Like the hon. Members for Scunthorpe and for Strangford (Jim Shannon) and my hon. Friend the Member for Brecon and Radnorshire (Roger Williams), I hope that we can reach consensus on a comprehensive strategy, but no country has ever successfully borne down on TB without doing something about the reservoir

5 Jun 2013 : Column 1577

of infection in the wildlife population. I believe that what we are proposing will achieve healthy cattle and healthy badgers. Our objective is clear: to remove this devastating disease from this country. We want to get back to having official TB-free status for this country. That will be good for farmers, good for wildlife and good for the taxpayers of this country, and I believe that the policy should commend itself to the House.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

The House divided:

Ayes 250, Noes 299.

Division No. 21]

[

4 pm

AYES

Abbott, Ms Diane

Abrahams, Debbie

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Allen, Mr Graham

Anderson, Mr David

Ashworth, Jonathan

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Balls, rh Ed

Barron, rh Mr Kevin

Bayley, Hugh

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Benton, Mr Joe

Berger, Luciana

Betts, Mr Clive

Birtwistle, Gordon

Blackman-Woods, Roberta

Blears, rh Hazel

Blenkinsop, Tom

Blomfield, Paul

Bottomley, Sir Peter

Bradshaw, rh Mr Ben

Brennan, Kevin

Brown, Lyn

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Burnham, rh Andy

Burstow, rh Paul

Byrne, rh Mr Liam

Campbell, Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Champion, Sarah

Clark, Katy

Clarke, rh Mr Tom

Clwyd, rh Ann

Coaker, Vernon

Coffey, Ann

Connarty, Michael

Cooper, Rosie

Cooper, rh Yvette

Corbyn, Jeremy

Crausby, Mr David

Creagh, Mary

Creasy, Stella

Crouch, Tracey

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Cunningham, Sir Tony

Curran, Margaret

Dakin, Nic

Danczuk, Simon

Darling, rh Mr Alistair

David, Wayne

Davidson, Mr Ian

Davies, Geraint

De Piero, Gloria

Denham, rh Mr John

Dobbin, Jim

Dobson, rh Frank

Docherty, Thomas

Donohoe, Mr Brian H.

Doran, Mr Frank

Doughty, Stephen

Dowd, Jim

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Francis, Dr Hywel

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

Goggins, rh Paul

Goldsmith, Zac

Goodman, Helen

Greatrex, Tom

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hain, rh Mr Peter

Hamilton, Mr David

Hamilton, Fabian

Hanson, rh Mr David

Harman, rh Ms Harriet

Harris, Mr Tom

Havard, Mr Dai

Hemming, John

Hepburn, Mr Stephen

Hermon, Lady

Hillier, Meg

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hood, Mr Jim

Hopkins, Kelvin

Horwood, Martin

Howarth, rh Mr George

Hunt, Tristram

Irranca-Davies, Huw

Jackson, Glenda

Jamieson, Cathy

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Graham

Jones, Helen

Jones, Mr Kevan

Jones, Susan Elan

Joyce, Eric

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Khan, rh Sadiq

Lammy, rh Mr David

Lavery, Ian

Lazarowicz, Mark

Leslie, Chris

Lewell-Buck, Emma

Lewis, Mr Ivan

Lloyd, Stephen

Love, Mr Andrew

Lucas, Caroline

Lucas, Ian

Mactaggart, Fiona

Mahmood, Mr Khalid

Mahmood, Shabana

Malhotra, Seema

Marsden, Mr Gordon

McCabe, Steve

McCann, Mr Michael

McCarthy, Kerry

McCartney, Jason

McClymont, Gregg

McDonagh, Siobhain

McDonald, Andy

McDonnell, Dr Alasdair

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

McPartland, Stephen

Mearns, Ian

Miliband, rh Edward

Miller, Andrew

Morden, Jessica

Morrice, Graeme

(Livingston)

Morris, Grahame M.

(Easington)

Mudie, Mr George

Munn, Meg

Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Pearce, Teresa

Perkins, Toby

Phillips, Stephen

Phillipson, Bridget

Pound, Stephen

Pugh, John

Qureshi, Yasmin

Raynsford, rh Mr Nick

Reckless, Mark

Reed, Mr Jamie

Reed, Mr Steve

Reynolds, Emma

Reynolds, Jonathan

Riordan, Mrs Linda

Robertson, John

Robinson, Mr Geoffrey

Rotheram, Steve

Roy, Mr Frank

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Russell, Sir Bob

Sanders, Mr Adrian

Sarwar, Anas

Sawford, Andy

Seabeck, Alison

Sharma, Mr Virendra

Sheerman, Mr Barry

Sheridan, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, rh Mr Andrew

Smith, Nick

Smith, Owen

Spellar, rh Mr John

Straw, rh Mr Jack

Stringer, Graham

Stuart, Ms Gisela

Sutcliffe, Mr Gerry

Tami, Mark

Thomas, Mr Gareth

Thornberry, Emily

Timms, rh Stephen

Trickett, Jon

Turner, Karl

Twigg, Derek

Twigg, Stephen

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watson, Mr Tom

Watts, Mr Dave

Whitehead, Dr Alan

Williams, Stephen

Williamson, Chris

Wilson, Phil

Winnick, Mr David

Wood, Mike

Woodcock, John

Woodward, rh Mr Shaun

Wright, David

Wright, Mr Iain

Tellers for the Ayes:

Julie Hilling

and

Heidi Alexander

NOES

Adams, Nigel

Afriyie, Adam

Aldous, Peter

Alexander, rh Danny

Andrew, Stuart

Arbuthnot, rh Mr James

Bacon, Mr Richard

Baker, Norman

Baker, Steve

Baldry, Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barker, rh Gregory

Baron, Mr John

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Bingham, Andrew

Binley, Mr Brian

Blackwood, Nicola

Boles, Nick

Bone, Mr Peter

Brake, rh Tom

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brokenshire, James

Bruce, Fiona

Buckland, Mr Robert

Burns, Conor

Burns, rh Mr Simon

Burrowes, Mr David

Byles, Dan

Cable, rh Vince

Cairns, Alun

Cameron, rh Mr David

Campbell, Mr Gregory

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Carswell, Mr Douglas

Cash, Mr William

Chishti, Rehman

Chope, Mr Christopher

Clark, rh Greg

Clarke, rh Mr Kenneth

Clegg, rh Mr Nick

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crabb, Stephen

Davey, rh Mr Edward

Davies, David T. C.

(Monmouth)

Davies, Glyn

Davies, Philip

de Bois, Nick

Djanogly, Mr Jonathan

Donaldson, rh Mr Jeffrey M.

Dorrell, rh Mr Stephen

Dorries, Nadine

Doyle-Price, Jackie

Duddridge, James

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Edwards, Jonathan

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Elphicke, Charlie

Evans, Graham

Evennett, Mr David

Fabricant, Michael

Fallon, rh Michael

Featherstone, Lynne

Field, Mark

Foster, rh Mr Don

Fox, rh Dr Liam

Francois, rh Mr Mark

Freeman, George

Freer, Mike

Fullbrook, Lorraine

Fuller, Richard

Garnier, Sir Edward

Garnier, Mark

Gauke, Mr David

Gibb, Mr Nick

Gilbert, Stephen

Glen, John

Goodwill, Mr Robert

Gove, rh Michael

Grant, Mrs Helen

Gray, Mr James

Grayling, rh Chris

Green, rh Damian

Greening, rh Justine

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, Stephen

Hancock, Matthew

Hands, Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Oliver

Heath, Mr David

Heaton-Harris, Chris

Henderson, Gordon

Herbert, rh Nick

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Hunt, rh Mr Jeremy

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Javid, Sajid

Jenkin, Mr Bernard

Johnson, Gareth

Johnson, Joseph

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kirby, Simon

Knight, rh Mr Greg

Kwarteng, Kwasi

Laing, Mrs Eleanor

Lamb, Norman

Lancaster, Mark

Lansley, rh Mr Andrew

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Lefroy, Jeremy

Leigh, Mr Edward

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Liddell-Grainger, Mr Ian

Lidington, rh Mr David

Lilley, rh Mr Peter

Llwyd, rh Mr Elfyn

Lopresti, Jack

Lord, Jonathan

Loughton, Tim

Luff, Peter

Lumley, Karen

Macleod, Mary

Maude, rh Mr Francis

May, rh Mrs Theresa

Maynard, Paul

McCartney, Karl

McCrea, Dr William

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McVey, Esther

Menzies, Mark

Metcalfe, Stephen

Miller, rh Maria

Mills, Nigel

Milton, Anne

Mitchell, rh Mr Andrew

Moore, rh Michael

Mordaunt, Penny

Morgan, Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Mundell, rh David

Murray, Sheryll

Murrison, Dr Andrew

Neill, Robert

Newmark, Mr Brooks

Newton, Sarah

Nokes, Caroline

Norman, Jesse

Nuttall, Mr David

O'Brien, Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Opperman, Guy

Osborne, rh Mr George

Paice, rh Sir James

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, Mike

Penrose, John

Perry, Claire

Phillips, Stephen

Poulter, Dr Daniel

Prisk, Mr Mark

Raab, Mr Dominic

Randall, rh Mr John

Redwood, rh Mr John

Rees-Mogg, Jacob

Reid, Mr Alan

Rifkind, rh Sir Malcolm

Robathan, rh Mr Andrew

Robertson, Mr Laurence

Rogerson, Dan

Rosindell, Andrew

Rudd, Amber

Ruffley, Mr David

Rutley, David

Scott, Mr Lee

Selous, Andrew

Shannon, Jim

Shapps, rh Grant

Sharma, Alok

Shelbrooke, Alec

Shepherd, Sir Richard

Simpson, David

Simpson, Mr Keith

Skidmore, Chris

Smith, Miss Chloe

Smith, Julian

Smith, Sir Robert

Soames, rh Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stanley, rh Sir John

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Stewart, Rory

Streeter, Mr Gary

Stride, Mel

Stuart, Mr Graham

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Swire, rh Mr Hugo

Syms, Mr Robert

Tapsell, rh Sir Peter

Thurso, John

Timpson, Mr Edward

Tomlinson, Justin

Truss, Elizabeth

Tyrie, Mr Andrew

Uppal, Paul

Vaizey, Mr Edward

Vara, Mr Shailesh

Vickers, Martin

Villiers, rh Mrs Theresa

Walker, Mr Robin

Wallace, Mr Ben

Ward, Mr David

Watkinson, Dame Angela

Webb, Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Mr Mark

Williams, Roger

Williamson, Gavin

Willott, Jenny

Wilson, Mr Rob

Wilson, Sammy

Wollaston, Dr Sarah

Wright, Jeremy

Yeo, Mr Tim

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Noes:

Karen Bradley

and

Mark Hunter

Question accordingly negatived.

5 Jun 2013 : Column 1578

5 Jun 2013 : Column 1579

5 Jun 2013 : Column 1580

5 Jun 2013 : Column 1581


Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.

The House divided:

Ayes 298, Noes 237.

Division No. 22]

[

4.15 pm

AYES

Adams, Nigel

Afriyie, Adam

Aldous, Peter

Alexander, rh Danny

Andrew, Stuart

Arbuthnot, rh Mr James

Bacon, Mr Richard

Baker, Norman

Baker, Steve

Baldry, Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barker, rh Gregory

Baron, Mr John

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Bingham, Andrew

Binley, Mr Brian

Blackwood, Nicola

Boles, Nick

Bone, Mr Peter

Bradley, Karen

Brake, rh Tom

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brokenshire, James

Bruce, Fiona

Buckland, Mr Robert

Burns, Conor

Burns, rh Mr Simon

Burrowes, Mr David

Byles, Dan

Cable, rh Vince

Cairns, Alun

Cameron, rh Mr David

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Carswell, Mr Douglas

Cash, Mr William

Chishti, Rehman

Chope, Mr Christopher

Clark, rh Greg

Clarke, rh Mr Kenneth

Clegg, rh Mr Nick

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crabb, Stephen

Davey, rh Mr Edward

Davies, David T. C.

(Monmouth)

Davies, Glyn

Davies, Philip

de Bois, Nick

Djanogly, Mr Jonathan

Donaldson, rh Mr Jeffrey M.

Dorrell, rh Mr Stephen

Dorries, Nadine

Doyle-Price, Jackie

Duddridge, James

Duncan Smith, rh Mr Iain

Dunne, Mr Philip

Edwards, Jonathan

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Elphicke, Charlie

Evans, Graham

Evennett, Mr David

Fabricant, Michael

Fallon, rh Michael

Featherstone, Lynne

Field, Mark

Foster, rh Mr Don

Fox, rh Dr Liam

Francois, rh Mr Mark

Freeman, George

Freer, Mike

Fullbrook, Lorraine

Fuller, Richard

Garnier, Sir Edward

Garnier, Mark

Gauke, Mr David

Gibb, Mr Nick

Glen, John

Goodwill, Mr Robert

Gove, rh Michael

Grant, Mrs Helen

Gray, Mr James

Grayling, rh Chris

Green, rh Damian

Greening, rh Justine

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, Stephen

Hancock, Matthew

Hands, Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Oliver

Heath, Mr David

Heaton-Harris, Chris

Henderson, Gordon

Herbert, rh Nick

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Hunt, rh Mr Jeremy

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Javid, Sajid

Jenkin, Mr Bernard

Johnson, Gareth

Johnson, Joseph

Jones, Andrew

Jones, rh Mr David

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kirby, Simon

Knight, rh Mr Greg

Kwarteng, Kwasi

Laing, Mrs Eleanor

Lamb, Norman

Lancaster, Mark

Lansley, rh Mr Andrew

Latham, Pauline

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Lefroy, Jeremy

Leigh, Mr Edward

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Liddell-Grainger, Mr Ian

Lidington, rh Mr David

Lilley, rh Mr Peter

Llwyd, rh Mr Elfyn

Lopresti, Jack

Lord, Jonathan

Loughton, Tim

Luff, Peter

Lumley, Karen

Macleod, Mary

Maude, rh Mr Francis

May, rh Mrs Theresa

Maynard, Paul

McCartney, Karl

McCrea, Dr William

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McVey, Esther

Menzies, Mark

Metcalfe, Stephen

Miller, rh Maria

Mills, Nigel

Milton, Anne

Mitchell, rh Mr Andrew

Moore, rh Michael

Mordaunt, Penny

Morgan, Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Mundell, rh David

Murray, Sheryll

Murrison, Dr Andrew

Neill, Robert

Newmark, Mr Brooks

Newton, Sarah

Nokes, Caroline

Norman, Jesse

Nuttall, Mr David

O'Brien, Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Opperman, Guy

Osborne, rh Mr George

Paice, rh Sir James

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, Mike

Penrose, John

Percy, Andrew

Perry, Claire

Phillips, Stephen

Poulter, Dr Daniel

Prisk, Mr Mark

Raab, Mr Dominic

Randall, rh Mr John

Redwood, rh Mr John

Rees-Mogg, Jacob

Rifkind, rh Sir Malcolm

Robathan, rh Mr Andrew

Robertson, Mr Laurence

Rogerson, Dan

Rosindell, Andrew

Rudd, Amber

Ruffley, Mr David

Rutley, David

Scott, Mr Lee

Selous, Andrew

Shannon, Jim

Shapps, rh Grant

Sharma, Alok

Shelbrooke, Alec

Shepherd, Sir Richard

Simpson, David

Simpson, Mr Keith

Skidmore, Chris

Smith, Miss Chloe

Smith, Julian

Smith, Sir Robert

Soames, rh Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stanley, rh Sir John

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Stewart, Rory

Streeter, Mr Gary

Stride, Mel

Stuart, Mr Graham

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Swire, rh Mr Hugo

Tapsell, rh Sir Peter

Thurso, John

Timpson, Mr Edward

Tomlinson, Justin

Truss, Elizabeth

Tyrie, Mr Andrew

Uppal, Paul

Vaizey, Mr Edward

Vara, Mr Shailesh

Vickers, Martin

Villiers, rh Mrs Theresa

Walker, Mr Robin

Wallace, Mr Ben

Ward, Mr David

Watkinson, Dame Angela

Webb, Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Mr Mark

Williams, Roger

Williamson, Gavin

Willott, Jenny

Wilson, Mr Rob

Wilson, Sammy

Wollaston, Dr Sarah

Wright, Jeremy

Yeo, Mr Tim

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Ayes:

Mark Hunter

and

Mr Robert Syms

NOES

Abbott, Ms Diane

Abrahams, Debbie

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Allen, Mr Graham

Anderson, Mr David

Ashworth, Jonathan

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Balls, rh Ed

Barron, rh Mr Kevin

Bayley, Hugh

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Benton, Mr Joe

Berger, Luciana

Betts, Mr Clive

Blackman-Woods, Roberta

Blears, rh Hazel

Blenkinsop, Tom

Blomfield, Paul

Bottomley, Sir Peter

Bradshaw, rh Mr Ben

Brennan, Kevin

Brown, Lyn

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Burnham, rh Andy

Byrne, rh Mr Liam

Campbell, Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Champion, Sarah

Clark, Katy

Clarke, rh Mr Tom

Clwyd, rh Ann

Coaker, Vernon

Coffey, Ann

Connarty, Michael

Cooper, Rosie

Cooper, rh Yvette

Corbyn, Jeremy

Crausby, Mr David

Creagh, Mary

Creasy, Stella

Crouch, Tracey

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Cunningham, Sir Tony

Curran, Margaret

Dakin, Nic

Danczuk, Simon

Darling, rh Mr Alistair

David, Wayne

Davidson, Mr Ian

Davies, Geraint

De Piero, Gloria

Denham, rh Mr John

Dobbin, Jim

Dobson, rh Frank

Docherty, Thomas

Donohoe, Mr Brian H.

Doran, Mr Frank

Doughty, Stephen

Dowd, Jim

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Francis, Dr Hywel

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

Goggins, rh Paul

Goodman, Helen

Greatrex, Tom

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hain, rh Mr Peter

Hamilton, Mr David

Hamilton, Fabian

Hanson, rh Mr David

Harman, rh Ms Harriet

Harris, Mr Tom

Havard, Mr Dai

Healey, rh John

Hepburn, Mr Stephen

Hillier, Meg

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hood, Mr Jim

Hopkins, Kelvin

Howarth, rh Mr George

Hunt, Tristram

Irranca-Davies, Huw

Jackson, Glenda

Jamieson, Cathy

Jarvis, Dan

Johnson, Diana

Jones, Graham

Jones, Helen

Jones, Mr Kevan

Jones, Susan Elan

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Khan, rh Sadiq

Lammy, rh Mr David

Lavery, Ian

Lazarowicz, Mark

Leslie, Chris

Lewell-Buck, Emma

Lewis, Mr Ivan

Love, Mr Andrew

Lucas, Caroline

Lucas, Ian

Mactaggart, Fiona

Mahmood, Mr Khalid

Mahmood, Shabana

Malhotra, Seema

Marsden, Mr Gordon

McCabe, Steve

McCann, Mr Michael

McCarthy, Kerry

McClymont, Gregg

McDonagh, Siobhain

McDonald, Andy

McDonnell, Dr Alasdair

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

McPartland, Stephen

Mearns, Ian

Miliband, rh Edward

Miller, Andrew

Morden, Jessica

Morrice, Graeme

(Livingston)

Morris, Grahame M.

(Easington)

Mudie, Mr George

Munn, Meg

Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Pearce, Teresa

Percy, Andrew

Perkins, Toby

Phillipson, Bridget

Pound, Stephen

Qureshi, Yasmin

Raynsford, rh Mr Nick

Reed, Mr Jamie

Reed, Mr Steve

Reynolds, Emma

Reynolds, Jonathan

Riordan, Mrs Linda

Robertson, John

Robinson, Mr Geoffrey

Rotheram, Steve

Roy, Mr Frank

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Russell, Sir Bob

Sarwar, Anas

Sawford, Andy

Seabeck, Alison

Sharma, Mr Virendra

Sheerman, Mr Barry

Sheridan, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, rh Mr Andrew

Smith, Nick

Smith, Owen

Spellar, rh Mr John

Straw, rh Mr Jack

Stringer, Graham

Stuart, Ms Gisela

Sutcliffe, Mr Gerry

Tami, Mark

Thomas, Mr Gareth

Thornberry, Emily

Timms, rh Stephen

Trickett, Jon

Turner, Karl

Twigg, Derek

Twigg, Stephen

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watson, Mr Tom

Watts, Mr Dave

Whitehead, Dr Alan

Williamson, Chris

Wilson, Phil

Winnick, Mr David

Winterton, rh Ms Rosie

Wood, Mike

Woodcock, John

Woodward, rh Mr Shaun

Wright, David

Wright, Mr Iain

Tellers for the Noes:

Heidi Alexander

and

Julie Hilling

Question accordingly agreed to.

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The Deputy Speaker declared the main Question, as amended, to be agreedto (Standing Order No. 31(2)).

Resolved,

That this House notes that bovine tuberculosis (TB) has, as a consequence of the lack of effective counter-measures, spread from a few isolated incidents to affect large parts of England and Wales, resulting in the slaughter of 28,000 cattle in England alone in 2012 at a cost of £100 million to the taxpayer; is concerned that 305,000 cattle have been slaughtered in Great Britain as a result of bovine TB in the last decade and that the cost is expected to rise to over £1 billion over the next 10 years; recognises that to deal effectively with the disease every available tool should be employed; accordingly welcomes the strengthening of biosecurity measures and stringent controls on cattle movements; further welcomes the research and investment into both cattle and badger vaccines, and better diagnostic testing, but recognises that despite positive work with the European Commission the use of a viable and legal cattle vaccine has been confirmed to be still at least 10 years away; further notes that no country has successfully borne down on bovine TB without dealing with infection in the wildlife population, and that the Randomised Badger Control Trials demonstrated both the link between infection in badgers and in cattle and that culling significantly reduces incidence; looks forward to the successful conclusion of the current pilot culls in Gloucestershire and Somerset; and welcomes the Government’s development of a comprehensive strategy to reverse the spread of bovine TB and officially eradicate this disease.’.

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Accident and Emergency Waiting Times

4.29 pm

Andy Burnham (Leigh) (Lab): I beg to move,

That this House is concerned about the growing pressure on Accident and Emergency (A&E) departments across the country over recent months; notes this week’s report from the King’s Fund which concludes that waiting times in A&E recently hit a nine-year high; further notes that in the Labour Government’s last year in office 98 per cent of patients were seen within four hours; believes that a combination of factors lies behind the extra pressure on hospitals but that severe cuts to social care budgets are one of the most significant causes; is further concerned that one in three hospitals in England say they do not have sufficient staffing levels to deal safely with demand on services; further notes that over 4,000 nursing posts have been lost from the NHS since May 2010 and that a recent survey by the Health Service Journal revealed that a further round of front-line clinical job losses are planned for the coming year; further believes that the Government has failed to show sufficient urgency in dealing with these problems; and calls on the Government to bring forward an urgent plan to ease pressure on hospitals by, amongst other things, re-allocating £1.2 billion of the 2012-13 Department of Health underspend to support social care in 2013-14 and 2014-15, and ensuring adequate staffing levels at every hospital in England.

Since the turn of the year, the Opposition have been warning the Government about building pressure in A and E departments, and yesterday there was confirmation of just how bad things have got. This year, waiting times in A and E hit a nine-year high, according to the King’s Fund. The pressure is not confined to A and E, however, and wherever we look we can see warning signs: hospitals operating with close to 100% bed occupancy, way beyond safe recommended levels; a treatment tent in a car park; long queues of ambulances outside A and E, double the number waiting longer than 30 minutes; a huge spike in the number of A and E diverts, where ambulances are turned away from units that cannot accept any more patients; reports of some hospitals issuing more black alerts in the past year than in the previous 10 years combined; more cancelled operations than for a decade; and a 30% increase in bed days lost to delayed discharges because care plans cannot be put in place, leaving older patients stranded on the ward and A and E unable to admit them.

The evidence is clear: this health and care system is showing serious signs of distress. In truth, A and E is the barometer of the system, and problems or blockages anywhere will soon show up in A and E as the pressure backs up. The situation requires decisive action and a comprehensive plan, both of which have been distinctly lacking in the Government’s response so far.

Today the Prime Minister complacently implied that the problems had been fixed, but for 34 of the 38 weeks this Secretary of State has been in post, major A and Es have missed the Government’s lowered A and E target. Today, six in 10 trusts are warning that next winter will be even worse. The Government’s response to date has been totally inadequate for the scale and urgency of the problems. First, they came to the House and denied there was a problem. On 15 January, the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) stated that

“patients are being treated in a much more timely manner than under the previous Government.”—[Official Report, 15 January 2013; Vol. 556, c. 720.]

An inaccurate statement without any basis in fact.

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As the pressure built, it was clear that that line would not hold, so the Secretary of State’s spin operation began. He said that the root cause of the pressure was the 2004 GP contract and changes to out-of-hours care. One must ask how the Secretary of State pushed that line with such confidence, given that a freedom of information request from his Department revealed that the first time he went to an A and E as Secretary of State was on 3 April—a full six months after he was appointed. Even then, it was the A and E within walking distance of this building. Did he just repeat back on camera what the first person he met said to him?

Throughout the early months of 2013 the NHS was going through the worst winter for a decade, yet the Secretary of State did not bother to visit any A and E department to see for himself the ambulance queues, the patients held on trolleys, or the staff stretched to breaking point. Just weeks before his first visit to A and E, he told us that hospitals were “coasting”. What an unbelievable statement. Would he have dared to say that if he had actually visited an A and E beforehand?

Helen Jones (Warrington North) (Lab): Does my right hon. Friend agree that one of the pressures on A and E comes from this Government’s cuts to adult social care? We all know that if old people are not given care in their own homes they are more likely to end up in hospital, yet the Government have cut more than £2.6 billion from adult social care, and more than 230,000 people are now not getting help, compared with four years ago.

Andy Burnham: My hon. Friend is absolutely right. Two-thirds of NHS finance directors have identified social care and its collapse as the single biggest driver of the pressure on A and E. The Government do not like to talk about that because of the record my hon. Friend just outlined, and I will come to that later in my remarks.

The Secretary of State visited his first A and E in April, and NHS England requested action plans only on 9 May, when hospitals had already been battling with the problem for months. It is simply not good enough. The NHS needs leadership and he has not provided it; instead, he has stuck to the spin. He continued to blame the GP contract, even when experts queued up to tell him it was not the cause of the problem. The NHS Confederation, the Royal College of General Practitioners, the King’s Fund and the Foundation Trust Network all told him that the causes lay elsewhere, but he was not listening because it did not suit his argument. When the NHS needed a Secretary of State, it was left with a spin doctor-in-chief.

That brings us to the crux of this debate and the charge that I lay directly at the Secretary of State’s door. By persisting with spin and by diverting attention elsewhere, the real causes of this crisis have been left neglected.

Andrew Selous (South West Bedfordshire) (Con): If the right hon. Gentleman looks at the graph of A and E attendances, he will see that the figure was pretty constant at 14 million until 2003-04, when it rose steadily to 21 million. Why does he think that there was that big rise in A and E attendances at the time of the change to the GP contract?

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Andy Burnham: The spin continues, doesn’t it, Mr Deputy Speaker? Let me explain why that happened. [Interruption.] I will explain if the hon. Gentleman will listen. Perhaps he should look at the subject in more detail before he comes to this place and makes a comment like that. In 2003-04 the statistics changed, and visits to walk-in centres and minor injuries units were added to the figures. If he read the King’s Fund analysis of trends in A and E over the past decade, he would see that it says that very clearly. Perhaps the next time he comes to a debate like this he might do his homework.

In the vacuum that the Government have left, it has been left to Labour to show the leadership that the NHS desperately needs. Last week, Labour convened an A and E summit here in Parliament to refocus minds on the real underlying causes of this pressure. We wanted to give front-line staff from all over England the chance to tell us in their own words about the reality on the ground right now and to suggest practical ways in which the pressure might be relieved. Now, today, we bring this urgent debate to the House to shock the Government out of their complacency and to force them to act on what was said at the summit. There were two overriding messages that all politicians would do well to hear: first, the pressure in A and E is an issue for the whole health and care system; and secondly, there is no one simplistic, single cause but a range of complex underlying factors.

Sir Bob Russell (Colchester) (LD): Let me bring a note of conciliation to the debate. Does the right hon. Gentleman agree that if the nation had more people who are knowledgeable about first aid, fewer people would make their way to A and Es in the first place?

Andy Burnham: That is a laudable aim. I do not think it is going to solve the A and E crisis right here, right now, but I do not disagree with it as an aim.

Drawing on what was said at the summit, I have developed an A and E rescue plan with five practical proposals. [Interruption.] Government Members do not want to hear it. Okay, later on they can give me their plan. I am putting forward a plan and calling this debate. They are not calling this debate. Why are they not doing something to take a grip on the situation? It is no good just sitting back and saying, “Oh”—[Interruption.]

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. I want to hear the right hon. Gentleman, as I am sure that people on both sides of the House do, and all the shouting is not going to allow any of us to do that.

Andy Burnham: It has been left to us to call this debate, and now Government Members sit there and groan. Well, it is not good enough. They are going to hear what I have to say because they need to do something about what is happening.

Dame Joan Ruddock (Lewisham, Deptford) (Lab): Before my right hon. Friend gets on to his plan, may I ask him a question? Given the chaos that he has described throughout the whole country—in London, ambulance queues have doubled in the past couple of years—why does he think that the Secretary of State believes it is sensible to downgrade the A and E service at Lewisham and divert tens of thousands of people to other hospitals where the ambulances are queuing all down the road?

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Andy Burnham: My right hon. Friend rightly identifies some of the contradictory chaos that now passes for Government health policy. I will deal directly with her point later in my speech.

Mr Kevin Barron (Rother Valley) (Lab): In the preceding debate, the Government tabled an amendment of great worth answering all the points with regard to badgers, but there is no amendment for this debate. They have no answer and are not prepared to put anything on paper about how to get over this current crisis in A and E. Does that not speak volumes?

Andy Burnham: The Government have more to say about badgers than about the current crisis that NHS staff up and down the country are dealing with. That says a lot about this Government.

Caroline Lucas (Brighton, Pavilion) (Green): I absolutely agree with the right hon. Gentleman that there are no simple answers. Does he agree that one of the pressures that is adding to the problems in A and E is that £3 billion has been taken out of the NHS to fund a reorganisation under the Health and Social Care Act 2012 that nobody needs and nobody wants?

Andy Burnham: I agree entirely. That decision was catastrophic for the NHS. Not only did it siphon £3 billion out of the front line to pay for back-office restructuring; it took people’s eyes of the ball. When they should have been focusing on the front line and patient care, they were worrying about their jobs and which organisations they would work in. The Government were warned about this reorganisation and I will come on to that. I have new evidence, which I will put before the House today, that says that this Government were explicitly warned about the risks to A and E of proceeding with their reorganisation at a time of financial stress. It is pretty damning and I will come on to it later.

What I want to do today is achieve something for NHS staff watching this debate. Let us try to reach some agreement about the causes and the practical steps that now should be taken. First, on social care, which my hon. Friend the Member for Warrington North (Helen Jones) has mentioned, the survey of NHS financial directors says that this is the single biggest cause of the pressure. More than £1 billion has already been taken out of budgets already by this Government, and the Association of Directors of Adult Social Services says that councils are planning further spending and services cuts this year. This is simply not sustainable. It is a false economy. Social care is the preventative part of the care system. If the Government continue to hammer councils, the problem will simply end up on the doorstep of the NHS and it will get bigger and bigger. The human cost will be huge.

We heard at last week’s summit that more and more people with dementia are presenting at A and E. That is intensely sad and it is the wrong place for them to be.

Siobhain McDonagh (Mitcham and Morden) (Lab): Does my right hon. Friend agree that the most upsetting comment made at the summit was by the nurse at Kingston who told us of a lady with dementia who, when she is hungry or lonely, phones 999 for an ambulance and says that she has heart pain?

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Andy Burnham: The room went quiet when the nurse spoke at the summit. I pay tribute to my hon. Friend for being at the summit during the parliamentary recess to hear that nurse. It was a valuable event. My hon. Friend is absolutely right: the loss of simple support in the home for people such as that woman means that they are left with no alternative but to go to A and E or the hospital as the last resort. That is the false economy that I am talking about. By ransacking council budgets to pay for their NHS spending plans, the Government have left this system with major problems that they urgently need to address. The worst thing of all is that they have left older people with no option but to end up in hospital.

Robert Flello (Stoke-on-Trent South) (Lab): I am grateful to my right hon. Friend for giving way; he is being very generous with his time. He is absolutely right: areas such as Stoke-on-Trent have had their budgets slashed and destroyed year on year under this Government. In Stoke-on-Trent, which is the third hardest hit area, the local authority is expected to spread the money it does have even more thinly across a population that is not only deprived, but ageing. The sniping and comments from those of the Government Front Bench are totally inappropriate. Does my right hon. Friend know when the Government got the NHS to write to accident and emergency departments to ask for their plans?

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. A lot of Members want to speak, so we need very short interventions.

Andy Burnham: That is part of my point. NHS England wrote to clinical commissioning groups on 9 May. What is going on here? They were all in the chaos of reorganisation until then—no one could have received a letter, because CCGs were not in place. In the crucial period between January and March, when the NHS was under intense pressure, primary care trusts were on the way out and CCGs were not in place. As a result, the NHS was in limbo; at the precise moment that it needed grip and leadership, it was drifting. That is absolutely shocking.

As I have said repeatedly, the Government must act to shore up social care in England, which is collapsing. Our solution is for the Secretary of State to use about half of last year’s underspend in the NHS, £1.2 billion, to provide emergency support to councils over the next two years to maintain integrated, home-based support. As he knows, the Budget revealed a £2.2 billion underspend in last year’s Department of Health budget. No use was made of the budget exchange scheme. In other words, he handed that money back to the Treasury. I call on him to reconsider his decision, reopen negotiations with the Treasury and act to prevent a social care emergency.

Margot James (Stourbridge) (Con): Between 2005 and 2010, the population of over-65s grew by 730,000 and the population of over-80s—the very elderly—grew by 27%. Why did the previous Government increase the budget for adult social care by less than 1% a year to cope with that additional demand?

Andy Burnham: Oh dear, Mr Deputy Speaker. It is hard for this Government, who have decimated social care, to lecture us about it. Between 2005 and 2010, A and E waits fell. That was after the GP contract was

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signed. Let us have some facts. We did much to support social care and to deliver an NHS with the lowest ever waiting lists and the highest ever patient satisfaction.

The second point in our A and E rescue plan concerns safe staffing levels—another aspect that we have raised repeatedly with the Secretary of State.

Mr Stephen Dorrell (Charnwood) (Con): Will the right hon. Gentleman give way?

Andy Burnham: I will give way to the right hon. Gentleman in a moment.

All over the country, NHS staff are saying that there are not enough people on the ward to deal safely with the pressure that they are under. The College of Emergency Medicine has warned of a “workforce crisis” in A and E and of

“a lack of sufficient numbers of middle grade doctors and Consultants in Emergency Medicine to deliver consistent quality care.”

More than 4,000 nursing posts have been lost since May 2010 and the Care Quality Commission says that one in 10 hospitals in England is understaffed. It emerged last week that the problem is set to get worse. A survey of NHS HR directors by the Health Service Journal found that 27% of trusts were planning to cut nursing jobs in the coming year, that 20% were planning to cut doctors and that one in three was not confident that they had enough staff to meet demand.

As I have said before, all parties in this House, including my own, need to learn the lessons of the failures in care at Mid Staffs and of the Francis report. The primary cause of those failures was dangerous cuts to front-line staffing. There is a clear risk that the NHS is repeating that mistake. I therefore call on the Secretary of State to intervene in the further round of job cuts and to ensure that all hospitals in England have safe staffing levels.

Mr Dorrell: May I bring the right hon. Gentleman back to the interface between social care and health care? He knows that I have a lot of sympathy for the points that he made about the importance of making that interface work more smoothly than it has done for a long time. Is the House to interpret his remark that an additional £1.2 billion ought to be made available for social care as a spending commitment that has the consent of the shadow Chancellor, on the day when the Labour party has said that it will not make good the child benefit changes that it opposed earlier in the Parliament?

Andy Burnham: It is important for me to answer the Chairman of the Health Committee. Those of us who are in the club of former Secretaries of State understand that the health and social care systems are interconnected and must be seen as one system, because the failure of social care lands on the doorstep of the NHS.

To answer the right hon. Gentleman’s point directly, the money that I was talking about would come from the underspend. It is part of the allocated budget that his Government gave to the Department of Health for 2012-13. The Department did not spend the whole budget so there was a £2.2 billion underspend. As he knows, the practice has been that Departments can take forward that resource to meet new pressures in later years. I am asking the Secretary of State please to ask

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for access to that money to relieve the pressure on social care. Simply handing it back to the Treasury when there is an A and E crisis and social care is collapsing is not good enough.

The third point I want to address is out-of-hours advice and the introduction of the 111 service. Last week’s summit heard worrying evidence that the problems of 111 are not just teething problems, as the Secretary of State has claimed. We were told that the problems were more structural and were a result of how 111 has been set up—a feature of the cost-driven contracts that have replaced the successful and trusted NHS Direct. Contracts have gone to the lowest bidder, and they are saving money by having inexperienced call handlers working to a computer algorithm that too often results in the advice “Go to A and E”. There has also been a huge reduction in nurse-led call back, which was the norm with NHS Direct.

Barbara Keeley (Worsley and Eccles South) (Lab): Does my right hon. Friend know that we had a useful debate on this subject in Westminster Hall this morning, when I made the point that the dropping back from clinician-led triage has caused a problem that the chief executive of my local hospital told me about—that falling back on computer and non-clinician advice has led to patients being brought into the emergency departments when they were actually on end-of-life pathways and should have community input?

Andy Burnham: That shows the human cost of the failure that we have seen in recent weeks; my hon. Friend has identified yet another aspect of it.

There has been a huge reduction in nurse-led call back, so inexpert advice is being to people who should probably have other options put to them. An internal graph produced by NHS Direct shows that under the old 0845 NHS Direct service, about 60% of calls received a nurse call back; under 111, that has now dropped to between 17% and 19%. What is happening to these people? They are getting poor advice, so they are frightened and are going to A and E. What is this Secretary of State doing about it? Absolutely nothing.

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): The Public Accounts Committee recently heard evidence about out-of-hours services in Cornwall. The bad experiences there showed that a lot of cost shunting was going on. If there was even a risk of taking somebody on through the GPs on call, it was cheaper and easier for that service to shunt the costs to the NHS through for ambulance services. Does my right hon. Friend agree that that is a complete waste of money and that it underlines the shambles that he has just described?

Andy Burnham: I agree that there is a false economy here. The picture is repeated. The Government go for these privatised contracts, such as with 111, at the lowest cost, resulting in a drop in standards and less clinical support. What happens? People then turn up at A and E. What happens when social care is cut? People turn up at A and E. What happens when NHS walk-in centres are closed? People end up at A and E. This has serious implications. Across England, 22 serious incidents, including three deaths, are being investigated in connection with NHS 111, and we know that one in five calls is abandoned. This service is failing; it needs urgent action to tackle these problems.

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Andrew George (St Ives) (LD): With the Serco contract for out-of-hours GP services in Cornwall having been referred to the Care Quality Commission, the manipulation of the data, falsely representing the outcomes of the service, has been identified. It is worth reminding the right hon. Gentleman that this was set up under a contract that resulted from decisions made when he was in government.

Andy Burnham: I remember debating that with the hon. Gentleman when I was the Secretary of State. Those problems rightly needed to be addressed, and the particular issue he raises today should be investigated. I hope, however, that he will also understand the problem that I am describing to the House. If we go down the path of fragmenting services—if we take a successful national service such as NHS Direct, for example, which was trusted by the public, and then break it up into a patchwork of fragmented, some privatised, services—this sort of chaos will be the result.

A report has emerged this afternoon, showing that the viability of NHS Direct is in serious question. The headline states, “Leaked report casts doubt over NHS Direct’s ‘overall viability’ in the wake of NHS 111 failings”. This is a warning that NHS Direct may well go down altogether. What an indictment that would be of this Government’s mismanagement.

Mr Gareth Thomas (Harrow West) (Lab/Co-op) rose

Andy Burnham: I shall give way one last time before concluding.

Mr Thomas: Are the closures and restricted opening hours of many walk-in centres not having an impact on the increasing A and E crisis? Alexandra Avenue polyclinic, which serves my constituents, now restricts its opening hours to weekends.

Andy Burnham: I entirely agree, and I shall say more about that issue shortly.

Let me return to the subject of the 111 service. Will the Secretary of State review the contracts with the aim of negotiating changes so that more calls can be handled by nurses? The use of the computer algorithm should be reviewed as a matter of urgency, and the full roll-out of 111 should be delayed until the problems have been solved.

There are more general questions to be asked about the scale and pace of NHS privatisation. NHS Direct offers an illustration of what happens when services are broken up. Those who attended last week’s summit heard that in some areas there had been a huge increase in the provision of 999 ambulances by private companies. It was said that on a single day in Yorkshire, 50% of 999 calls had been responded to by private operators. I think that the public would be surprised to know that. It shows that there is no part of our NHS that cannot be put up for sale by this Government.

Is the Secretary of State satisfied that those private crews are appropriately trained and have the right equipment? Is there not a danger that because contractors are operating in isolation from the rest of the system, they will all too often simply transport people to A and E? Does the Secretary of State envisage any limits to private 999 services? Given that the issue raises fundamental questions about emergency services, should there not be a debate about it before this goes any further?

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Fourthly—I come now to the point raised by my hon. Friend the Member for Harrow West (Mr Thomas)—there is good evidence to show that NHS walk-in centres have diverted pressure from A and E units. In 2010-11, there were about 2.5 million visits to such centres from people who might otherwise have gone to A and E. Analysis by the House of Commons Library shows that 26 of them closed in the last year alone, and that the number is down by a quarter. The Government have let that happen, but at least Monitor has intervened and set up a review of the loss of walk-in centres. Will the Secretary of State halt all further closures while the review is taking place?

That brings me to my fifth and final point, which concerns A and E closures and downgrades. At least 25 A and E units—one in 10—are under threat or have recently closed. The trouble with these plans is that they were drawn up in a different context, when A and E was not under the pressure that it is under today. Let me say this to the Secretary of State: if a clinical case can be made in support of closures—if there is evidence that lives can be saved—the Opposition will not oppose the plans. However, we cannot accept the pushing through of proposals that have not taken enough account of the latest evidence, and cannot show that extra pressure can be safely absorbed by neighbouring units. That is important, because the public will rightly ask this simple question: how can it make sense to close A and Es in the middle of an A and E crisis? To reassure people, will the Secretary of State personally review all the ongoing A and E closure or downgrade proposals on a case-by-case basis, in the light of the very latest evidence of pressure in the local health economy?

Mr Andy Slaughter (Hammersmith) (Lab) rose—

Kate Green (Stretford and Urmston) (Lab) rose—

Andy Burnham: I will give way one last time to each of my hon. Friends, but then I must finish my speech.

Mr Slaughter: What my right hon. Friend has been saying will be music to the ears of people in west London, where four A and E units are slated for closure. All of them are coping with dreadful circumstances. Will my right hon. Friend—and perhaps also the hon. Member for Enfield North (Nick de Bois), who seems to share his view—have a word with my local Conservatives, who are supporting all those closures?

Andy Burnham: I think that everyone needs to consider their position in the light of the evidence that is emerging about pressure on A and E, particularly in London. I pay tribute to the excellent and determined campaign run by my hon. Friend, and I noted what was said yesterday by the hon. Member for Enfield North. Perhaps one of the consequences of today’s debate will be agreement across the Floor of the House to delay any closures pending a personal review of the evidence by the Secretary of State.

Kate Green rose—

Andy Burnham: I will give way for the last time.

Kate Green: As my right hon. Friend will know, my local A and E unit at Trafford general hospital is one of the 30-odd units that are scheduled for downgrading. Meanwhile, it is more than 30 weeks since the two

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nearest A and E units, at Central and South Manchester hospitals, failed to meet the 95% performance target last September. Does my right hon. Friend agree that the Secretary of State should also publish advice that he has received from the Independent Reconfiguration Panel which will inform his decisions, so that we can determine whether the latest pressures have been taken into account?

Andy Burnham: I think that full openness about these decisions is essential in the current context. I know that the panel’s report is with the Secretary of State, and I think he owes it to local Members of Parliament to be open about its conclusions and the evidence on which they were based. That is why I ask him to review every proposed A and E closure personally, and to give a guarantee to communities such as that represented by my hon. Friend that no changes will be made unless he is personally satisfied that it is safe to make them.

In conclusion, this is a crisis that could have been avoided. For the last three years the NHS has been struggling with the toxic medicine of budget cuts and top-down reorganisation. All the focus should have been on the front line, but instead the Government siphoned £3 billion out of it to pay for a back-office reorganisation that no one wanted and no one voted for—a reorganisation that has placed the NHS on a fast track to fragmentation and privatisation.

But it is worse than that. The Government’s own risk registers, which they refused to publish during the passage of the Health and Social Care Act 2012, warned them of the consequences of pushing ahead with a reorganisation when the NHS was facing great financial stress:

“The consequences could be compromised clinical care and patient safety, the failure of the 95% operational standard for A&E wait and a concomitant impact on other trust services”.

So they knew the risks they were taking when they reorganised the NHS at a time of financial stress; they were warned about this A and E crisis, but ploughed on regardless. It is the height of irresponsibility. No wonder they wanted to keep the risk registers secret. But with the looming cuts to jobs and social care, the problems in A and E will get worse, not better, if no action is taken on the points I have outlined today.

We have given the Secretary of State a practical plan, and he either needs to accept it or put one forward of his own. Right now, his complacency is one of the biggest dangers facing the NHS. He has failed to act on warnings about the collapse of social care. He has sat on his hands while front-line jobs are cut in their thousands. He has presided over the disastrous 111 service. He has closed NHS walk-in centres and downgraded A and Es without a convincing clinical case. It is no good his standing up today and blaming everyone else: this is a mess of his making—his first real test as Secretary of State and he has been found badly wanting. People want answers and action, and he needs to start providing them right now.

5.1 pm

The Secretary of State for Health (Mr Jeremy Hunt): What we have heard today will rank as one of the poorest speeches ever given by an Opposition on the NHS. [Interruption.] I predict—[Interruption.]

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Mr Deputy Speaker (Mr Lindsay Hoyle): Order. [Interruption.] Mr Karl Turner, thank you for your advice, but we can manage without it today. I make this appeal to both sides: I want to hear what the Secretary of State has to say, just as I wanted to hear what the Opposition had to say.

Mr Hunt: Thank you, Mr Deputy Speaker.

I repeat: it was one of the poorest speeches ever given by an Opposition on the NHS, and I predict that the right hon. Member for Leigh (Andy Burnham) will bitterly regret choosing to make an issue of A and E pressures, because the root causes of the problem have Labour’s fingerprints all over them.

The right hon. Gentleman was right on one thing, however: there is complacency on this issue—not from the Government, who have been gripping it right from the start, but rather from Labour, which still does not understand why things went so badly wrong in the NHS on its watch.

Labour’s narrative has, I am afraid, a single political purpose at its heart: to undermine public confidence in one of our greatest institutions—an institution which, in challenging circumstances, is performing extremely well for the millions of vulnerable people who depend on it day in, day out.

Labour’s story today is a totally irresponsible misrepresentation of reality. One million more people are now going through A and Es every year than in 2010, which creates a lot of pressure, so how are A and E departments actually performing? The latest figures show performance, against the 95% target, of 96.7%. The week before it was 96.5%, then before that 96.3%, 96.6% and 95.6%. Yes, we had a difficult winter and a cold Easter, and I will come to the causes of the problems we had then, but, thanks to the hard work of NHS doctors and nurses, our A and E departments are performing extremely well.

Henry Smith (Crawley) (Con): The Secretary of State is absolutely right to say that we should point to the record of the previous Government, who closed the A and E department in Crawley.

Mr Hunt: Indeed. We were having a discussion about walk-in centres. It is true that Labour opened a lot of those, just as it closed or downgraded 12 A and E departments during its time in office. That is one of the reasons we face the problems we have today.

Angie Bray (Ealing Central and Acton) (Con): My right hon. Friend should know that my constituents welcome his decision to refer to an independent review the plans to close the four A and Es closest to my constituency. Does he agree that the review will need to look carefully at whether due consideration was given to the impact of those four closures on the neighbouring hospitals and their A and E departments?

Mr Hunt: I absolutely agree with my hon. Friend that the impact on neighbouring A and Es in all reconfiguration decisions is extremely important, and I will not authorise any changes in service provision unless I am satisfied that they will be consistent with improved patient safety.

Several hon. Members rose

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Mr Hunt: I will make some progress and then give way. I want to ask why the Opposition have chosen to call this debate. I am afraid it is nothing less than a smokescreen, because their objective is to try to dress up the pressures on A and E as a short-term crisis when, as every A and E department in the country will tell us, to deal with the pressures we need to address long-term structural problems that the previous Government either ignored or made worse.

Bill Esterson (Sefton Central) (Lab): May we talk about one of the pressures on A and E, which is the pressure of social care? I hope that the Secretary of State will accept that significant cuts have been made in social care under this Government and that the role of social care is crucial in keeping people in their homes in the first place and in returning them to their homes after they have been in hospital. As a result of those cuts, it is very difficult for social care to perform that role. Will he examine the suggestion by my right hon. Friend the Member for Leigh (Andy Burnham) to use the underspend from the Department of Health to support social care to perform its essential role?

Mr Hunt: I will come to that suggestion, but I agree with the hon. Gentleman. If we are going to deal with bed blocking, which is one of the root causes of the problems that many A and E departments talk about, we have to have better integration between the health and social care systems—that is essential. I say to him that the problem of the underfunding of social care did not start in 2010; as my hon. Friend the Member for Stourbridge (Margot James) said, it is a problem that goes back many years, and the failure to integrate health and social care was a failure that happened over 13 long Labour years.

Several hon. Members rose

Mr Hunt: I am going to make some progress and then I will give way.

There is something else that the Labour party does not want the public to notice and it is another elephant in the room: the NHS is actually doing better under the coalition than it ever did under Labour. Let no one forget the NHS we had in 2010: no cancer drugs fund for the 26,000 people who now benefit from it; 400,000 fewer operations every year; double the number of MRSA infections; and 18 times more people waiting for more than a year for their operation.

Several hon. Members rose

Mr Hunt: I am going to make some progress. The right hon. Member for Leigh talked about grip. There is one place where grip is badly lacking. Labour does not like to hear about this because it is Labour-run Wales, where, as the Prime Minister said this morning, the A and E target has not been met since 2009. It is where performance—[Interruption.] I know that Labour Members do not want to hear this, but I suggest they listen to it, because performance in Wales—[Interruption.] Let me finish making the point. Performance was worse in Wales than in England for every one of the weeks that we missed our A and E target this winter. If the right hon. Gentleman really cared about patients, he would be condemning what is happening in Wales.

Several hon. Members rose

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Mr Hunt: I will make my point and then I will give way. Labour Members need to hear about what is happening in Wales, because Labour runs the NHS in Wales. One patient in Wales had a cardiac arrest—[Interruption.] I know that this is difficult for Labour Members, but they need to hear about what is happening in Labour-run Wales. One patient had a—

Several hon. Members rose

Mr Hunt: I will give way to the shadow Health Secretary in a minute. One patient there had a cardiac arrest in the eye-examination room as there was no room in the resuscitation bay, and 24 to 36-hour waits for beds are now common in Wales. One patient spent a full three days in a Welsh emergency department. So let me give him a chance finally to condemn what is happening in Wales.

Andy Burnham: People watching this debate will be wondering why the Secretary of State is talking about something that is not his responsibility; nor is it mine. He is not responsible for the NHS in Wales; nor am I. I have put to him today serious questions about the NHS in England right now. He is the Secretary of State for the NHS in England, so will he now address the questions I put to him?

Mr Hunt: So there we are. Labour totally fails again to condemn the appalling shambles in the part of the country where it runs the NHS. I will tell the right hon. Gentleman why what is happening in Wales is completely relevant to the debate in England.

Wayne David (Caerphilly) (Lab): Will the Secretary of State give way?

Mr Hunt: The hon. Gentleman should listen to this. One reason for the problems in Wales is that Labour cut the NHS budget in Wales by 8%, or £814 million, and cutting the NHS budget is exactly what the shadow Health Secretary wants to do in England—

Chris Bryant (Rhondda) (Lab): Will the Secretary of State give way to a Welsh MP?

Mr Hunt: The hon. Gentleman, as a Welsh MP, might want to listen to this. Both the NHS budget and spending—

Wayne David: Will the Secretary of State give way to a Welsh MP?

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. We want a little more calm. Mr David, you are getting far too excited. It is not good for you and it is not good for the Chamber—[Interruption.] Order. I do not want you to repeat your point. I have just explained to you that I need you to be a little calmer. It is up to the Secretary of State whether he wishes to give way and at the moment he is not doing so. It is his choice and shouting will not make any difference whatsoever.

Mr Hunt: Thank you, Mr Deputy Speaker—

Wayne David rose

Mr Hunt: I will give way to the hon. Gentleman, if he will just take his place for a moment while I make my point. I will also give way to my hon. Friend the Member for Enfield North (Nick de Bois)—[Interruption.] I will reflect on whether I want to give way to the hon.

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Member for Rhondda (Chris Bryant), but I will certainly give way to the hon. Member for Caerphilly (Wayne David).

What is happening in Wales is directly relevant to what is happening in England, because in England the NHS budget has increased in real terms and NHS spending has increased in real terms. If we did not increase them both, that would mean fewer doctors, fewer nurses and longer waits for operations—[Interruption.] The shadow Secretary of State shouts from a sedentary position that the NHS—

Andy Burnham: On a point of order, Mr Deputy Speaker. The Secretary of State has just said at the Dispatch Box that the budget for the NHS has increased in real terms. In December, I referred the Secretary of State’s comments to the UK Statistics Authority and I received a letter back saying that they were incorrect. Will you ask the Secretary of State to correct the parliamentary record and ensure that when the statistics commissioner makes a ruling it is adhered to by the Secretary of State?

Mr Deputy Speaker: That is not a point of order, but the right hon. Gentleman has certainly made his clarification for the record.

Mr Hunt: I thought that the shadow Health Secretary might try to do that, so let me give him the figures. I have the figures provided by the Department of Health finance department, based on the latest GDP deflators, as published at the Budget. Spending in the NHS—not the budget—in 2009-10 was £99.7 billion and for 2012-13 it is forecast to be £106.6 billion. That is a cash increase of £6.9 billion and a real-terms increase of £0.6 billion, so there is a real-terms increase in the NHS budget. The shadow Secretary of State does not agree with the real-terms increase of £600 million in the NHS today; there would be a Labour cut in NHS spending and I suggest that he might want to correct the record, as I am afraid he has got this wrong.

Nick de Bois (Enfield North) (Con): My right hon. Friend knows, as his predecessor does and as the Prime Minister does, of my consistent opposition to the downgrading of Chase Farm hospital. Does he agree with me that it is utterly inacceptable for the hon. Member for Hammersmith (Mr Slaughter), who is no longer in his place, to suggest otherwise in this Chamber?

Mr Hunt: I agree, but I am afraid that the Opposition are playing fast and loose with the facts today, so it is perhaps not a surprise.

The hon. Member for Caerphilly has been extremely patient, so let me listen to his point.

Wayne David: I thank the Secretary of State for eventually giving way. Does he not accept that, despite the fact that the block grant to the Welsh Government has been cut by £1.4 billion, Welsh spending on the health service has been maintained in real terms?

Mr Hunt: What Labour did in Wales was cut the NHS budget by 8% and that is why that Government have not met their A and E targets since 2009. Those on the Labour Front Bench in England want to cut the NHS budget here. That would not help pressures on A and E; it would make them a great deal worse.

Several hon. Members rose—

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Mr Hunt: I shall make some progress, because this gets even worse for Labour.

The shadow Secretary of State wrote to me at the weekend, asking me to relieve pressure on A and E by using the health underspend to put extra money into social care. There is a way of releasing resources into social care, but it is not that, because the underspend he talks of sits largely with NHS trusts and clinical commissioning groups, which are allowed to keep their underspends and roll them over to subsequent years. If we took away that money and put it into social care, we would therefore have to take it away from hospitals, where it is needed most to help tackle pressures in A and E and other places.

Let us look at some of the hospitals that would lose money under Labour’s plans. Wigan and Leigh NHS Foundation Trust, in the right hon. Gentleman’s own constituency, had a £4 million underspend in 2012-13. It would be prevented from using that money to reduce A and E pressures, as would the Royal Cornwall, the Royal United hospital Bath, Nottingham University hospitals—

Chris Bryant rose—

Mr Hunt: I am going to make some progress. The Royal Wolverhampton, East Lancashire, Royal Liverpool and Broadgreen, North Bristol, Coventry and many other hospitals would also be prevented from using the money. So Labour’s solution to the A and E crisis is to cut funding to hospitals—about as logical as wanting to reduce debt by increasing the deficit.

From a Labour party that wants to be a Government in waiting, this is not good enough. It is against a cut in NHS spending that did not happen, but when there is a real cut in Wales it says nothing. It is against hospital reconfigurations in England, where we are hitting the A and E target, yet says nothing about reconfigurations in Wales, where Labour is missing the A and E target. It says it is against reorganisations and it has just proposed its own huge structural reorganisation to merge the health and social care system. Why is that? It is because in the end it is more interested—we have seen this today—in party politics than the right policies. I think we can expect better from someone who used to be a Health Secretary.

Several hon. Members rose—

Mr Hunt: I shall make some progress because I have some important points to make.

A and E pressures are not the only thing that happened to the NHS this winter; we also had the Francis report into Mid Staffs. That tragedy is also relevant to A and E pressures, because at the height of its failures in care, Mid Staffs, unbelievably, was actually hitting its A and E target. In fact, between 2004 and 2009, there were only three quarters in which Mid Staffs failed to see 95% of people within four hours—hitting the target and missing the point. But in Labour’s NHS, hitting the target was all that counted, because Ministers ignored three reports, 50 warning signs and 81 requests for a public inquiry into Mid Staffs and what was going on.

Things have changed in the NHS, and I say this plainly. It is harder now for hospitals to hit their A and E target, because we will not condone cutting corners to

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get there. Targets matter, but not at any cost, and we are determined to reach them by doing things properly, making sure that we always treat patients with dignity and respect.

Several hon. Members rose—

Mr Hunt: I shall make some progress.

Labour’s complacency on that issue is revealed as even more shocking when we look at the root causes of pressures on A and E departments, because nearly all of them involve issues that Labour either failed to tackle in office or made a great deal worse—for example, the IT fiasco, so heavily criticised by the National Audit Office. It is completely unacceptable that A and E departments are not able to access, with their consent, people’s GP records. Last year, there were 30,000 wrong prescriptions in the NHS and 11 deaths—something we know would be significantly improved with e-prescribing in hospitals. The Government have addressed that, with a fund that I announced last month and an ambitious programme to make the NHS paperless by 2018, learning from that procurement debacle for which we are now paying the price.

Let us look at other causes. The working time directive, which Labour signed up to, makes the recruitment of A and E staff very much harder.

Chris Bryant rose—

Mr Hunt: I think the hon. Gentleman should listen to this. Professor John Temple described that as having the biggest impact on the emergency and out-of-hours parts of the NHS, which is why the Government are now having to increase recruitment into A and E through the mandate that the Government have set Health Education England. Or there is the total failure—

Gloria De Piero (Ashfield) (Lab) In one week in April 2012, 75 people in Sherwood Forest trust waited longer than four hours at A and E. In the same week in April this year, 266 people waited longer than four hours at A and E. That is a 255% increase. How does the Secretary of State account for that?

Mr Hunt: I agree that A and E departments are under huge pressure, and that is why we are taking a lot of measures to deal with them, which is what I am talking about. But I am saying that we have to deal with the root causes, which were things that the shadow Secretary of State’s Government failed to deal with. [Interruption.] Labour Members need to listen. We listened to the shadow Secretary of State’s solutions, which were not really solutions; now I am telling them what we think needs to happen.

We welcome the fact that the Labour party has now seen the light and recognises the need for integration, but Labour Members need to show some humility, because it was the Labour Government who put in place many of the barriers—in particular payment by results mechanisms—that make that so hard to achieve. We are now trying to make integration a reality through the 10 pilots on removing barriers to integration announced by the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), as part of the vulnerable older people’s plan

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announced to the House last month. Without integration, we will not solve the problem of bed blocking, which is at the heart of the pressures on A and E.

Andrew Percy (Brigg and Goole) (Con): The Secretary of State is right to say that many of the present failures started in the Labour years, particularly the problems with integration. Does he share the concern that I and many of my constituents feel about the 50,000 beds that were lost under Labour Government? We lost the beds, but the intermediate care services and step up, step down facilities were never created to deal with the consequences. That is what is behind a lot of the A and E referrals today.

Mr Hunt: That is part of the problem with Labour’s approach to the NHS—a top-down approach of closing or downgrading A and E units and making the NHS sort out the problems. We are not doing that.

It is time that Labour took responsibility for the disastrous changes to the GP contract, which contributed to making it so much harder to get a GP appointment and piled further pressure on A and E departments—[Interruption.] No, they need to listen; this is important. The changes in 2004 handed responsibility for providing out-of-hours services to administrators in primary care trusts, at a stroke removing the 24/7 responsibility for patients that until then had always been a core part of being a family doctor. As we heard earlier today, even a former Labour Health Minister regretted those changes, saying before the last election:

“In many ways, GPs got the best deal they ever had from that 2004 contract and since then we have, in a sense, been recovering.”

It is important that Labour Members hear the list of independent voices all saying that we need fundamental change in primary care if we are to deal with pressures on A and E: the College of Emergency Medicine, the Royal College of Physicians, the NHS Alliance, the Family Doctor Association, the head of the Royal College of General Practitioners, who—surprisingly—said something in support of the Government in The Guardian this morning, the Foundation Trust Network and so on. All those voices were ignored by Labour as it put its head in the sand about that disastrous change to the GP contract.

Ian Swales (Redcar) (LD): Does the Secretary of State share my horror that the out-of-hours contracts awarded by the previous Government to companies such as Serco give them a financial incentive to call an ambulance rather than deal with cases through GPs or in the community?

Mr Hunt: The system is dysfunctional, and at the heart of the problem is Labour’s creation of a system in which GPs lost round-the-clock responsibility for the patients on their list. That is fundamentally wrong and we need to deal with it.

Yasmin Qureshi (Bolton South East) (Lab): Today’s debate is about the increase in waiting times at accident and emergency departments. In 2010, when Labour left office, 98% of people were seen within four hours; three years later, after three years of Conservative Government, the number of people who have to wait more than four hours has trebled. What is the Secretary of State going to do about that?

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Mr Hunt: Let me say very directly to the hon. Lady that since 2010 two things have happened that have contributed—[Interruption.] I am answering the question. First, 1 million more people are now going through A and E; secondly, the target has been reduced from 98% to 95% on the advice of the College of Emergency Medicine and the Royal College of Nursing. Labour has decided to do the same thing in Wales. Obviously, in that situation, the result is an increase in the absolute numbers; however, year on year since 2010, this Government have hit our A and E targets and we intend to continue to do so.

Sir Bob Russell: Mention has been made of an additional 1 million people going to accident and emergency. The derision I received earlier was an attack on organisations such as St John Ambulance, which trains first aiders, because the simple fact is, as I said when speaking to my ten-minute rule Bill 10 years ago, that first aiders will

“reduce visits to overstretched accident and emergency departments by people whose injuries did not warrant hospital attention”—[Official Report, 19 November 2003; Vol. 413, c. 809.]

We should be getting more first aiders out there. If the last Labour Government had listened to that, we would have 1 million more first aiders.

Mr Hunt: I welcome all things that can reduce the pressure on A and E, and I am sure that there is a role for increasing knowledge of first aid.

Several hon. Members rose—

Mr Hunt: No, I will make my concluding remarks. We will address these fundamental issues in our vulnerable older people’s plan, which is being published later this year. I have asked Sir Bruce Keogh, NHS England’s medical director, to lead an urgent review of demands on our emergency care and how services should respond in future. In the short term, we have changed the tariff arrangements for A and E payment to give hospitals a say in the use of funds earmarked to prevent avoidable admissions. The result is that A and E targets are now being met, not missed; long-term challenges are being confronted, not avoided; and the NHS, with its extraordinary professionals, is facing up to the great challenges of an ageing population with resilience and determination, treating more people more quickly and more safely than ever before in its history, and rather than deriding that performance for party political purposes the House should be celebrating its success.

Several hon. Members rose—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. We have 19 speakers to get in, so we are introducing a four-minute limit.

5.26 pm

Frank Dobson (Holborn and St Pancras) (Lab): That is the most extraordinary speech I have heard from a Secretary of State for Health in all my years in this House. As a former Secretary of State, I know that Secretaries of State cannot be responsible for everything, but this is the first speech in which a Secretary of State has claimed he is not responsible for anything. He quoted the Francis report. One of its most significant features was that it said that we should impose a statutory duty of candour on people working in the national

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health service; if anything goes wrong, they are supposed to come clean and admit responsibility. I hope that there will be a clause in a Bill introducing the duty that says that this Secretary of State should have a duty of candour and admit the things that have gone wrong.

What have Ministers been doing for the past three years? The main thing they have been doing is dismantling the national health service. Staff have been distracted from their jobs, and money—£3 billion—has been diverted into that reorganisation. Some of that has been spent on redundancy for nurses who work in accident and emergency. The Government have been proudly saying, “We have hit our new target.” Well, they reduced it and made it easier to hit. The 111 line has referred more cases to A and E than NHS Direct did. There have been cuts in social care, which have two effects on A and E. First, it means that more elderly people go to A and E for treatment because they are not getting the attention that they were from social services. Secondly, it means that there will be delays in patients going home, both from A and E and from ordinary hospital beds, and that causes delay, too. Walk-in centres have closed, and the Government have given the surplus money back to the Treasury, yet they deny that any single one of their policies has had any effect on A and E services. They have had three years in power, and they are still blaming other people.

The Government claim that the increase resulted from the change to the GP contract. They know full well that that is not true; they know that it was because walk-in centres and minor injuries units were counted in the figures for the first time. If the Secretary of State expects people in the national health service to respect him and take any notice of him, not just regard him as the Catherine wheel of spin, he has to come clean. He is telling people that if they get things wrong in the health service they must come clean and be honest with the public. If he does not apply that to himself he will be a bit like the dad who has told people not to give their kids a leg up, but who turns out to have employed both his daughters: he did not apply to himself what he said everybody else should do. My right hon. Friend the Member for Leigh (Andy Burnham) was right: there was spare money, but under the new set-up can the Secretary of State get it into the hands of the health service, or did his predecessor throw away that power?


5.30 pm

Mr Stephen Dorrell (Charnwood) (Con): I welcome the fact that we are debating increased evidence of service pressures in the national health service. Having attended health debates in the House of Commons for quite a few years, I can say that there is a depressingly familiar tone to this debate. May I tell the right hon. Member for Leigh (Andy Burnham) that if we want to develop party points in the House and convince the electorate that there is something in it, it is not a bad idea to begin by establishing where the real differences exist between the Government and the Opposition? If we look at the evidence for why we have experienced increased service difficulty in the health service, we see that it is not the differences between the Government and the Opposition that are striking but the fact that there is a shared analysis. However, there is an apparent unwillingness to apply that analysis and work it through in the necessary large-scale service change that we require.

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As for the roots of increased service pressures in the health service, I agree with quite of lot of what my right hon. Friend the Secretary of State said about the GP contract, but that is not why those pressures exist. Their true roots go back to the time in which the right hon. Member for Leigh was Secretary of State. In 2009, David Nicholson said that demand would go on rising in the health service, and that given the state of public finances we had to find ways of meeting that demand without continuing to make calls on the taxpayer on the scale that we had grown used to over the first 60 years in the history of the health service.

Steve Baker (Wycombe) (Con): In Wycombe, ever since our A and E was closed under the previous Government, people have wanted nothing more than to get it back. It is clear that medicine has changed and that they will not do so, but does my right hon. Friend agree that there has been a long-standing failure to explain those pressures to the public?

Mr Dorrell: I absolutely agree with my hon. Friend. We cannot blame people in the country for not understanding the need for change in the health service if politicians never explain why that need has arisen. I quite often quote Enoch Powell—not someone who wins a consensus across the House—who as Health Minister went to the equivalent of the NHS Confederation conference, which is now under way in Liverpool, to explain the need for the change in the service model in mental health. He said in his speech that

“Hospitals are not like pyramids, built to impress some remote posterity”.

That is the case that we need to begin to explain.

Chris Bryant rose

Mr Dorrell: I shall give way once more.

Chris Bryant: I am grateful for the right hon. Gentleman’s generosity. One of the ironies is that Enoch Powell recruited a lot of doctors overseas. He would have had absolutely nothing to do with the argument advanced yesterday by one of the right hon. Gentleman’s colleagues that all the problems in A and E are to do with the arrival of migrants. If anything, we need to change immigration policy in this country, so that more doctors can come here.

Mr Dorrell: I have four minutes, or with two interventions, six minutes, so if the hon. Gentleman will forgive me, I shall not go off into a discussion about immigration policy.

I want to focus on the changing needs that the health service has to meet. I sometimes wonder whether people talking about rising demand on the health service and rising demand for emergency care have ever sat in a GP’s surgery. Have they noticed around them in a GP’s surgery the kind of people who present in a surgery and the conditions that bring them there—dementia, diabetes and drug and alcohol abuse? How can we expect a service that was designed to meet the needs of patients, inasmuch as it was designed at all, in the 1950s, 1960s and 1970s to meet the needs of today’s increasingly elderly and dependent patients, without rethinking the way care is delivered?

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This is—I come back to my core point—a shared analysis. It is not a subject of party political debate. It is a shared analysis between the two Front Benches, and what is even more surprising is that not only is the analysis shared, but the conclusions about the right policy response are shared.

Andy Burnham: Will the right hon. Gentleman give way?

Mr Dorrell: Forgive me. I have a minute and a half and I want to develop what I think is an important point.

When I make the case for greater urgency about integration between the different parts of the health and care system, I am often told that I am supporting Andy Burnham’s plan. I am quite happy to support Andy Burnham’s plan. Actually, I gently claim credit for the fact that the Health Committee on a cross-party basis has been advancing this analysis from the beginning of this Parliament, and with due deference to the right hon. Gentleman and to my colleagues on the Select Committee I will also point out that part of the answer that the right hon. Gentleman is—rightly, I think—advancing builds on health and wellbeing boards, which are the creation not of me or of him, but of my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), the former Secretary of State for Health and now the Leader of the House of Commons.

The right hon. Member for Holborn and St Pancras (Frank Dobson) talked about a duty of candour. Could we not have a duty of candour about agreement in the House of Commons—agreement that what needs to happen is not to find artificial divisions, but to build on the need for urgent change to meet the needs of today’s patients?

5.36 pm

Heidi Alexander (Lewisham East) (Lab): It is a pleasure to follow the Chairman of the Select Committee, the right hon. Member for Charnwood (Mr Dorrell).

The speech that we heard from the Health Secretary was pathetic. He spent 25 minutes making up excuses for not taking action but not telling us anything about what this Government plan to do.

When I stood for election three years ago, A and E services were not an issue on the doorsteps of Lewisham East but now, as a result of this Government’s determination to decimate services at Lewisham hospital, it is the most frequently cited concern. My constituents are at a loss to understand why, when there is such pressure upon A and E, this Government want to get rid of the full A and E service at their local hospital. This situation is not limited to Lewisham. It is happening all over the country.

Dame Joan Ruddock: My hon. Friend will know that on every occasion when she and I have had exchanges with the Secretary of State—it is a great pity that he has left the Chamber—he has justified the downgrade of Lewisham hospital on the basis that 100 lives across the south-east of London could be saved. We can find no evidence for that. Both my hon. Friend and I have written to Sir Bruce Keogh—I did so on 14 May—who the Secretary of State always says is the man who made this recommendation. The Secretary of State takes no responsibility.

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Madam Deputy Speaker (Dawn Primarolo): Briefly. Interventions are supposed to be brief, not a speech in their own right. The right hon. Lady will have to resume her seat.

Dame Joan Ruddock rose—

Madam Deputy Speaker: Now.

Heidi Alexander: I agree that the evidence on which that assertion was based is deeply spurious and a meeting with Sir Bruce Keogh, which I requested, would be very helpful to the three Lewisham Members.

The situation, as I said, is repeated all over the country. There are more people stuck on ambulances waiting to get into A and E, more people waiting longer for treatment when they get there, and this Government’s answer is to close the A and E, ask people to travel further, and tell them to go to a bigger hospital, where the queue will probably be longer. If this is not the politics of the lunatic asylum, I do not know what is.

My constituents in Lewisham have been told that their full A and E service has to close in order to bail out the hospitals down the road. The whole decision-making process has been opaque and, in my view, deceitful. It is now rightly being challenged in the courts by Lewisham council and the save Lewisham hospital campaign. But for now, my constituents still face the prospect of seriously downgraded services at their local hospital. Not only are my constituents being told that they will have to travel further in future to get to an A and E, but to add injury to insult, they are being told to go to departments where performance is generally below that at Lewisham. In 29 of the 35 weeks between the end of September last year and the end of May this year, people were seen more quickly at the A and E in Lewisham than they were at the hospitals within the South London Healthcare NHS Trust where they are now being told to go.

In the first four months of this year, ambulances were placed on divert 25 times to Lewisham hospital. They were diverted away from the very hospitals where my constituents are now being told to go. It does not take a brain surgeon to work out why 25,000 people chose to march against these proposals in January. Under no circumstances should any changes at Lewisham hospital be made unless ambulance diverts have stopped and waiting time targets in neighbouring hospitals have been met. I do not want the changes to happen at all, but surely this is the least that the Government should commit to.

The Government seem intent on blaming everyone but themselves for the crisis in A and E. They seem oblivious to the fact that the things they are doing now, such as destabilising reorganisations and the devastating cuts to adult social care, are making the situation worse. They are shutting their eyes to the problem and ploughing on regardless with a programme of A and E closures. I accept that in some places reconfiguration of hospital services will be necessary, but this process must be driven by what is in the best interests of patients. That is not what is happening in Lewisham.

The Government want to blame everyone but themselves for the crisis in the NHS. The sooner we ditch the blame game and have a grown-up debate with thought-out solutions, the better our NHS will be for it.

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5.41 pm

Dr Sarah Wollaston (Totnes) (Con): This is an enormously complex issue and we must not look at A and E in isolation. We also have to be very careful about the way we use data. I recommend that all Members look at the King’s Fund blog on this to see how the way in which the codings were changed and the data recorded to include walk-in centres and minor injuries units between 2003-04 gives a different perspective to the debate.

Given that complexity, we need to look at the solutions, which need to come by ensuring that people can see the right professional at the right time in the right place. That is key to this. But as my right hon. Friend the Member for Charnwood (Mr Dorrell) said, we must also recognise that the key driver for demand in this is our ageing population. If we look at the impact within general practice, we see a 75% increase in the number of consultations during a 13-year period. This is not just within general practice. The patients who are arriving are much sicker and have much greater complexity, and that is the root of the problem. It is a cause for celebration that we are all living longer, but dealing with that needs detailed planning.

Mr David Lammy (Tottenham) (Lab): I am grateful to the hon. Lady for giving way, given her expertise in these areas. Does she recognise the work of Sir George Alberti a few years ago and the establishment of emergency care collaboratives that were very engaged with social care and local councils, and that the further cuts expected in local authorities will make this worse for elderly communities throughout the country?

Dr Wollaston: The reality that we face is that there is a limited amount of public funding. We can spend that pot of public money only once, so we must spend it in the right place, and that often means that we need to spend more of it within social care. That is why I welcome the fact that some of the health budget has been shifted to social care, and that is very important. I also commend Torbay. My constituency covers Brixham and Paignton, and Torbay has been nationally and internationally recognised for its work on integrating health and social care. It is no coincidence that it does so well on A and E waiting times, and we should be looking at what it has achieved.

But how will we keep people out of our A and E centres? In the Health Committee, we heard evidence about the effect that paramedic crews have. If the paramedic crew in an ambulance are highly skilled, the person they treat is less likely to need to go to casualty in the first place because the expertise is there to keep them at home. There needs to be better access to records. We need to consider how we can improve IT so that the patient owns their record and every part of the system can safely access their drug and medical history—with their consent, of course.

Mr Bradshaw: Given the hon. Lady’s previous distinguished career as a Devon GP, does she, like me, deplore the comments made today by a Government Minister, who sought to blame the current crisis in the NHS on the growth in the number of women doctors?

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Dr Wollaston: I commented on that on Twitter. The remark was unfortunate; I think women GPs contribute enormously, but there we are. I would say that, wouldn’t I?

The Parliamentary Under-Secretary of State for Health (Anna Soubry) rose—

Dr Wollaston: I am short of time, I am afraid.

I go back to how we get people directed to the right place. We need NHS 111 to do the job it is intended to do—direct and signpost people to the right place. Some 42% of people do not know how to access their out-of-hours service; they will go to where the lights are on. We need to make sure that there is good-quality information about how to see the right professional in the right place at the right time and about communication in all parts of the system.

We also need to consider how commissioners can be supported to keep people at home, which is the right place for frail elderly people, by using community resources. There are some wonderful organisations in my area—Brixham Does Care, Totnes Caring, Saltstone Caring and Dartmouth Caring. Having the flexibility to commission small local units is vital, rather than there being a push to commission larger units that do not have that local focus. The issue is about local focus helping to have local solutions. What works in Lewisham will not work in rural Devon, so let us get the solutions right and have flexibility.

Let us make sure that we address the delays within casualty departments and the pressures that cause that. Very often the issue is to do with diagnostics. Let us look at the groups of people who constantly re-attend. I do not want to bore the House too much with my views on minimum pricing, but anybody who wants to spend a Friday or Saturday night in an inner-city casualty department will see what the delays are due to. I hope to win my bet eventually with the right hon. Member for Exeter (Mr Bradshaw).

Let us have a sensible policy that considers mental health, for example. A huge number of readmissions in casualty departments involve people with mental illness. In the west midlands, liaison psychiatry is being used to help reduce readmissions among those with mental illness—again, it is about getting people the right support at the right time in the right place. Some 5.6% of bed days in the NHS are taken up by people who have been readmitted within a week of discharge. That is simply not acceptable.

There is also the issue of designing the tariffs. I was pleased to hear the Secretary of State refer to tariff reform. If the financial drivers are in the wrong place, we will not solve the problem. Let us try to take the party politics out of this debate and focus entirely on how we can support NHS England and our clinical commissioning groups to get the right care in the right place at the right time.

5.48 pm

Mr Ben Bradshaw (Exeter) (Lab): I associate myself absolutely with the remarks made by the hon. Member for Totnes (Dr Wollaston) about tariff reform, but given the time constraints, I will restrict my remarks to one

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particular issue that is putting pressure on the A and E crisis. I am talking about access to GPs.

I want to share testimony that I have recently received from people in Exeter. The first comes from a young teacher:

“Again and again, whenever I want to see a doctor there are no appointments available for as long as a week away, in addition to appointments not being made available at accessible times. Being a teacher, I am unable to easily pop out for a doctor’s appointment.”

Another constituent wrote to me last month about the A and E crisis:

“I believe one of the main reasons for this is that it has become very difficult to see your own GP unless you are prepared to wait three weeks for an appointment. I have personal experience of this, as do many of my friends and colleagues, and this is making people with minor ailments attend A and E in order to be seen.”

You will remember, Madam Deputy Speaker, that when Labour was in government, we introduced a requirement on GPs to grant appointments to their patients within 48 hours. We also introduced incentives in the GP contract for GPs to open at weekends and in the evenings, and we established GP walk-in centres in every primary care trust in England—in some areas, we established more than that. It worked. By the end of our Government, complaints from the public about GP access had declined significantly, as had pressure on A and Es that resulted from people not being able to see a GP.

By May 2010 more than 75% of GP practices in England were opening in the evenings and at weekends. Under this Government, however, 500 of those practices have reduced their opening times again. By May 2010, there were walk-in centres in every area offering quick, easy access to a GP, seven days a week and 12 hours a day. Since 2011, 25% of those centres have closed, and scrapping the requirement for GPs to offer an appointment within 48 hours has led to a return of the bad old days of people waiting days or weeks to see a GP, and therefore going to A and E instead.

Mr Lammy: Will my right hon. Friend give way?

Mr Bradshaw: I regret I will not do so because I have so little time.

When I wrote to the Health Secretary with the cases from Exeter that I referred to earlier, his colleague, Earl Howe, replied:

“It is our view that 48-hour access did not focus on outcomes, and specifying a particular model to deliver better services for patients misses the point about local needs, local services and local accountability.”

That, I am afraid, is gobbledegook. My hard-working constituents, who pay for the NHS, want to be able to see a GP when they need to and at a time convenient for them. Earl Howe’s letter went on to say that as this was a local issue, I should raise my concerns with the clinical commissioning group, which I promptly did. It replied stating:

“As this relates to GP services, the letter should be sent to NHS England.”

I await its response with interest.

Will the Minister help the House by making clear in her response who is responsible for ensuring that the public can see a GP quickly and conveniently? I was encouraged to hear the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North

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Ipswich (Dr Poulter) tell the “World at One” yesterday that he wanted to improved GP access, including opening times, in response to the A and E crisis. Hallelujah! May I suggest, however, that he and he colleagues start by stopping the closure of walk-in centres, and reintroduce Labour’s requirements and incentives for GPs to give appointments within 48 hours and to open their surgeries at weekends and in the evenings? Without such measures, I am afraid that current pressures on A and Es will simply get worse.

5.52 pm

John Pugh (Southport) (LD): The last time I was in A and E I had hit myself on the head with a 300 lb iron bar—don’t ask why. I had a lump the size of an egg, but no lasting damage, apparently. The time before I was involved in an accident on the M1. I was not driving the car, but I ended up in North Hampshire A and E. My latest visit was with my mother-in-law who had had a suspected heart attack. I use those cases to illustrate that although nobody wants to go to A and E, people end up there for a whole range of reasons. Either they have a genuine accident and emergency, or they fear that they have had an accident or emergency and need informed triage, or they have a problem and simply do not have anywhere else to go. I suspect that we are looking not at increased pressure because of a huge number of accidents and emergencies—although there are many elderly people, which will increase the number—but at a big increase in cases to triage and in the number of people with nowhere else to go.

I note that the situation is not inferior to that before 2004, but in relative terms I am prepared to admit that it is a crisis. So far the debate has been about whose fault that crisis is. We cannot say that the situation is entirely due to the GP contract and the extraction from out-of-hours service, but we could say that that will not help. We cannot say it is down to the strange decision to replace midstream NHS Direct with the 111 service, but that will not help. We cannot say it is all down to a massive reorganisation of the NHS and the siphoning off of millions into redundancy payments, but clearly that will not help. We cannot say it is due to the closure of walk-in centres. They were often paid for by the PCTs of the past and are not necessarily popular with GPs, but their closure will certainly not help. We cannot say that the situation is due to the absence of strategic health authorities, although in the past those authorities often forced ambulance trusts and hospitals to work seamlessly together, not just gaming their own targets and looking at performance indicators. They helped to stamp out trolley waits, parking up and needless diverts, but the absence of a strategic oversight is clearly not going to help. We cannot say that the failure of our system to deal with chronic alcohol abuse is the sole reason, but as the hon. Member for Totnes (Dr Wollaston) pointed out, it is not helping. The fact that we do not link treatment to successful rehab certainly does not help.

What would help, as we all agree, is rapid progress towards the integration of health and social care, proper community budgeting, stopping unnecessary admissions, increasing co-operation and resource efficiency, and making better use of hard-pressed social services budgets. This was the big-ticket item in the in-tray in 2010—the holy grail. There was also the instability of the acute

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sector. It is a genuine pity that well-intentioned people in this place spent the first two years of the Parliament wrangling about a largely pointless, if not positively unhelpful, reorganisation. Never mind missing A and E targets because of the stupid, adversarial, arrogant and hubristic culture of this place, where each successive Government feel obliged to do everything in a new way: it is not just A and E that missed the target; we missed the target.

5.55 pm

Ann Clwyd (Cynon Valley) (Lab): As colleagues will know, over the past few months I have read from the direct experiences of the 2,500 people who have written to me about their treatment in the health service. This time, I am going to speak about my husband, who died in October last year. That is because I have had the 117-page report from the hospital, which I asked a GP friend to have a look at because a lot of it is gobbledegook to any ordinary person.

My husband died from hospital-acquired pneumonia. One of the concerns that I have talked about is upheld by University Hospital of Wales in Cardiff. The report says:

“A delay in review by medical staff did occur in AU. Mr Y”—

it is anonymised, ridiculously—

“remained in EU for 6 hours longer than the target timescale of 4 hours. Mr Y then remained in EU for approximately 21 hours, significantly longer than the target time of 8 hours for this type of area.

Mr Y should not have been nursed in the EU/AU for the length of time he remained there. The length of time Mr Y spent in EU and AU fell significantly below the standard expected, and this is unacceptable.

The distress this poor experience caused is acknowledged and the Health Board apologises that the standard experienced by Mr and Mrs Y was below that expected.

This concern is upheld.”

There are many other things I would have liked to talk about, but there is not enough time. I asked my GP friend to look at the hospital’s record, and she said:

“I don’t think that the notes you were given are supposed to be a complete record that Owen was properly investigated or treated.”

She goes on to say:

“Of course Owen spent too long in Casualty. The analogy with a ‘battery hen’ is apt: cooped up on a too small trolley for 27 hours, pressed against the bars…no record of adequate food or water and unclothed.”

She goes on to ask:

“Why ever not? In 27 hours Owen is recorded as drinking 150 ml and eating one ice-cream—and he was dehydrated when he came in.”

There was apparently a “Do not resuscitate” notice. She goes on:

“The DNR notice and records are lamentable, and reinforce my impression that because Owen’s care plan on 11 October could not be fulfilled, there was no other clear care plan in place for him…But I am not surprised you did not fully comprehend what they were not going to do. The enquiry papers state UHW does not follow the Liverpool Care Pathway; this is a pity as they wrote Owen up for the LCP recommended medication after antibiotics were stopped yet failed to attend to the spiritual needs of the patient in this critical juncture.”

Mr Lammy: Will my right hon. Friend give way?

Ann Clwyd: No, I am sorry, I cannot.

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Finally, my GP friend said:

“These matters and the ways you expressed your concerns are so similar to the events described in the many many letters you have received from others who have described similar misgivings. It must be very difficult to have to ‘use’ your own very personal experience as a prompt to drive the response and search for answers that so many want from you. But that is your job as Member of Parliament, to identify what, if anything—”

Madam Deputy Speaker (Dawn Primarolo): Order.

6 pm

Andrew Percy (Brigg and Goole) (Con): This debate has improved as the Back-Bench contributions have gone on. It started off fairly gracelessly, with an attempt to lay all the blame for the pressures in A and E on this Government. That was pretty shameful. I like and respect the shadow Secretary of State, the right hon. Member for Leigh (Andy Burnham), but it was graceless of him to suggest that this is entirely of this Government’s making.

As a number of hon. Members have said, there is a broad range of issues behind the pressures on A and E services. Long before I was elected, I campaigned against some of the changes that made a difference in my own constituency and increased pressure on the NHS. We have heard about bed reductions and the lack of joined-up social and health services. I think there is an issue with GPs and I respect the view of the Health Committee Chairman on that. A lot of residents were confused—this was touched on by the right hon. Member for Exeter (Mr Bradshaw)—about where GPs’ services were and how they could access them after the change in 2004 in particular. I think that that has contributed to people choosing to access other services. I confess that I have absolutely no idea how the out-of-hours service in my area works. I am lucky that I have never had to use it, but a lot of people were incredibly confused by their out-of-hours service after 2004. The right hon. Gentleman also mentioned walk-in centres, but my area did not get one. If we are expected to use the one in Scunthorpe, that is not a sufficient local alternative.

We have also heard about a demographic shift, which is clearly a huge issue, as is population growth. After the failure of health services and all Governments to deal properly with palliative care and end-of-life plans, one of my hospitals in Goole experienced massive reductions in services, largely on the previous Government’s watch. Our mental health ward went and all the town’s mental health beds disappeared, as did medical beds in general. Service after service disappeared. When those mental health services were lost and replaced by apparently intensive home support, we ended up with people in crisis and, as my hon. Friend the Member for Totnes (Dr Wollaston) has said, presenting to A and E and other services.

The failure of social care is a problem, but I remember one of my local authorities—East Riding of Yorkshire—changing the criteria for access to its services many years ago as a result of funding pressures from the previous Government. I wish that Labour councillors at my other council, North Lincolnshire council, had listened to the Secretary of State before they tabled their budget for this year, which proposed removing social care from

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thousands of my constituents and changing the required criterion from “moderate” to “substantial”. If it had not been for Conservative councillors voting down the Labour budget and instead voting to protect social care, there would have been massive social care cuts in my area. I hope that the right hon. Member for Leigh will relay that to his colleagues in my area.

The failure to have proper intermediate care services has also been mentioned. My local authority is trying to address this through a £3.2 million scheme in my constituency to create a 30-bed unit. Bed blocking has been a massive problem in recent years and we all know about it. Plenty of people come in, but not enough go out the other side. The Labour party has to take some responsibility for that problem, because it has not appeared overnight. The issue has been affected by population growth and a demographic shift.

In the brief time remaining, I concur with the Health Committee Chairman that it would be much better to take the politics out of this debate.


6.4 pm

Stephen Pound (Ealing North) (Lab): I think that most people who have heard this debate would agree that we have generated more heat than light. That is a shame, because when one hears the words of my right hon. Friend the Member for Cynon Valley (Ann Clwyd), one realises that this is way beyond a party political issue. This is not about game playing or seeking political advantage for one side of the Chamber or the other. I have sufficient respect for the Secretary of State and the shadow Secretary of State to know that neither of them wishes to go down that road. This matter is simply far too serious.

We have heard tonight that A and E services are often the indicator or signifier—like the canary in the coal mine—that warns about the condition of the rest of the national health service. We have heard about a number of factors. One accusation is that there is a lack of knowledge about A and E.

I spent 10 years working in the A and E department of the Middlesex hospital and University College hospital. I must say that I worked in an ancillary capacity, rather than as a qualified medic, although I did wear a white jacket and would occasionally bluff. There is a huge difference between A and E then and now. Like a lot of MPs, I mystery shop in my local A and E once a month, just to sit and listen to what is being said. The difference between then and now is that virtually everybody who came into the Middlesex was brought in by ambulance and there were very few walk-in patients. I am not saying that it was not in a residential area, because it was. We had an excellent Member of Parliament in my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). Plenty of people did the right thing and voted for him. There is a difference of attitude now. That is exemplified by what we saw last week, when a mother took her daughter to a north London A and E department to ask that a doctor remove canine faeces from her daughter’s shoe in the safest possible way. There is no question but that there is a problem. People’s expectations have changed.

There have been some suggestions today. The prescription of the hon. Member for Colchester (Sir Bob Russell) was risible. The idea that we should lie back with a

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scalpel in one hand, biting on a bullet and perform our own abdominal surgery was fairly ludicrous. At least, that is how I heard his proposal.

I agree that we should make more use of community pharmacists, but above all we must recognise that we are now in a different world. People do not come to A and E in the middle of the night because they want to; they come to A and E because there is not a walk-in centre they can access during the day and there is no out-of-hours GP service because most of the GPs in London are elderly, single-handed GPs. People go to A and E out of sheer desperation. Yes, there is always a fool who comes in with a headache or something, but if Members go to their local A and E, as many of us do, they will see people who are on the edge of absolute seriousness.

We have to address the totality of the issue. The hon. Member for Southport (John Pugh), in one of the best argued speeches that I have ever heard, pulled the whole thing together. He did not refer to a mosaic of misery, but to all the competing factors. That is what we have to consider.

I do not see the Secretary of State as some Gargantua or Godzilla, crashing through Nye Bevan’s glorious creation and seeking to destroy it at every opportunity; I see him as a man who might be overwhelmed by the scale of the problem facing him. Let us step back from party political advantage and think about the people out there—the exhausted staff in the A and E departments and the patients in pain and agony.


6.8 pm

Dr Phillip Lee (Bracknell) (Con): It is a pleasure to follow the hon. Member for Ealing North (Stephen Pound). I agreed with some of the points that he made, but I did not agree with all his conclusions and he may not agree with mine.

It is striking that nobody has mentioned the report that was published today by the NHS Confederation and the Academy of Medical Royal Colleges. That report calls for the closure of hospitals and indicates that the funding model for health care in this country is not sustainable in the medium to long term. It is significant that so many organisations that should be respected by this Chamber have come to such difficult and politically unpalatable conclusions.

I have been encouraged by some of the contributions from the Back Benches in the past hour or so. There has been mention of the drivers of demand in this country and across western society, such as ageing, obesity and increased drug and technology costs. As was mentioned by the hon. Member for Ealing North, there has also been a significant change in attitude, which is difficult politically. Essentially, the population is becoming a bit softer. The generation that survived the war, a more stoic generation, would not think or dream of calling their GP in the middle of the night unless their arms were dropping off, but they are passing away and are being replaced by people who think it appropriate to call their GP at midnight because they have had a sore throat for a couple of hours. Clearly, that is not sustainable.

The challenge of the A and E crisis, which is the reason for this debate, is I suspect a first manifestation of evidence that the system is not fit for purpose. It is not fit for purpose before the baby boomer generation

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hit their 70s, and we should mull on that. We should also recognise the fact that change is inevitable and that hospital closures and reconfigurations will have to take place. My conclusion on how to deal with that is not party political.

An ideological legacy is in play here. We have a system that was designed for a stoic post-war generation—taxpayer funded and copied only by Cuba. We need to recognise that it is not fit for purpose and we need to have some tough debates with the public about how to fund it going forward. A financial legacy is also relevant. A recent one is the PFI scandal of the last few years, but let us be realistic: this country has significant debts and liabilities five times the size of our economy, so it means we need to be realistic about what we can afford in the future.

In conclusion, I agree with Members who said that we should take the party politics out of this debate. I would like to see a plan of where hospitals should be in the future. We need a hub-and-spoke model for acute hospitals; there has to be a national plan, so that we do not see some hospitals unfairly closed and others retained for various legacy reasons. The plan needs to be cross party; otherwise it will not pass. We need to reflect, too, on GP out-of-hours provision. I think GP surgeries should be open for longer and more appointments should be available for about 12 hours a day. I am not so sure that the current out-of-hours service is sustainable or, indeed, advisable in the longer term. Above all, we need a proper informed and rational debate with the British public about what is affordable, what is do-able and what is in all our best interests.


6.12 pm

Mr Gareth Thomas (Harrow West) (Lab/Co-op): I am grateful for the opportunity to follow the hon. Member for Bracknell (Dr Lee). Given the views he articulated, I hope he will come and canvass for my opponent at the next general election; we would be very happy to have him there. I say that in the context of the situation in the North West London Hospitals NHS Trust, which in 2010-11 was well within the waiting times targets for A and E. Just 2.9% of patients waited more than four hours, but by 2011-12, that figure had risen to some 10.8% at the end of the year, while for the whole of the last financial year the figure is 12.2%—the second worst set of statistics in London, surpassed only by the Barking, Havering and Redbridge University Hospitals NHS Trust, where almost 16% of patients had to wait over four hours.

Stephen Pound: I am grateful to my hon. Friend and neighbour for giving way. In view of what he has just said, does he think that the best possible prescription is that currently recommended by the Government whereby the existing A and E departments at Ealing, Park Royal, Hammersmith and Charing Cross all close? Does he think that will improve waiting times in A and E departments?

Mr Thomas: My hon. Friend, as ever, is ahead of me. He makes the perfectly reasonable point that if the Northwick Park and Central Middlesex A and E departments are not achieving the 95% target now, how can our constituents have any more confidence about reaching that target should the Central Middlesex and Ealing hospitals close?