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Steve Webb:
The hon. Gentleman will find that his Government have reviewed the formula in the past few years. It is wrong systematically to say across the south of the England that more money will be spent there without accepting the corollary of that choice. The Conservative party is saying, “Health cuts for the
north”, which is official Conservative party policy. [ Interruption. ] The shadow Secretary of State has said that the board would be independent, which means that he cannot guarantee delivery. His argument is: “Vote for me, and we will give more money to the south, but only if the independent board agrees to do so.” Will he clarify the situation? [ Interruption. ] Would more be spent in the south because of the formula or would the independent board decide the matter?
Mr. Lansley: It would be up to an independent board to arrive at a fair allocation of resources in relation to the burden of disease.
Steve Webb: Tory candidates who are campaigning for a change to the formula to give more money to the south cannot be sure that it would happen. [ Interruption. ] If the independent board did not give more money to certain areas, no one could do anything about it because it would be unaccountable.
The Minister of State, Department of Health (Andy Burnham): The shadow Secretary of State has said from a sedentary position that the independent board would allocate independently of Ministers the funding for each PCT.
Steve Webb: That was my exact understanding of the shadow Secretary of State’s remark. At the next election, people will be asked to vote Conservative on the basis of a set of promises on the health service that will be entirely undeliverable because the health service would be run by an unelected board.
Today’s debate has provided a valuable opportunity to consider the NHS work force, but we have heard nothing from the Government about the lack of opportunities, which is due to the lack of planning for the work force. There is a place for central planning in the NHS—I know that that is a lefty thing to say—but it is not happening in the marketised NHS. Physiotherapists cannot find jobs because of the lack of planning.
More than anything else, we need an end to centralised meddling, which involves the centre dabbling, fiddling and changing when it should not do so. Every few months, managers must respond to the latest initiative and meet the next target. Unlike some, we have welcomed the money that has gone into the NHS, but we oppose the constant fiddling and meddling, without which the NHS would not face many of the pressures mentioned in the motion.
Mr. Deputy Speaker: Order. Before I call the next speaker, I remind hon. Members that a 10-minute limit has been placed on speeches by Back Benchers, and it applies from now on.
2.39 pm
Mr. Kevin Barron (Rother Valley) (Lab):
I want to pick up a point raised by the hon. Member for Northavon (Steve Webb) about independent sector treatment centres. The Health Committee submitted a report to the House and the Government in July this year—we expect a reply to that report, which we may debate at some stage, in the next few weeks. The hon. Gentleman has stated that ISTCs are cherry-picking,
but the Health Committee found no evidence on that point other than anecdotal, although I hope that hon. Members will provide evidence in this debate.
Tony Baldry (Banbury) (Con): The orthopaedic treatment centre in Banbury is refusing to treat anyone under 18, anyone who lives on their own, anyone who does not have a telephone, and anyone who is overweight—in other words, anyone who presents any difficulties at all. I invite the Chairman of the Select Committee to come to that centre to see exactly how it is cherry-picking.
Mr. Barron: I will have a chat with the hon. Gentleman a bit later, but if what he says is the case, it is a great pity that those findings were not at least submitted as written evidence during the Committee’s inquiry, because that would have enabled us to comment on it.
Dr. John Pugh (Southport) (LD): Will the right hon. Gentleman give way?
Mr. Barron: No, I will start my speech, if the hon. Gentleman does not mind.
The events of this week involving the main Opposition party leave me a little confused. On Monday, as I drove down from Yorkshire, I heard about the Leader of the Opposition’s conversion in relation to the national health service, so I looked at the Conservative party’s website. Two comments somewhat confused me. First, the right hon. Gentleman says that he is
“committed to the NHS idea, ruling out any move towards an insurance-based system.”
I thought that he would have flagged that up at his party conference, assuming that it agreed with that, as just a few years ago, in 2001, he said in the Oxford Journal:
“We also need to look at a massive expansion of social insurance schemes, so that our health spending and outcomes can match that of other European countries. We want to keep and expand the NHS, but on its own it is simply not enough.”
Perhaps the Conservatives should have put that idea down for debate today.
Mr. Vaizey: Will the right hon. Gentleman give way?
We could then have had a discussion about the apparent conversion that has taken place in the past six years in terms of the money spent in the national health service, and how services have kept expanding while being paid for out of the public purse and not through private insurance.
I intervened on the hon. Member for South Cambridgeshire (Mr. Lansley) to draw attention to the extraordinary statement by the Leader of the Opposition on Monday, quoted again in the Conservative website news story:
“So my message to the Government is clear: the NHS matters too much to be treated like a political football.”
Wonderful stuff, is it not? I also have the Conservative party’s NHS campaign pack, which, I understand, is
about to appear on its website— [Interruption.] It is not entitled “save the NHS”, although I may sign up to one or two things in it, and I am prepared to share a few views about it with hon. Gentlemen. It is to be launched on Saturday by the Conservative party—I presume that it will be the non-political health service football that will be launched. That pack is very good and includes materials that can be purchased for action day, graphics to download and a template press release. All people have to do is take out the italics and put in how awful the NHS is in their part of the country. [Interruption.] Conservative Members who are making noises will find it very difficult to come to my part of the United Kingdom and fill in any type of press release saying that about the NHS there. I challenge them to come and do that on Saturday, although I will be holding a surgery.
Mrs. Linda Riordan (Halifax) (Lab/Co-op): If the Conservatives intend to launch that campaign in Halifax, may I remind them that we waited 20 years for a new hospital, and we got it in 2000 under a Labour Government?
Mr. Barron: Again, people would have difficulty taking out the italics and filling in the press release with details from my hon. Friend’s area.
Mr. Barron: Further to that press release—[ Interruption.] I will let its author speak in a few minutes. It is different from the motion in subtle ways. It includes a template for a council motion to be tabled at local government level, again to try to get everybody to agree how awful the NHS is. Once again, it will be a struggle to fill that in in south Yorkshire. None the less, although that press release says that almost 20,000 jobs have been lost from the national health service, the motion does not do so—it refers to posts. All of us who want to share the truth about such matters know that nowhere near 20,000 jobs are being lost in the national health service—not in the last 12 months, two years, three years or anything else. There are more than 80,000 additional nursing jobs in comparison with 10 years ago, and many other grades have more people working in them.
We received an e-mail from NHS Employers alluding to this matter, some of which was quoted by the hon. Member for South Cambridgeshire. That e-mail stated:
“Last week, NHS Employers contacted 18 trusts which had identified potential redundancies. Across all the organisations, the original estimate of the number of posts to be lost was 7,900, with the DTI subsequently notified of 3,999 jobs at risk. The number of actual redundancies (voluntary and compulsory) is 766. Of these 540 are in two organisations”—[ Interruption .]
I will go on, because the hon. Member for South Cambridgeshire missed all that out—clearly, he just picked up the second page when it came out of his printer. The document continued:
“The figures being widely quoted of up to 20,000 may turn out to be not too far off the total reduction in workforce numbers this year. This applies, however, not to people being made redundant but to the number of posts being taken out of
the system in a total workforce of some 1.3 million which experienced an increase of 268,000 during the previous six years.”
That has not stopped the Conservatives saying in their petition to councils that there have been 20,000 job losses in the national health service. I shall ask my party if it will produce a motion for our councillors to take to their council chambers, which says that those are not job losses in the real sense.
Mr. Barron: I note what the hon. Gentleman says from a sedentary position. The Conservative motion alludes to nurses in training who will not be able to get jobs, as was reported on the front page of my local newspaper earlier this year about those who do their practical work in Rotherham and then go to the medical school in Sheffield for nurse training. But what happened to them? They all got jobs. The only redundancies made at Rotherham district general hospital this year were three compulsory redundancies among administrative staff. To read the local press, one would have believed that hundreds of staff at our local district general hospital would be out of work.
Mr. Dorrell: If the University Hospitals of Leicester NHS Trust employs fewer people next year than this year, I call that job losses. What does the right hon. Gentleman call it?
Mr. Barron: In my view, posts unfilled are not job losses. When the right hon. Gentleman was Secretary of State, I accept that there were job losses throughout the national health service. Unfilled posts, however, are not people being made redundant or people being added to unemployment statistics in this country; they are merely jobs not filled.
If Conservative Members want to listen, the Health Committee currently has two ongoing inquiries, one of which is on deficits, which we are trying to bottom. My voice is going hoarse from talking to organisations such as the Royal College of Nurses, which keeps saying to the media that there are hundreds if not thousands of job losses. I keep asking it to send me the evidence of people being made redundant from the national health service. I said that months ago, and again two weeks ago, and the evidence has still not arrived The inquiries on both deficits and work force planning are still ongoing, and as Chairman, I and other Committee members would be more than happy to receive that evidence if it exists. Putting out press releases about the work force that do not represent the reality on the ground does no one any good in this debate.
Martin Horwood (Cheltenham) (LD): One of the problems for the Royal College of Nursing and the Royal College of Midwives is that they cannot extract the numbers from local NHS trusts and hospitals, or from the Department of Health. Surely the right hon. Gentleman should expect the Department to provide the numbers, not the RCN.
Mr. Barron:
We are doing that, and we are asking witnesses. I did not have any difficulty finding out what is happening in my local health community, in the
primary and acute sectors. Together with other Members who represent constituencies in the Rotherham borough, I have annual meetings on the issue. The reality is that this year there are three redundancies of administrative staff.
Andy Burnham: As a Yorkshire MP, my right hon. Friend may wish to comment on annex E of the Conservative campaign pack, which has a list of “job losses”, as they are called. It claims that 1,100 jobs will be lost in the Mid Yorkshire NHS trust. The information that the Department has is that although up to 400 jobs could be at risk, only six people will be made compulsorily redundant—though even six is too many. Does my right hon. Friend agree that the campaign pack includes such misleading information that it should be withdrawn immediately and not used as the basis for a national campaign this weekend?
Mr. Barron: Yes, I do, because it is wrong, false and misleading. This is no conversion to the national health service. They say on a Monday that they will not use the NHS as a political football and, before the ink is dry on that speech, they table a motion that does exactly that, with a campaign to be launched on Saturday morning. The people who work in the health service remember what happened between 1979 and 1997. Their memories are not as short as some people would believe. They know that the NHS has been a political football for far too long and they also know the improvements, for patients and the work force, that have taken place in the past few years.
2.51 pm
Mr. Kenneth Clarke (Rushcliffe) (Con): When my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) began his excellent and thoughtful speech at the start of this debate, he was accompanied by the usual cacophony of noise that we hear in every debate we have on the health service, with people briefed by the Government Whips Office denouncing us for treating the health service as a political football. I find that recurrent atmosphere ever more remarkable, because we are steadily moving towards a consensus in principle on the health service, of a kind that I never thought I would live to see.
We are all in agreement about the principles of the national health service. I have consistently believed that it should be provided free at the point of treatment, according to clinical need and largely funded out of taxation. The final loophole is only for prescription charges and so on, which we have always had in the system. I actually agree in principle with the reforms that the Government are introducing, because they are remarkably like the reforms that have been embarked on for the past 20 years.
I was delighted to hear the hon. Member for Hackney, South and Shoreditch (Meg Hillier) give an explanation of how the health service has always been a partnership between the private sector and the public sector. Her views would have seen her drummed out of the Brownies 10 years ago if she had said anything of the kind from the Labour Benches. Her predecessor, who was a very left-wing Labour MP, has now joined the Liberal Democrats, who are the last defenders of
the view of the old left opinion that provision by the state of the buildings, staff and everything else is a key part of the system.
We are all embarked on what I never really thought was a market system, but has been called the internal market. It is a market-influenced approach, in which there will be a wider variety of suppliers, including the independent sector with the state-owned and provided hospitals, and in which patient choice is brought into play because it gives rise to competition and cost control and directs taxpayers’ money to those places with greatest public demand because of the quality of service provided. In that way, the system reflects public need. That is our destination, but we are now in the middle of a familiar debate in which each side hurls at the other allegations about the acute crisis that we are in.
My principal complaint about the Government is that having had their miraculous Pauline conversion about four years ago, they have so far embarked on the process of reform in such an incompetent fashion that they are in danger of giving it a very bad name. They are in the middle of a classic crisis of the sort that my right hon. Friend the Member for Charnwood (Mr. Dorrell) and I are only too familiar with. The Government do not even understand how they got there and they are in denial about the financial problems underlying the present situation.
Patrick Hall: Will the right hon. and learned Gentleman give way?
I heard the Secretary of State using phrases that I remember using frequently when I was closing hospitals that we did not need. In my day, they were often Victorian workhouses. I would explain how we had to strive for more day surgery, shorter stays in hospital and more use of community services. That is all common sense when running any health care system. The snag is, as has been illustrated over and over, that that is not at the root of the present bad crisis. At the moment, many parts of the country—including mine—are being driven to short-term expedients to address financial deficits. They are saving money wherever they can. The failure to offer jobs to physiotherapists has nothing to do with a movement towards a more rational service. Student nurses are having more difficulty finding jobs and clinical staff are being shed because the NHS is in a total shambles. If the Secretary of State will not acknowledge that, we do not have much chance of curing it. I preferred my hon. Friend’s approach.
The crisis is caused, as crises in health care systems throughout the world are caused, by a complete inability to control costs; the complete lack of a financial management system for most of the NHS; and an inability to localise the services sufficiently and give enough discretion to the people with the competence to sort them out, if that is what they wish to do.
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