NHS (Charitable Trusts Etc) Bill

Baroness Keeley Excerpts

Friday 22nd January 2016 Commons Chamber

[Jeremy Quin]

The Comptroller and Auditor General already has a very valuable role, and I would not wish to place extra burdens on him. I take my hon. Friend’s point.

The purpose of the Bill is to provide clarity, so that donors know that the boards are in control of their destiny and will look after their assets appropriately in the interests of the charitable endeavours that they serve. Involving bodies such as the Comptroller and Auditor General would merely invite bureaucracy and confusion. There are myriad auditors prepared to do a good job to support charity trustees in their work and to ensure that their accounts are kept in good order, so I do not see the need to involve public bodies. With that in mind, in particular, I beg to differ with my hon. Friend the Member for North East Somerset, and I hope that he will not press his amendment.

I congratulate my hon. Friend the Member for Aldridge-Brownhills on introducing this Bill, which I wish a smooth passage. I hope that those who have tabled amendments will think again and not press them to allow for that smooth passage.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I congratulate the hon. Member for Aldridge-Brownhills (Wendy Morton) on bringing her Bill through to Report. The Bill will improve the independence of NHS charitable trusts, and I am pleased to speak on it. I did not serve on the Committee, but I note that it lasted only 10 minutes. The House has obviously since developed an appetite for debating amendments, which could be seen as surprising. However, the hon. Lady dealt with them very well, so I will keep my comments short.

[Michael Tomlinson]

Will the hon. Lady give way?

[Barbara Keeley]

No, because I want to keep my comments short, as I say.

As we have heard, funding from NHS charities supports innovation and research and enables the provision of additional facilities, services and equipment for their associated hospitals. Some Members have cast a shadow of doubt over the value of NHS charities, and I want to challenge that. Salford Royal NHS Foundation Trust in my local area has its own charity, and last year it raised over £450,000, which was used to provide additional services at the hospital. As with other NHS charities, the majority of its funding comes from donations and legacies, with some from investment income; there has been a great deal of debate about how donors feel about that. In some cases, however, donations come from patients and their families who are grateful for the care that they have received. Salford Royal is an excellent hospital, so it is very good that patients and their families are able to make donations via the charity to express their thanks. That is a very important aspect.



The charity funding of Salford Royal NHS Foundation Trust has been put to good use. In the past year, it has provided additional staff training and supported medical research, with the aim of promoting health and improving the treatment and care of patients. There has been a negative aspect to this debate, with doubt being cast on the value of NHS charities, but I do not agree with that. I agree with the hon. Member for Aldridge-Brownhills that the various amendments will not improve the Bill, and I am happy to support that position on behalf of the official Opposition.

--- Later in debate ---

[Barbara Keeley]

As we have heard, this Bill will improve the independence of NHS charitable trusts, and I am pleased to speak on Third Reading. As we have also heard, Great Ormond Street hospital provides essential care for many children in the UK and across the world through its research into many child health issues. I am glad that the Bill will ensure that the trust charity will continue to be able to benefit in perpetuity from royalties and other payments in relation to performances or publications of the play “Peter Pan”. I can assure the hon. Member for Aldridge-Brownhills (Wendy Morton) that the hospital’s research and care stretch well beyond Greater London.

The Bill will also remove the requirement for the Secretary of State for Health to appoint trustees of NHS charities. I hope that reducing the involvement of the Department of Health in NHS charities will provide the organisations with more freedom to grow, and with clear independence. I hope they will be able to attract additional donors; that is important for NHS charities such as the Salford Royal NHS Foundation Trust, which I mentioned earlier. The research that it has helped to fund spans a wide range of departments, from physiotherapy and urology to a joint project with the University of Manchester looking at factors that lead to complications for patients with type 2 diabetes. That shows what an important role our NHS charities can play in potentially life-saving research. Like many others, the charity has also focused on improving patients’ experience in the hospital. Equipment has been purchased by the charity to aid patients in their recovery. For example, the charity purchased reclining chairs for patients recovering from neurosurgery, which enable them to sit in a more comfortable posture.

NHS charities play a significant role in our hospital trusts. They provide funds for life-saving research and help NHS staff to provide the best care possible for patients and their families. On behalf on the official Opposition, I am pleased to support the Bill on Third Reading. It will help to ensure that NHS charities can continue their vital work supporting patients and staff in the NHS.

Vulnerable Adults: Transport

Baroness Keeley Excerpts

Thursday 21st January 2016 Commons Chamber

[Rebecca Long Bailey]

I thank my hon. Friend for those helpful comments. I completely agree. As she will hear, Tameside is not alone in suffering such savage cuts.

Salford City Council had to face the difficult decision to cut the in-house provision of vulnerable adult transport for over 200 families across the city, amounting to a £500,000 cut in transport support for those with special needs. That was alongside the £400,000 that the Government’s cuts took from the provision of adult social care support to those with learning difficulties in the same year. I must add that prior to the cuts the transport service was rated excellent as a council service. It was not inefficient and there were no plans to cut it had the funding been available.

Commenting on the Government cuts at the time, our mayor, Ian Stewart, stated that

“this is not about efficiencies any more. These cuts will cause untold damage to the services we provide”.

Even in this desperate funding crisis, the council worked hard to make the best of a terrible financial situation. In partnership with the individuals affected and their carers, appropriate alternative arrangements were made. Transport was not ended for anyone until suitable alternative arrangements had been agreed. The good news is that a number of parents were generally happy with the council’s new arrangements, because they can individualise their journey times. That means that they are not spending significant amounts of time on transport, which previously resulted in some people arriving at the day centre in an agitated mood. The council is very much aware that the change is not universally popular, and it continues to work with any individuals who express concern. The fact remains, however, that it does not hold sufficient funding to provide an in-house passenger transport service as it was provided.

I have spoken at length to some of the families affected. I have heard their tales of despair and their worry about which other services that they rely on might be cut in future. I have listened to the mayor, our councillors and council officers, who have frankly lost faith in the Government’s commitment to provide a welfare system, which should be there to look after the vulnerable. In the wider context, for the 2014-15 financial year, a total of £4 million had to be cut from community health and social care, £2.4 million from public health, £4.7 million from support services, £5.6 million from education, and £4 million from environment and community safety. These are not “efficiency savings”—they are cuts to front-line services.

Perhaps in 2010 there were areas where genuine savings could be made with minimal knock-on effects on front-line services, but by the time £97 million has been taken from the budget, there is nothing left to cut but vital front-line services. Even the Prime Minister’s own council leader had to explain this principle to him following the now infamous letter in which he criticised his local council’s cuts to front-line services. By 2016-17, Salford City Council will have to make budget cuts of £188 million in order to balance its budget; £83 million of that sum alone is the amount by which the Government grant has been cut. That is a cut of over 43%, but in real terms the figure is much higher.

This is not just an issue for Salford City Council. Every council has faced vast reductions in funding from central Government, and my local council is not alone in having to cut transport for those with special educational needs. Countless numbers of local authorities have reduced or completely ceased to provide transport for vulnerable adults. It is rather tenuous, therefore, for the Government to argue that all these councils have made the choice to cut such an important service when they could instead have made efficiency savings in their back offices. These councils have no such choice any more.

When my constituents visited me about this issue, my first reaction was to try to locate funding elsewhere. What about the northern powerhouse, I thought, all that money that is supposedly being unlocked in the north—surely Salford’s vulnerable people deserve a piece of that? When I examined the detail I became even more disillusioned. We have often heard the Chancellor wax lyrical about his so-called devolution revolution, which he argues will enable areas such as Salford to raise and spend revenues locally, but he fails to acknowledge that councils in poorer areas have very limited revenue-raising capacities.

For instance, the policy to allow councils to set and retain their own business rates without the safeguard of a grant scheme has the potential to create severe inequalities among different areas of Britain. Indeed, the director of the National Institute of Economic and Social Research has said that while he agrees with the principle, it would be “inconceivable” not to keep a grant scheme. He stated:

“does this have the potential to disadvantage deprived areas and advantaged rich ones?..Absolutely!”

The Institute for Fiscal Studies has expressed concern that such a move would create winners and losers, with poorer areas seeing a fall in revenue. Let us not forget that we are already seeing disparities between local authority cuts. Between 2010 and 2015, Salford saw cuts of £210 per head, while authorities such as Epsom and Ewell saw only a £15 per head decrease. With local government funding being cut in terms of the grant by 56% by the end of this Parliament, it is frankly terrifying for Members like me whose local councils will see even more significant reductions in their spending power.

The same issue arises with regard to the social care precept, which would allow councils to raise council tax by 2% in order to fund social care. The president of the Association of Directors of Adult Social Services has warned:

“The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality.”

[Barbara Keeley (Worsley and Eccles South) (Lab)]

My hon. Friend and parliamentary neighbour is making a great speech in support of our local council and about the difficulties it faces. On the social care precept, does she agree that a council such as ours, which has lost £15 million from its adult social care budget, will be able to raise, at most, only £1.5 million to £1.6 million? The gap is enormous. We no longer want to hear Ministers saying that they have put extra funding into social care, because, frankly, they have not.

[Rebecca Long Bailey]

My hon. Friend is right: councils in deprived areas will have the greatest social care needs, yet they will raise less than a third of what more affluent areas raise through this approach. I really fear that any revenue we raise across the city of Salford will barely touch the sides of the funding crisis in social care. Sadly, the Minister may be hoping to say that services such as in-house transport for vulnerable adults could be funded through a future increase in the social care precept, but that is not likely to be an option for Salford City Council. As I have outlined, councils in deprived areas have already been hit the hardest, and they will be hit worst again by the measures in the latest spending review.

The Government have had since 2010 to convince us that their argument for local government austerity is necessary. In that time, they have slashed the budgets available to councils for vulnerable adult transport and other essential services, while at the same time handing out tax breaks for millionaires, slashing inheritance tax and, despite their rhetoric, doing very little to crack down on tax avoidance. In fact, only in December we heard that five of the largest banks in the UK paid no corporation tax at all in 2014, despite making billions of pounds in profits.

The Prime Minister gave the game away in an interview on Monday morning, when he said that

“if you are a Conservative, you don’t believe in a big state”.

I fear that that is what these cuts are all about: rolling back the state and going back to a time when the vulnerable relied on the philanthropic donations of wealthy people with a conscience.

The cuts that have been inflicted on my city are clearly a political choice, not an economic necessity. My and my hon. Friend’s city is living in fear, with the sword of Damocles hanging over our heads, waiting for the next savage cut to drop.

I look forward to hearing the Minister’s comments and I hope he will be able to reassure me that my fears are unfounded. I also hope that as a result of this debate he will ensure that there is a much-needed boost to local government funding, in order to provide essential services such as the one I have outlined. I hope he amazes me with what he is about to say.

--- Later in debate ---

[George Freeman]

If the hon. Lady had asked her question in slightly more moderate terms, I might have been able to agree, but when she talks about “savage cuts” completely undermining any progress on integration, I cannot agree with her. That extreme language does not tally with the rather better numbers—I am not pretending that there are not challenges, because there are—but I will come to them in a minute.

[Barbara Keeley]

Will the Minister give way?

[George Freeman]

I will give way briefly, but I want to answer the questions that have already been asked.

[Barbara Keeley]

Like my hon. Friend and constituency neighbour the Member for Salford and Eccles (Rebecca Long Bailey), I want to talk about Salford. It was one of the last authorities in the country that managed to hold on to moderate eligibility for social care, but the cuts that my hon. Friend spoke about mean that we have had to move from moderate to substantial. There is not the funding in the system that the Minister is outlining.

[George Freeman]

I will come on to the numbers for Salford. I rang Salford this morning to get the very latest numbers, and they make quite interesting listening.

Let me just set the scene on the settlement. In the context of the tough public sector finances, we listened to local government and took steps to protect social care services. In the spending review, we reflected that by introducing a 2% social care precept to the council tax for authorities with social care responsibilities. It is ring-fenced: it has to be spent on social care. The precept could mean up to £2 billion of additional funding for social care by 2019-20, which would be enough to support more than 50,000 people in care homes or 200,000 people in their own homes. In addition, we have secured a further £1.5 billion by 2019-20 through extra funding for the better care fund, which brings that funding to a total of £5.3 billion. Those resources are secure, and they are in the hands of local authorities.

Let me turn to transport for disabled people in Salford. Rightly in my view, the provision of social care and the question of how to meet local need are very much matters for the local authority, as I think hon. Members would agree. That is at the heart of this issue. I understand that Salford City Council has decided that the transport needs of people who require support to get to local day care and respite care services can best be met, in the patients’ interests, by closing the in-house passenger transport unit and providing suitable alternatives for individuals.

I also understand from the local authority that a significant number of parents and carers have commented on how much better the arrangements are because they can individualise journey times. Instead of having to wait and then sit on the council bus to get to services, going on very long routes, the vast majority of users are getting a much more personal and bespoke service. It means that the users of the service do not spend significant amounts of time on transport, which used to result in some of them arriving at a day centre or home upset, agitated, delayed and frustrated.

The council has worked hard to resolve the concerns that have been expressed by care users and their families. Having spoken to the council this morning, I understand that all have now accepted the new arrangements. Indeed, the director of adult social services at Salford City Council has told me that he considers the change to be

“a success both in terms of outcomes for individuals and in delivering a saving to the council budget.”

[George Freeman]

I am not sure what the question was. It is interesting that the hon. Lady is saying that the review was the right thing to do and the service has improved, but the rationale for doing it was wrong. I beg to differ. If the rationale that we have to deliver more for less leads good councils, in this case Salford, to find a better way to deliver services that uses less money and provides a better service, that is good. It is exactly what we want councils across the country to do.

For far too long, local government has been hidebound by receiving far too much of its funding from central Government. For me, as a localist, it is anathema that the majority of local government spending comes from central Government. That is why we have begun the process of seriously rebalancing the funding settlement by providing more powers and freedoms locally to raise money that can be spent on locally agreed priorities. The social care precept and the retention of business rates locally are powerful things for which many of us have campaigned for years.

If Salford uses the full social care precept flexibility that we have just provided, it could raise £7.6 million in 2019-20. That will be on top of Salford’s additional income from the better care fund of £10.5 million in 2019-20.

This is not about cuts. It is about a Labour council making prudent decisions that not only improve the way in which services for vulnerable people with disabilities are delivered, but do so in the most cost-effective way. The council’s prudence extends to its decision to nearly double its non-ring-fenced reserves from £29.7 million in 2010 to £56.5 million at the end of 2014-15. I will just say that again: the council doubled its reserves to £56.5 million over the course of the coalition Government.

[Barbara Keeley]

The Minister is being rather complacent in the way that he is responding to this debate. Salford City Council has announced this week that it is having to use its reserves for flood victims, when the Prime Minister will not even apply to the EU solidarity fund for funds. On the point that the Minister makes about social care, the Prime Minister heard this week from the Conservative leader of Essex County Council, who pleaded with him to bring the money forward. The Minister is talking about money for 2019-20. We have to get through the time until then. The money is back-loaded and it is not enough. The situation is risky and uncertain because the money will be provided so late. I should tell him that council leaders are very worried about 2017-18.

[George Freeman]

I will take the question as being, what do I think about that statement? The hon. Lady is right that the funding ramps up, but she is not right in saying that it does not come on stream until 2020. Indeed, I have looked at the figures for Salford. The money that will go to Salford from the better care fund will be £1.1 million in 2017-18, £6.1 million in 2018-19 and £10.5 million in 2019-20. Similarly, the precept will rise over the course of this Parliament, depending on Salford’s decisions on raising it.

Salford’s reserves have gone from being £29.7 million in 2010 to £56.5 million. Those reserves are public money that is there to be used prudently. In this period when we are all having to make sure that our children do not inherit ever more debts, I do not think the fact that Salford City Council is having to dip into its reserves to ensure that it is able to provide services—which, remember, are costing less but delivering better quality—is the savage crisis that the hon. Lady referred to.

Care Homes: England

Baroness Keeley Excerpts

Wednesday 13th January 2016 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in a debate with you as the Chair, Mrs Main. I think it is the first time for me, although others have a different experience. I congratulate my hon. Friend the Member for Hove (Peter Kyle) on securing this important debate. As well as his speech, there have been speeches and interventions from my right hon. Friend the Member for Enfield North (Joan Ryan), my hon. Friends the Members for Dewsbury (Paula Sherriff), for Rochdale (Simon Danczuk), for York Central (Rachael Maskell) and for Redcar (Anna Turley), the hon. Members for Newton Abbot (Anne Marie Morris) and for Bexhill and Battle (Huw Merriman), and the SNP spokesman, the hon. Member for North Ayrshire and Arran (Patricia Gibson).

The care home sector in England is in crisis. A toxic combination of a chronic lack of funding plus rising demand and increased costs means that care providers are facing an extremely difficult time. I will go on to say more but we heard a great deal about that during the debate. The social care settlement announced in the autumn statement does little to provide the additional resources that the care home sector needs. As I said in Health questions last week, the Government’s funding proposals for social care are risky, uncertain and late. They are risky because the better care funding is back-loaded. It does not reach £1.5 billion until 2019. Indeed, it offers nothing this year and only £100 million next year.

Funding from the social care precept is uncertain. It can only raise £1.6 billion if every single council decides to raise council tax by the maximum amount and that is by no means certain. Only about half of councils chose to increase council tax this year. Despite social care pressures, it is unlikely that all councils will want to implement an unpopular tax increase at this time. Both sources combined are late, because they do not help this year and they only reach £3.5 billion in 2019-20. Council leaders—including, I think, a council leader in Essex—wrote to the Prime Minister asking him to move some of the funding forward.

In a joint review of the spending review undertaken by the King’s Fund, the Health Foundation and the Nuffield Trust, the total funding gap for social care is found to be between £2.8 billion and £3.5 billion by the end of this Parliament. We need to make it a goal to close that gap. The three organisations conclude:

“Public spending on social care as a proportion of GDP will fall back to around 0.9 per cent by 2019/20, despite the ageing population and rising demand for services. This will leave thousands more older and disabled people without access to services.”

I suspect that it is probably hundreds of thousands, not just thousands.

The plans for the social care precept are seen as unfair due to the wide variations in the revenue that local councils can raise from their council tax base. Deprived areas can have the highest need for publicly-funded social care, yet councils in those areas are less able to raise significant additional revenue from council tax.

Let me give the example of my local authority in Salford. The adult social care budget is now £61 million. It has had to be cut by £15 million since 2010 due to cuts in the central Government grant, and 2% of our council tax—the maximum we could raise if everyone paid and, of course, they do not—is £1.6 million a year so that does not close the gap. Ministers have failed to explain how the social care precept can be implemented in a fair way that addresses the differences in need across the country. That is important.

The care sector responded to the spending review by saying:

“We believe the package put forward for social care will not enable us to fill the current gap in funding, cover additional costs associated with the introduction of the National Living Wage, nor fully meet…growth in demand due to our ageing population… the settlement is not sufficient, not targeted at the right geographies and will not come soon enough to resolve the care funding crisis.”

That is absolutely clear, and it is the sector itself saying that.

The social care funding crisis is most apparent in the care homes sector. In his opening speech, my hon. Friend the Member for Hove gave a useful analysis of the differences between large and small providers, but I will focus on what could happen with the biggest care home operator. Four Seasons owns some 470 homes and cares for 20,000 residents, mainly older people. It has been reported that, in the third quarter of 2015, Four Seasons lost more than £25 million before tax, and the rating agency Standard & Poor’s has warned that Four Seasons could run out of money in as little as six months. Squeezed local authority fees and the cost of temporary nursing staff are cited by the company as the reason for its financial difficulty, and we know from this debate that those pressures are only going to rise.

The so-called national living wage will be introduced in April 2016, and we have just heard the views of the hon. Member for North Ayrshire and Arran, the Scottish National party spokesperson, on that. Perhaps the key thing, whatever we think of the level of the national living wage, and it probably is not enough, is that the Government have so far provided no assistance to help care home providers or local authorities to address the increasing costs caused by their own policy, welcome though it is, because increasing the pay of staff working in the care sector is vital—I think we all agree on that.

Before the spending review, a sector-wide group of charities, organisations and providers wrote to the Chancellor expressing concerns about the funding gap in social care. They said that a £2.9 billion social care funding gap would have these results:

“Up to 50% of the care home market will become financially unviable and care homes will start to close their doors. 74% of homecare providers who work with local councils, have said that they will have to reduce the amount of publicly-funded care they provide.”

Care homes are already finding it difficult to provide quality care, as we have heard. The CQC’s 2015 report recognised that, of course, adult social care providers face challenging times, but it raised concerns, as my hon. Friend the Member for Hove did, that nursing homes provide a poorer quality of care than other adult social care services. Indeed, just under half of nursing homes rated up to 31 May 2015 were rated good or outstanding, and one in 10 were rated inadequate. That trend is likely to continue unless the funding gap is addressed.

We have heard about the ResPublica report released in November, which projected a funding gap of more than £1 billion for older people’s residential care alone by 2020-21. My hon. Friend referred to that, and it could result in a loss of some 37,000 beds, which would be greater in scale than the collapse of Southern Cross. A loss of beds on that scale would have significant costs for individuals, families and the NHS. If all the residents of lost beds in care homes included in the report were to flow through to hospitals, the annual cost to the NHS is put by the report at £3 billion.

There has been excellent coverage in this debate of the postcode lottery that exists in certain regions of the UK. Of course, care homes in certain regions are much more likely to be subject to significant financial pressures. A market insight report by LaingBuisson found that the proportion of self-funders varies dramatically between regions, and we have already heard some examples. In 2014, in the north-west, only 18% of residents were self-funders, compared with 54% of residents in the south-east. That contrast has already been drawn out by my hon. Friends. Those differences have significant implications for the financial viability of care homes in regions with higher levels of local authority-funded residents.

It is no surprise that the Government’s policies have failed to attract investment in state-funded social care, and it has not happened on its own; but many providers have been forced to attract private funders to maintain their profitability, and LaingBuisson concluded:

“Prospective new care home developments for state-funded clientele…struggle to meet investment criteria because of inadequate fee levels on offer from local authorities in most areas of the country”.

That is a serious point.

The hon. Member for Bexhill and Battle raised the issue of migrants working in nursing in the care sector, but there is a further issue with recruitment to which my hon. Friend the Member for York Central referred. Independent Age and the International Longevity Centre produced a report called “Moved to Care,” which raised that issue:

“Migrants and particularly non-EU migrants play a big role in the care workforce. Nearly 1 in…5 care workers was born outside of the UK”.

The report states that one in seven care workers—more than 191,000 people—is a non-EU migrant. The care sector has a vacancy rate of nearly 5%. That is the recruitment problem that my hon. Friend the Member for Hove talked about. Given those statistics, the serious thing is that care workers do not appear on the shortage occupation list, so a fall in net migration could have a serious impact on the care sector. As the hon. Member for Bexhill and Battle asked—this is in addition to what I was going to ask today—would it be viable for skilled care workers, including senior care workers, to be included on the tier 2 shortage occupation list, as are nurses?

Good quality, affordable care in old age is a basic right, but the current pressures that care providers and local authorities face mean that there is a risk that good care will become the preserve of the wealthy. Julia Unwin, the chief executive of the Joseph Rowntree Foundation, has said that the effects of reduced home care capacity would be “devastating.” She said that,

“care homes are already under financial pressure.”

We have heard ample examples of that. She continued,

“if proper funding is not provided…with these additional costs, the Government risks creating a two-tier care home system where good care is only available to those who can pay for it.”

Ministers must do more to ensure that the most vulnerable people in our society start to receive the good-quality care that they need.

A sustainable financial settlement is needed, but the Government’s policies are ineffective and are failing to take account of differing needs across the country. We had an opportunity for a settlement with the Dilnot reforms, but chronic underfunding has led to long delays in implementation. Will the Minister reiterate his support for the implementation of the Dilnot reforms? After all, page 65 of the Conservative manifesto—that was not very long ago—stated that that is what the party would do.

Whatever we do about the cap on care costs, we must first address the deepening funding crisis. A first step would be for the Government to admit that the plans announced in the spending review do not address the funding crisis that has been so amply referred to in this debate. What steps will be taken to protect services from collapse? That is the priority. Without a radical change in policy, care homes will be unable to offer the services needed to ensure what almost everybody in this room would want—that every older person has the care they need and the dignity and respect that they deserve.

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[Alistair Burt]

We are constantly evaluating the better care fund. We work on it with local authorities on a regular basis, and with the Association of Directors of Adult Social Services, so it is constantly being evaluated. I do not know whether something else would add to that process.

[Barbara Keeley]

I have made the point about choices to the Chancellor in the past. Perhaps the Minister has not got the Chancellor on side yet; I hope that he will do so. However, the inheritance tax giveaway that this Government have enacted will cost £1 billion by 2020. How far would that £1 billion go in social care? A long way.

[Alistair Burt]

We could all pick items of Government spending that we do not particularly fancy and say, “Oh, if only it was applied to this, it would be great.” Every single Government and every single Chancellor have faced the same argument. We are where we are. We have made choices about a whole variety of things, and we have a range of obligations to deliver to the public. In this particular instance, however, I want to talk about what we are spending and what is new. I will do so briefly, but I must cover that.

The Government are giving local authorities access to up to £3.5 billion of new support for social care in 2019-20. We believe that the precept could raise up to £2 billion a year, and with that money and the £1.5 billion that was included in the spending review, we believe that by 2019-20 there will be the opportunity for a real-terms increase in spending on social care.

[Barbara Keeley]

Will the Minister give way?

[Alistair Burt]

No. I have only three minutes. If I give way, I will not be able to cover everything now.

[Barbara Keeley]

I just want the Minister to say how councils such as the Essex council that wrote to the Prime Minister will manage until 2019.

[Alistair Burt]

I will give two responses to that and talk about the equalisation of funding. First, we are working closely with local authorities and with ADASS. I do not pretend in any way that the situation will not be tough for the next couple of years; it will be. However, we believe the resource is there. Secondly, the social care precept will come in this year, and that money will be made available more quickly. It will be difficult and it will be tight, but a lot of changes are being made and a lot of work is being done to ensure that services are more efficient. Those things are going on all the time.

I want to address the problem that was raised about the precept and explain how it will be used to ensure that local authorities do not miss out. The Department for Communities and Local Government published for consultation a provisional local government finance settlement in December. Recognising that local authorities have varying capacity to raise council tax, it is proposed that the additional funding for the better care fund that will be available from 2017 should be allocated using a methodology that provides greater funding to authorities that benefit less than others from additional council tax flexibility for social care. That will include consideration of the main resources available to local authorities, including council tax and business rates.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 5th January 2016 Commons Chamber

[George Freeman]

I am delighted to be able to announce—the hon. Lady might already have heard this—that the Secretary of State has appointed Sir David Dalton from Salford Royal to lead on that. I repeat the offer that the Secretary of State made this morning: we are very close to an agreement, so the right approach is not to strike, but to come to the table and reach it.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Three hundred thousand fewer older people have publicly funded care packages than in 2010, and nearly half the current record level of hospital delayed discharges are due to waiting for a care package, and that will get worse as winter pressures mount. It is risky that the proposed increases in the better care fund are back-loaded; they do not reach £1.5 billion until 2019-20. The social care precept funding is uncertain because it will raise only £1.6 billion by 2020 if every single council decides to raise the maximum possible. Social care is in crisis now. Can the Minister explain why the Government are proposing risky, uncertain and late funding?

[George Freeman]

This is the most extraordinary welcome for one of the most important announcements in the autumn statement. Having come under pressure to raise more money for social care, the Chancellor and the Secretary of State announced £3.5 billion extra for social care, from the new adult social care precept and the better care fund. The Opposition say that it is not enough and that it will fail, but the data do not support that. If we look at the early data from the better care fund, which was introduced by this Government early last year, we see 85,000 fewer delayed transfers, 12,500 more older people at home within three months of discharge and 3,000 people supported to live independently. We are making real progress.

Specialist Neuromuscular Care and Treatments

Baroness Keeley Excerpts

Tuesday 15th December 2015 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in the debate with you in the Chair, Mr Brady.

As others have done, I congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing the debate. She gave a moving account of the Hill family in the light of Archie’s diagnosis and of the impact on Archie and his family of Duchenne. We have also heard excellent speeches from my hon. Friends the Members for York Central (Rachael Maskell) and for Bridgend (Mrs Moon) and the hon. Members for Romsey and Southampton North (Caroline Nokes), for South Down (Ms Ritchie), for Strangford (Jim Shannon) and for Dumfries and Galloway (Richard Arkless).

The all-party group for muscular dystrophy has carried out essential work to raise awareness and understanding of the needs of people living with muscular dystrophy and other neuromuscular conditions. I congratulate the APG on the quality of its inquiries and reports. The right hon. Member for Chesham and Amersham also paid tribute to the work of Muscular Dystrophy UK, and I join her in that tribute.

Providing access to treatment for people with muscular dystrophy is complex, because it is a rare condition. There are challenges in delivering localised, specialised care to people who have multiple, complex needs, but that cannot be an excuse for poor-quality care. As we have heard, some 70,000 people are affected by a neuromuscular condition in the UK. We must ensure that the NHS delivers equal treatment for equal need and that those with complex needs may have access to the treatment and support necessary to help them achieve the best quality of life possible.

In 2009 the APG’s Walton report showed clear deficiencies in the provision and planning of, and access to, care for people living with neuromuscular conditions. It found cases where care was “inadequate and not acceptable”. Although the report offered many sensible recommendations to improve the quality of care, the potential for progress was limited by the coalition Government’s reforms of the NHS under the Health and Social Care Act 2012.

Given those reforms, the APG undertook a six-month inquiry that considered their impact, releasing another report in March this year. Sadly, the reorganisation of the NHS and other reforms had done little to improve access to and availability of treatment for patients with neuromuscular conditions. Sadly, in fact, the reforms had made it even harder for patients to access support as a result of significant regional variations in the commissioning and funding of services. That is the nub of what I want to say.

There is a failure to join up services, and confusion about responsibilities and processes is a common theme. The hon. Member for South Down gave us an excellent quote on that lack of joined-up services. At the national strategic level there has been no specific mention of neuromuscular conditions in the five-year forward view, nor anything in the consultation document on the draft NHS mandate, which suggests a failure to recognise the specific needs of such patients at the strategic level. In fact, the five-year forward view groups together rare diseases and cancers, but there is a great deal of difference between all the conditions that we have discussed today and rare cancers.

There is a lack of clear guidance on which bodies in the NHS fund certain services and, as we have heard, sometimes people are not even receiving crucial respiratory support. Locally, there were examples of clinical commissioning groups failing to fund sessions of specialist neuromuscular physiotherapy or to provide sufficient funding for people to receive the right wheelchair at the right time. That is clearly so important and was mentioned by my hon. Friend the Member for York Central and the hon. Member for Romsey and Southampton North. It must be right for a child to have a comfortable chair while growing up.

The coalition Government’s reforms have also contributed to a delay in decisions on the availability of drug treatment for Duchenne muscular dystrophy, a life-limiting illness that affects about 2,500 boys and adults. The right hon. Member for Chesham and Amersham talked about that so well. To have to wait with a condition such as Duchenne for a decision on the drug Translarna is clearly agonising. It is a shame that the issue has been caused by NHS England halting its assessments to review its processes. I was not present at a Westminster Hall debate last week in which I understand that the Minister present said that he was “hopeful” that access to the drug would become available:

“I am hopeful about Translarna…NICE has been consulting on the process, and I believe the company has been engaging with NICE on pricing. I am hopeful that there will be a decision in the next few months”.—[Official Report, 8 December 2015; Vol. 603, c. 274WH.]

As he went on to say, however, the decision is not in his gift.

I hope that the Minister’s optimism is well founded, because as we have heard today it must be recognised that time is an important factor. The decision is different from some others, because the timing can affect the benefit that the boys will receive. I wish to ask, as everyone else has done, about that decision, and what he is doing to ensure that delays do not happen again. We must ensure that system of wider support is available for patients and their families and carers. In some cases people need 24-hour support and care; homes must be adapted; physiotherapy, speech and language therapy, and occupational therapy need to be available; and carers need access to the right advice and support, as has been said.

I am concerned, like others, that the Government’s failure to protect social care funding and other non-NHS health funding, such as training budgets, will mean that that wider network of support is not available when needed. The Walton report highlighted issues with social care back in 2009, but since then the number of people with access to publicly funded social care has fallen by 25%. The availability of the right support for people with specialist care needs is unlikely unless we have a sustainable funding settlement for both the NHS and social care. The difficulty with recent funding announcements, if the Minister intends to refer to them, is that the 2% social care precept and the better care fund are back-loaded funding mechanisms, with nothing this year and little next year.

We have heard about the regional differences in access to care. The Walton report highlighted that there were only 13 neuromuscular care co-ordinators when 60 were felt to be needed. My hon. Friend the Member for York Central said that there was only a single neuromuscular care adviser in North Yorkshire; in fact, no neuromuscular care adviser support is available for adults living with such conditions in Greater Manchester or the surrounding areas of the north-west. That is in spite of the fact that an estimated 8,100 people with a muscle-wasting condition live in the north-west. There is a need to ensure that clinical commissioning groups and other regional health organisations are aware of their responsibilities. Sadly, the findings of the 2015 APG report suggest little progress in the issue of unequal access.

Given the devolution deals on health and social care in certain parts of the country, will the Minister assure us that the inequalities in specialised services that we have heard about will be addressed and that the relevant bodies will be made aware of their responsibilities, which they do not seem to be at the moment? The debate has highlighted the fact that we have ingrained problems in our health and social care system. The lack of a sustainable funding settlement for social care and other recent reforms have led to fragmentation and instability in services. That means that inequalities in care sadly will continue. I urge the Minister to consider in full the most recent report and recommendations from the APG. We must ensure that people with neuromuscular conditions receive the care that they need, and that those inequalities in care are addressed.

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a pleasure to serve under your chairmanship, Mr Brady. I am left with 10 minutes in which to try to deliver my speech and the answers that I have carefully prepared while listening to colleagues’ comments. If I run short of time, I will undertake to write to everyone in the Chamber with answers to the points raised.

I start by paying tribute to my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) for securing the debate. She is a tenacious advocate on this issue, as on others. I join her in paying tribute to Archie and his family. I have met patients who suffer from these diseases and their families, and one’s heart goes out to them. One wants to pay tribute to the bravery with which they deal with their conditions. As is so often the case in the history of medical progress, the families, patients and carers are those who advocate and, in the end, win through to make their point heard, with the help of colleagues from across the House. My right hon. Friend eloquently paid tribute to the families of children with these disorders and diseases who, in many ways, suffer every bit as much as the patients who show such incredible fortitude. She asked me last week whether I would give her an A grade for effort and persistence. I will happily give her an A-plus in this end-of-term summary, but the people to whom we really want to give an A-plus are NICE and NHS England.

I want to touch on some of the excellent points that were raised. My right hon. Friend raised Vimizim and Translarna, so I will say something in detail about the timing of those decisions in a minute. She also made an important point about standards of care across the NHS in clinical trials, which was mentioned by numerous colleagues, and the importance of NICE giving more prominence to the time aspect of these conditions, which are unusual because they can deteriorate with every week’s delay in getting treatment.

The hon. Member for York Central (Rachael Maskell) gave us the benefit of her front-line clinical expertise. In case I run short of time, I shall say now that I will happily convene a meeting at the Department of Health with officials from my Department and NHS England, to which I invite colleagues from all parties who want to discuss the issues she and others raised about front-line care, because a range of practical issues about such care has been raised, in addition to access to drugs, and giving colleagues the chance to raise such points on behalf of their constituents would represent a powerful opportunity. The hon. Lady talked in particular about training and the interface of paediatric and specialist services, which I come across in connection with numerous different specialist conditions.

My hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) spoke passionately about James, Jules and Jagger Curtis, and the importance of expediting those particular decisions and quicker assessment, as well as adoption in general. That is a passion of mine, which was why I launched the accelerated access review to look systemically at what we can do to expedite getting new medicines into the service. She also touched on the importance of wheelchair access.

The hon. Member for South Down (Ms Ritchie) talked eloquently about Michaela and the importance of specialist, multidisciplinary teams. The hon. Member for Strangford (Jim Shannon), who gets the prize for appearing in more debates with me than any other Member of the House, which is a tribute to his activism as the Democratic Unionist party’s spokesman on these issues, highlighted the importance of Belfast as a hub of research and regional strategies in Northern Ireland and spoke about his constituents. This is a devolved matter, and while I pay tribute to the work of researchers and medics in Northern Ireland, it is important that the devolved Administration in Northern Ireland put in place a similarly enlightened commissioning process.

The hon. Member for Bridgend (Mrs Moon) raised the broader issues of Parkinson’s and neurological disorders, while the hon. Member for Dumfries and Galloway (Richard Arkless) spoke passionately about his mother’s suffering. Before I came to Parliament, I worked in Scotland and, as he highlighted, in this area, as in several others, Scotland pioneers some of the clinical commissioning work. The supreme irony of the debate was brought to light by his request that we depoliticise the NHS. For me, one of the greatest steps following the Health and Social Care Act 2012 was the separation of the NHS from the Department of Health. NHS England now operates under its own arm’s length management, subject to a mandate from Ministers

We do not control the NHS—believe me that if, for one afternoon, I could do that, I wish it was now. I would love nothing more than to pull the lever and give all these children the drugs that we all want them to get before Christmas, but that is not in my gift, and I suggest that it is in all our interests that it is not. It is right that such decisions are taken by NHS England and clinical professionals, advised by the very best people at NICE.

[Barbara Keeley]

It is important that the NHS mandate covers these conditions because at the moment it does not. Something must be done to make sure that they are covered.

[George Freeman]

In the few minutes I have available, let me say a few things about the main issues raised. I pay tribute to Muscular Dystrophy UK, Robert Meadowcroft, Emily Crossley, the Duchenne Children’s Trust, Action Duchenne and all the other organisations that work so hard in this area, and specifically on the two or three key drugs.

I remind the House that the decision from NICE on Vimizim is due before the end of the year. Without breaching due process, I have asked that, if that decision is in the pipeline, it can be made as quickly as possible, ideally before we all break up for the Christmas holidays. That is not in my gift, but I made that request. Similarly, I have requested that the Translarna decision, which I believe is due in February, is similarly expedited. However, again, that is not in my gift, and while during the year the Prime Minister and I have urged NICE and NHS England to do everything they can to expedite their decision making on those drugs, we do not have the power—rightly, in my view—to step in and breach process. It is fair to all patients in the NHS that decisions are taken properly.

Mental Health

Baroness Keeley Excerpts

Wednesday 9th December 2015 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

We have heard in this important debate from an astonishing 27 speakers, in addition to many interventions during the opening speeches. I welcome the involvement of all those who have taken part. In particular, I would like to thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), the right hon. Member for North Somerset (Dr Fox), my right hon. Friend the Member for Exeter (Mr Bradshaw), the hon. Member for Worcester (Mr Walker), my hon. Friend the Member for Rochdale (Simon Danczuk), the hon. Member for Erewash (Maggie Throup), my hon. Friend the Member for North Durham (Mr Jones), the hon. Member for York Outer (Julian Sturdy), the right hon. Member for North Norfolk (Norman Lamb), the hon. Member for Plymouth, Moor View (Johnny Mercer), my hon. Friend the Member for Manchester, Withington (Jeff Smith), the hon. Member for Bracknell (Dr Lee), my hon. Friend the Member for York Central (Rachael Maskell), the hon. Member for South Cambridgeshire (Heidi Allen), my hon. Friend the Member for Salford and Eccles (Rebecca Long Bailey), the hon. Member for Henley (John Howell), my hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), the hon. Members for Halesowen and Rowley Regis (James Morris), for Livingston (Hannah Bardell) and for Norwich North (Chloe Smith), my hon. Friend the Member for Bootle (Peter Dowd), the hon. Member for Bath (Ben Howlett), my hon. Friend the Member for Edmonton (Kate Osamor), the hon. Member for Macclesfield (David Rutley), my hon. Friend the Member for Norwich South (Clive Lewis) and the hon. Member for Lewes (Maria Caulfield). It is a remarkable number.

The Secretary of State was right to thank the hon. Member for Broxbourne (Mr Walker) and my hon. Friends the Members for Barrow and Furness (John Woodcock) and for North Durham for talking about their personal experiences. My hon. Friend the Member for Manchester, Withington also spoke about his experiences today. We should always thanks hon. Members who speak from their own personal experience. I also want to mention the leadership of the all-party group on mental health and the commitment of the right hon. Members for North Norfolk and for Sutton Coldfield (Mr Mitchell) and Alastair Campbell, who have formed a group arguing for equality for mental health and an increase in funding.

I want to thank my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) for her persistence in raising issues relating to suicide and the work capability assessment, and on the impact that changes to social security programmes can have on people with mental health problems. If we are to have a zero suicide ambition, as the Secretary of State mentioned, we must do more work on that particular issue, and on the crisis of male suicide, which was raised by the right hon. Member for North Somerset and my hon. Friends the Members for Rochdale and for Ashton-under-Lyne.

Right hon. and hon. Members have spoken with knowledge about mental health services around the country and about the excellent work being done in their own constituencies, often by charities and voluntary projects. Many speeches illustrated the fact that our mental health services are under intense pressure and in urgent need of improvement. In the previous Parliament, we heard much from Ministers on parity of esteem, but we saw little progress. I think all the speeches today have shown us that things have got worse. The independent King’s Fund commented recently that parity of esteem for mental health “remains a long way off.” The hon. Member for York Outer said exactly the same thing and the right hon. Member for North Norfolk called the current situation “morally wrong and economically stupid”.

Mental health services have faced cuts and Government promises on spending have not been kept. We focused on that in this debate. In 2012, the annual national survey of investment in mental health services found that spending on mental health had been cut for the first time in a decade, but rather than take action to put it right Ministers discontinued the survey. As my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) said earlier, since then it has been very difficult to make an accurate assessment of the level of investment in mental health services. Indeed, we have to rely on freedom of information requests and on expert analysis by charities and independent bodies. The King’s Fund found that about 40% of mental health trusts experienced reductions in income in both 2013-14 and 2014-15. The charity Mind reports a real-terms reduction of 8.25%, or almost £600 million, in the funding of mental health services at the same time that referrals to community mental health teams have risen by nearly 20%. Labour’s own analysis by my hon. Friend the shadow Minister found that one in three clinical commissioning groups was not increasing its spending on mental health in line with the growth in their budget allocations, despite an explicit promise from Ministers that that would be the case. If Ministers have the determination to change that, we would welcome it.

The suggestion made by the right hon. Member for North Somerset of ring-fencing extra funding for mental health was very welcome and was supported by a number of hon. Members. The Secretary of State admitted earlier that he just did not know by how much standards and investment varied across the country. The lack of information is simply not good enough. I urge the Minister to reinstate the national survey of investment in mental health. That is the way to go.

One area on which we have accurate information is funding for social care. Social care services play an important role in supporting people with mental health problems. Cuts to social care services have a serious impact on people with mental health needs, as do other issues raised in this debate such as housing. A report on mental health care from the Health Foundation found that the number of people receiving social care support for mental health problems has fallen by 25% since 2009-10. A recent survey of NHS mental health trusts found that cuts to social care budgets were having an adverse impact on their services. Indeed, as my hon. Friend the Member for North Durham said, we need to road-test policies from other Departments for their impact on mental health.

The recent spending review will surely go down as a missed opportunity to do something about the desperate funding crisis in social care, which does affect people with mental health problems. The Chancellor’s proposals on social care funding are woefully inadequate. They will leave a black hole in care services for older people and for people with mental health problems. To cite a local example, Government cuts to Salford City Council’s budget have caused budgets for adult social care to fall from £76 million in 2010 to £61 million this year—a cut of £15 million. However, the 2% council tax precept will raise only £1.6 million. The King’s Fund warned this week that the decision to use council tax rises to offset cuts in social care will widen the gap between richer and poorer areas but will raise less than half the £2 billion the Chancellor predicted.

Older people are not just being hit by cuts to social care; they are also being hit by cuts to mental health services. The Secretary of State said that depression was more debilitating than angina, asthma and diabetes, but depression affects 22% of men and 28% of women aged 65 or over—some 2 million people in England. In the UK, mental health problems present in 40% of older people attending their GPs, 50% of older people in general hospitals and 60% of older people in care homes.

The Secretary of State also said that talking therapies are more effective than drugs, but Age UK tells us that older people are six times as likely as young people to be on tranquillisers or equivalent medication, but only a fifth as likely to have access to talking therapies. While 50% of younger people with depression are referred to mental health services, only 6% of older people are. The Royal College of Psychiatrists estimates that 85% of older people with depression receive no help at all from the NHS. The Government are letting older people down by reducing their access to the services they need.

There is also a need for better emotional and psychological support for carers. Caring for a spouse or family member is more common in older age, and there are nearly 1.2 million carers aged 65 plus. Levels of stress and psychological distress are higher in carers who look after people living with dementia, and studies show that rates of depression can range up to 85% for carers of people living with dementia and up to 45% for carers of people living with anxiety.

The motion before us makes three clear calls, and I hope Members of all parties will join us in voting for the motion today. Good mental health is an issue for our schools, our workplaces and for our care homes, as well as for all our health services. I hope that Members on both sides of the House will join us in voting for the motion, which I commend to the House.

Sugary Drinks Tax

Baroness Keeley Excerpts

Monday 30th November 2015 Westminster Hall

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I am a late contributor to a long debate, so some of what I say will have been touched on, but I hope it is not all déjà vu.

Apparently today is the first day of Sugar Awareness Week, after “black Friday” and “cyber weekend”, or whatever—it is all good to know. According to Mick Armstrong, chair of the British Dental Association:

“Britain is addicted to sugar, and inaction can no longer be justified, either morally or financially.”

The debate, which to some extent reflects Britain’s love affair with sugar, is not the result of an intellectual curiosity, as subjects discussed in this Chamber often are, but arises from a petition. We have heard the figures —150,000 people have signed it—and we see it reflected in the number of people in the Public Gallery today.

One in four children leave primary school clinically obese—the hon. Member for Totnes (Dr Wollaston) said it is one in three—so we have to do something about the ticking health time bomb. The cost to the NHS runs into billions—my hon. Friend the Member for Warrington North (Helen Jones) mentioned £6 billion. Some people argue that the state should not interfere in such things, but it would not be the first time, because it is something that Governments of both complexions have done before, and as a result we have seen a reduction in the number of adult smokers in this country.

The clamour for action on sugary drinks and the arguments in favour of the funds raised going to tackle public health problems have received not inconsiderable public attention, at a time when health budgets are being squeezed. There is also the weight of expert opinion, not only the much mentioned one-time “naked chef” Jamie Oliver, but the Health Committee, chaired by the hon. Member for Totnes, who spoke movingly and powerfully earlier—she was a doctor first and an MP second—the British Medical Association, the British Heart Foundation, Diabetes UK and the British Dental Association. Hitherto, however, all appeals have fallen on deaf ears in the Government. The Royal College of Paediatrics and Child Health conducted a poll that revealed that 53% of the public support a tax measure.

Public Health England, in its sugar reduction action plan, states that the recommended proportion of added sugar in people’s diets should be 5%, but at the moment it is more like 12% for adults in this country. Added sugar accounts for 14.7% of calorie intake for children and 15.6% for teenagers. I am a mum myself and understand pester power and the attraction of sugary drinks. For under-threes, 27% of added sugar intake comes from soft drinks; for 11 to 18-year-olds, the category that I am a mum of, that figure rises to 40%. Furthermore, it is the 11 to 18-year-olds with the least amount of money who are attracted by cheaper alternatives to drinks such as water. Why is it that in any sweet shop water is more expensive than fizzy drinks?

Sugary drinks give a short fix of energy and have no nutritional value, while at the other end of the process the NHS is treating people for preventable illness. We have heard how most children in this country who go under general anaesthetic are doing so for tooth decay. Many hon. Members have also mentioned the figures for type 2 diabetes; 22,000 people in my constituency live with it, and it is responsible for a death every seven seconds in the G20 member states, which is a higher rate than HIV and malaria combined. At a meeting of the all-party group on diabetes, chaired by my right hon. Friend the Member for Leicester East (Keith Vaz), who is no longer in his place, we heard an impassioned speech from “St Jamie”, as one of my constituents called him at the weekend. I believe that in Jamie Oliver’s own restaurants there is a 10p levy on fizzy drinks.

On the one hand we have campaign groups and medical professionals, but on the other hand there is the argument about the nanny state. Many hon. Members have said that the solution is severalfold. The food and drink industries need to act more responsibly—they are the main lobbyists against the sugar tax—instead of arguing that any tax would be passed on to consumers and end up being a tax on the poor. They have also warned of sinister factory inspections and claimed that the tax would be unworkable, but they are acting in their own interests and not with the NHS health bill at heart. In Mexico, as we have discussed, a reduction in sales took place when a tax was introduced. I am almost reminded of that television programme set in the 1950s or ’60s, “Mad Men”, which is about the advertising industry. The advertisers in it say, “It’s not bad for you”, when they know it is.

There are good commercial operators. In my constituency is the UK headquarters of the French dairy company, Danone, which has its “Eat Like a Champ” programme, which 35 children will go through this year. It is unbranded, so no one knows it is a Danone programme, but it introduces healthy eating, diet and so on throughout the London boroughs. The programme has been developed with the British Nutrition Foundation. Such initiatives should be encouraged. The programme is also supported by Diversity—the pop group, not the concept—as its ambassadors. Danone is doing that as part of its corporate social responsibility. The hon. Member for Britvic—the hon. Member for Rugby (Mark Pawsey)—has gone now, but—

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Says the hon. Member for Danone.

[Dr Huq]

Yes, sorry. I am a secret lemonade drinker—no, I’m not.

I want to be brief, but we are discussing something important. Voluntary agreements do not seem to be moving fast enough. As everyone has said, we need a range of different approaches, and hiking up sugary drink prices by pennies is part of that. As for the industry’s worry that the cost would have to be passed on to consumers, the industry itself could absorb or partly absorb the cost.

Eleven to 18-year-olds will choose drinks based on price, because they are short on cash, although other factors could come into play—peer pressure, habit, availability and so on. We need to think smartly about things such as advertising bans, which have been mentioned, encouraging physical activity, curbing “buy one, get one free” types of promotions, discounting fruit and veg, and considering portion sizes. In New York the authorities have banned the largest size of soda cups.

I want to ask the Minister what happened to the ban on fried chicken shops at school gates, because I still seem to have them in my constituency. Such a ban was talked about, and it would be good if its implementation could be accelerated. Also, what about minimum unit prices for alcohol? If sugary drink prices go up but alcohol prices are low, there could be some awful, cataclysmic thing going on as a result, possibly—

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in the debate with you in the Chair, Mr McCabe. I thank my hon. Friend the Member for Warrington North (Helen Jones) for the excellent way in which she opened the debate. In fact, we have had some excellent speeches. There was a bit of discord in some of the interventions and speeches, but broadly we have settled on a similar set of views. I want to emphasise that the causes of obesity are complex and that a number of factors can be involved.

We need to tackle the problem at both ends. We have talked extensively about the supply side and the drink companies, but we also need to talk about the demand side. We need far better education about how we can look after ourselves. We also need to give people the means of eating better food. In addition, we need to encourage them to take more exercise—we have touched on that, but I will talk about it a bit more later.

To tackle obesity—I am sure that this is the consensus that is developing—we need a comprehensive and broad approach that helps families, schools and children to make the right decisions. That might include people seeking medical help—I have had constituents in this situation—to get them started on the path away from obesity. That might include a programme or a summer camp—some way of starting to have a different diet and lots of exercise.

Many Members have referred to the statistics on obesity. The Health and Social Care Information Centre statistics are quite frightening: one in five children leaving primary school is classified as obese, and one in every three children is obese or overweight. There has been a significant move towards healthier, more nutritious meals in schools, and that is vital. However, I have concerns about how children and their families manage in the school holidays, when those healthier school meals are not available.

[Geraint Davies]

On a point of order, Mr McCabe. Like you, I sit on the Panel of Chairs. I was here for the first one and a half hours of the debate, and I had to leave the room for 20 minutes. I have introduced a Bill on sugar, and I was wondering whether I could crave your indulgence and make a small contribution, given that the debate is meant to go on until 7.30 pm.

--- Later in debate ---

[Steve McCabe (in the Chair)]

No, we are going to continue with the winding-up speeches.

[Barbara Keeley]

I was saying that I have concerns about how children and their families manage in the school holidays. For anyone who has not heard about it, I want to commend the Feeding Birkenhead project, and the work done on it by my right hon. Friend the Member for Birkenhead (Frank Field). The project makes sure that children have healthy food in the school holidays. It is sad that we need to think about that issue, but we do.

Between April and September 2015, Trussell Trust food banks in Greater Manchester gave more than 22,000 lots of three-day emergency food supplies to people in crisis. Of those, nearly 9,000 were directed to children. We have talked about choice, but if we think this through, we realise that, if families rely on food banks to feed their children, that will limit the number of healthy meals they can make with fresh food. Clearly, for people in the upsetting circumstances of not managing financially, feeding their child with something is better than seeing them go hungry.

At the start of the debate, we heard about people who do not have local shops that sell healthy food, and we have to take that into account, too. Some people are also fuel-poor, while others work a number of jobs, which leaves them with little time to cook. We must not, therefore, jump to conclusions about why people are in this situation.

We should look at the wider issues around poverty, which must be addressed to ensure that people can access a good-quality diet. There is an awful lot more to achieving a good-quality diet than just wanting to do that. How, therefore, does the Minister plan to help families that have to rely on food banks? Next weekend, I will be helping the Trussell Trust food bank to collect food in my local supermarkets. On a previous occasion, one donor gave me lots of vegetables—onions and things like that. I thought they were part of her shopping, so I ran after her to give them back. However, she said, “That is just to liven the donations up. All the packet food seems a bit dull.” However, that is not the way Trussell Trust food banks operate—they have to have packet and tinned food. We have to think through what is happening in families where there is a reliance on donated food, which will not always contribute to a good enough diet.

Education must play a significant role. We want to provide children and adults with information about how they can achieve a healthy diet. One of the most interesting things Jamie Oliver has done—it was not his recent interventions here in the House—was his programme showing people how to cook. There were families that existed entirely on one or two sorts of takeaway.

[Geraint Davies]

Does my hon. Friend accept that, if one wanted to make money out of a potato, the easiest way to do that would be not to sell it, but to smash it up, mix it with salt, sugar and fat, reshape it into something called “Dennis’s Dinosaurs”, freeze them, give them a jingle and sell them cheaper than a potato to get addicts of sugar and other additives for manufacturers? Should we not, therefore, focus on providing lower-priced fresh food, and on increasing the price of sugar-impregnated food?

[Barbara Keeley]

As I was saying, we should look at the whole range of options. I want to talk about health campaigns. The Public Health England campaign Change4Life is an excellent example of providing families with information about small changes they can make to improve their health, as well as with advice on healthy recipes, diet and exercise. However, I fear that the announcement of a 25% cut to the non-NHS part of the Department of Health’s budget will have a significant impact on Public Health England. I want public health bodies to be able to continue campaigns to tackle obesity, but I am worried that their ability to do so will be damaged by these significant cuts. I am concerned that we will not in future be able to fund campaigns such as Change4Life, and that they may just not happen.

We must also be careful that the huge cuts to the public health grant given to local authorities do not reduce the advice and support available to those wanting to lose weight. At many community events in Salford, I have seen health improvement staff working with community groups and running all kinds of sessions. I fear that we will not have that in future.

Although the debate is about a sugar tax, I want to mention the importance of increasing physical activity among adults and children. I was a member of the all-party commission on physical activity, which published its report “Tackling Physical Inactivity—A Coordinated Approach” in 2014. We have discussed various aspects of our children’s health, but inactivity is a key factor, which is why a number of Members have referred to it. It is important that we encourage children to maintain active lifestyles from an early age.

[Dr Whitford]

May I draw the hon. Lady’s attention to a novel approach that has come out of St Ninians primary school in Stirling, called the daily mile? A teacher got the children to go out and run round the field. That seems to have made a huge difference at the school. Obviously, it costs absolutely nothing, and it seems to help the kids to concentrate, because they have been outdoors in the fresh air and—in our neck of the woods—probably in the rain as well.

[Barbara Keeley]

That type of initiative is wonderful, but fewer and fewer children are walking to school, and an awful lot more are being taken there by bus or by their parents. The Health Committee report reminds us that the latest figures show a fall in physical activity. In 2012, only 21% of boys and 16% of girls did enough exercise to meet the Government’s physical activity guidelines. That is a fall from four years earlier, when the figures were 28% for boys and 19% for girls. We are therefore going in the wrong direction, and we are all becoming couch potatoes. We might worry about this for ourselves, but it is a great concern when children are involved.

I am a former member of the Health Committee, and it is a pity that little emerges from the report, which simply reiterates and endorses the findings of its predecessor Committee’s inquiry, in which I was involved.

[Dr Wollaston]

I absolutely recognise that physical activity is important and that it should be for everyone, irrespective of their weight or age. Like me, the hon. Lady will remember Julie Creffield, who spoke so powerfully before our Committee in the last Parliament. However, the current Committee felt that it did not want to be distracted by something we had already produced some work on. We therefore wanted to endorse everything that was said by our predecessor Committee, rather than to go over that ground again.

[Barbara Keeley]

I thank the hon. Lady for that intervention, but I think it is a bit too easy to lose sight of physical activity, and that is why I have raised the issue. I hope we can be brave and bold about these issues too—it is good to be brave and bold about children’s health, but let us cover all the issues.

It has been said that treating obesity and its consequences alone costs the NHS more than £5 billion a year. It is great that we are having this debate, because we are past the point where we can just let things trundle along. Let me come to the crucial point in the debate. Public figures such as Jamie Oliver have come out in support of a tax on sugar, and he has added stardust to the debate. However, this is a complex issue, and the solutions must deal with that complexity. We know that something must be done, but what is that something?

The problem goes deeper than the demand side. The food and drink industry has not been dealing with the real problems. A number of hon. Members have talked about the Government’s responsibility deal, which has not worked. Firms have made promises and then failed to carry out their pledges. We have talked about labelling, which I will come on to. Many of the suggested interventions involve better labelling of products, but research by a team at the London School of Hygiene and Tropical Medicine suggests that interventions that improve information about and awareness of the risks do not necessarily translate into positive behavioural change.

As has been touched on, the responsibility deal focused mostly on salt, which was perhaps welcome. There have been real moves in that area, although every time I have a bowl of tomato soup these days, I regret that it does not taste like it used to. It is clear that salt is being taken out of our diets, but not sugar, which is the focus of our debate. The research team also found that although responsibility deal partners claim there has been “considerable sugar reduction” under their calorie reduction pledge,

“the current progress reports do not substantiate these claims.”

In fact, responsibility deal partners say they have reduced sugar levels under the calorie reduction pledge, but they have not.

[Geraint Davies]

On the relationship between sugar and calories, is my hon. Friend aware of emerging science showing that if two people both eat, for argument’s sake, 2,000 calories a day, and one has a history of eating a lot of sugar, that person will be predisposed to convert more of the sugar to fat than the other person, irrespective of the amount of exercise they do? That is a particular reason we should target sugar.

[Barbara Keeley]

I did not know that; my hon. Friend clearly has background knowledge and experience that I do not.

I want to come back to the responsibility deal, which is important in terms of the Government’s approach. That deal is seen as flawed because firms were allowed to decide what pledges they signed up to, and there were no penalties for those that did not honour their promises or, indeed, take part at all. At the time of the responsibility deal’s introduction, organisations such as the BMA, the Royal College of Physicians and Alcohol Concern complained that the pledges were not specific or measurable and that, in fact, the food and drink industry had simply dictated the Government’s policy. We have to get away from that.

The Minister will tell us more about a sugar tax, but it seems that the Prime Minister has ruled out action on sugar, despite the independent report commissioned by the Department of Health. That leaves me wondering whether the Government are listening to vested interests, instead of the experts whom they commissioned to write the report. The corporations that make the bulk of sales of sugary drinks in the United Kingdom want to maximise profits for their shareholders. They will not voluntarily lower the amount of sugar in their drinks unless there is something in it for them, or unless they are required to do so by law. Likewise, they will not reduce the amount or nature of advertising of sugary drinks—not voluntarily, anyway.

We must look back to what happened with the tobacco industry, which consistently pushed for a voluntary approach to avoid legislation. The industry trundled along, smoking continued unabated and profits were left alone. In my local authority, Salford, smoking was increasing at levels that really concerned me, particularly among young people. However, once specific regulations were introduced, such as warnings on cigarette packets and the blanket ban on smoking in enclosed spaces, smoking levels started to decline. I am therefore inclined to think that one of the most effective remedies would be a modest but compulsory reduction in the amount of sugar in soft drinks. A fiscal solution such as a sugar tax could well form part of the solution, but the Opposition retain a concern about the impact that extra taxes will have on the pockets of parents, as has been mentioned, particularly in low-income families. If we have learned any lessons from what happened with the tobacco industry, it is that intervention will need to involve legislation.

The report produced by Public Health England makes a number of recommendations, which Opposition Members will study in full. We believe a fiscal solution such as a sugar tax may be necessary, but we are not yet fully convinced. As a number of Members have said, we should not focus on one thing as a silver bullet. The Opposition will consider all the evidence on what can be done to tackle childhood obesity as we review our policy over the coming weeks and months.

This has been a high-quality debate. I hope that the petition and the debate will ensure that the Government do not repeat past mistakes with voluntary approaches such as the responsibility deal, which has generally been seen to have failed. I urge the Minister to look at a wide range of activities to tackle childhood obesity, including doing much more on physical inactivity.

--- Later in debate ---

[Jane Ellison]

That is not right. Again, I come back to the point stressed in the report by Public Health England—indeed, the Health Committee’s excellent report underlines it—that there is no silver bullet. It is really important that we address the fact that a number of wide-ranging issues need to be tackled and that several options are available to us in policy terms. PHE concluded that no single action on its own will be effective in reducing the nation’s sugar intakes. Its report shows evidence to suggest that higher prices in targeted high-sugar products, such as sugar-sweetened drinks, tend to reduce the purchases of such products in the short term.

Mention was made of the possibility of Cochrane reviews in coming years. An interesting article in the current issue of The Economist notes that the longer-term effect on public health is as yet unknown. Obviously that is because in most cases these measures have not been in place long enough, but it is an important concern—and the hon. Member for Swansea West (Geraint Davies) will have noted a degree of reticence on the part of those on his own Front Bench about the evidence, but anyway. We are, of course, well aware of what Public Health England said in its report about the evidence on higher prices. However, its report also argued strongly for implementing a broad, structured programme of parallel measures across all sectors, if we are likely to achieve meaningful reductions in sugar intakes across the population. As we have heard, it identified areas for action that include restrictions on marketing, advertising and price promotion, and work to reduce levels of sugar in food and drinks—I welcome the focus of a number of speeches on reformulation of product, as we think it has a significant role to play. Areas for action also included improving public food procurement and improving knowledge about diet and nutrition. We are considering all the evidence and working closely with Public Health England to develop our policies.

A number of Members have talked about education. This debate provides the opportunity for me to talk in more detail than I generally can in such debates about the Change4Life programme, in which we continue to invest significant sums. The Change4Life campaign has provided motivation and support for families to make small but significant improvements to their diets and activity levels. Last January, Change4Life’s Sugar Swaps campaign encouraged families to cut back on sugar through two TV advertisements focusing on sugary drinks and after-school snacks. That campaign also included radio, digital and outdoor advertising.

[Barbara Keeley]

I expressed concern about budget cuts for Public Health England. Will the Minister address that? I, too, admire the work it has done, but it is not helpful to cut the budget, is it?

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 17th November 2015 Commons Chamber

[Mr Speaker]

Equally briefly, the last question and answer. I call Barbara Keeley.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The ResPublica report, “The Care Collapse”, states that our residential care sector is in crisis. It says:

“Providers are being faced with an unsustainable combination of declining real terms funding, rising demand for their services, and increasing financial liabilities.”

It also states that a £1 billion funding gap in older people’s residential care would result in the loss of 37,000 care beds, which is more than in the Southern Cross collapse. No private sector provider has the capacity to take in residents and cover the lost beds, so those older people will most likely end up in hospital. What is the Minister doing to protect the care sector from catastrophic collapse?

[Alistair Burt]

As the House is aware, social care is a matter of great importance as we head towards the spending review round. We are aware of pressures in the system, and there is always contingency planning to identify particular problems. We are working hard with the National Care Association to improve the quality of care provided by the sector, and my right hon. Friend the Secretary of State has commissioned Paul Johnson, of the Institute for Fiscal Studies, to look at pressures in the care home sector and how to ensure that we can meet the challenges. If challenges require more money, which they always seem to do according to the hon. Lady, she needs to come up with ideas for how to provide that money, but she never does. It is the Government’s responsibility to meet those challenges within the context of the overall economic position.

Care Homes (Regulation)

Baroness Keeley Excerpts

Wednesday 4th November 2015 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you as our chair, Ms Vaz. I congratulate the hon. Member for North Devon (Peter Heaton-Jones) on securing this debate on an extremely important issue. I have read the document he referred to, which was sent to me by his constituent. I sympathise with his constituent and others who have lost their loved ones in similar circumstances; those are tormenting times for people. If any patient is failed by the NHS or a care provider, we must ask them serious questions about what went wrong. We must try to ensure that no patient or family member has to go through a similar situation. Often, what family members want is for nobody else to have to suffer in the way that they have.

The regulation of care and nursing homes is extremely important, particularly as more people are likely to rely on those homes given our growing elderly population. The hon. Gentleman mentioned the CQC and its recent reports and developments. It said in its “State of Care” report that

“there is room for improvement across the whole of the adult social care sector.”

That is a very damning conclusion for it to come to, having moved into social care and nursing care inspection. The hon. Gentleman referred to the statistics. Only around two thirds of social care provision was rated good or outstanding, and 7% of services were rated inadequate. It is of even more concern that fewer than half of nursing homes were rated good or outstanding; 10% received the lowest rating of inadequate. Out of 1,275 nursing homes that the CQC inspected, 127 homes were rated inadequate. That is very serious if we think about how many people are in those homes. Would any of us accept that standard for our grandparents, mothers, fathers, wives or husbands? Of course we would not. We would demand the highest standards for our family members, as the hon. Member for Strangford (Jim Shannon) mentioned.

The CQC found examples of extremely bad practice, including a nursing home with an overpowering smell of urine and with mould on the walls, and a care home that did not administer medication properly. Recent evidence to the Public Accounts Committee showed that improvements were needed to the CQC’s regulatory regime. However, the CQC now appears to be having to manage with fewer resources. I understand that it plans to pioneer a new approach of “co-regulation”, with providers sending in

“self-assessments of how they think they’re doing”,

which the CQC would then verify. When less than 50% of nursing homes are judged to be good or outstanding and 10% are rated inadequate, I find that very concerning. This is not the time to move to a system of self-assessment—a move that seems to be driven by a projected cut to the CQC’s resources. As the hon. Member for North Devon said, it already has serious staffing issues, with one third of its inspection positions vacant.

More needs to be done. We covered that well during the debate. I agree that more needs to be done to help families to raise cases of bad practice, so that lessons can be learned—a point that the hon. Member for Brigg and Goole (Andrew Percy) touched on when he talked about the CQC working better with families. Complaints about health and social care are dealt with by different services, which follow local complaints processes. The Parliamentary and Health Service Ombudsman looks at complaints about the NHS, the independent Health and Social Care Advisory Service undertakes investigations, and the Local Government Ombudsman investigates issues regarding local authorities and adult social care. It is clear that care is changing, but care in nursing homes always spanned all those areas.

Vulnerable older people being cared for in nursing homes can rely on a variety of health and social care professionals. In nursing homes, older people often have a number of medical and care needs, which are dealt with by different people, including care assistants, nurses, GPs, and through hospital treatment and care. We need to ensure that the regulation of the sector takes that into account. When there are failures by multiple organisations, all those involved must be held to account. That very thing—the changeover—makes it difficult. How can the regulatory framework for nursing homes be improved to deal with that overlap? We are now talking about the integration of health and social care in Greater Manchester and other areas of the country, but we need a regulatory and complaints system that works with what we have. We should be striving for a health and social care system in which all older people receive the care that they need. If that does not happen, we need clear procedures enabling people to have their issues investigated. It is not clear where family members can go if they become alarmed that care is not being provided adequately.

The social care system helps some of the most vulnerable people in our society. When they do not have a voice, we must ensure that they are heard. In this debate we have heard some worrying statistics about care not being provided as it should have been. We need to improve our regulatory and complaints system, so that we learn from cases such as that of the constituent of the hon. Member for North Devon. I am glad that there has been quite a bit of consensus in the debate about the need to improve standards of care and regulation. We look to the Minister to tell us how that improvement might happen.

Hospital Parking Charges (Exemption for Carers) Bill

Baroness Keeley Excerpts

Friday 30th October 2015 Commons Chamber

[Philip Davies]

I do not want to get distracted so early in my speech, but I will come to my local hospital during the course of my remarks, so I hope the hon. Lady can be patient. Of course, if I fail to deal with that point, she can always come back and chastise me for not having done so.

Let us look at the origin of the Bill. On 4 July, the hon. Member for Burnley explained it on her website blog—I am a keen reader of it, as I am sure are many others both here and in Burnley; indeed, I am sure that the Minister has a great regard for the hon. Lady’s blog. This is what she wrote:

“Having read through over 100 suggestions, and after much deliberation, I have finally chosen the subject for my Private Member’s bill: I intend to try to help carers by making provision for them to be exempt from hospital parking charges. During recent years, I have met with carers from across the constituency from different backgrounds, all of whom had different stories to tell but all with one thing in common: their willingness to support a sick person, whether it be a child with cancer, an elderly person with complex needs or a person attending hospital for regular treatments such as chemotherapy. All of these carers often have reason to be parked at hospitals for long periods and can incur charges which they can often ill afford. It seems to me that it is time we put an end to this ‘tax on illness’.”

Ten days later, however, the hon. Lady said something else in her blog; there was a subtle difference on which I would like to focus. She said:

“Many of you may know that I am trying, through the bill, to obtain free hospital parking for carers. Support for this is growing but, if I am to be successful, I really do need your help. I know from my conversations with so many of you, that hospital car park charges are a problem for many carers, who often spend a lot of time hospital visiting. If you are a carer, and this is a problem for you, please get in touch and share your problem with me. Sometimes it is more than the charge (though these are quite hefty and can mount up) because I understand that visiting, particularly for extended hospital stays during winter months, can be quite stressful and distressing, and queueing for parking can sometimes feel like the last straw. If I am to get this bill through government, I need plenty of evidence.”

In my experience, people usually get the evidence of a problem first, and then bring forward a Bill to tackle it. On this occasion, we seem to have had a more novel approach to legislation, which is to bring forward a Bill and then ask people for the evidence to support it. Personally, I view that as a novel approach, but I commend the hon. Lady for starting a trend that we may see more of in the months to come.

It strikes me from the hon. Lady’s blog that the Bill has been brought forward only on the basis of a worthy sentiment, from which very few people would dissent, because she was still collecting evidence to show the need for the Bill after she had announced she was going to introduce it. She did not look at the reality of situation, find a problem and then try to find a solution.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I have to wonder whether the hon. Gentleman listened to the beginning of my hon. Friend’s speech. She said that she had based the Bill on her own experience. She had been a carer, and she had had to pay the charges. I myself have asked constituents to get in touch with me about the issue. As all Members of Parliament should know, carers are busy, stressed people, who do not have the same time that everyone else has. All of us undoubtedly hear more about issues such as football governance than about caring, but there are 6 million carers in the country, and this is an issue for them.

[Philip Davies]

I entirely agree with everything that the hon. Lady has said. I do not think anyone would disagree with anything that she said about carers. She said that there were 6 million in the country, and that is a point to which I shall return. If we are talking about free hospital car parking, the number of people with whom we are dealing is clearly a factor, to which the hon. Lady has helpfully drawn attention.

[Barbara Keeley]

The hon. Gentleman really should have been listening. My hon. Friend’s Bill applies to carers who receive carer’s allowance, of whom there are 700,000. As I said a moment ago, there are 6 million carers, and at various times this will be an issue for them, but my hon. Friend has restricted her Bill to the 700,000 who do the most for caring and for society.

[Philip Davies]

We are already slightly all over the place with this Bill, and now the hon. Lady has drawn attention—probably not intentionally—to what a dog’s dinner it is. We are already arguing about how many carers there actually are, but in fact the Bill will apply to only a few of them, and the hon. Lady has just suggested that the vast majority will not even benefit from it. The hon. Member for Burnley has said in the past—and I may say more about this later—that the Bill is just a starting point, and that she intends to extend it further and further, so we have no idea where we may end up.

--- Later in debate ---

[Philip Davies]

I am pleased to hear that. I am sure that it will be a matter of great reassurance to the East Lancashire Hospitals NHS Trust that the hon. Lady was not interested in its opinion, even though Burnley happens to be her local hospital. I was surprised to find, given that she is trying to make such a fundamental change to hospitals, that the one in her own constituency—Burnley general hospital—had not received a request from her to discuss the impact of her proposals. I would have thought that, as the MP for Burnley, she would have taken an interest in that. I personally believe that the people who tend to know best about things are the people who deal with them every single day of their lives, be they nurses, teachers or checkout operators in supermarkets. When assessing the impact of her Bill on hospitals, I would have thought that Burnley general hospital would have been a good place to start.

We have already discussed who currently decides hospital car parking charges. The hon. Lady is right that such matters are decided locally. We should also note that there are guidelines around hospital car parking charges. NHS services are responsible locally for their own car parking policies for patients, visitors and staff. Back in August 2014, the Government published new guidelines on NHS patient, visitor and staff car parking principles—I hope the Minister will expand on this matter when he responds to the debate. They are guidelines only; they are not mandatory. The car parking guidelines recommend the provision of concessions to groups that need them, such as disabled people—both people with blue badges and people who are temporarily disabled—frequent out-patient attenders and visitors with relatives who are gravely ill. The Government guidelines on car parking charges say:

“Concessions, including free or reduced charges or caps, should be available for the following groups: people with disabilities…frequent outpatient attendees…visitors with relatives who are gravely ill…visitors to relatives who have an extended stay in hospital…staff working shifts that mean public transport cannot be used…Other concessions, e.g. for volunteers or staff who car-share, should be considered locally.”

It was also reiterated in the previous Parliament that relatives of people who are gravely ill or who require a long stay in hospital should also be exempt from car parking charges. The then Health Minister made that clear in an answer to a parliamentary question, in which he set out the people who should be exempt as far as the Government were concerned.

[Barbara Keeley]

What the hon. Gentleman is showing is the fact that we have a postcode lottery on this matter now. I want to give him a recent example that was given to me of relatives of somebody who was gravely ill and who then died on the 13th day that she had been in hospital. They were helpfully told, “If you had been coming here one more day, you would have got free car parking.” That was said to a distressed family on the day that their relative died. Does he really think that that is a suitable way for hospitals to go on?

[Philip Davies]

Everyone will have a massive amount of sympathy for the relatives in that example. However, I must point out to the hon. Lady that this Bill will not end terrible situations such as the one she has just described. Even if this Bill is introduced, there will be very many other similar cases, for which we can all feel sympathy. I am not entirely sure why she thinks that this Bill will eliminate any other terrible situation involving someone paying car parking charges; it will not.

--- Later in debate ---

[Barbara Keeley]

No one on the Labour Benches is suggesting that the Bill will eliminate the issue; it will ameliorate it and send an important signal to carers, who repeatedly find themselves in this situation. The example I gave was to show how badly some hospitals behave.

[Philip Davies]

If I had a pound for every time somebody brought forward a private Member’s Bill, or supported a private Member’s Bill, on the basis that it would send a signal, I would be a very wealthy person. Unfortunately, the problem is that we do not pass legislation to send signals. We pass legislation to bring something into the law of the land. The hon. Lady has sent a signal by making that point in this debate. If the whole purpose of this was to send a signal to show how important carers are to the country and how important it is that hospitals show some compassion for carers when they come to visit hospitals, the hon. Lady has achieved that by making that intervention. Perhaps therefore she may feel satisfied that we can leave the matter at that. We have all sent a signal about how important carers are, and I now want to move on to the Bill that is being proposed, which goes way beyond sending a signal.

We already have Government guidelines that set out a range of people who they think should be exempt, all things being equal. When hospital car parking charges were debated back in September 2014, the Minister stated that

“40% of hospitals that provide car parking do not charge and of those that do, 88% provide concessions to patients. However, I am aware that there are 40 hospital sites—which is 3.6% of hospitals in acute and mental health trusts—that have charges and do not allow concessions to patients who need to access services. As a Government, we want to see greater clarity and consistency for patients and their friends and relatives about which groups of patients and members of staff should receive concessions and get a fairer deal when it comes to car parking.”—[Official Report, 1 September 2014; Vol. 585, c. 89.]

Furthermore, in his latest position on the Bill, Lord Prior said that NHS organisations must have autonomy to make decisions that best suit their local circumstances and community interests, and that although the principles provide clear direction and leadership, a one-size-fits-all policy is not appropriate for car parking.

Although the Government have given strong guidance on where concessions should be made for hospital car parking they have, rightly in my opinion, left the final decision to be made by the hospital implementing the policy. Therefore, importantly, each hospital sets its own parking policies and is not required under law to make any exemptions. The Bill today will be the first time that Parliament has intervened to demand that hospitals give free car parking to a particular group of people.

The Government have set out guidelines about the people who, in their opinion, should be exempt from parking charges, or should receive concessions. They are people with disabilities, all frequent out-patient attenders, visitors with relatives who are gravely ill, staff working shifts who cannot use public transport and visitors to relatives who have an extended stay in hospital. Why does the hon. Member for Burnley not believe that those people should have the same benefit as regards hospital car parking charges as the people she includes in the Bill? Is she saying today that the people in the list I have just given are not as important as the people she wants the Bill to cover? Does she think that people with disabilities are not as important as carers? Is she saying that their needs are not as great? Is she saying that staff who cannot get there by public transport are not as important as the carers to whom she refers? Why are the carers so much more important? We all agree that they are important, but why are they so much more important than all the other vulnerable groups who she has spectacularly not included in her Bill while the Government are saying to hospitals that they should make some provision for those people? There is a great unfairness in her proposals.

--- Later in debate ---

[Philip Davies]

Absolutely, Mr Deputy Speaker.

Although there are no official statistics on this matter, in the NHS car parking impact assessment for 2009, the Department of Health provided an estimate of the revenue raised from hospital car parking charges as a whole, which was in the range of £140 million to £180 million. University Hospitals Birmingham NHS Foundation Trust raised £1.5 million from car parking in 2004-05. This measure would clearly leave a substantial hole in NHS hospital budgets.

As I have made clear, one consequence of the Bill would be increased car parking charges for people who do not apply for the free parking. One of my concerns is that we have already seen considerable increases in car parking charges at hospitals. Wye Valley NHS Trust has increased its average hourly rate from 33p in 2013-14 to £3.50 in 2014-15. I would be loth to put any additional cost on people who are using that car park. The Whittington health trust in London doubled its average hourly rate from £1.50 to £3, and Medway Maritime hospital in Gillingham increased its price for a five-hour stay from £5 to £8. Given that we are already seeing such huge increases in parking fees, I would not want to pass a Bill that would see people paying even more.

That point was highlighted by the British Parking Association in 2009, following the scrapping of hospital car parking charges in Scotland. It said:

“Car parks need to be physically maintained, somebody somewhere has to pay. Charges were not introduced to generate income but rather to ensure that key staff, bona fide patients and visitors are able to park at the hospital. Without income to support car park maintenance…funds which should be dedicated to healthcare have to be used instead.”

[Barbara Keeley]

On a point of order, Mr Deputy Speaker. The hon. Gentleman has been speaking for an hour and nine minutes, and we are now getting a lot of repetition. Many other people want to speak.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

In fairness, it is for me to decide whether there is repetition. I certainly do not need any advice. You should not be questioning the Chair’s ability to hold the speaker to account. I am sure that Mr Davies is well aware that many people wish to speak and that he wants to hear those other voices. He is in order, but I am worried that we will get into repetition. I certainly do not want to get bogged down in the maintenance of Scottish car parks. I am sure that he will move on quickly.

--- Later in debate ---

[Mr Chope]

The costs may vary from one hospital to another, but it is clear from the debate that the hon. Member for Burnley does not have the first clue about what the costs would be. We have established that they would be significant, but we have not established who would pay them. Would they be borne by the taxpayer through subventions to hospitals? The Scottish health boards were given £1.4 million to implement a similar policy.

If the money does not come from the taxpayer, would it come from increasing the charges of those who will continue to pay them? My hon. Friend the Member for Shipley (Philip Davies) made some really good points about that. According to the Government’s guidance, they believe that concessions should be disbursed more widely than just to carers. The perverse and unintended consequence of the Bill—this would be inevitable, in my view—would be that higher charges would be borne by people who are worse-off. To take a topical example, a working family on tax credits may be a lot worse-off financially than a carer affected by this Bill, but they would have to pay higher charges to use the hospital car park. That is an example of the perversity of the Bill.

[Barbara Keeley]

If I ever get the chance to make my speech I will come to this, but it is not just families who are on tax credits. A lot of working carers on the carer’s allowance will be hit by tax credit cuts, too.

[Mr Chope]

I hear what the hon. Lady says. I will not go down that route, Madam Deputy Speaker, because we have had enough debate about tax credits and I do not think you want time taken up on them. My point is that many people less well-off than the carers exempted under the Bill will actually pay for the cost of such exemptions. Interestingly, the hon. Lady did not disagree with that point in her intervention, but that is one of the Bill’s perverse consequences.

There is another problem. Clause 1(1) states:

“providing bodies shall make arrangements to exempt…carers engaged in…the qualifying activities…from charges for parking their cars in spaces provided for service users at hospitals”.

It does not state by whom the spaces are provided.

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I warmly congratulate my hon. Friend the Member for Burnley (Julie Cooper) on securing fourth place in the ballot for private Members’ Bills and choosing this important topic. I commend her on her excellent work. She deserves our thanks for raising awareness of this issue. The Bill and this debate enable us to shine a spotlight on the increasing challenges that many unpaid family carers face.

I want to talk specifically about carers and their finances, but first I want to add my perception of an unpaid carer to the comments we have just heard from the hon. Member for Christchurch (Mr Chope). Almost everybody in the sector counts carers who receive carer’s allowance, which is only £62 a week, as unpaid carers. I do not think many of us would think of £62 a week as payment. The term “paid carers” tends to refer to care workers. Apart from my hon. Friend the Member for Ealing Central and Acton (Dr Huq), we have not touched enough on carers’ finances and how they manage, but it is important that we do so. If a Bill, such as this one, would defray costs for a group, it is essential that we understand whether they need that help, and I will argue that they do need it.

The Bill has the full support of the Labour Opposition, and despite the many negative comments I hope that it receives the backing it deserves from both sides of the House. We have heard some rather curmudgeonly comments about the Bill, but much of it deserves our backing, and I hope it will get it. It would exempt carers who receive carer’s allowance from paying hospital parking charges in England. This is an important issue for those unpaid family carers, many of whom make regular trips to hospital with those they care for. The right hon. Member for Harlow (Robert Halfon) carried out research in 2014 and found that people are having to pay anywhere between £11 and £131 a week in hospital parking charges. As I mentioned, these carers get a carer’s allowance of £62, so clearly any week in which they clock up £131 in hospital car parking charges would be a rather frightening time.

One of my constituents, Patricia, tells me:

“My husband is disabled and I am his carer, we can sometimes have two appointments in a day at Salford Royal Hospital that can take up to five hours. The fact that disabled people have to pay car parking charges is disgraceful. Hopefully sometime in the not too distant future the people who have decided on these charges will see the error of their ways.”

When she spends six to eight hours at hospital, she pays £6 to park.

Carers Trust also cites the example of Rachel, who was a carer for her husband, who had Alzheimer’s, Parkinson’s and type 2 diabetes. The combination of his conditions meant regular trips to hospital so that her husband could receive the healthcare he needed. Owing to his dementia, Rachel stayed with him on the ward to feed and clothe him and calm him when he became anxious, and nurses and doctors were grateful for her support and the insights into her husband’s condition she could provide. Over the final five weeks that her husband was in hospital, she paid out £120 in car parking charges. To Rachel, having to check every day that she had put enough money in the meter seemed like a cruel punishment for providing care for her husband in the NHS.

Rachel’s experience is not uncommon. As many Members have said, there are over 6 million unpaid carers in the UK, and the thing to focus on is that they take a great deal of pressure off our healthcare services, but despite this great contribution, many carers are now deeply concerned about extra charges for care and about losing the support on which they rely because of Government budget cuts. Caring for someone else can be overwhelming and demanding, and can have a significant impact on the carer’s own health, on their finances and on their work and career. We know that carers can find that their incomes fall dramatically if they have to work fewer hours or leave work to care. According to the Carers UK “State of Caring” survey, almost half of the carers who responded said they were struggling to make ends meet. Of those, four out of 10 said they were cutting back on essentials, such as food and heating; almost four in 10 said they were using up their savings; and one in four said they had to borrow money from family and friends.

We are talking about carers struggling financially and now finding themselves cutting back on food, dipping into their savings or even borrowing money, and then they find they have to pay these hospital parking charges. Charging carers to park at hospitals adds stress to their lives and takes money out of their purses and pockets. It is no way to reward those unpaid family carers for the vital contribution they make to the NHS.

In a speech to the Local Government Association annual conference in July, the Health Secretary talked about the role of carers and about people taking more responsibility for their family members. He talked about developing a new carers strategy that examines what more we can do to support existing carers and the new carers we will need. This measure is one of those things that we could be doing.

If Health Ministers want to increase the number of family carers, which will be essential, they must consider the impact that caring has on a carer’s income and their future financial security. They should be arguing for carers to be exempt from some charges. The 2010 Government report, “A Vision for Adult Social Care” acknowledges that carers are the first line of prevention. Their support often stops problems from escalating to the point where more intensive packages of support become necessary.

Carers need to be properly identified and supported. Indeed, failure to identify and support carers has serious implications both for the NHS and social care services, but there are many indications that cuts to services have caused, and are causing, mounting pressure on carers. The Minister and I have stood across the Dispatch Box from each other only once before today, but he recently told the House in answer to Health questions:

“I do not think that carers’ invaluable contribution to society has ever been better recognised.”—[Official Report, 13 October 2015; Vol. 600, c. 156.]

I was surprised to hear that comment, and I am sure that many carers and many carers organisations were surprised, too. I feel that the reality is very different from the picture the Minister sought to convey. I can tell him that many carers actually feel unsupported, unrecognised and singled out by the Government’s austerity measures. With cuts of over £4.6 billion to local authority budgets, adult social care support has been reduced or removed in many areas, with many people now paying higher charges and depending on unpaid family carers to cover the shortfall in care.

Financially, unpaid carers have been hit by Government cuts and austerity measures in ways that I feel they should not have been. Around 5,000 carers have been hit by the benefit cap, and at least 60,000 have been hit by the bedroom tax. I brought forward a Bill to exempt carers from the bedroom tax, but the Government and some Conservative Members who are present opposed that sensible proposal.

The hon. Member for Christchurch raised the issue of tax credit cuts. It is becoming clearer that hundreds of thousands of carers in receipt of carer’s allowance and working tax credits could be hit by the Government’s proposed cuts to tax credits, yet many working carers rely on them. Carers UK gives the example of Michelle, who is a lone parent who cares for her son, Jake, who has cerebral palsy. Jake receives disability living allowance and, as his carer, Michelle claims carer’s allowance. She also works three short shifts at a local supermarket each week and is paid just over the national minimum wage. As she works 16 hours and is on a low income, she is also entitled to working tax credit alongside some child tax credit.

Michelle, in common with many carers in her situation—even some Conservative Members seemed concerned about parent carers such as Michelle—finds it very difficult to get the right specialist support for Jake outside school hours, so she cannot increase her hours of work. Jake often has hospital appointments, which also means she cannot take on any more work. If the tax credit changes due in April 2016 were in place now, Michelle’s income would be reduced by over £1,400 per year. As well as losing that £1,400, Michelle would have to continue to pay hospital car parking charges when her son has hospital appointments. That goes to the heart of the point raised by the hon. Member for Christchurch.

Is the Minister content to see a working family carer have her income reduced by £1,400? Carers on carer’s allowance are already caring for 35 hours a week or more, and they cannot be expected to take on more hours to try to make up the loss. I hope the Minister is fighting on behalf of those working family carers and making sure that the Chancellor considers them when he is looking at measures that might mitigate the tax credit cuts. If there is no protection or exemption from charges for carers, they might feel that the Government are turning their backs on them and taking for granted the support they provide and the benefit they bring to the economy.

Age UK’s report, “Briefing: The Health and Care of Older People in England 2015” paints a very clear picture of the current climate in health and social care. Since 2010, 400,000 fewer people are getting the care they need, so the reliance on unpaid family carers will be ever greater. An estimated 1.6 million people currently provide care for 50 hours plus per week, which is an increase of 33% since 2001. Over the next five years, around 10 million people will become carers, so support for carers and help for them to manage their finances will remain big issues.

Carers UK says:

“The growing cost of providing good quality care and support to an ageing population with more complex care needs means that putting in place the right support for carers is both a way of limiting the rise in care costs and a way of supporting carers to have a good life balance”,

to which legislation states they are entitled. As more of us are living longer, one in five of us will become a carer to a family member or a friend in the future, and that care role needs to be supported, financially, socially and in the workplace.

During the long hours I have been sitting here, a number of carers have commented on the debate via social media. One described some of the remarks that have been made today as

“a disgraceful and childish reaction to a very sensible Bill”.

Another said that the remarks were “shameful” and “insulting to carers”. Others said

“I’m glad this is being discussed”,

but that it was

“such a shame this issue is being degraded”,

and that the debate had brought the House into disrepute.

Carers also made very specific comments about Conservative Members, saying that they are “out of touch” and should be reminded that carer’s allowance is only £3,229 a year. One spoke of spending “a fortune” on parking

“for my son’s medical appointments both routine and emergency”.

Many observed that there seemed to be a suggestion that carers would abuse the free parking, which was deeply resented.

Carers’ lives can be made easier by relatively small changes. Ministers have so far turned down the case to exempt them from the bedroom tax. Exempting them from car parking costs is a simple but effective measure, which would show them that we understand the social, financial and emotional difficulties that are associated with caring. It is a small gesture that would show carers that we value their contribution to society. I commend my hon. Friend’s Bill to the House, and I hope that the Minister and all other Members will give it their support.

--- Later in debate ---

[Barbara Keeley]

This is about more than just sending a message. We are increasingly not exempting carers who are on this very low basic income of carer’s allowance—only £3,229 plus whatever extra benefits they might qualify for. They are not exempt from the bedroom tax because the Government have not made them so, they are not exempt from the benefit cap, and now they are not exempt from car parking charges. Some hospitals can do this: Torbay can make concessions, and Scotland and Wales can do it, so clearly it is not impossible.

[Alistair Burt]

No, it is not impossible, but the whole point of what we are talking about is to provide discretion, and I will come back to one or two of the elements related to carers.

As I have discussed with the hon. Member for Burnley, we are looking at the strategy for carers in the round, and I have got the responsibility of doing that. We will look at all sorts of things for the future. The economics will come into it—I take that point—and I think it is best to look at this as an overall strategy. I have offered to involve the hon. Lady, who has agreed; indeed, I would like one or two Back-Bench colleagues from all parties to assist me when that consideration of strategy gets up and going because of their particular interest in the subject. The overall impact on carers of all sorts of things that are happening at present can be taken into account. There will still be finite financial limits, which I will come to soon, but where life can be made easier, we obviously are looking to do that.

The hon. Member for Worsley and Eccles South mentioned the bedroom tax. The relevant rules already take account of the needs of carers. For example, non-spouse resident carers plus others who need to stay overnight are allowed an extra bedroom—[Interruption.] Well, if that is not true, perhaps the hon. Lady would like to intervene on me, but that is what the law says. Discretions are also offered by local authorities, and that too provides an opportunity to take account of what carers might need.

[Barbara Keeley]

The figure of 60,000 carers who are having to pay the bedroom tax comes from the Department for Work and Pensions. There are at least 60,000 of them who have to pay.

[Alistair Burt]

As I have said, the opportunities for discretion exist, but perhaps the way in which discretion is exercised is something that the carers strategy can look at.

It was this Government who passed the Care Act 2014. For the first time, carers—as well as those they were caring for—were given the right to be assessed by a local authority. We gave an extra £400 million for respite care, to be used by those who needed it during the last Parliament. It is therefore reasonable, given the availability of the carer’s allowance and the other measures I have mentioned, for the Government to indicate that carers are valued in ways that they have not been in the past. There has been an incremental increase in support for and recognition of the carer’s role over the years.

I stand four-square behind what my colleagues have done. The Secretary of State’s determination to devise a new carer strategy, on top of what is already there, is a recognition of the fact that more might well need to be done, but it also recognises the value of carers. Nothing we have heard today on either side of the House, including some graphic examples, has suggested that we do not value carers.

Before I respond to the points on car parking charges, I should like to mention the speeches that have been made today. The hon. Member for Burnley set out her case extremely well, and I shall come back to that in a moment. My hon. Friend the Member for Shipley (Philip Davies) is a necessary piece of grit in the oyster of the workings of Parliament. Mrs Thatcher said that every Government needed a Willy, but in addition, every Parliament needs either an Eric Forth or a Philip Davies. They remind us that, at the end of the day, this is not a game. If we pass a piece of legislation, it has consequences and, accordingly, it has to be right. Occasionally, my hon. Friend will say things that people find uncomfortable, but he is just doing his job.

The process of a private Member’s Bill is not easy. Indeed, as I go on talking for a while this afternoon, there will be plenty who say that these processes should be handled differently, but they are not. This is the way in which some things are examined. My hon. Friend made a good speech. Above all, he talked about the problems of economics that I referred to earlier. There are many things that we would all love to do, but often we cannot. We have to make choices. When the Government of the hon. Member for Worsley and Eccles South were in office, they had to make choices, and so do we.

The hon. Member for Birmingham, Perry Barr (Mr Mahmood) made a strong personal plea for the Bill. He mentioned patients on dialysis, and I would like to reassure him that those patients are already covered in our principles as frequent out-patient attenders. The amendment that we have just made to our provisions will ensure that carers of patients on dialysis will be covered by the guidance.

My hon. Friend the Member for Bury North—God bless it!—(Mr Nuttall) went into forensic detail about the Bill. I ask him to convey my good wishes to all at Fairfield hospital, which I remember very well. Both my children were born there, and my wife still has a plaque up on the wall from when she opened a piece of equipment there. My hon. Friend also went into forensic detail when he described the difficulties that would be created by the Bill. He gave it a necessary examination.

The hon. Member for Heywood and Middleton (Liz McInnes), whom we should thank for her services to the NHS over many years, made it clear how passionate she felt about this issue. In a perfect world, everything would be wonderful, and she finished by saying that it would be great if everyone could park for free at hospitals. They cannot do so, however, because the money would have to be found from somewhere. I will come back to that point in a little while.

My hon. Friend the Member for Solihull (Julian Knight) detailed his own personal campaigning for fairer charges in his constituency. He is a perfect example of how an MP of any party can take up an issue and how, when something is wrong that can be worked through, it can be done in a local capacity. He provided a series of perfect examples of what to do as a local Member.

The hon. Member for Ealing Central and Acton (Dr Huq) made a passionate plea for change. My hon. Friend the Member for Christchurch (Mr Chope) examined the Bill in depth, especially in relation to clause 1. He gave examples of where the present discretionary arrangements could work to people’s advantage, and we will come back to those later. If there was no example anywhere of guidance and of opportunity for discretion being used, then the strictures of the hon. Member for Burnley would be much stronger. The fact is that discretion is used in some areas. Various figures were quoted: some 63% of hospitals do not charge, and some 86% or 87% offer discretion. That allows local areas to take notice of the principles and make their own decisions about what is necessary.

May I just add a word about the phrase “postcode lottery”, which is a favourite of mine? A postcode lottery implies a situation in which there is no chance to do anything about it. Many of the things in modern political life that we term postcode lotteries are not postcode lotteries at all, because they all contain the opportunity for people to make a difference, or to change things. The point of local discretion and of transparency in the delivery of services is precisely that it enables people who represent an area to say, “Why isn’t it as good here as it is next door? What is it they are doing that we are not?” They can then apply pressure locally to get something done. They should not always run to Government to say, “It is your fault. You must standardise everything.” Neither should they throw their hands up in the air and say that there is nothing they can do about it. Therefore, I reject the term postcode lottery on most of the times that it is used. This is an example of where, if discretion is used in some areas, why is it not used in others, and what will people do locally to encourage it? Clearly, it happens in some, but not all, places, and it is not always the responsibility of Government.

My hon. Friend the Member for Shipley said that he longed for the day when Ministers could stand up at the Dispatch Box and say, “It is nothing to do with me.” Actually, local discretion is nothing to do with me. All too often people come running towards Government and demand that something is done, when, actually, the answer lies in their own hands, their own constituents’ hands, their own local decision-makers’ hands and, in this particular case, the hands of those who are making decisions about hospital charges. It is fair that responsibility is very widely spread.

Let me move on and say a little bit about the car parking matter. I will do my best to be quick. Everything that the NHS does is on an epic scale, and that is true even in relation to car parking. At hospitals alone, there are around half a million car parking spaces to finance, manage and maintain, and every day, millions of users need to be seen safely on and off the sites. Parking is an amenity that the NHS has to provide if the service is to function properly—or indeed to function at all. Problems are particularly thorny in large acute hospitals, but they also exist in others. Our aim is always to see that parking provision is sufficient, efficient and fair.

The level of car parking provision required is a reflection of massively increased car ownership. When I was a boy and used to go with my father, a GP, to visit our local hospital, there were no car parking charges and the car park was half empty. I was born and brought up in the late ‘50s and early ‘60s, and life was very different. The more people who use our hospitals, the more car parking spaces we will need. Very recently, I went to the Lister hospital, a local hospital used by my constituents, and saw its new car parking facilities, which make a huge difference, but they have to be paid for.

Car parking, like any other service, is provided at a cost. Owning land costs money, so hospitals have to meet finance costs as well as maintenance, lighting, security and so on. Across the NHS, we now see better and better facilities. It is inevitable that some form of charge needs to be levied to cover those very real costs. From this perspective, it is perhaps remarkable that the average cost of parking across the NHS is only £1.15 an hour—and has fallen slightly this year. Once we accept that there is a real and unavoidable cost associated with parking we have to ask ourselves, “If hospital parking costs are not paid for by drivers, who are they paid by?” Again, that was a hard question asked by Members on the Government Benches.