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 35 of 45.
“The House can vote to reverse the competition policy introduced by the Government in the 2012 Act and to remove the market madness now holding back the NHS, and it could all be done because it would be consistent with the coalition agreement. The simple fact is that nobody voted for the NHS to be broken up in this way. Who gave this Prime Minister and Government permission to put the NHS up for sale? Nobody. They said there would be no top-down reorganisation. In the fullness of time, “No top-down reorganisation of the NHS” will be to this Prime Minister what, “No rise in tuition fees” is to the Deputy Prime Minister.”
“Around the world, we see that competition not only costs more, not less, than a planned system such as the NHS, but results in more fragmentation. It will never be an answer to the pressures in A and E. We need an approach where clinicians can collaborate and develop integrated solutions to relieve pressure. How can we possibly achieve integrated care when there are several different providers, each providing a different part of the same patient pathway? The A and E crisis will be permanent, unless the Government accept its root causes and remove the barriers to its solution. The answer is in the motion before the House.”
“I think the hon. Gentleman is referring to Hinchingbrooke, the contract for which, he will recall, was signed under his Government. If he comes to the House, he should at least have the decency to get his facts straight. A procurement exercise began under the NHS preferred provider policy that I introduced, but he will find that his Government changed that to any qualified provider, and then appointed Circle health, whose shareholders also happen to be major donors to the Conservative party, to run the hospital. The Government are spending millions of pounds on competition advice under the regime introduced by the 2012 Act. Since last April, CCGs, have spent £5 million on external competition legal advice. How can that be justifiable at a time when we have a shortage of A and E doctors?”
“Let us have a proper debate. I did not say the worst winter for a decade; I said the worst year in A and E for a decade. Let us get it straight. The Secretary of State should not redefine the question at the beginning of his speech. I am talking about the last 12 months, from this day today back to February 2013. Let us get that absolutely clear and let him answer for the last year, during which he has missed the A and E target 44 times out of 52.”
“For the record, I am afraid that the letter the Secretary of State quotes had its facts wrong. The information provided by the south-western ambulance service that I quoted was accurate. I wrote to the service the day it wrote to me to put it straight, and I am afraid it has not come back since and said that I was wrong; so again, let us get the facts straight. We have had enough spin from the Secretary of State; he needs to start dealing in a bit of fact.”
“If everything is exactly the same, why did the Government legislate? Why did they need a 300-page Bill if they were doing everything that the previous Government had done? Let the Secretary of State answer this question directly. There was a huge debate in the House about section 75 of the Health and Social Care Act, and his Minister had to withdraw the regulations and rewrite them, but the view of the entire NHS is that section 75 requires services to be put out to open tender, and does not leave discretion with GPs. GPs cannot decide, as the Secretary of State has claimed. Services are being forced out to open tender. Is that the correct position, or is it not?”
“The right hon. Gentleman seems to be arguing that the Health and Social Care Act 2012 is perfect— [ Interruption. ] It was his Act; he was a Minister. I quoted him in my speech as saying that it now needs to be amended. Will he be straight with the House this afternoon: does it need to be amended to remove the role of the OFT?”
“Was as my hon. Friend as surprised as I was at some of the sneering from Government Members when she intervened on me to point out that the number of malnutrition cases has gone up significantly? All we got from them was sneering abuse, but the facts speak for themselves.”
“I think the Minister was in the Chamber when his predecessor as care Minister held his hands up and admitted he got it wrong on competition when the Health and Social Care Bill went through the House. He has given hints to newspapers that he feels the same way. Would he care to step into the confessional and admit that the Liberal Democrats got it wrong on competition in the NHS?”
“Figures out today show a staggering 60% rise in spending on locum A and E doctors under this Government—in some trusts, 20 times more—because they cannot recruit staff. It has now come to light that Ministers were warned about this problem three years ago. Dr Clifford Mann, president of the College of Emergency Medicine, said that when he tried to raise this issue, he was left feeling like “John the Baptist crying in the wilderness”. Why did Ministers ignore an explicit warning in 2011 from the top A and E doctor in the country?”
“Mr Speaker, sometimes it takes a long time to rewrite history, which was what the Minister was just doing. The first warnings did not come in 2004. Dr Mann said: “The first warning signs were three years ago when we failed to recruit 50% of our posts. Those concerns were raised at the time.” Why does he believe his concerns were ignored? He blames “decision-making paralysis” caused by a top-down reorganisation no one wanted and nobody voted for. Ministers dismantled work force planning structures, making redundant the very people who could have done something to stop the locum bill spiralling out of control. Will he now concede that breaking the coalition agreement promise of no top-down reorganisation has weakened the NHS and made the A and E crisis worse— [Interruption.]”
“All year, that barometer has been warning us of severe storms ahead, and yet, three weeks ago, the Secretary of State stood at that Dispatch Box and claimed that this was “a crisis that is not happening”. —[ Official Report , 26 November 2013; Vol. 571, c. 155.] He should try telling that to the families of people left waiting for hours on trolleys in corridors; to the people who have been ferried to hospital in police cars and taxis because ambulances are trapped in queues at accident and emergency; and to the A and E sister who attended our A and E summit here in Parliament last week and said: “It feels like we’re fire fighting. It’s crisis management.””
“As we approach the end of 2013, it is becoming clear that this has been the worst year in accident and emergency for at least a decade. All year, the pressure has been relentless. It is not just a winter crisis, but a spring, summer and autumn crisis. Across the 12 months, more than 1 million people have waited more than four hours to be seen, which is a threefold increase since 2010. For the past 22 weeks, hospital accident and emergency departments have missed this Government’s target. Last week, the target was missed by the NHS as a whole, which is a warning sign that winter has now arrived and things are getting even worse. Accident and emergency is the barometer of the whole health and care system.”
“I beg to move, That this House is concerned about recent Government statements on Accident and Emergency (A&E) and Government claims that it is not in crisis; notes that last week, 79 A&Es and the NHS overall missed the Government’s A&E target; further notes that attendances at hospital A&Es have increased three times faster since 2009-10 than in the period from 2004-05 to 2009-10, and that in the last 12 months more than one million people have waited more than four hours; believes there are a range of reasons for the current pressure on Accident and Emergency but that difficulty in accessing GP services is one of the primary causes; regrets the Government’s decision to cut funding for evening and weekend GP opening and scrap the guarantee of a GP appointment within 48 hours; and, to ease the pressure in Accident and Emergency, calls on the Government to reverse for winter 2013 its scrapping of the 48-hour appointment guarantee.”
“For instance, there is the paramedic who told us of his worries about ambulance response times getting longer because ambulances are trapped at A and E; and of the time when a patient who was held a long time at the door of a busy A and E suffered a heart attack and had to be rushed back to the ambulance. Another paramedic told us about being at the scene of a serious incident in a city centre. After calling for back-up, he was joined by a private ambulance which did not appear to have adequately trained staff to take patients to hospital. A community nurse spoke of her frustration at spending an hour and a half on the phone trying to get a GP appointment for a frail patient. An A and E-based occupational therapist said that she was now regularly diagnosing dementia for the first time in older patients who had ended up in A and E.”
“That is a question for the Secretary of State. How can it make sense to close so many A and E departments in the middle of an A and E crisis? This year, the facts on the ground have changed. As I have said, it has been the worst year for a decade. Any proposal to change A and E in areas such as that of my hon. Friend needs to be considered in the light of that new evidence. We need to consider whether it is safe to proceed. As the A and E sister said, it is crisis management. That is the view from the real world. In here, it is a different story. It is, “Crisis, what crisis?” My purpose in holding this debate is to cut through the spin. I want to bring into our debate today the voices of those A and E nurses, occupational therapists, paramedics, community nurses, and NHS 111 staff and mental health professionals who came to our summit.”
“I agree. The Government have made grave mistakes. I warned them—they misquote me every week—that it would be irresponsible to give increases to the NHS, which is what they were promising, if they had to ransack local government, particularly social care budgets, to pay for them. That is a false economy. It means that older people have support withdrawn from the home, and they drift towards A and E in ever greater numbers. That is what is happening today on this Secretary of State’s watch.”
“The Government are tearing up the social fabric of England’s most deprived city. This is a city in which people struggle to feed their kids and to make ends meet. Council services are utterly crucial in helping people to cope. The Government do not understand, or they do not care, and they just rip up the fabric of an entire city. It is disgraceful.”
“As the hon. Lady says, ambulance services and A and E are often now not working well together. I mentioned the paramedic held at the door, and we are hearing of queues at A and E. What we cannot have are perverse incentives in the system. The Secretary of State needs to look at the issue that she raises.”
“Dr Ellie Cannon, a GP who also writes for The Mail on Sunday , recently tweeted: “I’m sad to say that at my NHS practice if we have a patient who has unexplained symptoms, we have started asking if they can afford to eat”. How can that possibly be right in England in 2013? Has the Secretary of State considered reviewing the effect on people’s health of the growing problem of food poverty and has he discussed the effects of benefits policy on people’s health with the Secretary of State for Work and Pensions? If he has not, I suggest that he does so immediately.”
“The House is soon to debate the scourge of food poverty that now blights our land. Food banks are growing at an exponential rate. Indeed, we now read that it is Government policy to ask councils to set up more, even though they have just cut the funding of the councils with the most food banks. It is unbelievable. It suggests to me that they expect food poverty to be with us for some time to come and have no real intention of tackling it. People will go on having to choose between eating properly and putting the heating on— [ Interruption. ] The Secretary of State chunters, but he has no idea what it is like to do that, has he? People are making other impossible choices that might damage their health. I am told of the growing number of people now taking prescription medicines on an empty stomach because they cannot afford to eat properly.”
“I will make some progress because I am conscious that many Members want to speak in both debates. The picture that emerged from our summit was of a health service on the edge, creaking at the seams, with corners being cut and A and E as the last resort for people failed by other services—people who, in an ideal world, ought not to have been there. We heard of people with severe mental health problems in A and E because of a lack of crisis beds, people with severe dental pain who could not afford treatment, disorientated older people with dementia and, perhaps saddest of all, palliative patients in A and E waiting areas. It is clear that the cost of living crisis and this Government’s failure to support people through it might also be driving people to A and E.”
“Finally we have an admission that the pressure has built on his watch, but as ever, it is nothing to do with the Government. It is nothing to do with the break-up of NHS Direct and its replacement with the disastrous NHS 111, nothing to do with the closure of a quarter of NHS walk-in centres, nothing to do with the severe cuts to social care and the removal of home care from vulnerable people, nothing to do with the loss of 6,000 nursing jobs and nothing to do with the reorganisation that no one wanted and no one voted for that threw the entire NHS into chaos just when it needed stability and that has led to precious NHS money being spent on redundancy payments only for those people to be re-employed by new NHS bodies. No, it is now all the fault of the ageing society. You could not make it up, Madam Deputy Speaker.”
“I asked the Secretary of State whether he had spoken to the Work and Pensions Secretary, and he needs to do so urgently. The truth is that pressure has been growing all year on A and E and he has been ignoring the warnings, sticking to his usual line of blaming everyone else. His original line was to blame the 2004 GP contract, but that was undermined by the Chair of the Select Committee on Health and the inconvenient fact that there was no winter crisis in 2005, 2006, 2007, 2008 or, indeed, 2009. Having seen his original spin dismissed, the Secretary of State changed tack. In a message to NHS staff on 6 December he said: “Our ageing society has meant 1.2 million more people in A&E every year compared to 3 years ago”.”
“That is the central point of my speech: the removal of the guarantee that patients could get an appointment within two working days. The Government removed it in June 2010 and, as a result, we all hear stories, do we not, of people saying that they are getting up and ringing the surgery at 8 or 9 o’clock in the morning and are being told that there is nothing available for days. That is a result of the Government’s decision to remove the two-day guarantee. That is why people are facing that frustration. I shall explain that in more detail— [ Interruption. ] Government Members say that the guarantee did not work, but in 2005 nine out of 10 people said that they could get an appointment within two days. Have those Members checked the figures recently? There is falling satisfaction with GP services and it is happening on their watch.”
“I have heard from two senior sources that the Secretary of State has discussed within government whether Cobra should be convened to discuss the A and E crisis. Can he confirm or deny whether that is the case? I have no way of knowing, but he needs to give a straight answer. The longer we see the Secretary of State in this job, the more familiar we become with his style: spin before substance. That is the real danger when someone holds a job as important as his. If they use spin to distract people from the real causes of the problems, they end up neglecting those problems and precious time is lost.”
“I mentioned the reorganisation, through which we saw the complete disruption of training arrangements in the NHS. The Government’s eye was taken completely off the ball of the growing problem of recruitment, not just of GPs but of A and E doctors. That is a real problem around the country. We now have fewer GPs per 1,000 of population than we had a few years ago, so my hon. Friend is absolutely right to raise that issue. The new spin is that the Secretary of State admits that A and E has got worse on the Government’s watch, but it is not his fault and it is not a crisis. That is the public line, at least. In private, it is a different story. This is the Secretary of State who has taken up ringing hospital chief executives who are not meeting their A and E targets.”
“Last week, the NHS missed its A and E target—the hon. Lady’s A and E target—which is a lowered target. If she is going to maintain that complacency through the winter, I suggest that it might well backfire on her.”
“Since the change of Government, the previous Secretary of State and this one have talked about a formula based predominantly on need, not deprivation. The worrying thing about that is that it means that we have a formula based on the use of NHS services as opposed to the need to improve health. NHS England has been debating that issue this week and I hope that it has taken heed of what has been said in this House, because to do this to the NHS alongside the local government cuts mentioned by my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) will be catastrophic for the communities in this country with the greatest need.”
“A and E is getting worse and worse on his watch and people want to know how he plans to turn things around and ensure that all A and E departments and ambulance services can get safely through the winter. He now needs to put away his stock speech, cut the spin and get a grip, and fast.”
“Those are two practical suggestions that I hope the Government will consider and accept. If the Secretary of State will not accept them, he needs to put forward other suggestions of his own to help people get access to good advice via a GP or over the phone and to avoid A and E this winter. If he refuses to do that, is he really saying that everything possible has been done to ensure that things do not get worse in the months ahead? In conclusion, the NHS today stands on the brink of its most dangerous winter in years. It is a serious situation and people are looking for straight answers from the Secretary of State. It has got harder to get a GP appointment on his watch and people want to know what he is going to do about it.”
“Secondly—this is the centrepiece of what I want to say today—given the evidence to show that the 48-hour guarantee worked to divert people from A and E, there is a clear case for reintroducing it this winter. It is true that GPs might not be so keen on it, but it was valued by patients, and that is the most important thing. The Secretary of State needs to listen to what people are saying about their difficulties in getting an appointment in office hours, not in out-of-office hours. He must do something to address that. Will he divert some of the funding that he has made available to meet A and E pressures to that purpose, or indeed will he reclaim some of the funding he has handed back to the Treasury? It is so important that people can get appointments when they need them.”
“Does he accept that there is a crisis in A and E? He has gone quiet, but we will hear from him in a moment. Or does he still maintain that it is not happening? We need to know. With January just around the corner, people want practical answers to straight questions and some proposals to make things better. First, will he consider making urgent changes to NHS 111 and putting nurses and clinicians back on the other end of the phone line? Evidence from across the NHS tells us that the cut-price model of call handlers with computer algorithms simply does not work. Too often the computer says, “Call an ambulance or go to A and E.” The sensible change back to an NHS Direct-style system was recommended by Sir Bruce Keogh in his report and should be made right now ahead of the winter.”
“The Government have tried to blame GPs for the problem, but that is unfair, because this Government have cut the funding for general practice, cut the funding for delivering better patient access and convenience and, I have already said, cut the number of GPs per thousand of the population. The analysis could not be clearer. The question is where do we go from here. The House has got used to the Secretary of State’s stock speech, which takes no responsibility for what is happening now in the NHS and seeks to blame the previous Government for everything that is going wrong. Well I have news for him: that will not work today. A and E is getting worse on his watch. He has presided over the worst year in A and E for a decade. People need an honest assessment of the situation, and of the urgency and the NHS’s ability to cope this winter.”
“This is the simple truth that they do not like to admit: it has got harder to get a GP appointment under this Prime Minister and this Government. People who call their surgery early in the morning only to be told that nothing is available now know why. There are now 854 fewer GP practices in England offering evening and weekend openings than there were in July 2009. The Patients Association has found that six out of 10 people said they could not see a GP for at least two days and four out of 10 said they could not book an appointment for at least two days in advance. All that is leading to some people turning straight to A and E and others getting sicker while they wait and then arriving in A and E as a more serious case.”
“Secondly, it created incentives for GPs to offer evening and weekend opening. Thirdly, it allowed the previous Government to offer people a new guarantee of a GP appointment within two working days. And it worked. In 1997 only half of patients could get an appointment within 48 hours, but by 2005 nine out of 10 patients could do so. As a result, A and E was performing much better than it had been in 1997. What has happened since? This Government have scrapped all those measures to improve patient access and convenience. They removed the right set out in the NHS constitution to an appointment within two days, stating that it was no longer a priority. It might not be a priority for them, but let me tell them that it remains a high priority for my constituents and those of my hon. Friends.”
“The Secretary of State really needs to answer for the cuts to London’s A and E departments, particularly at a time of unprecedented pressure, and for the desire to bring forward closures supported by a financial case, rather than a clinical one, as in Lewisham. I want to set the record straight about the 2004 contract and dismiss the myths that have been put about. The fact is that it gave the public much quicker and more convenient access to GPs and relieved the pressure on A and E. Let me explain the changes it made. First, it created the ability to add an incentive to allow patients to book an appointment several days ahead. Members might recall Tony Blair being challenged on that very point during a live TV debate before the 2005 general election. As a result, he brought forward a new measure to give people that ability to plan ahead.”
“Do not the views of patients matter most? The right hon. Gentleman is quoting the professionals, but perhaps it is sometimes inconvenient for them to have to do things. Surely the point is that people are ringing surgeries and cannot get appointments. If he does not like the 48-hour target, surely he and the coalition Government should put forward their alternative so that people can get to see their doctor.”
“How can it be appropriate to introduce a debate on such fundamentally important issues as the way we care for older people with such narrow, petty, partisan, point scoring efforts? May I just say to the Secretary of State that he should not stand there and misrepresent the position of the Opposition? We will not oppose the Second Reading—we have tabled a reasoned amendment, because we do not believe his proposals for a cap are what they seem, but we will not oppose the Second Reading of this Bill. He should get his facts straight before he comes to that Dispatch Box.”
“On a point of order, Mr Speaker. Is it in order for the Secretary of State to misrepresent the views of the previous Government and previous Ministers, and refuse to take interventions? He has just said that I refused to change and strengthen the regulation system of hospitals in England—that is factually incorrect. I brought forward a new system for the registration of all hospitals in England in autumn 2009, on the back of recommendations from the CQC. Again, he should get his facts straight at that Dispatch Box.”
“The failure of successive Parliaments to face up to it has left in place today a care system in England which is underfunded, overstretched— [Interruption] —and in danger of being overwhelmed—a malnourished, minimum wage service where care is given in 15-minute slots, with barely time to make a cup of tea, let alone have a meaningful conversation or make someone comfortable.”
“The Bill began as a response to the Dilnot report and a reform of social care, but has since taken in major new measures on the NHS. It deals with issues that matter greatly to millions—issues to which that very thin speech we have just heard did not do justice. Worse, it was an inappropriate attempt to turn an occasion such as this into the latest stage of the Secretary of State’s political smear campaign. I refuse to sink to his level, and instead will deal with the important issues before the House today. For clarity, I will take the issues separately—social care, then health. Providing good care for all older and disabled people and finding a fair way to pay for it is the greatest unresolved public policy challenge of our times.”
“I beg to move That this House, whilst affirming its belief that the Care Bill [Lords] is a modest step towards a better social care system that protects some people from catastrophic costs, and welcoming the new rights for users and carers that the former Labour Government initiated, notes that the Bill’s deferred payment scheme will result in people continuing to have to sell their homes to pay for care; disagrees with the Government’s assertion that their proposals will cap care costs at £72,000 given that self-funders will face far higher bills; further notes that it includes provisions which could put NHS hospitals at risk of having services reconfigured without adequate consultation and without clinical support; further notes that the Bill fails to include measures to address the current crisis in care and meet the needs of the UK’s ageing population, including a genuinely integrated NHS and social care system; and therefore declines to give a Second Reading to the Care Bill [Lords] because it is an inadequate response to the scale of the challenge facing social care and fails fully to implement the recommendations of the Francis Report.”
“Is not the message that we are sending to people who work in our care service, particularly young people coming into the service, that looking after someone else’s mum or dad is the lowest calling they can answer, when really it should be the very highest?”
“The issues are huge. They affect every family in this country and the worries they have about how they will look after their mum and dad in later life. They did not hear any answers from the Government this afternoon. I hope my hon. Friend will hear a few from me. I know that she has campaigned on the use of zero-hours contracts in our care system. Is it not a sad reflection on both sides of the House that today in England around 300,000 care staff are working on zero-hours contracts? They do not have the security of knowing what they will earn from one week to the next, so how can we expect them to pass on a sense of security to those they care for?”
“I would like to say that I would have been shocked, but I know that the system just gets worse and worse each year as the pressure builds and corners have to be cut, and it is older people and their families who are paying the price. How can any “care” be given in five minutes? Of course it cannot. It does not make financial sense in the long run, because we have a care system that does not provide people with support in their own homes, buts leaves them to drift towards hospital, leaving our acute hospitals increasingly and unsustainably full of frail older people.”
“I would have thought that the hon. Gentleman had been here long enough to know the difference by now. We will not oppose the Bill, in the sense that we will not vote against it on Second Reading, but it contains measures to which we simply cannot give a clear endorsement, as I will go on to explain. That is the purpose of our reasoned amendment. We will not oppose the Bill’s passage on Second Reading, which is why I objected to the Secretary of State misrepresenting my position.”
“I agree with the hon. Gentleman, which is why I am not opportunistically opposing the Bill. I have tabled a reasoned amendment to put on the record the very serious concerns people have about funding for local authority care in England, the way the new cap will work and, in particular, the proposed clause on hospital reconfiguration—the Lewisham clause. I cannot let those concerns pass without making clear our position on them from the Dispatch Box. That is why we have taken that stand. That is why I am seeking to introduce my remarks in a non-partisan way.”
“The Government have not listened to that, and this Bill makes matters worse for local authorities by placing new, unfunded and uncosted burdens on them. The fact that it restricts the eligibility of those in substantial or critical need of support is, in itself, a clear admission on the Government’s part that the support system overall is being scaled back.”
“In short, the Government are promising future help instead of helping people right now. Secondly, the proposed £72,000 cap is not what it seems; it is a care con. On funding priorities, the Government are failing to face up to the scale of the funding crisis facing councils right now. In the cross-party talks on the Dilnot report, Labour stated a clear principle that the cap and the council baseline must be considered together as equal priorities. That was supported by Andrew Dilnot himself, as the right hon. Member for Sutton and Cheam (Paul Burstow) may remember, because he was also party to those talks. As a first step, we called on the Government to use some of last year’s NHS underspend to tackle the care crisis—and, by extension, to ease pressure on A and E—instead of handing the money back to the Treasury.”