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.”
The complete record
Every one of 2,246 lines we hold for Andy Burnham, in date order, each linked to its source. Free to read, in full, without an account. Page 26 of 45.
“Nine verbal reports and one formal complaint were made, but none was acted upon. Why? The questions do not just extend to senior staff at the hospitals, and the Secretary of State was right to raise questions about the role of civil servants and former Ministers. To quote one of the main observations of the “Lessons Learned” report: “As the investigations at Broadmoor and at Stoke Mandeville show, Savile’s involvement with those hospitals was supported and facilitated by Ministers or senior civil servants”.”
“As the analysis of what happened becomes more complete and the full picture emerges, the question will grow in people’s minds: “Where is the accountability?” That is what victims are crying out for, and that is what must follow. It must be the single most important question occupying the Government in dealing with these matters, and it must continue to be a priority for the next Government and the next Parliament. Much of what is revealed in the reports confirms what we already know about a pattern of criminal behaviour in hospitals where patients and victims were not listened to and staff felt unable or unwilling to challenge, but what changes with the Stoke Mandeville report is that it is now no longer possible to say that although the abuse was widespread, it was not known to people in senior positions.”
“I thank the Secretary of State for his considered and thorough statement, and for his evident concern for the many lives that have been damaged by these vile acts and systemic failures. He was right to repeat his apology to Savile’s many victims and their families, and the whole House will support his decision to do so. I add my thanks to all those involved in compiling these reports, and particularly Kate Lampard and Ed Marsden for their “Lessons Learned” report. Through their diligent work, the full scale and horror of Savile’s sickening behaviour across the NHS has finally been laid bare. It beggars belief that abuse on this scale, known to so many people, was allowed to continue for so long.”
“Let me take the Secretary of State back to a subject he likes to avoid—NHS privatisation. He tries to deny that it is happening on his watch, but we heard earlier about the ideological privatisation of cancer scanning in Cheshire and Staffordshire, despite its being more expensive than the NHS bid—and now it could get much worse. On the Friday before the recess, the Government sneaked out the public contracts regulations, which require NHS contracts worth over €750,000 to be opened up to full EU competition. Will the Secretary of State confirm that that is indeed the case in these regulations, and can he explain what mandate he has from the public to open up the NHS to private bidders across Europe?”
“The King’s Fund report said that as a result of the Secretary of State’s reforms there is “greater marketisation of the NHS”. People will notice that he failed to answer my question. That is because he wants to sneak these plans through under the radar. I serve notice on him today that we will fight him all the way, right to the very last day of this Parliament. If passed, these regulations will mean that almost every NHS contract will be forced to be advertised across Europe, shattering the promise he made to protect the NHS from EU competition law. Is it not now abundantly clear that he has forfeited the public’s trust on the NHS, and that five more years of this Government will lead to huge acceleration in NHS privatisation?”
“In conclusion, as I have always said, the lessons from Mid Staffordshire need to continue to be learned if the NHS is to be what we all want it to be: the safest and best health care system in the world. The Secretary of State has today taken some important steps towards that goal, but I hope he will respond fully to the serious questions I have raised.”
“On openness and transparency more broadly, the Secretary of State will be aware that the King’s Fund delivered a damning verdict on the Government’s reorganisation, concluding that it had damaged patient care. That is consistent with a survey of NHS staff, which found that 69% said the reorganisation had harmed patient care, with only 3% saying it had improved. It is suggested that the Government’s own risk register on the reorganisation warned that reorganising the NHS at a time of financial stress would damage front-line care. So that any future Government can learn the lessons of the past few years, will the Secretary of State publish the risk register, as recommended by Sir Robert Francis?”
“As Robert Francis warns today, that has made it even harder to get the culture right. We welcome the Secretary of State’s recent focus on nurse numbers, but will he concede that it was a mistake to cut staff so heavily? Will he back Labour’s plan to bring down the agency bill by recruiting 20,000 more nurses? We welcome the progress made at some hospitals in special measures, but may I caution the Secretary of State on his use of statistics? Is he aware of the graph on page 8 of the Dr Foster report, which shows that mortality rates at the Keogh trusts fell faster between 2006 and 2010 than between 2010 and 2014? There was never a tolerance or denial of high mortality, as he seemed to suggest in his statement.”
“Although that will help us to develop a more accurate measure of avoidable deaths than mortality rates, does the Secretary of State think it goes far enough? Should not the NHS learn from all serious failings? Will he give consideration to our suggestion that every death in hospital should be subject to an appropriate level of review? We welcome the renewed focus on staff numbers since the Francis report, but we also remind the House that in the first three years of this Parliament almost 6,000 nurses were lost and, with record numbers of people in hospital, nurse-patient ratios have not kept pace with demand and there are fewer nurses per head of population now than in 2009-10. One of the problems with having made so many permanent staff redundant is that, post Francis, recruitment has been heavily reliant on agency staff.”
“Chris Bird, whose mother Violet was one of those victims, recently told the “Today” programme that “it is criminal that the Government is stalling on implementing something like this that could save lives.” I have been informed by senior officials in the Secretary of State’s own Department that he personally is holding up this reform. Can he say whether that is true, and if so why? If it is not true, which I am prepared to accept, will he today set out a clear timetable for the introduction of this vital reform? Alongside that, we need better arrangements in hospitals for reviewing case notes when patients have died, as the Secretary of State mentioned in his statement. Over the weekend, the Government announced plans to introduce an annual review from a sample of patients.”
“I legislated for reforms of death certification in the Coroners and Justice Act 2009, which made provision for the independent scrutiny by a medical examiner of all deaths that are not referred to the coroner. Following successful pilots, Sir Robert Francis reinforced Dame Janet Smith’s recommendation. Dr Suzy Lishman, the president of the Royal College of Pathologists, says that introducing these reforms will “improve patient care whilst reducing harm and saving money”. It will therefore be a cause of great concern to a great many people, not least the families of the victims of Harold Shipman, that those reforms appear to be stuck in the long grass.”
“Both sides of this House supported Sir Robert’s original recommendations and we give credit to the Secretary of State for making significant progress with their introduction, but gaps remain where progress has not been made and that is a concern when standards overall in the NHS are recorded to be falling, not rising. In particular, there is a long-standing need to reform the system of death certification which goes back to Dame Janet Smith’s inquiry into the Harold Shipman murders. I took a personal interest in that as a Minister on the back of concerns raised by my hon. Friend the Member for Denton and Reddish (Andrew Gwynne)and James Purnell, the former Member for Stalybridge and Hyde.”
“In advance of today, I was contacted by a whistleblower who works in a hospital about a Care Quality Commission inspection planned for later this month and about the growing practice of hospitals running mock inspection days in advance of the CQC’s arrival, as schools have come to do with Ofsted. The whistleblower’s letter states: “I enclose a document that invites us for a mock inspection to show us what to do and say when the CQC comes. Is this the correct thing to do? I think not. I cannot reveal my name as I would be instantly dismissed. Can you help?” I am sure that the Secretary of State will be as concerned as I am to hear that and I will forward the information to him this afternoon. I turn now to the Secretary of State’s update on the Francis report on Mid Staffordshire.”
“That underlines the importance of any moves to improve the culture being introduced in the right spirit and being supportive rather than punitive, so that they do not reinforce the wrong culture and have the opposite effect to that which the Secretary of State is obviously trying to achieve. At the weekend, the Secretary of State proposed fines and jail sentences for failure to be open about poor care. Although we support his zero-tolerance approach, is he certain that how this is perceived on the ground will not create a climate of fear and have the opposite effect? Those concerns also apply to the new inspection regime introduced since the Francis report.”
“We had a significant number of contributions about cases in 2014.” The report specifically references figures from the latest NHS staff survey, which shows that reports of bullying have increased from 14% of staff in 2011 to 22% in 2013. Over the same period, the percentage of staff who feel able to speak out about poor care or to report errors or near misses has fallen from 98% in 2011 to 94% in 2013. Those figures suggest that things are getting worse, not better. Will the Secretary of State explain why he thinks that is and whether he will investigate the reasons further?”
“It reported in June 2010, and the Secretary of State’s predecessor announced plans for a “safe and independent authority” to which staff could turn when their organisations were not acting on concerns. Will the Health Secretary say why that has not progressed since then and assure us that there will be no further delays now that Sir Robert has reinforced that recommendation? Although I believe that the Secretary of State’s commitment to improve the culture in the NHS is genuine, he will no doubt be concerned by Sir Robert’s findings that it might have got worse in recent years. In his report, he said about the cases he examined: “Many were relatively recent or current. This is not about a small number of historic high profile cases from a time when organisations might argue the culture was different.”
“As he points out, his remit did not apply to any form of social care. That is a major concern, given that it could be argued that some of the poorest care provided in England today is in social care settings or in people’s own homes. Only at the weekend, a BBC investigation found that one in five care homes for older people is failing to meet standards for safety. Should we not today, across this House, establish the firm principle that Sir Robert’s recommendations should apply equally to all places where people receive care? Let me turn to the recommendation for an external organisation that staff can approach for advice and support. In response to the first Francis report in February 2010, I established an expert group to update whistleblowing guidance.”
“Our shared aim must be to create a climate in which every NHS worker feels able to raise concerns and feels confident that they will be listened to, that appropriate action will be taken and that they will not face mistreatment as a result. Sir Robert’s report will help achieve that. We particularly welcome the call for whistleblowers worried about losing their jobs to be offered alternative employment and for training in whistleblowing for all staff. Those measures are overdue. Will the Secretary of State say more about how Sir Robert’s principles will be enforced across the NHS and about the timetable for implementation? Will he confirm that they will apply equally to all providers of NHS services, including voluntary and private providers? That brings me to an issue of major substance not covered in Sir Robert’s report.”
“I welcome the Secretary of State’s statement and his obvious commitment to improve the culture of tackling poor care in the NHS; there is plenty of common ground between us. We endorse the principles laid out in Sir Robert Francis’s new report and we will work with the Secretary of State to get new safeguards on the statute book in the remainder of this Parliament, as he requested. It was the Labour Government who, in 1998, introduced the first legal protection for whistleblowers in the Public Interest Disclosure Act 1998, reinforced in the NHS constitution in 2008. Sir Robert’s new principles build on those foundations. We thank him and the review team for their work and praise every whistleblower who has had the courage to come forward.”
“(Urgent Question) : To ask the Secretary of State for Health if he will make a statement on what guidance has been issued by NHS England on declaring a major incident.”
“Will it not distract doctors whose sole focus should be on the emergency situation, and not on media and political considerations that should form no part of their judgment? If the Secretary of State agrees with me on that, will he today instruct NHS England to withdraw this guidance and issue more appropriate instructions to the NHS in the region? The NHS remains under serious pressure, and it needs the clearest of instructions based on what is best for patients. Will he act today, so as to leave the NHS in no doubt that that must be its paramount and only concern at all times?”
“However, his claim that this matter is purely local is called into serious question right now by this 86-page document headed “NHS England”— [ Interruption. ] He says it is from the local team, but this is a regional function of the national body, NHS England. The local claim will not wash, I am afraid. I will tell the Secretary of State what the guidance tells trusts to take into account. He says that it concerns only operational matters, but section 7.2.3 is headed “Politics”, and subsection (a) asks: “Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?” Subsection (c) asks: “Is there a risk of reputational damage?” Does not this muddy the waters hugely?”
“I shall quote from an e-mail sent by the head of operations at one trust, who said that the requirement had been “introduced by NHS England to effectively stop trusts from calling a major incident…Our hands will be tied in most cases if they wish to call a major incident for capacity reasons”. Is the Secretary of State confident that the new enhanced criteria are not unduly burdensome and will not cause unnecessary delays for a trust in an emergency situation? Is he satisfied that this guidance is consistent with good practice at national level and safe to be left in place? The Secretary of State has used the word “local” many times today, and spoken of the only consideration being relieving pressure on hospitals facing severe demand.”
“It is headed “NHS England” and it states: “Major incidents should be agreed with…the Director on call for NHS England”. Will the Secretary of State now withdraw his earlier statement to the House and confirm that this decision is not purely local, in that it has to be approved by NHS England? Let me turn to the impact that this has had on trusts. There are 17 enhanced criteria set out, including requirements that may cause serious time delays for trusts in an emergency. For instance, there is a requirement on the on-call CCG manager to visit the trust and undertake a review. Let me tell the Secretary of State how those new rules were perceived by senior managers.”
“In the first week of January, at least 14 trusts across England declared major incidents, including three in the west midlands. Official figures show that pressure continued into the second and third weeks of January, with only seven A and Es out of 140 meeting the Government’s target. There were ambulance diverts, and even an A and E closure, but no further major incidents were declared. On 7 January, when the Health Secretary was called to the House to answer an urgent question, he said: “The decision to declare a major incident is taken locally—there is no national definition” —[ Official Report , 7 January 2015; Vol. 590, c. 273.] He has just repeated that now, and called this a “local operational issue”, but that does not appear to be entirely accurate. Let me quote from the guidance that was sent in the middle of January.”
“I am grateful to the Minister, because I was going to mention my last year in office. Would he care to inform the House what the bill for management consultancy in the NHS was in 2010 and what it is now?”
“As the British Medical Association said last week, “these ongoing challenges are placing patient care and safety at risk.” Very poorly people are waiting hours for ambulances to arrive, hours to be seen in A and E, and hours on trolleys in corridors, and too many elderly people are then being held on hospital wards, trapped for days, weeks, even months or, in one case that I will come to later, a full calendar year.”
“We have called this debate today to see if we can establish a shared analysis across the House of the causes of the current crisis in accident and emergency departments, and from that, shared solutions. I hope we can all agree that the staff of the national health service and of the ambulance service are working wonders in the most trying circumstances, and that it behoves all of us to put forward our ideas today to relieve the pressure on them, but more importantly, to reduce the risks that too many patients are facing right now. As I have said to the Secretary of State before, things cannot carry on as they are.”
“I beg to move, That this House notes comments from leading experts that the NHS is under unprecedented levels of pressure and that this is putting patient care at risk; further notes that attendances at hospital A&E departments increased by 60,000 in the last four years of the previous Government and 600,000 in the first four years of the current Government; believes that this is linked to decisions taken by this Government, including cuts to adult social care, the abolition of NHS Direct, the closure of almost one in four walk-in centres and removing the GP access guarantee; and calls on the Government to match the Labour Party’s plans to raise an extra £2.5 billion a year for the NHS, funded by measures including a tax on properties worth over £2 million, to help ease the current pressure and ensure that the NHS is fit for the future.”
“Gentleman knows, is the worst-performing ambulance service in the country right now, and we hear today that the chief executive of London ambulance service, Ann Radmore, has resigned. The Secretary of State will need to explain to us today why it makes sense, in the middle of a difficult winter, to run an experiment in the most troubled ambulance service in the country.”
“I am not sure which figure the hon. Gentleman is referring to, but the figures in the motion apply to England. I will say more about them in a moment. The stories of failure keep coming. Today we read that a 38-year-old man in Bristol died of meningitis after an ambulance took four hours to arrive. This is by no means an isolated example. The response time target for the most serious calls has been missed for the past six months in a row. We need to hear today what the Secretary of State is doing about this. Rather than work to improve response times, the only proposal we have heard so far is to allow a pilot relaxing response time standards. There will be two pilots, one in the south-west and one in London. London, as the right hon.”
“What is his plan to stop the decline and bring A and E back up to acceptable standards? It is time he told us.”
“It is my responsibility to hold the Government to account on behalf of patients in England for what is happening in England now. That is my job, and I will make no apologies to the right hon. Gentleman or anybody else for doing it. The response times in the ambulance service are not good enough, nor is the plan to introduce an experiment in the middle of winter, but the problems are not confined to the ambulance service. We need, too, to relieve the pressure on hospitals. Last week just seven out of 140 hospital A and E departments in England met the Secretary of State’s lowered A and E target. Hospital staff are trying their best, but it is as if the Government have simply given up on it. If that is so, it means that they are giving up on the thousands of people waiting hours to be seen.”
“I do not think there is a massive difference between a pilot and an experiment. My objection is that that is being introduced in winter—and a difficult winter at that—in the most troubled ambulance service. I am not against a pilot, but it should be conducted at a quieter time of year. I should have thought that bringing it in now would strike the hon. Lady, with her long experience of the NHS, as more than a slightly risky thing to do. I need to hear today the Secretary of State’s plan. What is his plan to bring standards in ambulance services and A and E back up to where they should be? If he waits much longer to tell us, people will conclude that he simply does not have one. The simple truth is that our hospitals are full and operating way beyond safe bed occupancy levels. It is a system that is visibly creaking at the seams.”
“I shall give way in a moment. Another recent case symbolises just how bad things have got. Michael Steel, a dad of two, aged 63, was moved from his ward to a store cupboard while being treated for an inflamed liver. Mr Steel was unable to sleep because he was wheeled in and out of the cupboard while staff went to get drugs from the fridge. One nurse apparently told him it was “absolute chaos”. His son Tom took pictures of the ordeal, including a photo of the ward’s whiteboard where nurses listed his dad’s location as “stock room”. This is the NHS on the Secretary of State’s watch.”
“What we can see is that this decline began when the Government made the monumental misjudgment of bringing forward a top-down reorganisation that should never have happened, that nobody voted for, and that took 1.5 million eyes off the ball in the NHS. The Government should have been looking at the front line and maintaining standards there, instead of which they looked backwards, and focused on the reorganisation and the jobs merry-go-round that then carried on. It is really disgraceful that they did that and plunged the NHS into the chaos that it is today.”
“My hon. Friend describes the problems well. I know the hospital because I have been there with him. He is right that older people are becoming trapped in hospital. The support is not there for them in their own homes, and nursing home places are not available. I will come back to that theme in a moment.”
“We have record numbers of delayed discharges in the NHS right now. The number may even go past the 1 million mark—I am talking about days lost in the past year. That reorganisation that I mentioned a moment ago cost at least £3 billion, probably more. The budget was flat so where did that money come from? As my hon. Friend rightly says, it came from cuts to the general practice budget, cuts to the community services budget, cuts to the mental health budget and cuts to the social care budget. That is why the community has been stripped bare and people are trapped in hospital. This is a mess of the Government’s making.”
“Friend the Member for Halton (Derek Twigg) what he saw as the causes of the increased attendances at A and E. Let me remind the House of what he said: “We have looked into that matter in huge detail. There are probably three broad factors that are behind the increase in demand. One is the ageing population...The second factor is changing consumer expectation among younger people who want faster health care…The third factor is a refusal by NHS trusts to do what they were pressurised to do in the past, which is to cut corners to hit targets. —[ Official Report , 7 January 2015; Vol. 590, c. 280.] In other words, “Nothing to do with us, Guv.” It is the same old story with this Secretary of State. It is always someone else’s fault: older people’s fault, younger people’s fault, the previous Government’s fault—anyone but him.”
“I will make some progress. I mentioned record numbers of delayed discharges. There are also record numbers of people visiting A and E, record numbers of frail people being admitted through A and E, record numbers of people waiting on trolleys and record numbers of people trapped in acute hospital beds. This is the simple question that has not yet been answered by this Government: why is there this unprecedented pressure in accident and emergency? Until there are proper answers to that simple question—and agreement about the true causes of the A and E crisis—we will not be able to move forward with a proper solution, and that is the point of today’s debate. When the Secretary of State came here to answer the urgent question two weeks ago, he was asked by my hon.”
“My hon. Friend is right; I do know Warrington well. Speaking up for my own family who live in Warrington, I will not accept a situation in which their services are taken away without them having the democratic right to challenge those decisions. But that is what has been growing under this Secretary of State. We had the decision on Lewisham—the most outrageous example—in which he tried to close a successful A and E that was serving a very deprived part of London, without any proper process, and he lost in the High Court. Then we had a clause brought before the House that tried to close hospitals anyway. That is what the Government want to do; they want to ride roughshod over local people and close services where they want to, and we will not let it happen.”
“Over the first four years of this Government, they have increased by 600,000. That is a dramatic increase, which is explained not by those long-term structural issues, but by decisions taken by this Government.”
“As usual, my hon. Friend puts her finger on the issue: the crisis is not as the Secretary of State describes. I will come on to that right now, but the first request I will make of him today is to publish the research that proves that the three top reasons he gave in this House two weeks ago are indeed the reasons for the increased demand in A and E, because I do not believe that they are. Perhaps they have made a small contribution, but they are not the real reason for the crisis. Our analysis of what is behind the extra pressure is very different from his. Let me introduce an important and revealing fact into this debate, which picks up on my hon. Friend’s point. Over the past four years of the previous Government, annual attendances at A and E increased by 60,000.”
“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 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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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. 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.”