Health Infrastructure Plan

Karin Smyth Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

My right hon. Friend makes an important point. This money will be hugely important to doing exactly what she says: investing in our NHS buildings for the long term, so reducing the reliance on expensive capital repairs.

With this plan, we are also looking to deliver a step change in how we deal with capital in the NHS, which is also hugely important. Instead of stop-start investment, we are looking for a rolling programme of investment to make sure we get those facilities up to standard in order to reduce the day-to-day spend on repairs. I will happily talk to my right hon. Friend about what we can do to ensure that we go through due process as swiftly as possible so that her hospital trust can get on with it.

[Karin Smyth (Bristol South) (Lab)]

I worked on many business cases for capital projects during my long NHS career. These projects are important to local people, but local people across the country were misled over the weekend. This is a proposal to give permission to think about building a hospital; they are not new hospitals. The Government’s own response to the Naylor report said that sustainability and transformation partnerships are the chosen means of planning and delivering capital projects, so how were STPs consulted about which projects to progress?

[Edward Argar]

The hon. Lady, as she says, comes to this with a wealth of experience. The bids were put forward by individual trusts working with their STPs, and in the context of the STPs that have been developed. There is a synthesis and a read across to ensure that, in this announcement, we have picked the trusts that put together the most compelling bids in order to deliver value for money and improvements where they are needed.

Decriminalisation of Abortion

Karin Smyth Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

The specific offences to which the hon. Lady refers are a matter for the Home Office. The Government’s position is that they should not be repealed for England and Wales at this point. I absolutely understand the issue she raises with regard to the most vulnerable, and she and I have had discussions on that basis, but that is also a reason why simple repeal is not necessarily the best tool. To have a safe regime in place is also to protect exactly the people she identified. As I have said, from a personal perspective I do not think that the current law is in any way satisfactory, and I hope that in future we can have sensible discussions about how we might modernise it.

[Karin Smyth (Bristol South) (Lab)]

In my role as a member of the British-Irish Parliamentary Assembly, the committee on which I serve, which is chaired by the noble Lord Dubs, has for the past two years been looking at abortion policy across the whole of Ireland and Britain. Our report should have been available already, but there was some disagreement as to its final content. We will be updating it, hopefully for publishing in October. It would be helpful to discuss that report with the Government. As well as online medication, we have found other particularly concerning issues: we need to remember that there are no borders for healthcare for women across these islands, and there are no borders for how women across these islands will continue to support each other. We want to see more equality. Of real concern are the often very traumatic cases of late terminations. The workforce across our islands are not skilled—there are not enough of them and there are not enough good-quality skills. Does the Minister agree that the Government should at least look into those points regarding workforce?

[Jackie Doyle-Price]

Yes, absolutely. I would be delighted to meet the hon. Lady about her report. That there is difficulty in getting agreement comes as no surprise to me but, given the intentions of the people behind it, having that discussion would be useful. Yes, I have heard concerns expressed about skills levels, in particular to perform late-stage terminations, which are incredibly dangerous, as she is aware. I will endeavour to take that forward with the relevant bodies.

Adult Community Services

Karin Smyth Excerpts

Wednesday 26th June 2019 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

I beg to move,

That this House has considered re-procurement of adult community services by Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group.

It is a pleasure to serve under your chairmanship, Mr Gapes. I am pleased that this important subject has been selected for debate. Although they cannot be present, my hon. Friends the Members for Bristol West (Thangam Debbonaire), for Bristol East (Kerry McCarthy) and for Bristol North West (Darren Jones) fully support my comments. This is an important issue for the people of Bristol South, and it is a local example of the debate on the legacy of the Health and Social Care Act 2012 and of the invidious position that local managers are being put in to understand the procurement rules.

Hon. Members know that I speak frequently about accountability and the opaque way in which many parts of the NHS operate. We seem to have lost sight of the fact that, however individual bodies are constituted, our health services are public services that are paid for by taxpayers—our constituents. I have also repeatedly said that if we keep asking people to pay more for our health services, they must have a greater say in the way that those services are run, particularly when they are being changed.

I have spoken before of my concern about the attitude of my local clinical commissioning group in Bristol, North Somerset and South Gloucestershire to the openness and transparency of its work, especially on the reprocurement of adult community services. The lengths to which the CCG, supported by NHS Improvement, has gone to hide, cover up and obfuscate are nothing short of a scandal. Most infuriatingly, the whole protracted cloak-and-dagger exercise has been entirely unnecessary, because a far less onerous and costly approach could have been used instead. The reprocurement is the wrong approach at the wrong time to developing community services, and runs counter to the direction of travel being set, in theory, by the new NHS 10-year plan.

Before I review the shortcomings of the reprocurement in greater detail, I will remind hon. Members why it matters. Away from the jargon, acronyms, terse letters and confidentiality agreements, thousands of people across Bristol, North Somerset and South Gloucestershire simply want to know what is happening to their local health services.

My constituent Clive got in touch just over a year ago to tell me about the great work being done at the Healthy Together leg clinic at the Withywood Centre, which provides intervention and treatment for the leg ulcers of patients in south Bristol. It is exactly the sort of joined-up, innovative and integrated community provision that Ministers tell us they want to see—a true partnership between Bristol Community Health, local GP practices and Age UK in Bristol, which come together across different sites to deliver gold-standard patient care that promotes faster and longer-lasting wound healing. The clinic also provides a social setting where patients feel more supported and are encouraged to feel more in control of their condition. There is time for people to care.

The service has transformed countless lives in my constituency and has been nominated for a national award. As I saw first hand when I visited the clinic earlier this month, it is an exemplar of the sort of collaborative provision that the new adult community services contract could and should expand on. Such collaboration takes years to yield results and very much responds to the local needs of the particular community.

The people who are providing the service, however, do not know for how long they will be able to continue, because the CCG will not tell them. The patients do not know for how long they will be able to access that life-changing service, because the CCG will not tell them. As the local MP, I cannot lobby, engage or reassure people, despite asking repeatedly for a peek behind the self-imposed reprocurement iron curtain, because—hon. Members will have guessed it—the CCG will not tell me.

Interestingly, another consequence of the process, which I do not have time to really go into, is the destabilising impact on the voluntary sector. Age UK will have to wait, cap in hand, to see which successful bidder secures the primary contract and how it then decides to sub-contract the provision. The same goes for all voluntary organisations involved in this sort of service provision. It would be bad enough if the Healthy Together clinic were a one-off —the only service caught up in a closed-shop procurement mess—but it is not. In truth, every adult community service is in the same position, which is simply not good enough.

Despite a year of making speeches in this place, asking questions of Ministers, doing time-consuming research and making countless phone calls to offices, neither the CCG locally nor NHS Improvement nationally will engage with me beyond continually asserting that they had no choice but to go down this route. That is a prime example of what the Health and Social Care Committee referred to in its recent report, which said that the

“problems stem not only from the procurement rules themselves, but also from people’s interpretation of these rules and their difficulty in understanding what is permissible within the rules.”

In place of answers, I am forced to restate the litany of my constituents’ questions and concerns that have essentially gone unanswered. First, there is a fundamental lack of clarity surrounding the reprocurement and an abject failure to link it to any broader NHS strategies. I am not the only one who is concerned about the process. I have been spoken to privately by many consultants, nurses, and other staff throughout the healthcare system; I am grateful to them for contacting me.

At no point has the CCG properly defined a needs assessment in the request for proposals. Moreover, at no point has it made the business case for change—the most basic starting point for any such process. Staggeringly, there is no service baseline, so we do not know what services exist. By extension, there are no defined outcomes, so bidders are being asked to make proposals. That is not what commissioning is meant to be about.

Although Ministers continue to trumpet the importance of the sustainability and transformation plans, there is no sense of alignment with those plans, the NHS long-term plan or the emerging integrated care systems. Similarly absent is any indication of integration with local councils on social care or public health, which we all acknowledge are the key issues facing our constituents.

Secondly, there are concerns about the chosen procurement process, because any number of much less onerous and costly approaches were possible. As ever, however, accurately assessing the process is near impossible because of the vice-like secrecy that the CCG has used throughout. What is certain is that we do not know how much it is costing the CCG or the bidders, which include the current not-for-profit community service providers. That means that we do not know how much it is costing us, the taxpayers.

I worked in the national health service for many years, and I have some experience of procurement in the organisation, but I have struggled to understand properly the process through which the procurement has been undertaken. To illustrate, the CCG’s description of the chosen process, in its own words from its own document—bear with me, Mr Gapes, because I did not write it—says:

“The procurement is being undertaken using a process developed by the CCG which has similarities to a competitive process with negotiation. For the avoidance of doubt, the CCG is not running the process strictly in accordance with any specific procedure set out in the Regulations so reserves the right to depart from that form of procedure at any point. This Request for Proposals sets out the procurement process the CCG plans to use for this particular Contract. The inclusion of particular stages, the use of terminology and any other indication shall not be taken to mean that the CCG intends to hold itself bound by the full scope of the Regulations.”

What does that mean? I think it means that the process is as clear as mud, carried out behind a wall of secrecy, but with a disclaimer that enables the CCG to do what it wants without our knowledge. Although we cannot access the process details, what we know does not bode well.

There are myriad loose ends and errors throughout the process. Taken together, they form a significant body of concerning issues. Of course, I would never have known about them—most people do not—if I had not scoured 300 pages of detail and 100 clarification questions asked by bidders. In fairness, I doubt the CCG was expecting anybody outside the process, including the local MP, to do so, but I read them all because I like detail and I think it is important to know what is going on. A lot of the gaps and oversights concerned me.

There seem to have been incorrect working assessments about bed numbers at South Bristol Community Hospital; gaps relating to workforce numbers and staff who have been TUPE-ed; and a number of misunderstandings and examples of where the CCG lacked knowledge about current contracts, rental payments and void space. There is also missing information about assets, and the bidders were apparently expected to carry out the due diligence. That not only places a huge burden on providers, but runs the risk that the entire process will collapse if it is not carried out correctly, as has happened elsewhere. It is worth highlighting that the National Audit Office investigation into the collapse of the UnitingCare Partnership contract in Cambridgeshire and Peterborough found that bidders

“faced significant difficulties in pricing their bids accurately due to limitations in the available data”.

The evidence I have seen in the documentation suggests that that is now happening.

We should all be very worried about that, because failed procurements in Staffordshire for cancer services and end-of-life care, and in Cambridge and Peterborough, had similar procurement processes to the one chosen by Bristol, North Somerset and South Gloucestershire CCG. In each case, there was a secretive process, a complex procurement methodology and a failure to engage. Together, they cost taxpayers millions, and they all failed. Instead of learning lessons, NHS Improvement and the CCG seem intent on repeating the mistakes.

[Darren Jones (Bristol North West) (Lab)]

I congratulate my hon. Friend on securing this important debate. Does she agree that the complexity of the procurement process and the difficulty that she—an expert in this area—is experiencing means that patients who rely on these services and workers in not-for-profit organisations, who deserve to know what the process means and what the outcomes will be for them, find it impossible to take part as important stakeholders?

[Karin Smyth]

Absolutely—I completely agree. That is why I will continue to speak up on behalf of my constituents; I know I have my hon. Friend’s support.

Predictably, I would like to finish where I began, on the issue of secrecy and a lack of transparency. As I have highlighted, this absurd behind-closed-doors approach has bedevilled the reprocurement from the off. If this is such a great change to community services, why are we not trumpeting it? Reprocurement was first referred to in governing body papers in May 2018, but other than that there has been virtually nothing. There was no official announcement, no media blitz, no news stories or television news clips, no leaflets in local GP surgeries or South Bristol Community Hospital to enable local people to have their say on the plans—nothing. Although there has been talk of consultation, it seems that only 20 people from south Bristol took part. In fairness, there were some nods to engagement, and surveys were completed by 196 people. There was an engagement planning workshop with patients, carers and the voluntary sector, but because it is a contracting process, they were asked to sign a confidentiality agreement.

There is no evidence that even that limited feedback has been listened to or acted on. The workshop was merely an illustration to bidders of what stakeholders might want to identify when community services are planned and delivered. Tellingly, in documents from January, the CCG stipulated:

“Formal public consultation is not required as part of the procurement as no ‘significant variation’ to services is planned at this stage”.

Why is it being done if there is no significant variation to services?

All the documentation—approximately 300 pages in total—is hidden behind a portal, including more confidentiality agreements. The whole process appears so desperate to avoid the merest hint of engagement that it screams, “We’ve got something to hide!” It is utterly self-defeating, and serves no one well—not patients, bidders, the CCG or the community at large.

The CCG says that it is seeking a consistent service across all three areas and both acute trusts. Two of the CCGs and one of the trusts have been in deficit for years, and at various times in the past few years they have been on NHS Improvement’s naughty step. The deficits are now being shared across the whole community. The jam is being spread more thinly and differently from how it was spread before. The process is being embarked on to help spread the already struggling and inadequate level of service more thinly. Those service providers are spending money that should be spent on services on a process that I believe will inevitably reduce community services in Bristol.

I have great respect for the Minister, but I have no confidence that the Government will be able to make any difference to the local position. I hope that she takes note of the variability in how the rules are interpreted locally, as the Health and Social Care Committee noted in its response to the legislative proposals for the NHS long-term plan. Other commentators are saying the same. I hope the Minister will reflect on this local example. Will she explain directly or through her officials why, when I wrote to the Secretary of State about this originally, I got a reply from NHS Improvement? NHS Improvement is the provider regulator; this is a commissioning issue.

I believe that the Government should rapidly respond to the proposals to remove the requirement for competition under the section 75 regulations. There is no reason to wait; they need to get on with it. This saga shows that the lack of investment in NHS services remains a problem. Why not just build capacity rather than go through these expensive tendering processes with providers outside the NHS? I actually support the place-based approach to service provision in the NHS plan, but I object to the fact that this reprocurement goes counter to that plan.

At the very least, on behalf of local people, I would like the Minister to support my calls to see the proposals before contracts are signed for the next 10 years. We need a local plan and collaboration with the local authority that meets our health and social needs. I want a guarantee that people in south Bristol will not be worse off. Currently, no one can give me that.

Government Mandate for the NHS

Karin Smyth Excerpts

Thursday 25th April 2019 Commons Chamber

[Stephen Hammond]

The hon. Lady knows that the House and her Committee will have the fullest opportunity to scrutinise the document as and when it is published. She also knows that there is a commitment to publish it soon. She also rightly points out that it will deliver on the need to ensure that health and social care are integrated.

[Karin Smyth (Bristol South) (Lab)]

For most of my professional life, I was an NHS planner. I assure the Minister that the great expectation and anticipation of NHS planners for planning guidance in the mandate is very real. They are public servants who expect to be held accountable and do what the Government ask them to do. It is unacceptable to leave them in the dark. It is an insult to patients—taxpayers who pay for services and expect to know what they can receive locally. The delay is inexcusable.

The Minister says he has a plan and the Government say they have the money, so why cannot they publish it? What are they trying to hide?

[Stephen Hammond]

The Government are not trying to hide anything. The hon. Lady is right that it is an important document, and it is important therefore that we get it absolutely correct. I refer her to what the chief executive of NHS England said yesterday. He said:

“We have an agreed direction in the long-term plan…We have the budget set for the next year, and we have the NHS annual planning process…wrapped up…2019-20 is…a transition year…stepping into the new five-year long-term plan.”

The chief executive of the NHS thinks that the process is working acceptably.

Integrated Care Regulations

Karin Smyth Excerpts

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth]

The hon. Lady makes an interesting point. She is correct in as much as there is not currently a long queue of companies lining up to take control of whole health systems, but that could change if some new form of Transatlantic Trade and Investment Partnership is brought in by a post-Brexit deal. A number of these companies are becoming increasingly litigious in the courts, which is why Virgin Care took the NHS in Surrey to court. However, even if a private provider is not gifted a whole contract, which is the point that the hon. Lady is making, there is nothing to prevent it from buddying up with NHS bodies in joint ventures as a way of exercising influence over the way in which local health systems are configured. There is already evidence of private sector involvement in the establishment of the integrated care system, with Centene UK—an offshoot of an American health insurer—working with Capita in the Nottingham ICS.

[Karin Smyth (Bristol South) (Lab)]

Earlier in his remarks, my hon. Friend talked about confidence for people locally in what is happening in the NHS. Further to the point made by the hon. Member for Totnes (Dr Wollaston), only in February NHS England itself issued its case for primary legislative changes in which it says, with regard to these proposals, that it wants to

“start a broad process of engagement with the NHS, its partner organisations and those with an interest in how our health service operates.”

That will hopefully involve patients and the public. In Bristol, we embarked on a 10-year contract for community services on the day after the NHS plan was invoked without consultation with local people, an assessment of basic health needs or alignment with the rest of the situation. The problem is that we have yet another change that people locally do not have confidence in. It really is time for the Government to come forward with a cohesive change for the future.

[Jonathan Ashworth]

That is absolutely right. Notwithstanding the sincere views of the Select Committee, there is a lack of confidence out in the country about the way in which these commercial contracting arrangements work. We are seeing that in Bristol, as my hon. Friend so eloquently outlined. Despite the blasé attitude of the Secretary of State in the Select Committee, this is the same Secretary of State who has sat back and done nothing while a PET-CT cancer scanning contract in Oxford is privatised, leading to a fragmented service putting patient safety at risk.

Community Hospitals

Karin Smyth Excerpts

Tuesday 12th March 2019 Commons Chamber

[Fiona Bruce]

My hon. Friend has made one of my points for me. None of the major hospitals in east Cheshire lie within my constituency, although it is reasonably large, so my constituents must travel some distance to use their services.

I have mentioned the four-hour GP appointments on Saturdays and Sundays. They are always full, and are meeting a very clear local need. The convenience of such services cannot be overstated. During my visit, an elderly gentleman, clearly frail, arrived asking for directions to the X-ray department. I watched as he was directed to it immediately. He was seen, and he departed. All that happened within what seemed to me to be about three minutes flat.

The value of such local services for a population like mine, which contains a higher than average number of older residents, cannot be overstated. They are particularly appreciated by those who are less mobile owing to age or infirmity, or for whom a lack of convenient public transport facilities would make travel to the larger hospitals outside my constituency very difficult, if not impossible. Moreover, 9,000 fewer out-patient appointments across east Cheshire must reduce congestion.

The trust informs me that the Congleton Hospital site also has space for use by other NHS organisations, including providers of mental health and health visiting services. As local health partners and providers increasingly work together in support of their local communities’ health and wellbeing, Congleton Hospital, located as it is almost in the centre of the town, is ideally placed to become an even more strategic community health hub for additional services.

[Karin Smyth (Bristol South) (Lab)]

The hon. Lady is making a powerful speech on behalf of community hospitals. South Bristol Community Hospital was opened only in 2012, after 60 years of campaigning by local people. As three providers run different services in it and as it is a LIFT building, no one is really responsible for making it work. Does the hon. Lady agree that the health service must bear in mind that such hospitals are developed and fundamentally loved by their communities, and that those communities should have the ultimate say in what goes into them?

[Fiona Bruce]

The hon. Lady is absolutely right. Indeed, members of the community in Congleton are speaking out about the importance to them of their community hospital. I shall say more about that shortly.

On behalf of my constituents, I am pressing Ministers to consider resourcing Congleton Hospital as a community hub going forward. It has a very special place in local people’s hearts, as I have said, not least because of the manner in which it was funded many decades ago by local people’s contributions from wage packet deductions. It was founded in 1924 by public subscription as a memorial to those locally who gave their lives in the first world war, hence its full name: Congleton War Memorial Hospital. I spoke at greater length about this here in this place in 2014, when I raised concerns about the future sustainability of the hospital, so this is by no means a new issue. Indeed, in 1962 when there was a suggestion that the hospital be closed, it resulted in a mass meeting in the town hall with an overflow of some 2,000 residents, presided over by the then mayor leading to a petition of 24,000 signatures. Plans were quickly dropped. More recently, the £20 billion additional funding announced by the Prime Minister for investment in the NHS surely offers an opportunity for the future of the hospital to be secured, or even augmented as a community hub for the long term.

I have been in continuing dialogue for some months now with—and have met, together with local councillors—John Wilbraham, chief executive of the local NHS trust responsible for the management of the hospital, the East Cheshire NHS Trust. I am grateful to Mr Wilbraham for that open dialogue. We spoke again recently when he confirmed that, in his words, the sustainability of the site is on the agenda for the transformation programme to be discussed by the trust shortly. So also on the agenda is the future of the minor injuries unit, which is, as I have mentioned, causing particular concern to residents, as the trust is aware from recent public demonstrations which involved people from right across the community and political divides, including me and Congleton town mayor Suzie Akers Smith, who was in full mayoral regalia and chain.

I am grateful that Mr. Wilbraham has agreed to meet a cross-party group in the town shortly to discuss the hospital’s future further and look forward to that meeting. In the meantime, for the record I note that in his most recent letter to me of late December 2018 he confirmed, and I welcome this, that

“the Trust has no plans to change the service provision at the Congleton Hospital site and this remains the case. I continue to discuss with health and social care partners about the service offer from the hospital site and I understand the desire of you and the local population to maintain the facility. We await the publication of the NHS 10-Year Plan in early 2019 which provides the basis for the local health partners, including the town’s GPs, to set out its plans for the next 5-10 years. I am certain this will provide the opportunity to be clear on future service provision across the local health economy including Congleton.”

I am optimistic that both Mr. Wilbraham, as its chief executive, and the trust itself have listening ears. We need only witness the furore that arose in Congleton three years ago when there was a suggestion that car-parking charges be introduced at the hospital. The trust clearly registered the indignation of local residents, not least through a petition I presented here in Parliament at that time. That they could be asked to pay to park at their own hospital—a hospital they and their forebears had paid for by both wage packet deduction and subsequent fundraising and donations over the decades—aroused considerable consternation. The trust subsequently discounted the suggestion of car park charges outright; it listened to local people’s concerns.

I was pleased to note the chief executive’s reconfirmation of this in his most recent letter to me, with the words:

“I note the suggestion of car parking charges being introduced to supplement the income for the hospital site but this is not something the Board will be considering.”

Now that the 10-year plan has been published, and in the light of the Secretary of State’s indication of his support for community hospitals, I am today asking the Minister what more can be done to ensure that vital services provided by community hospitals in the heart of our local communities, like Congleton, are not swallowed up by larger hospitals at a distance. What the Congleton community seeks is reassurance that the future of Congleton hospital is put on a firm, clear and sustainable footing going forward, so that the periodic recurring concerns over the years about its future can be fully and finally put to rest.

--- Later in debate ---

[Caroline Dinenage]

The hon. Gentleman makes an incredibly strong point. I often stand at the Dispatch Box—usually during Adjournment debates—having listened to hon. Members talk about CCG decisions that they feel may not be in the best interests of their local area, but it is up to local areas to decide. The whole point of devolving money and decision making down to CCGs is that we trust them to be able to make the best decisions in the best interests of local communities to deliver services that best meet needs and priorities. If the hon. Gentleman feels that that is not happening and if he has had the opportunity to discuss that with his CCG, it could be a good idea to take the matter up with NHS England.

CCG funding allocations are decided by an independent committee, which advises NHS England on how to target health funding in line with a funding allocation formula. This objective method of allocation supports equal opportunity of access and reduces health inequalities. That way, the decision of where taxpayers’ money goes is decided in an independent and impartial manner.

As my hon. Friend the Member for Congleton will be aware, it is down to the CCG—in this case Eastern Cheshire CCG—to decide how it spends its allocation and to determine which services are the right ones for the local community it serves. One would hope that CCGs have the necessary clinical knowledge and local expertise to make informed decisions on how to spend taxpayers’ money. To support the long-term planning of services, NHS England has already informed all CCGs about how much funding they can expect to receive between 2019-20 and 2023-24. My hon. Friend may be interested to know that Eastern Cheshire CCG’s funding will increase from £270.2 million to £311.6 million over that period—a substantial increase. I hope that she will agree that that information gives CCGs the stability to plan appropriately and establish their services for the long term.

[Karin Smyth]

I do not disagree with much of the thrust of what the Minister is saying, because CCGs—I used to work for one—do spend taxpayers’ money. She will often have heard hon. Members say that there is no link between the accountability for that money, the work that we do as Members of Parliament and the decisions that are made by CCGs. The new NHS plan looks like it may want to do something about that, but will the Government send a message to NHS England and the CCGs that local democratic accountability must somehow start to be built into the CCG decision-making process?

[Caroline Dinenage]

The hon. Lady makes an interesting point, and it is one with which I have a certain sympathy. When NHS England comes up with the implementation plan for the long-term plan, I hope it will include suggestions as to how such issues might be addressed.

It is important to remember that the NHS is close to all our hearts. Fundamentally, it belongs to the people of this country. It is founded on a common set of principles and values that bind together the communities and people it serves. For that reason, it is welcome to hear my hon. Friend the Member for Congleton talk so highly of the open and honest relationship between her local NHS and the residents of Congleton. The examples she gave of the decision-making process for introducing car parking charges highlights how local people in Congleton are being listened to and, if I might say so, it says a lot for the people of Congleton. It takes a lot for the people of Congleton to demonstrate, but this shows that they do so effectively when they decide to take such action.

I commend my hon. Friend for the role she has played in the work to protect her local hospital and for all her activities in that direction. I also commend her for her ongoing efforts in forging constructive relationships, which are so important. These open conversations between health systems and the people they serve will, ultimately, allow us to continue building a sustainable future for the NHS.

Question put and agreed to.

NHS Long-term Plan

Karin Smyth Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Yes, absolutely. My hon. Friend is a brilliant advocate for Torbay and for the English Riviera, and has made the case so strongly for his local hospital. I was delighted that we could recently find the funding to support the case that he and local clinicians have made, and I look forward to working with him to make it a reality.

[Karin Smyth (Bristol South) (Lab)]

Before coming to this place, I was a senior manager in Bristol’s primary care trust and then the CCG. I want to pay tribute to the NHS managers who have kept the ship afloat since the Lansley reforms. Today’s plan is clear in its commitment to triple integration and seeking to free commissioners from the barriers to integration in the 2012 procurement rules, but tomorrow the CCG in Bristol will embark on a huge re-procurement process for some community services for the next 10 years based on those old rules. In the light of his plan, will the Secretary of State intervene locally and support my call to pause that divisive community services re-procurement?

[Matt Hancock]

I will raise the hon. Lady’s point with NHS Improvement, which considers these things. Local provision of services should, rightly, be decided by local clinical priorities, but she makes a cogent point that I will raise with NHSI, and I will ask its chief executive, Ian Dalton, to write to her.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 27th November 2018 Commons Chamber

[Stephen Hammond]

As my right hon. Friend the Secretary of State said earlier, we recognise the vital role that nurses play, and we are determined to support them. We are determined to have more nurses in training and more nurses treating patients. At the moment, a student on the loan system typically achieves 25% more in their pocket than they would have had on the bursary, but the Government recognise that there are still pressures, which is why we have the learning support fund, the exceptional hardship fund and support for mature students.

[Karin Smyth (Bristol South) (Lab)]

I talk to local employers who desperately want to support nursing apprenticeships as an alternative to the higher education route, but the uptake of apprenticeships is very disappointing. The levy can be used only for training costs, and trusts have been asked to plug the shortfall in funding for wider capacity building and to cover the 20% of time for which apprentices have to go to off-the-job training. Does the Department recognise this problem? What is being done to address it?

[Stephen Hammond]

The hon. Lady is right that the number of trusts that currently use the levy is not as high as it should be. We hope that all will do so. It continues to be a priority for us to broaden the routes into nursing. We will address in the long-term plan the specific matter about which the hon. Lady talks.

Budget Resolutions

Karin Smyth Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

The £20.5 billion is just for day-to-day running costs—the resource costs. Of course there is a capital budget, too, which includes £4 billion of taxpayers’ money. That goes towards ensuring that we can get the capital built. The critical point is that we have not only that £20.5 billion uplift in running costs but a capital budget. We will make further announcements on the allocation of the capital budget later in the autumn.

[Karin Smyth (Bristol South) (Lab)]

I am grateful to the Secretary of State for clarifying the £20.5 billion figure, which does not include training or capital. Of course, that contradicts the unhelpful briefing from Downing Street during the summer that it was something like £84 billion. Will he confirm that that £84 billion figure, which has been repeated in the media, is, as the Health Service Journal says, a fib, and that we are talking about £20.5 billion purely for resources in the NHS in England and Wales?

[Matt Hancock]

No. The £84 billion is the cash figure. The £20.5 billion is the real-terms increase by the end of the five years. If we add up all the extra money, we get £84 billion. It is there on page 36 of the Budget, if the hon. Lady wants to look. The biggest single cash increase comes next year, in 2019-20. It is all there in the Red Book.

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[Joan Ryan (Enfield North) (Lab)]

I thought I would start by picking out a few key points from the Office for Budget Responsibility report, which might have a slightly different emphasis from the points that the Chancellor would pick out. Let us start, on page 64, with household disposable income:

“Real household disposable income fell by 0.2 per cent in 2017”.

On page 65, the report says:

“We expect relatively weak growth in per capita real earnings and real disposable incomes… In 2019, real per capita disposable income growth is flat”.

On household saving and debt, on page 67, it says:

“We expect unsecured debt to rise steadily as a share of household disposable income”.

On household net lending and balance sheets, on page 70, it says:

“the ratio of household debt to income has risen steadily since the start of 2016…we expect the ratio of household debt to income to continue to rise steadily…with the ratio reaching just under 150 per cent by the start of 2024.”

On business investment and stockbuilding, on page 72, the report says:

“The latest data suggests business investment fell in both the first two quarters of this year…we expect a modest rise in business investment as a share of real GDP over the forecast period—less than would be typical at this stage of an economic cycle.”

On UK exports as a share of GDP, on page 77, it says:

“In August, the Government announced an ambition to increase the UK’s exports to 35% of GDP, but has not specified the date by which it believes that this can be achieved. The Government’s previous aspiration was to increase exports to £1 trillion by 2020—our forecast suggests that this will be missed by £320 billion. The Government is not on course to meet its current ambition in our forecast”.

On risks and uncertainties, on page 81, the report says:

“The outlook for productivity growth remains hugely uncertain.”

On page 83, it says:

“the probability of a cyclical downturn occurring sometime over our forecast horizon is…high”.

On assumptions regarding the UK’s exit from the EU, it says:

“we still have no meaningful basis for predicting a precise outcome upon which we could then condition our forecast.”

On page 91, it says:

“Real GDP Growth has been revised down in 2018”.

Now, the Chancellor, of course, would and did choose to cherry-pick a different set of headlines yesterday, but I think this is a more balanced picture than that presented by him.

I can assure the Chancellor of two things in relation to this Budget. First, the people of Enfield are sick and tired of austerity. Secondly, we have no confidence that the Government’s programme of austerity is coming to an end. The Government’s £1 billion cut to the Metropolitan police budget since 2010 has resulted in 230 police officers and police community support officers being removed from the streets of Enfield. Over the same period, violent crime has surged locally by 85%. Where was the Chancellor’s announcement to reverse those cuts, put more bobbies on the beat and help create safer neighbourhoods?

How can the Government have the cheek to say austerity is over, when they are still planning cuts of £1.3 billion to councils next year? By 2020, the Government will have slashed funding to Enfield Council by 60% in just a decade.

There is a better example in this Budget of the Government’s misguided priorities. The Chancellor announced more funding for potholes than for our schools. Pothole funding is welcome, but surely education should be a higher priority. Does the future of our children not matter? This is a slap in the face for many schools in my constituency, which are having serious problems paying for basic items such as pens and paper, let alone retaining and recruiting teachers.

Austerity is not coming to an end, and nor, as the Chancellor asserted, is the “economy working for everyone”. This year, we have seen household debt rise to its highest level on record. Over-indebtedness in Enfield is higher than the London and national averages, and we have more than 14,000 residents in real financial difficulty. One in three workers living locally does not earn a living wage, and the average worker is £800 a year worse off than they were a decade ago.

The Government’s abject failure to address the housing crisis means local families are struggling to cope with soaring rents and a lack of affordable homes, with our borough having the highest eviction rate and the second highest level of homelessness acceptances in the capital.

The last Labour Government lifted 1 million children out of poverty, but child poverty rates under the Conservatives are getting worse, not better. Some 34,000 children in Enfield are now living below the poverty line. This is a shameful record for the Government, and a record that could deteriorate still further as a result of their disastrous universal credit roll-out.

[Karin Smyth]

My right hon. Friend is making an excellent speech. Does she agree that the failure to say anything considerable in the Budget about early years support and education and Sure Start centres yesterday represented a glaring omission, and addressing those issues would have helped families in constituencies such as Bristol South and Enfield North?

[Joan Ryan]

My friend is absolutely right. In fact, in Enfield, we now see a real problem, as we do in many other parts of the country, with children not being ready for school at the age of five. This has a significant impact on their achievement throughout their school careers and on their future.

North Enfield Foodbank has said that food bank usage continues to increase, with Enfield having the fourth highest rate of food bank usage in London last year. The main reason for that increase is delays in the payment of benefits and changes to them.

The Chancellor said that the Government were

“delivering on the British people’s priorities, supporting our public services”—[Official Report, 29 October 2018; Vol. 648, c. 668.]

There is no public service or institution more important in our country than the national health service. Huge pressure has been placed on doctors’ surgeries. Well over half the residents who replied to my GP services survey said they had difficulty getting an appointment to see a doctor, and we know that, going forward, Enfield is short of 84 GPs to serve our growing population.

The Government’s chronic underfunding of our national health service since 2010 means that North Middlesex Hospital, like so many other hospitals across the country, is operating with a substantial financial deficit. NHS England is trying to deal with a deepening staff crisis, while hospitals are trying to recruit doctors and nurses. This is an impossible situation. We cannot square this circle. On public health, which warranted no mention whatever, we in Enfield are facing another £1 million cut by 2020, and everybody knows the link between poverty and health.

The Government have failed to address eight years of devastating cuts to our communities, and they are failing to deliver on the priorities of the British people. Austerity is not coming to an end. Yesterday’s Budget proves it. There is no hope here that I can take to the people of Enfield from this Conservative Government. I will not be supporting this Budget.

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I should like to highlight some of the facts and figures that the Chancellor missed yesterday before I move on to discuss some of the taxation and public spending measures. First, a record 8 million working people are now living in poverty. There are also 4 million children living in poverty, two thirds of whom are in working families. That number is going in the wrong direction. There are also 4 million sick and disabled people living in poverty—twice the number of non-disabled people. Our life expectancy is flatlining, and for women it is actually going backwards, but what do this Government do? They increase the state pension age. We also know that infant mortality has increased for the first time in 100 years, and that four in 1,000 babies will not reach their first birthday, compared with 2.8 per 1,000 in Europe.

Many epidemiologists have linked this reversal of the generations of health improvement with the austerity that this Government have wrought on the country as a whole and on people on the lowest incomes in particular. Resolution Foundation analysis published today and yesterday’s Budget book show that people on the lowest incomes will be hit disproportionately hard. The Government have not reduced inequalities. Have Ministers assessed the Budget’s impact on life expectancy? Will it continue to flatline, will it get worse or will it increase? I doubt they are able to say it is on the road to recovery.

On tax, I am pleased that small businesses, particularly those on the high street, will have their business rates reduced—that has been a particular issue for a number of my constituents—but what will that mean for councils’ revenue, and how will they be recompensed? My council has lost nearly half its budget from central Government. The digital services tax sounds great, but the OBR says it will affect around 30 tech giants, which will pay about £15 million each. How will that address the fundamental issue that, for example, in 2016, Google paid £36.4 million in corporation tax on declared UK sales of £1 billion, whereas according to its US accounts those sales were £6 billion?

On public spending, the Chancellor confirmed that the NHS would be given much-needed cash. That is welcome, but a range of think-tanks, from the King’s Fund to the Nuffield Trust, say it actually needs £30 billion by 2020. Again, the additional £2 billion for mental health crisis is welcome, but what about emphasising prevention? What about assessing the Government’s own policies on sanctions, work capability assessments and the personal independence payment process, which make the mental health of many claimants worse?

The £1 billion for social care is important, but it does not address the £2.5 billion funding gap since 2010 and does not help the 1.2 million people who need care but cannot get it. I worry that after the publication of the social care Green Paper, which is being consulted on, a new funding regime involving a social care insurance scheme will be announced. That would have disastrous implications for the NHS, as we see closer integration between the NHS and social care.

I could go on about the derisory figures for education and the fact that my local police force and our emergency services will receive nothing substantial, but I want to talk about homelessness, which is rising but was not mentioned in the Budget. We see rough sleepers on our streets in towns and cities up and down the country, but we hear nothing about the families who live in temporary accommodation or people who sofa-surf, as they are not deemed as having priority need for housing. That is the Government’s biggest shame. It epitomises their neglect of too many citizens and reflects not just their failure to ensure that enough houses are built for us all, with social and affordable homes as part of the mix, but their ill-thought-out social security policies, such as universal credit.

Universal credit has been a disaster from start to finish, and it has now been revealed to be driving homelessness. One shelter says UC is the reason why a third of its residents are in it. UC tenants of the housing association First Choice Homes in Oldham are in more than £2.5 million of rent arrears. Research suggests that nearly one in five people in Oldham struggles to pay a social rent. UC is part of that problem. Policy in Practice estimates that the changes to UC announced in the Budget will not have a significant effect. It says 345,000 more households will still be worse off and 29,000 will be no better off. Disabled people will still be worse off. People in employment will see some improvements, but self-employed people will see none at all.

[Karin Smyth]

My hon. Friend is a well-known expert in this area, which she has spoken up about many times. Does she agree that the Government’s inability to look at people in the round—particularly at their mental ill health, their disability, their poverty and their lack of access to work—drives some of the problems she highlights, including those with universal credit?

[Debbie Abrahams]

My hon. Friend hits the nail on the head. The human misery caused by such an inhumane policy cannot be underestimated.

L contacted my office recently after her UC was suddenly stopped because her son, B, has severe learning difficulties and L, who is the main carer, did not realise that he would have to make a separate claim once he had reached his 19th birthday. When the money stopped, L had nothing—she did not know why it had stopped and nobody contacted her. It was an absolute disaster for her, and she said:

“At times I just want to end it all…it’s just so hard and I get no support or respite.”

L is a candidate for the new mental health crisis fund that the Government have set out—a product of their universal credit policy. On top of this, the investment in UC does not offset other cuts to social security, with welfare spending set to fall in the next couple of years.

Most worrying are the cuts affecting disabled people, which have not been addressed in the Budget. In fact, according to the OBR, disabled people will be worse off. As the United Nations said last year, this Government are presiding over a “human catastrophe”. The Equality and Human Rights Commission estimates that families with a disabled adult and a disabled child will have lost 13% of their income—£5,500 a year—by 2022. This is on top of colossal cuts across other Departments. What about their help from the Chancellor? What about their bright future?

We have done a lot—the former Labour Government did a huge amount to improve life expectancy, and to lift disabled people and children out of poverty—but we need to do more. The inequalities in our society are getting worse, not better. These inequalities are socially reproduced, so they can be changed, and that should give us all hope. But political will is needed to tackle them, and I am afraid that this Government just do not have it in them.

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[Karin Smyth (Bristol South) (Lab)]

It is an absolute pleasure to follow my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy), who made an excellent speech.

We have had the usual smoke and mirrors about the real money that is going into the NHS through this Budget, but I think that everybody outside the Chamber agrees that it is not enough to meet the increase in demand that we all know about. Equally as concerning, however, is the fact that the percentage of the NHS budget that will be part of public spending over the forthcoming years will rise to roughly one third of overall spending. That says an awful lot about what we are not spending money on, as well as what we are spending.

Sometime soon, we will have the 10-year plan. The taxpayers, whom the Secretary of State was so concerned about earlier, will have absolutely no say in that plan, the priorities or how the resources are allocated. It is a completely missed opportunity to treat the public as grown-ups in the debate about health funding so that they are clear about the cost of health services, the extent of spending and the quality that money can buy, and understand what they are prepared to pay for.

Let me speak briefly about VAT. Page 50 of the Red Book refers to some tinkering around the edges of VAT, but the Government make no mention of closing the loophole that has been exploited by some NHS trusts. I visited a Treasury Minister recently to talk about wholly owned companies saving VAT. The Treasury seems unconcerned about the loss of income from VAT on wholly owned companies, and the Department of Health and Social Care seems totally unconcerned about the competing fragmentation of our services. It would be really good if both Departments had a chat with each other, decided what the policy should be and sorted it out.

I want to concentrate now on the Budget. Bristol is a city of high employment, and also a city with high rates of ill health and disability. The greatest inequalities are in my constituency, with people living on average for 19 years in ill health. The Marmot review on health inequalities estimated that between £36 billion and £40 billion are lost in taxes, welfare payments and costs to the NHS through health inequalities. This is a huge opportunity for us to do better.

I want to touch on universal credit and social care. Some 5,900 of my constituents currently claim employment and support allowance and the Government intend, at some point, to migrate them on to universal credit. In successfully claiming ESA, my constituents have been subject to the work capability assessment. Many have been initially refused, but then have successfully appealed that decision on one or more occasion. They will have proved to the Department for Work and Pensions that their long-term disability or ill health means that they cannot work and need financial support. There is still no recognition or understanding that these constituents will never work again. They do not need incentives or sanctions to work. The DWP agrees that they cannot work, but universal credit offers them no benefit, only a loss of income. Surely it is time to halt the migration of anyone currently claiming ESA and allow new claimants with an illness or disability to claim that benefit. We need a proper rethink about how we support those who most need our help.

The problem on social care is well documented. We know how many people are losing support, but it is still a silent misery for thousands of families, because until someone goes into the system, they do not understand how bad it is. The King’s Fund said that public awareness of the system is very poor and that

“As long as the public view the issue from behind a veil of ignorance, it is easier for national politicians to trade on…rivals’ proposals”.

I do not want to trade on fear and misinformation; I want us to set a path for what we need. I would like the Budget to have helped, but it has not. The language needs to change. Spending on social care is not a drain, a time bomb, a burden or a threat to assets. It is an investment in people and in our future. Every business, every public service and every family is struggling to cope with social care, and investing in it is an infrastructure issue. It is essential to our prosperity.

The cycle of ill health, disability and poverty is well known, as is the problem of low productivity, and poor educational attainment does not help. Last month, one of my colleges came up with the Love Our Colleges campaign to talk about underfunding in further education and the need to bridge the skills gap. College funding has been cut by 30% since 2009 at the same time as costs have increased dramatically, including for pensions. At the same time, however, the number of adult courses has dropped by 62% and the number of health and social care courses by 68%. How can that be a priority when there is that level of disinvestment? This is a huge problem in Bristol South because we do not send youngsters to higher education—further education is the driver of prosperity for our people.

As I highlighted earlier, also not mentioned was the OECD report on early years education. There was nothing in the Budget about this, despite evidence that early years education is a driver of prosperity. Nursery schools, which are under the control of local authorities, were forgotten even in the Chancellor’s miserly throwaway comment. He has not given them anything. They do not even get the pittance he threw away in the Budget.

Finally, I want to say something about our police services. Some 75% of recorded incidents are currently non-crime and include missing persons reports and issues relating to people experiencing mental health crises, all of which are highly resource intensive. I am currently on the parliamentary police force scheme and spending a lot of time with our police force, so I have seen this at first hand. The police funding formula has not been updated for a decade and does not reflect current demand. The police and crime commissioner has been clear about this. In Avon and Somerset, we have a very good system for analysing demand and the associated resource needs, but we are still not getting the money, even though we have proved we need the resource.

In conclusion, the Government are ignoring all the data and evidence, and not linking up their policies in order to deliver the improved productivity that this country needs and which will drive prosperity for all our constituents.

Social Care Funding

Karin Smyth Excerpts

Wednesday 17th October 2018 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

This year is the 70th anniversary of the NHS. It is also the 70th anniversary of our social care system, but that has received far too little attention to date. It is not getting any of the national celebrations—the birthday cakes and cards—and certainly none of the £20 billion birthday present that the NHS received from the Prime Minister.

Yet social care is more important than ever before. A quarter of older people now need help with daily living—getting up, washed, dressed and fed. More adults with physical and learning disabilities need substantial packages of support. There are 1 million paid care workers and 6.5 million unpaid carers. Yet despite the fact that this touches so many people’s lives and that there is an increasing demand, we have no sense from the Government of the reality of the situation. There has been a 10% cut in real terms in social care spending, with 400,000 fewer people getting any kind of help and support. A third of carers have to give up their job or reduce their hours to look after their loved ones, and a quarter of the paid care workforce leaves every single year. There is nothing from Government Front Benchers—no sense of the urgency of the challenge we are facing.

We cannot solve this problem without substantial extra funding. The Health Foundation says that we need £6 billion just to maintain the current inadequate system. It is not good enough.

Over the last 20 years, we have had 12 Green and White Papers and five independent commissions, but we have not solved this problem, and we need to understand why. Most people think that they are not going to end up needing this support. When they end up needing it, they do not realise that many of them will have to pay. They think the current system is unfair, but when radical proposals have been put forward for how to fund the system, they believe that those are unfair too.

This issue has been a political football. Labour was accused of imposing a death tax, and the Tories were accused of imposing a dementia tax—but it is not the politicians who suffer; it is the people who use the services and their carers. We cannot go on like this any longer.

I believe that one of the reasons this issue has not been solved is that much of it is about low-paid women who work in people’s homes and care homes invisibly. Caring is not valued, and we have to change that.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is making an excellent speech and she is an expert in this area. She is right; the language we have heard today is all about the challenges and the costs. This is an infrastructure issue, and it needs to be treated as such. Because women lead this workforce, it is not considered an infrastructure issue, and if we did that and changed the language around this, we would have a completely different debate. Does she agree?

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

I begin by thanking hon. and right hon. Members for their contributions from across the House. It is the convention to mention Members by their contributions. I apologise that, because of the time restrictions that have been put in place, that is not possible.

I pay tribute to all who work in our social care services, whether they work in the NHS or our councils or are paid or unpaid carers. We have been here before. I have a sense of déjà vu. It was in April that we called for immediate action from the Government to address the crisis in social care, yet here we are, months later, and no progress has been made. Since then, we have had a new Health Secretary and a new Communities Secretary, but still no new ideas and still no Green Paper. There is only so much longer this sector can wait.

Given the lack of support from the Government, and in the face of year-on-year cuts, local government has been forced to step up. With the Cabinet too busy squabbling among themselves and in the absence of any Government action, the Local Government Association has published its Green Paper on social care. It is worth the Government considering some of the responses that the consultation received. According to the District Councils Network, the

“adult social care crisis is the single largest problem facing local government services and their financial sustainability”.

[Karin Smyth]

The Green Paper commends Bristol City Council for its Well Aware project. Will my hon. Friend join me in congratulating Bristol on that online and telephone advice and guidance service, which has proven so popular, and will he or the Minister visit to see how it works in practice?

[Andrew Gwynne]

Absolutely. I am always happy to visit my hon. Friend’s city of Bristol and to see the great work it is doing in very difficult circumstances—Labour local government leading the way and making a difference where it matters.

The LGA estimates that adult social care services face a £3.5 billion funding gap by 2025—just to maintain existing standards of care—but councils in England receive 1.8 million new requests for adult social care a year, the equivalent of almost 5,000 extra cases a day. It is a national scandal. The Government should feel ashamed that 1.4 million older people are now not getting the necessary help to carry out essential tasks, such as washing themselves and dressing. That is 20% more people without care than only two years ago. One of the people experiencing adult social care said of their provision:

“I haven’t washed for over two months. My bedroom floor has only been vacuumed once in three years. My sheets have not been changed in about six months and my pajamas haven’t been changed this year. My care workers don’t have time for cleaning, washing or changing me”.

Those words were taken from a report by the Care and Support Alliance into the state of care in the UK, and it makes for heartbreaking reading, but we have yet to see a Minister even acknowledge that a crisis in local government funding even exists. “We introduced the social care levy,” said the Secretary of State. No, they enabled councils to raise more council tax in a limited way, but a 1% increase in his council’s council tax raises a very different amount from a 1% increase in my area. That only widens the inequalities and the unfairness.

The Secretary of State’s big announcement at the Conservative party conference of an extra £240 million of emergency funding for adult social care should not be celebrated; it should be a source of shame. The Conservative leader of West Sussex Council summed up the response to the announcement:

“I am not skipping round—I am really cross about it. It’s half a crumb. It’s not even a crumb.”

Earlier this year, the former Secretary of State for Health made a candid admission to the British Association of Social Workers, when he accepted his share of responsibility for the lack of progress since the Tories entered government in 2010. The crisis is a result of this Government’s policies. Our Prime Minister has given up and our councils are at breaking point, but the Government remain committed to their programme of cuts, taking £1.3 billion extra funding out of local government next year. Let that sink in for a moment. It is now being reported that nearly 50% of council heads are seriously worried about impending bankruptcy in their councils, which should send shivers down the spines of members of the Government. One of the chief executives surveyed by the Local Government Chronicle said:

“The next three years are secure if we can manage the demand in adults and children’s services...a complete lack of policy means that even with a well-run council and relatively strong local economy we are likely to start to significantly struggle in 2021/22.”

That is the reality, and that is why I commend our motion to the House.