I beg to move,
That this House notes comments from leading experts that the NHS is under unprecedented levels of pressure and that this is putting patient care at risk; further notes that attendances at hospital A&E departments increased by 60,000 in the last four years of the previous Government and 600,000 in the first four years of the current Government; believes that this is linked to decisions taken by this Government, including cuts to adult social care, the abolition of NHS Direct, the closure of almost one in four walk-in centres and removing the GP access guarantee; and calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion a year for the NHS, funded by measures including a tax on properties worth over £2 million, to help ease the current pressure and ensure that the NHS is fit for the future.
We have called this debate today to see if we can establish a shared analysis across the House of the causes of the current crisis in accident and emergency departments, and from that, shared solutions. I hope we can all agree that the staff of the national health service and of the ambulance service are working wonders in the most trying circumstances, and that it behoves all of us to put forward our ideas today to relieve the pressure on them, but more importantly, to reduce the risks that too many patients are facing right now.
As I have said to the Secretary of State before, things cannot carry on as they are. As the British Medical Association said last week,
“these ongoing challenges are placing patient care and safety at risk.”
Very poorly people are waiting hours for ambulances to arrive, hours to be seen in A and E, and hours on trolleys in corridors, and too many elderly people are then being held on hospital wards, trapped for days, weeks, even months or, in one case that I will come to later, a full calendar year.
I am not sure which figure the hon. Gentleman is referring to, but the figures in the motion apply to England. I will say more about them in a moment.
The stories of failure keep coming. Today we read that a 38-year-old man in Bristol died of meningitis after an ambulance took four hours to arrive. This is by no means an isolated example. The response time target for the most serious calls has been missed for the past six months in a row. We need to hear today what the Secretary of State is doing about this. Rather than work to improve response times, the only proposal we have heard so far is to allow a pilot relaxing response time standards. There will be two pilots, one in the south-west and one in London. London, as the right hon. Gentleman knows, is the worst-performing ambulance service in the country right now, and we hear today that the chief executive of London ambulance service, Ann Radmore, has resigned. The Secretary of State will need to explain to us today why it makes sense, in the middle of a difficult winter, to run an experiment in the most troubled ambulance service in the country.
I am grateful to the shadow Secretary of State. Can he explain why Labour only ever now has any interest in England’s health service? We would like to hear about Labour’s conduct of the Welsh health service and its message for Scotland. Does Labour not know that this is an English devolved matter?
It is my responsibility to hold the Government to account on behalf of patients in England for what is happening in England now. That is my job, and I will make no apologies to the right hon. Gentleman or anybody else for doing it.
The response times in the ambulance service are not good enough, nor is the plan to introduce an experiment in the middle of winter, but the problems are not confined to the ambulance service. We need, too, to relieve the pressure on hospitals. Last week just seven out of 140 hospital A and E departments in England met the Secretary of State’s lowered A and E target. Hospital staff are trying their best, but it is as if the Government have simply given up on it. If that is so, it means that they are giving up on the thousands of people waiting hours to be seen. What is his plan to stop the decline and bring A and E back up to acceptable standards? It is time he told us.
I thank the right hon. Gentleman for giving way. I am concerned. Does he understand the difference between a pilot and an experiment? Does he not think it is right that the Secretary of State should listen to clinically led advice about how we might improve ambulance waiting times, rather than just roll out changes without a pilot, not an experiment?
I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do.
I need to hear today the Secretary of State’s plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.
I shall give way in a moment.
Another recent case symbolises just how bad things have got. Michael Steel, a dad of two, aged 63, was moved from his ward to a store cupboard while being treated for an inflamed liver. Mr Steel was unable to sleep because he was wheeled in and out of the cupboard while staff went to get drugs from the fridge. One nurse apparently told him it was “absolute chaos”. His son Tom took pictures of the ordeal, including a photo of the ward’s whiteboard where nurses listed his dad’s location as “stock room”. This is the NHS on the Secretary of State’s watch.
I agree with the Chair of the Health Committee that the Secretary of State and his Ministers should listen to the professionals on the front line. If they had listened three years ago, we would not have been lumbered with the Health and Social Care Act 2012, because everyone at the professional end of the health service said, “Do not do it.” But they were ignored by the Secretary of State.
What we can see is that this decline began when the Government made the monumental misjudgment of bringing forward a top-down reorganisation that should never have happened, that nobody voted for, and that took 1.5 million eyes off the ball in the NHS. The Government should have been looking at the front line and maintaining standards there, instead of which they looked backwards, and focused on the reorganisation and the jobs merry-go-round that then carried on. It is really disgraceful that they did that and plunged the NHS into the chaos that it is today.
Last Friday evening, I spent time at Whiston A and E talking to doctors and nurses, who do an unbelievable job. I heard about the problem of getting elderly people back into the community when they have undergone treatment. There were also issues around recruiting and retaining nurses and the tariff there, but there does not seem to be any answer coming from the Government.
My hon. Friend describes the problems well. I know the hospital because I have been there with him. He is right that older people are becoming trapped in hospital. The support is not there for them in their own homes, and nursing home places are not available. I will come back to that theme in a moment.
On exactly that point, the Health Committee looked at the A and E crisis last week and was told by the president of the College of Emergency Medicine that delayed discharges were due to underinvestment in the community, by which he meant social care, GPs and district nurses. Indeed, one third of delayed discharges were down to social care. One third of frail elderly people, or vulnerable people, cannot go home because of the issues with social care, which has been cut by £3.53 billion under this Government.
We have record numbers of delayed discharges in the NHS right now. The number may even go past the 1 million mark—I am talking about days lost in the past year. That reorganisation that I mentioned a moment ago cost at least £3 billion, probably more. The budget was flat so where did that money come from? As my hon. Friend rightly says, it came from cuts to the general practice budget, cuts to the community services budget, cuts to the mental health budget and cuts to the social care budget. That is why the community has been stripped bare and people are trapped in hospital. This is a mess of the Government’s making.
I will make some progress.
I mentioned record numbers of delayed discharges. There are also record numbers of people visiting A and E, record numbers of frail people being admitted through A and E, record numbers of people waiting on trolleys and record numbers of people trapped in acute hospital beds. This is the simple question that has not yet been answered by this Government: why is there this unprecedented pressure in accident and emergency? Until there are proper answers to that simple question—and agreement about the true causes of the A and E crisis—we will not be able to move forward with a proper solution, and that is the point of today’s debate.
When the Secretary of State came here to answer the urgent question two weeks ago, he was asked by my hon. Friend the Member for Halton (Derek Twigg) what he saw as the causes of the increased attendances at A and E. Let me remind the House of what he said:
“We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population...The second factor is changing consumer expectation among younger people who want faster health care…The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets.—[Official Report, 7 January 2015; Vol. 590, c. 280.]
In other words, “Nothing to do with us, Guv.” It is the same old story with this Secretary of State. It is always someone else’s fault: older people’s fault, younger people’s fault, the previous Government’s fault—anyone but him.
My right hon. Friend knows Warrington well. As well as increasing ambulance response time and having fewer GPs than we had in 2010, we are now seeing one of the last specialisms—spinal services—moved from Warrington to Walton with no public consultation whatever. Does he agree that this is exactly the result of the Government’s reorganisation in which no one is accountable for any decisions and the future of hospitals such as Warrington is at risk?
My hon. Friend is right; I do know Warrington well. Speaking up for my own family who live in Warrington, I will not accept a situation in which their services are taken away without them having the democratic right to challenge those decisions. But that is what has been growing under this Secretary of State. We had the decision on Lewisham—the most outrageous example—in which he tried to close a successful A and E that was serving a very deprived part of London, without any proper process, and he lost in the High Court. Then we had a clause brought before the House that tried to close hospitals anyway. That is what the Government want to do; they want to ride roughshod over local people and close services where they want to, and we will not let it happen.
If the causes of the A and E crisis are deep and structural, as the Secretary of State has implied, why is it that the number of people in London waiting outside A and E in ambulances rose by 66% in one month—between November and December?
As usual, my hon. Friend puts her finger on the issue: the crisis is not as the Secretary of State describes. I will come on to that right now, but the first request I will make of him today is to publish the research that proves that the three top reasons he gave in this House two weeks ago are indeed the reasons for the increased demand in A and E, because I do not believe that they are. Perhaps they have made a small contribution, but they are not the real reason for the crisis. Our analysis of what is behind the extra pressure is very different from his. Let me introduce an important and revealing fact into this debate, which picks up on my hon. Friend’s point.
Over the past four years of the previous Government, annual attendances at A and E increased by 60,000. Over the first four years of this Government, they have increased by 600,000. That is a dramatic increase, which is explained not by those long-term structural issues, but by decisions taken by this Government.
Under the previous Government, Crawley’s accident and emergency was closed. Will the right hon. Gentleman now commit to increasing funding on the NHS, as this Government have done every single year of this Parliament, and promise to do for the next?
Changes we made were done in a planned way, with measures to increase capacity at neighbouring accident and emergency departments, and they were done for reasons of patient safety. Have a look at west London, where plans to close A and E departments are being railroaded through, leaving intolerable pressure on the remaining A and E departments. It is not acceptable, and the hon. Gentleman should challenge his own Government on what they are doing.
Does the right hon. Gentleman agree that with private health firms now on course to win more than £9 billion of NHS contracts, one of the real problems is the fragmentation of the NHS in front of our eyes. Is that a good reason to oppose further privatisation of the NHS, and will he admit that the process that set in train the privatisation of Hinchingbrooke should never have happened?
I have said that the market was let in too far, and, as Health Secretary in 2009, I changed policy away from what was a version of “any willing” or “any qualified” provider to “NHS preferred provider” and I stand by that. I agree with the hon. Lady that the market is simply not the answer to 21st-century health and care. When the Prime Minister stood at the Dispatch Box about an hour or so ago and said no privatisation on his watch, he was not being straight with the public. Services across the country are being put out to open tender and then transferred to the private sector. That is the Government’s record and the people of this country know it.
Does my right hon. Friend agree that it says everything about this Government’s attitude to the NHS that general practices that serve the most needy and vulnerable patients, like Devonshire Green and Hanover medical centres in my constituency, are under threat because of the withdrawal of the minimum practice income guarantee introduced by Labour? Does he agree that the Government should immediately stop the phased withdrawal of funding and review their decision to end MPIG?
I said earlier that there had been cuts to the GP budget, and that is one of the implications of those cuts. The Government have developed a plan to phase out the guarantee that secures practices in some of the more deprived communities. In east London there have been campaigns against practice closures; I know there are similar concerns in Sheffield. That process should be reviewed and if necessary stopped, because no practice should close as a result of any of those changes. That is the commitment I give to my hon. Friend today.
I want to make some more progress; I will give way later.
We need to know the reasons for the increase in A and E attendance. Safely meeting that demand would require an extra eight accident and emergency departments in England, but the Government have been closing, not opening, A and E’s. That is why there is so much pressure in the system.
There has been an even more dramatic increase in the last year. NHS England figures show that there were an extra 446 extra visits to A and E in the 2014 calendar year. That is a dramatic change on the Secretary of State’s watch and the time has come for some honesty from him about the real reasons for it. Until he faces up to those reasons, however uncomfortable they may be for him, he will not be able to develop a proper solution and the situation will get worse. We cannot let that happen.
Let me list what I believe are the decisions of this Government that led to the increase. I will identify four and take each in turn. The first, as Opposition colleagues mentioned, is the decision to scrap NHS Direct and replace it with the flawed NHS 111 service. NHS 111 was originally intended to be a call-handling service, and indeed was conceived by the previous Government. It was intended to simplify access; it was intended to patch people through to the relevant agency, be it the GP out-of-hours service or NHS Direct.
However, when the present Government came into office, they made a major change: they decided that NHS 111 would not signpost NHS Direct but replace it. That was a major mistake. The established and trusted NHS Direct model, a single national contract in the public sector, was replaced with 46 patchwork contracts in the public and private sectors across the country. They replaced the model of nurses on the end of the phone, to provide reassurance for families, with call handlers and computer screens. As a result, where 60% of calls to NHS Direct were handled by nurses, with NHS 111 it is only 20%.
But the present system of call handlers and computer screens is not a case of “computer says no”. The problem is that too often it is a case of “computer says, ‘Go to A and E.’” NHS England figures show that there has been a dramatic increase, in the last year, in the number of people calling NHS 111 who are referred to A and E, or to whom an ambulance was dispatched. In November 2014, there were 67,000 referrals to A and E—a 26% increase on the same month in 2013—and 108,000 ambulances dispatched—a 20% increase on November 2013.
All these problems have led to an increase in the number of days that people are taking off as a result of stress—nurses especially. Thousands of days are being lost to the system, adding to the crisis. Should we not be appreciating the staff in our NHS hospitals, and maybe starting by awarding them the 1% pay rise that the pay review body recommended for all of them?
The Secretary of State’s decision to reject the independent advice of the pay review body about what was fair and affordable, and to single out NHS staff for exclusion from the promise that the Chancellor had made that the public sector, as part of his restraint policy, would get 1%—to say that NHS staff would get less than that—was a kick in the teeth, and was to risk staff morale just at the moment that the NHS needed to be recognising and rewarding those staff, who are working so hard to keep things going. To make inflammatory comments such as those that the Secretary of State has made in the newspapers today is the wrong response. He should be getting back round the negotiating table with those staff. He should be working with them to find solutions. They are keeping the NHS going right now, and they deserve a bit better than they have had off this Secretary of State.
May I return my right hon. Friend to something very important that he said? He pointed to the distress of our constituents who are being told to go to A and E rather than having reassurance from a nurse on the end of the phone. This is the experience of all our constituents right now, and I would far rather all my constituents had access to a qualified nurse than were just told to go to A and E.
My hon. Friend calls it just right. One thing the Government could do right now would be to get more nurses on the end of those phones, to provide that experienced voice, that reassurance, that people with young children need before they decide to get in the car and go to A and E. I remember using NHS Direct in such circumstances myself. That reassuring voice has gone, and that is why NHS 111 is placing additional pressure on our A and E. The Secretary of State would not recognise it, with the reasons that he gave, but it is. Staff know it is. The ambulance service know it is. It is time we had a Government who faced up to that reality. My question for the Secretary of State today is: will he now concede that that flawed 111 service has contributed to the 600,000 annual increase in A and E attendances?
The second policy decision that I shall discuss is the closure of NHS walk-in centres. Colleagues who have been in the House for some time will recall that there was a winter crisis in A and E in most, if not all, winters in the 1990s. Then, in the late ’90s, NHS Direct was launched and NHS walk-in centres were opened, with the specific intention of giving people alternatives to attending A and E, which were then under major pressure. The locations of the first wave of walk-in centres were carefully chosen, often where an A and E had recently closed, including at Leigh infirmary in my constituency. In the decade from 2000 to 2010, around 230 walk-in centres were opened across England. Many of those centres became an established and understood alternative to A and E.
However, despite strong evidence to support them, a review by Monitor has found that almost one in four walk-in centres have closed under the coalition Government. Many more are under threat today. Monitor’s review surveyed people who used walk-in centres, and one in five said they would have gone to A and E if that alternative had not been available. Here is my next question for the Secretary of State: will he now concede that, in the areas where those centres have closed, there will have been extra attendances at A and E, and that was it a mistake to close those centres?
Thirdly, I will mention GP services, but let me start by clearing something up. The Prime Minister claimed today at Prime Minister’s questions that there are more GPs now than when he took office. I am afraid, as so often is the case at Prime Minister’s questions, that claim is simply not true. The last census of the GP work force conducted under the previous Government, in September 2009, found that there were 35,917 GPs working in England. The latest census for which figures are available, September 2013, finds 35,561 GPs working in England. When will Ministers start giving out facts from that Dispatch Box, rather than the spin we get week after week?
I asked the Prime Minister some weeks ago about the number of nurses in the NHS. In December, the number of NHS nurses in the system had been reduced by over 900 since May 2010, but we were told in November that it was up by about 2,500. The Government were using the figures, and the Prime Minister was answering questions, in terms of hours worked. As we know, nurses are working massive amounts of overtime on single-rate time. Nominal headcount nurses, at this moment in time, are minus over 900 compared with May 2010.
My hon. Friend makes his point very well. This is what we must challenge as we move forward. Before the general election, people need the facts about what is happening to the NHS. There has been a big drop in the number of nurses working in the community, as my hon. Friend mentioned, and these are the facts that we need to bring home to people.
It is not just the fact that the GP headcount has gone down. One of the present Government’s first acts was to scrap the guarantee of an appointment within 48 hours and incentives to open GP surgeries in the evenings and at weekends. That, combined with cuts to the GP budget, means that it has got harder and harder to get a GP appointment in recent years. The constituents of all the Members present say, “I am ringing the surgery at 8 or 9 every morning and being told that nothing is available for days.” In 2010, the vast majority—80%–of people said they could get an appointment within 48 hours; now, according to the GP survey, one in four people say they must wait a week or more to see a GP.
One of the problems in my constituency is that GP surgeries are relying on locums because it is not possible to find GPs to recruit on a full-time basis. Those locums provide a very erratic service; sometimes there is not even a locum available. That is adding to the problem, because as a result, all that is left to people is to go to A and E. I am sure that my right hon. Friend agrees that that is one of the contributory factors, and it proves his point that a chronic shortage of GPs has come about under this Government.
That is an absolutely vital point. It is not just about GP locums; there are also A and E locums. The Government have, throughout, cut training places, which were another victim of the reorganisation. Ever since then, the number of places commissioned for doctors—and nurses, I might say—has gone down. That leaves us with a bill for agency staff that is literally out of control—it has gone through the roof—and that means that money is now being siphoned out of the NHS at an alarming rate. That is mismanagement; that is what has happened. How must staff working in the NHS feel when they see the bill for agency staff spiralling in this way and know that they will not even get a 1% increase from this Government? They will draw their own conclusions about how this Government value them.
The shadow Secretary of State has spent quite a large part of his speech on diagnosis, but at the beginning he asked for solutions, so in that spirit I offer a creative solution. He will be aware that East of England ambulance service has had very poor response times for a number of months—in fact, a couple of years. Would he support a merger of the Red 1 and Red 2 ambulance response services with the fire and rescue service in the east of England, because such a combined force might be in a better position to provide quicker response times? Does he agree with that idea?
I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.
I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?
Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.
That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how
“hundreds of thousands of older people who need social care are being left high and dry.”
I am talking about creating a single budget. There is a big difference between that and what the hon. Gentleman says. I am saying that the time has come to merge the adult social care budget and the NHS budget. More than that, we are going to put an extra £2.5 billion into that integrated system. He should not come here today telling me what I need to do: where is his plan to put more money into the national health service?
My right hon. Friend is giving the House a very good analysis of the social care system. He may have looked at the National Audit Office analysis published in March 2014, which said:
“The intention in the 2010 spending review was to protect spending on adult social care”.
Despite that, because Ministers cut central Government funding for local authorities by 26%, councils have cut nearly £1 in every £10 spent on adult social care in the past four years, leaving Age UK’s director to describe the system as being in calamitous decline. That is clearly a central cause of the current A and E crisis, exactly as my right hon. Friend is arguing.
My right hon. Friend has absolutely nailed it. Those Ministers on the Front Bench decided—it was a political decision—to cut councils to the bone, and in doing so cut social care to the bone. That was precisely the warning that I gave back in 2010, having just left the Department of Health, where I remember being told that allowing social care to be cut would be a false economy of massive proportions because it would lead to huge inefficiency in the NHS. Hospitals would be unable to function because they could not get people home, and therefore the NHS would back up and the pressure would become impossible. That is what is happening. Those Ministers have done it, and they must be held to account for it.
At the start of his speech, the right hon. Gentleman said he was calling for common ground and consensus in this debate, although he seems to have become somewhat deflected from that path. He knows that I very much agree with his criticisms of the Health and Social Care Act 2012 and other things. He has said, on a constructive basis, that he wants to bring health and social care together. There is potential consensus and common ground in that regard. I would like to hear what more he can say constructively on the areas where, I think, we can find, across all parties, common ground and a way forward.
To find common ground, one has to tell it straight and put on the table the real reasons why there is pressure in A and E. I bet the hon. Gentleman would not disagree with a single reason I have given: NHS 111, closure of walk-in centres, difficulty in getting GP appointments, the collapse of social care—[Interruption.] Yes, he says he does not disagree with any of those things. If we have a shared analysis, then he and I will have a basis on which to devise solutions. I will come to those solutions later.
I said that I am going to make progress.
Today’s Age UK survey finds that the number of over-65s receiving care has fallen by 380,000 under this Government. Half of the 1 million people who struggle to wash or bathe now get no help at all. Two thirds of the 250,000 people who struggle to feed themselves every day are now left to fend for themselves. There are over 100,000 fewer day care places and over 50,000 fewer people getting meals on wheels. Age UK says:
“Our state-funded social care system is in calamitous, quite rapid decline.”
But worse, it is dragging down the NHS.
In a moment. I said that I had given way for the last time, but I will do so once more for the hon. Lady.
Record numbers of very frail, elderly people are arriving at A and E due to a lack of support in their own homes. Between 2009-10 and 2012-13, there was a 48.1% increase in the number of people aged over 90 being admitted to A and E via blue-light ambulance—in other words, 100,000 very frail, very frightened people in the backs of ambulances going round our towns and cities to be dropped off at a busy A and E. That is what is happening on this Government’s watch.
Today’s Age UK report contains aggregated England data. Does the right hon. Gentleman not agree that all over our country there are councils integrating social care with the NHS, and, indeed, increasing their social care budgets? Does he not recognise the good work that is going on in the integration pilots in Cornwall, for example?
I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.
The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.
For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E
“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”
My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?
The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.
As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?
Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?
On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?
I have said that I will not give way again.
All those measures could help in the short term, but the truth is that all parties must recognise that there will not be a long-term solution to the A and E crisis until we face up to the crisis in social care, and rethink how we care for the most vulnerable older people. It is not just about money; we need radical changes in the way we use existing budgets for health and care. We need to merge them so that we can change the way in which we care for older people. We need a model of care that starts in the home and supports people there, so that we can drastically reduce the numbers unnecessarily ending up in hospital and becoming trapped there.
Although that model is not just about money, it is partly about money: if such a transformation is to happen, extra investment will be needed to stimulate it. The Secretary of State likes to hold up the better care fund, but I am afraid that councils and the NHS simply do not share his optimism. It robs Peter to pay Paul: the money transferred to councils is nowhere near enough to backfill the cuts to social care, and it leaves a deepening hole in NHS finances. [Interruption.]
The Secretary of State asks where I would get the money from, and I will tell him. The Opposition have committed to provide extra money for an integrated NHS—£2.5 billion a year over and above what he has committed—with social care as part of a single service for the whole person. By contrast, under the public spending plans the Government have set out for the next Parliament, it is clear not only that the A and E crisis will deepen every year, but that it will soon become a full-blown NHS crisis.
The NHS used to be the Prime Minister’s priority; now it does not feature in his top six election themes. We know that there will be no money for it beyond what the Government have promised, because the priority is tax cuts for higher rate taxpayers, although they have not yet identified where the money for that will come from. If the outlook for the NHS is grim, it is utterly dire for local government and social care. Taking public spending back to 1930s levels will absolutely decimate what is left of our social care system, and if the system goes into freefall today’s problems in the NHS will become entrenched. Will the Secretary of State go back to the Chancellor, argue for a better deal for the NHS and social care, and match Labour’s pledge to prevent a permanent care crisis in the next Parliament?
The NHS is now at the crossroads, and the coming election presents an enormous choice between Labour’s plan to lift the NHS out of its current crisis by investing £2.5 billion in the NHS of the future, and the coalition approach under which—with the Government unable to face up to the mess of their own making in A and E or to produce a plan to turn it around, and unwilling to find the extra money it needs—the NHS is dragged down by a toxic mix of cuts and privatisation. The stakes could not be higher. This crisis cannot go on: patients have suffered enough. They need an election, a change of direction and a Labour Government to secure the NHS.
What utter, disgraceful nonsense! I will rebut every single thing that the right hon. Member for Leigh (Andy Burnham) has said.
This has been a tough winter for the NHS, and I first want to pay tribute to the hard work of staff on the front line who have been working exceptionally long hours in very challenging circumstances. What they want right now is practical help, a vision for the future and a sensible plan to get there—all of which this Government are delivering. They do not want to be turned into a political football. The public have noted that while Labour Front Benchers sometimes sound restrained in parliamentary debates, they are the opposite in the TV studios, where they do everything possible to whip up panic and a sense of crisis. That is not the behaviour of a responsible Opposition.
As NHS England and the King’s Fund have said, the NHS is coping well under real pressure and, in the words of Dr Cliff Mann, president of the College of Emergency Medicine, trying to weaponise it for political purposes is “toxic”. Indeed, Professor Chris Ham, of the King’s Fund, said this week:
“This is a long-term issue not to do with this particular government—the previous government faced many of the same challenges...patients who are really poorly will still get a very good and very quick service.”
In contrast to what we have heard from the Opposition, will my right hon. Friend join me in welcoming the seven-day-a-week GP surgeries opening up across Ealing and Acton and the plans for the new walk-in health centre for Acton? Will he join me in condemning the Labour-led council’s decision last night to cut the public health budget?
That is the reality: there are new and improved services for the NHS up and down the country, but what we get from the Labour party in my hon. Friend’s constituency is scaremongering leaflets saying that hospitals are being closed when they are not. Labour should apologise for scaring very vulnerable people. It claims to stand up for them, but by scaring them it is doing the exact opposite.
Unfortunately, the right hon. Member for Leigh (Andy Burnham) did not do me the courtesy of giving me a right of reply when he mentioned the walk-in centre in my constituency. Does the Secretary of State not think that it was completely irresponsible for the right hon. Gentleman to make such comments, given that the issue was raised by a whistleblower and that the information does not come from the clinical commissioning group that is considering walk-in centres in my constituency?
Exactly. My hon. Friend makes the point very well, and I will tell him something else about the hospital in his constituency. The George Eliot hospital was a failing hospital with very high mortality rates, and its deeply entrenched problems were swept under the carpet by the previous Labour Government, but this Government have turned it around and it is now a successful hospital. It is doing incredibly well because we faced up to the problems that Labour ignored.
Sickness-related absence is going up around the country. In Barnsley, it has gone up by two percentage points in the past two weeks. A one percentage point increase equates to £1 million a year. Not only will that hit budgets, but it is a real sign that the NHS is under severe pressure.
The NHS is under pressure, so the hon. Lady will welcome the fact that Barnsley Hospital NHS Foundation Trust in her constituency has 34 more doctors and 74 more nurses, and that we are currently doing about 2,000 more operations every year for her constituents. Yes, there is pressure, but this Government are investing on the back of a strong economy so that we can put more money into the NHS and give her constituents a better service.
I am going to make progress, but I will give way later.
I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.
The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.
Does my right hon. Friend understand Labour’s attack on privatisation? Under Labour, the NHS always had private-sector contractors as GPs— and nothing has changed; and it always bought all its pharmaceuticals from competitive, profit-making pharmaceutical companies—and nothing has changed. What is the shadow Secretary of State’s grievance?
Privatisation is one of the most pernicious fears that Labour is seeking to stoke up—not least because, as Secretary of State, the right hon. Member for Leigh allowed the decision to go through that Hinchingbrooke hospital should be run by the private sector. He has been running away from that decision faster than anything that anyone has seen before, because he is still trying to curry favour with the unions.
The companies on the shortlist for Hinchingbrooke hospital were Circle, Serco and Ramsay Health Care. He could have stopped that as Secretary of State, but he did not. He knows—[Interruption.] Those were the three bidders—the private sector-led bids. He could have stopped that process when he was Secretary of State, but he chose not to. That makes my point very well.
The Secretary of State and the right hon. Member for Wokingham (Mr Redwood) asked what had changed. Under Labour, we did not have tendering for £1.2 billion of cancer and palliative care services, as we are seeing now in Staffordshire and Stoke, where the majority of those tendering are private companies. We did not have that.
What the last Government did, that was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.
To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.
For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.
Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.
I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.
Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.
Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.
It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.
I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?
Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.
I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.
What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.
While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!
Although I appreciate that there will inevitably be a battle between the two parties to a certain extent in this debate, the Secretary of State is at his strongest—this is what I hear from all the health care professionals in my constituency—when he talks about his patient-centred vision for the health service of the 21st century and when he looks away from the here and now and towards the future that we all know is desperately needed by all our constituents: a patient-centred NHS. I hope that he will say a little more about that.
I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.
It has been well known in the NHS for decades that an ageing population means that more needs to be spent in real terms each year on the NHS than in the year before. In 2010, when the Government came to power, 8.2% of our gross national income was spent on the NHS, but that has now fallen to 7.9%. How can that possibly be an increase in the Conservative party’s commitment to the NHS?
Because the only way we could return the economy to growth was by tackling the deficit left by the Labour party—the worst deficit in the developed world. Labour left us with that problem; we have sorted it out and are turning the country round. If the hon. Gentleman wants to increase spending on the NHS, as I do, the only way to do that is through a strong economy, which is what the Government are delivering.
Let me make some progress. In A and E, as everywhere in our hospitals, it is important that whatever the pressures, people are given safe, compassionate care. Our NHS is one of the safest systems in the world, but we still have around 1,000 avoidable deaths every month. We still put the wrong prosthesis on someone once a fortnight, operate on the wrong part of someone’s body once a week and leave a foreign object in someone’s body twice a week. Just five years ago, we had the tragedy at Mid Staffs, which, we should never forget—[Interruption.] I am quite shocked that people are laughing when we are talking about harm that happens in the NHS every month and about what happened at Mid Staffs. We must not forget that Mid Staffs was hitting its A and E targets for much of the period that that same department was tolerating the most horrific care. Whatever the pressure to hit targets, the Government want every vulnerable person to be treated safely and with the highest standards of dignity and respect.
Two years ago, we introduced the toughest inspection regime anywhere in the world. The result was over 6,000 more nurses on our hospital wards, cases of MRSA and clostridium difficile halved over this Parliament and more than 200 NHS organisations have signed up to halve avoidable harm and avoidable death over the next three years. Care is getting safer. While we lead the NHS through that painful process, what is the reaction from Opposition Front Benchers? They criticise us for running down the NHS and still maintain—as the right hon. Member for Leigh did in December—that it was a mistake to hold a public inquiry into Mid Staffs. He talked about listening to patients, but this is what Julie Bailey, a Mid Staffs campaigner whose mother was a patient at Mid Staffs said about his comments in December:
“The message he is sending out is that it is better to cover things up than to criticise the NHS, however bad things are. The inquiry uncovered huge failings in the NHS and he thinks it shouldn’t have taken place at all. It is very worrying because if he becomes Health Secretary again at the election it is clear we would go straight back to the bad old days of covering up.”
One problem last month in my local hospital, the Princess Royal university hospital, was the lack of space, and ambulances were backed up. It is not just a staffing problem; it is a spatial problem. Does the Secretary of State agree that if we had more space in A and E departments, we could get people off the streets?
Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.
Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.
The Secretary of State reeled off a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.
Will the Secretary of State give way?
I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.
But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.
The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members, poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.
Does the Secretary of State remember the words of the Prime Minister when he stood at the Dispatch Box and presented the report from Stafford? He said that what happened at Stafford was not the fault of any previous Secretary of State, including my right hon. Friend the Member for Leigh (Andy Burnham). The Prime Minister was a statesman on that occasion; it is a shame that the statesmanship has slipped since.
I have a great deal of respect for the former Secretary of State, but if he had followed the debates on Mid Staffs in this Chamber he would know that my disagreement with the shadow Health Secretary is over the reaction to Stafford and whether we will learn from those mistakes. When I have made speeches talking about the problems of poor care in the NHS today, he goes straight out to the TV studios and says that that is running down the NHS. That is not acceptable when we are taking difficult decisions to turn round failing hospitals and face up to problems in exactly the way suggested by the Francis inquiry.
I will make some progress because I want to answer some of the questions asked by the right hon. Member for Leigh. One reason for the pressure I have outlined is that people increasingly expect to get medical care 24/7, just as they are able to bank, shop and book their holidays 24/7. The NHS cannot be King Canute and try to stop that—I am not blaming patients, but that is how patient expectations are changing, and we need to give them better alternatives to turning up in A and E.
Over the past two years, we have expanded weekend and evening GP appointments for more than 5 million people. We have also rolled out the 111 service, which now handles—these are the facts—three times more calls every year than its predecessor, NHS Direct. The right hon. Gentleman criticised 111, so let us look at the facts. Of those who call 111, 30% say they would have gone to A and E but decided not to as a result—that is 2 million journeys to A and E and around 600,000 ambulance call-outs avoided because of 111. Unlike NHS Direct, one third of all 111 centres can now access a summary of people’s GP records, and that will apply to nearly all 111 centres this year. Not only can people talk to a doctor or nurse, as they did with NHS Direct, but if they give consent they can do something that they could never do under NHS Direct and talk to someone who knows about them and their medical history.
Another big challenge facing A and Es is the increasing complexity of the illnesses that people are presenting with, including many older people with conditions such as dementia, diabetes or asthma. Such people often end up being admitted to hospital rather than treated and sent home, and that is not just challenging for the system; it is often wrong for the individual. A busy A and E can be the worst possible place for a frail, older person with dementia, which is why in our vision for the NHS every vulnerable person has a doctor who is continually responsible for their care, whether or not they are in hospital, and who ensures that they have proper care wrapped around them, thereby reducing the likelihood of emergency hospital admissions. Too often, that does not happen. Too often, the buck stops with no one. That is why, this year, we reversed the 2004 decision and brought back named GPs with personal responsibility for everyone aged 75 and over. That is helping 4.5 million people. With 800,000 of the most vulnerable people, we are going even further, giving them guaranteed rights to prompt and proactive care from their GP.
On social care, for too long, some of the most vulnerable people in our country have suffered from disjointed care with NHS and social care systems that, rather than talk to each other, constantly try to pass the buck. For the first time from this April, we have required all local authorities and NHS organisations to work together to plan care in a joined up and seamless way, as part of the better care programme.
I am going to make progress.
When that happens, we should see, for the first time ever, not an increase but a reduction in emergency hospital admissions. For patients, that will mean something important: a doctor or nurse will be in charge of every person in the social care system; medical records will be shared, so that people get safer and more joined-up care; and joint teams will work together across the NHS and social care systems, rather than the silos and boundaries that have plagued the system till now.
The Government have never pretended that the challenges facing the NHS are straightforward, but with more doctors, more nurses, more operations and safer care than ever before, we have shown our commitment to that most precious institution. We have put our money where our mouth is, with protection for the NHS budget during cuts, financial help this winter and support for the NHS’s plan for the future. More important than the money are the values behind it: our passion for the highest standards of compassionate care for every person who needs the NHS. Good care, not clever politics, is the future for our NHS.
Order. I should inform Members that 28 Back Benchers are seeking to take part in the debate this afternoon. I hope that it will not be necessary to have time limits, but I ask each Member to consider speaking for only eight minutes approximately, or 10 minutes maximum. If any Member speaks for too long, it will subsequently be necessary to have a time limit, which could be quite severe on the last few speakers. That would be unfortunate, so if that could be borne in mind and if Members watched the clock, that would help enormously.
Thank you, Madam Deputy Speaker. I will do my best to comply with your instructions.
As the Secretary of State was talking, my mind went back to the “responsible opposition” of the right hon. Member for South Cambridgeshire (Mr Lansley). I remember the efforts that went on for more than 40 years around Manchester to tackle the appalling level of infant mortality by reconfiguring maternity services. As the local newspapers said, that was stopped at every stage by politicians defending bricks and mortar. In the end, when that change went through, it was the Opposition who tried to reopen the issue. Before my noble Friend Lord Ara Darzi became a Minister, he did a very important review on London, where there were more single-handed GP practices than anywhere else in the country post-Shipman, and people attending A and E was a bigger problem than anywhere else. Lord Darzi put forward sensible proposals, which were agreed by clinicians and the NHS in London, but the right hon. Member for South Cambridgeshire opposed them. He issued an unfortunate press release about polyclinics—unfortunately, he spelt it “polly”, but it was not a clinic for parrots. I said to him, “Don’t adopt a policy that you can’t spell.” There are numerous examples of the previous Opposition doing that.
I bet I am not the only one in this House—I bet there are Members in all parts of the House—who rues the day when the right hon. Member for South Cambridgeshire got his hands on the NHS. His ideas for what to do, which culminated in the top-down reorganisation, were not new—I remember them from my first day as Health Secretary. He is not a bad man who hates the NHS, by the way. In many ways, he has great affection for the NHS, but he got things totally wrong. He slung across his draft Bill on what the NHS would look like after his top-down reorganisation. I read it that evening and it was horrendous.
The Government have done two things to erode confidence in politics in this country. The first is the Liberal Democrats’ conversion from opposing tuition fees to the extent that they wished to abolish them to supporting tuition fees to the extent that they agreed to treble them. The second is the Conservatives’ conversion from a pledge that there would be no top-down reorganisation of the NHS to the implementation of a top-down reorganisation so huge that, in the words of the previous NHS chief executive,
“you can see it from space”.
That is a vivid but not inaccurate description of a reorganisation that closed 170 organisations, created 240 new ones, made 10,000 staff redundant and re-employed 2,200 of them.
I will not highlight the right hon. Gentleman’s role in tripling tuition fees. The shadow Secretary of State said that, when he came into office—this is part of his defence— he got rid of the pro-privatisation agenda that he inherited. Who does the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) believe the shadow Secretary of State was criticising in that comment?
I do not understand the hon. Gentleman’s point about my role in trebling tuition fees. I certainly was the higher education Minister who introduced tuition fees, against fierce opposition. I supported them and made the arguments—all the arguments we now hear from Liberal Democrats—against the opposition of the Conservative party.
In terms of privatisation, we did introduce independent treatment centres. At every stage, we asked the local NHS, “Have you got the capacity to get these waiting lists down? Have you got the capacity to carry out the elective surgery without denuding emergency services?” which happened all the time. Hon. Members will be surprised how many found that capacity when we said, “Okay, we’ll introduce an independent treatment centre.” Suddenly, consultants stopped going to the golf course and taking Saturdays off. They got the waiting times down. In places that did not have capacity, we introduced independent treatment centres. The role of the NHS is to treat patients, and I am very proud of the record that we and my successor, my right hon. Friend the Member for Leigh (Andy Burnham), stood on in 2010.
Does the right hon. Gentleman agree that, since the late 1980s, every Secretary of State from both political parties, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson), accepted that one could raise the quality of patient care by introducing competition and choice of provider in the system? The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) quite sensibly pursued that policy, as did Alan Milburn, with particular vigour, and the shadow Secretary of State when he was in office. Will the right hon. Gentleman try to encourage his successor not to go back on that, because the health service is now much better at coping with the problems of changing demand than it was 20 or 30 years ago?
The right hon. and learned Gentleman knows, because we have debated this before—I will come on to some of the history—that the big difference between what he and other Governments did during the 1980s and what we did is the single tariff. They competed on price. We had a single tariff that meant that, wherever that operation took place, it was paid for at the same rate.
With that top-down reorganisation that we could see from space, all the Conservative party’s efforts to convince the public that they could be trusted with the stewardship of the NHS were thrown into disarray at a stroke. The fact that the NHS tops the list of public concerns as we approach a general election can be traced to that self-inflicted wound.
The Conservative party leader’s efforts to detoxify the Tory brand vis-à-vis the NHS could be described as an attempt to return to the consensus that existed prior to the 1980s. The great historian of the NHS, Rudolf Klein, says that following its contentious birth there followed 35 years when the NHS was “cocooned in consensus”. That changed in 1982, when the Thatcher Government’s internal think-tank, the Central Policy Review Staff, produced a paper with the option of replacing the NHS, a tax-financed health service, with a system of private insurance. This option—the right hon. and learned Member for Rushcliffe (Mr Clarke) will probably remember this—was, incidentally, presented to Ministers not by the Secretary of State for Health but by the Chancellor of the Exchequer. It was defeated thanks to the efforts of Norman—now Lord—Fowler, but it expressed for the first time the idea that a tax-funded NHS was wrong and broke that 35-year consensus.
From that moment, through weird and wonderful ideas, right up to 2005 when Conservatives Members stood on the platform of the ridiculous patient passport, their policy has been about taking money out of the NHS and changing the very principles of the service. I could not describe it better—I think there would be agreement on this—than the great American clinician and health care expert, Donald Berwick, who I believe the Secretary of State has used during his time in office as an adviser. He describes the NHS as
“one of the truly astounding endeavours of modern times”
and, in a wonderful phrase, as
“a towering bridge - between the rhetoric of justice and the fact of justice.”
This ideological battle is not over. Indeed, it has just been joined by the ultra-Thatcherite leader of UKIP. The hon. Member for St Ives (Andrew George) is no longer in his place, but he was perhaps right in thinking that we should get back to a consensus on the NHS.
We could raise relevant arguments about many aspects of the NHS. Indeed, my colleagues in Hull and I are talking to the Secretary of State about some issues central to Hull. However, in this speech I do not want to talk about clinical health or the successes of the NHS. I want to talk about one of its failures. At the tenth anniversary of the NHS in 1958, there was a debate in this Chamber. Nye Bevan, the great architect of the NHS who was mentioned earlier, stood up and said what a great success it had been, but that the failure had been mental health. He spoke, using the language of the time, of the disgraceful conditions in our mental hospitals. Of course, there has been a huge improvement since 1958, but it remains a fact that mental health is a poor relation of the NHS, and children and adolescent mental health is a poor relation of that poor relation.
I would like to cite three awful statistics published by the Office for National Statistics. First, 10% of children between the ages of five and 16—or to put it another way, three in every class—experience mental health problems. The second disgraceful statistic is that that figure rises to 60% when applied to children in care. The final disgraceful statistic is that 95% of imprisoned young offenders have a mental health disorder. Many of those young offenders should not be in prison at all. I have raised the case on the Floor of the House of my constituent, Vince Morgan, a young man with a severe psychotic illness who committed suicide in a prison cell having been failed by every single organisation and authority that was meant to help him. Section 136 of the Mental Health Act 1983 is still being used to incarcerate children, mainly as a result of the failure to provide sufficient in-patient tier 4 child and adolescent mental health services facilities.
Forgive me for being parochial, but this is a crucial issue in our area. In Hull and East Riding, we were served well by an in-patient unit called West End for 20 years. When NHS England assumed responsibility for tier 4 services as a result of the changes from the reorganisation—all other tiers being the responsibility of the local clinical commissioning groups—it changed the specifications for tier 4 units, saying that they had to be open seven days a week, 24 hours a day. There was no consultation with anyone. This was done in March 2013. As West End was open only from Monday to Friday, with children spending the weekends at home—a regular feature of CAMHS treatment—the unit was closed. The option of extending the provision, so that it was a seven-day service, was never offered. Parents of children who had benefited from this important part of the NHS had no input whatever in a decision made by a huge quango that had no local accountability and no local presence. So much for the glib slogan, “No decision about me without me”.
I raised this issue in the Chamber on 23 October. The Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, gave me a sympathetic response. I am convinced that he cares deeply about the problems of mental health, but he appears to be entirely powerless to do anything about them. Since then, there has been a review of tier 4 services by NHS England, which, as the Health Committee has said:
“does not provide a conclusive answer on the reasons for the current problems, nor on whether there are sufficient beds”.
In addition, that Health Committee report, published in November, pointed out that NHS England had
“presided over a system which has resulted in children being sent hundreds of miles to access care.”
There has been no resolution on this issue in Hull and East Riding, or in other parts of the country, such as Devon and Cornwall. We have a foundation trust provider that recognises the problem and has identified a site for a new seven-day in-patient service, but the commissioner at NHS England has yet to commission. The CCGs are powerless. The acute trust often has to open its adult wards to children.
Let me tell the House what this means to the victims of such failure—to the children who were once so well served by the West End unit. Maisie Shaw is a 13-year-old who has had serious mental health problems since her father died two years ago. Her mother, Sally, is a teacher. Clearly, children need to be close to their family when they are undergoing treatment. Family involvement is a crucial aspect of their recovery. In December, Maisie took an overdose after breaking into a locked medication box at her home in Hessle. As it was a Saturday, there were no CAMHS staff on duty and, of course, no in-patient facility. She was taken to Hull royal infirmary on Saturday and cared for in a locked ward at the maternity hospital, with a 24-hour guard until Monday morning. She was sent to Stafford, which is almost 200 miles away, and then to Sheffield, which involves a round-trip of 120 miles by her family to visit her. As part of her treatment, she will be home at weekends, but when her mother asked what help would be available for this very disturbed child if there was an emergency, she was told to ring 999.
The subject of my debate in October 2013 was Beth Hopper, who is now 15. Beth’s mother, Kathy, is a staff nurse for the NHS. Beth is an extremely intelligent girl who has, according to her school, huge academic potential. She suffered a severe mental breakdown at the age of 11 and spent nine months at the West End unit, which opened at weekends specifically to tend to her needs. Kathy believes that the unit saved her daughter’s life. Since West End closed, Beth has been sent away 19 times. She has been to Cheadle, 103 miles away. She has been to Liverpool. She has been to Warrington. She has been Nottingham. She has been Widnes. Of course, while there is no argument that to travel further for more expert care is a factor in physical health, it is rarely the case with mental health, particularly when the patient is a child. Indeed, Maisie and Beth’s clinicians in Hull often have to travel to care for her in these distant locations, thus adding to the cost of that care. It is no exaggeration to say that the condition of Beth and Maisie is actually being made worse by this treatment. It is truly scandalous.
So that Beth’s voice is heard in this debate, I will read out a letter that she sent to her mother the other week. She wrote this:
“I really just don’t know what to do or what I want, or what is best for me anymore.”
Forgive her grammar.
“I aren’t happy here. I am happy at home, but I am scared that things might go like they were before. I just want normality. I want to have the chance to be a kid for once, before it is too late. I feel as though nobody is listening to me. I am so isolated here I am scared to join the groups and don’t want to make new friends anyway. I want my old friends, who I miss.”
We need to hear these children’s voices.
I am listening with sympathy and concern to the case histories that my right hon. Friend is describing. He might be surprised to learn that a constituent of mine with mental health problems was sent to Hull, without any consultation with his family.
It could not have been a CAMHS service, because we have no tier 4 service available in Hull.
I have cited two long-standing cases from my average-sized constituency, but I have recently heard about another case—that of Jordan Hatfield, a 15-year-old who, last May, took 45 paracetamol tablets in an attempt to end her own life. She spent six days on a medical ward and has been in Cheadle for the past week. Her mother does not drive and has small children, so it is impossible for her to visit. My colleagues in east and north Hull, and across the East Riding, will have other examples, because, as the Select Committee and NHS England, in its obscure way, pointed out, there is a lack of services in this huge swathe of eastern England.
On the wider question of mental health, we will not achieve parity of esteem by cutting funding. NHS trusts providing mental health care have lost £250 million of funding since 2012—the first fall in a decade. In addition, as my right hon. Friend the shadow Secretary of State pointed out, two thirds of local authorities have reduced their CAMHS budgets since 2010, while more than three quarters of adults who access mental health services had a diagnosable disorder before they were 18, yet only 6% of the decreasing mental health budget is spent on under-18s.
The report of the taskforce on mental health in society, commissioned by my right hon. Friend the Leader of the Opposition, and published on Monday, has much to recommend it, particularly the right to mental health treatment in the NHS constitution; expansion of the enormously successfully IAPT—improving access to psychological treatment—programme; and the introduction of waiting-time standards for access to CAMHS. These are good ideas, and they need to be put into practice, regardless of which parties are in government. However, somebody needs to get a grip of this issue now. We cannot go on letting our children down in this horrendous way.
I will do my best, Madam Deputy Speaker, to stick to the eight-minute guideline—without casting any aspersion on the previous speaker, the illustrious former Secretary of State. I shall be watching the clock.
So much has been said about the situation nationally, and I found the speech by the shadow Secretary of State, which I listened to carefully, very political, controversial and adversarial. I shall do my best not to speak in that manner. Instead, I would like Members to listen to my personal experiences in the Watford area, from speaking to people and visiting, several times, the A and E department, the general hospital, the clinical commissioning group, and so on. As a Back-Bench Member, that is about the best I can do. It is very confusing watching these tennis matches—as soon as the Secretary of State says something, the shadow Secretary of State is on television saying completely the opposite. It is confusing for people who work in the NHS and the rest of our constituents.
As the Secretary of State said, there is unquestionably pressure on the NHS. Everybody knows that. We all know the statistics about people getting older and needing more medical care. I frequently have to ask my mother, when she phones the GP every other day, “Is it necessary?”, and I am sure she thinks it is always necessary, because when people get older, they need care, and the Government have to respond to that. However, these insinuations and open statements by the Opposition that NHS spending has been cut are untrue, and they frighten people. It is a fact—it cannot be disputed—that spending has increased in cash terms every year since the coalition came to power and by £13 billion overall, and will increase by £2 billion alone next year.
I have spoken to consultants and nurses at Watford A and E—I have been there nearly every week since the beginning of the year—and I have seen ambulances backing up, and all the things that people on both sides of the House have mentioned. When I ask the A and E consultants why, they say, “These are not people with trivial illnesses, but people with serious concerns.” It is not a question of people with sore thumbs phoning the national number and being sent to A and E—I am certain of that, having spoken to many people in reception. We are not talking about people who should be going to see a nurse or a walk-in centre; these are serious matters, and there are a lot more of them. The extra GP hours will help, but I will come to that later.
The Watford area is making progress, however. Northwick Park hospital has just opened a big A and E, which I am sure will take off some of the pressure; the Herts Valley CCG has had a 5.5% increase; and there are more than 1,000 extra doctors in the region since 2010—I have seen them; they are not just a statistic. I have spoken to them and the management. They are real people. Similarly at Watford general, we have 142 more full-time nurses. I opened a new ward last week at Watford general, and there is a £1.6 million ambulatory care unit. There are lots and lots of new things, yet Labour did a party political broadcast from Watford hospital that really annoyed the staff, the management and my constituents, because it frightened people and gave the impression that the service was disintegrating and disappearing.
On the important subject of GPs, there is no question but that it was a mistake by previous Governments to restrict GP working hours. I commend the Watford Care Alliance for being among the first to get money under the Prime Minister’s fund to finance seven-day opening for GP services till 8 o’clock, which has made a significant difference. In Watford alone, there will be 16,000 extra appointments this year, which is a lot.
I am delighted that the Health Secretary came to visit Dr Mark Semler, whom I hope he will agree was inspirational in the way he spoke about the programme. He is a local GP who has taken this challenge on. Of course, there are big challenges with IT and explaining it to other staff in the area, but he is an inspirational man, and I think we had a constructive conversation with all the doctors about the implications of this policy. They have taken on the extra hours, and they know it is providing a service. In time, it will help significantly in providing a service to my constituents and taking some of the pressure off A and E.
I am pleased that Watford was one of the first in the country to do that, and I think it has been a success. I know the Government’s ambition is to roll it out to the rest of the country, which would be a major step forward. The actual infrastructure—the offices, the surgeries, the premises—are there, and to anyone from a background outside the public service, it would seem strange to have all those assets and not to use them for the benefit of the customers, who, in this case, are the patients. I commend the Government for that and I thank the Secretary of State that Watford was one of the first places in the country to do this.
Finally, I want to comment on the air ambulance service, which, as he often does, my hon. Friend the Member for Bedford (Richard Fuller) mentioned earlier. I have seen it and think the service is very impressive, and I hope the Government will consider giving it some of the LIBOR funding—it would be an excellent use of that money.
I thank my hon. Friend for his constructive speech. It is incredibly helpful, because a lot of people get very concerned when we play “Punch and Judy” occasionally. Does he recognise the role of pharmacies, which are a key part of our NHS that we need to make greater use of?
My hon. Friend makes a good point. Some pharmacists feels under threat from internet pharmacists—not illegal ones abroad, but proper ones—but the personal contact with pharmacists and the advice they offer can provide them with an enhanced role in the internet era. So I agree with him totally.
And that, Madam Deputy Speaker, concludes my comments.
Whatever people like or dislike about the language, I do not think anyone could deny that the NHS at the moment is struggling to care for patients in the way that the hard-working staff in the NHS would like to be able to care for them and to deal with them as promptly as they would like. Everyone recognises that the NHS is managing to cope only because of its amazingly dedicated staff doing amounts of work and quality of work far above the call of duty. I have to say that a nurse from one of the two great hospitals in my constituency, to which the Secretary of State referred, said to me, “If he says how wonderful we are and then defends us not getting a pay increase, I will throw up.” I do not think she intended doing it in front of patients, but the hypocrisy of the approach she describes seems to me to be indefensible.
This situation is not entirely novel. A and E has been facing difficulties and has been overstretched in many parts of the country, even during the summer. That is largely because too many people are having to go to A and E or are being taken to A and E because they cannot be looked after properly at home. That is one of the main reasons. If people are kept in, there are not enough beds. I noticed that the Secretary of State quoted the King’s Fund. Having been interested in health care in London for 40-odd years, all I can say is that the main contribution of the King’s Fund has always been to demand reductions in the number of hospital beds; then, where there are not enough of them, it comes up with a million reasons why there are not enough—none of them being that there are too few beds; it is always some other factor rather than the shortage of beds itself that it manages to blame.
The reason why people, particularly the elderly and the physically and mentally disabled, have to go into hospital is that they cannot be safely looked after at home. Once they are in hospital and occupying a bed, they cannot safely be discharged home. So, they are brought in because there is no adequate care at home, and they cannot go back out of a hospital bed because there is no adequate care at home. The Government simply cannot get away from the fact that there have been massive reductions in care at home, particularly for the elderly. Logic suggests that if there are more elderly people who are chronically ill, there should be an expansion of the service to meet the increased need. In fact, however, services have been contracting.
The excellent work done by my hon. Friend the Member for Leicester West (Liz Kendall) a fortnight ago—just a small aspect of it—demonstrated that there had been almost 200,000 fewer people getting meals on wheels. I do not know whether the Government ever deigned to consider the impact of that, but if old people who previously relied on meals on wheels were not getting them, they were probably no longer being properly fed, and if they were not being properly fed, they were more likely to need nursing care. If no additional care was available, they were more likely to go to A and E and, once they had gone into a hospital bed, they were less likely to be safely discharged simply because they were no longer getting meals on wheels.
The meals on wheels service does not have the function only of providing food. On every day that a person gets meals on wheels, somebody is checking how they are doing, and it gives those who are lonely some human contact. The disappearance of all those meals on wheels will undoubtedly have led to more elderly people having to go to A and E, and fewer elderly people being able to be treated safely at home.
I am listening carefully to what my right hon. Friend is saying. He has the perspective of a London MP. In Hull over the Christmas period, we had the longest wait for A and E in the country—and this at the same time as we have seen a quarter of the local authority budget being cut, which impacts on social care. It seems to me that the two are very closely related. Does my right hon. Friend agree?
I entirely agree with that. The fact is that the services that can be provided at home need a higher priority than they have had in the past—under any Government. They need more staff with more time, because many of the people attempting to provide a service are given a quarter of an hour to dash in, help somebody wash or cook and then dash out again to rush along to somewhere else. If one person takes up more than a quarter of an hour, they will be late for the next person they are supposed to be looking after. What is more, all these people get lousy pay. In fact, the level of pay that such people get is a disgrace.
We also need a massive improvement in the co-ordination of services between hospitals, GPs, health visitors, nurses and the people providing those practical cleaning services and so forth. This will cost more. Anyone who pretends that we will not have to pay some more to get a service that works to replace one that does not is either just misleading themselves or—in the worst version—misleading other people.
Previous Governments have not expanded the services in line with the need, but the recent response of this Government has been to contract the service available, which is indefensible. Proposals under the new regime—if that is the right term, Madam Deputy Speaker—have brought about fragmentation, competition and binding legal contracts between various providers of these services. If anybody thinks that will improve co-ordination, they are again either deceiving themselves or attempting to deceive the rest of us.
In this country and in this House, we have to wake up to the fact that if we want a first-class service, we are going to have to pay a first-class fare. That was something I wrote in a long and entirely personal memorandum to the Prime Minister, not long before I foolishly resigned as Health Secretary. I pointed out that a massive increase in investment was needed. I am quite proud of some of the things I did when I was Health Secretary. That might have been the most important thing I did, because about two years later, the Government put an extra £40 billion into the health service. To be fair to the Prime Minister, I received a note from him saying, “Your long personal note triggered what we did.” I felt pretty glad about that.
When we talk about these issues, we need to bear in mind that our NHS is easily the most cost-effective system in the developed world. The total we spend on health care is 9.4% of gross domestic product: the Germans spend 11.3%, the French 11.6% and the United States, which has an insurance system like the one the leader of UKIP wants to introduce here, spends 16.9% of their GDP on health, and life expectation there is lower than ours.
The other really startling point, when we get people such as the King’s Fund and others demanding reductions in the number of hospital beds, is that for every 1,000 people we have three hospital beds, while the French have more than six and the Germans eight and a half. So far as I know, there is no daft consensus in either of those countries to get down to the British level.
It was a pleasure to listen to the right hon. Member for Holborn and St Pancras (Frank Dobson). I was particularly struck by the point he made about the important case for investing in our health and care system. I dare say that the note that he mentioned will in due course be published under the 30-year rule, and that we shall then have a chance to read the full text. It must be said, however, that it took nearly four years for the argument he was advancing to be understood and acted on, and that those were lost years during the a 13-year Labour Administration.
I may return to that point later, but first I want to talk about my own experiences of my local national health service, and in particular about a visit that I paid to my local trust, Epsom and St Helier University Hospitals NHS Trust, at the beginning of the month. During the visit I had a chance to meet staff, including A and E staff. I pay tribute to the hard work that is done in the trust, and especially to the work that is done in the A and E department. Last week Epsom and St Helier was placed sixth among all the London trusts in terms of the time for which people were having to wait in A and E, when measured against the standard, and, according to figures that were published yesterday, 99% of people are seen within the standard four hours. That is an example of great performance. The trust is facing great pressure, but it is doing a fantastic job none the less, and that side of the story ought to be told. We ought not to focus only on hospitals that may not have learnt some of the lessons that have been learnt by my local trust.
The A and E staff members whom I met made it clear that there was no single cause of the pressures in their department. In fact, the precise mix of factors varies from one hospital to another, and from one area to another. St Helier, however, has made excellent use of the winter funding it has received. It has added capacity to A and E, and has introduced examples of good practice. For instance, there are daily reviews of patients to ensure they are being given the right treatment in the right place; patients who are ready to be discharged are identified on the previous day so that arrangements can be made in good time; and there is a system of “ward buddies”, enabling corporate staff to provide additional administration support at times of extreme pressure—such as the present time—in order to assist safe discharge. A further welcome boost is the news that an extra £325,000 has been provided to assist people’s safe discharge to their own homes or to step-down care.
A piece of work examining the position in the Sandwell and west Birmingham area revealed huge variations between attendance rates by practice. Its authors found that some people considered A and E attendance to be the norm, and that a fifth of attenders made a conscious decision to go to A and E on the previous day. They also found that many A and E attenders believed that it was not even worth trying to access primary care in the first place. There are issues relating to communication, understanding of the system, and how we explain it. That cannot be dealt with in a universal, national way; it must be tailored to patients’ preferences and their expectations of the system at local level. That piece of work has already helped those in Sandwell to think about how to target messages more effectively in order to ensure that people have access to the support they need at the time they need it.
Does my right hon. Friend agree that there should be a proper investigation into winter planning in each area? As he says, factors vary greatly. In my area, for instance, the factors affecting Addenbrookes hospital are very different from those affecting the Lister hospital in Stevenage. I think that planning needs to improve. This year, the same thing happened throughout the country. The A and E departments asked for £700 million, the Government gave it to them, and yet there have been all these problems.
I think it important for the system to learn lessons from the areas where winter planning has worked well, and for us to ensure that those lessons are transferred and replicated around the country. The NHS is not always as good as it could be at ensuring that lessons are not just stuck in one place.
I must make some progress if others are to have a chance to speak.
The NHS has grappled with a productivity challenge during the current Parliament, but it should be noted that it was first set up and signed off by the last Administration. The target was £20 billion, and it was to be delivered within a shorter period than the coalition Government set in their 2010 spending review. The Labour productivity programme was set in 2009, and it was clear then that the NHS was on notice that it faced a very tough settlement regardless of which party was in government after the 2010 general election. Reducing management overheads has been a key part of our efforts to balance the books during this Parliament. Focusing on the management overhead costs of the commissioning side of the NHS in the legislation that went through the House at the beginning of the Parliament was sensible, and increasing clinical involvement in commissioning was another important move.
I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.
In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?
The right hon. Gentleman clearly was not listening to my speech. The central proposition is that what I described as the “root cause” of the A and E crisis was the imposition of devastating cuts in social care, which are leaving people unsupported in their own homes. Will the right hon. Gentleman now say—because he was there—that it was wrong of him and his colleagues to allow social care to be cut in that way, given that the cuts are now presenting the NHS with an enormous productivity and efficiency problem?
The right hon. Gentleman is right to raise that question. I wanted to ask him a question that relates directly to his point, and, indeed, answers it. I hope that he will agree with me—and, indeed, with the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb)—that we need a fundamental review of NHS and care spending, in the round, and that finances in that area need to be addressed before the spending review that any Government will carry out later in the year. We need to ensure that we are clear about the level of investment that will go into our health and social care system. So far, I have heard no clear indication from the right hon. Gentleman of his relative spending priorities when it comes to health and social care, and they need to be made clear if we are to establish a consensus.
My answer to the right hon. Gentleman’s question is that I want a single service: a single service for the whole person. I want a national health and care service. We should no longer have two budgets; we should have a single budget, and we should then use the money as best we can to support people, starting in their own homes—and we are going to invest an extra £2.5 billion.
The right hon. Gentleman did not answer the question that I asked him. I asked him whether he and his Government colleagues, in those early days, made a mistake in allowing social care to be cut to the bone? Every week I am accused of saying that it is irresponsible to give real-terms increases. The right hon. Gentleman allowed social care to be raided. Should we not receive an apology for that today?
Let me deal quickly with that and then come on to what we need to do next.
As a result of the 2010 spending review, we invested £7.2 billion extra in social care over the life of this Parliament. I regret the fact that not every local authority has fully spent that resource on social care, and although the right hon. Member for Leigh (Andy Burnham)wants to make this an issue of blame I want to try to try to analyse the problem. It has already been said that some local authorities have struggled purposefully to reorganise their services to make the best use of the resources available and have delivered better outcomes, not least by investing in services such as re-ablement, which significantly reduced the call on ongoing care services.
It was right for the Government to put the resources in and make the commitments we did and it was right in the autumn statement this year to commit the £2 billion for the NHS as a down payment to deliver Simon Stevens’ NHS Forward View. Although that is good news, I want to flag up a couple of concerns. First, there needs to be clarity about the funding commitment in every subsequent year during the course of the next Parliament. We have had some indications from the Labour party and some from the Liberal Democrats, but we have not yet had clarity from the Conservatives about how they would address the £8 billion gap.
Secondly, despite the commitment of £7.2 billion for social care during this Parliament, not all that money has got through to social care. I acknowledge the efforts that councils have made already, but we cannot ignore the fact that social care has been a poor relation of the NHS not just during this Government’s lifetime but under successive Administrations of parties of both persuasions over a very long time. I have asked the Secretary of State to ensure that social care benefits from some of this £2 billion and urge him again today to do just that. It is unacceptable that some councils are paying fees for care that condemns staff to rates of pay below the national minimum wage and it is no wonder that as a result we have among the highest staff turnover rates of any part of our economy and that it is so difficult to recruit.
To conclude—although I could go on a little longer—I want to address the comments made by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). In a debate that had been about much heat but not a great deal of light, he cast important light on one of the key challenges for whoever is in government after the election, which is how we ensure that we reform our mental health care system to deliver the parity of esteem the Government have set out as an ambition and have started down the road of delivering. We still have a long way to journey, however.
We still have a separation in our health care system between the service that delivers for physical health and the service that delivers for mental health, yet those two things are inextricably linked. We know that half of lifelong mental health problems start in adolescence and need to be addressed at that point. The goal of parity of esteem, which is shared across the House, is right. We need parity of esteem in outcomes, rights and resources and I welcome the investments made by the Government, the commitment to continue the improving access to the psychological therapies programme that was started by the previous Government and has continued under this one, the launch under this Government of a children and young people’s IAPT programme and the emergency care concordat. I thank the Minister of State, who is on the Front Bench today, for launching the children and adolescent mental health services review, which must provide a route map for reforming CAMHS for whoever sits in the Secretary of State’s office after the general election. If it does not, it will have failed in its task. We need a plan and we need that plan to be implemented through the spending review after the general election.
The debate has highlighted yet again that we are yet to reach consensus in this Chamber on how to improve our NHS. There are people of passion and commitment on both sides of the House who have in their heart and at their core a desire to maintain a national health service that is free at the point of use and available on the basis of need. We need to extend that to ensure that our social care system is no longer left behind in the way it has been by successive Governments.
Two years ago, a friend of mine collapsed on a football playing field and an ambulance was called. The ambulance should have reached this major emergency within eight minutes, but it took 17 minutes and my friend died of a heart attack on that field. The seriousness of this debate for many families beyond this Chamber—I am thinking of the wife and three children that he left behind—cannot be conveyed. It is right to begin by saying that the £700 million that has been found and the £150 million for the challenge fund are absolutely desirable and necessary at this time. I remember, as a former Minister in the Department dealing with the winter crisis, that those funds are very important.
I want to take the House back to a dark time for the NHS, when it was routine to wait in A and E for six, eight or 12 hours, and to what it took to change that system. It was a great privilege for me to begin my ministerial career in the Department of Health. The then Member for Darlington was busy, controversially, dealing with foundation hospitals. The then Member for Barrow and Furness was busy at that time, controversially dealing with nurses’ pay and increases we wanted, and with the GP contract. I found myself leading on emergency care, and I was the Minister who took through the changes for that A and E target.
We brought in Professor Sir George Alberti. For a number of reasons, it was hugely important that we had a clinician leading the charge across the NHS. We needed to persuade the GPs about access if this was to work. We brought in the target—48 hours, since abolished —and a lot of practice at the front door of A and E. The phrase we used all the time at that point was “See and treat and triage”, but it worked only if we looked at the system as a whole system. Important targets in the rest of the hospital—in cancer, in cardiac care—were necessary. Frankly, it is a crying shame that seven of the 15 major targets were missed under this Government.
We also needed to deal with social care, of course. If £3.53 billion is taken out of social care, there must be consequences. We should remember that much of this debate has been in the past tense. There are further cuts to come, with day centres to be closed. We see phrases pop up in local authorities such as “New pathways for the elderly”. New pathways to what? New pathways to isolation; new pathways to falling over at home alone; new pathways to going without food; and new pathways to ending up at the door of A and E.
We also introduced NHS Direct to ensure that nurses could deal with calls promptly and move on. I never conceived that we would get rid of the nurses in NHS Direct, and that we would move solely to a system of algorithm. Is it surprising that NHS Direct staff are directing people to the door of A and E? Our system worked because before people went to A and E they could go to a walk-in centre. We can call them urgent care centres if we want, but they are essential—they are part of the triage, a part of the see and treat method that we need. Again, however, one in four of them has been lost, resulting in the crisis we see before us.
Here in London it is worse, because we are losing A and Es—gone at Chase Farm, gone at Hammersmith, gone at Central Middlesex, going perhaps at Epsom and St Helier, gone at Charing Cross—and with a population rising to 10 million. This is a serious debate because it is about to get worse. No wonder the chief executive of the London ambulance service resigned yesterday. She is leaving a sinking ship under this Government’s watch, and this House and the people will remember that, because it is specious of the Secretary of State to come to this Chamber and say the debate is solely about more nurses and more doctors. It is not. It is about the system—the NHS.
Who is accountable under this new structure? Is it NHS England? Is it the CCGs? Is it the CQC? Is it another jargon organisation? No one is responsible—certainly the Secretary of State is not, because he gave up those responsibilities in 2012. That is the mess this Government have got into without even putting it in the manifesto. It is a disgrace.
I would like to tell the House what I think is an absolute disgrace. Not once during the speech made by the Secretary of State for Health, not once in any of the speeches made by Opposition Members and not once in Welsh questions earlier today did any Opposition Member raise the issue of what is happening in the national health service in Wales. Labour has been responsible for the health service in that part of the United Kingdom for the past 16 years, and Labour Members are running scared of making any mention of it or drawing any comparisons involving it. According to a House of Commons Library document—and they don’t come much more neutral than that—the NHS in Wales, run by Labour, is doing far worse than the NHS in England on almost every measure.
I do not know whether the hon. Gentleman was present for Welsh questions earlier; I certainly was. Perhaps he was asleep, because the shadow Secretary of State for Wales, my hon. Friend the Member for Pontypridd (Owen Smith), used three of his questions to the Secretary of State to ask specifically about the NHS in Wales.
I checked the Order Paper this morning, and no one had tabled a question about the NHS in Wales.
The shadow Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), said earlier that he was not responsible for Wales, but the reality is that there are 20,000 patients in England who are registered with Welsh GPs and who have their health care provided in Wales. The right hon. Gentleman is, to some extent, responsible for the poor level of service that those people are currently receiving.
The hon. Gentleman seems to be talking about records. This Government came in with no mandate whatever and planned to close nine of the 31 accident and emergency departments across London. What state does he think the A and E service in London would be in if his Government had been successful in every case? They were prevented from achieving their aim by public campaigns, including the one in Lewisham, in my part of London.
I am absolutely certain that the A and E situation in England would be far better under this Government than it is in Wales, where, according to the House of Commons Library report, 13% of patients in major departments wait more than four hours in A and E. That is approximately double the percentage recorded by major departments in England. The question of ambulances has been raised several times today. Wales has the worst ambulance response rate in the United Kingdom, with around 55% arriving within eight minutes, compared with more than 70% in England.
The shadow Secretary of State talked about privatisation, but it was the Labour Government who, quite rightly, started using the private sector to improve the national health service. I have here a quote from the Labour Secretary of State in 2002; I will not mention his name. He said of the private sector that
“we intend to use it when it can bring expertise or resources to help improve services.”—[Official Report, 26 February 2002; Vol. 380, c. 547.]
We have carried on doing the same thing. A few years later, a different Health Secretary said:
“The NHS has always made use of the private sector and will continue to do so”.—[Official Report, 25 October 2005; Vol. 438, c. 163.]
She also promised that, the following year, patients would be able to choose from any health care provider—NHS or independent sector—that met NHS standards.
It was Labour’s policy in government to use the private sector. There is nothing wrong with that, but it is totally ridiculous for Labour Members now to pretend that the Conservatives are trying to privatise the NHS. That is a big lie: we will never, ever privatise the NHS, but we are quite happy to use the private sector when it can provide a better service, just as the Labour Government did. The last word on this came in 2005, when Professor Allyson Pollock wrote a damning book about the privatisation of the national health service. She was criticising the Labour Government.
Does my hon. Friend agree that Labour took things a bit too far? The shadow Secretary of State tendered out the Hinchingbrooke hospital, which ended up in the private sector. That has not been a success, and I think it is better if a trust runs the hospital—
I agree with my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald). The reality is that Labour Secretaries of State said over and over again that they were quite happy to use the private sector, and they did. They were probably right to do so in many instances, and we have continued to do so. There has been no departure from that policy.
On a point of order, Mr Deputy Speaker. I have always to correct the record when these statements are made. I apologise for delaying the House, but I am going to carry on doing it. I did not put it out to tender; it was a process I inherited, and in the middle of that process I changed the policy from “any willing provider” to “NHS preferred provider”. Contrary to what the Secretary of State said at the Dispatch Box, NHS Peterborough and Stamford was still in the race.
Order. No—I said straight away that it was not a point of order, but a point of correction. The point is that it is all on the record for people to read tomorrow, to continue a debate on who is right and who is wrong. Both parties, quite rightly, have stated what their belief is. Mr David T.C. Davies has not much time to go and I am very worried that he will not get to the end of his speech. He has only eight minutes in total.
Thank you, Mr Deputy Speaker. I am grateful, because I want to talk about quite a few other things. We did not hear very much about waiting time comparisons, but of course the waiting times in England and Wales are very different. In Wales, people wait at least 26 weeks, with 14,745 having been waiting for more than nine months for treatment; in England, people wait about 18 weeks. One hundred and fifty people have died in Wales waiting for cardiac surgery.
My hon. Friend mentioned Professor Allyson Pollock. Is he aware that she particularly highlighted the extraordinary amount of money spent under the previous Government on the private finance initiative, mortgaging the future of the NHS to the tune of more than £80 billion? In the course of the next Parliament, that will cost more than £11 billion.
I commend the professor’s book, and I hope Labour Members read it, as well as looking at the NHS comparators between England and Wales, which they obviously have not done so far. I would like Labour Members to tell us whether—if they ever are in government; I hope they will not be—they will guarantee to continue with the cancer drugs fund, which has allowed thousands of people in England to live longer and more productive lives than they otherwise would have.
The situation is not the same in Wales, where these cancer drugs are routinely denied to people. I am talking about people such as my constituent Ann Wilkinson, who is also trying to care for a very ill husband but who has been denied Avastin. She has had to find other means to get it, and other seriously ill people in Wales have had to move to England or find people’s spare rooms to sleep in.
We heard something about cuts, but the reality is that we have guaranteed the NHS budget in England while it has been cut by about 8% in Wales. Thousands of people are members of Action for our Health, a group comprising people campaigning in Wales to be treated in England. Some people say that the NHS is the envy of the world, and perhaps it is, but the NHS in England is very much the envy of Wales. To see that we need only ask the thousands of people—ordinary patients—in a campaign group who want to be treated by the NHS that is run by this coalition Government and not by the NHS that is run by Labour.
I wish to finish by saying to my right hon. Friend the Minister that I congratulate him on the better ambulance response times he is delivering in England than Labour is delivering in Wales; on the better accident and emergency turnaround times he is delivering in England than Labour is delivering in Wales; on the shorter waiting lists in England than people face in Wales; and on the cancer drugs fund, allowing people to live longer in England than they otherwise would in Wales. Most of all, I congratulate him on protecting that NHS budget—on standing up for the NHS instead of cutting the budget, as the Labour party has done in Wales. I very much hope that he is able to continue with that good work in years to come.
If anybody wants to see the direction in which this Government are going with the NHS and what impact their policies are having on it, they should come up to my constituency.
Let us think back to the Prime Minister’s weasel words before the last general election—that the NHS was “safe” in his hands and that he wanted the initials NHS to be synonymous with and to define his name. Then let us look at what is happening today. It is a wonder he can lie in bed straight at night, as we see the NHS in crisis—the only thing it is doing is crying out SOS. He promised that there would be no reorganisation, but what do we get? We get the biggest reorganisation since the NHS was formed, and one set up for one thing and one thing only: to privatise the NHS. Some £3 billion has been spent on that reorganisation and the bill is going up—£3 billion that should have been spent on the sick instead of on P45s going out to thousands of nurses when cuts are implemented. It is disgraceful.
Ministers have only to come to Jarrow to see what is happening. In my local hospital three elderly patients wards have closed, a minor injuries unit has closed and now, to make matters worse, a popular walk-in centre, which sees over 27,000 patients a year, is to close. The closure is opposed by everybody in the area—the council, the trade unions, the patients and the staff.
Has my hon. Friend noticed that the Government are running true to form, like the previous Conservative Government, when we had bed blocking and people sleeping on trolleys because they could not get a bed in hospital? Has he noticed particularly that local authority budgets could have provided for the elderly and prevented bed blocking?
That is exactly the point that the shadow Secretary of State made in his opening speech.
As we heard earlier, local managers are not listening. They are stooges of the Government and they are carrying out the cuts without listening to local people. It is disgraceful. They are not incompetent, and nor are the Government—they know exactly what they are doing. There is a deliberate effort to sabotage the NHS by piling those 27,000 patients a year on to the local doctors.
I am listening carefully to what my hon. Friend says. His walk-in centre, like mine, was one of the first to open and is greatly valued by the community. I make this offer to him today: if he and his community can keep the campaign going and keep that centre open, and if I am the Secretary of State in May, it will stay open for good.
I am sure people in the area are extremely grateful for that statement of support and commitment and that pledge from the shadow Secretary of State. I only hope he will become Secretary of State.
The Government and the management of the NHS are not incompetent. They are acting deliberately. The 27,000 patients in Jarrow who now go to the walk-in centre will have to go to the doctors’ surgeries, where it is difficult enough already to get an appointment. That will only exacerbate the problem. When they go down to A and E, which is doing a terrific job, the situation will only get worse. The Government know exactly what they are doing. They are trying to sicken people of the NHS so that they can turn round and say, “The NHS is not working. We will bring in the private sector to help out and to take it over.” That is the policy of this Government.
I can assure the hon. Gentleman that after that pledge I will certainly be watching the shadow Secretary of State when he gets in, to make sure our walk-in centre is still going.
Who gains from the present situation? Only two lots of people—the Tories, many of whom are up to their necks in involvement with private health care providers, and the profiteers, the health care providers, who are going to come in and cherry-pick the best services so that they can make profits. I welcome the shadow Secretary of State’s statement and commitment today. It will boost the morale of the people of the north-east who are so desperate to keep the service.
The hon. Gentleman just asked the shadow Secretary of State whether his walk-in centre would be kept open and the answer was yes. However, we should not look at future promises. We should look at the past and what was done under the previous Administration. In 2006, Medway hospital in my constituency had the seventh worst mortality rate, yet nothing was done. We must judge Labour by what it did, not by future promises.
We must remember that it was the Labour party that created the NHS, that saved the NHS in 1997 and that tripled spending on the NHS in our last period in government. It is the Labour party, when we get in, that will return the NHS to the people—unlike the Tories, who would return the NHS to the profiteers who fund them and their organisation. The only way to get rid of the crisis in the NHS is to get rid of the Tories.
I am proud of the NHS and I am proud of its staff. The Lister hospital in my constituency is very large and employs thousands and thousands of staff who, I am proud to say, save lives on a daily basis. The hospital is one of the NHS’s big success stories, as it is currently undergoing a £150 million redevelopment.
I spend a lot of time at the hospital, because I am always opening things and looking at new plans and buildings, which include a new endoscopy unit and theatre, a new A and E unit and a new theatre and ward block, none of which have as yet been fully opened. I have opened a variety of other units, including new scanning units. Some £150 million has been invested in the NHS in Stevenage, which is the biggest ever investment in the NHS in Hertfordshire’s history. As the county predates the Norman Conquest, Members will understand that that is a pretty big investment.
I congratulate my hon. Friend on the investment and the fantastic facilities of his hospital. In my neighbouring constituency, we say that if someone wants to find the Lister hospital, they should look for the cranes, which are there for the construction of all the new buildings. Does he agree that it has taken a Conservative-led Government to make those improvements?
My hon. and learned Friend is correct, and he supported me all the way as I fought with the Treasury, the Department of Health and every single system to ensure that we got the deals signed, sealed and delivered and the buildings constructed on time. I am proud of the investment and the staff who work in the hospital, but I am concerned about the way that Members talk down the NHS. Thousands of NHS workers in my constituency feel very depressed about the situation. They put in a huge amount of hours and a great deal of effort, and what happens at the end of the day? People say that their A and E is in crisis. That is completely unacceptable. Last week, the A and E department in my constituency saw 93.7% of people within the four-hour target. This week, it is on target, with nearly 95% of people, which is down to those doctors and nurses working their backsides off on a daily basis to ensure that they save lives.
I pay tribute to the work my hon. Friend does in his constituency. I often see it on Facebook and read about it on the internet. He is a tireless campaigner for the health service in his constituency. He mentioned the A and E in his constituency. A linked issue is that of resources. In my constituency, £13.4 million has just been invested in resources for the A and E department—
My hon. Friend makes a fantastic point, and he is a fantastic campaigner, too. I am sure that that money would not have arrived without a huge effort on his part.
The Leader of the Opposition was in my constituency last week, and we were grateful to him for his visit. He came and celebrated the £150 million investment that I had secured for my hospital. He can come as much as he likes, because I got more donations, supporters and volunteers from his visit. Perhaps he could come on a weekly basis. Incidentally, let me talk about the Lister treatment centre, which the right hon. Gentleman visited. It was privatised under the previous Government. I ran an 18-month campaign to have this private facility returned to the NHS, and I succeeded. I am probably the only Tory MP in history who has managed to renationalise a part of the NHS that had been privatised under a Labour Government. I worked very hard on that campaign, but it was lonely work. The local Labour council did not back me; the local Labour candidate did not back me; the Labour shadow Secretary of State did not back me; the Leader of the Opposition did not back me; but the GMB union did and for that I am very grateful.
Three people died in that facility and 8,500 patients’ records were lost. It was a complete and utter shambles. Clinicenta Carillion, the organisation that was responsible for running that facility, destroyed the lives of thousands of people in Hertfordshire; that must never be repeated. That is what we talk about when we talk about the NHS. Who did I stand up for? I stood up for the patients, for the staff and for their families. Where did I get my information from? From members of staff who were working in that facility daily, under huge pressure, suffering and working as hard as they could to provide the best service they could. They could not do it, because their hands were tied behind their back—the contract was so bad. The local hospital was not even allowed sight of the contract until it was signed, sealed and delivered by the previous Government. They did not even know what they were being signed up to, which is a disgrace. I am proud of my hospital and the staff who work in it, but we must always remember that, at the end of the day, these are human beings, who are working incredibly hard to deliver real improvements in services.
Fortunately, that facility is being handed back to my local hospital. The Secretary of State for Health worked with me. He allowed me to come and see him, and we had a variety of meetings. I argued with the Care Quality Commission. I was very lonely throughout that campaign, but at the end of the day the Secretary of State worked with me and he nationalised that private facility, which the previous Government—disgracefully—privatised. I am proud of the Secretary of State, and I am only sorry that he is not in his place, because I wanted him to come and open one of our wonderful new facilities in February. The Prime Minister can come in March.
The facility that I was discussing got so bad that GPs lost confidence and wrote to each other saying, “Do not refer patients to this facility or you will put them at risk.” The CQC started proceedings to revoke the licence. That facility was falling apart—a facility that was privatised by the previous Government. It was nationalised by the Conservatives.
So I am proud of the NHS and proud of the staff who work in it. I am proud of the £150 million development in my constituency, which is making my hospital one of the most modern facilities in the UK. I am disgusted that the Leader of the Opposition wants to weaponise our local NHS and never once backed my campaign to bring that shameful private contract back to the NHS. The Labour party should apologise to my local community for playing Russian roulette with our local health service and politics with my constituents and patient safety.
It is a pleasure to follow the hon. Member for Stevenage (Stephen McPartland). I listened carefully to his speech. He has very good taste in one respect—the football team that he supports. Although he praised the NHS staff—of course, the NHS staff I represent and speak to work incredibly hard; I pay tribute to them—in almost everything else he said, he could not recognise the glaring fact of the reorganisation being the root cause of some of the problems that we are seeing, and he was wrong in his assessment of the shadow Secretary of State’s contribution. The NHS is an extraordinarily important issue to us all. Opposition Members show great passion, as the hon. Gentleman did, and we would all pay tribute to the hard work of NHS staff. There is no difference between us on that point.
I commend the speech by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), who is not in his place at this moment. I was particularly moved by his recounting of the experience of his constituents—teenage girls suffering from mental health conditions. It is what the House of Commons should be there for, to allow us to hear his constituents’ voices in that way. I would hope that, in our debates on mental health, we can do much more to bring those problems in our system to the fore.
I want to talk about what I see as three possible solutions to the current difficulties and crises in the NHS.
My hon. Friend makes an excellent point, but I want to outline some of the specifics that might be entailed by that position. I want to talk about three elements of changing the NHS that I take to be very important. One of them is pretty parochial, but the other two are terribly important for our whole country.
The first concerns a walk-in centre in my constituency. Not everybody in the House will be an expert on the geography of Merseyside and, specifically, the Wirral, though I know that everybody will appreciate how important it is that they learn about it. In my part of the world, our local hospital is quite far from those of us in south Wirral. There was a hospital in south Wirral called Clatterbridge hospital, which I was born in. Its emergency facilities closed many years ago; I think that I was almost one of the last babies to be born there. Services were moved up to Arrowe Park on the border of the Birkenhead and Wirral West constituencies. I well remember, when I was young, how far away Arrowe Park felt and, when members of our family were ill, what a long distance it seemed when getting there.
Under the previous Labour Government, with my predecessor’s support, Eastham walk-in centre was opened in south Wirral, near the Cheshire border. That walk-in centre has been a rip-roaring success. It treats people effectively. They can turn up at hours that are convenient, such as out-of-work hours. It is open at the weekends and until 8 o’clock at night on a weekday. I declare an interest as a parent of a young child who always seems to manage to get herself unwell at the most inconvenient times. Eastham walk-in centre has been there for us, and my constituents value it greatly.
Under the reorganisation, the new clinical commissioning group took over. In Wirral, we had a bizarrely complex structure of three federated CCGs for a population of about 350,000. Having three CCGs in Wirral was total madness. Twenty-five million quid was wasted on a reorganisation that nobody wanted and nobody voted for. The first thing the CCG wanted to look at was urgent care, and it put our walk-in centre under threat of closure. This is an incredibly important facility to the people of south Wirral. It brings the NHS to their doorstep. It totally changed the availability of out-of-hours facilities for people in my constituency. The CCG, in its lack of wisdom, thought it was just fine to say, “We’re not sure we need that. We can re-provide those services at GP surgeries, never mind whether they are open at a convenient time.”
The CCG never went through with those proposals, and rightly so. Since then, however, there has been a constant threat and a worry in my mind about Eastham walk-in centre. I want to make it clear to the Minister that if there is any risk at all of that walk-in centre closing, he will receive representations from me pretty quickly, because it is an absolutely vital service. Unless we again conceive of the NHS as being there for patients and the public first and think about how to bring these facilities close to people, we will never get an efficient and effective service fit for the next generation. Walk-in centres are absolutely vital. It sends a chill down my spine to hear the shadow Secretary of State say that one in four has closed; if anything, we should be opening more.
Secondly, I want to talk about social care and older people. We all know that we have the benefit of an ageing population in our country. With an older population, we will have a more experienced and expert population. I take it to be a good thing that people’s grandparents and valued members of their family are living longer, but with that comes a responsibility to look after them properly.
I ask Ministers what has happened to the better care fund. What evidence is there that it has been used to find solutions that are really working? All I see on my patch is council cuts and then the consequences turning up at the door of the hospital. Older, more seriously ill people in our community are turning up at A and E, with the distress to them of being there, the consequential responsibility on staff and the worry for families as people lie on trolleys.
We need a much more radical approach. Integration is clearly the answer, but I would like us to go further: I want us to truly address the work force issues in social care. It is not good enough that poverty pay is endemic among those who look after the most senior members of our community. That is not acceptable; nor is the zero-hours culture. We once had that problem in child care, but as a country we took on the responsibility of changing the culture in the work force for the good of our children, and we must do the same for the benefit of our older people.
I will not speak for much longer, Mr Deputy Speaker, but I want to say something about mental health, which should be part of the strategic approach that we must take to change the NHS for the benefit of the next generation. Parity of esteem is of course correct and absolutely right. I take it that there is now cross-party consensus on that issue and that everyone in the House thinks that we should treat mental health as seriously as we do physical health, with no barriers to getting proper treatment. However, I want us to do something else: we need to recognise the interconnected nature of physical health and mental health. It is not just that we also need to treat mental health, but that if we sort out people’s mental health issues and conditions and empower them to live better and happier lives, they will have better physical health and will make better use of the NHS’s scarce resources.
I have many conversations with my right hon. and hon. Friends on the Front Bench, but they do not always ask me for a full briefing before they draft their motions, as I am sure the hon. Lady appreciates.
I conclude by saying that with the appropriate use of walk-in centres, a radical approach to social care and real consideration of the interconnections between physical and mental health, the difference we can make to our NHS will be excellent.
I thank the Department for recent rises in health care funding in South Gloucestershire. Only yesterday, I received a written answer to a parliamentary question showing that South Gloucestershire CCG will receive £263 million for 2015-16, which is up from £249 million in 2014-15 and from £239 million in 2013-14. That 7% increase in per person funding, from £921 in 2013 to £997 today, is the 16th largest rise out of 211 CCGs. Tomorrow, I will attend the opening of the Leap Valley medical centre in Emersons Green, which is a brand-new, multi-million pound GP centre for the benefit of my constituents in Downend and Emersons Green. Things are therefore looking up for NHS funding in South Gloucestershire and Kingswood.
I was pleased to have a meeting with the Chancellor at which my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) and I convinced him to give £1 million from LIBOR funds to the Great Western air ambulance, about which the chief executive has said that he is absolutely delighted. As the local MP, I have been pleased to be able to push for such improvements in health care.
I want to raise my concerns about the health care situation in Bristol, particularly in relation to Southmead hospital, a brand-new hospital under a £500 million private finance initiative contract that was signed and sealed under the previous Government. As a consequence of the opening of Southmead hospital, Frenchay accident and emergency was closed. It is no coincidence that Southmead has struggled since that closure. As a candidate and as an MP, I fought to keep the A and E open, after the decision to close it was taken in the Bristol health services plan for 2004 to 2006.
I still believe that the closure of Frenchay A and E was an absolute disgrace for our local community. We all know that it happened when the local North Bristol NHS Trust decided to prioritise Southmead over Frenchay because Frenchay’s more expensive land could be used to build a housing estate. We are now seeing the consequence of the reorganisation that took place under the previous Government. It happened despite the fact that 50,000 people signed a petition to get the then Secretary of State, Patricia Hewitt, to refer the decision to the Independent Reconfiguration Panel, which she refused to do. It was a total mistake for the previous Government to decide to prioritise Southmead over Frenchay.
Cossham hospital, another hospital in my patch, was threatened with closure in 2004. The Save Cossham Hospital campaign group was fantastic in opposing that potential closure by the health chiefs of North Bristol NHS Trust as part of the disastrous Bristol health services plan. As a result, Cossham hospital has had a £19-million refurbishment and looks fantastic. I believe that the shadow Secretary of State visited it a couple of months ago.
However, there is a gaping hole, because the minor injuries unit that was promised for Cossham hospital is yet to be delivered. Along with all the parties and the fantastic Save Cossham Hospital group, which is led by Reg Bennett, we have collected well over 17,000 signatures to call for the minor injuries unit. I have secured several debates in Parliament, as the Minister well knows, to call for a Cossham MIU. Regardless of the status of the minor injuries unit, we were promised it because Frenchay A and E was closing. That decision was taken by the previous Government, as I said, and the final contracts were signed in February 2010.
Having been promised this health resource in Kingswood after Frenchay A and E closed, we deserve to get it. It is too far to get round to the other side of Bristol and there are no proper bus services to Southmead hospital. We must remember that NHS services are funded by the taxpayer, so every taxpayer deserves equitable treatment and access to local health care services. I do not believe that my constituents are getting that because Frenchay A and E has closed and Southmead is too far away. We need our minor injuries unit at Cossham hospital.
Only today, there was a meeting of the public health and health scrutiny committee of South Gloucestershire council. On 19 November, I spoke at the committee in person to call for the decision about the minor injuries unit to be referred to the Secretary of State. The committee agreed in principle. I contacted the Department this week, having had regular meetings with the Health Secretary to discuss Cossham and Frenchay, only to find that no letter has been sent by the committee to the Health Secretary. The Department of Health simply has not received such a letter. Today, it turns out that the committee is yet to refer the decision to the Health Secretary. Without that official referral by the committee, the Health Secretary cannot refer the decision to the Independent Reconfiguration Panel.
I call on South Gloucestershire’s public health and health scrutiny committee to get a move on, pull their finger out and send the letter to the Health Secretary. I hope that Ministers will confirm that once they receive the letter, they will be able to refer the decision about Cossham minor injuries unit to the Independent Reconfiguration Panel. It is simply not good enough for the committee to have this month-on-month delay without sending the referral letter to the Health Secretary. People in Bristol have waited too long. They saw Frenchay A and E close, which was a disgrace and will always be Labour’s worst legacy in my local area. We need the minor injuries unit at Cossham hospital and I will continue to fight for it every single day.
The national health service is, without doubt, the most precious asset this country possesses. It was created by a Labour Government against, as we should recall at all times, the votes of the Conservative party in this House of Commons.
The Minister who created the national health service was Aneurin Bevan. He did so by immense negotiation, including with the British Medical Association, which he got on board to support and participate in it. As well as having administrative abilities and abilities of persuasion, Nye Bevan was the greatest orator I have ever heard. I met him on a number of occasions and heard him speak. I remember one speech that he made at Labour party conference when a Conservative Government were in power, in which he said of a Minister, “The Marquess of Salisbury has an ancient lineage. It is almost as old as the Poor Law itself.” Nye Bevan would be horrified that in far too many ways, the national health service has descended to Poor Law levels.
Margaret Thatcher said:
“The National Health Service is safe in our hands.”
This Government’s hands are throttling the national health service. Under this Government, the NHS has had an extremely costly reorganisation that cost £3 billion and provided no benefit at all.
A recent survey of GP services—we all rely on our GPs; heaven knows that I would not be standing here today had it not been for my GP referring me to the national health service—showed that ratings have declined for every aspect of trying to see a GP, including opening hours, waiting for an appointment, and waiting in the surgery. Looking at causes, it pointed out that general practice has had its funding reduced over the past five years, and it is five years since this Government came to power. Too often, the system is blocked by bureaucracy that prevents it from operating effectively at the point of use.
Like other hon. Members, no doubt, I get a constant stream of letters on this issue from constituents, and this morning I received a letter from a constituent about his son:
“I have a son…who has psoriasis and he has had this for up to a year now. He has been putting up with it, but it has come to the stage now that it’s unbearable. It’s all over his body including his private parts too. He had to finish work due to that. He can’t sit down with it…He is not sleeping at night. He is bleeding all the time. He can’t go out. He is always in his bedroom…he is in pain day and night.”
My constituent’s GP referred him as an urgent patient to a local hospital, and he has an appointment for 28 March. He is going through hell, and he will go through two more months of hell before he is seen, let alone treated.
Again and again we get such cases. There was a recent debate and meeting about blood diseases. I have a constituent who has a blood disease. He has HIV and is making no progress at all. It is heartbreaking to read such letters, but it is far more heartbreaking to live through such a situation than it is to read about it or even try to help.
The situation is not only affecting the patients, or in some cases would-be patients. Without the essential contribution of NHS workers the service could not function, but they are being victimised. This year, 60% of NHS workers will get no cost of living pay increase at all. They have had a two-year pay freeze, followed by a 1% pay rise. National health service workers’ pay has fallen by 12% to 15% in real terms since this Government came to office.
As a result of the shortage of funds available to the national health service, very bizarre things happen. I want to draw the Minister’s attention to something that is happening in my constituency and ask him to look into it. I have no great confidence that I will get any response, because at recent Health questions I raised two cases and was told by the Minister that they would be looked into. That was the last I heard from the Department of Health on the subject.
I describe this situation because it is not only a major health issue, but a major community issue. Currently, there is no landing site available in Manchester for helicopter ambulances for either the Royal Manchester adult major trauma centre or the Manchester children’s hospital paediatric major trauma centre. There is a lack of money to provide a landing ground for air ambulance centres to do their vital work—heaven knows I praise them for it—so there is a plan to have a landing site in a park in my constituency.
Friends of Birchfields Park, the organisation of local residents that looks after the park, had a meeting on Saturday. I promised them that I would raise it in the debate. There will be a landing site in the park, but it is a small park and part of it will be lost. It will be used something like every three days, so there will be disruption the whole time. Apart from the disruption in the park, the site is next to two schools, one of which is extremely near to the proposed landing area. It is a heavily populated area. A ground ambulance must go the site to pick up the patients who are landed, which will affect traffic on an extremely busy road.
One of the most odd things of all is the effect on the park’s nature. Those responsible for suggesting that landing site say:
“The majority of wildlife will evacuate the area proximate to the aircraft due to the noise and displacement of air and downwash during landing and take-off.”
Apart from the affect on the wild creatures, which share this planet with us and ought to have as many rights as we have, the thousands of people who live in the area will be affected. I am not in any way belittling the air ambulance service—it is vital, essential and dedicated—but it is extraordinary that it will be reduced to using Birchfields park as a landing site because it does not have the money to create its own.
All hon. Members pay tribute to the national health service. As I have said, heaven knows I have a greater duty than most in the House to thank the NHS for what it has done. Everybody needs it. It is just about the only service in this country apart from education that absolutely everybody needs. It ought to be given priority, but it has been severely damaged by the Government. That is accepted by the electorate. Every opinion survey shows that the Government are blamed for what is happening to the NHS, and that the electorate are worried about it. Roll on 7 May.
It is a pleasure to follow the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), although he would not expect me to agree with everything he has just said.
I listened to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) with considerable interest. One thing that struck a chord with me was when, at the beginning of his speech, he said, basically, that the NHS should not be a political football. I could not agree more. It does a great disservice to the people who work so hard—the doctors, nurses and ancillary staff—to provide health care for the citizens of this country, to see it turned into a party political football. Let me explain what I mean by a political football.
The Opposition have, of course, a democratic right to hold the Government of the day to account for their stewardship of the health service, as they do on education or anything else. Of course, every individual Member of Parliament, regardless of party, has a right to fight for the interests of their constituents with regard to health care if they feel that it is failing their constituents.
No, I will not, because I only have eight minutes.
What I decry, however, is when, in the generality, the health service is used to attack a political party, whether the Government or whatever, simply to try to score cheap party political points. That does a grave disservice to the NHS. As the right hon. Member for Manchester, Gorton said, people in this country love the health service. They believe in it, free at the point of use for all those who are eligible to use it. I, like I imagine millions and millions of taxpayers, have no objection to paying our taxes to have a free health service. To appropriate the four freedoms of Franklin Roosevelt, there is a fifth freedom: the freedom from fear of a medical bill dropping on one’s mat and financially ruining one’s family.
Where I see the greatest and, to my mind, the most disgraceful attack is in the accusation, which is not new—it was being made in 1979, and, I suspect, before then, but fortunately I am a bit too young to remember exactly—that the Conservative party wants to privatise the health service. We do not and we never have done. As long as I am a politician, and my right hon. Friend the Prime Minister is, we never will. I find it extremely aggravating and hurtful when this cheap shot is made.
One of the examples of privatisation given is the use of the private sector to improve and enhance the health care of our constituents. Let me just explain something. Over Christmas, I read an extremely good new book, which I strongly recommend to the right hon. Member for Leigh (Andy Burnham), if he has not already come across it. “Nye”, by Nicklaus Thomas-Symonds, is the new biography of Nye Bevan. It is a fascinating book, particularly the part about when he was the Minister for Health from 1945 to July 1948 and putting together and negotiating the creation of the NHS. It sets out the arguments he had with the medical profession and others, and the compromises he had to make to establish the NHS. Many people do not realise that even to this day, as a result of those compromises, 95% of GP practices are private small businesses. I do not decry that, because they are treating patients, under the national health service, free of charge.
Historically, a lot of mental health care has been free of charge, but provided by the private sector. In the 1990s, when I was a Health Minister, I remember John Major using the private sector to bring down waiting lists and waiting times for operations. My constituents had no problem whatever with that, providing it was free and kept to the core principle of the NHS. The last Labour Government, the Blair-Brown Government, were quite happy to use the private sector providing it was benefiting NHS patients.
The shadow Secretary of State kindly mentioned—albeit in passing—Chelmsford walk-in centre and suggested it was a great political scandal and the next bandwagon he was going to jump on. May I point something out to him? The walk-in centre was created from the dying embers of his stewardship of the NHS, in March 2010, to be run by a private company. I have no problem with that, if it is serving NHS patients. However, its sole purpose was to reduce pressures on A and E at the local hospital, and I am afraid it has singularly failed to do that. The use of A and E at Broomfield hospital, just down the road, has increased inexorably and, in that respect, the walk-in centre has failed.
I am listening carefully to the right hon. Gentleman. As he knows, I have huge respect and affection for him, but he is arguing that NHS privatisation is a myth and that our accusation is wrong. If he does not mind, I will quote what he said during the Committee stage of the Health and Social Care Act 2012:
“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”—[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]
Why, then, is it a myth that he and his Government have exposed the NHS to a greater risk of commercialisation, marketisation and, indeed, privatisation?
First, competition was introduced on the current scale by the Blair-Brown Government, and secondly, there is nothing wrong, per se, with competition to get the best providers providing the best care for patients, so long as they keep to the sole ethos of the NHS, which is that that good care be provided free at the point of use for NHS patients. We saw that under his Government and under the Major Government, and this Government have used the private sector to ensure that patients are treated more quickly. We want them to be treated as quickly as possible, and if there is not enough capacity in the NHS, and if a private provider can provide the capacity, I see nothing wrong with that, and neither do most people in this country, if they are treated more quickly.
Returning to the walk-in centre, there were 40,000 attendances last year, 10,000 of which were by people beyond the Mid Essex CCG area. Of the remaining attendances, one third should have been self-caring or using their community pharmacy or 111, which the CCG is paying for, and another third should have been using their community pharmacy or GP, which the NHS is paying for. The CCG was therefore paying twice for the same care for the same patients, which is an utter waste of money. That money should be being used to care for more patients quicker, which is why the CCG has taken the decision it has. It is a rational decision, because the centre is failing to meet the aims it was set up for and instead ensuring that the NHS pays twice for the same patient to be treated. In place of the walk-in centre, there will now be an urgent care service at the local hospital for those people who should be going there. Sometimes, politicians have to do the right thing, regardless of political point scoring. Where it is in the interest of patients and the configuration of services, they should take the right decision, be reasonable and responsible and explain why it is the case.
In conclusion, I am delighted to see the hon. Member for Hackney North and Stoke Newington (Ms Abbott) in her place. I am fascinated to note that the nub of the motion is a call for an extra £2.5 billion for the NHS, which I am sure she strongly supports. What worries and concerns me—she may have a problem when it comes to voting at 7 o’clock tonight—is that the motion goes on to say that it is going to be
“funded by measures including a tax on properties worth over £2 million”.
Given the battle the hon. Lady had on the radio with a member—a right hon. Member— of her party from a southern Scottish constituency, I imagine that she is in turmoil, wondering how to justify that funding from that source.
I am in no turmoil whatever. I will be walking through the Lobby with pride behind my hon. Friends. We cannot know exactly how much a mansion tax, if levied, would raise towards the national health service. What we do know is that the British people who want to save the national health service from the depredations of Government Members have to vote Labour. We have to vote for my right hon. Friend the Member for Leigh (Andy Burnham) to become Secretary of State for Health—
In conclusion, it is sad that the hon. Lady has completely undermined the case and the costings of the right hon. Member for Leigh (Andy Burnham). I have no doubt that when she has swallowed her pride and gone through the Lobby today, she will battle as hard as she is renowned for battling and will hit the leader of her party over the head to try to get him to see common sense and abandon this ridiculous policy that she also thinks is ridiculous.
My party believes in an NHS free at the point of use and funded out of general taxation. I support much of what is in the motion today. I, too, would question what it states about outsourcing, as it is not quite clear whether outsourcing will be based on hypothecation in relation to how much the mansion tax raises or on how much the Conservatives happen to be spending. I believe we need to decide the right amount to spend on the NHS and then to commit to it, rather than simply say it should be £2.5 billion above however much the Tories spend—either cutting or increasing. We should make a decision about how much the NHS needs and then fund it properly. I support the principle of joining up adult social care with the NHS, and I thought that the shadow Secretary of State made a persuasive case for a single budget.
What does the hon. Gentleman think it tells us about his leader’s instincts when he said:
“I think we are going to have to move to an insurance-based system of health care.”?
Moreover, what does he think it tells us about his deputy leader’s instincts when he said that he wanted to
“congratulate the coalition government for bringing a whiff of privatisation into the…National Health Service…the very existence of the NHS stifles competition.”?
Does that not prove that ordinary people who rely on the NHS cannot regard UKIP as being in any sense on their side?
It proves nothing of the sort. The hon. Gentleman faces a very strong challenge from UKIP in his constituency from the excellent Bill Etheridge MEP. The policy of our party—[Interruption.] No, let me answer the point. Our policy is determined by our party as a whole. We are committed to an NHS free at the point of use and funded properly out of general taxation. [Interruption.] May I continue? I personally come from a mother and father who met in the NHS; the NHS and supporting it is in my blood. I believe in the NHS as I have described it, and I would appreciate the courtesy of people accepting the sincerity of what I say on that.
I am pleased to see the shadow Secretary of State still in his place as he has been throughout the debate, but when it comes to funding the social care budget, it is a moving target to determine what that budget is. We know the local government settlement for the year ahead, but not for beyond that. We do not know what either a Conservative-led or Labour-led Government might be able to, or choose to, spend on local government, or what proportion might be allocated to public health budgets. It thus strikes me as a significant risk to say, without greater clarity, “This is what the budget will be, plus the sum of £2.5 billion”—the figure selected by the shadow Health Secretary and his party, irrespective of what the baseline is.
Can the hon. Gentleman be absolutely certain of what his party might or might not do should it ever—unfortunately—find itself propping up a Government? Can he assure us that the road to Damascus-style conversion that he is describing represents the view of the whole of his party, and not just his individual view?
Yes, I can give the hon. Gentleman that assurance. It is the view of my party, it is the view of the whole party, and it is my own personal view, which is core to my politics and what I came to the House to represent.
The Prime Minister said earlier that I came to the House week after week to discuss the NHS in Kent. Following what could perhaps be described as an endorsement of my approach from the Prime Minister, I now wish to raise some of the issues that have arisen in Medway. One of the problems with the motion is that it makes no mention of introduction of the new GP contract in 2004, which I believe has been a significant driver of increased demand for A and E services.
In Medway, where the proportion of single-handed general practices is significantly higher than the national average, the burden of out-of-hours care falls largely on an organisation called MedOCC. While I would encourage constituents to use MedOCC rather than A and E when that is appropriate, I have one or two concerns about the way in which it operates.
Like the hon. Member for Wirral South (Alison McGovern), we had a young child who was ill, and we sought an appointment. My wife telephoned MedOCC and we were offered an appointment at a particular time, but were then told that the wait would be an hour and a half. We said “If the wait will be an hour and a half, why do you not give us an appointment an hour and a half later than the one that you have just given us?” However, that was not allowed. We had to wait for an hour and a half, because that was the procedure, and that was the way it had to be. Although we went to the MedOCC clinic because we thought that that was the appropriate service, I would understand it if a constituent in the same circumstances decided to take his or her chances at A and E, where it might even be possible to be seen more quickly.
It is important for an out-of-hours service—in our case, MedOCC—to be flexible and responsive, and to be operated in a way that makes it an attractive and appropriate alternative to A and E, and I shall develop that point further when I meet members of the clinical commissioning group on Friday.
The hon. Gentleman and I share the same hospital in Medway. Will he join me in welcoming the extra £13.4 million that has been given to its A and E department, the extra £6 million of winter funding, and the additional £10 million that has been given to the CCG to help to improve local health services?
I do indeed welcome those sums; I pressed for them strongly. I was particularly delighted by the provision of that £13.4 million for the rebuilding of the A and E department, which I think is essential. I am now campaigning for the provision of a further sum of approximately £20 million so that the hospital can build what it describes as an “emergency village”, consisting of short-stay medical wards around the A and E to improve the throughput of patients and the quality of care.
I have also helped the hospital with its efforts to ensure that patients are referred more appropriately, and are not necessarily sent to A and E. If a GP refers a patient to hospital and that patient has a known condition, surely it is better for the patient to go to the relevant ward than to be pushed through A and E, which is not an appropriate environment for someone who has already been assessed by a GP. Similarly, A and E is rarely the right environment for people suffering from dementia. It is best for action to be taken at the nursing home or by GPs, possibly based alongside A and E, who can make a speedy assessment and transfer the person to an appropriate treatment area. I am also pleased by the decision to end the so-called Star system in Medway A and E. The idea was that someone would be assessed by a senior clinician before it was decided what should be done, but that was not happening within a sensible time scale. That system has now been replaced by nurse-led triage, which I think will work better.
I am also grateful for the support we have received from other hospitals, notably the Homerton, which has an excellent A and E department. Medway has benefited from secondments there. It is important that those secondments and that support are integrated with the permanent staff in Medway hospital and the clinical director lead for emergency medicine is key.
We have had extra consultants appointed in emergency medicine at Medway hospital, which I strongly welcome, but I must mention the terms and conditions of emergency doctors. It is an extraordinarily demanding specialty and doctors working in it rarely have the opportunity to take on private work, which is a consideration for some but not all doctors when they make their choice of specialty. To encourage more doctors to come in to this field, should we consider changes to the lockstep consultant contract so that doctors in the extraordinarily demanding area of emergency medicine can perhaps receive more pay than others who are in specialties that are not as extraordinarily demanding, to which some might have been attracted by the potential for private earnings that they could not make in emergency medicine?
The Secretary of State tells me that what is actually required is more holidays for A and E doctors. That might be the case, but it would require pulling more doctors in to emergency medicine to cover for colleagues on holiday. I question a system in which high numbers of agency staff are used for a day or a week. Hospitals with problems in A and E and that have problems attracting people can fill places with those staff by paying very high rates, but they do not necessarily gel as a team or provide support in anything but the short term. We need to make emergency medicine attractive for doctors.
Finally, on the question of Monitor and the CQC, Medway hospital is a foundation trust. That happened in a largely box-ticking and financial exercise under the previous Government that ignored the death rate being one in 10 higher than it should have been, as mentioned by the hon. Member for Gillingham and Rainham (Rehman Chishti). Although Monitor has been reasonably sensible in its approach to Medway, it cannot come and run the hospital. We had to look to the board to do that. Similarly, the CQC has made some sensible interventions, for example on A and E, but in 2012 it said that Medway was a good hospital that was meeting all its standards. I believe that many of the problems we are seeing were in place then but were not identified by the CQC. My party wants to replace some of the alphabet soup of bureaucracies and regulators, such as Monitor and the CQC, with directly elected health boards that could, we believe, oversee these things better.
It is intriguing to follow the hon. Member for Rochester and Strood (Mark Reckless). I will leave my intrigue at that point and focus on the debate rather than him.
It is a shame that the shadow Secretary of State has left the Chamber, as I was about to say something relatively pleasant and polite about him—he will not hear it now. When he came up to Lancaster and Fleetwood a few weeks ago he joined me in praising my local A and E department, which had seen 97% of patients within four hours, the fifth best performance in the country that week. That is a superb achievement given the complex health economy in Blackpool. It is very rare that we are at the top of a league table for the right reasons in Blackpool, whether that is for football or for health care, so I welcome that.
It was interesting to note a more hidden and nuanced message in what the shadow Secretary of State had to say. The medical director of Blackpool Victoria says that between April and September 2014, 36% of those arriving at A and E did not need to be there. They could have received their diagnosis or treatment somewhere else, and the cost to the hospital was calculated at £842,000. The message I draw from that is that we still have an immense amount of work to do to ensure that people know where to go for the right treatment at the right time. It is, of course, incumbent on us to ensure that those alternatives are resourced, that people know where to go and that people have confidence in the alternatives.
We have not spoken enough today about pharmacies. Pharmacy trade bodies and the industry put so much into lobbying Members on both sides of the House, but I think it will require another decade or so of intensive lobbying of MPs before we finally get the message that it is far better to have first recourse to the local pharmacist to see whether one needs to go further in seeking appropriate health care. I rely on regular repeat prescriptions for my epilepsy, and I have saved myself many a GP visit by asking a question at my local pharmacy. We are overlooking the most basic corner-of-our-street access point for primary health care, and we should not forget it.
I want to praise another Member of a different political party from mine, and he is sitting on the Government Front Bench: the Minister of State has already been praised today for his approach to mental health care. It is warmly welcomed, particularly in a town such as Blackpool. Our new 74-bed harbour unit is about to open on the edge of the town. It has been long-awaited, and is much-needed following some of the appalling standards of care at the Parkwood unit over the past decade.
The Minister will know that he faces great challenges. I could easily have come here today and read out a number of immensely tragic cases involving young people not getting the appropriate mental health care. He still faces a battle with the profession, because clinicians differ over their assessment of this issue. I see far too many young people with some learning disorder who are somewhere on the autistic spectrum, where the clinician refuses to accept that they can both have a learning disorder and a mental health problem. They fall into that gap and are batted backwards and forwards between different providers. There must be a battle in the medical profession over how to reconcile those two different forms of clinical diagnosis.
Another point I want to raise—I have far more than I will be able to get into my remaining four minutes—was mentioned by my right hon. Friend the Member for Chelmsford (Mr Burns). I was struck by the shadow Secretary of State’s sudden enthusiasm for the walk-in centre in Jarrow—his instant commitment that it would be saved were Labour ever to come to power. We then heard from my right hon. Friend that these things are sometimes trickier than that—that there is more nuance, perhaps. We in this Chamber often think we know it all—don’t we? We think we know everything there is to know and that we can learn nothing from anybody else about anything in our constituency—that we are the sole experts of what is right. Occasionally it would be nice to listen to the clinicians. There might actually be a clinical argument for why a particular unit has to open, close or reconfigure, but all too often debates on the reconfiguration of services become a political football—which is exactly what my right hon. Friend was saying.
A good example is the stroke unit in Blackpool. It has been a controversial addition because it was designed to serve the entire north-west. Patients were coming down the M6 from south Cumbria, past four or five other hospitals, to get higher quality treatment in Blackpool. As the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) chuntered during the Secretary of State’s speech, the important point is that it was about outcomes. People were going to have a better chance of survival if they went to the stroke unit in Blackpool rather than their local A and E. Yet when that was debated, it was very hard to tease out the medical arguments in favour of this innovation, because all too often we were more concerned about focusing on saving bricks and mortar in our own backyards rather than on what is actually best.
Does my hon. Friend agree that the two brands in the NHS that the public really understand above all are A and E and GPs, and all the time we are talking about A and E we are getting away from the fact that sometimes care is better provided in a specialist stroke or heart centre?
My hon. Friend makes an important point, which is that so many different terms are used and answers given in this Chamber and elsewhere about where patients need to go. What they actually want is reassurance and confidence that when they go somewhere they will get the right treatment at the right time that solves their problem. They do not want it to be overcomplicated, and neither do we.
We have heard a lot of criticisms of this Government’s health reforms—they seem to be very unpopular on the Opposition Benches in particular—but let me highlight two that have been very good. One of them goes back to my younger days—when I had a finer figure, perhaps. My first proper job—Opposition Members will not like this—was as a health policy officer in the Conservative research department in 1999, so I listened with delight to the right hon. Member for Holborn and St Pancras (Frank Dobson) telling me all about the wonders of his time, because I scrutinised it quite carefully on a daily basis. I used to get a monthly present from the Association of Community Health Councils for England and Wales in the form of the London “Casualty Watch”, a monthly census of trolley waits in London accident and emergency departments. It was a pretty thick document. The census detailed page after page of trolley waits of more than 24 hours, and it was a shocking indictment of how Labour was running the NHS at that time.
That situation led to one of the Labour Government’s most shameful decisions: to abolish community health councils. I know that many Labour Members are embarrassed about that even now. One of the great things about our health reforms is that we have brought back Healthwatch, which has proved to be a thorn in the side of local health providers, of Members of Parliament and of the Government. We have brought back the ability of ordinary patients to affect the nature of the care in their communities. That is happening right now in Blackpool, and it is making a difference. I am delighted about that.
Another positive element involves putting public health matters into the local council. As I have said, Blackpool faces immense public health challenges, but putting Dr Rajpura, our local director of public health, into the council has been a tremendous success. It has helped to pull together all the disparate strands within the town as we face those challenges. Again, this has happened only as a result of our health reforms.
Another example that I want briefly to mention is the fact that some of our local nurses at the hospital have spun out their rehabilitation service into a community interest company called Spiral, which is now winning awards for the quality of its patient care. I am concerned that, if Labour were to reverse all these changes, the good things we have achieved would be washed away and lost, and the people who would suffer would be my constituents, including those who have turned to Spiral for their rehabilitation. That is my real concern.
I want to talk about the situation in hospitals across the Morecambe bay area, and I shall start with the inquiry into neonatal deaths at Furness general hospital. The inquiry is led by Dr Bill Kirkup, who distinguished himself as a member of the independent Hillsborough inquiry panel. It has now heard from more than 100 witnesses, of whom I was the first, over a period of nine months. That has involved regular long trips from Barrow to Preston for the grieving families, who have had to relive those deeply traumatic periods in their lives in great and painful detail.
There has been a lot of talk about politics today, and about its relationship with the national health service. I do not think we should deny the real differences between our parties; we should be prepared to debate them and to put the choice before the British people at the election. That will involve disagreement, argument and debate. However, it pains me to hear the Secretary of State accuse me and other Opposition Members of being selective in the way in which we talk about the problems in the NHS. I have to say to him that I do not care if the Morecambe bay inquiry turns out to be politically difficult for any side. As the Minister of State, the right hon. Member for North Norfolk (Norman Lamb), knows, I helped to secure the inquiry on behalf of the grieving families, who, with great persistence and determination, persuaded me of the need for an independent examination to run alongside the criminal inquiry, rather than taking place subsequently. I am determined to get to the truth, and I am determined that lessons should be learned, no matter how painful they might be for anyone.
The Secretary of State is no longer in his place, but if he wants to stamp out shabby political point scoring I advise him to have a word with his colleague, the hon. Member for Morecambe and Lunesdale (David Morris). It is a shame that the hon. Gentleman has not attended this debate to stick up for his own local A and E, which I know is facing real pressures. The last time the inquiry was in the news, the hon. Gentleman used those neonatal deaths—which did not relate to his constituency or to the hospital there—to call for the resignation of the shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham). I am sorry to speak so frankly, but if someone is prepared to use the deaths of babies for this kind of political stunt because someone in Tory central office suggests it or just because they themselves think it is a good idea, there is not much they will not do. So just as the families, who have gone through so much in their grief, will not forgive anyone who does not face up to the full gravity of the findings that are coming, so I will not forgive anyone who uses this inquiry for political sport.
For all the problems, and I understand that the inquiry may well make difficult reading, we in Morecambe bay and at Furness general hospital are not the next Mid Staffs. There will be no excuse for anyone who allows the destabilisation and turmoil that the region has suffered to be recreated in Morecambe bay just because it fits the narrative composed by Lynton Crosby or some election agent in Downing street. I hope I will get some assurance from the Minister on that point in his winding-up speech. It is also important that this inquiry, which I understand is to report in the middle of next month, is dealt with fully but is not allowed to divert focus from the real problems the trust is enduring now and the need for a proper funding solution to put our hospitals on a more sustainable footing.
Let me briefly address the pressures currently being felt in Morecambe bay. Ambulances have been mentioned, and the hon. Member for Blackpool North and Cleveleys (Paul Maynard), whom I have the pleasure of following, spoke of his local hospital in Blackpool. Patients in south Cumbria will often travel by ambulance to Blackpool. Sometimes that is a good thing, because of the real expertise available, but too often recently ambulances have been diverted from where they are needed in south Cumbria to serve the Blackpool area because of shortages there. On 5 and 6 January, two ambulances, one serving Ulverston in my constituency and the other Millom in the constituency of my hon. Friend the Member for Copeland (Mr Reed), had to come to Fylde and the Blackpool area. Obviously, once they were there they were required to serve other patients needing help in the Fylde and Blackpool area, leaving the service in south Cumbria severely stretched—and all this when the beginning of January had seen a 25% year-on-year increase in ambulance call-outs across the north-west. We urgently need from the Government not only action to relieve the pressure on accident and emergency departments, but a recognition that areas such as Furness, which are out on a limb, can end up in a difficult situation because of ambulances being redirected around the country.
There have been real pressures on A and E in my constituency, as there have been across the country. Two weeks ago, when this issue last flared up in the Commons, the University Hospitals of Morecambe Bay NHS Foundation Trust was cancelling all non-urgent operations so as to be able to deal with the crisis in A and E. I have spoken to people in the trust today and they say that the situation has eased a little in recent days but remains fragile. All these problems must be addressed, but I have repeatedly pressed the Government on this. I was so grateful to the shadow Secretary of State, on his recent visit to Morecambe, for the assurances he gave on recognising the unique geographical situation of Morecambe bay and the funding priority it would get under a future Labour Government. Our population of 300,000 is spread out across the Morecambe bay area and the transport links are difficult. If things are to be easier, our area ought to be more compact and served by one big general hospital, and it cannot survive with the three hospitals it has unless very severe cuts in services are made. We are still waiting for an answer from the Government on whether they will recognise that case and provide us with the long-term extra funding that our area needs.
I begin by paying tribute to the staff and leadership of Buckinghamshire Healthcare NHS Trust. The trust went through special measures as a result of the Keogh review, when it was found to have high mortality, and they have done a sterling job of turning the trust around. On my visit recently with my right hon. Friend the Secretary of State for Health, I found a renewed enthusiasm and optimism in the trust, and I am very grateful to the staff and leadership for delivering that outcome.
When the right hon. Member for Leigh (Andy Burnham) opened the debate, he asked for shared solutions, striking a markedly different tone from the usual partisan pose. I shall suggest some shared solutions later in my speech. But normal service quickly resumed. The right hon. Gentleman spoke of stories of failure. There are, of course, some stories of success, and I shall mention a few. England’s NHS has the best measured emergency care performance of any western nation, according to NHS England. Dr Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said:
“In the week ending December 28th A&E attendances were up more than 31,000 on the same period last year, meaning we successfully treated more patients in under four hours than ever before.”
I will come to why in a moment.
The Government have allocated an additional £700 million to cope with winter pressures. The College of Emergency Medicine said:
“This represents the largest annual additional funding yet seen.”
In the course of this Parliament, the NHS budget will have increased by £12.7 billion in cash terms. This additional winter pressures funding has paid for 2,500 additional beds in acute and community treatment and the equivalent of 1,000 doctors. There are almost 1,200 additional A and E doctors, including an additional 400 A and E consultants and 1,700 additional paramedics since 2010. Some 850,000 more operations are being delivered by the NHS each year compared with 2010, and numbers waiting longer than 18, 26 and 52 weeks to start treatment are lower than they were under the previous Government. It cannot reasonably be said that that is a continuous record of failure. There are considerable successes under this Government.
In an intervention on my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), I mentioned branding. One of the things that we could do is continue to tell patients that they should go where treatment can best be provided, but we see that patients stubbornly insist on going to hospital. The brand A and E is well understood; people know that if they have an urgent problem, they can go to A and E. It will take years of persuasion before people behave differently, and I do not think we should keep on persuading people to want something other than the preference they are clearly displaying by their behaviour, which I shall return to.
Let us not forget the legacy that the Government have had to cope with, including the grievous financial position that they inherited. Let us not forget that around the world special monetary measures are still in place to ensure that Governments can keep spending. We have had problems with patient care. I alluded earlier to the turnaround in Buckinghamshire; across the country, there have been special measures and turn- arounds. The BBC reported that a probe into whistleblowing has been swamped by people getting in touch. The Government have had to deal with an enormous range of cultural problems and turnarounds.
That brings me to solutions—first, funding. In Buckinghamshire there are pockets of real poverty. In my constituency in Micklefield, Castlefield, Oakridge, Bowerdean and Disraeli there are—by anyone’s standards —pockets of poverty and deprivation, but we suffer on funding because of how it has historically been calculated. It is time for us to look seriously at where the demands on A and E are coming from, and to reorientate funding towards the human factors producing that demand—that is, ageing. Where there are older populations, they should be properly funded. It is a simple matter of treating people humanely, decently and—dare I say it—equally.
Secondly, it is time for us to take seriously the documents of NHS England. I am talking about not just the urgent care review, which I have in my hand, but the “Five Year Forward View”. What we see emerging now is a clear vision of where places such as Wycombe should go. It is becoming increasingly obvious to me that we will never manage to achieve the return of an old-style A and E to Wycombe hospital. The clear reason for that, as set out by NHS England, is that the NHS is moving in a different direction. The urgent care review includes a clear model of future urgent care, with major emergency centres, emergency centres and urgent care centres.
I am not able to tell the hospital trust and the clinical commissioners what they should do, but if I could I would now have a clear understanding from NHS England’s own documents of what should be done in Wycombe. We have a very expensive public finance initiative hospital, and we need to make the most of it for the 20 years-plus that are left to run on it. We should have an urgent care centre, an enhancement of the current minor injuries unit, a pharmacy, GPs, social services, nurse practitioners, and a full set of services and diagnostics in Wycombe named in a way that the public can understand. We should be proud of the centre and encourage people in Wycombe to present there if it is the best thing for them to do. We should not turn off the 111 service, and we should provide the services that people need in the places where they present.
We cannot go on for ever pretending that we will re-educate the public to want something different; that is not going to happen. I am not suggesting that we have an enormous new surge in admissions—nobody wants that. What we should recognise is that the vast majority of people, when they are in difficulty, want quick reassurance. If the people of Wycombe were in charge, they would want our hospital to have a full range of diagnostic and treatment facilities available to them all year round, giving them peace of mind. They would not want poor quality care. I think most people would accept being stabilised and moved to the place that could give them the best care.
We have a heart attack and stroke unit. I do not suppose that many people in Aylesbury, where there is an A and E unit, would be very happy if they realised that in the event of a heart attack or stroke, they would be coming to Wycombe. But that is the point. A huge amount of confusion, waste and anxiety is being wholly unnecessarily created despite the fact that NHS England, through the forward view document and the review of urgent care, has set out a clear trajectory on how to give the public peace of mind and the right treatment in the right place—yes, close to home, but also making best use of the PFI hospitals, which are a millstone around the NHS’s neck. We should do the absolute best we can to get best value for money, which means a new generation of urgent care centres in places such as Wycombe.