Dementia and Alzheimer’s Disease

Emma Lewell Excerpts

Tuesday 12th April 2016 Westminster Hall

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Strangford (Jim Shannon) on his excellent speech and on securing the debate.

In the north-east, there are an estimated 25,841 people living with dementia. In coastal constituencies such as mine, South Shields, the figures are higher than average due to large elderly populations. Over the coming years the figure is projected to rise locally and nationally, with more than a million people forecast to be living with dementia in the UK by 2021. I am sure the absence of any mention of the NHS or social care in the recent Budget was of little comfort to those who have loved ones living with dementia.

As the numbers of people in need of care and support rise, real action from the Government is lacking. Yes, we have the Prime Minister’s commitment to making England

“the best country in the World for dementia care,”

and we are told that research investment has doubled and policies for improving diagnosis rates are in place, and that there are a million dementia friends, but commitment, research and reliance on charities are no substitutes for the care and support that thousands of people with dementia need right now.

Anyone who has ever had to make the heart-wrenching, emotional decision to have a member of their family placed in a residential or care home, even for a short while, will know that good care, dignity and respect are the cornerstones of providing loved ones with the safety and security they once enjoyed in their own homes. I know about that from my own gran, who was one of the strongest and bravest people I ever knew. As she got older, this strong woman became physically frail and, worse still, her mental health deteriorated too. Gran had dementia and, after many stays in hospital and some painful discussions, our family decided that she needed to be admitted into a care home. She escaped from the first home and was found alone, shivering in a field. At the second home she seemed happy enough, but she suffered an injury through carelessness of staff. If my gran had had carers at home, she would probably have had only one or two visits a day, with all of her getting up, getting dressed, meal times and bed times dictated by the times her care company could come, not when was best for her.

The thing is, though, gran’s story is not unusual; because in an age of increased need and reducing budgets, respect, dignity and choice are always the first to go. They cost nothing on the balance sheet in the first place, yet they mean so much to the people receiving care. This view is supported by the Alzheimer’s Society, which has reported that more than half of carers felt that their loves ones were not treated with understanding and dignity in hospital.

At present, we have a crisis in adult social care and in the NHS. Local authorities predict a £4.3 billion gap in adult social care by 2020, and NHS England and the Nuffield Trust estimate that by 2021 the NHS funding gap could have grown to £30 billion a year. Residential and care home providers and organizations that provide home care say openly that they do not know how much longer they will manage, because they have realized what we all know: there is no real profit to be made in good quality care.

The average cost of a year’s dementia care is £32,250 per person. I have always known that if we are really going to care for people living with dementia and support their families, we need to formulate policy starting with them and their needs. That is the approach that I took when I was a local councillor, and I am proud today that building has actually begun on South Shields’s £9 million centre of excellence for older people, an integrated care services hub with a focus on dementia, which I worked tirelessly on before coming to this place. I know that I do not have all the answers, but I know that the Government need to be more inventive and creative, and to address the crisis right now.

Oral Answers to Questions

Emma Lewell Excerpts

Tuesday 9th February 2016 Commons Chamber

[Alistair Burt]

Yes, indeed. We strongly support the initiative. Our work to look after children who need extra care, particularly in relation to their health and emotional needs, has been helped by the transforming care package, which is going through local authorities at the moment. Their vulnerabilities are certainly a matter of great concern, and that will be followed up by the Government.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Over 1 million elderly people are able to maintain independence and remain in their own homes due to the attendance allowance. What discussions has the Minister had with his colleagues about ensuring, when the fund is transferred from the Department for Work and Pensions to the Department for Communities and Local Government, that the allowance will remain at the same level?

[Alistair Burt]

The consultation is ongoing between Departments. A unit has been set up by the Department of Health and the DWP to look at a range of issues that concern us both. The actual detail of the future attendance allowance has not been finalised yet, but it is a matter of concern and discussion between Departments.

Post Office Horizon System

Emma Lewell Excerpts

Monday 29th June 2015 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate the hon. Member for North West Leicestershire (Andrew Bridgen) on securing this debate.

My constituent Tom Brown, a postmaster for 30 years, had a post office in Newcastle. In 2008, he informed the Post Office that there was a problem with his Horizon system, and it took away one of his base units to change it. He was told by the helpline—a euphemism because it has not been very helpful to many sub-postmistresses and sub-postmasters and has actually got them into more trouble—that the system would rectify itself. It did not. The next audit said that his figures were down by £85,000. He was arrested by Northumbria police, and his car and home were searched. Subsequently, the police dropped all charges as there was no evidence against him. Then, for some unknown reason, the Post Office took out a prosecution against him to take him to court for false accounting. That process took until July 2013, when he finally appeared in court for the third time. No evidence was put forward to the court, and after that the case was dropped.

This man has lost his home, his livelihood and his good reputation. He is one of the individuals who have gone through the mediation system, even though, as the hon. Gentleman outlined, the system is a sham. He was given four different dates that were all delayed. He described this to me as six hours of wasted time. The Post Office employed top lawyers from Newcastle to represent it. It again went through what it said was the evidence, and made no offer at all. The system is a sham. As the hon. Gentleman outlined, it has been a way of delaying decisions on these cases.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Does my hon. Friend agree that the Post Office has failed to be transparent about this process? My constituent, Mrs Carter, a sub-postmistress, asked the Post Office to audit her branch to get to the bottom of the problem, but it refused to do so.

[Mr Jones]

I will go further than that. It has not only not been transparent; it has gone out of its way to delay cases and hide evidence.

My concern about the work done by Second Sight is that it suggests that if information is returned to the Post Office, evidence will go missing. That is why I totally agree with the hon. Member for North West Leicestershire that there needs to be an independent judicial inquiry into this—as he described it—national scandal. I am pleased that my hon. Friend the Member for Hartlepool (Mr Wright), the new Chair of the Business, Innovation and Skills Committee, is present for this debate. I urge him and his Committee to look at this as a matter of urgency.

The fundamental point is this: who controls the Post Office? This organisation is out of control. It has led to people’s lives being ruined and, as we have heard, in some cases to people being given prison sentences when clearly they are innocent. It is important that we get to the bottom of this. Without a judicial inquiry, I fear that this national scandal will continue and these people’s reputations will continue to be blackened.

Oral Answers to Questions

Emma Lewell Excerpts

Tuesday 2nd June 2015 Commons Chamber

The Secretary of State was asked—

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

1. What assessment he has made of recent trends in ambulance waiting times.

[The Secretary of State for Health (Mr Jeremy Hunt)]

As you said, Mr Speaker, we shall have those tributes tomorrow, but I should like very briefly to echo your comments, because I know that the whole House is shocked and deeply saddened by the umtimely passing of Charles Kennedy. He was a giant of his generation, loved and respected in all parts of the House. Our thoughts are particularly with Liberal Democrat Members who knew him well, and to whom he was a very good friend over many years. We shall all miss him as a brave and principled man who had the common touch, and who proved that it is possible to be passionate and committed without ever being bitter or bearing grudges. Our thoughts are with his whole family.

I can tell the hon. Member for South Shields (Mrs Lewell-Buck) that the ambulance service is performing well under a great deal of pressure. Although a number of national targets are not being met, the service is responding to a record number of calls, and is making a record number of journeys involving all categories of patients.

[Mrs Lewell-Buck]

I echo the comments made about the late Member for Ross, Skye and Lochaber. He was one of the kindest Members of the House, and he will be greatly missed by many of us.

As for the Secretary of State’s response to my question, I think that his assessment was a bit off. When my constituent Malcolm Hodgson’s son-in-law broke his leg in a local park, he waited in agony for 50 minutes for an ambulance, and then waited a further five days for an operation. Can the Secretary of State explain how our ambulance and health services were allowed to fall into such a dire state over the past five years, and will he apologise to that young man for the delay and the pain that he suffered on the right hon. Gentleman’s watch?

[Mr Hunt]

I take responsibility for everything that happens on my watch. [Interruption.] I think it is a little early to ask the Secretary of State to resign—but maybe not. The ambulance service is under great pressure, but across the country we have 2,000 more paramedics than five years ago, we are recruiting an additional 1,700 over the next few years, and from March this year, compared with March the previous year, the most urgent calls—the category A red 1 calls—went up by 24% and the ambulance service answered nearly 2,000 more calls within the eight-minute period. There is a lot of pressure, we have a plan to deal with it, but we need to give credit to the ambulance service for its hard work.

Oral Answers to Questions

Emma Lewell Excerpts

Tuesday 25th November 2014 Commons Chamber

[Norman Lamb]

I very much appreciated and supported the findings of the Health Select Committee report into children and young people’s mental health services. The hon. Lady is absolutely right that we need to focus far more on preventing ill health and preventing a deterioration of it. If we can get into schools and work much better at maintaining people’s mental well-being, we can achieve much better results.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Despite what the Minister says, in South Shields, financial challenges have contributed to the closure of Bede wing mental health ward. This means that acute in-patient services are no longer provided in our borough. Can the Minister explain why mental health services are, in fact, being eroded under this Government?

[Norman Lamb]

Over the past decade and a half, there has been a very substantial reduction in bed numbers, and it is a trend that we should thoroughly support because we want to move away from institutional care towards supporting people at home in their communities. With children’s mental health, we have invested an extra £7 million this year to ensure that children get access to beds close to home when they need them.

National Health Service (Amended Duties and Powers) Bill

Emma Lewell Excerpts

Friday 21st November 2014 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I would like to offer my support for the Bill and congratulate my hon. Friend the Member for Eltham (Clive Efford) on bringing it to the House.

Members will be pleased that I intend to keep my comments brief. Our NHS is a monumental achievement and one that my party remains deeply proud of. There are many people alive today who remember what life was like before the NHS and who would never go back to a time when the poor could not afford treatment for preventable illnesses. That is the generation that truly understands what the NHS means and why we must protect it.

That is not to say that people today take the NHS for granted. In fact my inbox, like those of other hon. Members, has been overflowing with e-mails from constituents worried about the future of our health service. They want the principle of free and equal access protected and the needs of patients put before profit, as they should be. I and those people are afraid of the direction the NHS is heading in under this Government. We see the Tories wedging open the door for private companies to come in and deliver services, and we see hospitals encouraged to take on ever more private patients.

People do not believe the Government’s spin: they know that the changes are part of the creeping privatisation being encouraged by the Tories and that the reorganisation in the 2012 Act was all about Tory ideology, not patient care. The reorganisation wasted £3 billion and has seen millions more spent on tendering exercises and competition lawyers which could have been spent on treatment for those who genuinely needed it. They also know that they cannot trust a Health Secretary who has previously backed calls to dismantle the NHS or a party that brought the NHS to the brink of collapse the last time it was in power. Back then, it took a Labour Government to save the NHS, and now history is repeating itself.

The constituents who have written to me, the people I was proud to join on the NHS march earlier this year and those I joined last night for a vigil outside Parliament understand what is at stake. The NHS is more than just a service; it is a principle of fairness. Illness and accidents strike us all at some point, often without warning and leaving us little time to plan, and before the NHS, this kind of misfortune could destroy lives and condemn families to extreme poverty. Now we have a service that says nobody, whether rich or poor, should have their life ruined by misfortune. That is the principle that my hon. Friends and I are standing up for today.

Care Workers

Emma Lewell Excerpts

Wednesday 5th November 2014 Westminster Hall

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I congratulate my right hon. Friend the Member for Oxford East (Mr Smith) on bringing the debate to the House today. A number of colleagues have already spoken about the minimum wage, so I will try not to dwell on those issues too long, and will address some of the other significant and worrying challenges that care staff face.

Too many care workers are underpaid for the work that they do. Unison estimates that, altogether, 220,000 are not paid the minimum wage. HMRC found that half of care providers fail to pay the minimum wage and, despite the consequences of that for care workers, their families, the overall quality of the care work force and the standard of care that people receive, the Government have continued to fail to act.

The failure to pay for travel time is a common tactic and should not be difficult to fix. Earlier this year, during the passage of the Bill that became the Care Act 2014, I and Opposition colleagues raised the minimum wage issue time and again. We tabled amendments on Report asking Ministers to look specifically at travel time and travel costs. We were told that that would be addressed in the guidance that was published at the end of last month. I think that it is fair to say that the guidance is nowhere near strong enough. It says:

“Remuneration should be at least sufficient to comply with the national minimum wage legislation”.

To me, that says that it should be, but it does not have to be. It says that it would be nice if providers paid their staff a decent wage, but that there is no requirement for them to do so.

[The Minister of State, Department of Health (Norman Lamb)]

I just point out to the hon. Lady that this is a criminal offence; it is not an option. I totally agree with the points made by the hon. Member for Sheffield Central (Paul Blomfield). It is a criminal offence, and this is not an optional matter. There is no doubt in the law. Employers have to pay for travel time between appointments at people’s homes.

[Mrs Lewell-Buck]

I thank the Minister for that intervention. If that is the case, why is the guidance not stronger? What I read out is not the language of the minimum wage. The minimum wage is not a target, but a right.

[Mr Andrew Smith]

Does my hon. Friend agree that it is not good enough for the Minister simply to say “It is a criminal offence”, as though that solves the problem? It is not solving the problem, because hundreds of thousands of workers are not having their legal rights protected. In his speech, he needs to tell us what he is going to do about that.

[Mrs Lewell-Buck]

I could not agree more. The guidance should include a proper requirement for compliance with the minimum wage law; otherwise it will simply be ignored, as it currently is. I hope that the Minister will commit to strengthening that requirement when he sums up the debate.

Providers might also be convinced to pay their staff a fair wage if they thought that they might suffer consequences for non-payment, but it seems, sadly, that under this Government there are no consequences. The Government told us that they would “name and shame” companies that failed to pay the minimum wage, but so far only a handful have been named and not one of them has been from the social care sector. That is unbelievable when we consider that HMRC believes that half of providers are non-compliant. The Government’s relaxed attitude lets providers know that they can continue to ignore minimum wage laws with no consequences.

In all this, we have to remember that what affects care staff also affects the people they care for. Quality social care needs well trained, motivated staff who are able to build a strong relationship with those they care for. All the evidence suggests that things are moving in the opposite direction. The care sector is not an attractive place to work right now.

The weak requirements on the minimum wage create an unfair playing field for care providers. With the funding pressures facing councils, the incentive to commission on cost is stronger than ever, and as long as the wage is considered a target and not a requirement, providers that pay a fair wage will be at a disadvantage, compared with those that break the rules. The providers that win contracts will be those that are least able to attract and retain well trained staff, and service users will lose out as a result.

Pay is not the only problem. Care workers have told me horror stories about the way in which they are managed and the effect that that has on the people they care for. Timetabling of visits is a disaster. Appointments are booked back to back, so staff do not get to spend the time with clients that they are allocated. If a client needs a little extra help, dedicated care workers often go back in their free time. I have also heard of cases in which incompetent management has meant that multiple staff have been booked to cover the same appointment. After they have all shown up at the client’s home, only one of them has been paid. Not only is that bad for staff, but it means that clients sometimes do not see the same carer twice in a week, and they never get a proper introduction to a new staff member. Clients are expected to let a stranger into their home because they say that they come from an agency. The system owes people better than that.

Staff have told me that the training and supervision offered by some providers is close to non-existent. One employee told me that their training consisted of being given a set of forms to fill in, after which they were given no feedback and no professional advice or support. Not only were they not paid for that training, but they were told that they would be financially penalised if it was not completed in time. Essentially, they were training themselves, and the provider took no responsibility for making sure that its staff were fit to do their jobs.

Even on important matters of safeguarding, some staff received no training, and they were entirely unprepared to deal with situations in which they thought a client was at risk of harm. Worse still, although staff in such a situation should be able to refer the matter to a manager, in some cases even the managers did not appear to understand how safeguarding procedures worked or how to proceed, with the result that at-risk clients were left in serious danger. As many care staff work on zero-hours contracts, they are afraid to speak out. They cannot afford to challenge their employer or properly advocate on behalf of their clients, because if they do, they find that they are denied shifts.

That is why there should be a proper system of oversight, and it is why Opposition colleagues and I tabled amendments to the Care Bill to give the Care Quality Commission responsibility for overseeing the commissioning of services. It is not enough for the CQC simply to inspect services on the ground, because by the time an inspection is carried out, serious failings could have occurred. The CQC should look at the standards on which local authorities commission, to make sure that the providers to which they award contracts can do the job properly.

Between low pay, stressful working conditions and lack of support, it is no wonder that many skilled care staff are leaving the sector as fast as they can. To stand up for vulnerable people in care, we have to stand up for our dedicated and hard-working care staff. If the Government want to show that they value high-quality care, they need to start holding providers to account and making sure that they take their obligations to staff seriously.

Oral Answers to Questions

Emma Lewell Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

I share my hon. Friend’s concerns that the car park charges in some hospitals are just too high. I understand that hospitals have financial pressures, as do many parts of the system, but I am happy to talk to him on another occasion about what specifically can be done on this issue.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Annually 30,000 applications for funeral payments are rejected, leaving families committed to expensive funerals that they cannot afford. People who are approaching end of life are not advised, as part of their palliative care, about planning for funeral costs or their eligibility for support. What is the Secretary of State going to do to remedy this?

[Norman Lamb]

The hon. Lady raises an important issue and I am very happy to discuss her concerns further with her.

Health

Emma Lewell Excerpts

Monday 9th June 2014 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Our national health service is undisputedly one of the greatest achievements of any Government, yet the crisis that the NHS has experienced under the Government’s disastrous privatisation, threatens the survival of services and the quality of patient care. I am proud that it was a Labour Government who created the NHS, and I am proud it is a Labour Government who will reverse the damage done by the Health and Social Care Act 2012. In our health service, more than 4,000 senior nursing posts have been lost since 2010. Accident and emergency performances in the year following the Government’s reorganisation were the worst in a decade. Last year, South Tyneside hospital in my constituency had to cancel operations because of unprecedented demand for A and E services. Only two weeks ago, it emerged that the NHS in England had failed to meet a performance target for cancer waiting times for the first time ever.

The Government’s failed reorganisation has increased wasteful spending. The NHS now spends more on senior managers and management consultants than ever before, and it is increasingly bogged down in competition law, forcing it to spend money on lawyers that could have gone towards patient care. The pressures on our health service stretch well beyond hospital waiting rooms, as demand for NHS services is affected by trends in public health and the quality of social care. In those areas, we have seen massive cuts to local authority budgets of £2.7 billion. Faced with cuts of that scale, local authorities have been left with impossible decisions and have been forced to cut services, knowing that in doing so they would increase pressure on the health service.

Those who are lucky enough to be entitled to care find that their care worker can only stay with them for 15 minutes. These workers are poorly paid, with over 300,000 on zero-hours contracts. A third do not receive proper training. Unsurprisingly, staff turnover is high, so many clients do not manage to build a relationship with their carer. The Care Act 2014, which was passed in the last Session, presented an opportunity to address some of those issues, but unfortunately it was an opportunity that the coalition parties did not take. They rejected Labour amendments on low pay and zero-hours contracts that would have improved the standard of care that people receive. They also ignored charities that warned that the new eligibility criteria for support would exclude hundreds of thousands of people from the care system.

Of course, there are challenges facing social care, but we do not solve the problem by cutting support for those with moderate needs, only for them to end up in hospital. Last year’s QualityWatch report showed that about one in five hospital admissions could be prevented by better social care. The ultimate goal should be an integrated system like the one argued for by my right hon. Friend the Member for Leigh (Andy Burnham). The Government at least pay lip service to that idea, but in practical terms they have done very little. The better care fund announced last June was meant for that purpose, but it was actually just money diverted from existing NHS services, proving that the Government are not serious about promoting integration.

Underlying all of that are broader questions about public health. Poverty and ill health often go hand in hand, and malnutrition in particular has become a frighteningly normal part of life in Britain today. I know parents who skip meals so that their children can eat, and people for whom food banks are the only thing standing between them and starvation. Malnutrition affects an estimated 3 million people in the UK, which is a scandal in the fourth richest country in the world.

The previous Government left office with fewer people in poverty than when they arrived. Child and pensioner poverty fell even after the financial crisis took hold, and we were well on our way to eliminating child poverty by 2020. But under the coalition, this trend has been reversed, and instead of eliminating poverty by the end of this decade the Child Poverty Action Group estimates that the number in poverty will have risen to 4.7 million.

The coalition has allowed this crisis to develop, and the Queen’s Speech needed to recognise families’ desperation by delivering help with living costs such as food, energy and rent. Poverty, and food poverty especially, has a knock-on effect for our health system. Experts have warned that there is a public health emergency. We are beginning to see diseases such as rickets returning as children no longer receive the balanced diet they need. The symptoms of poverty pose serious challenges to our health service in the long term.

Our national health service survives in spite of this Government, not because of them. It is strong because of its work force and because of a public who resolutely believe in it and value it. In communities around the country, families are fed not because their country’s Government have helped them to find decent work, but because their fellow citizens give up their time to lend a helping hand. Our country faces some of its biggest challenges for generations, and people feel that Britain is no longer working for them. Worse yet, people feel that politics has no answers to the difficult questions of our time. All these challenges need a Government who are willing to be bold, but this Queen’s Speech gave no hope of that. It was more of the same from a coalition that has long outstayed its welcome.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

And the prize for patience goes to Nic Dakin.

Care Bill [Lords]

Emma Lewell Excerpts

Tuesday 11th March 2014 Commons Chamber

[Steve Baker]

I am extremely grateful to the Minister for that reassurance because in my constituency there is really only one story: the loss of services, and, because of the way the clause has been presented by Labour Members, people are worried about that.

It has been said that these hospitals are categorically different because they exist in a broader health economy, but that is not why they are different. Any business exists as part of a wider economy with dependencies and so on—the hon. Member for Lewisham West and Penge (Jim Dowd) suggested the example of Comet versus Currys. In private enterprise, if the administrator turned up and shut down our competitors when we failed, it would obviously be absurd, but the truth is that both sides of the House have made a positive decision to use the techniques of state socialism to provide health care. That choice has consequences, one of which is this clause.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It will come as no surprise that I support the proposal to remove clause 119 from the Bill. Of all reforms in the Bill, this clause has attracted the most attention from my constituents. They recognise it for what it is—a frightening power grab by central Government that will put services across the whole country at risk from the Secretary of State. It is a cynical move from the Government, who in their wildly unpopular top-down reorganisation of our beloved NHS claimed that they wanted to put more power in the hands of doctors. Now they seek to give sweeping new powers to the Secretary of State.

It is of course true that some NHS trusts and foundation trusts find themselves in tough financial situations, and in those difficult situations decisions will have to be made so that services continue to operate. That is what the TSA regime was set up to do, and it is an appropriate process for dealing with the difficulties within a trust. It is true that trusts do not operate in complete isolation, but the TSA is already required to act with the interests of the wider health service in mind.

[Mr Jim Cunningham (Coventry South) (Lab)]

My hon. Friend is right when she says that the Secretary of State wants the power to privatise—I will be brutal about it—NHS services. We must recall—this is why we cannot believe the Minister or the Secretary of State—that before and during the general election, the Prime Minister said that there would be no top-down reorganisation of the national health service—[Interruption.]

[Mr Cunningham]

I am sure my hon. Friend will agree that the changes the Government want to make are in order to privatise the national health service through the back door. That is why the Secretary of State wants that power. Equally, we cannot believe the Secretary of State because, during the general election, the Prime Minister said that there would be no major changes to the national health service, and no top-down reorganisation. Why should we believe this lot now?

[Mrs Lewell-Buck]

I could not agree more with my hon. Friend.

TSAs can consider the impact on neighbouring authorities when making their recommendations, but they cannot and should not reconfigure services in well-performing trusts. Well-run trusts can and do collaborate with their neighbours, and play a role in reconfiguring services to help to achieve financial stability, but that must be voluntary. It is wrong for the Government to act through TSAs to reconfigure services in well-run trusts, and to do so against the wishes of local people and clinicians. It is also wrong that the opinions of health care professionals should be overruled by financial concerns, especially when the decisions being made affect trusts that are not at financial risk. That undermines the ability of health care professionals to act in the interests of their public.

The Government’s defence of the proposal is that clause 119 is a clarification of existing law, and yet the amendment was tabled in the other place while the Government’s appeal over the downgrading of services at Lewisham was still being considered. Surely it is the role of the courts to interpret and therefore clarify the law. It is more likely that the Government anticipated that their appeal would be rejected, as it was, and acted to expand the powers of TSAs so that reconfigurations such as that proposed for Lewisham could go ahead in future. I want to be clear: when any Government amends legislation so that it can be interpreted differently in the courts, they are not clarifying things but changing them.

[Paul Burstow]

I take the hon. Lady’s general point and understand why she is making it, but yesterday we debated new clause 11, which would have made clear a mistake that hon. Members on both sides of the House believe the courts made on the applicability of human rights legislation to social care that is publicly provided within private institutions. In that instance, we were not changing the law, but trying to ensure that the courts interpreted it correctly in the first place. There are instances when we do that.

[Mrs Lewell-Buck]

I agree with the right hon. Gentleman, but I do not believe it applies to clause 119.

My constituents are not especially concerned by the technicalities of legislation. The letters and e-mails I receive show concern with the practicalities of clause 119. People tell me that they fear for local services because, as more trusts fall into financial difficulties—more than 30 are reported to be in serious danger of doing so—the Secretary of State’s power will spread over a wide region. Perhaps the trusts that those people or their relatives use will not have a TSA appointed, but it is likely that services in their area will collaborate with trusts that do have one appointed. That makes them a target.

If the heroic efforts of the people of Lewisham and my hon. Friends are anything to go by, public concern will quickly turn to public outrage and protest if clause 119 makes it to the statute book. Lewisham has shown the Government the strength of opposition they can expect when they attempt to force unpopular reconfigurations on local communities. It is difficult to understand why they propose using that model throughout the country, but it appears that that is their intention.

I am concerned that, by taking that approach and using the TSA regime for a purpose for which it was never intended, the Government will make it more difficult to have a level-headed discussion on meeting financial challenges. We need a mature debate on how to adapt services to improve sustainability, but clause 119 will lead to pitched battles up and down the country over the closure of individual departments. The clause has attracted more controversy than any other in the Bill, and with good reason. It ignores the will of clinicians and the communities they serve. It puts at risk services in every corner of the UK. The Government must change course now.

[Karen Lumley (Redditch) (Con)]

I shall make a short contribution on clause 119. I agree with the principle behind the clause and the Bill, but we must ensure that the NHS can operate properly and efficiently, and provide our constituents with the care they deserve. My hon. Friend the Minister and my right hon. Friend the Secretary of State know very well of the review in Worcestershire in the past two years. My hospital—the Alexandra—has been in the spotlight. We have fought long and hard to retain services locally. I pay tribute to the tireless campaigners who, like me, are desperate to keep our services. Finally, we have seen a clinical solution to the problem. We all welcome that in Redditch, but it is not the end of the story—I wish it were.

--- Later in debate ---

[Mrs Lewell-Buck]

I shall be brief. Throughout the passage of the Bill, I have felt that there is considerable consensus on what a good social care system should look like. For that reason, I am disappointed that the Government failed to be more accommodating towards a number of reasonable amendments tabled by the Opposition. In particular, I still cannot understand the Government’s decision to remove the CQC’s duty to inspect commissioning, which stood as part of the original Bill and mysteriously disappeared when it was in the Lords.

There are worse elements of the Bill, such as clause 119. We heard earlier that this is a grave threat to every hospital and community in our country. Members on the Government Benches supported the clause today, but I expect most of them will regret doing so at some point in the future. Yet again, this has been a sad day for our health service on this Government’s watch. Underpinning everything we have discussed in the many hours of debate on the Bill is the fact that local authorities all over the country are experiencing a funding crisis, driven by a Government who appear unconcerned about the effects of their spending cuts on the poor and the vulnerable. Even the sensible reforms in the Bill will not benefit everybody.

I shall end on this point. Those people who are seeing their care packages disappear, those who are locked out of the care system, and everyone who turns up at a hospital to find that departments are shut—let them know that it is this coalition’s fault. I hope all coalition members are proud of themselves.