National Health Service (Amended Duties and Powers) Bill
David Anderson Excerpts(9 years, 8 months ago)
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Clive Efford
There are issues about PFI, which we need to sort out. I must say, though, that the hon. Gentleman has picked on the wrong Member of Parliament. I have one of the very first PFIs in my local hospital. When was it advertised in the European Journal? In March 1995. It was a Tory PFI and it is one of the most expensive in the national health service; it is costing millions of pounds for my local hospital. Both Governments have something to answer for when it comes to PFI. There are issues that need to be put right, but people must understand that that will not happen under a Tory Government.
Mr David Anderson (Blaydon) (Lab)
My hon. Friend is making a good case. Is it not the truth that the one constant over the past quarter of a decade is that both Governments—they are equally matched in this—did not listen to the people who really knew about the NHS? I am talking about the people who work in the service. To be honest, our Government, to their shame, ignored the working people and those in the NHS who said do not go into PFI or foundation hospitals. Exactly the same thing happened in 2012 when the Tory party ignored the same voices of the people who were saying, “Don’t go ahead with this Act.” We should start listening to the people who know what they are doing—the people we rely on to deliver NHS services.
Clive Efford
All Governments have lessons to learn. This party is not saying that it has nothing to learn, but it wants to end the privatisation of the national health service. We must understand one thing: next May is when we have to fight to save our national health service. If we continue under this Act to keep privatising our services, we will not have a national health service as we understand it.
Sir Tony Baldry
May I remind the right hon. Gentleman of a document published on 31 October 2000, under the last Labour Government? The printout that I have is entitled, “A Concordat with the Private and Voluntary Health Care Provider Sector”. It is headed, “Socialist Health Association—Promoting health and well-being through the application of socialist principles”. It was a concordat introduced by the previous Government with the private and voluntary health care sector. It says:
“Introduction. There should be no organisational or ideological barriers to the delivery of high quality healthcare free at the point of delivery to those who need it, when they need it. The Government”—
the last Labour Government—
“has entered into this concordat with the Independent Healthcare Association to set out the parameters for a partnership between the NHS and private and voluntary health care providers. It describes a partnership approach that enables NHS patients in England to be treated free in the private and voluntary health care sector.
The key tests for any relationship between the NHS and private and voluntary health care providers is that it must represent good value for money for the tax payer and assure high standards of care for the patient. The involvement of private and voluntary health care providers in the planning of local health care services at an early stage will enable the NHS to use a wider range of health facilities within their locality. To achieve this Health Authorities in their strategic leadership role will be expected to ensure that local private and voluntary health care providers are involved in the processes designed to develop the local Health Improvement Programme as appropriate.”
And it carries on. The document is headed, by the last Labour Government, “Socialist Health Association…A Concordat with the Private and Voluntary Health Care…Sector”. Indeed, the last Labour Secretary of State for Health signed a concordat with the Independent Healthcare Association on 31 October 2000.
The decision to make greater use of private sector facilities for NHS patients did not require new legislation and it was possible to undertake it within the existing legislation on the NHS, but for the avoidance of doubt let me quote the Labour party manifesto from 2001. In the chapter on NHS reform, Labour promised to
“work with the private sector to use spare capacity, where it makes sense, for NHS patients”
and to
“create a new type of hospital—specially built surgical units, managed by the NHS or the private sector—to guarantee shorter waiting times”.
In my constituency, we have an independent orthopaedic treatment centre run by the private sector and introduced under the Labour Government. We have a Darzi walk-in centre run by private GPs, which was also introduced during the time of the Labour Government.
Mr Anderson
I thank the right hon. Gentleman for giving way in his long diatribe. He quotes the 2001 Labour manifesto, but it also said that any relationship with the private sector would not be at the expense of the terms and conditions of the staff working in the private sector who were transferred out. Today, Care UK people who work in Doncaster are facing a 40% cut in their take-home pay. Does he not see that that is one of the consequences of the Health and Social Care Act 2012?
Sir Tony Baldry
With respect, I think the hon. Gentleman is seeking to avoid the point, which is that the 2012 Act did not fundamentally change the situation in the NHS between the public and private sectors. I draw the House’s attention to a debate that took place in Westminster Hall in 2002 on the subject of the private sector in the NHS that was initiated by the then Chair of the Select Committee on Health, the then Member for Wakefield, David Hinchliffe. The Minister, John Hutton, made a speech in response that could easily have been made in identical terms by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). John Hutton said:
“I do not want to repeat arguments that have already been made about the future of our relationship with the private sector, but I shall deal with some more specific points. My hon. Friend the Member for Wakefield was concerned about whether reference costs provide a sufficient measure of value for money in the NHS. We accept that they do not, and we have tried to set out in our report several ways in which we can strengthen reference cost data.”
He went on to say:
“My hon. Friend also referred to the evidence that my right hon. Friend the Secretary of State gave to the Committee. He set out four essential tests that we apply to each prospective partnership in the NHS and private sector. Is it in the interests of patients? Is it consistent with the local and national strategies of the NHS? Is it value for money? Is it consistent with public sector values, including that treatment is determined by clinical need and staff are treated fairly? Those are the yardsticks by which we will judge and develop our relationship with the private sector. Provided that those tests are satisfied, we should use the private and voluntary sector where it has a track record of achievement or where it can offer clear potential gains.”—[Official Report, 11 July 2002; Vol. 388, c. 354WH.]
I have absolutely no doubt that those are views that my hon. Friend the Minister would endorse today. It is an entirely sensible approach to how the NHS and the private and independent sector should work. The National Health Service Bill passed during the Session of 2005-06 further enshrined the relationship between the national health service and the private sector in statute.
The Bill promoted by the hon. Member for Eltham misses the point. The Health and Social Care Act did not and does not introduce competition into the NHS, it does not change the rules on when to tender competitively and there is no requirement to tender all services. What it does do is manage the competition that has been introduced.
Sir Tony Baldry
I have given way to the hon. Gentleman once, and as the hon. Member for Easington (Grahame M. Morris) accused me, ungallantly and unfairly, of filibustering—even though everything I have said is relevant and to the point—I would like now to make a little more progress and come to my final point, or almost my final point.
Mark Reckless
My party believes in the NHS as a service that is free at the point of delivery. My father is a doctor, and my mother is a nurse. That belief is core to my values, and to the values of my party. [Interruption.] That is our policy. Our policy is determined by our party, and it is to support an NHS that is free at the point of delivery.
Mark Reckless
I think that the hon. Gentleman may be referring to the answer to a question that was asked two years ago, which is now being taken out of context. Our party is not quite like the Liberal Democrats with their federal policy executive, but we have formal measures for the making of policy, and UKIP has decided—
Mark Reckless
The hon. Gentleman is correct. There was a great deal of privatisation and, indeed, fragmentation of the NHS under Labour, and I do not deny that there has been more of it under the current Government. I think that it is a problem that has afflicted both main parties.
Mark Reckless
I will clarify the view of my party on the NHS in general, but I am afraid that I am not yet in a position to give details of its policy on the NHS in Scotland. I should be happy to seek to assist the hon. Gentleman on another occasion.
What happened in Medway was fragmentation. The hospital was cut loose by the Department of Health, and is now essentially run by an independent board. When there are problems and it is in special measures, there is now a potential for greater intervention, but we have in Monitor what appears to be a backstop regulator, rather than a regulator that is able to come in and run the hospital and turn it around. It can get rid of the chair and the chief executive, but it cannot make constructive improvements.
Mark Reckless
I will continue, if I may.
The independence of such hospitals, the inability of the House or the Secretary of State to drive improvements, and the decision to allow a hospital to become a foundation trust although one in 10 more people were dying than should have been the case, constitute an indictment of the last Government’s policy. I was delighted to hear from the Labour candidate whom I have faced in recent weeks that Labour is now against fragmentation and privatisation of the NHS. I welcome the Bill, and I am pleased to be able to support it.
Andy Burnham
The hon. Gentleman said that he could not understand Labour’s position, but surely he remembers 2012, when Opposition Members spoke with force against that legislation, which he then voted for in the Lobby. I know that it has been a long night, but he really should try to remember these things, because they are quite important.
Mr Anderson
Is it not also true that the hon. Gentleman went through the Lobby not once, but 18 times, despite being told time and again that what has now happened would happen? The people who had their finger on the pulse were telling us what would happen, but he ignored them.
Andy Burnham
It is a tiring business being an MP and it is possible to forget things, particularly when one drinks as many pints as UKIP Members do, but they should try to remember. Their party leader once said that he would give the NHS budget to insurance companies; apparently, he does not believe that now. The deputy leader, a Mr Nuttall, said that the right hon. Member for South Cambridgeshire was to be congratulated on bringing a whiff—just a whiff—of privatisation to the NHS, and the hon. Member for Clacton (Douglas Carswell), whom the Minister quoted earlier, described the Lansley reforms as “fairly modest”. He chided his Tory colleagues who were sniping against him at the time and said that the reforms must not be derailed. The party says it is anti-politics in the way things are done. This is sheer opportunism and dishonesty.
Dr Poulter
The chief executive makes exactly the point. It was of course the Labour Government who introduced competition into the NHS. If the hon. Gentleman has a problem, he should take it up with his colleagues further along the Front Bench who they introduced competition into the NHS. Monitor, as the sector regulator, must now have regard to having better integrated services, reducing fragmentation and putting more emphasis on the best interests of patients.
The fourth effect of the Health and Social Care Act has been to provide clarity about existing NHS practices on patient choice and competition that were introduced by the previous Government. Under the Act, nothing changed from the rules laid down under Labour on how commissioners should behave when they procure services. That has been borne out, despite the myths and scare stories surrounding the Act. Simon Stevens, a former Labour special adviser under Tony Blair and now head of NHS England, said to the Health Committee that
“if the claim was that CCGs have to start putting all of their health service purchases out to public procurement, that is clearly not true and it isn’t happening”.
That was the current head of the NHS making it clear and putting the record straight on the Opposition’s scaremongering. The NHS agrees: the NHS Confederation stated in its briefing on the Bill:
“The current rules are clear that no-one can pursue competition in the NHS if it is not in the interests of patients.”
Our NHS finances bear that out. In the last financial year, spending on independent health care provision by commissioners was shown to be about 6%, compared with 5% under Labour in 2010. That is hardly evidence of the sweeping privatisation of NHS services, but it is evidence of clinical commissioners making informed, clinically led choices for the benefit of patients.
Dr Steve Kell, chair of the NHS Clinical Commissioners, has made it clear that there is not a clinical commissioning group in the land that has any kind of “privatisation agenda”. What CCGs all share is clinical expertise and an unflinching desire to improve local health services for their patients. This Government will not stand in their way or play party politics with the judgments of doctors and nurses who are making the right choices in the best interests of their patients. Indeed, Dr Michael Dixon, chair of the NHS Alliance, and others wrote in The Daily Telegraph this morning:
“As NHS doctors, we are deeply concerned about the misguided and potentially disruptive National Health Service Bill being debated today.”
Working with other key health care organisations, NHS England—I hope that Labour Members will agree with this uncontroversial point—has set out how the health system must change over the next five years, looking at new models of care delivery and taking a more integrated approach to the delivery of health and care. Earlier in the year, the head of NHS England, Simon Stevens, made it clear that if the procurement, patient choice and competition rules stood in the way of delivering the required changes, he would say so. Clearly, he has not done so.
Let me be absolutely clear: the NHS England “Five Year Forward View” did not call for further legislative change—that is what the Bill proposes—or for structural upheaval or a return to Whitehall control of our NHS. I am sure that we can all agree that NHS England’s “Five Year Forward View” was an important piece of work that deserves to have broad cross-party consensus.
Politicians now need to leave the NHS to get on with the job: let the doctors and nurses run the NHS as we have freed them up to do. We can support leaders in the system, and help to free more money for front-line care through improved NHS procurement, better estate management and reduced spending on temporary staff. However, making top-down legislative change to the system, as the hon. Member for Eltham proposes, would be disastrous at a time when we should focus on supporting our NHS to deliver better care for patients.
It is important to look at what the Bill would do. It is quite simply wrong to believe that removing the parts of the 2012 Act that relate to the competition will stop competition law applying to our NHS.
Mr Anderson
Is the Minister happy that, because of competition, groups such as Care UK have cut professional health workers’ pay by between 35% and 40%? How does he expect those people to feel motivated to go to work every day when they cannot afford to pay their mortgage or to look after their kids properly? Is that really what we should expect in this day and age?
Dr Poulter
The hon. Gentleman will be aware that Care UK provides a lot of the care in the social care sphere. I understand that much of the social care commissioned by local authorities is already provided by the private sector. The big idea of the right hon. Member for Leigh is about driving further integration. Under the integration plans that he has outlined, more power would of course be given to companies such as Care UK. We support integration, but it must be done in a way that always meets the best needs of local patients, and it must be evolutionary change rather than revolutionary change, working with front-line professionals to do the best for their patients.
Care Workers
David Anderson Excerpts(9 years, 8 months ago)
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Paul Burstow
I will come to finance, but I hope that when we have contributions from Front Benchers there will be some indication of commitments for the future and of what has been done so far. For many years under the previous and current Administrations, local government settlements have left local authorities in a difficult position when funding social care. No one disputes that, but we should be honest about the fact that that problem did not start in 2010, although the incoming Administration had quite a bit of difficulty in dealing with the deficit.
I want to draw attention to 15-minute contracts, which are another aspect of this debate that relates to the guidance. During the passage of the Care Bill, hon. Members on both sides of the House, particularly in the Public Bill Committee, were very clear with Ministers that we expected the guidance to be clear on that point, as it is. It says:
“For example, short home-care visits of 15 minutes or less would not routinely be appropriate for people with intimate care needs”,
and goes on to list what that would mean in practice. I hope that the Minister will explain how he intends to ensure that local authorities are both supported and encouraged to ensure that the guidance is put in place.
I wanted to speak in this debate because at a constituency surgery about a month ago, a home care worker came to see me wanting to talk through what was happening to them and the people they worked with concerning their time sheets and pay. They have to pay for work-related calls on their own mobile phone, and for fuel in the car that the organisation provides. That might be thought to be a good thing, but I was told that the care workers have to take the car to be MOT-ed, and if it fails they are encouraged to drive it without. There is some pretty shoddy practice going on, and care workers are at the front.
The right hon. Member for Oxford East was right to highlight the issue of flu jabs, and I hope the Minister will say what is intended. The guidance is clear: health and social care workers should have access to the jab, but if it is not provided free to social care workers, it is likely that it will not be widely taken up.
Paul Burstow
I will give way, but I am conscious that I must keep my remarks short so that other hon. Members may speak.
Mr Anderson
The right hon. Gentleman was a Minister. Does he agree that it is wrong if people are not paid when travelling from one workplace to another?
Paul Burstow
A whole set of practices, of which that is one, result in people being paid less than the national minimum wage. That is why I wrote what I did very clearly in the White Paper on care and support and why, since leaving the Government, I have supported steps to have the guidance in place. I want to hear the Minister say in his response how that guidance will get traction on the ground in how local authorities behave.
The matter is important because we know that the care sector has among the highest rates of staff turnover of any part of our economy: 30% in some parts, and up to 19% to 20% in the care home sector. In the past 12 months, I have engaged with people from across the residential care sector while working with the think-tank Demos and looking at what we can do to address the issues that the right hon. Member for Oxford East has talked about. Domiciliary care workers are all too often hard done by, but we should not ignore those who work in residential care settings and are often paid barely above or even below the national minimum wage.
That is why we need HMRC to continue to engage proactively in this area and why I support the proposition that third parties, such as Citizens Advice, should be able to make referrals to HMRC so that it can trigger investigations when necessary. It is important to call out those who breach their obligations under the national minimum wage. When there is clear evidence that bad commissioning practices are making that happen, the Care Quality Commission should call out the chief inspector for those failures. I hope that Ministers will look at the powers available to allow inspections of local authorities in that regard.
We also need to pick up on the right hon. Gentleman’s point about how to raise public esteem for this work force. They have a deeply trusted role, even if the public are often sceptical because of the stories they hear. The role is important and responsible, and we do not properly honour and reflect that. That is why, in December, the Local Government Information Unit will publish further work looking at those issues and at what we can do to turn what is often seen as a temporary job into a permanent career with opportunities rather than one that goes nowhere, which is all too often how the sector is seen and treated.
There is an economic case for that, apart from the strong moral case that the right hon. Gentleman made. We have a generation in their 50s who are squeezed between caring responsibilities for their parents and their children. At the same time, they are expected to work and need to do so. We often stretch them beyond breaking point, and many leave the workplace. Supporting family carers more effectively and having reliable, cost-effective home care services is the right thing to do by them and by our economy. We recognise that in child care, but we have not recognised it in elder care. We now need to do so and to ensure that people want to work in the sector and see a future in it.
My final comments are about transparency. In my Demos work on the future of residential care, I and my fellow commissioners have said that several things need to happen. We need transparency in the way in which providers operate. There should be open-book accounting so we can see transparently how they are behaving in practice. We also need transparency in the CQC to provide clarity on the rates for care. There should be clear rates. The United Kingdom Homecare Association has produced a formula on its website, and it would be good if local authorities adopted it.
We also need more honesty about the long-term funding of the system, which is why we need the Office for Budget Responsibility to be given a new mandate for reporting on that so that there is more transparency and accountability in this place and we can hold Ministers to account on whether they are properly funding the sector.
Paul Blomfield (Sheffield Central) (Lab)
It is a pleasure to participate in this debate with you in the Chair, Mr Robertson. I join others in commending my right hon. Friend the Member for Oxford East (Mr Smith) not only on securing the debate, but on an incredibly powerful opening contribution.
During the conference recess, I carried out a community consultation. I spoke to about 1,800 constituents in 61 meetings over three weeks. The dominant issue that came out of that consultation was low pay and abusive payment practices, particularly from those who told me some fairly horrendous stories about working in the care sector, and particularly about zero-hours contracts and non-payment of travel time. I accept my right hon. Friend’s point that for some people, zero-hours contracts work, but there are too many abusive zero-hours contracts. I thought that I understood the issues: peoples’ uncertainty about what hours they would work from week to week, and the difficulties of navigating the benefit system on low pay. However, people told me stories of getting a phone call on a Sunday night and being told, “Get on the bus. Travel across the city. We have work for you tomorrow morning at 8 o’clock”, only to arrive and be told, “Sorry, there is no work available”, or, “If you would like to hang around till 2 o’clock this afternoon, we might have some work for you.” We really have to address that sort of abusive employment practice.
Another care worker told me of her experience of non-payment for travelling time. She will get one job on one side of the city, a second on the other side, and a third a considerable distance away again. Paid the minimum wage for contact time, she is in effect working eight hours but being paid for four or five—a really abusive practice that we must address.
Mr Anderson
Let me advise my hon. Friend that at a recent meeting with Unison members who work in the care sector, one of them made the point that she worked 27 hours a month travelling between jobs. That was 27 hours a month for which she should have been paid, but was not. That is a disgrace.
Paul Blomfield
I thank my hon. Friend for his intervention. He is absolutely right: it is a disgrace. However, last week on Radio 4’s “Today” programme, I heard a care commissioner and a care provider debating the issue and accepting almost as the norm—indeed, for too many people it is the norm—that travel time is not paid for. That was so accepted in the discussion that I had to check with the House of Commons Library that it is in fact an illegal practice. However, it is accepted across the sector by commissioners and providers. People doing some of the most important work in our society, as my right hon. Friend the Member for Oxford East pointed out, are denied the dignity of being paid even the minimum wage, and it is tough enough to make ends meet from month to month on the minimum wage.
The arguments about the impact on care standards, the increase in hospital admissions because carers are spending less time with people, and the impact on staff turnover are well rehearsed, but we need to get to the bottom line. It is simply wrong that people are being paid an amount that contravenes the law, and too many people are accepting that. Allowing these practices to continue makes a mockery of having a national minimum wage.
Yesterday was the day in 2014 on which women in full-time work in effect stopped being paid—I am referring to women’s wages as a proportion of men’s wages—because of the gender pay gap, which is widening under this Government. Is it any wonder that that gap is widening when abuses such as these in the care sector, in which most workers are female, are just allowed to continue? I use the word “allowed” carefully, because it is not that the Government do not know about the abuses. The Minister’s right hon. Friend the Secretary of State for Business, Innovation and Skills said:
“The problem with domiciliary care is that there is almost certainly an avoidance by companies to pay the minimum wage, and that overlaps with the problem of zero-hours contracts. We recognise that there are some very specific problems for workers in that sector.”—[Official Report, 26 June 2014; Vol. 583, c. 447.]
HMRC, too, knows that that is happening, because an investigation of care providers between 2011 and 2013 found that 50% or half of care providers investigated were guilty of non-compliance with the national minimum wage, yet what are the Government doing to tackle the exploitation of predominantly female carers looking after our frail, vulnerable and disabled relatives? According to the Public Accounts Committee in July 2014, “seemingly little” has been done. I am inclined to agree and, given the nodding heads on both sides of the Chamber, colleagues agree, too.
Having found a 50% non-compliance rate, HMRC has stopped carrying out proactive investigations into minimum wage compliance in the care sector. I hope that the Minister will explain that decision for us today and, more importantly, will commit to talking to colleagues across Government about reversing it, because it is simply not acceptable for the Government to say that they are concerned about this issue but remove the resources for addressing it.
In the same vein, given the overlap between non-payment of the minimum wage and the problem of zero-hours contracts, will the Minister look to give bodies such as trade unions and law centres a formal, third-party role, so that reports of national minimum wage breaches can be treated as formal complaints? I ask that because we know that part of the reason for the incredibly low level of reporting of abuses—there were just 11 complaints to the pay and work rights telephone helpline in 2011-12 from home care workers—is the precarious position in which care workers on zero-hours contracts find themselves. If they put their head above the parapet, they will find themselves with no work next month, so I would also like to hear from the Minister what the Government are doing to promote the pay and work rights helpline for those who do feel confident enough to use it.
Will the Minister assure us that when workers do complain, they will be paid what they are owed? I ask that because written answers to my hon. Friend the Member for Stockton North (Alex Cunningham) suggest that the Government are not in a position to say either way. I therefore urge the Minister to talk to colleagues about collecting the data, because how else will we know the success of HMRC’s intervention?
Care workers do one of the most important jobs in society. They look after those whom we are concerned about most—the most vulnerable—and whom we love the most, and they deserve better.
Mr David Anderson (Blaydon) (Lab)
It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing the debate. He may not remember, but in 2000 he and I sat in a room in Exeter and negotiated for the Labour party manifesto to contain a policy to protect people at every level where there was a two-tier work force—that is, where people were outsourced. We wanted to ensure that even if a worker was no longer employed by a public body, they would suffer no detriment. Where are we now? For a start, where are the 320 Tory MPs? This is a debate about care, and the fact that they are not here shows how much they care. It is an absolute disgrace.
The debate is about the exploitation of those we rely on to take care of the people who did everything for us, wherever we are and wherever we come from. My parents fought the fascists, and they helped to build the welfare state. Other people here might be younger than that, but whoever we are, we know that home care workers look after the people who gave us everything.
I became a care worker 25 years ago. I took a temporary job for 13 weeks, but I was still there 16 years later, before I came to the House. For most of that time, I was employed by Newcastle city council and I was involved in trade union work. One of the great parts of my job was working with home care workers. In the professional side of my job, I was a key worker looking after a number of elderly people. We used to arrange meetings with everybody from the director downwards, and the truth is that the key people were the home care workers. They were the people—almost always women—who went into people’s houses day in, day out and built up a rapport not only with the client, but with their family. A home care worker knew when their clients were feeling off-colour, when they had problems or when the grandbairns were not very well. They knew those things because they had continuity of care and continuity of access to their clients, and that is how proper public services should work.
Even in those days, in 1992, we were paid paltry wages. In the council, we were paid only £4.85 an hour, which was not very much even then. We were, however, paid more than those who were paid by the privatised agencies that were coming to the council at that time, as a direct result of the former Tory Government’s cuts. Home care workers who worked for an agency were paid £3 an hour. It took a lot of digging, but we found out that the agency was being paid £9 an hour, so it was getting 200% more than the person who was actually doing the work.
In many ways, things have not changed, except that those who run outsourced services have found different ways of exploiting people, whether by failing to pay for travelling time or by saying that people have to use their own car. We have heard a disgraceful example of a care worker being encouraged to drive a car that had failed its MOT test, which is absolutely unbelievable in this day and age. The Minister has said that such things are criminal. They are, and we should start treating those who do them like criminals. If we were talking about someone who was fiddling their benefits, the Government would be on top of them like a ton of bricks. Political parties are letting down those who do the most crucial work in our country.
I do not intend to continue to pick up the points that my right hon. Friend the Member for Oxford East made in his speech, which nobody can argue against. He is right to say that social care problems are not confined to councils and the NHS. Later today, there will be a meeting in Committee Room 19 with workers from Care UK, and it would be great if the Minister could come. The hon. Member for Strangford (Jim Shannon), who is no longer here, has mentioned Care UK. Workers in Doncaster have been on strike for three months against Care UK, because they are being transferred to the company and are facing a 40% pay cut. Some of those workers have 30 years’ experience. How on earth can that be right? How on earth can that be fair?
I spoke to a young woman in Gateshead who came to our council to collect money to support her and her family, so that she could try to stay out on strike and make a point against Care UK, which is exploiting its workers. The young woman told me that she was from Newcastle, and she had moved to Doncaster eight years ago to live with her partner. She said that if staff were forced to go back to work under the new conditions, she would have to leave work and come home to live with her mother. That is the sort of thing that was going on 100 years ago. It is a disgrace, in this day and age, that public services are being run by people who have such an attitude towards carers.
I have been advised by Unison that 70 of the workers who were outsourced to Care UK have left the service. We may end up losing people whose experience in the care service totals hundreds, if not thousands, of years. That will be to the detriment of the country, and to the real detriment of those people. Perhaps one reason why the Government have not been very active on the matter is that the chairman of Care UK, John Nash, has given the Tory party some £250,000 over the past few years. Not only has he been awarded contracts, but he is being made a peer along the corridor from where we all work.
We are talking about taking care of people. It is called care, and the Minister will have to show whether he cares for those people or not. If nothing serious comes out of the current situation and the work that was done by my colleagues on the Care Bill, we will have wasted our time. The Minister will not deserve to have any more respect from the people of this country, particularly the carers, whom we need to look to the most.
Liz Kendall (Leicester West) (Lab)
It is a pleasure to serve under your chairmanship, Mr Robertson. Like all hon. Members who have spoken this morning, I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on securing this absolutely essential debate, particularly as this is annual living wage week. As Members of Parliament we all get hundreds of e-mails and letters from people calling for us to speak up for issues. I do not get a lot of e-mails from care workers because they are frantically working, but our job is to speak up for people who do not have a voice, which is what he has enabled us to do today. People have spoken passionately about this issue.
Although I do not have the experience of my hon. Friend the Member for Blaydon (Mr Anderson), one of the first things I did after becoming an MP was to do a shift with a care worker in my constituency. My goodness, was it an eye-opener. Amanda, from New Parks, loved her job, and she desperately wanted to care for people. She said that she never thought that she would make anything of her life, and doing that job gave her a real sense of fulfilment, but she was rushed off her feet. She was trying to fill in for staff who were off sick or who had left. She said to me, “The trouble is that girls get more money at Morrisons than they do doing this, and they get their hours set, so why wouldn’t they go and do something like that?” That was the start of my understanding of just what this means to people. From the other side, I have seen constituents and members of my family receive 15-minute home visits, which are not enough to get someone up, washed, dressed and fed. It is barely enough time to have a proper conversation, which causes problems for people who are left isolated in their own home.
Many hon. Members have spoken powerfully about how home carers are undervalued, underpaid and undertrained. Undervalued because they do not even get the dignity of having a decent contract—nationally, there are more than 300,000 care workers on zero-hours contracts. Underpaid because up to 220,000 care workers do not even get the minimum wage, let alone the living wage, when they are doing some of the most vital work in looking after people whom we care for and love, and who brought us into this world. And undertrained because around a third of care workers receive no ongoing training, yet they are doing some of the most vital, intimate and personal tasks.
We are seeing low staff morale and high turnover of around 20% to 30% annually. Vulnerable people do not even know who is going to come in and help to get them out of bed or take them to the toilet. I would want to know who is coming into my bedroom to get me out of bed, yet that is not the experience of many people. It is not just that the present situation is not good for care workers; it is not good for the people who use care or for taxpayers, either.
We are seeing ever-increasing numbers of elderly people ending up going into hospital when they do not need to be there, and getting stuck there, too. Delayed discharges from hospital are at their highest ever rate, costing more than £260 million in the past 12 months. That would pay for 37,000 people to have a whole year’s worth of home care. Where on earth is the sense in that?
Like my right hon. and hon. Friends, I believe that the Government are not doing enough to tackle the problem. Many hon. Members spoke about the new guidance for local authorities to look at whether their service providers are paying their staff below the minimum wage. I do not think that that is anywhere near strong enough. “Should” needs to be “must”. If people are not paying what they are legally required to, enforcement should be much tougher. It was a profound mistake for the Government to remove the Care Quality Commission’s role in assessing the quality of council commissioning. If the CQC was able to assess whether local councils were commissioning care properly, that would be a key thing to check them on.
In July, the Public Accounts Committee, chaired by my right hon. Friend the Member for Barking (Margaret Hodge), said that it was
“astonished that...seemingly little has been done to rectify”
the scale of non-payment of the minimum wage in the care sector.
In April this year HMRC replied to a freedom of information request that I submitted. It said that half of all the care providers that it had been investigating—more than 100 employers—had been failing to pay the minimum wage in some form, and that more than £1 million was owed to workers. Imagine that. If anyone had stolen—that is what this is—£1 million, action would be taken. I am disappointed that Ministers and HMRC have not named the providers involved. Despite the Minister saying that providers should be named and shamed, that simply has not happened in the care sector. I hope the Minister will explain why not.
Several hon. Members said we need to make sure that HMRC proactively looks at the underpayment of the minimum wage and not simply wait for care workers to ring the pay and work rights helpline. Only 19 workers did so in 2012-13. We know they are not being paid, but they are busy. They are rushing round. They have lives to live. We should have much more proactive measures.
Mr Anderson
My hon. Friend is absolutely right. People are busy, but they are also frightened. They have no protection. Employers have complete control over their lives with zero-hours contracts. If people complain, they will not get any more work. That is the truth.
Liz Kendall
My hon. Friend is absolutely right. I was going to come to that point. If someone is on a zero-hours contract, they will be too terrified to tell their employer that they are not paying the minimum wage. I am not yet convinced that the Minister is working closely enough with Ministers in the Department for Business, Innovation and Skills. According to an answer to a written question from my hon. Friend the Member for Stockton North (Alex Cunningham), the Minister has had just one meeting all year with BIS to discuss underpayment of the national minimum wage in the care sector. That is not good enough. We need more action.
Several of my right hon. and hon. Friends rightly said that £3.5 billion has been cut from local council adult social care budgets. Within that context, the pressures are building.
Oral Answers to Questions
David Anderson Excerpts(9 years, 9 months ago)
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The Minister of State, Department of Health (Norman Lamb)
Last week, Mike Richards told me how waiting-time standards had transformed cancer care, and I think the same can happen for mental health. It is outrageous that somebody with a suspected cancer gets seen by a specialist within two weeks, but that if someone has a first episode of psychosis, who knows what will happen to them. That discrimination has to end, and we are delivering that.
Mr David Anderson (Blaydon) (Lab)
The good people who work in the NHS have faced six years of pay restraint. How much longer must they carry the can for the failures of the people who got us into this mess—the moneylenders, the LIBOR fixers, the people who mis-sold mortgages? How much longer must front-line staff pay for the mistakes of capitalism?
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Even in very difficult times this year, all NHS staff, either through their increments or through the 1% increase, will be getting a pay rise. Of course, we would like to do more, but the NHS finances are under pressure, and our priority is to ensure that we employ as many front-line staff as we can. We now have more than 13,000 more front-line staff working in the NHS than we did when we came into government.
Regional Pay (NHS)
David Anderson Excerpts(11 years, 8 months ago)
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Andy Burnham
The Government’s position was indeed made clear in Westminster Hall this morning, and perhaps we shall hear it again from the Dispatch Box in a moment.
The south-west trusts’ initial document stated that the consortium would explore
“radical changes to terms and conditions of the workforce”.
It went on to say that this would not be a negotiation, and that
“trusts would be obliged to dismiss and re-engage staff to secure such changes”.
That is disgraceful, and it is simply not possible for the Government to have no view on it. It is provocative, destabilising and divisive. However, it gets worse. In the vacuum left by Ministers, the chaos is spreading. We have identified a further 12 trusts across England that are actively considering opting out of “Agenda for Change”. There are five in the north-east, which gives rise to fears of a second emerging pay cartel. North Tees and Hartlepool has issued 90-day notices to 5,452 staff as a precursor to forcing them to sign new non-“Agenda for Change” contracts—staff who refuse to sign by March 2013 are threatened with the sack—and South Tees is considering a similar move.
Mr Anderson
I support what my right hon. Friend is saying. In the north-east there is real anger among people who have devoted their lives to the health service, and who are now being told that they will effectively be forced to sign new contracts, because otherwise they could face the dole. Is that any way in which to treat people who are relied on to make what are literally life-or-death decisions? It is a disgrace.
Andy Burnham
These are the same staff whom we were celebrating during the Olympic games, just a few months ago, for everything that they contribute to the NHS and to the care of others, but Ministers sit there and do absolutely nothing. It is disgraceful that any staff in the NHS should be treated in such a way.
This is no academic threat. These are the panic moves of an NHS that is experiencing increasing distress, in which control has been lost because it is facing the biggest financial challenge in its history. After the election, the £20 billion Nicholson challenge should have been the only show in town, but the previous Secretary of State was allowed to proceed with his vanity reorganisation of the NHS. Instead of focusing on saving money, the NHS has been busy wasting it: £1.6 billion, and rising. A full £1 billion has been spent on redundancies—1,300 people have received six-figure payouts, and l73 have received more than £200,000—while 6,000 nurses are losing their jobs. That is scandalous.
As unforgiveable is the Conservative party’s repeated inaccurate boast on NHS funding. I checked on the Conservative party website today, and in the “Where we stand” section it says this:
“We have increased the NHS budget in real terms in each of the last two years.”
Mr Hunt
May I just answer the question put by the hon. Member for Halton (Derek Twigg)? Let me make it clear: we are not proposing to abolish “Agenda for Change”; we are not proposing an end to national collective bargaining; we are not proposing the abolition of national pay scales; and current pay scales will not be cut. What we are doing is supporting the changes brought in by the previous Labour Government to ensure there is sensible flexibility in pay across the whole country.
Mr Anderson
The Secretary of State mentioned people working night and day. Does he agree with the agreement in “Agenda for Change” that people should get additional pay for working night shifts, both because such shifts are antisocial and as compensation for not only the impact on family life but the fact that people who work night shifts tend to die earlier?
Mr Hunt
I support the principles behind “Agenda for Change”, which were introduced in 2004 by the Labour Government of which the right hon. Member for Leigh was a member. I also support a number of other flexibilities introduced by the Government—the right hon. Gentleman supported the legislation—in respect of foundation trusts.
Mr Hunt
I want to make a little more progress, and then I will perhaps take one or two more interventions.
NHS employers have the ability to set their own terms and conditions, but the vast majority prefer to use national terms and conditions, and provided that those remain sustainable and fit for purpose, they are likely to continue to do so. I welcome the national negotiations between NHS employers and NHS trade unions, and I urge both sides to bring the negotiations to a swift and successful conclusion. Unfortunately, the time it is taking for agreement to be reached is encouraging some employers, such as those in the south-west consortium of NHS and foundation trusts, to examine alternative provision. Sadly, it appears that the people who bankroll the Opposition—particularly Unite—would rather put their members’ jobs at risk than work with employers to find an acceptable solution to help the NHS meet its financial challenge—[Interruption.] I am sorry they do not want to hear this—
Mr Speaker
I hope that it is a point of order rather than a point of frustration. We will hear it and I will discover whether it is.
Mr Anderson
On three occasions, the Secretary of State has said that the trade unions bankroll the Labour party. A large majority of the trade unions in the health service have no links to the Labour party whatsoever.
Mr Speaker
I am grateful to the hon. Gentleman, but that is a point of debate that he might wish to develop further if he is successful in catching my eye. We will leave it for now.
Mr David Anderson (Blaydon) (Lab)
I know it is unusual in this place to listen to anyone who has experience of the real world, but I will try yet again. I worked in the coal industry for many years—in fact for decades. In 1966, a national agreement was reached to bring parity to the system. It took six years for that to be applied across the industry. The main reason why that was done was that people thought it unfair that people who worked in some of the worst conditions in coalfields were historically disadvantaged because they did not produce as much coal as people who worked in coalfields where it was easier to get the coal out. It was the right thing to do. It was based on the principle that applies to this debate—that people should be paid for what they do, not for where they do it. That is the principle that should guide us today.
I had the privilege of presiding over the Unison national conference that agreed “Agenda for Change”. Unison was the last and most reluctant union to sign up to it because it saw some of the problems that it would bring in. We are now seeing those problems. People are exploiting “Agenda for Change.” They are exploiting some of the freedoms intended for families and trusts. Some employers will exploit almost anything. Seeing where we are today and some of what is going on across the country makes me believe that some of the concerns expressed were right.
Today’s debate cannot be separated from what is going on in the rest of the country. We are seeing an anti-worker attack, which is being driven to some extent by this Department but mainly by No. 11 Downing street. Let us look at what is going on. Let us reflect on the background: 750,000 jobs are to be lost in the public sector, while people are having to pay more for their pensions, work for longer and get less pension when they retire. Then there is the pay freeze.
A point was made from the Government Benches about getting the pay burden down, but health service staff will see a reduction of at least 10% in their living standards during the period of this Government. If that is not an example of the workers doing their bit—all being in this together—I do not know what is. Incremental freezes are being introduced, health and safety legislation is being watered down, job security is being weakened, and employment rights and access to industrial tribunals are being changed. There are changes to benefit rules that, officially, are about making work pay, but really mean that people have to go to work for as little pay as employers can get away with. We are back to the future—back to the low-pay, low-skill economy of the 1980s, when people were frightened to stand up for themselves because of the problems they were facing; when compulsory competitive tendering destroyed the conditions of manual workers whose roles were intrinsic to the safety of the national health service.
No one should be surprised to find out that some will be exempt from the regional pay proposals. Who are they? According to the Department of Health submission to the pay review body, the only exemption will be for highly paid managers working in the new bodies established by the Health and Social Care Act 2012. While the people being employed to privatise the health service will not be subject to the regional pay proposals, there will be an impact on the lads and lasses on the front line who look after our constituents day in, day out. That is the unfairness of the situation, and people will focus on the problems at that level in the current negotiations.
The Secretary of State said that he supported proper negotiations, but is it proper that North Tees and Hartlepool NHS Foundation Trust has served redundancy notices on people? That is no way to have proper negotiations. Is it proper that South Tees Hospitals NHS Foundation Trust is thinking about doing the same? City Hospitals Sunderland is trying to freeze increments without consultation or negotiation. Tees, Esk and Wear Valleys NHS Foundation Trust is also freezing increments, while all the trusts in Tyneside, which I represent, have said they will not introduce regional pay. That is one of the problems. Where it is easy to travel from one part of the region to the next, people will travel; people who are not getting a good deal in Hartlepool, Sunderland or Middlesbrough will travel to Gateshead, Durham or Newcastle. National terms and conditions are key, so that people are paid the same no matter where they work. Otherwise, recruitment and retention will become a huge issue.
It is clear that the majority of people who have spoken in the House and outside oppose regional pay. Ten north-east firms have urged the Government not to introduce regional pay, because reducing the spending power of public sector workers in the region will have a hugely detrimental impact on their businesses.
I raised a point with the Secretary of State about trade unions, but let me refer to the BMA, the RCN, the Royal College of Midwives and the Chartered Society of Physiotherapy. None of them is affiliated to or the paymaster of the Labour party, but all of them say, “Don’t do this.” But it is not just them saying it. The hon. and learned Member for Torridge and West Devon (Mr Cox), the hon. Members for Hexham (Guy Opperman), for Brigg and Goole (Andrew Percy), for Stafford (Jeremy Lefroy) and for Carlisle (John Stevenson)—all Conservative Members—are all against the proposal. A raft of Liberal Democrats—the hon. Members for North Cornwall (Dan Rogerson), for St Austell and Newquay (Stephen Gilbert), for Torbay (Mr Sanders), for Manchester, Withington (Mr Leech), for Southport (John Pugh), and for St Ives (Andrew George), and even the Secretary of State for Business, Innovation and Skills—are opposed to it. The Deputy Prime Minister is also opposed to regional pay, as was his party conference. How on earth can the Conservative party try to force it though?
Mr Bradshaw
My hon. Friend says that the Liberal Democrats have said they are opposed to it. Will not the test be how they vote in a few minutes’ time?
Mr Anderson
I have always appreciated my right hon. Friend’s talents, but I ask him please not to steal all my thunder.
Who wants regional pay? The Department of Health, but even more so, the Chancellor of the Exchequer, as it is part and parcel of an attempt to drive down workers’ conditions and undermine the work force for ideological reasons. He is putting the NHS at risk for the sake of party political advantage. It is a disgrace.
How will the Liberal Democrats vote tonight? I have read the amendment—I used to write amendments —and it is the easiest thing in the world to fudge your way around something, but this is a point of principle. Let us make no mistake. The people out there—the nurses, the midwives, the doctors—will read the weasel words of the amendment as exactly what they are. The basic principle is in the motion. We want the Government to tell the employers that there is a national pay bargaining agreement, and they should stick to that.
Mr Anderson
Clearly, there are issues about foundation trusts, but the Government can do what they want—or they can as long as the Liberal Democrats help them. Tonight, however, the Liberal Democrats have a chance of stopping the Government doing what they want, by doing what their party wants, and what the people they represent want—by throwing out the proposal, and voting on the clear principle that national pay bargaining should happen in the national health service, and nothing should be done to undermine it, including supporting the amendment.
Mr Deputy Speaker (Mr Nigel Evans)
I call Sir Nick Harvey, who should resume his seat no later than 3.40.
Adult Social Care
David Anderson Excerpts(12 years ago)
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Paul Burstow
No, I am talking about the time at which in the sequence of my speech I will make the point about the Dilnot commission recommendations.
I wish to make one other observation on the national care service White Paper that the Labour Government published seven days before the last general election was called. Our White Paper addresses the end-of-life care issues, but Labour’s failed to address them.
Mr David Anderson (Blaydon) (Lab)
The Minister is rightly critical of the failure of the previous Government to bring in care for the people of England. Does he support what was done in Scotland by the previous Government?
Mr David Anderson (Blaydon) (Lab)
In 1989 I became a care worker after losing my job as a coal miner. I did so almost by mistake, but it was one of the best decisions I ever made, and over the next 16 years, as a care worker and as a representative of people working in care, I came to realise that we can look at care in three ways: we can provide none, provide it on the cheap or provide quality. We cannot do a combination of the three, and I hope that in the Chamber tonight we all agree that, if we are going to do quality care, we need to look after the work force properly, train them properly, treat them like professionals, have them in numbers, respect them, treat them with dignity, have the resources in place and give them some responsibility. They respond to that if allowed to, and the best way they respond is by showing respect for, and treating with dignity, the people they are taking care of, building the trust and confidence not just of those they are caring for but of their carers—their family and their friends who look after them.
I believe that my Government did some good things over their 13 years in office, regardless of what the Minister says, but in truth we did not do enough. In 1999 we set up the Sutherland commission, but we backed down on it—we chickened out. We did the right thing in Scotland, and, yes, it was done under coalition government, but the commission was set up by a Labour Government.
We should have done more, and we have a chance today to do more. My view is clear: why is someone needing care because they cannot take care of themselves different from someone who needs care because they are ill? We never say to anyone who needs physical or mental care on the NHS that they cannot have it, but we do say that to people who cannot take themselves to the toilet, bath themselves or take their medication. We would never do that with children, so why should we do it with the elderly and disabled?
I am clear that there is a cost; of course there is. I want to ask the Minister about some of the things he was saying earlier, and I hope that I get a response. What resources are we going to put in? If there are to be 100,000 apprentices, what will that cost? If there is to be a new code of conduct, what is the implication of that? If there is to be extra training, what will that cost? All those things are welcome, but if we are just going to talk about them and not resource them, we might as well not bother to talk about them.
I would like to have clear in my mind the issue raised by my right hon. Friend the Member for Oldham West and Royton (Mr Meacher). What is the difference between what is now proposed and the death tax that the current Secretary of State so cleverly used during the last election to undermine the stuff that my Government were trying to do? He talked then about £8,000 a year and a saving of £40,000 for everyone. That has all disappeared—it is all under the carpet. Did he mean what he was saying back then and does he mean what he is saying now?
Yes, if we are going to do this properly, there will be a cost—but we always find the cost of going to war and of extending the nuclear deterrent. In the past week, we have found the cost of taking 3,500 troops off duty to save the embarrassment of the Home Secretary. If we can do all that for those reasons, why can we not do it to take care of the elderly, vulnerable and frail in this country?
We were attacked by the Minister, who said that Labour MPs were moaning and whining on. That is part of the game that we play in this place, but what about what other people are saying? The Care and Support Alliance says that
“the social care system faces collapse”,
while the Alzheimer’s Society says:
“Millions of vulnerable people had been promised vital reform but today they are being massively let down.”
Mencap says:
“this promising blue print will never get off the ground if it fails to address the chronic underfunding in social care.”
Finally, the UK Home Care Association says:
“The Coalition Government’s White Paper has failed the frail and disabled”.
Those are those organisations’ words—not mine, and not my party’s.
Like other Opposition Members, I believe that the only real answer is a care system funded from general taxation. We have a generational chance to make this a crusade, just as 60 years ago people in this House made a crusade for the NHS. I know that some Government Members will say that that has been anathema, because ultimately the NHS—when we get down to the bare bones—is socialism in action. It is socialism delivering for the people of this country. What I want would be exactly that—the strong providing for the weak, not the weak being let down by the strong. We have the chance to do that. It is a challenge for this generation. The question for all of us on both sides of the House is: are we up for it?
Margot James
I am grateful to the hon. Lady for clarifying that. According to local government statistics, in the six years up to 2010, the spend was flat, and I have mentioned the demographic pressures. Interestingly, the same analysis states that over the same time, NHS expenditure rose by 27%, expenditure on the police rose by 20%, and even expenditure on schools rose by 12%.
A picture is emerging of the deprioritising of adult social care under the last Government. That is the origin of the problem that we are debating. That is what gave rise to the restrictions of the eligibility criteria for care. Long before this Government came to office, many local authorities started to restrict eligibility to those in moderate need of care and then to those in critical need of care.
Mr Anderson
I appreciate it.
May I suggest that in criticising the last Government, the hon. Lady needs also to look at the record of the Government before that? Throughout the 1980s and 1990s, the social care and health service budgets were drastically reduced to a degree that was an embarrassment to this country.
Margot James
I welcome the hon. Gentleman’s intervention, but I will move on to the present day, relevant though the NHS and social care budgets of 20 or 30 years ago no doubt are.
We are beset by problems, although I was pleased to hear the Minister confirm that according to ADASS, social care spending has gone down by just 1% in the past year. Given the incredibly difficult economic situation that we are in, much of which we inherited from the previous Government, that is an achievement. However, we do have problems.
People value their independence, and most older people want to stay in their own home. With the right support, many can. To a large extent, the White Paper proposals will provide the support that is needed to enable more people to stay at home. Carers are a vital source of people’s ability to maintain their independence at home, and the 5 million carers who do an incredibly important job in our country do not get enough support at the moment. I welcome the extra money that is being put towards enabling them to have respite, because carers tell me that a break is what they need first and foremost. I am sure that no amount of money would ever be enough to give them the breaks and support that they need, but at least the White Paper proposals will provide some support.
Many people do not realise that social care is means-tested until they get to the point in their lives at which they need it. That means that we need more information to be available. We need to be honest with people about what is possible, what is available and what is not. All Governments are guilty of putting the best picture forward, which is sometimes misleading. I applaud the Government’s decision to commit £32.5 million to improving information, but perhaps I can make a plea on behalf of some of my older constituents: that investment should not all be online. Many older people do not communicate in that way, so we must allow for some leaflets in GPs’ surgeries, libraries and day centres, and for other traditional forms of communication. Otherwise, we will make older people who do not engage with new media even more dependent on other people to get information for them.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I was heartened by some of what I read in the motion tabled by the Opposition. Welcoming the measures laid out in the care and support White Paper was a good start to a process that will be immensely easier with genuine co-operation and communication. However, the speeches from the Opposition Front Bench were partisan and contained no acknowledgement that for 13 years they did nothing. The hon. Member for Leicester West (Liz Kendall) seems to have amnesia. Cheap party political squabbling is not attractive. I remind the hon. Member for Hackney North and Stoke Newington (Ms Abbott) that she was very political by trying not to be political. I remind her also that 40,000 people a year had to sell their homes to pay for their care. It reflects badly on her and on the House and does nothing to improve the lives of service users, carers and staff. A White Paper seven days before the general election announcement counts for little.
Care has to be funded in a way that is fair on service users and fair on the taxpayer. We agree with Dilnot that financial protection through capped costs and an extended means test are the right basis for any new funding system. Given the extra public spending that will be involved, we need to consider that alongside other priorities. An issue that has been raised throughout the debate is the funding for the means-tested system. The right place—the responsible place—to consider that is in the course of the spending review and I do not intend to pre-empt that tonight. I draw hon. Members’ attention to the progress report. Many of the answers to the questions that they raise are included in that. The hon. Member for Hackney North and Stoke Newington would do well to refer to figure 4 in the report.
We have allocated an extra £7.2 billion to improve care and support as part of the spending review. That comes as part of what we know is a tough settlement for local government. If spent well, it will go far and will help local authorities maintain people’s access to care and support. The recent report from Demos and Scope shows that this can be done, and that reduced funding does not have to mean a reduced service. By putting more into reablement services that help people regain their independence, for example, or by supporting people to live in the community instead of in expensive residential care, local authorities can provide the best standards of care while saving money.
My hon. Friend the Minister of State mentioned the £32.5 million for better online services and traditional communication methods to help people see what services are available, whether their care is paid for by them or by the state. Likewise, there is an additional £200 million for specialised housing. That additional money more than pays for the White Paper proposals leading up to the comprehensive spending review. As my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) said, the issue was ducked repeatedly by the previous Government in far more favourable economic times. He also drew attention to the absurd distinctions between health and social care and the need for integration.
My hon. Friend the Member for Congleton (Fiona Bruce) spoke from the heart about the needs of carers, the £400 million we have provided for carers’ breaks and the end of permanent billing. My hon. Friend the Member for Southport (John Pugh) spoke of the contribution older people make and how to stop the fit becoming frail. My hon. Friend the Member for Stourbridge (Margot James) reiterated the ADASS figures and the desire for people to stay in their own homes. My hon. Friend the Member for Truro and Falmouth (Sarah Newton) spoke with passion and knowledge of the unity and commonality of purpose we need and the divisive nature of the Opposition’s motion. My hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) pointed out the huge need to address the needs of people with disabilities.
These are ambitious plans. As well as setting out a comprehensive package of reform for the longer term, the White Paper announces changes that will make a difference immediately: a national eligibility threshold; proper and meaningful portability; duties to share information to ensure that people can move without losing their care; a focus on housing; provider quality profiles so that people can finally have clear information on the quality of care providers; mandatory adult safeguarding boards; and a requirement to assess carers’ needs and actually meet them—much neglected help and support. It also announces a code of conduct and minimum training standards for care workers so that people know that their care is underpinned by high standards of training and ethics. We will train more care workers, with 50,000 more apprenticeships by 2017, double the current number.
Anne Milton
The hon. Gentleman should welcome that.
The White Paper opens for business the new national information website so that people can find out more about all parts of the care and support system. It sets out legal entitlements to personal budgets so that care users, their families and their carers can choose what services they get. There are improvements to the transition from children’s services to adult services. These are big changes, egalitarian changes and, most of all, they will be effective changes. We are also reforming the existing social care legislation through the draft Care and Support Bill. The White Paper is about keeping people well and helping them to take control, get independent and live the lives they deserve with the certainty and security they need to do so with dignity.
There are times when we, as politicians, need not only to open our eyes and ears to the world outside this House, but to stand in the shoes of those we represent. They do not want to see us argue, squabble and bicker over their lives. On this issue, perhaps more than any other, we need to work together. If we do that, we can improve the system for millions of people, whether they use the services or care for someone who uses them. The system is funded until the next spending review.
I urge Opposition Members and Front Benchers to put aside party political differences and work alongside us to ensure that we have a system that is sustainable not only for this year and next, until the next general election, but for the years ahead. Older people in this country, the carers who support them and people with disabilities deserve that. The White Paper gives us a foundation on which to work, a foundation that has been missing for far too long. In 13 years in government, in favourable economic times, those now on the Opposition Benches did nothing that was sustainable in the long term. We need a foundation that gives us a chance to build a care and support system that future generations will be proud of. I urge the House to reject the motion.
Question put,
Rare Disease Strategy
David Anderson Excerpts(12 years, 2 months ago)
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The Minister of State, Department of Health (Mr Simon Burns)
May I begin by congratulating my hon. Friend the Member for Crewe and Nantwich (Mr Timpson) on securing this debate on what is a most important topic for a great number of people, and on the sensitive way in which he outlined his concerns, particularly those that affect his family? May I also congratulate him on running the London marathon an hour and a half quicker than the shadow Chancellor?
As we have heard, anybody, at any stage in life, can be affected by a rare disease, which can range from manageable conditions that do not affect daily living to debilitating conditions that have a significant impact on one’s quality and length of life. The Government are committed to providing the best quality of care to people with rare conditions, and the importance that we attach to services for people with rare conditions is clearly demonstrated in the reforms we set out in the Health and Social Care Act 2012. Through the Act, specialised services, which are currently provided at both national and regional level through a range of NHS organisations, will be brought together under one roof. From April 2013, the new NHS Commissioning Board will directly commission services for people with rare diseases on a national basis.
My hon. Friend asks for an explanation of how the NHS Commissioning Board will operate to ensure cluster-type service delivery in respect of rare diseases. Moving to a national standard system of commissioning but maintaining a regional focus gives the geographical and speciality oversight that he describes. National specifications will lead to services being defined once for England, allowing clear planning to take place across the country.
Mr David Anderson (Blaydon) (Lab)
I congratulate the hon. Member for Crewe and Nantwich (Mr Timpson) on a fine speech. As the chair of the all-party parliamentary group on muscular dystrophy, may I ask the Minister about two connected points in respect of what he has just said? There has been a great development within neuro-muscular services and work by the House and the Department. Will the Minister meet the all-party group and the muscular dystrophy campaign to discuss the progress of the national neuro-muscular work plan? Will he also give us an assurance on the positive advantages in the south-west region—he mentioned regional development—and confirm whether there will be strategic clinical networks for neuro-muscular services across the country?
Mr Burns
I am grateful to the hon. Gentleman. I recognise the tremendous work he does in this area of health care and congratulate him on his efforts. With regard to a meeting, I will pass on his comments to my noble Friend the Earl Howe, who has responsibility for this area of health care. On the hon. Gentleman’s second point, I am more than happy to give him the assurances he seeks.
The proposed operating model for specialised commissioning links national service knowledge and expertise with local contract knowledge of providers and pathways of care, cementing the new system together in the interests of patients. The benefits to patients with rare conditions are clear: a single national commissioning policy and better planning and co-ordination will result in improved consistency across the country.
My hon. Friend asked me to set out the Government’s thinking on the suggestion from the former chief medical officer for a national clinical director for rare diseases. I can assure him that there will be a director within the NHS Commissioning Board with lead responsibility for specialised services for people with rare conditions. The board will also consider the most suitable form of clinical advice covering the domains of the NHS outcomes framework. Rare diseases come under domain 2: long-term conditions.
Our commitment to people with rare conditions is demonstrated through our recently published, “A UK Plan for Rare Diseases”. The consultation was launched on 29 February—Rare Disease day—and was produced jointly by the four nations of the United Kingdom. The consultation will continue until 25 May and is an important step on the way to producing the final plan. I urge everyone with an interest in this area of health care to contribute to the consultation process.
This will be the first time that the UK has developed a plan to tackle rare diseases, and the consultation represents collaboration across the four nations of the UK. It brings together a number of recommendations designed to improve the co-ordination of care and to lead to better outcomes for people with rare diseases. We suggest that improvements can be made through earlier diagnosis, better co-ordination of services, stronger research and better engagement with patients and their families. Many of these recommendations will be of direct benefit to patients and can help the NHS to be more efficient and co-ordinated and to save money.
Earlier diagnosis through clear care pathways to expert centres can prevent disability, and in some cases save lives, by allowing an earlier start for effective treatment. It will also save money by avoiding more intensive or emergency treatment. More co-ordinated care saves patients’ time, money and stress by avoiding multiple visits to various clinics. As many rare diseases are of genetic origin, we must also embrace advances in genetics and genomic medicine and ensure that the NHS is ready to support and take full advantage of these developments.
My hon. Friend has already mentioned that people with rare diseases need to be able to access orphan medicines. Our priority is to give NHS patients better access to the innovative and effective drugs that their doctors recommend for them, including those designated as “orphan drugs”. The new system of value-based pricing will bring the price the NHS pays for drugs more in line with the value it delivers. Notwithstanding this, we know that there may be instances where an individual medicine should not be assessed under value-based pricing. We will keep the situation under review. If, as we begin to implement value-based pricing, it becomes clear that some treatments would be better dealt with through separate arrangements, we will explore alternative options.
The consultation document sets out a coherent approach to tackling rare diseases. It recognises existing developments while setting out a number of further developments, such as on better information for patients to help them manage their condition. My hon. Friend asked for reassurance that we are putting steps in place in preparation for the introduction of the international classification of diseases—ICD-11. I can assure him that the NHS is moving towards widespread use of systematized nomenclature of medicine clinical terms—Snomed CT—in preparation for the introduction of ICD-11.
The consultation will inform the final UK plan for rare diseases. We hope that the final plan will offer a framework for managing rare diseases wherever they occur. Each nation of the UK will then take forward implementation of the plan in accordance with its own priorities and patterns of service. In England, much of the implementation of the final plan will be for the new NHS Commissioning Board to take forward, in close dialogue with Public Health England.
As my hon. Friend will appreciate from my comments in this relatively short but important debate, he has raised an extremely important issue that all too often is forgotten in the mainstream of the NHS, where people concentrate on more acute services, rather than this highly specialised area. My hon. Friend the Member for Stourbridge (Margot James) mentioned a particular illness or condition. May assure her that following her intervention, I will ask my noble Friend the Earl Howe to write to her about the issue she raised?
In conclusion, the development of the first ever UK plan is an important signal of our continuing commitment to providing good quality services to people with rare conditions. The consultation is aimed at a wide audience, including not just clinicians and NHS specialised commissioners, but patients, their carers and families, support groups, specialist organisations, researchers, academics and colleagues from across social care. I call on all hon. Members to encourage their constituents with an interest in rare diseases to take part in this important consultation.
Question put and agreed to.
Health and Social Care Bill
David Anderson Excerpts(12 years, 4 months ago)
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Mr David Anderson (Blaydon) (Lab)
This debate is about contempt—for the Information Commissioner, for the tribunal, for the people who signed the e-petition, for the public who have contacted hon. Members in their hundreds of thousands and for the principle of transparency. For years, we had lectures from the Conservatives and Liberal Democrats when they were in opposition, when they said that sunlight was the best light.
We should not be surprised, because the whole debate on this Bill has been about contempt, starting with the contempt for democracy. The Government have no mandate, no support and no truth—the Conservatives promised no top-down reorganisation. The Conservatives and Liberal Democrats were not straight with the people, but why not? I hate to disagree with my right hon. Friend the Member for Wentworth and Dearne (John Healey), but this debate is political. The Conservative party has always opposed the national health service, because it is the living example that collectivism works. Conservatives oppose the NHS because they are against collective provision.
The hon. Member for Southport (John Pugh), who has tried his best to make something out of this mess, was right when he told the Liverpool Daily Post a number of weeks ago:
“If the Conservatives had gone to the country at the last election and said ‘we want a market-based health system’ they would have lost the election badly.”
The Conservatives knew that, which is why they covered it up.
The Government have shown contempt for the House, because even before they reached for the pause button, changes were taking place. Before we have even agreed the Bill, they have all but abolished 151 primary care trusts, with tens of thousands of people being made redundant. They are being replaced by 279 clinical commissioning groups, and strategic health authorities have been set up.
The new national commissioning board, which has not yet been agreed in law, has already got a chief executive, a finance director and seven board members, recruited at salaries of up to £170,000. That is before we have even passed the Bill. If that is not contempt, what is?
Worst of all is the Government’s contempt for the people to whom we look to deliver our services. The Government say, “We know best,” but anybody who was in the Chamber last week to hear the Government’s contempt for the work of Dr Chand, who did his best to ensure that the House looked again at the Bill, will know how the Government feel about health workers in this country.
Who are these people who know so much better than the doctors, nurses, general practitioners, consultants, radiographers, occupational therapists and porters? What is their background? There are researchers, a teacher, and a sales and business manager. In the Lords there are former Army people, journalists, lobbyists, MEPs and researchers, and people who worked at Tory HQ. Do they all know so much better than the people to whom we and the people we represent turn every day of the year to take care of us?
Who is against the Bill? Almost everybody, including the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, the Royal College of Radiologists, the Royal College of Physiotherapists, and the Royal College of Paediatricians and Child Health, the Faculty of Public Health and the GPs. I could be here all night going through the list, but the Conservatives and Liberal Democrats know it.
Susan Elan Jones (Clwyd South) (Lab)
There was one small omission from my hon. Friend’s list of the many opponents of the Bill: the agent of the right hon. Member for Bermondsey and Old Southwark (Simon Hughes), who is also deputy leader of the Liberal Democrats. Mr Gary Glover, on his Twitter account, said:
“Lib Dems have accomplished almost nothing on the NHS Bill.”
Surely the truth is that Lib Dems could accomplish rather a lot, because they could help us to defeat the Bill tonight.
Mr Anderson
My hon. Friend is absolutely right. As an eternal optimist, I continue to hope against hope that the Lib Dems will see the light tonight, but my guess is that they probably will not. They have shown contempt even for the democracy within their own party. They claim to be determined to be bound by the democratic decisions of their own party. They have not been. They have ignored their party. When they came to Gateshead two weeks ago, they said they would stand up to the Bill, but they have not. It is the double-talk and spin that we are all used to.
Two days ago, I visited my general practitioner, and on his practice nurse’s wall was a poem by Michael Rosen, the children’s poet laureate, who, in 2009, wrote a poem called “These Are The Hands”. It read:
“These are the hands
That touch us first
Feel your head
Find the pulse
And make your bed.
These are the hands
That tap your back
Test the skin
Hold your arm
Wheel the bin
Change the bulb
Fix the drip
Pour the jug
Replace your hip.
These are the hands
That fill the bath
Mop the floor
Flick the switch
Soothe the sore
Burn the swabs
Give us a jab
Throw out sharps
Design the lab.
And these are the hands
That stop the leaks
Empty the pan
Wipe the pipes
Carry the can
Clamp the veins
Make the cast
Log the dose
And touch us last.”
These are the people we should have been listening to. These are the people who have been ignored constantly by the Government parties. And these are the people who will never ever forgive them for what they are doing tonight. When the election comes, they will be thrown out where they belong.
Dr Wollaston
Listening to Labour and seeing the extreme shroud waving that has been going on is, frankly, enough to give anyone a headache. I took the Ibuprofen because of what I read in the impact assessment. The impact assessment presents a sensible, balanced portrayal of the realistic risks and benefits, and warns me of many points of which I need to take heed. It is far more likely that I am going to develop indigestion from taking Ibuprofen than that I am going to collapse from a fatal skin reaction.
Health and Social Care Bill
David Anderson Excerpts(12 years, 4 months ago)
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Andrew George
The right hon. Gentleman is aware that the conference was advisory on the issue. The motion before it actually congratulated our noble Friends in the House of Lords on having achieved significant amendments to the Bill. They have made the Bill less bad but not good enough to make it acceptable to myself—or indeed to many of my colleagues.
The right hon. Gentleman knows very well that Liberal Democrat Ministers and others cannot vote against the Government, so it is not very helpful of him to try to tease out such a situation. The pressure on those who are not so constrained has, however, been lifted.
Mr David Anderson (Blaydon) (Lab)
For the purposes of clarification, would the summit that the hon. Gentleman’s amendment puts forward include the trade unions? If not, why not?
Andrew George
The summit should be as inclusive as possible—so that there is no sense of it being exclusive. The professional bodies and patient organisations in the amendment would be included as well, so I hope that the hon. Gentleman is reassured on that point.
I congratulate my colleagues in another place on what they have achieved, but underlying that is a concern about the role of the private sector. Serco in Cornwall provides an important out-of-hours service, but there are serious concerns about how the service is being run, and I have raised concerns about that over the past year. The Secretary of State has pointed out that the contract was let under Labour, but even so we can learn lessons from the previous Government’s failings on letting private sector contracts, and there are issues, which I shall take up with the Secretary of State, in that regard.
The purpose of the amendment is to ensure that the debate calms down and becomes less tribal, so that people can speak more freely and the Government can reflect on the fact that the Bill has less support than it did when it started. Support is ebbing away, and opposition to it is increasing even at this stage.
Chris Skidmore (Kingswood) (Con)
It is an honour to speak in this debate.
I thought that I should set out the context of our discussion. Members on both sides of the House have talked about demand, in particular, and it is important to look at that question. Most importantly, we must admit that the NHS needs to adapt under new pressures. In 2001 the NHS treated 12 million patients. Today that figure is 17 million, so in other words the number of people accessing the NHS has risen over the past decade from 101 per minute to 124 per minute, resulting in the cost of drugs and prescriptions rising by more than 65%.
Chris Skidmore
No, I will not. The right hon. Member for Leigh (Andy Burnham) did not give way to me, I am afraid, so I am not feeling too charitable.
Despite the coalition Government’s added investment of £12.5 billion over the course of this Parliament, demand will only rise further, with 1.6 million people turning 65 in the course of this Parliament and many living into their 80s and beyond. The number of 85-year-olds will double by 2030. The NHS is facing a perfect storm—an ageing population combined with a rise in chronic conditions, including an increase in diabetes, which will take up as much as 25% of the health budget. That is why we are reforming the NHS. Just as this Government are committed to dealing with the deficit so that future generations will not be burdened with debt racked up yesterday, we must be committed to reforming the NHS so that future generations can enjoy an NHS that is free at the point of delivery regardless of the ability to pay. I am sure that that is what everyone in this House is committed to.
By placing GPs rather than management in control of patient treatment, we will not only drive up standards of care, allowing patients access to more treatments under any the qualified provider scheme, but ensure that recurrent cost savings are made to be reinvested in the NHS to cope with the rising demand. Above all, this is an evolutionary measure. My right hon. Friend the Member for Charnwood (Mr Dorrell) touched on the Blairite doctrine. It was a pleasure that we had Professor Julian Le Grand come to the Health Committee, where he said that if Tony Blair were still Prime Minister and he were advising him, he would have urged him to undertake this measure. It is great to see the right hon. Member for South Shields (David Miliband) in his seat. It would have been fascinating to see what would have happened if he had become leader of the Labour party. I am sure that we would not have seen the rank tribalism that we have seen from those on his Benches today.
NHS Risk Register
David Anderson Excerpts(12 years, 5 months ago)
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Mr David Anderson (Blaydon) (Lab)
I apologise for my earlier absence. I was speaking in a debate in Westminster Hall.
Today’s debate is not just about reform of the health service; it is about democracy, accountability and transparency. For long periods during the last Parliament, the Labour Government were challenged by Members then sitting on the Opposition Benches to initiate an inquiry into what had happened in Iraq. Those Members were right to challenge the Government over what they had done. Ultimately, after the troops had come home safe and sound, the inquiry took place, and we await the results. The Government were wrong to resist the calls for an inquiry at that time, and we should have got it right.
Similarly, as was pointed out earlier, the expenses debacle showed that Parliament as a whole had got it wrong in trying to hide information from the public. The public did not forgive us for that. One of the main reasons Members such as me are sitting on the Opposition Benches today and not over there is the fact that the public did not trust us because of the way in which we had mishandled that debate—and out of that debate came the position of the coalition in regard to transparency.
On 21 May, the Prime Minister said:
“Greater transparency across Government is at the heart of our shared commitment to enable the public to hold politicians and public bodies to account.”
The coalition agreement said:
“The Government believes that we need to throw open the doors of public bodies, to enable the public to hold politicians and public bodies to account.”
In December last year, the Deputy Prime Minister said:
“The third characteristic of an open society is the sharing of knowledge and information. In a closed society the elite think that, for the masses, ignorance is bliss. But in an open society there is no monopoly of wisdom. So transparency is vital.”
Why, then, are we having this debate? If transparency is so vital, why is the risk register not being published? The Government parties are aware of the strength of feeling in the country. The findings of a YouGov poll, published two days ago, showed that 68% of people in the country wanted the register to be released; that 80% of Liberal Democrat voters—that will be only a small sample, of course, because the Liberal Democrats do not have many supporters—wanted it to be released; and that 62% of Conservative voters wanted it to be released.
So what is this about? The hon. Member for Southport (John Pugh), who is sadly not in the Chamber now—although he has been present for most of the debate, unlike his colleagues—got it right when he said, according to the Liverpool Daily Post last week:
“If the Conservatives had gone to the country at the last election and said ‘we want a market-based health system’ they would have lost the election badly.”
That is the truth. This is a smokescreen: it is about detoxifying the Tory brand on the NHS. To give credit where it is due, the public relations master, the Prime Minister, got it absolutely right: he sold the people of this country the PR view that everything would be okay, and said that the NHS would be safe in his hands. He sold the people of this country a pup. It was a PR stunt backed by the coalition partners, who must wake up and realise that they have a responsibility in the House to put that right. There is absolutely no mandate for this piece of work. They told the people of this country that there would be no top-down reorganisation, but that is what is going on.
The coalition partners told the people of this country that the previous Government had failed on the NHS, despite the fact that 1 million people are treated every 36 hours; despite the fact that people across the country are living much, much longer than they were 20 to 25 years ago; despite the fact that satisfaction was at an all-time high; and despite the fact that we had persuaded the people of this country that it was worth saving the health service and putting in three times the amount of money that was paid into it previously. The myth that productivity did not go up under the previous Government was blown away by reports in recent weeks, so at every level, the Government have been proved wrong.
What do the Government do when they are challenged? They begin to blame the trade unions. I want to tell the House something about the trade unions. By and large, the vast majority of people in them are front-line health-service staff, including full-time officials in the unions which I am proud to belong to: in Unison, the deputy general secretary is a theatre orderly. The head of the health section was a nurse for many years; the head of nursing was always a nurse. In the Royal College of Nursing, people have to be nurses to get a job. The important people, who make trade union policy, are hands-on people who, day in, day out, and night in, night out, go into hospitals and other places where care is delivered, so they know exactly when we get it wrong.
The Government got it wrong on something else. From 1992 onwards, the unions advised the last but one Government and my Government that they had got it wrong on the private finance initiative. Last year, it was proved by a national audit that PFI had been a disaster. If the then Government had listened to the unions in 1992, we would not be here, but the option now for the people in the bunker is not to discuss the matter with the trade unions. That is a disgrace, and we should all support the motion today.
NHS (Private Sector)
David Anderson Excerpts(12 years, 6 months ago)
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Mr David Anderson (Blaydon) (Lab)
The manifesto that we put together in 2010 did not envisage a health service where the Health Secretary had given up control. It envisaged a health service where the Health Secretary would still have control and could set a cap for foundation trusts.
Andy Burnham
That is absolutely the point. The Government want to create an NHS where Ministers can no longer say what can or cannot be done, so we have GP practices, such as Haxby in York, sending letters to their patients saying, “We have decided that we are not going to fund your minor operations any more, but by the way, we are now providing those operations. Here’s our price list.” That is absolutely disgraceful, but it is a glimpse of the NHS that will emerge if the Health and Social Care Bill goes through. My hon. Friend is absolutely right: we must consider the wider context, within a system with competition at its heart and where every hospital is on its own and they are fighting each other. That is the context in which this 49% proposal needs to be considered. It represents a break with 63 years of NHS history and a “genie out of the bottle” moment. That is why we ask the House to reject it.
Mr David Anderson (Blaydon) (Lab)
The NHS is rightly the most valued institution in this country. It has an impeccable track record of continuing improvement and innovation going back more than 60 years. The staff on the front line and those in the support services who are disparaged by Conservative Members as somehow irrelevant to the success of the service have never been frightened to face up to the challenges of change. They are, however, sick and tired of the constant demands of know-it-all politicians on all sides for endless reorganisations, restructuring and re-profiling. That is why they were so disappointed after the Prime Minister had told them that there would be no more top-down impositions from on high; they and the British public were, quite simply, misled.
The fears around privatisation are a reflection of yet another change to the structure of the NHS, and it is a very unwelcome one. The Secretary of State tried to rubbish the trade unions tonight. He did not mention all the other professional bodies in the NHS that are opposed to the changes. The only people who seem to be in favour of them are those in the Tory party, and their friends in the Liberal Democrats. None of the people who are delivering the services want the changes to happen. That includes the GPs that the hon. Member for Crawley (Henry Smith) was talking about. They might well be doing good work in Crawley, but the key is that they do not want to have to do it in that way. The general public are also worried about the changes.
The Secretary of State said that we should not look back, but if we do not learn the mistakes of history, we will repeat them. We need to look at the situation that prevailed a long time ago. The working people in this country in the first half of the last century were desperate for a health care system. People came back from the devastation of world war one to a worldwide influenza epidemic. They were living in desperate conditions and working in massively unsafe workplaces. They were bringing up families whose lives were blighted and shortened by the diseases of poverty: tuberculosis, rickets, malnutrition and pneumonia. Their conditions of life at home and at work had changed little since the days of Dickens, yet we saw yet another world war where money that could not be found to build a decent society in peacetime was miraculously produced to kill millions in wartime.
At the end of that war, the men and women of this country were determined not to continue with that and were not going to put their faith in a Government and a private sector-driven economy that had failed them so badly. They turned instead to a Government who, despite the biggest debt crisis ever, determined that the health and well-being of this country’s people was paramount. That is why Labour built millions of homes for people, why swathes of industries that had been disgracefully run down by the private sector owners were nationalised, and why we, the Labour party, built the NHS to ensure that never again would the quality of a person’s health care depend on the depth of their wallets.
People quite rightly felt bitter about the way they had been treated for decades. That was perhaps best summed up by Nye Bevan, who set up the NHS, when on 4 July 1948, two days before the NHS came into being, he said:
“no amount of cajolery and no attempts at ethical or social seduction can eradicate from my heart a deep burning hatred for the Tory party that inflicted those bitter experiences on me.”
As expected, the Opposition did not like that, and Mr Churchill labelled Mr Bevan “the Minister for Disease”. Equally as expected, Nye Bevan was having none of it. Speaking from the platform of the Durham miners’ gala, he reminded people of the reality of life under Tory rule when he said—
Chris Skidmore
The hon. Gentleman is quoting history, so I wonder whether he would agree that Nye Bevan could be seen as the pioneer of private sector involvement within the NHS, given that he accepted that more than 4,000 pay beds should be part of the NHS in order to ensure bags of investment in facilities?
Mr Anderson
Of course, the reality is as envisaged by my right hon. Friend the shadow Secretary of State, who has accepted that there is a role for the private sector within the health service, but the debate is about how big it should be and how much control there should be of the health sector. [Interruption.] May I carry on?
As I was saying, Nye Bevan responded to Churchill’s criticism by saying:
“Who should be called the Minister for Disease? I am keeping mothers and children alive when he half starved them to death.”
That is the legacy with which the Conservative party is lumbered. It is the burden round the neck of Conservative Members when the people of this country get worried about private involvement in health care. I have no doubt that Conservative Members will not agree with me, but it was right and proper when my right hon. Friend the Member for Leigh (Andy Burnham) drew an analogy between this privatisation and that of the utilities. We should look at the results of those privatisations: unfettered and uncontrolled expansion, with our energy supplies now controlled by foreign companies; huge, uncontrolled price increases; millions of people in fuel poverty; no control over the security of supply; a national grid not fit for purpose; and an incoherent strategy to face up to the challenge of climate change. Those are all the result of giving away our vital services to the highest bidder. People are quite right to say, “Why would it be any different in health?”
The people of this country do not want the NHS to become a copycat version of the American model—a model that costs twice as much as ours to run, yet leaves 20% of the population out in the cold when they are ill. Our NHS has a tremendous track record, dealing with millions of people every week. Our life expectancy levels have risen rapidly, especially over the period when the previous Government reversed the years of underfunding that were the trademark of the last Tory Government. Public satisfaction rates were at record levels when we left office 18 months ago.
This present Government have broken their promise to the British people. They have lied to the staff who work magnificently to deliver our NHS. They are intent on breaking up the NHS and replacing it with a system based once again on a programme that puts profits before patients. If Conservative Members really believe in privatisation, they should ask the people what they want. The people have woken up to the reality of the Conservative party; they realise that once again the NHS is not safe in Tory hands—even though they are wearing the yellow gloves provided by the Liberal Democrats. Patients, as the figures clearly show, want no further privatisation of our NHS.