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 33 of 45.
“How about him reading the clause that we passed before he tried to close or downgrade Lewisham’s A and E? Would that not have been a good thing to do? He did not do that, however. He tried to plough on and downgrade a successful A and E in the teeth of opposition and he got found out. Yet he comes back here today and just thinks arrogantly he can ram the same powers back through this Parliament. What we have seen today from the right hon. Member for Sutton and Cheam (Paul Burstow), who positioned himself as though he was going to make a stand for local involvement in the NHS, is the worst kind of collusion and sell-out of our national health service. Just as the Liberal Democrats voted for the Health and Social Care Act, again they have backed tonight the break-up of the NHS. In the last few days the right hon.”
“The fifth area I want to challenge the Government on is the whole question we have just been debating. This goes to the heart of where the coalition began, which was that local people would be in the driving seat and local GPs would be in control. The coalition agreement said the Government would end centrally dictated closures. Well, they have ripped all that up this afternoon by passing clause 119 and keeping it in the Bill. They claimed they were just doing what we left behind. That is not the case, because the High Court told them otherwise. The High Court told them they had gone beyond the powers I had created in 2009. The Secretary of State was unable to answer that. He said everything was our fault—it is never their fault or his fault. Well, how about him listening to the Court?”
“The right hon. Gentleman has not answered the question. There was a responsibility on the CQC to provide oversight of local authority commissioning. This Bill removes it. Why does it do that? It is a backward step in my view. The fourth area is that, in respect of the care data scheme, the Bill fails to provide the assurances the Government tried to herald in the press a few days ago—to borrow the Secretary of State’s words today, a “rock-solid assurance” that data could never be passed to commercial insurance companies. I do not believe it is possible to claim that new clause 34, which has now been added to the Bill, does that. It just has general aims around the promotion of health. That does not stop data being passed to private health insurance companies. Again, I do not think the Bill does what the Secretary of State claims it does.”
“Only when we repeal the Health and Social Care Act and get rid of the powers that the Secretary of State has taken for himself today will we put the NHS back on the right path, away from the path towards fragmentation and privatisation, and begin to build a 21st-century NHS.”
“We will take the powers that the Secretary of State has taken for himself today and hand them back to local people. We will not get the care that we want until we are able to face up to the care crisis that this country now has. Our argument is that the full integration of health and care is the only way to reshape services around the person. That is the only way to go, and we will give a full green light to NHS organisations to collaborate and integrate, instead of working with the market regime that this Government have introduced. We have had the ludicrous spectacle of the Competition Commission telling two hospitals that wanted to collaborate that they could not do so because it would be anti-competitive. That is the reality of the NHS that this Government have created. That is the nonsense that people are facing on the ground.”
“We took action to address care standards in the NHS. The right hon. Gentleman is trying to politicise care failure. The Labour Government inherited the Bristol Royal infirmary scandal from the previous Conservative Government, along with the scandal at Alder Hey and the Shipman murders, but we did not try to politicise those failings. The Secretary of State is trying to politicise such failings today, however. The Lib Dems have shown again tonight that they simply cannot be trusted to stand up for the national health service. There is only one party in this House that will do that, and that is the Labour party represented on these Benches. The next Labour Government will repeal the Health and Social Care Act and restore the right values to the heart of the NHS. In so doing, we will also repeal clause 119 of this Bill.”
“Where in the new clause does it say that? Nowhere does it say that the data cannot be passed to private health insurance companies. Proposed new subsection 1A states that such information could be passed on “for the purposes of…the provision of health care or adult social care”. This is a very wide provision, and I see no clarity in it that delivers on the commitment that the Minister is giving to the House.”
“Before the Minister sits down, I would be very appreciative if he could direct me to the precise part of new clause 34 that prevents a private health insurance company accessing data.”
“To add to the theme that my hon. Friend is developing, is not one of the problems with care.data that we have had so many statements from Ministers and officials that have not in the end come to be true? At the last Health questions, the Secretary of State said that a leaflet would be sent to every home in the land to explain what was happening. That also was not true. Does my hon. Friend agree that this is bringing the whole scheme into disrepute?”
“To listen to the Secretary of State, one would not believe that those were the facts—”
“This debate is a welcome opportunity to review progress on the Francis report one year after its publication. That publication completed a long process of independent inquiry into the terrible failings at Stafford hospital, and it began in July 2009 with my appointment of Robert Francis, QC. Ever since, the onus has been on us all to learn the important lessons and implement all the recommendations of the Francis report. First, however, I will say a word about the previous Government’s record. It was the previous Labour Government who introduced for the first time independent regulation to the national health service, following the scandals of the 1990s at Bristol Royal infirmary, Alder Hey and, of course, the Shipman murders. It was that independent regulator which uncovered the problems at Mid Staffs.”
“I want to make some points at the beginning and then I will give way to the Secretary of State. Those were the actions of the last Government in dealing with the issues that we inherited. It was the last Government who left the national health service with the lowest ever waiting lists and the highest ever public satisfaction, and no attempt by the Conservatives to rewrite history can take away that fundamental strength in the NHS which the last Government left behind.”
“To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.”
“If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.”
“Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out. Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS.”
“We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.”
“It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.”
“My hon. Friend anticipates me, as I will come on to that subject. My point that the NHS has gone downhill is no better illustrated than by the crisis that is developing in mental health provision.”
“In a moment. On all measures, this winter has been just as bad as the last, with some patients waiting hours on trolleys, or held at the door of A and E or in the back of ambulances. A and E is the barometer of the whole health and care system, and that barometer is warning of severe storms ahead.”
“Pressure on hospitals, and how we relieve it so that they can care for people properly, is the core of this debate. What we have seen under this Government is an ever-increasing number of frail, elderly people coming into hospital via A and E. The Secretary of State shakes his head, but Francis made specific recommendations on the care of older people in hospital. The point I am making is that under him the number of older people admitted to hospitals as emergency admissions has gone up significantly, and that goes to the heart of the issues raised by the Francis report.”
“I hope that the Secretary of State was listening to my hon. Friend. The point I was making—he did not like it—was that there is plentiful evidence that the NHS has gone downhill in the 12 months since the publication of the Francis report. The chaos in A and E has increased, and pressure on mental health services has reached almost intolerable levels. Trusts face great difficulties in recruiting sufficient A and E doctors—a central issue in the Francis report, as it addresses safe staffing numbers.”
“He wants to put it all in his own terms, but this is the reality in the NHS right now and this is what has happened since the publication of the Francis report. He has put more pressure on hospitals, because he has made it harder for people to get a GP appointment, and hospitals today face greater difficulty in meeting their targets. Indeed, as I just said, in the 12 months since the Francis report, hospital A and Es have missed the target 32 times running. These issues go to the heart of what we are debating today.”
“That is the problem. The Government’s focus is on hospitals. All the while, alternatives to A and E are being degraded and taken away. It is an undeniable fact that it has become much harder to get a GP appointment under this Government. The Patients Association warns that it may soon be the norm to have to wait for up to a week. [ Interruption. ] The Secretary of State says, “Nonsense.” He should get out and speak to people. The people I speak to tell me they are getting up in the morning and ringing the surgery at 8 am or 9 am, only to be told there is nothing available for weeks. As my hon. Friend the Member for Stockton North (Alex Cunningham) said, they ring 111 and the advice given is to go to A and E. The Government have created the situation that the Secretary of State will not address.”
“It is simply not good enough and the sooner he pulls his finger out and does something about it the better. The Secretary of State’s failure even to acknowledge these issues today is a matter of some amazement, given that he could find time to talk on an area that is not his responsibility—the NHS in Wales. There are, of course, important issues that the Welsh Assembly needs to address, but voters in England might appreciate it if he spent a bit more time sorting out problems here rather than pointing the finger over there.”
“That is what I am saying: A and E is the barometer of the whole system. If there is pressure anywhere, in the end it shows up in A and E. Hospitals become jammed: they cannot admit people from A and E to the ward because people in the ward cannot be discharged home. This is what we are seeing. The Secretary of State is in denial, basically. He is shaking his head and saying that this is nothing to do with the issues raised by the Francis report. I am afraid that this is the real experience of people—staff and patients—up and down the country, and the sooner he wakes up to it the better for us all. If he thinks the situation with regard to getting a GP appointment is acceptable at the moment that is up to him, but those of us on the Opposition Benches find it completely unacceptable.”
“Friend the Member for Leicester West found that there was simply no bed available in the public or private sector anywhere in England on a day when a very vulnerable child needed support. A recent freedom of information request by Community Care found that in 2013-14 10 trusts sent children to young people’s units more than 150 miles away. The furthest distance was 275 miles, from Sussex to Bury. A 12-year-old girl from Hull was sent 130 miles away to a unit in Stafford. Her child and adolescent mental health services team were searching for a bed for two days, and were told that the Stafford bed was the only one available in the country.”
“Friend the Member for Easington (Grahame M. Morris) says, an urgent area that needs to be addressed is mental health. Some 1,700 mental health care beds have been cut over the past two years because these Ministers have allowed the first real-terms cut in mental health spending for a decade. As a result, alarming stories are emerging of very vulnerable children and adults being held in inappropriate accommodation, such as police cells. According to Mind, many trusts are reporting more than 100% bed occupancy. One trust in London has had to turn office space into temporary wards with camp beds. We are also hearing of children being sent hundreds of miles to find an available bed. In a constituency case, my hon.”
“Dr Clifford Mann said he felt like “John the Baptist crying in the wilderness” because the Government’s reorganisation brought “decision-making paralysis” to the NHS. What does Dr Mann say now? He says that even after the reorganisation these issues cannot be dealt with, because “there are now a lot of semi-detached organisations to deal with”. Government Members do not like hearing it, but the fact is that the reorganisation by the right hon. Member for South Cambridgeshire (Mr Lansley) damaged front-line care in the NHS. May I remind the Secretary of State that just 12% of people think standards in the NHS have got better under the coalition, while 47% think they have got worse? Rather than pointing the finger at Wales, the Government need to spend a bit more time sorting out the problems they have created in England. As my hon.”
“Another trust below the Welsh average was Barking, Havering and Redbridge, which includes Queen’s hospital, Romford. May I recommend to the Secretary of State that instead of sitting there mumbling away, he read an article on The Guardian website today by Saleyha Ahsan, an A and E consultant who has worked at Queen’s hospital, Romford? She writes: “Being a doctor in accident and emergency has at times resembled being a medic in a war zone.” May I remind him that this is the English NHS she is talking about—the one he is supposed to be responsible for? She goes on to say that the severe shortage of A and E doctors is a result of his predecessor’s failure to listen to the warnings from the College of Emergency Medicine about the looming recruitment crisis, because it was obsessed by its reorganisation.”
“I, as part of the previous Government, left the lowest waiting times in the history of the NHS, and A and E was performing much better at the end of the previous Government than it is now. Hospital A and Es have dropped right down, so we do not need to take lessons from the hon. Gentleman. Let us return to the issue of England and Wales. The mantra or script of Government Members is almost to deny that there are problems in England. Last week, 16 major A and Es in England were below the Welsh average on waits in A and E. Some trusts are seriously struggling, such as in Leicester, in the constituency of my hon. Friend the Member for Leicester West (Liz Kendall), and Great Western Hospitals NHS Trust and North West London Hospitals NHS Trust, where one in four patients were waiting more than four hours.”
“It is interesting that Government Members do not like it, but this is the reality in the NHS right now, 12 months after the Francis report. Patient care is being compromised in the mental health care system. If the hon. Member for Mid Norfolk (George Freeman) does not think that that is relevant, let me quote Professor Sue Bailey, the President of the Royal College of Psychiatrists. She said that mental health units are “heading for a Mid Staffs scandal”. If that is not relevant, what is?”
“I am pleased that the hon. Gentleman has acknowledged that it was I who appointed Robert Francis to begin the process of an independent inquiry into what went wrong. I shall say more in a moment about what I did, why I did it, and why I stand by what I did, because in my view what I did was help to get to the truth while also helping Stafford hospital to recover.”
“My hon. Friend is right: it is the poor relation that has always been on the fringes of the system, and is always the first service to be targeted for cuts. That has happened again in these difficult times. The Government are cutting mental health services more deeply than the rest of the NHS, and that has led to all the problems that I have been describing. I went to Stafford recently to meet campaigners who are working to support the hospital. One of them told me that because of the lack of available mental health beds, beds had had to be found in the hospital for people who were experiencing serious mental health crises. That is what begins to happen when we do not have adequate capacity on the ground. Government Members say that this is not relevant, but it is directly relevant to all the matters that we are discussing today.”
“Let me quote from the Nuffield Trust’s report, entitled “The Francis Report: one year on”. In his foreword to the report, Francis himself says: “Perhaps of most concern are the reports suggesting a persistence of somewhat oppressive reactions to reports of problems in meeting financial and other corporate requirements. It is vital that national bodies exemplify in their own practice the change of cultural values which all seem to agree is needed in the health service.” Robert Francis himself says that national bodies are still behaving in a top-down fashion—one year on.”
“The Patients Association has said that “vital recommendations have not been accepted and…patient care could suffer as a result.” We support measures that the Government are introducing in the Care Bill on the appointment of chief inspectors, but let us be clear: they were not recommendations of the Francis report, and, if we are not careful, they will risk reinforcing a much more top-down approach to regulation. The position is not helped, I might add, by the Secretary of State’s new habit of calling hospital chief executives directly himself. Indeed, one of the great ironies of the Government’s reorganisation is that it has left the NHS a more top-down organisation than it was before, with clinical commissioning groups yet to find their voice and NHS England calling all the shots.”
“A range of measures were proposed with the aim of achieving that change, including a duty of candour for individuals and organisations, regulation of health care assistants, and, crucially, moves to strengthen the patient voice at local level by giving Healthwatch more protection and prominence. Francis recommended that local authorities be required to pass centrally provided funds to local Healthwatch groups, but that recommendation was not accepted. Of the £43 million allocated by the Department last year, HealthWatch groups have received only £33 million, which leaves £10 million unaccounted for.”
“I believe that the Government have mishandled their response to the Francis report, and I shall cite three examples in support of my claim. First and most obviously, the Government have failed fully to implement 88 of the report’s recommendations, as they have themselves acknowledged. Secondly, Stafford hospital has, in my view, been hung out to dry. Thirdly, by overtly politicising the whole issue of care failure, the Government have created a climate of fear throughout the NHS—the worst possible response to what Francis said. It seems to me that the Government have missed the entire point of the Francis report. If we distil the report into a few words, it called for a culture change.”
“I do support that campaign, because I think that we need transparency so that local people can see whether their hospitals have enough staff. I also support the full integration of health and social care into a single service—an even deeper integration than a pooled budget—because I believe that that is the only way in which we will build a service based on the individual. We need a system in which all the needs of one person are clear and the service can start in the home, rather than this fragmented world in which care in the home is being cut and older people are being left at ever greater risk of hospitalisation. I find it worrying that Government Members seem to be in denial about what I have been saying, and that brings me to the central point that I want to make.”
“My hon. Friend has raised an important point. People are confused about the new NHS, and confused about who has responsibility for what. The Government have created more organisations, not fewer; the NHS is more top-down than it was before; and that is not changing the culture. Robert Francis himself has said that the culture is not changing. The Government are utterly complacent if they think that they have got everything sorted out.”
“The Labour party’s view—informed by the Lewisham and Stafford examples—is that the Government are misusing the administration powers created by the last Government to drive through reconfiguration on cost rather than clinical grounds, and we will therefore move to delete those powers from the Care Bill next week.”
“I did not disagree with the coalition’s decision to upgrade it to a full public inquiry, as that was always a finely balanced judgment, but I did warn at the time that the hospital would need further support, given what a full public inquiry would entail. I do not believe that it has been given that support. Worse, the administration process that it has undergone has been brutal. I do not believe that there is a district general hospital in the land that could survive a three-year public inquiry followed by financial administration.”
“However, I stopped short of a full public inquiry because I had been warned that such an inquiry could destabilise the hospital and prevent it from making improvements. The Secretary of State nods. That is the advice that I was given, but I told Robert Francis that he could come back to me and ask for powers to compel witnesses to appear before him if he felt that that was necessary. He came back to me to say that he felt that he had had all the co-operation that he needed. Indeed, he had had more, because of the nature of the inquiry that I had set up. As the Secretary of State will recall, after the first Francis report I commissioned a second-stage inquiry into regulatory systems.”
“That is why I believe that the conclusion of the trust special administrator process is both wrong and unfair on them. It will result in a significant downgrade of the hospital, and there is still no clarity in regard to important services such as maternity. The issue of the future of Stafford hospital goes to the heart of the handling of the inquiry and the decisions made about it. When I arrived at the Department of Health in June 2009, the official advice that I received was that I should not hold any further inquiry into what had gone wrong, because it would distract the hospital from the essential task of making immediate improvements. I could not accept that advice, because I believed that we needed to get to the full truth of what had gone wrong. That is why I appointed Robert Francis to conduct an independent inquiry.”
“Time is against us, I am afraid. The Secretary of State is wrong if he thinks that top-down regulation is the only answer. It cannot prevent things from going wrong in the first place. The Secretary of State should accept all the recommendations of the Francis report, including the recommendations that are designed to change the culture at a local level. Let me now turn to the future of Stafford hospital, and address the point made by the hon. Member for Stone (Mr Cash). If there was one thing that the people of Stafford deserved after what had been a long and painful process, it was the legitimate expectation that, at the end of that process, they would see a fully functioning local hospital that was both safe and sustainable.”
“Instead, we need services based around the individual, starting in the home, with all barriers to integration are removed. That is essential if we are to rethink the care of older people as the Francis report invites us to do, and this shows the big difference between those on this side of the House and those on the Government Benches. They talk about integration but have instead legislated for fragmentation. Only by repealing the Health and Social Care Act will we put that right, put the right values back at the heart of the NHS and build an NHS ready for the 21st century.”
“They feel that there is an attempt to magnify the failings of the NHS and run it down, and that it is linked to a drive towards more privatisation. What the NHS needs to address some of the major issues that the Francis report raised is the ability to collaborate and integrate. The great sadness is that the Health and Social Care Act has placed it on the opposite path, towards competition and fragmentation. We now have the unbelievable spectacle of the Competition Commission intervening for the first time to prevent sensible collaboration between hospitals. The logical consequence of “any qualified provider” is more and more providers dealing with one person’s care. This is a recipe for cost, complexity and fragmentation. I am clear that the market is not the answer to 21st century care.”
“It was in 1997 that the General Medical Council finally started to investigate what had gone wrong at Bristol. I say to those on the Government Benches, for goodness’ sake please remember and take the long view on these issues. Let us all use these moments by making them a catalyst for change in the NHS. NHS staff report to me that they now feel a climate of fear and an intensification of the blame culture, with the talk of uncaring nurses, lazy GPs and coasting hospitals. We have seen HSMR—hospital standardised mortality ratio—figures misused by Government spin doctors to generate misleading headlines that have damaged struggling hospitals. It even got to the point where a group of senior clinicians and managers felt compelled to write to The Guardian at the end of last year, calling on the Government to call off the attack dogs.”
“Perhaps the most unseemly aspect of the last year has been an attempt by some to politicise the failing at Stafford. That has created a climate of fear in the NHS that may make it even less likely that doctors and nurses feel able to report mistakes or poor care and achieve the culture change that the Francis report advocated. I would like to remind those on the Government Benches that this stands in stark contrast to the way the previous Government handled the care failures they inherited from the Government before them at Bristol and Alder Hey, and also the Shipman murders. At Bristol, doctors raised concerns but were not listened to. Parents whose children had died or suffered brain damage were ignored. For a long time nothing was done.”
“I believe we owe it to the people of Stafford to support their hospital and maintain as many services there as possible. If the Secretary of State were to visit Stafford and sit down with people on the Support Stafford Hospital group, as I have done, he would hear a real sense of injustice from them that their hospital has been dragged down by a barrage of negative publicity. Will the Secretary of State confirm today whether Stafford hospital will continue to have a maternity service? Rumours and nods and winks are no good; people need to know. What will he do to ensure that the people of Stafford do not have to travel miles to get basic services? I can tell the House that I will continue to argue for the fullest range of safe services at Stafford, as that has been my consistent aim throughout this entire process.”
“The hon. Gentleman makes a very important call, and I think he is right: hospitals are going to have to change, and the sooner we all wake up to that fact, the better. I would also say to him, though, that hospitals cannot be changed top-down, as I believe his Government are trying to do with clause 119 of the Care Bill: a power to drive through financially driven reconfiguration and create a twin-track route outside of the normal, established process. The normal process creates local oversight and scrutiny at democratic level, and independent judgment on changes from the Independent Reconfiguration Panel. That is the established route and it should not be bypassed. I say that while agreeing with the hon. Gentleman that we do need a cross-party approach.”