National Health Service

Baroness Keeley Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

The hon. Gentleman was not listening. The social care transfer comes in for the years 2011-12 to 2014-15, but I was talking about the year 2010-11 and, in the year ended, there was a real-terms cut to the NHS, as confirmed by Treasury figures. This debate is about that fact. He and his hon. Friends stood at the election, with those airbrushed posters all around them, promising that they would not cut the NHS, but in their first year in office, they delivered a real-terms cut to the NHS.

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

Is it not the case that, whatever Government Members say, 82% of councils offer social care only in critical and substantial cases, that thousands of people up and down the country are suffering the loss of their services, and that that will have a real hit on the NHS in years to come?

[Andy Burnham]

My hon. Friend makes a very important point. That was precisely why I said it was irresponsible for the Conservatives to promise increases to the NHS in the way that they did, on a much-reduced public spending envelope. That has led to precisely the consequences that she describes. Indeed, that hidden cut to adult social care has been quantified at £2 billion.

I remember well Conservative party claims before the election about death taxes, but what about the dementia taxes that the Conservatives have loaded on to vulnerable older people up and down this country, who are now paying more out of their own pockets to pay for the care that they desperately need? That is the effect of cutting adult social care and cutting council budgets in that way.

We today the nail the position once and for all. The real position is worse than the one I described because of spiralling inflation, which in effect means even deeper real-terms cuts for the NHS this year and in all the years that follow.

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[Paul Farrelly]

rose—

[Barbara Keeley]

rose—

[Mr Lansley]

In this motion, there is nothing to recognise the contribution from NHS staff; it just denigrates them. It says nothing about people who rely on the NHS to care for them.

[Joan Ruddock]

rose—

[Barbara Keeley]

rose—

[Mr Lansley]

Next, the motion fails to offer any—[Interruption.]

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[Mr Lansley]

I will not delay the House at length with further explanation of what I wrote in my letter, as the hon. Gentleman quite properly raised the matter with me at topical questions. It is our intention to move to more consistent commissioning of primary care across the country through the NHS Commissioning Board, but the driver for that is still local decisions about what GP services should be available in an area and which practices are involved. The hon. Gentleman knows from my letter that this is the view of the local primary care trust. In future, it will be for the health and wellbeing boards, not least the clinical commissioning groups, to look at whether primary medical services can be provided with or without the sort of facilities that the hon. Gentleman mentioned.

[Barbara Keeley]

The Secretary of State asked for some examples of the impact on constituencies; I can give him two. First, the savings being forced on Salford PCT have led to the shutting of the NHS walk-in centre in one of our most deprived wards, which was serving 2,000 patients a month. Secondly, there is the serious issue of the closedown of active case management for long-term conditions. Patient services in Salford are being downgraded as a result of the savings and cuts that have to be made.

[Mr Lansley]

The hon. Lady will forgive me for not commenting in detail on that. If my memory serves, that has been the subject of a referral by the local authority to me, which I have sent to the independent reconfiguration panel for initial advice. It would be unhelpful and improper for me to prejudice that.

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[Chris Skidmore (Kingswood) (Con)]

It is remarkable that we are having this debate today. As the Secretary of State has said, the Opposition’s motion is a remarkable own goal, especially as it has been confirmed that the Government will be increasing funds in real terms by 0.4% over the course of this Parliament. The shadow Secretary of State is shaking his head, but that will mean an extra £12.5 billion, which he has opposed today. It also remarkable that we have had confirmation from him of his comments in The Guardian on 16 June 2010, when he stated:

“It is irresponsible to increase NHS spending in real terms within the overall financial envelope”.

He agreed with that and I am delighted that he has put that on the record now that he has a second bite of the cherry, as the shadow Secretary of State for Health. He had an opportunity to make amends, and I thought he would, but unfortunately he has not. He also stated in the New Statesman on 22 July 2010:

“They’re not ring-fencing it. They’re increasing it.”

He was talking about the NHS budget and the fact that the Government were increasing it.

We have heard from the Secretary of State today that if there is an underspend, it has come entirely from the central departmental budgets. What is wrong with that? Does the shadow Secretary of State disagree that we might have cut down on costs such as the £115,759 he spent on a personal chauffeur during his time as Secretary of State? Does he oppose an underspend, given that during his time at the Department it spent £3.65 million on almost 26,000 first-class rail tickets? We have slashed that cost by more than 70%. Does he deny that he and the Department spent £1.7 million on luxury hotels during his time there? What is wrong with cutting such spending? What is wrong with the fact that Ministers are no longer using hotels such as the Hotel President Wilson in Geneva as they did in 2008 when the bill was £548.87 a night? If we are making those cuts to the central budget, I quite welcome our doing so.

[Barbara Keeley]

I wonder that the hon. Gentleman is not more worried about issues such as those I raised earlier. The real cuts being experienced in my constituency are in NHS walk-in centres and in the active management of long-term conditions. That is a real downgrading of patient care. I am surprised that he is bringing up these expenses; I think he should focus on what is happening in the NHS.

[Chris Skidmore]

I entirely agree that we need to integrate better social care in the NHS, and part of the reason why we have £2 billion going into social care is to tackle that problem. It is interesting that the hon. Lady does not deny that those spends have happened and that she does not apologise for the fact that the previous Government made those spends. Personally, I think they are a disgrace. Obviously, Opposition Members do not have a problem with spending £600 on a hotel in Switzerland, but I do. I say to the shadow Secretary of State, “Don’t build a greenhouse and then throw stones out of it.” Let us remember that it was the Labour party that gave us an NHS IT system at a cost of £12.7 billion—450% more than the original cost. It was the Labour party that gave us private finance initiative deals that were so badly drafted that they were worth £11.4 billion but cost £65 billion to pay off. What did the shadow Secretary of State say when he was the Secretary of State?

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[Rosie Cooper]

I fell for that last time and did not get to the end of what I had to say.

I will not go on about the rest of the problems that I see with the Bill—the financial challenge, the fact that we are open to European competition regulation, or the fact that the chair of the NHS Commissioning Board believes the Bill is unintelligible. I believe the Bill has been driven forward as an ideological exercise, rather than by an ideological desire to improve the quality of health care available.

[Barbara Keeley]

Will my hon. Friend give way?

[Rosie Cooper]

Forgive me; I need to get to the end of my speech.

My right hon. Friend the Member for Leigh dealt with the finances and the myth of real-terms growth in the NHS budget. My local trust is being asked to go beyond the 4% savings compounded over the next four years and will be expected to achieve 6% or £8.5 million in this financial year. On top of that, Monitor expects trusts to make a 1% profit. People who have given evidence to the Select Committee have said it is clear that there will need to be hospital closures in order to release money back into the wider health service. We are told that this is all part of managing demand and redesigning pathways—two horrible phrases that appear to be back in vogue.

I want to deal quickly with the re-banding of nurses to reduce budgets, which the Health Secretary appears to have little understanding of. I am sorry he is no longer in his place. He clearly told the Health Committee that he was unaware that re-banding was taking place. His problem is that Janet Davies from the Royal College of Nursing told the Committee that, although the RCN does not release conversations, that issue was clearly discussed. I really worry about that. Does he have a twin he is sending into meetings on his behalf? Does he simply not listen? It would not be the first time. Or is the truth even worse, and should he be described in terms that Mr Speaker would call unparliamentary? The Secretary of State said earlier that he stood by his answers to the Committee. He has also claimed that he did not receive a letter from me, but I can confirm that he received it at 11.57 on 13 October, and I have confirmation from his office.

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[Dr Poulter]

I thank my hon. Friend for clarifying an earlier point.

I will not engage in mud-slinging, but will talk about what hon. Members on both sides of the House want to emerge from the NHS. The right hon. Member for Leigh (Andy Burnham) was absolutely right that some service reconfiguration is necessary to deliver services in communities, improve community care and build an integrated health service with integrated health care. The right hon. Gentleman spoke specifically about an integrated system and better integrating adult social care, especially for the elderly, with current NHS providers, breaking down some of the silos between primary care, the hospital sector, and adult social services.

[Barbara Keeley]

Was the hon. Gentleman as concerned as I was at the Select Committee on Health on Tuesday when I asked Richard Humphries of the King’s Fund how the Health and Social Care Bill will impact on integrated commissioning? Richard Humphries said that there is a danger to integration because people are leaving PCTs, working relationships are being disrupted and broken up, and partnerships are being disrupted. As my right hon. Friend the Member for Leigh (Andy Burnham) said, we face years of disruption. That is the danger. Progress on the integration agenda was slow, but it is chaotic now.

[Dr Poulter]

I thank the hon. Lady for her intervention. Any period of transition will be difficult, and must be managed. Will the mechanisms and bodies that the Health and Social Care Bill will put in place be better able to deliver community-focused, integrated care than the existing system? I want to consider two matters that we will come to later: health and wellbeing boards, and basing commissioning fundamentally in the community. Both are good mechanisms for delivering better integrated care, and I will return to that.

We have too many silos in the NHS. The primary care sector often does not integrate with the secondary care sector as well as we would like. For example, hospitals are paid by results, but they have no financial incentive to ensure that they prevent inappropriate hospital admissions. We talk about better looking after the frail elderly and about ensuring that we prevent people with mental health problems from reaching crisis point and having to be admitted, but there are no financial incentives and drivers in the system to ensure that that is achieved to the extent we would like. A and E admissions in many hospitals are rising year on year—in rural areas that is partly because we do not have an adequate out-of-hours GP service—and far too often the frail elderly are not properly supported in the community.

If we put the majority of commissioning into the community with local commissioning boards, that will provide a more integrated and joined-up approach to local commissioning, which will undoubtedly help to prevent inappropriate admissions. We no longer want an NHS in which people with mental health problems or the elderly present in crisis because they have not been supported in the community. That must be the focus of care, and the focus of delivery of services.

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[Debbie Abrahams]

I am not going to give way—I am sorry.

In this year’s Budget, the Office for Budget Responsibility’s higher inflation forecast meant that NHS spending is now falling in real terms. House of Commons Library calculations show that it will fall by about 1% in real terms over the next four years—a loss in spending power of more than £1 billion by 2015. In the light of the recent inflation figures—[Interruption.] To help hon. Members out, last year’s figure was 5.6% based on the retail prices index. As inflation is at a three-year high, the loss in spending power is likely to be even greater. To keep his election promise, the Prime Minister would have to spend at least £1 billion more than he is doing.

This month’s King’s Fund report on NHS performance shows the effects of these financial pressures on the NHS, with the majority of finance directors saying that they are very or fairly pessimistic about the financial future of their local health economy. The Health and Social Care Bill, which is being debated in the other place, very conveniently sets out ways to help struggling foundation trusts. First, they can borrow money from the City to invest. Secondly, because foundation trusts will have to repay the money they have borrowed by treating more NHS patients and more private patients, they have been helped by the abolition of the cap on private patients’ income. However, as my right hon. Friend the Member for Leigh said, by raising income in this way they become economic enterprises and open themselves up to part B of EU competition law, so that they have to compete for every tender with private sector companies such as Capita, United Health, and so on. Incidentally, seven trusts, including in the Secretary of State’s constituency, have already said that they will be increasing the private bed cap. There is a private hospital in the Cambridgeshire University hospitals foundation trust area. Finally, when—not if—a foundation trust still ends up in financial meltdown, the Bill’s new failure regime means that they will be able to sell off NHS publicly owned assets to private equity companies. There are direct parallels with Southern Cross.

The impact of that is already being felt in patient care. In addition to what is said by constituents attending my and many of my hon. Friends’ surgeries, the King’s Fund report showed that the proportion of patients waiting more than 18 weeks for treatment has increased nationally. Over a quarter of NHS trusts admitted fewer than 90% of their patients within 18 weeks. In my constituency, Pennine acute hospitals trust is able to treat only 70% of patients within its 18-week targets. That is more than double the number of trusts failing to meet the 18-week target in 2010.

I am afraid, however, that an increase in waiting lists is what the Government want; it is one of the intended consequences of the Bill. This increase in demand is feeding the growing private health care and insurance market. We know from the US that as people on low incomes will be less likely to be able to afford these products, there will be a direct impact on the inequalities that the Secretary of State says that he wants to reduce.

[Barbara Keeley]

My hon. Friend is concerned about health inequalities. Is she as worried as I am about changing the weighting of health inequalities in allocations of funding? In Salford, our experience is that that can push GP practices in deprived areas into the red in their indicative budgets, so they will be cutting down referrals and reconsidering treatments—another way of denigrating and cutting the benefits of services to patients.

[Debbie Abrahams]

My hon. Friend is absolutely right. I will come to that in a minute.

In fact, that is broken promise No. 2. Last week in Health questions, I asked the Secretary of State why, in December last year, he made a political decision, against the advice of the Advisory Committee on Resource Allocation to maintain the health inequalities component of PCTs’ funding allocation at 15%, and instead reduced it to 10%. He replied that he had made no decision against the advice of that Committee. However, it is quite clear from last September’s letter to him from the chair of the Committee that that is exactly what he did:

“I would like to draw your attention to ACRA’s position in relation to the health inequalities adjustment. We recommend that the current form of the adjustment is retained”.

The

“current form of the adjustment”

was 15%, and the Secretary of State made a political decision to reduce that. He should be apologising to the House for misleading us in his response to my question. The effect of that reduction is to shift funding from poor health areas to good health areas. The Secretary of State owes an apology to the people in those areas, as well.

I turn to broken promise No. 3. Although the move of public health to local authorities is welcome in principle, the timing could not be worse. Already, we are seeing plans that jeopardise the public health function as they move into local authorities besieged with cuts. As Labour has consistently argued, our health and social care system needs to balance the treatment and care of people who are poorly with creating supportive environments that enable all our citizens to live as healthily as possible for as long as possible—focusing upstream on stopping people falling in rather than on pulling them out further downstream, to use a familiar metaphor. That is absolutely key, but unfortunately the current approach means that it is not going to happen. For example, public health budgets, said to be ring-fenced, are not being ring-fenced. The shadow budgets that were being provided to public health departments for 2012 were supposed to increase from 3.7% to just over 4%, but further analysis showed that that increase was due to merging the public health and drug action team budgets, and not to any new moneys. There was, in effect, no real increase in public health funding.

I anticipate a future broken promise in relation to what the Secretary of State has said about privatisation: I think it will be a case of “Watch this space.”

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[Stephen Pound]

May I thank the hon. Gentleman? I do not know how anyone persuaded him to bowl me that patsy ball that I can immediately crack to the boundary. He is absolutely right. Dr Hill, the radio doctor, opposed the national health service. Aneurin Bevan said that he had had to

“stuff their mouths with gold”.

Of course the producer interest opposed the beginning of the national health service because it was about the consumers—that was its major difference. Of course the vested interests opposed the creation of the national health service—that is no surprise. But that was then.

The national health service was born in compromise. I was born in July 1948, as was the NHS. For many years I was suspected to have been the first child ever born on the NHS, in Queen Charlotte’s hospital, but somebody in Salford beat me to it.

[Barbara Keeley]

Trafford.

[Stephen Pound]

Trafford. I beg your pardon. However, the year before I was born, my parents had a son who died at the age of seven months. The year before that, they had another son who died at the age of eight months. I was born on 5 July 1948, two days after the health service, and I have my five brothers and sisters alive to this day. It is that important.

When I worked as a porter for 10 years at the Middlesex hospital, where my sister and wife were nurses and one of my brothers was an ambulance driver—half the family seemed to be employed there—we realised the consequences of the pragmatic approach to the health service. We had a private patients wing where people like myself, paid by the national health service, did work for people who paid money to a difference source, and where doctors trained under the NHS got personal recompense. One of the single most important aspects of our lives has been political from day one.

Each of the Health Ministers will remember, as I do, that we have sat in the same House as an hon. Member who lost his seat over a hospital closure. Let us never forget Wyre Forest and Kidderminster hospital. It is almost impossible to be objective about this issue. When the Turnberg report was published, it proposed an entirely sensible reconfiguration of London’s acute general hospitals, but it was opposed by almost everyone because of parochial and local issues. When polyclinics were proposed under the previous Government—one of the most logical, sensible, rational and helpful ways of providing primary health care—they were violently opposed by the Conservative party.

The situation now is that there is no consensus. However, I have not often seen anything quite so consensual, positive and forward-looking as the reference in today’s motion to an offer made by the Leader of the Opposition and the shadow Health Secretary of

“cross-party talks on reforming NHS commissioning.”

What could be better for the country, and for the reputation of this House, than our recognising that the NHS is not a political football or an issue on which we can strike postures? Yes, there are ideological differences between us, and Opposition Members may wish to see a greater infusion of finance-led choice, more and more commercialisation and an end to the Whitley system, which has survived for so many years. They may wish to see local pay bargaining setting hospital against hospital, clinic against clinic and clinician against clinician, with a constant stream of industrial disputes as localised pay bargaining bursts out all over the place in some industrial conflagration that attracts even more attention. At the moment we have one of the lowest numbers of hospital managers anywhere in Europe, and we will inevitably have to spend more and more on a greater and greater number of managers to deal with all that localised bargaining.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

As my right hon. Friend the Secretary of State said earlier, the Health and Social Care Bill proposes the introduction of the first ever legal duty for the Secretary of State to have regard to the reduction of health inequalities. That covers both NHS and public health functions. We are also addressing the health needs of some of the most vulnerable people through the “Inclusion Health” programme.

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

My right hon. Friend the Leader of the Opposition and the officers of 12 all-party groups associated with care have urged the Government to commit themselves to the urgent reform recommended by Dilnot. Will the Minister update the House on the Government’s response to the Dilnot recommendations, and tell us when the cross-party talks will begin?

[Paul Burstow]

I know that the hon. Lady follows these issues closely. In September we published a plan for consultation on the proposals, which includes looking beyond the Dilnot commission’s recommendations at issues of quality, regulation, and many other aspects of how we can secure a comprehensive reform of social care. Today my right hon. Friend the Secretary of State wrote to Opposition Front Benchers with the aim of resuming the discussions across parties to ensure that we get the conversation going with the new Opposition Front-Bench team as soon as possible.

Health and Social Care (Re-committed) Bill

Baroness Keeley Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Dorrell]

My understanding is that the Government have clarified that foundation trust board meetings should be held in public and that, in future, it will be a requirement of licensing by Monitor. On the much broader point, I absolutely agree—the hon. Lady, who is another member of the Select Committee, knows that I agree—that providers of care to NHS patients, whether public or private, ought to have an obligation to provide information on the outcomes that they achieve and certainly on any complaints and other processes initiated by patients about the care they receive. That was one of the strong recommendations that the Select Committee made following its work on complaints. I think that that obligation ought to rest on all providers of care to NHS patients, whether they are foundation trusts or any other form of provider.

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

Will the right hon. Gentleman provide some clarification? I think that he said “should” and not “must”. For other functions, particularly relating to local government, the Government seem to be into dropping standards and codes of conduct—that is certainly the case in local councils—but surely trusts “must” have meetings in public, not “should”.

[Mr Dorrell]

Ministers can correct me, but my understanding is that, under the obligation being introduced, they “must” meet in public. I have no authority to speak for the Government, but I believe that that is what the Government intend. For myself, as a patient of a trust or other NHS provider, whether in the public or private sector, my interest lies in ensuring that the information about my—

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[Frank Dobson]

If the hon. Gentleman—and, for that matter, the Secretary of State and the Chair of the Health Select Committee—had ever listened to what I say, they would know that I think that we need change. We need organic change, however, rather than structural change, because structural change generally costs more than it provides. If the hon. Gentleman thinks that introducing a system in which virtually every transaction will be a legally binding document, with herds of lawyers grasping their share of proceedings, will reduce the amount spent on administration, he obviously believes in Father Christmas and various other mythical figures.

[Barbara Keeley]

Before we get into any more claims of more being spent, I want to touch on two examples of cuts, caused by the cuts and efficiency savings, which I raised with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow). The most deprived ward in my constituency is losing its NHS walk-in centre and all the people with long-term conditions are losing active case management. I raised those two cuts made by Salford PCT with the Minister in an Adjournment debate, to which I have received no answer. There is no answer. People in the most deprived wards with the greatest health inequalities are suffering from these cuts. I will not hear any more about more investment being made, because all I see as a constituency MP is less investment.

[Frank Dobson]

I agree entirely with my hon. Friend. A further point is that I doubt whether there is a single constituency anywhere in the United Kingdom of Great Britain and Northern Ireland that has seen more change in health provision than mine. There are not many places where a virtually trouble-free amalgamation of two major and famous teaching hospitals into one has taken place successfully. There are not very many places that have seen more small GP practices getting together in one location and improving their performance. Those things have always been done with my strong support, even when on some occasions, at least at the outset, the ideas were not popular with some local people. Therefore, I do not accept that I do not believe in change. I believe in sensible change, not stupid change, but stupid change is what we seem to be getting.

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[Frank Dobson]

I entirely agree with my hon. Friend. I think that nowadays those who call themselves members of the Conservative party only purport to be Conservatives. The basic Conservative approach in this world is, broadly speaking, not to make great changes without being absolutely certain that substantial benefits will result from them. A proper Conservative recognises the problems that arise during the process of change, and the unpredictability of things in human life. What we have now, certainly in relation in health and possibly in other spheres, is a Government who are going ahead with something which—good God!—cannot be regarded as well thought out, given that they have tabled 1,000 amendments on Report.

[Barbara Keeley]

I winder whether my right hon. Friend heard the Leader of the House say to the Hansard Society that

“it has simply become too easy for the Government to sideline Parliament; to push Bills through without adequate scrutiny; and to see the House more as a rubber-stamp than a proper check on executive authority.”

He also said that, in the Government’s view,

“a strong Parliament leads to a better Government.”

Does my right hon. Friend believe that the Bill, and the very shortened debate on its recommittal, constitute a good illustration of that?

[Frank Dobson]

In fairness, I think that given the accuracy of the present Government’s aim, if they tried to rubber-stamp something they would probably miss.

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[Grahame M. Morris]

We had this exchange many times in the Committee on a variety of clauses. We need to give some credit to the previous Government. I am old enough to remember when people routinely waited a year, 18 months or longer for life-changing operations such as knee and hip replacements. It is a real quality-of-life issue if someone has cataracts and has to wait a long time for an operation. I accept that Labour used the private sector. I am a socialist and make no apology for that, and I want the provision to be public sector. I was not a Member of Parliament and did not vote for the commissioning of private providers, but I acknowledge that the private sector played a role in bringing extra capacity and some innovation to the service.

[Barbara Keeley]

My hon. Friend is making a wonderful speech. I wanted to make this point when my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was speaking about the number of operations and the improvements during Labour’s term of office.

In the 1997 general election when I was campaigning in Wythenshawe and Sale, East constituency, I met someone who had been told that he had to wait two years for vital surgery and was desperately worried that he would die while he was waiting. I met someone in my constituency in last year’s general election campaign who received a diagnostic test on Monday, found he had cancer on Tuesday, went into hospital on Wednesday and was operated on on Thursday and his life was saved. From two years to four days—I thought that was the best testament to the improvement that Labour had brought about in the NHS.

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[Mark Simmonds]

I give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

[Barbara Keeley]

The speech of my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) is one of the best I have heard in the Chamber, as I think Opposition Members would agree. People outside the Chamber are saying that too.

On repetitiveness in the points that are being made, Report stage allows Members who did not serve on the Committee to say the things that they want to say. It is our chance right across the House to comment on the Bill, so that is not a valid criticism of what is going on in the debate.

[Mark Simmonds]

I hope the hon. Member for Easington has a better intervention to make.

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[Barbara Keeley]

I think that a few Labour Members are quite surprised by what the hon. Gentleman has said, and the Hansard writers might ask him where it came from. He cannot get away with making a statement like that and not saying where it came from—he should be quoting it. He is saying that the majority of people working in the NHS surveyed in 2009 did not put patient care at the top of the list, and he should quote where that information comes from.

[Dr Poulter]

The point is—I speak as a front-line doctor who still practises in the NHS—that far too often we see form-filling that gets in the way of our doing our job as doctors in hospitals, and that is not for the benefit of patients.

[Barbara Keeley]

Will the hon. Gentleman give way?

[Dr Poulter]

No, sit down. The hon. Lady should listen to this, because it is important. The point is that doctors and nurses need to be allowed to get on and do their jobs.

A key focus is not just about putting more money into front-line patient care but making sure that we have clinical leadership of services. Form-filling for the sake of it does not benefit patients; what benefits patients is allowing doctors to treat those in front of them. Under the perverse incentives that were created previously, the four-hour wait in A and E means that a patient with a broken toe is just as much of a priority as someone with potentially life-threatening chest pain. That is the problem with the service that we have, and that is why the clinical leadership and focus that this Bill is bringing will be so important.

Southern Cross Care Homes

Baroness Keeley Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

As I have made clear, given the current stage of the announcements on this solvent restructuring, we appear to be in a position where the scenario the hon. Gentleman asks about will not come to pass.

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

There are more than 300 residents in seven Southern Cross care homes in Salford, and their quality of life is our primary consideration. What assurance can the Minister give to those residents and their families that future providers will not play for short-term profit, but will truly consider their quality of life? Reassurances will not mean much if a new provider gets into the same business model and same way of carrying on as Southern Cross.

[Paul Burstow]

The hon. Lady is right. As we move forward and achieve a successful conclusion to this process, we must put in place the necessary measures to ensure that this cannot happen again. We must take a critical look at the regulatory environment in which this particular business model was allowed to grow—a business model that thrived during a boom, but that was predicated on the assumption that there would never again be a bust. There was a bust however, and that is why the company is in this mess.

Reform of Social Care

Baroness Keeley Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

My hon. Friend makes a fair point. It was clear that had we sought to publish a White Paper before Christmas, the net effect would have been that we did not give the public, stakeholders or the official Opposition the time needed to discuss the issue and to do the job properly .

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

It is clear that there are two issues: not just the future funding of social care but the current funding—the crisis referred to by my hon. Friend the Member for Birmingham, Erdington (Jack Dromey). Only 15% of councils are now meeting moderate need, but that figure used to be 50%. The Secretary of State cannot say that there is no crisis. It seems to me that building a future funding solution rests on not letting current provision deteriorate much further—but it is deteriorating rapidly. What, then, will Ministers do beyond the excellent cross-party work that probably will go forward to do something about the resources that are leaking away and the current crisis in provision?

[Mr Lansley]

I do not believe I did say that there was no crisis. The hon. Lady and the House must recognise, however, that last year the Dilnot commission, in an interim report, sought additional support specifically for social care and that we provided it through the local government grant and a transfer of resources from the NHS. She says that few authorities now provide social care for those with moderate needs, but that has been the product of years of change—it has been happening for many years. That creates a risk, but we are addressing that risk through the transfer of NHS resources and by helping people with lower levels of need through home adaptations, community equipment and reablement if they leave hospital, in order to make certain that we avoid the risk that we are running: of large numbers of people with moderate need falling rapidly into severe need.

Caring Responsibilities

Baroness Keeley Excerpts

Wednesday 15th June 2011 Westminster Hall

[Tony Baldry]

I am sorry, but I will not give way any more because these exchanges demonstrate why I need to read into the record for future debates the three paragraphs that I mentioned earlier. We would all love to have lots more money that we could spend, but alas that is not the case.

With regard to this particular debate, it seems to me that there is a lot more that can be done to help and support carers without necessarily spending a huge amount of extra money. The first thing that we ought to do, or at least we ought to make a much greater effort to do, is to identify which people are carers and to encourage carers to see themselves as carers. Local authorities provide considerable services for carers, but of course they can only provide those services if people identify themselves as carers.

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

Will the hon. Gentleman give way?

[Tony Baldry]

I will not give way, as I just want to make a little more progress.

I was quite interested in a note from Sainsbury’s. Sainsbury’s has been pursuing an initiative in Torbay to help to identify “hidden” carers. It was working with the Torbay Care Trust and it sought to identify customers in its supermarkets who might have caring responsibilities. Staff talked to customers and if it seemed that a customer might be a carer, they were asked if they were in fact a carer. If the customer said, “Yes”, they were then directed to a trained member of the Torbay Care Trust. In a very short period, that initiative led—in just one supermarket—to 140 new people signing up with the Torbay carers’ register.

Sainsbury’s is going to expand that initiative to other stores across the country. I suspect that huge numbers of people who act as carers do not know that that is what they are, for example, husbands and wives who look after loved ones, and young people who look after parents. We should be working as hard as possible to help people to recognise that they are carers. Considerable help and support are available for people who know they are carers. In carers week, one can see that a range of organisations have come together—

[Barbara Keeley]

Will the hon. Gentleman give way?

[Tony Baldry]

I will give way to the hon. Lady in a moment.

A range of organisations that provide advice and support have come together, including Age UK, Carers UK, Counsel and Care, Crossroads Care, Dementia UK, Macmillan Cancer Support, the Multiple Sclerosis Society, Parkinson’s UK and the Princess Royal Trust for Carers, but they obviously cannot give advice unless people actually recognise that they are carers.

[Barbara Keeley]

I agree that identifying and supporting carers is important. Will the hon. Gentleman therefore communicate to the Minister with responsibility for care services that he should support my Carers (Identification and Support) Bill, which the Government have indicated they would not support? The Bill would provide a basis for the proper identification of carers by NHS bodies, local authority bodies and schools. It is more appropriate that public bodies help to identify carers, rather than the task being left entirely to supermarkets such as Sainsbury’s.

[Tony Baldry]

I do not dissent from that, and in a second I will come on to the Law Commission’s report. It is important that we recognise carers, and if statutory bodies can help to identify them, that too is important.

We are fortunate this afternoon to have the Under-Secretary of State for Health present, and I wish to make a couple of points about carers and health. Often nowadays, when a person being cared for goes to see their GP or a specialist, the carer is treated as if they were invisible. The concept of patient confidentiality is being used as a mechanism for denying the person who is being cared for the support of their carer, whether it is children taking their aged parents to see the doctor, or a husband taking his wife or vice versa. Often, the carer is able to provide counsel and care for the person they are caring for, and they should not be seen by the GP or the health service as invisible. The NHS, GPs and the Royal College of General Practitioners need to work out a protocol for how the NHS deals with carers. There obviously have to be some balances concerning patient confidentiality, but it must be possible to work out how the NHS should deal with and respond to carers.

Carers are most concerned about the people they are caring for needing access to the NHS in the evenings and at weekends, when there are out-of-hours systems in place. The out-of-hours GP system was, as it happens, brought in by the previous Government, and it is of variable quality across the country. I think that the Minister will find that one of the growing pressures on the NHS is the number of people who self-refer to accident and emergency departments in the evenings and at weekends, because they can at least be confident of being seen, even if they do not need A and E treatment. They cannot be turned away at the door because the NHS has a duty of care when they turn up. It might be sensible to have primary care triage in A and E departments. We have a Darzi centre in Banbury, but I see no reason why one should not have primary care triage at the door of A and E so that people who do not require A and E services can be confident of accessing primary care without having to hang on on various helplines, or talk to distant voices in which they have no confidence. That would give much greater confidence to carers and to those for whom they were caring, and would significantly reduce the cost to the NHS of the significant number of inappropriate treatments and admission at weekends and in the evenings.

Another responsibility of the Department of Health are carers’ breaks, about which many carers are very concerned. One of the longest running campaigns of the all-party group on carers over the years has been on carers’ breaks. There are supposedly significant amounts of money in the system—some £400 million—for carers’ breaks but, as is the case with so much money, it is not ring-fenced. Some PCTs have been extremely good about that, but we will need to watch where the money goes, particularly as we transfer to GP commissioning. Can we develop systems of best practice? It is not just a question of talking about carers’ breaks; we also need to ensure that systems are in place.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Streeter—let us hope that we do not have too many more interruptions.

There cannot have been a more worrying time to have caring responsibilities, given the abuses at Winterbourne View; there must be a real worry that such things are happening in other care homes or hospitals. There are real worries about the future of Southern Cross, which is still very uncertain. There are also the issues that we are discussing, including the cuts to council budgets, which are resulting in the downgrading or loss of packages of care services. Carers have a range of worries and fears, some of which I want to cover, because these are serious problems for many families and it is right that we are debating them today. I congratulate my hon. Friend the Member for Edinburgh East (Sheila Gilmore) on securing the debate and on the excellent way in which she opened it.

It is 10 years since I started to meet carers in the course of research that I undertook for the Princess Royal Trust for Carers. In that work, I met many hundreds of carers, who opened my eyes to the issues with which they live day in, day out. Some time after I entered Parliament in 2005, I introduced the Carers (Identification and Support) Bill—not all Members were here when I said that I will send a copy to the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), and to the hon. Member for Banbury (Tony Baldry) because he seems to support the ideas behind it very much.

This year, the theme for carers week is, “The true face of carers”, and its aim is to highlight what life is like for carers and the challenges they face. New research for carers week shows that 80% of carers are now worried about the consequences of cuts to services. As has been mentioned, the survey of social service directors showed that adult social care services face cuts of £1 billion. The Minister has been asked this question, but I would like to emphasise the point: what assessment have the Government made of the impact on carers of the estimated £1 billion in cuts to social care services? I have some detail on impacts being felt in Greater Manchester.

Whatever we think about it, many councils are having to struggle with the Government’s swingeing front-loaded cuts, amounting to 27% over four years—that is the figure in the Budget. Many have found themselves having to cut grants to voluntary organisations, which is having an impact, and many are increasing or removing caps on care charges. As we have heard, the survey undertaken by my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) showed that 88% of the councils that responded were increasing charges for social care and 54% were cutting support to the voluntary sector. It is a double whammy—cuts in support and increases in charges.

Like everyone else, carers are hit by increases in the cost of living, which we must also take into account. Fuel costs and VAT affect them in the same way as they affect other people. Most carers are financially worse off than other people, because many have had to cut down on or give up work so that they can care.

For this debate, I asked local organisations in Greater Manchester to tell me exactly how cuts or fears about cuts are affecting carers. A staff member at the Bury, Salford and east Lancashire branch of Parkinson’s UK told me of her experience. She said that there had been a big increase

“in calls from people who are living on very tight budgets with no chance of increasing the family income due to disability and caring responsibilities, distressed because they can’t afford day to day living costs.”

The calls that she receives are about the knock-on effects of lack of money—stress, not eating well, relationship difficulties or breakdown, anxiety and depression. They can lead to illness worsening, and if a carer becomes ill and cannot cope, it can lead to hospital admission. She also said something that ties in with points made earlier in the debate:

“More people with Parkinson’s disease are being turned down for”—

allowances such as—

“disability living allowance and attendance allowance. There is no sense to who gets the benefit and who gets turned down…The distress this causes families is huge because they feel that they are begging. I can only imagine that families who don’t have support miss out completely. The benefit is meant to pay towards the extra costs of having a disability, the fact that genuine people are being turned down means that carers”—

would end up—

“having to do even more.”

My hon. Friend the Member for Edinburgh East raised carers’ eligibility for benefit, which I think is and will become the key issue due to the Government’s programme of cuts and the uncertainty. The Minister has already been asked the question, but will she tell us in this debate what the impact will be if those carers who lose their carer’s allowance decide that they can no longer afford to care? The responsibility for caring will then fall to the local council and the state.

[Jim Shannon (Strangford) (DUP)]

I do not think of my constituency as different from anyone else’s, so I am sure that the hon. Lady will agree that young carers clearly play an important role. Those who are 16 years old and under do not qualify for any financial assistance, but their role is critical for the family, parents and those they look after. Does she feel that the coalition Government should address the importance of young carers?

[Barbara Keeley]

I very much agree. I have a point to make later about that topic, because the staff who work on the young carers project in my constituency have said that they are very concerned about carers losing their education maintenance allowance. That is the one support that the state gave young carers and it is going, which is a worry.

To return to the testimony from Parkinson’s UK, the final points were about more carers contacting the staff member to ask for help finding respite because they are struggling to cope; financially, they cannot now afford a break, a treat or a holiday. I am glad that the hon. Member for Banbury raised that point. The staff member said:

“I know of one carer who has had to take on a part time cleaning job in the early evening because money is so tight. She puts her husband to bed before she leaves”—

for work—

“at 4pm so that he is safer and so she won’t worry that he will fall while she is out.”

I think that we would agree that we would rail at care agencies that put a person to bed at 6 or 8 o’clock, yet this carer has to put her husband to bed at 4 o’clock because that is the only way that she can do the cleaning job that she has to do.

I also had some input from a branch of Age Concern in Greater Manchester about how cuts to grants are affecting its dementia support service, which is important because it is another line of support. Cuts to grants of 40% over the next three years are affecting its capacity to deliver individual and group support. That goes against objectives 5 and 7 of the national dementia strategy. The staff member told me:

“Carer support groups have had to close. These are groups where carers can get a break, have a chat to other carers and get advice and information from staff. These groups help to maintain morale and prevent carers from becoming socially isolated.”

Even though there are personal budgets, which will come in in Greater Manchester, carers of people with dementia often find it hard to mix in other social groups because of the “different” behaviour of the person with dementia. Carers have described the groups as a “lifeline” and something “to look forward to”. The fact that they are being cut back is important.

The proactive support to carers of phoning them every few weeks is another aspect of Age Concern’s work that is being cut. The staff member said:

“We now have to wait for them to contact us for time-limited intervention. We know that many older people are proud and longsuffering and will often suffer in silence rather than ask for help.”

Before the cuts, branches of Age Concern in Greater Manchester ran special events for carers such as a carers day each year, parties and trips. The reduction in funding means that it can no longer offer the extras that it knows give people a better quality of life. I am very concerned to hear that carers in my area in Greater Manchester are starting to suffer.

I want to return to the two sides to the debate—values and choices. We are fortunate in Salford because, due to the way in which the cuts and the organisational turmoil in the NHS are being managed, we are not suffering as much as other areas. There are choices. Labour-run Salford city council is now one of only 15% of local councils still providing support to people with moderate care needs, as well as to those with substantial or critical needs. We are fortunate to have an excellent carers’ centre run by the Princess Royal Trust for Carers. Salford has tried to ensure that carers continue to be supported through these difficult times. As I mentioned earlier, however much the council and our local NHS bodies support carers and try to maintain what they are providing, the national changes and cuts affect our carers.

The young carers project will be affected when the young carers lose their education maintenance allowance. The centre manager told me of two other concerns: the changes to benefits and disabled people being called in to take work capability assessments. The extra worry of having to take them and of having benefits curtailed are starting to affect carers.

The centre manager also said that a major concern for her organisation was that although the carers’ centre was very well established, the service has to go out to tender through the joint commissioning process next year. She said:

“We are aware of a number of carers’ services which have gone out to tender in other areas, and bids have come in from organizations and agencies which have no experience, knowledge or expertise in carers and carer issues, including organizations from abroad.”

What reassurance can the Minister give to staff of the carers’ centre that an established, trusted and effective organisation such as theirs will not be undercut in the tendering process by organisations with no local knowledge and no experience or expertise with carers or in carers’ issues? Our carers in Salford would lose out if they lost the valuable support that they get from their carers’ centre.

The Government’s economic policies are damaging support to carers. Government cuts to local council budgets have gone too far, too fast. Councils pleaded not to have their budget cuts front-loaded. We have lost £1 billion from adult care services at a time of rising need, and we have lost billions in grants to the voluntary sector, but the worst thing is that we are only a few months into the first year of cuts, and we can already see the impact on carers. Carers are fearful about the cuts and distressed that they cannot manage financially. People with serious conditions such as Parkinson’s are being turned down for attendance allowance and made to feel like beggars if they appeal. Young carers are losing their education maintenance allowance. Carers are now unable to afford a break or holiday. It is shameful that a carer should have to take a part-time cleaning job and put her husband to bed at 4 pm.

That is not a record of which the coalition Government can be proud, and it is so early in this Parliament. I hope that carers week gives Ministers time to rethink the impact of the cuts that they are making.

[Mr Gary Streeter (in the Chair)]

Colleagues, three Members have sought to catch my eye, and we have 19 minutes before winding-up speeches begin, so can we regulate ourselves to about six or seven minutes each?

NHS Future Forum

Baroness Keeley Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. The Future Forum has made recommendations in relation to public health. One of them, which I announced today, is that we want to combine the direct integrated work on health protection and response to emergencies through Public Health England with continuing independence for expert advice, so I am proposing that Public Health England should be established as an executive agency. What is critical is that we create through the legislation a greater opportunity for local authorities to lead health improvement plans locally, so issues such as alcohol abuse and problem drinking will need not only national leadership, which we will give, but local leadership, which the Bill will empower.

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

Accountability is not at all clear. The Secretary of State said that clinical accountability will be in one place and democratic accountability in another. We are replacing one organisation—the PCT—with five. My constituents will just want to know where the accountability lies for important local NHS decisions. That has not become clear from the statement so far.

[Mr Lansley]

I repeat: from the public’s point of view, we know that what they wanted was genuine accountability, in the sense that the doctors, nurses and other health professionals who care for them should be able directly to design and influence the shape of services locally to meet their needs, but they also want a patient voice and a public voice. That has not existed in the past; we will enable it to happen. They will come together at the health and wellbeing board, where they will establish a strategy for their area.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 26th April 2011 Commons Chamber

The Secretary of State was asked—

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

1. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement.

[Mr John Leech (Manchester, Withington) (LD)]

14. What progress the NHS North West Specialised Commissioning Group has made in reviewing neuromuscular services in the region; and if he will make a statement.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I understand that the North West Specialist Commissioning Group received a report from its neuromuscular services review group at the end of March, and that it has since circulated it to all primary care trust chief executives with a request that it is shared with board members and GP commissioning consortia leads.

[Barbara Keeley]

The north-west has not seen the investment in extra services, such as transitional care and extra care advisers, that the report recommends, and now the Government’s proposed reforms are causing turmoil in specialised commissioning and real worries about how the commissioning of tertiary services will work in future, so will Health Ministers issue guidance to commissioners to ensure that the investment is made to cover those critical gaps in the north-west, and that emergency admissions are avoided?

[Anne Milton]

I thank the hon. Lady for her question, but I reject her assertion that the changes to the NHS—the modernisation of the NHS—have thrown the process into difficulty. Clearly, she feels that there is a problem in the first place. As I am sure she will agree, however, it will be down to the commissioning of the GP consortia and the primary care trusts to decide the best way to provide services in the light of all the information that they have. I understand that the commissioners will feed back to the specialised commissioning group on how they will deal with the recommendations.

NHS Reform

Baroness Keeley Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend. We will do that, not only formally across the country but in the informal manner that we do in the House. His point of view exactly illustrates the purpose of my statement. He served on the Committee that debated the Bill. Notwithstanding the good progress that the Bill has made and that we are making around the country, people have legitimate concerns and questions. They want to raise those and to know that we will listen and act on them.

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

Can the Secretary of State say more about the future of care trusts? Integration of health and social care is vital to all our constituents. With all the uncertainty, staff are being lost and more could be lost. During this natural break, what can the Secretary of State say to preserve the continuity of those people doing that vital work and the continuing support for care trusts?

[Mr Lansley]

I reiterate the point that I made a moment ago. There is nothing in what I have said today that should do other than give people on the ground confidence that they are building the improvement of services that they need for the future. At the heart of that is the integration of health and social care. We as a Government have made available in this new financial year £648 million through the NHS specifically to build that kind of integration between health and social care. It has been insufficient in the past; we are building it now. As the hon. Lady knows, the Bill allows care trusts to continue in formation, but it is also possible for care trusts to redesign around commissioning consortia on the one hand and health and well-being boards on the other.

Health

Baroness Keeley Excerpts

Tuesday 21st December 2010 Commons Chamber

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

I want to talk about support for the 6 million unpaid carers who provide social care to a family member or friend. More people are having to step in to provide high levels of care to family members. The 2001 census, about which we have heard so much today, found that 10% of all carers in the UK were caring for more than 50 hours per week, but figures published more recently by the NHS information centre show that that has now more than doubled to 22%. In Salford, the proportion has been much higher for some time: 24% of Salford carers cared for more than 50 hours per week in 2001, which was more than twice the national figure.

Carers are key partners in care for the NHS, but full-time care takes a toll on the carer’s own health, and their health needs should be recognised. Carers who care for more than 50 hours a week are twice as likely to suffer ill health as the general population, and those caring for a person suffering from dementia or stroke disease are also more at risk. Importantly, carers who do not receive a break from caring are much more likely to suffer mental health problems—that is, 36% of carers compared with 17% who do get a break.

The Government have announced £400 million of funding for carers’ breaks over four years, to be delivered through primary care trusts initially, but there are problems with this because the funding is not ring-fenced. The Labour Government allocated £150 million over three years to primary care trusts for carers’ breaks, but a survey by the Princess Royal Trust for Carers in 2009 found that less than a quarter of the first tranche of that funding had been used as intended to support carers. Given the financial pressures that are now facing primary care trusts, and their impending abolition in the NHS reorganisation, it is hard to see them doing a better job for carers now than they did last year when they did not have those pressures. There is great concern among carers and carers’ organisations about the impact of the NHS reorganisation and cuts to local authority budgets. Carers UK says that carers are worried that when commissioning is handed over to GPs they will lose services on which they rely. Many carers have negative experiences of dealing with GPs who do not have a good understanding of social care or of the specialist conditions that are giving rise to the care.

There is also much concern about cuts to social care that councils are making in response to the 27% cuts in their budgets over the next four years. The cuts are front-loaded, so together with the loss of area-based grants that were targeted at deprived areas, councils such as those in my area of Salford will have to make cuts of £40 million next year alone. The Government are putting £2 billion into councils’ social care budgets over four years, but that is only half of the £4 billion that the Association of Directors of Adult Social Services has estimated is needed to meet increasing levels of need. In addition, social care is one of the biggest areas of each council’s budget, yet the new money is not ring-fenced either, so councils are facing budget cuts of £5.6 billion over the same period. It is hard to imagine that social care will not be part of that.

We have already seen councils cutting funding to social care. Even before the comprehensive spending review, five councils with a “moderate” threshold were proposing to tighten their eligibility criteria to “substantial”. Birmingham council and the Isle of Wight have now proposed to raise their thresholds to meet critical needs only, and other councils are considering that. North Yorkshire county council plans to reduce its number of residential care homes by two thirds, and others are taking similar action. Councils are increasing their hourly rates for care and removing maximum weekly caps, which can mean charges doubling. For very many people, that will mean that the care is not available or they cannot afford it.

In Salford, we are very fortunate to have an excellent carers centre run by the Princess Royal Trust for Carers, with Dawn O’Rooke as the manager and Julia Ellis doing a fantastic job as the primary care project worker. Staff there are concerned about what they see as a marginalisation of carers support services owing to the twin changes of GP commissioning and council budget cuts. Salford carers centre has worked with GP practices to enable GPs to identify many carers and refer them on for advice and support. That identification and referral can make a significant difference for carers in their getting benefits, using personal budgets and getting checks on their own health. However, with GPs handling commissioning, there will be significant extra pressures of time. One reads day in, day out about GPs being very concerned about that. There is a real fear that GPs in Salford will no longer prioritise the development of support for carers.

Given our record in Salford, I hope that our GP consortiums and the city council will continue to support carers’ services so that the excellent work can continue. However, with GPs handling commissioning, there will be significant extra pressures, and it is hard to see councils and GP consortiums up and down the country prioritising carer support when they have so many other calls on their time and resources. Many people rely on unpaid carers, and more will have to do so over time. It is projected that that figure will reach 9 million in 25 years’ time. I therefore urge Health Ministers to put their support for carers high on their agenda and to keep it there throughout 2011.

It is an unusual experience for me to speak in this pre-recess Adjournment debate rather than answer it, which is what I used to do. I think that the Deputy Leader of the House has opted out a little bit by cutting his work load. However, I would like to wish everybody a very happy Christmas.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

I welcome all the contributions. We have had an excellent run-around of some hon. Members’ interests and specific issues relating to their constituencies.

I start with the hon. Member for Worsley and Eccles South (Barbara Keeley). As she rightly pointed out, the Government have recently announced that they will provide additional funding of £400 million to the NHS in the next four years to enable more carers to take breaks from their caring responsibilities. I commend her for her continued interest in the subject. I trained as a nurse and worked in the NHS for 25 years, and the question is now, as it always has been: who cares for the carers? The hon. Lady is right to highlight the problems that carers suffer—the impact on their physical and mental health and well-being, as well as the immense emotional burden that many bear.

The spending review has made available additional funding in primary care trust baselines to support the provision of breaks for carers. The new moneys will go into PCT budgets from April 2011 and into GP consortium budgets from 2013. The 2011 NHS operating framework, which was published on 15 December, makes it clear that PCTs should pool budgets with local authorities to provide carers with breaks as far as possible via direct payments or personal health budgets, which will doubtless ensure some progress.

The new funding is part of a package of measures that we announced in the recently published update to the carers strategy. The next steps set out the priorities for action in the next four years, focusing on what will make the biggest impact on carers’ lives. It is important to recognise that the subject is of interest to hon. Members of all parties. I do not think there is division along party lines. The hon. Lady’s insight into and knowledge of what is happening on the ground will be important to ensure that future policy and direction is well informed.

[Barbara Keeley]

Will the Under-Secretary say more about what will happen if PCTs do not spend the money on carers’ breaks? The Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is responsible for social care, campaigned in the House when the Labour Government had a similar problem. As I said earlier, the problem is that, according to a survey, only a quarter of the money had been spent on carers’ breaks. It is fine to allocate it, but the trouble is getting the PCTs to spend it.

[Anne Milton]

I thank the hon. Lady for that intervention. She is right to suggest that there can be an intention at Westminster, but the point is ensuring that it is effected on the ground. I will say a little more about that shortly.

We do not believe that a legislative approach is always the way to proceed when requiring health bodies and GPs to identify patients who are carers or have a carer and refer them to sources of help and support. Indeed, often it is not. We feel more comfortable with that as a weapon, but it does not necessarily produce the result that the hon. Lady wants.

It will be for PCTs and subsequently the GP consortiums to decide their priorities in the light of their local circumstances. However, we believe that GPs and their staff will play a vital role in identifying carers; many carers have not yet been identified. That is why we are investing £6 million from April 2011 in GP training, which will mean that more GPs and their practice teams gain a better understanding of carers and the support that they may need. That is important.

I believe that GPs are much better placed truly to understand the value and needs of carers. I do not need to tell the hon. Lady that the considerable social, human and, indeed, financial value that carers offer cannot be overestimated—she is aware of that. However, centrally driven methods are not always the best way forward. I welcome her continued feedback to ensure that we get the money spent where it is needed most.

Let me deal now with the speech made by my hon. Friend the Member for Colne Valley (Jason McCartney). I take the opportunity to pay tribute not only to midwives but to all the staff who will be working to deliver babies safely into the world, while we are enjoying our turkey or whatever we choose to eat on Christmas day.

The Government are committed to devolving power to local communities—to people, patients, GPs and councils—which are best placed to determine the nature of their local NHS services. I pay tribute to my hon. Friend for raising the matter previously and for continuing to raise his constituents’ concerns.

The Government have said that, in future, clinicians and patients must lead all service changes, which should not be driven from the top down. To that end, the Secretary of State has outlined new, strengthened criteria that he expects decisions on NHS changes to meet. They must focus on improving patient outcomes, consider patient choice, have support from GP commissioners and be based on sound clinical evidence. I think that that was what my hon. Friend was getting at.

The Department has asked local health services to consider how continuing schemes meet the new criteria. Some will be subject to further review. That does not necessarily extend to reopening previously concluded processes, as in Huddersfield—I would not like to lead my hon. Friend down an alley—or halting those that have passed the point of no return, with contracts signed and building work started. However, NHS Yorkshire and the Humber has advised that the decision to implement the looking to the future programme and change in maternity services in Huddersfield was clinically driven, with strong emphasis on patient safety and quality of care. It was also made after considerable scrutiny and consideration, including a formal period of public consultation and advice to the then Secretary of State for Health from the independent reconfiguration panel, whose recommendations were endorsed in full.However, I know that my hon. Friend will continue to gather local evidence and experience and feed it back, which I welcome.

Let us look at the problem described by the hon. Member for Blaenau Gwent (Nick Smith). I disagree with much of what he said. We have a bold public health strategy for the first time, and it has been widely welcomed. He should not believe everything he reads in the newspaper—it could lead him into all sorts of misapprehensions. The Government alone cannot improve public health; we need to use all the tools in the box.

The hon. Gentleman should note that health inequalities grew, rather than decreased, under the previous Government. There are massive opportunities to improve public physical, mental, emotional and spiritual health and well-being in England. As he rightly pointed out, we have some of the highest obesity rates of any country in the world. People living in the poorest areas die on average seven years earlier than people living in richer areas, and they have higher rates of mental illness, disability, harm from alcohol, drugs and smoking, and childhood emotional and behavioural problems. Changing people’s lifestyles and removing health inequalities could make double the improvement to life expectancy that we could make through health care, so we must address public health.

The Government published our strategy in our White Paper “Healthy lives, healthy people”. We will establish Public Health England, a national public health service, return public health leadership to local government, and strengthen professional leadership nationally by giving a more defined role to the chief medical officer, and locally through strong and inspirational leadership roles for directors of public health.

Historically, all the big public health improvements came via local authorities, and I am convinced that returning public health responsibilities to local authorities will achieve what we need, which is social and economic change as well as health change.