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Ms Angela C. Smith (Sheffield, Hillsborough) (Lab): If things really are as bad as the hon. Gentleman makes out, how is it that we have enjoyed significant reductions in the levels of heart disease in cities like Sheffield and elsewhere?
Mr. Lansley: The Prime Minister said at Prime Minister’s questions today, and it is stated in the amendment, that 200,000 lives have been saved by a continuing reduction in premature mortality from heart disease and cancer. That is true, and it is a testament to the work of staff right across the NHS. But if Members go back to Hansard of 27 November 2006, they will find that a member of the Front-Bench team asked what would have been the number of lives saved under the last Conservative Government, applying the same measure of the reduction in premature mortality. The answer was that, in respect of cardiovascular disease, between 1978 and 1996 535,000 lives were saved. In respect of cancer over the same period, 65,000 lives were saved. That adds up to 610,000 lives saved under the last Conservative Government on exactly the same measure as the Government say that 200,000 lives have been saved.
What does that prove? It proves, as we have always said, that the staff of the NHS are delivering an improving service every year. The point of the debate is that they know that that improvement in the service that they provide is not the result of decisions of the Secretary of State. It is not the result of what the Government have done. It is not even entirely the result of resources provided to the national health service, as staff achieved an improvement in thick years and thin.
Peter Carter, general secretary of the Royal College of Nursing, said:
“In the 1980s and 90s finance was extremely tight but you did not get the crisis we have seen in the last two years.”
Every year the NHS is improving and its staff are delivering better services, but they have no confidence in the way that they have been subjected to the serial failures and mismanagement by the Government.
Mr. Stephen Dorrell (Charnwood) (Con): Although it is undoubtedly welcome that we have seen improvements in premature mortality from cancer both under the last Government and under the present Government, will my hon. Friend reflect on the fact that, despite spending on health care in this country being in line with European averages, premature mortality from cancer in this country is running about 40 per cent. higher than in France, Germany or Italy? Should we not be comparing the performance of our health care system with other comparable systems elsewhere in Europe?
Mr. Lansley: Yes. I am grateful to my right hon. Friend. That is indeed what should happen. I say “we” advisedly. On both sides, we should look at outcomes, whereas the Government are obsessed with targets that deliver processes, not outcomes.
At Prime Minister’s questions at lunchtime, the Prime Minister said that there was a survey which showed that the health service in the UK was better than anywhere else. Try telling that to people who have lung cancer, who find that there are half a dozen PET scanners in this country and 500 in Germany. Try
telling that to a stroke patient who finds that there a few dozen places in this country where one can have immediate thrombolysis for stroke, but in Australia that is routine. We deliver 0.3 per cent. of appropriate patients thrombolysis for stroke. In Australia the figure is 10 per cent.
Ms Dari Taylor (Stockton, South) (Lab): Is the hon. Gentleman seriously telling the House that the 35,000 extra doctors and 80,000 extra nurses are not delivering an improvement in health care? That is how it sounds.
Mr. Lansley: The hon. Lady need not take it from me. The general secretary of the Royal College of Nursing— [Interruption.]
Mr. Deputy Speaker (Sir Michael Lord): Order. The hon. Lady asked a question of the Opposition spokesman. Perhaps she ought to listen to the answer.
Mr. Lansley: I am grateful, Mr. Deputy Speaker. Peter Carter, general secretary of the Royal College of Nursing, said:
“In the 1980s and 90s finance was extremely tight but you did not get the crisis we have seen in the last two years.”
He also said, as my right hon. Friend the Leader of the Opposition said at lunchtime, that money comes into the national health service but too much gets wasted. Staff right across the NHS are saying that they are trying to make progress but cannot because of the Government’s failures.
Mr. Lansley: I am going to make some progress.
The latest and one of the most serious failures of the Secretary of State has been the disaster of the medical training application scheme. The Royal College of Physicians called it
“the worst episode in the history of medical training in the UK in living memory”.
James Johnson, who has resigned as chairman of the British Medical Association, described the policy failures—failure to estimate the number of applicants correctly, failure to put in place a fair selection process by adopting selection criteria and a scoring system that undermined the principles of Modernising Medical Careers and failure to implement the technology in terms of its security or its functionality. Furthermore, Mr. Justice Goldring said in the High Court this afternoon:
“The fact that the claimant”—
“has failed in what was accepted to be an unprecedented application so far as the law is concerned does not mean that many junior doctors do not have an entirely justifiable sense of grievance. The premature introduction of MTAS has had disastrous consequences. It was a flawed system.”
That is a flawed system introduced by this Government with consequences so disastrous as to lead the chairman of the BMA, the national director of Modernising Medical Careers and the national clinical director of MMC all to resign, yet the Secretary of State sits there ignorant and oblivious to the consequences of what she has done.
Rob Marris (Wolverhampton, South-West) (Lab): I would like to take the hon. Gentleman back a little to when he was talking about a crisis. Can he tell the House when there was last a winter bed crisis in the NHS?
Mr. Lansley: From my recollection—I am sure that I will be corrected if I am wrong—it was 1999. That was the last time that there was a substantial bout of flu. We have been lucky— [Interruption.] Given that the Government failed to deliver flu vaccine at the right time, if we had had a substantial outbreak of seasonal flu at any point in the late autumn in either of the last two years, it would have had serious consequences.
Mr. Graham Stuart (Beverley and Holderness) (Con): Following the last piercing question from the hon. Member for Wolverhampton, South-West (Rob Marris) and my hon. Friend’s answer that the last time that we had a winter bed crisis was under this Labour Government, will my hon. Friend now answer another question? When was the last time that we saw a sustained improvement in productivity in the NHS?
Mr. Lansley: The answer is in the mid-1990s. There has been a sustained reduction in productivity in the NHS since 1997, estimated by the Office for National Statistics as up to 1.3 per cent. a year.
The purpose of the motion is to give the NHS the management and leadership it needs. Frankly, that can be delivered only through a general election, but some things could be done now that are not getting done because the Government are not only divided, but paralysed and inactive. We need an end to the closure of accident and emergency departments and maternity services. They are not a result of a clinical demand for change, but are being driven by short-term financial considerations and the impact of the working time directive. For two months I have been asking the Secretary of State for more training posts for junior doctors, but she has consistently failed to get on with delivering them.
Dr. Evan Harris (Oxford, West and Abingdon) (LD) rose—
Kali Mountford (Colne Valley) (Lab) rose—
Mr. Lansley: I give way to the hon. Member for Oxford, West and Abingdon (Dr. Harris)
Dr. Harris: Does the hon. Gentleman accept that the problems of training posts for junior doctors extend beyond the software of MTAS? There is a fundamental mismatch between the number of junior doctors looking for training posts and the number of posts available because consultant expansion has failed and there are not enough training programmes coming through. Does he accept that it does not make sense to plan medical students, plan house officers, plan senior house officers and plan registrars without planning for the end product, which is consultant posts?
Mr. Lansley:
The hon. Gentleman participated fully in the Opposition debate on 24 April, which explored those issues. The short answer is that it makes no sense to have work force planning—the Government’s approach
was described by the Health Select Committee as “boom and bust”—to set up the structures of medical training and to deliver large numbers of trainee doctors at a time when consultant posts are being abandoned because of financial deficits. Equally, it makes no sense to have junior doctors, costing £250,000 to train, who are then going to be without posts and who will abandon medicine and leave this country as a consequence of the Government’s failures.
We also need an independent review of the NHS information technology scheme.
Mr. Deputy Speaker: Order. I do not think that the hon. Gentleman intends to give way for the time being. Until he indicates otherwise, the hon. Lady may resume her seat.
Mr. Lansley: Thank you, Mr. Deputy Speaker.
We need a re-engagement of GPs with, for example, out-of-hours services. That is perfectly possible, but it will never happen while the Secretary of State is in place or if the Chancellor of the Exchequer carries on trying to engage in confrontation with the medical profession, rather than co-operation.
We need to abolish the central targets that undermine clinical priorities. NHS staff, particularly those in the medical profession, deeply resent the fact that the Government constantly dictate to them in that way, despite the fact that they are senior professionals. We need a fairer funding mechanism, because funding allocations have directly contributed to the impact of deficits across the country. We also need a Government who are prepared to accept the underlying good sense of many of the amendments made to the Mental Health Bill by the House of Lords, rather than persisting with their present approach to the Bill.
This Secretary of State has lost the confidence not only of the NHS but of many others with whom she has worked. Professor Halligan, the former deputy chief medical officer, has said that the NHS has
“a leadership void, which has caused it to lose its way”.
Andrew Foster, the former director of human resources for the Department, has spoken of
“a growing lack of confidence in the leadership”
of the Department— [ Interruption. ]
Mr. Deputy Speaker: Order. We must not have interventions from a sedentary position. Hon. Members would expect the Secretary of State to be given a fair hearing when she comes to address the House. They should extend the same courtesy to the hon. Gentleman.
Mr. Lansley: Thank you, Mr. Deputy Speaker. I remember that Sir Thomas More was a Chancellor of the Duchy of Lancaster, so, when it comes to it, perhaps decapitation is one approach to the problem.
Senior civil servants in the Department of Health were surveyed, and 84 per cent. did not believe that the Department was well managed. Professor Crockard, who is retiring as national director of MMC, said of MTAS:
“From my point of view, this project has lacked clear leadership from the top for a very long time”.
The Secretary of State has been jeered by nurses, and heckled by midwives only today. A unanimous vote among junior doctors at a BMA conference called on her to resign. James Johnson chose to resign as chairman of the BMA. All that he did, so far as I can see, was to stand between an angry medical profession and the Secretary of State. He said:
“It is the worst I have known it for over 30 years”.
NHS staff are continuing to deliver for patients. They are professionals, but they are not being treated professionally by the Government. They are angry because of the way in which they have been treated. The Government tell them that money is flowing, but they do not see it, and they are not given the chance to shape the care that they give to patients. They are angry because the Government are constantly telling them how to do their job, even though the Government are incompetent at doing their own.
The Secretary of State has been responsible for so-called NHS reform, but there is no coherent reform. Staff in the NHS do not know what is happening, why it is happening or where it is going. There is no inspirational leadership—there is not even competent management—but there are urgent tasks to be done. Even the Secretary of State’s own colleagues in the Government do not believe that she is capable of achieving those things, or that she will be responsible for doing so. The next Prime Minister will not keep her. The present Prime Minister would not defend her today. But the NHS needs change now. We should take charge, but we cannot. If there will not be a new Government, there must at least be a new Secretary of State, and that should happen now. I commend the motion to the House.
4.49 pm
The Secretary of State for Health (Ms Patricia Hewitt): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“believes that there is no need to reduce the salary of the Secretary of State for Health at a time when patient satisfaction is increasing, with nine out of ten in-patients saying their care has been good, very good or excellent, waiting times are at their lowest since records began, an extra 200,000 lives have been saved from heart disease and cancer since 1996 and investment in the NHS is being trebled by 2008.”
In view of the motion, perhaps I should declare my interest—although it is almost worth £1,000 to have been able to listen to that defence of what passes for Tory policy on the NHS.
It is one of the greatest privileges in our country to be Secretary of State for Health, a privilege that carries with it enormous responsibilities. I believe that every one of my predecessors, in both parties, has felt the same. But I also believe that the real privilege is to be a Labour Health Secretary in a reforming Labour Government. In the past two years, I have sought to discharge those responsibilities not only on behalf of the Government as a whole but, above all, on behalf of the patients and the public who elected us into government in three successive general elections. I welcome this debate, as I welcome every opportunity to set out the Government’s record on health.
Mr. Graham Stuart: Will the Secretary of State give way?
The hon. Member for South Cambridgeshire (Mr. Lansley) specifically mentioned junior doctors. I welcome today’s High Court decision to reject the findings of the judicial review initiated by Remedy UK. We are looking carefully at the comments of Mr. Justice Goldring, and I will make a statement to the House tomorrow on how we will fulfil our responsibilities to trainee doctors as we complete this year’s recruitment to more training places than there have ever been before.
Norman Lamb (North Norfolk) (LD): Will the Secretary of State give way?
Ms Hewitt: Not on that point, no. I will deal with it in my oral statement tomorrow.
The most important judges and the single most important test of the state of the NHS are the patients who use the service every day of the week. I find it extraordinary that the hon. Member for South Cambridgeshire scarcely mentioned them. Only last week, the Healthcare Commission published its latest national survey of patients. Nine out of 10 recent hospital patients said that their care had been good, very good or excellent—an even better result than just a year ago. What a tribute it is to the dedication and hard work of NHS staff that, in a year when very difficult decisions had to be made to return the NHS to financial balance, the level of patients’ satisfaction with their hospital care went up, not down.
Mr. Nicholas Soames (Mid-Sussex) (Con): The debate is not about national health service nurses, who do a magnificent job; it is about the right hon. Lady and the great misfortunes that she has brought to the health service. Will she consider the real worries of the constituents of Members in all parts of the House in south-east England, where reconfigurations are proving impossible? They are taking so long that they cannot even be brought forward. The right hon. Lady should understand that the motion is directed not against the nurses, but against her stewardship of the NHS.
Ms Hewitt: I will take no lectures from a party that starved the NHS of funds and left patients waiting 18 months or more for desperately needed operations.
Mr. Simon Burns (West Chelmsford) (Con): Will the Secretary of State give way?
Ms Hewitt: No. I want to make some progress before I give way again.
It is no accident that patients are more satisfied with their hospitals. Of course, that is down to the staff. There are well over a quarter of a million more doctors, nurses and other NHS staff—an increase made possible by our reforms and investment, which the Conservative party opposed every inch of the way.
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