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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“Will he confirm that public health outcomes will also be part of the operating frameworks for the NHS and social care, because it would be a disaster if the NHS were now to decide that public health was not its job? We are concerned about the Secretary of State’s responsibility deals. What exactly does he mean by that? What influence will industry have over future health policy? What does he say to the Liverpool health expert and Tory adviser, Professor Simon Capewell, who said that health experts on the public health commission “were outnumbered and outvoted by people from Tesco, Diageo, and other food and drink manufacturers—and the Commission went with what the industry wanted…which is a scandal”? What does he say when one of his own advisers offers that view?”
“The legislation is in place to end point-of-sale displays of cigarettes. The evidence is there and the experts are clear. Cancer Research UK says that “we need to put tobacco out of sight and out of mind to protect all young people. The Government has the opportunity to act with conviction and reduce the devastating impact that tobacco has on so many lives.” Will the Secretary of State do that: yes or no? There is little new in this White Paper, and little is clear about how its plans will improve health and reduce health inequalities. It is 96 pages long but short on detail. We welcome in principle the lead responsibility for improving health being passed to local government, but can the Secretary of State guarantee the powers and the funds that it will need to do the job?”
“Why is it that everyone else in the Government is set to make announcements affecting public health—on alcohol taxation or pricing, for example —except the Health Secretary? Far from being, as he said, a genuine cross-Government strategy, the White Paper—like his last one, on NHS reform—shows that this a Health Secretary working alone and operating largely in isolation from the rest of Government. There is nothing new in “nudge”, except the soundbite and how hard the Secretary of State is pushing it. We set out the importance of individual decisions and incentives, alongside the need for support services and Government action, in our White Paper on public health in 2004. The test for the Health Secretary is whether the Government will act when they can and when they are needed, especially to protect children.”
“However, the Government’s wider policies, which will lead to higher unemployment, poorer housing, greater poverty and an end to the Sport for All programme in schools, will do more damage to public health than his White Paper will do good, and more to increase health inequalities than his plan will do to reduce them. So what did the Health Secretary say to the Chancellor about policies that will see a third of a million public sector staff on the dole? How hard has he argued against the Education Secretary’s plan to axe the school sports partnerships, which have seen three times as many children playing competitive sport than six years ago, and nine out of 10 children playing more than two hours of sport each week?”
“It is not clear how it will help to improve public health, and it is not a guarantee that the big gains made in the last decade—in cancer screening, healthy food in schools, stopping smoking and free flu vaccines, as well as the big cut in deaths from heart disease—will be continued. However, in the spirit of responsible opposition, let me tell the Health Secretary that we can offer general support for his aims, which are very similar to those that we set out in our White Paper in 2004. I can promise him close scrutiny of his actions and those of his Government, because as the White Paper says, good public health depends on much more than what the NHS does. As he said in his statement, education, employment, environment and equality are the causes of the causes of poor health.”
“I thank the Secretary of State for advance sight of his oral statement. I am sure that the House will also thank him for the advance copies of the White Paper, which were available before he made his statement. On Sunday the Health Secretary promised a White Paper that would “take a radical new approach to public health”. Today he has published the White Paper, and it falls far short of his hype. He has had six years in opposition and six months in government to prepare for this White Paper, but it will disappoint many of those who are most committed to better public health in this country and most concerned that we still have a great deal further to go. For the most part, this White Paper is not new.”
“Let me quote from a Library research paper, which confirms: “Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.” There we have it—the facts in the figures. There is no real-terms rise in NHS funding, but a real-terms cut over this Parliament by this Government— [ Interruption. ] The Secretary of State says “Nonsense” from a sedentary position. If he wants to deny the figures in the Green Book, deny the report in the Library research paper, and take issue with the Nuffield Trust, who all say the same, he should do so. He should by all means take credit for funding social care, but he should not double-count the credit by including it for both NHS funding and social care funding.”
“The Prime Minister told Britain before the election: “We are the only party committed to protecting NHS spending.” In his coalition agreement with the Deputy Prime Minister, he went further, saying: “We will guarantee that health spending increases in real terms in each year of…Parliament”. The Government whom the Prime Minister leads are now breaking the promises that he made to the British people. The Secretary of State has been caught out double-counting £1 billion in the spending review as both money for the NHS and money to paper over the cracks in social care.”
“The motion is set in similar terms to the motion standing in the name of my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Education Secretary, which we will debate a little later. That is because in both health and education we are seeing many of the same broken funding promises, much of the same free market ideology, many of the same problems of big changes forced through without considering or caring about the consequences, and many of the same risks that the poorest and most vulnerable will lose out and that comprehensive, consistent public services will be broken up. Beyond the spending cuts, we are starting to see the pattern of what public service reform means in Tory terms.”
“I beg to move, That this House believes that the Government is pursuing a reform agenda in health that represents an ideological gamble with successful services and has failed to honour the pledges made in the Coalition Agreement to provide real-terms increases each year to health funding; further believes that the Government is failing to honour its pledge in the Coalition Agreement by forcing the NHS in England through a high-cost, high-risk internal reorganisation as set out in the health White Paper; is concerned that the combination of a real cut to funding for NHS healthcare and the £3 billion reorganisation planned by the Secretary of State for Health will put the NHS under great pressure and that services to patients will suffer; supports the aims of increasing clinician involvement and improving patient care, but is concerned that the Government’s plans will lead to a less consistent, reliable and responsive health service for patients which is also more inefficient, secretive and fragmented; and calls on the Secretary of State for Health to listen to the warnings from patients’ groups, health professionals and NHS experts and to rethink and put the White Paper reforms on hold, so that in this period of financial constraint the efforts of all in the NHS can be dedicated to improving patient care and making sound efficiency savings that are reused for frontline NHS services.”
“There is a good case for more funding in social care, but the truth is, as Age UK says, that in this Parliament it will be cut by an average of 7% in real terms. Social care may help the health service, but if money is spent on social care, it is not spent on NHS services, and it cannot be double-counted as NHS funding. When that is taken into account, and when the Secretary of State stops fiddling the figures, we see that the country and the NHS will get a real-terms cut, not a real-terms rise during this Parliament.”
“My right hon. Friend the shadow Chancellor said in response to the Chancellor’s spending review: “We support moves to ring-fence the” NHS “budget”. —[ Official Report , 20 October 2010; Vol. 516, c. 968.] People saw Labour’s big investment in the NHS bring big improvements—50,000 extra doctors, 98,000 more nurses, deaths from cancer and heart disease at an all-time recorded low, the number of patients waiting more than six months for operations in hospital down from more than 250,000 in 1997 to just 28 in February this year, and more than nine in 10 patients rating their experience of hospital care as good, very good or excellent.”
“There are, and have been for many years, built-in pressures on the NHS: the cost of staff, drugs and equipment rises by about 1.5% above general inflation, and the demands of our growing and ageing population adds £1 billion to the bill each year just to deliver the same services.”
“The number of patients waiting more than 13 weeks for diagnostic tests has trebled since last year, 27,000 front-line staff jobs are being cut, and two thirds of maternity wards are so short-staffed that the Royal College of Midwives says that mothers and babies cannot be properly cared for. This is not what people expected when they heard the Prime Minister say that he would protect NHS funding. In fairness, a proper, long-term perspective is needed on NHS financing. Year-on-year funding just below or even 0.1% above inflation is way short of the 4% average increase that the NHS has had over its 60 years. During the last Labour decade, it averaged 7% in real terms.”
“We still have a lot further to go. There have been big improvements in international comparisons, but we must go further. It beggars belief that the Government have decided not to press ahead with plans to give patients a guarantee of, for example, receiving test results within one week, especially as hon. Members on both sides of the House recognise the importance of early diagnosis for cancer, and the cancer specialist, Mike Richards, said that this contribution to early diagnosis could save 10,000 lives a year. Instead of building on those great gains, I fear that the NHS will again go backwards under this Tory-led Government. It is already showing signs of strain.”
“You don’t need me to tell you that it has never been done before in the NHS context and we don’t think, when you look at health systems across the world, that anyone has quite done it on this scale before.” Money is tight, and something must happen, but that can be done by building on Labour’s big improvements in the NHS over the last decade. It will be tough, but I will back the Government, as long as all savings are reused for better front-line services to patients.”
“The hon. Lady is right, and there is plenty of scope to do that. We recognised that, and we had plans to take out many of the managerial costs. I will come to that later, but it is hard to understand how creating three or even four times as many GP consortiums doing the same job as primary care trusts is likely to reduce rather than increase bureaucracy in the NHS. My right hon. Friend the Member for Leigh says that in Wigan there is one PCT, but it is set to have six GP consortiums. The same job will be done six times over in the same area. How is that a cut, or an improvement in the bureaucratic overheads and costs of the NHS? In the spending review, the NHS is set for the biggest efficiency squeeze ever. On 12 October, the NHS chief executive, David Nicholson, told the Health Committee: “It is huge.”
“I have read David Nicholson’s transcripts, and he was indeed talking about £15 billion to £20 billion of efficiency savings, which were not achieved, as the Secretary of State said, but planned. That is a big test for the NHS, and it will be more difficult because of his plans for reorganisation, which I will come to.”
“Of course Sir David was talking about the two together, because the Select Committee was understandably probing both matters. In the quote that I gave, he was talking about the significant efficiency savings required of the health service at this time of an unprecedented financial squeeze. Many would say that that is the toughest financial test in the NHS’s history.”
“10, early on the morning of the publication of the White Paper, and told “there’s nothing much new in it.” When did the Secretary of State tell the Prime Minister that he was breaking his promise? When did he tell the Prime Minister that he was not only breaking the Government’s promise but forcing the NHS through the biggest reorganisation in its history, with a £3 billion bill attached, at a time when all efforts should be dedicated to achieving sound efficiencies and improving care for patients? This is high cost and high risk; it is untested and unnecessary.”
“Gentleman, now the Secretary of State, ruled it out, saying that the NHS “needs no more top-down reorganisations”. The coalition agreement was clear and reassuring on this point. In it, the Prime Minister and the Deputy Prime Minister pledged: “We will stop the top-down reorganisations of the NHS that have got in the way of patient care”. That was before the Secretary of State’s White Paper plans, which the head of the King’s Fund has called “the biggest organisational upheaval in the health service, probably since its inception”. Promise made in May, broken in July. Promise made by the Prime Minister, broken by the Secretary of State. There is a story doing the rounds in the media of a journalist being briefed by No.”
“If the right hon. Gentleman reads the official record, he will see I have just said that I will back plans to get the efficiency savings out of the NHS. They are needed and they have to happen, and I will back them as long as all the savings are reused for front-line services to patients. Faced with the toughest test in its history, the least NHS patients and staff can expect is that the Government keep their funding promise. At this time of all times, the last thing the NHS needs is a big internal reorganisation. The Prime Minister ruled out such a reorganisation before the election, saying: “With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS”. The right hon.”
“In a way it does not matter whether I agree; it matters much more that the National Rheumatoid Arthritis Society and many other patients groups are deeply concerned about this. It is not just patients groups but professional bodies and NHS experts who are worried. Even the GPs are not convinced, and they are meant to be the winners in all this. They are meant to be the ones planning, buying and managing the rest of the NHS’s services. A King’s Fund survey carried out last month found that fewer than one in four GPs believe that the plans will improve patient care, and only one in five believe that the NHS will be able to maintain the focus on efficiency at the same time.”
“If two thirds of the GPs the hon. Gentleman met are in favour, one third are obviously not convinced, but they will be forced to do this anyway. That is part of the problem, and I will come to that in a moment. It is no wonder that the head of the NHS Confederation, the body that is there for those who run the NHS, told the Health Committee last month that “there is a very, very significant risk associated with the project”. Even the Secretary of State’s right-wing supporters in the Civitas think-tank tell him that he is wrong. They have said: “The NHS is facing the most difficult…time in its history. Now is not the time for ripping up internal structures yet again on scant evidence”.”
“Yes, of course; we had been doing that for some years before the election and we had plans to do it after the election, but the fact is that we did not win the election, and the Secretary of State is in power now. He is making the decisions and he is the one who is entrusted with the future of our NHS. He is the one who needs to answer to the House for his plans. The problem with broken promises is worse than I have already suggested. The coalition agreement promised: “The local PCT will act as a champion for patients and commission those residual services that are best undertaken at a wider level, rather than directly by GPs.” The Secretary of State’s plans will do precisely the opposite. He is abolishing the PCTs, not building on the best of what they do.”
“When did he tell people that lowest price will beat best care, because GPs will be forced to use any willing provider? When did he tell people that essential NHS services will be protected only by a competition regulator, similar to those for gas, water and electricity? And when did he say that he was creating a national health service that opens the door for big private health care companies to move in?”
“When did he tell people that, in place of 150 primary care trusts, there could be up to three times as many GP consortiums doing the same job? When did he tell people that GP consortiums will make decisions in secret and file accounts to the Government only at the end of the year? When did the Secretary of State tell people, and the Prime Minister, that nurses, hospital consultants, midwives, physiotherapists and other NHS professionals will all be cut out of care commissioning decisions completely? And when did he tell the Prime Minister that hospitals will be allowed to go bust before being broken up, if a buyer can be found for them? When did he tell people that NHS patients will wait longer, while hospitals profit from no limit on their use of NHS beds and NHS staff for private patients?”
“This is precisely why those who understand the health service, including those who run it, say that it is going to be so hard, at a time when the NHS has never faced such a tough financial challenge, to see through the biggest reorganisation in its history at breakneck speed. Whether on funding, reorganisation or the role of the PCTs, the Secretary of State is doing precisely the opposite of what was set out in the coalition agreement. He is running a rogue Department with a freelance policy franchise, in isolation from his Government colleagues. He claimed on the “Today” programme yesterday that he had been saying all this for four years before the election. So when did he tell people, and when did he tell the Prime Minister, that GPs will be given £80 billion of taxpayers’ money—twice the budget of the Ministry of Defence—to spend?”
“He went on to say that “this white paper could result in the biggest transfer of employment out of the public sector since the significant reforms seen in the 1980s.” This is not what people expected when they heard the Prime Minister tell the Conservative conference last month that the NHS would be protected.”
“The real question is why the right hon. Gentleman, if he had these plans, did not tell the Prime Minister and the Deputy Prime Minister when they were writing the coalition agreement what he wanted to do on funding, on reorganisation and on the role of primary care trusts. Why did he allow his Government to make these pledges to the British public in May and then break their promises two months later in the White Paper? Whatever the boss of Tribal health care says about the private health care companies, he described the White Paper as “the denationalisation of healthcare services”.”
“The one part of the Liberal health manifesto that they managed to get into the coalition agreement was this: “We will ensure there is a stronger voice for patients locally through… elected individuals on the boards of their local primary care trust”. Within two months, of course, that was not even worth the coalition agreement paper it was written on.”
“The treatment centres, which the hon. Gentleman mentions, helped contribute to bringing waiting times down to 18 weeks and helped to say to the British public, “Whatever treatment you need in hospital, you will not have to wait more than 18 weeks for it.” That was a consistent universal promise that we were able to make to patients as a guarantee for the future. That has now been ripped up, and we can see the result as waiting times and waiting lists lengthen. As I said at the start of my speech, my fear is that during this period of Tory leadership, we will see the NHS going backwards. As for the hon. Member for St Ives (Andrew George), I understand his problem. He is a Liberal Democrat and I have to say that this health policy bears very little of the Liberal Democrat imprint.”
“GPs spend an average of eight or nine minutes with each patient. If they plan, negotiate, manage and monitor commissioning contracts in future, they will have no time left to see patients. If they continue to be family doctors, commissioning will be done for them, not by them; it will be done in their name by many of the same PCT managers who presently do the job or by commercial companies that have already started hard-selling their services to GPs. The other day I picked up “The Essential Guide to GP Commissioning” helpfully published by United Health—one of the biggest US-based health care companies in the world.”
“Quite so. Estimates of the cost of the reorganisation are up to £3 billion, but we have not had any cost announcements from this Government, who will not tell us how much is going to be spent on reorganisation rather than on patient care. At a time when finances are tight, this is precisely the wrong prescription for the NHS over the next few years. It is no wonder that GPs have grave doubts—they trained as family doctors, not as accountants or procurement managers, and they are committed to treating patients, not doing deals over contracts. However, they will be forced to commission services, whether they like it or not; they will make rationing decisions, not just referral decisions for their patients; and they will have to take on the deficits or inbuilt funding shortfalls in their PCT areas.”
“It is a very good thing that the Royal College of General Practitioners is trying to bring the skills of many GPs up to speed because this is a big job for which GPs are not trained and not equipped, and which many do not want to do.”
“The GP fundholding experiment took place in a completely different context—within an NHS that still had an area-based plan and still had bodies accountable through the Secretary of State to Parliament. In the end, however, it did not work and we stopped it.”
“Members of Parliament wanting to hold Ministers to account in future when hospitals go bust, there are no contracted services for constituents or there is a serious failure in the system will be told, “It’s nothing to do with me”.”
“I thought the hon. Gentleman was in his place at the start of the debate. In that case, he will have heard me say that one reason for having an Opposition day debate on both health and education is that we see many of the same ideological fingerprints over the plans for education and for health. These are Tory ideological fingerprints, and I hope that this will become clearer as the debate progresses. Let us make no mistake: if these changes go ahead, patients will rightly question whether GPs’ decisions are about the best treatment for them or about the best interest of the GP budget and consortium business. The public will find “commercial in confidence” stamped over many of the most important decisions taken about our NHS services.”
“He wants shadow GP consortiums to be in place by April, and he will remove primary care trusts entirely two years after that. What he is doing is rushed and reckless. Almost every respondent to the White Paper has warned of the risks and said, “Slow down.””
“Part of the problem is that there is so little detail in the White Paper that we simply cannot see how the bodies taking big decisions about taxpayers’ money will be accountable to the public. I lost count of the number of times during the last Government when Health Ministers came to this House and to Westminster Hall and had meetings with Members in order to respond to and sort out the problems that their constituents were experiencing with NHS services. What the Secretary of State says he wants from the White Paper plan is to put patients first, to improve health care outcomes, to cut bureaucracy and to improve efficiency. These are “motherhood and apple pie” aims. We can support his aims, but we cannot support the action he is taking or the breakneck speed with which he is forcing these changes on the NHS.”
“Even the chief executive of the NHS has written to the Secretary of State saying: “Implementing the White Paper will require us to strike the right balance between developing early momentum for change and allowing enough time to properly test the new arrangements. Getting this balance right will be critical to maintaining quality and safety”.”
“I am very concerned if those plans are being speeded up rather than slowed down, because that would be entirely contrary to the view that has been consistently expressed by patients groups, experts in the NHS and professional bodies in response to the consultation on the White Paper. “Too far, too fast,” says the King’s Fund. According to the NHS Confederation: “It will be exceptionally difficult to deliver major structural change and make £20 billion of efficiency savings at the same time.” The Alzheimer’s Society says: “The pace of structural change has the potential to undermine the progress made in services for people with dementia and their families, unless handled carefully”. Almost every other group representing patients says the same.”
“The Government’s reckless big-bang reorganisation at a time of tough financial pressures in the NHS will wreck their reputation, but that is the Prime Minister’s problem. My problem is that he is set to wreck the great NHS gains made for patients over the last decade, and to wreck the founding principle of our NHS: that it should be available equally to all, free at the point of need, and properly funded through general taxation. We on the Labour side of the House will not allow him to do that. I commend the motion to the House.”
“The hon. Gentleman is new to the House, but he and his party are in government now. One of the frustrations for me and for other Labour Members is that his party is making the decisions, and is responsible for the future of the health service. Our plans would be different, but this is what the Government are planning. The Secretary of State has received the responses that I have quoted. He has been advised to listen, to slow down, and not to risk the future of the NHS in his consultation. However, he is not listening. I hope that the Prime Minister is listening, for the sake of the NHS, its patients and staff, and for the sake of us all. Here is a “thought for the day” for the Prime Minister. The Tories worked hard to be trusted by the public with the NHS before the election.”
“If the Secretary of State—who, I concede, has a six-and-a-half-year head start on me in this job—really cared about NHS patients, really cared about NHS staff and really cared about NHS services, he would not be putting the NHS through the biggest reorganisation in its history, especially at this time. As I said earlier, it is patients groups and bodies representing NHS staff who are saying, “Slow down—think again.” I urge the Secretary of State to do that today, and to rethink.”
“Will he also publish the figures so that this House and Members who represent these areas can make up their own minds about whether those big stealth cuts to the hospitals that treat many of our most critically ill kids are a good idea?”
“I wanted to intervene to discuss what my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) said about Great Ormond Street hospital. I have the official record of what was said at Health questions, to which the Secretary of State referred. He said that the proposal would have “the overall effect of reducing Great Ormond Street’s total income by less than 2%.” —[ Official Report , 2 November 2010; Vol. 517, c. 754.] How does he reconcile that with the trust’s figures, which say that the reduction will not be less than 2%, but will be more than 5.5%? Would he like, therefore, to correct the official record now?”
“The hon. Gentleman is right, of course; there is still more to do to improve health and to improve the NHS, but can I just check something? Did I hear him right? Did he say that the NHS had failed?”
“The Secretary of State’s answer simply will not do. He is in government now, not us. He is making decisions to make deep cuts to our specialist children’s hospitals. He is trying to keep the NHS out of the public spotlight, and we will make sure that the public know what his plans for the NHS are. I have the Secretary of State’s letter. He has not answered my questions and I ask him again to tell the House why, before today, no Minister has made any statement in public or in the House about these big stealth cuts to our children’s hospitals, and how much each one of the 35 specialist children’s hospitals will lose next year in funding to treat some of the most critically ill children in our country.”
“Will he accept the new House of Commons Library research report, which confirms: “Including the (social care) funding is critical to the description of the settlement as a ‘real terms increase’; without it, funding for the NHS falls by £500 million—0.54% in real terms.” When did the Secretary of State tell the Prime Minister that the Government are breaking his promise to protect the NHS budget?”