Ebola

Fiona O'Donnell Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

We are absolutely checking that, and it is all in hand.

[Fiona O'Donnell (East Lothian) (Lab)]

I do not know whether the Secretary of State has any plans to speak to the hon. Member for Clacton (Douglas Carswell), but if he does will he ask him why he now supports a party that would decimate the UK’s aid budget? Does the Secretary of State, like me, feel a great sense of pride in being part of a family of nations whose aid budget is saving lives in Liberia and Sierra Leone, and, in turn, keeping people in the UK safe?

[Mr Hunt]

The hon. Lady speaks extremely wisely and there is cross-party agreement on that matter. That shows why it is so wrong to make an artificial division between helping people abroad and helping people at home. I think we have a moral responsibility to help people in the poorest countries abroad in any case, but in my time in this House there has been no better example than this one of how doing so is in the interests of people in the UK, too. It helps to make us more secure, and we can be incredibly proud of the work we are doing as a result.

Early Childhood Development

Fiona O'Donnell Excerpts

Thursday 30th January 2014 Westminster Hall

[Fiona O'Donnell (East Lothian) (Lab)]

I apologise for my late arrival. I congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing, with her friends and colleagues, such an important debate. It is excellent to have the opportunity to debate these important matters at length under your chairmanship, Mr Weir.

Hon. Members might be surprised to see a Scottish MP contributing to the debate, because Scotland and England have such separate and distinct approaches to child care, maternal care and paternal care, but there are lessons that we can learn from each other, and that is why I was keen to make a contribution today. In addition, I have been working closely with two third-sector organisations, the National Childbirth Trust and Bliss, on problems that arise when babies are born prematurely, and I want to focus on the needs of children, parents and the wider family when babies are born prematurely.

I have personal experience of the strain that that causes, having given birth to twin boys eight weeks prematurely when I also had a two-year-old and a four-year-old. When anyone asks me how I do the difficult job of Member of Parliament, I assure them that it is a piece of cake compared with being a mother of four children under four. My first-born—my daughter—has cerebral palsy, and when my twins were born I was living in rural Oxfordshire and not driving, so I faced multiple barriers to making that important bond with my premature babies. It is an awful experience for a mother to arrive home when it is more or less obvious that she has given birth—it is especially evident when twins have left the uterus—but because the babies are not with her, no one comes up to ask what happened. The mother is deprived of the opportunity to celebrate the birth of her children.

There is constant worry and strain over whether those children will grow up healthy and well, or even make it through that dangerous period in their lives, and parents have to take each day at a time. I pay tribute to the staff in the special care baby unit in Banbury who brought my babies—who are now 6 feet 2 inches and feet 3 inches and making a useful contribution to society—through that time. The right hon. Member for Banbury (Sir Tony Baldry) had newly been elected, and while my twins were still in the womb, I marched in protest to keep the special care baby unit open, not realising that they would soon be using the unit’s services.

There are particular strains for working parents. I was not a working parent at the time, so I did not have to make choices about maternity pay. People frequently do not understand that a baby who is born significantly prematurely often does not catch up, in terms of age and stage development, until they are at least two years old—I believe that it can take longer than that, and it certainly did in the case of my boys—and maternity pay does not allow for that. A mother is faced with the difficult choice of whether to take paid maternity leave while her baby is in hospital and possibly critically ill, or wait until the baby returns home. I would like the Government to look at that, because it puts such a strain on parents.

The hon. Member for Congleton (Fiona Bruce) spoke about the need for other Departments to be involved. Given its responsibility for maternity and paternity leave, the Department for Business, Innovation and Skills should be part of a joined-up approach. The Department for Work and Pensions must also be part of that, because although poverty and deprivation are certainly not the only factors that contribute to a lack of secure attachment or the health and well-being of parents and children, they can make a huge difference. In my case, we suffered from the combination of four children under five and huge financial pressure on our family, and we were at risk of losing our home. I started childminding the children of wealthy parents, so that they could have piano lessons and beauty spa treatments, to try to make ends meet. That puts a huge strain on a family, and for a mother or father at home, the child is often the only outlet for that frustration.

My hon. Friend the Member for Rotherham (Sarah Champion) rightly raised the issue of Sure Start centres. We do not have them in Scotland, but like many Members, I have watched at least two episodes of “Benefits Street.” When a Sure Start worker worked alongside some parents, it was incredibly inspiring to see how empowered the mother was. She was talking about the need to create a calm atmosphere and be consistent. It was the most inspiring and optimistic thing to see a parent given such skills. The way to do that is not by punishing them or withdrawing benefits, but by getting alongside people, showing them that we are on their side and understand, and giving them the necessary skills. I very much hope that the children from that family will grow up happier, healthier and able to contribute to society, and that they will not need that kind of support when they are parents. Investment in the early days is so important and can make such a difference to children’s outcomes.

[Sarah Champion]

I was surprised, and quite shocked, that 26% of babies in the UK—that is 198,000—are estimated to live in a traumatic family environment, and the effect on their well-being is considerable.

[Fiona O'Donnell]

I thank my hon. Friend for her intervention. It is so distressing—no child chooses where it is born. No child is born bad; bad things happen to children. It is really depressing to face the idea that a child’s outcomes should be determined by the streets they were born between. At NCH, which is now called Action for Children, I worked with children who were at risk of being removed from their family. I always felt that that was an ironic term, because the best thing for some children was to be removed from their family, as it was for the parents, too. For those children, there was really no opportunity. Many had suffered emotional and, at times, physical and sexual abuse.

I urge the Minister to look at the excellent children’s panel hearing system that we have in Scotland, because it works well. It is great, because the child is absolutely at the centre of the process. This is not about what happens in the first 1,001 days, but seeing a child finally disclosing the abuse they have suffered, with us all having to leave the room until they felt able to tell their story, was the most remarkable thing, as was knowing that, hopefully, it was the beginning of a process of survival and recovery from that abuse. It was desperately sad to hear a 10-year-old boy say to me, “I know I can never be a parent, Fiona, because I couldn’t be trusted.” It is unthinkable that children should have to face such choices. As the hon. Member for South Northamptonshire said, we must educate health workers, teachers, nursery workers—everyone involved in a child’s care—to spot the early signs of abuse and not be frightened to raise concerns.

I look forward to hearing the Minister’s response, as well as that of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), particularly on the issue of parents of premature babies. We know that breastfeeding brings huge benefits to babies. I am a mother of premature twins.

[Andrea Leadsom]

I am grateful to the hon. Lady for giving way, because I wanted to make one little point that I did not cover in my speech. I am so glad that she received such excellent care for her pre-term babies. However, does she agree that it is rather shocking that if someone has a baby pre-term, we move heaven and earth—we helicopter babies all over the place—to find a neonatal intensive care unit, whereas if a child is born full-term and the mother has a psychotic incident, which happens in up to 1% of births every year, affecting up to 7,000 families in the UK, it is a postcode lottery as to whether an in-patient unit can be found? That could be a death sentence for the baby. It is completely unfair.

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[Fiona O'Donnell]

I absolutely agree, and I am grateful to the hon. Lady for making that point. It is unacceptable that there should be a postcode lottery when there could not be a more vital time to intervene.

I return to my point about the importance of breastfeeding and supporting mothers in providing nourishment for their child. That is especially true in the case of premature babies, because the recommended start date for a mother to breastfeed is three weeks post-term. Maternity leave rights and—particularly when parents cannot afford to take unpaid leave—maternity pay are therefore vital. This was 27 years ago, so some time ago, but when I had premature twins, the support and encouragement for mothers of premature babies to breastfeed was not what it should have been. I hope that that has improved, because it is a vital part of the bonding process. Although the mother cannot put the baby to her breast, at least being involved in putting the milk into the baby’s gut—knowing that they are giving that nutrition—is a vital part of feeling a success as a mother.

I congratulate the hon. Member for South Northamptonshire again on securing this debate. I hope that the Minister will look at the recommendations in the manifesto and work with organisations such as the NCT and Bliss, so that across the UK, we are all working to give all our children the best possible start and opportunity in life.

[Damian Hinds (East Hampshire) (Con)]

I rise to support my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) and her cross-party colleagues in the important work that they are doing in highlighting the issues we are discussing. The manifesto is accessible, understandable and persuasive. Speaking as a relatively new dad, so much of it is also very intuitive. It makes one think, “Yeah, of course; that is pretty straightforward and obvious,” although we need to see a lot more of it happening.

I want to take a slightly different angle and talk a little about social mobility and the effect of the first days and years of life on children’s eventual chances. When considering child development, it is always helpful to have in mind a sort of pyramid—in fact, there is such a pyramid in the manifesto. It creates a hierarchy of need. The sharp end of the pyramid is the very sharp end of the scale—the acute cases where, frankly, social mobility is not the top priority. The top priority is child protection, basic safety and health; social mobility is a worry for another day. At the base of the pyramid is the massive part—the world at large; most people. In the middle is the section of children I want to talk about today: those born into poverty and disadvantage who are not quite in the acute bracket.

We know that social mobility in this country is low by international standards—we are usually bracketed with Italy and the United States—and it has not been improving. On average, those of us here in our forties—including, as of a couple of days ago, my hon. Friend the Member for Winchester (Steve Brine)—have been less mobile in our lives than those of us here in their fifties. That is a poor state for any advanced democracy to find itself in. Why is that the case? When I was on the Education Committee, we used to find that everyone blamed the stage before. If we spoke to universities, they said that they were not getting the kids coming through from sixth forms; the sixth forms blamed the teachers doing the GCSEs; the secondary schools blamed the primary schools; the primary schools blamed the nurseries; and the nurseries said, “We are just not getting the kids through the door anymore.”

There is an element of truth in what they all said. The more one studies social mobility and children’s life chances, the more one realises that it increasingly does come down to the very earliest age. The all-party group on social mobility published a report called “Seven key truths about social mobility”. Truth No. 1 was that the point of greatest leverage for children’s life chances is what happens between the ages of zero and three—that is what we said, although it could equally be what happens between the ages of zero and two. The problem is that, of course, this is the public sector—we are trying to influence the Government and so on—and most of what happens between the ages of zero and two or three does not happen in a state-controlled or influenced setting; it happens at home. That makes things much more difficult.

Why is this a social mobility issue? How children are brought up is not particularly, or does not have to be, dependent on parents’ income, but there is quite a strong correlation. Figures from “An Anatomy of Economic Inequality in the UK”, a report made by the previous Government at the end of their term, show that on school readiness, for example, children from the poorest fifth of households reach about a third of the way up the percentile scale at age 3, versus more than 60% of children born into the wealthiest third. There is a bunch of statistics like that.

It is frightening that even toddlers’ cognitive ability test scores vary more dramatically according to their parents’ income than according to innate differences in ability. In the millennium cohort study, which tracks children through time, that gap does not narrow between the ages of three and five; in fact, it seems to widen as children go through school. Why? I am careful not to infer any direct causality. All sorts of factors may be involved, but there are significant differences in some things that people associate with home learning environments, and so on, according to socio-economic groups. In the lowest socio-economic group—the poorest fifth of households—only about 40% of children are read to every day at age 3, as opposed to more than 80% in the top 20%. Again, those figures are from “An Anatomy of Economic Inequality in the UK”. Those things can be tracked with a series of measures, including bed time, and so on.

[Fiona O'Donnell]

The hon. Gentleman may not be aware of work undertaken by the chief medical officer of Scotland, Harry Burns, on brain development in children from families with generations of economic deprivation. It showed that their brains were developing differently: the fight-or-flight part of the brain was overdeveloped. That shows that there is a real link between children’s life opportunities and deprivation.

[Damian Hinds]

Clearly, there is a link—a range of studies suggest different ways in which that link manifests itself—and I do not think that any commentator argues about its existence, but there is nothing inevitable about that; it ought to be possible to equalise children’s life chances. Of course, there are examples of both brilliant and awful parenting in every income bracket. Children’s development is no respecter of the home they happen to have been born into. As the right hon. Member for Birkenhead (Mr Field) says,

“it is primarily parents who shape their children’s outcomes—a healthy pregnancy, good mental health, the way that they parent and whether the home environment is educational”.

As he and many others say, what parents do is much more important than who they are.

Home life is difficult territory for the state. I suggest that we need to think harder about how to communicate what is known about successful, positive ways to parent—a quite substantial body of evidence—in a way that does not come across as, and in fact is not, telling people how to bring up their children.

Geography, as well as income group, reveals other interesting differences in early child development. There is a particular difference in London. When people are told this, they assume that child development is worse in London than elsewhere, because of all the issues in a big city like this. However, that is not so. There was another report last week about the different school results of children growing up in London, versus those growing up elsewhere. That is often attributed to the London Challenge, which started in 2003. There are a number of reasons to believe that the London Challenge was not the sole or primary cause of those improvements. One reason to disbelieve that is that the difference in attainment scores for disadvantaged children is apparent way before they get to secondary school; in fact, it is apparent even in pre-school assessments: on average, disadvantaged children in London seem to do about 20% better on the “good level of development” scale than disadvantaged children in the rest of the country. A bunch of things are different about London children and families.

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[Damian Hinds]

I have a similar instinct. I want to be careful not to imply a causality that we do not know to exist, but one factor in some ethnic communities is that there is greater multi-generational support and more extended families. Intuitively, it makes sense that such support can be an advantage.

Where does all that leave early child development from the perspective of social mobility? First, the Government have to address, head-on, the thorny question of how to help parents to parent, while keeping in mind the pyramid of need, with acute cases at the top, children born into poverty and disadvantage in the next layer down and everyone else below that. I suggest that that should start pre-natally, which is a big part of the manifesto “The 1,001 Critical Days”. Speaking as a recent dad, it is amazing how little we were told or read about what was going to happen after birth, because we were so fixated on pain and the other things that people worry about at the moment of maternity. Sure Start and Sure Start outreach can play an important part in that. I echo what my hon. Friend the Member for Winchester said on the variety of views on what Sure Start is. On the Select Committee, I always used to ask people to define Sure Start, and even when talking to professionals in the field, I would get different responses.

There is also a question about the role of television and new media in supporting mums and families to bring up children. Bookstart is fantastic, but it could be more targeted. I was surprised when we received free books through our door. If people in the income bracket of all of us in this Chamber are failing to buy books, or to get them out of the library, to read to our children, it is not a problem that will be solved by being given two or three books when the child is born. Like my hon. Friend, I pay massive tribute to the work done by Home-Start UK and others on direct one-to-one support.

[Fiona O'Donnell]

Will the hon. Gentleman also pay tribute to Mumsnet? Mumsnet is a safe, non-judgmental and anonymous place where mothers can chat and seek advice and information.

[Damian Hinds]

The hon. Lady makes a good point. Mumsnet is the sort of thing to which I was alluding when I talked about new media. When we talk about Mumsnet, we are obliged to say that Netmums is also available. There is a range of sources of non-judgmental peer-to-peer support, which is vital.

Secondly, the importance of evaluation also comes out of the manifesto “The 1,001 Critical Days”. Intuitively, we all know that there are lots of things that we can do in the earliest years of life that will make a massive difference to a child’s development and later opportunities, but it is difficult to persuade other people of what those things are. Evaluation therefore trades at a huge premium. I pay tribute to the work of the hon. Member for Nottingham North (Mr Allen) on early intervention, which I hope will change our mindset as a polity on how we intervene.

Thirdly, I am not suggesting for a moment that I think I have the answers, but we should not be afraid of talking more about the wider social context and what some of the impacts might be. While respecting people’s life choices and celebrating the diversity of society—families now come in all shapes and sizes—we should not, for the sake of children, be agnostic about what those choices are. We should also see what we can learn from the differences between communities in different parts of the country.

[Steve Brine (Winchester) (Con)]

It is a pleasure to follow my neighbour, my hon. Friend the Member for East Hampshire (Damian Hinds), whom I thank for the age check. I congratulate my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) on securing this debate and on the manifesto. She knows of my interest in this area, and she sent me a copy hot off the press. I read the manifesto avidly, and I am totally impressed with her work. She spoke eloquently about the cycle of deprivation, and she set out the case as to why, in many ways, society is broken. I will not go on about that, but I think the family unit is the answer that holds so much of this together. Some of my comments will probably tie together the interventions that we have had over the past 15 minutes.

Many Members will be familiar with the work of the Centre for Social Justice, which was set up by the Secretary of State for Work and Pensions when we were in opposition. The CSJ produced a report last year called “Fractured Families: Why stability matters,” which built on the seminal 2006 work “Breakdown Britain” and the 2007 work “Breakthrough Britain.” Basically, “Fractured Families” re-examines how family breakdown continues to plague our society, and it is blunt in saying that, despite the scale of the problem continuing to increase, Government action has been extremely weak. The report shows that the outcomes for children and adults who suffer from family breakdown are often terrible, and that there are huge costs to society. Someone mentioned a huge figure earlier, which I will repeat because it is so staggering. Family breakdown is currently estimated to cost the country some £46 billion a year, which is set to rise to just under £50 billion a year by the end of this Parliament. That is more than the Government spend on the defence budget—talk about ideas for deficit reduction.

The report also says that

“governments have chosen to ignore this problem, they have done so despite the public’s views.”

Those views are striking:

“89 per cent of people agree (52 per cent strongly agree) that ‘If we want to have any hope of mending our broken society, family and parenting is where we’ve got to start’…81 per cent of people think that it is important for children to grow up living with both parents.”

I think that it is time, and the report clearly agrees, that politicians on both sides of the House acknowledge that family breakdown is an issue that matters to the vast majority of people in this country and take whatever action they can to reverse it. The report makes a series of recommendations to all political parties in advance of the next general election, which people can read in their own time.

I want to restate something that my hon. Friend the Member for South Northamptonshire said. Earlier, I mentioned the statistics on speech and language difficulties among inmates. Some 80% of long-term prison inmates have attachment problems that stem from babyhood, which is staggering evidence. The good thing that must come out of that is to find a way to help families form the loving and secure bond that she talked so much about. That bond should come naturally when there is a new baby in the house but, as we know, post-natal depression, problems with conception or birth experience, domestic violence and the issues of poverty and deprivation set out by my hon. Friend the Member for East Hampshire can, and so often do, get in the way.

That is where Home-Start UK, which I mentioned earlier, has to be part of the toolbox. Its formula of parents helping parents has been incredibly successful over the course of my lifetime—40 years, as we have been reminded. In August 2013 I spoke at the annual general meeting of Home-Start Winchester and Districts, which has been going for a long time and does so much to help families through the really tough times.

When my wife and I had children, people said that children throw a hand grenade into marriages. I think that is nonsense; it is more like an atomic weapon. We had marriage preparation classes before we got married. The vicar who married us said that his one piece of advice was to share the teaspoon moments—the things that get on each other’s nerves. Ten years on—we celebrated 10 years last year—we still regularly share the teaspoon moments, more of them coming my way than going out. There is nothing like children, supercharged after a night of poor sleep or on a whiney day, to create teaspoon moments and to exaggerate them into whopping great soup ladles.

[Fiona O'Donnell]

I join the hon. Gentleman in praising Home-Start. I have experience of using its services in Banbury and it was the only group that came and said to me, “What do you need? What can we do for you?” Every other service said, “This is what we do. Is it of any use?”

[Steve Brine]

Absolutely. There are so many similar examples throughout the country. I urge all hon. Members who do not know their Home-Start people to get to know them. They work with families, and can share the teaspoon moments when they are there, or sometimes just shine a light of perspective. When new parents are exhausted, perspective is hard to come by. My experience of seeing Home-Start at work is that it helps parents to learn to live together after children. Learning to live together is hard enough, but doing so after children is a whole new skill.

Home-Start has been demonstrated to work. Its volunteer support and positive impact on parents and families have been shown to work. A three-year research project by a team at the universities of Amsterdam and Utrecht a couple of years ago revealed that children are still benefiting up to three years after their Home-Start volunteer stopped visiting. The good thing about what Home-Start is able to do here is that it is being copied: the Incredible Years programme and the family nurse partnership are both maternal and early-years public health programmes providing ongoing, intensive support to mums and dads and their babies.

The family nurse partnership is of particular interest to me. It is welcome that the Government have recently agreed to increase the number of family nurse partnership places to 16,000 at any one time by the end of this Parliament. I saw its inspiration at work last summer in Houston, Texas, where it is called the nurse family partnership. I was there with the Justice Committee and saw the partnership at work in Harris county. We were there as part of our major inquiry into crime reduction policies and the data we were shown were very impressive. The programme is expensive but the outcomes are good, with 60% fewer arrests and 72% fewer convictions among children of mothers participating in the programme than among those of mothers in a similar demographic and income bracket who did not. The number of days babies were hospitalised was reduced by around one third among programme participants. The figures are impressive.

It goes without saying that any remarks about early intervention in the first 1,000 days would not be complete without mentioning the troubled families programme. I am a big fan, and despite some mixed messages in the June 2013 spending review, the Government gave a commitment to extend the programme through the next five-year parliamentary period and confirmed £200 million from several Departments for a wider focus in 2015-16. That is sensible. I am regularly updated by Hampshire county council and Hampshire troubled families mapping, which have confirmed that 70% of client families are located in the top 30% of wards for health deprivation in the county. That laser-like focusing at a time of shrinking resources must be right. I know that it is bearing a dividend in Hampshire, as it is throughout the country.

The early years are about the state, but they are also about the big society, the third sector—the voluntary sector—and, ultimately, about creating more stable learned environments where those early years count, so that babies have a chance of normal development. The prize for us is absolutely huge, as all hon. Members who have spoken today have said, not just in money value, but in the value of human life. Ultimately, that is what we, as Members of Parliament, are about.

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[Jane Ellison]

If my hon. Friend does not mind, I will write to her after the debate to respond in the level of detail that she asks for, as that is not in my brief. However, I can reassure her that I think there are trials, supported by Government research funds, to consider some of the areas that she is interested in. I think that there is room to give her encouragement in that regard.

To return to the networks that I was describing, for women at risk of poor mental health during pregnancy and following childbirth, services do exist. Ministerial colleagues have visited excellent services in Blackpool, for example, that support women who have or are at risk of developing mental health or substance misuse problems in pregnancy or post-natally.

The key messages on smoking in pregnancy are also getting through. We have some way to go, but as I have said, the figure is beginning to drop. Teenage pregnancy can, of course, lead to poor outcomes for both teenage parents and their children. Teenage mothers have three times the rate of post-natal depression and a higher risk of poor mental health for three years after the birth. They are three times more likely to smoke during pregnancy and 50% less likely to breastfeed, with consequences for their children. It is imperative that we reduce the numbers of young women and girls getting pregnant and mitigate the impact of having a child when young.

The good news is that our rate of teenage pregnancy now stands at a historic 40-year low. In 2011, the last year for which we have figures, our conception rate for young women under 18 was 30.7 per 1,000, down from 35.4 per 1,000 in 2010. That is due to a lot of hard work, dedication and passion from our health care professionals, many of whose efforts have been described by Members in this debate. I pay tribute to their efforts and the important results that they are yielding.

Reducing conception by under-18s is one of a basket of indicators in the public health outcomes framework and our sexual health improvement framework, which was published in March 2013, to drive continual improvement. Despite our best efforts, though, some young women and girls will become pregnant, and we must do our best to mitigate the risks to those young mums-to-be and their babies. Several hon. Members, including my hon. Friend the Member for Winchester (Steve Brine), have paid tribute to the family nurse partnership, a preventive programme for vulnerable first-time mothers under the age of 20. It offers intensive and structured home visiting delivered by specially trained nurses from early pregnancy until a child is two. There are now more than 80 teams covering 91 areas across England, and the Government are committed to increasing the number of places on the programme to 16,000.

The family nurse partnership successfully engages with disadvantaged young parents, including fathers, to pick up a point mentioned by my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), who is no longer in his place. Of those who are offered the family nurse partnership, 87% enrol and a high proportion continue to engage until their child reaches their second birthday. My colleague the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, witnessed—other Members have referred to this during the debate—the transformational power of the programme, and he met family nurses and their clients in London in 2013.

Thankfully, we have 30 years of evidence from the USA and elsewhere that shows that the family nurse partnership programme improves outcomes for mothers and children in the short, medium and long term. That includes health and behaviour during pregnancy, reduced child abuse and neglect, improved school-readiness for the child and improved economic prospects for the mother. That list is the mirror image of all the different threats to health and wealth that have been articulated during the debate. It shows that the impact of some of these powerful early interventions can ripple down the generations, as other hon. Members have said.

To pick up a point made at the start of the debate, such interventions have also made great savings to the public purse in health, social care and the criminal justice system. I am glad that my hon. Friend the Member for Winchester mentioned the US research. We are undertaking a large-scale independent randomised control trial that will rigorously evaluate the programme’s effectiveness in the English context, and the initial findings will be reported later this year. I am sure that hon. Members present will be interested to see that, because it will be useful to see those data expressed in an English context.

The Healthy Child programme is a universal evidence-based preventive programme to improve the health and well-being of all children and to identify and treat problems early. Effective implementation of the programme should improve many of the outcomes highlighted in the “The 1001 Critical Days” manifesto, including the strong parent-child attachment, positive parenting, better social and emotional well-being among children and care that helps to keep children healthy.

[Fiona O'Donnell]

The Minister speaks about bonding between mother, father and baby in the early days. May I draw her out on the issue of maternity and paternity pay being included in the cap on benefit spending announced by the Chancellor in his autumn statement? Will she give an undertaking that that will not lead to a freeze or a reduction in maternity and paternity pay?

[Jane Ellison]

The hon. Lady will understand that that is not in my portfolio, but I am happy to draw her concerns to the attention of colleagues in whose portfolio it rests. I undertake to do so after the debate.

The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, has asked Public Health England to commission a rapid review of the evidence base for the Healthy Child programme, with a focus on primary prevention. The Department of Health is also working with the WAVE Trust, which was instrumental in developing the evidence base for the manifesto, with the Early Intervention Foundation and with others to explore how valuable work in prevention can be built upon. We will be interested in the outcomes of that evaluation.

Health and Social Care Bill

Fiona O'Donnell Excerpts

Tuesday 20th March 2012 Commons Chamber

[John Healey]

My answer to my hon. Friend’s second question is no, and I do not know the answer to her first question, which should really be directed to the Minister. We need an explanation of how the system for setting up, or in effect franchising, local patient organisations will be carried out, what sort of framework that will take place in, and what standards, if any, will be required for the way they are set up and run.

[Fiona O’Donnell (East Lothian) (Lab)]

Does my right hon. Friend not find it incredible that after a pause, two Bill Committees and all the debates in this place and the other place, we still do not have answers on a matter that is so important to patients?

[John Healey]

I find it dismaying, because there are so many people who are committed to the health service, work in the health service or are dependent on the health service, as we all are, and they want answers to that question, but the Government are simply not giving them. To be honest, I think that this stems from the genesis of the legislation, something that was ruled out explicitly in the Conservative party manifesto and the coalition agreement but then sprung in a White Paper less than two months after the general election. That meant that the civil service, the health profession and the NHS were unprepared for this huge reorganisation and this huge Bill, so in many respects, beyond the main decisions set out in the White Paper in July 2010, all the evidence indicates that the Government are making it up as they go along. The fact that we have seen more than 1,000 amendments to the Bill since it was first introduced is a further indication of that.

Is the Minister coming back?

--- Later in debate ---

[Andrew George]

I am not in a position to doubt that figure. The question is whether the ratio is sufficient to ensure that there is safe staffing in our hospitals now, as the RCN identified after a recent survey. I understand the argument advanced by Ministers that it comes down to the management and the management of paperwork within hospitals, and is not just about staff-to-patient ratios. I do not want to have a debate just about staff -to-patient ratios, but that issue has been raised today and I believe that it resonates with people out there in the country, who can see that nurses in particular are struggling to provide adequate services within their hospitals. Those ratios have an effect on the level of care that nurses can provide, as has been found by a variety of reports. The problem is not down to the callousness of the nurses or untrained care assistants who provide the services—where that exists, it should clearly be rooted out of the service—but to whether staff resources are sufficient to maintain safe services on our hospital wards. I think the RCN is right to raise that issue.

That concern is relevant to ensuring that we have adequate local healthwatch services because it shows that we need independent scrutiny of the health service by a body that is not in the pocket of anyone, including the local authority, but that is able to scrutinise hospitals and speak out about staffing levels in its area. We cannot be dependent on the RCN reporting such matters to the Department and on there being top-down diktats that impose mandatory staffing levels that apply in all circumstances. Rather, there should be a local healthwatch that looks at the guidance and recommendations of the professional bodies and ensures that the services in its local hospitals are adequate to provide safe nursing and hospital care. That is why it is important to ensure that the local healthwatch bodies are, as far as is possible, independent of any external influences, whether from the Department, the NHS Commissioning Board, clinical commissioning groups or the local authority. That is where I shall take my arguments.

[Fiona O'Donnell]

I feel as if I have been here before, in that I agree with some of what Government Members are saying. Will the hon. Gentleman therefore vote with us tonight?

[Andrew George]

I shall sidestep that question at present and return to it later, because I first want to listen to the Minister’s winding-up speech. As I want to ensure that he has adequate time, I shall conclude my remarks as swiftly as possible.

I could, however, initiate a brief yah-boo interlude, such as by saying that the previous Government got rid of community health councils. Many people look back at the era of CHCs as the halcyon days of independent scrutiny of local provision. In creating local healthwatch, we should as far as possible mirror, and learn from, the excellent services provided by the CHCs.

--- Later in debate ---

[Grahame M. Morris]

Although the HealthWatch issue is important, in the brief time available to me I want to talk about Lords amendments 249 to 283, dealing with the health and social care information centre and patient confidentiality. The amendments raise several issues about who would have access on a mandatory basis to the information provided by the centre as well as changes in the terminology used to refer to the persons who would be able to make such requests. There are important issues here about patient confidentiality and protections to ensure that the right checks and balances are in place. I am sure Ministers will be well aware of the arguments made in Committee about the issue, and I wish to seek some assurances and express some concerns. Perhaps the Minister may be able to address some of them.

One issue that was raised in Committee was the power of the Secretary of State to direct the information centre as he wishes. The Opposition think it is a good thing that the Secretary of State should discharge certain powers, particularly when failures happen, and be held to account for them by the House. Naturally, we support the view that people should have greater access to, and control over, their health and social care needs and the care that they receive. I am sure the whole House can subscribe to that idea. However, the opportunity to access health and social care records has to be tempered by protections for patient confidentiality and, equally importantly, protections to prevent the misuse of information by private bodies.

The Opposition have raised the issues of access to patient information and privatisation, and expressed concerns that sensitive information may find its way to organisations that will use it for commercial reasons. In Committee, my right hon. Friend the Member for Rother Valley (Mr Barron) spoke about the value to patients of anonymised data, which enable them to make relevant choices. It is not a huge leap of faith to imagine that those same data would be commercially valuable to pharmaceutical companies and commercial interests. I am concerned to hear from the Minister that adequate safeguards are in place in the Lords amendments.

[Fiona O'Donnell]

It is valuable to the debate that my hon. Friend is highlighting his concerns about confidentiality. Does he agree that a theme running through the Bill is that it will undermine the confidence that patients can have in the people who deliver services to them?

--- Later in debate ---

[Stephen Pound]

I am not entirely sure, Mr Speaker, whether you would allow the debate to go down that line, but were anyone in Northern Ireland to suggest a model such as that being proposed tonight, they would get a very dusty answer—it might not be replied to with sword or pen alone, but it would certainly be responded to.

The NHS is not something that we choose to buy into or out of. It is something that we all subscribe to. For many people—I should think everyone in this Chamber except me—it is a part of their birthright. People have been born under the NHS, have lived with the NHS, have funded the NHS and have supported it, and their voices must be heard. What we have tonight does not represent a valid mechanism for people to engage with the NHS. That is the key point. It is simply not good enough to set up a sub-committee of a quango and imagine that it has any force. We must realise that, yes, people may have different political opinions and there might be different priorities, but we do not have differential rates of national insurance. We pay national insurance because it is our national health service, and we have a right to have our voices heard.

[Fiona O'Donnell]

Does my hon. Friend agree that part of the problem is that such a complex measure is before the House? The Government’s thinking was not developed in the early stages, and the Conservatives’ coalition partners have contributed nothing throughout our scrutiny in Committee. That is why, at this late stage, the Opposition are still left trying to amend and improve the Bill.

--- Later in debate ---

[Stephen Pound]

I am grateful to my hon. Friend for her question. It is a great sadness and reflects ill on my personal life that I spend many a night browsing through Liberal Democrat and Conservative manifestos. I have searched; I have examined; I have deconstructed; I have applied the principles of Jacques Derrida to those manifestos. Have I found in there any smidgen, any suggestion, any hint or any implication that the NHS was to be fragmented, privatised and ultimately destroyed, and the connection between the people and the NHS to be ripped up, torn into shreds like the integrity of the Liberal Democrats, hurled from the window to flutter in the breeze of history, never, ever to be seen again? Had I found that, I would almost certainly have voted Labour—but as I did so anyway, that is neither here nor there. But the point that my hon. Friend makes is absolutely right. How can the people, who fund the NHS, who are born in the NHS, who live in the NHS and who will ultimately quit this mortal bourn in the NHS—when they depart this vale of tears, it will be with the comforting arm of the NHS about their shoulders—feel that they are best served by this organisation if their voice is not heard?

[Fiona O'Donnell]

If it is difficult for those people to imagine how they can rely on the NHS, surely they should take a lead from the Lib Dems at their spring conference and show Liberal Democrat Members that they need to listen to their members and vote with us this evening.

[Stephen Pound]

My hon. Friend tempts me down a partisan path. I hope she will forgive me if on this occasion I will not follow so closely behind her. All I will say is that Gateshead—that wonderful, glorious city—has been demeaned by the presence of those who spin endlessly before our eyes, desperately trying to justify their own appalling behaviour.

What we have this evening is a Bill that is inchoate in its extremities. There are so many different clauses. I challenge any individual to respond to a question on the total number of amendments that we have had to face before tonight. But above all, leaving aside all the numbers, the clauses, the subsections, there is at the heart of all this one basic irrefragable—

Health and Social Care (Re-committed) Bill

Fiona O'Donnell Excerpts

Wednesday 7th September 2011 Commons Chamber

[Fiona O'Donnell (East Lothian) (Lab)]

The Minister and the Government are fond of pausing with this Bill. I want to offer him the opportunity to pause as he comes near to the end of this long list of amendments and apologise to the many health organisations and patients organisations across the country for the anxiety and concern that he and his Ministers have caused.

[Paul Burstow]

I am sure that as people read the transcript of the debate they will wonder why that intervention came at this point, other than to make a cheap party point. It is one that many Members of the House will know has set the tone for much of the Labour party’s contribution to debate on the Bill.

I was about to discuss an important issue, which is how we improve the health of our nation through our public health services. Returning to amendments 1253 to 1260 and the role of director of public health, we are having discussions about how best to ensure that the director of public health has an appropriate status within the local authority. There is concern about who directors report to and are accountable to. We intend to return to that matter once the consultations are concluded to make that absolutely clear, and to address those concerns.

--- Later in debate ---

[Caroline Lucas]

It seems to me that if Wales and Northern Ireland have been able to abolish prescription charging altogether, it is certainly possible to do it. I would also argue that although everyone collectively having a stake in our public services may well mean that millionaires get a free eye test, under the type of regime that I would like to see they would be paying an awful lot more tax than they are under the Conservative party’s regime.

[Fiona O'Donnell]

I am aware that the hon. Lady sits close to Scottish National party Members, who may not have given an accurate picture of what has happened in Scotland. We have free prescriptions, but we also have 1,200 fewer nurses. People such as me are getting our prescriptions free, but that puts strain on other parts of the service.

[Caroline Lucas]

I thank the hon. Lady, but I do not agree that the two points that she makes are causally linked. Of course I do not want to see the abolition of nurses, but that does not mean that we should have to pay for our prescription charges. Either we want an NHS free at the point of delivery and with free eye tests and so forth or we do not. [Interruption.] Someone is speaking from a sedentary position, no doubt asking how we will pay for it. I will be very clear that there is massive potential in cracking down on tax evasion and avoidance, higher tax for the rich, higher corporate tax and so forth. We are essentially talking about political priorities. The priority that I represent—a great many more people are coming to this view—is that we should be willing to pay for the public services that we want.

Hon. Members may oppose amendment 48 on the basis that charging for prescription or for dental and eye care is an important way of raising revenue. In England, eligible patients pay a prescription charge of £7.20 an item. In Scotland the charge is £3 and Wales and Northern Ireland have abolished prescription charging altogether. England raised just £470 million through the charges in 2009-10, which was just 0.5% of the NHS resource budget.

Crucially, we should remember that income from charging in the NHS is not pure profit. There is a real cost to administering the plethora of exemptions and reduced charging rates for which different groups are eligible. For example, there are 11 different groups that are eligible for free dental care, 15 that are eligible for free sight tests and 12 that are eligible for free prescriptions. I hope that hon. Members will see the benefit of doing away with that convoluted and complex system, which provides little benefit in terms of income, and which goes directly against the NHS principles by significantly reducing people’s access to all forms of health care simply because of their inability to pay.

Much has been said by hon. Members on both sides of the House about the founding principles of the NHS, and it will continue to be said. However, I put it to hon. Members that amendment 48, more than any other, seeks to point out that much important NHS care and treatment is charged for, and that we need to go back to NHS services as they were envisaged by its architect, who has been referred to many times this afternoon. Hon. Members might recall that he resigned as Health Secretary as early as 1951, in protest at his Chancellor’s efforts to impose charges for prescriptions, dental treatment and eye care.

Amendment 1181 raises serious concerns about the way in which CCGs will be able to charge for services. Although the power to charge, under proposed new section 14Z3 to the National Health Service Act 2006, is intended to be of benefit to the health service, it is very disturbing. Its scope is unclear—I wrote to the Minister last week to ask for clarification—but the fact is that important limitations on how the Secretary of State can exercise that power would apparently not apply to CCGs. The measure could run a coach and horses through the principle of a free health service, and Parliament needs to be clear on its impact in practice.

It is extremely worrying that CCGs will be able to decide that certain specialist services—for example, for pregnant women or women who are breast feeding young children, or aftercare—are not appropriate as part of the health service. That would mean that the statutory guarantee that the NHS will be free will not apply, because CCGs can decide that certain services and facilities should not be provided as part of the NHS. If that happened, CCGs could use the charging power to decide to charge for supplying, for example, goods to pregnant women, or for instructing people how to use their rehabilitation equipment.

Amendment 1181 would ensure that that could not happen. Ministers might say, “CCGs are commissioners and not providers”. If so, why is a measure that allows CCGs to charge necessary in the first place? The amendment would make it absolutely clear that there is no way in which a CCG could charge for anything that is related to the basic core health service, such as hospitals, doctors, nurses or ambulances, whether they are acting under section 3 or proposed new section 3A of the 2006 Act. The amendment would also impose on CCGs the same limitation that is already imposed on the Secretary of State. Why was that omitted from the Bill?

It is right that raising funds under that power should not interfere with a CCG’s functions. However, the Bill says that raising funds should not interfere significantly, but what on earth does “significantly” mean in that context? How is it to be determined or measured? If companies such as UnitedHealth got hold of that power and reckoned they could make money out of it, they will be on to it in a flash. The very least that they should be required to do is demonstrate that dealing in land and supplying goods and the like will not take them away from fulfilling their commissioning role. I would prefer it if those giant profit-driven companies were nowhere near the health service, but while they are, we need far greater safeguards than currently exist.

Unfortunately, the previous Government gave overseas companies the legal route into the NHS, and this Government are seeking to smooth that route yet further. Hon. Members may recall that at Prime Minister’s questions on 18 May, the Prime Minister claimed that he had not heard of Mark Britnell, one of his health advisers, who was also a key adviser under Tony Blair, until he googled him the previous Sunday. The Prime Minister’s interest was stoked by a report of a speech that Britnell, global head of health care at KPMG, gave to a group of private health companies in New York last October. Dr Philip Hammond pointed out in Private Eye that according to a brochure summarising the conference, Britnell said:

“GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process…In future, the NHS will be a state insurance provider, not a state deliverer…The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”

That is a shocking thing to say, and no wonder the Prime Minister was keen to distance himself from it, at least in public.

My last point is about the final proposal in amendment 1181, which would mean that:

“Income raised by a clinical commissioning group as a result of the exercise of powers under this section shall be specified in its annual accounts, referred to in its annual report under section 14Z13, and paid annually to the Secretary of State.”

Without the amendment, it is completely unclear what CCGs will do with the money that they raise and how, if at all, it will affect their budget allocations. I think it would be madness for Parliament to give CCGs the right to charge for supplying goods, dealing in land and providing instruction for the purposes of raising more funds for the NHS, and then not to require them to account for it in any way, and not to ensure that the funds find their way back to the public rather than the private purse. This part of my amendment seeks to ensure that that is done.

Amendment 1234 refers to the fact that once they managed to get into the CCGs, multinational health companies such as UnitedHealth would be allowed to do the actual commissioning, thus creating a very unhealthy form of what is effectively in-house outsourcing. I understand that they will be able to charge for the supply of goods if the Government do not accept the amendment. Parliament cannot trust companies whose primary duty is to their shareholders to be in charge of so much taxpayers’ money, nor should such companies be given the right that the Secretary of State currently holds to charge for the supply of goods or for land deals. We should make it clear that CCGs cannot agree among themselves that their functions will be carried out by one of their private company members. Commissioning is a public function that should be exercised in the public interest, and private companies such as UnitedHealth should not be entitled to charge for any it.

Health and Social Care (Re-committed) Bill

Fiona O'Donnell Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Lansley]

No.

The OFT and the Competition Commission would obtain Monitor’s view on how a proposed merger would affect competition in the sector and whether it would bring benefits for patients. These views would then be considered, along with other evidence. However, the OFT would have discretion not to refer, where patient benefits outweighed any adverse impacts on competition—further illustration of the fact that competition law is not about promoting competition as an end in itself.

In conclusion—

[Fiona O'Donnell (East Lothian) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

No.

I return to the choice offered in this group of amendments between the Government and Opposition Members. The Government are putting forward a range of amendments to protect patients’ interests and to safeguard them when providers run into difficulties and access to services is threatened. The amendments show that the Government have listened and improved the Bill. These amendments are on top of the changes made at earlier stages to strengthen the safeguards and protections offered by Monitor as a new provider regulator.

The Opposition simply want to delete the whole of that part—delete the safeguards to stop price competition, delete the means to stop cherry-picking, delete the means to enable NHS providers to work on a level playing field. The Government’s new clauses and amendments move us forward with the right safeguards in place. Labour would take us back. I urge the House to support the Government new clauses and amendments in this group—specifically, new clauses 2 and 6 and amendments 90 to 107, 113 to 220, and 366 to 372.

--- Later in debate ---

[Debbie Abrahams]

No, I will make some progress.

The listening exercise failed to register the concern of many health professionals. Despite what the Government say, many health professionals feel very concerned about the amended Bill. Instead, the Government changed Monitor’s duty from one of promoting competition, as set out in the first version of the Bill, to one of preventing anti-competitive practice. The lawyers will have an absolute field day with that one. The Government talk of reducing bureaucracy, but I think we will see even more bureaucracy as a result of this.

[Fiona O'Donnell]

Does my hon. Friend recall, as I do, that time and again in the recommitted Bill Committee we asked Ministers and Professor Field what the impact of that change would be? We are still waiting for a satisfactory answer.

[Debbie Abrahams]

There are many unanswered questions about the Bill, which makes it particularly dangerous.

By opening up competition under the guise of increasing patient choice and clinician-led commissioning, the Government are trying to increase both demand and supply for these services, but the implication for a single-payer health system with a fixed budget, such as the NHS, is that this will inevitably lead to financial meltdown. The only way this can be avoided is by injecting extra capital into the system and the Bill achieves this in many ways. We need to look at not only this cluster of amendments but all the amendments and clauses in the Bill as a whole, because they are interrelated.

First, the Bill allows foundation trusts to borrow money from the City to invest. This is supported by the opening up of EU competition law. Foundation trusts are currently social enterprises and are exempt from part of EU competition, but this opening up will open the flood gates. It means that the trusts will have to compete for tenders with private health care companies. They will have to repay the money they have borrowed by treating more and more patients, including private patients, which will be aided by the abolition of the cap on income from private patients. However, many foundation trusts will still struggle, so the Bill introduces a new insolvency regime to enable private equity companies to buy NHS facilities and asset-strip them, which has direct parallels with the demise of Southern Cross.

Secondly, waiting lists will go up. We are already seeing that across the country, including in my constituency. We have seen that already because unrealistic efficiency measures mean that cash-strapped primary care trusts are rationing access to treatment such as cataract surgery and hip replacements.

--- Later in debate ---

[Mr Stephen Dorrell (Charnwood) (Con)]

I welcome the amendments that the Government have tabled for consideration. I also welcome the very detailed way in which my right hon. Friend the Secretary of State introduced what is, as I am sure he will acknowledge, a substantial group of amendments. He emphasised that their purpose is to give effect to the undertaking that the Government gave when they set up the NHS Future Forum to ensure that the findings of that forum are reflected in the legislation, and that the Bill, when it reaches the statute book, is built on the work of Professor Field and his colleagues.

One purpose of the amendments is to respond to many of the points that have been made, throughout the passage of the Bill, about the role of Monitor. I completely agree with my right hon. Friend that many of those observations about the supposed role of Monitor have been based on a misunderstanding, whether deliberate or otherwise, of the intention behind the Bill when it was first introduced. Whether the misunderstanding was deliberate or accidental, the Government are responding to virtually all those points in order to make it clear that, in the context of the Bill, the central purpose of Monitor is not to be a blind economic regulator based on the assumption that the health service is simply another utility. Various loose words have been used that bear that construction—but never by Ministers, and the implications of those observations have never been accepted by Ministers. As I have understood it—this is why I have supported the Bill throughout its passage—the Government’s intention has always been to ensure that the new NHS envisaged by the Bill gives effect to the basic commitment on which the Government were elected to ensure that the health service secures equitable access to high-quality health care for all patients regardless of their ability to pay.

[Fiona O’Donnell]

The right hon. Gentleman referred to a misunderstanding of the original Bill. The Secretary of State said that that arose because he was a poor communicator. Do so many organisations still oppose the amended Bill because he is still a bad communicator or because it is still a bad Bill?

[Mr Dorrell]

In considering these amendments, it is important to refer to the individual functions of Monitor envisaged in the amended Bill and test them against the assertions that have been made, throughout the passage of the Bill, about what Monitor is there for. We must also test them against the Future Forum’s recommendations about how the role of Monitor should be clarified in order to remove these misunderstandings.

First—I warmly welcome this—it is made clear in the Bill as amended and the supporting documentation from the Department that although the Government intend to continue, as did their predecessor, to encourage the conversion of NHS trusts to foundation trusts, there will be no reduction in the standards required to qualify for the status of foundation trust. The registration principles established by Monitor, which are broadly welcomed throughout the health service, are intended to justify the independence that comes with foundation trust status. Those standards will continue as a gold standard under the new NHS, and achieving them, rather than meeting some artificial deadline, is the key determinant of whether a trust achieves foundation trust status. I welcome the fact that the Government have made that clear. It responds to a specific recommendation by the Future Forum, and it is exactly right.

--- Later in debate ---

[Frank Dobson]

People have described me as old Labour, but I have moved on from that. I am now heritage Labour. Part of our heritage, however, is the national health service, and it is not the Tories’ heritage either. Those who play with the national health service—which is what I think the Government are doing, purely for ideological reasons—do us a disservice in two ways. They threaten the likely performance of the national health service and the people working in it, and they threaten the relationship between the British people and the national health service.

[Fiona O'Donnell]

Will my right hon. Friend give way?

[Frank Dobson]

No, I will not.

I believe that the national health service is popular for two reasons: because, in most parts of the country and for most of the time, it does a good job for people; and because people value the thought that it not only looks after them but looks after their families, looks after their neighbours, and looks after all of us. I believe that, in many ways, that is its most important function.

We live at a time when everyone is filled with growing concern about the divisive elements in our society, and the national health service, along with the feeling that people have for it as a collaborative organisation, is one of the few exceptions to that. The health service does not just bind the wounds of people in this country, but helps to bind us together. That, I believe, is why it is so dangerous that the Government are going against its basic principles, thus risking not only its performance, but its relationship with us and its binding function in our increasingly divided society.

--- Later in debate ---

[Grahame M. Morris]

I am grateful to my hon. Friend for expressing that concern, which many people share—even among the Government, although perhaps they conceal it. Such concerns are not restricted just to 38 Degrees and Opposition politicians. Lord Tebbit of Chingford, an outspoken man who could hardly be described as a left-wing agitator, raised real concerns about what he described as these privatising reforms. He said that there is something seriously wrong, and that

“What worries me about the reforms…is the difficulty of organising fair competition between the state-owned hospitals and those in the private sector. In my time I have seen many efforts to create competition between state-owned airlines, car factories and steel makers. They all came unstuck. The unfairnesses were not all one way and they spring from the fact that state-owned and financed businesses and private sector ones are different animals”.

I have rarely found myself in agreement with Lord Tebbit, but on this occasion his analysis is extraordinarily insightful. His comments underline many of the basic contradictions in the Bill and in the subsequent amendments, which number more than 1,000.

[Fiona O'Donnell]

Apart, perhaps, from his warm comments about Lord Tebbit, my hon. Friend is, as ever, making a well-informed and considered contribution. We face a lack of information, inaccuracy and changing numbers. Does he therefore agree that what we also need, given the concerns raised by many hon. Members about the potential for an increased health inequality gap in this country, is an equality assessment of the Bill?

Winterbourne View Care Home

Fiona O'Donnell Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I entirely understand that question. I suspect the hon. Lady speaks for many who saw the programme and therefore fear for their loved ones who may be in other institutions. That is why we have to act in a thorough and thoughtful way, why we have to act quickly, and why the various processes that I described today are the best way to reach conclusions quickly. Because of the separate criminal inquiry, a separate independent inquiry would not be able to start until those judicial processes had been completed. That is why we want the internal processes to go forward. We have provided external scrutiny to make sure that they deliver what we all want—greater assurance that the system will deliver the best quality care for our loved ones.

[Fiona O'Donnell (East Lothian) (Lab)]

The Minister has stated that there cannot be an inspector in every bedroom, and that is why he and hon. Members across the House this afternoon have acknowledged the vital role of whistleblowers in protecting vulnerable adults. Will he speak to colleagues in the Department for Business, Innovation and Skills to ensure that any changes to employment law do not make it more difficult for people to blow the whistle, especially new employees who often see a service through fresh eyes and therefore see faults that others have grown used to?

[Paul Burstow]

I will certainly have those discussions, and I would add that there is another area that we need to focus on, and that is the training and development of the work force. That is why just two weeks ago I announced not just a work force development strategy, but additional new resources to underpin that strategy for all providers to enable them to ask Skills for Care for the resources to develop their work force.