The legislative programme presented to Parliament last week by Her Majesty the Queen builds on four years in which we have not shirked our duty to the British people to restore confidence in disastrous public finances; to lead the country from the deepest recession since the second world war to the strongest growth in the G7; and to implement a plan that secures our long-term economic future. As part of that programme, we have been following a long-term plan to transform our NHS and help it to meet the challenges of an ageing population. However, we must remember that without the difficult decisions made to restore faith in our public finances, the NHS would have been in a very different position.
In Ireland, the health pay bill was slashed by 16% because it ran out of money. In Greece, health spending was cut by 20%. In Portugal, the public were asked to double their personal contribution to the cost of health care, but in England difficult decisions meant that we were able to protect the NHS budget, unlike the Labour party, which plans to cut it in England, and did indeed cut it by 8% in Wales, with disastrous consequences. Labour made the wrong call on the economy and the wrong call on NHS finances. Because we made the right call, the NHS is now doing extremely well in very challenging circumstances.
Later, Members will hear Andy Burnham talk about operational pressures facing the NHS. He is right: it is tough out there. This week, we will announce new measures to help the service to meet the challenges that it faces. We will no doubt also hear attempts to politicise what are essentially operational pressures, but what we will not hear is how much better the NHS is doing than it ever did when he was Health Secretary. The facts speak for themselves. Every single day—[Interruption.] This is difficult for Labour Members to listen to, but they would do well to listen. Compared with when he was Health Secretary, every single day we are referring 1,000 more people with suspected cancers to specialists. We are transporting 1,000 more patients—
I am going to make some progress and then give way. The right hon. Gentleman needs to listen. We are doing much more now compared with what was done when he was Health Secretary. If he listens, he might learn something.
This is what is happening every single day: 1,000 people with suspected cancers are being referred, and 1,000 more patients are being transported in ambulances in emergencies. Every day we are performing 2,000 more badly needed operations, we are seeing 3,000 more vulnerable people in A and E departments, and every day we are providing around 6,000 more GP consultations for members of the public and 10,000 more vital diagnostic tests. At the same time, MRSA rates have almost halved, mixed-sex wards have been virtually eliminated, and fewer people are waiting for 18 or more weeks for their operation.
The Health Secretary is standing there claiming everything is fine and giving a litany of successes. Let us just consider cancer care. He said the NHS was worse when we were in government. So that we are absolutely clear, will he confirm that the last set of figures show that the NHS is now for the first time missing its standard of treating cancer patients within 62 days?
The right hon. Gentleman should have listened to what I said: I said he was right to say it is tough out there, and I also said that this week we will be announcing measures to help the NHS deal with operational pressures. He talks about how long people are waiting for operations, so let us look at one particular statistic that sums up what I am saying: the number of people waiting not 18 weeks but a whole year for a vital operation. Shockingly, when the right hon. Gentleman was Health Secretary, nearly 18,500 people were waiting over a year, and I am proud that we have reduced that to just 500 people. Those results would not be possible without the hard work and dedication of front-line NHS staff, and whatever the political disagreements today, the whole House will want to pay tribute to their magnificent efforts.
Will the Health Secretary comment on the shambles he has reduced the NHS to in west London, where he is closing A and E departments, like that at Hammersmith on
What is happening in north-west London is going to make patient care better. It involves the seven-day opening of GP surgeries, over 800 more professionals being employed in out-of-hospital care, and brand new hospitals. That is a huge step forward, and the hon. Gentleman is fighting a lone battle in trying to persuade his constituents that it is a step backwards.
This Government recognise the pressure that the NHS is under, as I was telling the shadow Health Secretary. The fact that the population is ageing means that the NHS now needs to perform 850,000 more operations every year than when he was in office, which we are doing. That means that some patients are not receiving their treatment as quickly as we would like, so NHS England is this week announcing programmes to address that, ensuring that we maintain performance while supporting the patients waiting longest for their treatment, something that did not happen when he was in office. We will not allow a return to the bad old days when patients lingered for years on waiting lists because once they had missed their 18-week target, there was no incentive for trusts to treat them.
A and Es, too, are facing pressure and are seeing over 40,000 more patients on average every week than in 2009-10. NHS staff are working incredibly hard to see and treat these patients within four hours, and it is a tribute to them that the median wait for an initial assessment is only 30 minutes under this Government, down from 77 minutes under the last Government. However, as we did last year, we will continue to support trusts to do even better both by improving their internal processes and working with local health economies to reduce the need for emergency admissions. This will be led by NHS England, Monitor and the NHS Trust Development Authority.
I am aware of those shocking figures, and I am also aware that the Royal College of Surgeons says that 152 people died on waiting lists in Wales at just two hospitals because they did not get their treatment in time. I gently suggest to the shadow Health Secretary that the Labour party might want to fix what is going on in Wales if it is really serious about patient care, because how Labour is running the NHS in Wales is an absolute disgrace.
I am going to make some progress, and then I will give way.
The NHS is about more than just getting through difficult winters. Looking to the future, this Government will continue to take the bold steps necessary to prepare our NHS for the long-term challenges it faces. There are two key areas for action if we are to rise to this enormous challenge. First, we must never turn the clock back on Francis. The NHS will never live up to its founding ideals if it tolerates poor or unsafe care. The last Government presided over an NHS in which doctors or nurses who spoke out were bullied, in which problems at failing hospitals were brushed under the carpet and in which vulnerable older people were ignored and, tragically, on occasions, treated with contempt and cruelty. This Government have stood up for the patient, championing high standards with a new culture of compassionate care which is now transforming our health and care system.
The Secretary of State has already admitted some of his own failures this afternoon. Does he not think that some of the money he invested in his £3 billion reorganisation of the national health service could have been used to ensure that the NHS was hitting its targets today?
Perhaps the hon. Gentleman would like to look at the facts relating to the actual cost of the reorganisation. The net saving as a result of it has been more than £1 billion a year, and we are now employing 7,000 more doctors and 3,000 more nurses than when his party was in office. Last year, as a result of this programme—
This might not be something the Opposition agree with, but they should listen. I need to tell the House that we have put 10% of all acute trusts into special measures, and that in each and every one of them the warning signs were there under the last Government. The George Eliot hospital, for example, had one of the worst mortality rates in the country back in 2005. Tameside had to pay £9 million compensation for mistakes in just two years, and at the Queen’s hospital in Romford in 2006, a lady gave birth in a toilet, leading to the tragic death of her child.
The Secretary of State will be aware of a problem that is affecting thousands of women. It relates to medical implant devices that a court in America has banned. What is he prepared to do to deal with the situation in this country that is affecting thousands of women, both north and south of the border?
The hon. Gentleman mentioned to me earlier that he was going to raise that point. I will look closely at the issue, as it sounds like an extremely important one.
I want to look at what has changed under this Government. One of the trusts that has been in special measures is the Basildon and Thurrock University Hospitals NHS Foundation Trust. When the right hon. Member for Leigh was in office, inspectors at the hospital found blood stains on floors and curtains, blood spattered on trays used to carry equipment, and badly soiled mattresses. When the Care Quality Commission published those findings, it was allegedly leant on to tone down its press release. This Government put Basildon into special measures, and it now has 183 more nursing staff. I asked one of those nurses what the difference was. She said:
“It’s very simple. When we raised a concern before, they weren’t interested. Now, they listen to us.”
It gives me great pleasure to inform the House that the chief inspector of hospitals has today recommended that Basildon should be the first trust to exit special measures, and that Monitor has ratified that decision. The hospital has received an overall rating of “good” and has been praised for its excellent leadership. The chief inspector found that the trust had made significant improvements in a number of areas, including maternity services, which were rated as “outstanding”—
The Opposition might not care about what is happening at a trust in special measures, but we on this side of the House do.
On a point of order, Mr Speaker. The Secretary of State knows very well the issue I am trying to raise, because I raised it during the business statement last week. I want him to respond to an important fact. A leaflet was circulated in my borough on
The hon. Gentleman is an ingenious and indefatigable Member. He probably knows that I can best describe that as an attempted point of order, because it is not a matter for the Chair. That said—[Interruption.] Order. That said, the hon. Gentleman has made his point forcefully, and it would certainly not be in any way disorderly for the Secretary of State to respond to it if he wished to do so.
I am most happy to respond to what—I agree with you, Mr Speaker—is a thinly disguised point of order. I will happily say this: what I said was completely in order because I was simply restating information publicly available on the trust’s website.
I want to go back to talk about Basildon hospital, because of the remarkable turnaround there. Chief executive, Clare Panniker, and her term deserve huge credit for the changes that they have made, which will truly turn a corner for patients who depend on their services.
Order. I ask the hon. Gentleman to calm himself for a moment. I accept the great importance of these matters, but I hope that this is a point of order rather than of frustration.
The hon. Gentleman is nodding with great vigour and intensity. Let us hear the attempted point of order.
I want to be clear about what the Secretary of State just said. He said, “What I said was”. I seek your advice, Mr Speaker. How can I get clarification from the Secretary of State about whether he made an announcement during the purdah period in the days just before the election or whether it was a previous statement rehashed and reissued from weeks before?
The short answer to the hon. Gentleman is that he must use his best devices, both in this debate, where he might have an opportunity to catch the eye of the Chair later, and in Health questions, which, if memory serves me right, are coming up very soon—
As I said, they are coming up very soon, and I am grateful to John Penrose for concurring with my suggestion that “very soon” does indeed include tomorrow. There will also be opportunities at all times for Mike Gapes to table questions with the advice of the Table Office. I have known him for 20 years and more, and he is not very readily put off his stride. I have no doubt that he will continue to gnaw at the bone until he achieves an outcome that he regards as satisfactory. Meanwhile, we must continue with the debate and the oration of the Secretary of State.
The decision to place 11 trusts into special measures last summer was not taken lightly, but we can see today that it was the right decision. Across the whole NHS, the number of people who think they would be safe in an NHS hospital is as high as it has ever been, the number of people who think that people are treated with dignity and respect has risen by six percentage points over the year and the number of people who think that people are treated with compassion has gone up by eight percentage points. This Government have introduced new chief inspectors of hospitals, general practice and adult social care to oversee the toughest, most transparent and most independent rating system of any country anywhere. We have improved accountability with a statutory duty of candour, and we are supporting staff by publishing ward-level nurse staffing levels for every trust.
I thank my right hon. Friend for giving way. I am sorry that his congratulations to Basildon hospital were so dreadfully interrupted earlier, because its journey since 2009, when real deficiencies were highlighted, to where we are now with the special measures being lifted is, as he has said, real testament to the leadership of the hospital’s new management and the commitment of the staff. I thank him for the impetus that he has given that process, because it is only by admitting when things go wrong that we can put them right; that is the difference between the Government and the Opposition.
I congratulate my hon. Friend for her work campaigning for higher standards at her local hospital, and I agree with her. Why is it that interventions to do with improving safety and compassionate care are coming only from Government Members and that the Opposition are not interested? I just challenge Labour Members on whether they are really on the right side of the big changes that need to happen in our NHS.
I am going to make some progress because we have had lots of interventions. [Interruption.] I am going to make some progress and I have been very generous. [Interruption.]
Order. There is now a kind of institutionalised rowdiness about this debate, epitomised by Geraint Davies on the third row. It would be seemly if he would calm himself. I do not refer to people outside this place, but this debate is being keenly attended by a large number of citizens, who would expect Members to behave in as seemly a fashion as I feel sure they do on a day-to-day basis.
Despite the amount of work that has been done in the past year, there is still much to do to improve safety and care. According to a study based on case note reviews, around 5% of hospital deaths are avoidable. That equates to 12,000 avoidable deaths in our NHS every year, or a jumbo jet crashing out of the sky every fortnight. On top of that, every two weeks, the wrong prosthesis is put on to a patient somewhere in the NHS. Every week, there is an operation on the wrong part of someone’s body. Twice a week, a foreign object is left in someone’s body. Last spring, at one hospital, a woman’s fallopian tube was removed instead of her appendix. Last summer, the wrong toes were amputated from a patient. This spring, a vasectomy was given to the wrong man. To tackle such issues, we need to make it much easier for NHS staff to speak out when they have concerns. We need to back staff who want to do the right thing, and we are currently looking at what further measures may be necessary to achieve that.
Today, this Government vow never to turn back the clock on the Francis reforms, and I urge the shadow Health Secretary to do likewise when he stands up. Another vital set of reforms that we need to make if we are to prepare the NHS for the future involves the total transformation of out-of-hospital care. We know that prevention is better than cure and that growing numbers of older people, especially those with challenging conditions such as dementia, could be better supported and looked after at home in a way that would reduce their need for much avoidable and expensive care. This year, three important steps have been taken towards that vital goal. First, the new GP contract brought back named GPs for the over-75s—something that was so shamefully abolished by Labour in 2004. Older people often have chronic conditions that make continuity of care particularly important. However, Labour scrapped named doctors, and we are bringing them back.
We are also acting to break down the silos between the health and social care systems with an ambitious £3.8 billion merger between the two systems. The better care programme is, for the first time, seeing joint commissioning of health and social care by the NHS and local authorities, seven-day working across both systems and electronic record sharing, so that patients do not have to repeat their story time after time and medication errors are avoided.
The Secretary of State touches on a couple of issues, including safety, but ignores one of the most important ones, which is nurse-to-patient ratios. A safe patient-to-nurse ratio has been adopted at Salford Royal, and it could be adopted elsewhere. He is now talking about the better care fund. There is no new money in that fund, and if he is worried about pressure on the NHS, surely he should think about the £2.68 billion that is being taken out of adult social care. In my local authority of Salford this year, 1,000 people will lose their care packages. How is that good for alleviating pressures on the NHS?
Perhaps I can reassure the hon. Lady on those matters. First, the better care fund is the first serious attempt by any Government to integrate the health and social care systems and eliminate the waste caused by the duplication of people operating in different silos. The Government require all trusts to publish nurse-staffing ratios on a website that will go live this month. It is an important, radical change, and we are encouraging trusts to do exactly what she says is happening in Salford. It is important to say that, where other Governments have talked about integration, we are delivering it. We are doing one more important reform: we are taking the first steps to turn the 211 clinical commissioning groups into accountable care organisations with responsibility for building care around individual patients and not just buying care by volume.
From next year, CCGs will have the ability to co-commission primary care alongside the secondary and community care they already commission. When combined with the joint commissioning of social care through the better care fund, we will have, for the first time in this country, one local organisation responsible for commissioning nearly all care, following best practice seen in other parts of the world, whether Ribera Salud Grupo in Spain, or Kaiser Permanente and Group Health in the US—[Interruption.]
The Secretary of State mentioned the importance of integrating secondary and primary care. He will be aware that the chief executive of NHS England recently addressed the large number of community hospitals with a sword of Damocles hanging over them and whether or not they will continue to exist. He said that that issue should be revisited and, indeed, has argued that community hospitals should be developed and that we should protect that area of care. Does the Secretary of State believe that the chief executive of NHS England is calling for the retention and reopening of community hospitals?
Interventions should be brief—the hon. Gentleman is experienced enough to know that.
I agree with the new chief executive of NHS England. There is an incredibly important role for community hospitals and, indeed, for smaller hospitals. He was making the point that it is not always the largest hospitals that have the highest standards. One reason why the public like smaller hospitals is that they are more personal, and very often the doctors and nurses know people’s names, which makes a difference. They are also closer to people’s homes and easier to get to for relatives wishing to visit people in hospital.
I am drawing to a close, so I shall continue by saying that a long-term plan for our NHS that recognises immediate challenges and the need to reform going forward is what the Government have put into practice. It is not easy to implement, but it is the right thing to secure its future, and the right thing for our country. When Andy Burnham rises to speak in a moment, he will say—he told The Independent that he would—that the NHS should have been included in the Queen’s Speech, ignoring the Bill to introduce additional child-care subsidies that will benefit thousands of NHS employees and ignoring the impact on NHS finances of the Bill to curb excessive redundancy payments—something for which his Government were largely responsible. He will not mention the straightforward security that the Government offer the NHS by sticking to a long-term economic plan that is working, so that we have the best possible chance to ensure that the NHS can be properly funded going forward.
If the right hon. Gentleman does not address those points, I hope that he will use his speech to show that he has learned from some of the big challenges facing the NHS over recent years. Does he accept that, without the reorganisation of about 20,000 administrators, the NHS would not be able to afford 7,000 more doctors and 3,000 more nurses? Does he accept that, without restoring named GPs, we will not be able to offer the joined-up care to vulnerable older people that he claims to champion? Most importantly, will he say publicly that, without honesty about poor care—honesty that he has repeatedly criticised as running down the NHS—we would not now be turning round 15 failing hospitals such as Basildon? In that spirit, will he categorically retract his statement, as reported in the Health Service Journal last week, that mid-Staffs was a local failure whose significance for the NHS has been exaggerated by this Government? If he does not do so, I have to say that we disagree profoundly on the biggest change that our NHS needs. We can state that change in just three words: put patients first. It is what NHS staff want to do, and they all want support to do it, but it is simply not possible unless they have the administrative and political leadership that puts patients first in every policy, target and announcement. The Government are proud of our record on the NHS: proud of record levels of high-quality care given to record numbers of patients, proud of tough economic choices that enabled us to protect the NHS budget and, most of all, proud of 1.3 million NHS staff who work hard day in, day out, to make our NHS so remarkable. We will not let them or the country down.
Last week, the Secretary of State told the NHS Confederation that patient safety was crucial to the future sustainability of the NHS. Let me begin on a note of agreement. The Health Secretary is right to continue to send the clearest message to the NHS that patient safety must be its top priority. He knows that he has our support in introducing measures to implement the Francis report and, indeed, learning all the lessons from the terrible failings at Stafford hospital. A question arises that is perhaps more for the Government to answer than the right hon. Gentleman: why is the Secretary of State’s important priority not reflected in the Gracious Speech? It is approaching
18 months since the publication of the Francis report, yet many of its recommendations are still to be implemented. The failure to make progress in this legislative programme undermines the Secretary of State’s message today.
The Francis report recommended new legislation to modernise the regulation of doctors and nurses and speed up the handling of complaints. The regulatory bodies said that progress is urgently needed, and they were expecting a Bill in the Gracious Speech to implement those reforms. Not surprisingly, both reacted negatively to the decision to drop it. Niall Dickson, chief executive and registrar of the General Medical Council, said:
“We are disappointed that the government has not taken this opportunity to improve patient safety”,
“Both the NMC and the public it protects now continue to be left, indefinitely, with a framework that does not best serve to protect the public.”
I hope the Secretary of State will explain why that Bill was dropped and answer the concerns of Jackie Smith and Niall Dickson.
The right hon. Gentleman said he would start on a note of consensus on the Francis report, so does he now retract his comments last week that what happened at Mid Staffs was “a local failure” and that the Government were exaggerating its significance for the rest of the NHS? That was a very damaging thing to have said.
The Francis report found that the failing at Stafford hospital was principally a failure of the local board. I served in the previous Government, who inherited problems from the preceding one—care failings at Bristol royal infirmary and Alder Hey, and the Shipman murders. Contrary to what the Secretary of State said today, we took action to act on those failures and bring more transparency to the NHS. We introduced independent regulation to the NHS. He needs to look at the statements that he has made over the past year and consider whether his response has always been appropriate. He has used language such as
“Cruelty became normal in our NHS”—[Hansard, 19 November 2013; Vol. 570, c. 1097.]
Does he stand by such statements and does he think that is fair to the thousands of NHS staff who give their all every day, doing their best to serve patients?
Let me be absolutely clear. I have never blamed NHS staff for what happened at Mid Staffs. I blame the policy failures of the right hon. Gentleman’s Government. It is not just I who say so. Robert Francis said in his report:
“Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated” in the rest of the NHS. He continued:
“The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction.”
Will the right hon. Gentleman now retract his comment that this was “a local failure” whose impact has been exaggerated?
I am quite clear what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.
The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.
So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that
“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.
I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”
I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.
Is not another explanation for the absence of any mention of the NHS in the Queen’s Speech that the Government do not want it? They are quietly privatising the NHS by the back door, so they do not need legislation.
I think that that is exactly the reason. They introduced a reorganisation that nobody wanted, that nobody voted for, that put the wrong values at the heart of the NHS and that has dragged the NHS down, and all the while they are softening it up for accelerating privatisation. That is the record on which they will have to stand before the country in less than 12 months’ time. If the Secretary of State can justify that record and breaking the coalition agreement to his constituents, I would be very surprised indeed.
No, I am going to make some progress.
On the day of the Gracious Speech, 60 senior NHS leaders wrote to a newspaper to warn
“that the NHS is at the most challenged time of its existence.”
Just when it needs real leadership, it is being offered a period of drift from an increasingly dysfunctional Government and, sadly, the same is true on public health. The Government should have used this moment to regain the initiative and publish regulations on standardised packaging for tobacco and smoking in cars. Ministers announced on
“we will now push ahead” with banning smoking in cars following the vote in this House, but we are still waiting. We did not hear anything on public health from the Secretary of State today. When will they show some leadership and set out a timetable for these important measures?
It is not hard to guess the reason for this pre-election period of NHS silence. On every measure that matters to the public, contrary to what the Secretary of State said, the evidence is clear that the NHS has gone downhill under this Government and that it is getting steadily worse.
On the subject of preventive measures, my right hon. Friend might be aware that in Britain today child mortality among those below the age of five is the worst in the western world bar Malta, at one in 500? Washington university explains the cause as the welfare and austerity changes—food banks and the like. Will he comment on the impact of some of the welfare and other changes that have made the very weakest weaker, poor and unhealthier and are making them die earlier?
It is well documented that the policies of this Government in a range of areas are damaging the health of the nation, but what we get instead is drift from the Government on public health. There is no momentum at all to improve children’s health and the Queen’s Speech had absolutely nothing to say on it. Where are the measures that the Minister has been proposing? What has she been doing? Why does she not introduce them?
The right hon. Gentleman will be aware that the legislation for both the measures to which he alludes has already been passed by this House.
But regulations are needed. If the Minister does not know that—[Interruption.] It was the Opposition who brought forward the vote on smoking in cars and she committed to introduce regulations to implement it. She cannot duck the question. When will she do that? If she does not realise that she is going to introduce regulations, she needs to go back and do a bit more homework.
It is not hard to guess why the Government want a period of silence. On every measure, the evidence is clear that the NHS is getting worse. When the Prime Minister was challenged—
The Prime Minister set his own test for his reorganisation: its effect on waiting times. This month, waiting times hit a six-year high. Almost 3 million people are now on the waiting list for treatment, up by half a million since 2010, but that is not all.
I just gave way to somebody from Wales. What is the hon. Gentleman on about?
That is not all. As I said before, the NHS is now missing its standard to ensure that cancer patients start their treatment within 62 days. That will cause huge distress to thousands of families up and down this country.
Another way in which the NHS has got worse, and every patient knows this to be true, is that it is becoming harder and harder to get a GP appointment. It is a common experience for people to ring their surgery early in the morning only to be told that there is nothing available for days. A survey has found that almost half of GPs predict that the average waiting time will exceed two weeks by next year.
The clearest measure of growing problems in the NHS is what has been happening in A and E, which is the barometer of the whole health and care system. Problems or blockages anywhere in the health and care system will manifest, in the end, as pressure in A and E. If A and E is the barometer, what is it telling us? It is warning of severe storms ahead. Hospital A and E units have now missed the Government’s target for 46 weeks running. For the last four weeks, the NHS overall has missed the Government’s target, suggesting that the winter crisis has now been followed by a summer crisis.
Why is that happening? The fact is that cuts have been made to general practice, social care and mental health, which are pushing more and more people towards the acute hospital and placing it under intolerable pressure. Today, many hospitals are operating way beyond safe bed occupancy levels, and not surprisingly this is taking a toll on A and E staff. Today, we reveal that three times as many A and E consultants left the NHS in 2013, raising the worrying prospect of A and E now being trapped in a downward spiral.
I thank my right hon. Friend for giving way. May I just take him back to the point about GP access, because that is the start of the patient’s journey? In our survey in Salford, we did not find the situation that we had under the Labour Government, where 80% of patients could get an appointment within 48 hours. Now only half our patients can get an appointment within 48 hours, with one in seven having to wait more than a week, which is concerning, and one in five unable even to get through to speak to someone in their GP surgery. This is concerning us in Salford because these are people who may have worries—they may even have cancer and need tests—and they cannot get through to their GP.
My hon. Friend is absolutely right—the deterioration in general practice has been marked during the past few years. There have been changes that have disadvantaged patients. Within weeks of taking office, the Government removed the guarantee that patients could have an appointment within 48 hours. That explains the situation that my hon. Friend describes, alongside cuts to funding of general practice to the point that some practices now say they are on the brink of deciding whether or not they can remain open. The Government have responsibility for that situation, but there is not a word from the Secretary of State about it and there is not an acknowledgement that people have severe problems in accessing their GP.
In my constituency, the minor injuries unit at Guisborough hospital, the minor injuries unit at East Cleveland hospital in Brotton, a walk-in centre and medical centre in Skelton, and a medical centre in Park End—all primary or intermediary level facilities—will be closed, putting further pressure on the excellent but already outlying A and E unit at James Cook University hospital. When I write to Ministers to ask questions and for a meeting, I am told that I have already had too many discussions with them and that I cannot bring it up any further. Will my right hon. Friend please enlighten me about what he would do if were in power?
I will move on to that point. Whenever there is a problem, we are told, “Speak to NHS England.” I am afraid that is not good enough. Up and down the country we are seeing services closed without adequate consultation. NHS walk-in centres continue to be closed, piling more pressure on A and E departments. It is just not good enough. We have seen top-down changes driven through, and the hospital closure clause is on the books, so sadly this will continue.
It will only change when we have a Labour Government back in control—a Government committed to putting the public and patient voice at the very heart of the NHS.
I was talking about A and E and the reorganisation. We know that Ministers were explicitly warned about an A and E recruitment crisis by the College of Emergency Medicine a couple of years ago, but they said they were too absorbed with the reorganisation to listen or act. That brings me to the nub of the matter before the House: the root cause of the deterioration in the NHS is that reorganisation, which nobody wanted and nobody voted for. It threw the service into chaos just when it needed stability. As we warned, it has damaged standards of patient care. Four years ago the Government inherited a self-confident and successful NHS, with the lowest ever waiting times and the highest ever public satisfaction. Since then it has been destabilised, demoralised and reduced to an uncertain organisation that is increasingly fearful of the future.
The right hon. Gentleman refers to cuts in funding. The only cuts in funding that we have seen in this country have been in the NHS in Wales. With regard to patient satisfaction, I can assure him that the targets left behind by the previous Labour Government did nothing to satisfy patients who were left on the ground by ambulance services because they had already gone past the eight or 19-minute limit. I am afraid that the focus on targets, rather than patients, is something that this Government have had to address.
I think that it would behove Government Members to have a bit more self-reflection and humility. The hon. Lady was not a Member of the House at the time, but she may recall that before 1997 people used to spend years on NHS waiting lists, and some never came off them. Over Labour’s 13 years in government we saw waiting lists come down, and down, and down, to the point that, when we left office, they were at their lowest ever level. I am not claiming that the NHS was perfect and did everything right, but it had the highest ever level of public satisfaction. We must have done something right. A bit of balance and accuracy in this debate is just what the NHS needs.
Does my right hon. Friend agree that this destabilisation has reached such an extent that very good hospitals, such as those in Huddersfield and Halifax, have a cloud over them because they might lose their A and E departments? What does that do for morale and culture, which have been so good in those two hospitals? Up and down the country, morale has been shaken to the roots.
What I find surprising is that all over the country plans are being developed to close A and E departments. How can that make sense when we are in the middle of an A and E crisis? In west London my hon. Friend Mr Slaughter has done much work to raise concerns about the changes to hospitals there.
The question I would put to the Secretary of State is this: have the Government looked at the latest evidence? Are they looking at the fact that this year hospital A and E departments have missed his target for 46 weeks? If that is the case, is it safe to proceed with changes on this scale?
Order. The hon. Gentleman must not use an attempted point of order to try to make a point that he would make in the debate if he got the chance to contribute. He said that he wanted my advice. My advice to him is that persistence pays and he should keep at it, as I am sure he will.
I will give way to the hon. Gentleman before the end of my speech, but not now; I will do so when I am ready, because I want to develop my point, which is this: a successful NHS was thrown into chaos by reorganisation. Four years after Lansley’s big bang, the dust has still not settled. People out there are struggling to make sense of the 440 NHS organisations that have replaced the 163 that the Government inherited. They cannot make it all fit together and so are still sweeping up the mess. It was always nonsense to commission local GP services from a national level. To correct that, NHS England is now suggesting a new round of structural changes. This is the reorganisation that never ends. It is now rumbling into the fifth year of this Parliament. In fixing one problem, I fear the Government are going to create another—a local conflict of interest with GPs commissioning GPs. The truth that they do not like to face is that the former Health Secretary presented a defective and confused plan, and they now know, in their heart of hearts, that instead of pausing it, as they did, they should have stopped it altogether. They did not, and however much they tinker it will never make sense.
That is why the only Bill in the Gracious Speech with any link to health is the one that tries to clear up the mess of reorganisation. The small business, enterprise and employment Bill restricts redundancy payments to public officials. If ever there were a Bill that locked the stable door after the horse had bolted, this is surely it. When the Health and Social Care Act 2012 went through the House, there were repeated warnings from Labour Members, including my hon. Friend Liz Kendall, that the reorganisation would result in primary care trust staff being made redundant and then rehired, with, as a result, a huge waste of NHS resources. In June 2011, the Leader of the Opposition challenged the Prime Minister in this House on precisely that point. The Prime Minister failed to act on the warning. As a result—these are shocking figures; Government Members should listen to them—over 4,000 people have subsequently been made redundant and then rehired within the NHS. In the first three years of the reorganisation, there have been over 32,000 exit packages, averaging £43,500, and 2,300 six-figure pay-offs, 330 of which were worth more than £200,000. The total bill is £1.4 billion and counting. What a scandalous waste of NHS resources when people are waiting longer for cancer care.
We always know when this Government are on the ropes: it is when they furiously try to blame the previous Government. This time, they cite employment contracts, but that excuse will not wash. Given that they were explicitly warned about this when their health Bill was going through the House before the reorganisation took place, people will ask why on earth they did not bring forward the measures on redundancy in this Queen’s Speech before the NHS reorganisation, not after it. It all adds up to mismanagement of the country’s most cherished asset on a spectacular scale.
I would like my right hon. Friend to know about Port Clarence, a very isolated community in my area which lost the nurse it had for four hours a week. People are having to go through a tremendous tangle within the NHS to find out who is responsible. The local doctors cannot commission the service because they provide the nurse, so they have to go to NHS England, yet we cannot get any progress. It is a terrible state of affairs.
This is the point. The NHS is still struggling to make sense of the mess that the Government inflicted on it. Just when it needed clarity and leadership, what did it get? It got drift and chaos. That is the problem it is struggling to deal with.
The redundancy payments did not only cost £1.4 billion; they have also cost the NHS dearly in lost morale. I ask the Secretary of State to imagine how these redundancy payments and six-figure pay-offs look to the staff to whom he has just denied a 1% pay increase—an increase that would have cost a fraction of that £1.4 billion. The truth is that he does not know how they feel because he refused to meet front-line staff protesting about his decision at the NHS Confederation conference. Well, I did meet them, and I can tell him how they feel. They find it truly galling and feel that they have been singled out by the Secretary of State, whose decision seems like a calculated snub. May I suggest that he urgently reconsiders this approach and finds the time to sit down with staff representatives? Right now, a fragile NHS simply cannot afford a further drop in staff morale. The Chancellor promised this increase and the pay review body judged it affordable; the Secretary of State should honour it.
The truth is that a whole lot more is needed if the NHS is to be put back on track. It finds itself today in a dangerous place. It is facing escalating problems but has a Government who will not talk about them.
My shadow responsibilities do not extend to the NHS in Wales, but the Government have spent a year or more running it down. Just a few weeks ago, a Nuffield Trust report said that the picture was more mixed and that there were some areas in which the NHS in Wales was better than the NHS in England and vice versa. The Government need to look at themselves and to be fair to NHS staff, and not constantly repeat the mantra of running down the NHS in Wales and in England.
It was to prevent the NHS from being in this limbo—this silence—that we have brought this debate to the House. Until the Government face up to some of the problems caused by their reorganisation, the NHS will not be able to move forward. In the remainder of my time, I want to focus on two areas—leadership and competition—where uncertainty urgently needs to be removed.
First, on leadership, one of the major flaws of the Health and Social Care Act is that it has created confusion on that most fundamental question of all: who is in charge? Ever since the Act was passed, I have been told of continued tension between Ministers and NHS England. Ministers have repeatedly tried to instruct and overrule, ignoring the independence of NHS England for which they legislated. The problem is that thousands of NHS staff are left receiving mixed messages as to who is in charge.
I want to illustrate that point with reference to the growing crisis in mental health services, which the Secretary of State did not mention once. There are reports of growing problems in accessing mental health care and, in particular, a dangerous shortage of crisis beds. Despite that, NHS England has made a decision on the tariff which will lead to even deeper cuts to mental health care than to the rest of the NHS. This takes the NHS into new territory, because for the first time, as far as I can see, there is a direct contradiction between Department of Health policy and NHS England policy. The Government claim to support parity between mental and physical health, but their NHS policy is actively widening the disparity.
Therefore, in mental health—a policy of growing importance—we have complete confusion. People still look to Ministers to sort it out, but they have legislated themselves into the position of bystanders, shouting on the sidelines with the rest. The care Minister took to Twitter, no less, to vent his disgust at the “outrageous decision” by NHS England. People up and down the land will see that and say, “You’re the Minister! Don’t just tweet—do something about it!” The fact is that Ministers should have the power to enforce their own policy of parity, but in the interim NHS England should reconsider the decision to inflict cuts on a mental health system that is already in severe distress.
In the end, the answer to this uncertainty is simple: the Government should be legislating in this Gracious Speech to correct the flaws of the Health and Social Care Act and restore the Secretary of State’s duty to provide a comprehensive universal service. At a stroke, everyone would know where they stand and who is in charge, restoring grip and leadership in the NHS when it faces one of the most uncertain periods in its history.
The second area about which there is still considerable confusion is that of competition policy. When the Health and Social Care Act was going through, the Government’s mantra was that GPs would decide how best to organise care, but that is not what has happened in practice. Section 75 regulations are forcing commissioners to put services out to competitive tender when they do not think it necessary. That is leading to protracted legal disputes and millions spent on competition lawyers.
The nonsense that the Health and Social Care Act has inflicted on the NHS was plain for all to see last year when the then Competition Commission intervened in the NHS for the first time in its history to prevent collaboration between two NHS hospitals on the grounds that it was “anti-competitive”. What nonsense this is. It was succinctly summed up by the chief executive of the NHS, who said that
“you’ve got competition lawyers all over the place…We are getting bogged down in a morass of competition law causing significant cost in the system and great frustration for people in the service about making change happen. In which case, to make integration happen, we will need to change the law.”
That is precisely what this Gracious Speech should have done: change the law to help the NHS get on and make the changes it needs to make and remove the competition policy, which is fragmenting the NHS, not integrating it. That is the challenge the Government have ducked completely. The problem is that if they stay on this path, the NHS will head in the wrong direction. This Government and their Health and Social Care Act have placed the NHS on a fast track to fragmentation and privatisation when the future demands the integration of care.
The Opposition are clear that the market is not the answer to 21st-century care. The NHS now needs solutions of scale to rise to the increasing challenges that it faces. The NHS needed such leadership in this Queen’s Speech, but it was offered nothing. Instead, this Queen’s Speech leaves it lumbered with a Health and Social Care Act that puts competition before collaboration and the NHS on the wrong path for the future. The NHS urgently needs a Government who want to talk about the issues it faces and to get on with the job of securing its future. Let there therefore be no doubt that the next Labour Queen’s Speech will repeal the 2012 Act and pave the way for the full integration of health and social care.
I appreciate that some light-hearted comments have been made on both sides of the House, but my constituents have to wait longer for treatment, particularly for cancer care, as they do not have access to a cancer drugs fund. Will the right hon. Gentleman use all his influence with the Welsh Heath Minister to get him to look at introducing such a fund so that my constituents have the same access as people in England?
That is obviously a matter for the Welsh Government, but let me provide some clarity on the issue of cancer care. In Wales, 92% of people start their cancer care treatment within 62 days, compared with just 86% in England. I ask the Conservative party to think about that, given that it has constantly run down the NHS in the hon. Gentleman’s own country and constituency, and has misrepresented the outstanding job it does to treat patients with cancer.
We will legislate for an NHS that has the right values back at its heart: collaboration before competition, people before profits. We will ask the NHS to lift standards in social care, working to bring an end to the culture of 15-minute visits. We will make sure that people can access care closer to their homes, giving patients clear rights, such as the right to see a GP within 48 hours. This is a plan to put the NHS back on track, and it shows why a Labour Government cannot come a moment too soon for the NHS.
Order. The House will be aware that a great many colleagues desire to take part in the debate this evening and that time is limited. I am afraid that I therefore have to impose a time limit of eight minutes.
Perhaps I may allow the House a slightly more bipartisan interlude by concentrating for the moment on a different part of the Gracious Speech, which is the part relating to our country’s national security. I was delighted to see in the Gracious Speech the Government’s commitment to the NATO alliance, which is underpinned by the hosting in Wales of the NATO summit later this year.
However, as we approach the summit in Wales, we need to accept that there are big weaknesses inside our major military alliance. To an extent, the political and military roles that we clearly understood during the cold war have dissolved away, and western countries existing in peace and freedom have become fat on the prosperity and security that they have come to take for granted. Only four members of the NATO alliance currently meet the 2% of GDP floor of spending that they undertook to meet when they joined and, as a consequence, the European continent gives a lower priority to defence and is ever more addicted to welfare. As the Prime Minister and Chancellor Merkel have regularly pointed out, we have now reached a situation in which the European Union represents 7% of the global population, 25% of global GDP and 50% of global social spending. That picture is utterly unsustainable. It is a situation in which the pressures of defence have become great.
Of course, NATO has had recent success in the way it took charge of operations in Afghanistan, what it did in response to the invasion of Kuwait and, perhaps more successfully, what happened in the Balkans. However, not long ago the Libyan conflict showed us how many weaknesses the alliance has. We did not have enough of some key assets—such as intelligence, surveillance and reconnaissance, or air-to-air refuelling—to the extent that we would not have been able to carry out the Libyan campaign without the United States being on board. Such is the current weakness of European NATO.
We are confronted with a growing threat in the shape of Putin’s Russia, and we have stood by and watched serial bad behaviour from the Putin Government. They cut off gas to Ukraine, in breach of the NATO-Russia treaty, and we did nothing. We saw a cyber-attack on Estonia, and we did nothing. Russia invaded Georgia, parts of which it still occupies, and we did far too little. I am afraid that the signal the House sent after the debate on Syria only gave Putin the understanding that further aggression would not be rewarded with real resistance by the west, and I am afraid that the events we have seen in Ukraine are, at least partly, a result of how such decisions have been interpreted. We must be careful to ensure that our behaviour does not further reinforce that position.
We have allowed wishful thinking on Russia to replace critical analysis. We have all wanted to see Russia develop as an open, democratic, pluralistic system, but that is not going to happen, at least not under the current regime. The quicker we understand that, the better for the wider security picture. It is a bullying and thuggish regime that is not likely to change. Its modus operandi is clear: it pumps money into regimes or city states—wherever it can—to try to encourage them to be more Russia-friendly. It issues huge numbers of Russian passports to citizens in those places and then claims that it has to defend them.
The whole debate about the Ukrainian crisis misses one essential point: it is not to do with strategic or even tactical interests; it is a direct challenge to international law. Putin has said that the protection of ethnic Russians—not even Russian citizens—lies not with the states in which they live, or with the laws, constitutions or forms of government of such states, but with an external state, Russia, which can intervene to protect ethnic Russians wherever they may be. If we allow that to stand, there will be no international law, because it will sweep away every norm of international behaviour that has been accepted since world war two.
With all due respect to anybody outside our own borders, what the United Kingdom decides to do is a matter entirely for the United Kingdom, and what Scotland decides to do is a matter for Scotland. Nevertheless, since the hon. Gentleman asked me what I think about President Putin’s view on those issues, I will tell him what I think about Scotland. Any fragmentation would be not only a fragmentation of our country’s defences but a potential weakness inside NATO, and that is unlikely to help or give comfort to anyone other than those who are a potential threat to our national security. The hon. Gentleman raises an important point, in that events that take place inside the United Kingdom may well have resonances that are not naturally considered when decisions are being taken.
I want briefly to mention another area of national security of which the House must be very cognisant: the changing nature of the threats we face. We have gone from state threats in the cold war to the domestic terror threat we faced from the IRA, and we now face a transnational terrorist threat. That threat has come at a time when we have seen a huge growth in the internet, which allows a lot of the enemies of this country to hide. Back in 1995, when President Clinton was President of the United States, there were 130 websites in the world; at the end of 2012, there were 654 million. That is a lot of places for our enemies to hide.
Our security services need to be able to operate in the same environment as our enemies, and that to me was the essence of the great betrayal of Snowden. We depend on a moral and legal relationship between our employees and the Governments of our allied states to maintain our security, and there were three elements to what Snowden did. The first was his disclosure about the extent of National Security Agency surveillance. Had he done that inside the law it would have been a legitimate debate in a democracy, but to go further and set out the means by which our security forces carry out their business, or even potentially to set out the names of particular operatives, goes well beyond what is acceptable. In my view it goes from legitimate debate into the business of treason.
We do not have massively overwhelming security apparatus in this country. We spend 0.3% of Government spending on all our agencies put together, which is what we spend on the NHS every six days. We have good, strong oversight of our security services in this country that we should be proud of, but we must be clear when it comes to national security that peace and security are not the natural state of the world. Those things have to be fought for with every generation, and we have a responsibility to fund that appropriately. We can have neither such restricted freedom that we start to become what we claim to oppose, nor go off on a libertarian rant that takes us to a place that leaves us far less secure than we ought to be. If we get that balance right, we will be doing our duty in this House.
I wish to speak specifically about the pensions tax Bill and the private pensions Bill in the Queen’s Speech. The Government have proposed the biggest reform to pension tax rules in nearly a century. There is no denying that it is popular to give citizens—especially those with small pension pots—the choice to take lump sums that may be more beneficial to them than eking out a living from the small annual payments on which they would otherwise rely. Paying off a mortgage or a loan on retirement by drawing down a lump sum may well be better for such pensioners, but there is real danger in destroying good annuities. That has been going on for a few decades now, and is bequeathing a nightmare that Government policies are nowhere near capable of preventing.
We have a rapidly ageing population that is dumping a huge additional burden on the young, many of whom are already leaving university with massive debts thanks to this Government’s dysfunctional policies. Now they will be saddled with subsidising through their future taxes older people who are being encouraged to live for today and not protect themselves for tomorrow.
The closure of defined benefit schemes and the shift towards defined contribution schemes has been an utter catastrophe. Accelerated further by record demographic changes, that shift is a worldwide phenomenon and a product of the neo-liberal orthodoxy worshipped by Dr Fox, which has gripped Governments from the era of Margaret Thatcher and Ronald Reagan, and which this Government still seem to be in the grip of. In the US, for example, the number of defined benefit schemes halved in under 30 years, while direct contribution schemes tripled. Australia, also worshipping such neo-liberalism, saw an 80% reduction in the number of workers covered by defined benefit schemes from the 1980s.
That is the background, but there are disadvantages to the new pension freedom. For example, people might decide to spend all their pension savings at the point of retirement, dooming themselves to poverty later in life. Having saved into a pension fund, received tax relief for many years and reached retirement with a pot of money, they might be tempted to blow the lot at once, meaning that they will never have the benefit of the extra income that they would otherwise have had as they got older. If that happens, the tax relief they receive would not fund a pension, and employer contributions that they may have received along the way would end up funding immediate consumption, rather than providing a long-term income. We know that some people will do that; we do not know how many but we hope the number will be relatively low. Pensions expert Ros Altmann suggests that about 7% of people currently say that they would spend it all. In truth, it impossible to predict that accurately.
I am sure that my right hon. Friend is a supporter, as I am, of the idea of a British investment bank. Does he think that the Chancellor should have set up tax incentives to encourage people who have liberated their pension pots to reinvest in a British investment bank and create jobs and wealth for the future, instead of it being blown on everyday consumption?
That is a very good point.
The new flat-rate state pension, which is cited in mitigation for this new approach to pensions, still means that a lot of people will fall back on the state having spent all their pension savings. Around 20% of pensioners will still be on means-tested benefits even after the new system starts. People might also try to game the system by taking all their pension money and recycling it into a new pension fund, getting more tax free cash and another lot of tax relief. That could mostly benefit those who are reasonably well-off with high incomes in later life, and it could be costly in extra Exchequer spending on tax relief.
This is mainly a market problem, and it should perhaps have been possible to reform that market without the draconian retreat from annuities proposed by the Government. Would it have been possible to insist that insurers are obliged to treat customers fairly, and ensure they would be liable if they did not carry out suitability checks to identify which type of annuity was best and offer a good rate? Would it have been possible to reform the way annuities work, and allow more freedom but not complete freedom? What protections will be built into the new system to ensure that unsophisticated consumers are not left at the mercy of product providers offering poor product choices, or higher risk products that people simply do not understand and through which they end up losing significant sums? The Financial
Conduct Authority needs to be on top of that right from the start, but judging by past form can we be confident of that? I have very serious doubts.
If guidance is delivered by product providers, those providers are liable to entice their customers towards more poor-value products. Experience shows that they will do whatever they can to try to keep customers’ money, or give them poor value and make extra profit. The annuity market has worked poorly for years, with rising profits to insurers and reducing value for customers. How will the Government ensure that the new products developed finally offer good value, and that the charges are fair and terms reasonable?
The Government are right to legislate to permit collective defined contribution pensions, but I warn Ministers about over-hyping the benefits. In principle, such pensions ought to be better for employers than traditional final salary schemes and better for workers than traditional defined contribution schemes, but in practice they still suffer from market and actuarial risks. Ros Altmann points out that lower earners may subsidise higher earners, and younger members may subsidise older members. The new pension freedoms to take most, if not all, of the pension pot in a lump sum, however attractive and justified that may be to certain people, may also mean that people prefer pure defined contribution schemes that they can access in retirement if they wish. Collective defined contribution schemes, admirable as they may be in principle, usually mean that people cannot just take the cash, which means they may well be less attractive for members.
My challenge to the Government is this: rather than leaving the private pension system to market providers and their whims, why not build a new system that works? We need a system with longevity that savers will understand and find confidence in—a lack of confidence in this Government’s approach to pensions is something that I imagine savers and I share. While the Chancellor’s right hand further fragments and individualises pensions through these tax proposals, the pension Minister’s left hand makes legal collective direct contribution pensions. Why should any employer move to that collective system when they can see the Treasury going down precisely the opposite route? I doubt whether many will do so.
The Government are not doing anything like enough to face up to the time bomb of our ageing society and the whole person social care that the shadow Health Secretary eloquently advocated, or anything like enough to face up to the pensions needed to underpin the new life that is rapidly overtaking us, and the whole person care necessary to protect us. The whole Government philosophy of leaving private pensions to the market and saying to citizens, “Effectively, you are on you own” has failed abysmally in the past, just as I believe it will fail abysmally in the future at a terrible cost to all of us—pensioners, taxpayers and the public in general. I urge the Government to look again and come back with proposals that really begin to meet the scale of both the pension challenge and the whole person care challenge that haunts the whole of this country.
I am sure it would be churlish of me to consider for a second that the speech by Mr Hain owes anything to his new-found interest in pensions following his decision to retire from this place at the next election. I am glad he is following my example, but I am sorry to hear that he will be lost to this place. I have not always agreed with him, but I have always liked and admired him. I am sure he will be missed by this House and by his constituents.
Last year, I had the honour to propose the Gracious Speech, a task ably performed this year by my hon. Friend Penny Mordaunt. Like me, she got her loudest laugh for a joke about genitalia, which probably says all one needs to know about this place.
I was tempted to tear up my prepared remarks—they are not on health, but on the health of our democracy—thanks to the rather shockingly partisan speech from the shadow Secretary of State. I will not be tempted down that path, but I will make one point on health. My father-in-law died over Christmas in a national health service hospital. He had spent nine weeks in two different hospitals on five different wards, always receiving outstanding medical care but never that full personal, human and true compassionate care that the Secretary of State spoke about in his opening remarks. I wish him every success in his campaign to drive compassionate care in the NHS, because it desperately needs it.
I hope it goes without saying that I strongly support the coalition Government and their achievements, so I shall pass over that section of my speech in the interests of the eight-minute limit. I will simply say this: the Queen’s Speech is not the most radical of recent times, but that is not necessarily a criticism. It contains good and worthwhile measures that I applaud warmly. Indeed, I think the desperate search by politicians for novelty, sometimes engendered by the 24-hour media questing sensation, can actually work against genuinely good government.
I want to set my remarks in the context of 2015, which is not just an election year but an important year for Parliament. It would have been good if the Gracious Speech had made at least passing mention of the fact that in 2015 we will celebrate two important anniversaries: 750 years since the de Montfort Parliament of 1265, and 800 years since the sealing of Magna Carta in 1215. I know that you, Madam Deputy Speaker, have worked very hard with Sir Robert Worcester on the Magna Carta 800th Committee. Magna Carta embodies the principles that have underpinned the emergence of parliamentary democracy and the legal system in the UK and across the world: limiting arbitrary power, curbing the right to levy taxation without consent, holding the Executive to account and affirming the rule of law. De Montfort’s Parliament 50 years later flowed almost inevitably from just those principles.
I have the privilege to be the Commons Chair of the Speaker’s Advisory Committee on the 2015 anniversary, alongside Lord Bew from the House of Lords. These anniversaries provide a special opportunity for all of us in this place to engage the public in the history and purpose of our democracy. Parliament’s programme for 2015 will increase public understanding of the fact that Parliament’s work really matters to them, raising awareness of Parliament at work on a local level, particularly with young people. I hope hon. Members will participate in an initiative we are launching with individual schools in our constituencies later this year.
The celebration of and debate on Magna Carta and our emerging Parliament should serve to remind us of perhaps neglected fundamentals. Democracy is not just about voting once every four or five years for a local council, Parliament or the European Parliament. The first condition of democracy is the establishment of freedoms and rights in a society that can be upheld independently of the ruler or ruling elite. Voting comes next. That leads me to my three main concerns about the Queen’s Speech: the consequences for defence, liberty and the local experience of democracy.
On safety overseas, the Queen’s Speech said surprisingly little. My right hon. Friend Dr Fox made a powerful speech, saying many of the things I wished to say. In the year in which British troops end their combat mission in Afghanistan, we might have hoped for more on defence in the Gracious Speech. The UK has committed to spend 0.7% of GDP on international development. I welcome that, but why do the Government, who already spend more than 2% of GDP on defence in accordance with NATO guidelines, seem so reluctant to commit formally to this target? Why do they not do more to engage our European colleagues in meeting that target too? Why did the Queen’s Speech not say something about the preparatory work for the next strategic defence and security review? We need a debate on Britain’s place in the world, a debate that would inform the Scottish independence referendum and our relationship with the EU. An open debate ahead of the SDSR would be invaluable, and it would have been good to see a commitment to that in the Queen’s Speech.
On liberty, the Bill to strengthen the powers to prevent modern slavery and human trafficking is an excellent one to enact in the year of Magna Carta’s 800th anniversary. The work of the Gangmasters Licensing Authority has made a major contribution in my constituency to reducing the exploitation of those working in the farming and horticultural sectors, but much more remains to be done. I am proud to support a Government who are putting such an enlightened and important piece of legislation on the statute book. When we think of personal liberties, we should recall that of all Magna Carta’s many clauses only four remain on the statute book today. Two of those, clauses 39 and 40, are about no freeman being imprisoned except by the lawful judgment of his peers, and no one being denied justice.
I welcome the action on modern slavery, but I must sound a loud warning note on legal aid, for which further changes are planned in this Session, including secondary legislation on Crown court advocacy fees. We must recognise that access to justice is not just a Magna Carta right, but a fundamental part of our democracy. We cannot lecture authoritarian states on their lack of democracy if our own system is denying ancient rights to our citizens. If the state proceeds against an individual unreasonably, as has manifestly happened on several occasions recently, the individual should have the proper means to defend himself or herself against those proceedings. The legal aid bill is tiny: at £2 billion, it is just one-twelfth of the £24 billion housing benefit bill. In other words, an 8% saving in housing benefit would pay for the whole legal aid bill. This Parliament should be profoundly concerned that injustice will grow and families will suffer if deep cuts to legal aid are made. In the run-up to the commemoration of Magna Carta, we should be especially heedful of such things.
My final remarks perhaps reflect my deepest concern about democracy in our country. I end with one measure of direct relevance to my constituents and their sense of justice and fair play and the upholding of their democratic rights: the planning system. This one issue has done more to disillusion many of my constituents about the reality of local democracy than any other I am aware of. I agree we need to build more houses both nationally and locally. The three councils of south Worcestershire—Wychavon, Malvern Hills and Worcester City—agree with that view with passionate conviction, but I worry about exactly what is meant by the commitment in the Queen’s Speech to increase housing supply and home ownership by reforming the planning system.
A packed meeting at Badsey Remembrance hall on Friday was powerful evidence of the sense of betrayal that people in many parts of England feel about the collapse of local planning policies. Indeed, I believe my party has lost more voters to UKIP over this breakdown in planning than over the EU. At Friday’s meeting, attended by parish councils and residents from across the Vale of Evesham and throughout Wychavon, I told the audience about what was being done and our great success in building houses—some three times the national average in my constituency—in south Worcestershire. Our area is pulling its weight. We want to build houses in the quantities needed, but where local people believe they should be built and not where developers decide. It is the developers who have the whip hand in my constituency. Through no fault of my council, we are being punished for not having a local plan in place. The only reason we are late is that the Government failed to abolish the old top-down system of regional spatial strategies in good time. We followed Government policy, but we are being punished for doing so.
Wychavon district council wants to do the right thing and build the new homes that we need, but still the Planning Inspectorate makes it clear that it expects even more. The result is a demoralised district council and angry communities. All the inspectorate needs to do is say that planning permissions already granted will count against our target and commit to ensuring that our new local plan can be the test of new applications from developers now, not when it finally comes into effect.
At Badsey on Friday night I was given a bag of Vale of Evesham soil. The person who gave it to me wanted it to remind me of the valuable horticultural land being lost to unplanned development. It reminds me of much, much more: it is the soil of the county where the founder of our parliamentary democracy, Simon de Montfort, died. It stands for the liberty of the people. It is our sacred duty in this place to protect it.
This is the seventh occasion I have quoted from patients’ letters on the NHS. They are patients from all over the country. In some cases I will name where they come from, because they have given me their permission to do so.
A few weeks ago, when I gave evidence to the Select Committee on Health, I was asked whether things had changed as a result of the report I produced jointly with Professor Tricia Hart last year. The only way I could answer was to say that I will know that things have changed when the letters stop. I am afraid the letters have not stopped: they keep coming, and while they keep coming I shall continue to quote from them.
I received a letter from a woman who went to see a friend in hospital. The friend was given an enema while she was there. The letter states:
“Myself and other visitors therefore waited outside while this took place. The nurse then disappeared for forty minutes. When I questioned the nurse about being away for so long she explained that there are two other staff members on the ward but they are not qualified to carry out this procedure…I then waited outside again while she was changed. Once this was finished I noticed that her nightgown had not been changed, so therefore assumed it was clean. The next morning when I arrived with a clean nightgown, she was still in the previous day’s clothing and was not changed until she had been washed. Later, when I was going home, I found the previous nightgown shoved into a cupboard in a plastic carrier bag. The nightgown was completely soiled, so it was evident that she had been left wearing this from roughly 2pm and throughout the night. I reported this to a nurse who said she could not explain why this had happened.”
This illustrates again the importance of patients in hospital being shown dignity.
Another letter concerns a wife visiting her husband in hospital:
“The oxygen mask he had on had slipped down off his nose so many times it had blistered it, his wife had to put plasters from the pharmacy on herself. On his bed table at the foot of his bed was a pack of sandwiches, bottle of fizzy drink, a urine tray with urine in it and standing in that was a urine bottle half filled with urine…The man 2 beds up soiled his bed, stripped naked and walked round the ward with excrement all up his legs. Out of the ladies toilets came a lady crawling on her hands and knees with her underwear round her ankles, 2…nurses picked her up, said she was a naughty girl and dragged her up the ward. Then 5 minutes later out of the other door first appeared a walking stick, then a little man wearing a nightgown and a hat with a bobble on the top, stick in one hand and dragging his soiled nappy full of excrement behind him past” her husband’s bed.
Another letter said:
“I have been waiting for over three months for a colonoscopy at Singleton hospital, Swansea. I have pains in my stomach. I attach an e-mail received from the Health Board stating that the waiting list for urgent endoscopies in Swansea is 35-40 weeks. No estimate is given for non-urgent endoscopies. I find the situation scandalous. If you wish to publicise this appalling state of affairs and use my name, you can do so.”
The health board wrote to the man saying:
“Unfortunately, the Endoscopy department is experiencing a backlog of patients waiting for appointments, due to the ongoing demands on the service. The current waiting time in Swansea for an urgent endoscopy can be up to 35 to 40 weeks. Plans are in place to address the backlog over the coming months. In the meantime if you are experiencing symptoms which you are concerned about, they would suggest you make an appointment to see your General Practitioner”.
Another letter states:
“My mother aged 85 was admitted to hospital…and treated as an in-patient for 3 weeks for a badly sprained wrist. My concerns about the longevity of the injury and lack of improvement, continued pain and swelling were ignored and only after an official complaint was made…by me did medical staff agree to re x-ray the wrist, where upon it was found to be badly broken. Whilst still an in-patient…when her wrist was due to be set, my mother’s call for assistance to help her to the bathroom went unanswered and she fell in the ward. I was not contacted by the hospital and advised of her fall. When I made it known to staff that I knew she had fallen I was told ‘it was nothing, a little fall and there was no injury’. My mother was discharged…I had to call out her GP” a couple of days later
“since she was experiencing severe groin pain. Over the weekend the intensity of pain increased and my mother could no longer walk. She was taken by ambulance to Morriston Hospital, an x ray revealed a fracture of the pubis and my mother was again admitted as an inpatient that evening.”
She then talks about the standards of medical attention, stating that the
“care received was negligent, her treatment was inappropriate and exacerbated her injury. The consequence for my mother is long term and permanent impairment of mobility and quality of life.”
Another letter concerns someone admitted to a hospital in north Wales:
“Doctors were rarely seen especially not at weekends, equipment had to begged and borrowed from other wards. I feel that when he was admitted he was seen as a very old man who was probably not going to survive…He’d always been a positive, uncomplaining sort of person. It was subsequently discovered that he had an ulcerated digestive tract so forcing him to eat, as was initially happening, was bordering on the cruel.”
Finally, a letter states:
“I went to the GP last February and was diagnosed with a prolapsed womb. I was put on the proverbial waiting list. After two months I rang the Princess of Wales hospital to ask how long to my appointment. I was told the earliest I would be seen would be end of August possibly early September! A few weeks ago against all my labour principles and out of sheer anxiety of the unknown I paid £150 to see a gynae consultant (this was in one week of phoning for an appointment!) The consultant confirmed I had a prolapse, I would need a hysterectomy and a bladder repair…I was then told if I paid privately I could have the operation in two weeks!” at a cost of £6,646. The letter continued:
“However this is the punch line. If I wanted to be put on the NHS list it would be 9/10 months! That means from seeing my GP to surgery will be 18 months. I can not believe it! I refuse to go privately; I want NHS treatment. My condition is now impacting on my everyday life…without going in to the finer details it is undignified. I went back to my GP last week asking her to expedite my referral.”
That is one of many shocking cases, and I could fill the next five hours reading out the others I have received.
It is a great pleasure, but a daunting prospect, to follow Ann Clwyd, who is a model of dignity for the House and has shared some truly horrific experiences with us. I want to talk mainly about public health, but before I do so, I should like to raise an issue that is not unrelated to what the right hon. Lady has mentioned.
I have been fascinated by the fact that the Mid-Staffs issue has not resonated as a major concern with the vast majority of people in this country. Perhaps I missed it; perhaps it is there just under the radar. To me, it should be seared on our collective conscience as a nation. If 1,200 had wrongfully died, say, in police custody or in some other area of direct Government responsibility, there would be crowds of people out on the streets. Yet this was a collective failure and a national failure. Irrespective of what has been said in certain journals by certain Members, this was not a local issue, but a national one in which neglect, incompetence and something called cognitive dissonance was allowed to fester—and people died in large numbers.
We rightly revere the NHS. As with my hon. Friend Sir Peter Luff, I have had recent experience of a close relative being treated in the NHS, and I have nothing but praise for the staff who treated him. Where there is failure, and when people are treated in the sort of way mentioned by the right hon. Lady and dignity and care fall by the wayside, we have to act. I believe that the implementation of the Francis report is a major step on that road. I applaud the Secretary of State for his determined approach to put patients first, by putting in place measures, individuals and safeguards so that Mid-Staffs does not happen again.
As I said, I want to talk about public health, which I believe is so important to how we are going to be able in the long run to afford a national health service. So much of that is about diverting people away from needing it. It is also about addressing inequalities. I have worked hard with other Members to make sure, for example, that rural areas are not left aside. When I was the Minister with responsibility for rural affairs, my hon. Friend Mr Stuart raised the issue of stroke treatments in his constituency. It is, of course, much quicker and easier for a stroke therapy consultant to spend all their time in Hull, dealing with many more cases in one day, rather than getting out into the rural areas. Addressing those health inequalities is now, however, for the first time a statutory requirement. That is a major step forward. It does not just involve national bodies such as NHS England and Public Health England; local care commissioning groups and local authorities are ensuring that inequalities are addressed.
I agree with the hon. Gentleman that there is a specific need in rural communities. Does he support the Government’s action in taking need out of the assessment for public health funding, which has meant that areas such as mine in the north-east have lost funds that have been redistributed to wealthier areas in the south?
I do not know what happens in the hon. Gentleman’s part of the north-east, but I can tell him that there is now a real drive to deal with the problems in the constituency of my hon. Friend the Member for Beverley and Holderness. My hon. Friend felt that his constituents were getting a raw deal under the old system, and there is now a statutory requirement for that to be addressed.
The new responsibility for public health means a great deal to us as constituency Members. The West Berkshire health and wellbeing board, ably led by Councillor Marcus Franks, is taking the initiative locally, not just dealing with massively important issues such as reducing smoking but encouraging, through a partnership approach, lateral thinking and the tackling of disease and illness before they happen. We must ensure that that happens at local level as a result of legislation that has been introduced in the past.
I was pleased to be one of the authors of the natural environment White Paper. We worked closely with the Department of Health, with the aim of helping people to understand the healing benefits of nature and the great outdoors. Initiatives such as Walking for Health have created a virtuous circle. Improved health has led to greater companionship and less isolation, and organisations such the University of the Third Age have improved the quality of life for lonely and, in some cases, elderly people—and, of course, there is the additional benefit of a lower health care bill for the taxpayer. All that is crucial to our objective of diverting people from health services.
About 20 years ago, a health service manager said to me, “The trouble is—from my point of view—that clever people keep inventing expensive new cures which we have to fund. People survive longer as a result, and that means yet more costs, because they will need the NHS at a later stage.” I think that he was being light-hearted, but it was probably just a half-joke. His point was this: if we, as a society, are to be able to afford the NHS that we want in the future, whichever party is in government, we must continue to divert people from it by keeping them healthier. The lateral thinking to which I referred earlier has never been more important.
I applaud the housing association that, working with its local health and wellbeing board, identified a large number of elderly people who were being admitted to hospital following accidents in the home. Simply employing a handyman to do some work in their sheltered accommodation resulted in a reduction in the number of injuries, particularly serious injuries such as broken hips, from which many people do not recover.
Another initiative in my area is “brushing for health”. Good oral health is vital, and my local health and wellbeing board has launched a programme involving Sure Start and other children’s centres, encouraging children to adopt diets that are lower in sugar and to brush their teeth more regularly, and ensuring that they will have access to a dentist. Promoting that initiative will mean that less national health dentistry will be required in the future.
On Saturday, I was delighted to launch the Newbury dementia action alliance. We know that 800,000 people in this country are living with dementia, and that it is costing the country £23 billion a year. It is great to hear that the G7 world leaders are getting together and making dealing with dementia one of their priorities, but what does that mean in our constituencies? It means, at local level, stimulating the minds of dementia sufferers, supporting their carers, ensuring that healthy living is part of the norm and involving organisations such as the fire service and the police.
That was a very quick canter around the importance of public health. I am running out of time, but let me end by saying that when we talk about health, we must not just talk about the important factors that surround the core of the national health service. We need to prevent people from becoming ill in the first place, and that is why the Government’s concentration on public health is so welcome. There is, of course, much more to be done, but a very important change has been made.
It is a pleasure to follow Richard Benyon. Let me begin where he left off. For the past two years, along with other Members of Parliament representing the north-east and Cumbria, I have been arguing against attempts to alter the health service’s funding formula and reallocate funding, taking it away from deprived areas with poorer health outcomes and giving it to more affluent areas with better health outcomes. Last year, the Government’s original proposals would have led to a reduction of £230 million in the annual health funding of the north-east and Cumbria.
NHS England eventually opted for inflation-proofed increases for all clinical commissioning group areas, along with extra increases for some favoured clinical commissioning groups in more affluent parts of the country. I should welcome an assurance from the Minister that we will not have to go through that fight again.
The Government’s top-down reorganisation of the national health service is riddled with gaps and negative consequences. It has significantly increased pressures on A and E departments, which have now become the default places to visit if people need to see a doctor within days. It is no longer possible to make an appointment with a GP a day or so in advance, and many people have to wait several weeks for an appointment. There are arbitrary, cost-influenced restrictions on procedures and treatments, leading to a postcode lottery whereby some services are free in certain parts of the country but not in others.
Clinical commissioning groups are reported to have spent more than £5 million on competition lawyers to try to navigate competition law in relation to commissioning services. More than £1.4 billion has been spent on redundancies in the NHS, only for thousands of people to be re-hired under the new structures. I understand the latest figure is over 4,000. That point was made forcefully by my right hon. Friend Andy Burnham in his opening speech, and I support every word that he said.
There has to be an answer to this, and it is not coming from the Government. Health Ministers are increasingly hiding behind NHS England when it comes to big policy questions relating to the NHS, and more and more answers to parliamentary questions are being referred away from the Department and to unelected, largely unaccountable bodies. There is also the overarching issue of GPs’ now having key functions as commissioners, as well as functions as providers of services that are being commissioned. The obvious conflict of interest is corrosive to the ethical underpinning of the NHS.
I have the honour to represent the Freeman hospital and its internationally renowned heart units, including its high-achieving children’s heart unit. In the 2001 review of the Bristol children’s heart unit, Professor Sir Ian Kennedy clearly stated that England needed a smaller number of centres of excellence to undertake the complex, highly skilled procedures involved. No one has refuted his arguments, but, 13 years later, we are no closer to achieving the outcome that he said was desirable.
We cannot, and should not, let that issue drift. The Government have an obligation to set out a clear way forward that is compatible with Sir Ian’s recommendations, and to do so on the merits of the medical arguments and not on the basis of political expediency. The delays in addressing the issue over the four years of the current Parliament pose the risk that it will extend beyond the next general election, yet we are no clearer about the future of children’s heart units in England. Again, a response from the Minister on the issue would be welcome.
I want to raise the recommendations of the NHS Pay Review Body and the blocking of the recommendations by the Government. That decision comes after a two-year pay freeze and significant pay restraint following the two-year period. When factored against inflationary pressures, nurses’ pay has fallen by 10% in real terms over the past four years. Alongside that, contributions to the pension arrangements have increased, coming out of take-home pay.
The Government should not treat individual increments as if they were pay rises. Forty-five per cent. of nurses do not receive an increment. The Government should not set the NHS Pay Review Body recommendations to one side. They are wrong to insist instead on an offer of a 1% non-consolidated payment for this year, followed by a 2% non-consolidated payment for the following year. If nothing else happened at the end of this period, the nurses would be substantially worse off than they are today. These are pressing issues for the national health service.
I should like to make a more general point about the Queen’s Speech’s failure to touch on the most significant problem facing the north-east of England. Unemployment in the region remains the highest in the country, at 10.1%. Despite recent national falls in unemployment, it remains stubbornly high in the north-east.
The unemployment rate for the region has actually increased in 2014. There is a continued need to create sustainable well-paid jobs through private sector economic development in the region. The tragedy is that the parties do not quarrel about this: we agree on what needs to be done. The issue is doing it. Youth unemployment remains high and more needs to be done to open up opportunities to work and training.
Four years ago, the Government made sweeping changes to the delivery of economic development in the English regions. The Government’s reorganisation is not working for the north-east of England. Apart from the projects that were already under way under the last Labour Government, the present arrangements have little to show. Governments often make their largest mistakes in their first 100 days. Having abolished the regional development agency and Business Link, the Government have spent the last four years trying to set up structures that will carry out the functions that those bodies used to undertake, and in our region the efforts so far have achieved very little. This matters because it is our region’s core problem.
The Government’s original idea was that the new localism contained the answer to the north-east’s economic development questions. The coalition Government argued that the setting up of new locally based bodies would be the right way to provide economic development at local level. Over the past four years, the means has become the end. All energies have been focused on those structural questions. The purpose for which they were originally intended has almost been completely lost sight of. A single Minister needs to get a grip of these arrangements, which now span a range of different Departments, and force them to focus on specific economic development initiatives.
These are important issues. Now that the House has committed itself to fixed-term, five-year Parliaments, it is likely that all future final sessions will have something of the character of this one. There is something unsatisfactory about it all. I feel that some of the big questions and the attendant debate are slipping away from Parliament.
It is a pleasure to speak in the debate because it is a Queen’s Speech that will help to deliver a stronger economy for this country and better and stronger public services. Four years ago, this
Government embarked on a radical and necessary programme of measures to turn the fortunes of this country and our economy around. For 13 years, my constituents were betrayed and let down by the previous Government, as taxes rose while unemployment soared, the economy went into meltdown and public services wasted taxpayers’ money on a colossal scale.
It is a tribute to this Government’s economic focus and policies that we have been able to turn things around. Ministers have implemented many clear measures. For example, unemployment in my constituency is now almost half the level it was when it peaked under the previous Government in 2009. These are the positive policies that I bring to today’s debate on the NHS. It is a testament to this Government’s commitment to the NHS that we are now seeing an increase in spending.
I heard the opening speeches in the debate, including by Labour Members. It is appalling that the Labour party likes to talk as though it owns the NHS politically. That is wrong. Labour should listen to some of the facts not just in my constituency but in the eastern region. The fact is that Labour went into the last general election with plans to cut NHS spending—we have heard about the impact of that in Wales—while we have continued to invest in the NHS. While Conservatives recognise the increasing pressures that the country faces from demographics and the health care needs of the public—
I want to develop my discussion and go into more detail on the NHS. More investment in the NHS is required. This is not about cutting services, including front-line services, or funds. It is about expanding the NHS in the right way and, as the Secretary of State said, putting patients first and moving away from the bureaucratisation of the NHS.
Let me continue.
There were classic examples of that not just in my constituency but more widely in Essex. We heard earlier about Basildon hospital. In my constituency, one primary care trust saw its number of managers and senior managers increase tenfold over a decade. At the same time, it failed miserably to recognise the health needs of my constituents; we have a growing population as well as an ageing population. I had cases in 2010 where patients were denied access to life-saving hospital treatment and access to drugs because the PCT sought to prioritise spending on the bureaucracy of the NHS, rather than front-line patient care.
In Witham town, at the heart of my constituency, there is a chronic shortage of locally accessible health care facilities. All the talk by Labour and the slogans referring to “record investment” under Labour translated into nothing in my constituency. Under the previous PCT and the previous regime, we had consultation after consultation but no new services were created.
Just a second. Our GPs are among the most highly subscribed in the country, with 2,200 patients per GP compared to the national average of 1,500—that is over 40% more patients per GP than average. Not only did Labour fail to plan, but the former PCTs have left a chilling legacy of debt and financial mismanagement, which has held back our new clinical commissioning group from providing innovative solutions and new local health care.
I thank NHS England, the Department of Health and the Under-Secretary of State for Health, my hon. Friend Dr Poulter. They have been incredibly accommodating and are looking to create local solutions and to expand front-line services in Witham town. We have been looking at bringing in a new, purpose-built medical centre in the town, which would provide new and integrated primary care services and make services more accessible for local people. Such a centre could even go as far as integrating our local ambulance services, too, in order to bring greater collaboration and integration across our local NHS, which is needed.
These provisions do not need to be included in legislation. This is not about new legislation in the Queen’s Speech. This is about a commitment at the grass roots from health providers and GPs to get on and start delivering these services. We did not have that commitment before.
Another example of where we were completely neglected is the East of England Ambulance Service. It is a fact that we have had endless problems. That was down to a culture of mismanagement. Front Benchers will be familiar with the crisis that we had in our ambulance trust. We had great paramedics who were doing a very difficult job, but they were being let down by hospitals, A and E, and the target culture. The service was worse than poor; it was inadequate. The trust is now recovering, thanks to Dr Anthony Marsh. Last Thursday night, I joined the ambulance trust and its team from Witham ambulance station on patrol and I cannot praise them enough for the work they do. It was interesting to see the handover in patient care as we turned up at Broomfield hospital and Colchester general hospital. We need greater integration so that we are putting patients first in the provision of front-line services.
Colchester hospital has been held back because of the legacy of the culture of targets. Because of the problems we had with East of England Ambulance Service, Colchester hospital had a target-driven culture that led to horrific examples of falling standards of care and data being manipulated. Investigations are taking place now. While what has happened at Colchester is nowhere near as damaging as what we have seen at other hospitals such as Mid Staffordshire, it shows what happens when targets overtake the delivery of quality front-line patient care. This should not be about bureaucracy, inputs or targets. We need an integrated approach so we deliver effective front-line patient care.
We struggled in the eastern region, and in Essex in particular, with the NHS legacy of the previous Government. It has been a real challenge for all health care professionals—I have mentioned our hospitals and the ambulance trust—and these are individuals who are dedicated to serving patients and doing the right thing, but they have been held back. The innovations and the NHS reforms, as well as the new investment being provided, will help to secure new services for my constituents and a more patient-friendly approach in Witham town.
Today I would like to add my voice to those of all who have expressed disappointment and surprise that the Queen’s Speech contained not one word about the NHS. Last month’s local elections in Mitcham and Morden, and in large parts of London, were dominated by the issue of health. The verdict was overwhelming: overnight, Merton went from no overall control to Labour control, with the people of Mitcham and Morden electing 30 Labour councillors out of 30 for the first time in history. In large parts of Merton one issue stood out: the future of my local general hospital, St Helier. Anyone driving through Morden will see hundreds of signs in front gardens and windows—yellow signs with a red heart in the middle, all saying “Save St Helier.”
The Government should have used the Queen’s Speech to listen to the people. Labour would introduce an NHS Bill; the Government included not a word about the NHS. During the local election campaign, Merton’s Conservatives said that, no ifs, no buts, St Helier was safe. Their leader proclaimed that
“St Helier Hospital has been saved”,
but St Helier has been under attack for years under this Government. In 2011, the local NHS said the Government had told it to
“deliver £370 million savings each year...around 24% in their costs.”
A new body called Better Services Better Value was set up. It announced it would close A and E and maternity units across south-west London and Surrey, and St Helier would also lose its intensive care unit, paediatric centre, renal unit and 390 in-patient beds. A save St Helier campaign was launched, and the petition has now been signed by more than 13,000 of my constituents. Three local campaigners—Sally Kenny, Stan Anderson and Mary Curtin—decided the issue was so important that they should stand in the local elections in Lower Morden as residents whose primary aim was to save St Helier. Given the backing they had from Councillor Stephen Alambritis, the Labour leader of Merton council, they stood for Labour. Just before the election, doctors in Surrey, where Epsom hospital was also threatened, vetoed the plans. BSBV was wound down in ignominy. It seemed we had won a reprieve, but when the huge banner covering the front of St Helier hospital that said
“Coming soon—We’re spending £219m on a major development” was taken down, residents realised that victory was only temporary.
The best any of us could hope for was a few years’ peace and quiet. As it happened, the reprieve lasted until only five days after the election, when the local NHS published a new five-year plan that it says will
“change the way we deliver health services”.
Far from listening to the people, who voted in unprecedented numbers to save St Helier, it ignored the verdict of the people. The plan describes the
“likely need to reconfigure maternity and neonatal services”.
Of course, “reconfigure” is just a euphemism for closures, and it suggests that A and E units will be downgraded by 2018, with what it describes as the introduction of two levels of emergency departments—major emergency centres and emergency centres. The plans do not say which maternity units will be “reconfigured” or which A and Es will be downgraded to emergency centres, rather than full-blown A and Es, but, after years at risk, nobody thinks St Helier’s future is secure.
The leader of Merton council, who won an overwhelming mandate just weeks ago, is so angry that he has told the chair of Merton’s clinical commissioning group, who has headed the local NHS throughout BSBV, that the people had spoken and his job was no longer tenable. Councillor Alambritis said:
“BSBV has been a fiasco and the voters of Merton delivered a devastating verdict...Ultimately, responsibility lies with the Chair, and he has to go…Merton’s residents have demanded change, and the Chair needs to respond to that”— and so should the Government. They have spent the last four years undermining, rather than strengthening, our NHS.
In 2010, the Conservative party manifesto said it would stop the centrally dictated
“closure of A&E and maternity wards, so that people have better access to local services, and give mothers real choice over where to have their baby”.
The people of Merton remembered that quote, and it is no wonder they voted the way they did a fortnight ago.
This is a democracy. The Government should respect the ballot box. My constituents do not want a Queen’s Speech that has not got a single word to say about the NHS. They want a Queen’s Speech to save St Helier, and save our NHS.
I have reflected on the comments of Siobhain McDonagh and I really must tackle head-on the belief that because there is no Bill on the NHS, that is a weakness. The reality is that the NHS does not need more legislation. What it needs is good leadership and good performance management so that it delivers what we want it to deliver for our constituents. We will not improve the care of patients by sitting on these Benches and pontificating and giving the benefit of our experience. What we need to do is empower real practitioners to actually deliver change.
I cannot agree with the hon. Lady. The important thing is that Government Members make it clear to the NHS that we expect it to put the interests of patients at its heart. I want again to draw attention to what has happened in Basildon and Thurrock university hospitals trust because it is perhaps the best example of the profound change we have had in NHS culture over the last five years. We now have a Government, and leaders within the NHS, who are finally prepared to face up to what is going wrong and to deal with it, rather than to cover up, be complacent and say, “We’re no worse than anyone else.”
I have to say that it has been a turbulent journey for those of us involved in Basildon hospital over those five years. The shadow Health Secretary, who is not in his place, will recall coming to this House in 2009, at the same time as he spoke about Mid Staffordshire, to highlight exactly what was going wrong at Basildon. Since then I have had a number of conversations with senior managers in which I was told, “Well, we’re no worse than anyone else. You’ll find this everywhere.” That was not good enough, but after two and a half years of not making any progress at all, Members of this House had very robust discussions with Monitor and said, “This needs proper intervention.” That led to a complete change in the leadership. A new board was appointed that was more inclined to give challenge where it was due. We had a leadership team that put stronger emphasis on good clinical leadership, and a chief executive was appointed who was determined to make sure that Basildon hospital delivered the standards of care that all patients deserve. What we have had is cultural change, and cultural change comes from leadership; it does not come from legislation. As I have said in many contexts, any organisation is a creature of the person at its top, so when we get good leadership in individual hospitals we get a step change in performance.
I also wish to pay tribute to the Secretary of State for the continued emphasis he places on patients, because when the head of the NHS—the person operationally responsible here in Parliament for performance—is articulating that, it will spread the cultural change which will deliver the real change in performance. I pay tribute to Clare Panniker, Basildon hospital’s current chief executive, who has delivered this significant change in the 18 months she has been in post. She has taken Basildon from being one of the worst performing hospitals to a position where it is coming out of special measures. She has been ably supported by the chairman of the trust, who has also been prepared to give a robust challenge and to stand behind her when she was doing so. Most of all, I wish to pay tribute to all the staff at Basildon. It has not been easy for them—it has not been good for their morale to see in the newspapers regular reports of the latest horror story of poor care within the trust—but they have reacted to the cultural change that Clare Panniker has brought. They have bought into it and given good, honest feedback, and I no longer get whistleblowing letters from staff about the latest incident. They have procedures to act on things and the management then implement that change. It says a lot about the commitment of the staff in that hospital that they have bought into that process and delivered us to where we are now. We all need to learn that sunlight is indeed the best disinfectant. It is not good enough to pretend that there is not a problem when there so clearly is, and it is important that we continue to put patients at the heart of the NHS. Only by doing that will be able to ensure that the incidents witnessed at Mid Staffs and Basildon will become a thing of the past.
I wish to turn my attention to another issue that was not mentioned in the Queen’s Speech but which is on the Government’s legislative timetable for the coming year: the plan to introduce standardised packaging for tobacco products. I have to say to the Minister of State, Department of Health, my hon. Friend Norman Lamb that it is a very bad idea. I fully support the policy objectives of tackling tobacco consumption and, in particular, of dissuading and preventing children from ever taking up smoking, but I have worries that this tool is not effective and that its unintended consequences may bring about worse health outcomes than doing nothing at all. Sir Cyril Chantler is said to have examined that as part of his review, but I am not persuaded of the evidence. In particular, I believe that introducing standardised packaging will worsen the public health outcomes if unregulated illicit tobacco products replace the regulated ones. We all know how toxic regulated cigarettes are, but when unregulated products enter the market the health outcomes will be very much worse.
Sir Cyril Chantler has concluded that Her Majesty’s Revenue and Customs has been very effective in tackling contraband and illicit tobacco, and he has cited figures going back to 2001. Although they show an improvement, the nature of the problem has changed over that period. European Union enlargement took place during that time and there was an immediate rise in the amount of illicit tobacco, but that has been tackled, mainly through co-operation with tobacco manufacturers. That illicit tobacco was also a legal product, whereas the illicit tobacco coming into this country today is not from Europe and it is not from regulated markets; it tends to be made in places such as China and Indonesia. Some of these products are extremely nasty, with tobacco rolled with whatever is available and containing high levels of tar. I commend The Sun for the exposé it ran last week in which an illicit producer from Indonesia explained just how toxic some of his products are and how standardised packaging will help him make money by reducing the costs of production.
The Government’s own inquiry showed that there would not be an increase in the amount of illicit tobacco traded in this country. Does the hon. Lady not trust her own Ministers and the report they commissioned?
I was quoting that report and challenging its conclusions, which are based on a flawed analysis of the market—that is what I have been trying to explain. No, I do not trust that report. It is superficial and it has been put together with a particular agenda. As I say, it will lead to unintended consequences which will be very bad for public health.
My constituency contains Tilbury docks and the Purfleet ferry terminal. Despite the best efforts of Border Force, Essex police and the port of Tilbury, these products are getting through. Despite large seizures every week, Border Force does not believe that it is getting even 10% of the illicit product that is coming into the marketplace. It is estimated that one in three cigarettes smoked in London are illicit, and a good proportion of them will come through the ports in my constituency. Standardised packs will inevitably reduce costs for illicit manufacturers, who will be able to produce the product without differentiation in brand. I believe this proposal is a charter for a lot of very nasty people to make a lot of money, and if they do, the health outcomes we wish to see will not be achieved.
Let us be frank: we are talking about packets of cigarettes sold from holdalls behind pubs for a couple of pounds. Children do not start smoking by walking into their newsagents and picking a branded product; they are introduced to smoking via that holdall, at the back of the bike sheds or at the back of pubs. When cigarettes become that cheap, because of the proliferation of illicit products in the market, these children will be smoking some very nasty things. I ask Ministers to think again, because this is not the best tool for achieving a reduction in smoking and there will be unintended consequences for public health. I ask this Minister to sit down with Border Force and understand just how difficult the fight is that it is waging against serious organised crime and smuggling.
Interestingly, health is not even covered in the Queen’s Speech, but we are debating it so I will say a few words about it. The good news is that my granddaughter has just been accepted by Liverpool university to study midwifery, so that is some compassion coming back into the health service. The bad news is that on Friday I had a meeting with GP commissioners who came to see me because they are teetering on the edge. I am talking about the Northumberland commissioners who are running the doctors consortium. They had a budget, worked to it and were doing all right until the Government came along and clawed money back. I would not mind if the Minister tried to say why the Government clawed money back from them; I would be interested to know that.
We know what is happening in the health service and we know why there is no Bill. Since this Government came to power we have seen creeping privatisation; no corner of the health service is untouchable as far as privatisation is concerned. Sometimes I just wonder what is going to happen in the next few years—God forbid if the Tories get elected again, with this lot here in charge. Are we going to be paying for our health service? Are charges going to be put on the health service? That is a good question to ask to see whether we can get a denial from the Government—
Sit down, you will have your Welsh question in a minute. It would be good if the Minister could deny that he has any intention of charging for any services in the health service in the future, because they are creeping in little by little. As for the nurses—the people who run the health service and do all the work—their miserable wage rises are absolutely disgraceful and this Government should be ashamed of taking even that 1% away from them; they should get more but the Government are not even going to give them the 1%.
Let us get back to the reality. This Queen’s Speech was the dullest one I have seen in my 27 years in this place, and I think everyone would agree on that. I sat down and I said to myself, “How can I liven it up? What if it was my Queen’s Speech? What if I jumped on the bike of my hon. Friend Mr Skinner—although it has been pinched—and got into Buckingham palace to ask them to take my speech to the House of the Commons instead of the one they were going to read out?” My first Bill would be on the national minimum wage—I would put a Bill through to increase it to £10 an hour. My second Bill would be on a shorter working week—32 hours without loss of pay. My third Bill would call for full employment with no redundancies. There would be a repeal of all anti-union laws, and the reintroduction of collective bargaining.
My next Bill would restore health and safety for workers. The health and safety budget has been cut by 35%, so we need a Bill to put that right for working people.
My fifth Bill would bring an end to privatisation. There would be no more privatisation of the trains or the buses—[Interruption.] Never mind about the increases and the costs; this is my Queen’s Speech, not Labour’s. There would be no more asset stripping of public facilities. Bill No. 6 would be to get rid of Trident, which would make me popular, especially with the Scottish nationalists.
My seventh Bill would put the buses and trains back into public ownership. It would try to stop the privatisation of the east coast main line, but I very much doubt that we can stop it now, as this Government are hell bent on getting rid of it before they go out of power. But we will restore it to public ownership—at least I hope we will; I hope that our Ministers are listening, and that we will restore it.
My eighth Bill would bring education back under local democratic control. We have heard in the statement today how out of control things are. Local authorities are wavering. Their spending has been cut, and they have very little say over the academies or the free schools. Anything could happen in the education service now, because we no longer have that local watch, so we need to bring it back.
My ninth Bill would be about the national health service. I want free public health care for all. That would be a big Bill and it would cost a lot of money, but we need to stop this creeping privatisation. I would get that money from one place: I would go to the City and tell all those spivs and bankers, “Your bonuses are stopped, because of all the money you have spivved off the working people of this country.” It is the working people who have had to pay for the austerity measures. I would tax those people and get the money for the Bills in my Queen’s Speech.
The health service is very close to everyone’s hearts, and there are a lot of political gains to be made from it. I have to say that, as the Member of Parliament for Burnley, my election chances were boosted when Labour’s Secretary of State closed down our A and E unit. I am delighted to say that the coalition Government have now delivered us a brand new emergency centre in Burnley, which shows that the coalition Government have delivered good things, especially for the people of Burnley.
There is one issue that I really want to talk about today. I have been a councillor for 31 years—I stood for election only last month and increased my majority over Labour in my ward—and the issue that has become very close to my heart is the care of elderly people. I am talking about elderly people who are on their own. People from companies call on them in the morning to get them out of bed. They stay for 10 minutes to make sure they are up and have had some breakfast. They then come back at lunchtime to make sure they have eaten some lunch, and then again in the afternoon to make sure they have had their tea. They come back in the evening. As one elderly man said to me, “They come back at 8 o’clock and tell me to get ready for bed.” He said, “I don’t want to go to bed at 8 o’clock in the evening. I am 87 years old. I fought for this country, and now they are telling me that I have to go to bed at 8 o’clock. I don’t want to do that.” What he wants is for someone to come and see him in the morning and talk to him. He is housebound, and he does not have a family. He is not the only one in that situation. There are many more like him in Burnley.
We are a poor town and people cannot afford to pay for private services. These people want to talk to somebody in the morning when they get up; they want a bit of conversation. They do not want staff running in with their meals-on-wheels food in a foil container saying, “We’ll come back and see you later.” They want to talk to someone. They want to know that there is somebody who cares for them; somebody who is interested in listening to them. This elderly man has some fantastic stories about his life; I have seen him many times. When the staff come back in the evening, he is not asking them to stay all night. He is asking them to show a little bit of interest in him, and he certainly does not want to go to bed at 8 o’clock at night. He has never gone to bed at that time and for someone to tell him that he has to do so, “or he’ll be on his own” is wrong. I am not being political here. All I am saying is that we should care more for the elderly people of this country. I am talking not about people who are in their 60s, but about people who are in their 80s and 90s who, unfortunately, have been left on their own. They might be elderly ladies whose husbands have died. These are people who have worked for this country all their lives and fought for this country, and are now, certainly in my constituency anyway, being left alone. I find that hard to accept. I might be unusual. There might be people who think it is tough and bad luck, but I do not think that. We should be looking after these people and showing them some compassion. We are a wealthy country. Apparently, we are the fourth or fifth wealthiest country in the world, and the contribution that these people have made over their lives has helped to put us in that position.
Burnley is an industrial town; we had the pits and the mills. Now we have high-tech industry where young people work and create wealth. Fortunately these days, they are able to put something aside for their pension, which will help to look after them in their old age. The elderly people from the ‘70s, ‘80s and ‘90s could not do that; they were on poor salaries. In the main, the wives did not work. My mother never worked. My father brought up our family, and my mother never worked. All right, my mother and father are dead, but there are still people around who were in the same position. Many have lost a partner and in the main their children are out of the area, and they need us to care for them. Is it a lot to ask for someone to turn up and say, “Hello, Mr Jones. How are you?”
The whole House is listening very quietly to what the hon. Gentleman is saying because it resonates. My father is 87. He pays for carers to come in from an agency. What has upset us is the fact that his life savings are paying the wages of people who drive Lamborghinis, who employ people on the minimum wage and who provide very poor care to the people the hon. Gentleman is talking about. This Government need to act to ensure that the care offered to our people, which they pay for out of their meagre savings, is of the quality that they deserve.
I am grateful to the hon. Lady for her intervention. I do not know of a company that delivers services in Burnley that has an owner who drives a Lamborghini. In fact, I do not know anyone in my neck of the woods who has a Lamborghini. I do not know many people who can spell the word Lamborghini. At the end of the day, the hon. Lady is right: there are companies that are taking money, particularly from the state, and giving a very poor service. I do not want this to be a political point. What I want is to plead with the Minister and with the people in control—I am not in control, so I cannot deliver this—and say that we are living in an age where people are getting old and need looking after. Why can we not do a little bit more to look after these people? The people who get the sums of money to deliver this service should be a little bit more considerate and compassionate. They should not just walk through the door with a metal tray with a bit of food on that no one wants to eat, because it does not feel like the proper food they used to eat. Can we not just do a little bit more?
My message today is: can we do a bit more people for our old people—the people who have put us where we are today, who have delivered the prosperity of this country over the years; and who have fought for us in wars? Can we not show them a bit more consideration? If those companies with Lamborghinis exist, can we lean on some of them to train people properly to ensure that they have a bit more compassion?
I hope my hon. Friend will forgive me for turning my back to him, but I want to tell him through the Chair that one of the places that is trying to do what he is talking about, and which I visited recently, is Wiltshire, which is using its relationships with contractors to drive out 15-minute contracting and drive up training standards, which is making a difference. That is happening now, and it needs to happen in more places.
I am delighted to hear that, and I would like Wiltshire to become a standard that everyone else copies. I would hope that my constituency and the rest of Lancashire copies that. There are great companies—I know a few good companies that really care about the customer. These elderly people are customers: if Tesco treated people like some of those carers, they would shop somewhere else. Unfortunately, elderly people cannot go anywhere else, because a contract has been organised, and they have to use it. I urge the Minister to consider those suggestions and look at ways of improving the service that we deliver to our old people. I would be very happy if he did so, and I am sure that he would be too.
I completely agree with what my hon. Friend is trying to achieve. I hope that he is reassured that the Government have effectively introduced compulsory minimum training for all care assistants for the first time. I think he will welcome that.
I do welcome it, and I am delighted to have heard that. I just hope that we make it a major condition of all Government and local authority contracts that all companies deliver that service to our elderly people. We will all become elderly—I am catching up very quickly—so who knows how soon it will be before someone comes to my house to say, “Gordon, it’s bedtime. It’s 8 o’clock—it’s toilet time.” That’s the worst thing I think I have ever heard—someone coming in and saying that it is toilet time. An old man said to me: “I do not want to go to the toilet, but I am told that it is time to go to the toilet.” It is just not acceptable to do that to an elderly man. I am delighted to hear what the Minister said, and I hope that we ensure that it continues in future so that we really respect and care for the people who have put us where we are today.
It is an honour to follow Gordon Birtwistle. The House was listening raptly to a speech full of humanity and compassion. I pay tribute, too, to Ann Clwyd, who read out a lot of examples of what everyone will agree was shocking treatment. I genuinely hope that Ministers listened closely to those speakers and to many others who have made important points.
In the limited time available, I should like to draw attention to the obvious point that this is the last Queen’s Speech before the historic and exciting independence referendum in Scotland on
Today, we have been encouraged to speak about health, so I was pleased to find a recent international health watchdog report issued only a few days ago in Canada, which said:
“Imagine a land where a patients’ charter of rights and responsibilities is in place that includes wait-time guarantees; over 90% of patients requiring elective care are treated within 18 weeks from referral by a family physician to start of treatment/procedure including all diagnostic testing and specialist consultations. Over 98% of in-patient procedures and day-surgery cases are treated within 12 weeks of agreement to treat. Over 90% of patients are seen within four hours in the emergency department (i.e., admitted, transferred or discharged). Citizens can access the most appropriate member of their primary care team within 48 hours. Up-to-date statistics and reports on wait times and health system performance indicators are publicly available. In addition to providing timely access, this land has been successful in improving other dimensions of quality of care (e.g., significantly reducing levels of hospital acquired infections, reducing the level of inappropriate care), and performance in all of these dimensions is being tracked through the measurement and reporting of performance targets available for use by patients, providers and system managers alike. Fortunately, this land already exists—Scotland.”
That report was issued only a few days ago by the physicians watchdog in Canada.
I pay tribute, as did the Health Secretary, to the work of health professionals, who make a tremendous difference to people in the NHS system in England and, no doubt, to the NHS system in Wales and Northern Ireland. I pay tribute to all of them, and in particular to those who work in NHS Scotland. I am proud of the difference that the Scottish National party Government have made since taking power in 2007. Staffing has increased under the SNP by more than 6.7%.
I have very little time, and I would like to make progress. The Government in Scotland have protected the front-line NHS budget—Labour said that they would not—and there is high patient satisfaction in the NHS. Obviously, there is always much to do, but 87% of people are fairly or very satisfied with local health services, which is an increase of 7%. We have seen the abolition of prescription charges in Scotland, which is extremely welcome. Prescriptions still need to be paid for in England, and I encourage the UK Government to consider following the example of the Scottish Government. A Scottish patient on a low income saves £7.85 per prescription, compared with a similar patient in England, and people with long-term conditions save £104 per annum compared with a patient in England, where there is provision for a pre-payment certificate.
Free prescriptions are not the only advantage. Free personal care, which was championed by the former Labour First Minister in Scotland, Henry McLeish, has been introduced, and there is pride across the political spectrum in Scotland about that. Free personal care for the elderly improves the lives of over 77,000 older vulnerable people in Scotland, where personal care is free for people over 65 who need it. That kind of service would be beneficial for the kind of constituents about whom the hon. Member for Burnley talked so movingly. Of course, patients in England are not entitled to free personal care.
Those are examples of better decision making and better outcomes, because in Scotland we have the ability in our Parliament and through our Government to pursue the policies that we wish to pursue, as opposed to those that are pursued by Governments whom we have not elected, such as those pursuing privatisation in the NHS in England. There is a concern about protecting budgets in Scotland against further cuts from Westminster and the austerity agenda that it is driving, which is why people are now talking about full financial responsibility. I looked closely at the Queen’s Speech to see how that might take place: all three UK parties have now said that they wish to see the transfer of further powers, notwithstanding the fact that only a few years ago there was a line in the sand. There were to be no more transfers but, lo and behold, when the SNP won with an absolute majority and a referendum was in sight, suddenly everyone was in favour of more powers. However, there were no specific proposals in the Queen’s Speech—reinforcement of the reality, if anyone needed it, that to have the powers to make a difference in people’s lives and build on the successes of devolution, we have to vote yes.
I would wish the Queen’s Speech to include a series of measures that were not included: building and enlarging free child care; abolishing the bedroom tax; halting the further roll-out of universal credit and personal independence payments to create a fairer welfare system; simplification of the tax system to reduce compliance costs; negotiation of the removal of Trident nuclear weapons from Scotland; protecting the value of the state pension and putting more money into the pockets of pensioners; supporting enterprise in the economy by increasing personal tax allowances; making sure that the minimum wage increases at least in line with inflation; the creation of an oil fund so that we do not see the wasting of that natural resource, which can be there for future generations; and negotiating directly with the European Union to get a better deal for farmers and fishing communities. The list goes on. Those are all measures that could have been in a Queen’s Speech in Scotland if Scotland were in charge of all the normal powers that normal democracies are in charge of.
This Queen’s Speech was totally empty of any of those proposals—proposals popular with the electorate in Scotland, proposals that can be brought forward if we use the power that is in our hands on
I shall take this opportunity in what is nominally the health debate on the Queen’s Speech to speak more broadly about the national health service. I welcome the fact that there is not much in the Queen’s Speech on health policy, because what we have done already under this Government needs to bed down.
I have always tried to build cross-party consensus in the Chamber. At no point have I sought to make any party political points in relation to health care, primarily because, as a clinician who still practises in the health service and who has an extensive network of friends from medical school who are all approaching consultancy, I have been aware of the challenges that the NHS faces and have therefore always believed that there needs to be an understanding across the Benches for us to find the appropriate solutions.
We need to get a grip of the NHS challenges that we face. Significant changes are afoot in our society—changes in attitude and behaviour, and patients’ expectations change as each generation passes away. A stoic wartime generation is being replaced by arguably much softer ones. Their experience of pain and their approach to suffering are different, in my clinical experience. Each generation is becoming more and more obese. As I have already said, the society we live in is ageing. There have been some poignant contributions to this debate. That is fine and I share the concerns, but let us not kid ourselves: more than 20% of the population is now aged over 60. The proportion of people paying tax compared with the proportion of people who have retired is diminishing. We cannot lose sight of that reality, and we need to recognise that change is inevitable.
There are some welcome advances in medicine—in drugs, technology and the application of that technology to the care of patients—but these have invariably been expensive. The National Institute for Health and Care Excellence does a pretty good job of the cost-benefit analysis, but we are now saying no to drugs that enhance people’s lives. We need to reflect on that.
The NHS was introduced in 1948 by Nye Bevan, who represented a constituency that I sought and, funnily enough, failed to take in 2005. At that time, the budget was £437 million, the equivalent of £9 billion in current money. We are approaching or may have touched above £110 billion per year. He said that there would be an initial expense when he introduced the service and that costs would then fall as the population became healthier. I am sorry—Mr Bevan might have been right to introduce the service, but he was wrong in thinking that the costs of that service would diminish with time. Clearly, they have not.
What is there to do? I would say there are four things. First, we need to find a way of reducing demand on the services. This morning I attended an induction as I am about to start working at an urgent care centre in my constituency. It was striking to note who was coming through the door. The demand is great and it is growing, and we need to deal with it.
Secondly, we must improve the physical structures in the system. Our hospitals are 19th and 20th-century buildings and we are trying, and at times failing, to deliver 21st-century care in those environments. We need to improve them and to do it fast. In order to secure an appropriate plan for our nation, I suggest that we need some sort of cross-party committee and cross-party understanding of where those acute hospitals will be in the future. We will have fewer of them, but we will have more community-based hospitals delivering chronic care. Let us not forget that over 80% of the NHS budget is now spent on chronic care. We need to make sure that that care is delivered closer to patients’ homes.
In the future we will have telemedicine, which will deliver care in patients’ homes. This is the reality. It is already being piloted in Scotland, with some very good outcomes.
We need to recognise that, but with that will come changes in hospital infrastructure and, yes, extremely difficult politics. We have heard about the difficult politics in south-west London, west London and elsewhere. That will be replicated irrespective of who wins next year’s election. The problem is here and now and we need to deal with it. All parties should put skin in the game and make a decision on where those hospitals should be.
The third element is funding. This is the most emotive topic to discuss. Colleagues on the Labour Benches have proposed co-payments. From those on the Government Benches, there have been suggestions of health accounts and supplementary insurance schemes. There is a plethora of ways of funding health care—one only has to look abroad. In Norway people pay to see their GP; in Denmark they pay for their drugs at cost; in Germany there are supplementary insurance schemes; in France there are means tests, and the list goes on.
I have not 100% decided what I think would be the right thing in future in this country, but the debate is needed. I cannot see how we can go above 10% of GDP on health care spending and balance the books across the whole of Government. Perhaps there are people who think we should spend north of 10% on that—fine—and approaching almost 20% on welfare if we include pensions. We are approaching £1 billion a day expenditure on these two areas. I do not think that is sustainable, but I know that if it is to change we need a cross-party debate on the matter. It is not easy.
Finally, the political cycle does not help. We have heard how it helped Gordon Birtwistle get elected at the last election, and I am sure this will be replicated on both sides of the House in future. There is no avoiding it. I have walked the walk in my constituency: I stood at the last election calling for the closure of my local hospital, because I know that if we consolidate services in my region, we get better outcomes. People live who otherwise would not live. People suffer less. I did not think it was appropriate for a clinician who had worked in the region in which he was seeking to represent a constituency to say otherwise. I thought it appropriate that I stood on that. I continue to stand on it and I continue to stand for the consolidation of acute services in my region and for chronic care to be offered locally to people.
In conclusion, this country is very privileged to inherit a health care system that is pretty good. It is approaching first class by global standards, but it is a legacy that we must protect. Our grandparents have given it to us and we need to protect it in future, which means that we need to be open-minded about the changes required. I think the solutions will come from more than one political party and more than one expert group, but the time is now and we all need to work together.
It is often in the specific and the particular that we understand how public policy is most effective, far more than in mission statements, PowerPoint presentations and the sub-sections of the legislation that we pass. That is particularly true of the NHS. We have heard two striking examples of that already in the contributions from my right hon. Friend Ann Clwyd and Gordon Birtwistle talking about social care. It is also true of the reconfiguration and change in the health service, which I shall address in the few minutes available to me.
In many respects we understand across the piece what changes need to take place, yet we find that so many of the changes that have taken place at a higher level of public policy, particularly those implemented by the Government through the Health and Social Care Act 2012, have made it harder rather than easier to bring about the change that we need to deliver. In London in particular, an exceptionally complex environment, we saw that set out very clearly by the King’s Fund in its report last year, which made it clear that the Government’s reorganisation of the health service, carried out at considerable expense, had made it harder rather than easier to deliver the fundamental changes that we need by fragmenting its structure and undermining its capacity to introduce strategic leadership.
In north-west London, which we have already heard mentioned today, we are facing one of the most fundamental changes in the delivery of health care since the establishment of the national health service. The “Shaping a healthier future” agenda is rooted in a set of principles with which most of us could agree. We want to reduce the number of accident and emergency attendances and, in particular, to reduce the number of accident and emergency admissions when patients can be better cared for elsewhere, particularly within primary and community services, and we want to reduce the length of stay, particularly for elderly patients who would be better and much happier to be cared for with appropriate social care support in their own homes. Those are undeniable facts that are supported by the general principle that in many cases the higher level of acute care is more efficaciously provided in larger and more specialist units. Those things go together and they are worthy objectives.
It is in the detail of the implementation that we have a major problem. NHS England is apparently seeking to have a total of 780,000 fewer patients admitted to A and E over the course of the next two years. The “Shaping a healthier future” agenda translates into a reduction of 15% in the number of A and E admissions to be achieved in north-west London. As the King’s Fund’s health economist John Appleby has said, that is “not realistic or feasible”. The problem is not that it is not desirable or that we do not want to see it achieved over time, but that we are in the middle of a period of rising demand for A and E and the capacity simply is not there, either elsewhere in the acute hospitals sector or in community and primary care services.
Only a few months ago, Imperial College Healthcare NHS Trust, at the heart of the “Shaping a healthier future” agenda, said:
“We are yet to see any impact of primary care and community Quality, Innovation, Productivity and Prevention…schemes and therefore are planning to maintain the level of emergency care we provided” over the course of this winter. So, a hospital is saying that it cannot rely on the primary and community services being in place to divert people from A and E, yet almost in the same week the Secretary of State’s letter confirmed that the closure of the accident and emergency units at Hammersmith and Charing Cross, as we understand them, will go ahead as soon as possible. We now have a date in September, and his letter stated that
“the process to date has already taken 4 years causing understandable local concern”.
My hon. Friend has written a devastating critique to the new chief executive at Imperial about the fact that Hammersmith A and E in my constituency as well as other A and Es are being closed before there is appropriate provision to replace them. I would not hold my breath for a reply if I were her. I am still waiting for one to the letter I wrote to the clinical commissioning group on
I am grateful to my hon. Friend, who reinforces my exact point.
Since the Secretary of State’s letter and the decision to proceed with the Hammersmith and Charing Cross closures, it has been reported in the Evening Standard that Imperial is having to use winter pressure beds routinely to cope with patients displaced by the planned A and E closures, admitting that there are “risks” of over-crowding, and warning that ill patients will have to spend longer in ambulances. This is a demand for winter pressure beds in the middle of the summer. The expectation is therefore that there is already insufficient capacity years before the construction of a planned new and improved A and E unit at Imperial hospital. The closures are going ahead and Imperial clearly cannot cope. An Imperial official said:
“We have extra acute beds at St Mary’s Hospital, normally used during the busy winter period to ensure we can quickly admit those patients” in need. That is fine, but what will happen if and when we have a winter crisis or simply during the additional winter pressures? That capacity will not be available to help deal with them.
None of this is meant to suggest that there are not fine people in clinical and managerial practice focusing their attention on ensuring that services are in place to assist with that transition, but the scale of the challenge appears to be beyond what can be achieved realistically within the timetable. In the middle of all this—and no doubt connected to it—there came halfway through the year a letter from the west London clinical commissioning groups announcing that they have
“made an important decision to put funding into a central budget…£139 million…which means CCGs with a surplus will be supporting those with a deficit…We also agreed to explore how to bring together commissioning of primary care services across organisational boundaries”.
That seems to me to be perilously close to the end of clinical commissioning groups as far as we understand them. My understanding was that clinical commissioning groups were designed to be rooted in their local communities, to work in effective local partnerships and to reflect the local service providers, particularly primary care service providers and patients, at a local level. That has all gone with the wind in west London and I am extremely worried about it.
I am all the more worried because the whole transition programme is predicated on the delivery of improved social care, and it is social care with which we are now struggling to cope. In my local authority area, 1,000 fewer residents are getting social care than in 2010, and there will be a further £2.9 million cut this year. It is no surprise that the chief financial officer at Imperial trust, Bill Shields, has said:
“The cynic in me says” that the proposal to take money away from the national health service to fund social care
“is a way of taking money from the NHS and passing it on to the local authority…this will allow them to make good the cliff edge they have been through in the last few years and rebuild the local government public finances.”
It would also mean
“a significant real-terms reduction in NHS income…going forward”.
My hon. Friend makes a point about this panicked attempt to find more money in the primary care budgets and slosh it around west London at any consultation, and that is exactly the issue on which I am still waiting for an answer. This is chaos in the health service and is a reaction to closure programmes that have been carried out on financial grounds and that have now reduced the health service in west London to a chaotic and dangerous state.
It is extremely worrying because the whole thing is shrouded in a lack of transparency and a lack of effective communication about what is going on. The local authority is cutting its own social care funding and needs money to fill its black hole, whereas the trust at Imperial says that that is exactly what it is worried about. It says it is concerned about the transfer of money because that might not give it the increased local community services that would allow it to reduce emergency A and E admissions, which is what we want. In fact, those things are so far from being effectively integrated in a common purpose that the different sectors of the health service appear to be at war with each other financially, if not in any other way.
The problem is that the fragmentation and delay caused by the reorganisation in the national health service since 2010 have undermined what should have been a sensible method of progressing and building up community services to reduce the pressure on the acute sector. Meanwhile, today and in the coming weeks my constituents will find that their hospital is at capacity but is expected to deal with the extra demand from the Hammersmith and Charing Cross accident and emergency closures, whereas the constituents of my hon. Friend Mr Slaughter face the loss of their accident and emergency units without any appropriate provision. It is a shambles, I am extremely concerned, and I hope it is not too late to ensure that we can put something in place to prevent a true winter crisis this winter that would be of the Government’s own making.
Living in and representing a constituency on the border has given me a unique insight into the different systems that have now grown up in the NHS in Wales and the NHS in England. One thing has become absolutely clear—not just to me but to any independent organisation that has looked into this—and it is that the standards of care being delivered by this coalition Government are far higher in England than they are in Wales, where the NHS is run by members of the Labour party.
The reality is that, judged on virtually any single indicator that one would care to look at, standards of treatment are better in England than they are in Wales. The waiting times for cancer have not been met in Wales since 2008; the four-hour accident and emergency target has not been met in Wales since 2009; the ambulance response times targets have not been met in Wales for 21 months; and in Wales the funding for the NHS from Labour, which claims to be the party of the NHS, has been cut by 8% while NHS funding has been ring-fenced in England.
That has led to all sorts of situations. For example, an Opposition Member talked earlier about cancer in England. In England, of those people being diagnosed with cancer less than 2% have to wait longer than six weeks for their diagnosis, while in Wales 42% of people being diagnosed with cancer have to wait longer than six weeks to receive a diagnosis. The treatment times are also different; in Wales, people wait around 26 weeks, whereas in England the wait is just 16 weeks.
Behind these dreadful statistics are a range of human stories. I was grateful to the Secretary of State for Health for allowing me to meet him with a constituent of mine, Mariana Robinson. She had been trying unsuccessfully to get treated in Wales for months and there was absolutely no interest in helping her. She wanted to be treated in England; she was one of many people who would rather be treated by this coalition Government in England than by the NHS in Wales. Finally, after a great deal of correspondence and after receiving advice from the Secretary of State in London, the NHS in Wales has finally relented in this instance, and Mariana will now be treated in Bristol. I am grateful to the Secretary of State for his help.
Even this afternoon, while I was waiting to speak, I had yet two more e-mails from people who are totally dissatisfied with the treatment they are receiving in
Wales at the moment and who would be prefer to be treated in England. I was contacted by an 88-year-old veteran who had served in the Korean war in the Fleet Air Arm of the Royal Navy. He is in constant pain at the moment and unable to sleep because of a problem with wisdom teeth. He has been told that he will have to wait nine months for treatment in Wales. I do not believe that such a thing would be allowed to happen in England, but he has been told that he cannot seek any treatment in England; he has no right to transfer his health care to a place where it can be provided more efficiently.
Labour Members talked about the privatisation of the NHS. The Conservative party will never privatise the NHS; we have always believed that treatment should be free at the point of service. It is members of Labour in Wales who are responsible for supporting private health care, because they are putting patients in Wales in a situation where the only chance they have of being treated is to go and seek private health care. The 88-year-old veteran of the Korean war was told that if he wanted to have something done about the constant pain he is suffering, he would have to go private.
I was also contacted today by a lady, the retired head teacher of a school in my constituency, who found a lump in her breast. She expected to be seen by someone almost immediately, as she would have been in England, but she was told that the first appointment she will have will be some time in late August.
That is the reality of what is happening in Wales under a Labour-run NHS, and the Leader of the Opposition has said that we should “take lessons”—this is to quote him—from how the NHS is being run in Wales and try to implement them in England. My message today is to warn everyone, particularly Government Members, not to let these people be in charge of the NHS, because what we will end up with in England is longer waiting lists, slower ambulance response times, people not being diagnosed properly and no cancer drugs. Apparently, 150 people in Wales have died while waiting for heart treatment. It is an absolutely disgraceful situation.
I have talked to Government Members about a suggestion that I made in relation to the Government of Wales Bill, which is to let these people put their money where their mouth is. If they think they are doing a good job with the NHS in Wales, they should allow patients in Wales and England to opt to go wherever they want to for treatment. At the moment, we have two totally separate NHS systems, so patients in Wales do not have the right to access treatment in England and, of course, patients in England could not go to Wales. A lot of patients in Wales want to be treated in England. I do not believe there are any patients in England who would want to be treated by the Labour-run NHS, but perhaps there are some out there who fancy waiting longer to be diagnosed and then waiting longer again to get the treatment that they have a right to expect.
Let us see Opposition Members supporting a change to legislation that would allow patients in England to be treated in Wales, with the money required being added to the block grant given by the Government to the Welsh Assembly every year, and patients in Wales who want to be treated in England having the right to access that treatment in England, with the money required being deducted from the block grant that is handed over to the Labour party in Wales every single year. And let us see the direction of movement, because I know that an enormous number of people will immediately opt for the lower waiting times, the better diagnosis and the wider access to drugs that are available to people in England.
Does the hon. Gentleman accept that there are only 3 million people in Wales, and that when we compare Wales with a lot of the English regions and hospitals we do just as well? In London, we obviously have international centres of excellence. In Wales, we spend more cash per head. There is a sparser population and more nurses per 1,000 people, and we have better results on cancer than elsewhere, so there is a mixed picture. He is being completely political and undermining the morale of people working in the health service in his constituency; it is disgraceful.
It is not a mixed picture at all and we should be very clear about that. People wait longer for treatment in Wales than they do in England. People wait longer to be diagnosed in Wales than they do in England. People wait longer for an ambulance in Wales than they do in England. Money for the NHS is being cut in Wales and it is being ring-fenced in England, because the NHS will be a priority.
The real disgrace is that Labour Members have always prided themselves on being the party of the NHS and have gone out of their way to do so. Because they have that reputation, they know that in Wales, and possibly in England too if they ever end up running things, they can get away with making cuts and with cosying up to the unions because they feel that people will trust them.
I say to anyone independent and impartial who wants to know what it would be like for NHS patients if Labour Members ever get into government, they should look at what is happening in Wales right now.
Of course, people only needed to see the NHS at its highest satisfaction levels in 2010 to know what Labour in Westminster would do. I will correct the record on cancer waits, because of course Wales has a better record on cancer waits than England does: 92% of people in Wales are seen within 62 days, as opposed to 86% of people on this side of Offa’s Dyke.
That is a fairly minor difference—[Interruption.] Oh yes. However, what the hon. Gentleman has forgotten to say, of course, is that those people in Wales will have waited far longer for the diagnosis of cancer than people in England. That is why he is not being entirely straight in putting his facts across. When he is winding up, I challenge him to say whether he thinks what is going on in Wales at the moment is good and something that Labour Members would like to aim for. Is what is going on in Wales what they aspire to?
United Kingdom, and that is the vision for the NHS that Labour Members want to impose on the people of England. I advise people in England to look at the figures before they decide to vote for Labour Members.
I ask Andrew Gwynne if he would be prepared to allow patients in Wales to be treated in England, and patients in England to be allowed to go and be treated in Wales if they wish to do so. I doubt very much whether he would support such a thing.
I am grateful to the hon. Gentleman for giving way again. He is obviously not aware that the number of English patients being treated in Welsh hospitals has increased by 10% since 2010.
I am well aware of that, but the hon. Gentleman might not be aware that those patients have no choice. [Interruption.] He is laughing, but he does not understand how the system works. There are many patients on the English side of the border who are treated in Wales, but they have no choice about that. They have set up a pressure group, Action for our Health—he can look it up on one of his smart phones—because they are so disgusted with the service that they are getting in Wales that they want to be treated in England. The point is that they do not have a choice, and I believe that they should. Those English patients are very angry about the fact that they are treated in Wales and not given the choice.
When the Secretary of State was talking about some of the things that have gone wrong in the NHS, I heard an Opposition Member shout, “He hates the NHS.” My right hon. Friend does not hate the NHS, but he does believe in putting patient choice and patient voice first. He believes in standing up for patients against vested interests, wherever they may be. I fully support him in that and commend him for what he has done. My only criticism of Ministers in this Government is that they have improved services in England so much that I have an enormous mailbag of letters from people who want to access the services that they have put on offer. If anyone wants to find out what would happen if Labour ran the NHS in England, they should look at the facts and figures for Wales.
As this is carers week, I want to talk first about the impact that legislation and financial policy have on the one in eight people who are unpaid carers. We know that being a carer can have a significant impact on a person’s finances, career, relationships and, of course, health. Full-time carers are more than twice as likely as non-carers to have poor health, but sadly the pressure on them is increasing. Surveys last year told us that six out of 10 carers reported suffering depression, and nine out of 10 felt more stressed due to their caring role.
Since 2010, local government budget cuts have led to funding on adult social care falling rapidly. By this March, local authority spending on adult social care had fallen by £2.68 billion in four years—a 20% fall. Those Government Members who have talked about funding today have nothing to be proud of when they reflect on that. Nine out of 10 local authorities now set their eligibility for social care at “substantial needs” or higher, compared with less than half of that in local authorities in 2005-6. Therefore, fewer people are receiving publicly funded care—300,000 fewer since 2008. Of course more of the care work load therefore falls on unpaid family carers, who in turn report suffering more stress and depression.
Carers UK reports that the ever-increasing need for care and support in our ageing population will outstrip the number of family members able and willing to provide it. A carers week survey found that fewer than three in 10 people believe that they will become carers, but about six in 10 of them will have caring responsibilities at some time in their lives. Between the last two censuses, the number of over-65s providing care grew by 35%. Among carers aged 60 to 64, 54% of men and 36% of women who were caring were also in paid work. Therefore, the pressures on men and women juggling work with caring have intensified.
Carers UK has found that one in five carers surveyed have had to give up work because either they were unable to secure flexible hours or their employer lacked understanding of their caring work load. Many carers then build up significant debts and have to cut down on basic expenditure, even on heating and food, to manage. This afternoon, I met a couple of carers at a speed networking event downstairs who told me exactly that. They had had to give up their jobs to care.
Dr Jamie Wilson, a dementia physician, has said that
“the financial welfare of carers should form part of a holistic assessment of needs. The combined effects of loss of income, additional costs of care and declining state benefits have led to an increasing impact on the resilience of carers and their ability to maintain the health of their loved ones.”
The Care Act 2014 represents a wasted opportunity, because it places on local authorities a duty to assess a carer’s support needs, but it places no similar duty on the NHS. The Act makes it clear that a local authority can charge for the support provided to carers. I feel that the Government are failing carers in two ways. Giving carers new rights to assessment is meaningless when the support available is dwindling as a result of higher eligibility criteria and increased charges. A right to a local authority assessment is of little help to carers who have no contact with their local authority.
At the meeting downstairs, I spoke with a carer called Caroline, who had come in with Macmillan Cancer Support. She has a multiple caring work load but has never been referred by her GP, or by any doctor she had ever met, to any sources of support. She only found Macmillan Cancer Support through a website. That is why identifying carers is so important. Macmillan’s survey of over 2,000 carers found that over 70% came into contact with health professionals during their caring journey, yet health professionals identify only one in 10 carers, with GPs identifying less than that. We cannot be smug or self-satisfied about that situation.
The need for NHS bodies to identify carers and ensure that they are referred to sources of advice and support was raised at all stages of debate on the Care Bill in the Commons, but the Government did not accept amendments on the issue, so now we will need further legislation. Another weakness of the Act is that it restated the option for local authorities to charge carers for services. Carers’ organisations have repeatedly asked the Government to make it clear once and for all that local authorities should not charge carers for the support they receive. However, Ministers did not consider it appropriate for the Act to remove that discretion, which I think is a shame. I think that the Government are failing carers in a number of ways, as I have outlined. This carers week, it is time to show carers that we do value their caring.
Let me touch briefly on a further aspect of health policy that relates to the attitude of NHS staff towards patients, as highlighted in the Francis report. An important source of improvement in that area is the social media campaign #hellomynameis, run by Dr Kate Granger. The campaign started 10 months ago, after Dr Granger’s admission to hospital, when she noticed that many health professionals did not introduce themselves when treating her. She spoke movingly at the NHS Confederation conference last week on the importance for patients and their care of getting the small things right. She pointed out that, in patient relationships, health professionals have most of the power, but they can make things more equal if they introduce themselves and explain what they are doing. She also explained the impact on her when doctors and nurses described her only as “Bed 7” or “the girl with DSRCT”—a rare cancer. As she rightly says, health professionals should always try to find out the patient’s name and how they like to be addressed.
The #hellomynameis campaign has had great success on social media, but it deserves much wider backing. With 1.6 million people working for the NHS, we need to spread the message about the importance of treating patients as people. It should become routine for health professionals to think about a more courteous and human connection with their patients. I hope that shadow Health Ministers and Health Ministers will do all they can to support the campaign.
Finally, in the short time remaining, I want to refer to my concern about issues caused for my constituents by measures in the Infrastructure Bill to allow fracking or shale gas exploration under properties without permission or appropriate compensation. The measure will have negative consequences for people with homes, farms or businesses adjacent to shale gas wells. We have had an exploratory shale gas well at Barton Moss in my constituency since November 2013. I have heard from businesses adjacent to the site that are losing money as a result and from constituents who have been trying to move but are finding it impossible to sell their homes. I have to tell the Minister that the offer of a £20,000 community payment seems paltry by comparison with the losses that my constituents have already suffered, even during the six-month exploration. The Government seem more concerned about a rush for shale gas than about the communities affected by the industrialisation of land caused by this process. We must have more caution and more consideration for our communities.
I will end with a story that explains the difference between the NHS in 1997 and 2010. In the run-up to the 1997 general election, I met someone in Wythenshawe and Sale East who had been waiting two years for cardiac surgery and was worried that he would die while waiting. In 2010, in my constituency, I met someone who within one week went to his GP, was diagnosed and had specialist cancer surgery that saved his life. That is the difference a Labour Government did make and could make again.
Order. I regret to inform the House that more Members wish to speak than time allows under the current time limit. Therefore, to ensure that everybody gets in, I must now reduce the time limit to seven minutes. Even that is really tight, so Members might like to be sparing with their interventions, so that they do not slow us down.
The Gracious Speech was an extremely fine speech, but I would have liked more work on the care agenda. The Care Act 2014 made a very good start, but there is more to be done. This concerns me particularly because Devon has the highest number of over-65s in the country, and my constituency has a very large chunk of that population.
By 2035, 25% of the population will be over 65, 620,000 will be in care homes, 50% will have a sight impediment, and 75% will have a hearing impediment. Today, one in five over-80s has dementia, and that figure is set to double within the next 30 years. The demand is not going to diminish, while the supply is a real challenge for our society as a whole. Seventy-five per cent. of current need is met informally through the voluntary sector and by families. We must give thanks for that, but we then need to think about the financial contribution from the state. The NHS budget, which is now 8.4% of GDP, is in absolutely the right place—that is exactly what we should be spending given the current state of our finances—but the social care budget is decreasing and has decreased by 10% in real terms since 2010, if Age UK’s figures are correct. The reason is cuts in council funding. In my rural constituency, council budgets have been seriously hit, and I see the consequences day in, day out. Day centres in Devon are facing closure and support for supported living is being ripped out. This is a matter of great concern that must be addressed quickly.
I welcome the 2015-16 better care fund of £3.8 billion, but will it be enough and will it be too late? Age UK says that £3.41 billion more is required if we are really to meet the need. I am a great believer that we do not solve everybody’s problems through money, so we must look at what we need to do. There is nothing more important than health and dignity in the ageing population. We need to look at what we, in a civilised society, believe good care should look like. We need a proper debate about who pays. Is it the individual, their family, or the taxpayer? We need to look at who delivers it. Is it the family, the voluntary sector, or the state? Clearly, it must be all those.
The Care Act made a good start. It provided uniformity in the funding structure, consolidated the assessment process, capped costs, recognised carers and the need for support, put a duty on local authorities for care and well-being of our older population, introduced safeguarding adult boards and the star rating system—very good steps forward—and recognised that prevention is better than cure. In some ways, however, it was a missed opportunity. The commissioning process that decides what is ultimately purchased is not overseen. We still have a postcode lottery against which people’s only recourse is an individual appeal. We still have a conflict of interest in that our councils can commission and provide care, as many do. That has to change. On quality, star ratings are a good move. Let us remember that this is about relativity, not absolute quality. What are we paying for—brass or platinum? There is, as yet, no reassurance that wherever anybody lives they will get the fair share of care that they deserve.
Staffing issues were not addressed. Best practice as regards staff and patient numbers is a ratio of 1:5, but the reality is more likely to be 1:7 given the budgetary constraints. No thought was given to trying to deal with some of the training concerns. Skills for Care is a voluntary programme. If we are going to make something really work, there has to be some stick and some carrot. I am pleased that we have a studio school in Torquay that meets some of the training needs and that the University of Surrey will introduce a proper foundation degree in 2015, but more is needed.
Integration could have been addressed. This is not just about money; it is also about health and wellbeing boards. The King’s Fund suggested that there should be a requirement that providers are engaged in health and wellbeing boards. At the moment, only 30% are so engaged, and that needs to change. I am very pleased that in Newton Abbot we have a pilot on the frail and elderly that deals specifically with integration.
There has been a missed opportunity for change, and change must come soon. We need to think about how to fund smartly. How can we increase the amount available to councils? After all, prevention is better than cure; otherwise A and Es and the NHS pay the price. How can we better support families to care for their elderly as we help them to care for their children? What can we possibly do in terms of time, flexibility and tax support? How can we support the voluntary sector? There is not an inexhaustible supply of volunteers, and they are fed up with the form filling that makes their lives burdensome. How can we reduce the capital burdens that councils face when having to deal with providing care? The capital cost of the homes and day centres is driving the closures. Let us work with social enterprise, housing associations and others to look for a better model.
Let us improve quality and remove the postcode lottery. Let us, as we can under the Care Act, ask the Care Quality Commission to review the whole commissioning process. Let us look at what is provided by our county councils, what value for money we get, and whether it is the same across the country. What are we paying for? Are we finding that people in one county are getting bronze and those in another, where more money is allocated, are getting platinum? That cannot be right. Let us look, once and for all, at splitting purchasers from providers as we have in the NHS. Let us get rid of the potential bias that exists in this regard. Let us review the make-up of health and wellbeing boards and make sure that providers serve on them.
Without proper resource, and that means people, we cannot get this right. We need to ensure that more nurses are trained and that they get the respect and the pay that makes them want to work in social care as much as they want to work in the NHS. Let us produce a proper career path that drives respect and reduces the fear they live in that they are going to be criticised for trying to do their best in an impossible situation. Let us enforce the best practice ratio of 1:5. Let us look at how we are going to fill the gap whereby unless one gets to a level of substantial need one will not be funded by the state. There is so much to be done and so little time. This has to be a priority for Government this year.
As a Plaid Cymru MP, it is something of a problem to respond to the Queen’s Speech on health matters, not only because it contained little about health in the first place but because health is largely devolved. Some time ago, when Alan Milburn was Health Secretary, I asked him about nurses’ pay, and he responded that he was eternally glad that he had no responsibility for things Welsh. He was wrong at the time, but now nurses’ pay is devolved. That is the measure of the problem that I face.
On the whole, the content of the Queen’s Speech was rather thin, with little attention given to the growing challenges we face of rising inequality, regional disparities, and an economic recovery that is built on fairly precarious foundations. The impacts and consequences for Wales are fairly obvious because of our higher rates of sickness and disability, higher proportion of older people, and greater needs in respect of poverty. Hon. Members may have seen today’s report on child poverty, which paints an alarming picture and casts doubt on the Government’s ability to reach the 2020 target of eradicating it. I think that that is now beyond reach, unfortunately.
Given the nature of the Queen’s Speech, I fear that the coming year will be a matter of treading water. For Wales, we have the continuation of the Wales Bill, but we also have missed opportunities. There are matters of particular concern to Wales, not least the funding of the Welsh Government. I also fear that we will see further dismantling of the principles of the welfare state, dismantling of public services, and a failure to address the deep structural economic weaknesses that we have, with a recovery that is driven by an increase in personal debt and spiralling house prices in the south-east and in London, and continues, I am afraid, the UK’s long-term imbalance that has devastated the economy in Wales, in parts of England, and indeed in Scotland.
Plaid Cymru put forward an alternative Queen’s Speech with Bills that we would have liked to be included. The Bills have principles central to Plaid Cymru’s vision for Wales, which is built on equality, prosperity for all, and social justice. We have 10 ambitious and workable Bills founded on strengthening Wales’ economic position and its position in terms of democracy, and on improving the lives of our people, not least in respect of health outcomes.
When the pension tax Bill is before the House, we will call for proper consumer protection for people who will have large pots of money at their disposal, as the sharks are already circling. We are extremely glad that the Government are introducing the modern slavery Bill. We also welcome the legislation to strengthen the law in relation to child neglect and organised crime.
We particularly welcome the Bill to strengthen the complaints procedures for the armed forces. We have campaigned for a very long time on veterans’ issues, particularly post-traumatic stress disorder. We support the proposed measure and hope it will prevent ex-service people from suffering mental distress and psychiatric conditions, which have resulted in so many of them ending up in the prison system.
Other Bills are appealing at first glance. A case in point is the heroism Bill, which seems likely to garner good headlines in certain sections of the press, but I share the TUC’s fear that it will have a bad effect on health and safety legislation and working conditions in particularly dangerous industries.
Turning briefly to our own propositions, we would have liked an economic fairness Bill aimed at levelling up the growing wealth inequalities that exist on both an individual and geographical basis in the UK, which is the most unequal state in the European Union. Such a Bill would mirror that part of the German constitution that commits to regional equalisation and prioritises poorer areas for infrastructure and foreign direct investment.
We would also have liked a Bill to ensure that Wales is fairly funded on the basis of need. It is a long-standing complaint that Wales is underfunded to the tune of £300 million to £400 million, as identified by the independent Holtham commission. Every year, Wales loses that amount of money. The cumulative total has had a clear, bad effect on our economy and it is an ongoing injustice. More than that, it actually constrains the Welsh Government and what they can achieve, forcing them to choose between essential spending on health, education, economic development and many other desirable targets of expenditure. The effects of underfunding are seen throughout Wales, not least in our health service, but on this issue the coalition Government in London are deeply compromised as they chastise the Welsh Government for their undoubted failings in health, while at the same time denying them the resources and means to address those failings.
We were greatly disappointed, though perhaps not surprised, that the Government botched the chance to end zero-hours contracts, particularly in the care sector. We would have liked an employment rights Bill to adopt measures to protect and empower workers.
I will catalogue the other measures we would have liked to see, including a natural resources Bill transferring responsibility for all of Wales’s natural resources from the Crown Estate and Westminster to Wales. We would also have liked more direct support for the tourism and hospitality industry and, lastly, a Welsh-language provision Bill to strengthen the requirements to provide services in Welsh, particularly by private organisations working without Wales into Wales. In respect of this debate, I point specifically to private organisations providing health care in England.
Sometimes we in Westminster get obsessed with the minutiae and detail of Bills and Committees, but our constituents do not have the same obsessions. As the Institute of Directors has argued, it is better to focus on a small number of Bills. A Volkswagen car salesman gets obsessed with the latest VW model, but the general public just appreciate better, cheaper cars. An engineer gets obsessed with a new widget, but the general public just want the machines to work. Our constituents do not get obsessed with Bills, how many of them there are, or whether they are nuanced towards the left or right. What they care about is that we get things right—and we are getting things right. One could argue that things are not happening quickly enough, but 1.5 million new private sector jobs is a darn good start. Is the reduction of the budget deficit by a third enough? No, it is not, but it is a darn good start.
This debate is a little bizarre, in that it is on health, even though health was not in the Queen’s Speech. The people on the doorsteps of Rochford and Southend East have not said to me, “Mr Duddridge, what we need is a new Bill on the health service.” In fact, I would wager that one or two constituents in every constituency would say that we have had far too many Bills on the national health service over the years, including recently. Having set out on this strategic direction in the NHS, it is right that we stick to it, bringing GPs closer to the broader care of individuals and bringing together social services and more traditional NHS care.
The NHS is a great British institution. When I was a teenager I attended religious education classes with a vicar, who asked: “If you didn’t know whether you were going to be born to a rich or a poor country or to a rich or a poor family, whether you were going to be fully able or disabled, or whether you were going to be healthy or suffer from ill health, where would you want to be born?” I say to this House that I would want to be born here in the United Kingdom, and one of the reasons for that is the national health service. When my son and grandparents were ill, they would not have received care anywhere near as good elsewhere. Yes, one or two places might have a slightly flasher health service—at double the cost—with shinier bells and whistles, but when a member of my family was ill I remember being told: “Internationally, the hospital in the States is very good, but the hospital your family member needs is the one they are going to, because it is the best in the world.” I think we are all grateful for that.
My hon. Friend Dr Lee made an eloquent speech and he knows far more about the health service than I do, but he seemed to want politicians to coalesce and form a view that one Member’s hospital should close and another’s should be extended. That is part of a responsible debate in the House, but we truly need to trust health professionals. Southend has a particular problem with its stroke unit, which has historically been very good. The Basildon stroke unit started off from a lower base point, but stroke doctors across south Essex tell me that what south Essex needs is a single, hyper-acute stroke unit. We need to trust health professionals across the board.
I was going to make a speech about pensions on Wednesday, but I am making a speech about health today because I am going to meet the chief executive of Southend hospital on Wednesday. Despite health being one of the two ring-fenced areas, there are serious pressures. My hon. Friend talked about changes in pain threshold and people’s demands, but we cannot meet all those expectations. We need to have a balanced national debate about what we can do and the best way to do it.
Turning to other provisions, I welcome the private pensions Bill. If the Whip on duty is listening, I would very much like to serve on the Committee. I cannot imagine that many Members will volunteer and suspect I have already secured my place. More than 12 million people have underfunded pensions. It is a serious issue. The Chancellor has taken some useful first moves on annuities, allowing greater choice for people coming out of pensions, but greater clarity is needed for those going into pensions.
Having previously worked in the investment and pensions industry, I know that all too often Government tinkered with the system and layered in cost for people who had only a small amount of money to invest. People often discuss the pensions of those on fat cat salaries, but most people’s pensions amount to managing only thousands or tens of thousands. A clearer, collective instrument that shares risk—greater risk can be taken when shared by a number of people—will be worthwhile.
I am not going to rewrite the Queen’s Speech like Mr Campbell. I am not sure whether he was being real Labour, old Labour or a socialist, but I saw Members on the Opposition Front Bench give him welcome looks when he said that his speech was not Labour party policy. It would in many ways have helped Conservative Members if it had been Labour party policy.
One small change that I would have liked is a help to rent Bill. There are 15 million spare rooms in the United Kingdom. I am not talking about Opposition Members’ incorrect use of the term, but of spare rooms in houses that are owner-occupied and perhaps under mortgage. Not everyone wants to rent out a spare room to somebody, but the spare room relief of £4,250 has not been changed since 1997. Rather as we are doing with council and housing association property, we could release some of the spare rooms in owner-occupied houses by making it more financially advisable to rent out a room. There is nothing wrong in taking in a lodger—
Yes, it is now. That is true.
I want to highlight an issue that I had hoped the Secretary of State for Health would have been on the Front Bench to hear in person. I do not think that he appreciates its seriousness, given that this leaflet might have changed the result in the ward where it was distributed. The leaflet said:
“Official announcement from the Health Secretary
Whilst calling on residents over the last few weeks it has become clear that the most important issue is the proposed closure of King George Hospital A&E. Lee Scott MP together with the Conservative Councillors have pressured the Health Secretary into clarifying the situation. Please read his statement overleaf. The position is now very clear:
KING GEORGE A&E IS NOT CLOSING
Ruth Clark, Vanessa Cole, Thane Thaneswaran”.
I heard about the leaflet because the local newspaper, the Ilford Recorder, put on its website a story with the heading, “King George A&E to remain open beyond 2015, says Heath Secretary”. That was published on
The press office said that it would refer me, if I so wished, to somebody in the private office who would call me back. I did not get a call from the private office—I did not really expect one—but I decided to get to the bottom of the matter. I have written to the permanent secretaries in the Cabinet Office and the Department of Health to ask for an inquiry into whether any officials, civil servants or Ministers were involved in the leaflet issued in Redbridge.
I hope that the Minister will convey to the Secretary of State that I give notice that I shall write directly to him after this debate to ask, under freedom of information legislation, for all the information about what contacts, if any, there were between officials, advisers or SpAds—special advisers—in the Department with councillors in Redbridge or anybody else about the publication of the leaflet before the election. As it turned out, Labour won all three seats in Aldborough ward and it was successful in winning control of the council, but it is clear that the leaflet was designed to influence the result of the election.
When I raised this matter in the business statement last week, I was told by the Leader of the House that there “was no announcement”, and that the leaflet was just a restatement of existing policy. When I made a point of order earlier, I could not quite hear what the Secretary of State said, which was why I raised it again. I will have to read tomorrow exactly what he said, but I think that he said that the leaflet was a statement of existing policy. If so, why was a leaflet put out that said:
“KING GEORGE HOSPITAL IS NOT CLOSING”?
Under the existing policy, enunciated on the Government Front Bench in 2011, both the maternity and accident and emergency departments at King George hospital were to close in about two years’ time. Maternity services closed last year. The A and E closure was supposed to be by 2014, and then it slipped to 2015 because of the chaos, the deficit and the fact that the Barking, Havering and Redbridge University Hospitals NHS Trust, covering both Queen’s and King George hospitals, has been put in special measures, and we now have yet another chief executive to add to the litany of chief executives over recent years who were supposed to have solved the problem. It is a shame that David T. C. Davies is not in the Chamber, but perhaps he could come to Redbridge to appreciate what services are under a Conservative Government.
The reason the A and E department has not been closed is because it cannot cope with the existing pressures, and it would not be safe to close it. We have a growing population in north-east London, with very large numbers of young people and children, and a large migrant population. There are therefore enormous demands on services. We have relatively poor GP services—we still have single-handed GPs in some areas—so we cannot expect people to go to a GP. Many people are not registered or are temporary, and they therefore turn up at the hospital. These fundamental and deep-seated problems must be resolved before we can start to take away services. The people of Redbridge understand that, which is why there is a campaign to save our A and E at King George hospital.
I will continue to pursue this issue until I get to bottom of the complicity of someone in the Department in issuing the leaflets that were designed to mislead the public in the few days before the election. I assure the Minister that this will continue until I get the whole truth.
May I start by paying tribute to my predecessor, Anthony Steen, for his tireless work in bringing in a modern slavery Bill?
Today, however, is for talking about health, which is a great passion for me in this place and outside it. The NHS touches people’s lives 1 million times every 36 hours, which is a staggering figure. I believe that the NHS is worth every penny of the nearly £110 billion that we spent on it in the last financial year. I am very proud that this Government have protected the health budget, but that does not of course mean that there are not enormous financial pressures. We are now in the fifth year of effectively near-flat funding, and the issues set out by Mike Gapes are part of those pressures. We know that whichever Government were in power, there would have been serious challenges.
If the NHS is to be sustainable, we need to listen to the new chief executive of NHS England, Simon Stevens, who has called on all staff members to think like a patient and act like a taxpayer—we must do that to get every ounce of value out of our NHS—and to address issues of patient safety and of how we keep people out of hospital in the first place and get on with implementing the measures. The nature of the challenge has been set out in exhaustive detail; now we need to get on with the measures that have been put in place to help to prevent hospital admissions, to treat people at the right time in the right place, and to integrate health and social care. I want us to look carefully at the better care fund and the plans for getting best value out of it, and at the issues of patient safety that were mentioned earlier.
Given the absence of much legislation in the Gracious Speech, there is one regret that I want to point out: the absence of the Law Commission’s draft Bill on the regulation of health and social care. I hope that in summing up this debate, the Minister will give some reassurance that he can use secondary legislation to bring forward at least some of the measures in that draft Bill. It covers issues that touch 1 million people across 32 professions that are covered by nine regulatory bodies. Unless we clarify the language so that there is a common language in respect of patient safety across all those regulators, it will be difficult to implement some of the core messages from Francis and to act quickly in response to emerging threats to protect the public.
Every year for three years, the Health Committee has called on the Government to allow the General Medical Council to appeal panel decisions that clearly have not protected the public. Likewise, the Nursing and Midwifery Council would like powers to reopen cases in which it has been judged there is “no case to answer” if serious new evidence emerges. Alongside that, the General Pharmaceutical Council would like to implement transparency and to able to take enforcement action. Those are all simple measures that I hope the Minister will mention in summing up. I also want the unacceptable level of delays to be addressed.
I am very pleased to hear that.
There will not be an absence of debates on health in this place. Two Bills will probably come here from the Lords in this Session: the Medical Innovation Bill and the Assisted Dying Bill. I will briefly put some of my concerns about the Medical Innovation Bill on the record while there is time for it to be amended. I have no doubt that it was introduced with the best of intentions to bring forward innovative treatments. However, I fear that it will have the reverse effect: it could undermine research and open the door to the exploitation of people when they are at their most vulnerable.
Currently, clinical negligence law provides redress for patients who have been harmed as a result of treatments that would not be supported by anybody of medical opinion. There is insufficient evidence that doctors are not introducing new treatments or are put off from doing so because of the fear of litigation. The NHS Litigation Authority has made it clear that doctors are protected from medical litigation in that respect. However, the briefing note for the Saatchi Bill talks about a doctor being able to use a novel treatment if he is “instinctively impressed” by it. In other words, doctors will be able to use an anecdotal base for treatments, rather than a clear evidence base. There are dangers in going down that route.
There have been some amendments to the Bill. Lord Saatchi has accepted that a doctor should have to consult colleagues and their medical team, but not that they should consider a body of opinion or consult ethics committees. I fear that we could be turning the clock back. We should rightly be proud of the advances that we are making in the field of medical research. We should rightly be proud of the push towards greater transparency, particularly in respect of open data and drug trials. However, I fear that if we allow people to access innovative treatments that have no evidence base, we will open the door to the purveyors of snake oil, rather than those who want to allow patients to enter controlled trials to establish a clear medical evidence base.
We should not underestimate the extent to which the purveyors of snake oil are out there. I put on the record my congratulations to Westminster city council and its trading standards department on fighting two successful prosecutions under the Cancer Act 1939 against two individuals, Errol Denton and Stephen Ferguson, for peddling so-called nutritional microscopy to people who were at their most vulnerable—cancer patients and patients with HIV—and telling them that it was an alternative to evidence-based treatments.
We must therefore be careful in how we move forward with such legislation. We should take more notice of the concerns of the Medical Research Council, the Wellcome Trust and the Academy of Medical Royal Colleges, who feel not only that the Bill is unnecessary, but that it could turn the clock back on evidence-based medicine. I hope that the Government will look at the concerns that have been expressed about the Bill in its current form.
Finally, Lord Falconer’s Assisted Dying Bill would enable competent adults who were terminally ill to have assistance to end their lives, but it would require the involvement of a medical practitioner. Although the Bill comes under the responsibility of the Ministry of Justice, it would have profound implications for end-of-life care and medical practice. It would fundamentally change the relationship between doctors and patients. There is a risk that the right to die would slide into a duty to die. I have seen how often patients who are towards the end of their lives fear being a burden on their families, and they often go through periods of profound depression. I do not feel that this Bill is the way forward.
It is wonderful to follow Dr Wollaston, and I totally and utterly agree with her concluding remarks.
Some may say that the absence of any reference to health legislation in the Queen’s Speech is a blessing; after all, the unwanted top-down reorganisation foisted on the NHS by the coalition and the previous Secretary of State is said by many to have put such a strain and stress on the NHS that it has been brought to its knees. Many Members present will know from their casework, inboxes, surgeries and personal experience that there is a rising tide of public concern about the NHS because of the lack of accountability and because decisions are being made upstream from local services. Our constituents may well view the absence of any mention of health in the Queen’s Speech as evidence of complacency, disinterest and unconcern. I have to say that I would agree with them. The Government have taken away the local means to secure improvements in services, and in this Queen’s Speech they have missed an opportunity to bring back local focus and accountability.
I want to look first at GP provision. One of my constituents wrote to me in April out of “sheer despair” at her inability to get an appointment at her surgery for an issue that she has said is not urgent. She has a busy job, is at work at the times she needs to call the surgery, and cannot leave work at the drop of a hat should she be offered an on-the-day appointment. As she put it,
“the current system is an absolute joke, to put it mildly…this current NHS system is completely useless”.
My constituent needs and deserves Labour’s GP access guarantee. Is there anything like that in the Queen’s Speech? The short answer is, “No, there is not, but there should have been.”
My constituents do not have the same access to GPs as people in other areas. Building on NHS England’s most recent survey, the Royal College of General Practitioners shows that 16.82% of patients in Newham were not able to get a GP appointment when needed, compared with 5.36% in Bath and North East Somerset.
The Government should adopt the GP access guarantee to address those inequalities, and the Queen’s Speech would have been the right place to introduce such proposals.
Before its abolition, Newham primary care trust had a clear plan to tackle and improve the challenging local situation, of which I was an active and enthusiastic supporter. Today, I am far less sure that mechanisms are in place locally that have the capacity and motivation to root out poor practice and promote the best. My misgivings were confirmed when I asked who now decides what to do when, for example, there is a vacancy at a GP practice in Newham. The answer came back—I still find this astounding—that the decision rests with NHS England. What is more, I was told that the London office of NHS England has a small number of people who deal with the provision of GPs, dentists, opticians and pharmacists. They must struggle to keep up with the paperwork, let alone have any capacity to look at proactive work on quality, improvement and service development.
What local knowledge can NHS England have about what is happening on the ground in Newham? How can that make any sense, and how is NHS England accountable to Newham’s people and its clinicians? What does it say about the reality of this Government’s commitment to localism? It is surely a matter of great regret that the Secretary of State did not seek to use this Queen’s Speech to address some of those very real issues.
In his response, the Secretary of State will no doubt include fine rhetoric about control being in the hands of GPs locally through the clinical commissioning group. He will laud to the skies their skills, commitment to patients and the NHS, and their virtue in all respects. I have talked at length to my CCG in Newham and worked closely with it, and I assure the Secretary of State that I share his opinion of its estimable qualities. In fact, I would add more approving words to his glowing testimony. I also know, however, of the CCG’s absolute frustration at the straitjacket that the new NHS structure requires it to wear, and I share its recognition that the reality of local empowerment is very different from that described by the Secretary of State and enforced with the diktats of NHS England.
The new structures leave decisions in the hands of NHS England. Surely the current Secretary of State can see that that is nonsense. In his calm, perhaps even reflective moments, I think that he knows and would admit that, if only to himself. What a shame that he did not use the Queen’s Speech to intervene and turn his rhetoric of localism into more local control over NHS decisions.
It is a pleasure to follow my hon. Friend Lyn Brown. I am pleased to speak in this debate, and let me clarify if I stray slightly off topic that it is a tradition that one can be wide-ranging in one’s comments, but I will return to the NHS.
In my view the British people do not deserve the Gracious Speech as delivered. The first sentence contains a contradiction. It states that the Government
“will continue to deliver on its long-term plan to build a stronger economy and a fairer society.”
What is the evidence so far? So far there has been a tax cut to 40% for those earning more than £150,000, while at the same time some are struggling to pay the extra rent for the bedroom tax or a spare room. Those are among the most vulnerable people in society.
Added to that is a continued assault on the public sector, and as we start the new session, there are still unanswered questions about the Royal Mail privatisation. There are plans to privatise the Land Registry, for which there is no case to answer, in addition to other cuts in the public sector. The Land Registry, the possibility of the east coast railway, the Forensic Science Service, the scientists at Kew Gardens—all that is the Government interfering with services that are profitable, safe and should be left alone to carry on with their expertise for future generations. Even the chief inspector of Ofsted has said that he will end its contracts with third-party services and employ school inspectors directly, because he thinks it is too important. So are all those other services and so is the legal system, but that does not seem to bother this Government. This is a giant jumble sale of the public sector.
The Gracious Speech contains a statement about selling off-high value Government land—land and assets that belong to the British people will be gone for ever. Members may remember the selling off of cemeteries for 3p by the former leader of Westminster council. The Government do not need to sell off high-value Government land for housing because that can be done by building on land where there is already planning permission. People in this country can use their creativity to find new ways to design new homes and build them, such as the programme developed by Walter Segal where people on the housing waiting list in Lewisham were taught how to build their own homes. That gave them expertise and empowered them, and the houses were sustainable.
My hon. Friend Barbara Keeley is right when she says that the Gracious Speech will allow fracking under people’s homes whether they want it or not. There is no definitive evidence that fracking works. Some 75% of the chemicals used in fracking are toxic and 25% are carcinogenic. There are concerns about its effects on the environment and on public health.
As many Members have pointed out, it is no coincidence that the Gracious Speech is silent on the NHS. Instead, the Secretary of State wants to punish the very people who have borne the brunt of the reorganisation that, by conservative estimates, amounts to £3 billion. He says they cannot have a 1% pay rise. He is withdrawing funding from front-line services, such as GPs’ minimum practice income guarantee, which affects surgeries in places such as Tower Hamlets and some rural practices, and which will be withdrawn from Wales a year later. The Secretary of State cannot blame the Welsh Assembly Government for that.
There is a lack of doctors in A and E because they are going abroad. Where is the long-term plan to end that crisis? Where is the Secretary of State’s response, other than leaving it up to NHS England? The lack of accountability, which was pointed out by my right hon. Friend Andy Burnham, has been exposed since the implementation of the Health and Social Care Act 2012. Nothing has been done. Instead, we get announcements about community hospitals without consultation with local people about which hospitals are needed and where they should be placed. The Government want to use public money in their own way, but they do not want to be accountable for it.
There is a provision, as other Members have pointed out, for redundancies to be capped. The revolving door and merry-go-round of people being made redundant and then rehired as consultants has been exposed time after time by Her Majesty’s Opposition. That public money could be used for my constituent Grace Ryder, aged 9, who was recently diagnosed with type 1 diabetes. She wanted to draw attention to this and raise money for charity, so on Saturday she helped to organise a fair at Delves Baptist community church. This courageous girl has to wear a cannula in her stomach for the delivery of insulin. There is an alternative—a pod that has no tubes—but it is not available on the NHS and the family cannot afford the £90 per week that it costs. Instead of these vast redundancy payments, money should be spent on the courageous Grace Ryder and other children to help them lead as normal a life as possible. I would ask the Secretary of State, if he only bothered to listen, whether he is as courageous as Grace Ryder. Can he make this insulin pump available on the NHS?
To promote a fair, just and more equal society we need to tilt the balance back to the British people. The Government should look again at the scaling back of the Equality and Human Rights Commission and the equalities agenda. The organisation was there to help and to provide evidence for some of the myths that abound that may explain why some communities are not tolerant of each other. Her Majesty’s Opposition will repeal the Health And Social Care Act, which has caused chaos, insecurity and inequality in the NHS and repeal section 75, which forces competition, not collaboration, wasting millions of pounds on legal advice. We will also build affordable homes like those built under the vision of Walter Segal, which became a reality in Lewisham. Equality, opportunity, justice and tolerance should be the foundations of the Gracious Speech and our society.
I am sorry that this debate began with a speech that was smug and complacent even by the standards of the Secretary of State for Health. I thought we had reached a low point until I heard Jackie Doyle-Price using a speech on the NHS to promote the tobacco industry. I am glad that those speeches have been balanced by those we have just heard from my hon. Friends the Members for Walsall South (Valerie Vaz) and for Westminster North (Ms Buck). Indeed, the speech from the shadow Secretary of State, my right hon. Friend Andy Burnham, reaffirms Labour’s commitment to the health service, which is fairly lacking from this Government.
I am going to speak about the crisis in the west London health service, partly because it is such a major crisis and partly because I think it indicates the way the Tories are dealing with the health service generally. It began two years ago, almost exactly, with the announcement of the biggest hospital closure programme in the history of the NHS. Since then we have had sham consultations with 100,000 people petitioning and being ignored, U-turns, confusion, incompetence, refusal to answer questions and political chicanery to make what happened in Ilford, as we heard from my hon. Friend Mike Gapes, look like a model of probity. Now we have the contamination of the whole NHS locally, including the primary care sector.
When the closure programme began, the medical director of North West London NHS said, candidly, that if it did not close four A and Es and two major hospitals, it would literally run out of money and go bankrupt. Those are the words he used. I suppose we should be grateful to him, because those statements galvanised the population of west London to engage in “save our hospitals” campaigns, and they have been campaigning for two years in rain and snow. Despite huge disinformation paid for by the taxpayer, by a Conservative council and indeed by the NHS, when I now stand in Lyric square in Hammersmith on a Saturday, I can be sure that 99% of my constituents know what is actually happening. I pay tribute to those campaigners from all political parties—including a lot of ex-Tories, as well people from minor parties, Labour supporters and others. They have really made the running on this issue.
Yes, there were changes. Initially, for example, we were going to lose the whole of Charing Cross hospital. Now there will be a local hospital on the site. When that was first mooted, a senior member of the local Conservatives and a Cabinet member said:
“This is an enormous teaching hospital with a 200-year history. You can’t make the Charing Cross hospital into a local hospital. It’s absurd. People won’t put up with that.”
Within weeks, they were spending ratepayers’ and taxpayers’ money putting out leaflets saying that Charing Cross hospital had been saved. That was compounded last October when the Secretary of State for Health stood here and effectively said, “Oh, it won’t just be an urgent care centre. It’ll be a second-tier emergency department.” Let me clarify the three differences between those two: recovery beds, X-rays and GPs. I thought we had GPs on duty in urgent care centres, but apparently not; we can just have nursing cover. It is an urgent care centre by any other name; to call it an A and E is misleading. It will lead to people with serious medical conditions going there and risking their and their family’s lives—as we have already seen at Chase Farm and elsewhere. Charing Cross and Hammersmith will not have blue-light emergencies—except for heart attacks in the case of Hammersmith. We will not have a stroke unit; we will not have the 500 emergency beds; we will not have intensive treatment. This is a second-class, second-tier health service.
The worst transgression happened in only the past few weeks during the local election campaign. I am not making this up, Madam Deputy Speaker. After the postal votes were opened and the Hammersmith Conservatives saw that we were ahead in some of their safe wards, the Prime Minister was brought down at short notice and locked in the basement of the Conservative party offices with a local journalist and came out with this pronouncement:
“Charing Cross will retain its A&E and services”.
I believe that the Prime Minister is an honourable man, and that he was misled into making that statement. The statement is demonstrably false because the NHS has clearly said that most of those services—other than treatment services, primary care services and elective surgery—will not exist at Charing Cross hospital under any analysis.
I thus went to see Imperial. It was the day after the election and I had been up for 30 hours and was not in a terribly good mood. I went to see the new chief executive of Imperial, and I tried to persuade her that Charing Cross should stay open. I said that I would take the new Labour leader of Hammersmith council to see her, as he might be able to persuade her better than I could. I then left and went home. That evening, she e-mailed to say, “Oh, I forgot to tell you when you were here: we are closing the other A and E in your constituency on
At the same time, as my hon. Friend the Member for Westminster North said, the CCG is writing to tell us that it is good news that in year—in the middle of a financial year—it has decided to pull together £140 million from the CCGs around north-west London and to redistribute it into primary care. In other words, they are panicking and having to take desperate measures because the primary care services are so short of money and cannot pick up the slack from the closure of A and E services. We might think, “At least they are doing something”. A substantial proportion—they will not say how much—is going out of my CCG and into other CCGs because, they believe, that is a fair way to distribute money. We are losing not only both A and Es, but our primary care funding and, with the closure of Hammersmith A and E—if we cannot prevent it from going ahead in September—Imperial has admitted in its own board papers that there is insufficient capacity at St Mary’s hospital.
Has my hon. Friend conducted any analysis that could reveal whether the redistribution of funds among the CCGs will take money from the more deprived areas and give it to those that are better off?
I thank my hon. Friend for that intervention. In exactly the same way, the Government are choosing to close the A and E department at Hammersmith hospital, which is slap bang in the middle of one of the most deprived areas of London, covering White City, Old Oak, Harlesden, north Kensington and east Acton. That means that 22,000 people who rely on those A and E services every year will have to travel to St Mary’s hospital in Paddington. They will not be directed to Central Middlesex hospital, which will be closing on the same day, and they will not be directed to Charing Cross hospital, because the plan is to close that within a year or two. They will be told to go to St Mary’s, where there are not enough beds and not enough capacity in A and E to cope with the current demand. That is contrary to undertakings given in the House that there would be no closures of A and E services until alternative services were provided. There will also not be enough acute services to provide a training base for students at Imperial college.
Two weeks ago we won the election in Hammersmith, against the expectations of, at least, the Conservatives, and we won it on this issue. If the Government will not listen to the 100,000 people who petitioned, perhaps they will listen to the people of west London who, on the issue of the NHS, overwhelmingly voted Labour and against the policies that are being pursued by the Conservatives. They should listen, and they should think again about hospital closures that will cost the health and the lives of my constituents.
I am delighted to be called tonight. As a by-election winner just 16 weeks ago, I felt the pressure of being 650th in the order of seniority, but, following the Newark by-election, I am now 649th.
This was my first Gracious Speech, and I am prompted to echo the words of my hon. Friend Mike Gapes. I was born and raised in Manchester, 95 of whose 96 councillors are now Labour, while the 96th is Independent Labour. That reflects people’s serious concerns about health, the establishment of Healthier Together in Greater Manchester, and what has happened to Wythenshawe hospital’s accident and emergency services over the past few years.
I pay tribute to the Leader of the Opposition and the Prime Minister for their kind words about Paul Goggins. He was an extraordinarily dedicated public servant, and the Prime Minister was very gracious in dedicating the legislation on child neglect to his memory. My constituents and I are grateful for that, and I know that Paul’s family will be as well.
It often occurs to me that the NHS will really be 90 years old next year. Aneurin Bevan’s father died in his arms, of pneumoconiosis, without the benefit of any health care provision. Bevan felt that the pain of one was the pain of millions, and he decided on that day that he would build the extraordinarily fantastic service that became the NHS, which he created years later in 1948.
I thought about why the Conservative-Liberal Democrat coalition partners did not want health to feature in this year’s Queen’s Speech in terms of electoral strategy, which was probably wrong. The key to any electoral strategy is not about two competing answers to the question, but about who gets to frame the question in the first place. The coalition partners want to ignore the health service because they know from Aneurin Bevan’s legacy, from the fact that we are leading in the polls, and from the way in which my right hon. Friend Member for Leigh (Andy Burnham) pounds the Government on these issues day in, day out in every part of the country that it is ground that Lynton Crosby wants them to avoid.
The top-down reorganisation cost £3 billion, and what has it done for my constituency? The Government downgraded the A and E centre at Trafford general hospital, the first NHS hospital to be opened by Bevan in 1948. They shut the Wythenshawe walk-in centre, and there was then a crisis of pressure in Wythenshawe hospital’s A and E department. Fourteen weeks ago, I asked the Secretary of State to meet me to talk about that. I later sent him a personal note, but he has still not contacted me about such a meeting. His own MPs want to be involved in that meeting. MPs on all sides of the political divide want to sort that out. I am demanding that the Government meet local MPs to discuss the continuing pressures at the hospital. Those pressures are expounded day in, day out by surgery work.
Last year, my constituent Emma Latham lost her husband Steven, aged 43. They had to wait 40 minutes for an ambulance. In February this year, she experienced breathing difficulties. The call was categorised as a red 2, but she still had to wait 40 minutes for the ambulance service to arrive. Tony Gunning, another constituent of mine, who has liver and heart failure, waited over an hour for his ambulance and for dialysis. He is often bundled into a taxi home by Arriva, the private sector provider, when it can organise one for him. John Ireland, another constituent of mine, has a heart condition. He has been told it will be two weeks before he can see his local GP.
That is not good enough. The Government might not want this to be the agenda in the next 12 months but Labour Members will highlight every case, every hospital, every downgrade and every closure, and we will make the case clear to the British public next May. The NHS will last as long as there are folk to fight for it. We on the Labour Benches will fight for it.
It is great to address the packed Benches on the Government side of the Chamber. This Queen’s Speech ought to be remembered as the last Queen’s Speech of the first coalition Government since 1945. I confess I am one of those who thought that it might never happen, but to their credit the coalition Government have put aside their differences and come up with a plan for a Bill to levy a 5p charge on poly bags. That would normally earn them a place in history, but this Queen’s Speech has been overshadowed, as we saw again today, by the row between the Home Secretary and the Education Secretary. Since the theme of today’s debate is health, let me say to the Education Secretary that trying to humiliate that lady could be very bad for his health—ask the Police Federation! Perhaps he should try to recruit a retired counter-terrorism officer to mind his back.
This has always been a Government built on hype. It has been there from the beginning, when they claimed that trebling tuition fees and slashing public spending were all for our benefit and would eliminate the deficit within five years. That much heralded and rebranded long-term economic plan aims to cut the deficit by the same amount as my right hon. Friend Mr Darling would have achieved. What has become long term is the prospect of continuing cuts and a deficit stretching years into the future.
We were led to expect a Bill to regulate health and social care professionals, but that is absent, despite Winterbourne, the Francis report and the latest Anglia Retirement Homes scandal. I regret that, because there is little doubt that we need to regulate those professions and provide greater assurance and security to patients, residents and relatives. I want to be able to tell my constituent whose elderly relative was induced to give a loan of several thousand pounds to her carer to buy a car that something will be done and that such crooks will not get away with it. I want to be able to tell the family of Ms Jones that, if they see the call button by the bedside disabled or find their elderly relative naked from the waist down and covered in excrement, something will be done. I want to know that the people who are doing the caring have been properly vetted and have suitable qualifications and training, are supervised and will be given the time to provide the care that their patients need.
Of course I would have liked an admission that section 75 of the Health and Social Care Act 2012 was a disaster. Far from putting GPs at the heart of decision making, it has reduced clinical commissioning staff to second-rate auctioneers. At a time when Simon Stevens is calling for more local and community services to provide care for the elderly, section 75 requires doctors to act like second-hand car salesmen. The way forward is to construct models that bring together statutory and voluntary services. We need the local state working alongside bodies like churches, community groups and even neighbours. Clinical commissioning groups should be creative and imaginative; instead they are stymied by the Government’s market dogma.
As this is carers week, I would have welcomed a law that recognised the rights and needs of the users of health and care services, that empowered them so that joint commissioning bodies were not allowed to close respite care facilities because accountants advised them it was an easy saving. I am battling to protect the Kingswood bungalows in my constituency, a purpose-built facility less than 15 years old, but targeted by those whose priority is to manage the books, not the interests of patients; and my constituent with severe autism who has lived in a specialist autism community for over 17 years. It is his home, but just as we have seen the crass contempt for people’s needs with the bedroom tax, we are seeing people like him threatened with eviction because the accountants and the joint commissioning administrators think they have found a way to save a few quid. I would have liked some legislation to regulate and enforce action against those who look after their own interests while wrecking the lives of others.
I welcome the promise to raise the number of apprenticeships, because if there is one issue that threatens the health and well-being of a generation, it is the spectre of unemployment and the denial of a future for our young people, but how many will be real apprenticeships targeted on the 16-to-19 age range? As with every other bit of hype, too many of the current apprenticeships go to those over 25 and are often just an existing job that has been redesignated. This is, after all, the Government who think they can send a young graduate already engaged in productive voluntary work to Poundland to learn how to stack shelves.
A Bill promising proper training, relevant qualifications, a chance to build a portfolio of skills, real employment opportunities and the full engagement of employers: that is what young people need. If we are living in the age of micro-businesses, and self and portfolio employment, then let us give young people the training that allows them to make a go of these things, rather than leaving them to be ripped off and exploited.
Sadly, this is a Queen’s Speech with none of those relevant interests served.
Over the space of a few weeks from this April, my constituency has been overwhelmed by a perfect storm of cuts and closures pushed through by NHS England and the local clinical commissioning group, all the result of this Government’s agenda.
People in the rural East Cleveland part of my constituency need NHS services and support seven days a week, and that is why the last Labour Government proudly introduced NHS Direct and walk-in centres, but East Cleveland now faces a triple whammy. The South Tees clinical commissioning group wants to end minor injuries provision at East Cleveland hospital and Guisborough hospital. It has also decided to cease walk-in provision at Skelton medical centre at the end of June, while NHS England wants to abolish GP provision at Skelton medical centre.
Ending minor injuries provision does not, in the words of the CCG consultation letter, provide
“better care for the vulnerable and elderly”,
and I fear that the CCG is trying to disguise cuts to vital minor injury provision. This leaves no urgent care services in East Cleveland.
That is particularly problematic for the villages of East Cleveland, where public transport links are poor and an ambulance service provided by the North East Ambulance Service trust “cannot cope”, as its chief executive admitted. Over six months last year, the North East Ambulance Service recorded 10,599 delays, 196 of which were for more than two hours. Paramedics are left unable to respond to waiting 999 calls, and a regional BBC programme only last week showed that the situation is worsening. I have raised this matter in the House on many occasions.
Both the two small hospitals I cited were once run by the local primary care trust, but after the coalition NHS reforms were pushed through they were passed on to the main hospital trust for our area, the South Tees Hospitals NHS Foundation Trust, which runs the excellent James Cook university hospital in Middlesbrough. The trust is already facing a £30 million to £50 million black hole in financing, having had only a £5 million deficit last year; it is being investigated by Monitor and has to make drastic cuts. It is little wonder that what might be seen as easy targets in ancillary units such as these two small local hospitals come up on the trust’s radar.
In addition, we have had the CCG and NHS England turning their big guns on another NHS facility in East Cleveland: they are looking at, and have announced as a fait accompli, the total closure of the Skelton health centre and medical walk-in centre. That proposal is part of a national coalition approach that has been targeting walk-in clinics set up by the last Labour Government. If the closure goes ahead, Skelton will lose one of its GP practices, a nurse practitioner clinic and the attached pharmacy. The clinic serves people from the poorer areas of the ward such as Hollybush, the Courts and north Skelton.
Like local people, I feel that NHS England is basing its views on old numbers which we feel are suspect. The provider, LivingCare, which owns the practice, is gobsmacked, as closure letters to people on the surgery list went out before they were told about the possibility of closure. In certain instances not enough letters were sent to people actually registered with the GP practice. Skelton as a town is undergoing vast expansion, with new housing going up and more planned. More than 1,000 new homes have been built in the past three years, with the new local plan indicating a further 400 homes on open land to the east of that new estate.
LivingCare was hit by a further blow when NHS England then announced the imminent closure of another GP facility it runs in my constituency. Unlike the earlier closures, this was not in rural East Cleveland, but in deep urban south Middlesbrough, on the Park End estate. I know the area well as my mother was for many years a teacher at the St Pius X Roman Catholic primary school on the estate, and I have relatives who still live there. The estate has profound social needs, with associated poverty and high indices of ill health. The cuts occurring locally in my constituency will increase the likelihood of people going to A and E, even when that is not appropriate. Our A and E has struggled to cope with demand over recent years, so these cuts are a false economy.
The mess of the Tory-Lib Dem NHS reorganisation, and the human tragedy it brings in its wake, deepens by the day. The coalition has already wasted £3 billion on a reorganisation and £1.4 billion on redundancies, and it is leaving the NHS weakened and confused. Locally, through this consultation, we are beginning to see the consequences on our constituents’ doorsteps. The approach being taken flies in the face of the call by NHS England’s new chief, Simon Stevens, for a marked change in policy and a shift away from big centralised hospitals. The health service chief executive says that we need new models of care built around smaller local hospitals and that, combined with comprehensive walk-in and GP care, is what my constituents need, deserve and rightly demand.
I have not been idle on these issues, but all my efforts have been stymied by a combination of bureaucratic blocking and ministerial indifference, resulting in Ministers’ responding to my requests for meetings with refusals, despite earlier friendly patter. Despite an outcry from local people, a full-page protest poster in the local newspaper Coastal View & Moor News and a massive petition, I managed to organise a meeting with NHS authorities that was unhelpful to say the least. Instead of a commitment to examine the clinical arguments and the issue of closures putting more pressure on the A and E unit at James Cook university hospital—a hospital with one of the longest waiting times for A and E in the region, if not the country—the NHS reps at the meeting retreated behind the protection of contractual timetabling, based on funding cuts issued by the Department of Health, because the “Darzi clinics”, as they were at the time, are coming to the end of their five-year contracts. I can say now, without equivocation, that such an approach will inflame my constituents, as I have seen already on the doorstep.
I still want to offer Ministers the option to meet me to talk about this issue, because I really fear the consequences for East Cleveland, and for Park End in particular, of these services being taken away. There is absolutely nothing in the consultation offering the individuals there any other option. There is no plan to put people in other GP practices. My fear is that we will have a time lag, and about 2,000 to 4,000 people not knowing where to go for primary care and ultimately ending up in the A and E unit—again.
The first line of the Queen’s Speech said that the long-term plan was to deliver a strong economy and a fair society. Failure to deliver in that regard is contributing to aggregate health costs in Britain. The question is how we use the existing budget to deliver better health, as opposed to increasing the aggregate amount of money that we spend on health to the levels that are enjoyed in the European Union and the United States. The answer must be to reduce some of the drivers of health costs and the conditions that are causing those costs in the health service.
Obviously, the first driver is smoking. The Government have an opportunity to change packaging, stop children smoking in cars and accelerate the rate of transfer to e-cigarettes. There could be great savings there. At the moment, it costs us £5 billion a year to treat people for smoking-related diseases.
The second driver is obesity. The Forsyth report suggests that, by 2050, half the UK population will be obese. There are issues about school meals and exercise. There is an option—I do not know whether the Minister is interested in this because he is looking at his iPad—to put a 20% tax on sugary drinks, which is seen in New York, Mexico, France and Norway. Oxford university thinks that such a measure would reduce the numbers of obese people by 180,000 and of overweight people by 285,000, and generate about £250 million of revenue, which could be hypothecated to fund cheaper fruit and vegetables for poorer communities.
The reality is that only 10% of young people under the age of 18 consume their five fruit and vegetables a day, but children under the age of 10 are consuming 19 grams of sugar. There is a case for a sugar tax. Coca-Cola contains 11 spoonfuls of sugar, and there is 50% more sugar in sugary drinks than is advertised. We need to discriminate between certain ingredients, such as fructose versus glucose, because of their medical impact. It has been noted in American that fructose creates a different sort of fat cell in the liver and the heart, which causes much higher mortality rates. We need to focus in on the fact that there are different sorts of fat. Ironically, the EU, which I normally support, has suddenly agreed with the fructose lobbyists that fructose should be called healthier because the high from it is not as quick, but the damage is much greater. The same goes for palm oil, which is a big killer in America.
Some of these issues are about taxing ingredients in processed foods. Madame Deputy Speaker, if I gave you a potato and told you to make some money out of it, you probably would not—or you might because you are a good person—just sell that potato. The way to make money out of the potato is to smash it up, add fat, salt and sugar, reform it as Dennis’s dinosaurs, put some packaging around it and a jingle on it and get children who are poor into the habit of consuming a large amount of it, so they die an early death. We should be aware of that, and we should be the guardians of the budget and of the people.
The same is true of advertising. If one looks at the back of a cereal packet, it will say low fat, but what it means is 50% sugar, and sugar is fat. Sugar is converted to fat if it is not energised through exercise and the like. We should be here to protect people from that, but we have dismally failed to do so. In fact, the opposite has happened. The Government’s economic policies increase stress and poverty, which are drivers of poor health and cost.
Britain now has the worst child mortality rates of the western world, bar Malta, with one in 200 children dying under the age of five. According to Washington university, that is linked to welfare cuts, which have driven people into using food banks. We just have to look at the situation on employment. We are told that there are all these jobs—I can see the Minister trying to ignore me—but 1 million of them are on zero-hours contracts. People are moving from benefits into zero-hours contracts, which leads to discontinuity in their benefits. They are having to go to food banks. They are under stress and feeling hungry, which leads to ill health for them and their children. Research suggests that 45% of people in debt have mental health problems—
I can hear my hon. Friend Kevin Brennan listening to this. Research in the EU has shown that recession leads to suicide. Two thirds of people on whom the bedroom tax has been cruelly inflicted are disabled.
The Government are responsible for many of the costs, which will become intergenerational, long lasting and profound. That is part of a process of saying that the health service is too expensive for the poor, so we should privatise it. Aneurin Bevan famously said:
“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community.”
I should like to see a future in which that community is one nation—not the weakest crushed by the strongest—so that that cost is shared more evenly and is lower and Britain is healthier for it. We look forward to a more equal Britain in opportunity and outcome, where the health of the nation is better and the salvation of the health service is once more in our hands, with a Labour Britain next year.
Our national health service is undisputedly one of the greatest achievements of any Government, yet the crisis that the NHS has experienced under the Government’s disastrous privatisation, threatens the survival of services and the quality of patient care. I am proud that it was a Labour Government who created the NHS, and I am proud it is a Labour Government who will reverse the damage done by the Health and Social Care Act 2012. In our health service, more than 4,000 senior nursing posts have been lost since 2010. Accident and emergency performances in the year following the Government’s reorganisation were the worst in a decade. Last year, South Tyneside hospital in my constituency had to cancel operations because of unprecedented demand for A and E services. Only two weeks ago, it emerged that the NHS in England had failed to meet a performance target for cancer waiting times for the first time ever.
The Government’s failed reorganisation has increased wasteful spending. The NHS now spends more on senior managers and management consultants than ever before, and it is increasingly bogged down in competition law, forcing it to spend money on lawyers that could have gone towards patient care. The pressures on our health service stretch well beyond hospital waiting rooms, as demand for NHS services is affected by trends in public health and the quality of social care. In those areas, we have seen massive cuts to local authority budgets of £2.7 billion. Faced with cuts of that scale, local authorities have been left with impossible decisions and have been forced to cut services, knowing that in doing so they would increase pressure on the health service.
Those who are lucky enough to be entitled to care find that their care worker can only stay with them for 15 minutes. These workers are poorly paid, with over 300,000 on zero-hours contracts. A third do not receive proper training. Unsurprisingly, staff turnover is high, so many clients do not manage to build a relationship with their carer. The Care Act 2014, which was passed in the last Session, presented an opportunity to address some of those issues, but unfortunately it was an opportunity that the coalition parties did not take. They rejected Labour amendments on low pay and zero-hours contracts that would have improved the standard of care that people receive. They also ignored charities that warned that the new eligibility criteria for support would exclude hundreds of thousands of people from the care system.
Of course, there are challenges facing social care, but we do not solve the problem by cutting support for those with moderate needs, only for them to end up in hospital. Last year’s QualityWatch report showed that about one in five hospital admissions could be prevented by better social care. The ultimate goal should be an integrated system like the one argued for by my right hon. Friend Andy Burnham. The Government at least pay lip service to that idea, but in practical terms they have done very little. The better care fund announced last June was meant for that purpose, but it was actually just money diverted from existing NHS services, proving that the Government are not serious about promoting integration.
Underlying all of that are broader questions about public health. Poverty and ill health often go hand in hand, and malnutrition in particular has become a frighteningly normal part of life in Britain today. I know parents who skip meals so that their children can eat, and people for whom food banks are the only thing standing between them and starvation. Malnutrition affects an estimated 3 million people in the UK, which is a scandal in the fourth richest country in the world.
The previous Government left office with fewer people in poverty than when they arrived. Child and pensioner poverty fell even after the financial crisis took hold, and we were well on our way to eliminating child poverty by 2020. But under the coalition, this trend has been reversed, and instead of eliminating poverty by the end of this decade the Child Poverty Action Group estimates that the number in poverty will have risen to 4.7 million.
The coalition has allowed this crisis to develop, and the Queen’s Speech needed to recognise families’ desperation by delivering help with living costs such as food, energy and rent. Poverty, and food poverty especially, has a knock-on effect for our health system. Experts have warned that there is a public health emergency. We are beginning to see diseases such as rickets returning as children no longer receive the balanced diet they need. The symptoms of poverty pose serious challenges to our health service in the long term.
Our national health service survives in spite of this Government, not because of them. It is strong because of its work force and because of a public who resolutely believe in it and value it. In communities around the country, families are fed not because their country’s Government have helped them to find decent work, but because their fellow citizens give up their time to lend a helping hand. Our country faces some of its biggest challenges for generations, and people feel that Britain is no longer working for them. Worse yet, people feel that politics has no answers to the difficult questions of our time. All these challenges need a Government who are willing to be bold, but this Queen’s Speech gave no hope of that. It was more of the same from a coalition that has long outstayed its welcome.
Thank you, Madam Deputy Speaker. It is a pleasure to speak in this debate.
There is unanimity across the House on the importance of the NHS in our lives and the lives of the people we serve. The vast majority of people working in the HNS do fantastic work day in, day out, often in difficult conditions, to deliver a health service that is the envy of most parts of the world. In our desire to make that even better, we sometimes forget the very good things that are there, but when the NHS fails us, it is important that we tackle those failures effectively.
One thing I have noticed when talking to health professionals at whatever level in my constituency in Scunthorpe is that they, to a man and a woman, feel that the reorganisation that was thrust upon them by this Government after promising no top-down reorganisation has distracted attention and added work load, when there is already a challenging work load to tackle without having to deal with that. There is a big enough challenge anyway.
“Healthy Lives, Healthy Futures” is the consultation that North Lincolnshire clinical commissioning group is undertaking to find out whether to take forward health provision locally. That is an important endeavour, but the growth in the number of people turning up at A and E and the ageing population create great challenges for everyone. It is interesting that the financial challenges that are faced compound that. The PCT legacy debts were provided for and CCGs had further money taken out of their budget for that. A further £2 million was taken out of the CCG budget locally, although its budget is about £100 million, to deal with the pressures in specialist commissioning. The challenges involved in specialist commissioning need to be tackled. That might have been included in the Queen’s Speech.
One of the oddities of the Queen’s Speech is how little there is in it about the thing that are most important to us—nothing about standard cigarette packaging, despite the Minister saying that she would introduce regulations, nothing on smoking in cars, despite the Minister saying that she would introduce regulations, and nothing to make it easier for people to see their GP. In its consultation with local people, Healthwatch North Lincolnshire identified access to a GP as one of the big issues locally. I had hoped that something would be done on that. I am pleased that the shadow Health Secretary made it very clear that Labour will at the first opportunity repeal the Health and Social Care Act 2012 and by rolling back the costs of competition and marketisation will guarantee an appointment at the GP’s surgery within 48 hours. That is something to be proud of.
Another missed opportunity was to do something to end the abuse of older people. Why not respond to Age UK’s call to make it an offence to neglect a vulnerable adult and to ensure that directors of organisations that provide health or care services can be held accountable for neglect or abuse? Why not do something about that? There is so much that could be in this Queen’s Speech and is not but, as my hon. Friend Steve McCabe said, at least we have the 5p plastic bag Bill and we should be grateful for that.
Let me turn to another issue that could have been tackled in the Queen’s speech: the need to up the game on our work on antimicrobial resistance. Take for example tuberculosis, caused by bacterial infection through the air. If left untreated, it becomes deadly and BCG vaccinations are not as effective as they should be. Many people think that TB has been wiped out, yet London has the highest rate of TB of any capital in the western world. An increasing percentage of those cases are resistant to TB drugs and TB has always affected the poor. No new front-line drugs have been developed in 50 years, so why not tackle this disease, which is a real threat and is already here?
TB can be prevented by relatively low levels of investment in proactive diagnosis, outreach and good social and clinical care. It is a complex disease that can be made more complex by our health services, which often fail to diagnose it on first sight. Some doctors unfortunately prescribe antibiotics, which feed the AMR and do nothing to help patients with TB. We need to raise awareness of the disease and make sure that patients get the right support from health services that are properly staffed and equipped. We need comprehensive outreach for TB, with screening, diagnosis and treatment of people before their health deteriorates and before they can pass the disease on to others. In short, we need a preventive approach to TB and other infectious diseases like it.
We need to invest now to save later, and my point about TB is illustrative of the many other things on which we need action. Instead of that action, in this Queen’s Speech we have more of the same inaction and inertia. It is not good enough. I mark this Queen’s Speech low on its approach to health issues, and I look forward to hearing the responses from the shadow Minister and the Minister.
We have had a wide-ranging debate. I listened carefully to the powerful speech by Dr Fox—I am sorry he is not in his place—on his concerns about Russia, which I share, and to the thoughtful contribution made by my right hon. Friend Mr Hain about the Government’s pension reforms. I for one am sorry that this will be his last contribution in a Queen’s Speech debate and he will be sorely missed by Members on both sides of the House.
The main focus of the debate has been the NHS and social care. My right hon. Friend Mr Brown and my hon. Friends the Members for Mitcham and Morden (Siobhain McDonagh), for Ilford South (Mike Gapes), for Hammersmith (Mr Slaughter), for Wythenshawe and Sale East (Mike Kane) and for Middlesbrough South and East Cleveland (Tom Blenkinsop) spoke passionately about their local services and the pressures they face. Those pressures are being experienced by services across the country as our population ages and more people are living with long-term conditions and the biggest challenge facing us is to reform front-line services to get better results for patients and better value for taxpayers’ money when there is far less money around.
Some services must be provided in specialist centres so that patients get expert treatment 24/7, but there must be a fundamental shift in other services out of hospitals into the community, focused on prevention and joined up with social care so that people can stay healthy and living independently at home. The last Labour Government had plans to deliver these changes in every English region through Lord Darzi’s NHS next stage review, and the single biggest mistake by this Government on the NHS was to scrap those plans and instead waste three years and £3 billion on the biggest backroom reorganisation in the history of the NHS.
Ministers do not want to talk about their reorganisation and their failure to make the real reforms that patients will need in the future. The Queen’s Speech should have included a Bill to modernise the regulation of doctors and nurses, in order to improve the safety and quality of care. That was recommended in the Francis report, it is what the General Medical Council and the Nursing and Midwifery Council want, and it is what patients desperately need, but Ministers have failed to deliver. They are desperate to avoid another NHS Bill after their disastrous Health and Social Care Act 2012, especially in the year before a general election, but let me remind hon. Members of the mess made by that Act.
Ministers said they would cut bureaucracy, but instead they created 440 new organisations: NHS England; Public Health England; Health Education England; four regional NHS England teams; 27 local area teams; 19 specialist commissioning units; 221 clinical commissioning groups; and 152 health and wellbeing boards. It is a system so confusing and dysfunctional that no one knows who is responsible or accountable for leading the changes that patients want and taxpayers need to ensure that the NHS is fit for the future.
Ministers promised that their reorganisation would save money, but £1.4 billion has been spent on redundancy payments alone and more than 4,000 people who were made redundant have now been rehired somewhere else in the system. And as if this chaos and confusion was not bad enough, the new chief executive of NHS England says there has got to be yet more change, with yet another reorganisation of specialist commissioning, because costs have spiralled out of control, and a reorganisation of NHS England’s regional and local area teams. As my right hon. Friend Andy Burnham, the shadow Health Secretary, said, this truly is the reorganisation that never ends.
The real cost of the Government’s failure on the NHS does not stop with their reorganisations. Labour Members warned that handing responsibility for local GPs to a national quango such as NHS England, scrapping the 48-hour waiting target and removing Labour’s incentives for evening and weekend appointments would mean GP services going backwards and, as my hon. Friends the Members for West Ham (Lyn Brown) and for Scunthorpe (Nic Dakin) said, that is exactly what has happened. A quarter of all patients now say they cannot get a GP appointment in the same week, let alone on the same day. We warned that cancer care would go backwards when the Government abolished vital cancer networks, and that is exactly what has happened. Two weeks ago, the NHS missed the cancer waiting time target—the first time any cancer target has been missed since 2009. We warned that disproportionate cuts to mental health services would mean worse care for patients and extra costs elsewhere in the system, and that is exactly what has happened. Patients are being sent hundreds of miles away because there are not enough beds locally, causing them and their families terrible distress and costing taxpayers millions of pounds extra.
We warned that slashing council care budgets was a false economy that would mean fewer elderly and disabled people receiving the support they need, forcing them into hospital and piling pressure on families and local A and E units. As my hon. Friends the Members for Worsley and Eccles South (Barbara Keeley), for South Shields (Mrs Lewell-Buck) and for Westminster North (Ms Buck), as well as Anne Marie Morris, rightly said, that is exactly what has happened. Fewer elderly people are getting vital help, such as home care visits or support from district nurses, so more of them are ending up in hospital and getting stuck there for longer.
We have had the worst year in A and E for a decade, with a million people waiting for more than four hours. Delayed discharges are at their highest ever for this time of year. These delays cost £268 million last year, which could have paid for 20 million hours of home care. Where is the sense in that?
Rising emergency admissions mean planned operations are going backwards too. Three million people are now on hospital waiting lists, which is up by half a million people since 2010. Last year, 64,000 operations were cancelled—the highest figure in a decade.
The combined effect of the Government’s disastrous reorganisation and their incompetent decisions means that Ministers have lost a grip of NHS finances too. This year, trusts are in deficit for the first time in seven years, and twice as many foundation trusts will be in deficit compared with last year. The NHS trust deficit will be three times higher than they predicted even at the beginning of this year. The real tragedy is that all that could have been avoided if Conservative Ministers had not been blinded by politics and ideology and if Liberal Democrat MPs had had the guts to oppose them.
The truth is that there was nothing on the NHS in the Queen’s Speech because the coalition Government have no plan and no idea how to solve the problems they have created. In contrast, a Labour Queen’s Speech would repeal the Health and Social Care Act so that services can work together in the best interests of patients and get the best value for taxpayers’ money. A Labour Queen’s Speech would use savings from scrapping the costs of competition to guarantee new rights for patients to see their GP at a time that is convenient for them. A Labour Queen’s Speech would end the scandal of inappropriate 15-minute home care visits and exploitative zero-hours contracts so that elderly and disabled people get the quality of care they deserve.
A Labour Queen’s Speech would deliver the real reforms that patients and their families need to create one health and care system and ensure truly personalised care: integration, not fragmentation; wise expenditure, not waste; putting people first, not playing politics with their health and the services families rely one. That is what patients want, what taxpayers need and what our constituents deserve, and that is what a Labour Government will deliver.
I thank all right hon. and hon. Members who have contributed to today’s debate. It has been a wide-ranging debate stretching well beyond the NHS, as the shadow Minister said. I think that we all enjoyed the alternative Queen’s Speech from Mr Campbell. His Front Bench colleagues looked horrified, but it was the authentic voice of Labour.
Well, let us just make sure that Opposition Front Benchers listen to the hon. Gentleman.
We can be justifiably proud, it seems to me, of the action we have taken in health and care over the course of this Parliament. Nic Dakin made a speech that faded away from agreement, but at the very start he made the point that we should all pay tribute to a really remarkable work force in the NHS—1.3 million people doing incredible work. We want to free those people up as much as possible to do the very best they can.
That is equivalent to about 6,000 nurses a year. The right hon. Gentleman has to demonstrate how that would be paid for. The fact is that there is an average wage increase of 3% as a result of annual pay increments under Agenda for Change. We have ensured that at least everyone will get a 1% increase. If he is arguing for something different, he has to say where the money would come from to pay for it and how he would cope with 6,000 fewer nurses, which would be the result of his action.
For the first time, it is this Government who have made decisive moves to join up the care and health system and focus more on preventing ill health. Contrary to the shadow Secretary of State’s claims, the better care fund has been widely welcomed, and it has initiated action across the country to join up a very fragmented system. We have sent out the signal that we encourage innovation and change, driven by clinicians from the bottom up, not from the top down. Brilliant pioneers across the country are ending this fragmented system that has interrupted patient care for so long and failed patients. Those pioneers are combating loneliness, which my hon. Friend Gordon Birtwistle spoke passionately about. It is so far removed from the caricature offered by the shadow Secretary of State and the tired old refrain about privatisation. It was, after all, a Labour Government who mortgaged the future of the NHS to the tune of billions of pounds with their private finance initiative programme, giving massive windfall profits to private consortiums—a scandal of historic proportions. Yet Labour Members continue to argue that the Government are privatising —an argument that is based on thin air, not substance.
Will the Minister tell the House at what point the provisions of the Competition Act 1998 were introduced into the Bill that became the Health and Social Care Act 2012? I think it was this Government who did that. In the Public Bill Committee, I commented on the fact that they were exposing the NHS and undermining the category B status of the European competition regulations by putting the Competition Act at the very heart of the Bill.
I am sorry to disappoint the hon. Gentleman, but it was under the Labour Government that it was made clear that competition law applied to the health care system. Indeed, the Labour Government’s guidelines on the NHS replicated exactly the regulations under section 75 of the Competition Act that this Government have introduced. Time and again, we hear false claims by Labour Members.
This Government have developed a new health and care system that is totally patient-centred, led by health professionals, and focused on delivering world-class health outcomes. The difficult decisions that we have made on public finances have meant that we have been able to protect the NHS budget. The shadow Minister spoke as though the Government have had to face no financial challenge at all. She knows that across Europe, Governments have slashed pay for health workers and introduced co-payments. We have done none of that. We have protected the budget for the NHS, and we are proud of doing so; Labour did not commit to that in its manifesto at the last election. The truth is that the NHS is doing extremely well under a great deal of pressure.
This Government have laid solid foundations to transform our NHS to help it to meet the challenges of an ageing population, drive up standards, and focus absolutely on compassionate care. My hon. Friend Sir Peter Luff spoke movingly about his experience of the importance of compassionate care. We have introduced tough, robust inspections overseen by new chief inspectors of hospitals, of social care, and of general practice. We have introduced ratings of hospitals, care homes and GP practices so that people know how good their local services are. We have introduced, for the first time, fundamental standards and the ability to prosecute—to hold to account organisations and directors who seriously fail patients. We have introduced a fit and proper person test for directors; for the first time, compulsory training for health and care assistants; and—I am particularly proud of this—a statutory duty of candour to ensure that there is openness when things go wrong in the NHS or the care system.
Given the Minister’s focus on accountability and transparency, why will he not support the regulation of psychotherapists and counsellors? My private Member’s Bill would have protected 1 million people.
He or I could set up shop as psychotherapists tomorrow and see these vulnerable people who are currently at risk. Why will he not protect them?
The Government are not convinced by the argument for statutory regulation. The hon. Gentleman and I have had this debate many times, and I am happy to continue to discuss the matter with him.
In the wake of Francis, the Government are clear that poor or unsafe care will not be tolerated. There will be consequences for those who fail patients.
Opposition Members have criticised the lack of health legislation in the Gracious Speech, yet, as several of my hon. Friends, including the Members for Witham (Priti Patel) and for Rochford and Southend East (James Duddridge), have noted, people are not out there on the streets demanding a new NHS Act of Parliament; they want safe, good, compassionate care.
The Government remain committed to legislating on professional regulation when parliamentary time allows.
Let me complete this point.
This is a complex area and we should not rush to legislate. We will keep making progress to respond to the scandal of Mid Staffordshire for the remainder of this Parliament. We are working closely with the regulators to ensure that key provisions, such as a faster fitness to practise test for nurses and midwives and English-language checks for all health care professionals, are in place during this Parliament.
The shadow Secretary of State quoted selected statistics on access to a GP, yet 86% of patients are satisfied with their GP practice. The Government have introduced a £50 million challenge fund, which will support more than 1,000 practices to develop innovative and flexible services. That will include Skype and e-mail consultations, as well as extended hours, and will benefit more than 7 million people.
Ann Clwyd again spoke extraordinarily passionately, giving a voice to those who feel they have no voice in our system. We should all express our gratitude to her for her continued campaigning on this critical issue, which demonstrates that we still have a long way to go if we are to ensure that we have a system of which we can all be genuinely proud. Like the right hon. Lady, I hope that one day the flood of letters on poor care will stop. We are doing what we can through the actions we are taking and we are grateful to her for the enormously valuable work she did on the complaints system. I hope the Labour Administration in Wales will do the same, especially after she eloquently highlighted the problems there in a recent BBC documentary.
I have given way quite a lot; I need to make some progress.
Mr Brown asked about allocations. It is right that the allocation of funding is no longer a political football but in the hands of experts. NHS England is seeking to make progress on reducing inequalities.
Mr Campbell talked about charging in the NHS. Access to NHS services is based on clinical need, not on an individual’s ability to pay. That is fundamental to the NHS, and for as long as this coalition Government are in power the NHS will remain free.
We heard from Members on both sides of the House —my hon. Friend Dr Lee and Ms Buck—that health care needs to change so that care is provided more locally. The better care fund establishes a £3.8 billion pooled fund, to help people to stay healthy and independent.
Of course it is not new money—this is a different way of working. We have never claimed that it is new money; this is to ensure that we use the money more effectively. Indeed, the hon. Lady’s Front-Bench colleagues have made the argument that by pooling the health and social care budgets, we can achieve more with the money available.
No, I will not; I have given way many times. The fund is the largest financial incentive by any Government to promote integrated care, and it would be better if Opposition Members applauded the initiative rather than constantly criticising it.
At the start of this Parliament, this Government had five priorities for health and social care. We have delivered on all of them. Through the Care Act 2014, we have delivered the most profound change to the care and support system for a generation. After a decade of inaction under the previous Labour Government, we have introduced, for the first time, a cap on care costs and extended means-tested support. No one will have to sell their home during their lifetime to pay for care.
Under the leadership of Public Health England, we have created a new public health service, giving public health the priority it deserves in local government alongside other local services. As my hon. Friend Richard Benyon outlined, it is vital that we prevent ill health in the first place, as opposed to repairing the damage once it is done.
We are transforming health and care so that services are integrated around the needs of patients and users. We have revolutionised NHS accountability and seen a successful transition to a new health and care system. Finally, by focusing on outcomes rather than top-down diktat, we can identify what works and where we need to give additional support to help the system do more.
I always enjoy the hon. Gentleman’s emollient Dr Jekyll, in contrast to the Secretary of State’s Mr Hyde. Will he be following the Crosby diktat and keeping his head down and his mouth shut about the Government’s record on the NHS between now and the general election, or will the Liberal Democrats be doing something rather different?
I am very happy to speak for myself, and I will do so in due course. I am sure that the Secretary of State is enormously grateful to the hon. Gentleman for his description of him.
In the final session of this Parliament, the Government will continue to ensure that the new health and care system works with both integrity and purpose, delivering safe and compassionate care to patients, their families and friends.
Ordered, That the debate be now adjourned.— (Mr Gyimah.)
Debate to be resumed tomorrow.