys.
In November 2010, the Backbench Business Committee selected my application for a debate on the impact of the comprehensive spending review on the Department of Health, the NHS and public health. So many of the issues that have been raised are implanted in my mind, not least the loss of the funding for a new hospital that would have served many of my constituents in the south of Easington. I am concerned about the particular reference that has been made to that and I would be grateful if the Secretary of State or the Minister would deal with that in their closing remarks. A value-for-money assessment was made by both the Department of Health and the Treasury and it was found that the best way to take forward that proposal was with public funding, rather than through the private finance initiative route. The disingenuous position repeated by those on the Government Benches, including the charges laid against the Labour Opposition about our support for PFI, has been compounded. I remind right hon. and hon. Members on the Government Benches that in the case of the new hospital planned for my area we were directed to the PFI route, despite the criticism that has come from the Secretary of State and other Members on the Government Benches.
I am pleased that the motion focuses on the failed personal pledges of both the Prime Minister and the Secretary of State. A key promise was made to increase real-terms expenditure on the NHS, but it is another broken promise. It is probably the most fundamental one, as the NHS is such a beloved institution of the whole British public. Before the election, the Conservatives promised to protect the NHS and give it a real-terms budget increase year on year. The coalition document promised a 0.4% real-terms budget increase for the NHS over the spending review period.
I am sure that we all saw the expensive billboards before the election, to which my right hon. Friend the Member for Leigh (Andy Burnham) referred. They showed the Prime Minister, then Leader of the Opposition, saying:
“I’ll cut the deficit, not the NHS.”
That was not really about rebranding the NHS; it was more an exercise in conning the British public. Whereas Labour gave a guarantee to protect the front line of the NHS, the Health Secretary, then the shadow Health Secretary, saw a cynical opportunity to give a guarantee on spending. We now know from the Treasury’s own figures that that guarantee was false: it is a promise that has been broken. It was a guarantee that went against all the Tory mantra. We are constantly told by the Conservative party that public service delivery is not about how much we spend but about how we spend it—in fact, we heard that today from the Prime Minister in relation to police numbers. However, the Tory promise was never about protecting the NHS; it was about protecting the Tory brand.
Even the Tories’ biggest backers realise that the promise to increase funding on the NHS was a con. The Secretary of State cited James Purnell a little earlier, so perhaps I might cite Fraser Nelson, who is not a well-known socialist—he writes for The Spectator and is a right-wing commentator. He says:
“It has become clear now that there was a cynical competition to dupe the British public into believing that if they voted Tory at the General Election, the NHS would be safe.”
After 13 years of unprecedented rises in the NHS budget under Labour, and efficiency measures such as those on procurement—
The hon. Gentleman is talking about the 13 years under the previous Labour Government. I do not know what happened in his constituency, but my constituency lost accident and emergency provision, and we lost maternity provision. That was the direct consequence of Labour’s Department of Health.
I think we saw an unprecedented period of growth with the building of new hospitals and new facilities. I have some sympathy with the hon. Member for Enfield North (Nick de Bois) and what he is going through with the Chase Farm downgrading, because in my area the Hartlepool accident and emergency facility is also being downgraded to an urgent treatment centre. That is a cause of consternation among the public.
Well, it is being done under the Secretary of State’s Administration when an impression was given that there would be a moratorium and that we would not face such downgrading and closures. That was clearly a con that was sold to the public, so I do not accept the contention that the hon. Member for Crawley (Henry Smith) has put forward.
Let me press on, because time is limited. The NHS is hurting under this Government and these reckless reforms. On the promises for a real-terms increase, we know that health inflation has surged and that the spending power of the NHS is going down, so will the Minister now admit that the NHS is receiving a real-terms cut? This is not just about the NHS being held hostage to inflation. It is facing real financial pressures on the front line—which Labour promised to protect—for a number of reasons including the Government’s decision to push through this latest reorganisation, which is the biggest the NHS has ever faced, at the same time as pushing through £20 billion-worth of efficiency savings. The figure of £1 billion a year is being taken from the NHS’s existing budgets to meet the growing and ever-increasing costs of social care. The Select Committee on Health is now looking into that issue and I hope that we are able to come forward with some positive ideas that the Minister will consider.
My hon. Friend heard the Secretary of State’s responses to my questions. I know that my hon. Friend served on the Committee considering the Health and Social Care Bill. Will he confirm that competitiveness is still at the heart of that Bill and that the cap on private patients in the NHS is being removed from hospitals?
I am grateful for that intervention from my right hon. Friend and I should like to place on record, because the Secretary of State did not take the opportunity to do so, that the cap on private patient work, which had been set at 5%, is to be raised by the Bill. That must have a detrimental impact on the NHS in general, and on non-private patients, as resources are directed to the private sector and private patients.
I shall not, if the hon. Gentleman does not mind, because I do not think I will get any injury time if I do so and I have rather a lot to get through.
I have mentioned the transfer of resources from the NHS budget to meet the growing costs of social care. We have also discovered, from evidence that was given to the Select Committee, that there has been an underspend of almost £2 billion—much of it from the capital budget, with some of it, presumably, being saved by cancelling the new hospital that was to serve my area. Meanwhile many NHS trusts are sitting on hundreds of millions of pounds of debt, and figures produced by the Department of Health show that six large NHS trusts in London are predicting year-end deficits of £170 million. The pressures on the system are enormous and will inevitably show through in reductions in services, having an impact on the front line.
The reductions in tariffs for operations and the further pressures in that area will also mean that foundation and NHS acute trusts will bear the brunt of financial pressures within the system. Again, that means that the buck and the spotlight of transparency are being passed away from the Secretary of State to the NHS Commissioning Board, although he might have to reconsider that after last night’s Lords amendments.
Another area of pressure in the NHS comes from the huge redundancy costs being incurred as a consequence of the premature closure of primary care trusts and strategic health authorities, which is estimated to cost the taxpayer more than £1 billion. The opening up of the NHS entirely to the private sector, and the prospect of the £103 billion NHS budget being taken out of the public sector and placed within the remit of shareholders in private health care companies, is anathema to the majority of the British public. The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) is cringing, but the majority of the British public are cringing at the thought of this proposal.
It is remarkable that we are having this debate today. As the Secretary of State has said, the Opposition’s motion is a remarkable own goal, especially as it has been confirmed that the Government will be increasing funds in real terms by 0.4% over the course of this Parliament. The shadow Secretary of State is shaking his head, but that will mean an extra £12.5 billion, which he has opposed today. It also remarkable that we have had confirmation from him of his comments in The Guardian on 16 June 2010, when he stated:
“It is irresponsible to increase NHS spending in real terms within the overall financial envelope”.
He agreed with that and I am delighted that he has put that on the record now that he has a second bite of the cherry, as the shadow Secretary of State for Health. He had an opportunity to make amends, and I thought he would, but unfortunately he has not. He also stated in the New Statesman on 22 July 2010:
“They’re not ring-fencing it. They’re increasing it.”
He was talking about the NHS budget and the fact that the Government were increasing it.
We have heard from the Secretary of State today that if there is an underspend, it has come entirely from the central departmental budgets. What is wrong with that? Does the shadow Secretary of State disagree that we might have cut down on costs such as the £115,759 he spent on a personal chauffeur during his time as Secretary of State? Does he oppose an underspend, given that during his time at the Department it spent £3.65 million on almost 26,000 first-class rail tickets? We have slashed that cost by more than 70%. Does he deny that he and the Department spent £1.7 million on luxury hotels during his time there? What is wrong with cutting such spending? What is wrong with the fact that Ministers are no longer using hotels such as the Hotel President Wilson in Geneva as they did in 2008 when the bill was £548.87 a night? If we are making those cuts to the central budget, I quite welcome our doing so.
I wonder that the hon. Gentleman is not more worried about issues such as those I raised earlier. The real cuts being experienced in my constituency are in NHS walk-in centres and in the active management of long-term conditions. That is a real downgrading of patient care. I am surprised that he is bringing up these expenses; I think he should focus on what is happening in the NHS.
I entirely agree that we need to integrate better social care in the NHS, and part of the reason why we have £2 billion going into social care is to tackle that problem. It is interesting that the hon. Lady does not deny that those spends have happened and that she does not apologise for the fact that the previous Government made those spends. Personally, I think they are a disgrace. Obviously, Opposition Members do not have a problem with spending £600 on a hotel in Switzerland, but I do. I say to the shadow Secretary of State, “Don’t build a greenhouse and then throw stones out of it.” Let us remember that it was the Labour party that gave us an NHS IT system at a cost of £12.7 billion—450% more than the original cost. It was the Labour party that gave us private finance initiative deals that were so badly drafted that they were worth £11.4 billion but cost £65 billion to pay off. What did the shadow Secretary of State say when he was the Secretary of State?
I am grateful to the hon. Gentleman for giving way and I hope that my intervention allows him to cool his jets a little. One cannot make a case about this by arguing about minutiae. Will he accept that for many of us the reality of the NHS is what we see at Central Middlesex hospital, where somebody turns up on a Monday to be told that the accident and emergency department closed on the previous Friday and has now been rebranded without there having been any democratic input? If one has any complaints about that, however, one should not even bother trying to find a person to speak to. That is the reality. The NHS is over-commercialised and is losing touch with its roots.
The hon. Gentleman will regret his comments. We have to pay back £65 billion on PFI deals that were originally signed for £11 billion—that ain’t minutiae. Many constituents are concerned about the waste that took place under the previous Government.
In 1997, there were 23,400 managers. That has gone up to 42,500. We are making a genuine attempt to tackle the problem. I could go on, but I will put the party politics aside.
We are spending £1 billion more than we should on procurement because of the lack of consistency across the NHS, delivered principally by the previous Government. That is one area in which we could make vital savings. The NHS needs to change. Your boss, the Leader of the Opposition, said:
“To protect the NHS is to change it”
and we need to do so. The reforms that we are bringing in are essential if we are to deliver savings and also to ensure that the NHS survives when our ageing population means there will be twice as many 85-year-olds by 2030.
We need to reform the NHS and we do so in the spirit of what Tony Blair and new Labour put forward. Julian Le Grand, Tony Blair’s key adviser, said that the reforms were
“evolutionary, not revolutionary: a logical, sensible extension of those put in place by Tony Blair”.
When I asked him in the Health Committee whether this is what Blair would have done, he said: “Absolutely. Blair ‘would have tried’ to get these reforms through, but I imagine the left of his party may have prevented him from doing so.”
We are introducing these reforms principally so that we put power back in the hands of GPs and, above all, patients. We are making these reforms because we have to. The status quo cannot remain—[Interruption.] If the right hon. Lady wants the NHS to continue as it is, fine. If the NHS is to be free at the point of delivery, it needs clinician-led commissioning. That is what we are going to achieve.
I agree with much of what my hon. Friend says. Does he agree that on such an important subject as the NHS, the people we represent and who sent us here would expect us to be thinking about how we can improve the NHS for patients and for the people who work in it, rather than engaging in this ridiculous tit-for-tat party political scrap that we are seeing this afternoon?
I entirely agree. A constituent, a lady who sadly lost her foot through a rare cancer, came to my surgery recently. She is allowed only one type of plastic foot from the NHS and the PCT. She wants what is called an Echelon foot which will allow her to walk up a hill—she is a hill walker—but under the current model she cannot get that alternative foot. By bringing in any qualified provider, we will allow patients and clinicians the freedom to choose for the first time—a choice that was denied under the “any preferred provider” model that the shadow Secretary of State still clings to vainly. We need to ensure that our NHS operates for the 21st century and I hope the reforms will deliver that.
To sum up, I will oppose the motion. It is juvenile—the text could have been written by Adrian Mole. This is about getting away from the politics of debate in the Chamber and giving the NHS back to the professionals and the patients. It is not our NHS; it is their NHS, and we need to ensure that we achieve that aim.
I congratulate my right hon. Friend the Member for Leigh (Andy Burnham) on his appointment as shadow Secretary of State for Health, a brief to which he brings valuable experience. We are going to need every bit of that experience, given what the current Secretary of State is doing to bring the NHS to its knees.
I strongly disagree with my colleague on the Health Committee, the hon. Member for Kingswood (Chris Skidmore). This is not their NHS. This is not your or my NHS. It belongs to the people, all of us. We all have an incredible stake in the NHS. The Secretary of State and the Government play with it, with their reputation and with patients’ needs at their peril. I believe your policy will fundamentally damage the NHS—
Forgive me. I have a great propensity to do that. I believe passionately in the NHS and I take this all very personally. I apologise.
The Government’s policy will fundamentally damage the health service in terms of both the quality of care available to patients and the founding principles of the NHS. The more we debate Government health policy, the less the Secretary of State seems to be listening, whether to Opposition Members, medical professionals, patients, patient groups or constituents.
I might go further and say that I now believe the Secretary of State occupies a parallel universe—a universe where everyone wholeheartedly supports his policy and believes him when he says that there is real-terms growth in NHS spending, a universe where waiting times are not increasing, people are not being refused treatments, bed-blocking is not happening because of pressure on the social care system, a universe where he never discussed the issue of re-banding of nurses with the Royal College of Nursing.
Unfortunately, while the Secretary of State, ably supported by the Prime Minister, is off in that parallel universe, which we shall call delusional, the rest of us are left facing the terrifying reality of what the Government’s policy means to our constituents and to the national health service. We must disregard the rhetoric and the myth-making of the Conservative party as it seeks to demonstrate that it has changed when it comes to the NHS. Sadly for the health service, the Conservatives have not changed at all.
I have spoken repeatedly about the Prime Minister’s clear promises to the British people—one was that there would be no more pointless top-down reorganisation. He even said:
“When your family relies on the NHS all the time—day after day, night after night—you know how precious it is”.
How quickly those words were forgotten. Michael Portillo comments on the BBC’s “This Week” spoke volumes. He could not have made it clearer that the Government meant to misrepresent their position and mislead their voters. He said:
“They did not believe they could win if they told you what they were going to do.”
My fear is that their broken promises are leading us headlong into a broken NHS.
There is much I could say about how disgracefully the Government started to change NHS structures without the consent of the people or the House. Because of those broken promises, a failure to secure a clear mandate for the reforms from the British public, and an abject failure to secure support from the clinicians and the medical profession, we are left in the present mess. I hear time and again that the doctors, the nurses and the professionals are all behind the Government. Where are they? They are shouting loud and clear, “We’re not with you.”
I fell for that last time and did not get to the end of what I had to say.
I will not go on about the rest of the problems that I see with the Bill—the financial challenge, the fact that we are open to European competition regulation, or the fact that the chair of the NHS Commissioning Board believes the Bill is unintelligible. I believe the Bill has been driven forward as an ideological exercise, rather than by an ideological desire to improve the quality of health care available.
Forgive me; I need to get to the end of my speech.
My right hon. Friend the Member for Leigh dealt with the finances and the myth of real-terms growth in the NHS budget. My local trust is being asked to go beyond the 4% savings compounded over the next four years and will be expected to achieve 6% or £8.5 million in this financial year. On top of that, Monitor expects trusts to make a 1% profit. People who have given evidence to the Select Committee have said it is clear that there will need to be hospital closures in order to release money back into the wider health service. We are told that this is all part of managing demand and redesigning pathways—two horrible phrases that appear to be back in vogue.
I want to deal quickly with the re-banding of nurses to reduce budgets, which the Health Secretary appears to have little understanding of. I am sorry he is no longer in his place. He clearly told the Health Committee that he was unaware that re-banding was taking place. His problem is that Janet Davies from the Royal College of Nursing told the Committee that, although the RCN does not release conversations, that issue was clearly discussed. I really worry about that. Does he have a twin he is sending into meetings on his behalf? Does he simply not listen? It would not be the first time. Or is the truth even worse, and should he be described in terms that Mr Speaker would call unparliamentary? The Secretary of State said earlier that he stood by his answers to the Committee. He has also claimed that he did not receive a letter from me, but I can confirm that he received it at 11.57 on 13 October, and I have confirmation from his office.
I will not.
The point is that even if the Secretary of State was not aware of the re-banding, as he claims, that speaks volumes about how out of touch he is with the hard-working staff he is supposed to represent. Perhaps he would like to remove himself from his parallel universe—
May I take it as read that the NHS will struggle to find the £20 billion savings agreed in the Labour Budget? May I take it as read that that will impact on services and that people will notice and probably blame this Government’s legislation regardless of whether or not it compounds the problem? The debate we have been having on how NHS spending is or is not to be ring-fenced is almost a sideshow, compared with the huge challenge that is consistently emphasised by the Chairman of the Health Committee.
I draw Members’ attention to the fact that serious financial trouble is already breaking out in the acute sector. Seven of the 19 foundation trusts in the north-west have a red light, and that region is one of the more stable ones that we could consider. I cannot see any obvious happy endings, even without the Bill. Without the Bill we would still have competition by price, competition law would still be applicable, PCTs would still be capable of looking for the lowest common denominator and we would still have an unaccountable NHS.
To add to the general misery I am trying to perpetuate, on Saturday I had a severe abscess on my tooth, which was extraordinarily painful and unpleasant. After taking large doses of ibuprofen, which gave me a little relief for an hour, and my face being swollen and peculiar—a little more peculiar than it currently is—I sat up in bed in the middle of the night with my iPad looking up home remedies on the internet—cloves, bicarbonate of soda and so on. I found forums populated by desperate sufferers looking for a fix. What surprised me most were the American contributors, a considerable number of whom were obviously afraid to go to a dentist, despite the fact that the US is a rich country with no shortage of good dentists. They were settling for severe and continuous pain or for hit-and-miss experimentation, rather than risking debt and bankruptcy. Thankfully, I was in the UK and we have the NHS. On Sunday night, almost unbelievably, I was seen at 6.15 by an emergency dentist, a Polish dentist at the former Litherland town hall, which is now a busy Sefton NHS walk-in centre with a pharmacy attached—a service I did not know existed prior to these events.
Thankfully, the NHS is an institution built on solidarity. Through the state, we guarantee by our taxes each other treatment according to need and irrespective of means. It is a moral compact and Governments have been prepared to carry out that compact by ensuring that the services that are needed exist. Historically, they have done this in two ways: first, by buying services on our behalf; and secondly by providing services directly on our behalf. Governments and the people working in the NHS have done this relatively well and relatively efficiently, as the Wanless report and the Commonwealth Fund report have rigorously and exhaustively demonstrated. That is indisputable.
What is strange about recent developments is the Government shying away from their role as a provider of health care. The original debate was over the renouncing of the Secretary of State’s role as a provider, but we can also see the cutting loose of all hospitals as free-standing foundation trusts; the blurring of boundaries between NHS providers and other sorts of providers, with NHS providers doing more private work and the private sector doing more public work; the forcing—genuine forcing in some places—of non-hospital staff working for the NHS to become independent social enterprises; the neutrality of the Department of Health on whether individual NHS providers or provider networks survive, a neutrality that will be severely tested in the months to come; and the willingness to make NHS provision contestable as a matter of principle, rather than one of pragmatism. Not many people have noticed the ending of the Secretary of State’s powers to create a new foundation trust or hospital post-2015. We might have seen the last new NHS hospital opened by a Secretary of State in this country.
I found the Secretary of State’s unwillingness to stick to the wording of the Health Act 2006 slightly bizarre, if only because that would easily have brought peace, and may have brought peace now, depending on what exactly has happened in the House of Lords. In a sense, we all know that the Secretary of State does not, has not and cannot provide all the services himself and should not try to micro-manage. I did not seriously expect him to turn up at Litherland town hall on Sunday—visions of Marathon Man come before me. What concerns me is the ideological presumption that the Secretary of State should only be a purchaser or commissioner. There is a good reason for that concern; it is only possible to purchase in a market what that market offers. Markets are splendid things, offering choice and variety, but they do not have a guarantee that people will get what they are entitled to, and they do not ensure that health inequalities, or any sort of inequality, can be eroded, and they do not guarantee that public resources are spent and used in the most efficient way. They may lead to that, but not necessarily. Direct state provision is often a better option.
I respect my hon. Friend’s point of view, but surely what matters is quality of care for patients, which can be provided as well in the private sector as it can in the public sector, and it is not necessarily guaranteed in the public sector, as events at the Mid Staffordshire hospital have shown.
I did not say that it was guaranteed by the public sector. That is not the point I was making at all. Guaranteeing entitlement, addressing inequalities and ensuring public value are, to be blunt, largely the point of the NHS. I can quite understand—I partly regret it—that a degree of cynicism might exist about the public service ethos, and a sort of nostalgic support for that can sometimes be in place when the reality is that it is not there. There is doubt about its true impact and people inside and outside the NHS sometimes show that degree of cynicism, which is regrettable. I can understand the worry that NHS providers can become lax or inefficient or unambitious if they are not challenged, but the answer to that is not necessarily or obviously to get out of the provision business full stop, embrace the market, set up strange control markets with huge transactional costs, strange tariffs and the multiplicity of bean counters that go along with that. Of course there is also greater legal complexity. The end result of that is something that has few of the virtues of a real market and most of the vices. The Labour Government were to some extent part and parcel of producing such a market. I see no reason to make the state just a purchaser and never a provider, and it is not obvious to me that the answer is to hand over the money to one set of providers, the GPs, particularly if the pretext for doing so is to harden the commissioner-provider split, because GPs are providers.
In conclusion, publicly funded provision—public service infused with the right ethos—is often the most efficient and effective option, provided that it is coupled with genuine, local and rigorous accountability. That is what happens in many successful systems, such as Sweden’s, and it is a liberal solution. So far, there is not enough of it, although the Bill makes laudable moves in that direction, with health and wellbeing boards and so on, but this strange, unargued and ideological withdrawal from provision or interest in provision taints everything and leaks poison into the system—like an abscess.
I support the motion on the Order Paper this afternoon, and I am very sorry that the hon. Member for Kingswood (Chris Skidmore) has left his seat, because he was coming out with a load of reasons why the NHS is in the mess it is in now, saying that it was to do with the previous Labour Government. He mentioned Adrian Mole, but I would have advised him not to use such arguments when, in the same breath, he was talking about the money that was spent on the NHS IT programme. It was nowhere near the £12 billion that he mentioned. People would be wise to look at the IT system, because it was ambitious in terms of creating a national database, and given my experience on the Health Committee that looked at the issue in the previous Parliament, I must say that if we want to make the national health service efficient, we will do so with IT. Currently, there are few programmes that manage people with long-term conditions, yet they consume between 75% and 80% of the moneys spent on the NHS, so batting arguments around on that basis, as the current Government did in opposition in relation to IT will not make health care better or the national health service more efficient for people in this country.
Members have mentioned three issues with the coalition agreement. I am going to leave the one on finance as it stands, because there is an argument about the Treasury figures. We will see in the next year or two, if the next election is in 2015, exactly where the issue goes, and then we will be able to comment a little more than we are able to at the moment.
On moratoriums, I saw a very embarrassed Secretary of State at the Dispatch Box today, and I am going to be consistent, because when I was Chair of the Health Committee and sitting on the Government Benches, I criticised on two occasions then Government Front Benchers for such stunts. I did not criticise Health Ministers, but I did make one criticism in a closed place, after a Secretary of State—not for Health, but a Scottish Member who no longer sits in the House—stood on the picket line against the closure of a hospital in Scotland near his constituency.
Another criticism I made was of a Member—who is still in the House but, again, not a Health Minister—who was against changes to health care in Greater Manchester. I was asked by the media—I think it was the BBC—and I said that, if the issue is being looked at locally and it is recommended that such reconfiguration will improve patient services, it should go ahead and politicians should not speak out against it. I then received the quickest response I have ever had on any issue from No 10 Downing street, but I stick to what I said then: the matter had been looked at locally.
I listened to the Secretary of State—I am sorry he is not in his place now—when he talked about stopping top-down decision making and letting local commissioners have a look at the clinical evidence and safety aspects, but the independent review panel has been looking at those matters for years. The interference of people at the top has been the real issue.
Politicians have to get away from the idea that they must defend the national health service in its current configuration at all costs. That will not improve it—[Interruption.] The Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) laughs, but I am talking to him, and to the Secretary of State who stood holding up placards saying things would not happen which have happened. We should not do that. My right hon. Friend the Member for Leigh (Andy Burnham) has the image of that in his hand, but this is a lesson for all people in politics.
When the Health Committee in the previous Parliament looked at NHS deficits, it found that many years ago the major problem with deficits was in the east of England, because many small parts of the NHS were spread around marginal seats that had been fought for one way or another over the previous 20 or 30 years. That level of political interference does nothing for patient care. I am being even-handed in saying that, and I genuinely believe it.
I am going to move on from moratoriums. Ministers put well their arguments on those issues when they were in opposition, but now, given the decisions they are having to take in government, they are having to eat humble pie. It serves them right, as it served the last lot right.
I want to go on to the coalition agreement’s statement that there will be no top-down reorganisation in the national health service, because this current reorganisation is the worst, the biggest and the most savage. It has been defended again today on the basis, as the hon. Member for Southport (John Pugh) said, that GPs are going to be in charge, but they are going to get about £80 billion, and they are small, private, independent contractors, so the idea that there will not be any conflict of interest in some of the work that is going to take place is nonsense. It will be a matter for the courts.
I was also amazed when the hon. Gentleman said that we have competition now inside the national health service, because we do not in clinical services, and he will have to explain why there are 97 clauses in the Health and Social Care Bill which put competition law in clinical services on to the statue book of this land. Can somebody find me one country in the European Union which has competition law in clinical services? I have found none.
I sat on the Public Bill Committee for six months, and, on Third Reading, I asked the Minister who will make the winding-up speech today—I will ask him again, because I have to sit down in a couple of minutes—what the Competition Commission and the Office of Fair Trading had got to do with the merger of national health service trusts. That provision is written into the Bill, and it was not changed when the future forum looked at it; indeed, of the 97 clauses, only seven were changed. The Minister has not answered that question, and I asked Professor Steve Field when he went back to the Public Bill Committee what that had to do with the merger of NHS trusts.
I ask the Minister to answer this question when he winds up the debate. What have the Office of Fair Trading and the Competition Commission got to do with the merger of national health service trusts? I await the answer. I am fed up of asking the question.
The Secretary of State says, “We’re abolishing PCTs,” and indeed we are, but what PCTs do will be taken over by not one body but five different ones: clinical commissioning groups, health and wellbeing boards, clinical senates, the NHS Commissioning Board and local authorities—and that is how we get rid of bureaucracy! That is what the Secretary of State said at the Dispatch Box just a while ago, but five different organisations—some of them new—are going to be involved.
This is the biggest mistake that any Government have made with the NHS since it was brought in 60 years ago, and this Government would be well advised to take the Bill away and get on with serving the nation’s health care needs, not bringing in this competition law, which will be the end of the NHS as we know it.
It is always a pleasure to follow the right hon. Member for Rother Valley (Mr Barron). He would be surprised if I agreed with everything he said, but he made some good points in the first half of his speech.
Today’s debate has been a wasted opportunity for the Opposition, because nothing positive has come out of it—nothing about how we will better look after patients or how we will address very real needs in all our constituencies. There has been a lot of mud-slinging but very little talk about what will benefit patients and how we will deliver a patient-centred NHS.
That is to the detriment of the Opposition and to the way in which they have addressed the motion. It is disingenuous of Opposition Members to attack the Prime Minister and the Secretary of State for Health, and to try to give the impression that my right hon. Friends do not care about the NHS. All politicians and, I believe, everyone in the country care about the NHS, but we have slightly different views about how the service should be run.
I have a great deal of time for the hon. Member for West Lancashire (Rosie Cooper) and I like her very much on a personal level, but some of her points were wrong. In particular, it was wrong to bring the Prime Minister’s personal experience into the debate. He had a difficult family circumstance, and of course someone with that background will understand the NHS very well.
It might be useful at this stage to clear up the point about the letter. The hon. Member for West Lancashire (Rosie Cooper) said that my right hon. Friend the Secretary of State had not replied to her letter, as though it had been sent months ago. It was dated 12 October, so I presume that it arrived in the Department of Health on 13 or 14 October, about 12 or 13 days ago. Hon. Members know that the guidelines, which the Department rigorously keeps to, state that it may take up to 20 days to receive a response. My right hon. Friend has not been discourteous, and the hon. Lady will receive a reply within the time scale.
I thank my hon. Friend for clarifying an earlier point.
I will not engage in mud-slinging, but will talk about what hon. Members on both sides of the House want to emerge from the NHS. The right hon. Member for Leigh (Andy Burnham) was absolutely right that some service reconfiguration is necessary to deliver services in communities, improve community care and build an integrated health service with integrated health care. The right hon. Gentleman spoke specifically about an integrated system and better integrating adult social care, especially for the elderly, with current NHS providers, breaking down some of the silos between primary care, the hospital sector, and adult social services.
Was the hon. Gentleman as concerned as I was at the Select Committee on Health on Tuesday when I asked Richard Humphries of the King’s Fund how the Health and Social Care Bill will impact on integrated commissioning? Richard Humphries said that there is a danger to integration because people are leaving PCTs, working relationships are being disrupted and broken up, and partnerships are being disrupted. As my right hon. Friend the Member for Leigh (Andy Burnham) said, we face years of disruption. That is the danger. Progress on the integration agenda was slow, but it is chaotic now.
I thank the hon. Lady for her intervention. Any period of transition will be difficult, and must be managed. Will the mechanisms and bodies that the Health and Social Care Bill will put in place be better able to deliver community-focused, integrated care than the existing system? I want to consider two matters that we will come to later: health and wellbeing boards, and basing commissioning fundamentally in the community. Both are good mechanisms for delivering better integrated care, and I will return to that.
We have too many silos in the NHS. The primary care sector often does not integrate with the secondary care sector as well as we would like. For example, hospitals are paid by results, but they have no financial incentive to ensure that they prevent inappropriate hospital admissions. We talk about better looking after the frail elderly and about ensuring that we prevent people with mental health problems from reaching crisis point and having to be admitted, but there are no financial incentives and drivers in the system to ensure that that is achieved to the extent we would like. A and E admissions in many hospitals are rising year on year—in rural areas that is partly because we do not have an adequate out-of-hours GP service—and far too often the frail elderly are not properly supported in the community.
If we put the majority of commissioning into the community with local commissioning boards, that will provide a more integrated and joined-up approach to local commissioning, which will undoubtedly help to prevent inappropriate admissions. We no longer want an NHS in which people with mental health problems or the elderly present in crisis because they have not been supported in the community. That must be the focus of care, and the focus of delivery of services.
I wholeheartedly agree with my hon. Friend about the importance of integrating social care and the NHS. I want to share with him the good, concrete steps that are being taken in Cornwall, where we have a pilot health and wellbeing board, and the beginning of integration. That has not happened before in Cornwall, and we are about to have the first joint commissioning of services. That is the way forward to improve patient experience in the NHS.
I thank my hon. Friend for a helpful intervention, which makes the point very well that we need integration through community-based commissioning.
The other key factor is how better to integrate adult social care—the right hon. Member for Leigh made the point, as did the Secretary of State—into the current NHS system. At the moment, integration of services is sometimes variable. There is a good example in Torbay of a more integrated system, but what are the Government proposing that will at least facilitate the integration of services? Local health and wellbeing boards are definitely a step in the right direction because for the first time they will bring together adult social care from local authorities with housing providers, the NHS, and primary and secondary care. That must be a step in the right direction for delivering the integrated care that we all want. It will help to provide more community-focused care.
I referred to the concern about inappropriate admissions, and the fact that elderly people are not supported in their own homes. The savings in adult social care from doing things well are NHS savings, but at the moment there are different cultures in two different organisations, which do not always talk to each other in different parts of the country, and that will not benefit patients. Bringing people together on a health and wellbeing board must be good for patients and integrated care.
For all those reasons, I hope that we will have more positive Opposition day debates on the NHS, and I hope that the Opposition will at least concede that some good things are happening as a result of health care reform.
It is always a pleasure to follow the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). I do not want to impugn his integrity, or to suggest that what he wants for the NHS is not exactly what I want. The issue is how we do that. Unfortunately, some unhelpful remarks were made in the run-up to the general election. At the least, they were disingenuous; at worst they were duplicitous. This debate is about trust, and there are serious questions about whether we can trust the Government with our NHS.
My right hon. Friend the Member for Leigh (Andy Burnham) has argued that pre-election pledges have been broken, and I want to speak specifically about how that relates to NHS funding. The first broken promise came within months of the general election. We have heard about the posters that we all saw as we went round our constituencies, showing a congenial right hon. Member for Witney (Mr Cameron), now the Prime Minister, promising to
“cut the deficit, not the NHS”.
Last October’s spending review seemed to support that position, with a 1.3% increase in NHS resource spending and real-terms growth of what seemed to be 0.4%. The Secretary of State, who is just returning to his place, was unable to answer my question on that. I want to talk abut management costs, because the Department is focusing on that spending. It is important to be clear about management costs in the NHS budget. In 1999, they were less than 3%; in 2010, they were just over 3%. Independent research has shown that, if anything, the NHS is under-managed rather than over-managed. [Interruption.] I can certainly provide evidence for hon. Members.
I am not going to give way—I am sorry.
In this year’s Budget, the Office for Budget Responsibility’s higher inflation forecast meant that NHS spending is now falling in real terms. House of Commons Library calculations show that it will fall by about 1% in real terms over the next four years—a loss in spending power of more than £1 billion by 2015. In the light of the recent inflation figures—[Interruption.] To help hon. Members out, last year’s figure was 5.6% based on the retail prices index. As inflation is at a three-year high, the loss in spending power is likely to be even greater. To keep his election promise, the Prime Minister would have to spend at least £1 billion more than he is doing.
This month’s King’s Fund report on NHS performance shows the effects of these financial pressures on the NHS, with the majority of finance directors saying that they are very or fairly pessimistic about the financial future of their local health economy. The Health and Social Care Bill, which is being debated in the other place, very conveniently sets out ways to help struggling foundation trusts. First, they can borrow money from the City to invest. Secondly, because foundation trusts will have to repay the money they have borrowed by treating more NHS patients and more private patients, they have been helped by the abolition of the cap on private patients’ income. However, as my right hon. Friend the Member for Leigh said, by raising income in this way they become economic enterprises and open themselves up to part B of EU competition law, so that they have to compete for every tender with private sector companies such as Capita, United Health, and so on. Incidentally, seven trusts, including in the Secretary of State’s constituency, have already said that they will be increasing the private bed cap. There is a private hospital in the Cambridgeshire University hospitals foundation trust area. Finally, when—not if—a foundation trust still ends up in financial meltdown, the Bill’s new failure regime means that they will be able to sell off NHS publicly owned assets to private equity companies. There are direct parallels with Southern Cross.
The impact of that is already being felt in patient care. In addition to what is said by constituents attending my and many of my hon. Friends’ surgeries, the King’s Fund report showed that the proportion of patients waiting more than 18 weeks for treatment has increased nationally. Over a quarter of NHS trusts admitted fewer than 90% of their patients within 18 weeks. In my constituency, Pennine acute hospitals trust is able to treat only 70% of patients within its 18-week targets. That is more than double the number of trusts failing to meet the 18-week target in 2010.
I am afraid, however, that an increase in waiting lists is what the Government want; it is one of the intended consequences of the Bill. This increase in demand is feeding the growing private health care and insurance market. We know from the US that as people on low incomes will be less likely to be able to afford these products, there will be a direct impact on the inequalities that the Secretary of State says that he wants to reduce.
My hon. Friend is concerned about health inequalities. Is she as worried as I am about changing the weighting of health inequalities in allocations of funding? In Salford, our experience is that that can push GP practices in deprived areas into the red in their indicative budgets, so they will be cutting down referrals and reconsidering treatments—another way of denigrating and cutting the benefits of services to patients.
My hon. Friend is absolutely right. I will come to that in a minute.
In fact, that is broken promise No. 2. Last week in Health questions, I asked the Secretary of State why, in December last year, he made a political decision, against the advice of the Advisory Committee on Resource Allocation to maintain the health inequalities component of PCTs’ funding allocation at 15%, and instead reduced it to 10%. He replied that he had made no decision against the advice of that Committee. However, it is quite clear from last September’s letter to him from the chair of the Committee that that is exactly what he did:
“I would like to draw your attention to ACRA’s position in relation to the health inequalities adjustment. We recommend that the current form of the adjustment is retained”.
“current form of the adjustment”
was 15%, and the Secretary of State made a political decision to reduce that. He should be apologising to the House for misleading us in his response to my question. The effect of that reduction is to shift funding from poor health areas to good health areas. The Secretary of State owes an apology to the people in those areas, as well.
I turn to broken promise No. 3. Although the move of public health to local authorities is welcome in principle, the timing could not be worse. Already, we are seeing plans that jeopardise the public health function as they move into local authorities besieged with cuts. As Labour has consistently argued, our health and social care system needs to balance the treatment and care of people who are poorly with creating supportive environments that enable all our citizens to live as healthily as possible for as long as possible—focusing upstream on stopping people falling in rather than on pulling them out further downstream, to use a familiar metaphor. That is absolutely key, but unfortunately the current approach means that it is not going to happen. For example, public health budgets, said to be ring-fenced, are not being ring-fenced. The shadow budgets that were being provided to public health departments for 2012 were supposed to increase from 3.7% to just over 4%, but further analysis showed that that increase was due to merging the public health and drug action team budgets, and not to any new moneys. There was, in effect, no real increase in public health funding.
I anticipate a future broken promise in relation to what the Secretary of State has said about privatisation: I think it will be a case of “Watch this space.”
I apologise for missing the opening few minutes of the debate. I was attending the awarding of the gold Duke of Edinburgh’s award to 800 young people in London. It would be marvellous if the press would give as much time to reporting the fantastic achievements of our young people as to the occasional incidents of antisocial behaviour in our communities.
I wish to speak about what I have learned from the experiences that we have had in my constituency regarding our own hospital over the past few years, which have been very troubling for many of us. I will consider these under three headings. First, there is the quality of care and patient safety. As we have learned only recently in the report by the Care Quality Commission, there are problems with quality of care, particularly for elderly people, around the country. That is not the case everywhere; there are some fantastic instances all over the country of very high-quality care. However, it is clearly something that we have to address. I congratulate the Secretary of State on taking the initiative in instigating the CQC report, and I would be very interested to hear from him, as would my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes), about what action he proposes to take in the coming years. I know that the Secretary of State takes this matter extremely seriously.
Patient safety is absolutely essential to the NHS. “First, do no harm”—we all know that from the Hippocratic oath. It is given the highest priority, but it does not always seem to happen. Of course, it is a matter of several different things coming together, such as training, levels of staffing and process—but, above all, attitude. What is the Secretary of State doing more to promote the culture of patient safety throughout the NHS? Again, he takes that particularly seriously, and it was mentioned in last year’s White Paper.
Sometimes, the NHS seems almost to rely too much on the complaints system. A complaint happens when it is too late and when the experience has passed: when something unfortunate or tragic has happened, or when care has not been all that it could have been. I would suggest a system that has been taken up by some trusts and particularly in Brighton, whereby people can raise an issue via an urgent phone line while they, their loved one or their relative is in hospital, perhaps to an independent person who can take up the concern, whether it be about malnutrition in hospital, a lack of care or the inaccurate dispensing of drugs. It can then be addressed on the spot rather than after the event, when a complaint goes through the procedure and lots of letters are written and time consumed. I ask the Secretary of State to take that into account.
The second issue is changes in hospital services, which are a huge challenge for many acute hospitals, especially smaller ones. I agree with the right hon. Member for Leigh (Andy Burnham) and my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) that care has to be taken out of the hospital setting. That is being done across the country and it is essential to the future of the NHS. However, it has to be done in a careful and measured way, so that the reconfiguration and integration of community services complement each other. It is no good having reconfiguration without integrated community services. I heard the case of a constituent who was waiting in an NHS hospital for several weeks at a cost of about £600 a night when she could have been discharged, because the care services were not available in the community. I am glad to say that Staffordshire county council is working closely with the NHS to produce an integrated care trust. That must be the way forward for most, if not all, of the country.
There is concern in all our communities about emergency services. We have to bear it in mind that the population of this country is likely to rise to 70 million by 2028 according to the Office for National Statistics. We need to ensure that the local development plans that are being toiled over at the moment take into account the increasing population and where it will be in 10 to 20 years’ time, and that we do not just base our services on the current population figures. We must also consider communications and whether it will be possible for somebody to get to an A and E department in a reasonable time if their closest one is downgraded. Those matters need to be taken into account because they are of huge concern to all our constituents. I ask the Minister to respond on that point.
On communication, let us be honest about the pressures on the NHS and say that we will not be able to have everything that we want. We need to talk with our constituents and hear what their priorities are in each area.
Finally, I want to refer to shortages in trained staff. There has been a shortage of A and E consultants at my local hospital. I am grateful to the Department of Health, the primary care trust and the Secretary of State for taking a personal interest in the matter and giving us assistance. However, that is a short-term solution and we need a long-term one. The previous Government did well to start up some new medical schools, including one at Keele university in Staffordshire, but we need to train more people. I understand that up to 30% of NHS doctors come from overseas. We are relying on the medical training of other countries, many of which need those doctors more than we do. I ask the Secretary of State what plans he has to ensure that we begin to see a flow-through of trained doctors and nurses into the NHS. Of course, we have to start that now to fulfil the needs that we will have many years down the line.
Stafford has been through difficult times and continues to experience them, even though many incredibly dedicated people are tackling our problems. I welcome the help that the Government, the Secretary of State and the primary care trust have given. The next few years will be very trying for all of us as we meet those challenges. As my hon. Friend the Member for Central Suffolk and North Ipswich said, we must remember that the patient is at the heart of everything—not processes, not bodies, not organisations, but the patient.
There are few areas of our work in this House that may be described, honestly and without hysteria, as matters of life and death. The national health service is so utterly central to our existence, our future and the hopes of our country that it is no surprise that the emotions it engenders are as strong as those that have been witnessed on the Floor of the House this afternoon.
I have to tell the Secretary of State that he has a problem. He is a man of great charm, he is widely liked and he is popular, yet he has not sealed the deal on his disintegration, disaggregation and atomisation of the national health service. He has not been able to persuade the Royal College of General Practitioners, which tells us that three quarters of its members oppose it. He has not been able to persuade Professor Malcolm Grant, his own choice to run the commissioning board, who describes the plan as “completely unintelligible”. The Secretary of State wishes to persuade the nation that it is appropriate, at this time of all times, to spend about £3 billion on reorganisation—money that could be far better spent dealing with the dental abscess of the hon. Member for Southport (John Pugh) and all the other problems that face us.
The hon. Member for Truro and Falmouth (Sarah Newton) spoke for many in the House when she prayed for a depoliticisation of this issue. The reality is that the national health service was born amid the gun smoke of political opposition; it was born opposed entirely by one political party in this House and supported by another. Of the supporters—
Hold on a moment, I am just having a rant.
Of the supporters, let us give credit—because there once was a time when we could give credit to a decent, humane, sensible, consistent bunch of men and women—to the Liberals of those days and to Beveridge for the work that he did. Above all, let us never forget the transcendent genius of a south Wales miner’s son who left school at the age of 14, Aneurin Bevan, who gave us our national—I emphasise “national”—health service.
May I thank the hon. Gentleman? I do not know how anyone persuaded him to bowl me that patsy ball that I can immediately crack to the boundary. He is absolutely right. Dr Hill, the radio doctor, opposed the national health service. Aneurin Bevan said that he had had to
“stuff their mouths with gold”.
Of course the producer interest opposed the beginning of the national health service because it was about the consumers—that was its major difference. Of course the vested interests opposed the creation of the national health service—that is no surprise. But that was then.
The national health service was born in compromise. I was born in July 1948, as was the NHS. For many years I was suspected to have been the first child ever born on the NHS, in Queen Charlotte’s hospital, but somebody in Salford beat me to it.
Trafford. I beg your pardon. However, the year before I was born, my parents had a son who died at the age of seven months. The year before that, they had another son who died at the age of eight months. I was born on 5 July 1948, two days after the health service, and I have my five brothers and sisters alive to this day. It is that important.
When I worked as a porter for 10 years at the Middlesex hospital, where my sister and wife were nurses and one of my brothers was an ambulance driver—half the family seemed to be employed there—we realised the consequences of the pragmatic approach to the health service. We had a private patients wing where people like myself, paid by the national health