Andy Burnham: Changes we made were done in a planned way, with measures to increase capacity at neighbouring accident and emergency departments, and they were done for reasons of patient safety. Have a look at west London, where plans to close A and E

21 Jan 2015 : Column 239

departments are being railroaded through, leaving intolerable pressure on the remaining A and E departments. It is not acceptable, and the hon. Gentleman should challenge his own Government on what they are doing.

Caroline Lucas (Brighton, Pavilion) (Green): Does the right hon. Gentleman agree that with private health firms now on course to win more than £9 billion of NHS contracts, one of the real problems is the fragmentation of the NHS in front of our eyes. Is that a good reason to oppose further privatisation of the NHS, and will he admit that the process that set in train the privatisation of Hinchingbrooke should never have happened?

Andy Burnham: I have said that the market was let in too far, and, as Health Secretary in 2009, I changed policy away from what was a version of “any willing” or “any qualified” provider to “NHS preferred provider” and I stand by that. I agree with the hon. Lady that the market is simply not the answer to 21st-century health and care. When the Prime Minister stood at the Dispatch Box about an hour or so ago and said no privatisation on his watch, he was not being straight with the public. Services across the country are being put out to open tender and then transferred to the private sector. That is the Government’s record and the people of this country know it.

Paul Blomfield (Sheffield Central) (Lab): Does my right hon. Friend agree that it says everything about this Government’s attitude to the NHS that general practices that serve the most needy and vulnerable patients, like Devonshire Green and Hanover medical centres in my constituency, are under threat because of the withdrawal of the minimum practice income guarantee introduced by Labour? Does he agree that the Government should immediately stop the phased withdrawal of funding and review their decision to end MPIG?

Andy Burnham: I said earlier that there had been cuts to the GP budget, and that is one of the implications of those cuts. The Government have developed a plan to phase out the guarantee that secures practices in some of the more deprived communities. In east London there have been campaigns against practice closures; I know there are similar concerns in Sheffield. That process should be reviewed and if necessary stopped, because no practice should close as a result of any of those changes. That is the commitment I give to my hon. Friend today.

Several hon. Members rose

Andy Burnham: I want to make some more progress; I will give way later.

We need to know the reasons for the increase in A and E attendance. Safely meeting that demand would require an extra eight accident and emergency departments in England, but the Government have been closing, not opening, A and E’s. That is why there is so much pressure in the system.

There has been an even more dramatic increase in the last year. NHS England figures show that there were an extra 446 extra visits to A and E in the 2014 calendar year.

21 Jan 2015 : Column 240

That is a dramatic change on the Secretary of State’s watch and the time has come for some honesty from him about the real reasons for it. Until he faces up to those reasons, however uncomfortable they may be for him, he will not be able to develop a proper solution and the situation will get worse. We cannot let that happen.

Let me list what I believe are the decisions of this Government that led to the increase. I will identify four and take each in turn. The first, as Opposition colleagues mentioned, is the decision to scrap NHS Direct and replace it with the flawed NHS 111 service. NHS 111 was originally intended to be a call-handling service, and indeed was conceived by the previous Government. It was intended to simplify access; it was intended to patch people through to the relevant agency, be it the GP out-of-hours service or NHS Direct.

However, when the present Government came into office, they made a major change: they decided that NHS 111 would not signpost NHS Direct but replace it. That was a major mistake. The established and trusted NHS Direct model, a single national contract in the public sector, was replaced with 46 patchwork contracts in the public and private sectors across the country. They replaced the model of nurses on the end of the phone, to provide reassurance for families, with call handlers and computer screens. As a result, where 60% of calls to NHS Direct were handled by nurses, with NHS 111 it is only 20%.

But the present system of call handlers and computer screens is not a case of “computer says no”. The problem is that too often it is a case of “computer says, ‘Go to A and E.’” NHS England figures show that there has been a dramatic increase, in the last year, in the number of people calling NHS 111 who are referred to A and E, or to whom an ambulance was dispatched. In November 2014, there were 67,000 referrals to A and E—a 26% increase on the same month in 2013—and 108,000 ambulances dispatched—a 20% increase on November 2013.

Alex Cunningham (Stockton North) (Lab): All these problems have led to an increase in the number of days that people are taking off as a result of stress—nurses especially. Thousands of days are being lost to the system, adding to the crisis. Should we not be appreciating the staff in our NHS hospitals, and maybe starting by awarding them the 1% pay rise that the pay review body recommended for all of them?

Andy Burnham: The Secretary of State’s decision to reject the independent advice of the pay review body about what was fair and affordable, and to single out NHS staff for exclusion from the promise that the Chancellor had made that the public sector, as part of his restraint policy, would get 1%—to say that NHS staff would get less than that—was a kick in the teeth, and was to risk staff morale just at the moment that the NHS needed to be recognising and rewarding those staff, who are working so hard to keep things going. To make inflammatory comments such as those that the Secretary of State has made in the newspapers today is the wrong response. He should be getting back round the negotiating table with those staff. He should be working with them to find solutions. They are keeping the NHS going right now, and they deserve a bit better than they have had off this Secretary of State.

21 Jan 2015 : Column 241

Alison McGovern (Wirral South) (Lab): May I return my right hon. Friend to something very important that he said? He pointed to the distress of our constituents who are being told to go to A and E rather than having reassurance from a nurse on the end of the phone. This is the experience of all our constituents right now, and I would far rather all my constituents had access to a qualified nurse than were just told to go to A and E.

Andy Burnham: My hon. Friend calls it just right. One thing the Government could do right now would be to get more nurses on the end of those phones, to provide that experienced voice, that reassurance, that people with young children need before they decide to get in the car and go to A and E. I remember using NHS Direct in such circumstances myself. That reassuring voice has gone, and that is why NHS 111 is placing additional pressure on our A and E. The Secretary of State would not recognise it, with the reasons that he gave, but it is. Staff know it is. The ambulance service know it is. It is time we had a Government who faced up to that reality. My question for the Secretary of State today is: will he now concede that that flawed 111 service has contributed to the 600,000 annual increase in A and E attendances?

The second policy decision that I shall discuss is the closure of NHS walk-in centres. Colleagues who have been in the House for some time will recall that there was a winter crisis in A and E in most, if not all, winters in the 1990s. Then, in the late ’90s, NHS Direct was launched and NHS walk-in centres were opened, with the specific intention of giving people alternatives to attending A and E, which were then under major pressure. The locations of the first wave of walk-in centres were carefully chosen, often where an A and E had recently closed, including at Leigh infirmary in my constituency. In the decade from 2000 to 2010, around 230 walk-in centres were opened across England. Many of those centres became an established and understood alternative to A and E.

However, despite strong evidence to support them, a review by Monitor has found that almost one in four walk-in centres have closed under the coalition Government. Many more are under threat today. Monitor’s review surveyed people who used walk-in centres, and one in five said they would have gone to A and E if that alternative had not been available. Here is my next question for the Secretary of State: will he now concede that, in the areas where those centres have closed, there will have been extra attendances at A and E, and that was it a mistake to close those centres?

Thirdly, I will mention GP services, but let me start by clearing something up. The Prime Minister claimed today at Prime Minister’s questions that there are more GPs now than when he took office. I am afraid, as so often is the case at Prime Minister’s questions, that claim is simply not true. The last census of the GP work force conducted under the previous Government, in September 2009, found that there were 35,917 GPs working in England. The latest census for which figures are available, September 2013, finds 35,561 GPs working in England. When will Ministers start giving out facts from that Dispatch Box, rather than the spin we get week after week?

21 Jan 2015 : Column 242

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): I asked the Prime Minister some weeks ago about the number of nurses in the NHS. In December, the number of NHS nurses in the system had been reduced by over 900 since May 2010, but we were told in November that it was up by about 2,500. The Government were using the figures, and the Prime Minister was answering questions, in terms of hours worked. As we know, nurses are working massive amounts of overtime on single-rate time. Nominal headcount nurses, at this moment in time, are minus over 900 compared with May 2010.

Andy Burnham: My hon. Friend makes his point very well. This is what we must challenge as we move forward. Before the general election, people need the facts about what is happening to the NHS. There has been a big drop in the number of nurses working in the community, as my hon. Friend mentioned, and these are the facts that we need to bring home to people.

It is not just the fact that the GP headcount has gone down. One of the present Government’s first acts was to scrap the guarantee of an appointment within 48 hours and incentives to open GP surgeries in the evenings and at weekends. That, combined with cuts to the GP budget, means that it has got harder and harder to get a GP appointment in recent years. The constituents of all the Members present say, “I am ringing the surgery at 8 or 9 every morning and being told that nothing is available for days.” In 2010, the vast majority—80%–of people said they could get an appointment within 48 hours; now, according to the GP survey, one in four people say they must wait a week or more to see a GP.

Bill Esterson (Sefton Central) (Lab): One of the problems in my constituency is that GP surgeries are relying on locums because it is not possible to find GPs to recruit on a full-time basis. Those locums provide a very erratic service; sometimes there is not even a locum available. That is adding to the problem, because as a result, all that is left to people is to go to A and E. I am sure that my right hon. Friend agrees that that is one of the contributory factors, and it proves his point that a chronic shortage of GPs has come about under this Government.

Andy Burnham: That is an absolutely vital point. It is not just about GP locums; there are also A and E locums. The Government have, throughout, cut training places, which were another victim of the reorganisation. Ever since then, the number of places commissioned for doctors—and nurses, I might say—has gone down. That leaves us with a bill for agency staff that is literally out of control—it has gone through the roof—and that means that money is now being siphoned out of the NHS at an alarming rate. That is mismanagement; that is what has happened. How must staff working in the NHS feel when they see the bill for agency staff spiralling in this way and know that they will not even get a 1% increase from this Government? They will draw their own conclusions about how this Government value them.

Richard Fuller (Bedford) (Con): The shadow Secretary of State has spent quite a large part of his speech on diagnosis, but at the beginning he asked for solutions, so in that spirit I offer a creative solution. He will be

21 Jan 2015 : Column 243

aware that East of England ambulance service has had very poor response times for a number of months—in fact, a couple of years. Would he support a merger of the Red 1 and Red 2 ambulance response services with the fire and rescue service in the east of England, because such a combined force might be in a better position to provide quicker response times? Does he agree with that idea?

Andy Burnham: I am prepared to look at it, but I think that the future of the ambulance service should be in integrating better with the rest of the NHS—with GP out-of-hours services and NHS 111. Greater Manchester’s health service is piloting a critical response service to support the ambulance service, and I do not have any objection to that. However, this Government have not got it right when they say that the future of the ambulance service is to merge with the police and fire services as a single 999 service. For me, the ambulance service is a clinical service that should integrate better with the rest of the NHS, and I would prefer to go in that direction.

I said a moment ago that people could not get a GP appointment, and that is also what the GP survey tells us. An extra 290,000 patients say that they have turned to A and E when they cannot get a timely GP appointment. That includes the Secretary of State, who admitted in this House that he had done exactly the same. So will he today accept that the growing problem of people being unable to get GP appointments has played a significant part in contributing to the increase of 600,000 in the number of visits to A and E?

Fourthly, I turn to social care. In my analysis, this is the root cause of the problems we are now seeing. At the start of this Parliament, I warned the Government about their public spending plans and, in particular, warned them against raiding social care to stack up a claim that they were protecting the NHS budget. Government Members should be familiar with the quote because the PM quotes it every week at Prime Minister’s questions. To be more accurate, they will be familiar with half the quote, because that is all he uses, so let me give the House the full version. I said that it would be irresponsible for the Government to increase NHS spending if the way they did it was by raiding the social care budget. I said further that if that goes ahead, they will hollow out social care to such a degree that the NHS will not be able to function, because a collapse in social care support would end up dragging down the rest of the NHS with it.

That is precisely what is unfolding before our eyes right now in the NHS. A report today from Age UK shows how

“hundreds of thousands of older people who need social care are being left high and dry.”

Mr Marcus Jones (Nuneaton) (Con): If we were unfortunate enough for Labour to win the forthcoming general election, by how much would it increase councils’ adult social care budgets?

Andy Burnham: I am talking about creating a single budget. There is a big difference between that and what the hon. Gentleman says. I am saying that the time has come to merge the adult social care budget and the

21 Jan 2015 : Column 244

NHS budget. More than that, we are going to put an extra £2.5 billion into that integrated system. He should not come here today telling me what I need to do: where is his plan to put more money into the national health service?

John Healey (Wentworth and Dearne) (Lab): My right hon. Friend is giving the House a very good analysis of the social care system. He may have looked at the National Audit Office analysis published in March 2014, which said:

“The intention in the 2010 spending review was to protect spending on adult social care”.

Despite that, because Ministers cut central Government funding for local authorities by 26%, councils have cut nearly £1 in every £10 spent on adult social care in the past four years, leaving Age UK’s director to describe the system as being in calamitous decline. That is clearly a central cause of the current A and E crisis, exactly as my right hon. Friend is arguing.

Andy Burnham: My right hon. Friend has absolutely nailed it. Those Ministers on the Front Bench decided—it was a political decision—to cut councils to the bone, and in doing so cut social care to the bone. That was precisely the warning that I gave back in 2010, having just left the Department of Health, where I remember being told that allowing social care to be cut would be a false economy of massive proportions because it would lead to huge inefficiency in the NHS. Hospitals would be unable to function because they could not get people home, and therefore the NHS would back up and the pressure would become impossible. That is what is happening. Those Ministers have done it, and they must be held to account for it.

Several hon. Members rose

Andy Burnham: I will give way one more time.

Andrew George (St Ives) (LD): At the start of his speech, the right hon. Gentleman said he was calling for common ground and consensus in this debate, although he seems to have become somewhat deflected from that path. He knows that I very much agree with his criticisms of the Health and Social Care Act 2012 and other things. He has said, on a constructive basis, that he wants to bring health and social care together. There is potential consensus and common ground in that regard. I would like to hear what more he can say constructively on the areas where, I think, we can find, across all parties, common ground and a way forward.

Andy Burnham: To find common ground, one has to tell it straight and put on the table the real reasons why there is pressure in A and E. I bet the hon. Gentleman would not disagree with a single reason I have given: NHS 111, closure of walk-in centres, difficulty in getting GP appointments, the collapse of social care—[Interruption.] Yes, he says he does not disagree with any of those things. If we have a shared analysis, then he and I will have a basis on which to devise solutions. I will come to those solutions later.

Several hon. Members rose

21 Jan 2015 : Column 245

Andy Burnham: I said that I am going to make progress.

Today’s Age UK survey finds that the number of over-65s receiving care has fallen by 380,000 under this Government. Half of the 1 million people who struggle to wash or bathe now get no help at all. Two thirds of the 250,000 people who struggle to feed themselves every day are now left to fend for themselves. There are over 100,000 fewer day care places and over 50,000 fewer people getting meals on wheels. Age UK says:

“Our state-funded social care system is in calamitous, quite rapid decline.”

But worse, it is dragging down the NHS.

Sarah Newton (Truro and Falmouth) (Con): Will the right hon. Gentleman give way on that point?

Andy Burnham: In a moment. I said that I had given way for the last time, but I will do so once more for the hon. Lady.

Record numbers of very frail, elderly people are arriving at A and E due to a lack of support in their own homes. Between 2009-10 and 2012-13, there was a 48.1% increase in the number of people aged over 90 being admitted to A and E via blue-light ambulance—in other words, 100,000 very frail, very frightened people in the backs of ambulances going round our towns and cities to be dropped off at a busy A and E. That is what is happening on this Government’s watch.

Sarah Newton: Today’s Age UK report contains aggregated England data. Does the right hon. Gentleman not agree that all over our country there are councils integrating social care with the NHS, and, indeed, increasing their social care budgets? Does he not recognise the good work that is going on in the integration pilots in Cornwall, for example?

Andy Burnham: I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.

The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.

For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E

“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”

21 Jan 2015 : Column 246

My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?

The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.

As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?

Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?

On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?

Mr Marcus Jones: Will the right hon. Gentleman give way?

Andy Burnham: I have said that I will not give way again.

All those measures could help in the short term, but the truth is that all parties must recognise that there will not be a long-term solution to the A and E crisis until we face up to the crisis in social care, and rethink how we care for the most vulnerable older people. It is not just about money; we need radical changes in the way we use existing budgets for health and care. We need to merge them so that we can change the way in which we care for older people. We need a model of care that starts in the home and supports people there, so that we can drastically reduce the numbers unnecessarily ending up in hospital and becoming trapped there.

Although that model is not just about money, it is partly about money: if such a transformation is to happen, extra investment will be needed to stimulate it. The Secretary of State likes to hold up the better care fund, but I am afraid that councils and the NHS simply do not share his optimism. It robs Peter to pay Paul: the money transferred to councils is nowhere near enough to backfill the cuts to social care, and it leaves a deepening hole in NHS finances. [Interruption.]

21 Jan 2015 : Column 247

The Secretary of State asks where I would get the money from, and I will tell him. The Opposition have committed to provide extra money for an integrated NHS—£2.5 billion a year over and above what he has committed—with social care as part of a single service for the whole person. By contrast, under the public spending plans the Government have set out for the next Parliament, it is clear not only that the A and E crisis will deepen every year, but that it will soon become a full-blown NHS crisis.

The NHS used to be the Prime Minister’s priority; now it does not feature in his top six election themes. We know that there will be no money for it beyond what the Government have promised, because the priority is tax cuts for higher rate taxpayers, although they have not yet identified where the money for that will come from. If the outlook for the NHS is grim, it is utterly dire for local government and social care. Taking public spending back to 1930s levels will absolutely decimate what is left of our social care system, and if the system goes into freefall today’s problems in the NHS will become entrenched. Will the Secretary of State go back to the Chancellor, argue for a better deal for the NHS and social care, and match Labour’s pledge to prevent a permanent care crisis in the next Parliament?

The NHS is now at the crossroads, and the coming election presents an enormous choice between Labour’s plan to lift the NHS out of its current crisis by investing £2.5 billion in the NHS of the future, and the coalition approach under which—with the Government unable to face up to the mess of their own making in A and E or to produce a plan to turn it around, and unwilling to find the extra money it needs—the NHS is dragged down by a toxic mix of cuts and privatisation. The stakes could not be higher. This crisis cannot go on: patients have suffered enough. They need an election, a change of direction and a Labour Government to secure the NHS.

2.15 pm

The Secretary of State for Health (Mr Jeremy Hunt): What utter, disgraceful nonsense! I will rebut every single thing that the right hon. Member for Leigh (Andy Burnham) has said.

This has been a tough winter for the NHS, and I first want to pay tribute to the hard work of staff on the front line who have been working exceptionally long hours in very challenging circumstances. What they want right now is practical help, a vision for the future and a sensible plan to get there—all of which this Government are delivering. They do not want to be turned into a political football. The public have noted that while Labour Front Benchers sometimes sound restrained in parliamentary debates, they are the opposite in the TV studios, where they do everything possible to whip up panic and a sense of crisis. That is not the behaviour of a responsible Opposition.

As NHS England and the King’s Fund have said, the NHS is coping well under real pressure and, in the words of Dr Cliff Mann, president of the College of Emergency Medicine, trying to weaponise it for political purposes is “toxic”. Indeed, Professor Chris Ham, of the King’s Fund, said this week:

21 Jan 2015 : Column 248

“This is a long-term issue not to do with this particular government—the previous government faced many of the same challenges...patients who are really poorly will still get a very good and very quick service.”

Angie Bray (Ealing Central and Acton) (Con): In contrast to what we have heard from the Opposition, will my right hon. Friend join me in welcoming the seven-day-a-week GP surgeries opening up across Ealing and Acton and the plans for the new walk-in health centre for Acton? Will he join me in condemning the Labour-led council’s decision last night to cut the public health budget?

Mr Hunt: That is the reality: there are new and improved services for the NHS up and down the country, but what we get from the Labour party in my hon. Friend’s constituency is scaremongering leaflets saying that hospitals are being closed when they are not. Labour should apologise for scaring very vulnerable people. It claims to stand up for them, but by scaring them it is doing the exact opposite.

Mr Marcus Jones: Unfortunately, the right hon. Member for Leigh (Andy Burnham) did not do me the courtesy of giving me a right of reply when he mentioned the walk-in centre in my constituency. Does the Secretary of State not think that it was completely irresponsible for the right hon. Gentleman to make such comments, given that the issue was raised by a whistleblower and that the information does not come from the clinical commissioning group that is considering walk-in centres in my constituency?

Mr Hunt: Exactly. My hon. Friend makes the point very well, and I will tell him something else about the hospital in his constituency. The George Eliot hospital was a failing hospital with very high mortality rates, and its deeply entrenched problems were swept under the carpet by the previous Labour Government, but this Government have turned it around and it is now a successful hospital. It is doing incredibly well because we faced up to the problems that Labour ignored.

Angela Smith: Sickness-related absence is going up around the country. In Barnsley, it has gone up by two percentage points in the past two weeks. A one percentage point increase equates to £1 million a year. Not only will that hit budgets, but it is a real sign that the NHS is under severe pressure.

Mr Hunt: The NHS is under pressure, so the hon. Lady will welcome the fact that Barnsley Hospital NHS Foundation Trust in her constituency has 34 more doctors and 74 more nurses, and that we are currently doing about 2,000 more operations every year for her constituents. Yes, there is pressure, but this Government are investing on the back of a strong economy so that we can put more money into the NHS and give her constituents a better service.

Barbara Keeley rose

Frank Dobson (Holborn and St Pancras) (Lab) rose

Mr Hunt: I am going to make progress, but I will give way later.

21 Jan 2015 : Column 249

I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.

The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.

Mr Redwood: Does my right hon. Friend understand Labour’s attack on privatisation? Under Labour, the NHS always had private-sector contractors as GPs— and nothing has changed; and it always bought all its pharmaceuticals from competitive, profit-making pharmaceutical companies—and nothing has changed. What is the shadow Secretary of State’s grievance?

Mr Hunt: Privatisation is one of the most pernicious fears that Labour is seeking to stoke up—not least because, as Secretary of State, the right hon. Member for Leigh allowed the decision to go through that Hinchingbrooke hospital should be run by the private sector. He has been running away from that decision faster than anything that anyone has seen before, because he is still trying to curry favour with the unions.

The companies on the shortlist for Hinchingbrooke hospital were Circle, Serco and Ramsay Health Care. He could have stopped that as Secretary of State, but he did not. He knows—[Interruption.] Those were the three bidders—the private sector-led bids. He could have stopped that process when he was Secretary of State, but he chose not to. That makes my point very well.

Barbara Keeley: The Secretary of State and the right hon. Member for Wokingham (Mr Redwood) asked what had changed. Under Labour, we did not have tendering for £1.2 billion of cancer and palliative care services, as we are seeing now in Staffordshire and Stoke, where the majority of those tendering are private companies. We did not have that.

Mr Hunt: What the last Government did, that was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.

21 Jan 2015 : Column 250

To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.

For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.

Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.

Frank Dobson rose

Mr Hunt: I give way to the former Secretary of State.

Frank Dobson: Will the Secretary of State confirm that the only reason why he has been able to recruit British doctors is that the previous Government increased recruitment into medical schools by 35%?

Mr Hunt: I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.

Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.

Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.

It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The

21 Jan 2015 : Column 251

test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.

Andy Burnham: I have a direct question and I would appreciate a direct answer. If the agency bill in the NHS was the same as the one I left behind, would not the Secretary of State be able to afford the modest, below-inflation increase that the Chancellor promised to all NHS staff?

Mr Hunt: Let me tell the right hon. Gentleman why the agency bill has gone up. It has gone up because hospitals are trying to recruit doctors and nurses to tackle the problems of Mid Staffs that he left behind. As they improve their staffing, they will gradually get more full-time nurses, but in the short term, they do not want to put patients’ lives at risk.

I want to return to the situation this winter. To relieve the immediate pressures, we have given the NHS a record £700 million, which has allowed it to recruit an extra 796 doctors, 4,700 nurses and 3,094 other staff, making a total of 8,590 additional staff, and to increase bed capacity by 6,400. We have more staff, more beds, more GP appointments and more GPs in A and E than ever before for winter.

What is the impact of the extra support that we have given the front line? The target is to see and treat people in A and E within four hours. Compared with the last full year for which Labour was in office, 3,000 more people are being seen, treated and discharged within four hours every single day. The mean time that people wait for a first assessment has fallen from 77 minutes to 30 minutes, and nine out of 10 people, even under the pressure of the additional visits, continue to be helped within four hours. That performance is better than anywhere else in the United Kingdom—and, indeed, better than in Canada, Australia, New Zealand, Sweden and any other country in the world that measures A and E performance.

While the NHS is straining every sinew to meet high standards, the public will not accept the cynical politics that demands that we call it a crisis in England, while refusing to call it a crisis in Wales, where Labour is in charge and the problems are far worse. According to the House of Commons Library, in Wales, double the number of people are kept waiting in A and E, and nearly double the number of people wait too long for an urgent ambulance. For Labour, poor care matters only when there is a political point to be scored. For a party that aspires to run the NHS, that is simply not good enough. How Nye Bevan would turn in his grave if he knew that the party that founded the NHS was turning its back on patients with such contempt in his own back yard!

Mark Field (Cities of London and Westminster) (Con): Although I appreciate that there will inevitably be a battle between the two parties to a certain extent in this debate, the Secretary of State is at his strongest—this is what I hear from all the health care professionals in my constituency—when he talks about his patient-centred vision for the health service of the 21st century and when he looks away from the here and now and towards

21 Jan 2015 : Column 252

the future that we all know is desperately needed by all our constituents: a patient-centred NHS. I hope that he will say a little more about that.

Mr Hunt: I will, and that is what this is about—putting patients first. That is why we need important reforms such as ensuring that every vulnerable older patient has a named accountable doctor—I will mention that later in my remarks—and why we must remove barriers between the health and social care systems.

Sir Hugh Bayley (York Central) (Lab): It has been well known in the NHS for decades that an ageing population means that more needs to be spent in real terms each year on the NHS than in the year before. In 2010, when the Government came to power, 8.2% of our gross national income was spent on the NHS, but that has now fallen to 7.9%. How can that possibly be an increase in the Conservative party’s commitment to the NHS?

Mr Hunt: Because the only way we could return the economy to growth was by tackling the deficit left by the Labour party—the worst deficit in the developed world. Labour left us with that problem; we have sorted it out and are turning the country round. If the hon. Gentleman wants to increase spending on the NHS, as I do, the only way to do that is through a strong economy, which is what the Government are delivering.

Several hon. Members rose

Mr Hunt: Let me make some progress. In A and E, as everywhere in our hospitals, it is important that whatever the pressures, people are given safe, compassionate care. Our NHS is one of the safest systems in the world, but we still have around 1,000 avoidable deaths every month. We still put the wrong prosthesis on someone once a fortnight, operate on the wrong part of someone’s body once a week and leave a foreign object in someone’s body twice a week. Just five years ago, we had the tragedy at Mid Staffs, which, we should never forget—[Interruption.] I am quite shocked that people are laughing when we are talking about harm that happens in the NHS every month and about what happened at Mid Staffs. We must not forget that Mid Staffs was hitting its A and E targets for much of the period that that same department was tolerating the most horrific care. Whatever the pressure to hit targets, the Government want every vulnerable person to be treated safely and with the highest standards of dignity and respect.

Two years ago, we introduced the toughest inspection regime anywhere in the world. The result was over 6,000 more nurses on our hospital wards, cases of MRSA and clostridium difficile halved over this Parliament and more than 200 NHS organisations have signed up to halve avoidable harm and avoidable death over the next three years. Care is getting safer. While we lead the NHS through that painful process, what is the reaction from Opposition Front Benchers? They criticise us for running down the NHS and still maintain—as the right hon. Member for Leigh did in December—that it was a mistake to hold a public inquiry into Mid Staffs. He talked about listening to patients, but this is what Julie Bailey, a Mid Staffs campaigner whose mother was a patient at Mid Staffs said about his comments in December:

21 Jan 2015 : Column 253

“The message he is sending out is that it is better to cover things up than to criticise the NHS, however bad things are. The inquiry uncovered huge failings in the NHS and he thinks it shouldn’t have taken place at all. It is very worrying because if he becomes Health Secretary again at the election it is clear we would go straight back to the bad old days of covering up.”

Bob Stewart (Beckenham) (Con): One problem last month in my local hospital, the Princess Royal university hospital, was the lack of space, and ambulances were backed up. It is not just a staffing problem; it is a spatial problem. Does the Secretary of State agree that if we had more space in A and E departments, we could get people off the streets?

Mr Hunt: Space is a problem in some A and Es, which is why we have expanded A and E capacity. Other places have different problems, but the long-term solution is to have improved capacity outside hospitals in community care. That is the real challenge and what the “Five Year Forward View” is about.

Andy Burnham: Given what the Secretary of State has just said, may I gently remind him that I was the Secretary of State who appointed Robert Francis QC to inquire into what happened at Mid Staffs, against the advice of the Department of Health, and that report was published before the last election. If he is being fair, he should bear that in mind at all times.

The Secretary of State reeled off a list of things that are wonderful in the NHS today—everything has got better; everything is fine; and it is the best in the world. At the beginning of the debate, I reeled off cases of people waiting hours or even dying while waiting for ambulances, or being treated in cupboards. I hope that he will not conclude his remarks without addressing the very real suffering and poor care that is happening across England right now.

Mr Hunt: If the right hon. Gentleman did such a wonderful job and wants to talk about Mid Staffs, why are patient campaigners so outraged by his comments and feel that he did everything he could to brush those problems under the carpet?

Alan Johnson (Kingston upon Hull West and Hessle) (Lab): Will the Secretary of State give way?

Mr Hunt: I will give way to the former Secretary of State in a moment, but I want to finish—[Interruption.] Exactly. I have read the Francis report and I have acted on it. [Interruption.] I have just listed what we have done: £700 million, 4,700 more nurses and 800 more doctors.

Andy Burnham: It’s not working.

Mr Hunt: But the right hon. Gentleman’s constituency has more doctors and more nurses who are seeing more people every year within four hours and doing 4,000 more operations every year. That is working for his constituents, but there is pressure out there and we need to support people through a difficult winter.

The right hon. Gentleman mentions stories that are, of course, very tragic, but never once has he brought up stories about the problems happening in Wales. Too often, we get the impression that, for Labour Members,

21 Jan 2015 : Column 254

poor care under a Labour Government—whether in Wales today or Mid Staffs previously—does not matter as much as poor care under this Government when they can make a political point. A party that really cared about the NHS would be as outraged about problems when they are in power as they are when in opposition. For this Government, poor care is poor care, and we will deal with it wherever and whenever it happens.

Alan Johnson: Does the Secretary of State remember the words of the Prime Minister when he stood at the Dispatch Box and presented the report from Stafford? He said that what happened at Stafford was not the fault of any previous Secretary of State, including my right hon. Friend the Member for Leigh (Andy Burnham). The Prime Minister was a statesman on that occasion; it is a shame that the statesmanship has slipped since.

Mr Hunt: I have a great deal of respect for the former Secretary of State, but if he had followed the debates on Mid Staffs in this Chamber he would know that my disagreement with the shadow Health Secretary is over the reaction to Stafford and whether we will learn from those mistakes. When I have made speeches talking about the problems of poor care in the NHS today, he goes straight out to the TV studios and says that that is running down the NHS. That is not acceptable when we are taking difficult decisions to turn round failing hospitals and face up to problems in exactly the way suggested by the Francis inquiry.

Several hon. Members rose

Mr Hunt: I will make some progress because I want to answer some of the questions asked by the right hon. Member for Leigh. One reason for the pressure I have outlined is that people increasingly expect to get medical care 24/7, just as they are able to bank, shop and book their holidays 24/7. The NHS cannot be King Canute and try to stop that—I am not blaming patients, but that is how patient expectations are changing, and we need to give them better alternatives to turning up in A and E.

Over the past two years, we have expanded weekend and evening GP appointments for more than 5 million people. We have also rolled out the 111 service, which now handles—these are the facts—three times more calls every year than its predecessor, NHS Direct. The right hon. Gentleman criticised 111, so let us look at the facts. Of those who call 111, 30% say they would have gone to A and E but decided not to as a result—that is 2 million journeys to A and E and around 600,000 ambulance call-outs avoided because of 111. Unlike NHS Direct, one third of all 111 centres can now access a summary of people’s GP records, and that will apply to nearly all 111 centres this year. Not only can people talk to a doctor or nurse, as they did with NHS Direct, but if they give consent they can do something that they could never do under NHS Direct and talk to someone who knows about them and their medical history.

Another big challenge facing A and Es is the increasing complexity of the illnesses that people are presenting with, including many older people with conditions such as dementia, diabetes or asthma. Such people often end up being admitted to hospital rather than treated and sent home, and that is not just challenging for the

21 Jan 2015 : Column 255

system; it is often wrong for the individual. A busy A and E can be the worst possible place for a frail, older person with dementia, which is why in our vision for the NHS every vulnerable person has a doctor who is continually responsible for their care, whether or not they are in hospital, and who ensures that they have proper care wrapped around them, thereby reducing the likelihood of emergency hospital admissions. Too often, that does not happen. Too often, the buck stops with no one. That is why, this year, we reversed the 2004 decision and brought back named GPs with personal responsibility for everyone aged 75 and over. That is helping 4.5 million people. With 800,000 of the most vulnerable people, we are going even further, giving them guaranteed rights to prompt and proactive care from their GP.

On social care, for too long, some of the most vulnerable people in our country have suffered from disjointed care with NHS and social care systems that, rather than talk to each other, constantly try to pass the buck. For the first time from this April, we have required all local authorities and NHS organisations to work together to plan care in a joined up and seamless way, as part of the better care programme.

Diana Johnson (Kingston upon Hull North) (Lab): Will the Secretary of State give way?

Mr Hunt: I am going to make progress.

When that happens, we should see, for the first time ever, not an increase but a reduction in emergency hospital admissions. For patients, that will mean something important: a doctor or nurse will be in charge of every person in the social care system; medical records will be shared, so that people get safer and more joined-up care; and joint teams will work together across the NHS and social care systems, rather than the silos and boundaries that have plagued the system till now.

The Government have never pretended that the challenges facing the NHS are straightforward, but with more doctors, more nurses, more operations and safer care than ever before, we have shown our commitment to that most precious institution. We have put our money where our mouth is, with protection for the NHS budget during cuts, financial help this winter and support for the NHS’s plan for the future. More important than the money are the values behind it: our passion for the highest standards of compassionate care for every person who needs the NHS. Good care, not clever politics, is the future for our NHS.

Several hon. Members rose

Madam Deputy Speaker (Dame Dawn Primarolo): Order. I should inform Members that 28 Back Benchers are seeking to take part in the debate this afternoon. I hope that it will not be necessary to have time limits, but I ask each Member to consider speaking for only eight minutes approximately, or 10 minutes maximum. If any Member speaks for too long, it will subsequently be necessary to have a time limit, which could be quite severe on the last few speakers. That would be unfortunate, so if that could be borne in mind and if Members watched the clock, that would help enormously.

21 Jan 2015 : Column 256

2.42 pm

Alan Johnson (Kingston upon Hull West and Hessle) (Lab): Thank you, Madam Deputy Speaker. I will do my best to comply with your instructions.

As the Secretary of State was talking, my mind went back to the “responsible opposition” of the right hon. Member for South Cambridgeshire (Mr Lansley). I remember the efforts that went on for more than 40 years around Manchester to tackle the appalling level of infant mortality by reconfiguring maternity services. As the local newspapers said, that was stopped at every stage by politicians defending bricks and mortar. In the end, when that change went through, it was the Opposition who tried to reopen the issue. Before my noble Friend Lord Ara Darzi became a Minister, he did a very important review on London, where there were more single-handed GP practices than anywhere else in the country post-Shipman, and people attending A and E was a bigger problem than anywhere else. Lord Darzi put forward sensible proposals, which were agreed by clinicians and the NHS in London, but the right hon. Member for South Cambridgeshire opposed them. He issued an unfortunate press release about polyclinics—unfortunately, he spelt it “polly”, but it was not a clinic for parrots. I said to him, “Don’t adopt a policy that you can’t spell.” There are numerous examples of the previous Opposition doing that.

I bet I am not the only one in this House—I bet there are Members in all parts of the House—who rues the day when the right hon. Member for South Cambridgeshire got his hands on the NHS. His ideas for what to do, which culminated in the top-down reorganisation, were not new—I remember them from my first day as Health Secretary. He is not a bad man who hates the NHS, by the way. In many ways, he has great affection for the NHS, but he got things totally wrong. He slung across his draft Bill on what the NHS would look like after his top-down reorganisation. I read it that evening and it was horrendous.

The Government have done two things to erode confidence in politics in this country. The first is the Liberal Democrats’ conversion from opposing tuition fees to the extent that they wished to abolish them to supporting tuition fees to the extent that they agreed to treble them. The second is the Conservatives’ conversion from a pledge that there would be no top-down reorganisation of the NHS to the implementation of a top-down reorganisation so huge that, in the words of the previous NHS chief executive,

“you can see it from space”.

That is a vivid but not inaccurate description of a reorganisation that closed 170 organisations, created 240 new ones, made 10,000 staff redundant and re-employed 2,200 of them.

Dr Julian Huppert (Cambridge) (LD): I will not highlight the right hon. Gentleman’s role in tripling tuition fees. The shadow Secretary of State said that, when he came into office—this is part of his defence— he got rid of the pro-privatisation agenda that he inherited. Who does the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) believe the shadow Secretary of State was criticising in that comment?

21 Jan 2015 : Column 257

Alan Johnson: I do not understand the hon. Gentleman’s point about my role in trebling tuition fees. I certainly was the higher education Minister who introduced tuition fees, against fierce opposition. I supported them and made the arguments—all the arguments we now hear from Liberal Democrats—against the opposition of the Conservative party.

In terms of privatisation, we did introduce independent treatment centres. At every stage, we asked the local NHS, “Have you got the capacity to get these waiting lists down? Have you got the capacity to carry out the elective surgery without denuding emergency services?” which happened all the time. Hon. Members will be surprised how many found that capacity when we said, “Okay, we’ll introduce an independent treatment centre.” Suddenly, consultants stopped going to the golf course and taking Saturdays off. They got the waiting times down. In places that did not have capacity, we introduced independent treatment centres. The role of the NHS is to treat patients, and I am very proud of the record that we and my successor, my right hon. Friend the Member for Leigh (Andy Burnham), stood on in 2010.

Mr Kenneth Clarke (Rushcliffe) (Con): Does the right hon. Gentleman agree that, since the late 1980s, every Secretary of State from both political parties, with the exception of the right hon. Member for Holborn and St Pancras (Frank Dobson), accepted that one could raise the quality of patient care by introducing competition and choice of provider in the system? The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) quite sensibly pursued that policy, as did Alan Milburn, with particular vigour, and the shadow Secretary of State when he was in office. Will the right hon. Gentleman try to encourage his successor not to go back on that, because the health service is now much better at coping with the problems of changing demand than it was 20 or 30 years ago?

Alan Johnson: The right hon. and learned Gentleman knows, because we have debated this before—I will come on to some of the history—that the big difference between what he and other Governments did during the 1980s and what we did is the single tariff. They competed on price. We had a single tariff that meant that, wherever that operation took place, it was paid for at the same rate.

With that top-down reorganisation that we could see from space, all the Conservative party’s efforts to convince the public that they could be trusted with the stewardship of the NHS were thrown into disarray at a stroke. The fact that the NHS tops the list of public concerns as we approach a general election can be traced to that self-inflicted wound.

The Conservative party leader’s efforts to detoxify the Tory brand vis-à-vis the NHS could be described as an attempt to return to the consensus that existed prior to the 1980s. The great historian of the NHS, Rudolf Klein, says that following its contentious birth there followed 35 years when the NHS was “cocooned in consensus”. That changed in 1982, when the Thatcher Government’s internal think-tank, the Central Policy Review Staff, produced a paper with the option of replacing the NHS, a tax-financed health service, with a system of private insurance. This option—the right hon. and learned Member for Rushcliffe (Mr Clarke)

21 Jan 2015 : Column 258

will probably remember this—was, incidentally, presented to Ministers not by the Secretary of State for Health but by the Chancellor of the Exchequer. It was defeated thanks to the efforts of Norman—now Lord—Fowler, but it expressed for the first time the idea that a tax-funded NHS was wrong and broke that 35-year consensus.

From that moment, through weird and wonderful ideas, right up to 2005 when Conservatives Members stood on the platform of the ridiculous patient passport, their policy has been about taking money out of the NHS and changing the very principles of the service. I could not describe it better—I think there would be agreement on this—than the great American clinician and health care expert, Donald Berwick, who I believe the Secretary of State has used during his time in office as an adviser. He describes the NHS as

“one of the truly astounding endeavours of modern times”

and, in a wonderful phrase, as

“a towering bridge - between the rhetoric of justice and the fact of justice.”

This ideological battle is not over. Indeed, it has just been joined by the ultra-Thatcherite leader of UKIP. The hon. Member for St Ives (Andrew George) is no longer in his place, but he was perhaps right in thinking that we should get back to a consensus on the NHS.

We could raise relevant arguments about many aspects of the NHS. Indeed, my colleagues in Hull and I are talking to the Secretary of State about some issues central to Hull. However, in this speech I do not want to talk about clinical health or the successes of the NHS. I want to talk about one of its failures. At the tenth anniversary of the NHS in 1958, there was a debate in this Chamber. Nye Bevan, the great architect of the NHS who was mentioned earlier, stood up and said what a great success it had been, but that the failure had been mental health. He spoke, using the language of the time, of the disgraceful conditions in our mental hospitals. Of course, there has been a huge improvement since 1958, but it remains a fact that mental health is a poor relation of the NHS, and children and adolescent mental health is a poor relation of that poor relation.

I would like to cite three awful statistics published by the Office for National Statistics. First, 10% of children between the ages of five and 16—or to put it another way, three in every class—experience mental health problems. The second disgraceful statistic is that that figure rises to 60% when applied to children in care. The final disgraceful statistic is that 95% of imprisoned young offenders have a mental health disorder. Many of those young offenders should not be in prison at all. I have raised the case on the Floor of the House of my constituent, Vince Morgan, a young man with a severe psychotic illness who committed suicide in a prison cell having been failed by every single organisation and authority that was meant to help him. Section 136 of the Mental Health Act 1983 is still being used to incarcerate children, mainly as a result of the failure to provide sufficient in-patient tier 4 child and adolescent mental health services facilities.

Forgive me for being parochial, but this is a crucial issue in our area. In Hull and East Riding, we were served well by an in-patient unit called West End for 20 years. When NHS England assumed responsibility for tier 4 services as a result of the changes from the reorganisation—all other tiers being the responsibility

21 Jan 2015 : Column 259

of the local clinical commissioning groups—it changed the specifications for tier 4 units, saying that they had to be open seven days a week, 24 hours a day. There was no consultation with anyone. This was done in March 2013. As West End was open only from Monday to Friday, with children spending the weekends at home—a regular feature of CAMHS treatment—the unit was closed. The option of extending the provision, so that it was a seven-day service, was never offered. Parents of children who had benefited from this important part of the NHS had no input whatever in a decision made by a huge quango that had no local accountability and no local presence. So much for the glib slogan, “No decision about me without me”.

I raised this issue in the Chamber on 23 October. The Minister of State, Department of Health, the right hon. Member for North Norfolk (Norman Lamb), who is in his place, gave me a sympathetic response. I am convinced that he cares deeply about the problems of mental health, but he appears to be entirely powerless to do anything about them. Since then, there has been a review of tier 4 services by NHS England, which, as the Health Committee has said:

“does not provide a conclusive answer on the reasons for the current problems, nor on whether there are sufficient beds”.

In addition, that Health Committee report, published in November, pointed out that NHS England had

“presided over a system which has resulted in children being sent hundreds of miles to access care.”

There has been no resolution on this issue in Hull and East Riding, or in other parts of the country, such as Devon and Cornwall. We have a foundation trust provider that recognises the problem and has identified a site for a new seven-day in-patient service, but the commissioner at NHS England has yet to commission. The CCGs are powerless. The acute trust often has to open its adult wards to children.

Let me tell the House what this means to the victims of such failure—to the children who were once so well served by the West End unit. Maisie Shaw is a 13-year-old who has had serious mental health problems since her father died two years ago. Her mother, Sally, is a teacher. Clearly, children need to be close to their family when they are undergoing treatment. Family involvement is a crucial aspect of their recovery. In December, Maisie took an overdose after breaking into a locked medication box at her home in Hessle. As it was a Saturday, there were no CAMHS staff on duty and, of course, no in-patient facility. She was taken to Hull royal infirmary on Saturday and cared for in a locked ward at the maternity hospital, with a 24-hour guard until Monday morning. She was sent to Stafford, which is almost 200 miles away, and then to Sheffield, which involves a round-trip of 120 miles by her family to visit her. As part of her treatment, she will be home at weekends, but when her mother asked what help would be available for this very disturbed child if there was an emergency, she was told to ring 999.

The subject of my debate in October 2013 was Beth Hopper, who is now 15. Beth’s mother, Kathy, is a staff nurse for the NHS. Beth is an extremely intelligent girl who has, according to her school, huge academic potential. She suffered a severe mental breakdown at the age of 11 and spent nine months at the West End unit, which

21 Jan 2015 : Column 260

opened at weekends specifically to tend to her needs. Kathy believes that the unit saved her daughter’s life. Since West End closed, Beth has been sent away 19 times. She has been to Cheadle, 103 miles away. She has been to Liverpool. She has been to Warrington. She has been Nottingham. She has been Widnes. Of course, while there is no argument that to travel further for more expert care is a factor in physical health, it is rarely the case with mental health, particularly when the patient is a child. Indeed, Maisie and Beth’s clinicians in Hull often have to travel to care for her in these distant locations, thus adding to the cost of that care. It is no exaggeration to say that the condition of Beth and Maisie is actually being made worse by this treatment. It is truly scandalous.

So that Beth’s voice is heard in this debate, I will read out a letter that she sent to her mother the other week. She wrote this:

“I really just don’t know what to do or what I want, or what is best for me anymore.”

Forgive her grammar.

“I aren’t happy here. I am happy at home, but I am scared that things might go like they were before. I just want normality. I want to have the chance to be a kid for once, before it is too late. I feel as though nobody is listening to me. I am so isolated here I am scared to join the groups and don’t want to make new friends anyway. I want my old friends, who I miss.”

We need to hear these children’s voices.

Sir Gerald Kaufman (Manchester, Gorton) (Lab): I am listening with sympathy and concern to the case histories that my right hon. Friend is describing. He might be surprised to learn that a constituent of mine with mental health problems was sent to Hull, without any consultation with his family.

Alan Johnson: It could not have been a CAMHS service, because we have no tier 4 service available in Hull.

I have cited two long-standing cases from my average-sized constituency, but I have recently heard about another case—that of Jordan Hatfield, a 15-year-old who, last May, took 45 paracetamol tablets in an attempt to end her own life. She spent six days on a medical ward and has been in Cheadle for the past week. Her mother does not drive and has small children, so it is impossible for her to visit. My colleagues in east and north Hull, and across the East Riding, will have other examples, because, as the Select Committee and NHS England, in its obscure way, pointed out, there is a lack of services in this huge swathe of eastern England.

On the wider question of mental health, we will not achieve parity of esteem by cutting funding. NHS trusts providing mental health care have lost £250 million of funding since 2012—the first fall in a decade. In addition, as my right hon. Friend the shadow Secretary of State pointed out, two thirds of local authorities have reduced their CAMHS budgets since 2010, while more than three quarters of adults who access mental health services had a diagnosable disorder before they were 18, yet only 6% of the decreasing mental health budget is spent on under-18s.

The report of the taskforce on mental health in society, commissioned by my right hon. Friend the Leader of the Opposition, and published on Monday, has much to recommend it, particularly the right to

21 Jan 2015 : Column 261

mental health treatment in the NHS constitution; expansion of the enormously successfully IAPT—improving access to psychological treatment—programme; and the introduction of waiting-time standards for access to CAMHS. These are good ideas, and they need to be put into practice, regardless of which parties are in government. However, somebody needs to get a grip of this issue now. We cannot go on letting our children down in this horrendous way.

3.2 pm

Richard Harrington (Watford) (Con): I will do my best, Madam Deputy Speaker, to stick to the eight-minute guideline—without casting any aspersion on the previous speaker, the illustrious former Secretary of State. I shall be watching the clock.

So much has been said about the situation nationally, and I found the speech by the shadow Secretary of State, which I listened to carefully, very political, controversial and adversarial. I shall do my best not to speak in that manner. Instead, I would like Members to listen to my personal experiences in the Watford area, from speaking to people and visiting, several times, the A and E department, the general hospital, the clinical commissioning group, and so on. As a Back-Bench Member, that is about the best I can do. It is very confusing watching these tennis matches—as soon as the Secretary of State says something, the shadow Secretary of State is on television saying completely the opposite. It is confusing for people who work in the NHS and the rest of our constituents.

As the Secretary of State said, there is unquestionably pressure on the NHS. Everybody knows that. We all know the statistics about people getting older and needing more medical care. I frequently have to ask my mother, when she phones the GP every other day, “Is it necessary?”, and I am sure she thinks it is always necessary, because when people get older, they need care, and the Government have to respond to that. However, these insinuations and open statements by the Opposition that NHS spending has been cut are untrue, and they frighten people. It is a fact—it cannot be disputed—that spending has increased in cash terms every year since the coalition came to power and by £13 billion overall, and will increase by £2 billion alone next year.

I have spoken to consultants and nurses at Watford A and E—I have been there nearly every week since the beginning of the year—and I have seen ambulances backing up, and all the things that people on both sides of the House have mentioned. When I ask the A and E consultants why, they say, “These are not people with trivial illnesses, but people with serious concerns.” It is not a question of people with sore thumbs phoning the national number and being sent to A and E—I am certain of that, having spoken to many people in reception. We are not talking about people who should be going to see a nurse or a walk-in centre; these are serious matters, and there are a lot more of them. The extra GP hours will help, but I will come to that later.

The Watford area is making progress, however. Northwick Park hospital has just opened a big A and E, which I am sure will take off some of the pressure; the Herts Valley CCG has had a 5.5% increase; and there are more than 1,000 extra doctors in the region since 2010—I have seen them; they are not just a statistic.

21 Jan 2015 : Column 262

I have spoken to them and the management. They are real people. Similarly at Watford general, we have 142 more full-time nurses. I opened a new ward last week at Watford general, and there is a £1.6 million ambulatory care unit. There are lots and lots of new things, yet Labour did a party political broadcast from Watford hospital that really annoyed the staff, the management and my constituents, because it frightened people and gave the impression that the service was disintegrating and disappearing.

On the important subject of GPs, there is no question but that it was a mistake by previous Governments to restrict GP working hours. I commend the Watford Care Alliance for being among the first to get money under the Prime Minister’s fund to finance seven-day opening for GP services till 8 o’clock, which has made a significant difference. In Watford alone, there will be 16,000 extra appointments this year, which is a lot.

I am delighted that the Health Secretary came to visit Dr Mark Semler, whom I hope he will agree was inspirational in the way he spoke about the programme. He is a local GP who has taken this challenge on. Of course, there are big challenges with IT and explaining it to other staff in the area, but he is an inspirational man, and I think we had a constructive conversation with all the doctors about the implications of this policy. They have taken on the extra hours, and they know it is providing a service. In time, it will help significantly in providing a service to my constituents and taking some of the pressure off A and E.

I am pleased that Watford was one of the first in the country to do that, and I think it has been a success. I know the Government’s ambition is to roll it out to the rest of the country, which would be a major step forward. The actual infrastructure—the offices, the surgeries, the premises—are there, and to anyone from a background outside the public service, it would seem strange to have all those assets and not to use them for the benefit of the customers, who, in this case, are the patients. I commend the Government for that and I thank the Secretary of State that Watford was one of the first places in the country to do this.

Finally, I want to comment on the air ambulance service, which, as he often does, my hon. Friend the Member for Bedford (Richard Fuller) mentioned earlier. I have seen it and think the service is very impressive, and I hope the Government will consider giving it some of the LIBOR funding—it would be an excellent use of that money.

Oliver Colvile (Plymouth, Sutton and Devonport) (Con): I thank my hon. Friend for his constructive speech. It is incredibly helpful, because a lot of people get very concerned when we play “Punch and Judy” occasionally. Does he recognise the role of pharmacies, which are a key part of our NHS that we need to make greater use of?

Richard Harrington: My hon. Friend makes a good point. Some pharmacists feels under threat from internet pharmacists—not illegal ones abroad, but proper ones—but the personal contact with pharmacists and the advice they offer can provide them with an enhanced role in the internet era. So I agree with him totally.

And that, Madam Deputy Speaker, concludes my comments.

21 Jan 2015 : Column 263

3.9 pm

Frank Dobson (Holborn and St Pancras) (Lab): Whatever people like or dislike about the language, I do not think anyone could deny that the NHS at the moment is struggling to care for patients in the way that the hard-working staff in the NHS would like to be able to care for them and to deal with them as promptly as they would like. Everyone recognises that the NHS is managing to cope only because of its amazingly dedicated staff doing amounts of work and quality of work far above the call of duty. I have to say that a nurse from one of the two great hospitals in my constituency, to which the Secretary of State referred, said to me, “If he says how wonderful we are and then defends us not getting a pay increase, I will throw up.” I do not think she intended doing it in front of patients, but the hypocrisy of the approach she describes seems to me to be indefensible.

This situation is not entirely novel. A and E has been facing difficulties and has been overstretched in many parts of the country, even during the summer. That is largely because too many people are having to go to A and E or are being taken to A and E because they cannot be looked after properly at home. That is one of the main reasons. If people are kept in, there are not enough beds. I noticed that the Secretary of State quoted the King’s Fund. Having been interested in health care in London for 40-odd years, all I can say is that the main contribution of the King’s Fund has always been to demand reductions in the number of hospital beds; then, where there are not enough of them, it comes up with a million reasons why there are not enough—none of them being that there are too few beds; it is always some other factor rather than the shortage of beds itself that it manages to blame.

The reason why people, particularly the elderly and the physically and mentally disabled, have to go into hospital is that they cannot be safely looked after at home. Once they are in hospital and occupying a bed, they cannot safely be discharged home. So, they are brought in because there is no adequate care at home, and they cannot go back out of a hospital bed because there is no adequate care at home. The Government simply cannot get away from the fact that there have been massive reductions in care at home, particularly for the elderly. Logic suggests that if there are more elderly people who are chronically ill, there should be an expansion of the service to meet the increased need. In fact, however, services have been contracting.

The excellent work done by my hon. Friend the Member for Leicester West (Liz Kendall) a fortnight ago—just a small aspect of it—demonstrated that there had been almost 200,000 fewer people getting meals on wheels. I do not know whether the Government ever deigned to consider the impact of that, but if old people who previously relied on meals on wheels were not getting them, they were probably no longer being properly fed, and if they were not being properly fed, they were more likely to need nursing care. If no additional care was available, they were more likely to go to A and E and, once they had gone into a hospital bed, they were less likely to be safely discharged simply because they were no longer getting meals on wheels.

The meals on wheels service does not have the function only of providing food. On every day that a person gets meals on wheels, somebody is checking how they are doing, and it gives those who are lonely some human

21 Jan 2015 : Column 264

contact. The disappearance of all those meals on wheels will undoubtedly have led to more elderly people having to go to A and E, and fewer elderly people being able to be treated safely at home.

Diana Johnson: I am listening carefully to what my right hon. Friend is saying. He has the perspective of a London MP. In Hull over the Christmas period, we had the longest wait for A and E in the country—and this at the same time as we have seen a quarter of the local authority budget being cut, which impacts on social care. It seems to me that the two are very closely related. Does my right hon. Friend agree?

Frank Dobson: I entirely agree with that. The fact is that the services that can be provided at home need a higher priority than they have had in the past—under any Government. They need more staff with more time, because many of the people attempting to provide a service are given a quarter of an hour to dash in, help somebody wash or cook and then dash out again to rush along to somewhere else. If one person takes up more than a quarter of an hour, they will be late for the next person they are supposed to be looking after. What is more, all these people get lousy pay. In fact, the level of pay that such people get is a disgrace.

We also need a massive improvement in the co-ordination of services between hospitals, GPs, health visitors, nurses and the people providing those practical cleaning services and so forth. This will cost more. Anyone who pretends that we will not have to pay some more to get a service that works to replace one that does not is either just misleading themselves or—in the worst version—misleading other people.

Previous Governments have not expanded the services in line with the need, but the recent response of this Government has been to contract the service available, which is indefensible. Proposals under the new regime—if that is the right term, Madam Deputy Speaker—have brought about fragmentation, competition and binding legal contracts between various providers of these services. If anybody thinks that will improve co-ordination, they are again either deceiving themselves or attempting to deceive the rest of us.

In this country and in this House, we have to wake up to the fact that if we want a first-class service, we are going to have to pay a first-class fare. That was something I wrote in a long and entirely personal memorandum to the Prime Minister, not long before I foolishly resigned as Health Secretary. I pointed out that a massive increase in investment was needed. I am quite proud of some of the things I did when I was Health Secretary. That might have been the most important thing I did, because about two years later, the Government put an extra £40 billion into the health service. To be fair to the Prime Minister, I received a note from him saying, “Your long personal note triggered what we did.” I felt pretty glad about that.

When we talk about these issues, we need to bear in mind that our NHS is easily the most cost-effective system in the developed world. The total we spend on health care is 9.4% of gross domestic product: the Germans spend 11.3%, the French 11.6% and the United States, which has an insurance system like the one the leader of UKIP wants to introduce here, spends 16.9% of their GDP on health, and life expectation there is lower than ours.

21 Jan 2015 : Column 265

The other really startling point, when we get people such as the King’s Fund and others demanding reductions in the number of hospital beds, is that for every 1,000 people we have three hospital beds, while the French have more than six and the Germans eight and a half. So far as I know, there is no daft consensus in either of those countries to get down to the British level.

3.19 pm

Paul Burstow (Sutton and Cheam) (LD): It was a pleasure to listen to the right hon. Member for Holborn and St Pancras (Frank Dobson). I was particularly struck by the point he made about the important case for investing in our health and care system. I dare say that the note that he mentioned will in due course be published under the 30-year rule, and that we shall then have a chance to read the full text. It must be said, however, that it took nearly four years for the argument he was advancing to be understood and acted on, and that those were lost years during the a 13-year Labour Administration.

Frank Dobson: I should point out that, partly as a result of earlier negotiations, we had secured an increase of £20 billion.

Paul Burstow: I may return to that point later, but first I want to talk about my own experiences of my local national health service, and in particular about a visit that I paid to my local trust, Epsom and St Helier University Hospitals NHS Trust, at the beginning of the month. During the visit I had a chance to meet staff, including A and E staff. I pay tribute to the hard work that is done in the trust, and especially to the work that is done in the A and E department. Last week Epsom and St Helier was placed sixth among all the London trusts in terms of the time for which people were having to wait in A and E, when measured against the standard, and, according to figures that were published yesterday, 99% of people are seen within the standard four hours. That is an example of great performance. The trust is facing great pressure, but it is doing a fantastic job none the less, and that side of the story ought to be told. We ought not to focus only on hospitals that may not have learnt some of the lessons that have been learnt by my local trust.

The A and E staff members whom I met made it clear that there was no single cause of the pressures in their department. In fact, the precise mix of factors varies from one hospital to another, and from one area to another. St Helier, however, has made excellent use of the winter funding it has received. It has added capacity to A and E, and has introduced examples of good practice. For instance, there are daily reviews of patients to ensure they are being given the right treatment in the right place; patients who are ready to be discharged are identified on the previous day so that arrangements can be made in good time; and there is a system of “ward buddies”, enabling corporate staff to provide additional administration support at times of extreme pressure—such as the present time—in order to assist safe discharge. A further welcome boost is the news that an extra £325,000 has been provided to assist people’s safe discharge to their own homes or to step-down care.

A piece of work examining the position in the Sandwell and west Birmingham area revealed huge variations between attendance rates by practice. Its authors found

21 Jan 2015 : Column 266

that some people considered A and E attendance to be the norm, and that a fifth of attenders made a conscious decision to go to A and E on the previous day. They also found that many A and E attenders believed that it was not even worth trying to access primary care in the first place. There are issues relating to communication, understanding of the system, and how we explain it. That cannot be dealt with in a universal, national way; it must be tailored to patients’ preferences and their expectations of the system at local level. That piece of work has already helped those in Sandwell to think about how to target messages more effectively in order to ensure that people have access to the support they need at the time they need it.

Sir Oliver Heald (North East Hertfordshire) (Con): Does my right hon. Friend agree that there should be a proper investigation into winter planning in each area? As he says, factors vary greatly. In my area, for instance, the factors affecting Addenbrookes hospital are very different from those affecting the Lister hospital in Stevenage. I think that planning needs to improve. This year, the same thing happened throughout the country. The A and E departments asked for £700 million, the Government gave it to them, and yet there have been all these problems.

Paul Burstow: I think it important for the system to learn lessons from the areas where winter planning has worked well, and for us to ensure that those lessons are transferred and replicated around the country. The NHS is not always as good as it could be at ensuring that lessons are not just stuck in one place.

James Morris (Halesowen and Rowley Regis) (Con): Will the right hon. Gentleman give way?

Paul Burstow: I must make some progress if others are to have a chance to speak.

The NHS has grappled with a productivity challenge during the current Parliament, but it should be noted that it was first set up and signed off by the last Administration. The target was £20 billion, and it was to be delivered within a shorter period than the coalition Government set in their 2010 spending review. The Labour productivity programme was set in 2009, and it was clear then that the NHS was on notice that it faced a very tough settlement regardless of which party was in government after the 2010 general election. Reducing management overheads has been a key part of our efforts to balance the books during this Parliament. Focusing on the management overhead costs of the commissioning side of the NHS in the legislation that went through the House at the beginning of the Parliament was sensible, and increasing clinical involvement in commissioning was another important move.

Frank Dobson: Will the right hon. Gentleman give way?

Paul Burstow: I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.

In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result

21 Jan 2015 : Column 267

of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?

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

Paul Burstow: I will, unlike the right hon. Gentleman on many occasions earlier.

Andy Burnham: The right hon. Gentleman clearly was not listening to my speech. The central proposition is that what I described as the “root cause” of the A and E crisis was the imposition of devastating cuts in social care, which are leaving people unsupported in their own homes. Will the right hon. Gentleman now say—because he was there—that it was wrong of him and his colleagues to allow social care to be cut in that way, given that the cuts are now presenting the NHS with an enormous productivity and efficiency problem?

Paul Burstow: The right hon. Gentleman is right to raise that question. I wanted to ask him a question that relates directly to his point, and, indeed, answers it. I hope that he will agree with me—and, indeed, with the Minister of State, Department of Health, my right hon. Friend the Member for North Norfolk (Norman Lamb)—that we need a fundamental review of NHS and care spending, in the round, and that finances in that area need to be addressed before the spending review that any Government will carry out later in the year. We need to ensure that we are clear about the level of investment that will go into our health and social care system. So far, I have heard no clear indication from the right hon. Gentleman of his relative spending priorities when it comes to health and social care, and they need to be made clear if we are to establish a consensus.

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

Paul Burstow: I will give way once more, but then I must make rapid progress.

Andy Burnham: My answer to the right hon. Gentleman’s question is that I want a single service: a single service for the whole person. I want a national health and care service. We should no longer have two budgets; we should have a single budget, and we should then use the money as best we can to support people, starting in their own homes—and we are going to invest an extra £2.5 billion.

The right hon. Gentleman did not answer the question that I asked him. I asked him whether he and his Government colleagues, in those early days, made a mistake in allowing social care to be cut to the bone? Every week I am accused of saying that it is irresponsible to give real-terms increases. The right hon. Gentleman allowed social care to be raided. Should we not receive an apology for that today?

21 Jan 2015 : Column 268

Paul Burstow: Let me deal quickly with that and then come on to what we need to do next.

As a result of the 2010 spending review, we invested £7.2 billion extra in social care over the life of this Parliament. I regret the fact that not every local authority has fully spent that resource on social care, and although the right hon. Member for Leigh (Andy Burnham)wants to make this an issue of blame I want to try to try to analyse the problem. It has already been said that some local authorities have struggled purposefully to reorganise their services to make the best use of the resources available and have delivered better outcomes, not least by investing in services such as re-ablement, which significantly reduced the call on ongoing care services.

It was right for the Government to put the resources in and make the commitments we did and it was right in the autumn statement this year to commit the £2 billion for the NHS as a down payment to deliver Simon Stevens’ NHS Forward View. Although that is good news, I want to flag up a couple of concerns. First, there needs to be clarity about the funding commitment in every subsequent year during the course of the next Parliament. We have had some indications from the Labour party and some from the Liberal Democrats, but we have not yet had clarity from the Conservatives about how they would address the £8 billion gap.

Secondly, despite the commitment of £7.2 billion for social care during this Parliament, not all that money has got through to social care. I acknowledge the efforts that councils have made already, but we cannot ignore the fact that social care has been a poor relation of the NHS not just during this Government’s lifetime but under successive Administrations of parties of both persuasions over a very long time. I have asked the Secretary of State to ensure that social care benefits from some of this £2 billion and urge him again today to do just that. It is unacceptable that some councils are paying fees for care that condemns staff to rates of pay below the national minimum wage and it is no wonder that as a result we have among the highest staff turnover rates of any part of our economy and that it is so difficult to recruit.

To conclude—although I could go on a little longer—I want to address the comments made by the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson). In a debate that had been about much heat but not a great deal of light, he cast important light on one of the key challenges for whoever is in government after the election, which is how we ensure that we reform our mental health care system to deliver the parity of esteem the Government have set out as an ambition and have started down the road of delivering. We still have a long way to journey, however.

We still have a separation in our health care system between the service that delivers for physical health and the service that delivers for mental health, yet those two things are inextricably linked. We know that half of lifelong mental health problems start in adolescence and need to be addressed at that point. The goal of parity of esteem, which is shared across the House, is right. We need parity of esteem in outcomes, rights and resources and I welcome the investments made by the Government, the commitment to continue the improving access to the psychological therapies programme that was started by the previous Government and has continued under this one, the launch under this Government of a

21 Jan 2015 : Column 269

children and young people’s IAPT programme and the emergency care concordat. I thank the Minister of State, who is on the Front Bench today, for launching the children and adolescent mental health services review, which must provide a route map for reforming CAMHS for whoever sits in the Secretary of State’s office after the general election. If it does not, it will have failed in its task. We need a plan and we need that plan to be implemented through the spending review after the general election.

The debate has highlighted yet again that we are yet to reach consensus in this Chamber on how to improve our NHS. There are people of passion and commitment on both sides of the House who have in their heart and at their core a desire to maintain a national health service that is free at the point of use and available on the basis of need. We need to extend that to ensure that our social care system is no longer left behind in the way it has been by successive Governments.

Several hon. Members rose

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. Speeches of up to eight minutes would be helpful if we are to try to get everybody in—do not worry, you did very well, Paul.

3.32 pm

Mr David Lammy (Tottenham) (Lab): Two years ago, a friend of mine collapsed on a football playing field and an ambulance was called. The ambulance should have reached this major emergency within eight minutes, but it took 17 minutes and my friend died of a heart attack on that field. The seriousness of this debate for many families beyond this Chamber—I am thinking of the wife and three children that he left behind—cannot be conveyed. It is right to begin by saying that the £700 million that has been found and the £150 million for the challenge fund are absolutely desirable and necessary at this time. I remember, as a former Minister in the Department dealing with the winter crisis, that those funds are very important.

I want to take the House back to a dark time for the NHS, when it was routine to wait in A and E for six, eight or 12 hours, and to what it took to change that system. It was a great privilege for me to begin my ministerial career in the Department of Health. The then Member for Darlington was busy, controversially, dealing with foundation hospitals. The then Member for Barrow and Furness was busy at that time, controversially dealing with nurses’ pay and increases we wanted, and with the GP contract. I found myself leading on emergency care, and I was the Minister who took through the changes for that A and E target.

We brought in Professor Sir George Alberti. For a number of reasons, it was hugely important that we had a clinician leading the charge across the NHS. We needed to persuade the GPs about access if this was to work. We brought in the target—48 hours, since abolished —and a lot of practice at the front door of A and E. The phrase we used all the time at that point was “See and treat and triage”, but it worked only if we looked at the system as a whole system. Important targets in the rest of the hospital—in cancer, in cardiac care—were necessary. Frankly, it is a crying shame that seven of the 15 major targets were missed under this Government.

21 Jan 2015 : Column 270

We also needed to deal with social care, of course. If £3.53 billion is taken out of social care, there must be consequences. We should remember that much of this debate has been in the past tense. There are further cuts to come, with day centres to be closed. We see phrases pop up in local authorities such as “New pathways for the elderly”. New pathways to what? New pathways to isolation; new pathways to falling over at home alone; new pathways to going without food; and new pathways to ending up at the door of A and E.

We also introduced NHS Direct to ensure that nurses could deal with calls promptly and move on. I never conceived that we would get rid of the nurses in NHS Direct, and that we would move solely to a system of algorithm. Is it surprising that NHS Direct staff are directing people to the door of A and E? Our system worked because before people went to A and E they could go to a walk-in centre. We can call them urgent care centres if we want, but they are essential—they are part of the triage, a part of the see and treat method that we need. Again, however, one in four of them has been lost, resulting in the crisis we see before us.

Here in London it is worse, because we are losing A and Es—gone at Chase Farm, gone at Hammersmith, gone at Central Middlesex, going perhaps at Epsom and St Helier, gone at Charing Cross—and with a population rising to 10 million. This is a serious debate because it is about to get worse. No wonder the chief executive of the London ambulance service resigned yesterday. She is leaving a sinking ship under this Government’s watch, and this House and the people will remember that, because it is specious of the Secretary of State to come to this Chamber and say the debate is solely about more nurses and more doctors. It is not. It is about the system—the NHS.

Who is accountable under this new structure? Is it NHS England? Is it the CCGs? Is it the CQC? Is it another jargon organisation? No one is responsible—certainly the Secretary of State is not, because he gave up those responsibilities in 2012. That is the mess this Government have got into without even putting it in the manifesto. It is a disgrace.

3.39 pm

David T. C. Davies (Monmouth) (Con): I would like to tell the House what I think is an absolute disgrace. Not once during the speech made by the Secretary of State for Health, not once in any of the speeches made by Opposition Members and not once in Welsh questions earlier today did any Opposition Member raise the issue of what is happening in the national health service in Wales. Labour has been responsible for the health service in that part of the United Kingdom for the past 16 years, and Labour Members are running scared of making any mention of it or drawing any comparisons involving it. According to a House of Commons Library document—and they don’t come much more neutral than that—the NHS in Wales, run by Labour, is doing far worse than the NHS in England on almost every measure.

Andrew Gwynne (Denton and Reddish) (Lab): I do not know whether the hon. Gentleman was present for Welsh questions earlier; I certainly was. Perhaps he was asleep, because the shadow Secretary of State for Wales, my hon. Friend the Member for Pontypridd (Owen Smith), used three of his questions to the Secretary of State to ask specifically about the NHS in Wales.

21 Jan 2015 : Column 271

David T. C. Davies: I checked the Order Paper this morning, and no one had tabled a question about the NHS in Wales.

The shadow Secretary of State for Health, the right hon. Member for Leigh (Andy Burnham), said earlier that he was not responsible for Wales, but the reality is that there are 20,000 patients in England who are registered with Welsh GPs and who have their health care provided in Wales. The right hon. Gentleman is, to some extent, responsible for the poor level of service that those people are currently receiving.

Clive Efford (Eltham) (Lab): Will the hon. Gentleman give way?

David T. C. Davies: I am happy to give way, but I have to say that Opposition Members have used up rather more of their allocation than Members on this side.

Clive Efford: The hon. Gentleman seems to be talking about records. This Government came in with no mandate whatever and planned to close nine of the 31 accident and emergency departments across London. What state does he think the A and E service in London would be in if his Government had been successful in every case? They were prevented from achieving their aim by public campaigns, including the one in Lewisham, in my part of London.

David T. C. Davies: I am absolutely certain that the A and E situation in England would be far better under this Government than it is in Wales, where, according to the House of Commons Library report, 13% of patients in major departments wait more than four hours in A and E. That is approximately double the percentage recorded by major departments in England. The question of ambulances has been raised several times today. Wales has the worst ambulance response rate in the United Kingdom, with around 55% arriving within eight minutes, compared with more than 70% in England.

The shadow Secretary of State talked about privatisation, but it was the Labour Government who, quite rightly, started using the private sector to improve the national health service. I have here a quote from the Labour Secretary of State in 2002; I will not mention his name. He said of the private sector that

“we intend to use it when it can bring expertise or resources to help improve services.”—[Official Report, 26 February 2002; Vol. 380, c. 547.]

We have carried on doing the same thing. A few years later, a different Health Secretary said:

“The NHS has always made use of the private sector and will continue to do so”.—[Official Report, 25 October 2005; Vol. 438, c. 163.]

She also promised that, the following year, patients would be able to choose from any health care provider—NHS or independent sector—that met NHS standards.

It was Labour’s policy in government to use the private sector. There is nothing wrong with that, but it is totally ridiculous for Labour Members now to pretend that the Conservatives are trying to privatise the NHS. That is a big lie: we will never, ever privatise the NHS, but we are quite happy to use the private sector when it can provide a better service, just as the Labour Government

21 Jan 2015 : Column 272

did. The last word on this came in 2005, when Professor Allyson Pollock wrote a damning book about the privatisation of the national health service. She was criticising the Labour Government.

Sir Oliver Heald: Does my hon. Friend agree that Labour took things a bit too far? The shadow Secretary of State tendered out the Hinchingbrooke hospital, which ended up in the private sector. That has not been a success, and I think it is better if a trust runs the hospital—

Andy Burnham: I did not do that.

Sir Oliver Heald: Oh yes he did!

David T. C. Davies: I agree with my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald). The reality is that Labour Secretaries of State said over and over again that they were quite happy to use the private sector, and they did. They were probably right to do so in many instances, and we have continued to do so. There has been no departure from that policy.

Andy Burnham: On a point of order, Mr Deputy Speaker. I have always to correct the record when these statements are made. I apologise for delaying the House, but I am going to carry on doing it. I did not put it out to tender; it was a process I inherited, and in the middle of that process I changed the policy from “any willing provider” to “NHS preferred provider”. Contrary to what the Secretary of State said at the Dispatch Box, NHS Peterborough and Stamford was still in the race.

Mr Deputy Speaker (Mr Lindsay Hoyle): You have certainly corrected that. It is a point of correction, rather than a point of order. It is all on the record now and everyone can continue. Let us see whether we can turn the heat down a bit.

Sir Oliver Heald: Further to that point of order, Mr Deputy Speaker. I just do not accept the point of order that the shadow Secretary of State has made. May I just—

Mr Deputy Speaker: Order. No—I said straight away that it was not a point of order, but a point of correction. The point is that it is all on the record for people to read tomorrow, to continue a debate on who is right and who is wrong. Both parties, quite rightly, have stated what their belief is. Mr David T.C. Davies has not much time to go and I am very worried that he will not get to the end of his speech. He has only eight minutes in total.

David T. C. Davies: Thank you, Mr Deputy Speaker. I am grateful, because I want to talk about quite a few other things. We did not hear very much about waiting time comparisons, but of course the waiting times in England and Wales are very different. In Wales, people wait at least 26 weeks, with 14,745 having been waiting for more than nine months for treatment; in England, people wait about 18 weeks. One hundred and fifty people have died in Wales waiting for cardiac surgery.

21 Jan 2015 : Column 273

The Minister of State, Department of Health (Norman Lamb): My hon. Friend mentioned Professor Allyson Pollock. Is he aware that she particularly highlighted the extraordinary amount of money spent under the previous Government on the private finance initiative, mortgaging the future of the NHS to the tune of more than £80 billion? In the course of the next Parliament, that will cost more than £11 billion.

David T. C. Davies: I commend the professor’s book, and I hope Labour Members read it, as well as looking at the NHS comparators between England and Wales, which they obviously have not done so far. I would like Labour Members to tell us whether—if they ever are in government; I hope they will not be—they will guarantee to continue with the cancer drugs fund, which has allowed thousands of people in England to live longer and more productive lives than they otherwise would have.

The situation is not the same in Wales, where these cancer drugs are routinely denied to people. I am talking about people such as my constituent Ann Wilkinson, who is also trying to care for a very ill husband but who has been denied Avastin. She has had to find other means to get it, and other seriously ill people in Wales have had to move to England or find people’s spare rooms to sleep in.

We heard something about cuts, but the reality is that we have guaranteed the NHS budget in England while it has been cut by about 8% in Wales. Thousands of people are members of Action for our Health, a group comprising people campaigning in Wales to be treated in England. Some people say that the NHS is the envy of the world, and perhaps it is, but the NHS in England is very much the envy of Wales. To see that we need only ask the thousands of people—ordinary patients—in a campaign group who want to be treated by the NHS that is run by this coalition Government and not by the NHS that is run by Labour.

I wish to finish by saying to my right hon. Friend the Minister that I congratulate him on the better ambulance response times he is delivering in England than Labour is delivering in Wales; on the better accident and emergency turnaround times he is delivering in England than Labour is delivering in Wales; on the shorter waiting lists in England than people face in Wales; and on the cancer drugs fund, allowing people to live longer in England than they otherwise would in Wales. Most of all, I congratulate him on protecting that NHS budget—on standing up for the NHS instead of cutting the budget, as the Labour party has done in Wales. I very much hope that he is able to continue with that good work in years to come.

3.48 pm

Mr Stephen Hepburn (Jarrow) (Lab): If anybody wants to see the direction in which this Government are going with the NHS and what impact their policies are having on it, they should come up to my constituency.

Let us think back to the Prime Minister’s weasel words before the last general election—that the NHS was “safe” in his hands and that he wanted the initials NHS to be synonymous with and to define his name. Then let us look at what is happening today. It is a wonder he can lie in bed straight at night, as we see the

21 Jan 2015 : Column 274

NHS in crisis—the only thing it is doing is crying out SOS. He promised that there would be no reorganisation, but what do we get? We get the biggest reorganisation since the NHS was formed, and one set up for one thing and one thing only: to privatise the NHS. Some £3 billion has been spent on that reorganisation and the bill is going up—£3 billion that should have been spent on the sick instead of on P45s going out to thousands of nurses when cuts are implemented. It is disgraceful.

Ministers have only to come to Jarrow to see what is happening. In my local hospital three elderly patients wards have closed, a minor injuries unit has closed and now, to make matters worse, a popular walk-in centre, which sees over 27,000 patients a year, is to close. The closure is opposed by everybody in the area—the council, the trade unions, the patients and the staff.

Mr Jim Cunningham (Coventry South) (Lab): Has my hon. Friend noticed that the Government are running true to form, like the previous Conservative Government, when we had bed blocking and people sleeping on trolleys because they could not get a bed in hospital? Has he noticed particularly that local authority budgets could have provided for the elderly and prevented bed blocking?

Mr Hepburn: That is exactly the point that the shadow Secretary of State made in his opening speech.

As we heard earlier, local managers are not listening. They are stooges of the Government and they are carrying out the cuts without listening to local people. It is disgraceful. They are not incompetent, and nor are the Government—they know exactly what they are doing. There is a deliberate effort to sabotage the NHS by piling those 27,000 patients a year on to the local doctors.

Andy Burnham: I am listening carefully to what my hon. Friend says. His walk-in centre, like mine, was one of the first to open and is greatly valued by the community. I make this offer to him today: if he and his community can keep the campaign going and keep that centre open, and if I am the Secretary of State in May, it will stay open for good.

Mr Hepburn: I am sure people in the area are extremely grateful for that statement of support and commitment and that pledge from the shadow Secretary of State. I only hope he will become Secretary of State.

The Government and the management of the NHS are not incompetent. They are acting deliberately. The 27,000 patients in Jarrow who now go to the walk-in centre will have to go to the doctors’ surgeries, where it is difficult enough already to get an appointment. That will only exacerbate the problem. When they go down to A and E, which is doing a terrific job, the situation will only get worse. The Government know exactly what they are doing. They are trying to sicken people of the NHS so that they can turn round and say, “The NHS is not working. We will bring in the private sector to help out and to take it over.” That is the policy of this Government.

Steve Baker (Wycombe) (Con): Under the previous Government, my predecessor was not able to prevent the closure of A and E. If Labour is in government,

21 Jan 2015 : Column 275

I shall remember his speech today and the promise that was given to him, and I shall watch closely what happens.

Mr Hepburn: I can assure the hon. Gentleman that after that pledge I will certainly be watching the shadow Secretary of State when he gets in, to make sure our walk-in centre is still going.

Who gains from the present situation? Only two lots of people—the Tories, many of whom are up to their necks in involvement with private health care providers, and the profiteers, the health care providers, who are going to come in and cherry-pick the best services so that they can make profits. I welcome the shadow Secretary of State’s statement and commitment today. It will boost the morale of the people of the north-east who are so desperate to keep the service.

Rehman Chishti (Gillingham and Rainham) (Con): The hon. Gentleman just asked the shadow Secretary of State whether his walk-in centre would be kept open and the answer was yes. However, we should not look at future promises. We should look at the past and what was done under the previous Administration. In 2006, Medway hospital in my constituency had the seventh worst mortality rate, yet nothing was done. We must judge Labour by what it did, not by future promises.

Mr Hepburn: We must remember that it was the Labour party that created the NHS, that saved the NHS in 1997 and that tripled spending on the NHS in our last period in government. It is the Labour party, when we get in, that will return the NHS to the people—unlike the Tories, who would return the NHS to the profiteers who fund them and their organisation. The only way to get rid of the crisis in the NHS is to get rid of the Tories.

3.54 pm

Stephen McPartland (Stevenage) (Con): I am proud of the NHS and I am proud of its staff. The Lister hospital in my constituency is very large and employs thousands and thousands of staff who, I am proud to say, save lives on a daily basis. The hospital is one of the NHS’s big success stories, as it is currently undergoing a £150 million redevelopment.

I spend a lot of time at the hospital, because I am always opening things and looking at new plans and buildings, which include a new endoscopy unit and theatre, a new A and E unit and a new theatre and ward block, none of which have as yet been fully opened. I have opened a variety of other units, including new scanning units. Some £150 million has been invested in the NHS in Stevenage, which is the biggest ever investment in the NHS in Hertfordshire’s history. As the county predates the Norman Conquest, Members will understand that that is a pretty big investment.

Sir Oliver Heald: I congratulate my hon. Friend on the investment and the fantastic facilities of his hospital. In my neighbouring constituency, we say that if someone wants to find the Lister hospital, they should look for the cranes, which are there for the construction of all the new buildings. Does he agree that it has taken a Conservative-led Government to make those improvements?

21 Jan 2015 : Column 276

Stephen McPartland: My hon. and learned Friend is correct, and he supported me all the way as I fought with the Treasury, the Department of Health and every single system to ensure that we got the deals signed, sealed and delivered and the buildings constructed on time. I am proud of the investment and the staff who work in the hospital, but I am concerned about the way that Members talk down the NHS. Thousands of NHS workers in my constituency feel very depressed about the situation. They put in a huge amount of hours and a great deal of effort, and what happens at the end of the day? People say that their A and E is in crisis. That is completely unacceptable. Last week, the A and E department in my constituency saw 93.7% of people within the four-hour target. This week, it is on target, with nearly 95% of people, which is down to those doctors and nurses working their backsides off on a daily basis to ensure that they save lives.

Rehman Chishti: I pay tribute to the work my hon. Friend does in his constituency. I often see it on Facebook and read about it on the internet. He is a tireless campaigner for the health service in his constituency. He mentioned the A and E in his constituency. A linked issue is that of resources. In my constituency, £13.4 million has just been invested in resources for the A and E department—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. I do not want such long interventions. If the hon. Gentleman wishes to speak, we can always put him on the list. If he wants, he can save something for later.

Stephen McPartland: My hon. Friend makes a fantastic point, and he is a fantastic campaigner, too. I am sure that that money would not have arrived without a huge effort on his part.

The Leader of the Opposition was in my constituency last week, and we were grateful to him for his visit. He came and celebrated the £150 million investment that I had secured for my hospital. He can come as much as he likes, because I got more donations, supporters and volunteers from his visit. Perhaps he could come on a weekly basis. Incidentally, let me talk about the Lister treatment centre, which the right hon. Gentleman visited. It was privatised under the previous Government. I ran an 18-month campaign to have this private facility returned to the NHS, and I succeeded. I am probably the only Tory MP in history who has managed to renationalise a part of the NHS that had been privatised under a Labour Government. I worked very hard on that campaign, but it was lonely work. The local Labour council did not back me; the local Labour candidate did not back me; the Labour shadow Secretary of State did not back me; the Leader of the Opposition did not back me; but the GMB union did and for that I am very grateful.

Three people died in that facility and 8,500 patients’ records were lost. It was a complete and utter shambles. Clinicenta Carillion, the organisation that was responsible for running that facility, destroyed the lives of thousands of people in Hertfordshire; that must never be repeated. That is what we talk about when we talk about the NHS. Who did I stand up for? I stood up for the patients, for the staff and for their families. Where did I get my information from? From members of staff who

21 Jan 2015 : Column 277

were working in that facility daily, under huge pressure, suffering and working as hard as they could to provide the best service they could. They could not do it, because their hands were tied behind their back—the contract was so bad. The local hospital was not even allowed sight of the contract until it was signed, sealed and delivered by the previous Government. They did not even know what they were being signed up to, which is a disgrace. I am proud of my hospital and the staff who work in it, but we must always remember that, at the end of the day, these are human beings, who are working incredibly hard to deliver real improvements in services.

Fortunately, that facility is being handed back to my local hospital. The Secretary of State for Health worked with me. He allowed me to come and see him, and we had a variety of meetings. I argued with the Care Quality Commission. I was very lonely throughout that campaign, but at the end of the day the Secretary of State worked with me and he nationalised that private facility, which the previous Government—disgracefully—privatised. I am proud of the Secretary of State, and I am only sorry that he is not in his place, because I wanted him to come and open one of our wonderful new facilities in February. The Prime Minister can come in March.

The facility that I was discussing got so bad that GPs lost confidence and wrote to each other saying, “Do not refer patients to this facility or you will put them at risk.” The CQC started proceedings to revoke the licence. That facility was falling apart—a facility that was privatised by the previous Government. It was nationalised by the Conservatives.

So I am proud of the NHS and proud of the staff who work in it. I am proud of the £150 million development in my constituency, which is making my hospital one of the most modern facilities in the UK. I am disgusted that the Leader of the Opposition wants to weaponise our local NHS and never once backed my campaign to bring that shameful private contract back to the NHS. The Labour party should apologise to my local community for playing Russian roulette with our local health service and politics with my constituents and patient safety.

4.2 pm

Alison McGovern (Wirral South) (Lab): It is a pleasure to follow the hon. Member for Stevenage (Stephen McPartland). I listened carefully to his speech. He has very good taste in one respect—the football team that he supports. Although he praised the NHS staff—of course, the NHS staff I represent and speak to work incredibly hard; I pay tribute to them—in almost everything else he said, he could not recognise the glaring fact of the reorganisation being the root cause of some of the problems that we are seeing, and he was wrong in his assessment of the shadow Secretary of State’s contribution. The NHS is an extraordinarily important issue to us all. Opposition Members show great passion, as the hon. Gentleman did, and we would all pay tribute to the hard work of NHS staff. There is no difference between us on that point.

I commend the speech by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), who is not in his place at this moment. I was particularly moved by his recounting of the experience of his constituents—teenage girls suffering from mental

21 Jan 2015 : Column 278

health conditions. It is what the House of Commons should be there for, to allow us to hear his constituents’ voices in that way. I would hope that, in our debates on mental health, we can do much more to bring those problems in our system to the fore.

I want to talk about what I see as three possible solutions to the current difficulties and crises in the NHS.

Ian Austin (Dudley North) (Lab): Vote Labour, vote Labour, vote Labour.

Alison McGovern: My hon. Friend makes an excellent point, but I want to outline some of the specifics that might be entailed by that position. I want to talk about three elements of changing the NHS that I take to be very important. One of them is pretty parochial, but the other two are terribly important for our whole country.

The first concerns a walk-in centre in my constituency. Not everybody in the House will be an expert on the geography of Merseyside and, specifically, the Wirral, though I know that everybody will appreciate how important it is that they learn about it. In my part of the world, our local hospital is quite far from those of us in south Wirral. There was a hospital in south Wirral called Clatterbridge hospital, which I was born in. Its emergency facilities closed many years ago; I think that I was almost one of the last babies to be born there. Services were moved up to Arrowe Park on the border of the Birkenhead and Wirral West constituencies. I well remember, when I was young, how far away Arrowe Park felt and, when members of our family were ill, what a long distance it seemed when getting there.

Under the previous Labour Government, with my predecessor’s support, Eastham walk-in centre was opened in south Wirral, near the Cheshire border. That walk-in centre has been a rip-roaring success. It treats people effectively. They can turn up at hours that are convenient, such as out-of-work hours. It is open at the weekends and until 8 o’clock at night on a weekday. I declare an interest as a parent of a young child who always seems to manage to get herself unwell at the most inconvenient times. Eastham walk-in centre has been there for us, and my constituents value it greatly.

Under the reorganisation, the new clinical commissioning group took over. In Wirral, we had a bizarrely complex structure of three federated CCGs for a population of about 350,000. Having three CCGs in Wirral was total madness. Twenty-five million quid was wasted on a reorganisation that nobody wanted and nobody voted for. The first thing the CCG wanted to look at was urgent care, and it put our walk-in centre under threat of closure. This is an incredibly important facility to the people of south Wirral. It brings the NHS to their doorstep. It totally changed the availability of out-of-hours facilities for people in my constituency. The CCG, in its lack of wisdom, thought it was just fine to say, “We’re not sure we need that. We can re-provide those services at GP surgeries, never mind whether they are open at a convenient time.”