Andy Burnham
Prime Minister · MP for Makerfield · Labour (Co-op) · United Kingdom
“The right hon. Lady mentions leadership. Let me tell her and the whole House where Britain is showing leadership. There have been Conservative politicians at this Dispatch Box—Labour politicians, too—for decades who have talked about the importance of the two-state solution between Israel and Palestine.”
“I cannot comment today on quasi-judicial decisions, but we will take a pragmatic approach to oil and gas, as I have said before at the Dispatch Box. Let us get to the heart of this question, as the right hon. Lady invites me to do. What is the right way to fund defence and, yes, bring the welfare budget down?”
“I do not think the right hon. Lady is on strong ground when it comes to defence spending. It was 2.5% of GDP when the last Labour Government left office. It was 2.3% of GDP when the Government she was in left office. It is now set to be 2.7% in the next year.”
“This Chancellor, of all Chancellors, will be willing to provide that funding to our armed forces and back our defence investment plan. This Government’s commitment to the defence of this country is absolute. We have taken the strongest possible stance in supporting President Zelensky and Ukraine.”
“I think there are many people watching Prime Minister’s questions across the south of England who would now like Mr Speaker to be demoted in the way that my hon. Friend suggests. [Interruption.] This is very thin ice for a Leigh Leopards supporter to be on.”
“I remember well my visit to Stourbridge; it will not leave me, actually, because of the devastation, and the loss of everything in a moment for so many families. My hon. Friend’s support for them was really visible on the day, and the community is clearly very strong; that was evident.”
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“The price of holding down nurses’ pay in the way that has been done over the past six years is, in the end, nurses not feeling able to go above and beyond as they normally willingly do.”
“I asked her, “What did you do?”, and she said, “Well, I signed it straight away.” I asked why, and she said, “Because I’m currently doing a 45-hour working week, but they don’t know that.” In many ways, that illustrates the point: management do not know the value of what they get from the nursing profession. That anecdote tells the story about the job. It is more than a job to people. As my hon. Friend the Member for Newcastle upon Tyne North said, people give all of themselves to this job, but they have limits. When they feel as though those above them do not understand the commitment and the huge contribution they make to the NHS, and when they feel taken for granted, the good will and morale start to dry up. That is when the Government are in danger of achieving a false economy.”
“What is often forgotten and missed when we debate this subject is that the vast majority of nurses in the NHS—nearly all, actually—work beyond their contracted hours. I will never forget being at a meeting in Bristol with a nurse from the Bristol Royal infirmary. It was when the Government were looking at introducing regional pay, which the RCN led a campaign against. At the time, the nurse was being presented with a contract and asked whether she was prepared to vary her Agenda for Change conditions by moving from a 37-hour working week to a 39-hour one—it may have been 39 to 41 hours, but it was an increase.”
“Thank you, Mr Evans. I also thank the SNP spokesperson. I had not intended to speak but will grab this opportunity because it is an incredibly important debate. First, I pay tribute to the Royal College of Nursing and the Nursing Times , which have captured the voices of nurses all over the country. We heard some of those voices in the excellent speech by my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell), and I think they speak for the vast majority of those in the nursing profession. We meet at a time when the NHS is under unprecedented strain—certainly in recent times. Workforce morale is at the heart of the quality and sustainability of NHS services.”
“My hon. Friend the Member for Foyle (Mark Durkan) said that this is a pay cut. We should not call it a pay freeze because it is, in fact, a pay cut. The Government have manipulated the figures in this area. Let us call it what it is: a pay cut that has now been sustained over a number of years. People are at their limits. They cannot carry on having their pay cut every single year while they face other pressures and rising costs, such as accommodation costs, without there being a consequence. The consequences will be for their own sense of wellbeing, their own mental health or, indeed, their children’s quality of life. Nurses are now saying, in large numbers, that enough is enough.”
“Over recent years, we have seen the bill for private staffing agencies in the NHS increase year on year, to the point where it is now in the region of several billion pounds every year. Many trusts are in the grip of the private staffing agencies. That, of course, is also a factor in the cuts to nurse training that we have seen in recent years.”
“That is how it begins to appear. The Government are pushing people beyond their limits. There was the attempt to introduce regional pay, and there was the attempt to cut what is called the unsocial hours payment—there has been a whole series of initiatives that try to strip away support for the profession. It begins to feel like an attack on the profession. That is certainly how junior doctors felt, and I think GPs feel the same. The nursing profession is making clear today that it feels the same too. As I said, this is a false economy. As well as damaging the good will and the extra hours that people were willing to offer before, it has also, as my hon. Friend the Member for Foyle indicated, pushed people into the arms of private staffing agencies. That, in the end, is another false economy for the national health service.”
“It makes sense to have fairness in terms of headline pay for staff, to maintain good will, but on top of that, it makes sense to provide them with incentives to give any additional shifts or time to the in-house bank, rather than private staffing agencies. The Government have lost sight of that in recent times.”
“I am glad to hear the intervention of the former Minister, whom I worked well with in the previous Parliament. I want to take this opportunity to say that he did listen on regional pay. We made an argument about that issue, backed up by the RCN and others, and, to be fair, it did not go any further than the experiment in the south-west. I give credit to him for that. I also give credit to him for consistently showing a real regard for the pressures faced on the frontline. The hon. Gentleman makes an important point that the Minister would do well to reflect on. There is a huge false economy here.”
“It is not only a false economy; it directly damages the quality of patient care. When people arrive on the ward who do not know the team or the environment and have to be told everything, it builds in confusion and delays because staff have to take them through things. It does not make sense to use private staffing agencies to the extent that they are being used in the NHS. The cost is exorbitant—that is No. 1—but it also damages morale, because it leads to staff in the permanent employ of the trust working on the ward alongside people who are being paid significantly more than them for the same shift, despite having just arrived on that ward. That does not build a sense of team on the ward; it builds a sense of resentment.”
“In the immediate aftermath of the financial crash, it was acceptable, it seems to me, to ask the nursing profession to make a contribution to deficit reduction, but here we are, six years on, expecting people who are out there today, working flat out to keep an NHS in crisis going, to take pay cuts for the privilege of doing so. At some point, that strategy begins just to fall apart, and the NHS falls apart with it. I say to the Minister that we are not far from that point now.”
“It was the subject of hard discussions, but in the end it was agreed between the trade unions and the Government of the day. We did have in the Department of Health a social partnership forum, which brought together NHS Employers, trade unions and the Government to iron out problems relating to the nursing workforce. We did massively increase the numbers in the nursing profession. We did ensure that they were properly rewarded and had proper access to training. My worry is that we are seeing some of that break down.”
“In those circumstances, with everything else that I have described, including the downward pressure on headline pay, how can it possibly make sense to scrap the nursing bursary? Will that not just be another factor that adds to the growing sense of crisis in the profession? Every single piece of support that is there to develop the nursing profession is systematically being stripped away. We have seen years of that approach and are beginning to see the consequences in the national health service. Labour, of course, did not get everything perfect—I am not saying that—but I can say with some pride that when I was a Minister in the Department of Health, we brought through a major programme of investment in the nursing workforce, through Agenda for Change.”
“What does that make that nurse feel like, and is she likely to stay when we are in this prolonged period of uncertainty in which this growing hostility is felt to be around? There is a real risk here. We cannot simultaneously refuse to give clarity to those tens of thousands of nurses from other parts of Europe who are currently working in our NHS and run down the good will of nurses who are UK nationals. In the end, something will give, and it will be patient care, if we operate policies of that kind. Alongside that, there is the attack on nurse training. We have seen cuts to nurse training places over a number of years, so there is a shortage of nurses coming through. Many places are being and have been forced to recruit from overseas.”
“My hon. Friend makes two important points. The first was on the effect that Home Office immigration rules could have had on the nursing profession. I think the former Home Secretary, now the Prime Minister, made some changes in that regard. My hon. Friend is right that there is a much bigger context here: the post-referendum climate. The Government have been absolutely wrong not to guarantee the status of EU nationals currently working in our national health service. I have an example from my constituency of a Polish community nurse, who every day gets up early to go on her local round delivering insulin to vulnerable patients who are diabetic and housebound. One morning she heard a cry of, “Go home!”, out of one of the bedroom windows opposite.”
“Their limits are higher, but they do have limits, like everyone else. They feel taken for granted. Right now, the NHS cannot afford to lose the good will of the nursing profession. The Minister needs to listen carefully to what is being said today and he needs to make urgent representations, through the Secretary of State, to the Chancellor of the Exchequer in advance of the spring statement. A signal needs to be given to the nursing profession that the Government are listening and will take action, within the bounds of what is possible, to treat the nursing profession properly. I hope that, if nothing else, the Minister takes that message away from today.”
“Of course, and the point is very well made, but I will also say again that it does not help deficit reduction if nurses are being pushed into the grip of private staffing agencies as a consequence of pay policies. That is another way in which the Government’s short-sighted approach has not in the end produced benefits for the economy, as the hon. Gentleman says, nor helped us meet the target of deficit reduction, because so much money is being wasted every year. I will conclude on that point. The voices that have been mobilised in support of the lobby of Parliament today are real voices, as we heard from my hon. Friend the Member for Newcastle upon Tyne North. These people are the backbone of the national health service, the backbone of our communities and the backbone of our country. They have limits, though.”
“My hon. Friend has just mentioned people feeling a sense of fairness, particularly in the pay of those above them. Does he share my concern that in this current climate, while nurses’ pay is being cut, we are seeing large pay increases self-awarded to members of clinical commissioning groups and senior management? Does that not completely demoralise the whole local profession?”
“The House has yet to debate what Brexit means in practice, but after the events of this weekend can we at least all agree that the last thing that it should mean is biting your tongue in the hope of doing trade deals and thereby abandoning all the values that this country has long held dear?”
“I do not want to inject a partisan note into this debate, but we will be doing nobody any favours if we sit here today and think that the Bill, as good as it is, is enough. The Bill will not reverse the looming cuts to housing benefit.”
“I do not see that level of cross-Government working here. In addition to that commitment to work across Government, we need a clear ambition. What is the Government’s ambition on rough sleeping? I am not aware of one. Rough sleeping is increasing at an alarming rate, so what are they going to do about it? Will they reverse that trend? Will they make the same commitment that I have made in Greater Manchester that we should work to eradicate rough sleeping by 2020? [ Interruption. ] It is all very well the Minister looking the other way and talking to his colleagues, but what is he going to do about rough sleeping now and in the next few years? What is the Government’s ambition? Are they committed to reversing the increase? Will they go further and eliminate rough sleeping? We need to hear about that from the Minister today.”
“Although I expect the Bill to have a modest but welcome impact on homelessness, I believe that an annual review would reveal that it goes nowhere near addressing the scale of the problem and that Government funding for councils is inadequate. We must remember that most of the funding comes next year and then reduces sharply in the year after. In the third year, there is nothing at all. I do not want to wait until the third year to find out whether the legislation is working. The review should be conducted within 12 months. We need to hear much more from the Government. If they want to tackle homelessness and rough sleeping, there must be a cross-Government response. When Labour was in government, we established a rough sleepers unit, bringing together all the Departments with a role to play.”
“Member for Harrow East, but we all know that timetables shift after a Minister at the Dispatch Box commits to review something. The civil service will say, “We will review it in the autumn,” and that becomes the winter and then the spring. That is what happens, but it is not good enough. The problem is bigger than that. We need clarity and certainty. There should be a commitment to review how the legislation is working—both whether it is reducing homelessness and whether the Government are giving councils adequate funding. For the reasons outlined by my hon. Friend the Member for West Ham (Lyn Brown) a moment ago, I do not believe that the funding is adequate. I differ from my Front-Bench team here in that I think the review should take place within one year. We need more urgency.”
“Since 2010, rough sleeping has doubled across England and is increasing at an alarming rate. The problem is even worse in Greater Manchester, with a 41% increase in the past year across the 10 boroughs. According to local officials, that figure does not reflect the full picture. They believe that at least 300 people across Greater Manchester will spend tonight out on the streets. That is simply unacceptable, and I have not heard from the Government what they are doing about that. What are they doing now to help people find warmth and shelter? As I said, the number of people rough sleeping has doubled, but the Bill will not reverse that trend and our eyes need to be open to that. I support new clause 1, because urgency is crucial in this debate. We need a clear commitment to review what is happening. I take the point of the hon.”
“People will not just walk on by; they do not accept that things have to be like this. Homelessness and rough sleeping are not inevitable facts of life in 2017. Our society is wealthy enough to ensure that nobody should spend a night without a roof over their head. We need new urgency on both sides of the House to bring forward appropriate action to address the situation. If there is a problem with the Bill, it is that it goes nowhere near far enough to tackle the scale of the problem. It does not address the wider cross-governmental work that is necessary to provide an appropriate response. Let us take a reality check. The Minister will be aware of the figures that came out this week showing a 16% rise in rough sleeping over the past year—my hon. Friend the Member for Hammersmith (Andy Slaughter) referenced that in his opening remarks.”
“I rise to support new clause 1. This is my first speech on this important Bill, so I congratulate the hon. Member for Harrow East (Bob Blackman) on introducing it. He has done so with great persuasion and has performed an important service for us all. I also congratulate both Front-Bench teams on working constructively to bring the Bill to this point. I support the Bill but, as good as it goes, we will be kidding ourselves today if we leave this House, pat ourselves on the back and believe that the House has done everything that it could to tackle an emergency that is unfolding before our eyes. I chose to speak in today’s debate to reflect the rising concern among my constituents in Leigh—a concern that is shared widely in Greater Manchester—that an increasing number of people can be seen huddling in doorways across the region.”
“I hear what the hon. Gentleman is saying. There is cross-party support. I support the Bill—the hon. Member for Harrow East and the Government have my support today—but I am entitled to speak for the people who will be on the streets of Greater Manchester and the hon. Gentleman’s constituency tonight. I am entitled to give them a voice in this House. The Bill will not change their situation or reduce rough sleeping anytime soon, so who is speaking for them? It is unacceptable for the House to debate homelessness in a cosy way without facing the reality that rough sleeping is rising at an alarming rate. What is the Minister doing about that? The House and, more importantly, the people out there on the cold streets deserve an answer.”
“I am sorry if that injects a note that the Minister does not quite like, but tough. I am here to say it because he needs a better response than the Bill. If he thinks this is it, it is simply not good enough. The Bill is a step in the right direction, but I am afraid that that is all it is. In Greater Manchester, working with my hon. Friend the Member for Bury South (Mr Lewis) and Councillor Beth Knowles from Manchester City Council, we are committing ourselves and our councils to trying to end rough sleeping. If we can do that at our level, the Government should at least do something at their level.”
“My hon. Friend is absolutely right. The Bill focuses solely on the duties of local authorities, and we must remember that those local authorities are operating in the context of massive cuts to their budgets. We need to be honest with ourselves about whether they are going to be able to rise to the extra pressures that the Bill places on them. As my hon. Friend says, the Bill will do nothing to reverse the cuts to housing benefits that are coming down the line, which many experts believe will make homelessness and rough sleeping worse. The Bill does nothing to reverse cuts to mental health services that are pushing more people out on to the street. The Bill does nothing to reverse the cuts to social care, which are having the same effect. The Bill does nothing to build more affordable housing.”
“I have also read the briefing note from Crisis, and the hon. Lady will have seen that Crisis does not believe that the funding allocated to the Bill is adequate to meet the obligations that are being placed on local authorities, nor does it believe that the Bill will do anything to address the wider issue of housing benefits. However, I accept the hon. Lady’s point. I have not come here today to do anything to disrupt the passage of the Bill. It would help everybody if the Bill contained a commitment to a review so that we all know where we stand and so that there is a degree of urgency about how the House is addressing this issue.”
“I will welcome every single thing the Minister does to address this problem and, yes, I welcome that funding. What I do not welcome is the alarming rise in rough sleeping on the streets of Greater Manchester. I am sorry if it is inconvenient for the Minister to hear this, but it is clearly right to put those concerns to him.”
“The Minister mentioned time. If the Government were making the Bill a priority, perhaps they would make time to debate these issues and to propose their own initiative. Instead, we have a debate on a Friday as a result of a private Member’s Bill. I will welcome anything the Minister does to address the issue, but I do not accept a cosy cross-party debate today when the number of people sleeping rough on our streets is increasing every single week. It is a bigger issue than just patting ourselves on the back. More needs to be done, and the Government need to set out today their ambition to cut rough sleeping in the next few years. That is why I am here today. I fully support the Bill, but let us be honest about what it is: a modest first step.”
“The figures showing the rise since 2010 are shocking. Does the hon. Lady think that her Government are doing enough to tackle rough sleeping?”
“The Minister spoke a moment ago about successful implementation and a review to check that it has been achieved. Part of that success is about the bureaucracy—the successful implementation of the powers and provision of the money required so that local authorities can discharge their functions—but, as new clause 1 says, it is also about the effect the legislation has on actually reducing homelessness. Before he moves on, will he tell us what the Government’s objective is and what test they are setting themselves with respect to reducing both rough sleeping and homelessness by 2020? We can judge then whether they have been successful.”
“The hon. Gentleman says that the protections are in place for applicants. Amendment 2 guarantees a tenancy of at least six months. As I understand it, that is a reduction in the current level, which is at least 12 months. I am not saying that this is necessarily wrong, but I would like him to comment on it. Often, because of the complexity in their life, people at least need security in their tenancy so that they can sort out other problems that they may have. Is six months really long enough? Might it not lead to repeat homelessness as people do not have that longer-term security behind them?”
“I hear what the hon. Gentleman says, and I accept that we would see six months as a minimum, but why cap it at 12 months in the amendment? If we want a minimum standard, that is fine, but why put an upper limit on it?”
“On Government amendment 2, which I asked the hon. Member for Harrow East (Bob Blackman) about, why cap the tenancy at 12 months? That seems to encourage local authorities to offer shorter-term tenancies, rather than making standard offers of longer-term tenancies. The Select Committee did not recommend a 12-month cap, so why have the Government inserted such a provision?”
“As the Secretary of State knows, I support reforming freedom of movement, but in a way that does least damage to the economy, and particularly the regional economy. I see in the Prime Minister’s speech today that she makes specific mention of protecting the interests of Cardiff, Edinburgh, Belfast and the City of London, but there is no mention at all of the north-west of England, Greater Manchester or, indeed, any English region. Rather than leaving these crucial decisions to a London-centric, right-wing clique around the Prime Minister, is it not time now to open up this debate, give Greater Manchester a voice in it and establish a Brexit committee for the nations and regions?”
“One of the problems that our constituents will have with this plan is about how the road network will cope, because it feels like it is already at saturation point. The north-west of England desperately needs significant investment in rail infrastructure. Does the Minister for the northern powerhouse agree that high-quality west-east rail across the north of England is a higher investment priority than Crossrail 2 in London?”
“I will keep the gloating to a minimum, Mr Speaker. The Secretary of State is dressing it up very well, but the reality of what she has announced is that some schools in the most deprived parts of the country, which face the biggest challenges, will have money taken away from them and given to schools elsewhere. Would it not have been much fairer for her to have asked the Chancellor for more money to bring the gap up that way? Instead, she is making schools in the toughest areas make teachers redundant to pay for this change.”
“My hon. Friend is making an incredibly important point. I congratulate him on securing this debate, which will give hope to the many people out there who suffer with cystic fibrosis. Is he aware of new 96-week data that have recently been published that show that Orkambi slows decline in lung function by around 42%? Those data were not available to NICE when it made its appraisal. Do those data alone not make the case for a further accelerated review process on this absolutely compelling?”
“I realise that that is a challenge, but Ministers sometimes need to cut through the bureaucracy. The Minister is a good man, and I urge him to do that today.”
“It would be nice to have the confidence to know that I could see my children graduate university, start jobs and even have children of their own.” I am sure that Philip’s words would be shared by many other people in their 20s, or younger, with cystic fibrosis if they had the opportunity to vent them in this place. They are the appropriate words on which to finish. I recognise the difficulties, but we were here before with Kalydeco and we managed to find a way through. As my hon. Friend the Member for Bristol East said, nobody now doubts that that drug has made a huge difference to so many lives. We are in exactly the same position again, so let us learn from that experience. Let us not test people’s patience. Let us get the appraisal process moving towards a positive resolution.”
“If Melissa was on Orkambi then it could have kept her in a better state of health and prevented her becoming as ill as she was and would have prevented the worst. As for me; I’m looking to settle down and have children in the near future. Orkambi would help me to watch my children grow up rather than live to the predicted age of being in my 50s. I have had the dilemma of whether or not to pay into a pension because I won’t live to see retirement age and maybe even not long enough to be able to take a lump sum out at 55! Orkambi can change that.”
“All our lives we have had to take a cocktail of medications and have had frequent stays in hospital. In my opinion Orkambi would, amongst other things, reduce the number of hospital stays and also reduce the need for occasional extra antibiotics due to CF related illness (because we would be in better health as a result of Orkambi). Both of these mentioned would save the NHS money. I understand that it’s not a cheap medication but neither is a two week hospital stay, on a specialised ward, on extra antibiotics, six times or more a year. I do think that the stress of losing our mum had an impact on Melissa’s health.” Sadly, Melissa died in 2013. The letter continues: “The problem with CF is that once your health starts to slide, it’s very difficult to bring back to where it should be.”
“There are things that can be done, and we all urge him to use those flexibilities today. I could say a lot more, but the best way to use the time remaining to me is to refer to some of my constituents, many of whom have been in touch to encourage me to speak today. My office manager, Karen Aspinall, has a son in his 20s who has CF. Through her, I know how it is to live day to day with the challenges presented by CF. I close with the direct words of my constituent, Leigh resident Philip Grimshaw. He is 28 years old and his words say far more than I could. He and his sister Melissa were diagnosed with cystic fibrosis when they were very young, and this is what he wrote to me: “Melissa was diagnosed with CF as a baby after being very unwell since birth, and I was diagnosed as a result of this, at 7 years old.”
“Those treatments were often innovative and related to chronic conditions where the drug, if used, might have a long-term beneficial social impact, rather than an impact that would necessarily return money to the NHS budget. To be open about the shortcomings of the NICE process that we established, NICE was not able to consider the wider public budget, the Department for Work and Pensions budget and other budgets. My hon. Friend the Member for Dudley North spoke about people being able to work and care for their kids, and often the failure to fund a drug has a much wider social cost, yet the narrow process applied by NICE often did not take that into account. Orkambi is one such treatment where we need exceptional consideration of its potential wider impact. The accelerated access review has given the keys to the Minister.”
“We have heard excellent speeches from both sides of Westminster Hall on issues of great importance to our constituents, and Members have made their points in that spirit. I was involved in the establishment of NICE, which my hon. Friend the Member for Cambridge (Daniel Zeichner) mentioned, and it did become a world leader. I am the first to say that it can never be right for politicians to sit in judgment on treatments—judging that those who shout the loudest should therefore get the treatment. NICE was established for an important reason and, as a Minister, I always sought as best I could to stick to NICE’s judgments and not to undermine them. On occasion, however, treatments would come along that were, quite simply, exceptional and that could not be considered within the narrow confines of the NICE appraisal process.”
“I congratulate my hon. Friend the Member for Dudley North (Ian Austin) on the spirit in which he introduced the debate and on his consensual tone. I also commend him for the quality of the case he outlined in his excellent speech. He could not have done a better job of representing his constituents and all those represented by the Cystic Fibrosis Trust. My hon. Friend the Member for Bristol East (Kerry McCarthy) is right to pay tribute to Ed Owen, the departing chief executive of the CF Trust, who made an enormous difference to so many people during his tenure. I sympathise with the Minister, because I have been there when such difficult issues have arisen. I assure him that there is no party politics in this room today.”
“It is obviously reassuring to everybody that the Minister has taken such a close interest in the issue before coming to the debate. He says it was not a near miss. That may have been the case on the data that NICE had, but does he accept the point made by my hon. Friend the Member for Dudley North (Ian Austin) and other Opposition Members that those data were very limited indeed? The 96-week trial data that are now available would probably have produced a very different overall calculation.”