Future of the NHS

Emily Thornberry Excerpts

Monday 9th May 2011 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

This has been an interesting and important debate at an important time for our health service.

[Tony Baldry]

Where are they?

[Emily Thornberry]

I am being heckled already. I do not intend to make a habit of this—the hon. Member for Banbury (Tony Baldry) can heckle as much as he likes—but I will answer on this occasion. There is another draw this afternoon. My right hon. Friend the Member for Doncaster North (Edward Miliband) is speaking, but I understand that my hon. Friends will be coming in a moment.

We have heard a number of interesting and important speeches from Members who have shown great expertise and have been serving the community and the public through their work on Select Committees, including the Health Committee. We heard from my hon. Friends the Members for Easington (Grahame M. Morris), for Walsall South (Valerie Vaz), for Oldham East and Saddleworth (Debbie Abrahams) and for Pontypridd (Owen Smith), and from the hon. Members for Central Suffolk and North Ipswich (Dr Poulter) and for Stafford (Jeremy Lefroy). Listening to their contributions, we have had a taste of the quality of debate that took place in the Health and Social Care Public Bill Committee. It is a shame that the Government did not give an inch as a result of those debates.

We have heard from the Liberal Democrat representatives, including the hon. Member for Southport (John Pugh), who talked about the Jekyll and Hyde drafting of the Bill, and the hon. Member for St Ives (Andrew George), who said that he is likely to vote against it on Third Reading. We heard a characteristically passionate, robust and articulate speech from my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). My hon. Friend the Member for Eltham (Clive Efford) asked a very simple question that I will repeat in the hope of getting an answer: what changes will be made as a result of the pause?

I hope that the Secretary of State was listening to my hon. Friend the Member for Stockton North (Alex Cunningham) because he brought a dose of reality to the debate by explaining the effect the reorganisation will have on his poor constituency and the redundancies it is suffering.

[Andrew Bridgen]

Will the hon. Lady not concede, perhaps even reluctantly, that the real reason her party is acting as a roadblock to essential NHS reform is that it pays far more attention to its union backers and paymasters than to NHS patients and taxpayers?

[Emily Thornberry]

The great strength of being in opposition, in many ways, is the opportunity it gives us to listen to interested groups of every type, including representatives of the work force, experts and the public, and to hear their concerns about the Bill. Those concerns translated into more than 300 amendments that we tabled in Committee and more than 100 votes. As I have said, the Government considered it wise not to give an inch. However, on the day after the Committee finished its considerations, the Government decided that there ought to be a pause so that they could think again. The very fact that they decided to think again tends to encourage us to think that we might have been right in the first place. What a shame it was that they did not listen to us earlier.

For the Health Secretary, it must seem a lifetime since the Prime Minister said about him:

“He is probably the Health Secretary in the last 20 years who has the greatest understanding and greatest passion for the NHS.”

His Deputy Prime Minister stated in the foreword to the NHS White Paper that the reforms were

“rooted in the coalition’s core beliefs”.

Patient groups, professional bodies and health experts gave the underlying principles of the White Paper a cautious welcome, but I ought to explain to the Secretary of State that there is a difference between giving a cautious welcome to the underlying principles of a White Paper or Bill and reading the Bill and realising that it will not deliver on those underlying core principles. That is why there has been an increasing chorus of opposition. Our difficulty is that, although there were more than 6,000 responses to the White Paper, those concerns were largely ignored. When the Bill was published, those concerns increased to alarm and the criticism became less diplomatic, less polite and more forthright, and yet the Secretary of State continues not to listen. More people began to join the Opposition’s side of the argument. Although at the beginning the Secretary of State might have felt encouraged that he had many people in his “liberate the NHS” team, as more people realised just what the Bill was about, more and more of them decided that they had been on the wrong side of the argument and that the Bill was wrong and so crossed the room.

I pray in aid the comments made by the hon. Member for Totnes (Dr Wollaston), who talked about throwing a hand grenade into the NHS, and those of the Royal College of Nursing, which passed a vote of no confidence in the Secretary of State, with 98% of the vote. Its general secretary said that the Bill

“could well turn out to be the biggest disaster in the history of our public services”.

The British Medical Association called for

“a halt to the proposed top-down reorganisation of the NHS”.

When I listened recently to the hon. Member for North Norfolk (Norman Lamb), I was reminded of Luke 15.7 —there shall be more joy in heaven over one sinner who repenteth than over 99 just persons who do not need to repent. The number of people who are moving over to our side of the argument are becoming a flock. They say they realise that the Bill is not what they had first thought it was, that it needs to be fundamentally changed, and that if it is not fundamentally changed it needs to be scrapped.

Lord Owen has said:

“The coalition unexpectedly and inexplicably forged ahead with legislation for NHS reforms of staggering ineptitude.”

Lord Tebbit, who I believe is the Secretary of State’s former boss, has said:

“What worries me about the reforms, however, is the difficulty of organising fair competition between the state-owned hospitals and those in the private sector.”

I could go on. Michael Portillo has said of the Tories:

“They didn’t believe they could win an election if they told you what they were going to do because people are so wedded to the National Health Service.”

The whole of the Liberal Democrats have also crossed the room. Evan Harris has talked about the Bill being “disastrous”. Although I heard the right hon. Member for Charnwood (Mr Dorrell) say encouragingly that the Bill would give

“a holistic basis—a structure for the health service, going forward”,

the Health Committee’s report has not been so enthusiastic, if indeed what he said today could be characterised as enthusiastic. Lady Williams has said that the Bill is “completely misconceived”, and the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) has said that it needs “fundamental change”.

The Health Secretary must be feeling increasingly lonely. Perhaps the most deadly time was when the Chancellor of the Exchequer stated:

“I want changes too, and so does David Cameron”.

I appreciate that the Health Secretary has the Minister of State, the right hon. Member for Chelmsford (Mr Burns) and the Under-Secretary of State, the hon. Member for Guildford (Anne Milton) on his side, along with the hon. Member for Banbury (Tony Baldry). I respectfully suggest to the Health Secretary that he holds very tightly to the hand of the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow). It must seem a very long time ago that the Prime Minister said:

“I have been involved in designing these changes way back into opposition with Andrew Lansley. I take absolute responsibility with him for all the changes we are making.”

We will see just how long it is that the Prime Minister stands shoulder to shoulder with his Secretary of State.

There has been great excitement in SW1 bubble land on what effects the NHS reforms will have on the coalition and what the Lib Dems will do next, but the fundamental point is that it really does not matter what happens in SW1; what matters is what happens to our national health service. The Bill is a threat to our national health service. Leaving aside the political shenanigans and the saving of the Deputy Prime Minister or the Liberal Democrats’ soul, what is important is what happens to our national health service. We should be looking at the fundamental principles in relation to that. Everything else is just words, words, words. We are told that we must not rush GPs into consortia, but the majority of them have already been rushed into consortia and their PCTs are being abolished. If that is the extent of the fundamental reforms that the Liberal Democrats want, that would be very disappointing.

We in the Opposition have five tests: delete part 3 of the Bill; keep waiting time guarantees; ensure that consortia are not too small, involve wider expertise and require openness and accountability; ban GP bonuses, stop conflicts of interest and do not allow commissioning jobs to be done by the private sector; and keep a cap on the number of private beds. Let us do that, which would be a fundamental change to the Bill. Most importantly, let us delete part 3.

Instead of wasting time, energy and money on unnecessary top-down reorganisation, the Conservative party should have been building on Labour’s achievements. When we handed over the NHS to the Conservatives, we did so in trust. They should have built on our achievements. I am not saying that the NHS was perfect, but it was much better than it was when it was handed to us. These reckless, costly and ideologically driven reforms are not doing well for the health service. As the hon. Member for Totnes has said, while competition has a role, it is not an end in itself. If we allow competition to run rife within the NHS, it will fundamentally undermine its essence, which is that it is built on a culture of collaboration and co-operation. It is an expression of our fundamental commitment to equality.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 26th April 2011 Commons Chamber

[Paul Burstow]

My hon. Friend makes an important point about ensuring that competition is always based on quality, not just price. If she would like to write to me with more details about the matter, I would certainly be happy to follow it up with her.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Since the Government are no longer doing an assessment of the provision of social care by local authorities, I have done it for the Minister. My survey has found that not only have eligibility criteria been tightened, but 88% of councils are increasing their charges, 63% are closing care homes and day centres and 54% are cutting funding to the voluntary sector. Now that I have told the Minister the facts, will he take back his comment that

“no councils need to reduce access to social care”?

Would he like to start being straight with the public?

[Paul Burstow]

I will take Labour facts with a pinch of salt. Under Labour, social care was always very much the poor relation. Under this coalition, social care has received a £2 billion spending boost and an unprecedented transfer of resources from the NHS—something that the hon. Lady’s party, if it had been in power, would not have been able to do, because it would have been busy cutting the NHS.

NHS (Public Satisfaction)

Emily Thornberry Excerpts

Wednesday 30th March 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

It is an essential truth that there is mounting satisfaction with the national health service, just as there was during the Labour Government’s entire period in office. I thank my hon. Friend the Member for Leyton and Wanstead (John Cryer) for securing a debate on this important subject. It is a pleasure to serve under your chairmanship, Mr Bayley, for the first time.

It has been interesting to hear the different views expressed in this debate. We heard some interesting views from the hon. Member for Banbury (Tony Baldry), and I am glad to hear that his GPs are still speaking to him. Perhaps he should listen to a larger group of people who work in the national health service, because he will find that at the moment it is the NHS versus the Government.

I listened with interest to the hon. Member for Southport (John Pugh), and perhaps we should also put on the record the interest shown by Labour Members. Attending the debate are my hon. Friends the Members for Easington (Grahame M. Morris), for Stalybridge and Hyde (Jonathan Reynolds), for Gateshead (Ian Mearns), for Edmonton (Mr Love), for Wansbeck (Ian Lavery), for Leyton and Wanstead, for Blaydon (Mr Anderson), for Bolton North East (Mr Crausby), and for Birmingham, Erdington (Jack Dromey), and my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke). I shall give an honorary mention to the hon. Member for Strangford (Jim Shannon), too. I believe they would all speak with one voice: the national health service is popular. It is not perfect, but it is doing a good job. Leave it alone and do the right thing.

In 1997, only 35% of people were very satisfied with the national health service. According to the survey of British social attitudes, that figure rose to 60% under the Labour Government. The NHS became a non-political issue. The Ipsos MORI poll consistently showed that seven out of 10 people described the NHS as a key issue, but by 2009 only one in 10 people felt the NHS to be one of the most important issues for them. As a result, the Conservatives changed their strategy and tried to make the NHS a non-political issue. They tried to adopt it; I remember they did the same with green policies. I was working in the Department of Energy and Climate Change at the time, and for every new idea we thought of, the Conservatives would say, “That is a very good idea; we thought of it first.” They did practically the same thing with the health service.

The Prime Minister led the charge and spoke about the support that his family had received from front-line NHS staff. People wanted to believe him and felt sympathy for him. They understood what he was saying and wanted to believe his promise to protect the NHS. In fact, analysis has shown that attitudes to the Prime Minister changed fundamentally. He went from being seen as an ex-Bullingdon boy and a shadowy ex-adviser to Lord Lamont—

--- Later in debate ---

On resuming—

[Emily Thornberry]

Before the Division, I was talking about the way in which the former Bullingdon boy and shadowy ex-adviser to Lord Lamont was transformed by his seeming commitment to the national health service. People wanted to believe that he wanted to protect public services. When the Prime Minister summed up his priorities as N-H-S, people wanted to give him the benefit of the doubt.

Before the last election, the Conservatives made two promises about the NHS. First, they promised to increase spending year on year. Secondly, in November 2009, the Prime Minister told the Royal College of Pathologists:

“With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS.”

They have broken both those promises. Although we have heard them claim that the Secretary of State for Health talked about his proposals on a wet Wednesday afternoon in Wimbledon, the people do not believe it; they were not there to hear it, they do not believe that they voted for it, and they certainly did not vote for it when they voted for the Liberal Democrats, because they believed that they were voting for elected primary care trusts when they voted Lib Dem.

The Conservatives are taking a huge risk by undermining the NHS. Nigel Lawson has said that the NHS is

“the closest thing the English have to a religion”.

People meddle with it at their peril. Going into battle with it, as the Government have done, will be toxic for them.

The Conservatives are at long last realising that they have made a profound mistake, but it is too late, because people know that introducing competition into the heart of the national health service is completely at odds with the NHS ethos of equality and co-operation. That the Conservatives are doing all this without a mandate from the people makes it even worse. Their reforms are causing profound unease among health workers and the public.

The Conservatives are so desperate to cover up and to counter opposition that they have been trying to manipulate public opinion with false statistics. To hear the Prime Minister claim that we are behind the rest of Europe on heart disease and cancer was appalling. He was corrected by Professor John Appleby, who has already been quoted. It is simply inaccurate not to put into the mix the fact that the UK had the biggest fall in heart-attack deaths between 1980 and 2006 of any European country. At that rate, we will have one of the lowest death rates for heart disease. It is a similar story for lung cancer and breast cancer—two of the other main killers. That is, of course, as long as standards continue to improve and the NHS is not distracted by things such as a major reorganisation of the entire NHS.

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I am grateful to my hon. Friend for putting on the record some of the real health outcomes in this country. The hon. Member for Southport (John Pugh) summed it up when he said that even if those health outcomes were not improving, there is no causal link between that area and the reforms that the Government propose; does my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) agree?

[Emily Thornberry]

That is right. It is a little like saying, “There are some difficulties with the national health service, so let’s change it,” without looking to see whether those changes will actually attack the problems. None of us says that the national health service is perfect. More things need to be done, but instead of building on our achievements, the Government are undermining the national health service by taking it by the ankles, turning it upside down and shaking it hard. People do not support them in doing that. Some people even heard the Prime Minister say on the “Today” programme that the national health service was second-rate. However, the penny has finally dropped for the Conservatives and they realise that they are not bringing public opinion with them when they seek to undermine the national health service in this way, so instead they have tried to suppress the information that proves that there is huge public support for our NHS as it is now, fundamentally. That is the story of what has been happening in the last few days.

To begin with, we have the unedifying spectacle of the Secretary of State saying that he will not give out certain information about what the public feel about the national health service. Then he discovers that in fact it has been given out. It is wrong of the Conservatives to suppress information about what the public think about the national health service—information that the public have paid for. It shows what their views are, and gives us a baseline before this forthcoming major trauma for the NHS. Then the Secretary of State says, “Actually, I’ve made a mistake. I gave out the information in any event.” That is the other big concern about the present Government. Not only are their reforms fundamentally driven by their ideology, but they are incompetent. There is much criticism of that.

The bottom and top of it is this: the Conservative party can do whatever they want with statistics. They can spin as they wish with whatever they want. They can say black is white until they are red—or blue—in the face, but the truth will out. The truth is that the public love their NHS. Labour gave the Government the national health service on trust. They should work on what we have achieved and tackle any outstanding problems. My hon. Friend the Member for Easington gave me this quote because he did not have time to use it, but it needs to be said as often as possible. Bevan said:

“The NHS will last as long as there are folk left with the faith to fight for it.”

The NHS does have folk willing to fight for it.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 8th March 2011 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Some Government Members have supported the Government’s proposals for GP consortia because they believe that hospitals in their constituencies will be protected from closure, but yesterday’s leaked letter from the Foundation Trust Network to the Department of Health proves them wrong. It warns that financial stress is threatening the organisational survival of some foundation trusts. Now that they know that their hospitals are in danger, will the Secretary of State tell us all which faceless bureaucrats will be closing our hospitals and what extra powers, if any, local communities will have to stop them?

[Mr Lansley]

That will be the leak that took place when the head of the Foundation Trust Network gave it to the BBC.

The hon. Lady might not be very experienced in these matters, but she will know that at this time of year, in anticipation of the new financial year, hospitals tell their local primary care trusts how much money they would like to have, but that is not the same as the amount of money available in the whole system. That is part of the contract negotiations. She should also know that the necessity to deliver efficiency savings and redesign clinical services will mean that hospitals need to deliver 4% efficiency gains year on year, right across the NHS.

Neuromuscular Care (North-West)

Emily Thornberry Excerpts

Wednesday 9th February 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. It is also a pleasure to take part in Westminster Hall debates, which I usually find to be of much higher quality than those in the main Chamber. It is a shame that so few people attend these debates, because they can be outstanding.

I found today’s contribution by the hon. Member for Weaver Vale (Graham Evans) profoundly moving, and I am grateful to have had the opportunity to listen to him. The image of him selling rulers in the playground will stay with me, and those with muscular dystrophy are lucky to have such a passionate and committed campaigner on their side and in their corner. I too shall always remember to plagiarise Donald Dewar, but in a much less generous way than the hon. Member for Foyle (Mark Durkan). He attributed to Donald Dewar the phrase that plagiarism was undervalued, but I fear that I will simply use it as my own from now on.

Joking aside, this is a serious issue. I was not aware that there are 60 types of muscular dystrophy and that 1,000 children and adults in every 1 million of the population are affected by the disease. It is hugely important to learn such things in my job. It is unfortunate that so few people know about them and that I have to be in this position to learn about them. It is also of great interest that 8,000 people are affected by the condition in the north-west region. We have heard how aggressive Duchenne muscular dystrophy is, and the effect that it has on young boys is a great worry. I have also learned about the stupendous work of Stefan Spinty; it is important to remind the Department of Health that he is trying to run his network without any funding.

In broader terms, treatment for muscular dystrophy in the north-west faces two challenges. The hon. Member for Foyle touched on the first, which is the challenge of cutbacks to services in general. We heard of the cutbacks to special assistance for those with muscular dystrophy in the hon. Gentleman’s area. The cutbacks to mobility and adaptation in relation to people’s homes are larger concerns. Those things are very worrying.

The other challenge relates to the changes in GP commissioning coming at us if the Health and Social Care Bill is passed. We heard this morning that GPs often do not have a great deal of expertise in relation to muscular dystrophy. One could quote statistics that GPs will come across the condition only once or twice a year, but the stories we have heard from the hon. Member for Weaver Vale are more important. He talked about the woman with muscular dystrophy whose daughter clearly had the same condition, but when she told a doctor that there was something wrong with the child, she was told that she was fussing and silly. On the back of that, we heard that doctors have only about two hours of teaching on the condition, so we should all be worried about exactly what will happen to its treatment when GPs take over commissioning. The Government must reassure us about what the specific commissioning pathways will be for this condition, and what the role of the national board will be in relation to muscular dystrophy. It is only right that people with muscular dystrophy, their families and those who represent them are reassured that they will be treated properly and that their particular condition will be treated.

[John Pugh]

The hon. Lady’s point seems slightly tangential. If her argument is that what is wrong with the arrangements is the current ignorance of GPs about referral pathways, that situation has pre-existed these arrangements and may succeed them. It is an independent issue, is it not? It is not about structures.

[Emily Thornberry]

As the structures currently stand, it is understood by GPs that they can receive back-up, through the specialised services national definition set, from the various networks that have already been established. If the national health service is to be grabbed by the ankles, turned upside down and shaken hard, the problem is that in the ensuing chaos, GPs will be distracted and, in the short term, people with muscular dystrophy might not get the services that they deserve. That is a legitimate concern, which it is only right to lay at the Minister’s door, because it is this Government who will be putting the national health service through that process.

As I have already asked, will the Minister confirm that specialist neuromuscular services will fall under the remit of the national commissioning board? How will the board work with other services, such as community nursing, speech and language therapy, and continuing care and physiotherapy, which I understand will be commissioned by GPs? How will that work, and how will people with muscular dystrophy not fall between the gaps? Will the Minister provide more information about regional commissioning—already mentioned during the debate—which might arise under the national commissioning board? It would be reassuring for many to learn that the national commissioning board might have regional hubs, but we have yet to hear that stated specifically. If it were to be stated this morning, it would be good news for many people.

The other issue that I know the Minister shares my great passion for and interest in is the importance of increasing integration of services. People with the conditions we are discussing are clearly exactly the sort of people who need integrated services, so that they can have assistance in hospital—hopefully as an out-patient—and care in the community. There is a continuing disconnect between social care and health care. We all know that when those services do not connect properly, people end up as an emergency admission. We have already heard that £68.5 million is spent across England on unpaid emergency hospital admissions for people with muscle disease.

It is clear that savings can be made, and the holy grail for all of us is to ensure that there is better integration between the various services—both between primary and secondary care, and social care and health care. The challenge in the near future is to consider exactly how the Health and Social Care Bill will help with that integration. There is concern that, in fact, it will do the opposite.

It is important that the legacy is protected. The Muscular Dystrophy Campaign has been working constructively with the 10 NHS specialised commissioning groups across England, and significant progress has been made on improvements to neuromuscular services and on an increase in the number of muscular dystrophy care advisers. In the context of the changes to the national health service and the cutbacks in funding, there is concern that a lot of that good work may fall by the wayside. This morning would be a timely moment for the Minister to reassure us that the legacy will not be lost. Will he reassure me that the work being carried out by the regional specialised commissioning groups will not be put in jeopardy following the proposed reforms for their abolition?

Maternity Services

Emily Thornberry Excerpts

Tuesday 1st February 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I want to make three points about the provision of maternity services. The first is about the provision of extra midwives, the second is on the question of Sure Start and the third is about health visitors.

It seems to me that maternity and antenatal services are provided not only at birth; they are also post-natal services, and new mothers rely upon them strongly. I had two babies under a Conservative Government and one under a Labour Government. At none of those births did I believe that there was sufficient investment in maternity services. That situation continues.

During the last three years of the previous Labour Government there was a massive increase in investment in maternity services, and a new strategy was put in place. Unfortunately—perhaps fortunately—that coincided with a great increase in the birth rate. There was increased investment in maternity services; for example, the number of midwives rose in 2007 by 624, in 2008 by 571 and in 2009 by 787. However, that coincided with one of the largest rises in the birth rate. Being able to keep up with the increase was a problem.

We passed the baton on to this Government. They must build on our achievements and not let us down. We need to continue working on maternity services. Through an article in The Sun, the public heard loud and clear that the Prime Minister was promising 3,000 extra midwives. The fact of the matter is that 3,000 extra midwives would in any event not make up for the shortfall in their number. Even if the Government were to provide 3,000 extra midwives, we would still need at least another 1,700. The problem is that, having made that pledge and promise, the Government seem to be going back on it.

A spokesman gave this pledge on behalf of the Government:

“There must of course be enough midwives to meet the demands arising from the number of births.”

The Royal College of Midwives agrees; it calculated the national England-wide shortage of midwives in 2009 to be 4,756. If, as the nameless Conservative spokesman says, we should have enough midwives to meet demand, we need more than 3,000. The spokesman then said:

“The commitment to 3,000 midwives made in Opposition was dependent on the birth rate increasing as it has done in the recent past.”

My hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart) asked—she put it so beautifully—what was his starting point? What did he mean? The whole piece was written in the present tense. Midwives are stretched to breaking point. They are overworked and demoralised, but the increase in the number of midwives was contingent on a continuing rise in the number of births.

The spokesman’s next excuse was this:

“It was not in the coalition agreement because predictions now suggest the birth rate will be stable over the next few years.”

The veracity of that statement does not stand up to proper analysis. There has not been a prediction since the Prime Minister made his pledge, so we do not know what the difference would be. If improvements are made, we need to continue to build on them. I suggest that the Government are letting everyone down.

[Ms Gisela Stuart]

I have some figures on the future of the midwifery work force. The Department of Health document “Midwifery 2020: Delivering expectations” states:

“The midwifery workforce across the UK is ageing with 40%-45% of the midwifery workforce reaching the current retirement age in the next ten years.”

In other words, even if we stand still, we will undermine midwifery as a result of the fall in the work force.

[Emily Thornberry]

I respectfully agree with my hon. Friend. In a moment, I shall be speaking about another part of the work force, health visitors. They suffer exactly the same problem. The majority of the work force is over 55. It is important to retain such valuable and experienced people—they are mostly women—but we cannot increase their number if we continue to lose existing staff at the current rate.

According to the Library, the number of births in the UK was projected to fall in 2009-10, in 2010-11 and in 2011-12. If the Prime Minister’s pledge was based on the latest birth projections, perhaps he expects to cut the number of midwives. That is clearly nonsense. We need to consider what is needed and ensure that it is fulfilled.

My hon. Friend the Member for Birmingham, Edgbaston made a devastating analysis of the difficulties that will be caused by the changes the Government propose. How can we make forward projections and how are we to manage the national health service if we give NHS commissioning to doctors? They will simply consider the needs of the local area and not our national needs.

In passing, may I briefly touch on the important issue of Sure Start? During the election, the Prime Minister claimed that Labour was scaremongering when we said that there would be difficulties in relation to Sure Start. He said:

“Yes, we back Sure Start. It’s a disgrace that Gordon Brown has been trying to frighten people about this.”

The Under-Secretary of State for Work and Pensions, the hon. Member for Basingstoke (Maria Miller), then the shadow Minister for the family, said:

“It’s unforgiveable that Labour has used the tactics of creating fear and anxiety amongst families and Sure Start staff”.

[Mr Roger Gale in the Chair]

The Minister of State, Department for Education, the hon. Member for Brent Central (Sarah Teather), has said:

“Sure Start is at the heart of our vision for early intervention”

If that is true, why did the charities 4Children and the Daycare Trust find out that 250 centres, which serve 60,000 families, are certain either to close or be earmarked for closure? There are 3,578 children’s centres in England, 3,100 of which have been told that their budgets will be cut this year. About 2,000 services will be cutting their services as a result. The findings are based on responses from almost 1,000 Sure Start managers to a questionnaire sent out by 4Children and the Daycare Trust.

It is hugely important for a new mother to be able to find a friend, get guidance and go to a children’s centre. Nevertheless, centres offering such services are being cut. The other friend that mothers need is the health visitor. Again, when the Prime Minister was in opposition, he made a big thing about increasing the number of health visitors:

“The substantial increase in the number of health visitors will mean that families get more support—from properly trained professionals. Health visitors will be able to spend time with families, have the opportunity to spot parenting issues, and build the trusted relationships needed to help with them. For instance, if they feel a mother is not bonding with her baby, and recognise the cause as post-natal depression, they might gently recommend that she visit her GP, or steer her towards a local counsellor.”

He was absolutely right; no one can disagree with that. However, when I met London health visitors from the Community Practitioners and Health Visitors Association earlier this year, they told me that there was a huge problem in recruiting new health visitors. They were losing a lot of older, experienced staff through early retirement. Nearly a third of health visitors in London are over 55 and they have dangerous work loads. In some cases, there are more than 1,000 children per five health visitors. That is four times higher than Lord Laming—the writer of the Baby P and the Victoria Climbié reports—recommended. His recommendation is for health visitors to have a quarter of their current work load.

In an area such as London, which is very demanding, current work loads are dangerous. We need more health visitors. The Government recognise that a health visitor should have no more than 250 children under five and no more than 100 in highly vulnerable areas, as was recommended by Lord Laming and the Community Practitioners and Health Visitors Association. Will the Government consider that recommendation when they look again at how many health visitors are needed?

When I asked the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), whether the Government would take responsibility for recruiting and training the extra 4,200 health visitors promised, the answer I received was odd. She said that she will learn from the decisions on the case loads and they will be “locally determined”. In the same answer, she says that the Department is shortly to publish plans to

“conduct a demographic and geographical analysis to establish location and population need and match with trainees and training places; and ensure positive correlation between work force growth and population need.”—[Official Report, 27 January 2011; Vol. 522, c. 460W.]

On the one hand, the Government say they will look nationally and decide what the need is, and on the other they say that it will be left to localities to decide. We really cannot have it both ways. What we have is a lack of health visitors.

[Daniel Kawczynski]

The hon. Lady talks about the need for more health visitors and staff and maternity services. If there were a Labour Government, the NHS would not be ring-fenced and there would be cuts in the NHS budget. Only our party has promised to ring-fence the NHS budget. How can she promise additional services when there would have been cuts in the NHS budget under Labour?

[Emily Thornberry]

Although the Government have said that, in principle, there is a ring fence to the NHS budget, a closer analysis will show that that is not true. The real position is that there is double-counting of over £2 billion—

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

indicated dissent.

[Emily Thornberry]

The hon. Lady is welcome to intervene if she wants to get into an analysis. The Government’s promise of a ring fence and a year-on-year increase in the NHS budget is one that does not stand up to scrutiny. There is double-counting going on. Currently, given the increased demand, we must have 4% efficiency savings each year in the NHS. In fact, we will see cuts. It is simply not right for the Government to continue to say that the NHS budget is ring-fenced, that the NHS is safe with them and that services will not be cut. The reality is that the NHS is going through a very difficult time, and, on top of that, this Government are putting it through an absolutely needless reorganisation, which means that we will not get a national steer on things such as maternity services.

Simply giving commissioning to GPs will not help. It has been a matter of policy for years that we keep pregnant women away from doctors if we can, because they are not ill. We pass their care into the hands of the midwives, and hopefully everything will be fine. If a doctor is needed, bring the doctor in. Essentially, women go to a GP to find out that they are pregnant. They then go to a midwife and the midwife looks after them. That has always been the case. GPs do not have an understanding of midwifery or services for pregnant women. The difficulty is that such services will be sidelined and that is not fair on women. That argument was made to the Government when the point was being made that midwifery and post-natal services should be commissioned nationally. I do not know why the Government have changed their mind about that, and it is one of the questions I want to ask the Minister.

The NHS is going through great economic trauma. It is used to having a year-on-year increase in budget. Now, its budget will be cut year on year at the same time as the service is being reorganised. Will we have proper tactical decisions on midwives, community nurses and all those things on which mothers rely, or will we simply allow such services to be given to GPs—at a time when a cold wind is blowing through the national health service?

I think I have got through most of my questions to the Minister. I have just a few more. How will she drive improvements in maternity services? Before the election, the Prime Minister talked about maternity networks. What levers does he have that will make them a reality? Why did the Government ignore the representations of professional bodies such as the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists in relation to commissioning? Furthermore, why has the Prime Minister handed over commissioning to GPs and maternity services? Will the Minister give us an assessment of the involvement of midwives in GP pathfinder consortia?

--- Later in debate ---

[Anne Milton]

I thank the hon. Lady for her intervention; I think that we broadly agree on this issue. That is why we are focusing on public health. Preparation for pregnancy and having a healthy baby starts long before a woman gets pregnant. The education and support that women receive, the social networks that they are part of and improving the public’s health all matter. Nothing could be more important than improving the outcomes for women and, indeed, their babies.

Choice is important and it is also important that women can make informed choices; choices must be well informed to improve the outcomes for women and their babies. Furthermore, it is important that women have access to maternity services at an early stage in their pregnancy. In fact, ensuring such access is probably one of the most fundamental characteristics of high quality maternity care, which is why we have included the 12-week early access indicator as one of the measures for quality in the NHS operating framework for 2011-12.

Of course, it is also important that there are appropriate numbers of trained maternity professionals to provide the maternity service. The number of clinicians needed by mothers depends on several factors, ranging from the mother’s medical circumstances, to the complexity of the pregnancy, to wider societal factors, which can have a considerable impact.

Looking at the bigger picture, the birth rate must be considered when we are planning maternity services. Although the number of births in England has been rising since 2001, as I mentioned earlier, the birth rate peaked in 2008 and fell, by just less than 1%, in 2009 to about 671,000 live births. We are determined that staffing rates should be calculated purely on how many staff are needed to provide safe, quality care. We are considering ways to improve midwife retention and recruitment, and the planned number of midwives in training in 2010-11 is at a record level of about 2,500. Therefore we expect a sustained increase in the number of new midwives who will be available for maternity services during the next few years.

Complete and absolute focus on staffing numbers is totally ridiculous. If the birth rate shot up, 3,000 extra midwives would not be enough. Ensuring that the maternity work force has an effective skills mix is also an important consideration. I was recently in an extremely busy maternity unit, and the midwife there made it clear that what they needed was not more midwives but more support staff. Doubtless in other units there will be support workers in place, but not enough midwives. We want to focus on using the whole maternity team, including obstetricians, anaesthetists and support workers. It is not just the number of qualified midwives that is important, but their experience, and one issue that we need to address is attrition. A newly qualified midwife does not have the experience, nor perhaps the skills, to lead the team in a way that a midwife who has been in practice for 10 years or so can.

[Emily Thornberry]

Although I agree with what the Minister says, surely the difficulty she has is that the Prime Minister promised us 3,000 more midwives. Although I accept that we need experienced staff to ensure that midwives are trained up properly—the same applies to a number of different skills—the Prime Minister promised us the 3,000, so is it right that the Government are rowing back on that promise?

[Anne Milton]

There is no rowing back. We have always made it clear that the number of midwives will be in proportion to the birth rate. In fairness to the previous Government, they made concerted attempts, although much too late, to increase the number of midwives in training, and, as I have said, we have 2,500-odd in training now. We will continue to ensure that we have the right staff mix and the right number of midwives to ensure that women have safe births.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 25th January 2011 Commons Chamber

[Paul Burstow]

The NHS has real-terms increases in its resources, and those resources are going into the programme that we outlined in our outcome strategy. Three quarters of a billion pounds will be going into that programme to deliver improvements in cancer services and the £200 million, being extra, will go into improving cancer services. That is the commitment that the Government have made and that is the investment that we will make.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Is the Minister listening when Macmillan warns that the proposed changes to the NHS risk us losing expertise in the cancer networks? If that happens, Macmillan says that

“cancer treatment will get worse…some treatments could even collapse in parts of the country…more patients could die earlier”.

As the Minister in charge of cancer services, should not he be on the side of cancer patients, not backing his boss’s reckless reforms?

[Paul Burstow]

The last comment was pretty cheap, and no Government Member has suggested that the future of the cancer networks is in doubt. Indeed, in the coming financial year, the funding is secure. As we move to the new arrangements, it will be for the NHS commissioning board to decide the appropriate arrangements for commissioning in the future. We are clear that the expertise of those groups could, should and will continue to be used to support commissioning in the future.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 7th December 2010 Commons Chamber

[Paul Burstow]

I am grateful to the hon. Lady for her question and I know that she has campaigned on that issue. She will know that on 25 October, the Secretary of State asked the independent reconfiguration panel to consider the issue that was raised by the Portsmouth health overview and scrutiny committee regarding a referral of ward G5. The advice has now been tendered, and the Secretary of State has asked the panel to undertake a full review of the case. He expects that report by March of next year and I am sure that during that period, conversations at ministerial level will be helpful.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Most people want to die at home, but they are prevented from doing so by the lack of out-of-hours support. Also, 24/7 community nursing is popular with the National Audit Office because it saves money. Even the Government say it is crucial, so why do they not use some of the £3 billion they are wasting on top-down reorganisation to ensure that everybody gets a community nurse at the end of their life, if they want one? How can the Government guarantee care for the dying if they abolish primary care trusts?

[Paul Burstow]

Perhaps a little humility might have been a necessary preface to that question, including, not least, an acknowledgment that the hon. Lady’s question is based on the failings of the previous Administration to deliver the necessary improvements in end-of-life care. On GP commissioning, there is undoubtedly an opportunity to integrate health and social care to deliver more timely and appropriate community-based end-of-life care, and we intend to deliver it.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Lansley]

My hon. Friend will know that these decisions were made locally. Indeed, we support local decision making. We will ensure that such decisions are taken not only in the health service but alongside local authorities as part of their public health function. It is important that one is clear that a young person is competent to make such decisions. Subject to that, however, we are always clear that patients have a right to access health care on their own cognisance if they are competent to do so.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Does the Secretary of State accept that good preventative care walks hand in hand with good social care? Does he further accept that even if all efficiencies were made and every single pound of the so-called additional £2 billion for social care was to be spent, there will, as the Local Government Association and the Association of Directors of Adult Social Services warn, nevertheless be a shortfall of at least another £2 billion before the end of the comprehensive spending review? In those circumstances, why does the Treasury’s own document say:

“In social care, the Spending Review has provided additional funding needed to maintain current levels of care”?

Who is the public to trust and what are they to make of it?

[Mr Lansley]

First, may I welcome the hon. Lady to her position in the shadow health team? I do not accept her proposition. We are very clear about the nature of the efficiencies that can be made in social care, and we have established an efficiency group that is advising on how that can be done. In addition, in the spending review the Chancellor was able to announce that the Secretary of State for Communities and Local Government has made £1 billion extra available, and we have made £1 billion available through the NHS. On that basis, there is no need for local authorities to have to reduce eligibility to social care.

Rarer Cancers

Emily Thornberry Excerpts

Wednesday 27th October 2010 Westminster Hall

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

I am grateful for the opportunity to respond to the debate. I congratulate my hon. Friend the Member for Manchester, Withington (Mr Leech) on securing it and I particularly thank him for giving me notice of the focus of the debate, because, as he rightly says, the range of issues that could be covered in a debate on rare cancers is very wide. I hope that my remarks will therefore address his particular concerns.

The argument that my hon. Friend makes about the iniquities facing people with rare cancers is a clear riposte to the challenge posed by those who say that the NHS needs no reform because it works perfectly. That is often said to me, but my hon. Friend has set out a compelling case why there are areas in which scrutiny, change and reform are undoubtedly necessary. In fact, there are significant failings in the current system of drug pricing and access. The Government are determined to put them right so that we can help more people to get fair access to drugs and treatments that will help them.

In that regard, my hon. Friend rightly draws attention to today’s launch of the cancer drugs fund consultation. It is an important moment for the 27,000 people diagnosed with rarer cancers each year. The £200 million a year investment that we shall be making from 1 April 2011, on top of the £50 million that started to go into the system from 1 October this year, means that the NHS will be in a position to provide more support than it has been able to in the past. We will ensure that more patients get drugs and treatments not otherwise available on the NHS.

The Rarer Cancers Foundation has said that our interim funding for the cancer drugs fund will benefit more than 2,000 cancer patients this year alone. Clearly, the £200 million investment that we are making from next April will benefit thousands more. My hon. Friend—

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Will the hon. Gentleman give way?

[Paul Burstow]

I am afraid not, because in these debates one has to have obtained the permission of the hon. Member who secured the debate and then the Minister. For that reason, I cannot give way.

[Emily Thornberry]

Please excuse my inexperience. I have just one question—