Urgent and Emergency Care Review

Baroness Keeley Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

I have to gently say to the hon. Gentleman that recruiting nurses from the Philippines did not happen for the first time under this Government. One reason why those nurse vacancies have gone up is that the Government decided to conduct a public inquiry into what happened at Mid Staffs. The system reacts to that by wanting to hire more nurses, and I think that he should welcome that, not criticise it.

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

The report by the Health Select Committee on the A and E crisis found that only 16% of hospitals had the right level of consultant cover in A and E. Yesterday, we learned that half the vacancies for senior A and E doctors are unfilled, as doctors move to work overseas. The issue of staffing in A and E has been understood for the past three and half years, and there have been repeated warnings and reports. What has the Secretary of State done to address it and make sure that A and E wards have sufficient staff cover?

[Mr Hunt]

Recruiting 300 more A and E consultants than when the hon. Lady’s Government were in power.

Tobacco Packaging

Baroness Keeley Excerpts

Thursday 7th November 2013 Commons Chamber

[Mr Barron]

It is indeed. The packages themselves are there to attract young women. I have an empty packet in my office that demonstrates exactly that. The idea that packaging is not used to sell products or advertise them effectively is nonsense. The Silver Slide design is intended deliberately to undercut the health warnings that the law now requires on each packet.

The hon. Member for Ribble Valley talked about adverts and bill posters, and said that he could only understand the part at the bottom. When I introduced a private Member’s Bill in 1994 to get rid of tobacco advertising and promotion, it was pretty clear that most of the adverts on billboards were not understood by some people. They were deliberately designed for the inquiring mind. There would be a picture of a piece of silk with a cut halfway down the middle. The advert did not say Silk Cut cigarettes; it did not have to. However, who are the ones with inquiring minds? They are young people. Tobacco companies did that deliberately for many years, and the G. K. Chesterton quote is to get young people to say that they can take this on, and that they are not bothered about what people say.

In Australia, it has been decided that there should be no branding on tobacco packaging other than the product name shown in a standard font, size and colour. No other trade marks, logos, colour schemes and graphics are permitted. Colours and graphics have been selling cigarettes in this country for decades. In Australia, cigarette packs should not carry attractive designs and should therefore come in standard shape, size and colours, and the colours should be as unattractive as possible. There should be prominent health warnings front and back, in pictures as well as writing, and there should be a phone number and web address on every pack to help smokers to access quit services.

There are 100,000 premature deaths a year from tobacco smoking in this country. If those deaths had been caused by anything else in the 30 years that I have been in Parliament, this House would have been sitting 24 hours a day, seven days a week, until we could find a way to stop it. It is no good the Government saying that they will wait. We know what tobacco marketing has been like for decades. We have stopped most of it, and we should stop this advertising at the point of use as well.

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

In an area such as Salford, 1,000 young people—the figure was 1,100 in Barnsley—will start to smoke this year. If I am called to make a speech, I will talk about that. Ten months, a year or 18 months of delay will cause 1,000 or 1,500 young people in an area such as mine to start smoking, and that is a tragedy.

[Mr Barron]

And another 207,000 nationally will start this habit a year.

One might ask why people buy a packet of cigarettes when it has a warning on it, but this is an addiction. All sorts of addictions sadly roll over common sense, and tobacco is no different. Stopping young people starting is crucial, and that is working. Smoking rates for young children are diminishing now, as are rates for adults, partly as a result of taxation and partly because we are stopping tobacco companies promoting cigarettes.

There are no figures to show that counterfeiting is more likely with plain packaging. Earlier this year, the Japanese company came to the House and told us that there would be more counterfeiting, but there is no evidence of that. It showed us—I have one in my pocket —a counterfeit packet. It looks like any other Benson & Hedges packet, so counterfeiting happens now. Standard packaging could include features to protect against counterfeiting, and it is for the House to regulate to introduce them. Hon. Members should not use the arguments that have been sold by the tobacco companies year after year. When it was found that tobacco related to massive numbers of deaths, the companies were still questioning that decades after the event—they still do now. They use this House to do it on occasions and, I have to say, it is wrong. When there are 100,000 premature deaths a year, we as legislators have some responsibility to alleviate the problem. I know that smoking is addictive and it is difficult for people to stop.

--- Later in debate ---

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

I congratulate the hon. Member for Harrow East (Bob Blackman), my hon. Friend the Member for Stockton North (Alex Cunningham), my right hon. Friend the Member for Rother Valley (Mr Barron) and the right hon. Member for Sutton and Cheam (Paul Burstow) on securing the debate on this important subject. We need to keep focusing on the issue because it has a great impact on the health of our constituents and most of all on the children and young people in our constituencies.

As an MP representing Salford, I want to speak today because, as others have said about their constituencies, smoking, smoking-related deaths and lung cancer rates are all too high in Salford. One in four of the population in Salford smoke, which is higher than the national average of one in five people in England as a whole. As a consequence, we have much higher rates of smoking-related death in Salford and a higher incidence of lung cancer, with 175 new cases of lung cancer diagnosed each year. The right hon. Member for Sutton and Cheam said that it was estimated that 530 children in his borough would start smoking this year. In Salford, sadly, the figure is nearly 1,000—almost double.

As we have heard in the debate, so many smokers— estimated at eight out of 10—start by the age of 19 and one in two of those young people will die of smoking-related diseases if they become long-term smokers. We know and we should continue to reflect upon the fact that this habit is the biggest cause of premature death in the UK and long-term smokers have a life expectancy that is 10 years shorter than non-smokers.

There has been some debate about the early evidence from Australia on the introduction of plain packaging. It suggests to me that branded cigarette boxes influence the perception of smoking among young people, and that plain packaging can help in the fight against starting smoking. That is why the issue is important and it is largely what I shall speak about here. As the right hon. Member for Sutton and Cheam said, 70% of those interviewed in a study in Australia who smoked from plain packets said that they thought the cigarettes were “less satisfying”. That is an important finding. They rated quitting as a higher priority than those who continued to smoke from a branded pack did.

A separate study found that 80% of children interviewed rated plain cigarette packs as “uncool”. Members who have spoken so far have rightly focused on how much packaging influences that perception of cool, because brands are very important to young people. Those are powerful findings from Australia.

I believe that there is weight behind the argument that cigarette packaging is the last legal form of tobacco advertising and that it has an influence on young people’s perception of smoking. That in itself is why we should take action to introduce plain packaging.

In the excellent Westminster Hall debate on 3 September —we have already touched on this, but it is worth reflecting on—the then Health Minister, the hon. Member for Broxtowe (Anna Soubry), talked about the power of packaging. She said:

“I have never forgotten the first time that I bought a packet of cigarettes.”

She deliberately chose a particular brand

“because they were green, gorgeous and a symbol of glamour.”

She said:

“I distinctly remember the power of that package. It was the opening of the cellophane and the gold and the silver that was so powerfully important to many people who, as youngsters, took up smoking.”—[Official Report, 3 September 2013; Vol. 567, c. 23WH.]

That was a very honest admission from a Health Minister, but she still went on to adopt the “wait and see” approach that we are getting from the Government. The health of our young people does not have time for wait and see.

In the previous Parliament we introduced a ban on smoking in public places, and I was very pleased to be a Member of this House when we voted for that. I visited Copenhagen earlier this year and found myself in public places where people were lighting up cigarettes. I was surprised, because it is easy to forget how unpleasant it is to be in a public place where people are smoking and to come home with clothes and hair reeking of smoke. It is very unfamiliar to us now. Much worse, of course, are the health impacts for the people in those places who do not want to inhale smoke.

My hon. Friend the Member for Barnsley Central (Dan Jarvis) outlined the steps that have already been taken to make smoking less attractive. Tobacco advertising has been banned from TV, billboards and sports such as Formula 1. Surely the next step is to tackle the advertising on the packaging.

In 1950 the figures were much higher: around 80% of men and 40% of women smoked. Amazingly, cigarette advertising at the time used images of doctors and celebrities to promote the different brands. One brand even used images of Santa Claus smoking—imagine that in the run-up to Christmas—to prove that it was easy on the throat. In the Westminster Hall debate my hon. Friend the Member for Vale of Clwyd (Chris Ruane) told me about a cigarette pack currently being sold—we have heard today from the right hon. Member for Sutton and Cheam about some of the packs available—and described it as

“a lovely 1950s retro pack, which opens up to show nice pink cigarettes inside”—[Official Report, 3 September 2013; Vol. 567, c. 18WH.]

Those packs are targeted at young teenage girls, and that is very cynical advertising. As I have said, the early evidence suggests that the attractiveness of the brand does have an impact, especially on young people, who are so impressionable. We know that the colour pink is being used because it is attractive to young teenage girls.

Early reports suggest that plain packaging can make such a big difference by changing perceptions of smoking. That is important for our children. A review commissioned by the Department of Health and the Public Health Research Consortium showed that standardised packaging was less attractive, more effective in conveying messages about the health implications of smoking and more likely to reduce the mistaken belief that some brands are safer than others, the old idea that flavourings or menthol make it less damaging, which is also untrue. All the evidence suggests that plain tobacco packaging greatly reduces the attractiveness of cigarettes for children, and Australia’s stance is supported by the World Health Organisation.

I want briefly to congratulate stop smoking services in Salford, particularly on their programmes focused on reducing smoking in families with children under 16. If children do not see their parents smoking, they are less likely to start smoking themselves. Many of our programmes in Salford are targeted at those families.

All the tobacco advertising I have talked about is pernicious. However it is done, whether with slim packages, colouring or making it look like perfume, it focuses on young people, and particularly young women who want to remain slim. It is almost unbelievable that tobacco companies used to use Santa Claus and doctors to promote smoking and tried to persuade us that it was safe. I do not want to continue to see 1,000 young people in Salford start smoking each year. It is time we took the next important step to close down cigarette advertising by introducing plain packs. It is time to prevent our children from starting smoking. It is time the Government supported the amendment to the Children and Families Bill that will take that important step. Above all, it is time to reduce the large numbers of people affected by smoking-related illness and early death, both in Salford and across the country.

[Guto Bebb (Aberconwy) (Con)]

It is a pleasure to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing the debate and the other Members who went to the Backbench Business Committee to ensure that it took place. However, my comments will not be particularly supportive of my hon. Friend’s views on the issue. I look at the matter from the perspective of a member of the Public Accounts Committee, which recently produced a significant report on the impact of tobacco smuggling on the loss of tax revenue in the UK. Having seen the evidence, I came to the strong conclusion that the case for plain packaging is certainly unproven.

The hon. Member for Worsley and Eccles South said that she wanted to ensure that 1,000 children in her constituency do not take up smoking. I wonder what the evidence is to suggest that those 1,000 children will not take up smoking simply because of a change in the product’s packaging. The right hon. Member for Rother Valley (Mr Barron) explained that he started smoking by stealing cigarettes from his father. I wonder whether his father’s choice of brand had any significant impact on his decision to steal a single cigarette. When I was growing up in Caernarfon, when people wanted to smoke they went to a local post office to buy singles. I suspect that they gave no consideration whatsoever to the brand; the point was that they could buy cigarettes very cheaply, usually one at a time. It was an important development when that was made an illegal practice that would not be tolerated. However, it is still the case that the driver is the price, not the branding. That is what I want to talk about.

When the Public Accounts Committee researched the smuggling of tobacco products into the UK, some of the information that emerged from that work was shocking. For example, in the top 10 recognised consumer brands of cigarettes in this country there are often two or three that are illicit and that it is illegal to supply in this country—for example Jin Ling, Richman and Raquel. Strictly speaking, those brands should not be available and so they would not be affected by legislation on plain packaging, yet independent consumer surveys show that those brands, despite being illicit and illegal, are recognised by the public.

The question we must ask, therefore, is why and how those brands are gaining a foothold in this country. Clearly it is unacceptable that they are smuggled into the country, and at such a rate that they are now recognised consumer brands. The key point we must recognise is that the driver for the sale of those products is not the branding or the so-called attractive packaging; it is the price. A packet of 20 cigarettes costs between £7.50 and £8. My son, who is lucky enough to have a paper round, would have to spend half his weekly wage if he decided to buy a packet of cigarettes legally, yet he could go out to any estate or high street in my constituency and, if he was switched on, find a packet of illicit tobacco for between £2 and £2.50.

I therefore argue that the driver encouraging young people to start smoking is more likely to be the price than the branding. If a young person can buy a packet of 20 cigarettes for 15% or 20% of their weekly paper round wage, they would be more tempted to do so than if they could buy it for 50% of their wage. By concentrating on plain packaging, we are ignoring an important fact: price is a driver for the sale of these products.

Time and again hon. Members have argued that plain packaging is about protecting young people, yet in university towns the young people often smoke roll-your-owns. The figure for roll-your-own tobacco is absolutely atrocious. In my constituency, which has no higher education facility, 48% of loose-leaf tobacco will be smuggled and illicit. The vast majority will not be recognised UK brands. In any town with a university or further education college, the percentage of illegal and smuggled loose-leaf tobacco will be even higher. What is the driver? What is persuading young people to buy tobacco products that are not officially marketed in the United Kingdom? The answer, I argue, is price.

[Barbara Keeley]

The hon. Gentleman seems to be arguing that people who are already addicted, such as older students, will smoke anything, but that is not surprising. We have repeatedly argued that young people get addicted in their early teens, and his arguments do not negate that.

[Guto Bebb]

The hon. Lady completely misrepresents my view. I said clearly at the outset that the temptation for young people is much enhanced if the product is affordable, and I think she fully understood my point.

It is important to recognise the problem of illicit and smuggled products because evidence—yes, to be tested and argued about—has been presented to suggest that plain packaging will actually make it easier for these products to be made available. I am fully aware that there are arguments on both sides. However, what is being said in this debate is, in effect, that the Government’s decision to wait to look at the evidence from Australia somehow indicates that they are in league with the tobacco companies. I find that quite distasteful.

I genuinely approach this debate from the point of view that I would like the number of people who smoke to be reduced—to nothing, I hope. I have never smoked, and if any of my children smoked I would be absolutely furious. Indeed, I lost my father to lung cancer at the young age of 63. My children never saw their grandfather simply because of his smoking. If the evidence was clear that plain packaging would be the answer, I would be supportive. I find it very odd that Members are saying that looking at the evidence is somehow condemning people to die. That is emotional and unacceptable language.

When Populus recently surveyed a number of police officers about whether they thought that plain packaging would be helpful, 86% of them clearly stated that they thought it would make it easier for illicit tobacco products to be supplied and that those products would be targeted at young people who could afford them. Sixty-eight per cent. of the police officers thought that plain packaging would lead to an increase in the size of the black economy in relation to tobacco products. A full 62% thought that an increase in cheap tobacco products would result in an increase in the use of tobacco products by children. Those are very interesting and important findings from a poll of police officers. Are their views correct? We need to look at the evidence and consider very carefully whether it supports them.

--- Later in debate ---

[Luciana Berger]

That point has been made by other hon. Members in this debate. I remember from when I was a young person that children do not get their money only from their parents and that they do not necessarily buy the cigarettes themselves. Often, they see other people getting out their packs of cigarettes.

The children in the university of Stirling study who were shown a packet of Silk Cut cigarettes were found to be more than four times more likely to be susceptible to smoking. Those children had never smoked.

It is the packaging that entices children. If we want to discourage children from ever starting to smoke, we need to question whether that is an acceptable way to market a product that is highly addictive, seriously harmful and clinically proven to kill. Smokers advertise tobacco brands to other people every time they take out their pack to smoke. The packets should not be glitzy adverts, but should carry strong and unambiguous health warnings about the dangers of smoking. We should not allow those warnings to be subverted by the design of the rest of the packet.

I will move on to my second theme. We have heard a few arguments against standardised packaging in this debate. We have also heard those arguments from the tobacco industry. I will deal with each of the arguments in turn. Much of the discussion has centred around evidence. Hon. Members have said that there is no evidence that standardised packaging will work. That is not true.

Last year, the systematic review by the Public Health Research Consortium, which was commissioned by the Department of Health, looked at all the evidence on standardised packaging. The findings are clear for everyone to see. It found that standardised packaging is less attractive, especially to young people. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) rightly pointed out that it takes away the cool factor. The review also found that standardised packaging makes health warnings more effective and combats the utter falsehood that some brands are safer than others. Those findings have been backed up by 17 studies that have been published since the systematic review. Government Members, including the hon. Member for Ribble Valley, have asked for evidence. We have the evidence.

A separate study that was published in the British Medical Journal in July looked at research from Australia soon after the introduction of standardised packaging. It found that smokers who used standardised packs were 66% more likely to think that their cigarettes were of a poorer quality, 70% more likely to say that they found them less satisfying, 81% more likely to have thought about quitting at least once a day in the previous week and much more likely to rate quitting as a higher priority in their lives than smokers who used branded packs. Not only are people less likely to take up smoking when presented with standardised packs; people who already smoke are more likely to think about quitting if the cigarettes that they buy come in standardised packaging.

[Barbara Keeley]

My hon. Friend is being very generous with her time. The hon. Member for Rossendale and Darwen (Jake Berry) seemed to be quite satisfied with the Government’s action on this issue, although that is perhaps not surprising given the views that he has put forward in this debate. However, it is a fact that fewer people have quit smoking successfully and that fewer people have attempted to quit with NHS help over the last year. That is the first time since 2008-09 that those figures have fallen. I talked about quit services in Salford, but such services are now less successful and there must be a reason for that. Does my hon. Friend take that as seriously as I do?

[Luciana Berger]

I thank my hon. Friend for that important intervention. The figures that came out just the other week do show a drop in the number of people who are quitting smoking through NHS services. I am very concerned about that. As I said at the start of my contribution, 200,000 young people still take up smoking every year. That is exactly what we are seeking to address in this debate.

We have reflected a lot on the Australian experience. The former Australian Health Minister, Tanya Plibersek, reported that there was a

“flood of calls…in the days after the introduction of plain packaging accusing the Government of changing the taste of cigarettes.”

She went on to say:

“Of course there was no reformulation of the product. It was just that people being confronted with the ugly packaging made the psychological leap to disgusting taste.”

That is a significant point. Far from there being no evidence, there is a swathe of evidence.

The second claim raised during our debate is that standardised packaging would increase the trade in counterfeit cigarettes, or impact on the printing trade. Again, it is important to clarify that we are talking about standardised packaging. I have heard hon. Members use the term “plain packaging”, but we are not discussing that. I know I am not allowed to demonstrate this at the Dispatch Box, Madam Deputy Speaker, but standardised packaging is clearly printed; it is not a plain pack. Current packaging is already so easy to forge that covert markings enable enforcement officials to identify counterfeit cigarettes, and all key security features on existing packets would continue on standardised packets. Standardised packaging would make pictorial warnings more prominent and packaging harder to forge.

We heard in an important contribution that standardised packaging might lead to an increase in illicit trade, but that is simply not true. Andrew Leggett, deputy director for tobacco and alcohol strategy at Her Majesty’s Revenue and Customs, stated in oral evidence to the House of Lords European Union sub-Committee on Wednesday 24 July:

“There are a number of potential factors that weigh on counterfeit packaging”,

but that if standardised packaging was introduced, it was

“very doubtful that it would have a material effect.”

--- Later in debate ---

[Jane Ellison]

The Government are following discussions in another place closely. Beyond that, I am not able to comment in this debate, but we are well aware of those discussions and Ministers are participating in them.

Australia introduced standardised packaging in December 2012, and New Zealand and the Republic of Ireland have committed to do that. In addition, other academic studies are emerging about the effects of that policy.

The UK has a long and respected tobacco control tradition internationally, although at times in this debate it has been possible to miss that point. Under successive Governments the UK’s record has been good, and we will continue to implement our existing plan to reduce smoking rates while keeping the policy of standardised packaging under active review. The tobacco control plan for England sets out national ambitions to reduce smoking prevalence among adults, young people and pregnant mothers. As the plan makes clear, to be effective, tobacco control needs comprehensive action on a range of fronts.

I will talk a little more about this in the context of devolved powers of public health to local government, but there is a slight danger that by focusing only on one aspect of tobacco control, we forget that there are other—and indeed more—things that we could do. Even if it was possible to say today that we would do this tomorrow, we would still be debating how we could effectively control tobacco and stop children taking up smoking. As various hon. Members have said, including the right hon. Member for Rother Valley (Mr Barron), this is an ongoing battle to protect children’s health.

[Barbara Keeley]

Is the Minister concerned about the fact that between April 2012 and March 2013, there was an 11% decline in the number of people setting a quit date? We are concerned about children, but if they are still watching their parents smoking, it is more likely that they will start. I hope that she is disturbed by the fact that the numbers setting out to quit are falling—it is the first fall since 2008-09. The Minister should address that point.

[Jane Ellison]

We are aware of that, but smoking in this country has dipped below 20% for the first time ever. I am aware of the hon. Lady’s concerns and I shall talk a bit about some of the public health campaigns and the new opportunities, not just for the Government but for local government and individual Members, on tobacco control policy.

As our plan makes clear, effective tobacco control needs comprehensive action on many fronts. The Government are taking action nationally. We are committed to completing the implementation of legislation to end the display of tobacco in shops. Since 2012, supermarkets can no longer openly display tobacco. In 2015 all shops will need to take tobacco off view. Tobacco can no longer be sold from vending machines, which has stopped many young people under 18 accessing smoking.

I do not want to downplay the importance of this policy—we are conscious that it could make an important contribution—but we can do many other things. The reasons why children, in particular, take up smoking are very complex, and are to do with family and social circumstances. One policy alone will not address that. Local authorities have a vital role to play, which is why we have given local government responsibility for public health backed by large ring-fenced budgets—more than £5.4 billion in the next two years. I encourage all hon. Members who have participated in today’s debate to ask tough questions of people locally. I hope that they are talking to their public health directors, health and wellbeing boards and clinical commissioning groups about where tobacco control sits in the armoury of local government. That is why this power has been devolved. The local insight and innovation made possible by that policy will help us to tackle tobacco use at a local level as well as through policies that the Government can put in place.

--- Later in debate ---

[Jane Ellison]

I will move on as I have tried to respond to the hon. Gentleman’s point.

Our local stop smoking services are among the best in the world. The fact is that smokers trying to quit do better if they use them. Research has found that

“English stop smoking services have had an increasing impact in helping smokers to stop in their first 10 years of operation”—

although I hear the challenge that has been made on the recent drop—

“and have successfully reached disadvantaged groups.”

The latter are obviously particularly important from a public health point of view.

This year, Public Health England has launched a new dedicated youth marketing programme. This marketing strategy aims at discouraging a range of risk behaviours, including tobacco use, among our young people. In this financial year, that is worth more than £1.5 million.

[Barbara Keeley]

The Minister does not seem to be saying what the Government will do about the decline in quitting—the fact that stop smoking services are not reaching people to the extent that they should be. Does that concern her, and is she going to do something about it?

[Jane Ellison]

That is something that I will look at carefully, but I point out to the hon. Lady that obviously this issue now falls under the remit of Public Health England. It will be on my agenda for the next meeting with the chief executive, and I will write to her after I have had that discussion, if that would be helpful.

--- Later in debate ---

[Bob Blackman]

This being the first time I have spoken when you have been in the Chair, Madam Deputy Speaker, I congratulate you on your election to high office.

We have heard today from 11 Back Benchers, as well as the two Front Benchers, and hon. Members have put their arguments strongly. Clearly, I am wholly in favour of standardised packaging for tobacco products, and the quicker it is done the better. Three arguments have been advanced against its rapid introduction. The first concerns the illicit trade. In reality, the illicit trade continues now, but the evidence is that through the security marking of packaging and cigarettes themselves, and with greater vigilance from our customs and excise people, the illicit trade can be stamped on hard. The tobacco industry, which is against standardised packaging, uses the illicit trade as an excuse.

Secondly, we have heard that the big tobacco companies would use the money they currently spend on packaging to cut the cost of tobacco. My answer is to increase the tax. We must ensure that tobacco is expensive so that people are discouraged from purchasing it. Thirdly, the key argument from those who oppose the measure seems to be, “Let’s delay and prevaricate. Let’s wait and see what happens. Let’s wait for everyone else to decide, and then take action ourselves.” As we have said, 300,000 under-18s start smoking every year, so the longer we delay, the greater the number of people taking up smoking and dying prematurely.

[Barbara Keeley]

I imagine that the hon. Gentleman was as disappointed as me to hear the Minister’s response. There is a tendency among Health Ministers to say that everything is at arm’s length. Like me, I hope that he rejects the Minister’s claim that responsibility lies with Public Health England, local government and Members themselves. The action we need is action that only the Government can take. Does he support that view?

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

I am very sympathetic to the point made by my hon. Friend. The chief inspector has indicated that he will look at how individual wards are run on a granular level to ensure there is the right skills mix to look after patients on any particular day, with proper accountability for patient care.

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

The chief inspector of hospitals says he will monitor levels of unanswered call bells, but not the ward staffing levels that cause the bells to be unanswered. Is that not ridiculous? Is it not time that Ministers changed their minds on this important issue, as Robert Francis has now done?

[Dr Poulter]

As the hon. Lady will be aware, on the basis of the Francis report the Berwick review considered that issue in detail and highlighted the fact that safe staffing levels are not about ticking a box for minimum staffing, but about developing tools that recognise the individual needs of patients on the ward. The previous Government went down the route of tick-boxes in health care. I worked on the front line during that time and that route did not deliver high-quality care. We need the right tools to support front-line staff so that they make the right decisions in looking after patients. It is not about tick-boxes; it is about good care.

Accident and Emergency Departments

Baroness Keeley Excerpts

Tuesday 10th September 2013 Commons Chamber

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

It appears that the Secretary of State is not listening to the Health Committee, which has looked into the issue. The Chair, the right hon. Member for Charnwood (Mr Dorrell), has made it clear that he does not think the 2004 GP contract is to blame for these issues, but we found out that only 16% of hospital trusts have the recommended level of emergency consultants, and we noted that nearly £2 billion has been taken out of adult social care. When will the Secretary of State deal with the staffing cuts and budget issues that are actually causing the A and E crisis?

[Mr Hunt]

My right hon. Friend said to the House that he largely agreed with the changes that I wanted to make to the GP contract. I always listen very carefully to what the Select Committee says, but I point out to the hon. Lady what Professor Keith Willett, who is the person at NHS England who is in charge of all A and E departments, said. He said that between 15% and 30% of the people attending A and E departments could be looked after by primary care. If we ignore that—I am afraid that what Labour did in 2004 has made the problem a great deal worse—we will not solve the underlying problems with A and E.

Tobacco Products (Plain Packaging)

Baroness Keeley Excerpts

Tuesday 3rd September 2013 Westminster Hall

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

It is a pleasure to speak in the debate under your chairmanship, Mr Hollobone. As an MP for Salford, I want to speak because smoking, smoking-related deaths and lung cancer rates are all too high there. One in four of the population in Salford smoke, which is a much higher rate than the average of one in five people in England as a whole. Consequently, we have much higher rates of smoking-related death and a higher incidence of lung cancer, with 175 new cases of lung cancer diagnosed each year. The worst statistic is perhaps the Cancer Research UK estimate that around 1,000 children in Salford start smoking each year; that addiction will kill one in two of them, if they become long-term smokers.

Early evidence from Australia on the introduction of plain packaging suggests that branded cigarette boxes can influence the perception of smoking among young people and that plain packaging might help the fight against starting smoking, which is what is important to me. In a study there, 70% of those interviewed who smoked from plain packets said that they thought that the cigarettes were “less satisfying”, and they rated quitting as a higher priority than those who continued to smoke from a branded pack. In an important separate online study, 87% of the children interviewed rated plain packets as “uncool” and said they would not want to be seen with them.

There is, therefore, weight behind the argument that cigarette packaging is the last legal form of tobacco advertising and that it has an influence on young people’s perception of smoking. That is why it is really important that we take action to introduce plain packs.

In the previous Parliament, we introduced a ban on smoking in public places and it made a difference. I visited Copenhagen earlier this year, and found myself in public places where people were lighting up. It is easy to forget how unpleasant it is to be in a public place where people are smoking and to come home with clothes and hair stinking of smoke, but worse is the effect of second-hand smoke on health. Since 2002, tobacco advertising has been banned from TV, billboards and sports such as Formula 1; the next step is to tackle the advertising on the packaging.

In 1950, 80% of men and 40% of women smoked. Cigarette advertising at that time used images of doctors and celebrities to promote the different brands. One brand even used images of Santa Claus smoking.

[Chris Ruane]

I mentioned two packs earlier. One I was not able to get hold of for today, despite my trying. It is a lovely 1950s retro pack, which opens up to show nice pink cigarettes inside—very appealing to a 12-year-old. What does my hon. Friend think about that kind of retro advertising by the tobacco industry?

[Barbara Keeley]

It just shows that all these methods are being used to attract smokers—particularly, and sadly, young smokers. To think that we once used Santa Claus to claim that a brand was easy on the throat. We have heard of the damaging impacts and the dreadful way in which people die.

I congratulate the stop smoking services in Salford, particularly for their programme that focuses on reducing smoking in families with children under 16. Research has shown that, if children do not see their parents smoking, they are less likely to start smoking themselves. Many of our programmes in Salford are targeted at families. I think it is true that most smokers do not want their children to start smoking.

All the advertising is pernicious. It focuses on young people, and on young women who want to remain slim and, for heaven’s sake, in the past, it used Santa Claus and doctors. It is time we moved on to take the next important step to close down cigarette advertising by introducing plain packs. It is time to prevent children and young people from starting smoking—I do not want to continue to see 1,000 children a year in Salford starting to smoke—and to reduce the large numbers of people affected by smoking-related illness and early death, in my authority and across the country.

--- Later in debate ---

[Anna Soubry]

I suppose that I am sort of grateful for that intervention. It was not the most helpful, but it was a fair one and it is a good point that needs addressing. I have no difficulty in waiting for the evidence to emerge from Australia. It is on that point that I agree with the hon. Member for North Antrim (Ian Paisley). However, it is the only point on which we agree on this matter. It is important that we consider the evidence. Of course we know that the Irish Government have also said that they want to introduce this measure. Again, we will wait and see. It is no simple matter to introduce standardised packaging. There will be many challenges that the Irish will face in their attempts. It is right and fair that we wait to see all of that as it develops.

[Barbara Keeley]

rose—

[Anna Soubry]

May I make some progress, because it is really important that I make the matter clear? The coalition Government have made no final decision. As I have said, we wait to see the evidence as it emerges from both Ireland and Australia. It is important to say that standardised packaging is no silver bullet. There is no simple solution to the problem of persuading both the remaining 20% of the population to give up smoking and our youngsters not to smoke.

I want to deal if I may with some of the excellent points that have been made. I, like many other Members, have talked about the power of the package. The hon. Member for Vale of Clwyd (Chris Ruane) helpfully brought in some packets. He mentioned the cigarettes that are deliberately targeted at young women. My hon. Friend the Member for Banbury (Sir Tony Baldry) asks why children, in the face of the overwhelming evidence and the health messages, take up smoking. He is right to say that we need to do more research. We know many things.

We know, for instance, the power of parents. If a child is brought up by parents who smoke, they are likely to smoke because they will see it as the norm. One of the great benefits of the legislation that was introduced by the previous Administration—I pay full credit to them for introducing that ban on smoking in open places—was that it made smoking less socially acceptable. Effectively, it turned many of us into modern-day lepers. If we wanted to smoke, we were reduced to standing outside, ostracised from our workmates, and that was a powerful reason why so many of us gave up smoking. Many of us remember with shame, as I do, sitting in restaurants thinking that we had some God-given right to smoke next to people who rightly found it deeply offensive, and who were trying to enjoy their meals. It is astonishing to look back at films and television programmes of only a few years ago to see how acceptable smoking was and how the previous Parliament changed that.

I absolutely agree with all those who are trying to nail the falsehood in two important parts of this argument about standardised packaging. The first is whether it is plain. I concede that one of the great failings of this debate is to explain what we mean by “standardised”. That goes back to the point that was inaccurately made by my hon. Friend the Member for Bury North. I never said that packaging would be glamorous or glitzy, but that, as I think my hon. Friend the Member for Harrow East also tried to say, under the regulation and legislation holograms can be put on standardised packaging—not to be attractive but as part of the argument against the claim that anybody will be able to counterfeit it.

Far from being a counterfeiter’s charter and dream, standardised packaging is a counterfeiter’s nightmare. I wish that I had with me some of the packets that have been produced by Australia. If we had them, Members would see that they are far from plain. On the contrary, they have colour in them, but they have the standardisation, which takes away this incredibly powerful marketing tool and the attraction for young people.

[Barbara Keeley]

On the point about waiting for the evidence, it is not 20% of people who smoke in Salford but 25%, and much more in some areas, and it is 1,000 children. As we wait, 1,000 children every year will start smoking in Salford. Why are we waiting?

[Anna Soubry]

I think I have explained why we have waited. My understanding of the statistics is that it is 20%, but it differs in different parts of the country. I also want to make the point that the Government have not stepped away from taking action against the harmful effects of tobacco. We have a tobacco control plan for England that sets out our national ambitions and our comprehensive evidence-based strategy of national and local actions to achieve them, including high-profile marketing campaigns. Our Stoptober campaign, which was hugely successful last year and which we will be running again this year, provided help and assistance to smokers, the majority of whom want to quit.

I also want to pay tribute to local authorities, which now have responsibility for public health. I have met members and representatives from councils in the north-east who are doing some terrific work persuading people to stop smoking or not to take it up, and that shows good local action.

As ever, the clock is against me, but I hope that I have made the Government’s position absolutely clear. I congratulate again everybody who has spoken in this debate. My own views are clear, but it is right to wait to see the evidence. I assure Members that the wise words from so many different parties today will be taken back to the Government and will be listened to. It is to be hoped that in due time, standardised packaging will be introduced.

Managing Risk in the NHS

Baroness Keeley Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

As so often with the spin that we hear from Government Members, it is our achievements they are trying to claim credit for. I left behind the plans for the training of those doctors, but we do not hear much credit coming in this direction, do we? Government Members are happy to take the credit and then they try to cast off all the blame for everything else. My point is that criticism must be fair and made with care. We all have a duty to point out the failings of the NHS, in our own constituencies and nationally, and that is what I did when I did the Secretary of State’s job. However, we have to do that responsibly and fairly, especially for hospitals and those who manage them.

Hospitals are not the architects of all the problems we read about. For example, they are all struggling with the fallout of severe cuts to social care budgets, the appalling cost of which I recently revealed: a 66% increase over two years in the number of over-90s coming into A and E via blue-light ambulances. In human terms, more than 100,000 very frail and frightened people have been speeding through the streets of our communities in the back of ambulances. Hospitals have to absorb that extra pressure and also struggle with longer delays in getting people back home. We are in real danger of asking too much of our hospitals by allowing them to be the last resort for people who would be better supported elsewhere. Without a greater understanding of that situation in the current debate, and if the trend towards the vilification of NHS managers continues, who will take on the job of running our acute trusts? Good people will walk away and no one will want to do the job. Again, the NHS simply cannot afford that.

This crude blame game is an election strategy with two components: run down the NHS; and pin all the failings on the previous Government. The NHS cannot take 20 months of that until May 2015. It has been destabilised and demoralised already; if the Government are not careful, they will push it over the edge.

The Secretary of State needs to change course and find a way of bringing people back together, so the purpose of the debate is to put forward two constructive proposals to manage risk in the NHS—one for now, the other for the long term. First, I turn to the immediate proposal. It is clear that the best way to draw a line under recent events and unify people would be for the House to embrace today the analysis and main recommendations of the Francis report. The motion highlights the three most significant recommendations: benchmarks on safe staffing; a duty of candour on individual NHS staff; and the regulation of health care assistants. If all parties endorsed those proposals, it would send staff a message of support and recognition of the pressure that they are under, while the patients who have suffered poor care would receive the positive message that the parties are working together to prevent that from happening to others.

Given the tragic events that lie behind them, public inquiries should, when possible, produce consensus. It is extraordinary that, having commissioned a three-year public inquiry, the Government have slowly been distancing themselves from the Francis report’s analysis and conclusions ever since its publication. It is hard not to conclude that the report did not deliver what the Government wanted and that they have spent the past five months rewriting it. They have come up with their own recommendations on chief inspectors for hospitals, general practice and social care, yet dragged their feet on the actual recommendations. They have substituted the verdict of Francis on Ministers in the previous Government with that of the kangaroo court of Lynton Crosby. We do not oppose chief inspectors, but if the Government believe that ever-tougher central regulation will bring about the culture change locally that everyone agrees is necessary, they are mistaken. We need change that will have an immediate effect on the ground, and that will support staff and improve care for patients.

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

My right hon. Friend has probably been in the Chamber on most of the occasions when I have raised the question of safe staffing with the Secretary of State. It was cited in the Francis and Keogh reviews, and the Care Quality Commission tells us that one in 10 hospitals has unsafe staffing levels. The Secretary of State dances around the issue again and again, but he will not take action. Yesterday, I asked him to introduce transparency to the process so that hospitals do not have wards with ratios of two staff to 29 patients, but he refused to answer my question. Does my right hon. Friend agree that if hospitals were transparent about their ratios, that would be the way forward, because we would know where we were?

[Andy Burnham]

The Keogh report exposes alarming ratios at my hon. Friend’s hospital and others. We have been warning the Government for months—years, in fact—about cuts to nursing numbers. It is neither right nor fair to criticise nurses for being uncaring when too many of them are unsupported and are working in conditions in which they have to make compromises that they would rather avoid.

Staffing emerged as the main concern arising from the Keogh report, but the problems go way beyond 14 trusts. The CQC says that one in 10 trusts in England does not have adequate staffing levels. Can we agree today that the staffing in all hospitals must urgently be brought back up to adequate levels, as defined by the commission, with clear benchmarks set for the future? [Interruption.] I am pleased if the Secretary of State is agreeing, because that represents progress, so I look forward to finding out how his plan will be delivered.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a great pleasure to rise to speak in support of the amendment tabled by my right hon. Friend the Prime Minister.

Both sides of the House believe in our NHS, the staff who work in it and the care they provide for patients. I am also sure that both sides recognise that, in the wake of the Francis inquiry and yesterday’s report from Sir Bruce Keogh, the 65th year of the NHS has been its most challenging and that we need to face up to those challenges.

This debate has had three key themes: the importance of the NHS, the staff who work in it and the care they provide for patients; the importance of making greater productivity gains in the NHS to improve care and make sure that we do more with our resources; and the importance of openness and transparency and the need to learn lessons from things that have gone wrong, so that patient care can be improved.

Back Benchers have made some high-quality contributions. It is always a pleasure to hear the hon. Member for Walsall South (Valerie Vaz) and the right hon. Member for Holborn and St Pancras (Frank Dobson). The hon. Member for Halton (Derek Twigg) made a very strong case for his local health care services. I pay particular tribute to the right hon. Member for Cynon Valley (Ann Clwyd), who has done some tremendous work in looking at how we can improve the NHS complaints procedure. She read out a number of examples of things that have gone badly wrong, from which we need to learn lessons for the future. The work she is doing at the moment is hugely important and valuable, and the Government look forward to receiving her report shortly.

My hon. Friend the Member for Bracknell (Dr Lee) highlighted some of the challenges with the existing NHS estate and the need to modernise facilities and make some of the older buildings more fit for purpose to meet the needs of patients in the modern world. My hon. Friend the Member for Bristol North West (Charlotte Leslie) made a very brave speech. She spoke at great length—and rightly so—about the importance of involving the medical royal colleges in deciding how hospital inspection processes should be implemented and about the importance of clinical leadership and involvement in those inspections to help understand what good care looks like. After all, those colleges are centres of excellence in their fields and it is right that we listen to what they have to say.

My hon. Friend the Member for Southport (John Pugh) made a particularly thoughtful speech. He called for good management and spoke of the need for good managers in the NHS. He also made the important point that, in all our debates on patients who have been let down, the regulators have often not played their part. That is why we need to ensure that the regulators continue to come to the table and that the improvements at the CQC continue. The regulators need to remain fit for purpose.

The problem with mandatory staffing ratios is that they would just provide another tick box that would not necessarily bear a relation to what good clinical care looks like. There is a clear difference between mandatory staffing ratios and appropriate staffing levels, as the Francis report indicated. We need staffing levels that reflect the needs of the patients on the ward. Those will vary from ward to ward and will change on a daily basis according to the needs of different patients. It is important that we consider the patients who are in front of the doctors and nurses on the day. It may not be nursing care that is needed, but care from other members of the multi-disciplinary team such as physiotherapists and health care assistants. That is why it is wrong to use mandatory staffing ratios as a measure of good care.

[Barbara Keeley]

The point that I keep raising with the hon. Gentleman, other Ministers and the Secretary of State is that there must be transparency in the numbers. Ratios of 2:29 have been reported to me, which nobody would be comfortable with. My excellent local hospital puts information about staffing ratios on the boards in each ward. Does he not think that we should move rapidly to provide transparency on this matter? I am asking not for mandated ratios, but transparency so that patients and their families can see what the ratio is.

[Dr Poulter]

The hon. Lady makes a very good point about the importance of having staffing levels that are appropriate to the needs of the patients. That is why NHS England is considering toolkits that will help hospitals to build the right care in the right place and at the right time for patients and to adapt care so that it is provided by the appropriate professionals, according to patient need.

The debate has rightly focused on transparency and openness. We have not got that right in the NHS since the Bristol heart inquiry, which took place under the previous Government. Both the Government and the Opposition believe that we need to support staff who feel that they need to speak out and that there needs to be greater transparency and openness. I believe that the steps that the Government are taking will make a difference. We are introducing a contractual right for staff to raise concerns and issuing guidance on good practice in supporting staff to raise concerns. We are strengthening the NHS constitution and have set up the whistleblowing hotline to support whistleblowers. We are also amending legislation to secure protection for all staff through the Public Interest Disclosure Act 1998. We are doing good work and it is right that we continue to do all that we can to support staff in raising concerns about patient care, where that is appropriate.

We must focus on improving productivity in the NHS so that we can do more with the resources that we have. As the Secretary of State outlined, that is about improving the technology in the NHS so that we can spend more money on care and free up staff time. If we use technology to better join up health and social care, staff will spend less time on paperwork and more time with patients, which will improve patient care.

It is important to consider the fact that there are higher levels of morbidity and mortality at weekends and in the evenings. There needs to be more consultant cover and out-of-hours cover at those crucial times to ensure that the service is more responsive to patients. The Government are addressing that.

In conclusion, at the beginning of this debate, the right hon. Member for Leigh (Andy Burnham) rightly highlighted the long-standing problems in our NHS. Although Labour is now talking about social care, it was the last Labour Government who cut the social care budget between 2005 and 2010. Although Labour is now talking about the risk register, the last Labour Government refused to publish it.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is right to highlight the fact that the figures show that last year alone 50,000 bed days that would otherwise have been wasted were saved by investing in social care and implementing the service transformation that we all require. However, this is about making all NHS and social care budgets go further, and recognising that if we are to improve the care of older people, particularly frail elderly people, we have to invest in more community prevention and community-based care, which is what this Government are doing.

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

As we have heard, two thirds of NHS leaders have said that the shortfall in social care spending is having an impact on their services. The Minister can try to get rid of that and talk it away, but in week after week of taking evidence in our inquiry into emergency care, the Select Committee on Health has heard the same thing. We know that elderly patients now form a much larger proportion of admissions—40% of admissions to emergency units are people aged 65 to 85. Is not the £1.8 billion cut in spending now really hitting NHS services and making the emergency care crisis worse?

[Dr Poulter]

I am afraid that the Opposition are very confused about their figures. As I explained earlier, the £2.7 billion—or 20%—figure represents the savings that councils have made to meet demand, and real-terms spending next year is expected to go up. The point from the ADASS and other surveys is that integration works. This Government are investing in integration. According to the Dilnot report, it was the last Government who cut in real terms the amount of spending going to social care between 2005 and 2010—and the hon. Lady was a member of that Government.

Hospital Mortality Rates

Baroness Keeley Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I very much hope that that acquisition can proceed and I agree with my hon. Friend that it is the way forward. Although we have to ensure that that happens properly, Northumbria can give North Cumbria the leadership that it badly needs, so the process would be positive.

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

Since the publication of the Francis report, it seems that we have been going round and round the question of safe staffing levels, which I have raised several times. Ratios of two nurses to 29 patients, or worse, have been reported to me—I do not think that they are uncommon—and the CQC tells us that one in 10 hospitals has unsafe staffing levels. It must be accepted that the number of nurses has reached unsafe levels in these 14 hospitals and many parts of the country. The Secretary of State cited Salford Royal hospital, but will he act now to ensure that all wards in all hospitals publicise their staffing ratios, because I would not want a relative on a ward with a ratio of 2:29?

[Mr Hunt]

The right ratio of patients to nurses depends on the type of patients in a ward, because different wards have different requirements. Salford Royal has a good model through which it ensures that it has the right number of nurses. As I said to the hon. Member for Rotherham (Sarah Champion), I accept what Francis says about safe staffing, but he did not recommend the Labour party’s policy of minimum mandated national staffing levels. I am following the recommendation of the Francis report, which I think is the right way forward.

Tobacco Packaging

Baroness Keeley Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

If I were in court, I think I would have to plead guilty to that one, Mr Speaker. In all seriousness—it is a very serious point—one of the things in the EU directive that we specifically looked at was the percentage of the package that should contain health warnings. It is now going up to 65%. There will be no flavourings. Again, this is very important in tobacco products. All this is designed for the next generation.

It is really important to add this: standardised packaging was about making cigarette smoking unattractive to young people. It is the next generation; that is the fundamental aim. That is why it is really important, even for those who use that aim to argue in favour of standardised packaging, that we find out what the evidence is in Australia, which is doing it. That is why my hon. Friend is right to say that good, evidence-based legislation is always the best.

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

I am proud that the Labour Government in 2006 gave a free vote on the legislation for smoke-free workplaces. That was an important step forward. Perhaps the Minister should be thinking in those terms now, because today’s decision to take no action will really disappoint the 190 health organisations, including the royal medical colleges and the World Health Organisation, that have supported the move to standardise packaging on tobacco products. Will they not now be drawing the conclusion that the Government, as my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) has said, have given in to vested interests and entirely lost their way on public health?

[Anna Soubry]

I do not give in to pressure from anybody, and neither does anybody else in my Department or indeed in my Government. We have taken a decision to wait for the emerging evidence from Australia, and that is the right thing to do.

Health and Care Services

Baroness Keeley Excerpts

Wednesday 3rd July 2013 Commons Chamber

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

I thank the Chair of the Select Committee, the right hon. Member for Charnwood (Mr Dorrell), for the way he opened the debate.

The context of our debate on public expenditure for health and care is, as we have heard, not just the substantial upward cost pressure on the NHS, but substantial cuts to the budgets of local councils, which are affecting their social care budgets. Adult social care directors tell us that £2.7 billion has been cut from care budgets since 2011, representing a significant 20% of those budgets. That level of cuts now means actual service reductions, as well as increased charges for service users—a fact brought home to me week in, week out by the cases I am now seeing in my constituency. My local authority of Salford had maintained eligibility criteria of “moderate” until this year and has been pushed by cuts into changing it to “substantial”. That is very sad.

Often what are described as efficiency savings in social care budget cuts are actually cuts to the fees paid to care providers. Some 45% of the adult social care directors polled by the Association of Directors of Adult Social Services said that they did not increase fees to care homes to cover inflation this year, while nearly half said that providers in their areas were now facing financial difficulties as a result of savings made in fees paid to councils. In many cases, this has led to the poor care that we have had described in so many reports, and to which the right hon. Member for Charnwood has just referred. We hear of care tasks timed down to the minute, and paid care workers earning less than the minimum wage because they are not paid for travel time or costs.

The social care directors also warned that worse cuts are still to come, given that further cuts to local council budgets are still planned. Sandie Keene, the president of ADASS, warned Ministers that further cuts could have seriously adverse consequences for families. She said:

“it is absolutely clear that all the ingenuity and skill that we have brought to cushioning vulnerable people as far as possible from the effects of the economic circumstances cannot be stretched any further, and that some of the people we have responsibilities for may be affected by serious reductions in service—with more in the pipeline over the next two years.”

Not surprisingly, the Local Government Association has warned the Government that they need to ensure protection for adult social care in future. Zoe Patrick, chair of the LGA’s community wellbeing board—so perhaps the most senior wellbeing board in the country—has said:

“We need an urgent injection of money to meet rising demand in the short term and radical reform of the way adult social care is paid for and delivered in future, or things will get much worse.”

Both the LGA and the Society of Local Authority Chief Executives have warned that the planned cuts will get in the way of implementing the Dilnot proposals and the measures in the Care Bill. They also say that the Government’s impact assessment for the Bill significantly underestimated the likely cost to councils of the new duties under the Bill—an issue that came up repeatedly on the Joint Committee considering the draft Bill. I hope that as the Care Bill makes it way through Parliament—and certainly by the time it reaches the Commons—issues to do with the cost on local authorities will be dealt with.

Some £1 billion of funds from NHS budgets was earmarked for transfer to councils responsible for adult social services in the 2010 comprehensive spending review. However, three years into a four-year process, much of the funding continues to be spent in a short-term way—there was much focus in our report on that fact—and not on the systemic transformation that social care needs if it is to ensure sustainable services in future. Let me give an example. Of the £648 million transferred in 2011-12, 18% was used just to maintain eligibility criteria, with £284 million spent on offsetting pressures and cuts to services and another £149 million allocated to working budgets. As we have heard, that is not the sort of systemic transformation that the Health Committee would like to start seeing.

Of course, this firefighting is not surprising given the cuts to local council budgets, which I have touched on, but it is not sustainable if our aim overall is the transformation necessary to achieve the integration of health and care services. We have seen a downward spiral in social care funding. It is clear that more must be done to move from using scarce resources when they are allocated as a sticking plaster to cover the costs. They should instead be used to build more joined-up services. With another £2 billion a year moving from the health budget to social care from 2015, it is extremely important that we start to get this right. I fully support the call made in the Committee’s report for a ring fence to protect social care funding. That is important.

As for health spending, the Department of Health says that it managed to save £5.8 billion in 2011-12, but evidence provided to our Committee by the National Audit Office shows that much of that was made through one-off savings, such as pay restraint and other staff cost savings, reducing payments to NHS providers and some savings that were truly one-off, such as land sales, which cannot be repeated. Those savings are not sustainable and cannot continue in the long term. There is an argument, which we keep coming back to, that a lead needs to be taken as soon as possible to transform how services are delivered.

I welcome the suggestion of a pooled budget for health and social care services to help older and disabled people. I see that as a move in the right direction. Indeed, the shadow Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), has repeatedly made the point that integration is the future direction of health and social care. Mike Farrar, the chief executive of the NHS Confederation—I guess this was the expression of an NHS view—said of pooled budgets:

“This allocation should help address the need to join up services and provide the right care for people, allowing them to stay in their own homes. But NHS organisations will want to have strong assurances that the money going to social care does the job it is meant to do.

Rather than see local health and social care budgets as separate, we need to support integrated care by bringing together providers and commissioners to look at how we can spend our money to the best effect.”

That must be what we start to see.

Creating joint budgets has the potential to facilitate a move towards more joined-up working, but as the right hon. Member for Charnwood outlined, there need to be safeguards. In fact, we need to be clear that the money intended for social care should definitely be spent on it. Labour’s whole-person care approach is a vision for a truly integrated service—not just battling disease and infirmity, but aspiring to give people a complete state of well-being across all the services, physical, mental and social. Shared budgets are one small step towards that, but we want to see a people-centred service, strengthening and extending the NHS in this century, not whittling it away.

Let me turn to the long-term funding of social care to avoid catastrophic costs falling on certain groups of people, particularly those with long-term conditions or dementia. Support will be given in such a way that people must meet thresholds and a spending cap. First, people must meet eligibility criteria, which, we know now, the Government plan to set at the “substantial” level. Secondly, they must fall below a means-tested threshold. I understand that the upper level is to be set at £100,000, but the lower level is still set at £14,250, with an assumption that assets between those thresholds attract interest, which affects the calculation of social care funding.

After all that there is the cap, set at the—in my view—high level of £72,000, plus accommodation costs of £12,000 a year. I feel that the £72,000 that individuals must contribute to their care before they exceed the cap is not as it seems. That is how the figure is expressed, but the metering will take account only of the costs that the council would pay for care. Many thousands of families are already paying a top-up for care. Cuts to council budgets, which I touched on earlier, will continue to depress the rate at which they pay towards providers, yet that is the rate that would be taken into account in the calculation of the metering.

My hon. Friend the Member for Leicester West (Liz Kendall) has analysed the plans and said that

“families will face losing even more of their homes than they do now”.

Since she pointed that out, we have learned that in 2016, with accommodation costs of £12,000 a year and councils at that point paying about £500 a week, it would take about five years to reach the care cap. Even at that point, we now know that care needs would have to be at the “substantial” level. Families using nursing homes charging more than the local authority rate will therefore have to pay the extra cost, as they do now.

I have had constituents paying £40,000, plus interest, for care costs, which were taken out of the value of their home, which was eventually sold for only £60,000. There are people in my local authority area who have homes valued at only the £50,000, £60,000 or £70,000 mark who surely will look at the cap set by the Government and think that it would help them. It is unfair not to tell people that what they think is a cap set at £72,000 will, for many of them, turn out to be much higher.

The Health Committee has committed to look at the implications of the Government setting the cap at a level higher than that recommended by the Dilnot commission. I hope that the review shows that this is not a policy to brag about straightforwardly, as the Prime Minister did today. I understand that the number of people likely to be helped by a cap set at that level is around 110,000. I am sure that many people would be surprised by that low figure. However, I am pleased that the direction of travel for Government policy is towards what the Health Committee has repeatedly set out in its reports on social care and the whole-person approach set out by my right hon. Friend the Member for Leigh. Pooled or joint budgets are a small step on the way. I hope that Government policy will start to move further towards addressing some of the other vital issues in social care that I have outlined. Unless we solve those issues in social care, we cannot move forward on the whole picture.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

May I begin by thanking the Health Committee and its Chairman for the report and the clarity with which he presented its findings, and Members from all parties for the thoughtful way in which they have debated the issues today? The right hon. Member for Charnwood (Mr Dorrell) is known for his diligence and attention to detail, and his speech clearly illustrated those instincts.

Before I address the points raised by the report, let me put on record our gratitude to the many thousands who work in our health service. As we approach the 65th anniversary of the NHS, we should take a moment to pay tribute to those staff who are doing a tremendous job, often in difficult and challenging circumstances.

With the indulgence of the House, I would also like to place firmly on the record my support for and appreciation of the dedicated doctors, consultants, nurses, carers and support staff in Tameside general hospital, many of whom will be feeling battered and bruised today. Tameside general hospital serves most of my constituency and today’s media reports highlight some of its failings. Deep-seated issues need to be grappled with urgently, but we should also recognise and listen to the many decent, good and hard-working staff who work there, because they often have many of the solutions and have not been listened to in the past.

I also apologise for leaving the Chamber briefly during the speech of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). There was no discourtesy intended to either her or the House: I was dealing with the BBC’s breaking news that both the chief executive and the medical director of Tameside general hospital have resigned, which I support. Sadly, it has come three years too late—I called for it to happen three years ago—but, nevertheless, it is a step in the right direction to ensure that Tameside general hospital has a safe and secure future.

[Barbara Keeley]

We heard from the hon. Member for Southport (John Pugh) about the value of executive leadership. Our conurbation of Greater Manchester has one of the best and safest hospitals in the country. The Salford Royal hospital is the seventh safest in the country and has an excellent chief executive. Today the leadership of Tameside hospital has changed and I hope that the people of Tameside will end up with an excellently led hospital. I agree with the hon. Member for Southport. My example shows the difference between a hospital that is well led and one that is not.

[Andrew Gwynne]

I agree with my hon. Friend. Had she been listening to BBC Radio Manchester this morning, she would have heard me making precisely that point. The situation at Tameside is incredibly frustrating for me and my hon. Friends the Members for Stalybridge and Hyde (Jonathan Reynolds) and for Ashton-under-Lyne (David Heyes). Whenever we meet the chief executive and chair of Tameside hospital—we do so frequently—they always give us excuses as to why Tameside is different from the rest of Greater Manchester because of the industrial legacy and poor health outcomes in the borough, but one could make exactly the same arguments for Salford: there is no reason why one part of Greater Manchester should have an excellent hospital while another has one with long-term problems.

Following that slight indulgence, I want to turn to the report and focus on four key areas. First, the right hon. Member for Charnwood made some pertinent points about the Nicholson challenge. To be fair, in previous reports the Health Committee has taken the consistent view that the Nicholson challenge can be achieved only by making fundamental changes to the way in which care is delivered. It makes that argument in this report too. It states:

“Too often…the measures used to respond to the Nicholson Challenge represent short-term fixes rather than long-term service transformation.”

The Select Committee is right about that.

If we are to sustain the breadth and quality of health and care services, we need a fully integrated approach to commissioning—something that the right hon. Member for Charnwood and others have spoken about powerfully. The Opposition agree with that. I hope that the right hon. Gentleman will agree that we have put forward bold proposals for a genuinely integrated NHS and social care system that brings physical health, mental health and social care into a single service to meet all our care needs.

We know that that approach works. In Torbay, integrated health and care teams have virtually eliminated delayed discharges. Partnerships for older people have helped older people to stay living independently in their own homes and have delayed the need for hospital care—something that my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) rightly referred to. Where physical and mental health professionals have worked closely together, they have shown that a real difference can be made.

An integrated, whole-person approach is the best way to deliver better health and care in an era when money remains tight. As the Committee’s report notes,

“the care system should treat people not conditions.”

The right hon. Member for Charnwood was right to point out that developing the role of health and wellbeing boards is the best way to plan such integrated care. He reaffirmed that he is “happy to endorse” the Burnham plan. We were happy to hear that. He is right that there is an issue with single commissioning budgets without checks on local government. As somebody who has a background in local government, I think that he is right about the need to extend the ring fence to social care spending. Unless those budgets are protected, there will be a temptation to siphon off the money that is needed to provide the integration that we all want to see.