Under pressure over his disastrous and unwanted NHS reorganisation at Prime Minister's Questions today - a reorganisation which is diverting billions away from the frontline and which risks 6,000 nurses being laid off - David Cameron repeatedly gave misleading answers about the NHS under the Tories.
David Cameron's Health Bill puts the NHS on a knife edge and is a clear broken promise from the government that promised no top down reorganisation of the NHS. But rather than admit that the Bill is putting huge strain on the health service at a time when resources are already tight, the Prime Minister is instead resorting to misleading claims on waiting times, patient experience and the experts' opinion.
Waiting times
The Prime Minister claims Waiting times are down, but he's not giving the full picture.
"Waiting times are down" - David Cameron, Prime Minister's Questions, 8 February, 2012
But in fact the latest figures for patients who waited more than 18 weeks show an increase of 43% since the election.
There has been a 217% increase in people waiting more than 1 year for treatment.
More doctors and more clinical staff
The prime minister claims there are more doctors and clinical staff thanks to the Tory-led government: "4,000 extra doctors in the NHS, the number of clinical staff up" Prime Ministers Questions, 8 February 2012
The truth is, as any medical student could tell you, it takes seven years to train a doctor - these doctors are a result of Labour's investment in the NHS.
While Labour's investment and reform saw more doctors and more nurses in the NHS than ever before, under the Tories the NHS is losing frontline staff. Since the election the NHS has lost 3,500 nurses and is expected to lose a further 2,500 - 6,000 over the Spending Review period.
GP support for the Tory plans
One of David Cameron's wildest claims was that GPs are showing their support for the reforms by implementing them: "Today 95% of the country is covered by general practitioners who are not actually supporting our reforms they are implementing our reforms." David Cameron, Prime Ministers Questions, 8 February 2012
This just doesn't stack up, a Royal College of GPs survey of its members showed that 98% of respondents wanted the government to drop the Health and Social Care Bill.
"When asked if the College should call for the Bill to be withdrawn as part of a joint approach with other medical royal colleges, more than 98% of respondents said they strongly supported (65.8%) or supported (32.4%) such action."
And last week Dr Clare Gerada, Chair of the Royal College of GPs, criticised the Bill on BBC Radio 4's Today programme.
Dr Gerada later told BBC Radio 4's Today programme: "This Bill is a burden, it makes no sense, it is incoherent to anybody other than the lawyers. It won't deal with the big issues that we have to deal with, such as the ageing population and dementia. It will result in a very expensive health service and it will also result in a health service that certainly will never match the health service that we have at the moment - or at least had 12 months ago."
Professional support for the Tory plans
Similarly, the Prime Minister tries to claim that hospitals support the reforms: "... and just today 50 foundation trusts have written to the Newspapers in support of our reforms and objecting." - David Cameron, Prime Ministers Questions, 8 February 2012
Yet the British Medical Association, the professional association of doctors, believe that it is better to withdraw the Bill altogether and come up with a new plan - one that will actually improve care and make the NHS more efficient:
"The government has had to make so many amendments to remedy the initial flaws in the legislation and has brought in so many checks and balances that the level of complexity and bureaucracy in the new NHS will be huge. It would be better to withdraw the Bill altogether and come up with a new plan - one that will actually improve care and make the NHS more efficient.
"We are not alone in this view; the bodies representing the majority of clinical staff in the NHS are all in agreement and the decision to come out against the reforms was not one that any of us took lightly. The Lords must listen to the serious concerns being voiced by the profession before it is too late. They mustn't accept minor tweaking - many of the things the government wants, such as clinician-led commissioning, don't require legislation and can be achieved without further structural change."
Cutting bureaucracy
Still, says David Cameron, the Tories are cutting the bureaucracy in the NHS:
"What we're doing is cutting the bureaucracy in the NHS. We are taking four and a half billion pounds of bureaucracy that will be ploughed into patient care. Now if you don't support the reform you won't see that money going to operations, doctors, nurses, hospitals, healthcare assessments." - Prime Ministers Questions, 8 February 2012
But the truth is very different. The Royal College of GPs says that the NHS is going from having 163 statutory organisations to 521 and the NHS Confederation believe that more complex structure could potentially lead to paralysis in the system:
"The bureaucracy with the new Bill, post-pause, means that we have gone--we have calculated this--from 163 statutory organisations to a proposed 521, not counting the commissioning support organisations. Clearly, we have massively increased the bureaucracy, if one calls it that, within the new, post-pause NHS. With respect to the national commissioning board and whatever, the current, post-pause Bill seems to be very incoherent. No matter what one felt about the pre-pause Bill, it was coherent. This is not. It is neither liberating nor controlling. It neither allows for GPs to be innovative, nor does it give them tight restraints."
Dr. Clare Gerada, Royal College of GPs
"We remain concerned that the proposed, more complex structure could potentially lead to paralysis in the system. It needs to be clearer how the various bodies in the system will be expected to work effectively together, which organisations will lead on certain crucial issues such as improving the quality of care, and how potential disputes will be resolved."
Health and Social Care Bill House of Lords - Report Stage Briefing February 2012, Pg 2
NHS reform
In all of this, the Tories are desperate to claim, wrongly, that Labour is against NHS reform.
"Now he used to be in favour of the reform. Let me read him this, who said this? 'To safeguard the NHS in tougher fiscal times, we need sustained reform.' That was in the Labour manifesto at last election. And on the issue of money, because the money in the NHS is important, we are committed to £12.5bn in this parliament and yet his health spokesman, sitting right there, said, and I quote: 'It would be irresponsible, irresponsible, to spend more money on the NHS.' They are not in favour of the money, they are not in favour of the reform, they are just a bunch of opportunists." - David Cameron, Prime Minister's Questions, 8 February 2012
This could not be further from the truth. Labour supports NHS reform - but this is the wrong reform at the wrong time. The reform and investment of the last Labour government saved and radically improved the NHS. Even David Cameron chose admit that Labour is not against all NHS reform - quoting Labour's policy as set out in our 2010 Manifesto.
"But to safeguard the NHS in tougher fiscal times, we need sustained reform."
Labour Party manifesto 2010, p. 4:3
We were committed to delivering up to £20 billion of efficiencies in the frontline NHS, and we guaranteed to ensure that every pound was reinvested in patient care.
But the Tory-chaired Health Select Committee says that the government's top-down reorganisation "often creates disruption and distraction" which is getting in the way of reforming service delivery and releasing savings.
"The reorganisation process continues to complicate the push for efficiency gains. Although it may have facilitated savings in some cases, we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings."
Health Select Committee, "Public Expenditure", Thirteenth Report of Session 2010-12, 17 January 2012, p. 20
As former Labour Health Secretary Alan Milburn said this morning, the Bill is "a roadblock to meaningful reform".
"The Health and Social Care Bill is a patchwork quilt of complexity, compromise and confusion. It is incapable of giving the NHS the clarity and direction it needs. It is a roadblock to meaningful reform."
Alan Milburn, The Times, 8 February 2012
Labour is opposed to this top-down reorganisation which is hindering the necessary reform of the NHS.
Private sector involvement in the NHS
Last of all, an increasingly desperate government claims Labour is proposing a system which would mean cancer hospitals like Royal Marsden having to cut the services they deliver.
"And let me tell you one thing that would really damage cancer treatment in this country and that is the proposal, from the party opposite, to cap at 5% any private sector involvement in our hospitals. In the Royal Marsden, one of the best cancer hospitals in the country, they would have to cut by a quarter the services that they deliver. What a crazy left-wing plan that only the honourable gentleman could come up with." - Prime Minister's Questions, 8 February, 2012
David Cameron is misrepresenting Labour's policy. It would not require the Royal Marsden to cut back on its services. Labour is proposing an amendment to the Health and Social Care Bill which limits the degree to which the proportion of private income can change from its current level without proper scrutiny and clearance. In our system, this would be dealt with on a case-by-case basis. Where foundation trusts wish to change the proportion of private income they will have to consult and get agreement from their Members and governors. If the resulting level is greater than 5%, this would also need to be cleared by Monitor - with much tougher tests to demonstrate benefit to NHS patients. This ensures the decisions are taken locally and that benefits to NHS patients must be demonstrated.
This is a world away from the Tories' proposal to let all trusts earn up to 49% of their income from private sources. In an environment where the Tory-led government have watered-down Labour's waiting-time guarantees, and where the NHS frontline is under pressure and waiting lists growing, the government's proposal risks NHS patients waiting longer as hospitals treat more private patients and NHS get pushed to the back of the queue.