Editorial Wednesday 8 February 2012: Prime Minister's Questions - a few observations

Hats off as ever to the brilliant folk at Hansard for the transcript below, which I follow with three observations.


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Edward Miliband (Doncaster North) (Lab): On the day the Prime Minister completed his NHS listening exercise, he said, “some of the people who worked in our NHS were sceptical of our changes. Today, we are taking people with us. It’s in this spirit of unity that we want to continue.”

Why does he think he has failed?

The Prime Minister: Today, 95% of the country is covered by general practitioners who are not actually supporting our reforms; they are implementing them. Just today—[ Interruption. ]

Mr Speaker: Order. The House must calm down. There is a long way to go, so let us hear the answers. There will be plenty of time. Calm.

The Prime Minister: Thank you, Mr Speaker. Just today, 50 foundation trusts have written to the newspapers in support of our reforms and objecting to what Labour is proposing, and the signature at the top of the list, which the right hon. Gentleman might not have noticed, is that of one Anne Campbell, the former Labour MP for Cambridge. She, running her local foundation trust, supports the reforms. That is what happens: Labour MPs leave this House and start implementing coalition policy.

Edward Miliband: Even the right hon. Gentleman does not believe that nonsense he just came out with. Last Friday the Royal College of General Practitioners said that his health Bill would “cause irreparable damage to patient care and jeopardise the NHS.”

[Interruption.] The Health Secretary is shouting from a sedentary position—from some distance away, I notice. It is nice to see him here. The Prime Minister says that he wants the voice of doctors to be heard in the NHS. Why does he not listen to them?

The Prime Minister: It is always good to get a lecture on happy families from the right hon. Gentleman. I care passionately about our NHS, not least because of what it has done for my family and because of the amazing service I have received. I want to see that excellent service implemented for everyone, and that means two things: we have to put more money into the NHS, which we are doing, but we also have to reform the NHS. He used to be in favour of reform. Let me read him something. Who said, “to safeguard the NHS in tougher fiscal times, we need sustained reform.”?

That was in the Labour manifesto at the last election. Because the NHS is important, we are committed to £12.5 billion in this Parliament, yet his health spokesman, who is sitting right there, said that it would be “irresponsible” to spend more money on the NHS. The Opposition are not in favour of the money. They are not in favour of the reform. They are just a bunch of opportunists.

Edward Miliband: Isn’t this interesting? The Prime Minister says that this is all about reform, but the Tory Reform Group has come out against these proposals. It comes to something when even the Tories do not trust the Tories on the NHS. Let us hear what Clare Gerada, chair of the Royal College of General Practitioners—[Hon. Members: “Oh!”] So when the people Government Members want to put at the heart of the NHS say things about their Bill, they just groan. That says it all about those on the Government Benches. Clare Gerada said, “this bill is a burden. It makes no sense, it is incoherent… It won’t deal with the big issues… and it will also result in a health service that certainly will never match the health service that we… had 12 months ago.”

Which part of that does the right hon. Gentleman not understand?

The Prime Minister: Let us look at what has happened to the NHS over the past 18 months—[ Interruption. ] Yes, let us look at the figures: 100,000 more patients treated every month; 4,000 extra doctors since the election; the number of clinical staff up; the level of hospital-acquired infections down; the number of people who are in mixed-sex wards down by 94%. That is what is happening, because there is a combination of money going in and reform.

Now, we know what happens if we do not put in the money and do not undertake the reform, because there is one part of the NHS which is run by Labour, and that is in Wales. Let us have a look at what is happening to the NHS in Wales. Labour has cut the money, and one third of people are waiting longer than 18 weeks. That is what is happening in Labour’s NHS, and if we did not put the money in and did not have the reform, it would happen right here, too.

Edward Miliband: I am not surprised that the right hon. Gentleman is getting so agitated, because he thought that the NHS was his way to modernise the Conservative Party, and I am afraid that it is coming apart. I will tell him why: it is because the promises he made before the election are coming back to haunt him. We all remember the promise of no more top-down reorganisation. Now he says that he knows better than the doctors, better than the nurses, better than the midwives and better than the patients associations—people who day in, day out rely on and devote their lives to the health service. This is a matter of trust in the Prime Minister. Can he honestly look people in the health service in the eye and say that he has kept his promise of no more top-down reorganisation?

The Prime Minister: What we are doing is cutting the bureaucracy in the NHS. We are taking out £4.5 billion of bureaucracy which will be ploughed into patient care. If you don’t support the reform, you won’t see that money go into operations, doctors, nurses, hospitals, health care assistants. That is what is actually happening in the NHS, but there is one group of people I will not listen to, and that is the people who ran the NHS under Labour. This is what they did: £6 billion wasted on the NHS computer; £250 million spent on private sector operations that were never carried out. We still have private finance initiative agreements whereby we pay £300 every time someone changes a light bulb. That is what we got from Labour. We are putting the money in, we are putting the reform in, the number of operations is up, the waiting times are down, the NHS is improving, and that is the way it is going to stay.

Edward Miliband: I shall tell the right hon. Gentleman about our record on the NHS: the shortest waiting times in NHS history; more doctors and nurses than ever before; the highest level of patient satisfaction ever in the health service.

But everyone will have heard a Prime Minister unable to defend the promise that he made: the promise of no more top-down reorganisation—a Prime Minister who has broken his word. The reality is this: all his attention is on this pointless, top-down reorganisation, and the front line is suffering: the number of people waiting more than 18 weeks—up, under him; A and E targets being missed; cancelled operations. Why will he not just give up, stop wasting billions and drop his Bill?

The Prime Minister: If the Opposition’s record was so good, why were they thrown out at the last election?

Now, let me just—[ Interruption. ] Let me—[ Interruption. ]

Mr Speaker: Order. I am worried about Opposition Members. They must calm themselves and do so straight away.

The Prime Minister: Let me remind the right hon. Gentleman of the clear test that he set for the reforms and for the Government. He said that the test was whether waiting times and waiting lists would come down. Let me now give him the figures: in-patient waiting times, down; out-patient waiting times, down; the number of people waiting more than a year, down to its lowest ever level; the number of people waiting for six months, down to its lowest ever level; and, indeed, the number of people on the waiting list—what he said was the clear test—is down. This is what it proves about the Labour leader: even when he moves the goalposts, he can’t put it in the back of the net.

Edward Miliband: The person who is moving the goalposts is the Prime Minister. The reality is that the key test that was set for the health service was the number of people waiting more than 18 weeks, and that number is up 43% since the general election. However much he twists and turns, that is the reality.

In his heart of hearts, the Prime Minister knows that the Bill is a complete disaster. That is why his aides are saying that the Health Secretary should be taken out and shot, because they know it is a disaster. The reality about the Bill is this: the doctors know that it is bad for the NHS; the nurses know that it is bad for the NHS; and patients know that it is bad for the NHS. Every day the Prime Minister fights for the Bill, every day trust in him on the NHS ebbs away and every day it becomes clearer that the health service is not safe in his hands.

The Prime Minister: Let me tell the right hon. Gentleman that the career prospects of my right hon. Friend the Health Secretary are a lot better than his. That is what this is about. This is not a campaign to save the NHS; this is a campaign to try to save the right hon. Gentleman’s leadership. I make this prediction: the NHS will go on getting better and his prospects will go on getting worse.

So, three thoughts:

1. The Prime Minister is genuinely convinced that the 'bureaucrats versus doctors' line will work.

And in the simple-minded short-term, he is probably right.

In the medium term, Mr Cameron is of course on a hiding to nothing with this, because
a) everybody who knows anything about health policy and practice knows that you need managers (that's how you pronounce 'bureaucrats' once you're neither deluded nor stupid);
b) the Bill is turning clinicians into hated 'bureaucrats', so workforce-wise, Labour can do the 'you've created x hundred new bureaucrats as well as y hundred new layers of management and z hundred new bureaucracies' for, ooh, the next three years; and
c)  the more that doctors become involved in management, the more they will realise that 'The Dark Side' can fairly often be a euphemism for 'the shitty end of the stick'.

2. "Now, what I want is, facts. Teach these boys and girls nothing but Facts. Facts alone are wanted in life. Plant nothing else, and root out everything else. You can only form the minds of reasoning animals upon Facts: nothing else will ever be of any service to them. This is the principle on which I bring up my own children, and this is the principle on which I bring up these children. Stick to Facts, sir! " (Bleak House, by Charles Dickens)

Facts and David Cameron are a bit of an 'oops' area, as we pointed out when the Prime Minister misled the House of Commons over the Mark Britnell issue.

The Guardian's excellent NHS reform LiveBlog has got a rapid rebuttal by the Welsh Government of the PM's quotation of a series of facts about the NHS in Wales.

"Claim: The Prime Minister claimed a third of Welsh patients were waiting over 18 weeks for treatment.

"Fact: The Prime Minister is wrong. At the end of November 2011, 22 per cent (1/5) of Welsh patients waiting over 18 weeks and over from referral to treatment. Our target is that 95 per cent of patients should be waiting less than 26 weeks from referral to treatment.

"Claim: The Prime Minister claimed 27 per cent of patients treated in Wales are waiting over six weeks for direct access to diagnostics at end November 2011.

"Fact: The Prime Minister is wrong. 18 per cent of Welsh patients are waiting over six weeks for direct access to diagnostics. Our target for direct access to diagnostics is eight weeks".

(The ever-brilliant Dr Rob Findlay of Gooroo kindly points me to the source of the rebuttal stats here.)

Oops. Mr Cameron's approach is beginning to remind me of Stephen Colbert's "truthiness'.

3. Language matters, and a PR hack like Mr Cameron knows this. So when the PM said to Labour leader Ed Miliband "the career prospects of my right hon. Friend the Health Secretary are a lot better than his", you could just stop at the attack on Mili-E's leadership.

Or you could pause for a moment, and think that "career prospects", with its implications of an unspecified future, is a very different thing from saying that Mr Lansley is going to keep his current job.