John Healey
MP for Rawmarsh and Conisbrough · Labour · United Kingdom
“Mr Spock, I think some would say, Mr Speaker! My hon. Friend is right. Despite global conflicts, trade tensions and rising threats in the world, which are pushing up inflation, bearing down on growth and pushing up borrowing costs, the UK economy is demonstrating huge resilience.”
“The Prime Minister and I have been clear that we must cut the costs of welfare. On levels of taxation, we had a period of Conservative Government, with low growth and high debt. They crashed the economy with the mini-Budget, and we had levels of taxation that were putting pressure on business, adding to the cost of living.”
“The hon. Lady is talking to the person who led the work to establish a defence and security partnership with the European Union and bilateral agreements with other countries, on which we now build both our economic strength and our national security strength. On the question of the Budget, I ask the hon.”
“Since day one in the job, the Prime Minister and I have been in lockstep in our determination to meet Britain’s fiscal rules. This is the bedrock on which we build good growth and help give a bit of breathing space to families and businesses.”
“May I start by paying tribute to my predecessor, my right hon. Friend the Member for Leeds West and Pudsey (Rachel Reeves)? I am proud to have been a member of a Government with the first female Chancellor in 700 years.”
“My hon. Friend speaks up very strongly for his local area. He is right about the importance of pubs, social clubs and live venues, and about the importance of the 20% cut that we announced in July. These are the things that make the places where we live the places that we also love.”
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“I am surprised that the Health Secretary was asked a direct question and did not answer. I would simply encourage my right hon. Friend to keep asking the questions that he feels are important for the future.”
“My hon. Friend won his seat at the last election because he helped to expose the truth about the Conservative plans for housing—a truth that it denied but which has now come true. He is absolutely right. The truth about what is happening in the health service now is that patients are starting to see the signs of strain and services being cut, and that is not what they expected when they heard the Prime Minister, before the election and afterwards, promising to protect the NHS.”
“The problem for PCTs, and the managers and staff who work in them, is that they are being asked to do several things at the same time: to make unprecedented efficiencies at a time when the NHS is being put through its tightest financial squeeze in history; to axe its own jobs; and to guide the reorganisation and ensure that it can take place. That is a tough challenge for anyone. I am sure that the hon. Gentleman will keep on his local PCT’s case.”
“The Lib Dems’ principal concern was to strengthen local and public accountability of health services, but the Bill seriously restricts openness, scrutiny and accountability to both the public and Parliament. It will lead to an NHS in which “commercial in confidence” is stamped on many of the most important decisions that are taken. I therefore say to the hon. Gentleman and his Lib Dem colleagues: this is not your policy, but it is being done in your name. The public will hold you—”
“The main evidence of any influence of Lib Dem ideas on health policy in the coalition agreement was the commitment to “ensure that there is a stronger voice for patients locally through directly elected individuals on the boards of their local primary care trust”. The Bill abolishes PCTs. The Lib Dem policy priority before the election was to ensure that local people had more control over their health services. The Bill places sweeping powers in the hands of a new national quango—the national commissioning board—and a new national economic regulator, which is charged with enforcing competition, to open up all parts of the NHS to private health companies.”
“I am more interested in what we will be facing in future. I am more interested in the claim by the Health Secretary that there will not be, as he describes it, a rigged market in future, but a level playing field for all providers. However, my hon. Friend— [ Interruption. ] Well, we will see. The hon. Gentleman is a member of the Select Committee on Health, and he follows such matters closely. I urge him to read page 42 onwards of the impact assessment, because there he will see the preparations for being able to pay for the sort of thing that he criticises in the health service. As the hon. Gentleman gives me this opportunity, let me say to him and his Lib Dem colleagues that what we are facing is clearly Conservative health policy, not coalition health policy, and certainly not Lib Dem health policy.”
“I accept that correction, Mr Deputy Speaker. Let me put it in these terms. The policy is not Liberal Democrat policy, but it is being done in their name, and the public will hold the Liberal Democrats responsible if they allow the Tories to do this to our NHS.”
“That is one of the things that worries experts and those in the health service the most. It is also one of the things that the right hon. Member for Charnwood (Mr Dorrell) and his Health Committee were most concerned about. [ Interruption. ] The right hon. Gentleman is nodding. “Disruptive” was one term that the Committee used for the changes.”
“Well, my hon. Friend is right in this respect: people will come to see clearly that they cannot trust the Tories with the NHS; they will come to see clearly what these changes really mean for their services; and they will come to see clearly what the future of the NHS holds.”
“No, I do not accept that, but I will tell the hon. Gentleman that the measures in this Bill will undermine many of his principal concerns and policy priorities about opening up the NHS to the public and to Parliament. I hope that he will take a close look at what the Health Secretary really plans.”
“The Prime Minister writes in The Times today, just as the Health Secretary did last week, both of them producing 700 words about their health plans, yet they made not a single mention of competition. We will explain and expose the truth throughout this debate and the Bill’s passage through Parliament because these changes will break up the NHS; they will open up all areas of the NHS to price-cutting competition from private health companies; and they will take away from all parts of the NHS the requirement for proper openness, scrutiny and accountability to the public and to Parliament. These Government changes are driving free market political ideology into the heart of the NHS, and that is why doctors are now saying: “As it stands, the UK Government’s new Bill spells the end of the NHS.””
“My hon. Friend is right—and the chief executive of the Patients Association, Katherine Murphy has said just that. Many patient groups are making the same arguments and issuing the same warnings. My serious concern is that this Government have told only half the story from the start. The Health Secretary and the Prime Minister are happy to talk about GP commissioning and happy to talk about cutting management—the organisational changes—but they downplay or deny the deep ideological changes at the heart of these plans. The Health Secretary mentioned the new economic regulator, Monitor, in just one line in a speech lasting more than 40 minutes. The Prime Minister said last week in his speech on public services that these reforms “are not about theory or ideology”.”
“With this Bill, the Government are now breaking their promise to stop top-down internal reorganisations and they are putting extra unnecessary pressure on the NHS. Patients are starting to see waiting times rise; they are starting to see discharges from hospital delayed; they are starting to see wards mothballed and staff posts cut. That is not what people expected when the Prime Minister promised to protect the NHS. The Prime Minister’s most personal pledge to the public is becoming his biggest broken promise.”
“The public are being told that the reorganisation is “patient centred”, but patients are being sold a false promise on the NHS. The changes in the Bill come in only in 2013, but patients are already seeing the consequences of the Government’s handling of the health service. The Government have scrapped Labour’s waiting time targets, which were, of course, the patients’ guarantee of being seen and treated promptly. They are breaking the Prime Minister’s promise of a real increase in NHS funding, so Scotland is being short-changed next year by £70 million and Wales is being short-changed next year by £40 million. England, if we take out the double counting of cash to be spent on social care rather than on NHS services, faces a shortfall next year of £1.2 billion on the Prime Minister’s promise.”
“This is ideological. It is about driving politics into the heart of the NHS, and in some respects breaking what has been a 60-year consensus. Parties on all sides have tried to make decisions about the best interests of patients and better services, and not about their own political ideologies. That has changed today, with this Bill.”
“Despite the boast about putting patients at the heart of everything that the NHS does, there is no place for patients on the bodies that will make the most important decisions on the NHS. There is no place for them on GP consortia, no place for them on the national commissioning board, and no place for them on the regulator, Monitor.”
“I want to make a bit of progress before I give way again. The public are being told that this reorganisation is patient-centred, but most patients’ GPs will not, in practice, be doing what the Government claim they will be doing. GPs spend an average of only about eight minutes with each patient. If they continue as family doctors, the commissioning will not be done by them; it will be done in their name by the managers in the primary care trust who carry out that function now, or by private health companies that are already hard-selling their services to GP consortia. Those consortia are being sold a false promise as well. Because expanded open-ended choice of treatment means funding unused capacity in the system, it is highly unlikely to happen at a time when NHS finances are under pressure.”
“They are the words of the Health Secretary, published on ConservativeHome last week. The Prime Minister argues that this is somehow an evolution and not a revolution. The Bill, however, is more than three times as long as the legislation that set up the NHS in 1948. The NHS chief executive told the Select Committee on Health: “The scale of change is enormous—beyond anything that anybody from the public or private sector has witnessed”. The Health Secretary argues that the Bill is somehow an extension of Labour policies. That is wrong, and it disguises again the fundamental changes to the NHS in the Government’s plan. Make no mistake, Mr Deputy Speaker: this is a revolution, not an evolution.”
“The hon. Gentleman has already heard some of my hon. Friends mention the analysis of Dr John Appleby, published in the British Medical Journal online last week. He took to task those who had made the sweeping assertion that somehow Britain’s health service lags behind those of the rest of Europe. It is an argument that the Prime Minister advances. It is an argument for change, he says, because we are still a long way from European standards of care. Let me read something to the House. We have been told that “if you have heart surgery in England, you now have a greater chance of survival than almost any other European country – over the last five years, death rates have halved and are now 25 per cent lower than the European average.” Those are not my words, or even those of Dr John Appleby.”
“His actions would not achieve the full-scale switch to forced market competition, which is the true purpose of the changes. Meanwhile, the biggest challenges and changes for the NHS will be made harder, not easier, by the reorganisation. Such challenges include making £20 billion of efficiency savings and improving patient services; ensuring better integration of social care and health care, of primary care and hospital care, and of public health and community health; and providing more services in closer reach of patients in the community rather than in hospital. But the Government will not listen to the warnings from the NHS experts, the NHS professional bodies, patient groups or even the Select Committee on Health.”
“We will defend to the end a health service that is there for all, fair for all and free to all who need it when they need it. If the stated aims for the reform were all the Government wanted—we have heard the Health Secretary say that he wants a greater role for doctors in commissioning, more involvement of patients, less bureaucracy and greater priority put on to improving health outcomes—he should do what the GPs say: turn the primary care trust boards over to doctors and patients, so that they can run this and do the job. But there is no correlation between the aims that the Health Secretary sets out and the actions he is taking. There is no connection between his aims and his actions. He is pursuing his actions because his aims are not sufficient.”
“My hon. Friend may be right. I have not seen the regulations, but that is certainly in the impact assessment, so he is on to an important point. Government Members and the Health Secretary have spent a long time talking about Labour’s plans, policies and record, but the debate at the heart of this Bill is not about whether competition, choice or the private sector has a part to play in the NHS—they have and they do. The debate at the heart of this Bill is about whether full-blown competition, based on price and ruled by competition law, is the right basis for our NHS. That is why Labour Members oppose this Bill. We want the NHS run on the basis of what is best for patients, not what is best for the market. We want the NHS to be driven by the ethos of public service, not by the economics of forced competition.”
“They are starting to ask, “What on earth are the Government doing with the NHS? Why don’t they listen to the warnings? Why is the Prime Minister breaking the very personal promise he made to protect the NHS?” The Bill puts competition first and patients second. That is why we will oppose the Bill tonight and expose this truth in the months ahead. These are the wrong reforms for the wrong reasons at the wrong time.”
“Because the reorganisation will force doctors to make rationing decisions as well as referral decisions for their patients, they will make treatment decisions with one eye on their patient and the other on their budget and their consortium’s bottom line. The Government say they are devolving power to front-line services, putting clinicians in control, making the NHS more accountable and improving the integration and quality of services, but in the Bill they are making the forces of competition and centralisation far stronger than those of devolution, democratic accountability or the development of quality in patient services. We will explain and expose the gap between what Ministers are saying and what they are doing in every debate at every stage of this legislation. Patients and staff are already seeing signs of strain in the NHS.”
“If patients have been sold a false prospectus, that is true of GPs too. GPs are being told that they will call the shots on deciding who provides care for their patients, but they are being set up by the Government. They are likely to find their hands tied by Monitor and the Office of Fair Trading and by the courts enforcing competition law. They are likely to find their decisions challenged by private companies if they do not accept “any willing provider”, especially one that offers to undercut on price. The chair of the Royal College of General Practitioners recently issued a warning to her colleagues. She said: “I understood these reforms were about putting GPs at the centre of planning healthcare for their patients, not about making sweeping cuts, which will include shutting hospitals, making enormous redundancies, closing services”.”
“My hon. Friend is right. The more that NHS staff see of the changes and the consequences of this Government’s handling of the NHS, the more concerned they are about the changes and the more they are starting to see the NHS go backwards. But the Government will not listen to these warnings that are coming from all sides. They are in denial about the risks: the risk that patients will see services get worse, not better; the risk that up to £3 billion will be wasted on internal reorganisation; the risk that innovation and improvements in care that come from greater collaboration will be blocked by the Office of Fair Trading, competition courts and the new market regulator; and the risk that the Bill will create the monster of a full-blown market in health care which GPs will not control and nor will Ministers or Parliament.”
“The right hon. Gentleman started by saying that the policies are an evolution. If that is the case, why did he say: “I thought we were looking to develop existing institutions rather than starting again, and that appeared to be confirmed in the coalition agreement.””
“The Secretary of State talks a lot about GPs using £80 billion of public money to commission services, but if they are to carry on being family doctors, the planning, negotiating, managing and monitoring of hundreds of commissioning contracts will be done not by GPs but in their name, either by the people who do it now in primary care trusts or by the big health companies that are already hard-selling the service to new GP consortia. Is he not deliberately disguising the true purpose of his changes, which is to open up all parts of the NHS to big private health care companies?”
“Why will the right hon. Gentleman not be straight with the public? I have with me the White Paper—57 pages and only three references to the market, all of them to the social market. He talks about GP commissioning, but not about the hard-line political ideology that underlines these changes. The Bill puts no limit on the use of NHS beds and staff to treat private patients, it puts no limits on big private health care companies undercutting and undermining local hospitals, and it puts at the heart of the new system an economic regulator charged not with improving services but with guaranteeing and enforcing competition. Is this NHS reorganisation not like an iceberg, with the substantial ideological bulk being kept out of the public’s sight?”
“Amendment 8 in particular lays the groundwork for the Exchequer Secretary and his colleague the Chancellor to make the right decisions in order to honour their promises in the Budget. There were big improvements as a result of Labour’s investment in the NHS over the past decade—51,000 extra doctors, 98,000 extra nurses, patient satisfaction at an all-time high—and it is hard to remember that in 1997 there were more than 280,000 people waiting more than six months to get into hospital for the operations they needed. I make that point to explain the broader context to amendment 8, as I am conscious that the House is debating a relatively narrow provision.”
“With them, we are offering to him, his boss the Chancellor and his colleagues in government the opportunity to act to prove to the public that they will honour the promises the Government made about protecting NHS funding and ensuring it sees a real funding increase each year, not a real cut. The Bill and national insurance contributions legislation more generally are about raising and allocating national insurance funds and contributions paid into that fund. The NHS has had a special place in that legislation certainly since 2002, when we decided to move, from April 2003, to raise an extra 1% on earnings above £43,800 and to allocate all that extra income to the health service and the NHS. The amendments we tabled, including amendment 8, give the Government the chance to do the right thing by the NHS and the British people.”
“I beg to move amendment 8, page 2, line 2, at end insert ‘The National Audit Office shall report to Parliament by the time of Royal Assent on the Finance Act 2011 on the sum that would be required from the product of additional rates in order for the health service allocation to grow in real terms in every year.’. It is good once again to face the Exchequer Secretary across the Dispatch Box, although not so good to do so from the Opposition side and with him on the Government side. However, he is a serious Minister doing a serious job. He showed that in the way he responded to my right hon. Friend the Member for Delyn (Mr Hanson) and the debate on the first group of amendments. I hope that the Exchequer Secretary will feel that amendment 8 and the amendments that were not selected were intended to be helpful to the Government.”
“The Exchequer Secretary is a talented Minister and he has an opportunity to give his big boss, the Prime Minister, the confidence that he clearly wishes to see by accepting the amendment and allowing the NAO to do an independent report, demonstrating the extent of the shortfall and the extent to which the Government are breaking their promise fully to fund the NHS. By doing so, he would do the House and perhaps even himself a favour.”
“The amendment suggests having an independent assessment and a report carried out by the National Audit Office. The independence is important: it is designed to try to give the public more confidence in what the Government are doing; to give this House more confidence in what they are doing; and to give everyone more confidence that what was a central promise from the Government and a personal promise from the Prime Minister is in fact being met. This subject came up at the last Prime Minister’s Questions before Christmas, and it was interesting to note that the Prime Minister told the House: “I am confident that we will fulfil our goal of real-terms increases every year in the NHS.” —[ Official Report , 15 December 2010; Vol. 502, c. 902.] That will not happen next year.”
“On 20 October, the Chancellor promised to increase health spending over and above inflation. That promise is being broken by £1.3 billion. Our amendments today, including amendment 8, are intended to be helpful, as I said to the Minister. They are intended to demonstrate how the Government can deal with the problem, if they have the will to keep their promises on funding for the NHS. We endeavour to act as a responsible Opposition, as our leader promised we would. The amendment is therefore designed to show helpful ways in which the Government can use this legislation to keep good both the Chancellor’s word and the Government’s promise to protect NHS funding, and thereby to see a real increase each year in this Parliament, and not, as at present, to deliver a real-terms cut.”
“That has been confirmed by the Library, and by independent, authoritative bodies in the health field and the Select Committee on Health, which said in its report into public expenditure on 14 December that “the Government’s commitment to a real terms increase in health funding throughout the Spending Review period will not be met.” So the Government are breaking their promises to protect NHS funding in England, Scotland and Wales. Next year, Scotland is now being short-changed in NHS funding by £70 million, while Wales is being short-changed by £40 million. In total next year, there will be a shortfall from the promise made by the Government to the British people in their coalition agreement of more than £1.3 billion—not a rise in NHS funding next year, but a cut.”
“One of the significant changes in its independent, authoritative assessment of this country’s economic prospects was to its forecast for inflation, thereby changing the deflator—in other words, the amount by which the Government and everyone else anticipate that costs in general, and Government spending in particular, will rise. Instead of a GDP deflator for 2011-12 of 1.9%, as set out in the OBR’s June report, its updated economic forecasts in November gave a deflator of 2.5%. In other words, even before we take into account the double-counting of funding for both the NHS and social care, we have, instead of the wafer-thin rise of 0.1% for England that the Chancellor promised, a much heavier cut, of 0.5%.”
“The House will notice that it refers to the National Audit Office, which is an independent, authoritative body. The Minister will appreciate the assessments, analyses and authoritative views of independent bodies. He and his colleagues set up the Office for Budget Responsibility. Its independence has—shall we say?—been put on perhaps a slightly more questionable footing than that of the NAO, but it is nevertheless an important organisation. Indeed, the problems of the hon. Gentleman and his colleagues were compounded when their Office for Budget Responsibility updated the economic forecast and the fiscal numbers in November.”
“It is an extraordinary state of affairs that a series of serious and significant pledges, set out formally in the coalition agreement in May, should have been broken in the White Paper produced by the Health Secretary in July. My hon. Friend is right: the one thing that the Government promised not to do in the coalition agreement was to go ahead with a top-down internal reorganisation, but that is exactly what is now planned. It could cost up to £3 billion. It is high risk and high cost; it is exactly the wrong thing to do at this stage, when the NHS is facing such tight financial pressures. I also have to say to the Minister that his colleagues are already showing signs of strain. I am anxious to return to the amendment that the House is discussing.”
“The Budget, of course, provides the Chancellor’s opportunity to make good his word and make good the promises that his Government have given to the British people on the NHS.”
“One of the two consequences of devolution is that in this area of health such decisions are taken in Wales for Wales. The second, however, is, I have to concede to the House, that I, as an English shadow Health Secretary do not follow those decisions in detail, so I think the hon. Gentleman is going to have to prosecute that argument in his home area. Finally, the House will note that the date in the amendment is anticipated to be after the expected Royal Assent to the Bill, so it is tied to the Finance Act. The Exchequer Secretary might want to discuss with the Chancellor the idea of doing this assessment, publishing the report and highlighting the shortfall, showing the extent to which the promises they made to protect NHS funding and give it a real-terms increase in each year of this Parliament are being broken.”
“The Minister was talking about the shadow Chancellor and the approach we take to the decisions that the Government have made on NHS funding. May I therefore remind the Minister of what my right hon. Friend said when he so ably responded to the spending review statement? He said: “We support moves to ring-fence the health budget”. —[ Official Report , 20 October 2010; Vol. 516, c. 968.]”
“Thank you, Mr Speaker, for allowing this urgent question to ask the Secretary of State for Health if he will make a statement on the Government’s preparations for and response to the current flu outbreak.”
“I hope last week’s figures mean we may be over the worst, but, with 783 people in critical care and a long winter still ahead, what steps will the Health Secretary take if the numbers of ill people continue to rise? Can he now, today, give the House the reassurance he has failed so far to give the public, which is that he really has got a grip on this situation? Finally, when all the bodies he is relying on to sort out this situation will be abolished under his internal organisation, what assurance can he give the public that this will be any better handled in the future?”
“Why did he axe the annual autumn advertising campaign to help boost take-up of the flu jab and help the public understand who is at risk and what treatment is available? We know it works, and this was a serious misjudgment. Why was the Government’s first circular to midwives, urging them to help get pregnant women to take up the flu jab, not sent out until 16 December? Why has there been no move to offer vaccines through antenatal clinics, and why are the Government not publishing details of the numbers of pregnant women who are seriously ill or who have died, as they are with other groups that are most at risk? With proper planning and preparation, we should not have seen GPs and pharmacies running out of the vaccine in some areas last week, nor should we have seen parents confused about the treatment available for their young children.”
“I thank the Health Secretary for that statement, but the truth is that he has been slow to act at every stage of this outbreak, and that is putting great pressure on the NHS across the country. It is working flat-out in our local hospital in Rotherham. We have had to open extra beds, and since last Tuesday have cancelled all non-urgent surgery. Four of the 50 patients in the UK who have so far died linked to this flu have been in Rotherham, and two were constituents. The Health Secretary talks about seasonal flu, but we knew this would not be like normal winter flu because we knew swine flu would be dominant, so the central question for the Health Secretary is why he made less preparation for a flu outbreak that was expected to be more serious.”
“May I welcome the Secretary of State’s sensible rethink and change of mind on the funding of specialist children’s hospitals after Labour Members raised concerns during the previous Health questions? During those questions he also got his NHS funding figures in a twist, so what has he got to say about the updated inflation forecasts on page 83 of last week’s Office for Budget Responsibility report? They show that for the next four years the inflation increase will be bigger than the cash increase in the NHS—in other words, the NHS will get a real cut in funding, not a real increase. Does he accept the OBR figures? Does he accept that they are hard proof that the Government are breaking their promise to protect NHS funding?”
“Perhaps I should have asked the Secretary of State whether he has even seen the OBR report. Let me try to help him. The OBR’s inflation figures mean that the NHS will not get the 0.4% real increase that he bragged about and that was stated in the spending review; the NHS will get a 0.25% decrease—a cut—in funding, as has been confirmed today for me by the House of Commons Library. No wonder the Prime Minister is rattled and is asking what on earth the Health Secretary is doing with the NHS. Does the Health Secretary accept that this confirms that the coalition’s pledge to guarantee that health spending rises “in real terms in each year of the Parliament” is being broken? How does he explain that to the Prime Minister and how does he explain it to the public?”
“Will he make and win the big arguments in government about the damage to health that comes from no work, poor housing and bad education? In government, it is deeds that count, not words.”
“We welcome the health inclusion board and the new national public health service, although we thought that this Government were committed to cutting, not creating, quangos. But is not the fact that the inclusion board will tackle the health needs of groups such as homeless people, drug users, alcoholics and sex workers an admission that GPs on their own do not know, and will not commission, what they need for the future? Is not this one of the first in a series of bodges that will be needed to make the Secretary of State’s massive reorganisation plans for the NHS actually work? Whatever he says, we and the public will judge him on what he does. Will he ensure that his £3 billion internal reorganisation of the NHS does not damage public health? Will he take tough decisions about Government action on tobacco?”