Social Care Services

David Anderson Excerpts

Tuesday 17th May 2011 Westminster Hall

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

It is a pleasure, Mr Brady, to serve under your chairmanship. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this morning’s debate, which concerns an incredibly challenging and complex matter.

I am concerned that few Government Members are here today, so I congratulate the hon. Member for Newton Abbot (Anne Marie Morris) on attending. That makes me think that we are not all in this together, and it seems that only Opposition Members wish to represent their constituents on this matter.

I wish to contribute to this debate specifically on the standard of care being provided to vulnerable elderly people. I recently participated in a series of hard-hitting reports by Tyne Tees Television’s “North East Tonight” programme. Tyne Tees’s findings on the standard of care provided in some care homes in the north-east were distressing and disturbing, and I am pleased to have the opportunity today—again, I thank my hon. Friend for securing the debate—to highlight some of those concerns and present them directly to the Minister.

I must point out that there are some fantastic care homes in the north-east and that they have some dedicated staff and carers. However, the “North East Tonight” reports were timely, being broadcast in the same week that a paper by Newcastle university’s institute for ageing and health predicted a care home crisis unless there is major investment in the care system to support the rapidly increasing number of elderly people.

In 2010, there were 2.6 million people aged over 80, but by 2030 that figure is expected almost to double to 4.8 million, with one in five needing regular care. The Newcastle university paper predicted that there will be an 82% increase in the number of care home places needed—that is 630,000 extra places between now and 2030 just to cope with the demands of an increasingly older population.

In its investigations, Tyne Tees uncovered reports of former care-home workers who were forced to leave their jobs. Those workers were given bad references, which make future employment in the sector difficult, because they had blown the whistle on the unacceptably poor standards of care. That included lifting the lid on cases of dangerously poor hygiene, of residents not being fed properly, of a lack of interaction between staff and residents and of a total lack of stimulus for the people living there. The investigation also uncovered cases of appalling neglect of vulnerable care-home residents—according to relatives, it was often because there were simply insufficient staff on duty to ensure that their loved ones’ needs could be properly taken care of.

Tyne Tees also reported that many relatives were afraid of reporting concerns about the quality of care being provided, because they thought that it might put their loved ones in greater danger. It is understandably difficult to complain about the poor standard of care being provided for a relative when, in the first instance, the complaint has to be made to the people who are providing it.

Tyne Tees invited me to view its findings. What immediately struck me, as a mother of young children, was the contrast between the standard of care provided to young children in child care settings and the standard of care provided to vulnerable elderly people in care homes. If Tyne Tees had uncovered similar cases of neglect and fear of whistleblowing in nurseries in the north-east, I am sure that there would have been a national outrage, and rightly so, yet the treatment of older people is too often shamefully brushed under the carpet.

The Tyne Tees series of reports received unprecedented feedback through e-mails and Facebook comments, and people wrote to Tyne Tees to back up its findings and report similar concerns. That shows the level of concern across the north-east—and, I am sure, across the country—about the situation.

I recently had to intervene in support of a family seeking help for Jessie Wiseman, an elderly constituent. She is 91 and blind, and she was found living in squalor after ambulance workers paid a routine visit to her property. Despite concerns having been raised by her GP and her son about Jessie’s deteriorating condition, social care workers failed or act and she rapidly declined. That is why I welcome the recommendations in the recently published Law Commission report to introduce a set of statutory principles, a statutory basis for adult safeguarding boards and a duty on councils to assess carers and investigate adult safeguarding cases.

[Mr David Anderson (Blaydon) (Lab)]

Is it not the case that the failings in adult care have gone on for a long time, because, unlike child care, it has never had a statutory basis? In arguing for such a basis to be put in place, we may find that the Government say that this is just more red tape and bureaucracy.

[Catherine McKinnell]

I agree that that is a great concern, which is why the Minister must take on board the deep concerns that are being expressed today. In any event, reforming the law will still not be enough.

I am pleased that, as a result of the Tyne Tees investigation, the Care Quality Commission has agreed to review its reports and to conduct unannounced assessments on the homes in question. However, I am concerned that it appears to have required a television programme to spur the Care Quality Commission into action. By placing their loved ones in residential care, people are putting huge amounts of trust in a service. They rightly expect that the Care Quality Commission is adequately monitoring, regulating and inspecting all care homes on a frequent basis.

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

It is a pleasure to be serving under your chairmanship, Mr Brady. I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing this debate, which is timely not just because of the demonstrations that we saw outside this place last week, but because we are in the pause before the Health and Social Care Bill comes back to Parliament. This debate is also a matter of great personal passion. In 1989, thanks to the behaviour of a previous Tory Government, I lost my job in the coal industry and had to take up a job in care. Although I ended up in that sector almost by mistake, it was one of the best things that ever happened to me. I met some fantastic people who were dedicated to taking care of the frail and vulnerable people in the city that my hon. Friend represents. Sadly, in the early 1990s, a lot of that care, commitment and dedication was lost. A series of cuts from the national Government decimated the care services across the whole country, and we see the same happening today.

I hope that the Health and Social Care Bill will be withdrawn in its entirety. Despite what they say, it is clear that the Government are leading us to a privatised NHS. The experience of social care should show us what happens when we put services out to the private sector. We are told that the White Paper has been delayed. There may be some last-minute qualms from the Government about how far they can go against public and professional opinion. I am surprised that the pause has happened now, because public and professional opinion has always been against this Bill, even when it was first announced. Perhaps that opinion took a while to sink into the minds of the Government; it certainly did not immediately sink into the minds of the Liberal Democrat members. It clearly has now, and thank God for that. I hope that the Minister, along with his colleagues in his party, will work with other people across society to ensure that the Bill does not go any further and that we do not see the same damage to the health service that we have seen to the social care services.

Research carried out by Unison suggests that, if recent trends continue, the last council-run residential care homes will have closed in 15 years’ time and there will be no local authority-employed home care staff left by 2020. That is part and parcel of this Government’s drive not just to boost the private sector but to deconstruct public sector provision and give councils less and less responsibility. The anti-public sector phalanx in the Cabinet will, I am sure, be happy to see that happen and it will celebrate the disappearance of council-run services. It will argue that the private sector always performs better, despite the fact that that has not been shown to be the case.

[Alex Cunningham]

My hon. Friend is talking specifically about local authority provision of care homes. Is it not more important that we invest in extra care facilities and that we work with elderly people so that they can live in their own homes, because that is what the vast majority of them want to do?

[Mr Anderson]

I agree with my hon. Friend. My own personal experience was in a purpose-built site that did just that. We took in people for a week at a time for respite and we also provided day care, but the individuals all lived in their own homes. Although that was cost-intensive in labour terms, the quality of care was good. We took care of not just the individual but the needs of the family, and we built very close working relationships with them. If we want to have quality care in this country, we must bite the bullet and accept the fact that we have to pay for it. The previous Government accepted that if we wanted quality health care, we had to increase the public payment into it.

[Catherine McKinnell]

In my contribution, I highlighted the worrying case in my constituency of Jessie Wiseman whose care at home was contracted out to a private care provider. Some 15 visits took place over eight weeks before she was discovered in an appalling state. However, the local authority took no responsibility for it. This story feeds into the debate on the worrying trends that can take place when services of this nature are put out to the private sector.

[Mr Anderson]

The privatisation of home care services in this country has been a complete failure and a nightmare. I have represented home care workers for many years and have seen the service deteriorate. We had a dedicated work force who had a set list of clients whom they went to see day in, day out. They built a relationship with that person and their family. When those jobs were contracted out, it was said, “We will send worker A on this day and worker B on that day.” The home care worker lost that direct link with not just the family but the wider team within the authority. That team would work together and take a holistic view and work better for the person concerned. It is clear that services are being contracted out to save money. If we save money, services will not be as good.

It is clear that we will see problems being stored up if we lose public sector capacity in home care services. At the moment, some 31,000 residents are being taken care of by Southern Cross Healthcare. Their homes now hang in the balance as a result of reckless business practices and local commissioning, which has allowed the organisation to become so dominant in the market. Southern Cross and Four Seasons—the big two in residential care—have operated casino-style finances, and both are now teetering on the brink of collapse. A toxic cloud, formed by irresponsible borrowing, weakening demand, council cuts, the slump in care home property values and the collapse of favourable credit facilities, now hangs over the heads of frail elderly people and their families at a time of insecurity and when they need real security.

How has it come to this? How has RBS, a state-owned bank, become the biggest shareholder in Four Seasons in exchange for writing off debts of £300 million? Would taxpayers’ money not be better spent directly on care homes run by democratically accountable councils, rather than being tied up in byzantine financing arrangements?

Across the social care market, research by Community Care suggests that one in five providers expect to go out of business in the next financial year. The regulator describes the home care market as a cottage industry of small, often barely viable providers alongside a few giants such as Care UK, whose chairman kindly provided £21,000 to fund the personal office of the Secretary of State for Health—perhaps that is one reason Care UK is doing so well.

If Southern Cross, Four Seasons or indeed local providers collapse, how will local authorities find new homes for people when they no longer run them? When home care providers default, as they often have and might in future, how will local authorities fill the gap if they have scrapped their own home care teams, which is happening up and down the country?

What about the quality? Care Quality Commission data show that privately provided care services are less likely to be rated “good” or “excellent” and five times more likely to be rated “poor”. I know that the Government do not like targets or standards, but when their own commission is saying such things its message should be listened to. Private providers consistently score lower on a range of indicators of quality and safety. When we look at the employment practices of some providers, we cannot be surprised that home care workers do not stay in their job. They are not paid for their travel time between visits, and they have to provide their own mobile phones and pay for their uniforms. They suffer from underpayments; they often have zero-hour contracts; and they sometimes have to pay towards the cost of administering their own time sheets. No wonder people do not see it as a job for the future or a career that it is worth investing their time and talents in. We need real regulation of employers to stamp out employment practices that have impacted so badly on home care users and, through them, on staff.

Where are we today? We have a Government who want more from staff for less; who want more work by fewer staff, because they are making 500,000 public sector workers unemployed; who want more pension contributions from less pay and for poorer pension provision; and who want people to spend more time at work by making, in particular, women work until they are 66 years old, with less time at home and in retirement.

What did we get last week? The Chancellor has a new red tape initiative. What is he going to do when people are losing their jobs? If there is a chance of redundancies being managed sensibly, what does he talk about? He wants more chances of people being sacked, with less chance of real support by limiting the time to consult. People will have more chance of being made redundant and less legal support to challenge decisions taken by their employer.

The CQC sees a vacuum in regulation and in the checking of safety and quality of care. The CQC’s risk-based approach is resulting in a dramatic drop in inspections. A freedom of information request by Community Care found a 70% drop in CQC site inspections in the past year alone, at a time when more people are in need of care.

[Anne Marie Morris]

I thank the hon. Gentleman for being so generous in giving way. The statistics are interesting, but care homes in my constituency of Newton Abbot complain that more visits are being made. I spoke to the CQC just this week and it said that it was making on-site visits to every home within its purview in the south-west. There might be a regional difference, but in the south-west, where there are a huge number of elderly people, the number of visits is going up, not down.

[Mr Anderson]

I thank the hon. Lady for that. More inspections are good: we want inspections that work; otherwise, we will get into the problems that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) mentioned.

Staff and service users fear that there is an over-reliance on provider self-assessment and secondary sources rather than direct inspections. There are fewer indicators and data sources for adult social care providers than there are for NHS providers, yet the methodology is common. Alongside a “lighter touch” approach from the regulator, local authorities are cutting quality assurance departments, which, as Community Care showed, means fewer local checks on the quality and safety of care being provided.

Some of the changes that the unions and workers at the CQC would like to see, which I agree require serious and urgent consideration, include reinstating and strengthening the requirements on the types of incidents and issues that must be reported to the regulator. These should again include medication errors, significant injuries, accident and emergency admissions, safeguarding referrals, matters where staff are subject to disciplinary action or dismissal and unusually high staff turnover. Those are all indicators of things that might be going wrong, but they are not being recorded as they should be. A minimum frequency should be set for how often a service is visited.

I have no doubt that the hon. Member for Newton Abbot (Anne Marie Morris) is correct about the experience in the south-west, but it should be replicated across the country because it would give people greater confidence that things were being done properly. There should be a greater range of tools so that service users and employees can make their concerns known to people who can affect outcomes. We want to encourage people who want to blow the whistle where necessary, and give people whose relatives are in care confidence that, if they make a genuine complaint, the care will not be reduced.

I hope the Minister will look at my points, provide answers on the failures of private adult social care providers and say whether anything can be done to make the CQC more representative. For years, adult social services have been regarded as the Cinderella service, which is a disgrace. People are in care not because they want to be but because they have to be, so I hope we will work together to try to make adult social care something this country can be proud of.

--- Later in debate ---

[Paul Burstow]

I have rehearsed some of the findings from the ADASS survey, which shows that although the changes are tough, they are not as unprecedented as the past 13 years of experience would suggest.

The hon. Member for Blaydon talked about the mixed economy of provision in social care and lamented the passing of a time when a public service offer was the almost exclusive way in which social care was provided. He harked back to a golden age that has passed and that may never have truly existed. I am not certain whether I heard him describe a solution or route map that would get us back to the past that he hankers after. If he has one, perhaps he would share it on another occasion. He also talked about Southern Cross. As a Minister, I am, of course, only too well aware of the issues with which that company is currently grappling. Above all else, I am concerned to safeguard the interests of the residents who live in those homes. That should be on our minds whenever we talk about Southern Cross and its prospects. We need to ensure that we secure its future for its residents.

[Mr Anderson]

I agree with the Minister entirely. I also agree that the previous Government did by no means get things right for 13 years, which is also true of other previous Governments. My worry is that we are being railroaded by a cuts-led agenda. In the past, we at least had a safety net of council provision, but that will no longer exist. Therefore, when organisations such as Southern Cross go belly up, there will be no one to pick up the pieces.

NHS Reform

David Anderson Excerpts

Monday 4th April 2011 Commons Chamber

[Mr Lansley]

Yes, I do join my hon. Friend in applauding the Great West commissioning consortium, because it and others across London are demonstrating that instead of having the top-down diktat of how services should be changed in London, they are in the process of designing, from the point of view of the populations they serve, what the requirement is for them and their services in their area. That is a better and more sustainable basis on which to design community-led and primary care-led services for the future.

[Mr David Anderson (Blaydon) (Lab)]

This debate was confused before today. Can the Secretary of State put in writing exactly what things will be put on hold and what things will carry on? For example, he said that he is taking a natural break but GP commissioning groups can still continue to be set up. If the natural break is a good idea, surely that is a pointless exercise.

[Mr Lansley]

No, the hon. Gentleman misunderstands. I was very clear in my statement and in subsequent responses to questions. Right across the country, there are thousands of people who are developing the pathfinder consortia, taking NHS trusts through to foundation trust status, and building the health and well-being boards and new public health structures in local government. They should be confident in doing that, because the Government continue to be committed to achieving those changes. In the process of doing so, we will engage with them to ensure that the legislation specifically gives them the support that they need.

NHS (Public Satisfaction)

David Anderson Excerpts

Wednesday 30th March 2011 Westminster Hall

[Tony Baldry]

Again, that is a slightly bizarre argument from the hon. Gentleman. There has been much talk about competition in the NHS, which is surprising as the Labour party appeared to be in favour of competition in its own election manifesto. The coalition Government have made it clear that the only competition that will exist in the NHS is competition on quality, not price. The Secretary of State could not have made that clearer in the House when he said:

“At the point when a patient exercises choice or a GP undertakes a referral, the price of providers will be the same. By extension, competition must be on the basis of quality.”—[Official Report, 16 March 2011; Vol. 525, c. 387.]

To deal with another misrepresentation, EU competition law already exists and the health reform proposals do nothing to change that. They do not, in any way, extend competition law. The Bill makes it absolutely clear that any competition can only be on quality, not on price. In any event, I find it strange that the Labour party and others suddenly seem to be coming forward to express concerns about the private sector in the NHS, when it was the previous Labour Government who, for example, in Banbury set up a privately run, privately managed, privately owned independent treatment centre and a privately managed, privately owned independent Darzi GP centre. The previous Labour Government, bizarrely, gave the private sector—because their contracting was so poor—some £250 million for operations that were never carried out. However, given that they have left the NHS with an overdraft of £60 billion, I suppose that they would consider £250 million thrown away on operations that were never actually carried out as, possibly by their standards, small change.

We have to realise, with an ageing population, more extensive treatments and new drugs becoming available, that we have to tackle bureaucracy in the NHS. We need to reform the NHS to make sure that it is as efficient and as effective as possible. We are ensuring that patients have choice—choice based on quality and from whom they receive care. There is simply no issue on this, in that the Labour Party said in its manifesto at the general election, and I am sure that the hon. Member for Leyton and Wanstead has read it:

“Patients requiring elective care will have the right, in law, to choose from any provider who meets NHS standards of quality”.

We have made it absolutely clear, under the coalition Government, that the NHS will remain free at the point of need, paid for from general taxation, and be based entirely on need, not on the ability to pay. Those are fundamental principles of the NHS. They have been fundamental principles of the NHS ever since it came into being, and the coalition parties are, I am sure, determined not to undermine, in any way, any of the rights in the NHS constitution. Indeed, the coalition Government are seeking to protect the NHS, throughout the duration of the Parliament, by increasing NHS funding by £10.7 billion. A substantial number of GP groups, all over England, have volunteered as pathfinders to demonstrate how GP commissioning can work. GPs throughout Oxfordshire are coming together to form a suitable GP consortium.

Let me tell the House what is being said by those in my constituency who are involved in the GP consortium. Local GP Dr Judith Wright, who is co-ordinating the north Oxfordshire GPs, has said:

“Andrew Lansley’s proposals will give power to local GPs to decide how that budget should be spent to meet local health needs. Priorities will be decided by doctors through a process informed by patients, local authorities, public health and secondary care”.

Dr Wright went on to observe:

“I believe that GPs are best placed to be able to meet this challenge. Collectively they know the health needs of their local population. They can act as a catalyst for change. They will have a role in deciding the destination of local services and the route to get there.”

Andrew McHugh, who is the practice manager at Horsefair surgery in Banbury, observed:

“The health budget is a finite resource. Andrew Lansley’s proposals will give power to local GPs to decide how that budget is spent in order to meet local health needs. Priorities will be decided by doctors through a process informed by democratically accountable public and patient involvement. We need to be looking for innovative ways of spending the health budget wisely.”

In a recent issue of Prospect magazine, Ali Parsa pointed out that, as a nation:

“We used to spend 3 per cent of our GDP on healthcare in the 1980s…6 per cent in the 1990s, 9 per cent now and on our way to 12 per cent.”

In the current financial climate, that is unsustainable. Business as usual is not an option. We need to review what treatments are provided to ensure they are clinically effective and cost-effective—in other words, evidence-based practice. I think that Dr Judith Wright and Andrew McHugh’s comments are extremely balanced and sensible.

[Mr David Anderson (Blaydon) (Lab)]

I just came from a meeting of the British Medical Association about two hours ago. Its members asked me very clearly to pass this message on to the party on the Government Benches: will they please stop using the fact that GPs are becoming involved to suggest that they support the moves? They see becoming involved in terms of having no alternative—they say that it is being forced on them and that they are becoming engaged in the interests of their patients, not because they believe in what is being done.

[Tony Baldry]

May I suggest to the hon. Gentleman and to others that they actually start listening to what is being said? They might start by noting what was said in their own election manifesto. They might start listening to what the Prime Minister and the Secretary of State are saying on the Floor of the House of Commons, and the hon. Gentleman might as well do them the courtesy of just listening to what GPs in my constituency are saying on the record. It is clear that he is not listening. If he wishes to have a dialogue of the unlistening, that is a matter for him. The changes that the NHS needs are straightforward: less waste, more involvement, power to GPs and front-line doctors, nurses and other health professionals, and putting patients first. There is not really an intellectual divide on this matter. Indeed, the shadow Secretary of State earlier observed:

“The general aims of reform are sound—greater role for clinicians in commissioning care, more involvement of patients, less bureaucracy and greater priority on improving health outcomes”.

I could not have put it better. As for less bureaucracy, ever since the coalition Government came to office, one of the things they have cut in the NHS is bureaucracy. That has resulted in 2,000 fewer managers since the general election, but, interestingly, 2,500 more doctors.

I have every confidence in the Secretary of State for Health. He and his ministerial team, while we were in opposition, took considerable efforts to visit Banbury on a number of occasions to understand the challenges being faced by the Horton general hospital and to meet with GPs. As he observed to local GPs before the general election, GP commissioning will enable those GPs in north Oxfordshire, south Northamptonshire and south Warwickshire who wish to send their patients to the Horton hospital to do so, confident that the money will follow the patient.

Again, I do not think it surprising that the shadow Secretary of State should have observed:

“No one in the House of Commons knows more about the NHS than Andrew Lansley—except perhaps Stephen Dorrell. But Andrew Lansley spent six years in Opposition as shadow health secretary. No one has visited more of the NHS. No one has talked to more people...in the NHS…these plans are consistent, coherent and comprehensive. I would expect nothing less from Andrew Lansley.”

If Opposition Members are not willing to listen to me, perhaps they would be willing to listen to the shadow Secretary of State.

The Secretary of State, when in opposition, visited my constituency at least three times, and I believe I am correct in saying that every member of the Government ministerial team in the Commons visited my constituency at least once, to understand the challenges and needs of hospitals such as the Horton. The Royal College of General Practitioners said that it believes that there should be more clinical commissioning. Even the British Medical Association has confirmed that it believes that GP-led commissioning is the right way forward. Indeed, the only opponents to the proposals appear to be the Labour party and the trade unions, but, given what the Labour party did when it was in office, and what it stated in its manifesto and even more recently, one can only conclude that, now that it is in opposition, it seeks to jump on every passing bandwagon, feels obliged to say whatever will keep the trade unions happy and seeks to block every sensible reform.

The views of the trade unions on all of this are as depressing as they are, perhaps, predictable, and in the category of trade union I also place the BMA. It is right to recall that the BMA opposed GP fundholding, longer opening hours for GP surgeries, which clearly would have been for the benefit of patients, and foundation hospitals. In fact, I cannot think of a single NHS reform over the years which it has not opposed, or a single one on which it has been in the vanguard.

No one pretends that health care systems around the world are facing anything other than enormous challenges. That is no less so in the UK. We need to be sure that patients and taxpayers get the best value possible for every pound spent in the NHS. We need the best possible outcomes in the NHS, whether for stroke victims, heart attack victims or those who have long-term medical conditions. The reforms are about building on the strengths of the NHS, improving it and making it better able to tackle the challenges of the 21st century. That is how we will ensure that people will rightly continue to be supportive of, and satisfied and happy with, the NHS, which we all want to be the best possible health service in the world.

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

I congratulate my hon. Friend the Member for Leyton and Wanstead (John Cryer) on getting this debate. Like the hon. Member for Banbury (Tony Baldry), I stand here as the son of a nurse, though she stopped work before the NHS was created. Through her lifetime she saw the improvements in the NHS. I also stand as a man whose niece is fighting for her life in intensive care in the Royal Victoria Infirmary, Newcastle. She is a young girl of 40 years old. I call her a girl because from the day she was born she has been hit by muscular dystrophy. She has needed the NHS from the first minute of her life. It has been there for every moment, as it was for one of my sisters, who sadly died at 53 of the same disease. The NHS was always there for them, never perfect, but second to none when compared with health services around the world. Those of us fortunate to have better health have always been prepared to pay to ensure that those who need help were able to get it.

Due to my experience with muscular dystrophy, I have the privilege of being the chairman of the all-party parliamentary group on the subject. That group has shown what we as parliamentarians can do together. We have come together, across the parties, and made huge improvements in the past few years in ensuring that specialist commissioning groups have worked with the all-party group here and with PCTs on the ground, making real improvements in the lives of people suffering from muscular dystrophy. We had a meeting about a month ago in this House. People came from across the country and across the political spectrum, and there were also professionals in the health service. They were all concerned about the direction of travel on which the Government are bent. Their concerns are: will they still be able to access the things they need? Will specialised commissioning groups still be able to work together to deliver the services they want? They have genuine concerns that the all-party group will take forward with the Minister as the debate continues.

This debate is about satisfaction. Why is satisfaction up? There are a number of reasons. Although I have some issues with the hon. Member for Banbury, I agree with him in that I have campaigned against the private finance initiative since before the previous Government took office, since the early 1990s, when the idea was first floated by the former Secretary of State for Health and now Lord Chancellor and Secretary of State for Justice, the right hon. and learned Member for Rushcliffe (Mr Clarke). I opposed it back then, and I have thought it the wrong direction for my Government to take over the past 13 years. The truth is that my Government had to do something.

The hon. Member for Banbury hit the nail on the head when he said that spending on health was 3% of GDP in the 1980s. We know it was 3% because people were being looked after in Victorian hospitals. As my hon. Friend the Member for North Durham (Mr Jones) regularly says, in his area people were being looked after in an old workhouse. That was not good enough for the Labour party, and it was not good enough for the people of this country. That is why we decided that over the period we would increase investment in the NHS, and we increased it by 300%. The people of this country went along with that, including when we put 1% on national insurance contributions. People supported that move because they believed in the service that the NHS delivered. We should never forget that.

During discussions on developing a more capital-intensive NHS, into which a lot of money went, we saw real moves on staff harmonisation, recognising the roles of staff and increasing the responsibilities of people at different levels in the health service. A huge amount of work went into that. While that was happening, other work was being done on improving public health across the board.

The hon. Member for Southport (John Pugh) raised the issue of productivity. It is strange how he defined productivity. I would be interested to read the report from the NAO on defining it, and I am glad that he has brought it to my attention. Productivity used to be measured in the health service by recording when an episode concluded. An episode could be concluded when someone died. A hospital where more people died was more successful in terms of productivity than one where somebody kept coming back and that episode was not concluded. That is a perverse way to look at productivity. The real measure of productivity is that there are twice as many people alive at 85 and over than there were 20 years ago. Should we not celebrate that? Is that not a productivity increase of which we can all be proud? That is the result of the work done.

I am not going to pretend the NHS is perfect. We know it is not perfect; every one of us as constituency MPs will have dealt with issues.

[Ian Mearns (Gateshead) (Lab)]

It is not a question of not thinking that it is perfect, but one of wanting constantly to improve it. The hon. Member for Southport (John Pugh) offered a view, with which I concur, that an individual’s experience of the NHS is different from their broad view, based on what they read in the press. The personal experience of the vast majority of people is either positive or very positive. The broad view is less so, which is hardly surprising, since the vast majority of editors of news journals in this country do not regard good news as news at all. It is also true that many people have a positive view of services they perceive to be under threat. Take the example of a local school. There is always a more positive view if it is under threat. The problem in this country is that millions of people, sadly, believe the NHS to be under threat.

[Mr Anderson]

I thank my hon. Friend and neighbour: I will discuss that with him later.

As a constituency MP, I have had three cases over the past six years of supporting people making complaints against the NHS. We took them as far as we could, trying to raise resolutions. However, none of those people opposed the NHS as an organisation; it was the specific treatment they had received that they were complaining about. There have actually been hugely improved outcomes, as I know from talking to thousands of ordinary folk across the constituency. How happy they are that we built—thankfully, before this Government got in—a new health and leisure centre in Gateshead. Unlike the Building Schools for the Future money, that was not stopped. We got it built before 7 May last year: thank God for that. The real people who matter—the public—are concerned about where we are going.

We should be thankful for the people who work in the NHS. I get really frustrated and annoyed when I hear coalition Members and the Secretary of State, who seems to take real pleasure in denigrating trade unionists, as if trade unionists were removed from this. The vast majority of trade unionists who represent health workers are hands-on professionals. They are not sitting in an office all day; they are at the coal face. They are not just talking about representing people; they are doing it, day in, day out. It is a disgrace that a party pretending to be the party of the big society should denigrate the people who are part of the largest voluntary group in the country. They stand up for people day in and day out. At the same time as standing up for their colleagues, they work in the service, they represent the service and they fight for the people they take care of. Their voice is important; their voice is informed and should not be ignored.

What do we see? We see Ministers refusing to listen to groups within the health service. I just picked up a report of the Second Reading, when I referred to one of those groups, the King’s Fund. Others include the Ministers’ own colleague, the hon. Member for Totnes (Dr Wollaston); the British Medical Association, denigrated here by the hon. Member for Banbury; the Royal College of Physicians; the Royal College of Nursing and the head of Arthritis Care. Every one of those has been ignored by the Government, on the basis of “We know best.”

Most Conservative Members have had a degree of education way beyond mine. However, in this debate, the words of my hon. Friend the Member for Bolsover (Mr Skinner) should be heeded, when he said that a lot of them have been “educated beyond their intelligence”. If this debate does not show that, nothing else does. The truth is that constantly over the past 13 years, health professionals have said to us, “Let us get on with the job.” The promise the Conservative party gave in opposition was that it would do exactly that; it would let them get on with the job, because there has been far too much meddling in the health service. I agree with that but, now, instead of letting them get on with the job, the Government are turning the health service upside down. Not only will it not work, it will make it much worse. It is a disgrace that it is happening.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

As others have said today, Mr Bayley, it is a pleasure to serve under your chairmanship.

We have had an interesting debate. Some speeches were a continuation of what has been said in the Health and Social Care Bill Committee, and they bordered on fantasy. Other speeches were extremely informative. The speech of my hon. Friend the Member for Banbury (Tony Baldry) was in the latter category, and my hon. Friend the Member for Southport (John Pugh) made a reflective and interesting speech. I listened with extreme interest, as I always do, to the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke), who made a typically thoughtful speech about an area of health and social care on which he is an acknowledged expert. I listened to the hon. Member for Easington (Grahame M. Morris), as I often do these days, and to the hon. Members for Birmingham, Erdington (Jack Dromey) and for Blaydon (Mr Anderson). It was rather like a curate’s egg—parts of it, depending on which hon. Member was speaking, were all right, and other parts slightly broached on to fantasy island.

I congratulate the hon. Member for Leyton and Wanstead (John Cryer) on securing this important debate. He may be surprised to hear that I am in considerable agreement with him on certain areas. I wish to clear up a number of his questions about the surveys. In an intervention on the hon. Gentleman, I alluded to the Ipsos MORI survey. There is something slightly ironic about claiming that we refused to publish it because of its content, given that the previous Government failed to publish similar surveys in 2007, 2008, 2009 and 2010. To say that they did not publish it because the Opposition did not table parliamentary questions asking for it to be published shows breathtaking gall.

The fact is that we published the March 2010 survey following a written answer in December from the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is responsible for social care. It was placed in the Library, but it was not placed on the Department of Health website, for which I offer an apology. Some Members referred to the comments of my right hon. Friend the Secretary of State. Those statements were made in good faith but he was given the wrong advice. That is unfortunate, but he made that statement some three months after the results of the survey had been published.

The hon. Member for Leyton and Wanstead asked whether we will continue with the survey. I can tell him that a further survey has been done. It has not been completed, in so far as it has not yet been given to the Department, but that will happen in due course. What happens in future remains to be seen, as no decision has been taken on future exercises. The hon. Gentleman also mentioned the general life-style survey. Again, no decision has been taken. In light of that information, it is incorrect to say that we will not allow it to proceed.

On the question of the British social attitudes survey, things are a little more complex. The hon. Gentleman will be aware that the Department of Health is not the only Department involved; it is a cross-Government survey, and the Department of Health has some interest in it, but not exclusively so. Again, that is being considered, so I cannot give a definitive answer as to what will happen.

Many hon. Members, including the hon. Member for Leyton and Wanstead, pointed out that the last survey published by Ipsos MORI said that public satisfaction with the NHS was relatively high. That is self-evident, and I suspect that all hon. Members, as constituency MPs, will be aware of that from their constituents, their correspondence and just talking to people. As we heard, the most recent research puts overall satisfaction rates at 72%.

If we were discussing the future of any other public service, perhaps the debate would end there. However, we are not here today to discuss other public services, such as local bus services or rubbish collections, vital as they are. We are here to discuss the national health service, which for the public is literally a matter of life and death, and they have a high regard for it. People expect the NHS to be there when they are at their most vulnerable, or when their family members are in greatest need.

One cannot quantify what the NHS means to the people of this country with a smattering of national statistics, however comforting they might seem. The public have never been over-inclined to set great store by the pronouncements of politicians about the brilliance of the NHS, however familiar such pronouncements might be. However, people do not live their lives through the monochrome of MORI’s painstaking statistical analyses. They do not judge the NHS on the numbers. They judge the NHS on their experience of it; it is the NHS staff that they meet, and what they say and do, that ultimately informs their opinion.

The fact that satisfaction rates are relatively high is without doubt a tribute to the fact that those staff treat thousands of patients every day. I am sure that Members on both sides of the Chamber are united in their admiration for the work of staff across the board, and we should congratulate them on doing it day in, day out, when looking after our constituents, ourselves and our families. They do a fantastic job. We should never forget that we owe them a debt of honour and gratitude.

[Mr Anderson]

Will the Minister give way?

[Mr Burns]

No. If the hon. Gentleman will forgive me, I do not have much time.

We should not kid ourselves that that is the whole story. Although some may be only too content with the fact that three quarters of people are happy with the NHS, I am not. High levels of public satisfaction are a genuine compliment to the work of NHS staff, but they do not undermine the case for modernisation or imply that the NHS is perfect or should never change. There is plenty of room for improvement, building on the high satisfaction rates that we already enjoy, as shown by the various surveys mentioned today.

The House will know that although the money going into the NHS has dramatically increased over the last decade, which I welcome, productivity has not. In fact, it has fallen by 0.2% every year since 1997. In hospitals, it has fallen further—by 1.4% a year between 1997 and 2008. However, such statistics can sound quite abstract. We should think about what they actually mean for patients.

Some of the targets and incentives in the current system are simply perverse; far from promoting good-quality care, they encourage poor care. Take maternity services. With antenatal care, the more visits or scans providers can record, the more they are paid. It is in the financial interests of the hospital to provide care on a purely reactive basis, dealing with problems as they arise, rather than preventing them from happening.

The result is poorer health outcomes for the mother and child and a bigger bill for the taxpayer. No midwife or doctor would ever organise the system in such a way. No doctor or nurse working in acute care would design a system in which a hospital would be paid for a mistake rather than be penalised for it. For example, would they pay if a patient were discharged from hospital only to be bounced back into A and E a week or so later because they were not properly treated? No health professional would choose to work in an environment in which they and their colleagues are rewarded not for how well they treat patients, but for how well they process them through the health system.

Hon. Members claim that there is no rationale for our reforms, but they are wrong. I do not claim that the NHS is failing; there is much that is good about it, and much of what it does is internationally acclaimed. None the less, if hon. Members were honest they would accept that there is room for improvement, as was shown by the Ipsos MORI poll.

I do not think that it is right that pensioners over the age of 75 in the primary care trust that serves the constituency of the hon. Member for Leyton and Wanstead are almost twice as likely to be admitted to hospital in an emergency than those over the age of 75 in Devon or Cornwall. I do not think that it is right that, in some parts of the country, people are more than five times more likely to die of heart disease.

In its current form, the NHS cannot hope to cope with the rising demand from our ageing population and the relentless rise in the cost of drugs and treatment. Our health system is no longer battling with infectious disease. The typical patient is not a young man with TB or polio, as it might have been in the 1940s, but someone who is over 75 with probably two, if not more, long-term conditions and social care needs, too. It is a very different problem that requires a very different kind of health service.

Even more importantly, as a nation, we should be aspiring to be as healthy and to live as long as our European neighbours. A recent OECD report found that, if the NHS were to perform as well as the best-performing health systems, we could increase life expectancy by three years. The argument for change could not be clearer.

The ultimate objective of modernisation is to ensure that the quality of care that people receive is on a par with the best available anywhere in the world. To do that, we need to make fundamental changes to the NHS. For example, we need to ensure that it is the GP and not a manager or civil servant in Whitehall who determines the needs and requirements of their patients. A radical extension of patient choice would allow patients to choose not only where they are treated, but which consultant-led team will treat them. Patients could choose their GP and even, where appropriate, their treatment.

There should be greater accountability and transparency in the NHS to give patients the information that they need to make choices and to drive up quality. As the Society for Cardiothoracic Surgery said only last week, publicly reporting on the performance of hospitals and surgeons treating patients with heart disease can improve mortality rates by 50%.

There should also be more independence and freedom for clinicians, so that if local health and social care professionals think that they can deliver better services to support stroke patients, they can set up a social enterprise that will do that. We will give genuine freedom to foundation trusts, so that they can strive to provide the best possible outcomes for patients.

In conclusion, there have been a lot of disingenuous statements about privatisation of the health service and the quality of care. If hon. Members are prepared to listen, I will assure them that we have no intention of privatising the health service. We just want to improve patient care.

Health and Social Care Bill

David Anderson Excerpts

Monday 31st January 2011 Commons Chamber

[John Healey]

My hon. Friend is right—and the chief executive of the Patients Association, Katherine Murphy has said just that. Many patient groups are making the same arguments and issuing the same warnings.

My serious concern is that this Government have told only half the story from the start. The Health Secretary and the Prime Minister are happy to talk about GP commissioning and happy to talk about cutting management—the organisational changes—but they downplay or deny the deep ideological changes at the heart of these plans. The Health Secretary mentioned the new economic regulator, Monitor, in just one line in a speech lasting more than 40 minutes. The Prime Minister said last week in his speech on public services that these reforms

“are not about theory or ideology”.

The Prime Minister writes in The Times today, just as the Health Secretary did last week, both of them producing 700 words about their health plans, yet they made not a single mention of competition.

We will explain and expose the truth throughout this debate and the Bill’s passage through Parliament because these changes will break up the NHS; they will open up all areas of the NHS to price-cutting competition from private health companies; and they will take away from all parts of the NHS the requirement for proper openness, scrutiny and accountability to the public and to Parliament. These Government changes are driving free market political ideology into the heart of the NHS, and that is why doctors are now saying:

“As it stands, the UK Government’s new Bill spells the end of the NHS.”

[Mr David Anderson (Blaydon) (Lab)]

rose—

[Nick de Bois (Enfield North) (Con)]

rose—

--- Later in debate ---

[John Healey]

My hon. Friend may be right. I have not seen the regulations, but that is certainly in the impact assessment, so he is on to an important point.

Government Members and the Health Secretary have spent a long time talking about Labour’s plans, policies and record, but the debate at the heart of this Bill is not about whether competition, choice or the private sector has a part to play in the NHS—they have and they do. The debate at the heart of this Bill is about whether full-blown competition, based on price and ruled by competition law, is the right basis for our NHS. That is why Labour Members oppose this Bill. We want the NHS run on the basis of what is best for patients, not what is best for the market. We want the NHS to be driven by the ethos of public service, not by the economics of forced competition. We will defend to the end a health service that is there for all, fair for all and free to all who need it when they need it.

If the stated aims for the reform were all the Government wanted—we have heard the Health Secretary say that he wants a greater role for doctors in commissioning, more involvement of patients, less bureaucracy and greater priority put on to improving health outcomes—he should do what the GPs say: turn the primary care trust boards over to doctors and patients, so that they can run this and do the job. But there is no correlation between the aims that the Health Secretary sets out and the actions he is taking. There is no connection between his aims and his actions. He is pursuing his actions because his aims are not sufficient. His actions would not achieve the full-scale switch to forced market competition, which is the true purpose of the changes.

Meanwhile, the biggest challenges and changes for the NHS will be made harder, not easier, by the reorganisation. Such challenges include making £20 billion of efficiency savings and improving patient services; ensuring better integration of social care and health care, of primary care and hospital care, and of public health and community health; and providing more services in closer reach of patients in the community rather than in hospital. But the Government will not listen to the warnings from the NHS experts, the NHS professional bodies, patient groups or even the Select Committee on Health.

[Mr Anderson]

In a disparaging comment earlier, the Secretary of State said that the voices of concern were the voices of the trade unions. They are led by people who were health professionals and they represent 1.3 million professionals. Surely somebody in this place should listen to what they say and not to Government Members, who have a biased reason for doing this.

[John Healey]

My hon. Friend is right. The more that NHS staff see of the changes and the consequences of this Government’s handling of the NHS, the more concerned they are about the changes and the more they are starting to see the NHS go backwards. But the Government will not listen to these warnings that are coming from all sides. They are in denial about the risks: the risk that patients will see services get worse, not better; the risk that up to £3 billion will be wasted on internal reorganisation; the risk that innovation and improvements in care that come from greater collaboration will be blocked by the Office of Fair Trading, competition courts and the new market regulator; and the risk that the Bill will create the monster of a full-blown market in health care which GPs will not control and nor will Ministers or Parliament.

If patients have been sold a false prospectus, that is true of GPs too. GPs are being told that they will call the shots on deciding who provides care for their patients, but they are being set up by the Government. They are likely to find their hands tied by Monitor and the Office of Fair Trading and by the courts enforcing competition law. They are likely to find their decisions challenged by private companies if they do not accept “any willing provider”, especially one that offers to undercut on price. The chair of the Royal College of General Practitioners recently issued a warning to her colleagues. She said:

“I understood these reforms were about putting GPs at the centre of planning healthcare for their patients, not about making sweeping cuts, which will include shutting hospitals, making enormous redundancies, closing services”.

Because the reorganisation will force doctors to make rationing decisions as well as referral decisions for their patients, they will make treatment decisions with one eye on their patient and the other on their budget and their consortium’s bottom line.

The Government say they are devolving power to front-line services, putting clinicians in control, making the NHS more accountable and improving the integration and quality of services, but in the Bill they are making the forces of competition and centralisation far stronger than those of devolution, democratic accountability or the development of quality in patient services. We will explain and expose the gap between what Ministers are saying and what they are doing in every debate at every stage of this legislation.

Patients and staff are already seeing signs of strain in the NHS. They are starting to ask, “What on earth are the Government doing with the NHS? Why don’t they listen to the warnings? Why is the Prime Minister breaking the very personal promise he made to protect the NHS?” The Bill puts competition first and patients second. That is why we will oppose the Bill tonight and expose this truth in the months ahead. These are the wrong reforms for the wrong reasons at the wrong time.

--- Later in debate ---

[Dan Byles (North Warwickshire) (Con)]

I am grateful for the opportunity to speak in this debate, and declare an interest in that my wife is a general practitioner.

It is an oft-stated fact that the NHS holds a special place in the hearts of British people. That is why it is so important that this vital institution is managed effectively and sustainably so that our children and grandchildren can continue to use and rely on it in the years to come. However, the problem with the cherished position that the NHS holds is that it makes it difficult to discuss and debate its future dispassionately. It is extremely important that we in this House are able to discuss NHS reform sensibly and without the hyperbole and hysteria shown by the shadow Secretary of State in his opening remarks and by the hon. Member for Eltham (Clive Efford), whose frankly disgusting remarks were not worthy of this Chamber.

The previous Government, who undertook considerable, frequent and, dare I say it, well-intentioned reorganisations of the NHS, found that each reorganisation was opposed by a variety of interests for a variety of reasons. Although they spent too much time reorganising the bureaucracy of the NHS, and generally adding to it on each occasion, I welcomed some of their reforms and am happy to say so, with the notable examples of foundation trusts and the greater involvement of private and other providers. In too many cases, however, previous reforms took the form of shuffling the management deck chairs. Strategic health authorities and primary care trusts were reorganised and reorganised again, often before the ink at the top of the old letterheads had dried, while the number of bureaucrats soared relentlessly.

The challenges faced by the NHS are considerable, and to deny the need for further change is dangerous. Cost pressures within the NHS are rising. This has, in part, been driven by the blunt way in which the previous Government pushed up health spending without insisting on robustly improving outcomes alongside that increased spending. As a result, we have seen productivity fall—a trend that must be reversed if the NHS spending model is to be sustainable. That health care inflation has also been driven by outside factors. Costly new drugs and treatments, coupled with an ageing population, have created serious challenges and will continue to do so.

A hard-headed analysis of these demographic changes has led the coalition Government, rightly, to commit to ring-fencing the NHS from Government spending cuts and guaranteeing real-terms increases in NHS spending—a commitment, I might add, not matched by Labour. With the privilege of a ring-fenced budget comes a responsibility on the side of the NHS to maximise productivity and efficiency to ensure the best possible clinical outcomes for patients within that budget settlement.

[Mr Anderson]

If it is a ring-fenced budget, why does the Royal College of Nursing believe that there will be 27,000 fewer nurses in a year’s time?

[Dan Byles]

The NHS budget is going up in real terms every year, as the hon. Gentleman can see by looking at the books. We are all aware that the system we inherited had ongoing problems because of the high management costs and other structural problems within the NHS. There will be no shortage of nurses as a result of any underfunding by the current Government—I can assure him of that.

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

I rise to speak not only as a former official of Unison, the biggest trade union in the health service, but as a former care worker. Like most other union officials who have been bad-mouthed as the voice of conservatism, I have actually worked in taking care of people. Perhaps once in a while the people who have delivered services to the vulnerable, the sick and those in need in this country might be listened to. The last time the Conservatives were in power, they did not listen to the voices of such people about the health service, which is why we saw the introduction of compulsory competitive tendering, which led to hygiene-related diseases. We saw massive waiting lists and people waiting on trolleys in corridors.

I do not want to put my views tonight, but the views of the people who work in the health service, such as my GP, who asked me this morning how, if we are to go through all these changes, he will be able to take the time off to learn business administration and how to use a computer properly so that he will be able to challenge the people who will run his service. The King’s Fund says that it questions

“the need to embark on a fundamental reorganisation when evidence shows health outcomes and public satisfaction have improved.”

The hon. Member for Totnes (Dr Wollaston) says that

“it does look like somebody has tossed a hand grenade at the PCTs”

and, even more importantly:

“If the expertise isn’t there…inevitably they’re going to be having to turn more to the private sector.”

Dr Hamish Meldrum, chairman of the British Medical Association, says:

“Ploughing ahead with these changes as they stand, at such speed, at a time of huge financial pressure…is a massive gamble.”

He also says:

“We will quickly see failed consortia bought up on the cheap by foreign companies and see bits of the NHS run from abroad.”

Sir Richard Thompson, president of the Royal College of Physicians, says:

“The fragmentation of services would have detrimental impacts on the various areas the reforms seek to improve”.

Dr Peter Carter from the Royal College of Nursing says:

“The RCN is also concerned that the fragmentation could result in unexplained variations in service, a reduction in collaboration and less sharing of good practice—all of which impact on quality care.”

He also says:

“We don’t think it’s been properly thought through… In May last year the average waiting time was nine weeks. Our concern at the moment is that short-sighted false economy will end up costing the public money and result in patient care going backwards.”

The head of Arthritis Care says that

“the Bill risks creating a ‘free-for-all’ situation where only those patients who shout the loudest will get the services they need.”

In a letter to The Times on 17 January, the leaders of six professional health service organisations said:

“The scale and ambitions of the cost-reform programme are extremely risky and potentially dangerous.”

Last Monday, in a letter to The Times, 190 nurses from one trust said that the

“figures from the Royal College of Nursing show 27,000 nursing posts are being cut. These proposed reforms will make matters much, much worse…The proposed reforms will be rapid, costly and staggering in scale: they presage nothing less than the complete reconstruction, if not privatisation, of the NHS”.

This morning, in the Newcastle Journal, 12 doctors representing people from Northumberland in the north to Yorkshire in the south said that

“enforced financial competition, creating a health ‘market’, risks damaging our health service. Forcing GP consortia to tender contracts out…runs the huge risk of seeing large commercial, profit-driven companies entering the market. They will pursue the most profitable contracts…and ignore aspects of healthcare which are not profitable, leaving behind ‘Cinderella’ services. There can be no doubt that the use of their size to undercut on price…could damage local services in the north-east.”

Those are not my words. They are the words of those we as a nation trust to take care of the people who send us here. To rubbish them, like Government Members have done tonight, as the voices of conservatism means just one thing: arrogance. It shows that they are not prepared to listen to those who take our people forward and look after them. [Interruption.] No, I am not going to sit down; other people want to speak. The truth is that the people of this country will never forget that, and they will not forget the human shields in the Liberal Democrats who are giving cover to that policy.

Wheelchair Services

David Anderson Excerpts

Monday 28th June 2010 Commons Chamber

[Mr David Anderson (Blaydon) (Lab)]

Some five years ago, as a new Member, I was approached by a number of children from Ryton comprehensive school in my constituency to see whether I would attend a lobby by the Muscular Dystrophy Campaign that was being held outside the Department of Health. The lobby was held to support a teacher at the school who had a son by the name of Sam who had been diagnosed as suffering from Duchenne muscular dystrophy—the type of muscular dystrophy that attacks young boys in particular, many of whom do not live to see out their teens.

As a result of that lobby, I was approached by a colleague who is now a Minister and asked if I would take on the role of chairing the all-party group on muscular dystrophy. As a young volunteer—well, not so young, but a lot younger than I am today—I did not know what I was letting myself in for, but I can quite safely say that that was one of the most important decisions that I ever took in the House. As a result of the work that we have done over the past five years, we have made great strides in helping people with muscular dystrophy. However, the truth is that we are still a long way from finding a cure. As part of that work, we decided to hold a series of hearings, to which we would invite patients, professionals and people from the Department of Health, as well as people from the specialist commissioning groups and the Muscular Dystrophy Campaign.

Following that work, we produced a report last summer entitled “Access to specialist neuromuscular care”. Its subtitle is “The Walton Report”, because one of the key players in producing it was Lord John Walton. He was born 88 years ago, and is one of my constituents. Based in Newcastle upon Tyne, he has a long history as a leading light in the work on neuromuscular diseases. He has been a distinguished Member of the House of Lords for about 20 years. He brought to the Committee a real sense of purpose. Others who were involved include our old colleague Dr Ian Gibson, who is no longer in the House, and many others from both sides of this House and from the House of Lords. We produced the report based on people’s real-life experiences of living day to day with muscular dystrophy.

We knew that it was not going to be possible to find a cure. We knew that we were not going to get into a debate about research or about trying to find a drug that would be the silver bullet that cured muscular dystrophy. We knew that that would not be possible. However, we heard time and again from people living with the disease that their basic care needs were not being properly addressed. An example is hydrotherapy. Why is it that children who have hydrotherapy during term time cannot have it during the holidays because the caretaker is not at their school? If access to drugs were involved, and a child was told, “Go away for six weeks. You can’t have your drugs because we’re on holiday,” there would be an outcry. Similarly, parts of the country have good access to physiotherapy, but other parts do not.

A further important issue that cropped up time and again was that of access to powered wheelchairs. Because of the frequency of this complaint, we asked the representatives of the Muscular Dystrophy Campaign to go away and work with people to produce a new report. That report came out last week, and it is called “Get moving—the case for effective wheelchair services”. I have sent the Minister a copy, and I hope that he has received it, because he will then be able to give us all the right answers later. I am sure he will not mind if I put my glasses on so that I can read it properly.

These are some real-life experiences of people with muscular dystrophy. They are setting out some basic stuff very clearly indeed. Wendy Hughes from Devon describes her son’s situation, saying:

“I have never been more angry or upset about a seemingly hopeless situation. Zak’s fight for independence has been an upward battle and completely frustrating, demoralising and hopeless for the whole family”.

A patient whose 10-year-old wheelchair is described as “falling apart” said:

“I have had no chance of trying another chair. I need a different type and shape of chair now. No one is listening and it’s soul-destroying.”

Jill Brown, from Wiltshire, is 68 years old and has progressive neuropathic myopathy. She has been waiting 12 years for the powered wheelchair that she needs. Six weeks ago, she finally received it. Sadly, because her condition has worsened, the chair no longer meets her needs.

The report contains a catalogue of complaints and heart-rending real-life stories. Christopher Powell lives in Plymouth, and has a muscle-wasting condition. He says:

“My current wheelchair has so many faults and I’m paying through the nose to get it fixed. I actually had to make my own headrest for the wheelchair, made out of a Pringles tube wrapped in a sock. It’s very embarrassing.”

Mark Bishop is from Herne Bay and has had problems getting a wheelchair adapted to suit his needs. He says:

“It ended up taking two years for wheelchair services to adapt a wheelchair they had to what I wanted, and even now it’s not finished…Someone with a Meccano kit could have done a better job.”

Karen Duckmanton lives in Essex. She, too, has Duchenne muscular dystrophy. She says:

“Even though I can’t walk and I need to be in my wheelchair all the time, wheelchair services told me that because I still had a small amount of power in my arms, I could not have an electric wheelchair. I think pushing the wheelchair has made my arms worse. I’ve been told I would be on the waiting list for 18 months for another wheelchair assessment.”

Carol Lawson from Chester-le-Street, quite close to where I live, said:

“I was given a manual chair by wheelchair services but I live on my own so lots of things like windows and shelves were out of reach for me—I couldn’t even hang clothes in the wardrobe. So I asked wheelchair services for an electric chair with a rising seat but they told me they couldn’t fund it.”

That is the story we hear left, right and centre when we approach the Department of Health and the various primary care trusts, although the need for provision has been accepted. It was recognised last year by Phil Hope, the former care services Minister, who said as recently as 19 March:

“Not having the right equipment to get about easily can restrict freedom, isolate and prevent an individual from fully contributing to society. That’s not right. That’s why we are developing a national entitlement standard for wheelchairs services.”

There has been national guidance on wheelchair services for a number of years now, but what is the real experience of the people concerned? They tell us plainly that the guidance is not working, but why is it not working? Here are some of the reasons given by the health service:

“Lack of awareness: Wheelchair Services may not have the specialist knowledge needed for these complex conditions.

Limited funding available: Wheelchair Services may have been allocated a limited budget by PCTs.

Equipment is restricted: Wheelchair Services may have a limited list of equipment it is willing to fund.

Equipment rationing: Equipment may be limited to one piece per patient.

Excessively strict criteria: The provision of equipment is often based on strict assessment criteria rather than actual need.”

Wheelchairs are not just a means of getting about, however. For some people, they are life support mechanisms.

[Julie Hilling (Bolton West) (Lab)]

Is my hon. Friend aware of the excellent work done by the charity Whizz-Kidz, which provides bespoke wheelchairs for young people? Does he agree that wheelchairs that fulfil the needs of young people, fit them and are suitable for their purposes, enabling them to lead fulfilled lives, should be funded by the national health service?

[Mr Anderson]

I entirely agree. I have done some work with Whizz-Kidz, and the appendix to the report contains a reference to its work. However, while everyone welcomes the great work that is being done by the Muscular Dystrophy Campaign and other charities—especially Whizz-Kidz—we should not have to rely on charity.

Mobility is as important to the quality of these people’s lives, and in many instances to their longevity, as medication. If someone was told, “I am sorry but you will have to get into a queue because there is not enough medication to go round,” every one of us here tonight would be knocking on the GP’s door, or asking the primary care trust or the strategic health authority, “What are you playing at?”

This is not like an assessment by the National Institute for Health and Clinical Excellence, when people are told “Yes, it would be good if you could have this, but we cannot afford it.” In this instance, people are being told, “You cannot have it for a variety of reasons.” In some parts of the country, such as Newcastle, there is a one-week waiting list; in others, there are waiting lists of up to 18 months. However, it ultimately costs the NHS more when people do not have the right wheelchair. They end up in hospital with diseases caused directly by the fact that they are not mobile, and experience physical as well as mental difficulties caused by the stress and strain of living with their problems.

At a lobbying event last week, a gentleman from Essex spoke to the main provider of wheelchairs there. That gentleman was almost in tears. He said—this was a gentleman in his mid-forties—“I have had this wheelchair for 12 years, and I cannot cope with it any longer.” But the truth is that this is not a difficult problem to solve. The Minister will probably talk about resources. We could all come into the Chamber every night and speak about a particular health-related problem, and I accept that there are limits, but the fact is that this could be cost-effective. People would not be in hospital, there would be fewer emergency admissions, and people could lead much better lives if they were not tied to equipment that does not work properly.

We must accept that the current position is not the position of 10, 20 or 30 years ago. People who are disabled now, thank goodness, expect more, and we as a society should give them more. Some great young people are involved in the Muscular Dystrophy Campaign who go to university and lead independent lives in their own houses, with access to transport and travel around the world, and we should help them in every way we can.

There are a number of things that I should like the Minister to do. I hope that he will agree to meet me, along with representatives of the campaign and of the working group of the all-party group on muscular dystrophy. We are asking the Government to act on the following recommendations. We want them to set up a short-life review group led by the Department of Health to address the failings of wheelchair services, and to get that review group to examine the savings and improvements made by new service models and to ensure they are implemented nationally. We want them to set a national target for waiting times for wheelchairs at a maximum of 18 weeks from the initial referral to the delivery of the chair—I know the new Government are not keen on targets, but we are talking about really looking after people. We also want the Government to set aside an adequate ring-fenced budget for wheelchairs in each PCT under the supervision of a specialised commissioning group. We want them, too, to set up uniform eligibility criteria and a national consensus regarding the features and equipment that should be provided by the NHS so that that can be developed fully. As it is pointless providing a wheelchair if its condition is not maintained, PCTs must accept the cost of maintaining all wheelchairs, including those that have already been bought, modified or privately funded, and that maintenance should be carried out quickly and efficiently.

We should also look to the scheme set up by the people involved in the campaign which is aimed at ending the wheelchair postcode lottery, so that there is the same access to wheelchairs across the country. It is wrong that people in some areas get better access than people in others, but people with muscular dystrophy find that that is the case time and again and it is totally out of order. We should fully implement definition 5 in the specialised services national definitions set, with a named lead for special equipment on the specialised commissioning group. The above recommendations should be used to develop and form a national strategy for wheelchair provision to reduce waiting times, improve access and bring an end to the current postcode lottery.

I know those are big demands, but these people need them. The first young gentleman I saw in a specialised wheelchair was a young man of 25 who had served in the Army Signals. Most of his contemporaries were dead, but he has been saved because his father and mother went to a fête and Lord Tebbit and his wife were there. We all know the sad story of what happened to Lord Tebbit’s wife, and she was in a specialised wheelchair. The young man’s parents talked to Lord Tebbit on that day, and he pointed them in the right direction. They were therefore able to go and see the people who had built the wheelchair for his wife and get a purpose-built one for themselves, which they had to pay for.

This is not on in the 21st century. It should not be a matter of luck in bumping into somebody somewhere who says, “Why don’t you do this?” We are talking about saving lives and improving lives. The truth is, sadly, that a lot of these people will be dead before they are out of their teens. The lucky few will probably live to 30. In other parts of the world, they possibly live for 10 years longer and we can learn lessons from them, and a key part of the way they look after people is access to wheelchair services.

I have spoken specifically about the work we have done in the Muscular Dystrophy Campaign. Since this debate went on to the parliamentary agenda, at least five groups have contacted me and my office, saying these issues apply across the board. I have no doubt that they do, and I will be happy to work with them and the Minister to try to see whether we can find a strategy that works. It is very important, and it is life-saving.

[The Minister of State, Department of Health (Mr Paul Burstow)]

May I start by thanking the hon. Member for Blaydon (Mr Anderson) for taking the initiative in bidding for the debate and for securing it this evening? He has raised some very important issues on behalf of both constituents and the muscular dystrophy movement.

I know the hon. Gentleman has a very strong personal interest in this issue and I was delighted to attend the event in the House that he organised last week when he launched the report he has described this evening. I was sorry not to have been able to be present when he delivered it, but he rightly set it out in great detail this evening.

While I was at the event, I met a number of families who had been affected by muscular dystrophy and heard about some of the difficulties they have faced, and the hon. Gentleman has talked tonight about some of the very powerful testimonies set out in the report, which make compelling reading. The conversations I had with people at the reception left me in no doubt that wheelchair services is an area that really does require improvement: real improvement in how wheelchair services are commissioned and delivered, and real improvement in extending personalisation to wheelchair services, where there is still far too much off-the-shelf or “like it or lump it” provision. I hope that my responses and remarks will reassure the hon. Gentleman and the Members on both sides of the House who have stayed for the debate that the Department of Health and I take the issues seriously and that we want to make good progress.

I am keen that we take on board the observations that the hon. Gentleman set out tonight, which are contained in his report. I certainly welcome the work done on commissioning and writing the Walton report. He may be aware that there is already an advisory group looking at wheelchair services, involving service users, representatives from the NHS and local government, clinicians and third sector organisations. It would be very helpful indeed if a representative from the muscular dystrophy campaign was involved with the group and, through the debate, I extend an invitation to that organisation to take part. I also invite the hon. Gentleman and members of his all-party group to meet the chairman of the advisory group, David Colin-Thomé, to discuss specific issues arising from the report, with a view to holding a meeting with me to discuss how we take matters forward.

I certainly agree that there is a great deal in what the hon. Gentleman said. We can see from the reviews carried out over recent years that there has been tangible improvement, but—an important but—as the hon. Gentleman outlined, it has been extremely limited. The experience for many people is a poor one. The service is characterised by long waiting times. As we have heard, it is quite common for people to wait months for a wheelchair, and not uncommon for them to wait years for a powered wheelchair. That really affects outcomes for people. It poses particular problems for children whose needs change as they grow, and for those with progressive conditions such as muscular dystrophy or motor neurone disease, whose needs can change very rapidly. The service is also characterised by considerable regional variation—in assessments, procurement, and choice for the individual. Quite simply, that is unacceptable.

The majority of wheelchair services are provided by the national health service, and should be subject to consistent, national standards, applied by local commissioners to the needs of individual populations. I think the hon. Gentleman and I agree on the diagnosis, but we might disagree about the best way to effect a cure.

The hon. Gentleman suggested that we should ring-fence wheelchair funding and introduce a new target on waiting times. However, we are already performing the biggest ring-fence possible. By providing real-terms increases in NHS budgets for the duration of the Parliament, we are protecting all health services, including wheelchair services, at a time of unprecedented spending restraint; yet even with that protection, the NHS faces a stark challenge as the population ages and lives longer, and the increasing costs of treatment squeeze health budgets. That demands greater efficiency and cost-effectiveness across the whole of the health service.

If the NHS is to meet that challenge, local organisations must have the freedom to allocate funds in the best interests of their local communities. In that sense, I am afraid that proposals for a new ring fence and centralised targets swim against the tide. The Government strongly believe that we need less Whitehall control, not more; we need to liberate the NHS and ensure higher standards for patients.

In the case of wheelchair services, a ring-fenced budget could have the opposite effect. By extending autonomy for the local NHS, a ring-fenced budget could effectively cap resources, and cap the amount a trust spends on wheelchairs, rather than allowing commissioners to make a judgment, informed by local need, about what should be spent on those services. Furthermore, ring-fencing could result in services that fail to improve, and we need to make sure that does not happen.

With greater freedoms come greater responsibilities for the local NHS. We want to strengthen both the patient and the clinical voice, so that patients, general practitioners, consultants and other clinicians, rather than layers of NHS management, call the shots and control the way services work. We will strengthen accountability and transparency so that the public can hold the local NHS properly to account for the decisions it makes, and poor performance can be properly challenged across the country.

We need to address a number of issues and the hon. Gentleman has touched on several of them. First and foremost, commissioning has to improve. The fact that wheelchair services account for only a small proportion of local budgets means that they have been neglected by too many. Good assessment of local need is rare, performance information is patchy and procurement is often left to individual wheelchair service managers.

Furthermore, higher costs due to rising demand and improving technology have not been properly reflected in many local budget allocations for wheelchair services. As a result, service managers have tended to focus on purchasing the right volume of wheelchairs for their communities, but not necessarily the right kind of wheelchairs for individual clinical needs. That gives rise to some shocking examples of the sort that the hon. Gentleman mentions.

[Mr Anderson]

I thank the Minister for his studied reply. One of the things that came to me was the fact that the spending that is put aside averages £2,000 per chair, but people want probably five or six times that amount for a chair that really meets their needs. Although I take on board the resources issue, it is pointless people saying that they can commission a number of chairs if, as he says, they are not worth having.

[Mr Burstow]

I take the point, but if one caps a budget, the danger is that the likelihood of rationing the service increases even further. We want to ensure that the services are tailored to local needs, but there are clearly some quite unacceptable performances around the country in how the service is being delivered at the moment.

On a related point, there are several funding streams for wheelchair services, and that is rather confused and confusing. Alongside NHS provision for wheelchairs, they can also be supplied through local children’s trusts and Jobcentre Plus, so there is duplication and inefficiency in the system, not to mention problems for service users in terms of understanding where their entitlement might lie. Indeed, in preparing for this debate, my jaw nearly hit the floor when I read that 57% of wheelchair budgets currently go on back-office costs. Fifty-seven pence in every pound that the taxpayer puts into these services fails to reach the front line at the moment. That is not acceptable; it is not a good way to use our taxpayer-funded resources for the health service. In these financially straitened times, it is clear that we have to make the available funding work much harder than that, and we can achieve much greater efficiency and a much better quality of service by encouraging a more co-ordinated system of assessment and provision across the Government. For example, there is a good argument for managing procurement regionally, not locally, so we can benefit from the economies of scale that that would provide.

It is also important that commissioning is sufficiently flexible to accommodate those who wish to use personal health budgets to purchase wheelchair services. I agree with the hon. Gentleman that more needs to be done to ensure that commissioning and procurement processes work for those with the most specialised needs. I do not think that we have been bold enough in using third sector organisations, in the sense not that they are charities that hand out something that the state does not provide, but that they are good partners with the state to go the extra mile to deliver the sort of service that we need. Indeed, Whizz-Kidz has been mentioned in the debate, and there is a major success story in the partnership that that charity has formed with NHS London, local primary care trusts and local authorities to improve wheelchair services for children.

I want to encourage more of those innovative partnerships with the voluntary sector, so that we can start to make a difference by improving quality and efficiency in the system. For instance, we could usefully deploy the specialist skills of a social enterprise such as Whizz-Kidz as the main procurement body in a more co-ordinated regional system. That area needs further exploration across the NHS.

The Whizz-Kidz example demonstrates another important point: the picture is not entirely black. There are beacons of best practice in some parts of the country, and we need to learn more from them so that one area’s best practice becomes common practice throughout the country.

I can announce tonight that the Government will be pursuing a pilot programme specifically to examine the commissioning of wheelchair and seating services. The work in the two regional sites that have been selected—the east of England and the south-west—will see PCTs, councils, NHS trusts and clinicians examining new ways of commissioning wheelchair services along the lines that I described. They will make recommendations for new models that will be underpinned by consistent approaches to eligibility and access, which could then be established across the country. I understand people’s frustration and desire that this should happen quickly, which the hon. Gentleman articulated clearly. However, the big risk of rushing to a conclusion is that we will not arrive at the best possible solution. It is important that we work through solutions to develop a robust, evidence-based system.

The pilot programme is an important start on building up the comprehensive understanding that we need. It will help us to uncover the best ways of organising wheelchair services to meet people’s individual needs, and it will sow the seeds for best practice to take root across the whole NHS. I hope that we can work with the hon. Gentleman and his all-party group to ensure that we achieve the tangible outcomes that we all want so that all people who need powered wheelchairs get the quality of life that they desire and can contribute to society in the way in which they want.

I thank the hon. Gentleman for initiating this helpful debate and look forward to seeing how we can take things forward in the future.

Question put and agreed to.