Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

I, too, as I know will all my ministerial colleagues, congratulate my right hon. Friend the Secretary of State on a remarkable tenure in his post.

It is clear that mature student numbers dropped immediately after the higher education reforms, but they then started rising and have now exceeded the rate before the reforms. I am happy to give the hon. Gentleman the details of that. We are also clear that we need to nurture mature students, which is why the consultation asked the specific question that it did. We want to invite answers from the service about how best we can do that because we are clear that the current system is not working as well as it should.

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

2. What recent assessment he has made of the effectiveness of specialist nurses in supporting disabled people.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

Specialist nurses make a valuable contribution to the care of disabled people. They have specialist post-registration qualifications, which are attained through additional training. There are now 3,000 more nurses working in the NHS than in May 2010, ensuring that disabled people continue to receive the highest possible quality care.

[Debbie Abrahams]

In May 2010 there were 5,360 learning disability nurses. In January 2016 there were 3,619. The Government promised to protect the NHS frontline. Why does this protection not extend to people with learning disabilities?

[Ben Gummer]

It is true that the skills mix and the way in which specialist nurses have changed over the past six years may well account for the variation that the hon. Lady has noticed—I am willing to write to her with the detail—but the total number of nurses has increased, and we are giving better and more varied training to nurses across the board so that they can deal with the specialist problems that are increasingly the core part of their work.

NHS Bursaries

Debbie Abrahams Excerpts

Wednesday 4th May 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

And where has the hon. Member for City of Chester (Christian Matheson) been during the debate? [Interruption.] Oh, I beg your pardon, but that is not as good as being here in on the Floor of the Chamber in real life.

Thank you very much, Mr Deputy Speaker, for this opportunity to respond to the debate. I thank the hon. Member for Lewisham East (Heidi Alexander) for raising the important question of the development and expansion of nurse training in England. I thank colleagues for a good debate, with discussions informed by those with close connections with the NHS, either personally or through family.

I pay tribute to all those who work and train in hospitals, who fill the posts that we have been speaking about, and who are the subject of our debate. They are not only nurses and midwives; several colleagues made specific references to allied health professionals, such as those in dietetics, occupational therapy, orthotics and prosthetics, physiotherapy, podiatry and chiropody, radiography, speech and language therapy, operating department practice, dental hygiene and dental therapy—all important components of the NHS. We recognise the importance of the work done in our hospitals, and we thank them for their effort.

This has been a not unusual debate in which the Government propose changing something and the Opposition react with horror. Whether the Government’s arguments are good or bad, that is how it goes. There have been a variety of Opposition arguments—some good, some less good—but whenever change is proposed, there is a set of reactions. As for the poorest reaction, I say this to the hon. Member for Lewisham East with great sincerity: please do not go down the class route. It was absolutely unnecessary to try to pick out what people might have heard in various places as they were growing up and graduating. I am the son of a doctor and a teacher, so there were public health workers in my household. The sense that I got of public service and commitment was possibly shaped then. I do not think that the experience was any different from that of the hon. Lady, or of the hon. Member for Liverpool, Wavertree (Luciana Berger), who had a private education at Haberdashers’ Aske’s School for Girls. I see no evidence in the hon. Lady’s obvious commitment to mental health and everything else that her conversations shaped her poorly in any way. To suggest that the Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), may not have picked up the same sort of information, and that that may have impacted on his care and work as a Health Minister, was pretty low. The hon. Member for Lewisham East should not go down that road again.

The two main arguments presented today against what we are trying to do have been about deterrents, or the idea that the occupations are somehow unpalatable and that people will not go into them. On deterrents, I am old enough to have been here for the original debates on the introduction of student fees. Everyone protesting against them at the time said that no one would ever go to university again, and that people from poor backgrounds would never go to university. The same arguments come up every time the subject is raised, and the same arguments have been proved false time and again. What is not false is the damage done at the time of the debates when it is suggested to those who want to aspire to higher education, and to take themselves in a different direction, that it will somehow be made impossible, and that they should not want to do it. Those arguments have been used time and again, and they have been used again today. They were wrong then; they are wrong now.

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

What is unique about this situation, as has been mentioned several times, is that a disproportionate number of the nurses using the bursary scheme enter as mature students, including three of my nieces. If bursaries were not available to them, they would not have gone on to train as excellent nurses.

[Alistair Burt]

If the hon. Lady had been here for the entire debate, she would have heard people speak about the problems of hardship following bursaries; that was referred to by the hon. Member for Ilford North (Wes Streeting) and by Government Members. People want access to more funds, which might help those whom the hon. Lady just mentioned, but the assumption is that, because it will be a student loan and because it is a change, people just will not want to do the courses. There is no evidence to suggest that that is correct. Using it as a scare story is unhelpful for the recruitment that we want.

Southern Health NHS Foundation Trust

Debbie Abrahams Excerpts

Tuesday 3rd May 2016 Commons Chamber

[Alistair Burt]

I know that my hon. Friend has followed these matters closely for her constituents. Since last year there have been nine changes to the board, and the chair of the board left last weekend. NHS Improvement has the powers to alter governance, and I know from speaking to NHS Improvement that it takes that power and responsibility extremely seriously. The balance is between ensuring continuity and stability so that what the trust has promised is delivered, and wholesale change, which would provide an opportunity for further delay and prevent the work going on, but I know that NHS Improvement is very aware of its responsibilities in relation to governance, as I hope is the trust itself.

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

It is right that this House legislated for parity of esteem for mental health care; I am proud that we did that. I recognise the Minister’s commitment to quick resolution so that we can implement recommendations to address the failings of the trust. Will he consider an independent inquiry similar to the first independent inquiry into Mid Staffs that my right hon. Friend the Member for Leigh (Andy Burnham) initiated in 2010?

[Alistair Burt]

I can do nothing more than repeat what I said earlier. I am aware that there might be circumstances in which an inquiry would bring out more and would demonstrate the degree of concern that colleagues in the House might find appropriate and that the families and others would understand. My first duty is to make sure that everyone is safe in the trust and to ensure the completion of the work that needs to be done to deliver what the CQC has found. Even after this very thorough work by CQC, which is transparent—that is why we are talking about it today—if anything further is needed, I will give it genuine and serious consideration.

Junior Doctors Contracts

Debbie Abrahams Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. The deal on the table is fair for junior doctors; there is higher premium pay for people who work regular Saturdays than there is for nurses, paramedics, healthcare assistants in their own operating theatres, fire officers, police officers and pretty much anyone else in the public or private sector. Under the new contract we are bringing down premium rates for Saturday pay, but we are making sure we compensate that with a 13.5% increase in the basic pay—to my knowledge, that is not being offered anywhere else in the public sector. That will mean take-home pay goes up for 75% of junior doctors. It is a very fair deal. It is designed to make sure that they are not out of pocket as we make changes that are safer for patients, which is why we should be talking about these changes and not having these strikes.

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

A phased implementation is not the same as having a pilot with an independent evaluation to assess the effects of this contract on the workforce, and on safety and quality of care. Why will the Health Secretary not accede to the wholly reasonable proposal to pilot the new contract, which will break the current deadlock?

[Mr Hunt]

We have had eight studies in the past six years—those were independent studies, not commissioned by the Government, and they covered areas such as paediatric and cancer care, emergency surgery and a whole range of other areas. Six of those eight studies mentioned staffing levels at weekends as something that seriously needs to be investigated. Today there are higher mortality rates for weekend admissions, and the Government have a responsibility to do something, not to commission further studies. That is why we are determined to press ahead.

Brain Tumours

Debbie Abrahams Excerpts

Monday 18th April 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Edward. I pay tribute to my hon. Friend the Member for Warrington North (Helen Jones) for her exceptional speech and to the chair of the all-party group on brain tumours, the hon. Member for Castle Point (Rebecca Harris), for making such a moving speech.

As we have heard, brain tumours account for 40% of all cancers in children. They are the leading cause of male deaths for 20 to 29-year-olds and they are the biggest cancer killer for those under 40. We do not have a good survival rate for brain tumours; four out of five people will die within five years of being diagnosed. Brain tumours are on the increase. Twenty-nine people a day are diagnosed, reducing life expectancy by 20 years on average, which is the highest for any cancer.

Brain tumours are the largest cause of preventable or treatable blindness in children, and childhood brain tumour survivors are 10 times more likely to suffer long-term disability than well children. This accounts for 20,000 additional disabled life years for all children who are diagnosed each year. We have heard about the low base of research funding for brain tumours. The Minister has already been asked about that and I look forward to a favourable response.

Behind all the facts and figures are the personal stories. I was particularly moved by one of my constituents who wants to remain anonymous. He has a young family and he has had a difficult time. He told me he has gone from being a fit, healthy individual to one who struggles to do many of the everyday things that a dad wants to be able to do with his children. He was diagnosed last year at the age of 40 with a grade 2 oligodendroglioma. After an 11-hour craniotomy, during which he was awake, he has spent much of the past nine months fighting infection and undergoing extensive physiotherapy to help him to learn to walk again and to enable him to live a relatively normal life. He started radiotherapy at the Christie last month to try to control the regrowth of the tumour. Unfortunately, the nature of these things means that it is almost certainly regrowing, yet he says he is one of the lucky ones with, hopefully,

“a decent number of years ahead”

of him. However, he is taking nothing for granted. He has been lucky in terms of being awarded an Access to Work grant, which has been invaluable in helping him to stay in work.

I also want to mention a young man, Christopher Clarke, who was 18 when he died of his brain tumour. He was a lovely lad. He was so cheerful in spite of the diagnosis and prognosis. He had a profound effect on his circle of friends. Even 10 years after his death, they are still fundraising for the trust that was set up in his name.

Satvinder Uppal was 54 when she died of a brain tumour five years ago last week. The real issue for Satvinder’s family was the delay in diagnosis of the brain tumour, which we have heard is common. In spite of prolonged jaw pain, severe headaches and memory issues, the tumour was not picked up when she went on various occasions to visit her GP. It was not until she collapsed at home that she was finally diagnosed at A&E. As her family said,

“The specialist cancer centre was brilliant, but getting the diagnosis in the first place was the issue.”

What does the Government plan to do to extend brain tumour research from the current low level? What will the Minister do to ensure that clinical guidelines reflect the poor diagnosis rates?

Dementia and Alzheimer’s Disease

Debbie Abrahams Excerpts

Tuesday 12th April 2016 Westminster Hall

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

I add my congratulations to the hon. Member for Strangford (Jim Shannon) on his exceptional speech and on securing the debate. It is a pleasure to speak, however briefly, in the debate as a co-chair of the all-party parliamentary group on dementia, as the only MP—I think that is still the case—who is a dementia friends champion, and as a former carer for my mum, who had Alzheimer’s disease. As we have heard today, if anyone’s life has not already been touched by someone who has dementia, it soon will be.

I commend the Government for their commitment and, in particular, the Prime Minister’s challenge and the investment in research funding that was announced last year at the World Health Organisation’s first ministerial conference on global action against dementia. It needs global action; we cannot act in isolation. It is estimated that by 2018 the global cost of dementia will be $1 trillion. I therefore ask the Minister to update us on the longer-term plans for building on that research investment and, specifically, what funding has been set aside to meet the challenges that make up the Prime Minister’s challenge on dementia and whether we are on track.

In addition to research, we need to ensure that hospital services take into account the specific needs of people with dementia. We know from the recent Alzheimer’s Society campaign, “Fix Dementia Care”—my hon. Friend the Member for South Shields (Mrs Lewell-Buck) mentioned some of the results—that 57% of carers, families and friends of people with dementia felt that the person they cared for was not treated with understanding or dignity in hospital; only 2% of hospital staff understood the specific needs of someone with dementia. We obviously need to address that. Could I put in a plug for the APPG report? Seven out of 10 of the people in hospital are not actually there for their dementia, but for something else. We have a report coming out next Wednesday on dementia and comorbidities, and I hope that people will be able to join us for that.

I am sure that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) will mention this in her winding-up speech, but we cannot divorce the issues in relation to social care from dementia care. I called on someone, just in a regular door-knock, and she obviously had dementia. She was on her own. She greeted me with an empty medication bubble pack and just said, “I don’t know what to do.” Too many people are isolated in that way. So many demands are placed on family carers. I hope that the Minister can address some of those issues.

[Graham Stringer (in the Chair)]

We have gone slightly over time because of the unusual circumstances, so could the Front-Bench spokespeople bear that in mind? You have marginally over seven minutes, and that will leave just over a minute for Jim Shannon.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Alistair Burt]

Overall access to NHS dentistry is good, but it does vary from area to area, and West Yorkshire, as the hon. Member for Dewsbury (Paula Sherriff) well knows, is one of the areas that worries us and that we are trying to do something about. Work is being undertaken in the West Yorkshire area to look at issues around NHS dentistry. I have met a number of hon. Members to discuss this matter. It has my attention, so I will be monitoring it closely, and my hon. Friend was right to raise it.

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

The King’s Fund analysis revealed that there will be not a £10 billion, but a £4.5 billion real-terms increase to the NHS. Will the Health Secretary apologise for misleading not just this House but the public as a whole?

[Mr Speaker]

Order. The hon. Lady must not accuse a Member of misleading the House. If she wishes to insert the word “inadvertently” she would spring back into order, which is where I am sure that she wishes to be. Do I take it that the word “inadvertently” has been inserted?

[Debbie Abrahams]

I am happy to insert “inadvertently”.

[Mr Jeremy Hunt]

The hon. Lady may inadvertently have not been listening to my previous answers. Let us look at what Simon Stevens, the chief executive of the NHS, actually said about that spending settlement. He said that the Government had listened to and “actively supported” the NHS case for public spending.

NHS: Learning from Mistakes

Debbie Abrahams Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

My colleague, the hospitals Minister, will have those discussions with the Northern Ireland Health Minister. However, the hon. Gentleman is right that if we are going to have a learning culture, it needs to be across the UK, not just in England. That is why I welcome the discussions we have with the Scottish NHS and the Welsh NHS. There are things that we can learn from each other, and we should be very open-minded in doing so.

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

We must all strive to improve safety and quality in the NHS, but the Health Foundation report that the Secretary of State referred to stated that 40% of patients said there were too few nurses to care for them—this is three years after the Francis report. The Government say that the NHS must learn more, but what are they doing to learn from the inquiries that have been held?

[Mr Hunt]

Well, quite a lot. For example, we have increased the number of nurses by more than 10,000 since the Francis report was published, to ensure that we do not have a problem with safety on our wards. We recognise that it is incredibly important not to have short-staffed wards, and we are making more reforms in this Parliament to ensure that we recruit even more nurses. It would be good to have some support from Labour on that.

NHS and Social Care Commission

Debbie Abrahams Excerpts

Thursday 28th January 2016 Commons Chamber

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

I congratulate the right hon. Member for North Norfolk (Norman Lamb), my hon. Friend the Member for Leicester West (Liz Kendall) and the other Members who secured this debate. We have heard some thoughtful speeches and different views from both sides of the House. I reflect on the comments of the hon. Member for Faversham and Mid Kent (Helen Whately), whom it is a pleasure to follow. I, too, believe that the commission, although in principle a good idea, would be a distraction.

My hon. Friend the Member for Walsall South (Valerie Vaz) talked about what was different in 2009. In 2011, just after the coalition Government formed, we had the opportunity to hold a cross-party roundtable. It was proposed by my right hon. Friend the Member for Leigh (Andy Burnham), but rejected by the coalition. It comes down to what many people have said about the difficulty of taking politics out of such a debate. It is down to political will.

There are a few points I want to talk about. The hon. Member for Bracknell (Dr Lee) made the point—and, although coming from a different viewpoint, I fundamentally agree with him—about having different ideological perspectives. I want to focus for a moment on the Health and Social Care Act 2012. I served on two Bill Committees with the hon. Member for Stafford (Jeremy Lefroy)—who really embodies the term “honourable Gentleman”, so I am sorry I disagree with him on this point. At the time, the Opposition made real efforts to explore and provide the evidence base for the implications of the Bill and what would happen, and I am afraid that much of that has come true.

All this is based on the fact that the Government, and at that time the coalition Government, have a different view of the NHS and, I suspect—although I cannot recall whether this is on the record—how it should be funded. We believe absolutely passionately—we fought the general election on this basis, as we did on a number of issues—in a publicly funded NHS, funded through general taxation, with the NHS as a preferred provider. We have committed to repeal the Health and Social Care Act, because we believe that its basis—section 75, which compels all providers to put their contracts out to tender—is wrong, and it has been proven wrong.

[Caroline Flint]

My hon. Friend is right: we do support a publicly funded NHS, but it has also been Labour party policy in social care that we think people should make a contribution. The problem with the politics is that we cannot come to a defined space where we can all agree on what is a reasonable contribution. We have to be up front about these things, because we need a system, particularly in social care, where we have to look at other models of how we provide those services and what will be expected for people to finance them, do we not?

[Debbie Abrahams]

I would not disagree with my right hon. Friend, but to pretend—and that is what it would be—that we could reach that conclusion on a cross-party basis would be an illusion. That does need to happen, but we come from completely different perspectives, and that needs to be considered.

In the first year of the legislation, contracts worth £16.8 billion of public money went out to tender under the Health and Social Care Act, with 40% going to private healthcare companies. We could track that because it was on Supply2Health, a public website that was taken down, which meant we could no longer monitor it. Care UK won 41 contracts worth £110 million; and again, the association of donations to different political parties is on the record. Some £5 million has been wrapped up in funding for competition lawyers. In my constituency in Oldham, my community trust, which also provides our mental health services, has said that the amount of time and money wrapped up in competing for tenders has increased inexorably. That is a distraction, and having a commission, getting away from these central points, would also be a distraction. As I say, we come from different ideological perspectives.

[Mark Durkan]

Given what my hon. Friend has said about the impact of the legislation in the last Parliament, does she believe that a commission would have a more adverse impact on the long-term future of the health service than that legislation is having, which is based on the old way of doing business?

[Debbie Abrahams]

We come from completely different perspectives, as I have just mentioned to my right hon. Friend the Member for Don Valley (Caroline Flint). My hon. Friend the Member for Walsall South said this had been mooted back in the ’60s, but if we think that now, just a few months after our debate on the Health and Social Care Act, something has suddenly changed, I would respectfully ask, what has changed?

Again, a commission would be a distraction from what we really need to have our eye on: what is happening in health and social care at the moment. We know that the decisions made about staffing and training, for example, have put our workforce plans in jeopardy. One reason why we have financial problems is that three out of four trusts are now in deficit—currently a deficit total of about £840 million, which will run up to £1 billion by the end of the year.

[Norman Lamb]

Is there not a danger with the approach that the hon. Lady advocates? We can continue to have a go at the Government and say how awful the pressure on staff and the deterioration of services are—I accept that a lot of that is happening—but is it not better to try to achieve a solution rather than wait in the hope that at some point in the future, a Government might take a decision to provide the necessary funding and other necessary changes?

[Debbie Abrahams]

As I teased the right hon. Gentleman last week at a Radio 5 Live interview, “so says the former Minister who was saying something quite different just a few months ago”! I do not want anyone to be under any illusion about this. I am not saying that we should not be planning for 30 and 40 years hence. I am saying that, given the vastly different ideological perspectives —I have provided one example, showing how much we disagree about the Health and Social Care Act 2012—trying to pretend that we can agree is naive.

In the last Parliament, I was chair of the parliamentary Labour party’s health committee, and we undertook an inquiry that looked into the effectiveness of international health systems—it is published on my website for everyone to have a look at. We were particularly concerned about quality and equity in access and outcomes, because we knew there was a vast difference in both those respects. The inquiry showed quite conclusively that where there was competition, privatisation or marketisation in the health system, health equities worsened. It revealed that there was no compelling evidence to show that competition, privatisation or marketisation improves healthcare quality. In fact, there is some evidence to show that it impedes quality and increases hospitalisation rates and mortality. This was peer-reviewed evidence—a review of a review of evidence—not one-off studies. It was the strongest type of evidence showing that marketisation and privatisation worsen health equity and worsen the quality of care.

We need to take a forward view, 30 or 40 years hence, about how to continue to fund the NHS and social care. This is a distraction, however, from the crisis that we have right now. We have seen A&E waits up 34% since 2015, failure to meet cancer 62-day treatment standards up 14%, and diagnostics up 36%. It goes on and on. Mental health cuts in 2014 meant the equivalent of £600 million-worth of cuts to mental health trusts. What has changed in the last few months? Delayed discharges reflect the care crisis, with £3.6 billion taken out of the budget for social care in the last Parliament. There is supposed to be £4.3 billion and a 2% precept, but it has been rightly said that it will not make up the difference. As my hon. Friend the Member for Leicester West said, since 2010, half a million fewer older and disabled people have received state-funded support.

In my constituency, I was doing my regular door knocks when I encountered an elderly lady in her 70s. She opened the door and presented me with a bubble pack of medicines and told me that she did not know what she had to do. She had never met me before. She was dishevelled and wearing a dressing-gown in the middle of the afternoon. This was a woman who clearly needed our help and needed support. She was all on her own and did not know what the medications were. I managed to get somebody there. I wonder, though, how much more this is likely to be happening up and down the country. The system is in a crisis, which is a real concern.

[Dr Wollaston]

In many instances around the country, the use of care co-ordinators and the existence of a single point of contact are not only providing better care for individuals, but saving money for the whole system by avoiding the need for admissions and allowing people to go home early. We should focus on the good examples, and on how services can be made available in a more co-ordinated way.

[Debbie Abrahams]

I entirely agree. That was another of our manifesto pledges. I also thought that what the hon. Lady said in her speech was spot on.

Let me return to what I was saying about distractions. We also need to look at the issue of funding and resources. The hon. Member for Totnes (Dr Wollaston) said something about that as well. Real-terms growth in spending in the last Parliament was the lowest in the history of the NHS, at less than 1%, whereas between 1997 and 2009 it was about 6%. The figure in the last Parliament was about 7.5% of GDP, slipping below the European Union average. We are now moving towards the bottom of the league, which is where we started in 1997.

So far, we have not even talked about devolution. I am a Greater Manchester Member of Parliament. The devolution offer to Greater Manchester was £6 billion, although the current collective health and social care economy is worth £10 billion. There has been no talk of contingency arrangements for, say, a flu pandemic. It is an absolute disgrace.

I also agree with the hon. Member for Totnes about the lack of an evidence base for decisions. I have provided an evidence base: our committee looked into resources and funding and how both quality and equity could be improved, and found vast disparities across the country, as well as disparities in outcomes for different groups of people. We should repeal the Health and Social Care Act and ensure that the NHS is the preferred provider.

[Maria Caulfield]

Will the hon. Lady give way?

[Debbie Abrahams]

I hope the hon. Lady will not mind if I do not. I have spoken for some time, and I am being pressed by you, Mr Deputy Speaker—[Interruption.]

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Not by me.

[Debbie Abrahams]

Go on, then.

[Maria Caulfield]

The hon. Lady spoke of repealing the Act. As a former NHS employee, I am frustrated by the fact that there has been too much reform, reorganisation and reinventing of the wheel. I issue this plea: please do not make any more structural changes.

[Debbie Abrahams]

I have chaired a trust, I am a former public health consultant, and I entirely agree with the hon. Lady. In the run-up to the election, we committed ourselves to repealing the Act without a reorganisation, because we thought that we could integrate and bring together health and social care in a better way that would not have required that reorganisation.

We need to feel confident that our NHS and care system is there for all of us, and for our parents and our children. It should be based on people, not on profit.

[Several hon. Members rose—]

--- Later in debate ---

[Alistair Burt]

I accept that. I was not in this post in the period from 2012 to 2015. I am certainly ensuring that we are progressing. I am glad that we have sorted that out. The coalition’s involvement with and commitment to this issue have been immense, and I am very proud to carry that on in the way I am doing.

My hon. Friend the Member for Lewes (Maria Caulfield) brought her experience to this debate. She spoke about the integration of budgets for social care and for local authority expenditure in the national health service, which is absolutely crucial. For me, integration is not about getting two groups of people to sit down in the same room every few months or so to have a discussion. It really cannot be done without a combined budget. So long as there are perverse incentives for one budget or another, it will not work.

We are making progress on that and have clear plans to get it done by 2020. We will follow our progress with a scorecard to find out where we are. We have spoken for too long about finding the holy grail, but we are further towards it than anyone has been before. That is not a bad place to be, but we must ensure that we make progress. A lot of this is about relationships; it is not just about organisations being in the same room. Unless people really talk to each other and have a real sense of what can be done collectively, we will not get anywhere.

My hon. Friend made the heartfelt plea, “Leave us be from time to time.” That would certainly be echoed by virtually everybody I have ever been involved with in the public sector during the past 30 years. They just wish we would decide what is to be done and let them get on with it for a while before changing it again. I am quite sure that this Government have absolutely absorbed that lesson.

The hon. Member for Don Valley—[Interruption.] Will she forgive me? Once I have been in the House for a few years, I will get all such distinctions right. The right hon. Member for Don Valley (Caroline Flint) speaks from a position of great experience and great success. She spoke about the successes and the failures in the system, which we all know about, and about how the commission could look at them. Again, I am not quite sure that it could bear the weight of doing so.

The right hon. Lady addressed the political issues and how difficult some of them are. If she will forgive me for saying so, she made an intervention on the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) that exemplified the point. There are difficult political challenges within parties as well as between parties across the Floor of the House, and I noticed the little challenge that was made.

I must say to the hon. Member for Oldham East and Saddleworth, who spoke with great passion about her party’s commitment to a publicly funded or taxpayer-funded NHS with no deviation from the line, that that is simply not true. It suits her to say it, but it is not true. Let me quote from an article from the New Statesman of 27 January 2015, under the headline “Labour can’t escape its Blairite past on the NHS, so it should stop crying ‘privatisation’.” It said that Alan Milburn

“serves as one of many reminders that not so long ago, during the New Labour years, the Labour party was driving through dramatic reforms in the NHS and did not shy away from private money in doing so.”

There are variations on a theme, even for the hon. Lady, and she perhaps protested about the public nature of the NHS a little too much.

[Debbie Abrahams]

I am grateful to the Minister for giving way as he did not challenge me when I made that point. Does he, however, accept that Labour stood on the platform of saying that the NHS should be the preferred provider? As other hon. Members have said, we have learned how important it is that policy driving the NHS should be based on evidence. We now have evidence that a health system with an internal market, or a marketised or privatised health system, which is what this Government are seeking, does not help to improve quality or to reduce inequity in healthcare. That was our platform.

[Alistair Burt]

Well, the platform was clearly stunningly successful. I am not embarrassed by being reminded of the Labour party’s NHS platform at the last election, because it did not succeed. For one reason or another, the public did not believe the stories run about us and the NHS, and they did not believe in Labour’s competence to handle the NHS. As we know, the amount of private sector involvement in the NHS is extremely small, and I am not sure that I accept the hon. Lady’s description of how it has all turned out. This is an example of how careful we must all be in dealing with such issues. We must not pretend to our publics that we are something we are not and that our opponents are something that they are not.

My hon. Friend the Member for Stafford (Jeremy Lefroy)—he has great experience, given the work he has done with the NHS—spoke about best practice. He wanted the commission, but again added more pressure in the things it would be doing and considering. I would make the point that such a commission happens at a point in time. I know that it would be designed to look ahead, but it would inevitably consider the circumstances pertaining at the time. We need a process for discussing the NHS and its funding—where the money is coming from and how it is spent. We need to make the process work, rather than thinking that one push into the grass will do the job. Again, I am not sure that the weight will be borne in that way.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 5th January 2016 Commons Chamber

[Alistair Burt]

I am grateful to my hon. Friend for raising this issue. We share his view: we want to see greater choice in end-of-life care so that people are able to be cared for and die in the place they choose and which is appropriate to their needs, whether that is a hospice, a hospital or their own home. The recent Choice review set out a vision of enabling greater choice at the end of life. I am working with NHS England to see how this can be best achieved and the Government expect to comment on that soon.

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

The Health Secretary recently received a letter from a range of social care organisations and charities panning the spending review offer, saying it

“is not sufficient to resolve the care funding crisis”

and warning of an

“increasing number of older people”

without sufficient support,

“increasing pressure on the NHS.”

Will the Health Secretary finally admit that the offer in the autumn statement is just not good enough?

[Alistair Burt]

That social care was an important part of the Chancellor’s spending review was noted by all. Up to £2 billion will be available through the social care precept—that will be added to council tax—and there is a further £1.5 billion available by 2020, so all in all £3.5 billion will be available by 2020. We all know resources for social care are tight; that is why we need best practice everywhere to make the best use of resources, which many leading authorities are already doing.