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NHS Spending

Volume 612: debated on Wednesday 6 July 2016

I beg to move,

That this House notes that the Vote Leave group during the EU referendum campaign claimed that an extra £350 million a week could be spent on the NHS in lieu of the UK’s EU membership contribution; further notes that senior figures who campaigned, including the hon. Member for South Northamptonshire, the hon. Member for Uxbridge and South Ruislip and the Rt hon. Member for Surrey Heath have subsequently distanced themselves from that claim; and calls on the Government to set out proposals for additional NHS funding, as suggested by the hon. Member for South Northamptonshire on 4 July 2016.

It is a pleasure once again to face the Secretary of State for Health.

Nobody can doubt that much of the case that was made by the Vote Leave EU campaign was based on assertions that have since crumbled. For instance, within hours of the vote to leave the European Union, the Tory MEP, Daniel Hannan, said that taking back control of immigration did not necessarily mean cutting it. That will have been news to millions of people who voted to leave.

We also heard that there was no hurry to get on with leaving the EU. Why then the urgency of the campaign? The most striking reversal of all came from Nigel Farage. Within hours of the vote, he said that it was a mistake for the Vote Leave campaign to claim that leaving the EU would mean £350 million a week more for the NHS. Some of us were surprised by that, because this was no ordinary campaign slogan; it was painted on the side of the Vote Leave battle bus, which travelled thousands of miles up and down the country. It was emblazoned on the backdrop to speeches by the luminaries of the Vote Leave campaign. The British public is entitled to ask: where is the £350 million a week and when can we expect to see the Government start pumping that new money into our NHS? We all know about the financial and other pressures already facing the NHS.

Does my hon. Friend not think the public are also entitled to ask where the serried ranks of leave campaigners are today?

My hon. Friend makes an important point. I do not see a single solitary leave campaigner in the Chamber this evening. It makes me wonder what the whole campaign was about. Was it about their egos? Was it some elaborate Eton wall game? Are they not concerned that the public may have been misled?

As I was saying, we know about the financial pressures already facing the NHS. A survey by the Healthcare Financial Management Association of 200 NHS finance directors in hospitals and clinical commissioning groups reveals that no fewer than one in five believe that the quality of care will worsen in 2016-17, and even more of them—one in three—fear that care will deteriorate in 2017-18 as a result of financial pressures. Waiting times, access to services and the range of services offered were seen to be among the most vulnerable areas. There is no doubt that those pressures will be made worse when we leave the European Union.

I begin by congratulating my hon. Friend most warmly on her appointment as the shadow Secretary of State for Health. We miss her on the Back Benches, but we are delighted that she has reached the dizzy heights of the shadow Cabinet.

One place where we are feeling the pinch is in diabetes. We have had a number of reports that the DESMOND and DAFNE—diabetes education and self-management for ongoing and newly diagnosed, and dose adjustment for normal eating—schemes to provide structured education for type 1 and type 2 diabetics, are being cut. Does my hon. Friend agree that prevention is so important that we should ring-fence resources to deal with the crisis affecting diabetics?

I am grateful to my right hon. Friend for making that important point. We are seeing pressures on public health services and expenditure across the piece. What he says about ring-fencing money for diabetes is very important and I support him.

The Health Foundation think-tank says that

“Leading economists are…unanimous in concluding that leaving the EU will have a negative effect on the UK economy”.

As a result, the NHS budget could be fully £2.8 billion lower than currently planned by 2019-20. In the longer term, the NHS funding shortfall could be at least £19 billion by 2039, equivalent to £365 million a week—and that assumes that the UK is able to join the European economic area. If that does not happen, the shortfall could be as high as £28 billion, or £540 million a week.

Those figures are not just numbers in a ledger. We know what poor care means in practice. Today’s Care Quality Commission report on North Middlesex University Hospital revealed a series of terrible incidents: an evening when only one commode was available for more than 100 patients; a patient left sitting on a bedpan for more than an hour; and a patient who lay dead in A&E for four and a half hours before being found. We can foresee similar consequences in other hospitals if pressures bear down on the NHS budget, not only because of all sorts of externalities, but because of our leaving the EU.

We know about the endemic problems in the NHS. Earlier today, we discussed the junior doctors rejection of the Government’s new contracts. We know that nurses and midwives are in uproar because of the Government’s plan to scrap the bursaries that would-be nurses and midwives rely on when they are studying. A fresh injection of cash, as promised by the Vote Leave campaign, could not be more timely.

While we are talking about the implications of Brexit for the NHS, I remind Members that any restrictions on freedom of movement—a subject that is being discussed extensively in the wake of the Brexit vote—will be little less than disastrous for the NHS; 55,000 men and women in its workforce originate from the EU. It would be completely catastrophic for social care; 80,000 men and women out of 1.3 million workers in that field are EU nationals.

I represent a constituency that voted strongly for remain—I think that Hackney had the second highest remain vote in the country—and I believed that a remain vote was in the best interests of the UK, but as we heard earlier today in the House, there has been a horrifying upsurge in racist abuse and hate crime, triggered by the Brexit vote. It is as if people now have permission to be openly racist. It is interesting that Vote Leave supporters are now distancing themselves from anti-immigrant politics, but the unpleasantness unleashed by the Brexit campaign is already poisoning public discourse. However, I believe strongly in democracy, so I believe that we have to respect the referendum vote. In many cases, it was a cry of pain and rage against Westminster elites, on which we all have to reflect.

The late Member for Chesterfield, the right hon. Tony Benn, who was an opponent of the EU to his dying day, said:

“My view of the EU has always been not that I am hostile to foreigners but I am in favour of democracy.”

I respect those people who voted to leave. My experience of the EU campaign is that people wanted information, were trying to compare competing claims, and were doing their best to exercise their right to vote responsibly. The turnout was high. Nobody wants to think that the Vote Leave campaign peddled deliberately bogus slogans. I speak on behalf of not just Labour Members, but the British voting public as a whole. At a time when money was never more needed for the NHS, when can we expect to see the £350 million a week extra for the NHS that the Vote Leave campaign promised would be a consequence of the Brexit vote—or was it deceiving the public?

Perhaps I will cut down my speech a bit. I give a particularly warm welcome to all my Back-Bench colleagues here; it is wonderful to see them coming out in support in such numbers. I thank the shadow Health Secretary for calling this debate. She is right to talk about the issues of NHS funding—though not particularly through this motion, which I will come on to speak about. I welcome her to her first Opposition day debate, as I welcomed her earlier to her first statement. This is a brief that she knows well, having been shadow Public Health Minister, and having campaigned on a lot of very important topics, including plain paper packaging for cigarettes. She has done a lot of work with the all-party sickle cell and thalassaemia group as well. I wish her luck in two areas. The first is with her parliamentary questions, after last week’s question to the Department for International Development about a drought in Indonesia, when it was in fact in the Philippines. Secondly, I wish her luck finding some Front-Bench colleagues, just as I need luck finding some Back-Bench colleagues in these debates.

We are in agreement on Brexit; we were both on the remain side, and I campaigned strongly with the hon. Lady. I agree with her that however much we may have disagreed with the vote, it is very important that we respect it. She and I both worried about the damage that it might do to our economy and society if we left, but we also agree that it would do incredible damage to something even more important than them—to our democracy—if the British people were to think that the Westminster establishment was trying somehow to ignore their decision.

From the reasonable tone of her comments, I know that the hon. Lady understands that Vote Leave was not speaking for the Government when it said that there would potentially be an extra £350 million for the NHS. In fairness to the Vote Leave campaigners, at various points they clarified downwards that slogan on the side of the bus and said that they were really talking about a net figure of more like £100 million that could potentially go to the NHS, rather than £350 million.

I will give way first to the shadow Health Secretary, then to the Scottish health spokesperson.

If the Vote Leave campaigners brought down the figure that they thought could potentially be given to the NHS, why did they not repaint the wording on the bus?

That is, perhaps, not a question for me as a Government Minister to answer, but I take the hon. Lady’s point. I give way to the hon. Member for Central Ayrshire (Dr Whitford).

The point that many of us made in the referendum campaign is that even the net figure—the more like £100 million net contribution that we make to the EU—is not a figure that we can bank on with any certainty because, even if it did materialise after an exit from the EU, it would be negated by the very smallest of contractions in the economy, which would itself reduce the tax base and the amount of public spending available. The Institute for Fiscal Studies said that that £100 million a week would be negated by a contraction in the economy as small as 0.6%. I do not think any of the economic forecasts said that the contraction would be as small as that; all of them said that it would be much bigger than that.

I share the right hon. Gentleman’s concerns about—with your permission, Mr Speaker—the lie on the side of the bus. As Secretary of State for Health, will he now, on behalf of the whole country, and particularly on behalf of people who were deceived and let down by that claim, take up with the Electoral Commission why that lie was allowed to stand for so long?

I understand the hon. Gentleman’s concerns. Let me give him a challenging reply. The trouble that we have—those of us who disagree with the outcome—is that that issue was exhaustively debated and, for whatever reason, people chose to disbelieve our concerns or decided that they were not worried about it.

I understand why the shadow Health Secretary has brought the motion before the House, but the reason it is a difficult one to debate is that essentially the argument about the £350 million, or the £120 million, or the £100 million is dependent on the state of the economy. That is something that we cannot know now, only 12 days after the Brexit vote result. However worried we are about the impact of that vote, in discussions about the economy we have to be careful not to talk it down, because in the end we have a responsibility to recognise that there may be opportunities and we need to make the most of the ones that exist.

I understand the point that the right hon. Gentleman is making. On the other hand, I believe the Treasury has downgraded our prospective growth rate from 2% to 0.5%. Presumably, future spending plans will be based on that revised future growth rate. Is it not reasonable, therefore, to start making the assumptions that he has been wary of making so far?

It is perfectly reasonable to make the assumptions that the hon. Gentleman mentions, and there are plenty of reasons why we could look at some of the early impact on the economy even in the past 12 days and be concerned about the potential impact on the tax base and public spending more broadly. My nervousness as a Minister about talking those things up is that I do not want to talk down the British economy. Even though, as I say, I campaigned against the Brexit vote, I recognise that we are now going to leave the EU, I want the economy to be successful and I want us to make the most of the opportunities that face us.

On the broader issue of NHS funding, this debate indicates that there is some consensus—the Prime Minister mentioned this earlier today at Prime Minister’s questions—on the umbilical link between the health of the economy and the amount we are able to spend on the NHS. We are proud of the fact that we were able to protect spending in the last Parliament and to increase it by £10 billion in this Parliament on the back of a growing economy. Given that Health is the second biggest spending Department, we must recognise that it is vital to the NHS that we maintain that growth, despite the choppy period we are possibly about to go through.

I understand what the Secretary of State is saying about the health of the economy, but this debate also links to the previous debate because of the number of EU nationals who work in the health service. Has he made any estimate of the cost to the health service if all these EU nationals were forced to leave the UK in the course of this Brexit?

We are currently doing the analysis the hon. Gentleman is concerned about, but I should just say to him that I accept the Home Secretary’s assurance and confidence that we will not end up in a situation where EU nationals, upon whom we absolutely depend in the health and social care system, and who do an absolutely outstanding job, would not be allowed to remain in the UK. She has said she is very confident that we will be able to negotiate a deal whereby they are able to stay here as long as they wish and to continue to make the important contribution they do, and I accept that assurance.

Further to the point made by the hon. Member for Angus (Mike Weir), will the Secretary of State give the House an assurance that he will release that analysis and that it will be sufficiently comprehensive to allow us to see a regional breakdown of the significance of EU nationals working in our health service?

I will take away the hon. Gentleman’s request, and I will, of course, try to be as transparent as possible with Parliament about all the analysis and research we do on these topics.

On the point my hon. Friend the Member for Harrow West (Mr Thomas) has just made about having an assessment if we do end up, essentially, forcibly repatriating EU citizens in the United Kingdom, there will of course be a flip side: something like 3 million British expats in the EU would have to return to the UK as well. Many of them are, to put it politely, of pensionable age, with challenging health demands in many regards. Will the Secretary of State also provide an assessment of what effect that would have on the national health service?

I am sure that that is analysis we can do, but I cannot do it at the Dispatch Box as a direct response to the hon. Gentleman. However, as I am sure he is well aware—we made this point during the whole Brexit referendum debate—we have reciprocal health arrangements with other EU countries at the moment. Those are immensely convenient to people travelling to and visiting other European countries, because they mean those people can access healthcare completely free of charge. The bill is actually sent to the Government, and that arrangement includes pensioners who have retired to Spain and France and Italy as well. It would be very sad if, as a result of the new relationship with the EU, we lost that convenience. That is one of the reasons why I am confident that other EU countries will be happy for British pensioners to remain in them. As long as those countries are able to charge us for the healthcare costs, the burden to them should be minimal.

The Secretary of State spoke about NHS spending. Does he agree that cuts to local government spending on social care are putting increased financial pressures on the NHS? At St George’s hospital, a cost of £1.3 million has been attributed to inefficient discharges.

First, may I welcome the hon. Lady to her place as a doctor and as someone who knows a great deal about NHS matters? Although I am sure we will not agree on every health matter, it is always valuable and a great asset to have someone with medical experience in the House, and I am sure she will make a huge contribution in that respect. She is absolutely right to say that what happens in the social care system has a direct impact on what happens in the NHS, and that we cannot—as, in fairness, happened under Governments of both colours over many years—look at the NHS and the social care system as completely independent systems when we know that inadequate provision in the social care system has a direct impact on emergency admissions in A&E departments. She is right to make that point.

Let me make a broader point in concluding my comments. I think that there would be agreement across this House on the huge pressure on the NHS frontline at the moment, and that there is recognition of some fantastic work being done by front-line doctors and nurses to cope with that pressure. I shall give a couple of examples of the extra work that is happening, compared with six years ago. The A&E target is to see, treat and discharge people within four hours. Every day, we are managing to achieve that, within the four-hour target, for 2,500 more people than six years ago. On cancer, we are not hitting all our targets, but every single day we are doing 16,000 more cancer tests, including 3,500 more MRI scans, and treating 130 additional people for cancer. There are some incredible things happening.

However, we all recognise, and this perhaps lies behind the Opposition’s concerns in bringing this motion to the House, that in healthcare we now deal with the twin challenges of an ageing population, in that we will have 1 million more over-70s within the next five years—a trend that is continuing to grow—and of the pressure of scientific discovery, which means we have new drugs and treatments coming down the track. They are exciting new possibilities but also things that cost money. I for one, as Health Secretary, believe that as soon as economic conditions allow, we will need to start looking at a significant increase in health funding. That is why it is incredibly important, as we go through the next few years negotiating our new relationship with Europe, that we work very hard to protect the economic base that we have in this country, the economic success that we have started to see, and the jobs that do not just employ a lot of people but create tax revenues for this country. It is incredibly important that we pilot the next few years with a great deal of care, because what happens on the economy will have a huge impact on the NHS.

I am grateful to the right hon. Gentleman for giving way, and, if he will forgive me for saying so, temporarily fond of him as a result, because he is allowing me to raise a particular constituency concern. Northwick Park hospital, which serves my constituents, currently has a deficit of almost £100 million and is having to axe 140 staff posts as a result of the lack of funding for my local clinical commissioning group, by comparison with other parts of London. Will he undertake to look specifically at the issues facing Northwick Park hospital and Harrow clinical commissioning group as his further analysis of the need for additional spending in the NHS is taken forward?

I am very happy to do so. I have visited that hospital, where the challenges very much reflect what the hon. Member for Tooting (Dr Allin-Khan) said about links to the social care system. It was clear to me that the staff in the A&E department are working incredibly hard getting people through it, but struggling to discharge people from the hospital, which is why they were not hitting their target.

I have just been handed a note by a ministerial colleague, Mr Speaker, which I hope you will indulge me and let me read out, because I have never been handed such a note before. It says: “Apparently everyone wants to go and watch Wales play, so Whips happy if you felt you wanted to shorten your remarks.” On that basis, I will conclude by thanking the shadow Health Secretary for bringing this motion to the House and for her comments in support of it.

The right hon. Gentleman is not only an experienced member of the Cabinet but a very seasoned parliamentarian, and I think he is well attuned to the feeling in the House, as I am sure that other colleagues will now also be—not that I am hinting or anything.

God, the pressure.

We recognise that this figure of £350 million a week chimed with people in the country, because people are concerned about the funding of the NHS. The Secretary of State for Health talks about an extra £8 billion going forward, plus the additional £2 billion that was added to that, which was for bailing out massive debts. However, that is a change of description. Normally, funding is described as being for the Department of Health, but that is just NHS England. Public Health England and Health Education England were facing cuts of £3.5 billion. Therefore, the extra money going forward is only £4.5 billion. We have heard Members talk about their local trusts being in deficit. This is now so widespread, it cannot be blamed on management.

Despite the fact that the NHS somehow always managed to come out just in the black up to April 2013 and has been careering into the red ever since, the Secretary of State never seems to accept that this is to do with the Health and Social Care Act 2012 changes and the huge administration costs of outsourcing and fragmentation. The Secretary of State lays the blame for all this with agency staff.

Given the debate that we have just had on EU nationals working in this country, particularly in our public services, I have to say that we could be facing an absolute meltdown. We have 50,000 nurses and doctors from the EU in the NHS, and almost 80,000 careworkers. The Minister for Immigration hinted that those who have been here for over five years can stay, but that their benefits and rights may not be quite the same. So my husband, who is from Germany, can stay, but is his pension going to disappear? He has worked here for 30 years, but what protections will he no longer have? What about the people who have been here for less than five years—the high-flying researchers, academics or medics —who could go somewhere else? Do the Government really think that these people are just going to sit at home with their families until the last possible minute? No, we are going to lose them, and agency costs for nurses and doctors will go through the roof. For social careworkers, it will not matter: they do not earn over £35,000, so they are unlikely to get to stay, and we are unlikely to be able to replace to them.

As well as the fact that the £8 billion we always hear about is not actually £8 billion, we know that local government has faced huge cuts and, as was referred to earlier, that social care is where the real problem lies. The NHS money is just going to haemorrhage out the back door.

The £350 million a week figure that was painted on that bus was a disgrace. The shadow Health Secretary, the hon. Member for Hackney North and Stoke Newington (Ms Abbott), talked about it being an Eton game, but I think that it was an Eton mess. People were just playing with the facts. The rebate was not included. Public service payments, such as the common agricultural policy and regional funds, were not included. However, as the Secretary of State says, when we get down to the £110 million or so a week, that does not include all the other benefits that support the NHS and our economy. How much will it cost us to take part in Horizon 2020? How much does Switzerland have to pay to be part of this?

This is going to cost a lot of money. The Secretary of State said that it would take a 0.06% fall in GDP to negate the £100 million, but economists estimate that the fall will be between 1% and 3%. We do not want that to happen, but all the experts agreed that that was the likely outcome.

Like most people in Scotland, I absolutely believed in the remain campaign, but to me there was a poverty to the debate. Why are we having these two debates today instead of before 23 June? We had very little open discussion of the issues in this place. One of the problems is that we have never talked about anything good that we have got from the EU in the past 40 years. Of course, I have been lucky—I got my other half from the EU—but, to be honest, most of us have had many gains. We have cleaner air and cleaner water, and we have tackled acid rain. We have cleaner beaches. We have a single European medicines agency, so new drugs get to patients quicker. That agency is located here in London, but it is unlikely to remain here.

I always listen very carefully to what the hon. Lady says, but is she not being a little unfair on the United Kingdom? I seem to remember that the Clean Air Act 1956 set the bar for the European Union in the regulation of one of the areas that she has identified—namely, the cleanliness of the air that we breathe.

I was not on the planet in 1956, so I do not quite remember. We know from the recent cheating that there is a lot more work to be done on the control of car emissions, which cause a lot of ill health, but some of the progress in that area has come from EU regulation. Problems such as poor air quality and climate change cannot be dealt with by one country alone; we need to work together. In a health sense, we have had massive gains in the past 40 years, but politicians have never talked about that.

The EU has been a great whipping boy. All that the public have heard about the EU in the last 40 years is, “It wasnae my fault; the EU made me do it,” or stories about straight bananas. That is the responsibility of everyone who has had access to a microphone or spoken in this place about the EU. We should not be surprised that when people had the £350 million figure drummed into them by it being on that bus and on the news every night, they would fall for it. The mainstream media have a lot to answer for in not challenging these figures and not asking, “Exactly what is your plan? Exactly where is that money going to come from?” We should not blame people who want extra money for the NHS for wishfully accepting those claims, even when the cracks appeared around the edges.

Part of the problem has been the quality of the debate. Several of my colleagues warned people who believed in remain not just to go for a “Project Fear” type campaign, and I think that running such a campaign was a mistake. People think that “Project Fear” worked in Scotland, but in actual fact Better Together support started, as a percentage, in the mid-60s and fell to 55%. We started at 27%, and we ended up at 45%. “Project Armageddon” clawed back a little bit in the last two weeks, when we were told that the supermarkets would go and the banks would go, and that we would have no money and no food to buy, but a negative campaign of saying that the sky will fall does not lead to success.

Does my hon. Friend agree that difference was that the yes campaign in Scotland came forward with a positive vision to combat “Project Fear”, but that was totally lacking in the EU referendum?

I thank my hon. Friend for that remark. If we had spent more time reminding people honestly of what the EU has brought us, which includes all the people who have been working in our health and social care services, we might have helped them to realise that we have been gainers, not losers.

The hon. Lady is absolutely right in the case that she is setting out. Is not part of the reason why people voted the way they did because they actually wanted to give additional money and resources to an NHS and social care system that has been badly starved of cash? That is particularly true of social care. People have seen their elderly relatives being unable to get the help, the aids and the adaptations that they need in the home, which piles pressure on to the NHS. They wanted the NHS to have that cash.

I totally agree. Of course, we all want the NHS to have more money. It is the United Kingdom’s single most prized possession and creation. The problem is that we did not counter the argument that it was struggling because people from the EU were taking up the appointments and the beds. EU nationals are much more likely to be looking after us than to be standing in front of us in the queue. There is an absolute responsibility on us all, particularly on the missing members of the leave campaign. This is very much a case of a big boy doing it and running away—very, very quickly.

As somebody who was in the leave campaign, I think it is important that we remember that we worked across parties on it, whichever side we were on. In Yorkshire, I worked with colleagues from the Green party, the Labour party and UKIP, although I did not work with the SNP, obviously. It is the responsibility of both camps. I have seen “Project Fear” in both camps.

We need to move on from this now. It is pure economics. If we are pulling out of the EU, as the public have voted to do and as I am personally happy that we are doing, we must make sure that we start talking Britain up; otherwise we will talk ourselves into a recession. Members on both sides of the House need to pull together and talk Britain up. At the end of the day, both sides could have handled this better.

Order. Before the hon. Member for Central Ayrshire (Dr Whitford) answers the intervention, I must remind the House that this debate is not about the EU campaign. We are talking specifically about the NHS. I understand that the hon. Lady was—perfectly reasonably—using examples, but we must not stray any further.

I totally agree. It is just that the paucity of the debate has allowed such an inaccurate figure to endure.

We are where we are. Going forward, we need to look at the realities and what the economy will allow. But there are challenges. I ask the Secretary of State to speak to his colleague in the Home Office and try to deal with the issue of EU nationals working in the NHS. The cost of replacing them with agency staff will be absolutely crippling.

I am pleased to follow the hon. Member for Central Ayrshire (Dr Whitford) and agree with many of her points.

I share concerns expressed about the misleading statements made on the national health service during the EU referendum campaign. Many of my constituents who voted to leave were swayed by the pledge that a future outside the European Union could result in £350 million extra every week being invested in our NHS—and if not £350 million, then £120 million would do very nicely at the moment and make a big difference. Whether they voted leave or remain, people feel very disillusioned with such misleading statements.

The breathtaking speed with which prominent figures from the leave campaign have backtracked on that promise shows how hollow their words really were. People on both sides of the debate are upset and angry about what has happened. They understand that our hospitals, doctors and nurses need better support and more investment. I therefore fully support the motion.

I completely agree with the right hon. Lady that we need more investment, but does she agree that the Government are right to point out that we have invested an extra £8 billion in the NHS already?

If the hon. Lady looks at my constituency she will see a perfect storm when it comes to health funding. We are underfunded in public health, in social care, in primary care and in acute care. She can come up with whatever figure she likes, but the experience on the ground is that we are suffering very badly.

I will come on to talk about the Care Quality Commission report, out today, on our hospital. I do not know whether the hon. Lady has seen it, but if she wants to talk about increased spending, I suggest she look at that report. What it says about what is going on in an acute care hospital is unprecedented.

Two of the prominent leave campaigners who endorsed the £350 million figure are now running to be leader of the Conservative party and our future Prime Minister. Does my right hon. Friend agree that those two people should be brought to this House and made to explain to the country just where they will get the £350 million from?

I absolutely agree. Nothing makes the public feel more disillusioned and separated from the political and democratic process than to be given promises by politicians who, once the public have given their vote to them, walk away from those promises. That is not acceptable.

Does my right hon. Friend accept that as well as the £350 million promise, the issue of access to GP primary care appointments caused a lot of anxiety in many communities? That is the fault not only of the funding situation but of the way in which primary care has been run down in the past six years.

The lack of primary care—particularly in London but also elsewhere—is a key factor behind the huge pressures on our accident and emergency departments and urgent care. No wonder people go there when they cannot get an appointment.

It takes four years to train a nurse and five years to train a doctor, but the divorce proceedings triggered by article 50 will be done in two years. It clearly presents a critical problem for NHS funding if staff leave when the UK leaves the EU.

As we have heard, Brexit will present us with many problems, particularly with health care provision. Not only are we not getting large sums of money, but we will actually be worse off. We will face many challenges because of that decision, and if the promise of £350 million led people to vote in a particular way that will undermine the funding we receive, that is a desperate state of affairs.

People feel badly let down by the leave campaign’s empty pledges on the NHS over the past few months, and residents in Enfield are deeply disenchanted by the Government’s failure to fulfil their recent promises to our local health service. Before the 2010 general election, the then Leader of the Opposition—actually, he was then Prime Minister of the coalition Government—stood outside Chase Farm hospital in my constituency and vowed to protect its A&E and maternity units. By 2013, his Government had shut both departments. Many of us warned at the time that closing Chase Farm’s A&E department would put huge strain on other local health services, including North Middlesex University Hospital NHS Trust, which is the subject of the CQC report that I referred to earlier. We were right, and almost three years since the decision to close Chase Farm’s emergency department, the NHS in Enfield has reached breaking point.

Earlier today the Care Quality Commission published its report into the standard of care at North Middlesex hospital, following a spot check by its inspection team in early April. It found that the closure of Chase Farm’s A&E has led to significant increases in patient numbers attending the emergency department at North Mid. Despite being one of the busiest A&E departments in the country, North Mid’s urgent and emergency services have been graded as “inadequate”, and patient safety has been compromised. Patients who arrive at the emergency department are not seen quickly enough by clinical staff, and they are waiting too long to be seen by a doctor. Some blue-light patients are being brought in, and hard-pressed nurses are dealing with them because no doctor is free to treat them.

My right hon. Friend is making a strong case for her constituents and their hospital. Does she recognise that although the situation she describes at North Middlesex hospital is particularly bad, such things have also been witnessed in many other parts of London, not least in north-west London where the London North West Healthcare NHS Trust has shut an accident and emergency department at Central Middlesex hospital? As a result, there has been a big increase in pressure at Northwick Park hospital, which serves my constituents.

Absolutely. North Middlesex is just the first hospital to reach absolute crisis point, but I am well aware that other hospitals, particularly in outer London, are heading down a similar path and facing real difficulties. If we consider A&E waiting times, we see that hospitals are sliding into that difficult scenario.

Junior doctors and trainees have been left unsupervised in North Middlesex hospital’s A&E department at night, without competent senior support—in fact, no consultant has been available from 11 o’clock onwards. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) referred to such cases. In one instance, one commode was available for 100 patients in the whole of the emergency department. Staff raised concerns about the lack of vital medical equipment, including missing leads for cardiac machines so they could not get an instant read-out. Trolleys in the resuscitation area lacked vital equipment. There was an oppressive, overbearing culture at the hospital that meant staff did not feel confident in raising concerns, and they even stopped reporting incidents of staff shortages, as management had not responded to them in the past.

The CQC report reinforces the findings of Health Education England and the General Medical Council. At a high-risk summit in May, the GMC threatened to withdraw junior doctor post-graduate trainees if the numbers of A&E staff and middle-ranking doctors and consultants were not increased. That would effectively close the busiest emergency department in London. This is an unprecedented situation. The future of North Mid A&E has been put at risk. Even medical trainees at the hospital are not prepared to recommend the A&E for treatment to their friends and family. In interviews with Health Education England, they said that that was

“because they felt the department was unsafe.”

My constituents have had to suffer the consequences of shocking mismanagement and a lack of leadership at North Mid. The chief executive is now on leave and I understand she is stepping down. Although there is a lack of leadership, she cannot be held solely responsible for what has happened. The Prime Minister and the Health Secretary have told us repeatedly that the NHS is safe in their hands, yet huge pressures have been placed upon North Mid due to a lack of central Government funding. Patient care has suffered further as a direct result of the hospital not having enough equipment, consultants, doctors and nurses. It has had to spend large parts of its budget on locums and agency nurses.

What is the Government’s solution to ensuring that hospital departments, such as those at North Mid, do not remain dangerously understaffed? Is it to divert a large amount of funding to help to solve this situation and put patients first? No: they decide to go to war with junior doctors over their contracts and abolish NHS bursaries for student nurses, while we have hospitals going abroad to try to recruit staff. That is an insult to dedicated professionals who deserve our admiration, respect and support. The Government’s actions will discourage the future frontline staff we so desperately need.

The NHS is facing a huge financial challenge, so a commitment to spend an extra £350 million a week, or even £120 million a week, on the NHS in lieu of our EU membership was clearly a very attractive offer to our constituents. NHS England needs to plug a funding gap of £30 billion a year by 2021 and a few months ago it was revealed that nearly every hospital in the country was in deficit. We are obviously not going to get £350 million or £120 million a week and I think that that was always known by the leave campaigners. In fact, the Government are seeking to suck out £5 billion in savings through the sustainability and transformation programme. I know that savings and efficiencies, particularly in back-office services, can and must be found, but not at the expense of patient safety.

My hon. Friend the Member for Lewisham East (Heidi Alexander), the former shadow Health Secretary, warned that the scale of savings required could

“not be delivered without putting patient care at risk… These ‘efficiencies’ will mean cuts to staff, cuts to pay, rationing of treatments. And it will be patients who suffer.”

Her analysis is spot on. We have witnessed the disastrous effects of this course of action in Enfield. We need more investment in North Middlesex University hospital, and in the NHS in general, not less. I join my parliamentary colleagues on the Labour Benches in calling on the Government to increase spending on our NHS. It is most regrettable that, given the urgent need for more funding and the very real and justifiable concerns of people in Enfield, they should have been led to believe Brexit could possibly mean major new funding for the NHS.

In closing, I think I corrected myself wrongly. In the run-in to the 2010 general election, the current Prime Minister was, of course, the Leader of the Opposition, and he made a promise to keep our hospital open, which, when he became Prime Minister, he then closed. That kind of behaviour is very similar to what the leave campaigners did in promising money that does not really exist. It is hoodwinking the voter and it is not acceptable. It desperately undermines the voters’ faith in politics and democratic processes.

Before I begin, may I apologise to you, Madam Deputy Speaker, and the House authorities for posting a picture of this Chamber on the popular social media and networking site Twitter? Its purpose—it has now been removed—was purely to demonstrate that, at the point of taking the picture, only two Conservative MPs were in the Chamber and both were Ministers. The other point I would like to make before moving on is how much, as a bereft supporter of the English national football side, I am looking forward to cheering on Wales in what I hope will be a victory against Portugal this evening.

The Cumbrian health economy is experiencing the most prolonged period of intense pressure, strain and threat that it has ever faced.

Order. Before the hon. Gentleman gets into the body of his speech—I do not want to interrupt his argument—I want to thank him for the point he made and for his immediate action in removing the picture that he had tweeted. For the avoidance of doubt, it is simply not allowed, but as soon as he realised that he had done something that was not allowed, he acted immediately, and I thank him for doing so.

That is greatly appreciated, Madam Deputy Speaker.

Despite the dedicated and incredible efforts of local NHS staff in my constituency, I see health inequalities on a daily basis, and many of my constituents experience profound access challenges to health services in my constituency and elsewhere across Cumbria, caused in part by our inadequate transport infrastructure, but also by a clearly insufficient profile of investment in local services. So far, I am afraid to say, my calls for improvement have fallen upon deaf ears.

In north and west as well as east Cumbria, we are currently subject to the ongoing success regime process. Funding for the important second phase of the West Cumberland hospital has not yet been released by the Government, and the communities I represent are gravely concerned about the uncertain future facing our local health services, including beds not just at the West Cumberland, but at our local community hospitals in Keswick, Millom, Maryport and elsewhere—and that is before we even consider the profound challenges to primary care, too.

In spite of the challenges that we face and the strength of feeling in my constituency, the Health Secretary, who is no longer in his place, has paid not one visit to the West Cumberland hospital, or any of our community hospitals on whose behalf I speak tonight, in the four years in which he has held his position. Moreover, he has refused my invitation to visit West Cumbria to see for himself the unique challenges that we face in our part of the world. Without visiting the hospital, experiencing the transport inadequacies and seeing the vital work of consultant-led accident and emergency, maternity and paediatric services that the West Cumberland hospital provides, the Health Secretary cannot and does not understand the necessity for his immediate intervention in our troubled health economy.

Most recently, owing to the fact that the Health Secretary would not come to us, my constituents and I—health campaigners from across the piece—decided to go to him. West Cumbrian health campaigners, including Mike Bulman, Mahesh Dhebar, Rachel Holliday, Siobhan Gearing and the fantastic Pamela McGowan from the News & Star newspaper, planned to make a 700 mile round trip to London to meet the Health Secretary, to outline the challenges that our health economy faces and to put our case to him. However, at short notice, but coincidentally on the day after he announced his ambition to stand as leader of the Conservative party, the Health Secretary cancelled the meeting. The decision to cancel that meeting was seen by my community as the calculated insult that I am afraid it surely was.

I led the local campaigners instead to the Department of Health to meet the gracious and approachable Under-Secretary responsible for care quality—the Minister in his place today. The delegation handed to him a confidential document containing the cases given to local campaigners by local mothers about babies who were likely to have suffered fatalities—and maternal fatalities, too—if consultant-led maternity services had been unavailable at the West Cumberland hospital in Whitehaven. The Government are well aware that consultant-led maternity services at that hospital are non-negotiable and absolutely essential—whatever the successor regime that comes forward in the immediate future. Any other option would compromise the safety of local mothers and their babies.

It is clear to me, to my community and to Simon Stevens, the chief executive of the NHS, who visited my constituency only a few months ago, that consultant-led services must be retained and improved at West Cumberland hospital. Removing those services from Whitehaven would be dangerous—

The debate stood adjourned (Standing Order No. 9(3)).

Motion made, and Question put forthwith (Standing Order No. 41A(3)),

That at this day’s sitting the Motions in the name of the Leader of the Opposition may be proceeded with, though opposed, until 8.00pm; and Standing Order No. 41A (Deferred divisions) shall not apply.—(Charlie Elphicke.)

Question agreed to.

As I was saying, the removal of those consultant-led maternity services would actively undermine the principle of a truly national health service, and will never be accepted by me or by my community. I am therefore deeply concerned by a recent report, based on a leaked e-mail, which suggests that the success regime is indeed considering the removal of maternity services from Whitehaven as one of the options on which it wishes to consult. That is appalling. If the success regime turns out to be a Trojan horse initiated by the Government to slash budgets and remove services, I have just one message to send to the Government today: my community will never accept that, and cannot and will never forgive it.

There is no doubt that consultant-led maternity services are what west Cumbrian women and their families need, want and deserve. Removing those services from the remotest constituency from Westminster in England, in terms of accessibility, would be not only unsafe, but without precedent in our country. It is clear that this move is being driven by the Government’s determination to cut costs, and not by the safety of mothers and babies.

My community now calls on the Government and those responsible for the success regime to make the immediate, clear and unequivocal commitment to consultant-led maternity services at West Cumberland hospital—and other services—that communities in west Cumbria deserve. Without a clear commitment to our consultant-led services, including a fully functioning consultant-led maternity service at West Cumberland hospital, it will be impossible for us to support the work of the success regime in the future.

I have since urged the entire community of west Cumbria to join me, and our local campaigners, in fighting any proposals to remove essential consultant-led services from West Cumberland hospital. We are a community of campaigners, patients, families and NHS staff, united in our commitment to our local national health service, and we are determined to build a 21st century health economy, equipped to overcome the challenges that we face in my incredibly rural constituency. We will not allow the Government, by any means, to strip away our services, leaving a threadbare health service, unfit for purpose, to future generations in the community of west Cumbria. My community is determined; what we are missing is the immediate commitment, support and investment from the Government that we so clearly require.

Just two weeks ago the country voted to leave the European Union, and I regret that. Many of those voters, including a large number of my constituents, voted on the basis of their belief that a Brexit vote would result in an extra £350 million per week for the NHS. Since that vote, prominent members of the leave campaign have been quick to renege on a key promise that swung so many people behind their prospectus. As we observe the Conservative leadership contest, it appears likely that those prominent campaigners will wash their hands of the responsibility of delivering on the commitments that they made. In communities like mine, where people voted in the belief that their vote would help to fund the investments that we need in our health services, that is an unforgivable betrayal.

Now is the time for the Government to fulfil their responsibility to provide a truly national health service. My community needs and deserves no less than an immediate intervention to ensure the release of funding for the second phase of the redevelopment of West Cumberland hospital and a commitment to the retention and improvement of consultant-led services, including accident and emergency, maternity and paediatric services. We also require a commitment to the retention of beds at our community hospitals. Brexit campaigners in the Government, especially those who aspire to be not just the next leader of the Conservative party but the next leader of our country, have a particular responsibility to stand before the House and the country, and explain to all the people whom they knowingly deceived why they did it, where the money is coming from, and what they are going to do about it.

I want to begin by speaking about the NHS as experienced by my constituents. Getting an appointment to see a GP can be very difficult because recruitment of doctors in Burnley and Padiham is an enormous problem and many posts remain unfilled. This is not a temporary situation; this is how it is all the time.

The fact is staff do their best, but they are not magicians. Too often patients requesting an appointment are told to phone back the following day at 8.30 am and hope for a cancellation, and heaven forbid that a patient should want to have some continuity of care. This is especially difficult for the elderly and those suffering with mental illness. I tell the Minister that they really need to see a familiar face, and to have access to a GP with whom they have an established rapport. Sadly, they are denied this.

Unplanned admissions to hospital are also difficult. Patients often wait for hours on trolleys in cubicles and draughty corridors until a bed is available. This bed queue is the direct result of the fact that there is a shocking shortage of quality support for the elderly and mentally ill in need of care in the community.

The elderly and mentally ill really do bear the brunt of an NHS in crisis. Every week in my surgery I hear of their suffering at the hands of a poorly resourced and inadequately staffed NHS. One lady told me only a couple of days ago that she took her daughter, who is self-harming and threatening to hang herself, to the mental health crisis unit. The unit was so busy that she had to wait 23 hours for a diagnosis, after which it was decided that she needed to be sectioned and admitted. For the next four days, because no bed was available, she slept in an easy-chair. At that point a bed was found in Potters Bar, London. The family of this lady, including her five-year-old daughter, live in Burnley, at a distance of over 200 miles. They cannot afford the train journey to visit her.

I mention all of this not as a criticism of any of our NHS workers—far from it; they are at the sharp end doing their best in an impossible situation. They work in the health service because they care, and it pains them to see patients treated in this way. I mention all of this, none of which is untypical, because it is this misery that the Brexit campaign spoke to.

The leading Brexiteers, who have been mentioned in this place already today, played out the most cruel deception. They promised in their campaign that if the UK left Europe the NHS would receive a funding boost of £350 million per week. This untruth—that is what it was—was not a mistake or a miscalculation, although it was totally reprehensible; it was a deliberate attempt to deceive the British public. When deception of this magnitude is peddled by senior people, some of them Government members, who could blame people for believing that they would get a better NHS outside Europe?

Only hours after the referendum result was known the Brexit camp withdrew this promise of extra NHS funding because, of course, the fact is that it is this Conservative Government who starve the NHS of funding, not the EU.

Throughout this referendum campaign, there were numerous times when the campaigns were deceitful. There were numerous times when things that could not be promised were promised. Today, the Vote Leave official Twitter page still has a headline that says:

“We send the EU £350 million a week. Let’s fund our NHS instead.”

That is still on the Vote Leave Twitter page. In fact, they have not posted since the 23rd; I think they have screwed things up and run away.

I was a bit surprised that the Labour party’s motion did not mention the right hon. Member for Birmingham, Edgbaston (Ms Stuart), because when I looked up the £350 million claim, the first quote that came up was:

“Every week we send £350 million to Brussels. I’d rather that we control how to spend that money, and if I had that control I would spend it on the NHS.”

That was said by the right hon. Lady, and it was patently untrue.

BBC Radio 4’s “More or Less” looked at the statistics. For anyone who does not listen to the programme, I should say that it is rather excellent and tends to debunk what politicians say on a regular basis. It does not usually say something is actually false, however; it will say “It’s not quite right.” But with this claim, it said that it was false.

I hear what the hon. Lady says about my right hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), but she is not in the Government so does not have the power to transfer that money to the NHS budget, unlike those on the Conservative Benches. Does the hon. Lady agree?

I agree that the right hon. Member for Birmingham, Edgbaston is not in the Government, but she was in the Vote Leave campaign and made those promises.

Going back to “More or Less”, Tim Harford said:

“If we left the EU we wouldn’t have an extra £350 million to spend on the NHS.”

He also talked about the amount of money that we pay to the EU in comparison with the amount that comes back and said that the

“rebate is about £85 million a week. Unless you think we’d continue to get the EU rebate after we left the EU, it’s impossible to make the claim that there would be £350 million a week to spend on the NHS.”

He went on to say:

“We reckon that in the year 2014 the UK paid £280 million a week to the EU and received back £90 million a week in contributions to farmers and poorer regions and another £50 million in spending on British companies.”

Therefore, the most that could possibly have been available is £140 million, and there was no way that anybody in the leave campaign was ever going to spend all that money on the NHS.

It is not unusual, however, for people to be disingenuous. The people of Scotland are actually quite used to people telling untruths during referendums. The article below the now-famous headline, “The Vow”, stated:

“People want to see change.”

Well, they certainly delivered that. The article also said:

“We will honour those principles and values not only before the referendum but after.”

Ruth Davidson, leader of the Conservative party in Scotland, said on 2 September 2014:

“No means we stay in”

the EU. The Conservatives have completely failed to deliver on the promise they made to the people of Scotland. They are trying to drag Scotland out of the EU against our will.

This Conservative Government have a terrible record of making disastrous pledges, mostly because I think they did not expect to have a majority. They thought that they could write anything they wanted into their manifesto and then backslide on it because they were not going to have a majority. They had the fiscal charter, which was disastrous and condemned us to austerity. They had the removal of the subsidy for onshore wind, which was also disastrous. They had the pledge to have an EU referendum and they thought that they could avoid that one because they would not get a majority, but now look at what has happened.

There was also the disastrous, awful, horrendous migration cap. I am faced with constituents most weeks who sit in my office and explain to me what they do for their community and the work that they do in local government or the NHS. They talk about their volunteering and say to me, “Why does this Government want to send me back to another country?” The only answer that I can possibly give them is that this Government signed up to a migration cap and are therefore trying to reduce the number of people here based not on how hard they work, how much they give to their community or how much they put into NHS services, for example, but on trying to reduce the headcount. The Government’s behaviour is absolutely ridiculous.

What does that mean for the future of political campaigning? People across the UK are looking at the pledges, such as the one that is still on the Vote Leave Twitter page saying that £350 million should be spent on the NHS, and their trust in politics and politicians is being eroded further than ever before. If we want to try to bring things back, we are going to have to work incredibly hard and be incredibly truthful. Our campaigning is going to have to be incredibly positive. The fear factor inspires nobody, and we are losing the trust of so much of the population. They do not believe what we say because we constantly present them with fear, which is not good.

The Health Secretary spoke earlier about having to be careful in what he said in case he further damaged the British economy. He did not want to talk down the economy, which I understand, but I hope that that does not mean that the Conservative Government will refuse to be positive about the benefits of migration. The people who come to this country to work in our NHS and in other services provide a huge economic benefit to the UK as a whole and Scotland in particular. It is important to our country’s economy that people are willing to come here. If the Government are scared about damaging the economy and their ability to use people as bargaining chips and are unwilling to talk about the benefits to the British economy of migration, that is a major issue. Things are bad enough already; we do not want to make them any worse.

I want to mention a few other things that people have said. The hon. Member for Uxbridge and South Ruislip (Boris Johnson) said that people would value NHS services more if they had to pay for them. He then said that the £350 million should go to the NHS. Those two things are mutually incompatible. It is a shame that such points were not highlighted a bit more during the campaign.

So many Westminster Governments over so many years, and indeed decades, have been unwilling to do anything other than take part in short-term politics, focusing on what will be of benefit in the next five years in order to try to win elections. The NHS is a prime example, because some of the health measures put in place by the Conservative Government avoid touching on some of the thorniest issues. For example, breast feeding counselling and support, access to which is being reduced, costs money now but will result in a financial benefit—a return to the Treasury—many years later. It would be good if the Government were willing to take such decisions, which may mean they have a smaller budget now, in order to give people health benefits in 20 years’ time.

Earlier this week we had the main debate on the estimates. NHS and health budgets regularly go against HM Treasury guidance by transferring capital to revenue spend, which other Departments are not allowed to do. What I want to know is why that money is not being spent on capital projects. What capital projects on which the money should be spent are being avoided? Why are the Government not funding the NHS revenue spend to the levels they should be? Why does the NHS have to make these transfers between capital and revenue, rather than being adequately funded?

Madam Deputy Speaker, thank you for your indulgence in allowing me to speak in this debate. I really appreciate it.

The Public Accounts Committee, of which I am a member, has published seven reports since January on the workings of the Department of Health, including on diabetes, the cancer drugs fund, services for people with neurological conditions, access to GP services, acute hospital trusts, NHS clinical staff and personal budgets in social care. We have had two further hearings, for reports yet to be published, on discharging older people from hospital and specialised services.

I recommend those reports to those on the Government Front Bench—I have a few copies with me, just in case they do not wish to watch the football tonight. Taken together, they paint a bleak picture of a system under immense pressure, with commitments undelivered, a massive increase in complexity as a result of the Health and Social Care Act 2012 and, above all for the Public Accounts Committee, continuing poor data upon which to make decisions and manage performance, as well as a complete lack of clarity about accountability for delivery on the areas we have investigated.

The concerns outlined in our reports include: on staffing, that trusts have been set unrealistic efficiency targets, and that the shortage of nurses is expected to continue for the next three years; on funding, that the financial performance of trusts has deteriorated sharply, and that this trend is not sustainable; and that the data used to estimate trusts’ potential cost savings targets are seriously flawed.

Northern Lincolnshire and Goole NHS Foundation Trust has only just been taken out of special measures, but last week’s Care Quality Commission report highlights a concerning dip in standards at Diana, Princess of Wales hospital. The bosses have said that that is because they struggled to recruit quality staff. Does my hon. Friend agree that removing the NHS nursing bursary is long-term pain for short-term gain?

I agree with my hon. Friend. In fact, one of the reports I have with me is the one we published in December about the work of the Care Quality Commission and some of the concerns that have already been issued about the work it does to uncover issues such as the ones she has highlighted in her constituency.

Does my hon. Friend agree that a worrying number of trusts are now in deficit, whereas 10 years ago they were simply bubbling along well—in fact, they were getting more money for their budgets? Even for North Middlesex hospital, which we have heard about extensively tonight, the situation is increasingly worrying, as it is now in deficit for the first time in 10 years.

I agree and I will talk about some of the issues with trusts.

Hon. Members have provided examples that highlight our concerns about how the Department is managing to do what Parliament intended with the funds voted to it. They highlight the importance of giving the Public Accounts Committee and Parliament the opportunity to review the departmental accounts properly.

The Department of Health annual accounts cover more than 20 arm’s-length bodies and delivery partners, not only NHS England, but the Care Quality Commission, NHS Improvement, the National Institute for Health and Care Excellence, the Human Tissue Authority, Health Education England, the NHS Litigation Authority and—one of my and, I am sure, many hon. Members’ favourite organisations—NHS Property Services Ltd.

Within NHS England, NHS trusts reported a record deficit of £2.45 billion in 2015-16—almost £500 million worse than planned, and triple the size of the 2014-15 deficit. As my hon. Friend the Member for Hornsey and Wood Green (Catherine West) said, a record 121 out of 138 acute trusts ended 2015-16 in deficit. Analysis by the King’s Fund and the Health Foundation has challenged the Secretary of State’s claim that, in the 2016-17 Budget, the NHS will receive the sixth biggest funding increase in its history. The chief economist at the King’s Fund concluded that this year’s total real spend increase of 1.6% is the 28th largest increase since 1975-76.

The Health Foundation noted:

“The health budget has been protected from cuts but spending growth is substantially below the growing pressures on the service…In exchange for this protection, the NHS has been asked to absorb these pressures through improved efficiency. There are opportunities to improve the efficiency and effectiveness of the NHS but realising these savings is proving to be a huge challenge—particularly against a backdrop of staffing shortage.”

Given the size of the trust deficit and the implications for the budget of NHS England, which takes up by far the greatest part of the Department’s budget, there are widespread concerns about how the Department might stay within its departmental expenditure limit. Failure to do so would be an exceptional breach of control. As my friend, the hon. Member for Aberdeen North (Kirsty Blackman) said, there are issues about the way in which capital has been transferred to revenue and so on.

The Public Accounts Committee understands that the accounts will be available before the recess—perhaps next week, which would be very welcome. We need to look at not only NHS England’s spend, but that of the other 20 or so bodies that make up the Department of Health. I know that you, Madam Deputy Speaker, and Parliament will take a dim view if the Department’s accounts are not subject to proper scrutiny when the Committee, which had some additional training this year to review the accounts, is ready to undertake such scrutiny.

In addition to my concerns about last year’s accounts and this year’s departmental budget, I believe that Brexit now poses huge risks. My major concerns are about staffing, procurement and medicines, but there are many others. In my NHS career as a non-executive director on a trust board and as a manager, I read and indeed compiled many a risk register. It is truly a joyful task. The Department requires all its bodies to identify, assess and mitigate risks. As anyone in any business knows, risk registers are an essential part of the planning process. Few if any risks to business could be greater than Brexit. I would expect the Department to have a robust Department-wide risk assessment process, and I would expect it to include Brexit.

Yesterday at Health questions, I asked what was being done across the Department, including the NHS, to assess and mitigate the risks to its current year budget of Brexit’s huge impact on staffing, procurement and medicines. I received a far from satisfactory reply—although he tried to be helpful—from the Under-Secretary of State for Life Sciences. I therefore pose three key questions to Ministers: what are the risks of Brexit that the Department must surely have already identified through its risk register or by other means? How are they to be mitigated? When will they be debated and discussed in Parliament?

It is a pleasure to follow my hon. Friend the Member for Bristol South (Karin Smyth). I will be unashamedly parochial and pursue the point that I made in an intervention on the Secretary of State about the future finances of the Harrow clinical commissioning group and the London North West Healthcare NHS Trust. It includes Northwick Park hospital, which serves my constituents. I should declare an interest in that I have been operated on and indeed members of my family have been born at Northwick Park hospital, with which I therefore have a particular affinity, as do my constituents.

My hon. Friend is right to remain parochial and focused on his hospital. One of the scandals of North Middlesex is that all the local MPs have been kept in the dark about all the serious faults that were known to the hospital and to NHS officials. None of that was shared with the local MPs.

My right hon. Friend made a very powerful speech about North Middlesex hospital. I am pleased to say that I have a positive relationship with the managers at North West London Hospitals Trust as they have always made themselves open and available to answer my questions. I hope that they will read Hansard and see my right hon. Friend’s warning in relation to the difficulties that she has had with previous managers at North Middlesex hospital and will do even more to provide transparency in our area.

Let me talk now about my concerns about the finances at Northwick Park. Back in 2014-15, North West London Hospitals Trust had a deficit of some £55.9 million. That had risen to £100 million by the beginning of this financial year. The trust management board is optimistic that it can get that deficit down over the course of the next financial year to just over £88 million, which is an enormous sum in its own right and will, if that figure is achieved, still be without question one of the biggest deficits in the NHS in England. To achieve that target, it has committed to axe 140 posts. My concern, and the concern of many of my constituents, is that services at Northwick Park and indeed in other parts of the trust will be affected despite the intentions of the management.

The situation at Northwick Park has been compounded by the decision to close a number of accident and emergency departments in north-west London in recent years. In particular, the decision to close Central Middlesex hospital has undoubtedly had an impact, increasing the pressure on the services at Northwick Park hospital. Although it was great to see some new investment at Northwick Park—we now have an upgraded accident and emergency department—no extra beds were created in the hospital, which is a major concern.

I recognise that time is a concern, so let me underline my last point, which is about the funding of Harrow clinical commissioning group. In the past three years for which parliamentary figures were available, it has received the lowest funding of any London CCG. The Secretary of State was very generous in offering to go away and review that situation. I ask the Minister who is due to reply to this debate whether he would be willing to receive a deputation of local general practitioners and me to discuss the funding of Harrow CCG, which is one of the causes of the difficult financial situation at Northwick Park hospital that serves my constituents.

In what has been a hugely significant day in a monumentally significant fortnight, we have been discussing issues that are also of huge significance, but I fear that the contributions will be lost amid the historic nature of the events are currently engulfing this place and the whole country.

Let me turn now to the contributions to this debate. The hon. Member for Central Ayrshire (Dr Whitford) rightly highlighted the uncertainty now facing our staff who have come from the EU. There is also a very real fear that agency costs will go through the roof as a result of the decision that has been made.

My right hon. Friend the Member for Enfield North (Joan Ryan) spoke with graphic clarity about the problems that a lack of funding has caused the health services in her own constituency. She also pointed to the promises to protect local services that have not been honoured. She talked about the scandal of junior doctors left unsupervised in the North Middlesex hospital A&E. I know that she has a debate in Westminster Hall on that issue next week, and I am sure that some of the matters that have been raised today will get a further examination then.

My hon. Friend the Member for Copeland (Mr Reed), who, as my predecessor in this shadow role, has great knowledge of this area, spoke passionately about the challenges that his community faces in delivering an effective health economy. He is right to be concerned that the success regime could indeed turn out to be a Trojan horse.

My hon. Friend the Member for Burnley (Julie Cooper) gave a personal and troubling story about a recent case involving one of her constituents. I agree with the hon. Member for Aberdeen North (Kirsty Blackman) that all of us as politicians will have to work much harder to restore and retain trust in what we say. My hon. Friend the Member for Bristol South (Karin Smyth) spoke with the benefit of her own great experience of the NHS and her more recent experiences as a member of the Public Accounts Committee and the many critical reports it has written. I assure her that I have already considered many of them, so I trust I have her permission to watch the football later.

Finally, my hon. Friend the Member for Harrow West (Mr Thomas) spoke with great authority about the difficulties of his own local NHS trust. I think every Member who has spoken tonight has mentioned challenges in their own constituency, but more significant is the fact that every Member who has spoken tonight said that at least some of their constituents voted to leave the EU because they thought it would mean more money for the NHS.

Those are the Members who have spoken. Who have we not heard from? Where are the right hon. and hon. Members who have spent the last few months spearheading the campaign up and down the country claiming that there was £350 million a week just sitting there, ready to be spent on the NHS. Could it be that because it was a promise that could never be kept and should never have been made, we have seen a collective abrogation of responsibility by people who, frankly, should know better? Make no mistake: those who have associated themselves with such claims will be expected to account for their actions, but let us not allow those wild statements to distract us from the crisis in the NHS caused by this Government.

The challenges we already face in the finances, quality of care and the workforce put the NHS in a precarious position, but be in no doubt: those challenges were there before we voted to leave the EU. It has been clear for some time that the NHS does not have the resources needed to deliver the services that people expect. Only this week, we have heard where the Government’s priorities appear to be, with the Chancellor talking about reducing corporation tax yet again. Is it not interesting that we only hear such extra-parliamentary statements about tax cuts, and not about the extra investment that the NHS patently needs? Indeed, the Chancellor’s last big spending decision on the NHS was to cut £1.1 billion from this year’s capital budget, which came to light only after a study by the House of Commons Library—an approach about as far removed from parading impossible pledges on the side of a bus as I can imagine, but to my mind just as dishonourable.

As we know, the overall deficit in the NHS last year was a record £2.5 billion—a record deficit despite pledges from the Government that the investment needed would be front-loaded now to ensure that the NHS could implement the service transformation needed before the middle years of this Parliament, when the funding increases already announced for the NHS are microscopic. What will the NHS look like a few years down the line if the money that is supposed to be preparing us for the rocky road ahead will in fact be used to plug the black hole in finances left over from the last year? Surely, whatever the implications of the referendum result, the Government must recognise that their existing financial plan for the NHS needs comprehensive re-evaluation.

Only yesterday, we had a report from the Healthcare Financial Management Association that revealed that 22% of the NHS finance directors in hospitals and CCGs surveyed said that quality of care will worsen during this financial year. It does not end there: one in three finance directors fear that care will deteriorate in the next financial year. They warn that waiting times, access to services and the range of services offered are all likely to suffer because of the inadequate funding settlement. I know the Minister will try to reassure us that plans are in place to put the NHS back on an even keel, but I suggest that he listen to the 67% of CCG finance officers and 48% of trust finance directors who have said that there is a “high degree of risk” associated with achieving their organisation’s financial plans for this year.

In addition, only 16% of finance directors have expressed confidence that NHS organisations in their area will be able to deliver the changes required by their local sustainability and transformation plans. Along with the challenges they anticipate in delivering planned efficiencies, finance directors say that continued high spending on agency staff and inadequate funding of social care are pressures that are not going away. As my hon. Friend the Member for Bristol South mentioned, the Minister will be aware of what the Public Accounts Committee said: that the 4% annual efficiency targets imposed are

“unrealistic and have caused long-term damage”.

None of that will be news to the Minister. It is high time the Government acknowledged that within the current parameters, hard-working NHS staff are being set up to fail.

Across a whole range of indicators, the NHS is experiencing its worst performance since records began, but let me be clear: I do not for a second hold the people who work on the frontline in the NHS responsible for that. Indeed, it is only through their dedication that the health service keeps going, despite the best efforts of the Government to destroy staff morale. Be it the current generation of junior doctors alienated by botched contract discussions, the next generation of nurses deterred from entering the profession by tuition fees, or the thousands of EU nationals working in the NHS who fear for their future in this country, existing staff, who are at breaking point, see nothing from the Government that gives them confidence that the Government have a clue how to fix this mess.

Let us once and for all nail the myth propounded by Government Members that this Government have been generous in their funding for the NHS. The King’s Fund and the Health Foundation looked into this claim. Despite the oft-repeated mantra that this year’s funding increase is the sixth largest in the NHS’s history, they said:

“We find that…this year it is in fact the 28th largest funding increase since 1975”.

That is the truth. That is the cruel deception at the heart of the Government’s NHS plans.

NHS Providers, the organisation that represents NHS trusts, had this to say about the size of the deficit:

“the combination of increasing demand and the longest and deepest financial squeeze in NHS history is maxing out the health service”.

The fact is that the NHS is halfway through its most austere decade ever. It is getting a smaller increase this year than it got in any single year of the last Labour Government. Since the health service’s creation in 1948, NHS demand and costs have risen by 3.5% to 4% a year, and on average funding has kept pace. Now funding will rise, on average, by only 0.9% a year between 2010 and 2020. That is a quarter of the historical average, and well below what is needed to provide the same quality of service to a growing, older population.

I return to my opening remarks. It has been a seismic few weeks for this country. Politicians have been exposed as cavalier with the facts, cynical in their actions and irresponsible about the future of this country. Let us not allow that approach to continue to pollute our politics. Let us have the courage to be honest about the challenges that lie ahead. Let us stop the pretence that the NHS can continue to be the service that most of us want it to be within current Government spending limits.

Let us also be clear that the answer is not to emblazon buses with cheap slogans and then run away from those slogans at the first opportunity. Instead, the challenge for all of us in this place who want the next generation to enjoy the same access to the NHS that my generation has taken for granted is to provide a coherent, credible set of policies and then actually deliver them. On that measure, this Government have fundamentally failed. I therefore commend the motion to the House.

First, may I apologise to the House for not being here at the beginning of the debate? I did, however, see the contributions of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who set up a powerful case in support of the Opposition’s motion, and of the hon. Member for Central Ayrshire (Dr Whitford).

I would not dispute the motion’s central contention. We have just had an enormous public debate—as the hon. Member for Ellesmere Port and Neston (Justin Madders) made clear, a debate of a magnitude that this nation has not seen for decades. A central claim in that debate—a claim on which the referendum hinged—was that there would be an additional £350 million for the NHS to spend every week, were we to withdraw from the European Union. To be very clear about that claim, it is not one that any Member who supported Vote Leave can run away from. It was emblazoned not just on the bus, but in even more explicit language on a poster, which said:

“Let’s give our NHS the £350 million”—

not “some of” or “a part of”, but “the” £350 million—

“the EU takes every week”.

Members will know my position in this debate. It is not my purpose to revisit the arguments for one side or the other, but Members on both sides of the House, of this great debate and of the referendum campaign have a duty to hold to account the people who made those claims, because the referendum was won partly on the basis of them, and people will expect results.

I would like to put on record the nature of our contribution to the European Union every week, so we can be clear not about the claims, but about the facts. The simple fact is that it is wrong to take one year’s contribution as typical, because our contribution varies from year to year. Over the past four years, our gross contribution has in fact been £313 million a week. If we were to deduct the rebate, which is £69 million a week, and public and private sector receipts, which are a further £108 million a week, our net contribution per week is actually £136 million, worked out on a rolling average from 2010 to 2014. I would therefore suggest to those on both sides of the House, and on both sides of the campaign, that the figure needs to be challenged and challenged again.

Any money that might or might not be coming to the NHS needs to be seen within the framework of that claim. It is important for us at this stage not to move away from the claims made in the great referendum campaign. It is important that we bring the country together, but that does not mean that we should not bring some sort of scrutiny to those claims over the next few years, when the effects of Brexit will be played out and when our constituents will feel those effects in their pockets and in the security of their families, although some will say that that will be to the positive and others to the negative.

In the next few years, we will have to take consistent measures to bring scrutiny to the claims that were made. However, it is not just the money that is important in terms of Brexit. I, too, am concerned that we bring scrutiny to bear on the other issues facing healthcare, whether the regulation of medicines, research funding—universities have expressed real concern about that in just the past couple of days—or workforce supply. In that respect, I would like to reiterate the support that my right hon. Friend the Secretary of State for Health expressed for the migrant workers who have come to this country to serve our NHS. Many of them provide skills we cannot provide in our own country, and their dedication to our national health service is equal to that shown by those serving it who were born in this country, and I would like to personally thank them for their contribution and service.

On that issue, I think we can have some agreement across the House. Where, I am afraid, I part company from Opposition Members, however, is on their comments about the claim that was made by Vote Leave—as the hon. Member for Aberdeen North (Kirsty Blackman) made clear, it was also made by Labour Members of Parliament. That claim has not been made by Her Majesty’s Government; nor is it one that can be attached to the Department of Health.

In addition, it has been said that the money released by Brexit, even if it were to materialise, would be backfilling what the Opposition claim to be a deficit in NHS funding. That description could not be further from the truth, and I would advise Opposition Members to look at the OECD’s latest figures, which were released earlier this week. They clearly demonstrate that healthcare funding in this country is now just above the average for the EU15. It has moved up from being below average, and we are now achieving parity with countries such as Spain, which has a fantastic healthcare system that is much admired around the world, and indeed Finland. Given that position, we should surely praise this Government and the previous coalition Government, who protected healthcare funding, even when the Labour party suggested we do the opposite.

In 2010, the Prime Minister said healthcare funding would be protected, even though the Labour Chancellor of the Exchequer before the 2010 election suggested it should be cut. Under this Secretary of State and this Prime Minister, NHS spending has undergone its sixth biggest rise in the history of the NHS, despite the fact that we have been contending with the biggest financial crisis this country has faced in its peacetime history since the great depression in the 1930s. The financial environment of the NHS therefore bears positive scrutiny, compared with the situation in other leading countries in the European Union and with the history of Government funding for the NHS. Of that, the Conservative party is justly proud.

That does not mean, however, that there are no pressures within the NHS. I would like to pick up on some of the comments made by hon. Members, which I know they have made earnestly because they care very much for their local health systems. The hon. Member for Copeland (Mr Reed), who is a doughty campaigner for West Cumberland hospital and for healthcare provision in his area, knows that I will meet him again and again—I hope, soon, in Cumbria—to discuss the issues that he has in his locality. We are a receptive ear, but we must always pay attention to clinical advice as it pertains to his local area and not to the political exigencies that might exist. Rightly, we have removed political decision making from the disposition of services. That is precisely why the reconfigurations in the constituency of the right hon. Member for Enfield North (Joan Ryan) took place. It is always easy in government to try to make political decisions on matters that should be the preserve of clinicians, but that is the wrong thing to do, because one makes decisions for reasons of political expediency rather than clinical reasons. That is why we rely on the success regime in the hon. Gentleman’s constituency and in the whole of Cumbria, as we do in other parts of the country, to provide a clinical consensus and the arguments for change that local clinicians will wish to see.

The hon. Member for Bristol South (Karin Smyth) has an expertise unrivalled in this House in the management of finances at a local area level. She is right to say that Brexit poses particular problems for staffing of NHS and social care services, procurement and medicines. As a member of the Public Accounts Committee, she has provided very good criticism of how the NHS has been running its finances, which has not been good enough over the past five, 10 or 15 years—indeed, for many years. This Secretary of State and this team are doing a great deal to correct that. She is right, for instance, to point out that NHS Property Services has not worked as well as it should have done in the past. I hope that in the months and years ahead she will see reforms that give her greater pleasure than dealing with NHS Property Services gave her in her previous role.

The hon. Member for Harrow West (Mr Thomas) described the problems at his local hospital, as did the right hon. Member for Enfield North in relation to North Middlesex hospital, which I have discussed with her. Both hospitals suffer similar problems to other hospitals on the outside rim of London—discernible and discrete problems that we are endeavouring to correct and to provide solutions to. I hope that the right hon. Lady has seen, in the movement over the past few days, our determination to sort out the problems at North Middlesex. As the Minister responsible for hospitals, I do not want to leave this job without having given stability and certainty to the hospitals outside London that they have not had for many years.

I intervene merely to underline the request for a meeting with the Minister to discuss the finances of Northwick Park and, crucially, of the clinical commissioning group in my area.

Of course I will give the hon. Gentleman a meeting. If the issue is about general practitioners, I will refer him, if he does not mind, to my right hon. Friend the Minister for Community and Social Care. However, I will certainly meet him to discuss finances and hospitals. I will arrange both meetings on behalf of his constituents.

I thank hon. Members for this short but constructive debate. It is the first stage in the necessary scrutiny of the claims that were made by both sides in the EU referendum. We are now going to see, in the months and years ahead, who was right. I hope very much that I and the people on my side were wrong, because if so, it will be easier to deliver the spending commitments made by Vote Leave. I fear not, however, in which case we will have some very difficult years ahead. However, people can be sure that in this Government they have a Secretary of State, a ministerial team, a Prime Minister and a party that will continue to commit the funds that are necessary to the NHS, so that we improve on our position in the European averages. We will continue to fund it better than any previous Government to provide for the ambitious designs for this, our national health service, which we all care so much about.

Question put and agreed to.


That this House notes that the Vote Leave group during the EU referendum campaign claimed that an extra £350 million a week could be spent on the NHS in lieu of the UK’s EU membership contribution; further notes that senior figures who campaigned, including the hon. Member for South Northamptonshire, the hon. Member for Uxbridge and South Ruislip and the Rt hon. Member for Surrey Heath have subsequently distanced themselves from that claim; and calls on the Government to set out proposals for additional NHS funding, as suggested by the hon. Member for South Northamptonshire on 4 July 2016.