NHS (Government Spending)

Lord Walney Excerpts

Wednesday 28th January 2015 Commons Chamber

[Dr Poulter]

As the hon. Lady will be aware, front-line staff use IT and understand the importance of joining it up to benefit patient care while also protecting confidentiality. On the point about district nurses, she is right that we need to transform the model of care, which is why the Government set up the £5.2 billion better care fund—to ensure we join up more effectively what happens between our acute hospitals, the wider NHS and adult social care. This approach will be transformative, delivering better care for the frail elderly and providing more care in people’s homes.

Of course, part of that is about changing work force models and ensuring that staff who have traditionally worked only in hospitals, supporting people with long-term conditions such as multiple sclerosis, can also work in the community. [Interruption.] The hon. Lady is chuntering away, but I have answered her question in an informed and sensible way, having spoken about how our work force models need to change as part of our investment in integrating and joining up care so that patients looked after now in a purely hospital environment can have access to staff across both community and hospital care, which is important for people with long-term conditions such as diabetes, multiple sclerosis and dementia. I hope she can support that.

It is also important to consider some of the equally important funding decisions we have made in maternity care. In 2013-14, we provided £35 million of capital funding for the NHS to improve birthing environments, which represents the single biggest capital investment in maternity care for decades. That has benefited more than 100 maternity units, including through the establishment of nine new midwifery-led birthing centres in eight areas, and transformed many local maternity services across the country. Improvements delivered by our maternity investment fund include: more en-suite bathroom facilities in more than 40 maternity units, providing more dignity and privacy for women; more equipment such as beds and family rooms in almost 50 birthing units, allowing dads and families to stay overnight and support women while in labour or if their baby needs neonatal care; and bereavement rooms and quiet areas at nearly 20 hospitals to support bereaved families after the thankfully rare but always tragic loss of a baby.

Our £35 million maternity investment has made a big difference to the experience mums and families have of NHS maternity services.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

Will the Minister give way?

[Dr Poulter]

I have been very generous in giving way, but I must now make some progress.

[John Woodcock]

rose—

[Dr Poulter]

No, on this occasion, the hon. Gentleman will have to forgive me.

Our capital investment in maternity services, which, as I said, is the biggest for decades, is making a big difference to mums, dads and new families. Thanks to our investment in the midwifery work force, we now have the highest ever number of midwives working in our NHS—about 2,000 more than in 2010—providing more personalised care and support for women and new mums. However, we must all recognise the challenges facing our health and care system in the months and years ahead. NHS England’s “Five Year Forward View” argued that we needed to do more to tackle the root causes of ill health through a radical upgrade in prevention and public health; to give patients more control over their own care, including through the option of combining health and social care, and new support for carers and volunteers; to ensure the NHS changes to meet the needs of a population that lives longer; and to develop and deliver new models of care, local flexibility and more investment in our work force, technology and innovation, some of which I have already outlined.

That is why the Government have provided additional funding for NHS front-line services in 2015-16, including £200 million to pilot new care models and £250 million for the first tranche of the new £1 billion fund, spread over the next four years, for investment in new primary and community care facilities to support our GPs and primary and community care work force in the important work they do. In community care, we are committed to undoing the terrible mistake that was Labour’s 2004 GP contract, which left so many people, particularly the frail elderly, without the GP care they needed at evenings and weekends. Our investment will support GPs to provide care for patients seven days a week so that patients will once more be properly supported during evenings and weekends. We are also training an extra 5,000 GPs, in addition to the 5,000 extra we have already seen under this Government, to provide that care.

We are clear, however, that if the NHS is to meet the challenge of increasing patient demand and expectations, it cannot stand still. By 2018, 3 million people in our country will have three or more long-term conditions, so we must continually adapt and change how we deliver care to support patients, families and carers, and deliver more care in people’s homes and communities. For our part, and as part of our plan for our NHS, not only are we delivering a strong economy so that we can protect our NHS budget, but we will continue to be ruthless in delivering greater efficiencies in estate management and procurement and in reducing back-office costs so that we can reinvest that money in front-line patient care. Furthermore, we will continue to back front-line staff with the training, equipment and new technology they need to do their job and provide high-quality patient care, which is why we have already made available an additional £2 billion down payment to deliver NHS England’s “Five Year Forward View” and why the Prime Minister has committed to continuing to protect our NHS and ensuring that it has the additional money it needs to deliver first-class patient care in the months and years ahead.

In conclusion, I would like to thank the dedicated NHS staff working incredibly hard to keep us well looked after and safe in this busy winter period. As a practising doctor—I know Labour does not like it, given its dearth of real-life experience and the number of former special advisers on its Front Bench—I know how hard our NHS staff work and how dedicated they are to delivering the highest-quality patient care. I remind the House that we have been able to increase the money available to our NHS only because we have the growing economy to pay for it; because our long-term economic plan is working; and because, under this Conservative-led Government, there are more people in work than there were under Labour. Anybody who does not have an economic plan for the economy—and Labour has no plan for our economy, as has certainly been clear in today’s debate—does not have a plan for the future of our NHS. Through economic policies and by creating growth and jobs, we have been able to announce additional NHS funding for 2015-16 without having to raise taxes, including on people’s homes, as Labour would like to. This gives our NHS the funding it needs to begin implementing the plan set out in NHS England’s “Five Year Forward View”, so that it can continue to be a world-class, sustainable health service, delivered free at the point of need.

When we came into power, we took two big strategic decisions with our NHS: to increase funding and to cut bureaucracy and waste, and to reinvest that money in more doctors, nurses and front-line staff and to improve front-line patient care. That is exactly what we have done, so the choice on 7 May will be clear: between a Labour party that bankrupted Britain and would do so again, at the same time bankrupting our NHS, and a Conservative Government, committed to securing our NHS by delivering a strong, stable and growing economy.

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[John Woodcock (Barrow and Furness) (Lab/Co-op)]

I have a great deal of affection for the hon. Member for Daventry (Chris Heaton-Harris), but I have to say to him that the only people who are using that word are those on the Government Benches, because they apparently have nothing to say about the future of the NHS under the stewardship of a Conservative Government—God forbid—or about the real crisis that our accident and emergency services are suffering across the country. I should like to hear a little more from them about what they actually plan to do, rather than hearing this ridiculous nonsense.

We all know that the national health service faces major funding challenges in the years to come. NHS England has set that out clearly, and we have put forward concrete proposals to raise the extra money that our NHS needs. That will involve increased funding and, I have to say, radical reform. The merging of health and social care is a major undertaking that will unlock huge efficiencies and deal with one of the major pinch points of inefficiency that is wasting billions of pounds as well as creating great difficulties in people’s lives. Families simply do not know where to turn at the moment.

That scale of ambition has not been matched by the Government. In fact, at the very moment that they should be encouraging front-line workers to innovate and work together from the bottom up to come up with the new ideas necessary to take the NHS to a new level, they are tying them up with the red tape of compulsory competitive tendering. That is the last thing those people need at a time when a radical new approach to delivering services is needed.

I want to focus on the specific funding situation in the University Hospitals of Morecambe Bay NHS Foundation Trust. It is regrettable that the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), who is a doctor, refused to take my intervention on the subject of maternity services. He must know, given that we have been talking about my maternity unit and maternity services across the Morecambe Bay area for some years now, that the situation is now critical. It will be the subject of a major report in the next couple of weeks, and there are real funding issues involved.

I shall run briefly through the trust’s recent funding history. In 2011, the University Hospitals of Morecambe Bay NHS Foundation Trust announced that it was facing a cut of £15 million—around 4% of its annual budget—as a result of the efficiencies and cuts to hospital funding being required by the Government. At that stage, it managed to avoid reductions in front-line staffing and facilities. The required additional spending resulting from the clinical and staffing failures found by the serious Care Quality Commission reports led to the trust’s finances falling into deficit by about £25 million annually. Ministers are still insisting that that must be eliminated.

The Better Care Together reconfiguration plan was submitted to NHS England and Monitor by the trust last July. It set out a scheme that would allow for up to £18 million of annual savings achieved over a five-year period. The trust, NHS England and the Department have been going backwards and forwards on the details of this plan, but it has boiled down to this basic point: innovative changes in approach and some difficult decisions mean that local health care experts are proposing to reduce the trust’s deficit by a full 70%, but—this is the key point—our whole area is clear that the unique combination of geographical isolation, poor transport links and severe health needs in pockets of some of the worst urban deprivation in the country in Barrow make this a unique case, meaning we cannot go further than that 70% proposed reduction without cutting deeply into vital services across our hospitals.

It is a shame that the hon. Members who represent the Royal Lancaster infirmary, which is part of Morecambe Bay’s trust, are again not here to make this case. However, I want to ask the Minister something, and she can rise now or deal with this in her summing up. Will she follow the lead of the shadow Secretary of State, recognise our unique case and pledge to bridge the gap? Until we get that promise I will keep working with anyone in our community across Morecambe Bay who will join us in demanding the funding deal our hospitals desperately need.

The hon. Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Morecambe and Lunesdale (David Morris) are not here to stand up for their hospital today, so I will be out at the weekend with the people who will replace them as MPs: our brilliant candidates Amina Lone and Cat Smith. We will not stop until our hospitals are secure. The Government are proving themselves to be not up to this job, so they should get out of the way.

National Health Service

Lord Walney Excerpts

Wednesday 21st January 2015 Commons Chamber

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

I want to talk about the situation in hospitals across the Morecambe bay area, and I shall start with the inquiry into neonatal deaths at Furness general hospital. The inquiry is led by Dr Bill Kirkup, who distinguished himself as a member of the independent Hillsborough inquiry panel. It has now heard from more than 100 witnesses, of whom I was the first, over a period of nine months. That has involved regular long trips from Barrow to Preston for the grieving families, who have had to relive those deeply traumatic periods in their lives in great and painful detail.

There has been a lot of talk about politics today, and about its relationship with the national health service. I do not think we should deny the real differences between our parties; we should be prepared to debate them and to put the choice before the British people at the election. That will involve disagreement, argument and debate. However, it pains me to hear the Secretary of State accuse me and other Opposition Members of being selective in the way in which we talk about the problems in the NHS. I have to say to him that I do not care if the Morecambe bay inquiry turns out to be politically difficult for any side. As the Minister of State, the right hon. Member for North Norfolk (Norman Lamb), knows, I helped to secure the inquiry on behalf of the grieving families, who, with great persistence and determination, persuaded me of the need for an independent examination to run alongside the criminal inquiry, rather than taking place subsequently. I am determined to get to the truth, and I am determined that lessons should be learned, no matter how painful they might be for anyone.

The Secretary of State is no longer in his place, but if he wants to stamp out shabby political point scoring I advise him to have a word with his colleague, the hon. Member for Morecambe and Lunesdale (David Morris). It is a shame that the hon. Gentleman has not attended this debate to stick up for his own local A and E, which I know is facing real pressures. The last time the inquiry was in the news, the hon. Gentleman used those neonatal deaths—which did not relate to his constituency or to the hospital there—to call for the resignation of the shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham). I am sorry to speak so frankly, but if someone is prepared to use the deaths of babies for this kind of political stunt because someone in Tory central office suggests it or just because they themselves think it is a good idea, there is not much they will not do. So just as the families, who have gone through so much in their grief, will not forgive anyone who does not face up to the full gravity of the findings that are coming, so I will not forgive anyone who uses this inquiry for political sport.

For all the problems, and I understand that the inquiry may well make difficult reading, we in Morecambe bay and at Furness general hospital are not the next Mid Staffs. There will be no excuse for anyone who allows the destabilisation and turmoil that the region has suffered to be recreated in Morecambe bay just because it fits the narrative composed by Lynton Crosby or some election agent in Downing street. I hope I will get some assurance from the Minister on that point in his winding-up speech. It is also important that this inquiry, which I understand is to report in the middle of next month, is dealt with fully but is not allowed to divert focus from the real problems the trust is enduring now and the need for a proper funding solution to put our hospitals on a more sustainable footing.

Let me briefly address the pressures currently being felt in Morecambe bay. Ambulances have been mentioned, and the hon. Member for Blackpool North and Cleveleys (Paul Maynard), whom I have the pleasure of following, spoke of his local hospital in Blackpool. Patients in south Cumbria will often travel by ambulance to Blackpool. Sometimes that is a good thing, because of the real expertise available, but too often recently ambulances have been diverted from where they are needed in south Cumbria to serve the Blackpool area because of shortages there. On 5 and 6 January, two ambulances, one serving Ulverston in my constituency and the other Millom in the constituency of my hon. Friend the Member for Copeland (Mr Reed), had to come to Fylde and the Blackpool area. Obviously, once they were there they were required to serve other patients needing help in the Fylde and Blackpool area, leaving the service in south Cumbria severely stretched—and all this when the beginning of January had seen a 25% year-on-year increase in ambulance call-outs across the north-west. We urgently need from the Government not only action to relieve the pressure on accident and emergency departments, but a recognition that areas such as Furness, which are out on a limb, can end up in a difficult situation because of ambulances being redirected around the country.

There have been real pressures on A and E in my constituency, as there have been across the country. Two weeks ago, when this issue last flared up in the Commons, the University Hospitals of Morecambe Bay NHS Foundation Trust was cancelling all non-urgent operations so as to be able to deal with the crisis in A and E. I have spoken to people in the trust today and they say that the situation has eased a little in recent days but remains fragile. All these problems must be addressed, but I have repeatedly pressed the Government on this. I was so grateful to the shadow Secretary of State, on his recent visit to Morecambe, for the assurances he gave on recognising the unique geographical situation of Morecambe bay and the funding priority it would get under a future Labour Government. Our population of 300,000 is spread out across the Morecambe bay area and the transport links are difficult. If things are to be easier, our area ought to be more compact and served by one big general hospital, and it cannot survive with the three hospitals it has unless very severe cuts in services are made. We are still waiting for an answer from the Government on whether they will recognise that case and provide us with the long-term extra funding that our area needs.

Oral Answers to Questions

Lord Walney Excerpts

Tuesday 13th January 2015 Commons Chamber

[Jane Ellison]

It is exactly that kind of flexibility that we so much welcome in the “Five Year Forward View”, recognising the potential of smaller hospitals. My hon. Friend’s local hospital, which he champions so well, can apply to be one of NHS England’s prototypes, and I would encourage it to do so.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

Does the Minister accept the case made by commissioners and the trust in Morecambe Bay that, notwithstanding all the efficiencies and changes in services, the trust could not close its deficit, due to its near unique geography and health need, without significantly cutting vital services for the area?

[Jane Ellison]

These are clearly difficult local questions that local health leaders need to look at. If there is a particular issue the hon. Gentleman would like to draw to our attention, we will certainly be able to examine it. I recognise that unique geography is involved, but steps are already being taken by NHS England to try to close some of those gaps and to deal with those challenges that smaller hospitals face, working with Monitor and looking at, for example, the tariff regime. I encourage him to look at that, too.

Oral Answers to Questions

Lord Walney Excerpts

Tuesday 25th November 2014 Commons Chamber

[Norman Lamb]

My hon. Friend is absolutely right about the importance of early interventions. Next year, we are introducing for the first time a six-week maximum waiting time standard for access to psychological therapies to start treatment for conditions such as anxiety and depression, and a two-week standard for starting treatment for those suffering a first episode of psychosis. I am also calling on every FTSE 100 company to sign up to Time to Change, so that they can show leadership in how they deal with their employees.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

It is one thing to say it, but completely another to do it. I am sure that the whole House will recognise improvements that happen, but does the Minister understand the scale of the crisis, not simply in the NHS but in the education system where more and more young people are increasingly finding that they simply cannot get anything like the support they need at increasingly difficult points in their lives?

Five Year Forward View

Lord Walney Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I am absolutely delighted to do that. The new hospital inspection regime we have introduced has shone a light on some outstanding leadership. One of the best examples is Basildon hospital, which had terrible problems, including blood-stained floors, blood on the carpets and syringes left lying around in wards. That failing hospital has been turned around by an inspiring chief executive, Clare Panniker, and in the space of just 18 months it has now officially been rated as a “good” hospital by the CQC. We welcome the brilliant leadership of a growing number of female chief executives.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

GP commissioners in Morecambe bay are doing exactly the kinds of things mentioned in the report by shifting their focus from primary care to prevention. They know, however, that all the things they could do will not come close to closing the £25 million deficit. The Government say that they have to close it, but doing so would decimate hospital services. Will the Health Secretary listen to our case about the special funding needs of the area?

[Mr Hunt]

I am very happy to look into that. I recognise that all clinical commissioning groups face very real financial challenges to balance their books. That is why the report is so important, because it says that we cannot go on like this for ever and we have to look at changing the model decisively. It addresses the three things that could give hope to the hon. Gentleman’s CCG: increased real-terms funding based on a strong economy; more imagination in looking for efficiencies; and innovation and technology. We are absolutely committed to doing those things.

Special Measures Regime

Lord Walney Excerpts

Wednesday 16th July 2014 Commons Chamber

[Mr Hunt]

Such reports will be used. Members of the public will be involved in the inspection regime and the way that care homes respond to complaints and concerns raised by families will be an important part of what the new chief inspector looks at.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

We all hope that the special measures regime speeds up the improvements that are needed in Morecambe Bay hospitals, but does the Secretary of State accept that the turmoil that those hospitals have been in for years now will never properly end until the Government recognise that the trust simply cannot deliver services with the same level of funding, given the almost unique challenges of rural isolation, severe deprivation and health need in the area?

[Mr Hunt]

I thank the hon. Gentleman for the work he has done with James Titcombe on the tragedy that happened at Morecambe Bay. I think there are particular issues in that trust owing to the fact that it is on two sites that take a long time to travel between geographically. The point of the new regime is to ensure that those issues get surfaced and that Ministers and the system have to address them. I hope that that is what will happen.

Oral Answers to Questions

Lord Walney Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is right about the seriousness of the issue of antimicrobial resistance. Some 25,000 people die in Europe every year as a result of the failure of antibiotics—more than die in road traffic accidents. I raised the issue at the World Health Assembly and I have discussed it closely with the Prime Minister.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

The Health Secretary will be aware that the chair of Morecambe Bay trust has stood down today, ahead of what is expected to be another critical report from the Care Quality Commission about services. What guarantees can the Health Secretary give the worried people who are served by the Furness general hospital that its A and E department will be protected and the vital national industries that depend on its services will continue to be able to rely on them?

[Mr Hunt]

First, I thank the hon. Gentleman for the work that he does locally, in particular with people such as James Titcombe, who has campaigned extensively to improve the quality of care at Morecambe Bay. I assure the hon. Gentleman that whatever the problems are at Morecambe Bay, we will be transparent and open, and we will make sure that we deal with them promptly. That is why we have had these independent inquiries. We will look closely at what the report says and make sure that we act quickly.

Urgent and Emergency Care Review

Lord Walney Excerpts

Tuesday 12th November 2013 Commons Chamber

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

The response that the public health Minister gave to my written question showed that ambulance response times have increased over the past two years in 11 out of 12 trusts in England. Why is this happening?

[Mr Hunt]

Just as there is more pressure on A and E departments, there is also more pressure on ambulance services. We are treating that as very much part of how we support accident and emergency services over the coming period. There are particular pressures in the London area, the east of England and the east midlands, and we are doing everything we can to put those problems right.

Care Quality Commission (Morecambe Bay Hospitals)

Lord Walney Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. That regime was utterly flawed, and as far as we can tell, inspectors looking at hospitals and care homes had targets of inspections they had to complete in a way that was totally counter-productive to the concept of a rigorous, thorough, independent inspection where people speak out without fear or favour when they find problems.

I also thank my hon. Friend for the other point he makes: that the people who work at the University Hospitals of Morecambe Bay NHS Foundation Trust are working extremely hard and under great pressure. I think they are doing a very good job by and large, but there are clearly very severe problems with the trust that we need to get to the bottom of, and it is very important that we recognise that if we are going to create a safety culture in the NHS, we need to back the people on the front line. They did not go into the NHS to have to deal with these terrible breaches in health and safety; they went into the NHS because they care for people and they want to do the best for people at their most vulnerable.

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

May I first thank the Secretary of State and the shadow Secretary of State for those words of apology to the Titcombe family and other families who have long been pressing for an inquiry and this kind of day of reckoning for the CQC? It is hard to imagine what it must be like to lose a child, but then to be faced with an almost impenetrable wall of bureaucracy, with one organisation and one group of people passing them over to another group, and with all of them ultimately washing their hands of accountability, is truly shocking. That has been laid bare in this report, and I commend its authors for bringing it to the attention of the public.

What the Secretary of State says about the staff in this trust is very important, because these are front-line people who have been failed by poor leadership and a poor inspection regime, which absolutely has to change.

The report says the particular issue here

“may constitute a broader and ongoing cover-up.”

Is the Secretary of State satisfied that that is not the case? If he is, how can he be? What can he do to look more widely than just at the CQC itself when looking into this allegation?

Health and Social Care

Lord Walney Excerpts

Monday 13th May 2013 Commons Chamber

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who made a thoughtful and considered speech on an issue of great importance nationally, as well as to his constituents.

It was a pleasure to be in the Chamber to hear such a powerful speech on plain packaging for cigarettes from my hon. Friend the Member for Barnsley Central (Dan Jarvis). Frankly, if Ministers are not convinced after hearing his arguments, they should probably not be in their place. I think that they are convinced and I hope to see them make progress.

I want to start on a note of consensus. I welcome the inclusion in the Gracious Speech of the Bill on mesothelioma compensation. This dreadful disease is a time bomb that, once detonated, often goes on to kill within months. With its shipbuilding heritage, more individuals in Barrow and Furness suffer from mesothelioma than in any other constituency in England. We owe a duty of care to all those who are suffering: they made an honest living and what is happening to them is not right. We should applaud all those who have pushed for further progress, including former Labour Ministers and the hon. Member for Chatham and Aylesford (Tracey Crouch), who I understand wanted to be here but is on her sick bed.

There are early concerns about the Government’s paucity of ambition. It is vital that the Government mandate a scheme that will build fittingly on the work of my predecessor, Lord Hutton, who expanded and speeded up compensation in the previous Parliament. However, many will see the thin programme last week as a missed opportunity to address increasing alarm about the Government’s poor stewardship of the NHS. It would be too optimistic to hope that Ministers have had an early change of heart on the costly and ill-conceived reforms they have just bulldozed through Parliament. In addition to the lamentable absence of plain packaging legislation, they could have introduced measures that sought to bridge the yawning gap between their rhetoric on listening to local people and the reality that is seeing the clear wishes of residents on NHS services ignored up and down the country.

In Barrow and Furness, we hope that health professionals in charge of provision across Morecambe bay will heed the passion and powerful arguments from local people on oncology, maternity, and accident and emergency provision. While residents understand that it can make sense to travel to get the best that 21st century health care can offer, like so many across the country they love their local hospital, they think it should have its fair share of the very best, and they think local provision, that is accessible to them and visiting loved ones, is a basic part of a quality service, not something to be dismissed as an unnecessary luxury.

I have some hope that the new management team at Morecambe Bay NHS Foundation Trust will listen to local concerns. An early test will be the publication of revised plans for Furness General hospital’s oncology unit this month. However, we see what is happening in other areas where the Government’s local engagement test is proving to mean little more than holding a meeting and nodding in an understanding manner, and ignoring everything people say and downgrading services anyway. When my constituents see the scale of the upheaval and cuts to front-line nursing staff involved in reducing the budget of Morecambe Bay Trust by £25 million within two years, they are, understandably, very wary of trusting Government promises that no efficiency savings will be allowed to affect the quality of patient care. I hope the Minister will tell me whether the Government will heed calls, including from the trust itself, for a rethink on the speed and scale of the cuts they are imposing.

Will the Government not take heed of the dismay felt about recent NHS reorganisations and enact measures to strengthen the power of local opinion in determining the future of our hospitals? We live in times of strained resources, but faith in the future of the NHS may continue to be eroded until we learn genuinely to trust local communities. When we come to look back at the history of the NHS over the current decade, I think we will see this as the time when we were bound overly tightly to the idea that the clinician always knows best. We will come to see the Government’s blind faith in the clinical stamp for taking services away as an early 21st century equivalent of the “Whitehall knows best” mentality that gripped reforming Governments after the second world war. Just like the “Whitehall knows best” ethos of the 1940s and 1950s, the clinician knows best mantra has the best of intentions but is insufficiently responsive to challenge from the patients who rely on the services that are being shaped by those at the centre.

Let me be clear. It is essential that health professionals make their case when decisions are made. Their expertise is immense and people should not deviate lightly from their plans. However, it is by no means certain that any one group, even one bursting with medical experience, will always call it right first time. Their views must be subject to scrutiny. Often the clinical push to concentrate a specialism at a single site takes less account of local geography and community links to health facilities than is demanded by local people, who ultimately pay the clinicians’ wages.

This is not an argument for sentimentality. The views of local people will sometimes be irreconcilably different in a single area, but if, for example, Barrow families suddenly face the prospect of a 100-mile round trip to visit a relative—because a unit at Furness General hospital has moved to Lancaster—their views on the move will be important. Many communities across England are fighting for their local health services. Some are threatened by cuts, but others are at risk from this clinically led decision-making model.

[James Duddridge]

The hon. Gentleman is making some valid points, several of which I am deeply sympathetic to, but on clinicians, is he referring to GPs or specialists? Does he think that the clinical commissioning groups of GPs who are more fixed in the community could have an impact on, for example, oncology and other specialisms in local hospitals?

[John Woodcock]

That is a good point, and it remains to be seen. We hope so, but the system has yet to be put to the test.

I am disappointed that no move towards genuine localism was outlined in the Gracious Speech. It is time for a people’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto that ought to be heeded. That would require a step change in our NHS away from a model that, yes, might have helped deliver improvements in health outcomes of which the country should be proud, but which has done so—

[Norman Lamb]

Will the hon. Gentleman give way?

[John Woodcock]

I will give way, if the Minister is quick, because I do not have much time left.

[Norman Lamb]

I am interested in what the hon. Gentleman is saying, and I accept the point about the importance of accountability. [Interruption.] He has just realised that he has got an extra minute of time, so I have done him a favour. Does he accept, however, that the old NHS, which we reformed, had no local accountability at all and that we have introduced some accountability through the health and wellbeing boards, bringing together local authorities and the NHS?

[John Woodcock]

It is an interesting point. I am not claiming that the system operating now is fundamentally different from that of three years ago, but around the country people who were promised a say in local decisions have been devastated to find out that they have none. Unquestionably, what has been put in place is not adequate. It is a sop to localism that does not do what it says. It would be a step change to move away from the current model.

Following the current model has meant alienating many local people who understood the trade-offs, but nevertheless fervently desired to keep services local. Whatever happens, surely the current tension between national planning and local unrest is unsustainable in the long term. In opposition, the Conservative party told the public that it understood that and pledged to end local hospital service closures, but of course its promises turned out to be a cheap election con trick. Instead, Ministers have forced through an expensive, chaotic and divisive health reform package that ultimately has pushed NHS decision making still further from the people it serves. We need a change of direction. Local communities pay for the health service they receive, and they deserve to be treated with greater respect.

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[James Duddridge (Rochford and Southend East) (Con)]

It is a privilege to be called to speak in the debate, and it is good to follow the hon. Member for Bridgend (Mrs Moon). Some of her comments about rare kidney diseases resonated with me, as I have recently visited the very good renal centre in Southend. I have also looked into the issue of rare diseases. Individually, they might be rare, but collectively they are quite common as a group, and the funding for the relevant drugs and for more general treatment can be tricky.

I have a quite carefully drafted speech here, but I was blown away by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who spoke without notes and whose speech was a fantastic tour de force. I am tempted, perhaps unwisely, to pick up on a number of issues that have been mentioned in the debate, some of which have been quite controversial. I did not listen to every single speech today; I missed half an hour. While I nipped out for a cup of tea, I heard colleagues on this side of the House speaking out against equal marriage—perhaps some Opposition Members did so as well—but I for one am glad that that legislation will be dealt with in this Session. The carry-over motion will ensure that we have ample time to debate it and to work through some of the issues. In 20 or 30 years, we will look back in confusion as to what the problem was. We are perhaps introducing the legislation faster than the public has an appetite for, but politicians sometimes need to lead rather than follow.

At lunchtime today, I had the privilege of having lunch with my mum and dad, who were in very good form. They said that they had been looking for me during the Queen’s Speech but had been unable to see me, and I told them that the debate was carrying on today. I asked them what they had thought of the speech, and they told me they thought it was very funny. I am not sure that either Her Majesty or the Prime Minister wanted to create that impression. I asked my mum why she found it funny, and she described how Black Rod had got stuck halfway down and been held up by the Speaker.

There has been a debate today about whether the Queen’s Speech was too narrow. The right hon. Member for Rother Valley (Mr Barron) criticised Conservative Members for talking more about what was not in the speech, but the general public do not think in terms of Bills and Acts; they think in themes, as my hon. Friend the Member for Blackpool North and Cleveleys said. One theme of today’s debate has been immigration seen through the prism of the NHS, although the general public probably also look at it through other prisms, including housing and Europe. Looking at the Queen’s Speech in a thematic way is perhaps slightly more useful.

I am tempted to make some comments on Europe. It is constructive that we should vote on the matter. If the coalition is to survive, it will need to be more comfortable about having open debates rather than simply private ones. We will need to have more open debates, rather than fewer, if the coalition is to be healthy all the way through to 2015. It is a strength of democracy to have open debate rather than narrowly commit ourselves to certain lines.

On immigration, the right hon. Member for Rother Valley talked about the use of extremist language. Actually, far from its use being negative in this context, the use of immoderate language can sometimes be essential if we are to have an open discussion. Otherwise, the debate gets overtaken by the Daily Mail and the Daily Express. We should have a full and frank debate on immigration, and on other issues.

When we consider health—the main focus of today’s debate—I think politicians are sometimes too scared to ask questions about a merger or a closure, for example, and to query whether those are the right things to do. We should be more open minded. The hon. Member for Barrow and Furness (John Woodcock) said that more local people should be involved in the process. I am sure he is right, but I am not sure that that is a totally new thing, as the Minister intervened to say in the latter part of his speech. I was certainly very close to the position the hon. Gentleman stated. I am not sure which of us should worry more about that, but it is a statement of fact about how I felt.

The commitment to spending 0.7% of gross national income on international aid was not in the Queen’s Speech. That is a totally arbitrary figure, but it is a promise that all the main political parties made and one that I fully support. To be frank, I cannot get het up about whether or not the commitment is built into a piece of legislation. If my family was starving in Ethiopia, or in the northern badlands as Bob Geldof would describe them, I would not care whether the money was coming because it had been mandated or because it had been promised. It makes little difference. I certainly congratulate the Government on actually spending that money, which is far and away the most important thing.

Let me deal with the deregulation Bill—legislation announced in the Queen’s Speech to reduce the body of existing legislation. I feel that an awful lot more can be done. The Bill has not been published, but I think that the Government have been too modest in their ambitions when it comes to deregulation. The Better Regulation Task Force is producing some really strong ideas.

[John Woodcock]

I am fascinated by what the hon. Gentleman is saying. Perhaps he was about to mention this, but what does he want to deregulate?

[James Duddridge]

At the moment, we have piecemeal deregulation, whereby we look at specific issues and then deregulate. I was elected as chair of the Regulatory Reform Committee, which as a body deals with pieces of legislative reform that the Government think can be fast-tracked for regulation or deregulation in order to avoid burdensome regulation. That is very much a piecemeal process—we looked, for example, at veterinary legislation—but it would be much better to have a big thematic review of issues surrounding care homes, for example. Rather than look at health and safety, the medical issues or equipment separately, it would be better to have a thematic review, cutting across Departments in the same way this debate cuts across the division between the health service and social services, local councils and different funding streams. I think it is our responsibility to do that here in the House of Commons.

The deregulation Bill will be good and tidy up bits of the statute book, but I would like to see a lot more detail about how that is going to happen. A Joint Committee will be set up between the Lords and the Commons, and I would very much like to serve on it, but as much as possible we should open out the number of Bills that we are looking at. Setting aside the issue of whether we should be in or out of Europe, the increase in European legislation demands that we face up to a two-for-one deregulatory challenge, just to stay standing. We need to go further.

The economy is another key theme in the Queen’s Speech. Given our current economic position, if we had had a Conservative Government from the outset, I believe such a Government would have tested every single Bill by asking, “Will this Bill help the economy? If not, it is marginal, and we should push it to one side—certainly when it comes to parliamentary time and impact.” I think that the Budget is much more important. When we highlight the themes in the Queen’s Speech, we should not judge ourselves by the amount of paperwork we sign off. The Budget is, in many ways, more important. Corporation tax, the national insurance deal and so forth will get Britain booming. I have seen it in my local area, where, for example, Southend airport has boomed, generating over 500 jobs in the few years that it has been motoring in a serious way, as opposed to when it was a rather hobbyist airport. There is much still to be done, but we should not judge ourselves by the volume of legislation. In fact, through the deregulation Bill, we should be able to reduce that volume.

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[Sarah Champion (Rotherham) (Lab)]

I would like focus on two groups of people who are not adequately covered in the Care Bill: young carers and the disabled.

I recently had the pleasure of spending time with a remarkable group of Rotherham young carers who are supported by Barnardo’s. Because of funding limitations, Barnardo’s is able only to work with young people between the ages of eight and 18, and only 100 in a year. Sadly and shockingly, Barnardo’s estimates that 3,000 young people are carers in Rotherham alone. It has on its waiting list children as young as six who are counting down the days until their eighth birthday when they can get some support.

The young carers asked me to make colleagues aware of their plight. Hannah told me that the main thing she wanted was recognition for the work she did. She understands her mum, who suffers from severe depression, better than anyone. Hannah wants her experience to be fed into her mum’s assessments. As she said,

“they trust me to look after her but they don’t trust my opinions.”

When Hannah calls the medics to say that her mum is deteriorating, she should be taken seriously. Instead, young carers have to contact their Barnardo’s worker to lobby on their behalf, because they are not recognised by the authorities.

I welcomed many of the measures in the draft Care and Support Bill, but they are limited to adults caring for adults. The Care Bill represents a missed opportunity to improve the rights of all carers, including adults caring for children and young carers. The young carers I met know that, because of them, their parents do not have to stay in hospital, a mental institution or a care home. They know how much their help saves the Government. On their behalf, I urge the Minister to make sure that the Care Bill gives young carers a little support in exchange.

Consolidating provisions relating to adult carers in previous Bills will create neat, codified legislation, with

“clear legal entitlements to care and support”

for adults, while young people will be left with piecemeal, leftover legislation that practitioners will struggle to navigate. This is highly problematic. As I have said, workers often need to act as advocates for young carers and protect their rights. This area has long faced the challenge of a confusing legal framework, and the Bill has the potential to make matters worse. It appears to provide a clear picture of carers’ rights, while in effect excluding some of the most vulnerable carers.

I recognise that the bulk of the changes needed to protect young carers need to be made in the Children and Families Bill, but changes could also be made in the Care Bill. In order to prevent inappropriate caring, it is important that measures are put in place to ensure that adults’ needs are met and that young people with potential caring roles are identified as part of an adult’s assessment. Not only would that recognise the important role that young carers play, but it would allow their needs to be acknowledged formally, forcing existing services to be more accommodating. For example, all of the young carers I met faced challenges at school, with inflexibility on late homework, missing school and the need to call home during the day. If young carers are formally recognised as part of the assessment process, that could be fed through to the school and teachers could be notified of the young person’s needs, allowing them to be better supported.

On the Bill’s implications for those with disabilities, my office has seen a marked increase in the number of cases of disabled people struggling to make ends meet. The introduction of the employment and support allowance has been confused and poorly administered. I have dealt with numerous cases of vulnerable people being placed in unnecessarily stressful situations and left financially worse off by this Government’s reforms. Such cases already make up 10% of my overall case load. The abolition of incapacity benefit will soon be followed by the abolition of the disability living allowance and the introduction of personal independence payments, meaning that disabled people are being squeezed at an unsustainable level.

[John Woodcock]

My hon. Friend is making an important speech. Does she share the concern of my local disability association that the problems with the ESA benefit and how it has been reassessed have led to grave worries about the introduction of personal independence payments?

[Sarah Champion]

I thank my hon. Friend for yet another example of the extreme stress that people are being put under and the mismanagement of this entire process. The pressure of the burden being placed on them is intolerable.

I am extremely concerned that the Government’s Care Bill will put further pressure on that vulnerable group. The key issue for social care reform is eligibility. A third of social care users are working-age disabled people. The Bill will not improve the social care system for them, and 105,000 disabled will be shut out from receiving the social care that enables them to live their lives.

My hon. Friend the Member for Easington (Grahame M. Morris) mentioned statistics from Scope that make depressing reading. Four in 10 disabled people who receive social care support say that it does not meet their basic needs, including eating, washing, dressing and just getting out of the house. A third of working-age disabled people say that cuts to their social care have prevented them from working or volunteering.

The Bill appears to focus on the elderly and does not address the care crisis facing disabled people. For those working-age disabled people who do not meet the eligibility threshold, the £72,000 cap on care costs will not apply. They will continue to need to meet the cost of their social care. If an individual’s care needs increase later in their working life to the point that they become eligible for social care, the cap will not take into account the contributions they have already made to meet their care needs.

I agree that the introduction of a national eligibility threshold is a step in the right direction. Alongside a new assessment system, I hope that it will end the postcode lottery in care provision. However, it is vital that the threshold is set at a level that ensures that working-age disabled people receive support to meet their basic needs.

The Government spend £14.5 billion a year, or 2% of public expenditure, on adult social care, which includes older people’s services. However, it was estimated by the Dilnot commission that social care services are under-resourced by £2 billion. Those services are being further squeezed by the pressure of an ageing population and a 33% reduction in local council budgets. Local authorities are therefore dramatically under-resourced for the demands that are placed on them. As a consequence, they have been raising the threshold at which disabled people become eligible for support. Recent surveys suggest that almost half of local authorities plan to reduce spending on care services for adults, which will hit those with learning difficulties and those with disabilities.

Unless there is sustainable funding for adult social care, the situation is likely to get worse. The upcoming spending review must be used to secure more long-term funding for social care services to underpin the Care Bill. The Government must not lose sight of disabled people and young people as the Bill progresses.