I beg to move,
That this House is concerned about recent pressure in Accident and Emergency departments and the increase in the number of people attending hospital A&Es since 2009-10; notes a recent report by the Care Quality Commission which found that more than half a million people aged 65 and over were admitted as an emergency to hospital with potentially avoidable conditions in the last year; believes that better integration to improve care in the home or community can relieve pressure on A&E; notes comments made by the Chief Executive of NHS England in oral evidence to the Health Select Committee on 5 November 2013, that the NHS is getting bogged down in a morass of competition law, that this is causing significant cost and that to make integration happen there may need to be legislative change; is further concerned that the competition aspects of the Health and Social Care Act 2012 are causing increased costs in the NHS at a time when there is a shortage of A&E doctors; and calls on the Government to reverse its changes to NHS competition policy that are holding back the integration needed to help solve the A&E crisis and diverting resources which should be better spent on improving patient care.
Our purpose in calling this debate is twofold. First, we want to help the House to develop a more sophisticated understanding of the underlying reasons for the sustained pressure in accident and emergency departments throughout England. Secondly, we want to remove what we see as the major barrier to a lasting solution in A and E.
What has been happening in A and E over recent years? Between 2007 and 2010, attendances at A and E were fairly stable, although they rose slightly. Over those three years, attendances at hospital A and E departments increased by 16,000. Between 2010 and 2013, something changed. In the first three years of this Government, attendances at A and E increased by a staggering 633,000.
What is going on? It is all too easy to reach for simplistic answers. In truth, the picture is complex and a range of factors has contributed to the rise. However, it is possible to point to underlying causes. One of those is clearly the general economic climate. People have been living under greater pressure and are struggling with the cost of living. A and E has become the last resort for people who are not able to cope for a range of reasons. If Members speak to A and E staff, they will be told that there has been a rise in people arriving at A and E who have a range of problems linked to their living circumstances, from people who have severe dental pain because they cannot afford to see the dentist, to people who are suffering a breakdown or who are in crisis, to people who cannot afford to keep warm and are suffering a range of cold-related conditions.
The right hon. Gentleman is explaining why there is increased pressure on A and E. Does he not accept that A and E performance has improved since the general election? The average waiting time is down from 77 minutes under the last Government to 30 minutes.
No, I do not accept that. This has been the worst year in a decade in A and E departments. Almost 1 million people have waited more than four hours to be seen. In my year as Secretary of State for Health, the figure was 350,000. There has been a big increase in the number of people who are waiting a long time. I was going to come on to the average waiting time, but since the hon. Gentleman mentions it, let me make the situation clear now. The figure that he is talking about and which appears in the Government amendment relates to the waiting time until an initial assessment, not the total waiting time in A and E. [Interruption.] The Secretary of State is nodding because, as ever with him, it is all about the spin. That figure does not mean anything to the public. They want to know how long they will spend waiting in A and E in total. We need to have a bit of truth in this debate.
My right hon. Friend was making a point about the wider economic pressures that are leading to greater pressure within A and E. Was he as shocked as I was to read in the Manchester Evening News last year that people in our area are presenting at A and E as a result of malnutrition? Is it not an appalling indictment of the Government that they have allowed that to happen in the 21st century? It is putting huge pressure on A and E departments across the north-west, including those at Wythenshawe hospital and Manchester Royal infirmary.
That is an indictment of the Government. They have made it harder for people to afford a good basic diet. We have seen a rise in hypothermia, rickets and scurvy. Sadly, we have also seen the rise of food banks under this Government. That is why I am beginning my speech by saying that there is a range of reasons for the sustained pressure on A and E.
I will make a little progress and then I will give way.
There have been record levels of hypothermia this year and thousands of over-75s have been treated in hospital for respiratory or circulatory diseases. That brings me to the second underlying cause of the increase in attendances at A and E. The ageing society is not a distant prospect on the horizon. Demographic change is happening now and it is applying increasing pressure on the front line of the NHS.
We all need to face up to the uncomfortable fact that our hospitals are increasingly full of extremely frail elderly people. Too many older people are in hospital who ought not to have ended up there or who are trapped there because they cannot get the right support to go home. That situation is unacceptable and it has to be addressed.
Does the right hon. Gentleman not accept that the emergence of older people visiting A and E in far greater numbers has been coming on for a long time? I know that he does not like to be reminded of the 2004 GP contract, but surely he agrees that it is a factor, because older people have not been able to get the necessary support over a long period. The Government are putting that right by integrating health and social care far better.
The hon. Lady wants me to answer that question, but I direct her to her right hon. Friend, the Chairman of the Health Committee, who has dismissed the self-serving spin from the Government that says that these problem are all to do with a contract that was signed 10 years ago. I began my speech by citing figures that show an exponential rise in the number of people attending A and E since 2010. Many of those people are very frail older people. That is the issue before the House, so it does not help the debate for the hon. Lady to stand up and make a spurious political point.
Is not one of the reasons why more elderly and frail people are going to hospital that there has been a £1.8 billion cut in adult social services and support? Those people are ending up in hospital because they are not receiving the care that they need at home.
My hon. Friend is absolutely right. I will come on to say that the single most important underlying cause of the A and E crisis is the severe cuts that we have seen to adult social care. That has created a situation in which older people are trapped on the ward and cannot go home because there is not adequate support at home. That means that A and E cannot admit to the ward because the beds are full. Hospitals are operating way beyond safe occupancy levels. Because of that, the whole hospital begins to jam up and the pressure backs up through A and E. When A and E cannot admit to the ward it becomes full, so ambulances queue up outside because they cannot hand people over to A and E.
That is exactly what is happening in our NHS at the moment. A and E is the barometer of the whole health and care system. If there is a problem anywhere in the system, it will be seen eventually as pressure in A and E. That is what is happening. The simplistic spin from the Conservative party, which says that it is all to do with a GP contract from 10 years ago, is discounted by expert after expert.
My right hon. Friend rightly said that back-ups in A and E cause problems elsewhere. May I draw his attention to the fact that over the past 18 months, more than 1,600 people have waited more than 20 minutes in ambulances outside Warrington hospital before they could even get to A and E and the clock starts ticking? North West Ambulance service says that it cannot be accurate about the waiting time for hundreds of incidents. Does that show that waiting times may be even worse than first thought?
I fear my hon. Friend is absolutely right. I know Warrington hospital well and the pressures that have been on it, and I agree that ambulance response times have increased across the country because so many ambulances have been held in queues outside A and E, unable to hand over patients to A and E staff because it is full. That has left large swathes of the country—particularly in rural areas—without adequate ambulance cover, and very serious incidents have taken place across the country, not least in the Minister’s area of Norfolk where people have not received ambulances on time. That is the consequence of the pressure on A and E not being addressed, and it is threatening to drag down the rest of the NHS.
My right hon. Friend is making an incredibly powerful speech that goes to the very heart of our NHS and the staff who work in it. North East Ambulance Service is one of the highest performing services in the country and reaches 80% of most seriously ill or injured patients within eight minutes. Last week, however, it had to hold an emergency summit because staff morale is at an all-time low. Assaults on staff are increasing dramatically, and the stress and pressure of waiting outside A and E to admit patients is having a deeply damaging impact on the wider NHS. Does my right hon. Friend agree that that is not what the Prime Minister meant when he said that the NHS was safe in his hands?
My hon. Friend’s point was also made powerfully by ambulance staff at an A and E summit held by the shadow Front-Bench team in Parliament before Christmas when a paramedic spoke of the phenomenon she has just described. He mentioned an occasion when staff were at the door of A and E waiting to hand over a patient to A and E staff, when the patient had a heart attack. The staff did not know what to do and had to go back to the ambulance to try to stabilise the patient. Those sorts of joining points or disconnects in the system are leading to real pressure on staff who do not know what to do in those difficult circumstances. The system is in danger of being overwhelmed, and the pressure on staff must be addressed urgently.
I share the right hon. Gentleman’s view that delays in handover at A and E are not acceptable, and I remember well that last decade, under the previous Government, ambulances were stacking up outside the A and E at the Norfolk and Norwich hospital. Does he welcome the fact that this winter, delays of longer than 30 minutes are down by more than 30% compared with last year?
Yes, there has always been pressure on the ambulance service at this time of year, but if the Minister wants me to join in with his complacency, I am afraid I will not. The past 12 months have been the worst in A and E in a decade, and there are reports of ambulances across the country held in queues. Is the Minister satisfied with the performance of the ambulance service in his region of east England? Was he satisfied with the way the case I mentioned was handled? I do not believe he was or that his complacency at the Dispatch Box will be appreciated by his constituents.
As a Norfolk MP I assure the right hon. Gentleman that we are on the case regarding ambulances, and the Minister is leading the charge. I am interested in the facts. Is not the truth that we are treating 2,000 more patients every day in under four hours in A and E, and that we have 350 more A and E consultants? In Norfolk and Norwich hospital, people tell us that it was under Labour, with the IT issues, integration, GP contracts and working time directive that A and E became chaotic. The right hon. Gentleman’s attack is unfair, ill-judged and overly partisan.
I acknowledged that there is always pressure in A and E, but the fact is that it performed better in every month when I was Health Secretary than it has under the current Health Secretary. The hon. Gentleman mentions Norfolk again. We have been looking at the Minister’s website, which makes us wonder whether he considers himself a Minister or an observer of events in the NHS. Under the headline “Norman Lamb’s North Norfolk Ambulance Survey” he states:
“I have been campaigning over the last year to improve unacceptable ambulance response times in rural Norfolk.”
My God, this is the Minister! He is campaigning against his own Government.
I wonder whether the Minister will write to the Minister about that problem. The spin from those on the Government Front Bench may kid some of their Back Benchers, and it has certainly kidded some Liberal Democrats who I have been speaking to across the Chamber, but it will not kid patients who go to A and E and see people on trolleys, camp beds or blocked in ambulances.
My hon. Friend is absolutely right, and I would love the Government to explain that everything is fine and that there is no problem at all to more than 100,000 people who have waited more than four hours on a trolley this year, or almost 1 million people who have waited more than four hours in A and E. The complacency is not justified, and if those people were to read the Government’s motion, I am afraid, quite frankly, they would be astonished.
Perhaps I may help my right hon. Friend by saying that the campaign in North Norfolk began on the Minister’s website after the excellent campaign run by the Labour prospective parliamentary candidate, Denise Burke, who pointed out how deficient local services were—[Interruption.]
Will my right hon. Friend join me in condemning the Government for still classing A and Es as such when, like the one at Charing Cross, they are in practice closing and turning into GP-run clinics? The Government are still calling them A and Es, and people are misled. That will lead them to go to the GP-run centres when they should be going to properly staffed A and Es, and we will get tragedies such as the one at Chase Farm.
I am afraid that under the coalition, NHS treatment for “Gove-itis” is being rationed, like everything else, unfortunately. As my hon. Friend said, the Government claim they are keeping A and Es and call them “local” A and Es, but they are actually downgrading A and E units all over the country. How can it make sense to close and downgrade A and Es in the midst of an A and E crisis? In west London, as my hon. Friend knows, incredible changes are being introduced without proper regard for the evidence I am presenting to the House today of a change in A and E and of sustained pressure on A and E units. The Government must go back and consider their plans for my hon. Friend’s constituency and the rest of London.
I totally agree with the right hon. Gentleman that the last thing the health service requires is complacency, but synthetic rage does not help either. He must remember that when he was Health Secretary, and indeed a Health Minister, up to seven ambulances were queuing outside Treliske hospital in Cornwall. That problem happens from time to time and it would be better for parties to co-operate and to come together to try to find a solution, rather than simply trying to score political points and ignoring the past.
I will put forward a solution that the hon. Gentleman might support. I think he supported the campaign to oppose the Government’s Health and Social Care Bill, and I pay credit to him for that as we worked across party lines on that issue. It is my job to hold the Government to account where there are problems in the national health service, and if the Minister is saying to me that there are no problems in the health service right now, I am afraid I do not agree with him. Emergency services are under intense pressure. If he looks back to our time in government, as he invited me to do, he will see that the winter crisis was a regular feature at the turn of the millennium and the early years of the last decade, although it got progressively better and better and we did not see the annual winter crisis. Now it is back with a vengeance, although it is different. The winter/spring crisis has become a summer/autumn crisis too. The pressure is relentless and it needs a proper, lasting solution.
Would the right hon. Gentleman care to reflect on the fact that we now have 350 more A and E consultants in the NHS? Given his commitment to cut the NHS at the last election, if he is going to offer a sensible improvement, where will the money come from? How will he pay for it? That is what the people out there want to understand.
First, I would be grateful if the hon. Gentleman did not continue to misrepresent what I said on the NHS. I have never said, “Cut the NHS”. I stood at the last election on a commitment to protect the NHS budget in real terms. He stood on a manifesto promising real-terms increases for the NHS. I said that if there were to be increases for the NHS, they should be given to social care instead, and that would have relieved some of the pressures on A and E. Let us have the facts straight.
Secondly, the hon. Gentleman boasts about having enough A and E doctors. Perhaps he should speak to people from the College of Emergency Medicine and hear what they have to say on that subject. They talk of warning the Government of a recruitment crisis in A and E about two or three years ago. They said that they could not get through to Ministers who were obsessed with structural reorganisation. They were left feeling like John the Baptist crying in the wilderness—their words. Perhaps before the hon. Gentleman shouts the odds in the House, he should speak to the people who know about these things and who warned his Government —who failed to act.
One of the major problems with the pressure on A and E is the number of older people trapped in hospital. This is a product of demographic pressure and the ageing society. Nursing staff talk of how, when they first qualified, it was rare to see someone in their 90s on the ward. Now they are there in great numbers and that makes the task of meeting their needs much more complex. When people reach an advanced age it is simply not possible to separate out their physical, social and mental needs. Need becomes a blur of all three. Our hospitals are not geared up to provide the additional mental and social support that very frail elderly people often need.
I have given way to the hon. Lady once: I want to make some progress.
Some, but not all, of the needs of older people are met in an acute hospital environment, which explains why their condition often drops like a stone. It is a phenomenon that was accurately identified by Robert Francis QC in his report, published a year ago this week. He called for an overhaul of the way in which older people are cared for in acute hospitals. He was right to do so, and while I applaud some of the steps the Secretary of State has taken in that regard, such as the move towards a named consultant, I do not believe it will tackle the root cause of the problem, which is the arrival of far too many older people in hospital in the first place. Only when that is tackled will we begin to address the underlying causes of the A and E crisis.
I am grateful to the former Secretary of State for giving way, because I am concerned—especially as we are talking about not distorting the facts—by his initial analysis. He attributed part of the pressure on A and E to an outbreak of scurvy and rickets cases. I do not want anybody in my constituency or elsewhere to be unduly alarmed, so can he please put on the record what proportion of people reporting to A and E, including those who are not seen within four hours, are doing so because they have scurvy? He can give the numbers in absolute figures or percentages, but it is important that the House not be misled and that we are given the unvarnished truth.
The hon. Gentleman should climb off his high horse for a moment. In answer to an important point made by my hon. Friend the Member for Stretford and Urmston (Kate Green), I pointed to the increase in cases of scurvy, rickets and malnutrition. If he wants—[Interruption.] If he wants to deny that that is the case, that is up to him—[Interruption.] If he speaks to A and E staff, he will hear that people who are not eating properly are turning up in ever greater numbers—[Interruption.] I have answered his point and I will now make some progress.
It is the case that too many older people are arriving at hospital in the first place. A recent Care Quality Commission report found avoidable emergency admissions for pensioners topping 500,000 for the first time—[Interruption.]
Order. The exchange between the hon. Member for Liverpool, Walton (Steve Rotheram) and the hon. Member for Taunton Deane is most unseemly. I remind the latter that he is a distinguished former member of Her Majesty’s Government and he should comport himself with appropriate dignity. That is what we look for in an hon. Member who aspires to be a statesman.
The beard is certainly helping. I suggest that the hon. Member for Taunton Deane (Mr Browne) visit Liverpool Walton, because he will see more food banks there than anywhere else in the country. He will meet families who cannot afford to put enough food on the table to give their kids a decent diet. He will see the direct effects of some of his Government’s policies on some of the most deprived communities in the country.
I agree, and the last time we had a debate on this issue I quoted a well-known GP who said that she has taken to asking her patients whether they are eating properly, because many are presenting with unexplained symptoms that she cannot identify. People on several prescription medicines who are not eating properly are putting themselves at risk—
I am grateful to the right hon. Gentleman for giving way. I do not dispute that there are people who live on a small amount of money or that some of those who go to see doctors are not eating adequately. But he attributed the pressures on A and E in part—he raised the issue, not me—to an increase in the number of people who are reporting to A and E with scurvy and rickets. He made that point with all the authority of a former Secretary of State, so he should tell the House how much of the extra pressure on A and E is attributable to people who have scurvy or rickets. If he does not know, why did he raise the issue in the first place?
I began by saying that the reasons for the rise in A and E attendances were complex. I did not say—if the hon. Gentleman was listening—that there were any simplistic reasons. I did say that there had been a rise in malnutrition and diseases linked to it. If hon. Members on the other side of the House want to dispute that fact, I will have that debate any time they wish. They seek to suggest that malnutrition is not a problem, but they are confirming how out of touch they are.
As I was saying, the number of emergency admissions of pensioners has topped 500,000 for the first time. It is rising faster than the increase in the ageing population. There were 65,000 more emergency admissions in the last 12 months compared to the previous 12 months, a clear sign of more frail, elderly people ending up in A and E. Hospitals are operating way beyond safe recommended bed occupancy levels, with increasing numbers of frail, elderly people on the wards. That means that A and E finds it increasingly difficult to admit people, and pressure backs up through A and E.
The Government’s amendment seems to have been written in a parallel universe. Let us get this clear: the last 12 months have been the worst in A and E for a decade. Hospital A and Es have missed the Government’s target in 44 out of the last 52 weeks. How can that equate to A and E performing strongly, as the amendment suggests? It serves only to confirm an impression that has been building about this Secretary of State since he took office: that he seems to spend more time paying attention to spin doctors than he does to real doctors.
One problem my food bank has reported to me is that people are reducing the number of drugs they are taking because they cannot afford to buy them. There is a queue in A and E departments to register. Not only are people waiting in ambulances outside, but there are queues of people, as happened in a hospital very close to this place, waiting to be registered.
My hon. Friend is absolutely right. She knows the pressure people are under in our area. What we have heard from the Government is denial that this is the reality in many parts of the country. [Interruption.] We can hear them shouting now, claiming that it is a myth that people are using food banks and not eating properly, and that they cannot afford to heat their homes because of the rise in fuel bills under this Government. All of that is placing extra pressure on A and E, and people are waiting longer and longer to be seen.
I thank the right hon. Gentleman for giving way; he is being very generous. As he is widening the debate out to the wider economy, does he not accept that, although there are many reasons for increased A and E consultations and some of the issues relating to nutrition are valid, the point made by the hon. Member for Bolton West (Julie Hilling) about people not being able to afford prescriptions must be fallacious? They will receive free prescriptions if they have a very low income and are attending food banks. There are many more reasons than the right hon. Gentleman is giving credit for.
Not for the first time, Government Members are showing how out of touch they are with what is happening. The hon. Lady says that she is not aware that any family is unable to afford a prescription item. Let me put her straight: that is what many families are facing at the moment, particularly those who are in work, who do not get free prescriptions. They are facing difficult choices about whether they can afford to buy their prescriptions. If she is saying she does not recognise that problem, then I am afraid she really needs to get out of this place a bit more.
I did not intend to intervene, but I should say to the House and to the hon. Member for Stourbridge (Margot James) that I met recently representatives from community pharmacy associations and others who said to me, explicitly and clearly, that people from what one would assume to be relatively well-off families—middle class and relatively affluent—who are prescribed multiple prescriptions are now choosing not to pay for them because of the cost of living and the squeeze on their finances. They are choosing to go without, and that is apparent at pharmacy counters.
My hon. Friend puts his finger on it. There are families who are choosing between eating, heating or other essentials, such as prescriptions. That is the reality for many families and it is having an impact on their health. For those on the Government Benches not to recognise that that is the reality of life for many people, I fear for the state that we are in. They have been shouting at me for the past few minutes about scurvy. I can tell the hon. Member for Taunton Deane (Mr Browne) that the number of admissions has doubled. There are a relatively small number of cases, but they are on the rise. He really should not sit there barracking and dismissing the whole problem. He would do well to look at the facts.
Today, the Secretary of State says that the NHS got better in the past year. He should say that to the 131,000 people left waiting on trolleys for more than four hours. He should say that to the people finding it harder to get a GP appointment under his Government, left ringing the surgery at 9 am to be told that nothing is available. He should tell that to the families of children who have suffered a mental health crisis, but are told that there are no beds available anywhere in the country and end up being held in police cells. The truth is that the Government have failed to get the A and E crisis under control and it is threatening to drag down the rest of the NHS. In the past 12 months trolley waits are up, waiting times are up, emergency admissions are up, cancelled operations are up and delayed discharges are up, too. That is the reality of what is happening in the NHS.
One of the main reasons for the intense pressure on A and E is the collapse of social care in England. In December, a report from the Personal Social Services Research Unit found that, due to local government cuts, social care support in the home has been withdrawn from about 500,000 older and vulnerable people. These are people who were receiving support in the home, but are no longer getting any help. Even for those people still receiving some support, we continue to hear stories of corners being cut: slapdash 15-minute visits where staff have to choose between helping people wash or helping people eat. If we carry on like this, our hospitals will become more and more full of older people. A and E will be overwhelmed by the pressure and that really is no answer to the ageing society. That brings me to the second part of our debate today: the solution.
What is clear to most people is that there will not be a solution to the sustained pressure on A and E without better integration of hospital services with social care, primary care and more collaboration between the two. What is also clear is that there is now great frustration among people working in the NHS that they are being prevented from developing solutions to the A and E crisis by a large barrier standing in their way: the Health and Social Care Act 2012. This Government like to talk about integration, but the fact is that they have legislated for fragmentation. Under this Government, market madness has run riot throughout the NHS and is now holding back solutions to the care that older people need.
Will the right hon. Gentleman welcome the exact example that he so urgently seeks: Haltwhistle hospital in Northumberland? It is currently being built and I have been around it. It is integrated, with the local authority on the top floor and the NHS on the bottom floor. That is surely the model and the way forward.
I agree with the hon. Gentleman. There are examples of good practice out there, but I suggest that he speaks to chief executives of clinical commissioning groups and trusts. They are telling me that the competition regime introduced by his Government is a barrier to that kind of sensible collaboration. The chief executive of a large NHS trust near here says that he tried to create a partnership with GP practices and social care, but was told by his lawyers that he could not because it was anti-competitive. Does the hon. Gentleman support that? Is that what he thought he was legislating for when he voted for the Health and Social Care Act? People are being held back from doing the right thing for fear of breaking this Government’s competition rules.
Recently, we heard of two CCGs in Blackpool that have been referred to Monitor for failing to send enough patients to a private hospital. The CCG says that there is a good reason for that: patients can be treated better in the community, avoiding costly unnecessary hospital visits. That is not good enough for the new NHS, however, so the CCG has had to hire an administrator to collect thousands of documents, tracking every referral from GPs and spending valuable resources that could have been spent on the front line.
My hon. Friend is right. For the very first time in the history of the NHS, competition intervenes to block sensible collaboration between two hospitals seeking to improve care and make savings. Since when have we allowed competition lawyers to call the shots instead of clinicians? The Government said that they were going to put GPs in charge. Instead, they have put the market in charge of these decisions and that is completely unjustifiable. The chief executive of Poole hospital said that it cost it more than £6 million in lawyers and paperwork and that without the merger the trust will now have an £8 million deficit. That is what has happened. That is not just what I say; listen to what the chief executive of NHS England told the Health Committee about the market madness that we now have in the NHS:
“I think we’ve got a problem, we may need legislative change…What is happening at the moment…we are getting bogged down in a morass of competition law…causing significant cost and frustration for people in the service in making change happen. If that is the case, to make integration happen we will need to change it”—
that is, the law. That is from the chief executive of NHS England.
That was Labour’s law.
No, it was your law, your Government’s law, the Health and Social Care Act 2012—the same law against which his own care Minister, the hon. Member for North Norfolk (Norman Lamb), has recently been speaking out. He recently told the King’s Fund:
“I have a problem with the OFT being involved in all of these procurement issues… I think that’s got to change… In my view I think it should be scrapped in the future… That might happen at some future date… we’ve got to look at the barriers and address them and sort them out.”
Is that just his view, or the view of the whole Government? [Interruption.] He voted to let the OFT into the NHS. Why is he now changing his tune?
The former care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), said the same:
“The one area I have my concerns about is the way”—
the 2012 Act—
“opened up the role of the OFT.”
Yes, but did we not tell him that two years ago when he voted for the Act and when his hon. Friend the Member for St Ives (Andrew George), who is sitting next to him, joined us in the Lobby to oppose it? This is exactly what we warned them about. We warned them that it would let the market run riot through the NHS, but they would not listen, and that is why we are where we are today.
It is not just Ministers who are saying it; the comments by the chair of the Care Quality Commission at the weekend show the utter confusion in Government policy on competition in the NHS:
“We need more competition…more entrants into the market from private-sector companies”.
Will the Secretary of State clarify? Is that a statement of official Government policy? Is it his policy to get more private sector companies and more competition into the NHS? Is that what he wants? If that happens, it will mean more enforced competition leading to the fragmentation of care, and it will load extra costs on to the NHS at the worst possible time.
We are seeing this across the NHS. We have also seen contracts going to companies whose shareholders are Tory party donors. The closeness of the links between the Tory party and private health care is worrying.
Since April, when their Act came in, seven out of the 10 contracts let have gone outside the NHS. That is the clearest of all wake-up calls about what is happening to the NHS under this Government: it is being broken up and sold off. Under section 75 of the Act, clinicians have to put services out to tender, regardless of whether they are performing well, and that is the big difference between this Government and the last one. They are enforcing competition and marketisation in the NHS, but nobody voted for it.
Why, when the right hon. Gentleman was Secretary of State, were the previous Government prepared to pay private sector providers 11% more than NHS providers?
Let me explain the difference to the Minister. When we were in government we used the private sector in a supporting role to help bring down NHS waiting times; he is using the private sector to replace the public NHS. There is a very big difference. He might remember that as Secretary of State I introduced the NHS preferred provider policy. At the time, his party complained—it said it was wrong—but I did it because I believed in the public NHS. I believe in what it stands for, unlike him and his party.
I remind the right hon. Gentleman that, unlike him, I have worked for the NHS and understand what it is like to work on its front line. Will he confirm that the previous Government introduced private sector provision into the NHS and paid 11% more to private sector providers than to NHS providers? This Government will not allow that.
The Minister looks pleased with himself, but I am afraid he has got his facts wrong. We did not introduce the private sector into the NHS; it has always worked with the private sector to relieve pressure on waiting lists. As a doctor, he should know that. He might also know that waiting lists and times came right down under the last Government, because the private sector supported the NHS, and I am proud of how we brought waiting lists down, but he is using the private sector to replace the public NHS. He is saying that any qualified provider can provide NHS contracts. I had a policy of designating the NHS as the preferred provider. So let us get the facts straight. There is a major difference between the two positions.
I think the hon. Gentleman is referring to Hinchingbrooke, the contract for which, he will recall, was signed under his Government. If he comes to the House, he should at least have the decency to get his facts straight. A procurement exercise began under the NHS preferred provider policy that I introduced, but he will find that his Government changed that to any qualified provider, and then appointed Circle health, whose shareholders also happen to be major donors to the Conservative party, to run the hospital.
The Government are spending millions of pounds on competition advice under the regime introduced by the 2012 Act. Since last April, CCGs, have spent £5 million on external competition legal advice. How can that be justifiable at a time when we have a shortage of A and E doctors? Around the world, we see that competition not only costs more, not less, than a planned system such as the NHS, but results in more fragmentation. It will never be an answer to the pressures in A and E. We need an approach where clinicians can collaborate and develop integrated solutions to relieve pressure. How can we possibly achieve integrated care when there are several different providers, each providing a different part of the same patient pathway?
The A and E crisis will be permanent, unless the Government accept its root causes and remove the barriers to its solution. The answer is in the motion before the House. The House can vote to reverse the competition policy introduced by the Government in the 2012 Act and to remove the market madness now holding back the NHS, and it could all be done because it would be consistent with the coalition agreement. The simple fact is that nobody voted for the NHS to be broken up in this way. Who gave this Prime Minister and Government permission to put the NHS up for sale? Nobody. They said there would be no top-down reorganisation. In the fullness of time, “No top-down reorganisation of the NHS” will be to this Prime Minister what, “No rise in tuition fees” is to the Deputy Prime Minister.
The choice on the NHS in 2015 is becoming clear: it can stay on the fast track to fragmentation or it can return to its values of putting integration over fragmentation, collaboration over competition, and people before profits. That is what the Opposition believe in. Let us have that debate so that we can save our NHS for future generations.
On a point of order, Madam Deputy Speaker. In response to yesterday’s sensitive statement on Sri Harmandir Sahib, the shadow Foreign Secretary, the right hon. Member for Paisley and Renfrewshire South (Mr Alexander), made a point about documents pertaining to Lady Thatcher not being released. In fact, they were released back in January. I would appreciate your guidance, Madam Deputy Speaker, as this is a very sensitive matter, and I would hate to see it politicised.
I am grateful to the hon. Gentleman for notice of his point of order, but this is a matter for the right hon. Member for Paisley and Renfrewshire South (Mr Alexander), whom I understand he notified of his intention to raise it in the Chamber. It is not a point of order for the Chair, but he has got his concerns on the record, and I think he will have to leave it at that for today.
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes the strong performance of NHS accident and emergency departments this winter; further notes that the average waiting time to be seen in A&E has more than halved since 2010; commends the hard work of NHS staff who are seeing more people and carrying out more operations every year since May 2010; notes that this has been supported by the Government’s decision to protect the NHS budget and to shift resources to frontline patient care, delivering 12,000 more clinical staff and 23,000 fewer administrators; welcomes changes to the GP contract which restore the personal link between doctors and their most vulnerable patients; welcomes the announcement of the Better Care Fund which designates £3.8 billion to join up health and care provision and the Integration Pioneers to provide better care closer to home; believes that clinicians are in the best position to make judgements about the most appropriate care for their patients; notes that rules on tendering are no different to the rules that applied to primary care trusts; and, a year on from the publication of the Francis Report, notes that the NHS is placing an increased emphasis on compassionate care, integration, transparency, safe staffing and patient safety.”.
The right hon. Member for Leigh (Andy Burnham) today made some strong accusations. He talked about the worst winter in A and E for a decade. For months now, he has been predicting a winter crisis in A and E, but as ever, when we look at the facts, they simply do not stack up. Let us look at the last week available for A and E statistics, which is the week ending 26 January. Over 96% of patients were seen within four hours. At this stage in the winter, we have missed the target four times; at the same stage when he was Health Secretary, he had missed it 12 times. That is three times more. [Interruption.] He says the target is different. It is true: on the basis of advice from clinicians, the target was reduced from 98% to 95%, so let us strip out the targets altogether and just ask a simple question. How many people every day are being treated within four hours? Under him, it was fewer than 52,000; under this Government it is nearly 55,000. That is 3,000 more people every day.
The right hon. Gentleman did not just say that; he also said that people were waiting longer and longer to be seen, but that is simply not true. When he was Health Secretary, shockingly, people had to wait on average over an hour to be seen in emergency departments. With 350 more A and E consultants—as my hon. Friend the Member for Mid Norfolk (George Freeman) rightly mentioned—under this Government we have cut that to just 30 minutes. The right hon. Gentleman has the gall to stand up and criticise a record that is better than his.
In relation to those targets, the Secretary of State ignores the number of people who have not registered because they are in ambulances or because there is a huge queue to be registered. I wonder how that is factored into his claim that people are always seen within half an hour, when patently they are not.
With great respect to the hon. Lady, it was under her Government that we had the horrific tragedy of ambulances circling round hospitals because hospitals did not want to admit them in case they missed their four-hour A and E target. There is a lot of pressure in the system, but the fact is that 3,000 more people every day are being seen within four hours than when her Government were in power. That is something that A and E departments up and down the country can be rightly proud of.
I have had reason to visit my accident and emergency four times with my young son, who is 10 years old and an enthusiastic rugby and football player. On those four occasions—for a broken nose, a damaged knee, damaged ankles and damaged elbows—we were seen within minutes for pain relief and were out of A and E within two hours.
That is exactly what is happening in so much of the country. Despite a lot of pressure, our A and E departments are holding up extremely well. I wonder how the staff in that hospital would feel about the constant running down of the NHS that we get from the Opposition.
Let us look at the figures that the right hon. Member for Leigh quoted in more detail. How does he get the number he quoted for the worst winter for a decade?
Let us have a proper debate. I did not say the worst winter for a decade; I said the worst year in A and E for a decade. Let us get it straight. The Secretary of State should not redefine the question at the beginning of his speech. I am talking about the last 12 months, from this day today back to February 2013. Let us get that absolutely clear and let him answer for the last year, during which he has missed the A and E target 44 times out of 52.
Let us be absolutely clear. Why has Labour decided to remove the word “crisis” from the motion it submitted to the House this afternoon? It does not mention the word “crisis” at all, because the winter crisis that the right hon. Gentleman has been predicting for over six months now has simply not materialised.
Let us look—this is important—at how the right hon. Gentleman has been manipulating the statistics. He knows perfectly well that there is no A and E target for single categories of A and E; rather, the target applies to all A and Es. He gets his numbers by singling out the biggest A and E departments, type 1s, which are extremely important. How did type 1s—the most important and biggest A and Es—perform during the winter when he was Health Secretary? Let me tell the House: they missed their target every single week up until this point in the year. There are indeed pressures on A and E departments, but why does he think the country will listen to him, when by his own yardstick he failed to deliver every single week up until this point in the year?
The right hon. Gentleman has been predicting a winter crisis for months, and we are still waiting. For him, these debates are not about the reality on the ground; they are about hyperbole and spin. As someone who has been Health Secretary, he must know—this is a serious point—the effect that lurid headlines based on dubious statistics have on morale for staff and those using the NHS, but still we get the same cracked record, because for him, politics always matters more than patients.
It is not just A and E performance; under this Government—[Interruption.] It might not be comfortable for the Opposition, but let us look at the figures. Under this Government, MRSA rates have virtually halved, mixed-sex wards have nearly been eliminated and when it comes to elective care, more than 35,000 fewer people are waiting more than 18 weeks. That is thanks to the efforts of hard-working front-line staff. Our NHS is doing 800,000 more operations year in, year out than it did under Labour—something we can be immensely proud of.
My right hon. Friend the Member for Leigh (Andy Burnham), the shadow Secretary of State, has referred to comments by Dr Cliff Mann about the shortage of A and E doctors and the fact that the issue was flagged up some two years ago. What will the Government do to address the 50% shortage in A and E doctors, not only in England but throughout the UK?
The hon. Lady is right to highlight the fact that there has been a long-standing issue with recruitment into A and E. We have made some good progress. We have 350 more consultants in post than at the time of the election, but we need to do even better, so we are looking at the training process for A and E consultants. We are also looking at the contractual terms for A and E consultants, particularly as they relate to things such as shift work, to try to make it a more attractive profession. I am confident that these issues are now being addressed—in fact, I have had some encouraging feedback from the College of Emergency Medicine saying that it, too, is confident about that.
I will give way in a minute, but this is an Opposition day debate, so I want to return to the central motion. Let me remind the right hon. Member for Leigh that he told this House—in fact, he had an Opposition day debate to do it—that the NHS budget had been cut in real terms. It had not: it rose. He also claimed that the number of nurses was being cut, when actually it went up. His attempts to talk up a winter crisis have been disproved time and again. That is important, because we have not had a proper apology to this House in relation to the letter he received from the chief executive of the south-western ambulance trust complaining about his spinning, which stated:
“information provided to your office in response to a Freedom of Information request…has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain.”
The right hon. Gentleman should not be playing politics with the pressures in A and E; he should be getting behind front-line staff, who are working extremely hard and who find that kind of tactic extremely demoralising.
For the record, I am afraid that the letter the Secretary of State quotes had its facts wrong. The information provided by the south-western ambulance service that I quoted was accurate. I wrote to the service the day it wrote to me to put it straight, and I am afraid it has not come back since and said that I was wrong; so again, let us get the facts straight. We have had enough spin from the Secretary of State; he needs to start dealing in a bit of fact.
I will tell the right hon. Gentleman exactly what the facts are. The other word I heard him use several times in his speech was “complacency”. I will tell him what complacency is: it is complaining about an English NHS that is hitting its A and E targets and completely ignoring Labour-controlled Wales, where the NHS has been missing its A and E targets since 2009. Something else that is complacent is this idea Labour has that, almost a year after the Francis report, the lessons of Mid Staffs stop at the border of England and Wales—that Wales has nothing to learn and does not need to do a Keogh report into excess mortality rates, which the Welsh Labour Government have consistently refused to do. People in Welsh hospitals are suffering because the Welsh NHS has refused to bite the bullet on excess mortality rates.
Tonight, at a “Save Our Hospitals” meeting in west London, I shall be speaking to A and E doctors and GPs about the largest-ever closure programme: four NHS emergency departments are to close in west London. Eight west London MPs, including me, have asked the Secretary of State to meet us and discuss the issue. Shall I tell those who attend tonight’s meeting that the Secretary of State is still refusing to meet eight MPs who collectively represent nearly a million people in west London?
As the hon. Gentleman knows, I must follow a strict legal process in relation to such decisions, and we have had an extensive consultation. However, let me say this to him. When he talks to those MPs, he should tell them the facts about the proposals for north-west London which I approved—proposals for three brand-new hospitals in which seven-day working is to be introduced, 24/7 obstetrics, 16/7 paediatrics, seven-day opening of GP’s surgeries, and a range of other services which will help to address precisely the issues raised by the right hon. Member for Leigh in connection with transforming out-of-hospital care, which I support. As a result of those proposals, the services that I have listed will be available in north-west London before they will be available in many other parts of the country. I hope that the hon. Gentleman will inform the MPs whom he is meeting of those important facts.
My right hon. Friend may remember that in 2009 the Labour Government transferred an A and E unit from Burnley to Blackburn, some 15 miles away. Last week, we opened the doors of a new emergency facility in Burnley to replace the one that Labour had shipped out. Does my right hon. Friend agree that it is right to invest capital in A and E, and to stop listening to the rubbish that is being spoken by Labour Members?
I understand my hon. Friend’s frustration. This is the shadow Secretary of State who said that it was irresponsible to maintain the NHS budget at its current levels and who actually believes that it should be cut, and he has stuck to that position. It is not possible to make such investments by following the right hon. Gentleman’s advice.
The right hon. Gentleman talked a great deal about competition, and I am afraid that his comments about that also showed a wilful disregard for the facts. He raised two distinct issues, and he was right to do so, because they are important. The first relates to mergers. NHS hospitals often need to concentrate services for clinical and safety reasons, but the involvement of the Office of Fair Trading and the Competition Commission is not a result of the Health and Social Care Act 2012, as the right hon. Gentleman alleged. As he well knows, it is as a result of powers that they have under Labour’s Enterprise Act 2002. All my Front-Bench colleagues agree with me that we must ensure that when those powers are exercised, they are exercised in a way that is in the best interests of patients. For that reason, I have had useful discussions with both the Competition and Markets Authority—which is replacing the OFT and the Competition Commission—and Monitor about how their respective roles can be clarified.
Yes, I can explain that. When drafting the Act, my predecessor wanted to ensure that investigations would not be carried out by both Monitor and the Competition Commission. [Interruption.] If Members wish me to answer the question, I will happily do so.
If we repealed the Health and Social Care Act—as the right hon. Gentleman has often argued should happen—the Competition Commission and the OFT, or the Competition and Markets Authority, would still have the power to stop mergers, under the Enterprise Act. The right hon. Gentleman should get his facts right before presenting his arguments.
Secondly, the Health and Social Care Act did not introduce new rules in relation to procurement. For all the efforts of the right hon. Member for Leigh to convince people otherwise, clinical commissioning groups observe the same procurement requirements as applied to primary care trusts. Labour may have made many mistakes in office, and the right hon. Gentleman may have shifted his own views dramatically to the left, but it will not do for him to try to seek cover for that by attaching blame to the Health and Social Care Act.
If everything is exactly the same, why did the Government legislate? Why did they need a 300-page Bill if they were doing everything that the previous Government had done? Let the Secretary of State answer this question directly. There was a huge debate in the House about section 75 of the Health and Social Care Act, and his Minister had to withdraw the regulations and rewrite them, but the view of the entire NHS is that section 75 requires services to be put out to open tender, and does not leave discretion with GPs. GPs cannot decide, as the Secretary of State has claimed. Services are being forced out to open tender. Is that the correct position, or is it not?
I am about to answer, if the right hon. Gentleman will be a little bit patient. The Act does not change the procurement requirements under which PCTs operated. It does not change the locus of the Competition Commission or the OFT under the Enterprise Act.
While we are correcting some facts, the right hon. Gentleman may be interested to know—as would my hon. Friend the Member for Taunton Deane (Mr Browne), but he is no longer in the Chamber—that we have the figures for the number of people admitted to the NHS with scurvy in 2011-12 and in 2012-13. In 2011-12, the number of admissions not just to A and E departments but in total—[Interruption.] Yes, including A and E departments. In 2011-12, eight people were admitted—[Interruption.] This was the right hon. Gentleman’s big argument about why A and E departments are under so much pressure. In 2012-13, 18 people were admitted. With the greatest respect, I think that the right hon. Gentleman is building his house on sand.
We have figures for 2010-11, because they were included in the answer to a parliamentary question that I asked just before Christmas. The Minister of State, who is present, replied that they were not the total figures, because the Department had the hospital admission figures but did not have the figures for primary care admissions.
With the greatest respect, what we heard earlier from the right hon. Member for Leigh was a big argument about a massive growth of pressure on A and E departments that had been caused by, among other things, scurvy, and we found that the total number of admissions was 18. I think that that says a great deal.
On the subject of disastrous mistakes made by the Labour Government, may I point out that one of the omissions in their motion is the lack of any apology for the £63 billion ticking time bomb generated by off-balance-sheet dodgy deals under the private finance initiative? The worst in the whole country, which was signed off by the right hon. Member for Leigh (Andy Burnham) at Peterborough and Stamford Hospitals Trust, has produced an indicative structural debt of £40 million a year. [Interruption.]
I am afraid that my hon. Friend is absolutely right. Perhaps the situation is put into perspective when we know that those PFI deals are costing the NHS more than £1 billion a year: £1 billion that could have been spent on providing compassionate care and looking after patients with dignity and respect, but instead is having to finance Labour’s appalling mismanaged PFI contracts.
Let me return to the issues raised by the right hon. Member for Leigh. I think that a much more substantive argument relates to the things that he chose not to say. This is the day before the anniversary of the Mid Staffs report, and this is the day on which hospitals are finally putting behind them Labour’s appalling legacy of poor care. We have 14 hospitals in special measures—all of them, incidentally, with A and E departments—making encouraging progress after a very difficult year, with 650 additional nursing staff and 50 board-level replacements between them. Every single one of those hospitals had warning signs under Labour, but rather than sorting out the problems, Labour chose to sweep them under the carpet, sometimes because they had arisen during the run-up to an election. There are 5,900 more clinical staff in the NHS than there were a year ago, and there are 3,300 more hospital nurses than there were at the time of the last election. All those people are vital to the functioning of our A and E departments.
Bullying, harassment and intimidation were perhaps the ugliest features of Labour’s management of the NHS. Now we have seen courageous A and E whistleblower Helene Donnelly being given a new year honour, alongside brave campaigner Julie Bailey, who was literally left out in the cold when she came to lobby the right hon. Member for Leigh about poor care at Mid Staffs.
There is much to do—poor care persists in too many places—but with a new Ofsted-style inspection regime, in England but not in Labour-run Wales, we can at least be confident that poor care in A and E departments and throughout hospitals will be highlighted quickly, and not hidden away. We will keep people out of A and E departments in the first place—that is something to which the right hon. Gentleman referred—with the return of named GPs for the over-75s and integrated health and social care through the better care fund: precisely the joined-up, personal and compassionate care that was envisaged when the NHS was founded 65 years ago.
Was not one of the key points that Francis made about transparency? The Secretary of State is making claims about staffing numbers which are not recognised. Ministers have had the opportunity to go along with a better scheme of transparency in hospitals, whereby they display every day on the ward their staffing ratios—as Salford Royal does. The Secretary of State will not accept that, however. If he thinks that putting out the totals of staff once a month is an adequate way of dealing with the Francis recommendations, he is fooling himself.
We on the Government Benches will take absolutely no lessons about transparency in the NHS from Labour after what it did for so many years. I think what we are introducing is a huge step forward, because for the first time every hospital in the country will, as a minimum, have to publish their ward-by-ward staffing ratios every single month. They can publish more—they can do what Salford does—but for every hospital in the country to do that every month is a huge step forward.
The Secretary of State talks about finding alternatives to people presenting at A and E. May I commend Rowley Regis hospital in my constituency, which has just opened a GP-led primary care assessment centre in order to deal with people in the community—in a community setting—rather than having to refer to A and E? That hospital used to have five in-patient wards, but they were closed by the Labour party and the right hon. Member for Leigh (Andy Burnham) when he was Secretary of State. However, three of them have been reopened in the past three years, which is a substantial new investment in a very important community hospital.
I commend what is happening; it is very important that locally driven solutions are providing good alternatives to going to A and E. One of the most important things we can do for my hon. Friend’s constituents is make sure we have proper continuity of care so that for our most vulnerable patients there is a doctor who knows what is up with them at any time, whether they are in or out of hospital, and who can give them joined-up care and make sure they have a proper care plan wrapped around them. That is the kind of care we need to see.
My right hon. Friend is making a very pertinent point about transparency, because again what the Opposition refuse to acknowledge is how many patients were left off the books. It has been discovered in my hospital trust that a significant number of patients who were not discharged because there was not a link-up with social care were left off the books and so did not show in the statistics.
I think my hon. Friend is talking about the issues in West Hertfordshire trust, which I am extremely concerned about. The whole House will want to get behind the efforts of the outstanding chief executive there, who is sorting out those problems.
It is of course challenging when we read about these things in the media, but we have to remember that it is essential that poor care or cover-ups such as the ones that may have happened in that case are brought to the surface very quickly. That is the big change we want to make.
Does my right hon. Friend agree that it is the right policy to highlight trusts such as Northumbria, which is leading the way on integration between hospice care and local authorities, and which is also assisting another trust, in this case North Cumbria, which is presently in special measures and which we hope will come out of them very soon?
Absolutely. One of the most encouraging developments in the last year was the setting up of buddying systems so that hospitals in difficulty such as North Cumbria—where I think there was a pay-out of £3.6 million to just one person under the last Government because of some utterly appalling care—are given help by a hospital that is being run well.
Will my right hon. Friend join me in welcoming the progress being made under the Keogh review at the George Eliot hospital, where changes to working practices and more innovation are meaning that the A and E department is turning into one of the best performing in the country?
I will make some progress, because I need to make one final point.
All of these changes cost money, at a time when we are still living with the economic mess we inherited from Labour. None of these changes would be possible without the tough decisions we took on public spending in 2010, all opposed by Labour, which allowed the NHS budget to be protected and, as growth returns to the economy, secured for the long term.
Our amendment talks about the Francis report, which I know is desperately uncomfortable territory for the Labour Opposition—the 81 times they refused to have a public inquiry; the 50 warning signs missed by Labour Ministers and the officials working for them; the warning signs ignored at countless other hospitals now in special measures.
Thank you, Madam Deputy Speaker. We will all draw our own conclusions about why the Opposition are using these tactics, but I want to offer the Opposition today, a year after the Francis report, a chance to draw a line under this whole tragedy. I as Secretary of State am happy to move on from Mid Staffs in terms of the debates in this House if the Opposition pass three tests: to tell Labour in Wales to do a Keogh-style mortality review so that we deal with the poor safety in Welsh hospitals, just as we are doing in England; to apologise to the relatives and survivors of Mid Staffs not just for what happened, but for the policy mistakes that led to what happened; and to commit Labour to more compassionate, safer care in the NHS by promising never to accuse those who highlight problems of “running down the NHS”, and instead to support every whistleblower and concerned member of the public when they raise concerns. Do that, and the world will know that Labour has changed; but fail to do it, and the country will know for sure that the NHS is simply not safe in Labour’s hands.
Order. Many Members wish to speak. I am not going to set a time limit at the beginning, but I ask each Member to take no longer than eight minutes, including interventions. If Members take more time than that, it will be necessary to place a time limit on all contributions.
Given the heated exchanges we have just had, I want to make it clear that I am speaking in support of the Opposition motion.
Given the extent of the crisis that is being faced by accident and emergency departments around the country, one would be forgiven for thinking that this Government must have inherited an NHS on the brink of collapse. In fact, the opposite is true. I know we have stopped doing the patient satisfaction surveys, but at the time that was discontinued, patient satisfaction was at an all-time high and we must not forget that the national health service had been transformed by the Labour party. I worked in the health service and I remember what it was like in the 18 years when the Tories were running it. The NHS that the Labour party inherited in 1997 was transformed. The budget for the NHS was £30 billion then, but when we left the NHS in good health in 2010, the budget was over £100 billion. The 18 years of Tory neglect had been thoroughly addressed with new hospital buildings. Every single A and E department was replaced.
What have we seen since? We have seen an unwanted top-down reorganisation, which nobody wanted and nobody voted for, coupled with under-investment, and the slashing of alternative services has placed a huge burden on our A and E services. By referring to alternative services I am talking, for instance, about walk-in treatment centres, including my own excellent Healthworks in Paradise lane, Easington Colliery. It is under enormous pressure yet offers a fantastic service with out-of-hours and weekend opening, but we are not sure whether that will continue because of pressures that the clinical commissioning group is facing. By almost any standard, it is clear that the performances of accident and emergency departments are struggling under the current Government. It is clear that patients are waiting longer to be seen and that the numbers of delayed discharges and emergency admissions are up—I think the Secretary of State admitted that. The number of cancelled operations is certainly up.
I am following carefully what the hon. Gentleman is saying; he is making some very good points. Does he acknowledge that 45% of the health service budget is spent on 5% of the population—namely, those vulnerable people with multiple chronic illnesses? Getting that right must be the key to the future. What does he think the solution is?
I am grateful to the right hon. Gentleman for that intervention, because his point is germane to my argument. I shall develop that subject in the few minutes I have left when I talk about the consequences of what is happening in social care. I certainly feel that some of the policies that his Government have supported have contributed to the crisis. For example, the top-down reorganisation has had a damaging effect on A and E performance. I will address that point in a moment.
Other hon. Members have spoken today, in interventions on my right hon. Friend the Member for Leigh (Andy Burnham), about patients being ferried to hospitals in police cars. That has certainly happened in County Durham, and it must be a cause for concern. The A and E crisis can largely be placed at the Government’s door, because they have not faced up to some of the problems. It has rightly been pointed out that the number of admissions had risen by 633,000, not least because of demographic changes involving more older people and people with core morbidities and multiple conditions. That is placing a huge amount of extra pressure on A and E departments, but that pressure is being compounded by damaging cuts to local authority budgets.
My own local authority, Durham county council, is experiencing cuts of £222 million between 2011 and 2017. I know that Ministers will say that social care is ring-fenced and that £3.8 billion is being transferred to the home care fund, to be made available to clinical commissioning groups and local authorities, but what that means in real terms for the people living in Easington is that EDPIP—the East Durham Positive Inclusion Partnership—which supports frail elderly people and young people in vulnerable families, is closing down because of a lack of funding from the local authority. Similarly, East Durham Community Transport, which provides transport to take the frail elderly—including my mother, incidentally—to day centres and elsewhere, has been severely curtailed.
The Government have been warned by experts that cutting the staggering £1.8 billion from council social care budgets in the first three years of this Government would have a knock-on effect for the NHS, particularly in accident and emergency departments. That point has been made in expert witnesses’ evidence to the Health Select Committee, on which I have the honour to serve. Because of the cuts to social care, fewer older people are getting adequate support in the community, and are therefore visiting A and E departments instead. The impact of that is twofold. First, it means that those with care needs are not getting the treatment they need. Secondly, it means that our A and E departments are being put under great strain. Directly and indirectly, the Government have ignored warnings that by slashing social care they would make it difficult to discharge patients with care needs because it would be unsafe to send them home.
Perhaps it would be pertinent at this point to mention the comments of Sir Bruce Keogh to the Health Committee’s inquiry into urgent and emergency medicine. When I asked him if the cuts in social care bothered him, he said:
“Yes, it does bother us and I think it bothers everybody. We are trying to maintain a stable and improving service in the NHS at a time that our colleagues in social care are taking a massive hit to their baseline.”
I am grateful to my hon. Friend for that intervention, and I hope that her point will not be lost on Ministers. That is a significant factor.
The lack of adequate support in the community and in the home has stored up problems in the NHS, and I am convinced that they will be exacerbated by what is now happening. I know that we have done some good work on the Care Bill—there is good intent there—but I have real concerns about whether the resources necessary to make social care really work will be provided. We have seen attendances at hospital A and Es continuing to rise.
We have had this discussion on the Care Bill. The hon. Gentleman talks about the need for additional resource, but in Committee there was no indication from the Opposition that they would make a commitment to provide extra resources. Is he now saying that they would do so?
I cannot thank the Minister for that intervention. We have had many exchanges during the passage of the Care Bill, but that decision is above my pay grade. It would be for those on our Front Bench to determine the level of such resources. The purpose of this debate is to consider the A and E crisis. I would like to think that that commitment could be made, however, and if the Minister is asking me personally whether I support it, the answer is that I do. I believe we should also support free end-of-life care, which I know the Minister and many others on the Government Front Bench support. However, I must make some progress with my speech.
The lack of adequate support in the community has had an impact. It has contributed to increased attendances at A and E departments. I hope that Members will not have forgotten that, two years ago, the Prime Minister said:
“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E”.
Well, I am afraid that we have gone back to those days. Sadly, by removing the social care needed for many elderly people to avoid unnecessary trips to hospital and to return home when their stay should be over, the Prime Minister is bringing back those days. I urge hon. Members to support the Opposition motion today.
First, I want to praise all those who work in accident and emergency departments up and down the country to provide a vital full-time 24/7 service locally and nationally. Many Members have already pointed out that it is almost a year since the Francis report was published. Its reception in the House demonstrated one of the best examples of cross-party respect from the Prime Minister and the Leader of the Opposition and, subsequently, from my right hon. Friend the Secretary of State and the shadow Secretary of State. I would like to see that cross-party support being built on.
I should also like to praise the Secretary of State for the work that he has done to take the recommendations forward. He has mentioned some of them today, including those relating to the chief inspector of hospitals, to social care and to general practice. Many more aspects of the report have already been mentioned, and there will no doubt be more to come. I must stress, however, that we need to have a proper debate on the Francis report now, one year on, in Government time in the House, to see where we have got to.
I also pay tribute to all those people who did the work that enabled the Francis report to come about. They include Julie Bailey, Helene Donnelly and the many others who worked with Cure the NHS, and all those in Stafford hospital who have subsequently responded to the report to make the hospital a place that I am proud to say now provides some of the best care in our region, including those in the A and E department. We have, however, lost our 24/7 A and E department; we now have a 14/7 A and E department. That is something that we are going to have to look at again; we need to look at how we are to cover the out-of-hours emergency care in our area. Nevertheless, we now have some of the best A and E care in the region, because it is consultant led. We now have sufficient consultants to cover that service.
I want to make four points that I believe need to be taken fully into account in this debate on A and E services. The first is about doctors. The Secretary of State has already mentioned the problem with recruiting people into emergency medicine. It is not seen as the most attractive career, perhaps because of the shift work involved. We need to look at the whole training structure. Perhaps it would be better for trainee doctors to spend more time in accident and emergency departments in their foundation years. Perhaps we should add a third foundation year in order to enable them to spend more time in A and E, because that is surely where they will learn most about this kind of medicine.
We also need to look carefully at the role of specialisms in the NHS. Although that would be the subject for a whole other debate, it is very important, because we have more than 60 specialisms in this country, compared with about 20 in Norway. Their increasing role means there is a need to maintain a full-time specialist rota of up to 10 consultants, which is placing increasing stress on the finances of the NHS. That is true in A and E, as elsewhere. That is a subject for another day, but it is a very important point.
Another area to mention is demographics, although I will not go on at length about it because the facts are known to us all. In Staffordshire, we are expecting the number of over-85s to double and the number of over-60s to go up by 50% in the next 25 years. There is no doubt that we have reached a tipping point, particularly as the baby boomers enter their retirement years, and that is not recognised. It is not just a straight line graph; there is a bit of exponential growth in the number of older people now coming in to our hospitals. That is to be expected.
I agree with everything the hon. Gentleman has said so far. Will he also consider the fact that A and E waiting time rises have also been caused by: the effect of walk-in centres closing; the closure of NHS Direct and its replacement by the botched 111 system, which has not helped anyone; and a real cut in adult care, which has meant that a lot of elderly people have been taken to hospitals, instead of being cared for at home, and they cannot be released unless they have somewhere safe to go to?
My hon. Friend may not be aware that a briefing was given by the College of Emergency Medicine to Members of Parliament. One of its representatives, I believe it was Dr Mann, was asked by hon. Members about the closure of walk-in centres and he replied that there was an initial blip but that levels went back to what they were before. So in his view those closures made very little difference.
We do not have sufficient data on this. I urge the Government to examine how we can collect more data about the reasons why people come to A and E and whether their visits could have been prevented by other provision. I am sure that that can be done in some cases, but at the moment we are arguing at cross purposes because we do not have sufficient data.
Another point, on the lack of integration, relates to discharges. There is pressure on hospitals to discharge people, particularly the elderly, because of the pressure on beds. One GP in my constituency raised this issue, citing one of their patients who was improperly discharged and saying that they were very distressed at the condition in which they found him. Stafford hospital has come up with a solution, which it will implement shortly, whereby every patient with complex needs will not be discharged unless it is absolutely clear that they have proper care in the community to go to. We would expect that for all patients, and I am very glad that Stafford hospital is taking that up.
The final reason to mention is that patients are often confused about where to go, and I am therefore glad that the Government have undertaken a review of the classification of A and E departments. We have A and E departments, urgent care centres and minor injuries units, and we have various grades of A and E. We need a national classification that makes it clear what services people can get at which point. Often people turn up and find that they have come to the inappropriate place.
I also wish to make a few remarks about the competition matters that have been raised in the debate, and I do this from a local perspective. The trust special administrators for the Mid Staffordshire NHS Foundation Trust have proposed that Stafford hospital should merge with University Hospital of North Staffordshire in Stoke and that Cannock hospital should merge with Wolverhampton’s trust. That is the right solution, it is not being opposed and we are not finding any problem with competition law. There is a big difference between the acute and non-acute sectors. As the acute sector runs in a tight way around the country, it is very difficult to see how there can be much competition in provision within it, because that has been provided exclusively by NHS trusts up to now. Within the non-acute sector we have found in my constituency that, under competition rules, an NHS service that went to the private sector under the previous Government has come back into the NHS under this Government, because it was determined that the NHS would provide a better service. So this does work both ways; it does not always go the way some people think it might.
We must not lose sight of the real hard work that people are doing in A and Es up and down the country. Almost all the work that goes on there is incredibly good and is what our constituents need, but we must make sure that the points that I and others have outlined are dealt with, because with the demographics going the way they are, we will face increasing pressures year on year.
First, I thank my right hon. Friend the Member for Leigh (Andy Burnham) for tabling the motion, because it gives us an opportunity to examine the whole issue of competition. Hon. Members will recall that I intervened on the Secretary of State on the subject of when competition came in to health care in this country, and he said that it had always been there. The hon. Member for Stafford (Jeremy Lefroy) and the right hon. Member for Sutton and Cheam (Paul Burstow) will recall, as they served on the Committee for the Health and Social Care Bill, that when I intervened on the right hon. Member for Chelmsford (Mr Burns), a Minister at the time, to ask what the Competition Commission and the Office of Fair Trading had got to do with the mergers of NHS trusts, he did not answer me. I asked that question during a clause stand part debate and he did not know that the question was coming. It was not part of an amendment and it was not flagged up to the advisers as being something likely to happen. I raised it on several occasions in that Committee and on the Floor of the House during an Opposition day when he was winding up, and he did not answer me then either.
We have now got the answer, and it came in November. My right hon. Friend mentioned what the then outgoing NHS chief executive said to the Health Committee last November. Commenting on the new rules, he said:
“I think we’ve got a problem, which may need legislative change.”
Of course, that is absolutely right, because we had legislative change when the Health and Social Care Act 2012 came in—that is the truth. It changed statute: it meant that the OFT and the Competition Commission can interfere in health care. That is what it did and that is what it was meant to do. That is what the Opposition questioned and voted against at the time—that is the truth.
My right hon. Friend talked about the cost of all this in terms of the Freedom of Information Act and the millions of pounds spent on external competition lawyers. My local Rotherham hospital has spent tens of thousands of pounds on London lawyers, and for what? There is no prospect of a merger or anything else. This money is seeping out of the local health pot, just so that advice about competition law can be got from lawyers based in London. This is real: if people want to do anything, they are going to have to take legal advice about doing it. That is the truth.
I have to say to my right hon. Friend the shadow Health Secretary that he may have an ally in the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb). I am told that he said last week:
“I have a problem with OFT being involved in all these procurement issues…I think that’s got to change. In my view it should be scrapped in the future.”
I wait to see how he is going to address these things—if he did indeed say that—when he winds up this debate. If he did say it, I agree with him, as would many others out there.
I wish to make a couple of other points, one of which is about what happened in Bournemouth and Poole, where a merger was blocked by the Competition Commission last autumn. When it was blocked, the chief executives of the Bournemouth and the Poole hospital trusts said in a joint statement that they were “deeply disappointed” by the decision. They said:
“The benefits of merger, which included increased access to consultant care and new patient facilities, will now be much more difficult to deliver, which is disappointing for both our patients and staff.”
They went on to say:
“We recognise that the Competition Commission has a statutory role to perform”—
my argument is that it never had such a role before a change in the law—
“and specific criteria which it must use to assess benefits, but we believe that the outcome of the process is fundamentally wrong. The assessment of the merger was always weighted to put competition ahead of benefits to patients, and we do not believe the NHS is best served in this way.”
The Government amendment to our motion today states that
“clinicians are in the best position to make judgements about the most appropriate care for their patients.”
That is not the case in Bournemouth and Poole. The Competition Commission has decided, against clinicians’ wishes, to stop the merger going ahead. That is the truth, and that is how we should read the amendment. It is false in what it says. It then goes on to say that it
“notes that the rules on tendering are no different to the rules that apply to primary care trusts.”
That is not true. The rules changed when the Health and Social Care Act was passed. That is why competition and changes in the health service are matters for lawyers now. [Interruption.] The hon. Member for Bournemouth East (Mr Ellwood) might represent one of the hospitals, but his hospital and his local clinicians stopped the merger because the Competition Commission said that it was wrong. This is about competition law, and not about providing patient services.
Let me touch briefly on the matter that is in today’s press. The Secretary of State said that we had to keep people out of A and E; he is absolutely right. If I made an addition to our motion today, it would have been around the issue of alcohol. Alcohol is a major problem in accident and emergency departments throughout the land. It used to be an issue on Friday and Saturday nights, but now it is an issue seven nights a week in cities. Not that long ago, the Prime Minister said that the Government were considering putting a minimum price on a unit of alcohol to reduce binge drinking and to improve public health. Today we had an announcement from the Minister for Crime Prevention, the hon. Member for Lewes (Norman Baker)—not from the Department of Health—that the Government are to ban the sale of cheap alcohol in England and Wales because they want to cut back on alcohol-related crime. People who work daily with the problems of alcohol and alcoholism have expressed views on the matter. The Alcohol Health Alliance, which includes the medical royal colleges, said that the impact of the ban on selling at below duty plus VAT would be negligible. It will affect about 1.3% of sales.
Eric Appleby, the chief executive of Alcohol Concern, said:
“The idea that banning below-cost sales will help tackle our problem with alcohol is laughable, it’s confusing and close to impossible to implement. On top of this, reports show it would have an impact on just 1% of alcohol products sold in shops and supermarkets leaving untouched most of those drinks that are so blatantly targeted at young people. The government is wasting time when international evidence shows that minimum unit pricing is what we need to save lives and cut crime.”
I could go on, but suffice it to say that the Government have completely dumped the idea that alcohol is a threat to the public health of this country. The measure will not stop people bingeing. It will not stop alcohol-fuelled people turning up at A and E. The truth is that some 50% of people who turn up at A and E get no treatment at all. We should be looking at the societal effects that are driving people into A and E departments—whether it is closure of walk-in centres or the fact that too many people are falling down because they have had too much to drink and believe that they have a right to block up A and Es and potentially slow down treatment for those who are facing an emergency. The Government are ducking the issues related to alcohol and are ducking the problems in A and E departments up and down the land. It is about time they showed some courage and did something positive. Alcohol is a public health issue, not a crime issue.
May I start by agreeing with the right hon. Member for Rother Valley (Kevin Barron)? The issue of alcohol has been ducked by successive Governments for a very long time. He is absolutely right to campaign on it, and I absolutely agree that we need to see the introduction of minimum unit pricing. However, we should not in any way give the impression that that of itself is the entire solution to what is a broad societal problem. None the less, it most certainly would make a significant contribution. I hope that, at the next election, it will be part of my party’s platform on public health issues.
My hon. Friend the Member for Stafford (Jeremy Lefroy) was right to call for a debate on the Francis report. I hope we will be granted Government time to debate it. If not, I would certainly join him in an application to the Backbench Business Committee for a debate on the Floor of the House. We should have the opportunity to bring Ministers here to debate the report.
Before addressing some of the comments made by the shadow Secretary of State, I wish to place on the record my thanks to the staff at my local hospital, St Helier, for all the work they do not just over the winter period when the pressure is undoubtedly at its most acute, but right across the year. Having been in the hospital over the Christmas period singing carols, which hopefully did not discomfort people too much, I saw for myself just how that pressure can build. I also saw how well the staff are perceived by their patients.
I want to register a frustration with the Minister today about something that has been going on in my patch for several years now. For almost as long as I have been an MP, clouds have from time to time gathered over the future of my local hospital. In 2010, the previous Labour Government signed off an outline business case for the rebuild and refurbishment of St Helier’s hospital. That was great news, and a culmination of work by my right hon. Friend the Member for Carshalton and Wallington (Tom Brake), the hon. Member for Mitcham and Morden (Siobhain McDonagh) and me. We secured funding from the Government worth some £219 million. Then there was a change of Government; a coalition came in. Given the spending review and the desire to tackle the public borrowing problem, it was far from certain whether that funding would stay in the Budget. Again, the three of us lobbied hard, and we were delighted when my right hon. Friend the Chief Secretary to the Treasury was able to confirm the funding.
However, in the dying days of the primary care trusts, a review was launched of accident and emergency and maternity services in south-west London. It was called Better Services Better Value, but it offered neither. It has been an absolutely crystal clear case study of everything that is bad and wrong about NHS change management. There are some really good examples of change management, stroke care in London being the exemplar. However, we have to refer to that example too often, as there are too few other really good examples of change having been managed well. All too often the public feel left out of such processes, and it is no wonder they mount the barricades to oppose change of which they feel no ownership.
My right hon. Friend the Member for Carshalton and Wallington and I were repeatedly told during the process by the then chief executive of the primary care trust, Ann Radmore, that the rebuild of St Helier was a fixed point in the whole process. It was not to be touched; it was sacrosanct and the rebuild would happen regardless. I have to say, however, that the events of the past three years have left me feeling betrayed and lied to. As a result of the uncertainty caused by BSBV, three years on—despite GPs having now declared BSBV’s proposals unviable, and having gone back to the drawing board—my local trust and clinical commissioning group are saying they cannot proceed with that £219 million. They lack the will and vision to take it forward, and I hope the Minister can confirm today that the £219 million is still in the Department’s budget lines and that he will encourage my local NHS to work with my local councils and Members of Parliament to bring forward these plans.
The motion moved by the shadow Secretary of State today feels a bit thin, and a little like a re-editing of its previous two incarnations in an attempt to create the sense of a febrile environment of a looming and predicted crisis and calamity that is about to engulf us all. That tactic has been adopted by the Opposition time and again, and time and again it has not been borne out on the ground. The analysis of the right hon. Member for Leigh (Andy Burnham) is deeply political, and let me give just one example. He lays the blame for delayed discharges principally at the door of budget pressures on social service departments. That is not true. If he looks at the figures, he will see that the bulk of the pressure is caused by delayed discharges in the NHS, not social services. I do not pretend for one moment that there are not parts of the country where social service cuts are impacting on delayed discharges, but the picture is more nuanced and complicated, and I wish the shadow Secretary of State had the courage to say that, rather than repeating a uniformly gloomy picture that is not true.
I refer the right hon. Gentleman to the Select Committee on Health’s report on the matter. The data were completely conflicted. Again and again, individuals from the NHS told us that social care was the problem, as Sir Bruce Keogh, whom I quoted earlier, said to me just a few weeks ago. Our report said that NHS England should sort this out. There are figures that the right hon. Gentleman could quote and figures that my right hon. Friend the Member for Leigh (Andy Burnham) could quote, and we should not be confused about this.
I entirely agree that if there is any doubt about the figures, it needs to be resolved, but there seems to be a disconnect between what people think is happening and what the figures show. I have been to events at which clinicians have said that the problem is the local social services, but when they are shown the figures they are surprised. Perhaps that is why we need, as the hon. Lady says, to ensure that there is an agreed way in which such things are reported, which is what, I think, was put in place by the previous Labour Government. These figures have been collected for a long time, and they have consistently shown that social care is not the principal driver of delayed discharges.
I am sorry to have missed the beginning of my right hon. Friend’s speech, but as he knows there is a big lobby going on. That was the point I was trying to make to the Secretary of State, although obviously I did not make it very well. Under the previous Government, West Hertfordshire Hospitals NHS Trust had a significant number of delayed discharges—although that is coming right down now—and the figures were not on the books, so to speak, thanks to a very creative form of accounting. It is nuanced and there have been problems on all sides. To try to paint it as one-sided is totally wrong and it certainly is not a new phenomenon; it has been going on for a considerable time.
That is absolutely right. For example, in continuing health care there is often a great deal of contestability that leads to discharge delays, but they are NHS-caused delays. I am not saying that the NHS should be blamed any more than social services, but I want some honesty about how the figures are presented as they do not bear close scrutiny in the argument made by the right hon. Member for Leigh. His solution is simplistic, too. It is good to have a debate about competition policy—I remember Labour Ministers trumpeting the introduction of the first competition policies in the NHS and the establishment of the competition and collaboration committee in the Department of Health. Labour established those policies.
Monitor’s role is to protect the interests of patients—that is what it says in the Health and Social Care Act 2012—not to promote competition. The idea that we can solve the problem by sweeping away Monitor opens the doors to competition red in tooth and claw. Of course, the Competition Act 1998, the EU’s competition legislation and procurement law would still apply without any of the fetters, barriers or protections that Monitor can and should be providing in its role as the regulator of competition in the NHS.
The problem is that EU competition law was brought into our law through the 1998 Act. That was what opened this particular box, and by bringing Monitor into the picture and giving it the mission of protecting the interests of patients, we put that issue back in its box—and the right hon. Member for Leigh would sweep that away.
The right hon. Gentleman seems to be arguing that the Health and Social Care Act 2012 is perfect—[Interruption.] It was his Act; he was a Minister. I quoted him in my speech as saying that it now needs to be amended. Will he be straight with the House this afternoon: does it need to be amended to remove the role of the OFT?
The right hon. Gentleman must be reading my notes as that was my very next point. One thing about our politics is that it is very difficult for people to admit their mistakes, so let me do just that today. I regret that we included in the 2012 Act a provision for the OFT to deal with the specific issue of mergers. At the time, the argument was that the OFT had the expertise, but it clearly did not. Monitor should have that role. I want to address that issue either through agreement—the Secretary of State has suggested how that might happen—or by amending the legislation. That is my view based on how things have developed over time, and one cannot be more straightforward than that.
I thank the right hon. Gentleman.
The right hon. Gentleman spoke about Hinchingbrooke hospital and the franchising arrangement. The process started and was two thirds of the way through by the time the previous Government left office. There were only private sector providers in the competition when the previous Government left office—
I hope the right hon. Gentleman has had the opportunity to go and see what is happening at Hinchingbrooke, because it is doing fantastically well. It is being led by clinicians and is making a huge difference as a result. We should take heart from that.
Let me end by drawing out one point about A and E pressures. The situation is complex and driven by a multifactoral set of problems. There are seasonal changes, with high-volume, less complex A and E attendance in the spring and summer, and a pattern of fewer but more complex cases in the autumn and winter that often drive up admissions. It is also important to note that it is a question not just of an ageing society but of a rise in co-morbidity, which drives the pressures in our A and E departments. There are also changes in behaviour as people regard A and E as the first point of access for any ailment, driven by the fact that nine out of 10 GPs opted out.
In conclusion, the motion is flawed and does not celebrate the successes of this Government, not least in driving integration in a way that the previous Administration failed to do. For that reason and many others besides, it should not be supported and the Government amendment should be supported instead.
Order. I remind Members who wish to speak that I asked each Member to take eight minutes including interventions and without compensating for the time lost so that we could fit everybody in. We are in danger of being unable to fit everybody in because people are running over their time, so I remind Members to help each other out. If they are unable to, we might need a time limit, but I think we should be able to avoid that.
The Health Committee has held a number of inquiries into urgent and emergency services. The College of Emergency Medicine told us in its evidence that increased demand, combined with a more complex case mix, was the driver that had led to departments struggling to meet the four-hour target. We were told that type 1 emergency departments, which offer a consultant-led 24-hour service with full resuscitation facilities, had
“reached the limits of their compensatory capacity.”
We heard that there were
“more people out of hours, more after midnight, more ambulance and more elderly.”
I checked that with the chief executive of Salford Royal hospital and have checked again in the past 24 hours. He told me that the trends that I first reported in our debate last summer have continued at the hospital. There are now 14 more ambulance arrivals each day—reflecting sicker patients, not self-referrals—which is an increase on last summer. There has been a 13% increase in admissions for stays lasting longer than 72 hours, with a drop in shorter stays, a 31% increase in triages into the hospital’s resuscitation area, and an 11% increase in admissions into critical care. There is now a different mix of patients being admitted. The chief executive, Sir David Dalton, tells me that those trends now appear to be year-round, rather than a purely seasonal impact of winter pressures. He said—my hon. Friend the Member for Stretford and Urmston (Kate Green) might touch on this—that Salford Royal is also now experiencing additional pressures from north Trafford patients.
I am concerned that the current crisis in A and E will continue, and indeed worsen, as a result of continued cuts to social care budgets. We have heard a certain amount of complacency from Ministers today about this winter. It has not yet been a hard one, and there is plenty of time for flu pandemics. Sandie Keene, the president of the Association of Directors of Adult Social Services, has warned that
“it is absolutely clear that all the ingenuity and skill that we have brought to cushioning vulnerable people as far as possible from the effects of the economic circumstances cannot be stretched any further, and that some of the people we have responsibilities for may be affected by serious reductions in service—with more in the pipeline”.
That is the really worrying point, because we are not even at the end of the cuts we have to make.
As I have said before—I make no apology for mentioning it again—my local authority has already lost £100 million in funding since 2010, and it will lose another £75 million by 2016. It has had to cut its adult social care budget by 20%. This is a crunch year for us, because we have had to change our eligibility criteria from “moderate” to “substantial”, which is a difficult cut to make. About 1,000 people are predicted to lose their council-funded care packages, and another 400 who would have qualified under the “moderate” eligibility criteria will not now do so.
The work to reassess those people is ongoing, but Sir David Dalton tells me that
“following the initial scoping there is clearly a risk of more frequent attendances, increased admissions and a prolonged length of stay for this cohort of patients.”
Salford Royal is having to review the possible increased work load for community nursing teams, especially the district nurses, who the chief executive feels
“may need to pick up increased duties for these patients.”
It is clear that there is a straightforward shift: as those people in Salford lose their care packages, the hospital is having to pick it up.
Nationally, the number of people over 65 receiving publicly funded care has fallen from 1.2 million to fewer than 1 million. All across the country there has been a serious fall in the number of older people receiving publicly funded care. Some of those who have lost that care will fund it themselves, but in other cases the work load will fall on unpaid family carers. We have been warned about that in surveys. Carers UK found that 55% of carers are caring for someone who has been admitted to emergency hospital services in the last three years, and a significant number of them said that additional support could have prevented the emergency admission.
We also know—this is a worry for those who are concerned about carers—that full-time carers are themselves more than twice as likely to be in poor health as people without caring responsibilities. The Care Bill has not yet completed its passage through the House, but it does not do enough to support full-time carers, particularly given the funding situation for social care. Carers are the first line in prevention, so properly identifying and supporting them can prevent an escalation in demand. However, identification of carers is not happening and the Care Bill does not do enough to change that.
Macmillan Cancer Support has found that 70% of carers of people with cancer come into contact with health professionals. GPs and hospital doctors should identify carers and signpost them to information and advice, but in many cases they do not. Many hon. Members will encounter such people in their casework. The Care Bill gives a carer a right to a local authority carer’s assessment, but that is meaningless for a carer who has no contact with a local authority. In fact, 1,000 fewer families this year will have that constant contact with, and support from, their local authority.
Carers UK yesterday published a report on caring and family finances, which found that almost half of carers are cutting back on food and heating and that over half have reported that money worries are starting to take a toll on their health. The report quotes one carer:
“With the cuts I have cut down to eating one meal a day so I can ensure my husband has enough food to keep him well.”
We know that the caring that unpaid carers do saves our economy billions of pounds every year, but we have to face the fact that they are choosing between heating and eating, and in some cases eating only one meal a day. As was noted earlier, there is also the lack of funding to pay for prescriptions. Carers UK has warned—we should take note of this—that if this country’s 6.5 million carers are not supported, we will be pushing them to breaking point. In my authority, for example, if they are left unable to care, they will not be able to go to social care and will have to go straight to the NHS.
We know that the NHS is struggling in the wake of unnecessary reforms that redirected £3 billion from the front line. The cost of living crisis is clearly starting to have an impact. This is cold homes week, and it is estimated that people suffering from the cold costs the NHS an extra £1.36 billion a year, and that figure might continue to rise with fuel bills.
Last Friday I met a couple in their 50s who said that they could afford to have their heating on for only an hour a day—last Friday was absolutely freezing, as Thursday had been. It is interesting to reflect on how we could maintain our health if we could afford to have the heating on for only an hour a day. Since 2010, 145,000 more older people have had to receive hospital treatment for cold-related illnesses and respiratory or circulatory diseases, which is a real worry.
On NHS staffing, the Health Committee inquiry highlighted the fact that only one in five emergency departments have the right level of consultant cover for 16 hours a day. That worrying situation is not set to improve because, despite increased recruitment, very few higher trainee posts in emergency medicine are being filled—156 out of 193 such posts were left unfilled in the latest recruitment round. Even Salford Royal, which is an excellent hospital, is experiencing recruitment difficulties. I understand that it still has 2.3 full-time vacant posts, against the eight consultant posts it should have in emergency medicine. That is a good record compared with 52% of posts that are vacant in most hospitals.
As my right hon. Friend the Member for Leigh (Andy Burnham) said earlier, the president of the College of Emergency Medicine feels that we are suffering “decision-making paralysis” across the NHS. The college said recently that it felt that its position was akin to that of
“John the Baptist crying in the wilderness”.
It is a great pity that the warnings it made three years ago about understaffing were overlooked while attention was focused on NHS restructuring. I do not think that the recruitment drive the Secretary of State keeps talking about is the answer, because it will not address the high drop-out rate. We have to recognise that the increasing pressure on A and E will remain a strong disincentive to a career in emergency medicine.
In conclusion, the Government’s unnecessary and costly NHS reforms, combined with the swingeing cuts to social care budgets, are responsible for the crisis, and accident and emergency departments have been left to try to pick up the pieces. I support the motion and urge other Members to do the same.
It is always a pleasure to speak about the NHS in this House and to recognise the hard-working staff who do their best for their patients and our constituents. I am pleased that the shadow Secretary of State is still in his place. I recognise that the NHS is important to him, but I strongly suggest that his accusation that Government Members are complacent is far from the truth, as the evidence of nearly four years in government shows.
The right hon. Member for Leigh (Andy Burnham) is rightly proud, as are other Labour Members, of increased spending on the NHS during their 13 years in government, but he is at risk of seeing that as the only way of helping patients. My concern is that that led to a complacent attitude under Labour that simply putting in more money would solve everything, with the result that it missed the opportunity to make significant reforms.
Instead, over the past 18 months in particular, the Care Quality Commission has been truly strengthened. There is now no concern about opening the lid on the problems that we know exist in parts of our NHS. Many Members will bring such examples, from our casework, to the House today. That is why I am proud that we have strengthened the CQC through an independent inspector of hospitals. At times, I have criticised the CQC for being too timid and for not being prepared to be more public about its concerns and to go in and act. However, the short-notice inspections are important in ensuring that patients feel confident that they will get not only excellent treatment, as they largely do, but the care that they deserve when they are under the custodianship of the NHS.
I cannot see how Government Members are being complacent in any way, but another element of complacency on the part of the Opposition crept in with the suggestion that targets were the right thing. We all know that if we do not measure something it often does not get done. With regard to ambulance services, however, while the regional targets of 75% of patients being covered within eight minutes of red 1 calls may well have been met in most of the country, that did not show what was actually happening on the ground. My hon. Friend the Minister of State, and the Under-Secretary, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), have been vocal for a long time in pressing the case for not just hitting a regional target, but focusing on individual patients. Complacency set in whereby it was thought that as long as we were hitting our regional target everything was fine, yet we knew, as MPs, that everything was certainly not fine.
In the east of England, resources were focused on the main urban centres. People out in the countryside—not even that isolated, but in smaller towns or villages—were almost ignored because they did not help the centre to hit its regional target. If they had broken their hip, it almost did not matter that they were lying on the floor for four hours waiting for somebody to come, because it was not a life-threatening injury. The hon. Member for Warrington North (Helen Jones), who is no longer in her place, referred to the North West ambulance service. I am proud that Members of Parliament from across the east of England—I particularly mention my hon. Friend the Member for Witham (Priti Patel)—have worked together to hold our ambulance service to account, with the outcome that we managed to get its entire board replaced. That was a very difficult thing to do, especially when we were at times accused of attacking and undermining the NHS. In fact, far from showing complacency, individual MPs were working together to make sure that patients came first, not some artificial target that was bad for patients.
I wanted to say thank you to the hon. Member for Leicester West (Liz Kendall), who is sadly no longer in her place on the Opposition Front Bench, because she put me in contact with Anthony Marsh, who was chief executive of the West Midlands ambulance service and is now, thanks to action by this Government, chief executive of the East of England ambulance service. During his very short tenure, he has already been able to bring a new sense of urgency and a recognition that staff are not coming through the pipeline quickly enough, and he is doing something about that. I am confident that when we meet him next week, we will be able to understand his plans even further.
One of the reasons I was accused of Gove-itis earlier is that it frustrates me that Members of Parliament are accused of complacency when in fact they are working hard to help their constituents. Far from being complacent, we have approached this in a consistent way. I recommend to MPs from other parts of the country that instead of just waiting for someone in Whitehall to act on these issues, and mocking MPs who say they are working hard to press their case and hold their local board to account, they should get on and do it, not just wait for others to do so. I give credit to NHS England. At times, getting it to recognise the real problems that we were facing on behalf of our constituents felt like wading through treacle, but it has finally got the message, and together we are starting to turn the situation around.
We have heard about aspects of hospital provision. I do not wish to go on for too much longer, Madam Deputy Speaker, because it is important that everyone who wants to have their say can do so. In fact, I am putting in a bit of a bid for an Adjournment debate in Westminster Hall about NHS funding and the elderly population. [Interruption.] Well, if you don’t ask, you don’t get. I listen to patients in my area who have 200-mile round trips to get to the specialist hospitals. We are concerned about a potential reconfiguration of stroke services that would make it physically impossible for patients to be seen within 60 minutes of the 999 call being made. As a consequence, as my hon. Friend the Minister of State will know, we have been pressing the case for more funding to be given to areas of rural sparsity in light of the fact that geography matters in trying to deal with such situations.
I recognise that Labour Members feel strongly about the NHS, but so do Government Members; it is a universal thing. As we continue to support the NHS, there is no way that we can ever be accused of complacency. The reality is that we are dealing with the issues, not putting a lid on the problems. We have had the Francis inquiry and we continue to work on many of its recommendations. I am therefore very happy to support the Government’s amendment.
It is a great pleasure to follow the hon. Member for Suffolk Coastal (Dr Coffey) and to speak in this debate.
I have spoken several times about the experience in my area, where in recent months we have been undergoing a major reconfiguration of hospital services, particularly accident and emergency. I have to report that, whatever the metrics or the resourcing may be demonstrating, the patient experience as reported to me, particularly regarding our A and E departments at Manchester Royal infirmary and at Wythenshawe hospital, is that there is a great deal of pressure and strain in the system. People are reporting long waits in very pressured environments, and there is a genuine sense of unhappiness about the atmosphere in which they feel emergency care is being provided because of the stretched services. A whole range of pressures are coinciding. There is rising demand due to some of the social reasons that right hon. and hon. Members have mentioned, including individuals’ behaviour; public health crises; pressures on resourcing in the NHS; and the pressures brought about by reconfiguration itself. It is hard to disentangle which of those different pressures is contributing to so much stress in the system.
I would like to highlight a few key points that I hope the Minister will take on board. There is no doubt that more change is coming in the NHS and we are learning quite a lot in my area as we go along. First, the reconfiguration of accident and emergency services and their downgrading to an urgent care centre at Trafford general hospital has immediately been followed by rising numbers at neighbouring A and E departments. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) mentioned the huge rise, in percentage terms, at Salford Royal hospital. That is also the case at Wythenshawe, in particular, as we are discovering on the doorsteps in Wythenshawe and Sale East. My colleague Mike Kane, who I hope will very soon be an hon. Friend in this House, has been talking to hundreds of local people, and we know that Wythenshawe hospital is experiencing very great pressure.
On 10 out of 13 days in January, Manchester Royal infirmary’s A and E department failed to meet the four-hour waiting time target, as did Wythenshawe on 11 out of 13 days, and four Manchester trusts failed to meet the target in quarter 3. It is difficult to disentangle whether that is attributable wholly or in part to the reconfiguration of services. None the less, there are real pressures in our A and E departments in Greater Manchester. Particularly in the immediate aftermath of the reconfiguration at Trafford, there have been reports of long ambulance queues, especially at Wythenshawe. That is not surprising, because the reconfiguration has inevitably created significant numbers of additional ambulance journeys as people are presenting at what is now an urgent care centre but may have to be transferred elsewhere for specialist care. I understand that there have been 100 extra ambulance journeys in the immediate aftermath of the reconfiguration. People are also going to what are, in effect, their own places. I think that is understandable, because, as the hon. Member for Stafford (Jeremy Lefroy)—who is no longer in his place—has said, the picture is confusing.
Local road signs used to say, “A&E”, but now they say, “A&E not 24 hours”, following the reconfiguration at Trafford. To be frank, that is an utterly meaningless piece of information for somebody driving to an A and E department, because it gives them no idea of when during those 24 hours the service will not be open. There is also real confusion about what is or is not available at the urgent care centre and whether it is safe to go there.
Local people tell me that the reason they do not go to Trafford is that they do not believe they are any longer allowed to go there. That was not the clinicians’ planning assumption when the urgent care centre was introduced, but that is what patients believe. As the hon. Member for Stafford said—Sir Bruce Keogh has put his finger on this, too—it is really important that patients are given clarity about what is available, where to go and when. We have to pay much more attention to educating the public about that.
Another difficulty that we discovered very quickly is that the decision tree used by North West ambulance service has resulted in its taking cases to Wythenshawe and to Salford Royal and Manchester Royal infirmary which should, under the original plan, have gone to Trafford urgent care centre. We are learning a lot from what is going on in the aftermath of the reconfiguration. It would be interesting to hear from the Minister how the lessons will be taken on board and distributed.
Pressure is also being created in a wider context. My right hon. Friend the Member for Leigh (Andy Burnham) mentioned in particular the pressure of rising poverty, which is, without question, leading to higher levels of need and people presenting at our hospitals. The number of hospital admittances as a result of malnutrition nearly doubled—it went up from 3,161 to 5,499—between 2008-09 and 2011-12. They did not all present at A and E, but they did all present at a hospital and that is of real concern.
Was as my hon. Friend as surprised as I was at some of the sneering from Government Members when she intervened on me to point out that the number of malnutrition cases has gone up significantly? All we got from them was sneering abuse, but the facts speak for themselves.
When the Manchester Evening News published a report about the shocking rise in malnutrition in our region, people were horrified and commented voluntarily on how disgraceful and shameful it was that, in such a rich economy, we could be in such a situation. There is no doubt that that is partly because of pressure on family incomes.
I want to highlight the position of disabled people in particular, who face extra costs for special diets, aids and adaptations, prescription charges and continence pads. All of those costs have to be met by disability benefits that are of dwindling value. There is also further pressure on the services on which they rely, including day services, respite care, access to mobility aids and care at home, which is under great pressure because of social care budget cuts.
In conclusion, against a backdrop of great pressure—some of it to do with changes to the NHS, some with rising remand and some with wider environmental factors—change and further reconfiguration may be necessary, but it is very difficult to do it. I want to finish by making three points to the Minister about what we are learning from the situation in Trafford, where we are integrating health and social care. First, it is not a quick fix. Secondly, it is not possible to remove services from our hospitals before the care and provision is available in the community—that is of real concern at a time when budgets are pressed. Thirdly, there is a huge piece of work to be done—the Government have not embarked on it—on educating the public and driving up public understanding. The public in my local area are extremely confused about what the NHS is able to provide to them and where they should go to get it. I am sure we are not unique. The situation is undoubtedly creating additional pressure for hospitals and other NHS providers, and I hope the Minister and his colleagues will address it.
I apologise to both Front Benchers for missing the opening statements due to a commitment I had at the Foreign and Commonwealth Office. Thank you, Madam Deputy Speaker, for calling me to speak.
I want to discuss problems with the NHS in my locality. My constituents have been affected by a number of difficulties in the NHS in recent years, predominantly down to the legacy and failings of the previous Labour Government, particularly the deficit of NHS local health care provision. Mid Essex has suffered as a result of the bloated bureaucracy of the primary care trusts and strategic health authority, which took money away from front-line care and patients. That is Labour’s legacy.
To put that in context, between 1997 and 2009 the number of managers and senior managers in the East of England strategic health authority more than doubled from 1,300 to well over 2,700. The number just kept increasing. The worst case involved Mid Essex PCT—I was so thrilled when PCTs were dismantled—and its predecessor trusts, whereby between 2001 and 2009 the number of managers and senior managers soared from 10 to 102, while the proportion of administrative staff working in the PCT itself doubled from 17% to 33%. That money should have gone to front-line patients in Witham and Mid Essex. That is the legacy we are trying to overcome.
When this Government came to office, those two PCTs were spending a combined total of £25 million on management costs alone, which is simply shocking and appalling. That is why the reforms are not just welcome, but vital to Mid Essex and my constituency: money can now be spent on providing care and investing in the health and care services that my constituents and patients desperately need. The actions taken by this Government mean that more of the record levels of spending on the NHS—which the Government are committed to and which the Opposition opposed—will be spent on patients in my constituency, rather than on administrators, managers and bureaucrats.
One of the most damaging aspects of Labour’s legacy in my constituency is the incredible health deficit in Witham town. Witham is a growing town and I am very proud of it—it is incredible. Despite the NHS deficits we have faced, our patients have campaigned and I have worked alongside them. My hon. Friend the Member for Suffolk Coastal (Dr Coffey) has been clear and consistent in making the point that this is about campaigning together, on a united front at a local level, to make the case for reform and change.
The town’s population is set to grow by more than 11% over the next decade, yet we have a chronic shortage of GPs and health services. That is well documented and I have raised the issue in the Chamber and in Westminster Hall on a number of occasions.
Does my hon. Friend share my concern that Labour Members have made no apology for the fact that GPs were allowed to opt out of out-of-hours services? That resulted in many more people presenting themselves at A and E simply because they were unaware of where they could go. Surely Labour should have foreseen that that would happen when it made dramatic changes to GP contracts.
My hon. Friend is absolutely right. This is a challenge we all face, particularly in rural constituencies. That deficit needs to be addressed.
There are about 2,200 patients per GP in Witham town, compared with the national average of 1,500. Patients would also like to see more out-patient services delivered locally in the community, rather than have to travel to Braintree, Chelmsford or Colchester. Colchester and Chelmsford both have hospitals that are undergoing major reviews at present. The challenge we face is to bring in new services to serve our expanding town. The prospects of achieving that objective are enhanced by the fact that this Government are putting record sums into the NHS and by the dialogue at community level between the town council and NHS England. I commend both, but specifically Witham town council for its support, and particularly Andrew Pike of NHS England and his team for working closely with me to examine the options, despite significant pressures and resistance in some quarters.
I know that we can count on the encouragement of Ministers, who have listened and been incredibly supportive. That brings me back to the fundamental point that if the Labour party, when it was in government, had bothered to take the issue seriously, more progress could have been made. The issue is of course about the allocation of resources: we need less on management and bureaucracy, and more on front-line patient care.
Another very significant health care concern for my constituents is that raised by my hon. Friend the Member for Suffolk Coastal about the East of England Ambulance Service NHS Trust. It has been a disaster, as the Secretary of State and Health Ministers are well aware. My hon. Friend the Minister of State has been part of our campaign. He was assiduous in his support of us all in pushing for and achieving the resignation of board members last year, and in relation to the trust’s poor performance in getting ambulances to patients efficiently and on time, rather than having four-hour waiting times and some deaths. We must not forget that deaths and casualties have resulted from that neglect.
I welcome Ministers’ involvement and support and, by contrast, we have now seen changes. The previous members of the trust’s board, many of whom, including a Labour councillor, were appointed under the previous Labour Government, ought to have provided strategic leadership—this is all about leadership—but they left the trust in an appalling state, under-staffed, poorly resourced and ill-equipped. They did not scrutinise the management of the trust, but left a serious black hole in its finances and a shortage of paramedics and ambulances that has caused my constituents and patients throughout the region to suffer unnecessarily.
As the House has heard, the trust is now led by Dr Anthony Marsh, and it is on a massive recruitment drive to bring in the paramedic numbers it needs to serve my constituents and the rest of the region. I commend him, because he is working incredibly hard: we are climbing Everest to deal with the legacy we were left. Collectively, local MPs are supporting him in his task to repair the damage to the structures left to us, including in relation to the formation of the trust, because in effect we inherited an appalling and devastating legacy.
It is quite clear from our time in government that if such problems had arisen under the previous regime, they would have been swept under the carpet. We have seen with the scandal of Mid Staffs and other trusts, to which the Labour party turned a blind eye, that there is no doubt that Labour closed its eyes and completely ignored the fact that patient care was neglected and the overall cost in lives, which is appalling. I therefore welcome the commitment from our Health Secretary and the Government to support us not only in facing the challenges, but in bringing transparency and shining a light on the NHS, which is vital.
To make one other point, the teams in our ambulance trust have been working so hard. We really commend and praise the front-line teams, because they have had an appalling time. We are now improving services for my constituents, which, frankly, was not possible under the previous Labour Government.
Thank you for calling me, Madam Deputy Speaker. I will certainly leave sufficient time for the hon. Member for Walsall South (Valerie Vaz) to follow me.
It is a pleasure to speak in this debate. When it comes to the NHS, the nub of the matter is the same for both Government Members and Opposition Members. We have a real pride and interest in it, and we want it to do well. Over our years in this world, we and our families have all been recipients of its services, so it is very important.
The issue is a UK-wide one. Recently in Northern Ireland, some tough decisions have had to be made to close some A and E departments at particular times, and there have certainly been bumps in that process and better preparation might have prevented those problems. Such a decision was taken by the chief executive of the trust in my Down district council area. The hon. Member for South Down (Ms Ritchie) and I had an opportunity to meet the chief executive to discuss the issue and put forward our constituents’ viewpoint, but our opinion was not met favourably. The chief executive felt that there was no other option, and that other hospitals in the area could cope with the additional pressures. That decision has come under close scrutiny and review, and the savings or outcomes are not yet fully known, but the decision was taken and it stands.
The thrust of this debate is about improving patient care. The Government amendment to the Opposition motion mentions
“compassionate care, integration…and patient safety.”
We could combine the wording of both the motion and amendment and look for the same thing, and it is important to do so.
The NHS is one of the things that we can most be proud of in the UK—a system by which all people are entitled to a high level of care at no cost other than their tax and national insurance contributions. However, no matter how much money is spent in the Health Department, there is always a need for more. The portfolio of a Health Minister or Secretary of State is not one that I would take on for, as we used to say, all of the tea in china, and that is a lot of tea. I take my hat off to my colleague Edwin Poots at home, and all those who have to make tough decisions. I sometimes feel that I could not make such decisions, but I understand why they have to do so.
In preparation for this debate I considered the differences between how A and Es are run and the different quality of care in A and Es in different areas. In delving into the subject, I came across the last three words of the Opposition motion, which are “improving patient care”. I was shocked by a briefing I received from Macmillan Cancer Support, which was referred to by the hon. Member for Worsley and Eccles South (Barbara Keeley). Macmillan is very close to my heart, as I believe it is to many in the Chamber, because of the issues it deals with. I was left with no option but to use this opportunity to highlight the care of the cancer sufferers and survivors, whom we all know.
According to Macmillan Cancer Support, between 2015 and 2020 the number of people living with or beyond cancer in the UK will rise from 2.5 million to 3 million. By 2020, almost half the people living in the UK will be diagnosed with cancer during their lifetime. Just this week, I had an opportunity to go to the Backbench Business Committee—I was seeking a debate on another issue—and the hon. Member for Basildon and Billericay (Mr Baron) asked for a debate on cancer. The figures and headlines that we have seen this week indicate that cancer is a time bomb. It is frightening stuff. It used to be said that one in three people would be intimately affected by cancer, with a diagnosis for either themselves or an immediate family member; now that is changing to a cancer diagnosis for one in every two people.
In the run-up to that, we must certainly get our ducks in a line—if I may use such terminology—to ensure that we are ready, and that patient care will be of top quality, no matter what people’s postcode. The fact is that although our palliative care is second to none and there have been improvements in diagnosis rates, the UK is not to the fore in survival rates. Given that we face one in every two people having a cancer diagnosis in the very near future, that needs to change and to become a priority. If we can deal with a diagnosis early, we can improve survival rates. That is what we should all try to achieve.
Macmillan highlighted that a recent study on cancer survival rates in 29 countries in Europe—the Eurocare-5 research—has shown that the UK continues to lag behind other European countries. Macmillan is pleased to learn that the UK five-year survival rates for melanoma are 85% compared with the European average of 83%.
The hon. Gentleman is correct in respect of prostate cancer. Medical organisations are also trying to highlight that problem.
Despite the improvement, I am concerned that the overall survival rates for nine out of 10 common cancers are lower than the European average. We have low survival rates for kidney, stomach, ovarian and colon cancers, and intermediate survival rates for rectum, breast and prostate cancers, cutaneous melanoma and non-Hodgkin’s lymphoma. Furthermore, the UK has one of the lowest survival rates in Europe for elderly patients. One reason for the rise in cancer rates is that people are living longer. Given that we have an ageing population, it is essential for the Government and the NHS to prioritise cancer care and early diagnosis.
Both the motion and the amendment refer to an integrated system. This week, we had the climax of the Committee stage of the Care Bill. The Minister who is responding to this debate said that he had visited Northern Ireland to see how our integrated care system works. The hon. Member for Leicester West (Liz Kendall), who was here earlier, expressed a wish to come to Northern Ireland to see how that system works. I hope to facilitate that for her so that the Opposition can understand the system that we have back home. We must have early diagnosis. That relies on patients informing their GPs of their symptoms, but also on the correct referrals being made and tests carried out when patients present at A and E departments. That should be considered when there is any shift around in care for those in A and E. If somebody is sent home with painkillers and told to make an appointment with their GP, how does that link up to the integrated system?
As I stated at the beginning of my comments, no matter how much money is allocated to the Department of Health, it will never be enough to meet the needs. For that reason, the Department is tasked with making savings. I understand that that is essential, but it is also important that the care that people receive through the NHS is second to none. There is a way of balancing those demands. Tough decisions need to be made and changes must be put in place, but the priorities must be clear. I ask for cancer care, including early diagnosis and support services, to be prioritised. I hope that everyone agrees that the most important words in the motion are “improving patient care”. On that, I think the House can unite.
I am grateful to the hon. Member for Strangford (Jim Shannon) for being so concise in his remarks. It is always a pleasure to follow him.
This debate takes place against a background of confusion and contradiction in the NHS. I hope that we will not end up with a national health disservice. We read all the documents and hear all the announcements about efficiency savings, but we still have not heard the lesson that people and patients should be at the heart of the NHS.
Many of the policy makers in the health service who appeared before the Health Committee warned us that there was not much detail in the lead-up to the Health and Social Care Act 2012. There was no pre-legislative scrutiny and then there was a pause. Not for the first time, the Government rushed to get legislation through without proper scrutiny and without an electoral mandate.
That played into the hands of the people who think that this Government and this country are up for sale to the highest bidder, and that there is no commitment to the people of this country. The Shard is an example. I understand that a number of its floors have been allocated to a private hospital. That is somewhere where pearly kings and queens cannot afford to live—they cannot even afford to go up to see the view.
I am pleased to see a number of my colleagues on the Health Committee in the Chamber. We hear a lot of first-hand evidence. At a time when there are concerns about A and E, the Government seem to be intent on fiddling about with name changes. The NHS Commissioning Board is now known as NHS England. The integration transformation fund is now known as the better care fund. Interestingly, the Chancellor announced in the spending review in July that the £3.8 billion that has been allocated to the integration transformation fund—aka the better care fund—will only be available in 2015-16. However, the problem needs to be addressed now.
That £3.8 billion is not extra money, but money that has been underspent in the NHS over the past few years. The underspend was £2.2 billion in 2013 and £1.4 billion in the previous year. When I asked the Secretary of State on 26 November last year why the underspend was not used for the NHS, he said that I should ask that question of Labour Ministers. I do not know whether he meant that I should do so in 2015. As I pointed out in an aside, which was not picked up by the Official Reporters, I am not a time traveller like Dr Who and was only elected in 2010. The rules of the House say that I should have had a proper response, rather than a dismissive one.
Another issue is that people have been fired and then rehired. One in five of the 19,000 staff who have been given redundancy payments has returned to the NHS. That is more money that has been wasted and that should have been spent on patients. Primary care trusts were disbanded and then re-formed with a different name. Urgent care boards were set up—their name was then changed to working groups—to ensure that there was a forum to replace the PCTs. All of that has strained resources and made staff suffer, without any increase in pay. There is job creation. However, it is not in front-line services, but in the appointment of a chief inspector, which was not suggested by the Francis report, and of assistant chief inspectors. There may well be assistant assistant chief inspectors as well.
The Select Committee heard evidence that the pay policy was significant in enabling the NHS to fill the gap, and NHS England said that, so far, around 25% of efficiency gains had come from pay. Ask A and E doctors who are struggling with working unsocial hours while locums without continuity in patient care are paid more, and they will say, “We need more staff; it is more money wasted on locums and agencies.” Perhaps Ministers should think about golden handcuffs for A and E staff, or the equivalent of an A and E special allowance to recognise the work of those doctors and staff in A and E. That might go some way towards ensuring that we keep them in their place and provide a safe service while doctors are trained. The College of Emergency Medicine has made repeated calls for such measures, and the emergency medicine taskforce made recommendations in 2011, yet we are still waiting for action.
Many Members will know from their own hospitals that patients are suffering from delayed discharge. I have seen that first hand at Manor hospital after the closure of the accident and emergency department at Stafford hospital, where perhaps the relationship with local government is not at the same stage as it is with the local authority in Walsall, for example, and it takes longer to discharge patients. We are still waiting for the £4 million that is needed because we have had to take the strain of the closure at Stafford hospital.
When giving evidence, Sir Bruce Keogh, the NHS medical director, acknowledged that 20% to 25% of people in hospital should have been discharged. The Secretary of State said that himself, having spoken to chief executives of hospitals with approximately two wards full of people who could be discharged. Our House of Commons Library says there have been £1.8 billion of cuts in social care, but apparently, the boffins at NHS England have not “dissected out” why people are in hospital when they do not need to be there. They are working on it now—that serious work on delayed discharges has apparently only just started, despite there being a problem for some time.
The urgent and emergency care review suggested that there should be emergency centres and major emergency centres. Sir Bruce said that NHS England was still listening to that proposal, but in a contradictory view, the Committee was told in the same evidence session that the clinical commissioning groups and other working groups are organising their networks to ensure that that is the outcome. Worse still, it was admitted that they have no intention of stopping any reconfigurations during that review.
I am sorry; I have no time. The Secretary of State wants to reconfigure but he does not want a national debate. He gives himself extra powers if he does not like what the courts and local people say. We need that debate. We need to tell people the truth based not on ideology but on fact, because it impacts on the type of medical work undertaken, and on how we train the next generation of doctors, nurses and health care professionals and what specialties there will be.
The Nuffield Trust gave evidence to the Select Committee and said that people have made the easy savings and now they are running out. People’s memories are long. They have paid their taxes and expect the state to look after them when they need it; not to have to show their credit card as soon as they walk into an emergency centre, or a major emergency centre—whatever it will be called. People do not want prime NHS property in the centre of a city to be sold off so that they have to travel further to get to hospitals.
Chaos, confusion, contradiction, and finally, from the Secretary of State an admission. In evidence last December he said that hospitals want to employ another 4,000 nurses compared with a year ago—an admission that 4,000 nurses have gone missing on his watch. The shadow Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), made it clear that he does not want a further top-down reorganisation, and he started the conversation about whole-person care in the 21st century in a speech in January last year. Finally, Margaret Mead the anthropologist said:
“Never doubt that a small group of committed citizens can change the world…indeed, it’s the only thing that ever has”
We have in the staff, patients and people of this country a group of citizens who want to save their NHS.
This debate has laid bare the stark reality of the Government’s blinkered approach to the NHS. They are utterly complacent, hopelessly out of touch, and in complete denial not only about the scale of the crisis in A and E, but about how their changes to competition rules are making things even worse. They have nothing to offer patients and our hard-working doctors and nurses who tirelessly serve the NHS every single day, except smoke and mirrors to try to disguise the real causes.
The Government have come to the House today celebrating “the strong performance”—it is in their amendment—of A and E. We have previously heard the Secretary of State insisting that the NHS is getting better. Almost 1 million patients have waited longer than four hours in the last year and Ministers are asking for a pat on the back. In the last 12 months, trolley waits are up; delayed discharges are up; 18-week waits are up; median and mean waiting times are up; emergency admissions are up; cancelled elective operations are up; cancelled urgent operations are up; and we have even seen patients being ferried to A and E in the back of police cars because no ambulances are available. It is not getting better, it is getting worse.
If Ministers will not listen to us, perhaps they will listen to the experts and those on the front line. Today, the Foundation Trust Network has said that
“pressure on the emergency care system is growing”.
Ministers like to forget about the confusion and disorder that they have inflicted upon the NHS through their £3 billion top-down reorganisation, but they should acknowledge it. My hon. Friend the Member for Walsall South (Valerie Vaz) referred to it in detail, and it is the same top-down reorganisation that the Prime Minister promised would never happen on his watch.
Let me remind the House of the warnings the Government were given at the time. In December, Dr Clifford Mann, president of the College of Emergency Medicine, revealed that he advised Ministers more than two years ago of a growing crisis in A and E. But his words were unheeded, leaving him and his colleagues feeling like
“John the Baptist crying in the wilderness.”
Dr Mann warned that the Health and Social Care Act 2012 would take up
“a lot of time and resources from the medical royal colleges and other organisations.”
He added that it
“tied us all up in knots”—
“a lot of decision-making paralysis and stasis in the system”.
While Dr Mann was warning of dangerously low staffing levels, spending on expensive locum doctors in A and E has rocketed by 60% in the past three years.
The issue here is that too few doctors are picking emergency medicine in the final stages of their training, and who could blame them? It might take six years to train a doctor, but it only takes a second for the Government’s A and E crisis to deter a junior doctor from going into emergency medicine.
The disruption the College of Emergency Medicine talks about is the disruption that the care Minister and his fellow Liberal Democrats allowed to happen when they nodded through the Health and Social Care Act, but we hear reports that his party is preparing to disown the NHS reorganisation and pretend it had nothing to do with them.
The right hon. Member for Sutton and Cheam (Paul Burstow) has admitted today that he got it wrong on competition. Why does the care Minister not own up and admit that he got this wrong, and that he should have listened to his own supporters and hundreds of thousands of people across the country who pleaded with him not to go through with it?
The human cost of that mistake is clear for all to see. We can see it in the sheer number of people coming through the doors of A and E. As my right hon. Friend the shadow Health Secretary pointed out at the beginning of this debate, attendances at A and E rose by 16,000 in the last three years of the Labour Government. In the first three years of this Government, they have rocketed by 633,000. Ministers may be pleased that the NHS is still standing after being subjected to this level of pressure, but the question they should ask is, why are so many more people coming to A and E in the first place?
The hon. Lady mentioned the figure of 633,000 extra people presenting to A and E. In his opening speech, the shadow Health Secretary attributed a proportion of that number to people who had scurvy or rickets, as he tried to paint a Dickensian picture of national squalor. Now that she has had a few hours to check, can she tell me how many of those 633,000 people were diagnosed in A and E with either scurvy or rickets?
The hon. Gentleman may not have been here when we had the response from the Health Secretary. I will come on to the very points the hon. Gentleman raises in my speech, and I look forward to going through all the big issues we have with malnutrition in this country.
I echo the comments made by my right hon. Friend the shadow Secretary of State about the sneering we have heard from Government Members this afternoon regarding some very serious issues. Any case of scurvy in 21st-century Britain is shameful.
My hon. Friend the Member for Stretford and Urmston (Kate Green) talked about the catalogue of coincidences that have led to so many more people going to A and E in the first place. I refer back to the increase of 16,000 in the last three years of the Labour Government, and of 633,000 in the first three years of this Government. Why is that? A quarter of walk-in centres have closed. NHS Direct was abolished. The guarantee of a GP appointment in 48 hours was scrapped, and extended GP opening hours were cut. As my hon. Friends the Members for Easington (Grahame M. Morris) and for Worsley and Eccles South (Barbara Keeley) said, £1.8 billion has been hacked from social care budgets, with thousands of people losing their care packages.
Is the hon. Lady prepared to admit, just a teensy bit, that some of the added numbers going to A and E, which I agree are putting a lot of pressure on the departments, are partly to do with the change in GP contracts introduced by the Labour Government? That is driving people to A and E, because no GPs are working the hours that would allow people to be seen.
I just do not know what to say to that because it is so ridiculous. There was an increase of 16,000 in the last three years of the Labour Government, which has rocketed to 633,000 in the first three years of this Government. The gap in those figures is tremendous. The GP contract happened in 2004. When have we seen crises in A and E? Not under the Labour Government, but under this Government—the Tory-Liberal Democrat Government.
What else has happened under this Government? We have seen the Health Secretary handing back £2.2 billion of underspend to the Treasury, 2,300 managers receiving six-figure pay outs and £1.4 billion siphoned off to pay for redundancies. My right hon. Friend the Member for Leigh also raise the issue of the amount of money NHS trusts are now having to spend on expensive legal fees as a result of competition, introduced through the Health and Social Care Act. That goes to show that when it comes to our NHS, this Government know the cost of everything but the value of nothing.
As the hon. Member for Stafford (Jeremy Lefroy) said, our elderly population is growing, but half a million fewer older people are receiving support compared to 10 years ago. That means more older people going to A and E because they cannot receive the care they need at home, and more older people stuck in hospital beds because there is no safe place to discharge them to.
I am not giving way because I have only three minutes left.
As my right hon. Friend the Member for Leigh said earlier, the CQC recently reported that in the last year, more than half a million pensioners were admitted as an emergency to hospital with potentially avoidable conditions. There is another reason for that: it is now harder, not easier, to get a GP appointment under this Government. The Royal College of General Practitioners says that it will soon become the norm for people to wait a week or longer to see their GP. Just this week, I was contacted by a constituent whose partner was suffering from chest pains. They contacted the GP but could not get an appointment for eight days.
This is what patients are having to endure right across the country, and it is being made even harder by the cost of living crisis hitting families all over Britain. People are having to eat less, and less healthily, and more than half a million people are being forced to turn to food banks. As my hon. Friend the Member for Worsley and Eccles South described so poignantly, carers are having to make the choice between heating and eating. GPs are now asking patients when they last had a meal. It is no coincidence that, as food bank use has exploded, so have cases of malnutrition. There has been a 42% increase in malnutrition cases, and in 2012-13 more than 5,000 people were thus diagnosed in English hospitals. I share the view of my hon. Friend the Member for Stretford and Urmston that that is a disgrace in 21st-century Britain.
Doctors are now treating diseases we thought had all but disappeared. It is not just scurvy; rickets and vitamin deficiency are also on the rise. The Government have already given us the longest fall in living standards since the 1870s; we now have the Victorian diseases to match. They should be ashamed of every single case of these 19th-century diseases returning to 21st-century Britain.
That is not all. With energy bills up by £300 and more children living in fuel poverty, is it any wonder that episodes of hypothermia have jumped by 40% in the past three years? We have seen a 29% increase in the number of excess winter deaths—31,000 deaths that by definition were entirely preventable—while new figures this week show a dramatic increase in the number of older people being admitted to A and E for cold-related illnesses. Furthermore, there have been 145,000 more cases of over-75s being treated in hospital for respiratory or circulatory diseases, compared with 2009-10.
Ministers cannot resolve the crisis in our NHS. They know what is happening and that their policies are stoking the crisis, but they will not admit it. Only Labour can preserve, protect and progress our NHS. Our approach focuses on the patient, and it champions integration and collaboration, not competition, fragmentation and profit. We want a public, integrated NHS free at the point of use, and a whole-person approach that combines physical, mental and social care and helps to take the pressure off A and E. That is the principle behind our motion today, and I urge Members on both sides of the House to support it.
This afternoon, we have been presented with more of the same from the Labour party—the same scaremongering, the same misinformation, the same unwillingness to offer solutions. In short, it is the same old Labour party.
Earlier this week, we heard from the right hon. Member for Leigh (Andy Burnham) that the N was being wrenched off the NHS and that it was being sold to any company, but in reality only 6% of expenditure in the NHS goes to private providers. He talks about “market madness running riot through the NHS”, but listen to the facts: between 2006 and 2010, under Labour, total spending on the independent and private sector more than doubled; and between 2007-08 and 2010-11, under Labour, the number of operations conducted by the independent sector tripled. Since then, the figure has been around 46%.
Labour is desperately trying to make the public believe that its skewed vision is the reality of the NHS, but this view is of course total nonsense, and I am happy to try to set the record straight.
I think the Minister was in the Chamber when his predecessor as care Minister held his hands up and admitted he got it wrong on competition when the Health and Social Care Bill went through the House. He has given hints to newspapers that he feels the same way. Would he care to step into the confessional and admit that the Liberal Democrats got it wrong on competition in the NHS?
I certainly think we have to avoid any repeat of what happened in Bournemouth. It is absolutely right for politicians to make that clear.
The Labour party has tried to paint a picture of crisis in A and E. We know that there is more pressure on this vital service.
My hon. Friend is making some excellent points about Labour’s record of inviting competition into the NHS when in office. The success of that record might have been the reason why Labour’s manifesto in 2010 promised:
“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality at NHS costs”.
If I am right, that is called “any qualified provider” or “any willing provider”, which is exactly what this Government have pursued. Labour’s rewriting of history is breathtaking.
There are 1.2 million more people visiting A and E than three years ago—the hon. Member for Stretford and Urmston (Kate Green) is right that the system is under pressure—but the increase in the number of A and E attendances peaked in 2009-10, under the previous Labour Government, when there was a year-on-year increase of 4.7%. Since then, the increase has been slower, and in the last full year for which data are available it was just 1.2%—clear evidence that the Government’s policies are starting to work.
Doctors and nurses in our A and E departments up and down the country are doing brilliant work. Last week the NHS not only met the four-hour A and E target, but improved on its score from the same time last year. By contrast, in Labour-run Wales, A and E targets have not been met since 2009. The College of Emergency Medicine has said that Welsh A and E departments are on their knees, at the “point of meltdown”, and are putting patients at risk in Labour-run Wales. The college has complained of the ruthless
“pursuit of targets and financial balance at the expense of quality of care.”
In England, we have already met the target for more weeks this winter than when the right hon. Member for Leigh was Health Secretary. He missed his A and E target for two of his three quarters—was that a crisis in those days?—whereas we are seeing 2,000 more patients every day in under four hours than when Labour was in government. Ambulance performance is better than at the same time last year, meaning more ambulances arriving on scene in under eight minutes. Across the country, delays in handing over patients at A and E have dropped by a third compared with last year as a result of new sanctions, so we are not complacent.
As my hon. Friends the Members for Suffolk Coastal (Dr Coffey) and for Witham (Priti Patel) rightly said, we are sorting the problem. Opposition Members would like people to think that the NHS is going to ruin. They are so desperate—using the examples of scurvy and rickets. Of course, when that happens it is incredibly serious, but to suggest that that is part of the problem is outrageous. We heard the figures for scurvy, but there were 66 admissions for rickets in 2010-11 and 65 in 2012-13, so the figure has gone down. The truth is that we inherited a dysfunctional system that was crying out for reform—too many people ending up in hospital because of crises in their care, and far too much money spent on bureaucracy, as my hon. Friend the Member for Witham made clear.
For years I have argued the case for a different approach. We are making the essential changes and supporting NHS staff through difficult times. For this winter we are investing an additional £400 million in total—more than ever before. Having put plans in place earlier than ever before, with urgent care boards deciding what works in local areas, we are already seeing the benefit of those additional funds, with 320 more doctors, 1,400 more nurses, 1,200 other staff—occupational therapists, physiotherapists and so on—and more than 2,000 additional beds.
Throughout this debate we have heard that urgent and emergency care needs to change, and rightly so, but may I remind the House that we are the Government who are making that change? We have asked Bruce Keogh to undertake a fundamental review of urgent and emergency care, but there are still far too many people ending up in hospital because of crises in care. There are too many people with long-term conditions who are still receiving unco-ordinated care. That is frustrating for the patient, it wastes money for the system and it can lead to worse health outcomes, as we fail to prevent such conditions from getting worse. It is our aim in government to join up services, fitting them around people’s lives and providing better care closer to home.
The right hon. Member for Leigh seems to have had a recent damascene conversion to the case for integration. It is a shame that in the 13 years his party had in power, it did nothing significant to achieve it. In fact, many of the things it did and the decisions it made took the NHS in the wrong direction—on tariffs, on incentivising more activity in hospitals, on the disastrous private finance initiative and on the equally disastrous GP contract. I am proud to say that it is this Government who are taking the practical steps to make integration more commonplace throughout the country. We have selected 14 integrated care pioneers and we now have the £3.8 billion better care fund to achieve joined-up care throughout the country.
The truth is that the right hon. Gentleman and the whole of the Opposition have systematically dismissed the real issue with empty rhetoric. They want better care in A and E, yet we have started the reforms that will revolutionise urgent and emergency care. They want the health and care services to become more integrated. We are leading the charge to make that happen, and to improve care and support for people throughout the country. They want us to change competition law. We have made it clearer and easier to understand, and have balanced that with the need for integration, and the need to help doctors to know how and when to use it.
The Opposition are fighting their own shadow. Well, they can shadow-box all they want. They can waste time complaining rather than coming up with solutions, but this Government are actually tackling the issues, and making the changes to the health and care system that patients so desperately need.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.
Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.
The House divided: Ayes 298, Noes 231.
The Deputy Speaker declared the main Question, as amended, to be agreed to (Standing Order No. 31(2)).
That this House notes the strong performance of NHS accident and emergency departments this winter; further notes that the average waiting time to be seen in A&E has more than halved since 2010; commends the hard work of NHS staff who are seeing more people and carrying out more operations every year since May 2010; notes that this has been supported by the Government’s decision to protect the NHS budget and to shift resources to frontline patient care, delivering 12,000 more clinical staff and 23,000 fewer administrators; welcomes changes to the GP contract which restore the personal link between doctors and their most vulnerable patients; welcomes the announcement of the Better Care Fund which designates £3.8 billion to join up health and care provision and the Integration Pioneers to provide better care closer to home; believes that clinicians are in the best position to make judgements about the most appropriate care for their patients; notes that rules on tendering are no different to the rules that applied to primary care trusts; and, a year on from the publication of the Francis Report, notes that the NHS is placing an increased emphasis on compassionate care, integration, transparency, safe staffing and patient safety.
On a point of order, Madam Deputy Speaker. Members will have heard the concern during Prime Minister’s questions about the loss of the main line between London and Penzance. We understand locally that the rest of the Dawlish sea wall might go tonight. Has the Secretary of State for Transport given any indication that he intends to update the House on the current situation and on the measures that he is putting in place to ensure that the economy of the south-west is protected and the rail line kept open?
I thank the hon. Lady for her point of order, although she and the House will appreciate that it is not a point to be dealt with by the Chair at this moment. I have received no indication that the Secretary of State for Transport intends to come to the House today, but the hon. Lady has ingeniously used the moment to draw attention to a serious matter that is, I am sure, appreciated as such by the Ministers concerned. I am certain that her point, albeit that it is not a point of order, will be noted by those by whom it ought to be noted.