PARLIAMENTARY DEBATE
NHS Funding - 31 October 2016 (Commons/Commons Chamber)

(Urgent Question): To ask the Secretary of State if he will make a statement on NHS funding.

Compared with five years ago, the NHS is responsible for 1 million more over-75s. In five years’ time, there will be another 1 million over-75s. Our determination is to look after each and every NHS patient with the highest standards of safety and care, but there is no question but that the pressures of an ageing population make this uniquely challenging.

I welcome the chance to remind the House of this Government’s repeated commitment to supporting our NHS. The NHS budget has increased in real terms every year since 2010. NHS spending has increased as a proportion of total Government spending every year since 2010, and is 10.1% higher per head in real terms than when we came to office. The OECD says that our spending is 10% higher than the OECD average for developed countries. At 9.9% of GDP, it is about the same as that in other western European countries, for which the average is 9.8%.

Given the particularly challenging current circumstances, in 2014 the NHS stepped back and for the first time put together its own plan for the future. It was an excellent plan, based on the principle that because prevention is better than cure, we need to be much better at looking after people closer to or in their homes, instead of waiting until they need expensive hospital treatment. The plan asked for a minimum increase of £8 billion in NHS funding over five years. It asked for this to be front-loaded to allow the NHS to invest in new models of care up front.

Following last year’s spending review, I can confirm to the House that the NHS will in fact receive an increase of £10 billion in real terms over the six years since the “Five Year Forward View” was published. In cash terms, that will see the NHS budget increase from £98.1 billion in 2014-15 to £119.9 billion in 2020-21. That rise is highly significant at a time when public finances are severely constrained by the deficit that this Government regrettably inherited. Because the NHS’s particular priority was to front-load the settlement, £6 billion of the £10 billion increase comes before the end of the first two years of the spending review, including a £3.8 billion real-terms increase this year alone. That £3.8 billion represents a 52% larger increase in just one year than the Labour party was promising over the lifetime of this Parliament.

This morning the Chair of the Health Committee and her colleagues on that Committee said that the Government’s NHS spending claims were “inaccurate” and “false”. The Opposition agree with that analysis. Ministers—and the Secretary of State has just done this again—tell us that they are investing £10 billion more in the NHS, but it has now been confirmed that that figure is

“not only incorrect but risks giving a false impression that the NHS is awash with cash.”

Is not the reality that the Government have cut adult social care, the public health budget and the NHS capital budget? Now we learn that the average amount we spend on healthcare for each person in this country will fall in 2018-19. Does that not raise serious questions about the claims that Ministers, and, indeed, Prime Ministers, have been making from that Dispatch Box? In fact, the only way the Government’s figures could be further discredited is if the Secretary of State slapped them on the side of a bus and got the Foreign Secretary to drive it.

Will the Secretary of State admit that the Government have not actually given the NHS the money it needed? Will he give us an accurate account of spending plans for the NHS? Will he tell us when the Chancellor is going to respond to the Health Committee’s letter, and what representations he himself is making to the Chancellor ahead of the autumn statement?

We have also learned today from Health Service Journal that one in three local areas intend to close or downgrade A&E departments within 18 months, one in five expect to close consultant-led maternity services, and more than half plan to close or downgrade community hospitals. Will the Secretary of State confirm whether those reports are accurate? How many A&E departments, maternity units and community hospitals does the Secretary of State expect to close or be downgraded within the next year and a half? Our constituents want those answers.

Before the last election, the Secretary of State told us he was “confident” about delivering the money the NHS needed. Today that confidence has been exposed as utterly misplaced. Tory promises are completely in tatters. Rather than defending the Prime Minister’s spin on the £10 billion figure, why does the Secretary of State not stand up for patients and staff, and deliver the funding that the NHS and our social care sector desperately need?

I start by welcoming the hon. Gentleman to his first urgent question in his new role. As I am a relative old timer in my role, I hope he will not mind me reminding him of some of the facts about health spending.

First, the hon. Gentleman said that the Government did not give the NHS what it asked for. Let me remind him that Simon Stevens, a former Labour special adviser—I know for new Labour, but he was none the less a Labour special adviser—said at the time of the spending review settlement last year that

“our case for the NHS has been heard and actively supported”

and that the settlement

“is a clear and highly welcome acceptance of our argument for frontloaded NHS investment. It will…kick start the NHS Five Year Forward View’s fundamental redesign of care.”

I will tell the hon. Gentleman who did not give the NHS what it asked for: the Labour party. At the last election, it refused to support the NHS—[Interruption.] I know this is uncomfortable for the new shadow Health Secretary, but the reality is that the party on whose platform he stood refused to support the NHS’s own plan for the future. As his question was about money, I will add that the Labour party also refused to fund it. The NHS wanted £8 billion; Labour’s promise was for additional funding of £2.5 billion—not £6 billion or £4 billion, but £2.5 billion, or less than one third of what the NHS said it needed. Even if we accept the numbers of the Chair of the Select Committee—and, as I will go on to explain, I do not—Labour was pledging over the course of the Parliament only around half of what this Government have delivered in the first year of the spending review.

The hon. Gentleman used other choice words, one of which was “spin”. I will tell him what creates the most misleading impression: a Labour party claiming to want more funding for the NHS when, in the areas where they run it, the opposite has happened. Indeed, in the first four years of the last Parliament, Labour cut NHS funding in Wales when it went up in England—[Interruption.] Yes, it did. Those are the official figures. That is in a context in which the Barnett formula gives the Government in Wales more than £700 more per head to spend on public services, so there is more money in the pot.

The hon. Gentleman talked about social care. May I remind him of what the shadow Chancellor at the time of the last election—Ed Balls, who is now sadly no longer of this parish—said? During the election campaign, he said of funding for local councils “not a penny more”. We are giving local councils £3.5 billion more during the course of this Parliament.

The hon. Gentleman talked about other cuts that he alleges will happen in A&E departments and other hospital services. I simply say to him that we have to make efficiency savings. I do not believe they will be on the scale he talked about, but how much worse would they have to be if the NHS got a third of the money it currently gets?

If the hon. Gentleman and his party think the NHS is underfunded, they need to accept that the policies that they advocated in the past two elections were wrong —they advocated spending less than the Conservatives. Until they are serious about changing their policy, no one will be serious about listening to their criticisms.

I agree with the Secretary of State that prevention is better than cure, but he will know that achieving the aims of the five year forward view was dependent on a radical upgrade in public health and prevention. He will know that it was also dependent on adequate funding for adult social care. In addition, there are continuing raids on the NHS capital budget, and we need to put in place the kind of transformation that he and our sustainability and transformation partnerships wish to achieve.

Will the Secretary of State therefore confirm that he recognises the serious crisis in social care and the effect it is having on the NHS, and the effect that taking money from public health budgets is having? Although I accept that he does not agree with the Health Committee’s appraisal of the £10 billion figure, I am afraid I stick by those figures.

I have enormous respect for my hon. Friend. I respect her passion for the NHS, her knowledge of it and her background in it, so I will always listen carefully to anything she says. I hope she will understand that just as she speaks plainly today, I need to speak plainly back and say that I do not agree with the letter she wrote today, and I am afraid I do think that her calculations are wrong.

The use of the £10 billion figure was not, as she said in her letter, incorrect. The Government have never claimed that there was an extra £10 billion increase in the Department of Health budget. Indeed, the basis of that number has not even come from the Government; it has come from NHS England and its calculations as to what it needs to implement the forward view. As I told the Select Committee, I have always accepted that painful and difficult economies in central budgets will be needed to fund that plan. What NHS England asked for was money to implement the forward view. It asked for £8 billion over five years; in fact, it got £10 billion over six years, or £9 billion over five years—whichever one we take, it is either £1 billion or £2 billion more than the minimum it said it needed.

I think my hon. Friend quoted Simon Stevens as saying that NHS England had not got what it asked for. He was talking not about the request in the forward view, but in terms of the negotiations over the profile of the funding we have with the Treasury. The reason that the funding increases are so small in the second and third year of the Parliament is precisely that we listened to him when he said that he wanted the amount to be front- loaded. That is why we put £6 billion of the £10 billion up front in the first two years of the programme.

I fully accept that what happens in the social care system and in public health have a big impact on the NHS, but on social care we have introduced a precept for local authorities combined with an increase in the better care fund—[Interruption.] This is a precept, which 144 of 152 local authorities are taking advantage of. That means that a great number of them are increasing spending on social care. It will come on top of the deeper, faster integration of the health and social care systems that we know needs to happen.

On public health, I accept that difficult economies need to be made, but it is not just about public spending. This Government have a proud record of banning the display sale of tobacco, introducing standardised packaging for tobacco, introducing a sugary drinks tax and putting more money into school sports. There are lots of things that we can do on public health that make a big difference.

On capital, I agree with my hon. Friend about the pressure on the capital budget, but hospitals have a big opportunity to make use of the land they sit on, which they often do not use to its fullest extent, as a way to bridge that difficult gap.

With some 80% of trusts in deficit and only 4% meeting accident and emergency targets, I am grateful to the Health Committee for flagging up the dire financial state of the NHS in England, as evidenced by its letter to the Chancellor. We learn from that document that the £10 billion figure is a bit of a fallacy. In Scotland, the SNP Government are committed to investing an additional £2 billion by 2021, but any reduction in new money for the NHS from the UK Government would have an impact on Barnett consequentials. Given that the UK Government have already slashed Scotland’s budget by 10% between 2010 and 2020, they need to be honest and transparent about what that reduction will mean for Scotland’s funding. With the Department of Health having accidentally not adjusted its books for an extra £417 million from national insurance contributions, and having broken its control total by £207 million, will the devolved Governments get any share of that additional £624 million?

Many people in Scotland will be somewhat surprised by the hon. Gentleman’s comments, because in the last Parliament spending on the NHS in England went up by 4%, whereas in Scotland it fell by 1%. The IFS confirmed that at the time of the independence referendum, saying:

“It seems that historically, at least, Scottish Governments in Holyrood have placed less priority on funding the NHS in Scotland…than governments in Westminster have for England”.

In this Parliament, the hon. Gentleman’s party has already lost a vote on NHS cuts in the Scottish Parliament and been criticised by Audit Scotland for its performance. When the SNP has the courage to increase NHS spending in Scotland by the amount we are increasing it in England, we will listen, but until then it should concentrate on looking after Scottish NHS patients in Scotland.

Order. Understandably, there is extensive interest in this subject. Accommodating anywhere near the number of would-be contributors will require brevity, to be exemplified—I hope and if he is true to form—by Mr Philip Hollobone.

People in Kettering appreciate plain speaking. Can the Health Secretary tell the House what the NHS budget was in 2014-15, what it will be in 2020-21 and what the difference is between the two numbers?

I want to get the exact figures in order to live up to my hon. Friend’s reputation for plain speaking, which is second to none. The NHS budget in 2014-15 will be £98.1 billion and in 2021 it will go up to £119.9 billion. In real terms, that is a £10 billion increase.

Is there not an urgent need to be straight with the British public about the resources we will need to maintain both the NHS and the care system, and to confront the fact that we will all have to pay a bit more to ensure that our loved ones get care when they need it?

When the right hon. Gentleman and I worked in government, we both campaigned hard on many occasions for more funding for the NHS, including mental health—a particular priority for both of us. The answer to his question is yes, and that is why we are putting in more money in this Parliament. My own view is that in future Parliaments we will need to continue to increase the amount of funding going in to the NHS. The only point I would make is that what funds the NHS is a strong economy, so we have to make sure that increases in NHS funding are sustainable and compatible with a strong economy. That is something that this Conservative Government have a very good track record of delivering.

The plans to achieve savings from community pharmacies are causing a great deal of concern in my constituency. The patients group at the John Hampden surgery and residents in and around Prestwood believe that the plans may result in the closure of our excellent rural pharmacy in Prestwood. What reassurances can the Secretary of State give to my constituents today that no pharmacies will close that are more than a mile from any other pharmacy? Will he make sure that he takes into account the implications for GPs’ workloads when looking at pharmacies?

First, the people of Prestwood are lucky to have such an assiduous MP to campaign for their interests in Parliament today; indeed, my right hon. Friend always does so. I can give her that reassurance, because in the package of efficiencies we set out—it is right that we ask pharmacies to make efficiencies in the way they are run, just as we are asking the rest of the NHS to make efficiencies in the way it is run—we are protecting all pharmacies that are a mile or more from any other pharmacy. In that sense, we are absolutely determined to protect provision for her constituents and all our constituents who depend on rural pharmacies.

If the Government had stood by their word and invested the promised £10 billion in the NHS, does the Secretary of State agree that the downgrade of Dewsbury A&E might not have been necessary?

First, may I welcome the hon. Lady to her place in this House? I am sure that she will make an extremely important contribution. Yes, she is filling very big boots, but, if I may say so, she has made a very good start.

On what happens with A&E departments, changes in the pattern of the services we provide have been a feature, both when the hon. Lady’s party has been in power and when my party has been in power, because the needs of the people who use the NHS also change. We therefore need to strike the right balance between reassuring people that services are provided near where they live, while ensuring that they receive the right care when they get there. For strokes, that does not always mean going to the nearest hospital, but somewhere with 24/7 stroke care and the greatest chance of saving the patient’s life. If the hon. Lady has concerns about Dewsbury hospital, I am very happy to talk to her further.

At a time when every Department, with the exception of the Department for International Development, has to reduce public expenditure, it seems a remarkable feat of political skill to have secured an increase for the NHS bigger than either the Home Office budget or that of the Ministry of Justice. Will the Secretary of State tell me whether there are parts of the United Kingdom where health expenditure is not rising as fast as in England? If there are, which political parties are in charge there?

I thank my right hon. Friend, whose passion and commitment to higher standards for the constituents he serves have inspired me in this job, just as I know they have inspired many others in the education field. There are indeed parts of the United Kingdom that allow us to make a very good comparison of the commitment to and funding of the NHS. In Wales, funding went down in the first four years of the previous Parliament. In Scotland, funding went down over the course of that Parliament. Both the Scottish National party and the Labour party like to talk about the NHS, but when it comes to writing the cheques, they are nowhere to be seen.

Can the Secretary of State guarantee that every A&E department in north-east London, with a rapidly rising population, will remain open for the rest of this Parliament? If he cannot guarantee that, how many will close and which ones? What is his hit list?

What I can guarantee is that the decisions about the future of A&E departments will be taken locally by clinicians who have the best interests of their patients at heart. I think that the hon. Gentleman and I would be able to agree that these decisions are not best taken by Secretaries of State. It is much better that they are taken by people who do not have any party political axe to grind. Any decision to change service provision at an A&E has the opportunity, if it is so wished, to be reviewed by the Secretary of State when it goes through an independent process. That is exactly what would happen in north-east London, were the local community to wish it.

Under the previous Labour Government, Burnley general hospital lost its A&E department and a number of key services. Under the coalition Government, a new £9 million urgent care centre opened and just last week the trust submitted plans for a £15 million development of the hospital. Does that not perfectly demonstrate the unprecedented investment in the NHS since Labour left government?

It absolutely does. I much enjoyed visiting with my hon. Friend some health facilities in his constituency during the general election campaign. The difference between Conservative Members and Labour Members is that we recognise that every penny of the NHS budget has to come from a strong economy. We know that if we take that for granted, we end up having to cut the NHS budget, which is what has happened in Spain, Italy, Greece, Portugal and many other countries that have lost control of their national finances. That is something that Labour Members would do well to remember.

The Government have been well and truly found out on this issue. Rather than quote selectively from Simon Stevens, the head of the NHS, will the Secretary of State confirm that among the conditions that Mr Stevens put down to the Government as part of the five-year review was an increase in public health spending, not a 20% cut, and a policy of maintaining spending on social care? Will he also confirm—he was there in Simon Stevens’ presence before the Select Committee—that Mr Stevens made it quite clear that those conditions and others had not been met?

Actually, what Mr Stevens said—I was there—was that social care and, indeed, public health provision needed to be maintained. We are increasing the social care budget by £3.5 billion over this Parliament. Although I accept that difficult cuts are being made to the public health budget, we are doing other things that do not cost money to make sure that we continue to improve this country’s excellent record on public health.

We all want a well-funded NHS. I congratulate the Secretary of State on making sure that we now have record spending in England. Last night, the A&E department of the Queen’s medical centre was tweeting that it effectively could not cope. We all of course congratulate and thank the hard-working staff in A&E, but the problem was demand. Does my right hon. Friend agree that the NHS can do much more to improve the way it signposts people? It was urging people to go to the urgent care centre, which does stitching and mends broken bones, all of which was news for many people in Greater Nottingham.

My right hon. Friend is absolutely right. That, of course, is why all parts of the NHS in England are embarking on the sustainability and transformation programme, which is designed to do precisely what my right hon. Friend says—to find smart ways to reduce demand. That will include, for example, better use of pharmacies, better use of GPs, more mental health provision—[Interruption.] Opposition Members are shouting, but why were they not prepared to put the money into the NHS to help us implement these plans? There would be no sustainability and transformation plans on the thin gruel that they promised for the NHS at the last election.

I was always against the private finance initiative. This Government have set up a £1.5 billion bail-out fund for PFI. I put it to the Secretary of State that that is to rewarding past profligacy and penalising frugal trusts such as the Royal Wolverhampton NHS Trust. When will the Secretary of State redress this imbalance, stop rewarding profligacy and reward frugality?

I am getting more and more impressed with the hon. Gentleman’s questions. Last time, he accused me of being a Corbynista, and today he is criticising me for profligacy, when the general tone of most Members seems to be that we are being rather too parsimonious with the NHS. I completely agree with him that private finance initiatives were an utter disgrace, leaving the NHS with over £70 billion-worth of debt by 2010. Unfortunately, there does not seem to be a strong correlation between shiny new buildings and good care for patients, as can be seen in a number of Care Quality Commission reports. We are doing everything we can to unwind that very difficult problem.

Order. We require pithiness personified. I think that calls for Sir Desmond Swayne.

How much more would the Secretary of State have had to spend per year by 2021 if the Chancellor had taken the Labour party’s advice?

If the Chancellor had taken the Labour party’s advice, the NHS would have had £5.5 billion less to spend every single year. I just ask Members who are worried about their A&E departments, worried about mental health and worried about GP provision on which of those services the axe would have had to fall if we had followed Labour’s spending plans?

Since the 2010 general election, we have lost over 1,500 mental health beds, there are 5,000 fewer mental health nurses and over 400 fewer doctors working in mental health. The pledge that the Secretary of State made at that Dispatch Box on 9 December—that every clinical commissioning group would increase its spend on mental health—lies in tatters. When will this Government’s rhetoric on equality for mental health be matched with adequate resources?

I will tell the hon. Lady when that rhetoric became reality. We now have the highest dementia diagnosis rates in the world, according to some estimates. We are treating three quarters of a million more people with talking therapies every year than we were in 2010. Every single day, we are treating 1,400 more mental health patients. By the end of this Parliament, because of our spending plans, we will be spending £1 billion more on mental health every single year, treating 1 million more people. I think that that is pretty good.

Is not one way to help the NHS to deal with its financial pressures by focusing on improving quality and using proper data? Professor Tim Briggs’s report, “Getting it Right First Time” is already improving patient outcomes and saving the NHS money.

I thank my hon. Friend for bringing Professor Briggs to meet me. He is an extremely inspiring man. He has established that every time someone has an infection during an orthopaedic operation, it costs the NHS £100,000 to put it right, but that is happening 0.5% of the time in the case of some surgeons and 4% of the time in the case of others. Dealing with variation of that kind is a way not just to reduce costs, but to avoid enormous human heartache.

NHS managers in Greater Manchester have made it clear that the pressures on the NHS are a function of pressures on the social care system and that costs are rising because of increases in the national living wage and the need to fund overnight cover. What is the Secretary of State doing to address those financial pressures on social care, given that the precept does no more than scratch the surface?

I agree that there are real pressures, although I should add that many Members were worried about some of the poor working conditions of people in the social care system and that 900,000 people on low pay in the system will benefit from the introduction of the national living wage. However, I agree that leaving people parked in hospitals when they should be being looked after in the community is financial nonsense. What is happening in Greater Manchester is one of the most impressive examples of health and social care integration in the country, and that must be the long- term answer.

I am very proud of the Government’s funding record, but does my right hon. Friend agree that it is also crucial to make the right strategic decisions? For example, it was a Conservative-led Government with a Conservative Health Secretary who delivered the urgent care centre in Corby, which has transformed health opportunities in our area and taken pressure off our A&E.

My hon. Friend is absolutely right. Although I was not personally responsible for the decision in Corby, I am very happy to take credit for it.

Representatives of the Department of Health and NHS England have appeared before the Public Accounts Committee eight times so far this year. We have taken a detailed look at the Department’s accounts, following the Comptroller and Auditor General’s unprecedented explanatory note, and I am glad that the Health Committee has said that it will examine the issue further.

The Secretary of State said that prevention was better than cure. The “General Practice Forward View” refers to a £2.4 billion increase in investment by 2020. Can the Secretary of State assure us that that crucial investment in primary care will be protected and not used to plug hospital deficits?

It is a vitally important investment. The first speech that I made as Health Secretary after the last election was made to GPs, and I said then that we wanted to deliver an extra 5,000 doctors working in general practice. It is vital that we eliminate hospital deficits, but we are making good progress in doing so.

Does my right hon. Friend agree that, when it comes to funding the forward view, the treatment of patients in their homes is not principally about cost-cutting but is part of a radical change in health provision for the future on which clinicians agree?

Absolutely. The simple principle for those of us who are not doctors is that it is much cheaper to nip illnesses in the bud than to wait until they progress. Treating someone at stage 1 or 2 of cancer is not only cheaper for the NHS, but much more likely to lead to a full cure. That is the whole foundation of the strategic change that we are making in the NHS.

My constituents who are watching these exchanges will think that the Secretary of State is living in a parallel universe. The sustainability and transformation programme in Merseyside is reputed to be tackling a £1 billion deficit. The way in which it has decided to tackle it in Wirral, in my area, is to draw up plans to close Clatterbridge, our cancer hospital, to close Arrowe Park, our acute hospital, to close the Countess of Chester hospital, and to create some new hospital in Ellesmere Port at some time in the future. No one believes the blather from this Secretary of State.

I do not recognise the plans the hon. Lady is talking about, but I say to her that we do need to change our service provision; we are dealing with many more older people, and her constituents need better care at home and in the community than they are currently getting. Any big changes will be subject to a proper consultation, and would indeed go before the Independent Reconfiguration Panel and if necessary end up on my desk. I also say to the hon. Lady that setting her face against all changes may be—

I didn’t say that.

Well, that was the tone of the hon. Lady’s question, and setting her face against all changes may not be the right thing for her constituents.

Does my right hon. Friend agree that patients get better in a cosy environment in community hospitals, and can he give me an assurance that he will love and maintain them for as long as he is in post?

I am sure that no one could do a better job of loving and maintaining community hospitals than my hon. Friend. Community hospitals have an important role to play. I have three excellent ones in my constituency. At best, they represent the change we need to see in the NHS, which is personalised care closer to home, but that does also mean that they sometimes need to change the way they deliver services within a building even if the NHS logo remains firmly on the outside of that building.

I was proud to sign the cross-party letter to the Chancellor on NHS funding, in which we quote the Care Quality Commission saying that

“adult social care…is approaching a tipping point”

and that is having an impact on those who rely on it and on “the performance” of the NHS. Does the Secretary of State recognise that this Government’s cutting social care funding by over a third was a false economy, that there will still be a gap in social care funding even if all councils took up the precept and that, for as long as we have that, we will have hospital deficits and delays?

I do recognise the pressures in the social care system, but, in an era of very constrained national finances, funding for the social care system is going up by £3.5 billion a year by the end of this Parliament, which is a significant and important rise. I say to the hon. Lady that it is this Government who have set the CQC free to tell us the honest truth about the quality of care in our hospitals, GP surgeries and social care system, and it is because of that that we are able to have the kinds of questions and answers we are having today.

I congratulate my hon. Friend on her excellent question. I absolutely agree with her, as someone who worked in healthcare before she came to this House, that it is vital to nurture the links between the health and social care systems if we are to deal with some of the issues that concern Members on both sides of the House. There are some very good examples of where this is working well, but it is not happening in as many places as it needs to, and we all must focus on that.

The Secretary of State was in Cambridge on Friday. Did he have an opportunity to notice that at Addenbrooke’s, the hospital that serves Cambridge, the number of over-85s coming into A&E has risen by almost 12% year on year, and on Friday there were 100 over-85s in that hospital who should have been out in the community? Does he agree that that is proof perfect of the failure of this Government’s policies on social care, which are the root cause of the problems in our NHS?

The hon. Gentleman is looking at the record of this Government: we have 1,200 more doctors in our A&E departments, who are treating within four hours 2,500 more people every single day. We are also putting more money into the NHS and into the social care system. Addenbrooke’s is a hospital under great pressure, but it is determined to co me out of special measures and do its best for patients, and I salute all the staff, whom I much enjoyed meeting there on Friday. The one thing they would not want is the NHS budget to be cut from current levels.

The Secretary of State knows that over 50% of the deficit at my local trust, Sherwood Forest Hospitals NHS Foundation Trust, and 25% of all its annual revenue goes on paying off its PFI premium. Will the Secretary of State take this opportunity to look again at my trust and others? Will he also remind the House which party left that toxic legacy for my constituents?

I am happy to remind the House, as my hon. Friend requests, that we inherited this situation from the Labour party in 2010. Despite that toxic legacy, the people working in the Sherwood Forest hospitals have done an incredible job of turning the trust around since it was put into special measures a few years ago. I commend them on their progress, which I hope will bear fruit and allow the trust to come out of special measures soon.

I would like to conclude these exchanges by 4.30 pm because there is other pressing business. If people take a long time, they are preventing their colleagues from contributing. I am sorry, but it is as simple as that.

Does the Secretary of State believe that there is a need for additional funding for adult social care over and above that which has been already allocated?

We are putting extra money into adult social care, and local authorities have the ability to increase their funding to adult social care through the new precept. In an ideal world, everyone would like more money to go into the NHS and social care system, but Government Members know that those systems are powered by a strong economy and that we can increase our budget only at a rate that the economy can afford. The past six years show that if we take care of the economy, we can increase the NHS and social care budget, and that is what we are doing.

Is it not the case that there will never be enough money to go into the NHS? Does the Secretary of State, like me, find the sanctimonious finger-wagging from the Opposition Front-Bench team utterly nauseating given that Carwyn Jones in Wales said that the Labour Government there would make an 8% cut to the NHS in Wales? That is the legacy of Labour.

That is absolutely the point. In Wales, people wait twice as long to have a hip replaced and the figure on A&E is about 10% lower than in England. The consequences for patients in Wales are horrific. That is why everyone watching today’s exchanges will take them with a big pinch of salt.

The Health Committee has been quite clear that of the actual £4.5 billion being spent by the Government on increased funds—not the £8 billion or the £10 billion mentioned by the Secretary of State— £3.5 billion comes from cuts to public health and to education and training. The Secretary of State can come to the Dispatch Box and twist it all he likes, but he has been found out. Every health sector worker in this country has his number and knows him to a tee—we know exactly what he is doing.

I just do not agree with the hon. Gentleman. I stand by the numbers. I am afraid that, on this occasion, the Health Committee got its numbers wrong. The figure of £10 billion did not come from the Government; it was a figure that the NHS said that it needed. In fact, it needed less than £10 billion and we are delivering more than was asked for—something that the Labour party was not prepared to do.

The Secretary of State has taken an interest in the rurality and sparsity that hospitals in Lincolnshire wrestle with. Will he confirm that it is because this Government are spending half a trillion pounds on the NHS over the course of this Parliament that workers and patients at Pilgrim hospital, for example, can be confident about the hospital’s future?

All NHS facilities in my hon. Friend’s constituency and across the country can be confident that the NHS has a bright future. In fact, if we are to deliver the NHS plan, more rural and remote places are precisely where we must pay most attention to keeping people healthy and well in their homes. That is why not only community hospitals, but GP surgeries and all the places upon which rural communities depend are a vital part of the NHS’s future.

I wrote to the Secretary of State over the summer because trollies were bumper to bumper in the corridors of Royal Stoke University hospital. This was not mid-winter but high summer. Since then, there have been more hospital bed closures in cottage hospitals, so I repeat my invitation and ask the Secretary of State to come to Stoke-on-Trent and see for himself the crisis in the funding settlement, which is hitting some of those with the most chronic health conditions.

I am happy to visit the hon. Gentleman’s local hospital, as I have been concerned about it for some time. I know that things have been particularly challenging there in the wake of what happened in neighbouring Mid Staffs, which has created its own pressures on the hospital. I also know that its staff work extremely hard in very challenging circumstances, so, yes, I will visit that hospital.

Does my right hon. Friend agree that achieving improvements in public health comes down not simply to the amount of money spent by the Government on it, but to a range of factors, including how it is spent, regulation, education and individuals’ choices?

I absolutely agree with that. This House should be very proud of the fact that, according to the UN, when it comes to public health this is the fifth healthiest country on the planet—after Iceland, Andorra, Singapore and Sweden, if my memory serves me correctly. That is a record we want to continue.

A lot of figures have been bandied about today. For the record, when Labour inherited office in 1997 the amount spent on the NHS was £33 billion, whereas by the time we left office in 2010, 13 years later, the figure had gone up to £100 billion. It is an easy figure to calculate: three times more in real terms. We can contrast that with this Secretary of State for Health, who is coming here today fiddling figures and shutting Bolsover hospital.

I gently say to the hon. Gentleman that if he thinks his party was so right to increase funding during Labour’s time in office—and I think it was right—he should support the Conservative party when it is increasing NHS funding by three times more than his party is promising.

It is clear to me that the NHS cannot rely solely on the Government to achieve financial sustainability; nor should it be used by some as a political football. Does my right hon. Friend agree that there is a responsibility on all NHS stakeholders to work together to cut waste where it exists, and towards a long-term sustainable social care programme?

My hon. Friend is absolutely right about that, which is why we need to make difficult efficiency savings—around £22 billion during this Parliament. We made about £18 billion to £19 billion-worth of savings in the previous Parliament, so I think it is doable. It will not be easy, but she is right in what she says.

If things are as rosy as the Secretary of State is making out, why is the London Borough of Redbridge, where I am an elected Member, suffering from public health cuts and, even while charging the social care precept, is still barely able to cover the costs of wage increases, let alone improve the service? He should have been lobbying the Chief Secretary this afternoon, not painting this ridiculously unjustifiable rosy picture.

I do not think the hon. Gentleman was listening to my statement, which said clearly that the NHS is under unbelievable pressure. It does not really work for the Labour party to campaign for increases in the minimum wage, which we read about today, and then to criticise the increasing costs in the adult social care system caused by the national living wage that was introduced by this Government.

Will the Secretary of State look at splitting the Calderdale and Huddersfield NHS Foundation Trust, so that the disastrous PFI deal at Halifax, where we will pay £700 million for a hospital that cost £64 million, will stop dictating the closure and downgrading of services at Huddersfield?

I salute my hon. Friend for the campaign he is leading at the moment, standing up for his constituents. He is right to point to PFI as one of the principal causes, and we now have to find a way to deal with that issue in a way that improves and does not detract from the quality of care offered to the people he represents.

According to Sir Richard Sykes, the chair of Imperial College Healthcare NHS Trust, “the problem is funding”, we are “killing” NHS staff by making them work 18 hours a day, and it is not in a position to close any more accident and emergency facilities in north-west London because there is not the capacity to do so. How is the NHS in north-west London supposed to save £1.3 billion over the next four years, as its sustainability and transformation plan proposes?

The best way it could do that is by ignoring all the leaflets that the hon. Gentleman puts out, totally misleading his own constituents about the plans the NHS has.

Give a serious answer to a serious question—you’re a buffoon! [Hon. Members: “Ooh!”]

Order. I did not hear the offending term, but if it has been reported to me accurately, and the Clerks are invariably accurate in these matters, it seems to me to be a matter of taste, rather than of order.

It is regrettable that the Chair of the Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), has led this attack on a Government who are doing so much. Will my right hon. Friend tell me what more is being done to recoup the money that should have been clawed back from those who had health insurance and who should not have used our system?

My hon. Friend is right to point out that problem. For years, under the previous Government, there was a total resistance anywhere in the NHS to ensuring that the only people who received care free at the point of use were people paying for the NHS through the taxes that they or their families pay. That is something to which we will put a stop. There is much more work to be done. We have the second biggest aid budget in the world. That is the way that we help developing countries, but we cannot have an international health service.

NHS trusts’ deficits are now the worst that they have ever been, with 85% of acute hospitals unable to balance their books. That situation will be made even worse as the falling value of the pound raises the cost of imported medicines and equipment. What assessment has the Secretary of State made of the extra funding needed to protect the NHS from the devaluation of sterling following the Brexit vote? What will he do to support trusts, such as Nottingham University Hospitals NHS Trust, which are already in deficit?

There are indeed a number of cost pressures in the NHS, but the NHS also has the advantage of being the single largest purchaser of healthcare products—equipment and medicine—in the world, and therefore we have huge scope to get better prices for those things than we currently get. We are supporting hospitals such as the one in the hon. Lady’s constituency by centralising procurement and bearing down on the cost of agency staff and locum staff. Given that pay accounts for more than 70% of the typical hospital trust, that will help.

Labour in my home area of Wales has cut the NHS by 8%. Can my right hon. Friend confirm to this House that he will never follow its example?

It is not just the money that Labour has cut. It has refused to set up an independent inspectorate of hospitals such as we did in England, which is the sure way of knowing that we never have a repeat of what happened at Mid Staffs. I urge the Welsh Government to think again about their approach to that.

Darlington’s A&E is among the one in three earmarked for closure or downgrading. In his opening response to what is an urgent question, not a statement, the Secretary of State said that he did not accept that figure of one in three. How many A&Es will be downgraded, or does he not know?

Those plans come up from local areas. The NHS is not projecting that we will have significant reductions in the need for emergency care over the next few years. What matters is that we make sure that, yes, people can get to an A&E near them, but that when they get there, they get the right expert care, and that is what local areas are working on.

In my constituency, a nurse-led practitioner service has been closed because of a lack of resources. Similarly, stroke rehab has been cut because of a lack of resources. Our A&Es are not meeting waiting times, and are now under threat because their orthopaedic services have been privatised and handed out to Circle, which may not contract back to their local healthcare trust, thereby undermining the capacity to maintain those A&Es. Does the Secretary of State accept responsibility for any of that?

I accept responsibility for the fact that in the hon. Gentleman’s part of the country, as in every part of the country, we have more doctors, more nurses and more operations than there were when his party left office.

I am particularly concerned that the Government are cutting supply in public health to create demand for a private healthcare market, which means that, like the United States, we will have a two-tier system. I was very concerned by the vague response that the Secretary of State gave to my hon. Friend the Member for Wallasey (Ms Eagle). Will he guarantee this afternoon that there will be no closures of Arrowe Park hospital, Clatterbridge hospital or the Countess of Chester?

With respect to local service provision, these things are decided locally. If the hon. Lady wants to dig up the old chestnut about the privatisation of the NHS, let me say that the outsourcing of services to the private sector increased much faster under her Government than under this Government. If we did have those malign motives for the NHS, increasing its budget by £10 billion over the course of this Parliament and increasing doctor training by one of the biggest increases in its history would be a strange way of going about it.