I beg to move,
As an Amendment to the Address, at end add 'but regret the absence of measures in the Gracious Speech to deliver reforms which would make public services genuinely accountable to patients and parents;
believe that the measures proposed offer no prospect of raising long-term productivity or value for money in public services;
object to the absence of measures to reduce bureaucracy;
regret the failure to abolish centrally-dictated targets and support public services focused on outcomes;
note the lack of commitment to improve public health and outcomes to reduce health inequalities;
regret the failure to provide patients with meaningful information to improve local accountability;
deplore the failure to bring forward proposals on social care;
further regret the lack of measures to break the link between poverty and educational achievement and to raise standards in literacy;
call for proposals to tackle the United Kingdom's declining position in international education league tables and to give pupils in state schools the opportunity to sit the best examinations;
note the lack of proposals to ensure higher standards of child protection;
further regret the absence of measures to reverse the decline of science and to make schools accountable to parents rather than bureaucrats;
and seek long-term reform of public services rather than short-term palliatives.'.
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I tell the House that Mr. Speaker has selected the amendment in the name of the Leader of the Opposition. Interestingly, in his speech last Wednesday at the commencement of these debates, the Prime Minister sought to upstage the Queen's Speech itself. It was not hard to do; we knew the Queen's Speech would be thin, but it turned out to be skeletal. I do not object to having fewer Bills—
I am grateful to the hon. Gentleman for that.
Legislative hyperactivity and lack of delivery are the story of this Government—I am now waiting for another "Hear, hear" from the hon. Gentleman—but if the Government propose legislation, one would at least expect that it might be original, purposeful and substantive. On health, the Government's approach is none of those. It is certainly not original.
Almost three years ago, my right hon. Friend Mr. Cameron and I called for an NHS constitution to be established in primary legislation, and the Government are now following our lead, but do their plans have the necessary purpose? The Government's plan is to construct an NHS constitution that, by their own admission, does not extend new legal rights to NHS services. That is astonishing; their consultation states to the public that they are not setting out to create any new legal rights. All the rights or pledges could be provided under existing powers. Even the much-vaunted new legal right to choose can be, and indeed probably will be, established by a direction issued by the Secretary of State under existing legislation. NHS bodies can already be required by direction under existing legislation to comply with any of these rights or pledges, and certainly to have regard to them.
So what does the Government's proposal—the centrepiece of the Queen's Speech so far as health is concerned—achieve? It achieves this: the Prime Minister said he wanted a constitution, so he has to have one. I wonder whether Ministers are even aware of how meaningless their response to the prime ministerial commitment has become. However, I think the public and the people who work in the NHS do know. The consultation issued this summer on the NHS constitution resulted in 1,008 replies to the Department of Health, including just 178 from NHS staff. That is not even one response for each NHS hospital; not even one in 5,000 NHS staff could be bothered to reply.
No doubt Ministers think that silence betokens consent. I do not think so; I think silence means contempt—contempt for the Government, where NHS staff feel that responding to the Government is pointless because they do not listen. In a top-down culture, what price consultation? When gimmicks abound, why should NHS staff have given this particular Government proposal any more credence? We will see whether Ministers listen to consultation. Three weeks ago, another consultation on the pharmacy White Paper ended, with 80,000 responses received. If consultation means anything, the Secretary of State will say this afternoon that the Government will make no changes to the existing GP dispensing arrangements because he has listened to the results of that consultation. I challenge him to do so.
What I said was that Ministers probably think that silence betokens consent, but in my view silence means contempt— [ Interruption. ] No, I have said it twice, and that is sufficient, even for the purpose of educating the Secretary of State for Children, Schools and Families.
I regret the lack of engagement with the idea of an NHS constitution. My third point is about substance, and there is an opportunity for substance there. We could have had legislation in prospect that would genuinely put the values of the NHS into primary legislation. We could have NHS bodies given greater freedom and autonomy, which the Prime Minister said—before he became Prime Minister—that he favoured. It turns out that he is not remotely interested in giving those freedoms to the NHS.
A constitution could do what constitutions are bound to do—define in statute for NHS bodies, often for the first time, their respective duties and responsibilities, both within the service and towards patients. A constitution could give patients choice, and a voice, after the Government have so disgracefully dismantled any effective statutory voice for patients at a national level. It could also strengthen the link between inspection and complaints. The Government have just legislated—wrongly—to remove from the new Care Quality Commission responsibility for the consideration of second stage complaints and hand it to the Parliamentary and Health Service Ombudsman. How can the new Care Quality Commission acquire and use intelligence about what is happening in the NHS if it does not have a responsibility to investigate unresolved complaints?
The ombudsman will get £4.6 million, which is less than half the amount of money that is currently being spent by the Healthcare Commission—between £10 million and £11 million—on second stage complaints. The Government blithely assume that the number of second stage complaints going to the ombudsman will be about half the number that currently go to the Healthcare Commission, but there is no basis for that belief. It is at best naive and at worst dangerous. The system is at serious risk, and if that carries on, the NHS will not be the learning organisation that it should be. I urge the Government to reconsider.
The opportunity is there for a health Bill in this Session that could make a real difference. Typically, the Government have failed to take that opportunity. The Secretary of State is pursuing a "do nothing" strategy for the Department of Health—least said, soonest mended. We should not be surprised by that, because before he became Secretary of State he described his approach to his responsibilities. He said, "I just drift along." At least that provides plenty of room for his Under-Secretary, Lord Darzi, to hog the limelight. It is a pity that Lord Darzi has not understood that he is just window dressing for a Government who are chronically incapable of delivering.
I shall give one example. Hon. Members will recall that in October 2007, in anticipation of a general election, Lord Darzi was prevailed on to publish rapidly his interim report. The headline proposal was the Health Innovation Council, which Lord Darzi was to chair. Many people were prevailed on to become members of the council. It was announced that it would spend £100 million on a new health innovation fund—half from the Wellcome Trust and half from the Government. The details of the fund were to be published early in 2008, bids would be sought by the second quarter of 2008 and innovation would, as a consequence, flow throughout the NHS. What happened? The council met, twice, for rather inconclusive discussions; no details of the fund have been published; no bids have been sought; no money has been offered; and nothing has happened. It has all just drifted, again.
On the subject of platitudinous Labour soundbites, perhaps my hon. Friend recollects a vintage example of the genre—the 1999 pledge by the former Prime Minister, Tony Blair, that within the following two years everyone would once again be able to see an NHS dentist just by phoning NHS Direct. Does my hon. Friend share my concern that since then 1.2 million of our fellow countrymen and women have lost access to NHS dentistry, including many thousands in my constituency and his?
I am very concerned about that. The House will have an opportunity next Thursday to debate dentistry, but the Government should be ashamed of the current position. As my hon. Friend rightly says, we were promised in 1999 that everyone would have access, but the consequence of the Government's contract is that 1.2 million fewer people have access to dentistry.
The Government also promised that the change in charging for dentistry would be neutral, in the sense that the amount raised through charges would not increase as a proportion of dental expenditure. That did not happen either. The latest figures published by the Government suggest a 14 per cent. increase in dental charges in the latest year alone. That is about £65 million extra from dental charge income. Patients are paying more, fewer have access, and the dental contract is not delivering as it should.
My hon. Friend is right. The great bulk of orthodontic work is provided privately, but work for children whose oral health would otherwise be prejudiced is done through the NHS. That is very difficult to access, and can often lead to the circumstances to which my hon. Friend refers. It is important that we ensure that children get good access. I was in a hospital recently and the staff told me about the rising numbers of children with dental caries presenting to hospitals as a consequence of an inability to access NHS dentistry. That will get worse. I do not know whether Ministers are aware of it, but from the coming year many primary care trusts will tell their dentists that they cannot have children-only contracts. So NHS dentistry will be taken away from children whose parents are not accessing NHS dentistry. That is a scandal, and I hope that Ministers will do something about it.
Does the hon. Gentleman think that it is right and proper that dentists should say to parents, "We'll look after your children under the NHS if you take out private insurance with us"? Does he agree that those dentists should be ashamed of blackmailing individuals in that way?
The right hon. Gentleman makes a different point. I am not asking dentists to tell parents that they should be private patients. The point that I am making is that dentists who offer NHS services should not take NHS access away from children if they are already registered with them. That is what will happen. If he is suggesting that we should see the number of children accessing NHS dentistry falling, with all the potential consequences for poor oral health, I would be surprised. That seems contrary to many of the things that I have heard him say in the past.
A central and joint responsibility for both Secretaries of State—and also at the centre of our concerns—is children's health. The Department for Children, Schools and Families is pushing for a child health strategy to be published, but the Department of Health is letting that drift. That will not do. I hope that the Secretary of State for Health will now tell us when he will publish that child health strategy.
Drift will not do either when it comes to the protection of vulnerable children. The Secretary of State for Children, Schools and Families has responded to the latest tragic events in Haringey by announcing a review by Herbert Laming and the establishment of a task force. The Select Committee was told yesterday by Ofsted that three children a week die from abuse or neglect, which is a compelling case for urgent action.
The joint area review of children's services in Haringey illustrated one of the important points with painful clarity:
"the reliance on national and local performance indicators is too great and does not enable understanding of the quality and effectiveness of service provision on the ground."
When we respond, as we must, to the tragic baby P case, I hope that Ministers recognise—and perhaps will use this afternoon to say—that constant structural change and a tick-box, top-down attitude will not do for protecting children. We have to move on from that.
Like other hon. Members present this afternoon, I remember when the then Secretary of State, Mr. Milburn, responded in the House to Lord Laming's report on the Victoria Climbié inquiry. He announced the creation of children's trusts, even though Lord Laming had not recommended them. That is an example of the Government offering a structural solution that Lord Laming had not asked for. It did a disservice to Lord Laming's report from six years ago to offer a structural response to the problem that he identified.
In his report, Lord Laming stated:
"I am convinced that it is not just structures that are the problem but the skills of the staff that work in them...The single most important change in the future must be the drawing of a clear line of accountability from top to bottom without doubt or ambiguity about who is responsible at every level for the welfare of vulnerable children".
How can it be that, six years later, it took weeks of public pressure in the same borough of Haringey for such accountability to be brought to bear, for the facts to be exposed and for those at the most senior levels to accept responsibility? We must all take responsibility for the fact that things that Lord Laming asked for, and which were understood early in 2003, were clearly not being put into effect culturally in the social work profession and in those services with responsibility for children. It is important that we make sure that that accountability is in place now, and that we recognise the need for improvements in skills.
In 2006, in the absence of Government action in that respect, my hon. Friend Tim Loughton, set up the Opposition's own commission to look into how to improve the training, recruitment, status and perception of social workers. Its report was published in 2007, and I urge the Government to look at some of the examples that are available, including work done on this side of the House. Instead of starting again from year zero, with another task force and another report that will take a great deal of time to prepare, they should think about how we can do things.
I shall take one example from our report. It suggests that we should recognise that experienced social workers far too often go into hierarchies of management and are not retained on the front line. The report proposes that we should recognise the need for them to be retained in front-line care and that, to make that happen, we should create a structure of consultant social workers.
I urge the Government not to push every issue off to a new review or task force. We need to think—by all means on a cross-party basis—about the things that need to be done now that we know can make a difference in the short term.
I am grateful to the hon. Gentleman for giving way. For the most part, we have proceeded in this matter in a cross-party way. I am pleased that he recognises the importance of Lord Laming's original report, and that he welcomes the urgent progress report that I have asked Lord Laming to compile. Does the hon. Gentleman think that Lord Laming is the right man to do the progress report?
I do. The right hon. Gentleman may or may not recall that I was vice-chair of the all-party parliamentary group on child health when Lord Laming produced his original report. I had my own debate on child health at the time and did not share some of the concerns expressed in that report. As I have said, that report concentrated on structures and did not focus enough on the importance of skills, leadership and accountability in the social work profession. It discussed those matters, but it has not been acted on sufficiently. I have no difficulty accepting that Lord Laming is capable of finding out why his earlier recommendations in that regard are not being implemented.
My point is that Lord Laming can produce a report, but that does not mean that the things that need to be done will get done. We have to be aware of what needs to be done, and producing reports is not the sole answer.
I met Lord Laming on Monday to discuss the review that he is to undertake. Does the hon. Gentleman share my concern about the narrowness of its terms of reference?
I confess that I have not read the terms of reference of Lord Laming's review, so I shall leave that question to my hon. Friend Michael Gove, who may want to refer to it later.
I return now to the Government's legislative intentions. The Secretary of State for Health announced this week that the Government are going to remove point-of-sale displays for tobacco products. I hold no brief for tobacco—I wish that no one were a smoker—but how can it be legal for a shop to sell cigarettes to adults but illegal for it to put such products on a shelf? What is the point of the Government constantly mandating increasingly alarming labels for cigarette packets—as the Minister of State, Dawn Primarolo, did recently—and then require them to be hidden? How can they say that their proposal is aimed at sales in shops of cigarettes to young people, when we legislated less than two years ago to make it illegal for shops to sell tobacco products to under-18s?
The day before yesterday, the Government claimed that removing displays of cigarettes can reduce smoking prevalence among young people by 10 per cent., but the evidence from other countries shows that similar bans have not had that effect. It is true that smoking prevalence rates among 15 to 19-year-olds in Canada declined after 2002, but that cannot be attributed to the removal of tobacco displays. The provinces that removed tobacco displays achieved a success rate broadly equal to those that did not, so the ban apparently had no great effect. In Iceland, Government statistics show that the display ban had no impact on the number of 15 to 19-year-olds who smoke—in fact, the proportion rose from 14.4 per cent. to 15.2 per cent.
Many small businesses will be hit by the proposal, and it is simply not good enough to say to them that the Government have the best interests of public health at heart when the evidence to back that up is not there. The Norwegian Department of Health and Care Services said last year that
"there is yet no scientific study published that definitely shows the impact that a ban against public display would have on the number of people who smoke".
Yes, I recall that report, which contained no such reference. If international example and guidance are important, we should listen to them.
No doubt we will have this debate when we discuss the health Bill, but Ministers have had an outing this week on the basis of evidence that has been reported in an uncritical fashion. It is rather important that we in this House base our arguments on the evidence.
I am listening carefully to the hon. Gentleman. I have not yet made up my mind about the issue, but it strikes me that if a ban on display does not work, sales will not be adversely affected and corner shops will not suffer. If corner shops were to suffer as a result of a ban, the ban would be working in cutting tobacco sales. Which is it?
No, it would raise the question why the ban does not work, because the percentage of illegal sales is already high. If one removes the point of display, there may be an impact not only on costs but on the proportion of sales going through small retailers rather than the illegal trade. I am surprised that the Government are not more concerned about protecting their income. If they want to do something about the issue, we have suggestions. There are things that can be done on enforcement against the illegal trade, which would at least mean that the price of cigarettes would have an impact on smokers, many of whom do not realise what the real cost of tobacco, including duty, would be if they had to pay it. There is much that we can do on nicotine patches, such as ensuring that the right strength of patch is available to help habitual users of tobacco.
There is a lack of practical action when there are things that ought to and can be done to help people facing the risk of unemployment. The Secretary of State for Health knows that rolling out cognitive behaviour therapies, which the Government are committed to do, can and should be achieved across the country, rather than only in certain areas. In 2004, Lord Layard told the Government that we needed 10,000 more cognitive behaviour therapists. The Government are committed to 3,600 but only over the next three years and only in one in seven primary care trusts. Given the current unemployment risks, it must be right for such therapists to be available throughout the country.
We know that the impact of such therapy can be substantial; it can double the rate at which people who lose their employment get back to work. The evidence suggests that an increase of 1 per cent. in unemployment would lead to a 7 per cent. increase in demand for mental health services. We know where the biggest short-term demand for health services will be, but we do not have a strategy to respond to it.
Does the hon. Gentleman agree with the Liberal Democrat view that there should be an entitlement within a defined period to access treatment such as CBT, which has been approved by the National Institute for Health and Clinical Excellence as an effective treatment, especially as all the evidence suggests that early access to such treatments has a disproportionate impact on individuals suffering from anxiety or depression?
No, I do not propose to go down that path, which involves simply reintroducing more targets. We need to ensure that capacity is available rather than simply setting targets.
The Government have, of course, set plenty of targets, and I shall remind them of one. In 1997, Labour told us that their plan for the NHS was
"rooting out unnecessary administrative cost".
In 2006, Members will recall—because there was so much argument about it—that the Government proposed to halve the number of primary care trusts from 303 to 152. They told us that it would save the taxpayer £250 million by reducing management costs. What happened? In 2005-06, the management costs of PCTs were £1.09 billion. By 2007-08—only two years later—after reorganisation, the amount rose to £1.178 billion. The costs are not £250 million down, but £88 million up; an extra £333 million has gone into administration, which is not available for the front-line care that Ministers said that it would be used for. It is unbelievable. That is only one example, but there are many others.
Ministers constantly tell us about the importance of the front line, but the resources do not reach it, which is the experience of people right across the NHS. They are constantly told that they have resources, but they do not see the situation in the same way.
No, I gave way to the hon. Gentleman earlier, and I want to finish my speech, because time does not permit me to go on too long.
Two years ago, my right hon. Friend Mr. Cameron and I said that the Government and the NHS should focus on outcomes, not targets. This summer, Lord Darzi's report endorsed the emphasis on outcomes, but it did not actually get rid of the targets. On Monday, the Secretary of State published the new operating framework and it is still littered with targets. We know what dominates the thinking of NHS managers—the so-called must-do targets, not the outcomes that in reality matter most for patients.
The Conservatives will focus on what we need to achieve the outcomes for the people whom we are here to serve, not on how people in services go about achieving them. Of course, performance management has to follow evidence of effectiveness and benchmarked performance, but objective measures such as standardised mortality rates should be mixed with more subjective ones, such as patient experience and self-reported outcomes. All those things should also be benchmarked against the best in the world.
When evidence was published by the Healthcare Commission of the scale of adverse events and harm resulting to patients, it was entirely typical of the Government that their response was, "Well that's all right, it's about the same level as elsewhere in the world." Ministers seem to be prepared to use international benchmarking only when it justifies the level of error in the NHS. They do not use international benchmarking for infections and admit that our MRSA rates are much higher than best practice or that our rates of clostridium difficile can be four times the average for other hospital systems. They do not use international benchmarks to admit that our cancer survival rate is a quarter worse than the best in Europe, that our stroke mortality is a third worse than Germany's or that deaths from lung disease in the UK are two thirds worse than the European average. The NHS should be focused on those issues. That is what is most important, not whether every PCT sets up a Darzi centre.
The Government talk about world-class commissioning. We need world-class services, but we will not get them with a one-size, top-down bureaucratic approach. We will get them through innovation, professionalism, responsiveness to patients and the rigorous application of evidence-based care. Treat the staff of the NHS like drones, and they will behave like drones; trust them like professionals, and they will respond.
The Government have de-professionalised the NHS, which is why they have seen declining productivity year on year. That is why, despite their targets, performance has fallen short. Patient choice has diminished—fewer patients say that they have experienced access to choice—and practice-based commissioning has stalled. Patient experience measures have deteriorated, and the foundation trust programme has not met its 2008 targets. Health inequalities have widened— [ Interruption. ] The Minister of State says that I do not like targets. What is the point of targets if they do not deliver? What was the point of saying that every hospital should be a foundation trust by 2008, when only about half of them are?
The Minister of State may like to recall that back in 2006, Tony Blair described his four drivers for health reform—patient choice, foundation hospitals, independent sector treatment centres and practice-based commissioning. All four have stalled or disappeared from the reform process. The Blairite reforms have gone. What do we have in their place—world-class commissioning? It does not feel world-class yet.
We will not have world-class NHS services unless the Government recognise what is really needed—to trust NHS professionals, to make the service more accountable to patients, with less to top-down bureaucracy, to reinvigorate our public health service and to focus at every level on patient outcomes. We are committed to reforms that would make a real difference to patients and NHS staff. For the Government it is all Darzi or drift; it is about money spent and money wasted; it is all inputs and not enough outputs.
The Queen's Speech is all short-term gimmicks and does not include the long-term reform that our great public services so badly need. The Government have run out of steam—they are out of ideas and out of time. I agree with my right hon. Friend the Member for Witney: bring on the election. I commend the amendment to the House.
I welcome this opportunity to debate the measures in Her Majesty's Gracious Speech. The proposals on health set out how we will expand patient choice, enhance quality, protect the health of young people and safeguard the values and principles of the NHS for future generations. The proposals on education will provide new powers to improve standards in schools, provide greater opportunities for young people and improve the local organisation of children's services to make them more responsive and accountable. The child poverty Bill will enshrine in legislation our intention to eradicate child poverty by 2020.
Eleven years ago, the NHS was on its knees, after nearly two decades of neglect and underinvestment. In schools, only 35 per cent. of pupils achieved five or more good GCSEs, including English and maths, and the Conservative Government were preparing to introduce nursery vouchers for early-years provision that was scant and inadequate. Now, we see improved standards, nursery places for all three and four-year-olds, new schools and hospitals, reductions in mortality rates from the three big killers—heart disease, stroke and cancer—and the best ever A-level and GCSE results.
By far the most damaging legacy of the previous Government was long waiting times, which delayed important surgery for many months and even years. By the end of 2008, no patient will need to wait more than 18 weeks from the time that they are referred by their GP for treatment, and the average wait will be no more than eight weeks. It is worth reflecting on the way that that enormous achievement by NHS staff has changed a mindset that became entrenched in the Conservative years. Only recently, a clinician at St. Thomas's was telling me about how, in 1994, her chief consultant took his medical team out to dinner to celebrate the fact that they had reduced the waiting times for hip replacements from five years to three years. The chief medical officer tells of elderly patients in the 1980s seeking to bequeath in their wills their places on the waiting lists to family members, having waited years for a cataract operation. That was the reality of life in the NHS under the Conservative party.
I agree that substantial progress has been made on access to treatment, particularly in acute hospitals, but what about mental health? Does the Secretary of State agree that we need to tackle the outrageous waiting times in mental health care as well? People frequently wait more than a year for access to cognitive behaviour therapy. If they have the money, they can pay to go privately. If they have not got the money, they just wait. That must be tackled.
That will be tackled. The hon. Gentleman is right to say that there are unacceptable waiting times in mental health care, but I will come on to mental health in a minute. The leader of the Liberal Democrats described mental health as being in crisis in this country two weeks before the World Health Organisation said that we had the best mental health services in Europe. I will come on to mental health, because I believe that a chunk of time needs to be devoted to it.
Apart from waiting times, there has also been dramatic progress on tackling health care acquired infections. In September, we announced that we had achieved and exceeded our ambitions of reducing MRSA cases by half—achieving a 57 per cent. reduction in three years. In October, we announced that clostridium difficile cases had fallen by 38 per cent. among the over-65s. We have seen dramatic improvements in primary care. GPs see patients for longer—the length of consultations has gone up by 50 per cent.—and the number of consultations per year has risen from around 221 million in 1997 to nearly 300 million this year. Following the agreement reached with the British Medical Association earlier this year, which Opposition Members opposed, 65 per cent. of GP surgeries are now offering additional weekend and evening appointments—again, meeting and then exceeding our ambition, which was to have half of all surgeries opening for longer by the end of the year.
Will the Secretary of State forgive me if I do not make a party political point and refer to the future, rather than the past? I am very proud of the fact that we are doing a lot of work with the National Audit Office in trying to raise up the agenda the Department of Health's work on dementia, stroke and end-of-life care. I wonder whether he will say a word about his priorities now that he will address that problem. He has mentioned, of course, his efforts on cancer and heart disease, but dementia, stroke and end-of-life care are very important as well.
The hon. Gentleman is, of course, absolutely right. We published our stroke strategy a year ago, in December 2007, and everyone involved, including the non-governmental organisations and the Stroke Association, is very pleased with the progress that has been made. The hon. Gentleman is quite right to mention dementia. It is an important issue, and only a couple of weeks ago, I mentioned in a speech that cancer had a stigma 20 years ago—people did not talk about cancer in polite society—and that that was now the case with dementia. Of course, no one made jokes about cancer, but people make light-hearted references to dementia, which has to stop.
Our dementia strategy, which will be published shortly, will concentrate on raising awareness, removing the stigma and ensuring a better quality of care and much earlier diagnosis. A dementia sufferer usually goes to a GP about seven or eight times before dementia is diagnosed, so a lot needs to be done there as well. We published our strategy on end-of-life care four months ago. Once again, it entails working with the voluntary sector and NGOs to develop the ability to convince people that, if they choose to die at home, support services are available to them and their families to ensure that they will be okay. That is the biggest single reason why families are sometimes reluctant to allow their loved ones to come home.
Following the NAO reports on dementia and stroke, the Government adopted the strategies that the Secretary of State has discussed, and I am very pleased that they did so. When I have visited stroke units, I have found some excellent work going on. However, a physiotherapist told me that, once the person is discharged, so long as they can get around indoors, they then get virtually nothing at all—they go from very good support to nothing. Stroke victims need continuity of care when they go home. Is the right hon. Gentleman making plans to ensure that that support is provided?
The hon. Lady is absolutely right. That is why the strategy focuses on prevention, on what is done immediately someone has a stroke—thrombolysis and so on—and on a better quality of care. As important as all that is, however, as Macmillan has been saying for many years, aftercare back in the community is crucial. It is one of the three central features of the stroke strategy, and we intend to ensure that every aspect of that strategy is implemented.
May I return the Secretary of State to dementia? He said that the national dementia strategy will be published shortly. As he knows, there are three elements to the welcome work that the Government are doing on dementia: first, there is the national strategy; secondly, there is the research summit; and thirdly, there is the review of anti-psychotic medication. The timetable has slipped quite significantly in relation to all those elements, and he will recognise the concern of all those involved that the urgency originally expressed by the former Minister with responsibility for care services, the present Under-Secretary of State for International Development, Mr. Lewis does not appear to have been persisted with, which is a matter of extreme concern. Will the Secretary of State assist us by saying exactly when each of those elements will be available?
I believe that the Minister of State, Department of Health, my hon. Friend Phil Hope had a meeting yesterday with the all-party group that the hon. Gentleman chairs. The dementia strategy should be published very shortly—not before Christmas, but very soon in the new year—but getting a day in the grid is the problem. I believe that the review of anti-psychotic treatment will be ready by about the spring—it is on a slightly longer time scale. I am sorry, but I have forgotten the hon. Gentleman's third point.
The Government indicated that the research summit would be held this summer, but that did not happen. I take the opportunity to thank the current Minister with responsibility for care services for coming to the meeting. He explained that all those things will be available shortly, but I simply wonder whether we could have a little more specificity.
The hon. Gentleman is seeking a definition of "shortly". The research conference will take place at about the same time as we publish the dementia strategy, so it should take place very early in the new year. I am not trying to be difficult, but the way in which this works is that we have to get our slot in the system, and I hope that we will get a date very soon.
Only two weeks ago, I opened the first GP-led health centre, in Bradford; the second opened on Tuesday, in Corby. We were rather disappointed: we expected the Opposition Front-Bench team to be outside with placards, protesting vigorously, along with the BMA, but there was not a single protest. All we had was the local community, absolutely delighted to have that fabulous facility in their community. The centres provide access to primary care services from 8 am to 8 pm every day of the year, including Christmas day. The next year will see 152 such centres open, many of them offering additional services such as podiatry, physiotherapy or speech and language therapy. In addition, many will be able to perform minor operations and offer specialist services to patients with asthma or diabetes who would otherwise have had to go to hospital for treatment.
We are also funding 112 additional GP practices to provide much needed services for under-doctored areas, which, for the most part, have suffered from a chronic shortage of GPs since the NHS began. That is a vital step in tackling health inequalities. There is a clear correlation between limited access to primary care services and poor health.
On that very point, my right hon. Friend knows that I have invited him to my constituency to open the new Moorgate medical centre. The centre is now open and patients are benefiting from it. It is of enormous value to my constituents, who welcome the investment that paid for it. May I repeat my invitation to him to perform the official opening function in a few weeks' time?
I am pleased to hear that. I think my hon. Friend is duty bound to inform the local population that the Conservative party opposes GP-led health centres, saying that they will lead to 1,117 GP practices closing. Have any closed or are any likely to close in his constituency? I expect that experience to be repeated throughout the country.
I suggest that the Secretary of State should indeed go to Bury. As well as seeing the centre that Mr. Chaytor mentions, the right hon. Gentleman could take the opportunity to go to Fairfield hospital and shut the maternity services there at the same time.
Once again, the Opposition use that tactic. They said in a press release issued in summer 2007 that 29 hospitals were going to close; immediately, 15 of those hospitals pointed out how wrong they were. A hospital that they said was going to lose its accident and emergency department did not even have an A and E department. Then, the Opposition moved to arguing that 1,117 GP practices would close if GP-led health centres opened, because, they said, each centre would have 20 GPs. In fact, the most each centre will have is five. They were wrong on every count.
My recollection of the shadow Secretary of State's last visit to my constituency is that he was not allowed inside Fairfield hospital to look at the work being done in maternity care— [ Interruption. ] My recollection is that the photo was taken outside the building. The reorganisation of maternity services in Greater Manchester was necessary—
I do not want the hon. Member for Bury, North inadvertently to mislead the House, Mr. Deputy Speaker. I have visited Fairfield hospital twice. On the most recent occasion, I had a full visit all the way round the maternity services and a lengthy meeting with clinical staff.
What my hon. Friend the Member for Bury, North was about to point out is that we have got off second-stage complaints and the health innovation fund and on to the real meat and gravy of health services. The reconfiguration of maternity services in his constituency should have been carried out 40 years ago. Clinicians in the Manchester area say that they have been trying for 40 years to reconfigure maternity services to save babies' lives. The Conservatives, in another failed campaign, have said that there should be a moratorium on closures.
The Secretary of State made an important point about dealing with under-doctored areas. It has long been a scandal that the poorest parts of our communities have far fewer doctors than the leafier suburbs— [ Interruption. ] I support what he is doing. However, will he please say what steps are being taken on the minimum practice income guarantee? I know that steps are being taken to eradicate it, so that payments to GP practices are based on need and population, but how long will it take?
My right hon. Friend the Secretary of State for Children, Schools and Families was saying that it was worth turning up to learn that the Liberal Democrats also oppose GP-led health centres. The hon. Gentleman asks about the MPIG. This year's deal with the BMA begins the process of eroding the MPIG. We would have liked to have a multi-year deal, but that was not possible; instead, we agreed a one-year deal and we agreed on the principle of eroding the MPIG. If we continue to erode it on the same basis in future years—I see no reason why we would not—the proportion of practices that depend on the guarantee will decrease from about 90 per cent. now to about 20 per cent. in four or five years. That is a very important development and I praise the BMA—I do not praise the hon. Gentleman; that would be a first—for recognising the fact that, as he says, the MPIG militates against tackling health inequalities.
On his journey from his Hull constituency to Bury, my right hon. Friend will pass through Huddersfield, where we would love him to open something. However, may I remind him of the disgraceful campaign the Opposition waged in Huddersfield? The Calderdale and Huddersfield NHS Foundation Trust was angered by the time it took to guide their large party around the hospital and by the misleading press release that they issued afterward.
My hon. Friend should be gentle with Mr. Lansley, who has already had to apologise for something he said earlier this week. If he had to apologise for all the mistakes he has made, he would be at the Dispatch Box for hours and I would never make progress on my speech.
Before we leave the topic of the reorganisation of maternity services and the development of much stronger community-based maternity services, is not the great irony for the Opposition that, if they had pursued their policy of listening to the medical profession without any interference from primary care trusts, acute trusts or the Department of Health, the changes would have been made many years ago, to the vast benefit of the overwhelming majority of women?
It took three attempts, but my hon. Friend has made his point well and eloquently.
As I mentioned earlier, significant improvements have been made to mental health services, in particular community-based and preventive treatment. Since 1997, an additional 740 community-based mental health teams have been introduced, providing early intervention and intensive support; the number of consultant psychiatrists has increased by 64 per cent., the number of clinical psychologists by 71 per cent. and the number of mental health nurses by 21 per cent.
Does my right hon. Friend agree that one of this Government's great successes has been their suicide prevention strategy, which has cut suicides in England to the lowest level since 1863? Unfortunately, the strategy is due to end in 2010. Will he assure me that the focus will not be removed from suicide prevention and that we will continue to put it at the forefront of our mental health strategy?
My hon. Friend makes a good point. I wish that I had not given way, because she has stolen my thunder; that point was in my peroration. I can give her the assurance she seeks. Of course, all these measures take money. Earlier this year, the shadow Secretary of State talked about £28 billion more going into health under the Tories, but we have not heard what will happen. We have not heard whether they would match the spending in 2010-11 that we announced on Monday. I would be interested to hear about that before the end of the debate, because the spending is important, if we are to do all the things that we want to do on mental health and other issues.
Before I gave way, I was going to say, "And the suicide rate has fallen to its lowest level since records began in 1848." That will teach me. One in four people will experience an episode of mental illness at some point in their life. Mental illnesses such as depression are one of the leading causes of disability in this country, and 42 per cent. of people on incapacity benefit are on it because of a mental health problem. Until recently, access to psychological therapy was limited, even though, as the hon. Member for South Cambridgeshire said, it is widely acknowledged as the most effective way of treating mild to moderate depression.
As recently as seven years ago, only 9 per cent. of people with depression or anxiety were offered psychological therapy by the NHS. In October 2007, I announced that there would be a rapid expansion of access. The 13 new psychological therapy pilots that I launched a year ago have treated 17,500 people. This month, 35 primary care trusts launched their services; that is 15 more than we had anticipated. By 2011, we will have recruited 3,600 therapists, who will have helped to treat 900,000 people. Those are just some of the many developments that led the World Health Organisation in October to describe mental health services in this country as the best in Europe. In schools and children's services, there has been similarly dramatic progress.
I will make some progress, if my hon. Friend does not mind. There has been a significant expansion in child care and early years education, and greater achievement by pupils at all key stages. More young people than ever before are going on to study at university. Far from variable tuition fees discouraging poorer people from going to university, the social class gap in higher education is narrowing; it grew in the 40 years after the Robbins report. I point that out to my hon. Friend Dr. Gibson, who, I remember, engaged in the debates on the issue.
One of the defining moments of this Government came when we pledged to eradicate child poverty by 2020. That has been one of the most important catalysts for improving the life chances for children in this country. In October, the OECD reported that there had been faster growth in income equality in the UK than in any other developed country, and that the poverty rate had fallen well below the international average. It described the achievements in this country as "remarkable". There are now 600,000 fewer children living in relative poverty than when we took office, and the number of children living in absolute poverty has halved, yet we need to do still more. The measures set out in the Gracious Speech will strengthen children's trust boards, so that they can lead on local improvements to services. There will be a Bill to raise standards in schools and improve education and training for 16 to 19-year-olds and enhance the skills of those already in the workplace. We will also introduce a Bill that will convert our pledge to eradicate child poverty altogether by 2020 into a legislative commitment.
On health, we need to adapt to meet new challenges. An ageing population and the prevalence of lifestyle diseases such as obesity bring different pressures on health and on social care. Smoking, poor diet and lack of exercise account for most of the disease burden in this country. The next stage review, led by my noble Friend Lord Darzi of Denham, set out how we would ensure that the NHS promotes good health and well-being as effectively as it detects and treats illness.
On health, a major cost to the NHS is diabetes, and recent research suggests that there may be a link between diabetes and coeliac disease. I am a member of the all-party group on coeliac disease and dermatitis herpetiformis. Will my right hon. Friend, or one of his Ministers, meet the group to discuss the disease, which, as my right hon. Friend will know, has a prevalence of about one in 1,000? With the right diet, the adverse symptoms of that disease are entirely preventable, but coeliac disease goes undiagnosed in many carriers for years, and costs the NHS dear while those people are undiagnosed. That is aside from the devastation to those people's lives. Will he agree to meet the group?
My hon. Friend raises an important point about coeliac disease, and of course I, or one of my fellow Ministers, will meet the group. The next stage review set out how the NHS will ensure that it promotes good health and well-being effectively. It also set out how the NHS will further improve quality of care and give patients greater choice.
I thank my right hon. Friend for giving way. One of the big problems for people with Parkinson's disease is simple to address. When they are required to go to hospital, they should have access to the same medication that they were taking at home, at the same time as they took it at home. All too often, however, their health deteriorates in hospital because they have to fit in with the nurse's medication rounds, rather than getting medication as and when they need it. Is there any way in which that can be addressed in the current review?
The current review is all about the issue of personalised care. It is about how we move away from a regimented system and look at the needs of individuals, not least for the important reasons that my hon. Friend raised. There are many other ways in which a stay in hospital could be much more beneficial if the routine were changed. We are finding that out in an initiative called "The Productive Ward", in which we give nurses and clinicians the ability to organise how the ward works, having listened to the patients on their wards. My hon. Friend makes a profound point.
The health Bill will introduce several measures that will support the implementation of the next stage review, including measures to enable the NHS to explore the potential for personal budgets by piloting direct payments to patients with long-term conditions, and provisions requiring all NHS providers to measure the quality of their services and make that information available to the public. The Bill will also propose several measures to support the health of young people and, in particular, to promote health and well-being. We have already set out a groundbreaking strategy to tackle obesity; it is the first of its kind in the world. An essential component is "Change for Life", the social marketing campaign that brings together community groups, retailers, employers, the media, schools, health services and national and local government to encourage people to lead healthier lives.
We need to do more to tackle smoking, which still accounts for 87,000 premature deaths in England. Two thirds of smokers start before they are 18. I am genuinely perplexed by the approach taken on the issue by both the Conservative and Liberal Democrat Front Benchers—by the "nanny state" allegation from the Liberal Democrats, and by the other criticisms that we have heard today. The hon. Member for South Cambridgeshire started his speech by talking about the importance of consultation. He said that there had been a derisory response on the NHS constitution, but a very big response—86,000 responses—to a consultation on something or other; I forget what it was.
Yes, pharmacy, on which there will be a report very soon. The response on the smoking issue is the biggest that we have ever had on any consultation. If the hon. Gentleman believes that one should simply follow the result of consultation—that is a rather dangerous belief, if taken to its obvious conclusion—he will support the measure in question. The overwhelming response from 100,000 people consulted was that we should remove tobacco from display.
The hon. Gentleman talked about a lack of evidence, and having evidence-based measures. We have found that in other countries where such a measure has been introduced, smoking has reduced among young people. The number of young smokers in Canada, for instance, was reduced by 32 per cent. among 15 and 19-year-olds as a result of the implementation of the measure. There was a 26 per cent. fall among 15 to 16-year-olds in Iceland. That is why Australia, New Zealand and many other countries are taking that route, and why we must do so, too. We should recognise that a youngster who starts smoking between the ages of 11 and 15 is three times more likely to suffer a premature death than somebody who begins smoking at 20. Given the efforts over the years to reduce the number of smokers, with the figure down to 22 per cent., and given the recognition of what a huge public health issue smoking is, and the fact that it is the biggest health inequalities issue—in manual occupations, 29 per cent. still smoke, compared with the overall figure of 22 per cent.—I am perplexed why responsible politicians in both Opposition parties should oppose the measure. I believe that they will be on their own, without public support, when the measure is introduced.
We will take measures, too, to ban vending machines, which provide only 1 per cent. of the overall cigarette market, but provide 17 per cent. of the cigarettes sold to 11 to 15-year-olds. We will take steps, first, to restrict access to vending machines, but if that does work, we will ban them. The steps that we will take to promote health and well-being will have a significant impact on the health of our society.
The NHS is the proudest achievement of a Labour Government. Massive investment and greatly improved services mean that in the 60th year of the NHS, the case for a national health service that provides universal health care, free at the point of need, is supported as strongly by the public as it was at its inception. By 2011, investment in the NHS will have trebled. On Monday, I announced an average increase of funding of 5.5 per cent. for primary care trusts over the next two years, representing a £164 billion investment in the NHS over the next two years. That will mean a rise in local spending on health from £426 per person when we came into government in 1997 to the grand total of £1,612 by 2010.
When the Opposition were in government the figure was £426 per person, but under this Government it is £1,612. As a result of extra investment supporting the skills and abilities of its dedicated staff, the NHS has reduced the rate of premature deaths from heart disease by 50 per cent., from stroke by 44 per cent., and from cancer by almost 20 per cent.
My hon. Friend is absolutely right. Up to now, the Opposition have sought to suggest that they are as dearly attached to the NHS as the Labour party, abandoning their patient passport scheme, on which every single Opposition Member was elected. They have sought to say that they will invest more. The hon. Member for South Cambridgeshire got into trouble in February for saying that his party would put £28 billion into the NHS. Now we know that it is going to spend less overall and less on public services. We know from Mr. Hammond, the shadow Chief Secretary to the Treasury, that it will spend less on the NHS. We have not heard it from the lips of the hon. Member for South Cambridgeshire, so I would be perfectly willing to accept an intervention from him, as we need to know whether the Opposition will match our spending in 2010-11. [ Interruption. ] Okay, he does not wish to do so.
The constitution that we published alongside the NHS next stage review set out the key principles and values of the NHS, reaffirming our commitment to a service for all our people, with the finest medical treatment available, based on need, not on wealth. It enshrines the rights and responsibilities of patients and staff, bringing together existing legal rights with pledges and commitments about the standards of service that the NHS will provide. It establishes patients' legal right to choose where they are treated for certain services, and it sets out a patient's right to all NICE-recommended drugs and treatments.
The health Bill will place a legal duty on the NHS, its regulators and any independent or voluntary sector bodies that provide NHS services to have regard to the constitution. It will also commit the Government to renewing the constitution every 10 years. I believe that by building on the solid foundation established over the past 11 years, the NHS constitution and the measures that we have set out in the Gracious Speech will accelerate further progress, improve quality and intensify the focus on prevention. That will further enhance the huge progress made in health and education, and I commend the Gracious Speech to the House.
I welcome the opportunity both to reflect on the state of these vital public services and the Government's intentions, and to explain our alternative vision.
This debate coincides with the Healthcare Commission report on the state of health care in the UK. It is right to acknowledge, first, that that report had lots of positive things to say about progress in the national health service. The Secretary of State mentioned that progress has been made on survival rates for heart disease, stroke, and cancer. Survival rates for those serious diseases have improved, which is something that we should all welcome. We should welcome, too, the substantial improvements in access to care, compared with the position 10 or 11 years ago. There has been a dramatic improvement, and it would be churlish to fail to recognise that—
But the Healthcare Commission drew attention, too, to the fact that there were areas of serious concern. Ian Kennedy, the chair of the Healthcare Commission, focused on patient safety, and I want to concentrate for a few minutes on the area of most significance—child protection, particularly the tragedy involving baby P. Again, it is important again to acknowledge that the Secretary of State for Children, Schools and Families acted commendably fast in recognising the seriousness of the failings and in mapping out a way forward. However, it is also right to say that so far, the emphasis and focus, particularly in the media, have been on the failings of the local authority—and there were many—rather than on the failings of other agencies. I think that there are lessons to be learned, and it is important to reflect on them for a moment, particularly the situation in the local health service, because serious concerns have been raised with me.
I understand that the paediatric service for child protection in the borough was outsourced to Great Ormond Street. I understand that there was a team of four doctors, of whom two have resigned, one has been on special leave for a year, and one is off sick. Given the fundamental importance of that work—I make these comments not in any sense in a partisan way, as we all have a common view of the importance of addressing these issue—that is an alarming situation in itself. Incidentally, if either Secretary of State is unable to respond to these points today, I am happy for them to respond in writing later. What factors have led to this situation? Why has one of the doctors whom I mentioned been on long-term special leave for a year? Is it the case that the primary care trust cut funding for a designated doctor post, and is it the case that the paediatrician who did not recognise the broken back and ribs in the case of baby P was a locum employee?
I have heard concern expressed that when children are brought into St. Ann's hospital in Tottenham as possible victims of abuse, there is a tendency for no information to arrive with the child to put the medical team fully in the picture about possible concerns. That relates to the issues of co-ordination and the sharing of information between agencies dealt with in the report released by the Secretary of State for Children, Schools and Families. I understand that when one doctor filled in a critical incident form at that hospital, in relation to another case, he was told not to do so because it would show up poor record keeping. I do not know whether there is any truth in that allegation, but it is a serious matter and it clearly needs to be investigated. What short-term steps have been taken to ensure that there are proper safeguards in place for other vulnerable babies and children in that borough? What are the longer-term lessons for the NHS—as opposed to the local authority, which has had its fair share of attention—particularly with regard to the responsibility and accountability of the clinicians involved?
That takes me to the wider question of child protection. Such tragic cases open up a debate on parenting and on how we can best protect children. The case of baby P is a stark case of failure, but throughout the country, every day, social workers are grappling with the genuinely difficult dilemma of whether to remove a child from their parent or parents and to place them in care. It is massively challenging work, and the last thing we should do is to stigmatise social workers and make that an unattractive profession, thus putting able people off going into it. After such a disaster, there is a risk that policy is shaped in response to it, and that there is a swing of the pendulum into a different approach, which may not itself be right.
I would like to mention the other side of the coin. There are many cases in which there are genuine concerns about the failure of authorities to remove a child who is at risk, but in my constituency I have been dealing with the case of the Webster family, which was covered in the national press last year. They had a little boy who was taken into the Norfolk and Norwich hospital complaining of pain, and it turned out that he had multiple fractures. The child was removed, along with his two siblings, and after a long process the three children were adopted. That family lost their three children. Subsequently, it was proved through further medical evidence that they were innocent, and that there was an innocent explanation for the fractures—a nutrition deficiency. That case is a disaster. It is a disaster in the system and a gross miscarriage of justice for a family to lose their three children when they are innocent. It cannot get much worse than that. My plea is for us to avoid another swing of the pendulum, and to focus instead on ensuring that procedures are exacting, rigorous, thorough and professional, and that we focus on standards of professionalism in social care and in the NHS.
My hon. Friend is well aware that I have been concerned about both false positives and false negatives in the public family law environment. Does he share my concern that it is difficult for parents to get a second, expert opinion because they require the permission of the judge, which is often refused in family court proceedings?
I share that concern, and because it is so fundamentally important that we get such decisions right, the opportunity for a second opinion ought to exist in all cases. Had it been available in the Webster case, we might have avoided the miscarriage of justice that subsequently ensued. If we focus on standards of professionalism in reaching the right judgment, we stand the best chance of avoiding those dreadful miscarriages of justice, and of ensuring that children who are genuinely at risk are protected and withdrawn from their parents, if necessary. There should be no rush to put children into care, but the right decision, based on absolute professionalism, must be made.
Sure Start is one of the Government's genuine successes. The WAVE Trust is a good organisation, which has been influential in guiding Government policy development—I believe that it has engaged with all parties. It focuses on the first three years of a child's life, recognising the importance of getting things right in those years. It concentrates on parenting and ensures that children avoid adverse, damaging experiences that can affect their life chances, including their future health. Mr. Duncan Smith and Mr. Allen produced a good pamphlet, which focuses on the importance of investing in the first three years of life.
A recent article in The Lancet on a research report shows that Sure Start has started to make a difference. We should acknowledge that and recognise that it has been a positive policy move. However, an article by Rachel Sylvester in The Times earlier this week warns that there are signs that the approach in children's centres and in Sure Start is moving away from parenting skills and towards education. I hope that the Secretary of State for Children, Schools and Families, if he is listening, will ensure that the focus on parenting in children's centres, which has been so valuable and, according to the research, shows success, is maintained and not lost.
I want to deal with the Government's proposals for a national health service constitution. It is hard to object to the warm words and aspirations in the proposed constitution, but the Government must answer the key question of whether it will make a difference. Ten years down the line, will patients be able to say, "Ah, we're being treated better because of that NHS constitution"? Does it tackle the key challenges that face a publicly funded health system?
First, the draft constitution specifically precludes discrimination on the basis of race, gender, disability, religion or sexual orientation, but not of age. How can that be right? Secondly, we all agree that the divide between health and social care can be a problem. Should we therefore also consider the possibility of a social care constitution, so as not to entrench that divide further?
I welcome the equality Bill, but one has to ask why age has been left out of the list of discrimination that the NHS constitution seeks to tackle. We all know that age discrimination happens in the NHS. There is clear discrimination in mental health services: for example, elderly people who suffer from depression and anxiety do not have access to cognitive behavioural therapy. My hon. Friend Greg Mulholland is right that we should deal with discrimination based on age as well as that based on other matters.
The amendment encapsulates the priorities that we should address, although I do not believe that the Conservative programme tackles them properly or effectively. They include quality of care and outcomes, on which it is right to focus, as well as accountability. Sadly, the Conservative approach—establishing an independent national quango—would reduce rather than increase accountability, but the amendment is right to refer to it. It also mentions the need to tackle bureaucracy, to ensure value for money, to have a renewed focus on public health—the area that has so often suffered when the finances have got tight—and to tackle health inequalities.
Earlier this year, a King's Fund report said:
"If the NHS constitution did not confer any legally enforceable rights or guarantees it would, similar to the Patients' Charter"—
that was the thing that the Conservatives came up with—
"before it, be seen as a political device that simply raises expectations, which then cannot be met. Indeed it would hardly be worthy of being called a constitution."
That identifies the real risk of this document, which is that it will raise expectations. People will assume that it will deliver something to them that is not being delivered, but ultimately it will amount to motherhood and apple pie, and there will be no extra delivery.
Will there be any legally enforceable rights or entitlements within this constitution? It seems that there will not be; the sanctions for breaching the NHS constitution do not appear anywhere. Trusts will have to "have regard to" things—that wonderful legal phraseology means, of course, absolutely nothing, because one can be acting entirely within the legal framework if one has regard to something and then entirely ignores it. [Interruption.] I shall ignore the abuse from Rob Marris, which is so uncharacteristic. The proposals contain a reference to the responsibilities of patients, but what does it amount to? There is no substance to it.
What about the issue of missed appointments? Missed appointments cause the NHS enormous additional costs, and many are avoidable. We can do a lot to reduce the number of missed appointments, by using technology and sending text messages, emails and so on—but should we not be considering the idea of charging people, where appropriate? We should recognise that some people's condition means that they may be unreliable —[Interruption.] Well, there was a great intake of breath from Mr. Chaytor, but if we are talking about responsibilities, where are they set out? They appear to be entirely nebulous. If we are not talking about responsibilities in any meaningful sense, we should not even use the word.
Does the hon. Gentleman not realise that in most general practitioner practices and in most hospitals the normal practice would be, as it is in other areas of our public and commercial life, to overbook the number of appointments in the first place? That happens with aeroplanes, trains, coaches and MPs' surgeries; that is how one deals with this. Does he not also realise that many people who miss appointments do not do so wilfully? Such people miss appointments because of varied and complex pressures in their personal life, and fining them for missing an appointment would be too extreme.
I made the point that there would be many circumstances in which such an approach would be inappropriate, but we should consider having such a power, and run pilot schemes. The hon. Gentleman raises the point about a system of overbooking, but if he were to talk to any GP or hospital clinician, he would find that there is a massive problem with missed appointments. If we are having to deal with delivering health services in a much tighter financial situation, we must examine ways of saving wasted costs, and this is one area that we should examine. The main point I am making is that if the constitution talks about responsibilities, those must be genuine responsibilities. If they are not, we ought not even to refer to them, because the concept is meaningless.
The King's Fund also discusses whether the constitution will endure and whether it will be vulnerable to change by successive Governments for political reasons, suggesting that if it is to have any real value, it ought to be a document that does endure, and cannot simply be changed on a whim by successive Governments. However, the constitution appears to contain no mechanism to prevent that from happening, which is also a criticism. It says nothing, either, about continuing health care or the funding of people with complex needs, which is surely a critical aspect of health care. If the constitution fails to address that at all, it is surely weak. The idea of having second opinions in child care cases has been mentioned, but the constitution says nothing about the right to a second opinion either. That, too, should be addressed.
Let me turn to smoking. We all agree that action should be taken to enable people to give up smoking and to warn people, particularly youngsters, of the risks of taking it up. There is clear evidence that a proportion of young people buy their cigarettes from vending machines, so we readily support action to clamp down on the sale of tobacco from vending machines. Indeed, we might need to go further than the Government have proposed, so as to avoid any risk of youngsters below the legal age buying tobacco in that way.
However, the Government's case on displaying tobacco is not as good. The Conservative spokesman, Mr. Lansley, referred to the risks of misinterpreting the statistics, but it was fascinating to read that the real price of cigarettes in Canada increased by 159 per cent. between 1979 and 1991. That led to the teenage smoking rate falling from 42 to 16 per cent., which clearly shows a direct link between price and teenage smoking rates. We know that price has an effect, but there has been no proposal on price. Canada cut the tax in 1994, because of concerns about smuggled cigarettes, and the real price fell by a third. That led to the teenage smoking rate increasing, from 16 to 20 per cent. We know that price is a relevant factor—it was referred to by the World Health Organisation—yet the Government have made no proposals on price.
We advocate other measures. We should establish a criminal offence of supplying tobacco to an under-age smoker. The Government appear to be flunking that one and have not come forward with any proposals. It is a criminal offence to buy alcohol in order to supply it to an under-age drinker, but why is it not a criminal offence to supply tobacco in the same way?
As for smuggled tobacco, the current statistics show that one in six cigarettes purchased in this country has been smuggled, as has 50 per cent. of the rolling tobacco. A recent article in the European Journal of Public Health highlighted the link between smuggled tobacco and deprived communities, saying:
"the people with the highest likelihood of having bought smuggled tobacco...are...heavier smokers with higher levels of addiction, living in socially deprived areas and with low educational attainment."
People in deprived communities are obtaining their tobacco across the table in the pub or at the front door, yet we are talking about removing displays from shops—a controlled environment, after all—which will do very little to address health inequalities.
The hon. Gentleman and I represent similar rural constituencies. Although I have absolutely no brief for the tobacco industry, what worries me about the proposals is the fate of village shops. Does he think that one way round would be to have the ban, but to exempt small village shops and corner shops?
That is certainly an option. I share the hon. Gentleman's concern that village shops are under enormous pressure already. Many are teetering on the brink—indeed, many have already closed—and any further loss of income could tip them into closure. That is something that we should all be concerned about.
I understand that it is already the practice in many areas for shops to sell smuggled tobacco under the counter. Dr. Gibson has confirmed that he is aware of the practice, and I have heard of it happening in Haringey. If that is true, then removing the display of legally sold cigarettes in shops will only open the door to a vastly greater risk of smuggled tobacco being sold under the counter. How on earth can that be policed? This is one of those cases in which the law of unintended consequences might well apply.
I also want to mention smoking cessation, because there appears to be little evidence that the steps that the Government are taking having any real effect. At the moment, under the quality and outcomes framework— QOF—system, GPs get paid for mentioning smoking cessation to their patients and for telling them to suggest a date by which they could have given up. That is it; they get the payment just for doing that. There is no requirement to demonstrate success in the strategy of encouraging their patients to give up; they get the payment simply for mentioning it. In California, however, under the Kaiser Permanente insurance scheme, there is a much more intensive focus on counselling, on prevention, on mechanisms to encourage people to give up smoking, on smoking cessation programmes and on nicotine replacement therapy. Within that community of insured people in California, the smoking rate has been reduced from 18 per cent. to 9 per cent. It has been halved, and people benefit much more from that intensive approach.
Rather than taking a nanny state approach, or, as Mr. Leigh has pointed out, taking steps that could push small village shops into closure, we should do things that are effective in helping people, and which will actually facilitate their giving up smoking.
Does the hon. Gentleman agree that it is nonsense that in the European Union—of which the United Kingdom is a member state—there are still subsidies for tobacco producers? That is crazy.
I absolutely agree with that. It is remarkable that that still occurs in this day and age. This is why international action on such issues, and on finding much more effective ways of tackling tobacco smuggling, must be a real priority.
I shall finish by addressing some of the things that the Queen's Speech does not deal with. It is a massive challenge to make the NHS secure, sustainable and more effective, particularly in tackling the very poor provision of care for elderly people, at a time when we are seeing rapidly rising costs in our health system. Costs are rising because of lifestyle conditions such as obesity and alcohol abuse, and also because of the dramatically ageing population and the availability of new medicines. Costs are also rising at a time when the likelihood of sustained real-terms increases in funding is surely at an end. The Secretary of State mentioned a real-terms increase for the forthcoming year, but that provision is likely to end in 2010-11, after which the position will become much more difficult. The state of the world economy, and the impact that that is having on this country, will surely mean that focusing on ensuring that our health system is sustainable must be our highest priority. Unless we can get better value for money, we will surely be heading for a crash.
The Secretary of State said that the Darzi review pointed to a direction in which prevention became the real priority, but simply stating that it is a priority, without providing any real mechanisms to make it happen, will not result in any meaningful change. Our approach involves dismantling the wasteful, secretive, central bureaucracy and creating real accountability and financial responsibility locally. It also involves getting the finances working—we are talking about spending about £100 billion a year—to achieve the objectives that we all want to see: prevention, better self-care and better health for our citizens. As Derek Wanless said when he made the case for increasing spending on the NHS, our health system will be sustainable in the long term only if we are much more effective at helping people to care for themselves and to improve their health. So far, we have failed to achieve any meaningful change.
There has been a massive increase in funds for the health service, but the increase has been particularly at the acute end—for repair services. Meanwhile, community care and social care have been under intense pressure. Over the years of funding increases, the NHS has had five times the increase in funding that social care has had—without any explanation as to why that should be the case. Yet if we get our preventive services right, we will reduce pressure on acute services.
Thirdly, then, we must surely look at ways of integrating health and social care. The silo approach that we have is crazy: the patient does not understand the difference between health and social care, yet the system divides up care and budgets according to those dividing lines. We must ensure that we get better integrated care. We need to reflect on areas such as Torbay, where health and social care have been brought together at a service level, in order to avoid the crisis admissions to hospital that are so costly for the NHS.
Fourthly, we must ensure that we have more effective use of funds in our acute hospitals. At the moment, without good enough commissioning of care from our primary care trusts, the payment by results tariff is sucking money through the system. With social care under intense pressure, as I have said, many acute hospitals are making surpluses. Surely that is crazy.
The NHS needs to be better at adopting innovation. I want to refer specifically to photodynamic therapy, in which I know Dr. Gibson has shown some interest. Pioneered at University College hospital, London, this is a cancer therapy that avoids invasive surgery and means that the patient may be able to leave hospital within two days of treatment. It has been shown to be effective with many cancers and it has the potential to be effective with many more cancers. It was recommended for further analysis in the cancer strategy a year ago, yet a year later, that further analysis has not even started.
If photodynamic therapy realises its potential, it will be massively cheaper to the NHS than invasive surgery, chemotherapy and radiotherapy. Patients who have the good fortune to end up in UCH—if they have head or neck cancer, for example—will benefit enormously from this therapy. However, one of my constituents contacted me to ask why he was never told about the possible availability of photodynamic therapy. Surely these innovations going on in our hospitals should be spread around the country much more effectively.
Finally, it is important to put more power in the hands of patients, so that they can vote with their feet—empowered with information and support to make the right decisions about their care. The Secretary of State referred to the pilots for developing personal budgets. We support them, but we believe that they should go further, as they have enormous potential to give patients real power and put them in charge of determining what their priorities are, particularly when they are suffering from long-term chronic conditions.
So far, very little of the public debate has been about how to avoid the crash, with massively increasing costs at a time when no more money will be made available. It is always the most vulnerable who are affected if we fall into crisis. That has been the case in the past with long waiting times, and it will be the case in the future unless we get it right. Surely the Government have to start mapping out a way forward to make better use of the available £100 billion to invest in preventive services, to keep people healthy and to ensure that the NHS is sustainable in the future.
It is a pleasure to be called to speak in this important debate.
Sometimes we on the Back Benches wish that there were a curb on Front-Bench speeches. Norman Lamb spoke for 35 minutes. I almost lost the will to live. I say that because half of the debate time today has been taken up by Front-Bench spokesmen. No wonder the Chamber is so sparsely attended on an important debate on education and health, when Back Benchers turn up and have to wait so long to make a short contribution. It is disappointing sometimes to see the way in which those on the Back Benches are treated. I make that as a general point, Madam Deputy Speaker. You know that I can get irritable, because a long time ago you were one of my students and knew that I was an irritable lecturer. However, I will get on with my speech and try to make it reasonably lively.
Twenty years ago, we had the Education Reform Act 1988, which most of us associate with the person who is now Lord Baker. Some important reforms were introduced: testing and assessment, which is taken very seriously, the national curriculum, and the inspection service. The Select Committee on Children, Schools and Families, which I have the privilege to chair, is going through them. We have conducted a major inquiry on testing and assessment, have come to the end of an inquiry into the national curriculum, and are going to take a thorough look at inspection. In a sense, I always try to use the Queen's Speech debate to say what is happening in terms of the progress that we have made over the past 20 years. Too often in the Chamber, we make party political points against one another, but if we took a more historical view, we would see that we agree on quite a lot of issues—but not all of them. We fundamentally disagree on some of them, and I shall come back to that.
It is part of a Select Committee's job to attempt to establish the value for taxpayers' money and the progress that is made over a longer period. It is with great interest that we look at this Queen's Speech. It is quite thin, but it does include a portmanteau education Bill. There is an awful lot in it to do with education: from training and apprenticeships to the reform of the Qualifications and Curriculum Authority; measures to promote equality; the introduction of primary legislation to enshrine the child poverty targets for 2020; and the general aim to help families and businesses. I make no apology for concentrating on families and children in my remarks.
The newish Select Committee that I chair is different. Being Chairman of a Select Committee was a simpler task in the past because the Chairman called one Department to account. The responsibility is much more complex with children, schools and families, which I am told span 10 different Departments, if we follow families and children across those arbitrary divisions. The needs of families and children do not pay any respect to those artificial divisions between, for example, health and education.
It would be wrong if, at this time, with the enormous public interest in the welfare of children—particularly the most vulnerable children in our society—I did not spend a little time talking about them. It happens that one of the Select Committee's decisions was to show that we were taking our responsibility for children seriously, and for the past few months we have been looking intensively at the whole area of children in care—looked-after children. We have been taking that very seriously and have learned a great deal. As soon as one gets into this territory, the vocabulary and acronyms are different, and there is a tremendous learning curve, which members of the Committee have enjoyed.
As we approached the end of the inquiry, we were hit by the awful tragedy of baby P. As we studied the ramifications of the baby P case, we learnt very quickly not just how many children become vulnerable each year, but how many children's lives are ended when they are murdered by their parents or carers. The figures given to the Committee only yesterday by the chief inspector of schools were chilling indeed. During the early part of the debate about baby P, we were given figures from the National Society for the Prevention of Cruelty to Children stating that a child was murdered between once a week and once every 10 days; the chief inspector suggested that the figure was nearer to three children each week.
The issue is very serious, but it must be dealt with in a balanced way. When a tragedy such as this occurs, we need to establish what happened, and whether it is a one-off case or whether there are systemic problems to be addressed. The Secretary of State has moved very quickly in facing up to that responsibility. Unfortunately, we have seen yet another regrettable attempt by the British media to conduct a trial by television and newspapers even before the facts are known. I believe that we have a heavy responsibility to introduce some balance to that knee-jerk attitude to every crisis, and put it into perspective.
What went on in Haringey was not good. I have been given privileged access to some of the documents involved, and they are very disturbing indeed. What do we learn from this case? We certainly learn that the role of Ofsted needs to be re-evaluated. The evidence that we took yesterday caused me to worry about just how often inspectors enter local authority children's departments, how close they get to those departments, how often they go to meetings, meet real people and discuss the issues across the table, and to what extent inspections are paper-based.
As I listened to the chief inspector's evidence yesterday, I had the impression that Ofsted's system, which is not bad for the purpose of evaluating schools, has been transported to child welfare, where it is less appropriate. I told the children's commissioner that I found it surprising that, given that there are only 150 local authorities, there was not a member of the inspectorate in every one. It would not have to be a long-term arrangement, I said, but there should be a presence. A member of the inspectorate should regularly accompany social workers on difficult visits, and should sit in on case conferences.
Of course, we now live in the world of the e-mail. We all know organisations in which colleagues who are just across the corridor from each other do not knock on the door and speak, but e-mail instead. That disease exists in health and social services organisations in both the private and the public sector. I believe in the good old-fashioned presence of a person at a table, looking others in the eye and talking about a case—perhaps asking "When did you last see this family?", "When did you last discuss the child?", "When did you last talk to the child on his or her own?" or, "When did you last ask whether there was a man in the house? Did you ask a neighbour whether there might be a man living in the house whom you had not known about?" That last question is a common theme in many difficult cases of this kind. In the context of the baby P case, I issue a plea for us to look very seriously at the systems.
As the hon. Gentleman probably knows, I have been studying the systemic aspects, and trying to establish how many serious case reviews following a child's death have occurred nationally. Ofsted has only been able to look at the figures since
I know of and respect the hon. Gentleman's work, and I will be as helpful as possible in my role as Chairman of the Committee.
We are looking for systemic problems, and we picked up on one yesterday that caused great shock: the records of the Ofsted investigations of children's departments were not kept for longer than three months. Apparently, a lot of the original information about what went on in the inspection, such as who was met, what was said and who attended what meetings, disappears after three months. I ask the Secretary of State to look into that.
The answer we got yesterday was that the volume of material would have been too great. I can understand that in terms of school inspections as there are thousands of schools, but I find it more difficult to accept in respect of 150 local authorities and children's departments. Our role in this House must be to get the answers right, and we await with great interest the findings of the Laming inquiry, which is being carried out at the request of the Secretary of State.
I want Members to bear in mind that the social workers in this country do a wonderful job. They are underpaid, and in many ways they are under-trained. Before the baby P case, a chief executive of a London authority gave evidence to the Committee and said that he no longer trusts the training of social workers in our country and would prefer, as far as possible, only to hire social workers from Australia, South Africa and Canada. That was a remarkable comment, but the Secretary of State intends to look at the training of social workers, and also how they are used and managed. Earlier, a Member talked about accountability, and I agree that accountability is important, but so is good management. The management of a large children's department is a very challenging job, and all of us know that merging social services with education has been difficult. There is a great tension in that. Some of us represent constituencies whose local authorities have an expert director of children's services who came from social services; others have someone who came from education.
We must look at these matters very carefully. Although there have been criticisms of the director of Haringey social services, we should look a little more carefully at, and a little more kindly on, the stress of that job. We should sometimes be a little more objective and thoughtful about the comments we make about people before we know the full facts.
Does my hon. Friend agree that the occasionally poor reputation that social workers have is rooted in their unfair treatment in the media, and would it not be a good idea if those in the broadcast and print media commenting on social issues of this kind were required to get some detailed knowledge of the pressures faced by people on the front line, because they are too quick to judge, condemn and excoriate the work of social workers, who are at arm's length from us in doing a job we need to have done?
I entirely agree with my hon. Friend on that point. Social workers do a great job. Yes, we should look to see if we can improve their training and we should look at their management, but it is one of the hardest jobs in the world. If there is a tendency to take people off the front line quickly, and to promote them into the management and administration of the children's department, we must find out how to combat that by encouraging people, and by giving them time away from the front line to rest them and then bringing them back. It is a very hard job and we must respect that. We must also respect the complexity of the management task faced by the 150 directors of children's services, who have very large empires to manage. A little more humility is called for.
My hon. Friend is right about the media. For example, last week a study was published in The Lancet which said that 5 per cent. of children in developed countries were subject to abuse, either sexual or physical. When one looked at the full reports, it became apparent that the figure of 5 per cent. was never mentioned—it was only in the press reports. The media treatment of that report gave people in this country the wrong idea. For a start, hardly any of the original research was carried out in this country.
How many times do we hear on the BBC the words, "Research carried out by this programme"? We know what that consists of. Indeed, we had an example this weekend when it was claimed that research carried out by the BBC had found that a tiny number of MPs— 20 or 23—were unhappy with some aspects of the Speaker's performance. That was not research. It was some kid in the office who had pestered MPs over the weekend. Too often, the media, especially the BBC, do such things; the "Today" programme loves to do it. Many members will have been rung up as part of that alleged research. I know what real research is, and that is not real research.
The amendment expresses the Opposition's concern about international tables. We do not stress the good news enough, and the trends in international mathematics and science study, or TIMSS report, shows how extraordinarily well our children have done in mathematics. The performance of the 10 to 14 age group has improved dramatically, and those on both sides of the House should welcome that. The investment in early years education, children's centres and Sure Start takes a long time to show results, and we are always in danger of making those issues a purely party political contest, with the Opposition saying that whatever the Government have done is wrong. Actually, as Chairman of the Select Committee, I see an enormous amount of good.
However, before the Secretary of State for Children, Schools and Families gets too happy about that, let me say that the Committee's most recent report, which will be published in the new year, points to some concern. I totally disagree with Mr. Duncan Smith, the former Leader of the Opposition, and his talk of the broken society and an underclass. Such language gets us nowhere. I hate the terminology and I think that it gets in the way of evaluating what is happening in our society. It is true that some people suffer from social deprivation and a long-standing lack of good employment prospects, but the situation is dynamic and people move in and out of it. There are problems and challenges, and all parties have to find ways to ensure that every child gets a chance to fulfil their real potential. Sometimes that will be through the academic route, and sometimes through an apprenticeship, training and skills route. Thank goodness, we are achieving provision, especially for 14 to 19-year-olds, that is beginning to address all the talents.
We should also give talented people the chance to move easily between disciplines. In a sense, what was wrong with the Education Act 1944 was that people stayed on one track; if they were academic, they went to grammar school—that was their future. People who went to secondary modern school had little chance of getting requisite skills, while those who lived in areas with technical colleges went down a different route again. The apprenticeship provisions in the Bill that we will consider later this Session will ensure that 14 to 19-year-olds have access to a range of potentials.
Finally, I want to say something about child development. One of the great things about a Select Committee is that we can take a cross-party look at very difficult subjects. We can take conventional wisdoms and the sort of street knowledge that people pass on without much research and gather evidence to see whether they are right. Most of us will have been troubled by the oft-repeated research that asserts that a child's potential is more or less decided by the level of stimulation that it receives up to the age of 22 months. If that is true, it poses a great challenge to everyone interested in the future of this country's children.
I remind the House that 22 months is about the age of little baby P when he died. If that stimulation is so important, are we making the right decisions to ensure that the right environment is provided for all children? Of course, we have come a long way already with early years provision. We have children's centres and Sure Start, and children aged three now get 15 hours of free nursery care. All of that is good, but you will know, Madam Deputy Speaker, that child care is still expensive in this country. The challenge is to provide good, stimulating environments for children as early as possible. Income levels should present no bar to that, but at present they do limit what is provided for very young children aged between nought and three. We are not doing a bad job and I do not want to castigate the Secretary of State or the Government, but we must do even better because that is the crucial age.
I advise the House that my Committee will call evidence on levels of stimulation and the development of a child's brain. We want to establish how accurate the research to which I referred earlier and the conclusions based on it are.
The hon. Gentleman is right that the evidence shows that the investment has to be made in the early stages of a child's life, so does he agree that the Government should abandon their gimmick of the child trust funds? Billions of pounds are tied up in them, although 18-year-olds get a payment of only a few hundred. Should we not spend that money on early-years education, because that will make a difference to people's life chances?
I am sorry, but I rather like the child trust funds. Earlier, the Liberal Democrat spokesman, the hon. Member for North Norfolk, spoke about tobacco. Along with other hon. Members, I campaigned for many years on the smoking and tobacco issue. We were trying to change the culture associated with tobacco use and smoking, and that meant that we had to tackle advertising, education and every aspect of trying to get people to stop smoking so as to improve their health and development. The same is true with child development. We must try everything, but the Queen's Speech is absolutely right that we have to eradicate child poverty.
For that reason, the child trust fund is one of the essential ways in which we will change children's life chances. No approach can work immediately, and the child trust funds are a long-term investment. Over five or 10 years, we shall be able to see whether they work. Many of the policies that we have embedded over the past 11 years will take a long time to evaluate. Over time, I think we shall see that child trust funds are very useful indeed.
This will be my last point, because after criticising a previous speaker, I am going on for far too long—[Hon. Members: "Yes".] I am sorry, but normally Back Benchers, even Select Committee Chairmen, have to listen the Front-Bench lot and are then restricted to 10 or 12 minutes, so I am speaking up for Back Benchers. There is no limit today, so I am taking a little longer than usual— [ Interruption. ] I shall go on for even longer now.
I shall end on the point about culture. We are trying to change cultures and it is difficult. It has to be done in terms of tackling child poverty and in a variety of ways. Some of the things we do will not work—surprisingly enough. We are human beings so sometimes our responses to problems will not work or will not work as well as they should, but then we learn the lessons. Over the past few years, one of the things I have liked is that often when the Government recognise that something is not working too well they change it. Sure Start is a good example. Some of the Sure Start schemes were not very good when they started. I have to tell Members who like localism that it was often because the impetus was too localist—everybody came up with their own ideas and some of them did not work, so Sure Start had to be changed. As long as the Government continue to make pragmatic judgments—seeing whether things work and recognising that sometimes there are mistakes—they will have my support. On the other hand, when they do things in a bone-headed way and carry on regardless, they will not have my support or that of members of our Committee.
Much in the Queen's Speech will give us plenty of work over the coming months. There are some interesting interventions and innovations for the qualifications framework. The Secretary of State must make sure that the framework is independent and seen to be independent so that it can speak fearlessly about the qualifications system. People will approve of that.
The very last thing I want to say— [ Laughter. ] In that case, the penultimate—or rather pre-penultimate—thing I want to say is about apprenticeships. Only last Saturday, our Committee produced a report on apprenticeships. It was a good experiment, because the Select Committee on Innovation, Universities, Science and Skills was producing a pre-legislative report on the draft Apprenticeships Bill at the same time. We did not collude, but we came to similar conclusions. We are positive about the apprenticeship route and about the expansion of apprenticeships. We are concerned that the targets will not be met, because as the economy is going through a slight hiccup—I shall not use the other word—and the tough times mean that the private sector will be challenged to produce enough apprenticeships, the real challenge will be to introduce them in the public sector.
The largest employer in my constituency is the university—there are not many apprenticeships there. Health and the local authority are among the biggest employers—there are not many apprenticeships there either. The sooner we can have apprenticeships in every part of our public sector system, the better. If we can achieve that, the Secretary of State and the Government will have my support.
It is always a pleasure to listen to Mr. Sheerman for half an hour. I know that he is irritable, because the last time that I questioned in the Liaison Committee the saviour of the world, otherwise known as the Prime Minister, the hon. Gentleman shouted across the Committee Room, "Who does he think he is?" I do not think that he was referring to the Prime Minister at the time. So I will try not to irritate him, and he might agree with quite a lot of the early part of my speech, because I want to talk about efficiency.
As the parties get less ideologically divided—[Hon. Members: "Ho, ho!"] It is true, actually—efficiency becomes more and more important. We heard a bit of banter between Front Benchers earlier about their public spending plans. The truth is that, if there is a Conservative Government, they will not want to do less in health and education, but they will want to do it more efficiently. I give credit to the Government, who want to do things more efficiently as well, but whether they succeed is, of course, a matter for debate.
Efficiency figured very large in the pre-Budget report and in the spending review. The Government claim that they want to deliver efficiency savings of a massive £35 billion. As Chairman of the Public Accounts Committee, I have often questioned whether they will actually achieve that, but I have never disagreed with the objective, which is even more important in health. We heard the Secretary of State for Health mention that he is increasing spending by what sounds like a very healthy 5 per cent., but given an ageing population and the increasing costs of health technology, unless we can achieve efficiency gains of 3 per cent. every year, that is just a standstill budget, so efficiency is absolutely central to what we are talking about.
I want to go further than in the past, and I believe that we could achieve more efficiency. True efficiency is about achieving the same outcomes for a lot less spending. That is about the absolute, resolute and obsessive pursuit of efficiency, line by line, programme by programme. It may be a rather boring subject—it is not often at the forefront of political debate—but it is absolutely essential. Let us make no mistake: if we do not achieve massive efficiency savings, we will face armageddon in our public services.
The hon. Gentleman says that efficiency is a boring topic. Certainly to an accountant such as myself, it is meat and drink and not boring for a moment. He says that efficiency is all about getting the same outcome for less input—I paraphrase him slightly—but does he not agree that there are circumstances in which to spend more is, first, to get a better quality of service and, secondly, therefore to have a lower cost per unit of production? Earlier today, I pointed out to my right hon. Friend Mr. Williams, who is Chairman of the Public Accounts Commission, that Her Majesty's Revenue and Customs reorganisation, which with the hon. Gentleman is very familiar, risks losing people who might have bridged the enormous gap between the tax that should be collected and the tax that is collected after tax avoidance. That is the case, is it not?
It is true that, at certain times, people make policy decisions and have to spend more, which may indeed achieve their policy objective. Of course I accept that, which is why I do not want to talk about policy differences in a lot of my speech. I want to try to bring the Government and, indeed, Conservative Front Benchers with me as far as possible. I do not believe that it is the duty of an Opposition—certainly not an Opposition Back Bencher—to oppose everything and propose nothing. So I hope to make some practical suggestions about how we can improve efficiency.
The Chancellor recently raised the bar on efficiency savings by another £5 billion, which is quite a difficult task. My call might not be strictly within the rules of poker, but I see his £5 billion and want to try to help him raise another £5 billion. Let me give some ideas, not for cutting services, but for encouraging all the major Departments to match the greatest progress made by their most efficient colleagues in five core categories of efficiency. Let us look at all the Departments and at who does things most efficiently, to try to bring the rest up to that level of efficiency.
Item 1 on that five-point agenda for efficiency is the civil service pay bill. It is true that the Government have made some progress in reducing numbers in some Departments, but not in reducing staff costs. A reduction in numbers running to tens of thousands—I agree that it has been achieved—has been accompanied by a real-terms increase in the pay bill of more than £1 billion. If all Departments matched the greatest staff reductions achieved in Whitehall, the saving to the public purse could be a massive £1.7 billion. Of course—I will mention this now—the new contract for general practitioners is an example of a Department implementing new arrangements that have increased, rather than reduced, inefficiency. Partners in GP practices are now putting in less time and their productivity has decreased; only their pay is burgeoning, having increased on average by 58 per cent. since 2003. I think that we all recognise that major mistakes were made in that contract, which we never want to see made again.
On the subject of staff costs, are the tasks of Whitehall Departments really so different that, apparently—what the NAO tells me is extraordinary—the average civil servant in one Department can cost almost 60 per cent. more than the average employee in another? I know that Departments perform different tasks, but it seems extraordinary to me that we have such a range. If we could bring the most costly and the least efficient up to the level of the least costly and the most efficient, we could save another, staggering, £800 million.
Outsourcing and consultancy form my second item. Consultancy is often discussed. It seems to me scarcely credible that any part of Government could have consultancy expenditure equivalent to even half its staff costs, let alone the 87 per cent. of staff costs spent by one Department, but that is apparent by analysing last year's accounts. The average central Government body spends five times more on consultants per employee than the private sector—a whopping £10,000 for every civil servant employed. Is that necessary? Do we need all those consultants? We have very good civil servants—they are there in the Box. Although we are not allowed even to refer to them, they are fantastic people doing a great job.
When the NAO reported on the use of consultants, it concluded that efficiency gains of up to 30 per cent. could be achieved without reducing the underlying value of the work purchased. The NHS spent £600 million on consultants last year, when the public sector as a whole spent £2.8 billion, so the saving could be as much as £800 million a year.
Let us take a long look at other running costs, such as the costs of accommodation, leases and IT, which provide the third item on the agenda. I offer the Government and the Opposition a further £900 million saving. I hope that my hon. Friend the shadow Chief Secretary to the Treasury reads my remarks today—I am happy to help anybody, Government or Opposition, with these ideas.
The startling variation in accommodation costs for each individual civil servant provides clear scope for improvement. When the NAO examined this matter in 2006, it found that the Department of Health—I mention that Department, because we are talking about it today—spent nearly three times as much per person as the then Department for Education and Skills. Today, the Secretaries of State for Children, Schools and Families and for Health have been sitting side by side in the Chamber, so perhaps we should ask them to explain the difference between their Departments' spending. I do not understand it.
Perhaps the Government should consider extending their shared ownership schemes to their Departments, so that they learn lessons from each other. London property prices may not be what they were, but all of us here represent provincial constituencies, do we not? Are we sure that every civil servant currently based in the capital would not be better employed at less cost in our own communities—in Huddersfield, Gainsborough or, indeed, North Norfolk? Why are so many still based in the capital?
The House may need to bear with me as I go through the next item on my list—comparisons of asset values. As an accountant, David Taylor will be interested in this subject, but the eyes of other Members present may glaze over, but it is a fantastically important subject. The Government aim to dispose of £30 billion of assets, but even though last year their main Departments got rid of approximately £1.5 billion of assets—well done—they managed to add a hefty £10 billion of assets. That so often happens in public debate: we hear the good news, but not the bad. I salute the Ministry of Defence, which achieved the highest level of disposals in Whitehall, and the Department of Health did pretty well, too. If others had marched forwards as far, another £850 million would have been captured by all of us.
According to my rough calculations, so far we have identified savings of £4.8 billion and counting. In search of the final big push that would enable me to keep my promise to try to save the Chancellor £5 billion—no small sum—I considered those Departments that make grants. The Departments that are the subject of today's debate figure heavily among them. A recent National Audit Office report made recommendations to help grant makers better manage the demand and flow of applications, and streamline their processes. A saving of 10 per cent. as a result of greater efficiency in grant administration across the public sector could plough £220 million back to the Treasury. I have now achieved, just in one short speech, savings of £5 billion.
I freely accept that efficiencies are not certain; there are problems with information, challenges in delivery, and variations in circumstances, so we could undershoot, or indeed overshoot, on all those five items. However, surely that is not an argument for the abandonment of the agenda; it is an argument for adding to it. To try but fail is honourable; to fail to try would be criminal. That is why I think that efficiency should be a central part of what we try to do. My challenge to the Government is to take inspiration from Mr. Micawber. It may not be fashionable in these "Buy now, pay later" times, but the Government's accounts book should be reviewed, entry by entry, in a concerted effort to alleviate the misery of spiralling borrowing.
In debate after debate on the work of the Public Accounts Committee, I have emphasised three broad themes of which the Government should take note in their forensic self-analysis. I start with unnecessary administration. The private sector has long focused on minimising the proportion of resources that it invests in administrative functions, so that it can focus on what delivers value for the customer. It is essential that the public sector take that approach. That can be achieved both by cutting down the complexity of administration and by sharing the management of administrative services. We hear a great deal about that problem in the NHS. Every time that we talk to our doctors and consultants, and people whom we know in the NHS, they harp on at us about the cost of administration—a vital point. We should listen to them all the time.
My second theme is commercial skills and astuteness. The role of the Government is changing from one in which they delivered most public services themselves to one in which they manage other organisations that deliver services on their behalf. No matter who wins the next general election, the process will go on and on. The Government will withdraw more and more from the front line and will use other people to manage their services. Government will become ever more commercial.
In those circumstances, the delivery of services is underpinned by commercial arrangements, so the Government need to improve their ability to manage contracts. We have to employ the best people and pay them the right price. We should bring them in from the City and the merchant banks to work for us. When it comes to private finance initiatives, new contracts or hospital running costs, we have to get the best people working for us and pay them the best price, which pays in the long run.
Frankly, the public sector still lacks the commercial nous to derive maximum benefits from its suppliers. Take one well-known example in the education field. The interest of celebrity chefs in school dinners has helped to draw attention to one small specific area of procurement. We looked at the issue and showed that there was scope to realise over £200 million of efficiency savings in food procurement in just one year, by 2010-11. More than half of those savings could be achieved in schools and hospitals without affecting quality. Ultimately, actions such as joint purchasing could help to avoid situations such as those that we found at the time of our investigations. For instance, we found that one public body pays 32p and another £1.10 for the same loaf of bread.
I come to my final theme: making better use of resources. The Government do not always manage the vast array of resources in their control, including office buildings, service delivery and agents, as efficiently as they should. Earlier this year, the National Audit Office published a report on managing financial resources. It found that since 2003 Departments have indeed improved their management of finances, but, incredibly, that 40 per cent. of them invariably provided decision makers with a full analysis of the financial implications of policy proposals. It is amazing that in only 40 per cent. of cases in which Ministers make difficult policy decisions they were told about the financial implications of those decisions. The message must be driven home that the management of financial resources is the responsibility of everyone in the Department, from the Secretary of State down, and not just the central finance team.
The Government need to know what is being spent, where and on what, and I hope that there is a central emphasis on everything that Ministers and their top civil servants do. They need to know whether one Department pays more for the same service than another, and they must embrace, not avoid, comparisons of cost and performance across the public sector. Departments must benchmark all the time with other Departments, and they must look at what is going on abroad. They must always seek to do the most efficient thing, and pay people to work for the public sector and Ministers to get the best results.
All those disciplines should apply to the Government's proposed programme. The aim of government is not to legislate at any cost—the Government are clearly not doing so, as we are not overloaded with legislation, and I congratulate them on that—but when the costs and benefits are totted up, how many of the proposed Bills would help the fastidious Mr. Micawber to obtain happiness by balancing his affairs? We should look at all those Bills and ask how they will achieve happiness by balancing our financial affairs.
If the House will allow me, I shall propose one final test to be applied to all the Government's proposed legislation. It is simple: does the proposal reduce the overall burden on the public purse, and is it efficient? That legislative impact assessment should be policed, perhaps by the House, with more rigour than the Government have put into their own regulatory impact assessments. If the answer to the question is yes, the Bill should be allowed to proceed to further debate. If the answer is no, it should be allowed to go forward only if accompanied by an equal saving elsewhere. Now is not the time for either the cost or the burden of government to grow, because we simply cannot afford it. I urge all public bodies to keep at the forefront of their thoughts the fact that taxpayers and all those who use public services rely on them to get this right. Given the storm-tossed state of the public finances, the success or failure of programmes to achieve true efficiency in the public services will have a major impact on all our lives.
If the House will forgive me, before I conclude may I make one or two policy points? In everything that I have said so far, I have spoken as Chairman of the Public Accounts Committee. I hope that what I have said is not politically sensitive and that Members on both sides of the House agree with it. However, from my own personal perspective as a Back Bencher, may I make one or two points? This is where I fear that I may lose Government Members, but the debate offers an opportunity to express one's point of view, so why should I not do so?
Yesterday, the Prime Minister, without telling me in advance—fair enough; all is fair in the House—attacked me on the Floor of the House, so I could not pop up and put the record straight. May I now make clear my point of view that the Government have made a major error in seeking to solve our economic problems by cutting VAT at a time at which prices in the shops are falling through the floor? The point that I made, not as Chairman of the PAC but from my own personal perspective, was that the best way to help the poor is by raising tax thresholds to get people out of paying tax altogether and to attack the poverty and unemployment trap.
It may be Liberal Democrat policy—what do I care? If I see a good policy, I will embrace it—but it is also the policy of many Conservative Members of Parliament. There is nothing original about this, as there are many people on the left who believe that the best way to help the poor is not by cutting VAT, because a much higher proportion of poorer people's budget is spent on items that do not attract VAT in the first place. That is the point that I made, but I was quoted out of context by the Prime Minister. However, it is much better to be attacked by the Prime Minister than not to be mentioned at all, so I do not mind very much.
May I make two brief points about education and health? The report by Sir Jim Rose was published this week—another report on education—and seeing that my hon. Friend Michael Gove, the shadow Secretary of State, has just walked into the Chamber, I shall make an appeal to him. Often, we on the right are accused of being too obsessed by the structures of education, and it is said that while we have been obsessed in that way, the left has been more concerned about the minutiae, and that it has won the debate. Let me say straight away that I am not the slightest bit interested in returning to the 1950s, in having more grammar schools or in any of that. All I say to Sir Jim Rose and to all those on the Government and the Opposition Front Benches who think that they can micro-manage the thousands of schools in this country is that they are deluding themselves. We have to trust our professionals; we have to trust head teachers.
I know a bit about education—after all, I have educated a few children in my time. I believe that head teachers want to have the freedom to set their own curriculum as much as possible, to hire and fire their staff, to interview potential pupils and to select their own pupils. I know that I start to lose everybody in the Chamber when I say this, but if they were given the same freedoms that independent schools have, there would not be a rush back to grammar schools. Most schools would hardly change at all. My son went to a comprehensive school; I have never sent a child to a grammar school. I am not interested in that, but I am interested in allowing the head teacher of my son's comprehensive school the ability to manage the school in the way he wants. He should not be micro-managed all the time by the Department, and he should be able to interview and select, if he wants. If we did that, it would revolutionise schools.
I know that I do not take everyone with me on that, and I shall go one step further and lose virtually everyone in the Chamber. I believe passionately that we have to end the totally rigid divide that we alone have in this country between the private and public sector. It does not happen elsewhere. We have to encourage people to shift between the public and private sector. We have to have people who are setting up new private schools. We can bring that process in slowly, starting with reception classes, or start the process in some postcode areas. We should do what the French do. The French pay staff salaries in private schools, so fees in private schools are minuscule in France compared with—
Surely in France the vast majority of private schools are state schools under any other name, because they are Catholic schools that are financed by the state. The idea that the French definition of a private school is analogous to the British definition is absurd.
I am not saying that the system is exactly comparable, and I know that many parents in France use private schools because they want their children to have a Catholic education—that may be the same here. I am not arguing for a sudden revolution, but a gradual change.
I know that my hon. Friend the Member for Surrey Heath, the shadow Secretary of State, agrees with that. He has been very innovative. He has looked at what is happening in Sweden, and he will come up with ideas to make it easier for people to set up private schools. All I am asking is why it is considered to be so wrong and reactionary to break down the rigid divide between the state and the private sector in education. I have never understood that, and if we can find ways of being innovative and of helping people to break down that divide, we should. If I cannot take Mr. Chaytor with me on that, can I at least take him this far—please do not go on with this process of trying to micro-manage our schools on the curriculum? The people involved are professionals and they know what is best. Rely on parent power: if head teachers do not deliver what people want locally, people will not want to send their children to those schools.
I say the same thing about health, and again, I know that I will lose people on this issue. Why do we have a rigid divide between the public and private sector in health? My family and I rely completely on the national health service. I have no private health insurance, but if a retired person, after paying tax all their life, wants private health insurance, I do not see why they should not be given tax relief on it. The last Conservative Government did that, and it is simply fair. If people are denied a particular medication because it is too expensive and they want to top up the cost from their own resources, why should they not be allowed to do so?
As with education, I believe that we should not try to micro-manage the national health service. We should rely on professionals and on their good judgment. Increasingly, we should step back and set budgets—the Government are doing that through foundation hospitals—and proceed apace, relying on the professionals to run hospitals in the way they think best. However, I will not take the House with me on many of those things.
I have considerable sympathy with the earlier remarks that the hon. Gentleman made in his capacity as Chair of the Public Accounts Committee. However, I am slightly confused about one thing. The earlier part of his speech was about the Secretary of the State and others in Departments ensuring that we get cost-effectiveness and efficiency in public services, which is right. Yet, in the second part of his speech, he has argued that the Government should not micro-manage education and health. Surely, there is an inherent contradiction between the two: if we are going to get real value for money, it has to be led from the centre, and it follows that we cannot allow complete independence and freedom from Government control of health and education.
I do not think that that follows. Let us remember that much of what I said was, for instance, about the efficient use of asset management and the roll-out of computer systems. What is increasingly happening in relation to health, for instance, is that the Government say to hospitals, "We will pay you through the primary care trust so much per hip and then you can get on with it. If you do it efficiently and learn good practice, you can keep more of your money." I pay tribute to the Government on that.
There is not a dichotomy between me and the hon. Gentleman on this. A grant-making body can pay so much per pupil in schools, and we can say that we will pay so much for a secondary or primary school pupil if a child needs a statement or if a body is prepared to give him a statement. I know a lot about that from my personal experience. After the school has received the money per child, it is free to manage that child in the way that it thinks is best. The same also applies to foundation hospitals. Once the money has been disbursed per hip, per cancer treatment, or however it is done, real scope is given to the professionals to run the budget in the most efficient way.
I see foundation hospitals in exactly the opposite way. Out of the 107 foundation hospitals that have been set up, there are more than 1 million members. It seems that we are getting more public involvement from outside than the more mainstream trusts, rather than simply letting the professionals have their way in foundation hospitals.
That may be a good point. Perhaps the principle behind foundation hospitals is right, but we have not implemented it in the right way. The Minister has heard the hon. Lady's intervention, so perhaps we will learn from that practical experience.
Whatever the House might think about those ideological differences, I hope that we all agree that we have to be much more commercially astute in the way in which we operate our public services. Whatever side of the argument we support, we must ensure that we are committed to our public services and that we make them as commercially efficient as the private sector. There is no reason why that should not be done, and if we do it, we will achieve much more for our constituents.
I am delighted to be able to speak in the debate on education and health in response to the Gracious Speech. I spoke in the debate on the same subject last year and much has happened since. I am not only a member of the Select Committee on Children, Schools and Families, but parliamentary private secretary to the public health Minister. I will not be able to talk in detail on health matters because tradition dictates that my new role prevents me from expressing my strong support for steps to remove point of sale displays for tobacco products. It also prevents me from welcoming steps to help cut the cost of having cancer by making prescriptions free for cancer patients. It most certainly means that I am not in a position to say how welcome it is that the Department of Health has shown a clear commitment to the health of our children by putting forward joint funding for pilots of extended and universal free school meals. As I have always said, I came here to break the mould.
Health issues are pertinent to my constituency. For example, in the Sunderland metropolitan area, life expectancy is 18 months below the national average and death rates from smoking, heart disease, strokes and cancer are all above the national average. I am enjoying my new role, but I want to make it clear that I am acutely aware of the priorities for health care in my patch and that although my public voice on such matters may be diminished—
I shall follow your advice, Madam Deputy Speaker, and I am grateful for your patience.
My focus today will be on education. Last year, I called for pilot schemes on universal free school meals, and in September they were announced. I also called for better provision for children with dyslexia, and I am pleased to say that we are well on the way to securing that, too. It was an honour to play my part in highlighting the need to improve provision, not just for children with dyslexia, but for all children with special educational needs. I had a privileged opportunity to steer my Special Educational Needs (Information) Bill successfully through the House, and I am grateful for the help and support that I received from Members on both sides of the House. The Special Educational Needs (Information) Act 2008 should lead to improved information on the types of needs these children have, and it is my fervent hope that this improved information will raise outcomes in years to come. I cannot let this chance go by without reminding Ministers of the need to spell out how the new powers in the Act will be implemented.
I spend so much time talking to charities and stakeholders with an interest in SEN, but a number of interests that still need attention have come to the fore. I hope that the education and skills Bill can be a vehicle for addressing some of those problems. Last year, I focused on two issues in depth and I achieved some success, so this year I shall cover more matters, although perhaps in less detail, and hope for a similar outcome. Recent answers to written parliamentary questions have said that the Government are considering the specific remit of Ofsted's report on SEN in our schools. The sooner we know what that remit will be, the better.
It is good to see that an interim report has been published today by Brian Lamb as part of his ongoing review of parental confidence in the statementing process. As a parent of a child with a statement of SEN, I know all too well the feelings of "fighting" or "battling" the system that this report recognises. Better information for parents, better outcomes for children and a place in mainstream policy for SEN and disability issues are all vital. I know for a fact that the report is not falling on deaf ears as far as the Secretary of State is concerned.
There is a consensus among the charitable sector that we need to define types of need more clearly when we record SEN, so let us hope that the Ofsted report will examine in detail whether the current categories of recording need are efficient. There is consensus, too, that parents deserve better information about SEN provision, so let us hope that Ofsted will consider the need to empower parents to make well-informed decisions. We also know that there are similarities in the difficulties that children with medical conditions such as epilepsy or diabetes face in our schools, and it may be a smart move to ask inspectors to examine how a joined-up approach to delivering support to those whose unique physical or mental abilities create barriers to learning could be achieved.
I realise that I am digressing somewhat from the substance of the proposed education Bill, and I wish to return more tightly to it, while keeping a focus on SEN issues. It is extremely welcome to see that the Bill will provide teachers with the right to request time for training. Not only does that reflect the Government's wider focus on upskilling our work force, but it allows scope for teachers to develop specialist skills in support of those with SEN. Last year, the Government announced £18 million of funding for a masters qualification in teaching and learning. If they are to match their words with action, it is imperative that the qualification be required to contain work on supporting pupils with dyslexia and other SEN. I know that is something that Dyslexia Action is keen to secure, and it has my full support in that.
We must also examine measures to improve the skills of those who work with our children without requiring huge time commitments from teachers over and above their already heavy work load. When the Government publish the children's work force strategy, I hope that they will have considered the possibility of using rights for teachers to request training to deliver further training on SEN. I am considering a campaign calling for one in five INSET days—in-service training days—to be given over to our SEN children, who, as some hon. Members may know, make up one in five of our school population. I understand that there are potential barriers to making that a reality, but I cannot help thinking that "One in five for one in five" is a catchy campaign slogan.
Why not give teachers the right to undertake training in different special educational needs, when they are already required to teach pupils with such needs in schools every day? In the case of deaf children, there are things that teachers could learn in a matter of hours that would benefit children for a lifetime. Awareness of acoustics and the aural environment can make an immediate difference. I will continue to work with the National Deaf Children's Society on the proposal. I hope not only that it will benefit deaf children, but that it can be adapted to help a range of children with special educational needs.
I congratulate the hon. Lady on the points she has made so far. Does she agree that one major problem is that teaching assistants are not necessarily trained in sign language to a level sufficient for interpretation, which is important for maths and science? I therefore hope that she will call for those higher levels of sign language qualifications in her campaign.
I thank the hon. Lady for her intervention. We have worked together a lot in the course of my private Member's Bill and on the Children, Schools and Families Committee, and I know how keenly we agree on a lot of SEN issues. I certainly do hope that teaching assistants and learning support assistants will be included in any SEN training, because they spend a lot of time with our children in schools. One-to-one time is often spent with the teaching assistant or a learning support assistant, so it is vital that they should receive such training.
The ultimate aim, which we all share, is to lift the level of support received by pupils in schools. I note from the information published on the Department's website that the Bill will look at changes to learning in juvenile detention centres and prisons. It is an established fact that the prevalence of special educational needs among the prison population is far higher than it is in wider society. I hope that any eventual changes will look at the difficulties with learning that those in prison face and that any attempt to tackle the stagnant educational development of our young prison population will ensure that those unique challenges are addressed.
Does the hon. Lady agree that one of the problems in enabling young prisoners to continue their education or training is that when they move prisons, it is difficult for them to continue the course they were studying? Does she think that the Government should look into that as a matter of urgency?
I do not have great expertise in the subject, but I take the hon. Gentleman's word that what he describes is the case and urge the Government to look into that, too.
In addition, there will be measures to review school transport for those in post-16 education. There is already a feeling that a wider review of school transport is needed across all age ranges to plug holes in budgets through which money can often leak—I am thinking of the use of taxis, for example. The recent outrage felt by the public at the case of baby P was shared by all hon. Members. It is a cliché to say that lessons must be learned following such tragedies, but I want to make a couple of points about that. It has already been noted that we cannot allow such cases to lead to all child care workers being tarred with the same brush, but at the same time we cannot miss the opportunity to lift the level of professionalism among child care services. Whatever the whys and wherefores of today's UNCIEF report, we are clearly lagging behind much of Europe. That cannot be allowed to continue. The report notes that provision here is hampered by a lack of well-trained staff.
I mentioned in the House recently that the Danish system uses pedagogues as professionally trained workers who form an extra layer in the protection and development of vulnerable children. It is so often the case that those of us in the House with a progressive viewpoint hold up the Scandinavian system as an example in the hope that it can be mirrored here. I was pleased when the Secretary of State said that there were already plans to look at trials of such workers, because such trials could reveal very interesting results. There need not be a presumption that we must put more children into care, but we should strive to ensure that the level of care that those already in the care system receive is world class.
Another Bill in the Gracious Speech that will put us on a stronger footing for the future is the welfare reform Bill. Those proposals caused a bulge in my postbag when they were first announced. Some constituents were worried that their benefits would be withdrawn, but the majority were happy at the prospect of ending a something-for-nothing culture. We all know the value of work, and it is not just about bringing home a wage; it offers much more. It is important for children to grow up with work as the norm, for adults to feel as though they are contributing to the community around them, and for the country to make the most of all its talents. That might sound idealistic, but I believe that that is the kind of future that we need to aspire to, and more so now, in these times of difficulty, than ever before. We need to get parents into work, to set an example to their children. We need to support those parents in equipping their children to take on a job that comes with rights, including the right to a decent living wage, the right to equal pay and conditions, the right to flexible working, the right to gain further skills and, above all, the most important right, which will now be enshrined in law: the right not to live in poverty any more.
My hon. Friend mentioned the right to training. Soon, millions of workers in Britain who did not fail themselves but who were failed by the education system in past generations will have the opportunity to demand and expect extra training. Does she agree that it is essential that education does not stop at 18 or 21, and that the millions of people out there who did not have the benefits of the system will now be able to enjoy the benefits of training? That is one of the key points in the Bill.
My hon. Friend has made a valid point, which I was not going to cover in my speech, so I thank him for that. As he knows, I am a huge supporter of union learning representatives, who do amazing work in encouraging people back into education when, for whatever reason, they did not have adequate chances at school.
I definitely did not come into the House to quote literature, but there has been much talk of the hard times that we are now facing. As my learned and highly intelligent colleagues will know, "Hard Times" is also the title of a book by Charles Dickens that marked him out as an early supporter of the rights of the working class—something that I certainly did come into the House to be. Dickens used that book to call on people to strike the heaviest blow in their power. With the measures set out in the Gracious Speech, the Government seem to be striking their own blow. Some have said that it contains only a small number of Bills, but that does not worry me or my constituents as long as it has a big impact. I hope that it will do so, especially for children with special educational needs, as well as for those living in poverty. If it does, this year's legislation will be not only about impact but about legacy, and I very much welcome the measures in it.
I should like to start by making it clear that I pay tribute to members of the NHS—doctors, nurses and any other staff working in the service—and that none of my words imply any impact on them or criticism of them. I am sure that Members on both sides of the House will see what I am alluding to. I particularly want to pay tribute to John Goulston, the chief executive of Barking, Havering and Redbridge Hospitals NHS Trust, for the work that he is doing in trying to turn the trust round, following its previous abysmal administration, about which I shall say more in a moment.
First, I want to talk about the amount being paid out in claims for negligence in the NHS. In my own trust, in the past four years, £33,534,380 has been paid out. That represents 179 claims. There are still 180 claims outstanding, so the final amount could be tens of millions of pounds more. My distress is compounded when I think that across London, £250 million has been paid out in the past three years. I thank the Secretary of State for meeting me to discuss the problem, and for his awareness of how to address it.
I shall refer to two cases, which I will simply call A and B, in order to leave the people anonymous. One lady went for a kneecap replacement, but it was put in the wrong way round, as she realised when she was unable to walk. Not only did she receive compensation, but the operation—with all its associated costs—had to be redone. More tragically, case B concerns a lady in perfect health who went into hospital to have a baby, but something went wrong and she was left paralysed, brain-damaged and in a very distressing state—with multi-payouts of moneys following on. My point is not to apportion blame, but to say that we must look more deeply into how such events are happening and why. Perhaps retraining through the General Medical Council is necessary, but we must stop this happening in the future. For example, my own area's NHS trust has a deficit of some £90 million—and the vast bulk of it is due to cases such as those two.
The General Medical Council investigates the doctors involved in such cases. The problem is that that is not happening quickly enough: many of these cases drag on and on for years, yet while they are being investigated the doctors continue to operate on patients. I hope that the Secretary of State agrees—in fact, I know from the words he kindly exchanged with me the other day that he does—that patients have the right to know if a doctor who is operating on them is being investigated as a result of a serious complaint connected with another case. I hope that some measures in the Queen's Speech will provide some assistance with such problems.
I mentioned earlier the previous administration of my area's trust, which brings me to another point that I have previously raised with Ministers and the Secretary of State. A former chief executive—in this case I will provide the name: Mark Reece, whom I have named here before—left the trust in a bad position, with vast debts, yet received quite a sum of money as a payoff, and, indeed, for his pension. Once such payments have been made by the NHS, we must ensure that the people concerned cannot be re-employed as consultants elsewhere in the country and earn even more money from the NHS. That is simply rewarding failure, and it has to be stopped. I say that because this gentleman—together with his partner, a former chief executive of Maidstone and West Kent NHS Trust, who also had a pay-off—has indeed formed a consultancy with the hope of advising the NHS on how to run trusts up and down the country. I would say that those two people are not the right ones to be advising the NHS on anything anywhere in our country.
Together with my colleague Mike Gapes, I recently visited the maternity wing of the Queen's hospital, Romford, and I can only pay tribute to the work being done there. I say this in a completely non-political way, but I think that the Government have a facility there that they have done proud, as the services that constituents receive there are first class. But—I am sorry that there has to be a but—it can take up to one and a half hours for my constituents in Ilford, North to get there by two bus journeys. Today I received a complaint from a constituent about how long it can take to get there. Although that is a great facility, we must also enhance and improve the King George hospital, which also services my constituency, to ensure that my constituents can receive services as close to their own doorsteps as possible.
We heard earlier from the Secretary of State about the services of polyclinics, and I believe that Mr. Chaytor paid tribute to one that opened recently in his constituency. One is opening in my neighbouring constituency, and I welcome anything that enhances services to patients. However, it will not help my constituents, so I very much hope that all GP services are protected, with no closures whatever, so that people can get the service they deserve as close as is humanly possible to their own doorsteps.
My hon. Friend makes a point that resonates in Bromley and my area—which is not dissimilar to his, although mine is in south London and his is in north London—about the threat to our area of polyclinics. I think that the Secretary of State for Health said that polyclinics were mainly for areas that did not have many GPs, but in areas such as Bromley and Ilford, where there are enough GPs—even though too many of them probably work single-handedly—they are not a relevant solution, because they mean concentrating services in one area, which causes lots of transport problems. Polyclinics are not appropriate for our areas.
I thank my hon. Friend for that observation. Of course, there is a problem attached to polyclinics. I have said openly that although I am not against them, I do not want services in any constituency diminished because of them. People need contact with their own doctor, who knows them, has dealt with them for a number of years and can give them the services that they need and deserve.
On the subject of education, Mrs. Hodgson referred to special educational needs, and I want to concentrate on one aspect of that: the teaching of our teachers. In a recent report by the National Autistic Society, a large number of teachers said that they were ill prepared to understand the needs of autistic children. Training is vital. I hope that that will be covered in the proposed Bills.
I recognise that the Secretary of State for Children, Schools and Families, who was at a meeting that I attended not so long ago, has said that the needs of the most vulnerable children in our society will be addressed, and I believe that he honestly wants to do that. However, relief teachers come into schools and do not know the pupils. I want a system the same as the one used in hospitals, whereby a new team that relieves a shift is given the notes of the patients whom it is servicing. In a recent case, a relief teacher took away from the child of one of my constituents the bar of chocolate that was needed because the child suffered from diabetes; the chocolate was medication. The child had a bottle of Lucozade and a bar of chocolate, and was not being naughty or eating in class. Those things were necessary because of the child's medical condition, but the relief teacher was not aware of that. Again, that is a matter of training, but also a matter of information being passed on by schools to relief teachers.
Mr. Sheerman said that Back Benchers could not speak for as long as Front-Bench spokesmen, and then went on to speak for longer than the Front Benchers. I do not intend to do that, but I do want to put across my final few points.
I am fortunate. The education system in the London borough of Redbridge is first class. Many people try to get into our schools and our education system, and I commend the borough for that. However, I want better provision of education for special needs children. We have two good schools, in Hatton and Little Heath, which are doing a fantastic job. I want to ensure that they get the resources that they need. I apologise—possibly to those on my Front Bench—for what I am about to say, but this is me saying it; I am not saying it on behalf of my party. I want resources ring-fenced for special needs children so that there is not a postcode lottery. We know about the burdens on local authorities, whatever the political persuasion of those running that authority, and there is a finite amount of money. However, I want the right sums of money to be put into the education of special needs children, and I want to ensure that they get it—and that will be possible only if we have ring-fenced funding. I ask the Secretary of State to consider that. As I said, it is my personal view.
If we do not help the most vulnerable children in our society, we should hang our heads in shame. We were all elected to this House to do that job and ensure that we protect those individuals and young people. I, for one, will do everything in my power to make sure that it is done.
I want to focus on the proposed Bill to give the NHS a constitution. Unlike Mr. Leigh, I think that our public services need more public involvement rather than less, and on the basis of my constituency experience, I am sceptical about the suggestion that we should leave professionals to their own devices. I feel that that has led to a slightly unrepresentative NHS that sometimes makes decisions in its own favour as an institution rather than considering the needs of individuals.
In 1996, during the last days of the last Conservative Government, the authorities at St. Helier hospital, which serves half my constituency, made a private, closed decision that the hospital should close and move further into Surrey, further away from those with the greatest health needs living in my constituency. A process was set in motion by NHS officers, who concluded that the hospital should be moved to Belmont, in the Surrey suburbs—one of the areas with the highest incomes and the lowest health needs and, indeed, an area that did not want a big hospital.
How could such a decision be made? I wonder whether it was anything to do with the fact that not one of the 18 board members of Merton and Sutton primary care trust comes from, or lives in, my constituency. They all live in much more affluent areas, and know my area less well. What is more, in an area that is hugely ethnically diverse, all but one of the board members are white. I believe that such boards are set up as they are because people choose other people in their own image and likeness. Potential board members are judged on the basis of whether they are members of other quango boards and whether they have similar experience. The difficult people who tend to challenge the status quo are not included in the selection process.
The NHS later set up a public consultation on where the hospital should go. To no one's surprise, St. Helier was the favourite choice and Belmont the least favourite, but the NHS wanted to stick to its decision. At that point, all the local boards rowed in behind the official NHS view that the hospital should move further into Surrey, despite the opposition of thousands of residents. Depending on whether or not one is charitable, one can believe either that the health service appointed consultants to re-examine the evidence or that it appointed them to manipulate the consultation results in order to suggest that people had voted for Belmont when they clearly had not. Because most people had answered the question "Would you like a hospital near to where you live?" in the affirmative, it was suggested that that constituted evidence that Belmont was near to where they lived, and that that justified the move. Even people living in the Belmont area did not want the hospital there. A staggering number of people wrote to me saying "We do not want our nice residential area to be bulldozed to pieces, we do not want ambulances with blue flashing lights, and we do not want more bus services." No one wanted Belmont, except, of course, the NHS.
Over the years, we had more and more arguments about the issue. Members who have been involved in arguments about hospital reconfigurations, or in any similar campaigns, will know how daunting it is to be faced with a wall of experts and professionals, given the limited resources possessed by many of our communities and, in many instances, by Members of Parliament. My local residents, however, had one thing in their favour. In 2004, the London borough of Merton had a Labour council, which, after being consulted by residents, used its powers to have the decision to close the hospital called in to the Secretary of State. The decision was reconsidered by my right hon. Friend John Reid and subsequently by my right hon. Friend Ms Hewitt: they had listened to the people.
Late in 2005 the then Secretary of State, my right hon. Friend the Member for Leicester, West, instructed the NHS to rebuild the hospital at St. Helier. She agreed with residents that it was better for it to be there, because that was most likely to reduce health inequalities. After all, the life expectancy of people in my constituency is 10 years shorter than that of those living in the Belmont area.
One would have thought that that was the end of the matter, because the Secretary of State had made her decision. However, the local NHS did not give up that easily. There is nobody from our area on its boards, and there is no constitution to say this was unreasonable, so although Ministers told it to build a hospital at St. Helier and to stop working on Belmont, it continued to make progress with its initial plans. It held meetings with Transport for London where it made it clear that Belmont was still the favoured option. It then announced that—lo and behold—planning issues meant that the hospital simply could not be built at St. Helier. It asked the Secretary of State to reverse the Government's decision, and to build the hospital in leafy Belmont as it had originally hoped would happen.
Again, local residents were up in arms. After all this time, why would the local NHS not listen to us? How could it be that there was nobody in the NHS establishment who would represent us? The Government had represented us; the local council had represented us; even the former Mayor of London, Ken Livingstone, had supported us. He told the local NHS, "Look, I'm in charge of London's planning policy, and St. Helier is the right place to have this hospital." The local NHS just would not listen to us, however, so we campaigned, fought and lobbied, and eventually, after years and years, it looks as if we have won.
I have to say that I think we now have an excellent deal. Not only has St. Helier been saved, but it is going to be rebuilt and refurbished. There will be new wards with single rooms, to cut down on infections and improve patient privacy, a new local care centre, and a new 24/7 GP service. There will also be four care centres, including one at the Wilson, the hospital the Tories closed down in the early 1990s. These care centres will have diagnostics and treatments, and dentists and GPs, open when people want them. Moreover, the Wilson is not just getting a care centre. It will reopen as a hospital, performing minor operations, and with more than 50 intermediate care beds for people recuperating from operations or needing care they cannot get at home.
My constituents have seen a stark contrast between how their views are treated by local and national Government on the one hand and by the NHS on the other. That is because democratically elected organisations are far more likely to represent the views of those who are least able to express their own views. Sometimes it has seemed as if our achievements were in spite of, rather than because of, the NHS. As I reflect on our 11 years in power, I think it would have been much better if there had been a constitution for our NHS earlier, and in particular a constitution that forced the local NHS to listen to patients and staff, and which obliged it to be representative of the communities in which it is situated.
Why, after all these years, have we not had even one local person on one of our NHS boards? Why, too, should the local NHS professional bodies be packed with people who have little connection with my constituency? I am particularly concerned about the composition of my primary care trust's professional executive committee. It is dominated by a practice far away from Mitcham and Morden. The medical committee comprises eight clinicians. The last GP from Mitcham to serve on this board was taken off it more than a year ago. Now all its members are white, even though the majority of the GPs in the PCT are not, and they represent an area that has the best health in the PCT area, rather than the worst. Six of the eight PEC members are from the same commissioning group, the Nelson, even though this group covers possibly the most affluent neighbourhood in the PCT. I should have thought that allowing a single commissioning group to dominate such an important committee was extremely dangerous. Indeed, I have received complaints that this very powerful practice-based commissioning group is at an advantage. It certainly appears to have a disproportionate influence.
I am especially anxious because this extremely unrepresentative committee is taking decisions about health care in my area. Both locally and nationally, we have been told to demonstrate that there is equal access to health services. Even the Conservatives who run Merton council say that bridging the gap between my constituency in the east and the far more affluent west of the borough is the top priority. As I have said, the Government have instructed the local NHS to take more account of health inequalities, but I am not convinced that the PCT can eradicate inequality in the local NHS, because it is not representative of either the local NHS or local people.
I hope that a new constitution will offer us an opportunity to achieve that. I want the NHS to listen to local people and to come from local people. I want it to reflect the people whom it serves and the people who work in it. I support the Government's plan to introduce a new constitution for the NHS, but I want it to ensure that local residents are represented. I want my local NHS to reflect the area that it serves. Over the last four years, foundation hospitals have shown that communities want to be involved in their NHS as a whole, not as a particular interest group or with a particular agenda. The 108 foundation hospitals have more than 1 million members, with turnouts in elections that often exceed local election numbers. If we can get far more people involved and having their say in an institution that unites this country, we will have a much better chance of having a service that reflects the needs and demands of local residents.
I am pleased to see that the Secretary of State for Children, Schools and Families is back in his place, because, as hon. Members will not be surprised to hear, I intend to talk about the child protection system. For some years, I have been concerned that the system makes the wrong decisions, including both false positives, when it intervenes when it should not, and false negatives, when it fails to intervene when it should.
For some time, I have been trying to identify how many serious case reviews have taken place following the death of a child, because that would provide a threshold from which we could track trends. The Department has been singularly unhelpful. In fact, when I gave up trying to get information out of it and went to all the local children's services authorities, the Department kindly instructed them not to give me their lists of serious case reviews. I am pleased to say, however, that the Chairman of the Select Committee has agreed that the Committee will work to try to find out that information. Ofsted has given us all the figures—including the 210 figure from yesterday—but it has only been tracking the figures from
We should not focus only on one case: we must look at the system and where it is going wrong. We also have to consider the wider aspects, such as the Laming review. Lord Laming is obviously the ideal person to review the extent to which his proposals have been implemented, but he is not the ideal person to review to what extent other proposals should be implemented. The Government have gradually moved towards the idea, which I proposed, that we need to look at the whole system of public family law. That starts with the initial references, moves on to the assessment processes and the integrated children's system, and—if there is a reference—it moves into the family courts, and we have not yet decided to look at how those work. I am still hoping that in January the Committee on Legal Affairs and Human Rights of the Council of Europe will agree to investigate the family division of the High Court. I shall go into some of the reasons why the family division is part of the problem.
In the initial process, the local authorities initiate proceedings. They often start with child protection conferences, which are often organised to prevent extended family members from attending. I had such a case today. One of my members of staff agreed to go to a child protection conference in Birmingham with a constituent—I do not know what has happened because I have been in the Chamber—and the time was changed at the last minute. We could say, "Well, that happens sometimes," except that it also happened previously with another constituent. We arranged to accompany that constituent to the child protection conference and act as an advocate, but the authority—this was Solihull rather than Birmingham—changed the time of the conference. We were told, "You've missed it, it's already happened." That is an abuse of process and it should not be tolerated. In a sense, though, it is a symptom of the attempt to drive out the extended family.
We need to be straight about the fact that such things do not always happen. I work with many social workers, and there was a conference in Stafford—also attended, not surprisingly, by Mr. Kidney—arranged by Rachel Bramble that looked at why things are going wrong in social work. The fact that people are being driven out of the profession is evidenced by all the vacancies that exist, but why do people not want to work in the sector?
The existing process is almost designed to exclude people, but then cases go into a court environment that is frightening and bewildering for people who have never been there before. Indeed, it has taken me some time to understand the processes involved. The House will be aware that I co-ordinate the Justice for Families campaign, and we are approached by people from across the country who are facing care proceedings. We refer matters to local constituency MPs, try to find volunteer McKenzie friends and so on, because there are great difficulties with the legal processes in the courts.
In an earlier intervention, I said that the single-expert system meant that people could not get a second opinion without the judge's permission. Judges tend to refuse that permission, and they pride themselves on the efficiency of the system under which an expert is appointed jointly by the local authority and the parents involved. The problem is that the system is a machine for miscarriages of justice. A number of social workers have complained to me, and last year one explained how he used to collude with parents' solicitors to ensure that the parents would lose their case. That is a criminal offence, but it is very difficult for me to take the matter further, as that would mean the social worker involved having to give evidence against himself.
A case in Oldham would serve well for a review of the single-expert system. The parents were refused a second opinion in both the county court and the Court of Appeal. When they applied again to the Court of Appeal, they were told that they could have a second opinion, which confirmed that the baby had not and could not have been hurt by them. Not only were the parents not guilty; they were provably innocent.
In one sense, the failure to allow a second opinion is based on practice on the continent, where the parties involved have their own experts as well as the one appointed by the court. The idea is that the court-appointed expert can make a decision about the truth of the other expert evidence. In this country, what happens with experts meetings is a move in that direction.
I see a great many cases, of which the Webster case is a good example. Once initiated, a case like that will trundle through the system. Everything happens and the children are adopted, but then all of a sudden it becomes apparent that once again the court has got it wrong. Such problems are driven by the single-expert system.
I proposed an amendment to the Children and Young Persons Bill that would have enabled people to get expert evidence. At present, when the court has gathered all the expert evidence, it is illegal for a parent's solicitor to telephone a doctor and ask whether he or she knows anything about a case. That would be a contempt of court, and it is another example of how the single-expert system is a machine for generating miscarriages of justice. Given that some solicitors also conspire against parents in such cases, the House will see that the situation can be very difficult.
I received a letter from the eastern region of the Legal Services Commission, dated
"funding will continue on the basis that Mrs. M should accept that her case is being publicly funded, and that contesting Interim Care Orders, where there is no change of circumstances, is not an issue on which she would expect to be legally represented."
Basically, that means that Mrs. M is allowed non-means-tested funding as long as she does not say no to the interim care order. In other words, she can have a solicitor at the hearing, but she has to agree to the order. That is not the way towards a proper judicial process, and, as I have said, such an approach drives everything else. The Department for Children, Schools and Families has done some good statistical work. Earlier this year, it analysed about 400 cases, and table A2.42 of its report shows what a low proportion of cases are chucked out of court.
There is a problem with the single-expert system. Sometimes, people cannot get legal aid when they want to contest a case; they simply have to accept it and work with it. We need to look at the criteria used to determine when a child is taken into care. The phrase in the section 31 threshold is "risk of significant harm", but that could mean many different things. Obviously, everyone accepts that baby P and Kyra Ishaq should have been in care, and there are many similar situations, but should we put a 16-year-old in care because his parents have split up and he will not talk to one of them? I do not think so, but some judge does.
Domestic violence is a difficult area, and it is challenging for kids. If parents split up and do not see each other because Mum was a victim of domestic violence, should we still be trying to take her children away from her? I do not think so. We learn from women's refuges that women are so frightened of losing their children that they do not actually report domestic violence. Margaret Halliday of the Salisbury women's refuge will provide that information, and I, too, can provide lots of evidence.
Another criterion is secure care for welfare reasons. In some of those cases, children should not be in secure care. There is no evidence that it does anything for them, and they are, in effect, suffering imprisonment without having committed an offence—much like the boy who will not talk to his mum. Not co-operating with professionals is another reason that does not seem sensible. The mere fact that somebody does not immediately snap to and do exactly what they are told should not be good cause to remove their children and have those children adopted. That does not mean that if the children are missing medical attention because the parents never take medical attention seriously, there is not a grave issue. Another reason is "comments eroding children's self-esteem"; so if the parent tells the kids they are stupid, the children need to be taken into care. I do not think so. Then there is missing school. Obviously kids should be going to school, but we have a one-trick pony—a system whereby at a certain point the child is taken into care. We need much better scrutiny of the operation of the section 31 threshold.
There are important reasons why the system correlates with the false negative environment. It is in part caused by the way the integrated children's system pressurises practitioners into making an early decision about the truth of the case and not changing it thereafter. That is the basis of an article that I have written with Sue White, who is professor of social work at Lancaster university, and Allan Norman, who is a social worker and lawyer based in Birmingham, where he runs his own practice—Celtic Knot. The article has been published on the Community Care and Family Law websites and in The Birmingham Post, and I have also sent a copy to the Minister, so there is no sense in my re-reading out what is available on the internet.
Haringey, like many authorities, has a target, for the number of children in care, which is kept for budgetary purposes. The target for March 2007 was 365, and the target for March 2008 was 352. In part, the objective of reducing numbers in care is laudable. That is also true of trying to reduce the weekly costs, which have run at higher than £800 per child per week. On
Given the inherent constraints on the number of children in care, if children are put into care who should not be in care—one of my examples was from Haringey—it pushes resources in the wrong direction, so we have difficulties with that. That is a bit of a run through; I could go on for a long time about other aspects, but two other Members want to speak, and if I can do another five minutes that would be quite reasonable. [ Interruption. ] They are both smiling.
I want to raise mental capacity and the RP case. It is not sub judice, simply because it has been through all the domestic courts and has got to the first stage in the European Court of Human Rights. That case is absolutely appalling in my view. An expert was appointed who said, "Mum's too stupid to instruct a solicitor and therefore isn't allowed to operate her own proceedings." The Official Solicitor was brought in and said, "Sorry, we're going to concede this case. That's it. You've had it." So there was no trial. There was a 10-minute hearing, at which everything said by the local authority was accepted as gospel, and that was it, except for the fact that we have taken it up and said that audi alteram partem—hearing the other side—is a key part of a trial process. Interestingly, although the expert at the time said, "Mum didn't have the capacity to instruct a solicitor," another expert has said more recently, "Well, she's obviously got the capacity to instruct a solicitor." In fact, she has done quite well at presenting her own case in the Court of Appeal. I have the transcripts of those hearings if anyone wants to read them, and the case is now in the European Court.
Good news from my point of view is that the Equality and Human Rights Commission is showing some interest in mental capacity and what is happening in the Official Solicitor's office. We have about 180 cases a year where parents are basically excluded from judicial proceedings. They have no locus—something that is not allowed in criminal proceedings, which people have been able to contest since a case in the 1800s. In family court proceedings, it is seen as perfectly acceptable to put parents in a situation where they cannot contest the proceedings.
I have another case, which I call the HP case, in which a lady who does not speak English was given an IQ test in English, did rather badly—whoops—and contacted the Official Solicitor. We went to the Court of Appeal, which said, "Tough." So that quite appalling case is going to Europe as well.
We have international cases where it is thought more important to ensure that no one escapes the family courts in Britain than to look after the children better. I know of two such cases: the one that is well known from The Times, and another one that is not so well known, where the court's objective is to get an eight-year-old back to England, away from his or her mother and leave the mother with another baby in situ. When I suggested to the Government that it would be better to put the child first and to transfer the case to the local jurisdiction, the response was, "Oh, no, we can't do that; the courts have to win," even though it is better for the child for the case to be transferred to the foreign jurisdiction.
I want to make a few points about Ofsted, which has been very good in this area. It has started to reveal in its reports some of the truth about how the Children and Family Court Advisory and Support Service operated. It has also revealed the truth about the serious case review. Baby P died in August 2007, and Ofsted started taking responsibility for the sector in April 2007. I do not think that those two things can be correlated. It is a ray of light in an area that has involved people covering up for one another for years.
The problem is that secrecy tends to prevent accountability. In fact, secrecy is often used to prevent Members of Parliament from finding out about such cases. Generally, what the Government say should happen is the right thing. I do not think that the Government's objectives are wrong. The problem is that something quite different actually happens. What is needed is a much wider inquiry, which is independent of people who make money out of the area. Perhaps the departmental Committee can look at that—perhaps the Justice Committee should do so as well—but we need people to look at it who are not interested in sweeping things under the carpet and saying that everything is perfect and that everyone is doing a brilliant job. Some people are doing a brilliant job. Another whistleblower came to me who had faced disciplinary action for telling the truth, which I thought was not very clever. I do not know what has since happened in that case. There are some very good people doing a very good job in difficult circumstances; the problem is that the secrecy has allowed bad practice to develop in an unaccountable way.
I will be happy to meet the relevant Minister and the departmental Select Committee to go through all the details. I met Lord Laming on Monday, although I think the terms of reference of his inquiry are far too narrow. What we need is a wider inquiry, because this matter cannot be kicked into the long grass. Problems arise every day across the country, particularly in England and Wales. Scotland generally has fewer problems, for reasons that I could go into at length, were it not five minutes to the hour—I have said that I will speak for only so long. This is an important issue and both sides of the coin matter. I ask the Government to consider instituting a wider inquiry.
I rise to speak briefly in support of the new proposals on health and education in the Queen's Speech and to make a few remarks about the general direction of schools policy.
I endorse almost all the comments that the Chairman of the Children, Schools and Families Committee made on policy, especially his comments on the structure of the debate. I have been a Member of Parliament for 11 years and I have attended every Queen's Speech debate in that time. I may be wrong, but my perception is that each year fewer Back Benchers wish to contribute, or wish to spend time sitting in the Chamber, because of the length of time allocated to Front Benchers. If we are serious about involving more Back Benchers and younger MPs in these debates, we have to take a careful look at the dominance of the Front Benchers.
As a member of the Procedure Committee, let me say that the Committee is considering such issues. If any Member were to refer such a matter to the Committee, I presume that it would be viewed favourably.
I am pleased to hear that. It is an important matter that should be pursued.
Although I do not want to discuss the Haringey case at length, in the context of the comments made by the Chairman of the Children, Schools and Families Committee, it is striking that in the past few months the important subject of children in care and the position of vulnerable children has moved inexorably up the agenda. It does the Government credit that they have prioritised vulnerable children to a far greater degree than has ever been the case before in our country. Let me say this, however: it is easy to discuss such matters when there is a high-profile case in which the whole country is interested; it is less easy to maintain a high political profile for children in care and vulnerable children in the absence of that high level of media attention. I hope that all hon. Members and the Government will sustain their present interest in policy to improve the position of children in care, even when the media interest dies down.
It is an absolute scandal that children in care perform so poorly in our schools, are so neglected and are so overlooked. In the past few months, we have reached a turning point. I hope that we can maintain a high level of interest in those unfortunate children.
Does the hon. Gentleman agree that it is a perverse intellectual dichotomy that, every month of the year, detailed information relating to the actions of social workers in children's services is routinely disposed of under the auspices of Ofsted, yet, at the same time, thousands of DNA records of completely innocent people are kept? Do we not have our priorities completely wrong in that respect?
The hon. Gentleman makes an important point. At yesterday's meeting of the Children, Schools and Families Committee, I was startled to hear the admission by Ofsted's chief inspector that records were routinely destroyed after three months. The defence offered was that it would be difficult to store such a large number of records, but it seems to me that the widespread use of electronic information storage completely invalidates that argument.
I talked to the head of children's services in my local authority, and a key point that they wanted to communicate to me is that in some high-profile cases, but not in the case of baby P, those who cause abuse deliberately travel around and move to different areas so that it is hard for the record system to follow them. Does my hon. Friend agree that we need to consider the issue of people who deliberately move around? There are proposals for a tracking system, and we need to speed that up quickly.
That is an extremely important point, and it highlights the crucial significance of greater co-operation and communication between police, local authorities, and the national health service. Whenever there is a tragic case such as that of baby P, the media routinely decide to target social workers, but they are less aggressive about the inadequacies in some of our policing systems, and certainly about those in some of our health care arrangements.
Finally on children in care, the reluctance of some local authorities to increase the number of children in care is certainly partly a financial matter, but we have to accept that the quality of institutionalised care that our country has provided over many decades has been appalling. That partly explains the reluctance to put more children into care. If we learned the lessons of some of the Scandinavian countries and provided a higher quality of residential care, and could be assured that the quality of parenting that children would receive in a residential setting was without question better than that which they had received at home, perhaps we would be less reluctant to put children into care, temporarily or permanently.
On schools policy, in my constituency, since 1997 every primary school, secondary school and GP surgery has had its roof fixed. My local hospital has not only had its roof fixed but has been totally rebuilt. That is to the enormous credit of my party's Government. In addition, there is the welcome prospect of seven new local health centres being built in the very near future. My local authority is on the verge of being able to rebuild or refurbish all its secondary schools, where necessary.
The chief executive and the director of children's services in Bury are keen to support the bid that they submitted on
Also enormously to the Government's credit is the inexorable rise of standards in schools over the past 10 years. It is unfortunate that each year, when the GCSE, A-level and key stage test results come out, parts of the community, and Members in parts of this House, routinely want to rubbish the improving standards and achievements of our children.
It is unfortunate that the Chairman of the Public Accounts Committee has left the Chamber, because he raised a number of interesting issues, on many of which I could agree with him; there is a good deal of common ground between us. He raised a number of issues to do with micro-managing our schools system. That is astonishing coming from someone of the party that introduced the Education Reform Act 1988, which imposed on a generation of young people the most micro-managed system imaginable, and which resulted in the hugely prescriptive national curriculum, Stalinist forms of testing and assessment, and the unbelievably inaccurate league tables that are routinely published, and which drive the behaviour of head teachers in our schools. It is beyond belief that anyone who supported that legislation could accuse this Government of wishing to micro-manage our school system. One of the most interesting developments of the past 12 months is the recognition, not just by the Government but in all parts of the House, that the era of the ERA—the Education Reform Act—has probably come to an end. We have exhausted the advantages gained from the 1988 Act—and there have been some—and we have to build on that and move on. The shift of direction to a more comprehensive approach to children's services, with a greater emphasis on children's well-being and a new focus on the remaining inequalities in our school system and on the importance of social mobility, is welcome, and I look forward to the proposed legislation in the Queen's Speech significantly advancing that new agenda.
Like the hon. Gentleman, I applaud the movement towards looking at important objectives such as social well-being. However, does he agree that the Government do not appear to have taken on board the fact that there is a great deal of teaching to the test, particularly at key stage 2, which has narrowed the curriculum unnecessarily for many children?
That is an important point, but I do not agree with the hon. Lady, because the statement by the Secretary of State some weeks ago—in fact, it was made in the week in which she and I were on a Select Committee visit to Canada—made the biggest change to the testing and assessment system since 1988, and fully recognised the damaging effect of teaching to the test. In fact, I was going to go on to praise the Secretary of State for making that statement and changing our testing and assessment system, and essentially getting rid of the increasingly redundant key stage 3 test, and for leaving the door open to future reforms to the key stage 2 test. The progress that we have made in the past few months on testing and assessment is hugely welcome. The progress on curriculum reform, with the publication of the Rose review and the new freedoms for individual schools to be more flexible about the curriculum so that they can tailor it more to children's individual needs and develop a more personalised approach to the curriculum, is hugely welcome.
A consultation was launched this week, and the notion of a school report card replacing the bog-standard league table is hugely welcome. I hope that there will be adequate time for all hon. Members to consider what ought to go into the new school report card, which I hope will abandon once and for all the idea that raw scores are the only measure of a school's success. I look forward to the far more sophisticated but easy-to-understand form of a report card that will give full recognition to the complete range of a school's achievements.
There are two points on which I want to focus in a little more detail, beginning with my annual comment on school admissions. The Secretary of State will know of my interest in the subject, and that the Education and Inspections Act 2006 made significant improvements to the admissions system with the new code. Only this week, the Government published the revised code on school admissions, which will take effect early next year. I welcome it as another step towards a fairer admissions system that is likely to lead us a little further down the road to a better-balanced school intake. As all the international research indicates, countries that have balanced school intakes and that have the least inequalities and the flattest hierarchies between schools by and large perform better on all educational criteria. I welcome the new duty on the admissions authorities to meet the needs of the local area, and I welcome the improvements to admissions forums so that they, too, are more representative, and have to consider the fairness of admissions policies for that area.
There is one element in the new revised code that I hope the Secretary of State will speak about in his closing remarks: the school's ethos. The Department's press release says that schools will be allowed to advise parents of their ethos during the application process and ask that children respect that ethos. Will the Secretary of State assure the House that the issue of ethos will not become a criterion for the selection of children? If that does happen, and if children, or parents on their behalf, have to sign up to a particular ethos as an admission criterion, it will be a hugely retrograde step. I would be grateful if the Secretary of State commented on the question of ethos in his winding-up speech.
Would I be right to infer from the hon. Gentleman's comments that the Labour party is against schools having an ethos of, say, excellence for all pupils in a community? I wonder what the rationale behind his comments is. Is he against excellence? Is he against schools moving forward throughout the community?
With respect, that is a pretty fatuous question, because obviously I am not. My point is that there is an important distinction between requiring parents to say that their children will accept the ethos of the school and allowing schools to select which children they wish to admit. That is the fundamental distinction I am trying to make.
Allowing time for the final speakers in the debate, I would like briefly to make one other point, which concerns the 14-to-19 phase of education. The Government have made enormous progress in the past two or three years on that issue. They have done so 10 years later than they should have done; we should have been grappling with the 14-to-19 sector as soon as we were elected in 1997. Nevertheless, I welcome the progress that we have made. Two issues emerge, however, from the establishment of this as a distinct sector, and from the development of diplomas as the central part of the curriculum in that sector. The first is the question of funding. My right hon. Friend the Secretary of State will know that for many years there has been an enormous discrepancy—as much as 15 per cent.—between the per capita funding of students in the 16-to-19 phase of education and the rest. I welcome the fact that that discrepancy has recently been reduced; I understand that it is now down to 9 per cent. Given the structural changes in 16-to-19 education and the handing back to local authorities of the funding responsibility, is it not self-evident that we must have a uniform funding system, not only for the 16-to-19 phase, but for the 14-to-19 phase? I would be grateful if the Secretary of State commented on equality of funding between institutions in the 14-to-19 sector.
My final point on that sector, and of my contribution, concerns the structures of 14-to-19 education. One of the issues that I found controversial in the 2006 Act was the power of presumption that schools currently without a sixth form could open one. I have raised that point with the Secretary of State before, and I raised it with the Secretary of State for Innovation, Universities and Skills. As we move to an era beyond 2011 where the annual rise in public investment will be far less than it has been during the past 10 years, the last thing we want is an enormous explosion in the number of new, small sixth forms. All that will mean is that the cost of educating each student will be disproportionately higher, and we will not get the economies of scale increasingly necessary beyond 2011. It has been a concern to many of us that the academies programme, of which I am a strong supporter in most respects, although not every detail, was originally built on the assumption that every academy would have its own sixth form. So, hey presto, there were 400 new sixth forms at a stroke—even though there were not enough young people to fill them. I welcome the fact that that is no longer a requirement of academies and that they can be founded without a sixth form. The majority of our sixth-form colleges perform outstandingly and there has been a rapid improvement in the performance of the overwhelming majority of our further education and tertiary colleges. I am fortunate in having two of the most outstanding colleges in the country in my constituency—the Holy Cross sixth form college and Bury college. I realise that that does not apply to every part of the country, but it must be increasingly self-evident that the most economically effective and educationally advantageous way in which to deliver the new 14-to-19 phase of education is through the college sector, not through the proliferation of small sixth forms.
I confidently predict that if the Government do not take this issue far more seriously than any previous Government, perhaps not by the end of the next Parliament, but certainly by the one after, we will have to close large numbers of sixth forms because the budget will simply not stretch to cover those costs. Again, I would be grateful if the Secretary of State took this on board and perhaps opened up a dialogue with our right hon. Friend the Secretary of State for Innovation, Universities and Skills, because it is an issue that obviously covers both Departments. If we are to make the 14-to-19 sector a success and implement our plan to increase the education and training participation age, it is crucial to recognise that it can only be done by strengthening the college sector and increasing the role of colleges in the delivery of that phase. I am afraid that that means a reduction in the number of independent sixth forms.
I shall focus on just one aspect of today's discussion about the Government's programme of activity for the forthcoming legislative Session: the national dementia strategy, to which the Secretary of State for Health referred in his opening speech. At the outset, I should say that I fully welcome the concept of a national dementia strategy, as, I suspect, do most Members. It is immensely important, and has been for a significant time.
In August 2007, the former care services Minister, Mr. Lewis—not the other Bury Member, Mr. Chaytor—said that we should work to bring dementia out of the shadows. He was entirely right to say that and I applaud the Government for acting on that impulse and arranging for a national dementia strategy to be brought forward. I hope that the House will forgive me if I cover the reasons why a national dementia strategy is so necessary and why dementia is such an important subject.
The figures may be well known to hon. Members, but I will repeat them. Some 700,000 people in the UK now have dementia. That figure will probably double in the next 30 years, and the cost to the UK economy will treble during that period. That is a significant figure, because the current estimated cost to the UK economy is £17 billion a year, which is more than the cost of heart disease, stroke and cancer combined. Those are very significant figures, which is why the strategy is, as I said, extremely welcome.
The strategy is welcome, at least in part, because a problem of that scale should never be ignored. That fits into the context of what other hon. Members said earlier about mental health issues more generally. It is true, and worth recognising, that people do not like to talk about mental health issues in the same way as they like to talk about physical health issues. Some stigma is attached—and that is true of dementia.
It is not just recognition of the scale of the problem that we require. We also need people to have the courage to come forward and explain that it is happening to them, and how they are coping with it. In the context of dementia, one of those people is the author Terry Pratchett, who the House will know has recently revealed that he has a form of dementia. Since then, he has actively campaigned on the subject, talked a great deal about research, and described what has happened to him in terms of a tsunami that will hit the United Kingdom. He is right to talk in those terms.
Two aspects of a tsunami are important, and someone who is about to be hit by one will want to know two things. First, they will want to know how big the wave that is about to hit them is; I have said a little about that. Secondly, they will want to know when it will hit. How urgent is the problem? It is with regard to the urgency of the problem that I have some difficulties with the Government's position. I have no doubt that the Government have done entirely the right thing in arranging to introduce a strategy, but I am becoming a little concerned, as I know others in the field are, that the Government's sense of urgency has started to slip.
When the former care services Minister spoke about his intention to introduce a strategy, he said that he hoped that it would be available by the summer of 2008. However, the Department of Health issued a press release on
"The full Strategy, to be launched in the Autumn, will have three main aims".
I shall return to those aims in a moment, but it became clear at that point that the Government wished to introduce the strategy in the autumn. We know that the Government have a very flexible concept of autumn, but we are clearly no longer in the autumn now. We then asked the current care services Minister when exactly we might expect the strategy. I asked the Secretary of State that question today, too. The Minister has said that it will be introduced shortly and, under further cross-examination, that that might mean early in the new year.
I understand that things are difficult in government. Other priorities arise, and the Government sometimes find that time scales slip a little. However, an issue of such importance and urgency must be dealt with expeditiously. Those involved with dementia—those who have it, those who care for them, and the professionals working in the sector—regard the situation as urgent. They feel that they have persuaded the Government of that—indeed, the Government have made it clear that they regard dementia as a priority. With that must come a sense of urgency, but if time scales continue to slip, that urgency must fall into doubt, which would be extraordinarily regrettable.
The one aspect of the strategy that I urge the Government to regard as especially important is training. Training applies to various different aspects of dementia, and in various ways to those involved with it. The draft consultation document on the dementia strategy says that it will have three main aims. The first aim will be
"to increase awareness of dementia and remove the stigma associated with it,"
the second to
"ensure early diagnosis and intervention,"
and the third to
"improve the quality of care that people with dementia receive"
There can be no argument about any of those aims, and training is key to delivering the second two.
I want to talk about two aspects of training, the first of which is training for general practitioners. They are, as the name suggests, practitioners of general medicine. No one expects them to be experts in every medical condition. However, one of the problems that we face in dealing with dementia is that general practitioners are extraordinarily reluctant to make diagnoses. I suspect that the failure to make such diagnoses is in many cases down to reluctance rather than inability.
It is often said—rightly, in my view—that where we are with dementia now is roughly where we were with cancer 30 or 40 years ago. There is sometimes a sense in the medical profession that it is not worth diagnosing dementia because nothing can be done. One of the problems is that that is largely true. There is currently no cure for dementia, and there are no effective treatments. However, it is not true that absolutely nothing can be done. Any support for or understanding of those with dementia is of such immense value to them and those who care for them that it is worth making any diagnosis as early as possible. If we expect general practitioners to make diagnoses, as we want them to, we will need to give them the training to allow them at the very least to recognise the signs, and to refer patients to a specialist medical practitioner who can then make a diagnosis.
I pay tribute to my hon. Friend's work on the all-party group on dementia. Does he agree that it is imperative that the review in the new year, if it arrives, should raise the disparity between government and other funds going into research into dementia, and those going into research into other conditions? We need a public debate, to ameliorate the problems that he has raised.
My hon. Friend is absolutely right about that. The timetable for research is also slipping. The Government have quite rightly suggested that there should be a research summit, and when the Department of Health's press release was issued, it said that that summit would be held over the summer—in other words, over this past summer. That clearly did not happen either; the timetables are slipping. My hon. Friend is also right to say that the level of funding for dementia research is minimal compared with the funding for so many other conditions. It becomes all the more important to invest in research when we have no cure and no effective treatments, because we are not going to find either unless a substantial amount of research is done.
The hon. Gentleman is making a well-informed and thoughtful speech. A moment ago, he referred to training. Does he agree that some general practitioners need training in Alzheimer's, for example, to make them aware that it can strike young people in their late 20s? As with other forms of dementia, it is often thought to be solely an older person's disease but, sadly, that is not the case.
I entirely agree. The problem with dementia is that they have got you coming and going. A doctor will often be unwilling to accept that young-onset dementia could possibly be the explanation, and in cases of older-onset dementia they might well say that there are plenty of other explanations for the symptoms, and that this is simply what happens when people get older. The hon. Gentleman is absolutely right to draw our attention to young-onset dementia, and we also need to persuade the medical profession to have the courage—as well as the knowledge—to make these diagnoses in cases of older-onset dementia.
Training is also important in another respect—training for those who care for people with dementia, either in a residential care home setting or as visiting social workers for people with dementia who live at home. It is crucial that such people have an understanding of what dementia is, how it affects people and what can be done to ameliorate its symptoms. It is remarkable that anyone who works in a care home has to receive training in lifting, handling, fire regulations and many other things, yet they do not have to undergo even one single hour of training in dementia. That is even more ridiculous when we consider that a substantial proportion of the care home population—perhaps some two thirds of them—have dementia, and that that proportion is likely to increase.
The policy of this Government is—as, I am sure, the policy of any future Government would be—that people should be cared for in their own homes for as long as possible, and for as long as they wish. That means that those who have to be cared for in a residential environment will, generally speaking, be those who cannot be cared for at home, and substantial numbers of those people will be in that position because they have an advanced form of dementia. It is therefore becoming more important than ever that those who work in a care home environment understand dementia and receive training in it. The Government's dementia strategy states that training is important and that the strategy will cover it. I very much hope that when they put the final touches to the strategy, they will recognise how important that subject is, and that it should run through all the aspects of dementia that the strategy rightly seeks to address.
In my last point, I want to link what I have been saying to the theme that has rightly emerged in many hon. Members' speeches today, by saying something about the tragedy of baby P and all that surrounds it. The argument for training for the broader social work profession is also relevant here. We need a better-trained social work profession. We know that numerous substantial mistakes were made in the case of baby P, and in other cases that we have heard about, and it seems to me that training is part of the answer. However, training can be of real value only if we can retain the staff who have been trained. One of the problems in the social work profession generally, and in the care home sector in particular, is that it is very difficult to keep members of staff in position for long. There is a huge amount of churn in the profession. People do not stay in one job for long, and the training that they have received may go to waste if they move on to another job or occupation.
We need to examine ways of keeping people in their jobs for longer, and one of the ways of doing that is to recognise that the caring professions are just that. First, they are made up of people who wish to care. Secondly, they are made up of people who wish to be treated as professionals. We have to allow them to achieve both those aims. One of the counter-intuitive aspects of the baby P incident, it seems to me, is that when we hear about those terrible failures in the social work profession, we put down social workers as a result. As I say, however, counter-intuitively, the right answer may instead be to raise up the social work profession and say how important it is, if we expect people to act as qualified professionals with good judgment, and to give them the training and then the space to exercise it. That is a hugely important lesson to draw from this episode: it is not an easy lesson, but it is an extremely necessary one.
Let me finish where I began—on the dementia strategy—and say to the Government simply this: I welcome the strategy, as I think most sensible people would, but the Government have raised many hopes in bringing it forward, so they must not disappoint. The strategy must deliver not just the detail but the urgency that the Government promised. We must see it brought forward soon, because it seems to me that there are few more important things that any Government can do.
I thank you, Mr. Deputy Speaker, and the Government Front-Bench team for their understanding in allowing me to leave the Chamber briefly earlier in order to see my daughter's nativity play. Even though we all face tough economic circumstances, I know that all hon. Members will want to find time in their schedules for seasonal festivities.
I was particularly pleased to read about the great fun had by all at the Christmas party held by the Secretary of State at the Department for Children, Schools and Families. I understand that, as well as wine and canapés, the Secretary of State also laid on for members of the press a Scalextric demonstration, a Nintendo Wii and some Star Wars light sabres. Those were not products acquired during the seasonal sale that Woolworths has just launched to celebrate the life-saving effects of the recent VAT cut; nor were they the toys that the Prime Minister threw out of his pram on hearing what the German Finance Minister thought of his policies. They were, in fact, there to help members of the press celebrate the first anniversary of the children's plan.
I also understand that the climax of the party was a light sabre duel between the Secretary of State and Mr. Michael White of The Guardian, modelled on the epic duel between Darth Vader and Obi-Wan Kenobi in Star Wars—these are serious times and we need serious people. I also understand that the Secretary of State won, and I am sure that, as he triumphed, he uttered the words that the Home Secretary spoke to my hon. Friend Damian Green just the other week—"May the force be with you". But whether or not we believe in the force, and the power of the dark side, I am sure that we can forgive light-heartedness at this time.
Of course, some hon. Members may have been in good spirits yesterday for reasons other than the formal anniversary of the children's plan. They may have been listening to the Prime Minister taking pride in his global rescue plan. Well, we now know what the man in charge of Europe's biggest economy thinks of that. The Prime Minister may believe, in his more modest moments, that he is Franklin D. Roosevelt, but the truth is that he is closer to a political Max Mosley: he thinks he is king of the world and he has clearly got money to burn, but all people remember is that he got a terrific spanking in German. [Interruption.] Thank you.
We have had a good debate this afternoon. My hon. Friend Mr. Lansley brought his customary authority and gravitas to discussion of the NHS, underlining his reputation as a stalwart friend of health professionals everywhere. The Secretary of State for Health made the traditional partisan points with his customary lightness of touch and discussed forthcoming Bills in a way that reminded us why he is such a valued member of this Government.
Norman Lamb brought his considerable intellect and passion to bear, and I welcome the increasingly reformist focus of Liberal Democrat health and education policy. Mr. Sheerman, the Chairman of the Select Committee on Children, Schools and Families, spoke comprehensively and well, and with particular authority on the need to improve child protection. My hon. Friend Mr. Leigh, Chairman of the Public Accounts Committee, combined a proper regard for efficiency in the public sector with pungent prescriptions for reform, not all of which I necessarily share.
Mrs. Hodgson made a series of telling points on the need to improve support for children with special educational needs. My hon. Friend Mr. Scott spoke with great passion about the need to improve the service that his constituents get from the NHS. He also made a powerful plea on behalf of children with special educational needs.
Siobhain McDonagh spoke persuasively in favour of the NHS constitution, using her constituency experience to powerful effect. John Hemming spoke, as he has done so often and with such passion, on child protection. In an intervention, he asked specifically whether we agreed with the terms of Lord Laming's inquiry. We do not, as we made clear in a letter to Lord Laming. We fear that they are too narrow. We want Lord Laming to ask not just whether his 2003 recommendations are being followed, but whether we need to do more to reform the child protection system.
Lord Laming has said that the foundation of current children's services is robust, but we are not persuaded of that assertion. He also argues that serious case reviews, including the serious case review in connection with baby P, should remain confidential. We disagree. We have nothing against Lord Laming as an individual—indeed, he was patron of the commission on social workers, chaired by my hon. Friend Tim Loughton just the other year, which produced many recommendations that the Secretary of State now appears to be implementing—but we think that it is important, as I am sure the whole House would agree, for there to be no bar on serious questions being asked on raising the bar in child protection.
Mr. Chaytor made a characteristically thoughtful contribution on child protection and schools policy, and my hon. Friend Jeremy Wright spoke movingly and effectively about what we can do to help those living with dementia.
I can freely praise one or two speeches that I was not able to hear in full, because the notes taken by my colleagues on the Front Bench have been so generous. I can also praise the Secretary of State's speech, which I have not yet heard, because I know what is in it—not because it has been leaked to me by the Department for Children, Schools and Families, but because he displays an admirable consistency in the political message he propagates. Whatever the occasion, wherever the platform, whoever the opponent, he repeats the same line: we on the Government side are saints who are investing in stronger motherhood and much more apple pie, and the other guys—it can be Scottish nationalists, Liberal Democrats or even German Social Democrats—are monsters from the Jurassic era who will cut, cut and cut again.
Psychologists have a term for people who repeat the same behaviour over and over again, whatever the circumstances and whatever the efficacy. They call it obsessive-compulsive behaviour. But any such diagnosis of the Secretary of State's approach would be mistaken. Another psychological term captures his approach much more accurately. It is called transference. Transference occurs when people accuse others of behaviour which they themselves exhibit. If Jeffrey Archer accuses someone of embroidering the truth, that is transference. If Simon Cowell accuses someone of arrogance, that is transference. If Peter Mandelson accuses someone of irresponsible leaking, that is transference. When the Secretary of State accuses others of wanting to inflict cuts, that is actually what he has been doing.
Before the last election, the Secretary of State told us that a Tory Government would reduce future spending by £35 billion, but now his Government are reducing spending by £37 billion. His own Department is not immune. Let us look at some of his budgets, such as the budget for Building Schools for the Future. On school building, he has failed so far. We were promised 200 new schools by the end of this year. We have had fewer than 20. Now local authorities have had to go cap in hand to the European Investment Bank for money for school building because none is available in Britain. The pre-Budget report says, ominously:
"DCSF is assessing the value for money of Building Schools for the Future".
A senior Treasury source was quoted as saying of the school building programme that
"it's clear we're going to have to scale it back and scrap some considerable parts of the programme."
On child care, the Secretary of State has failed so far. We were promised by the Prime Minister that we would have for every three and four-year-old an entitlement to 20 hours of free child care, and we were promised an extension of that entitlement to all two-year-olds. But again, in the pre-Budget report we are told that that entitlement will not be extended to 20 hours for three and four-year-olds, and the entitlement for two-year-olds will not be extended to all—so cuts again.
On diplomas, the Secretary of State has failed so far. We were promised that 50,000 students would take these new qualifications—then 40,000, then 30,000, then 20,000. Now the number is 12,000 and falling. In a parliamentary answer that I received today, we discover that funding for diplomas is going down as well. It is being cut from £117 million in 2008-09 to £78 million in 2010-11. That is a 34 per cent. drop in funding. So there are cuts in that programme too.
I feel sorry for the Secretary of State having to make these cuts. It is not his Department's fault. He should really take the matter up with the team who have been responsible for economic management over the last 10 years and who have landed us in this mess. Perhaps he should have a word with the man who has been principal economic adviser at the Treasury for the last decade: the chap who designed the regulatory regime that allowed the banks to behave as they did.
I commend to the Secretary of State an article in today's Daily Telegraph by Dr. Irwin Stelzer, who says:
"It is beyond question that Britain's problems stem in part from its fractured regulatory system, with responsibility split between the Bank of England, the Financial Services Authority, and the Treasury. A close study of the relevant documents fails to reveal that this system was forced"
upon us by the United States, says Stelzer, adding that
"it sprang full blown from the brains of Chancellor Gordon Brown and his sidekick, Ed Balls."
The guilty men are there in front of us.
The Secretary of State will have an opportunity to respond in due course. I must make progress if I am to finish my speech within the allotted time.
The Secretary of State is an intelligent man with many decent instincts—
The Secretary of State will have an opportunity in a second.
I am afraid, however, that like many talented young people the Secretary of State has fallen in with a bad crowd—in his case, the Brownites. Since getting in with this gang, the Secretary of State has been determined to live according to its members' aggressive rituals, the most important of which is the drawing of dividing lines. He has tried to draw dividing lines on all the issues that I have mentioned, although in doing so he merely exposes his own weakness. He is just like a gang member who wields a weapon but only harms himself.
The Secretary of State will have an opportunity in a second.
The Secretary of State should appreciate the limits of aggression and try a different path.
In just a few minutes' time, the Secretary of State will have an opportunity to speak for 15 minutes, and I look forward to hearing from him then.
The real story of the Queen's Speech, and the biggest dividing line in British politics, is the divergence between the path trodden by the Secretary of State and the road taken by the Secretary of State for Work and Pensions.
Can the hon. Gentleman guarantee that he and his party will match the DCSF's public spending on education this year, next year and the year after that? Can he give that commitment?
I shall wait to see what the Secretary of State actually pledges to commit to education spending. Until we know the details of what he is spending, we cannot know what to match and what to increase. We know, for example, that diploma funding has been cut, but we found that out only today. As the pre-Budget report unravels and as we discover the reality of what is going on, we will come up with the answers that the Secretary of State himself has so far failed to give.
I was talking about the divergence between the path trodden by this Secretary of State and the road taken by the Secretary of State for Work and Pensions. While the Secretary of State for Work and Pensions is pressing ahead with reform, taking on vested interests and challenging the left of his party—creating, indeed, a radical new centre-ground consensus—the Secretary of State for Children, Schools and Families is opting for none of the above. While welfare reform, and the spirit of Blairism, live on in the heart of James Purnell, the cause of schools reform, which was championed by Mr. Blair at the start of this Parliament, has now been put to sleep by Ed Balls. Academies have had their freedoms curtailed; Lord Adonis has been shunted into a siding at the Department for Transport; Bruce Liddington, the schools commissioner responsible for diversity in schools, has been dismissed and not replaced; and Sir Cyril Taylor, the guardian of the independence of academies at the Specialist Schools and Academies Trust, has been dispensed with as well.
In his education Bill, the Secretary of State plans to introduce more powers for bureaucrats, more new bureaucracies and more bureaucratic burdens on teachers. That represents a tremendous missed opportunity. It is sad that in this Queen's Speech there was so little of conspicuous merit, apart from those welfare proposals which the right hon. Member for Stalybridge and Hyde largely copied from the recommendations of my hon. Friend Chris Grayling. In that sense, the Gracious Speech was mostly old, with very little new; most of that was borrowed, and all of it was blue. Members will perceive an irony there. When Opposition Members are given Government papers and publish them, they get arrested. When Government Members get Opposition papers and publish them, they get a fresh White Paper and rave reviews. It is a course that I recommend to the Secretary of State.
What this country needs is a Government committed to reform, ready to tackle vested interests, determined to extend parental choice and convinced of the benefits of diversity. What this country needs is a Government who, instead of searching for dividing lines, seek unity around reform, instead of generating bureaucracy for those on the front line, believe in freedom for professionals, and instead of presiding over economic turmoil and falling living standards, offer change, optimism and hope. That is why we desperately need a Conservative Government, and that is why I commend the amendment to the House.
I am grateful to Michael Gove for giving me advance notice of something this afternoon, and I think that I probably owe him an apology. He wrote to give me advance notice that he would be absent from the Chamber for his daughter's nativity play, which was very courteous of him, but I, unfortunately, did not give him advance notice of my intention to intervene on him. If I had done so, he might have had the chance to write into the script of his speech the answer to my intervention, because I have to say once again that, as has been the case time and again in the past year, what we have had from the hon. Gentleman is a well-written, erudite, humorous and insubstantial speech.
I shall now move on to the substance. I want to do so by, without patronising Members, thanking them for their contributions to this excellent debate, with the exception of the speech that we have just heard. We might have some disagreements about methods, but there is common agreement that we want to do the best by the children of this country for their safety, education, well-being and happiness. There has been clear commitment to that in speeches made from all parts of the House, some of which I shall now mention.
My hon. Friend Mrs. Hodgson, whose Bill on information for children with special educational needs will be very important indeed, made an important speech in which she talked about training for teachers with SEN specialities. Mr. Scott also talked about the importance of making sure that there is proper training in SEN for those teachers, and I thank him for his contribution.
My hon. Friend Siobhain McDonagh made an important speech on health, and on the fact that we need to involve local communities in the management of health services.
Although I do not agree with everything John Hemming has said, I know he is committed to the cause for which he campaigns, and I can say to him today that, following the Ofsted reports of recent weeks, we will be able to give him the detailed information that he wants on serious case review numbers.
Jeremy Wright made a speech on dementia, which is not an area in which I have expertise. I know that he wants a Government strategy to be implemented sooner rather than later, but when that strategy is published, I am sure that he will contribute to the debates that follow on the important subject of how we make sure we take forward care for people with that disease.
This Queen's Speech takes forward the commitments that we made in our children's plan and, one year to the day after its publication, our progress report, "One Year On"—to make sure every child can succeed, to tackle all the barriers to children's progress in and out of school and to work together, and intervene early, to make sure children are safe and properly protected and that their well-being is promoted. In the Queen's Speech, we committed to set out in law the responsibility of all of us to do the following: to keep children safe through children's trusts; to establish the legal basis for our new standards regulator, Ofqual; to strengthen our intervention powers to ensure that all schools can be good schools and all local authorities can tackle underperforming schools; to give schools more power to tackle bad behaviour; and to reform the provision and funding of 16-to-19 education. Opposition Members claim that there is nothing in the Queen's Speech, but nothing could be further from the truth.
One of the failures identified in Haringey was the insufficient challenge by the local safeguarding children board to its members and front-line staff. Often the chairs of these boards are also the chairs of children's services. Has the Secretary of State given any further consideration to the conflicts of interest that arise in that situation, and to having independent chairs?
I have done, and I have made it clear that no serious case review should be chaired by anyone other than an independent person. In those areas that have had an inadequate serious case review, we are now asking an independent person to review the case and to report to us as soon as possible.
Haringey has been the subject of debate for hon. Members on both sides of the House. We and our constituents have all been shocked and appalled both by the terrible suffering that that little boy endured and by the failure of services to act and intervene early to ensure that he was properly protected. We have acted, with cross-party support, for which I am grateful, to make changes in Haringey. We have also established, through Lord Laming, a process to produce an urgent progress report on the implementation of the Every Child Matters reforms. With Ofsted, we are also taking forward reforms to the serious case review regime. I have also announced today a new national task force to investigate how we can further enhance training and support for social workers. I hope that my work with my right hon. Friend the Secretary of State for Health on the reform of social work will also have cross-party support.
As the Secretary of State will be aware, the chief inspector of Ofsted told the Select Committee yesterday that three children a week were dying as a result of abuse, whereas the Department suggested that the true figure was a third of that. Can he explain that discrepancy?
I can—I explained it this morning, but I will set it out in further detail. Ofsted's figures use a wider definition of harm. In the case of the children in the Department's figures, a serious case review had been done because of a direct act of harm that led to the child's death at the hand of a parent or other family member. The Ofsted figures include, for example, the death of a young person in which there is a suspicion of neglect, but the cause of death, such as anorexia nervosa or suicide, is not direct murder or manslaughter by a parent. That explains the difference.
I would like clarification on one point from the hon. Member for Surrey Heath. Earlier, Mr. Lansley made it clear that he supported Lord Laming's work to ensure that his reforms are being properly implemented. At the weekend, according to The Sunday Times, the hon. Member for Surrey Heath said that he had issued a declaration of no confidence in Lord Laming, the former chief inspector of social services who is conducting an independent review. It would be helpful to clarify that the hon. Gentleman has confidence in Lord Laming and that he is happy for Lord Laming to carry on with that work.
I explained in my speech, when I referred to the remarks by the hon. Member for Birmingham, Yardley, that I have nothing against Lord Laming— [ Interruption. ] If the Minister of State, Department of Health, Phil Hope had been listening, he would know that I said that I had concerns about the terms of reference, but nothing against Lord Laming.
That is a helpful clarification that The Sunday Times was wrong on that point.
Norman Lamb made some important points about the particular practices of health services in the Haringey case. I assure him that the re-running of the independent serious case review and the wider work being done on the Haringey case by the Healthcare Commission will ensure that the points that he raised are properly addressed. It would be wrong for me to prejudge that review now, as it is ongoing. The points made by the hon. Gentleman, and by the Chairman of the Select Committee, about ensuring that we have the best on-the-ground inspection, are absolutely right. I know that Ofsted is also committed to ensuring that the inspection regime is robust in safeguarding cases. I will ensure that that happens.
He who pays the piper calls the tune. Who will appoint the independent chair of a serious case review? Will it still be the director of children's services, or will it be Ofsted?
The appointment will be made by the local safeguarding board. In Haringey, that board is now independently chaired by Graham Badman, the former director of children's services in Kent. That will be a matter for each area to decide.
Some wider issues to do with health were raised, and it was a learning experience for me to listen to the debate. I was pleased to hear the Liberal Democrats acknowledge the dramatic improvements in the NHS over the past 10 years. With my right hon. Friend the Secretary of State for Health, I visited the brand new hospital currently being built in my constituency. I was able to see how the investment is being put to good use, but I was surprised to discover today that not only do the Conservatives oppose the new GP centres that are being opened around the country—a Conservative Government would close them—but they oppose the action being taken on tobacco advertising in shops.
We want to make sure that our children and young people are safe and properly protected, but it is no great surprise that Conservatives and some Liberal Democrats oppose those important reforms. After all, the Conservatives also opposed the rise in national insurance contributions that has funded the NHS improvements, and they also voted against the improvements in maternity and paternity leave that we have introduced. When we debate these matters in future, it is important that we remember the Opposition's track record.
My hon. Friend Mr. Chaytor made some important points about the funding of education for 16 to 19-year-olds. He said that we must treat properly the role of ethos in the admissions code and talked about how we plan 16-to-19 education. He asked me to confirm that we would continue with the important investments that we are making as part of the Building Schools for the Future programme, and he invited me to Bury to visit one of those schools.
I am pleased to say that I am very happy to go to Bury and see how our investment is being put to good use, but I cannot give my hon. Friend the assurance that he seeks because I am afraid that the Opposition remain committed to cutting £4.5 billion from the Building Schools for the Future programme. Fourteen secondary schools in the Bury area are set to be rebuilt, but two would be cancelled under Conservative plans. Moreover, we cannot avoid the embarrassment of visiting one of the schools that the Conservatives would cancel, because they have not told us yet which they are.
If the Opposition told us where the axe would fall, we would know which school to visit, but it is revealing to look at the list of speakers in today's debate. There are 27 schools in the constituency of South Cambridgeshire, and four would be closed under Conservative plans. Two of the 17 schools in the constituency of Ilford, North are set to be closed, and the same is true of five of the 36 schools in the constituency of Rugby and Kenilworth.
My right hon. Friend will be pleased to hear that Stockport, an authority in the later stages of Building Schools for the Future, is preparing a bid for capital that includes £30 million for Reddish Vale technology college, which he has visited. Can he guarantee that it will not be scrapped on his watch?
I am afraid that I can give no such guarantee. We are doing the right thing—bringing forward our capital programme to invest in our schools and support our economy. In the case of Stockport, in Denton and Reddish, of 13 schools, two are set to be closed if the Conservatives have their way, and 360 schools are set to be closed—