Social Care Funding

Debate between Debbie Abrahams and Baroness Keeley

Wednesday 17th October 2018 Commons Chamber

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

I beg to move,

That this House notes that eight years of Government cuts to council budges have resulted in a social care funding crisis; further notes that 1.4 million older people have unmet social care needs; notes that Government grant funding for local services is set to be cut by a further £1.3 billion in 2019-20, further exacerbating the crisis; recognises with concern the increasing funding gap for social care; further recognises that proposals from the Government to invest £240 million will not close that gap; and calls on the Government to close the funding gap for social care this year and for the rest of the Parliament.

In October 2016, the Prime Minister told this House that her Government would provide a long-term sustainable system for social care that gives people reassurance. Then the Conservative manifesto said:

“Where others have failed to lead, we will act.”

But the Government have failed utterly to act and people in need of care have paid the price of that inaction. It is approaching a year since the Government promised they would deliver a Green Paper, yet it is still nowhere to be seen months after the planned publication date originally scheduled for summer. Since then, we have seen a further £1 billion cut from social care because of the cuts the Government have made to the budgets of the councils that deliver it, with disastrous consequences for the social care system.

The Prime Minister has not heeded her own warnings about failing to act. During last year’s election campaign, she said that

“the social care system will collapse unless we do something about it. We could try and pretend the problem isn’t there and hope it will go away, but it won’t. It will grow each year.”

That is exactly what has happened. The problem has not gone away and it has grown in the past year.

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

Does my hon. Friend agree that in addition to the immediate injection of £2.5 billion funding for social care, with 20% of the poorest local authority areas losing nearly £280 million in the past year compared with 20% of the most affluent local authorities gaining £55 million, we also need to address the issue in relation to the deprivation grant funding allocation?

[Barbara Keeley]

We do need to address that. Things have come to a pretty serious pass.

Shop Direct (Greater Manchester)

Debate between Debbie Abrahams and Baroness Keeley

Tuesday 1st May 2018 Commons Chamber

[Debbie Abrahams]

Absolutely; my hon. Friend has hit the nail on the head. This is a thriving business, and the callous disregard with which the workers have been treated is absolutely shameful. My hon. Friend the Member for Heywood and Middleton pointed to the fact that this business was named employer of the year. How can it be?

The decision is especially worrying because Shop Direct is not in financial trouble. It reported an increase in underlying profits before tax of 10.2% to £160.4 million last year. It has seen sales growth increasing over five consecutive years. The decisions it has made are purely commercial. The proposed site in the east midlands will employ fewer staff as Shop Direct moves towards increased automation. Given that automation is likely to offer commercial opportunities but also huge challenges for the UK labour market as a whole, the experience of Shop Direct workers has a wider impact on the UK labour market as a whole.

I am grateful to the Business Secretary for meeting me earlier today, but I will be seeking urgent action from the Minister in recognition of the support needed by Shop Direct workers in Oldham and Little Hulton and by workers across the country whose jobs may also be under threat as a result of automation.

Since the announcement, I have met the leader of Oldham Council and the USDAW union representatives for Shop Direct, alongside my hon. Friend the Member for Oldham West and Royton. I have also spoken to and subsequently met Shop Direct directors at a meeting convened by Greater Manchester Mayor Andy Burnham, together with my hon. Friend the Member for Worsley and Eccles South, council leaders, the Salford Mayor, Department for Work and Pensions and Department for Business, Energy and Industrial Strategy representatives and USDAW representatives, where we tried to seek a way forward.

It was essential to bring together around the table all the parties affected by Shop Direct’s proposed relocation to the east midlands so that it could hear directly from us our huge concerns about the move. At the meeting, Oldham Council tabled alternative proposals for a site of a similar size, accompanied by a favourable business package, at Broadgreen Park, Chadderton. Very disappointingly, however, this was rejected, and there was no willingness from Shop Direct to engage on alternative proposals in Greater Manchester.

Given that the Shop Direct executives appeared to have made their decision, my colleagues and I then pushed them to describe what specific training and support they would provide for the workforce over the next two years—including their communications strategy, given the poor communication to date—while in particular looking at options for the Raven Mill site as a specialist returns centre.

The Mayor put forward a proposal at the meeting to establish a taskforce, led by Greater Manchester’s Growth Company, which was agreed by all parties, including both Shop Direct and the Department for Work and Pensions. I understand that the first officers meeting of the taskforce was held yesterday, and I am awaiting feedback from it.

Working closely with USDAW, we will be holding the company to their legal obligations to engage in a meaningful consultation. The consultation started formally today, and the union has clearly stated that its test of whether it is meaningful is that Shop Direct should fully explore any options for relocating to a nearby site, as staff, through their trade union, are entitled to a say in the future of the business. The company has said in a statement that it will

“be partnering with local and national organisations to provide our colleagues with tailored advice and training, including career skills, access to financial planning and vocational courses to support re-training. It’s also our plan to offer apprenticeships in in-demand skills across our existing operational sites.”

I am grateful for the response to my letter to the Prime Minister which I received last night not from this Business Minister but from another one—the Under-Secretary of State for Business, Energy and Industrial Strategy, the hon. Member for Watford (Richard Harrington)—but it only goes so far. What specific discussions has the Minister had with colleagues in the DWP and elsewhere on support, quality training and reskilling for the Shop Direct Greater Manchester workforce over the next two years?

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

I want to ask my hon. Friend about the Little Hulton employees. Unemployment in Little Hulton is double the national average. As she has already said, no consideration has been shown for the loyalty of the staff there, many of whom have worked for the firm for decades. When we had the meeting with our friend the Greater Manchester Mayor, Andy Burnham, there was a clear expectation that staff would remain in place for two years—across two Christmas seasons—and not take their redundancy until the end of that period. In a difficult place for unemployment, employment chances may come up during that period, and I really think that redundancy packages should be offered to staff earlier. Does she agree?

[Debbie Abrahams]

My hon. Friend makes a very valid point, and this needs to be explored. Again, I was struck by the lack of awareness among the directors we met about that situation, which really needs to be given considerably more thought.

I would be grateful to the Minister for an assurance that focused plans will be developed regarding skills and retraining packages, employment advice and financial support. Locally, it is vital for all parties, including the Government, to partner with Get Oldham Working, which provides holistic support to Oldham residents to access employment and training opportunities, as well as to work with local employers to understand the workforce and skills requirements better. Will the Minister commit to his Department working with the council on workforce support and employment opportunities for current Shop Direct employees, and will BEIS representatives be actively involved in the taskforce that has been set up for this purpose? What discussions has he had about supporting Oldham Council and Shop Direct to bring new employment to the Shaw and Chadderton sites, and about ensuring that the future of all Greater Manchester sites are secured?

Turning to the wider implications of automation, the move to increased automation is given as a key driver behind Shop Direct’s proposals to move to the east midlands. The Minister will be aware that the Bank of England estimates that 15 million UK jobs will be affected by automation by the 2030s, with PricewaterhouseCoopers saying that a third of all UK jobs will be affected. There is already evidence of this in the retail sector and although automation will affect jobs at all levels, it will hit low-paid jobs first. The potential effect on already widening inequalities is a real risk, and the estimates do not even factor in the impact of Brexit on the economy and jobs.

We therefore need to know what measures the Government have put in place to support workers affected by the ascendance of automation. What are the Government doing to assess the impact on the labour market as a whole, and on socioeconomic inequalities? The Minister’s letter mentions the Matthew Taylor report and his positive outlook on innovation, but while we must embrace change we must also manage it, recognising that at each stage both positive and negative effects will be associated with industrial progress—as history has taught us—and we must look to mitigate the negative effects. The “we” in this are businesses, workers and their unions, and the Government. What, specifically, is being proposed to mitigate the negative effects of automation? For example, what engagement have the Government had with businesses regarding the challenges of automation, and in particular the way employers manage the transition to automation that supports their needs to compete, but recognises their responsibilities as employers?

The Government’s industrial strategy, published last year, stated that the Government will introduce a national retraining scheme in England by the end of this Parliament, with a high-level advisory group—the National Retraining Partnership—bringing together the Government, businesses and workers, through the Confederation of British Industry and the Trades Union Congress, to set the scheme’s strategic direction and oversee implementation. Given that the first meeting was only on 5 March, what progress has been made to date on this and how does the Minister envision this helping my constituents in Shaw and others affected across Greater Manchester? In addition, what support will be offered to agency workers, such as those at Blue Arrow, who will feel the impact in my constituency; and will it be worker led rather than employer led?

The sum of £40 million was announced in the spring statement to test innovative approaches to help adults upskill and reskill. What progress has been made on these pilots, and will the Minister consider a pilot in the Shaw and Greater Manchester areas? Information from Oldham Council indicates that Oldham’s labour market expects growth in health and social care, and business and financial services, which could be ideal for a national retraining scheme pilot, supporting career changers. I hope that the Minister will say something about that in his remarks.

I gently say to the Minister that, given that the Government cut £1.15 billion from the adult skills budget between 2010 and 2015, and the adult education budget is 40% less than it was 10 years ago, the money allocated to the national retraining scheme is a drop in the ocean. But whatever funding is available, I want to make sure that Oldham, and Greater Manchester as a whole, gets a fair crack at it.

Our vision for this country must be for a high-skill, high-pay, knowledge-driven economy, and the Government must recognise the investment needed to achieve that. Focusing, as much of the industrial strategy does, on a few elite sectors will not deliver on the ambition to transform Britain’s economy. Will the Minister therefore look at setting up sector councils, modelled on the highly successful Automotive Skills, for every strategically important industry, bringing together Government, business, trade associations, research councils and so on, so that they can collaboratively plan and take action for the future security and growth of each sector, including small and medium enterprises?

As people increasingly transition between jobs, training and re-training, we need to have a responsive, supportive and enabling social security system. This does not exist at the moment. The hostile environment in the Home Office is replicated in the Department for Work and Pensions. This has to stop. I would be grateful for the Minister’s reassurance that he will do everything in his power to work with the Secretary of State for Work and Pensions to ensure that my constituents are afforded the dignity and respect that they deserve, and that he will report back to the House on the joint work that he will undertake with the Secretary of State to make our social security system fit for purpose for everyone affected by this new world of work.

It is clear that as well as affecting nearly 2,000 workers in Greater Manchester, Shop Direct’s proposal to relocate and move towards greater automation in its distribution facilities is indicative of profound changes in the labour market and the nature of work. Together with colleagues, I will continue to do all I can to support the 1,992 people affected by this decision and to maintain jobs on the sites affected. There are serious questions for Ministers about the impact of automation on the labour market, the increasingly insecure nature of work and our inadequate social security system. All those issues need to be addressed. I look forward to the Minister’s response to the many points I have raised.

Women and the Economy

Debate between Debbie Abrahams and Baroness Keeley

Wednesday 9th December 2015 Commons Chamber

[Debbie Abrahams]

rose—

[Barbara Keeley]

rose—

Museum of Science and Industry

Debate between Debbie Abrahams and Baroness Keeley

Wednesday 26th June 2013 Westminster Hall

[Debbie Abrahams]

Thank you, Mr Brady. I thank my hon. Friend for her intervention, and I wholeheartedly agree with her. Outreach work is one of the things MOSI is doing. The potential threat to the work done in our schools is a real issue.

The museum hosts a range of high-profile events promoting science and innovation. They include the Manchester science festival, which, in 2012, included MOSI’s first citizen science project—Turing’s Sunflowers. The project drew participants from 13 countries and generated the largest ever data set investigating Alan Turing’s hypothesis about the mathematical patterns in sunflowers—we will all know about that, and we will be discussing it over tea later. There is also the FutureEverything art exhibition and conference—a ground-breaking mix of cutting-edge digital technology, art and music. Those are the types of programmes MOSI puts on, and they are so accessible for such a wide range of groups.

MOSI also runs tailored programmes for schools and colleges, reaching 75,000 young people a year. Through MOSI’s science, technology, engineering and mathematics network contract, high-quality, innovative projects are delivered to volunteers and schools. Over the past year, the STEM ambassador programme has placed ambassadors in 140 schools in Greater Manchester, working with 450 teachers and providing at least 100,000 instances of engagement with pupils in face-to-face activity.

Of course, we must not forget the under-six programme, which allows the children of my hon. Friend the Member for Manchester Central and others to explore and find out first hand about the magic of science.

I am looking forward to visiting the exhibition on the brain that is coming to MOSI next month.

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

My hon. Friend is making excellent points, and I congratulate her on securing the debate. In our debate last week, we focused on the point that the funding threat to a much loved museum is a matter of huge concern to people in the region who work in science and engineering, such as the astrophysicist Tim O’Brien. He has said that he has no doubt that places such as the museum make our future scientists. Does my hon. Friend agree that it is vital to our future productivity, as well as providing excellent learning outside the classroom?

[Debbie Abrahams]

I totally agree with my hon. Friend. The activities and exhibitions can inspire the next generation of scientists and engineers, as I have mentioned.

We must not forget that MOSI also directly makes a key contribution to the region’s economic prosperity. A recent study of its economic impact shows both direct and indirect impacts. It is one of the top two visitor attractions in Greater Manchester and generates a direct gross value added benefit of more than £7 million as an employer and through procurement, but there is also nearly £28 million in off-site expenditure, generating a GVA of £8 million. MOSI’s development plans have the potential to increase those impacts.

As I have mentioned, after the 25% real funding cut in the last spending round, there is the prospect of a further 10% cut in the comprehensive spending review this afternoon, and the SMG has made it clear that if that happens a tipping point will have been reached and activity will have to be cut dramatically. That will include the closure of one of its regional museums. SMG has proposed a different approach. It has suggested, for example, moving the group from the responsibility of the Department for Culture, Media and Sport to the Department for Business, Innovation and Skills, and protecting the current funding level for both revenue and capital. That would provide a foundation on which the group would seek further major revenue and capital investment from the private sector. I should be grateful if the Minister commented on those proposals, as well as confirming that the CSR does not threaten MOSI or the free access to museums introduced by the Labour Government. To introduce such a threat would, as my hon. Friends have said, be myopic, to say the least, and bring into question the Government’s commitment to fairness, growth and the regions.

I am immensely proud of Manchester’s contribution to the world’s science knowledge base. Through our entrepreneurs and industrialists, the applications of that knowledge have changed how we live. MOSI not only inspires future generations to become the new Geim, Novoselov, Turing or Dalton, but, as curator of those achievements, protects our cultural heritage and contributes to our cultural identity. That is something that we should honour and celebrate, not destroy.

Carers

Debate between Debbie Abrahams and Baroness Keeley

Thursday 20th June 2013 Commons Chamber

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

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on organising this debate. I am grateful for the opportunity to speak after such thoughtful contributions. I want to focus on unpaid carers; I will leave others to talk about the care system as a whole.

As we have heard, carers play a vital role, not just for their family members and friends but for the country. In the past decade, the number of carers has grown from just under 5 million to nearer 7 million. By 2037, it is estimated that the number will have increased to nearly 9 million. In my constituency, there are 11,076 unpaid carers, nearly a quarter of whom provide care for more than 50 hours a week. As has been said, we know that this is an underestimate of the actual number who provide care. My hon. Friend the Member for Worsley and Eccles South talked about the lack of information and advice, which has certainly been identified in my constituency. Age UK in Oldham recently opened an information and advice centre, and I hope that people will avail themselves of that. Like other Members, I, too, have had the plight of carers increasingly brought to my attention in my surgeries. Their situation is a growing problem.

In today’s terms, the role played by carers saves the economy £119 billion a year. That is more than the total NHS budget and nearly six times the adult social care budget. The country could not survive without the work that carers do, and that is even more so today, with the crisis that social care is facing. We are facing the double whammy of an ageing society—it is great that we are, on the whole, living longer, although austerity is certainly having an impact on life expectancy—and a meltdown in social care in local authorities, with cuts to their budgets having an impact on social care budgets. Unfortunately, carers are picking up the tab. A recent Carers UK survey showed that a third of those caring for more than 35 hours a week have no support at all. Although 3 million carers juggle work with caring responsibilities, one in five has been forced to give up work.

In addition to the lack of support for caring, carers across the UK are starting to see the impact of the Welfare Reform Act 2012. Changes to financial support with housing and council tax in some areas mean that many families are experiencing reduced financial support from more than one of the changes. The discretionary funding set aside by councils to support people affected by the bedroom tax is enough to help only one in 10 disabled people. Carers who require an additional room because they cannot share with partners who sleep in hospital beds, or parents of disabled children who need the space for care workers to provide overnight care are being seriously let down. More than 5,000 families with care needs are faced with either moving or finding an extra £700 a year.

The cumulative effects of the economic downturn, a squeeze on wages and the increasing costs of essentials such as food and fuel, along with the cuts in social security support, are making it more difficult for carers to manage. More than four in 10 carers in the Carers UK survey said they had been in debt as a result of caring. This year will see other changes to the benefits system, as the transfer of disability living allowance to the personal independence payment and the universal credit are introduced, which is also of considerable concern to many carers. DLA was the gatekeeper to carer’s allowance. The changes mean that 10,000 fewer carers will not be entitled to carer’s allowance. Many of us have already called on the Government to review these changes and undertake a cumulative impact assessment of the effects of these welfare reforms. For many, they will be the tipping point.

In addition to that, and as a consequence of debt and a lack of support, there are significant effects on the health of carers. Eight out of 10 carers report that their caring role affects their physical health and nine out of 10 say that their mental health has suffered. This is not only a human tragedy; we are storing up problems for the future by not caring for our carers.

I know about that from my personal experience of caring for my mum—I have spoken about her before—who died of Alzheimer’s last September. She had Alzheimer’s for 10 years, and for the last three years was unable to communicate or to feed or toilet herself. Although my mum lived in the States, I provided respite care during leave, so I can personally attest to the physical and emotional toll that it had on me. In the last few months of her life she was bedridden. I am little, but I am fairly fit and strong, yet physically trying to lift her to bathe her or change her continence pads was something I found really difficult to manage. The worst thing was the emotional toll, however, as I worried how everyone was coping.

I want to spend the last few minutes talking about young carers. One of the last research projects I worked on before I was elected to this place concerned the effect on young carers’ health of their caring role. Many people will be surprised to learn that, according to recent census figures, there are more than 178,000 young carers in England and Wales. Those are the official figures, but we know that they are an underestimate. Children as young as five are looking after family members who are physically or mentally ill or disabled, their roles ranging from doing household chores to providing nursing or personal care.

The effects on those children and young people are immense and lifelong. Because of their caring responsibilities, nearly a quarter of young carers often miss school or have educational difficulties. Young carers are also more likely to grow up in poverty, to be socially excluded, to have low aspirations and achievement and to have relationship issues. Those problems can follow them throughout their lives. There is also evidence of significant effects on their physical and mental health, with anxiety, depression and self-esteem issues being particularly prevalent. It has been shown that, after a year of caring, morbidities fail to return to pre-caring levels.

Services do not always respect young carers and the role that they play. My research indicated that many young people felt excluded from discussions about their family member’s care, even though they were providing much of it. Some of the responses to questions on whether the young carers should be allowed to see their parents in hospital, for example, were quite heartbreaking. Similarly, many young carers felt that there was a lack of understanding and support from their teachers and schools. I echo what my hon. Friend the Member for Worsley and Eccles South said about this. We must ensure that schools take seriously their role in supporting young carers.

[Barbara Keeley]

I have mentioned the fact that we have a young carers project in Salford that is doing great work. It was interesting, however, that one of the schools involved came back to the project and said, “We have no young carers at all”, when the project knew that it did. The perception among some head teachers is that they do not have any. Is my hon. Friend worried about that as well?

[Debbie Abrahams]

I totally agree with my hon. Friend; that is very worrying, and we must try to do better by those young people.

I am encouraged by what the Minister has said today about the discussions, but I reiterate my hon. Friend the Member for Worsley and Eccles South’s sentiment that warm words are not enough. Will he tell us when we can expect to have the amendments included in the Children and Families Bill? The rights of parent carers of disabled children are also still in limbo, and the Government must bring forward changes to the Bill to ensure that the rights of that group of carers are not left behind. I recognise the Government’s commitment to carers’ rights, but I reiterate my earlier remarks: no matter how much we legislate for assessing carers’ needs, it is meaningless without the means to implement it. Local authority budgets have been pared to the bone, and that is having an impact on social care budgets. How are we going to deliver those assessments? A further £800 million of cuts are planned for this year alone. I would be grateful if the Minister would address that point as well.

National Health Service

Debate between Debbie Abrahams and Baroness Keeley

Wednesday 26th October 2011 Commons Chamber

[Debbie Abrahams]

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

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

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

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

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

[Barbara Keeley]

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

[Debbie Abrahams]

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

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

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

The

“current form of the adjustment”

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

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

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