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It was a debate the Labour Party could not win at the vote; the Coalition has the weight of numbers and is always going to vote down a motion that criticises its decisions and record – in this instance, it called for “much-needed honesty” in the public debate on the NHS, and “in particular, NHS spending”.
But it was also a debate that had to take place, and Andy Burnham, the Shadow Secretary of State for Health, was right to put the arguments before the public. Anyone listening to the arguments with an open, if inquiring, mind could see that Labour has won this argument.
The Opposition Day debate in the House of Commons yesterday was called by Mr Burnham after Andrew Dilnot, head of the UK Statistics Authority, wrote to caution the government that its claims of increased spending on the health service, year on year, during every year of the current Parliament, were inaccurate. He stated that the figures show a real-terms cut in expenditure between the 2009-10 tax year when Labour was in power, and 2011-12.
In fairness, the next sentence of the letter went on to say that, “given the small size of the changes and the uncertainties associated with them, it might also be fair to say that real-terms expenditure has changed little over this period”. Even so, that is not an agreement that funding had increased; it is an assertion that the best the government could say is that funding has been at a standstill.
Mr Burnham pointed out two drains on NHS funding that have taken £3.5 billion out of the system – savings of £1.9 billion that went back to the Treasury instead of being ploughed back into NHS services as promised, and £1.6 billion spent on Andrew Lansley’s vanity-prompted, ideologically-based top-down reorganisation that brought private companies into the NHS with disastrous results.
(I think my own opinions may have intruded into the narrative of the last paragraph, but since these conclusion will be obvious to anyone who reads what follows, I feel justified in drawing attention to them here)
I hope we all know what the promises were. The 2010 Conservative Manifesto stated: “We will increase health spending in real terms every year”; the Coalition Agreement said “We will guarantee that health spending increases in real terms in each year of this Parliament”. And week after week, ministers from the Prime Minister downwards have claimed that is exactly what they have delivered. Until recently, the Conservative Party website prominently stated: “We have increased the NHS budget in real terms in each of the last two years”. And on October 23, from the Health Secretary, Jeremy Hunt, to the House of Commons: “Real-terms spending on the NHS has increased across the country.”
But there’s a mismatch here, said Mr Burnham. People have heard that spending is increasing, but what they have seen is an ever-increasing list of cuts to funding and services. Along with other Labour MPs, he delivered a devastating list of these cuts in support of his claims. These included:
- 750 jobs cut at Salford Royal Hospital, with a total of 3,100 job losses across hospitals in that area, and two walk-in centres closed.
- Cuts to the mental health budget.
- A broken pre-election promise not to close accident and emergency at Queen Mary’s, Sidcup; it closed after the general election.
- A plan to close accident and emergency at Lewisham Hospital.
- Cuts to cancer networks.
- £1 billion spent on managerial redundancies when patients are seeing treatment restricted and nurses laid off in their thousands.
- 7,134 nursing posts have been lost since the Coalition came in, 943 in the last month alone.
- Training places are being cut by 4.6 per cent this year, after a 9.4 per cent cut in 2011-12.
- 125 separate treatments have been restricted or stopped altogether since 2010.
- More than 50,000 patients have been denied treatments, kept off waiting lists, and there have been big falls in operations for cataracts, varicose veins, and carpal tunnel syndrome. “We have heard claims about reducing waiting lists but that is because people can’t get on the waiting list in the first place,” said Mr Burnham.
- West Midlands Ambulance Service advised on Tuesday that there are about half a dozen hospitals in the West Midlands whose A&E staffing situation is so critical that it is having a knock-on effect to turnaround time of ambulances.
- In Bolton, South Tees, Maidstone and Tunbridge Wells, large numbers of staff have been given 90-day redundancy notices.
The consequences were clear, according to the shadow Health Secretary:
74 per cent of NHS leaders described the current financial position as the worst they had ever experienced or very serious, he said. “The reason the government’s cuts feel much deeper is because they are contending with the added effects of a reorganisation that nobody wanted and that they pleaded with the former Secretary of State to stop. Cuts and reorganisation – it’s a toxic mix. As trusts start to panic about the future, increasingly drastic cuts are being offered up that could have serious consequences for patient care.”
Leading on from this, he said the Care Quality Commission found that 16 per cent of hospitals in England did not have adequate staffing levels. “I am surprised a warning of this seriousness hasn’t received more attention,” Mr Burnham said.
“The Prime Minister has cut the NHS – fact,” said Mr Burnham. “But just as he airbrushed his poster, he has tried to airbrush the statistics and has been found out.
“What I find most troubling about all of this, and most revealing about the style of this government and the way it works, is that even when they are warned by an official watchdog, they just carry on as if nothing has happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? ‘Labour left plans for a cut.’ Simply untrue.
“According to Treasury statistics, Labour left plans for a 0.7 per cent real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this government that slowed spending in 2010-11, which allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the promise that all savings would be reinvested, and it was this government that still has published plans, issued by HM Treasury, for a further 0.3 per cent cut to the NHS in 2013 and 2014-15 – contrary to the new statement that they have just put up on their website.”
He said the Coalition parties’ arrogance “seems to give them a feeling that they can claim black is white and expect everyone to believe it“. (Would it be in poor taste to hope that, in this case, Douglas Adams is proven correct and they all have terminal experiences the next time they venture onto a zebra crossing?)
“The lethal mix of cuts and reorganisation is destabilising our hospitals,” said Mr Burnham. “They are the first to feel the full effects of the free-market ideology that they have unleashed on the NHS. No longer a ‘One NHS’ approach, where spending is managed across the system, but now a broken-down, market-based NHS. The message to Britain’s hospitals, from this government, is this: ‘You’re on your own. No bailouts. Sink or swim. Oh, but if it helps, you can devote half your beds to treating private patients.’
“So we see increasing signs of panic as they struggle to survive in this harsh new world. And we see half-baked plans coming forward to reconfigure services, with an effort to short-circuit public consultation. Will the Secretary of State today remove the immediate threat to Lewisham A&E by stating clearly that it is a straightforward breach of the rules of the administration process to solve the problems in one trust by the backdoor reconfiguration of another? In Greater Manchester, will he ensure that the future of all A&E provision is considered in the round, in a citywide review, rather than allowing the A&E at Trafford to be picked off in advance? And in St Helens and Mosley, will he reverse the previous SoS’s comments when he told the CCGs they had no obligation to honour financial commitments to the hospital, entered into by the previous PCTs?
“It’s chaos out there, and [the Health Secretary] urgently needs – in fact, they all need to get a grip, not just the Secretary of State; all of them.
“Cuts and reorganisation are resulting in a crude drive to privatise services, prioritising cost over clinical quality. Across England, deals have been signed to open up 396 community services to open tender under ‘any qualified provider’. But these deals are not subject to proper public scrutiny as the deals are held back under commercial confidentiality. In Greater Manchester, plans are advanced to hand over patient transport services to Arriva, despite the fact that an in-house bid scored higher on quality, and despite the fact that the CQC recently found serious shortcomings with the same provider in Leicestershire. Nobody has asked the patients who rely on this service whether they want this change.
“‘Any qualified provider’ is turning into the NHS version of compulsory competitive tendering, a race to the bottom and a rush to go for the cheapest bid, regardless of the effect on patients and services. What clearer symbol could their be of a privatised, cut-price, Coalition NHS than the decision in Greater Manchester to award patient transport to a bus company.”
In the NHS constitution, patients and staff “have the right to be involved, directly or through representatives, in the planning of healthcare services, the development and consideration of proposals for changes in the way those services are provided, and in decisions to be made affecting the operation of those services”. So Mr Burnham asked: “Why doesn’t he just press the pause button now, and ask people if they want their ambulance services run by a bus company? ‘The NHS belongs to the people,’ says the first line of the NHS constitution – not when this government has finished with it, it won’t!
“People will remember the personal promises this Prime Minister made on the NHS to win office. Promises it now seems had more to do with his desire to de-toxify the Tory brand than with any genuine regard for the NHS.
“No top-down reorganisation of the NHS – broken.
“A moratorium on hospital changes – broken.
“And real-terms increases in every year of this Parliament – broken.
“They can now see the chaos that the breaking of these promises is visiting on the NHS: Nurse numbers – cut.
“Health visitors – cut.
“Mental health – cut.
“Cancer networks – cut.
“Cataract operations – cut.
“The man who cut the NHS, not the deficit.”
How did the Coalition combat these assertions? First with an attempt to divert the debate onto the NHS in Wales, overseen by a Labour Assembly Government, where spending has been cut. This was a matter that has exercised David Cameron very much during recent Prime Minister’s Questions, and it was welcome to see Mr Burnham set the record straight as thoroughly as he did yesterday.
He said the Coalition has given to the Welsh Assembly Government a real-terms funding cut of £2.1 billion – and this is the truth of it. I remember discussing the matter with Assembly members last year and it seems that even funding, which had been set aside to cushion the expected blow of cuts from Westminster, had been clawed back by the UK Treasury, with no regard for the consequences to Welsh NHS patients.
“They have done their best to protect health spending in that context,” Mr Burnham said. “Since 2010 there has been no reduction in frontline staff, particularly nurses, unlike [the UK] government. The Welsh Assembly are doing the best they can with the awful hand of cards which [this] government dealt them.”
Next, Mr Burnham was asked if he regretted “removing and reducing health spending to old people and rural areas, which happened under his watch”. It appears that this was a fabrication, dreamed up by the questioner, as Mr Burnham said it bore no relation to reality: “There was no reduction in health spending on my watch. I left plans for an increase. He illustrates my point.”
We heard that the chief economist of the King’s Fund, John Appleby, said that before the general election, the former chancellor had left plans for 2011-12, 2012-13 that would see a cut in real terms.
“I did the deal,” said Mr Burnham, “just months before the general election, protecting the NHS in real terms.
“At the election I was arguing for real-terms protection. I said it would be irresponsible, yes, to give real-terms increases over and above real-terms protection because the only way [to] pay for that would be taking it off councils, hollowing out the social care budget.”
One Tory who seemed particularly keen to assert his superiority said she was “very disappointed” to hear Mr Burnham “talking down the NHS”. She claimed that, before the election, the NHS knew it was facing an “unprecedented efficiency challenge”. And she said that, under Labour, productivity in the NHS fell continuously. Would the shadow health secretary acknowledge the achievements of the NHS in achieving a productivity gain?
This member got what she deserved – a three-word dismissal: “Productivity hadn’t fallen.” It’s a classic Tory ploy, criticising the opposition’s previous record to take the heat off their own current policies. But it doesn’t work when it’s based on a falsehood.
All of these were interjections from backbenchers. We could expect more high-quality responses from the Health Secretary himself, couldn’t we?
Judge for yourself.
“This government is spending more on the NHS than Labour would have, and because that money has moved from the back office to the front line, the NHS is performing better now than it ever did under Labour,” said Jeremy Hunt, the well-known misprint, providing no proof to support his claims.
“In 2011-12, spending went up by £2.5 billion in cash terms, 0.1 per cent in real terms, on 2010-11. And this year, 2012-13, it will go up again, as it will in every year of the Parliament.” But this did not address Andrew Dilnot’s assertion – that spending had dropped from 2009-10 levels. He was being selective with his statistics, and one can only conclude that he was trying to avoid dealing with an inconvenient fact. This was the point at which I knew Labour had won the argument.
“He [Andy Burnham] can hardly come to us, criticising our plans for NHS spending, if his own plans would have led to not higher, but lower NHS spending.” Note that it had already been stated that this was not what Mr Burnham had been doing. He made it clear that he would have protected levels of spending.
Mr Hunt joined the attack on the Welsh Government by stating that Labour has announced plans to cut the NHS budget by eight per cent in real terms, “despite an overall settlement protected by Barnett” (the Barnett settlement is a funding plan for devolved governments. Note that Mr Hunt did not say what the settlement was, and we are therefore deprived of the ability to determine whether this settlement is fair). Mr Hunt went on to ask of his Labour counterpart, “Will he condemn the choice that Labour made in Wales? If he doesn’t want to condemn that, let me tell him what the BMA says is happening in Wales. They talk of a ‘slash and burn’ situation. They talk about ‘panic on the wards’. Would he want that to be repeated in England?” He seemed not to have noticed Mr Burnham stating this is exactly what is already happening.
On a personal note, I use hospitals in Wales – a lot. My girlfriend is disabled and I myself have had occasion to seek hospital treatment. It has always been timely, professional, conducted in a calm, warm, welcoming atmosphere. I have seen no signs of panic on the wards, and if any aspect of the service is being slashed and burned, I haven’t experienced it myself. I have absolutely no complaints about the health service in Wales; if I were to level criticism anywhere, it would be across the border in England.
The final shot in the Wales mini-debate came from a Labour member, who wondered if the cut in Welsh health funding “has got anything to do with the cuts in capital spending from the Westminster government?”
This member added: “And has he any comment to make on National Audit Office figures that show spending on health in Wales is higher than that in England? Or does that not fit with his fictitious version of events?”
Fictitious. That’s exactly right. Now contrast Mr Hunt’s approach to questions from the opposition with the style already displayed by Mr Burnham – who, as evidenced above, tackled his critics head-on, answering them directly with the required facts.
The question was: Will he confirm just how many nurses have been cut under this government’s watch? The answer? “The nurse to bed ratio has gone up. The average bed is getting an extra two hours of nursing care, per week, than under Labour.”
That’s not an answer, and the Labour backbenchers knew it. Smelling blood in the water, another asked: “Why won’t he answer the question put to him – how many nurses have lost their job on his watch? Don’t tell me about nurse-to-bed ratio – answer the question.”
Fat chance! The response, again avoiding a direct answer, was: “The number of clinical staff in the NHS has gone up and not down. I don’t want to micro-manage every hospital in the country and tell them how many doctors and how many nurses.”
Mr Hunt returned to the Coalition line on NHS spending: “”We are increasing spending by £12.5 billion; he [Andy Burnham] thinks that is irresponsible.”
He was, of course, shot down – by two separate comments. One female Labour member stated: “My understanding of that english is that things had not changed much, in any circumstances, but the Secretary of State has said, consistently, he and the government were pledged to an increase. There is nothing in that letter [by Andrew Dilnot] to suggest that any increase has occurred.
And I believe it was Dame Joan Ruddock who said: “I find it impossible to find a record of this extra spending. It seems the reality is cuts and reductions to services.”
No point in listening beyond that. Coalition demolished.
Note: I apologise for the lack of information on who said what, other than the Health Secretary and his Shadow. I’m afraid I was too busy taking down what people were saying to catch their names, as they flashed up on my computer screen. It is not my intention to cause offence.