NHS Services (Access)

Andy Burnham Excerpts

Wednesday 15th October 2014 Commons Chamber

[Andy Burnham (Leigh) (Lab)]

I beg to move,

That this House notes comments from leading experts that the NHS and social care services are at breaking point; believes that this is linked to the Government’s decision to reorganise the NHS; further notes that one senior Cabinet minister has said that reorganising the NHS was the Government’s biggest mistake; further believes that the NHS reorganisation has wasted money which could have been spent on frontline care; further believes that access to NHS services is now deteriorating and that staff numbers are not keeping pace with demand; notes the report by the Nuffield Trust, entitled Cause for Concern: Quality Watch annual statement 2014, published in October 2014, which found that it is now becoming harder to access care in many settings, with some people facing extreme waits; calls on the Government to act swiftly to reverse the deterioration in accident and emergency, cancer and referral to treatment waiting times; further calls on the Government to publish its independent evidence on the costs of reorganising the NHS; and further calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion to invest in building the NHS workforce of the future.

Back in 1997, people were waiting months and years, and even dying, on NHS waiting lists. The last Labour Government brought that scandal to an end. Following the Wanless report we increased investment in the NHS, although that was opposed at the time by the Tories. Slowly, over the course of the past decade, the NHS rose up the international league table to the point where, in June 2010, it was judged by the Commonwealth Fund to be one of the best—if not the best—health services in the world. Of course it was not perfect, and there were terrible failings at Mid-Staffs, but the legacy inherited by this Government included the lowest ever waiting lists and the highest ever public satisfaction. That was Labour’s record: a massive turnaround in the fortunes of the NHS from the crumbling service that we inherited.

So where, after four and a half years of the coalition Government, does the NHS stand in 2014? It is at “breaking point”—[Interruption.] Hon. Members laugh, but those are not my words but those of the seven medical royal colleges and trusted organisations, including the Royal National Institute of Blind People, the Multiple Sclerosis Society, Anthony Nolan and the Alzheimer’s Society, which wrote an open letter last week to all the political parties. They said that

“staff feel undervalued and demoralised…things cannot go on like this.”

[David Morris (Morecambe and Lunesdale) (Con)]

Will the right hon. Gentleman give way?

[Andy Burnham]

I want to make some progress.

The letter identifies six areas of major concern, and I shall focus on three of them today. The first is GP services. The letter states:

“A shortage of GPs means that patients are struggling to get an appointment to see their doctor.”

Paul Turner-Mitchell got in touch with me today to say that getting a GP appointment is now like trying to get sought-after concert tickets with the phone stuck on redial. I am sure that a lot of people watching this debate today will know exactly what he means. It is becoming the norm for people to ring the surgery early in the morning only to be told that there is nothing available for days. This year, 13 million people have either waited a week or more for a GP appointment or could not get one at all. That figure has gone up by 2.5 million since 2011.

Why is this happening? It is happening because the GP budget has been repeatedly cut under this Government, because Labour’s 48-hour appointment guarantee has been axed and because the Government—in the words of their own GP taskforce—have presided over a “GP workforce crisis”. The number of GPs per 100,000 population increased from 54 in 1995 to 62 in 2009. However, the figure has now gone back down to 59.5.

At Prime Minister’s questions today, the Prime Minister tried to claim that there were 1,000 more GPs in the NHS than under the last Government. This is simply not true. I wonder what we can do about it, Madam Deputy Speaker. We have a Prime Minister who regularly abuses statistics at that Dispatch Box, and even when he has been found out, as he has on many occasions—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. I am going to request that the right hon. Gentleman rephrases the point he just made about the use of the statistics, as he made an accusation against the Prime Minister and I do not think it is acceptable for him to say that. Will he rephrase it, please?

[Andy Burnham]

I will rephrase it, Madam Deputy Speaker, but we have had rulings from the Office for National Statistics in respect of these things. I shall say that the Prime Minister has misused statistics at that Dispatch Box and there is plentiful evidence that that is the case. Statistics have been misused, and I wish to give this example from today. Figures from the 2009-10 census—this was the final year of the previous Government —show that there were 32,426 GPs then. The most recent figures report 32,201 GPs, which is 226 fewer. So let us get some facts on the record.

The second area highlighted by the letter is accident and emergency, the classic barometer of the whole health and care system. The letter states:

“Major accident and emergency departments in England have failed to meet their waiting times targets for an entire year.”

An entire year! What have Ministers been doing? In fact, it is longer than a year, as the target has been missed for 63 weeks running. We must remember that we are talking about this Government’s own, lowered A and E target. Before the Secretary of State says that that is not the figure for the whole NHS because it excludes minor injury units and walk-in centres, I can tell the House that the NHS as a whole has missed the A and E waiting time target for five out of the past six weeks. Almost 95,000 people waited longer than four hours in A and E in September 2014, which compares with 70,000 in September 2013. So there has been a dramatic deterioration. A and E performance over the past six weeks has been worse than it was last winter. Loud alarm bells should be ringing in the Department about this coming winter, but instead of having a plan it seems that Ministers have given up on ever meeting their own target again. The annual winter A and E crisis is now a permanent spring, summer and autumn crisis, too.

[Helen Jones (Warrington North) (Lab)]

My right hon. Friend is rightly outlining this Government’s failures on health. Is he aware that towns such as Warrington face a triple whammy, whereby the number of full-time equivalent GPs is down, ambulance response times are up and yet while this Government last year gave £10 million to Cheshire West and Chester to deal with winter pressures, they gave absolutely nothing to the hospital in my constituency? Does he think that decision was politically rather than health based?

[Andy Burnham]

Many questions are raised by that decision. Areas of the country where services were being run well would say that they did not get money and instead the money was given to areas where things were not working properly. The situation my hon. Friend describes is what is happening across the NHS in England. The Government have cut the GP budget, the mental health budget and the social care budget, and all that has led to increased pressure on hospitals. There are too many people in hospitals right now in England. The wards are full and people cannot be sent back home because the social care is not there. So the wards do not become free, and A and E cannot admit people to the wards because no beds are available. A and E therefore becomes blocked. Ambulances cannot hand patients over to A and E so they end up queuing outside, meaning that ambulance response times get worse. That is the knock-on effect of the Government’s policies across the NHS, and the deteriorations she is seeing for her constituents are mirrored right across the country.

[Helen Goodman (Bishop Auckland) (Lab)]

My right hon. Friend describes it brilliantly. Does he agree that he is describing a system that shows exactly why privatisation and competition is completely inappropriate in the NHS?

[Andy Burnham]

All the evidence from around the world tells us that more market-based health systems cost more than systems such as the NHS, and are more complex and fragmented. The clear conclusion I draw is that the market is not the answer to 21st-century health and care. The Government believe it is, which is why they must be defeated if we are to protect our national health service.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I hear what the right hon. Gentleman is saying. If he is concerned about other providers in the health service, will he explain why the previous Labour Government were happy to pay private sector providers 11% more than NHS providers for providing NHS services?

[Andy Burnham (Leigh) (Lab)]

We brought in other providers in a supporting role to add capacity to bring down NHS waiting lists to the lowest ever level. That is what the previous Government did. By contrast, this Government are doing something different. It is mandating tendering on GP commissioners, requiring people to compete, wasting money on running tenders and privatising the national health service, which is why they must be stopped.

[Andrew George (St Ives) (LD)]

It is fair to say that the previous Labour Government did introduce the private sector to many areas of the NHS. They also introduced a requirement for the tendering of many NHS services. If we follow the logic of Lord Warner, who is setting out the general direction of Labour party policy, we will find that that is clearly where the heart of Labour party policy has been and probably will go.

[Andy Burnham]

May I remind the hon. Gentleman, for whom I have a lot of respect, that I, as Health Secretary in 2009, introduced to the national health service a policy of NHS preferred provider? That is because I am not neutral about the NHS. I believe in the public NHS and what it represents, which is people before profits. Any policy that I develop will always be based on that principle. I was attacked at the time by the Conservative party for introducing such a policy, but I make no apology for it. We used the private sector in a supporting role, but the Government want to use it in a replacement role, and there is a very big difference between the two things. If they were continuing what we had done, why did they need a 300-page Bill to rewrite the whole legal basis of the national health service?

[Steve Rotheram (Liverpool, Walton) (Lab)]

Is my right hon. Friend aware that even the Chancellor agrees that the disastrous top-down reorganisation of the NHS was a huge strategic error? Does he agree that those on the Government Benches, including the hon. Member for St Ives (Andrew George), should apologise—I include in that the newly elected hon. Member for Clacton (Douglas Carswell) who has somehow found his way on to the front Bench on the Opposition side, but hopefully not for long—and support the private Member’s Bill of my hon. Friend the Member for Eltham (Clive Efford) when it comes before the House on 21 November?

[Andy Burnham]

I am interested to see this new friendship that my hon. Friend has struck up with the hon. Member for Clacton (Douglas Carswell) on the Front Bench. My hon. Friend is absolutely right. The promise was that there would be no top-down reorganisation. We told the Government that it would be a major mistake to break that promise. They broke that promise and now they are admitting it in private to newspapers. I will come to that point a bit later.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is worth saying to my right hon. Friend and to the hon. Member for St Ives (Andrew George) that all of us on the Health Committee were very concerned yesterday when we spoke to people in Staffordshire and Stoke, because they were talking about what seemed to be the privatisation of cancer and end-of-life care services. That seems to be going on much to the consternation of clinicians and radiologists who were not consulted; much to the consternation of NHS staff and of an awful lot of patients and people who live in that area. It is very concerning indeed that we find ourselves in that situation. That could be one of the biggest mistakes that is made in the NHS.

[Andy Burnham]

I am glad that my hon. Friend raised that point, as again it highlights the major difference between us and the Government. They were saying that we brought in private providers. Yes, that is true, but that was to bring down waiting lists for planned operations, such as hip and knee operations. As she has just rightly said, the Government are putting out to tender cancer services. That is a very different thing. The Government are presiding over a major increase in private ambulances providing blue light 999 services. That is a massively different policy from the one they inherited, which is why the points they have made simply do not hold water.

[David T. C. Davies (Monmouth) (Con)]

The right hon. Gentleman is making some emotional points here. Does he support the policies of his colleagues in Wales, and does he endorse the way in which they have dealt with the NHS in Wales?

[Andy Burnham]

I do get emotional about the NHS, because I believe in it, unlike the hon. Gentleman. That is fine, I do not mind—it does animate me. Let us have a look at Wales and, as I am about to come on to cancer care. In England, only 84% of patients receive treatment within 62 days. That is not good enough, and Wales has better figures on cancer care. The analysis of the four home nations’ health care systems found that there is good and bad in all of them and this Tory attack on the national health service in Wales has to stop.

I will move on to cancer and I will go back to the letter that I was quoting. It said:

“Thousands of patients are facing longer and even unacceptable waits to find out whether or not they have cancer, because services are under extreme pressure and referral targets are being missed.”

In 2014, 10,000 people in England had to wait longer than the recommended 62 days to start their cancer treatment. The number of patients waiting longer than six weeks for diagnostic tests has doubled in the past year—doubled, for cancer tests. That is simply not acceptable. We need to hear today what the Secretary of State is going to do about it and may I suggest that the very first thing he should do is stop the cuts to cancer care? A parliamentary question shows that expenditure on cancer services has fallen by £800 million in real terms since 2009-10; the information comes from his Department and I will send it to him. That is why the NHS has missed the cancer treatment target for two quarters running, the first time that it has ever done that.

The evidence is indisputable. The NHS has gone downhill on this Government’s watch and the question follows of what they are doing to bring GP, A and E and cancer services back up to national standards. That is what our motion and, more importantly, patients demand to know from the Secretary of State today, but they will also want to know why the NHS has gone from being a successful service four years ago to being at breaking point today. The front page of The Times on Monday offered us an answer. It quoted a senior Cabinet Minister who said:

“We’ve made three mistakes that I regret, the first being restructuring the NHS. The rest are minor.”

The Secretary of State is conveniently looking down and avoiding my eye at this point, but I am sure he has found out who that was. I am sure he knows. I know that he is avoiding looking at me, but is he prepared to tell us who it was or is he going to carry on with his head buried and avoiding—[Interruption.] He is blushing. I see that he has the good grace to do that, at least. It is an embarrassing comment, it really is, from a senior Cabinet Minister, but what use is it to people now, when people such as the hon. Member for St Ives (Andrew George) and I were pleading with the Government to stop the process, to admit that it was all a mistake? It is an embarrassing situation for the Secretary of State to deal with, but at least we have from the very top of this arrogant Government the first admission that their reorganisation was a major mistake.

The article goes on to quote an ally of the Chancellor, who says:

“George kicks himself for not having spotted it and stopped it.”

Not having spotted it? This was famously the reorganisation so big we could see it from space. Not spotted it? What planet was the Chancellor living on? The truth is that the Government could have and should have stopped the reorganisation for the simple reason that they were elected on a promise of no top-down reorganisation and did not have the permission of a single person in this land to carry it out. That is why Thursday 7 May 2015 will be their day of reckoning on the national health service.

If this private apology now is designed to bring people back on board, it will not work. Doctors and nurses lined up to plead with the Government to call the reorganisation off, but they ploughed on. In the words of Mark Porter, chairman of the British Medical Association:

“The damage done to the NHS has been profound and intense”.

Let me focus on just one example of that damage, staffing costs, as the Secretary of State was talking about them this week. The staff census shows very clearly that in the early years of this Parliament, when spending on back-office restructuring was at its peak, front-line nursing posts were cut by about 7,000. At the same time, the reorganisation threw nurse training into chaos. Training places were cut and have never recovered, down from 21,000 a year to 18,000 today.

The NHS has been recruiting more staff in the wake of the Francis report, but this is where the damage done by the reorganisation is hitting NHS trusts. They are being forced to recruit overseas or to turn to agency staff because there are simply not enough nurses coming through the training system.

I have been contacted by a whistleblower from a trust in Liverpool who says that it is now common for staff to receive text messages from agencies such as Pulse offering huge fees—up to £1,000—to work weekends in London or the north-east, with all travel and accommodation costs paid. That is now the norm, and it is happening on this Secretary of State’s watch. Some nurses are literally taking off one uniform on a Friday night and putting on another for the weekend. That is why the agency bill is out of control, and it is happening on his watch.

In 2013-14 the NHS spent £2.6 billion on agency staff. For foundation trusts that is a staggering 162% over what was planned. That helps to explain why trust deficits are mounting. Does not this mismanagement of the staffing budget explain why the Government are now reneging on their promise to pay nurses a meagre 1% pay rise? Is not that the real reason? I wonder how the Secretary of State thinks those nurses will feel when they read this week that senior mangers’ pay has increased by 13.8% on this Government’s watch, while their pay has gone up by only 5%. I am told that he has refused to meet the unions even to discuss it. It is not good enough. He should get to the negotiating table tomorrow and start treating the staff of our national health service with the respect they deserve.

[David Morris]

Will the right hon. Gentleman give way?

[Andy Burnham]

I will not.

The Secretary of State now claims that his reorganisation is saving £1 billion a year, but the truth is that that is a fantasy figure. The reorganisation, which cost £3 billion and counting, turned the 163 NHS organisations into 440 separate administrations with their own running costs. It introduced a new competition regime that is eating up tens of millions of pounds of NHS money. Perhaps that is why Kieran Walshe, professor of health policy at Manchester business school, said:

“I haven’t found anybody who thinks that this reorganisation has made the NHS more efficient and more productive… and I don’t think you find many people who think that the new system costs any less to run.”

The Secretary of State needs to clear this up today. Either he publishes the independent analysis that he claims supports his figure of £1 billion, or he stops making a claim that is simply not credible.

[James Morris (Halesowen and Rowley Regis) (Con)]

I thought that this debate was about access to services. One thing that the right hon. Gentleman has not mentioned is mental health services. One of this Government’s achievements is that 100,000 more people are getting access to psychological therapies than under the previous Government, and last week the Government announced for the first time access standards and waiting time targets for mental health services, which were never in place in the 13 years of the Labour Government.

[Andy Burnham]

I am afraid that the hon. Gentleman is wrong, because I mentioned the cuts to mental health services earlier in answer to my hon. Friend the Member for Warrington North (Helen Jones). The talking therapies he mentioned were introduced by the previous Government —indeed by me—and in some places they are not being cut, which I am pleased about, but in others they are. The letter I referred to from the royal colleges and other organisations talked about a crisis in mental health. They say that people are being ferried hundreds of miles to find emergency beds. That is the reality on this Government’s watch. I think that a little less complacency and a little more focus on these problems would not go amiss.

[Mr Kevan Jones (North Durham) (Lab)]

My right hon. Friend should be congratulated, along with my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson), who brought in the IAPT—improving access to psychological therapies—programme. It was a revolutionary system for dealing with access to mental health services. Is not it the case that this Government, even though they obviously think that there are votes in championing mental health, are cutting not only the number of in-patient beds, but the mental health budget across the country?

[Andy Burnham]

My hon. Friend is right. We heard the commitment that the Deputy Prime Minister gave last week, and I am sure that he means it, but people will ask why they have not done anything about it in this Parliament. It is lip service. We introduced talking therapies and many other things. The key point is that they cut it faster than they cut the rest of the NHS. Worse still, they introduced a tariff decision this year that will cut it even further and make the problems even worse. It was Labour that proposed parity of esteem between mental and physical health in law. The Government accepted it, but they have done absolutely nothing about it.

[Lilian Greenwood (Nottingham South) (Lab)]

One of the groups most affected by cuts to mental health services is children. On this Government’s watch we have seen increasing numbers of children with mental health difficulties treated on adult psychiatric wards. Is that not completely unacceptable?

[Andy Burnham]

My hon. Friend puts it very well. If mental health is the poor relation of the NHS, then child and adolescent mental health services are the poor relation of the poor relation. How can that be the case when we are talking about children who need the best possible support—the most vulnerable children—being denied the services that they need? My hon. Friend the Member for Leicester West (Liz Kendall) discussed at a shadow health team meeting a constituency case where a family were trying to find a bed for a child who was in a crisis and not one bed was available for that child in the whole country—not one bed. She is nodding. That is the reality. I wish that Government Members would focus on that rather than making complacent statements.

No amount of spin from the Government can disguise the fact that the NHS is heading for the rocks and urgently needs turning around, so the question is how we get it back on track. I have two positive proposals to put before the House on policy direction and on funding. Let me take each in turn. Instead of just admitting privately that the reorganisation was a mistake, the Government should be actively working with us to begin to put it right—and they will soon have a chance to do so. In five weeks, my hon. Friend the Member for Eltham (Clive Efford) will bring a Bill before this House to repeal the worst aspects of the Health and Social Care Act 2012. When the Government’s reorganisation was going through, their mantra was “Doctors will decide.” The Prime Minister repeated this in his “Today” programme interview during the Conservative party conference when he said:

“there’s nothing we’ve done which makes it more likely there’ll be private provision in the NHS”.

[The Secretary of State for Health (Mr Jeremy Hunt)]

That is true.

[Andy Burnham]

The Secretary of State says that it is true, but that is not how people see it in the real world. Doctor after doctor tells me that their legal advice under section 75 of the Act mandates them to run open tenders for services. Today we see the evidence of how the NHS is changing under that regime. The BBC reports that more than half of contracts awarded by clinical commissioning groups are going outside the NHS. Why is this a problem? Because it is wasting NHS resources on tenders and leading to fragmentation of care when the future demands integration. We need Government Members to tell us today whether they will vote with us on 21 November to repeal mandatory tendering and thus be true to what they originally said they wanted to do, which was to let doctors decide how services are provided.

[Nigel Adams (Selby and Ainsty) (Con)]

I want to take the shadow Health Secretary back to his words earlier when he seemed to be concerned that private operators are in danger of putting profits before patients. Why, when he was Health Secretary, did he personally sign off on a private-only shortlist for the Hinchingbrooke hospital franchise?

[Andy Burnham]

That is inaccurate, because it was not a private-only shortlist—there was an NHS bidder in the frame at the time. The hon. Gentleman needs to keep his facts straight. As I said earlier, I introduced the NHS preferred provider principle, and that is my policy. [Interruption.] If he wants to dispute that, then the facts will speak for themselves. The shortlist had public and private on it.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

rose—

[Andy Burnham]

I will give way one last time and then finish.

[Nicola Blackwood]

The shadow Secretary of State is being very generous, and I hope that he will respond to me in a non-partisan way. I speak as the daughter of two NHS workers and as somebody who has recently had a very close family member survive an emergency operation for a life-threatening illness. Will he clarify Labour’s position on what it would do in government about a reorganisation, because the difference between a restructuring and a reorganisation is not clear to me? The British Medical Association and GP leaders have been very concerned about exactly what the policy is and what it would mean, so will he make that clear? He has been criticising certain policies, and I would like to understand what his policy would be.

[Andy Burnham]

I am glad that the hon. Lady asked that—it is a very fair question. I imagine that a reorganisation is the last thing that people in the NHS would want right now. My definition of a structural reorganisation is where we stand down a whole set of organisations and then create a whole set of new ones. I have been very clear that I will not do what the right hon. Member for South Cambridgeshire (Mr Lansley) did. I will work with the organisations that I inherit. I will work with CCGs, and with health and wellbeing boards, in particular. Health and wellbeing boards were one of the few good things that came out of the Act, because they are a partnership between local government and the NHS, and that is something I can work with. She asked a fair question and I hope I have given her a fair answer. A structural reorganisation where we make everybody redundant again and recreate organisations will not help anybody. In fact, if the Government wanted GP-led commissioning, they should simply have put doctors in charge of the old primary care trusts. If they had done that, they would have saved a lot of money and a lot of heartache in the process.

I am going to finish on NHS funding. The letter I mentioned at the beginning called for a long-term spending plan for the NHS. The NHS Confederation has put that at £2 billion a year. At the Conservative party conference, the Prime Minister committed to maintaining the ring fence for health in the next Parliament, but experts are clear that that will not be enough to prevent the NHS from tipping into a full-blown crisis. Indeed, the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), has said:

“Maintaining the ring-fence on health spending is not enough.”

I am sure the hon. Lady is right, but her problem—and the problem for everyone on the Conservative Benches—is that they have chosen a different spending priority. They have given a commitment to tax cuts for higher earners, which will cost an unfunded £7 billion. What that means in reality is that if the Tories get back in, any spare money will go towards filling that black hole and there will be nothing left for the NHS, so the outlook for the NHS under the Tories in the next Parliament is very bleak indeed. Given current policy direction on competition and the funding plans they have announced, the NHS is looking at a toxic combination of cuts and privatisation under a re-elected Tory Government.

By contrast, Labour’s priority is not tax cuts for some, but a strong NHS for all. We have found an extra £2.5 billion a year—that is not spin; it is money we have committed to—to build the NHS of the future, and the question before the House tonight is whether it should call on the Government to match it.

Labour’s plan is for a national health and care service—full integration of health and social care, starting in the home and building one team around the person. We will do that by recruiting 20,000 more nurses, 3,000 more midwives, 8,000 more GPs and 5,000 extra home care workers by the end of the next Parliament—a new generation work force in the NHS, working from home to hospital, transforming the delivery of care. Social care is prevention, and by uniting it with the NHS we can turn the financial tide around and place the system on a path towards financial sustainability.

Labour has a credible plan for the NHS and the money to back it up. This House needs to decide tonight whether it agrees and whether it is prepared to match the money needed to turn the NHS around. The decision we make tonight will clarify the decision before the country next May. Will our top priority be, as the PM used to say, those three letters: NHS? Or will it be tax cuts for some, but an NHS crisis for all? That is the choice. We have made ours and our choice is the NHS.

--- Later in debate ---

[Mr Hunt]

I will make some progress first.

[Andy Burnham]

rose—

[Mr Hunt]

I am very happy to give way to the right hon. Gentleman.

[Andy Burnham]

This is the most important part of the debate. The Secretary of State is right about the elephant in the room. This is the thing that people in the NHS will pay most attention to today. He has gone through his record in this Parliament, but the problems in the next Parliament will be large, as I am sure he would agree. He needs to say today whether he thinks the ring fence will be sufficient, or does he think that the NHS will need more money over and above the ring fence if it is to avoid crisis in the next Parliament?

[Mr Hunt]

First, let me just correct for the record what the right hon. Gentleman has said. The Prime Minister’s commitment was not just a continuation of the ring fence; he has committed to continue to increase funding in real terms for the NHS. If the right hon. Gentleman looks at the record of this Government, he will see that we have increased spending on the NHS by more, in real terms, than Labour’s promises at its conference. The point about promises is whether the people making them are credible. Which party will deliver the strong economy that can fund the NHS?

--- Later in debate ---

[Mr Hunt]

My hon. Friend is absolutely right. That is why the management pay bill doubled under Labour and why we took the difficult decision, which the Opposition bitterly opposed, to get rid of 19,000 administrators and managers so that we could recruit the extra doctors and nurses. I notice that Opposition Front Benchers are very quiet on that point because they cannot answer the simple question of how they would pay for those extra doctors and nurses if the Health and Social Care Act 2012 was reversed. [Interruption.] Ah! They would pay for the extra doctors and nurses by bringing in new taxes that the country is not paying at the moment.

The right hon. Gentleman talked about structural reforms. We ought to discuss the structural reforms that he chose not to talk about, such as making the Care Quality Commission independent, with new chief inspectors for hospitals, adult social care and general practice. He tried to vote down that legislation in this House. So far—[Interruption.] I know that this is uncomfortable for Labour Members, but they should listen, because the new inspection regime has put 18 hospitals into special measures. Five of them have been turned around completely and have exited special measures, and important improvements are being made at the others.

The motion talks about Government mistakes, so will the right hon. Gentleman finally accept the catastrophic mistakes that he made as Health Secretary, such as failing to sort out the problems at those hospitals, even though there were warning signs at every single one of them? Does he accept that because Labour ignored those warning signs, patients were harmed and lives lost? Will he finally apologise to the relatives of patients at Mid Staffs whom he made wait outside in the cold because he refused to meet them and hear their concerns? Will he make that apology now? He has not apologised and it is clear that he does not want to do so today.

The right hon. Gentleman talked about A and E. Just as when he was Health Secretary, there have been weeks when the target has not been met. What he did not tell the House is that, thanks to our reforms, we have 800 more A and E doctors than four years ago and nearly 2,000 more people are being treated within four hours every single day than when he was Health Secretary.

As the motion refers to Government mistakes, perhaps the right hon. Gentleman might like to acknowledge some of his own mistakes on A and E, such as the 2004 GP contract that removed personal responsibility for patients from GPs, making it more likely that people would end up in A and E, or the failure over 13 years to integrate the health and social care systems, meaning that many vulnerable older people continue to end up in A and E unnecessarily—something that we are putting right through the Better Care programme.

When the right hon. Gentleman spoke about NHS performance, he talked repeatedly about missed targets. That is a really important issue and is perhaps the biggest dividing line between his approach to the NHS and mine. Of course targets matter in any large organisation, but not targets at any cost. That is why the Government have been careful to ensure that in the new inspection regime, waiting time targets are assessed not on their own, but alongside the quality and safety of care.

[Andy Burnham]

The Secretary of State makes an important point, and as Health Secretary, I said that over-reliance on targets was not right. I accept that point, but he now needs to answer a question of mine. He has not removed our targets for A and E or for cancer. Does he consider it acceptable that the NHS is missing the national cancer target? If not, what will he say to reassure families that that will get better soon?

[Mr Hunt]

Let us deal with the cancer target. When the right hon. Gentleman left office—[Interruption.] I am dealing with the cancer target. When he left office, we had the worst cancer survival—

[Andy Burnham]

Forget that—I am asking about now.

[Mr Hunt]

The right hon. Gentleman may want to forget that, when he left office, we had the worst cancer survival rate in western Europe, but why did we have that? We had the worst cancer survival rate in western Europe because we were not diagnosing cancers quickly enough. Under this Government—this is the inconvenient truth for the Labour party—we have treated for cancer nearly three quarters of a million more people than in the last Parliament. We have done that because, as the Prime Minister said, we are referring 50% more people. Access to cancer care has dramatically improved under this Government, and we are starting to climb back up the European league tables.

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[Andy Burnham]

Will the right hon. Gentleman give way?

[Mr Hunt]

Let me finish my point about targets because it is important. The NHS over which the right hon. Gentleman’s Government presided was, as the former NHS chief executive Sir David Nicholson said, an NHS where

“patients were not the centre of the way the system operated.”

Labour’s NHS was obsessed with targets, and we have still not had an apology for the policy mistakes that led to Mid Staffs. We have got rid of a number of targets; we are happy to keep a few benchmark targets, but we will not be obsessed with targets at any cost.

May I gently suggest that the Labour party re-read the Francis report? These are Sir Robert’s words about the culture during the Mid Staffs period, when the right hon. Gentleman was a Minister. He described an

“insidious negative culture involving a tolerance of poor standards”

resulting from

“a focus on reaching national access targets”.

If the right hon. Gentleman does not want to listen to Sir Robert, will he listen to families who suffered in Mid Staffs, Morecambe Bay, Basildon and countless other hospitals, all of whom are simply incredulous that Labour wants to put him back in charge of the NHS, while he refuses to acknowledge the terrible problems caused by Labour’s NHS target culture?

The right hon. Gentleman also talked about privatisation. That may hit the spot for his trade union supporters, but it does not stand up to scrutiny. He knows that the use of the private sector for secondary care has grown more slowly under this Government than it grew under Labour. He knows that the biggest single privatisation decision in NHS history—the decision to contract out a whole district general hospital to the private sector—was allowed not by me, but by him when he was Heath Secretary. Let us set the record straight, because he tried to give the impression to my hon. Friend the Member for Selby and Ainsty (Nigel Adams) that that decision was not taken—[Interruption.] Let me make my point, and then I will give way. The right hon. Gentleman approved a shortlist for Hinchingbrooke hospital, which had on it two private sector providers and an NHS provider. He did not tell my hon. Friend that the NHS provider then pulled out, and that he accepted the continuation of that process with an all-private shortlist—[Interruption.] That is what happened, and if he wants to deny it, I will give way to him now.

[Andy Burnham]

The question is: when was that contract signed? Will the Secretary of State answer that question?

[Mr Hunt]

Actually, the question is: when did it become an all-private shortlist, and why did the right hon. Gentleman allow that to happen if he is now saying that the privatised running of hospitals is such a bad thing? I think that we have found him out, and he will want to correct the record and the impression that he gave to my hon. Friend the Member for Selby and Ainsty.

[Mr Hunt]

I am grateful to my right hon. Friend because he makes it clear that, when the right hon. Member for Leigh was Health Secretary, he accepted an all-private shortlist. He will want to correct the record on that point.

[Andy Burnham]

The right hon. Member for Chelmsford (Mr Burns) has contradicted the Secretary of State. The right hon. Gentleman said that the bidder withdrew at a later stage, but the Secretary of State said that the bidder withdrew earlier. The Secretary of State cannot have it both ways. The right hon. Gentleman flatly contradicts him.

[Mr Hunt]

The right hon. Gentleman is quite wrong. My right hon. Friend said that there was a list of three providers, all with private provision involved. When the right hon. Gentleman was Health Secretary, he accepted that all-private shortlist for the Hinchingbrooke decision. In other words, the biggest privatisation in NHS history happened because of a decision taken by the shadow Health Secretary.

Government Members are not ideological. We believe there are times when we can learn from the independent sector, but, normally, people use the private sector when they are looking for innovation or better value. Only a Labour Government would sign deals with the private sector, paying 11% more than the NHS rate, and ending up paying more than £200 million for operations that never happened. What a shocking waste of money. When the right hon. Gentleman next talks about privatisation, instead of inventing a privatisation agenda that does not exist, will he apologise for a botched one that existed when Labour was in office?

Finally, there is a comparison that Labour never wants to make when talking about NHS performance: what happens over the border in Wales. That is where the policies that the right hon. Gentleman supports are put into practice. Let us see the difference. A record one in every seven Welsh people find themselves sitting on an NHS waiting list, compared with just one in 17 people in England. The urgent cancer waiting time target has not been met once since 2008 in Wales, but it has been missed in England in only two quarters in the whole period. A and E waiting times have been met every year in England, but they have not been met since 2008 in Wales.

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[David T. C. Davies (Monmouth) (Con)]

The Secretary of State and his Ministers will know that I have had cause to write to them, to e-mail them and even to meet them on numerous occasions to discuss the absolutely appalling second-rate NHS treatment that patients in my constituency are receiving. They are receiving such treatment from an NHS that is run entirely by the Labour party, which is enacting precisely the policies that Opposition Members wish to enact here. Those patients include Mariana Robinson, whom the Secretary of State was good enough to meet recently. She has waited months for diagnostic treatment for an illness that could well be cancer; she does not know what it is. She wants to be treated in England by the coalition-run national health service.

Those patients also include Mr Christmas in Abergavenny, a war veteran who is in his 80s. He had constant chronic pain in his tooth that was keeping him awake at night, but he was told that, despite his age and his war service, he would have to wait nine months for any form of treatment. In the end, he was forced to use his meagre savings to go private. Ann Wilkinson also wants to be treated in England. She has stated very publicly that she has cancer, but there is no cancer drugs fund in Wales and she wants to have access to Avastin. I believe that she will shortly present a petition in Parliament and in the Welsh Assembly demanding the same high standards in Wales that this coalition Government are already delivering in England.

Some Opposition Members, including the hon. Member for North Durham (Mr Jones), wanted to quote statistics.

[Andy Burnham]

The hon. Gentleman mentions access to cancer services. He might have heard me say earlier that the NHS here is missing its national cancer target, with more people waiting longer than 62 days. In England, only 84% of patients start to receive treatment within 62 days. Does he acknowledge that 90% of patients in Wales start their treatment within 62 days?

[David T. C. Davies]

When they have been diagnosed. The right hon. Gentleman has failed to point out that while only 2% of patients wait more than six weeks for diagnostic treatment in England, 33% of patients do so in Wales. That is absolutely disgraceful. If a situation in which 2% of patients are waiting more than six weeks is bad, what on earth are we to make of a situation in which 33%—one in three, or so—are waiting that long? I hope the hon. Gentleman would agree that that is a disgraceful situation.

The hon. Member for North Durham talked about ambulance response times and gave the House some interesting examples. However, the recent Nuffield report demonstrated that the worst ambulance response times in the United Kingdom were in Wales. We have accident and emergency targets, for those in Wales who are lucky enough make it into a hospital, but those targets have not been met since 2009. We have waiting list targets of 26 weeks, as opposed to the 18-week targets that apply in England. One in seven of the population in Wales is on a waiting list. That is what lies in store for people if they vote Labour at the next general election.

It was interesting that the hon. Member for Worsley and Eccles South (Barbara Keeley) was unwilling to say what she thought voters should do about people who wanted to cut NHS budgets. Despite all the Opposition rhetoric, this coalition Government have kept their promise and continued to fund the NHS. In real terms, we have increased its budget, whereas Labour—where it is in office—has cut NHS funding in real terms by about 8%. It cannot escape any of the blame for this. We heard about reorganisations earlier, and we have had several in Wales. We went from having five health boards to having 22 and then back to having seven. Not only has Labour been in power constantly, either completely or as the dominant party, ever since the Welsh Assembly was set up in 1999, but it has rammed those health boards full of Labour party supporters, failed parliamentary candidates, ex-Assembly Members, local councillors and the like. In one case, Labour put in a former general secretary of the TUC, who, I am guessing, is probably not a supporter of the Conservative party. Labour has politicised the health boards and it must therefore take complete responsibility for the shambles that has led to so many people wanting to be treated not in Wales but in England, by the coalition-run NHS.

No more damning example of all this can be given than the recent antics with the OECD, which is trying to carry out a comparison on NHS systems across the whole of the United Kingdom. The coalition Government are keen for that study to go ahead and are delighted with the opportunity to have themselves compared with Wales, and they should be; they have every reason to look forward to that. But of course the reaction in the Welsh Assembly has been one of absolute horror. I am told by very reliable sources that the Welsh Assembly Government cancelled the visit by OECD officials because they were so desperate to try to ensure that no report comes out before the general election. Of course, people watching this debate do not have to take the word of anyone in this room; they simply have to Google “Wales NHS waiting lists” or something similar to see story after story about people who have been badly treated by the NHS in Wales and want to be treated by the NHS run by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who is sitting on the Front Bench.

I could suggest much that would improve things. Ideally, I would like to see the power taken away from the Welsh Assembly, because it has simply made such a mess, but that is never going to happen. If Opposition Members are confident that they could do a good job with the NHS, they should support the OECD report, and get their colleagues in Wales to get behind it and bring it out as quickly as possible. They should allow funding to follow patients, so that where a patient from Wales wants to be treated in England, that should be able to happen, with the money simply deducted from the Welsh Assembly block grant. Of course, the same should apply vice versa; any patients from England who want to be treated in Wales should be allowed to have that chance—I do not see many doing that.

One of the more irritating bits of propaganda coming out of the Labour party is that it says that lots of people from England are being treated in Wales. That is true, as historically there have been people with Welsh GPs who have to be treated in Wales even though they live in England. However, these people have set up an action group called Action4OurCare and are trying to take legal action on this. These are normal patients, not party activists, who want to be treated by the coalition-run NHS.

About the only good thing that comes from all this is that Labour apparently wants to make the NHS one of the main planks of its election campaign. I say bring it on, because I cannot wait to debate the NHS with Labour party members all over the United Kingdom. I will ask them about Wales and the cuts to the budget, the lack of a cancer drugs fund, the long hospital waiting lists and the fact that its ambulance response times are the worst in the United Kingdom. I shall remind them that people are already voting with their feet—they are voting to get out of the Labour-run NHS in Wales and get into the coalition-run NHS in England. They will shortly have the opportunity to vote not with their feet but in the ballot, and I very much look forward to seeing them have the opportunity to do so.

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[Andrew George (St Ives) (LD)]

It was in fact the Liberals who were the architects of the NHS, but perhaps that might be lost from history. The fact is that we have yet another occasion when the nation will be looking down and counting their shirt buttons as Members on the two Front Benches trade dodgy statistics and rewrite history. I am talking about the nature of the rather tribal debate that we had in the opening exchanges. My fear is that that is the biggest risk to the NHS—too much tribalism and not enough time spent addressing the serious issues of the NHS.

The right hon. Member for Leigh (Andy Burnham) is absolutely right that there are serious issues in the NHS that need to be addressed. What usually happens on these occasions is that the Secretary of State beats the right hon. Gentleman around the head with a report from Mid Staffs. I am pleased that on this occasion he did not, because that is often done in very bad taste and rather inappropriately.

Equally, I have to say to the right hon. Member for Leigh that, as the Secretary of State reasonably pointed out, he failed to acknowledge that Labour cannot ignore the fact that it ushered in and rolled out the red carpet for the private sector. The arrangements for the tendering for Hinchingbrooke hospital happened under a system set up by the then Labour Government. No matter at which stage various companies or NHS trusts fell out of or withdrew from the process, the course had been set by Labour. Unless he is telling us that he was going to preordain the outcome of a proper and open tendering process, which would of course be anti-competitive, he must have known that one of the options—this is what happened—was that a private company would take over the running of the hospital.

[Andy Burnham]

I am grateful to the hon. Gentleman for giving way, as I want him to be absolutely clear about how I operated that process. It followed the NHS preferred provider principle, which I introduced, and I began by asking the officials in the Department to see whether a local NHS trust was prepared to come in and take over. Addenbrooke’s was the trust I had in mind, but for some reason it was not prepared to do so at that point so we had to find a runner. I said that we had to go out more broadly, but my intention was clear: I wanted an NHS provider. That was where things had got to. The former Minister, the right hon. Member for Chelmsford (Mr Burns), mentioned March, but things were going into purdah at that point. That was where the process was when we left government and I want the hon. Gentleman to be clear on that point.

[Andrew George]

I am grateful to the right hon. Gentleman and, of course, he has now had the opportunity to put that point on the record. However, he must recognise that as others have said—indeed, I made this point when I intervened on him—the Labour Government rolled out the red carpet with the policy of independent treatment centres, walk-in centres and other services, where the taxpayer paid dearly for services that were not delivered.

The right hon. Gentleman knows that I did not support the Health and Social Care Act 2012. I saw it as a missed opportunity to address a large number of issues and it engaged in a top-down reorganisation that was not necessary. I fear that both the Conservative party and the Labour party appear to have been beguiled by a set of PowerPoint-wielding management consultants who have persuaded them that changing how the system works is an easy solution when, as a number of Members have mentioned, more than anything else the NHS needs much more integration of services—certainly not fragmentation—and for standards within it to be addressed.

The House knows that I always look to make a constructive contribution to such debates, so, as the Minister knows, I have been championing the case for safe staffing levels. The campaign of the Safe Staffing Alliance has argued for no more than eight acutely ill patients for every registered nurse, excluding the nurse in charge, on acute hospital wards. We need to establish a floor below which standards cannot fall, because services are often engaged in a race to the bottom because of financial pressures. That is very important. It is encouraging that that issue is now being taken seriously and I hope that the Government will consider the recommendations from other bodies to advance the cause.

With regard to the integration of health and social care in the wider community, there has always been the mantra that we need fewer hospital beds, and that certainly happened under Labour. That has resulted in many of our acute hospitals being on red alert and unable to manage the situation, with patients on inappropriate wards or stuck in ambulances queuing outside. That was clearly predicted by many people, not least me, when the policy was being pursued.

What we need to do is front-load the system to ensure that we can discharge patients from hospitals safely. We do not have the facilities for that, either in the community or in primary care. Of course, having that system of discharge and avoiding unnecessary admissions depends on having adequate services at home. Ultimately, that falls on the shoulders of home care workers, who themselves face a race to the bottom, as they are often paid the minimum wage and their travel times and costs are not properly covered. We therefore need a new benchmark that puts a floor in the system by paying those workers a living wage, covering their travel times and expenses, and protecting them so that we do not end up with the race to the bottom that I fear we are seeing in the system.

We need to ensure that we have safe services. Ultimately, we need to address care standards in our hospital wards and press for, rather than simply talk about, the integration of health and social care in order to address the fundamental challenges that the NHS faces.