NHS Spending

Gareth Thomas Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

We are currently doing the analysis the hon. Gentleman is concerned about, but I should just say to him that I accept the Home Secretary’s assurance and confidence that we will not end up in a situation where EU nationals, upon whom we absolutely depend in the health and social care system, and who do an absolutely outstanding job, would not be allowed to remain in the UK. She has said she is very confident that we will be able to negotiate a deal whereby they are able to stay here as long as they wish and to continue to make the important contribution they do, and I accept that assurance.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Further to the point made by the hon. Member for Angus (Mike Weir), will the Secretary of State give the House an assurance that he will release that analysis and that it will be sufficiently comprehensive to allow us to see a regional breakdown of the significance of EU nationals working in our health service?

[Mr Hunt]

I will take away the hon. Gentleman’s request, and I will, of course, try to be as transparent as possible with Parliament about all the analysis and research we do on these topics.

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[Mr Hunt]

First, may I welcome the hon. Lady to her place as a doctor and as someone who knows a great deal about NHS matters? Although I am sure we will not agree on every health matter, it is always valuable and a great asset to have someone with medical experience in the House, and I am sure she will make a huge contribution in that respect. She is absolutely right to say that what happens in the social care system has a direct impact on what happens in the NHS, and that we cannot—as, in fairness, happened under Governments of both colours over many years—look at the NHS and the social care system as completely independent systems when we know that inadequate provision in the social care system has a direct impact on emergency admissions in A&E departments. She is right to make that point.

Let me make a broader point in concluding my comments. I think that there would be agreement across this House on the huge pressure on the NHS frontline at the moment, and that there is recognition of some fantastic work being done by front-line doctors and nurses to cope with that pressure. I shall give a couple of examples of the extra work that is happening, compared with six years ago. The A&E target is to see, treat and discharge people within four hours. Every day, we are managing to achieve that, within the four-hour target, for 2,500 more people than six years ago. On cancer, we are not hitting all our targets, but every single day we are doing 16,000 more cancer tests, including 3,500 more MRI scans, and treating 130 additional people for cancer. There are some incredible things happening.

However, we all recognise, and this perhaps lies behind the Opposition’s concerns in bringing this motion to the House, that in healthcare we now deal with the twin challenges of an ageing population, in that we will have 1 million more over-70s within the next five years—a trend that is continuing to grow—and of the pressure of scientific discovery, which means we have new drugs and treatments coming down the track. They are exciting new possibilities but also things that cost money. I for one, as Health Secretary, believe that as soon as economic conditions allow, we will need to start looking at a significant increase in health funding. That is why it is incredibly important, as we go through the next few years negotiating our new relationship with Europe, that we work very hard to protect the economic base that we have in this country, the economic success that we have started to see, and the jobs that do not just employ a lot of people but create tax revenues for this country. It is incredibly important that we pilot the next few years with a great deal of care, because what happens on the economy will have a huge impact on the NHS.

[Mr Gareth Thomas]

rose—

[Mr Hunt]

I have almost concluded, but I will give way one last time.

[Mr Thomas]

I am grateful to the right hon. Gentleman for giving way, and, if he will forgive me for saying so, temporarily fond of him as a result, because he is allowing me to raise a particular constituency concern. Northwick Park hospital, which serves my constituents, currently has a deficit of almost £100 million and is having to axe 140 staff posts as a result of the lack of funding for my local clinical commissioning group, by comparison with other parts of London. Will he undertake to look specifically at the issues facing Northwick Park hospital and Harrow clinical commissioning group as his further analysis of the need for additional spending in the NHS is taken forward?

[Mr Hunt]

I am very happy to do so. I have visited that hospital, where the challenges very much reflect what the hon. Member for Tooting (Dr Allin-Khan) said about links to the social care system. It was clear to me that the staff in the A&E department are working incredibly hard getting people through it, but struggling to discharge people from the hospital, which is why they were not hitting their target.

I have just been handed a note by a ministerial colleague, Mr Speaker, which I hope you will indulge me and let me read out, because I have never been handed such a note before. It says: “Apparently everyone wants to go and watch Wales play, so Whips happy if you felt you wanted to shorten your remarks.” On that basis, I will conclude by thanking the shadow Health Secretary for bringing this motion to the House and for her comments in support of it.

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[Joan Ryan]

As we have heard, Brexit will present us with many problems, particularly with health care provision. Not only are we not getting large sums of money, but we will actually be worse off. We will face many challenges because of that decision, and if the promise of £350 million led people to vote in a particular way that will undermine the funding we receive, that is a desperate state of affairs.

People feel badly let down by the leave campaign’s empty pledges on the NHS over the past few months, and residents in Enfield are deeply disenchanted by the Government’s failure to fulfil their recent promises to our local health service. Before the 2010 general election, the then Leader of the Opposition—actually, he was then Prime Minister of the coalition Government—stood outside Chase Farm hospital in my constituency and vowed to protect its A&E and maternity units. By 2013, his Government had shut both departments. Many of us warned at the time that closing Chase Farm’s A&E department would put huge strain on other local health services, including North Middlesex University Hospital NHS Trust, which is the subject of the CQC report that I referred to earlier. We were right, and almost three years since the decision to close Chase Farm’s emergency department, the NHS in Enfield has reached breaking point.

Earlier today the Care Quality Commission published its report into the standard of care at North Middlesex hospital, following a spot check by its inspection team in early April. It found that the closure of Chase Farm’s A&E has led to significant increases in patient numbers attending the emergency department at North Mid. Despite being one of the busiest A&E departments in the country, North Mid’s urgent and emergency services have been graded as “inadequate”, and patient safety has been compromised. Patients who arrive at the emergency department are not seen quickly enough by clinical staff, and they are waiting too long to be seen by a doctor. Some blue-light patients are being brought in, and hard-pressed nurses are dealing with them because no doctor is free to treat them.

[Mr Gareth Thomas]

My right hon. Friend is making a strong case for her constituents and their hospital. Does she recognise that although the situation she describes at North Middlesex hospital is particularly bad, such things have also been witnessed in many other parts of London, not least in north-west London where the London North West Healthcare NHS Trust has shut an accident and emergency department at Central Middlesex hospital? As a result, there has been a big increase in pressure at Northwick Park hospital, which serves my constituents.

[Joan Ryan]

Absolutely. North Middlesex is just the first hospital to reach absolute crisis point, but I am well aware that other hospitals, particularly in outer London, are heading down a similar path and facing real difficulties. If we consider A&E waiting times, we see that hospitals are sliding into that difficult scenario.

Junior doctors and trainees have been left unsupervised in North Middlesex hospital’s A&E department at night, without competent senior support—in fact, no consultant has been available from 11 o’clock onwards. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) referred to such cases. In one instance, one commode was available for 100 patients in the whole of the emergency department. Staff raised concerns about the lack of vital medical equipment, including missing leads for cardiac machines so they could not get an instant read-out. Trolleys in the resuscitation area lacked vital equipment. There was an oppressive, overbearing culture at the hospital that meant staff did not feel confident in raising concerns, and they even stopped reporting incidents of staff shortages, as management had not responded to them in the past.

The CQC report reinforces the findings of Health Education England and the General Medical Council. At a high-risk summit in May, the GMC threatened to withdraw junior doctor post-graduate trainees if the numbers of A&E staff and middle-ranking doctors and consultants were not increased. That would effectively close the busiest emergency department in London. This is an unprecedented situation. The future of North Mid A&E has been put at risk. Even medical trainees at the hospital are not prepared to recommend the A&E for treatment to their friends and family. In interviews with Health Education England, they said that that was

“because they felt the department was unsafe.”

My constituents have had to suffer the consequences of shocking mismanagement and a lack of leadership at North Mid. The chief executive is now on leave and I understand she is stepping down. Although there is a lack of leadership, she cannot be held solely responsible for what has happened. The Prime Minister and the Health Secretary have told us repeatedly that the NHS is safe in their hands, yet huge pressures have been placed upon North Mid due to a lack of central Government funding. Patient care has suffered further as a direct result of the hospital not having enough equipment, consultants, doctors and nurses. It has had to spend large parts of its budget on locums and agency nurses.

What is the Government’s solution to ensuring that hospital departments, such as those at North Mid, do not remain dangerously understaffed? Is it to divert a large amount of funding to help to solve this situation and put patients first? No: they decide to go to war with junior doctors over their contracts and abolish NHS bursaries for student nurses, while we have hospitals going abroad to try to recruit staff. That is an insult to dedicated professionals who deserve our admiration, respect and support. The Government’s actions will discourage the future frontline staff we so desperately need.

The NHS is facing a huge financial challenge, so a commitment to spend an extra £350 million a week, or even £120 million a week, on the NHS in lieu of our EU membership was clearly a very attractive offer to our constituents. NHS England needs to plug a funding gap of £30 billion a year by 2021 and a few months ago it was revealed that nearly every hospital in the country was in deficit. We are obviously not going to get £350 million or £120 million a week and I think that that was always known by the leave campaigners. In fact, the Government are seeking to suck out £5 billion in savings through the sustainability and transformation programme. I know that savings and efficiencies, particularly in back-office services, can and must be found, but not at the expense of patient safety.

My hon. Friend the Member for Lewisham East (Heidi Alexander), the former shadow Health Secretary, warned that the scale of savings required could

“not be delivered without putting patient care at risk… These ‘efficiencies’ will mean cuts to staff, cuts to pay, rationing of treatments. And it will be patients who suffer.”

Her analysis is spot on. We have witnessed the disastrous effects of this course of action in Enfield. We need more investment in North Middlesex University hospital, and in the NHS in general, not less. I join my parliamentary colleagues on the Labour Benches in calling on the Government to increase spending on our NHS. It is most regrettable that, given the urgent need for more funding and the very real and justifiable concerns of people in Enfield, they should have been led to believe Brexit could possibly mean major new funding for the NHS.

In closing, I think I corrected myself wrongly. In the run-in to the 2010 general election, the current Prime Minister was, of course, the Leader of the Opposition, and he made a promise to keep our hospital open, which, when he became Prime Minister, he then closed. That kind of behaviour is very similar to what the leave campaigners did in promising money that does not really exist. It is hoodwinking the voter and it is not acceptable. It desperately undermines the voters’ faith in politics and democratic processes.

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[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

It is a pleasure to follow my hon. Friend the Member for Bristol South (Karin Smyth). I will be unashamedly parochial and pursue the point that I made in an intervention on the Secretary of State about the future finances of the Harrow clinical commissioning group and the London North West Healthcare NHS Trust. It includes Northwick Park hospital, which serves my constituents. I should declare an interest in that I have been operated on and indeed members of my family have been born at Northwick Park hospital, with which I therefore have a particular affinity, as do my constituents.

[Joan Ryan]

My hon. Friend is right to remain parochial and focused on his hospital. One of the scandals of North Middlesex is that all the local MPs have been kept in the dark about all the serious faults that were known to the hospital and to NHS officials. None of that was shared with the local MPs.

[Mr Thomas]

My right hon. Friend made a very powerful speech about North Middlesex hospital. I am pleased to say that I have a positive relationship with the managers at North West London Hospitals Trust as they have always made themselves open and available to answer my questions. I hope that they will read Hansard and see my right hon. Friend’s warning in relation to the difficulties that she has had with previous managers at North Middlesex hospital and will do even more to provide transparency in our area.

Let me talk now about my concerns about the finances at Northwick Park. Back in 2014-15, North West London Hospitals Trust had a deficit of some £55.9 million. That had risen to £100 million by the beginning of this financial year. The trust management board is optimistic that it can get that deficit down over the course of the next financial year to just over £88 million, which is an enormous sum in its own right and will, if that figure is achieved, still be without question one of the biggest deficits in the NHS in England. To achieve that target, it has committed to axe 140 posts. My concern, and the concern of many of my constituents, is that services at Northwick Park and indeed in other parts of the trust will be affected despite the intentions of the management.

The situation at Northwick Park has been compounded by the decision to close a number of accident and emergency departments in north-west London in recent years. In particular, the decision to close Central Middlesex hospital has undoubtedly had an impact, increasing the pressure on the services at Northwick Park hospital. Although it was great to see some new investment at Northwick Park—we now have an upgraded accident and emergency department—no extra beds were created in the hospital, which is a major concern.

I recognise that time is a concern, so let me underline my last point, which is about the funding of Harrow clinical commissioning group. In the past three years for which parliamentary figures were available, it has received the lowest funding of any London CCG. The Secretary of State was very generous in offering to go away and review that situation. I ask the Minister who is due to reply to this debate whether he would be willing to receive a deputation of local general practitioners and me to discuss the funding of Harrow CCG, which is one of the causes of the difficult financial situation at Northwick Park hospital that serves my constituents.

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

First, may I apologise to the House for not being here at the beginning of the debate? I did, however, see the contributions of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who set up a powerful case in support of the Opposition’s motion, and of the hon. Member for Central Ayrshire (Dr Whitford).

I would not dispute the motion’s central contention. We have just had an enormous public debate—as the hon. Member for Ellesmere Port and Neston (Justin Madders) made clear, a debate of a magnitude that this nation has not seen for decades. A central claim in that debate—a claim on which the referendum hinged—was that there would be an additional £350 million for the NHS to spend every week, were we to withdraw from the European Union. To be very clear about that claim, it is not one that any Member who supported Vote Leave can run away from. It was emblazoned not just on the bus, but in even more explicit language on a poster, which said:

“Let’s give our NHS the £350 million”—

not “some of” or “a part of”, but “the” £350 million—

“the EU takes every week”.

Members will know my position in this debate. It is not my purpose to revisit the arguments for one side or the other, but Members on both sides of the House, of this great debate and of the referendum campaign have a duty to hold to account the people who made those claims, because the referendum was won partly on the basis of them, and people will expect results.

I would like to put on record the nature of our contribution to the European Union every week, so we can be clear not about the claims, but about the facts. The simple fact is that it is wrong to take one year’s contribution as typical, because our contribution varies from year to year. Over the past four years, our gross contribution has in fact been £313 million a week. If we were to deduct the rebate, which is £69 million a week, and public and private sector receipts, which are a further £108 million a week, our net contribution per week is actually £136 million, worked out on a rolling average from 2010 to 2014. I would therefore suggest to those on both sides of the House, and on both sides of the campaign, that the figure needs to be challenged and challenged again.

Any money that might or might not be coming to the NHS needs to be seen within the framework of that claim. It is important for us at this stage not to move away from the claims made in the great referendum campaign. It is important that we bring the country together, but that does not mean that we should not bring some sort of scrutiny to those claims over the next few years, when the effects of Brexit will be played out and when our constituents will feel those effects in their pockets and in the security of their families, although some will say that that will be to the positive and others to the negative.

In the next few years, we will have to take consistent measures to bring scrutiny to the claims that were made. However, it is not just the money that is important in terms of Brexit. I, too, am concerned that we bring scrutiny to bear on the other issues facing healthcare, whether the regulation of medicines, research funding—universities have expressed real concern about that in just the past couple of days—or workforce supply. In that respect, I would like to reiterate the support that my right hon. Friend the Secretary of State for Health expressed for the migrant workers who have come to this country to serve our NHS. Many of them provide skills we cannot provide in our own country, and their dedication to our national health service is equal to that shown by those serving it who were born in this country, and I would like to personally thank them for their contribution and service.

On that issue, I think we can have some agreement across the House. Where, I am afraid, I part company from Opposition Members, however, is on their comments about the claim that was made by Vote Leave—as the hon. Member for Aberdeen North (Kirsty Blackman) made clear, it was also made by Labour Members of Parliament. That claim has not been made by Her Majesty’s Government; nor is it one that can be attached to the Department of Health.

In addition, it has been said that the money released by Brexit, even if it were to materialise, would be backfilling what the Opposition claim to be a deficit in NHS funding. That description could not be further from the truth, and I would advise Opposition Members to look at the OECD’s latest figures, which were released earlier this week. They clearly demonstrate that healthcare funding in this country is now just above the average for the EU15. It has moved up from being below average, and we are now achieving parity with countries such as Spain, which has a fantastic healthcare system that is much admired around the world, and indeed Finland. Given that position, we should surely praise this Government and the previous coalition Government, who protected healthcare funding, even when the Labour party suggested we do the opposite.

In 2010, the Prime Minister said healthcare funding would be protected, even though the Labour Chancellor of the Exchequer before the 2010 election suggested it should be cut. Under this Secretary of State and this Prime Minister, NHS spending has undergone its sixth biggest rise in the history of the NHS, despite the fact that we have been contending with the biggest financial crisis this country has faced in its peacetime history since the great depression in the 1930s. The financial environment of the NHS therefore bears positive scrutiny, compared with the situation in other leading countries in the European Union and with the history of Government funding for the NHS. Of that, the Conservative party is justly proud.

That does not mean, however, that there are no pressures within the NHS. I would like to pick up on some of the comments made by hon. Members, which I know they have made earnestly because they care very much for their local health systems. The hon. Member for Copeland (Mr Reed), who is a doughty campaigner for West Cumberland hospital and for healthcare provision in his area, knows that I will meet him again and again—I hope, soon, in Cumbria—to discuss the issues that he has in his locality. We are a receptive ear, but we must always pay attention to clinical advice as it pertains to his local area and not to the political exigencies that might exist. Rightly, we have removed political decision making from the disposition of services. That is precisely why the reconfigurations in the constituency of the right hon. Member for Enfield North (Joan Ryan) took place. It is always easy in government to try to make political decisions on matters that should be the preserve of clinicians, but that is the wrong thing to do, because one makes decisions for reasons of political expediency rather than clinical reasons. That is why we rely on the success regime in the hon. Gentleman’s constituency and in the whole of Cumbria, as we do in other parts of the country, to provide a clinical consensus and the arguments for change that local clinicians will wish to see.

The hon. Member for Bristol South (Karin Smyth) has an expertise unrivalled in this House in the management of finances at a local area level. She is right to say that Brexit poses particular problems for staffing of NHS and social care services, procurement and medicines. As a member of the Public Accounts Committee, she has provided very good criticism of how the NHS has been running its finances, which has not been good enough over the past five, 10 or 15 years—indeed, for many years. This Secretary of State and this team are doing a great deal to correct that. She is right, for instance, to point out that NHS Property Services has not worked as well as it should have done in the past. I hope that in the months and years ahead she will see reforms that give her greater pleasure than dealing with NHS Property Services gave her in her previous role.

The hon. Member for Harrow West (Mr Thomas) described the problems at his local hospital, as did the right hon. Member for Enfield North in relation to North Middlesex hospital, which I have discussed with her. Both hospitals suffer similar problems to other hospitals on the outside rim of London—discernible and discrete problems that we are endeavouring to correct and to provide solutions to. I hope that the right hon. Lady has seen, in the movement over the past few days, our determination to sort out the problems at North Middlesex. As the Minister responsible for hospitals, I do not want to leave this job without having given stability and certainty to the hospitals outside London that they have not had for many years.

[Mr Gareth Thomas]

I intervene merely to underline the request for a meeting with the Minister to discuss the finances of Northwick Park and, crucially, of the clinical commissioning group in my area.

[Ben Gummer]

Of course I will give the hon. Gentleman a meeting. If the issue is about general practitioners, I will refer him, if he does not mind, to my right hon. Friend the Minister for Community and Social Care. However, I will certainly meet him to discuss finances and hospitals. I will arrange both meetings on behalf of his constituents.

I thank hon. Members for this short but constructive debate. It is the first stage in the necessary scrutiny of the claims that were made by both sides in the EU referendum. We are now going to see, in the months and years ahead, who was right. I hope very much that I and the people on my side were wrong, because if so, it will be easier to deliver the spending commitments made by Vote Leave. I fear not, however, in which case we will have some very difficult years ahead. However, people can be sure that in this Government they have a Secretary of State, a ministerial team, a Prime Minister and a party that will continue to commit the funds that are necessary to the NHS, so that we improve on our position in the European averages. We will continue to fund it better than any previous Government to provide for the ambitious designs for this, our national health service, which we all care so much about.

Question put and agreed to.

Resolved,

That this House notes that the Vote Leave group during the EU referendum campaign claimed that an extra £350 million a week could be spent on the NHS in lieu of the UK’s EU membership contribution; further notes that senior figures who campaigned, including the hon. Member for South Northamptonshire, the hon. Member for Uxbridge and South Ruislip and the Rt hon. Member for Surrey Heath have subsequently distanced themselves from that claim; and calls on the Government to set out proposals for additional NHS funding, as suggested by the hon. Member for South Northamptonshire on 4 July 2016.

Land Registry

Gareth Thomas Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Further to the point made by the hon. Member for Brighton, Pavilion (Caroline Lucas), does my right hon. Friend accept that many businesses that work in property and data are also concerned about the possible privatisation of the Land Registry? They worry that a privatised Land Registry would see the new business owner seeking to extract maximum value from the business, rather than trying to improve access to the data.

[Mr Lammy]

My hon. Friend is absolutely right. There is deep concern about a hike in fees and a profit motive distorting a public institution that we all value. I hope that the Minister will take that on board and give the House some comfort on that in the coming hours. I give way to the right hon. Gentleman.

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Alistair Burt]

Yes, the work that YoungMinds and a range of other partners have done and continue to do to ensure that children and young people can access information safely is commendable. Children, young people and their parents have expressed the need to access both high-quality and reliable information and support online. That was reflected in the “Future in mind” report on children’s and young people’s mental health. We are investing with MindEd and a number of groups and organisations to work on apps for young people. It is important that they have access to safe material to exclude that which is rather darker.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

The Minister will recognise that walk-in centres run by experienced GPs can offer important support to children with mental health problems, yet popular walk-in centres that were established by local GPs in my constituency are being put out to tender, putting at risk the leadership and involvement of those experienced GPs in the centres. Will the Minister give guidance to the NHS Procurement Authority that walk-in centres should be led by local GPs with experience of that area?

[Alistair Burt]

I will look at what the hon. Gentleman says. As he will appreciate, I am not responsible for individual commissioning decisions. The commissioners will have full regard to the needs of the local population when they are putting those services out. It is important that access is increasingly available at GP and primary level, as well as in other areas where the Government are investing further money. I will have a look at what he says.

Cities and Local Government Devolution [Lords] Bill

Gareth Thomas Excerpts

Wednesday 21st October 2015 Commons Chamber

I am making the radical, earth-shattering, civilisation-ending suggestion that what the Scots did could work for England and that the English people are just as capable of benefiting from such a system as the Scottish people are already. We could assign a chunk of income tax, not directly to every individual local authority, because that would become a nightmare, but, in essence, to the equivalent of the Scottish Government, which would be the Department for Communities and Local Government. That chunk would go to the DCLG as a block of, say, 10p in the pound, through the distribution mechanism, as now, with proper equalisation, as now, and no changes in the rates. That would give everybody a really clear line of account. If it was on people’s wage slips that that chunk of their national income tax went to local government, everyone would suddenly start to take much greater interest in their local government because they would see for the first time that they were spending that chunk of their income tax money on it.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I agree with my hon. Friend’s argument on income tax. Might the full suite of property taxes, not just business rates, also be worth considering in this context? I draw his attention to my amendment, clearly not as well drafted as his, suggesting that property taxes should be devolved in full to London. I hope to catch Mrs Main’s eye and say a few words on that later.

[Mr Allen]

Our London colleagues have done some fantastic work on how to localise taxation that is currently held by the centre. That has to be done sensitively and carefully, but as I said earlier—I do not think my hon. Friend was present then—every other western democracy manages that difficulty without a problem. In Sweden, America, Canada, Italy, Germany and Holland, it is second nature to retain money locally from business rates, landfill taxes and land taxes such as stamp duty. They get by pretty well. In fact, because that system is institutionalised, their local government has immense power over and above what we have as vassals. In effect, we do what we are commanded to do according to the crumbs left in the begging bowl after the Chancellor has done his bit for the national economy.

It is absolutely open to us to do work similar to that done by my hon. Friend, Professor Tony Travers and consecutive London Mayors to liberate people. Nottingham gets a lot of tourists because of the Robin Hood tradition and the castle, so we could have a hotel tax or a bed tax of £1 a night. That happens in other western democratic countries and the people endorse it. There is a big caveat though: no council should do this unless the people have okayed it and bought into it. Councils should also be able to borrow on the open market on the basis of their credit rating, but they need to have the consent of the people. It is perfectly possible for us to do what my hon. Friend suggests.

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[Mr Allen]

I again agree with my hon. Friend. We are not there yet and it is not a done deal yet. We need to make the points that he very ably makes about equalisation. I will say to him, however, that if it is a choice between being instructed by Whitehall how to spend not very much money and having not very much money to spend locally, I would go for spending it locally every time, because we will maximise value and spend the money sensitively. Whatever money is available, it is better spent by those who know what they are doing, rather than by the man in Whitehall. I totally accept my hon. Friend’s points.

[Mr Gareth Thomas]

Will my hon. Friend give way?

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[Mr Thomas]

Is not a further argument for local taxes being controlled at local level that it allows local government a full range of policy responses to deal with local problems? I offer the example—I hope to catch your eye on this later, Mrs Main—of the housing crisis in London, where an ability to impose higher taxes on empty homes might be one part of the solution to the housing crisis.

[Mr Allen]

The nuance that I would add to my hon. Friend’s excellent point is that local taxation need not necessarily always be collected locally. Income tax is a very good example. Provided that it is distributed fairly from the centre, it makes a lot of sense for collection to be a central function, with Her Majesty’s Revenue and Customs simply continuing to do what it does, openly and transparently. Other things—he mentioned a hotel tax, business rates and so on—are much more amenable to local decision making, but we are long way from that.

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[Mr Betts]

My hon. Friend is right, and the Committee made that recommendation in the previous Parliament. It is a way that we can devolve the redistribution process to more local areas. That does not work everywhere, but it would probably work well in areas such as Manchester that have a spread of different local authorities

[Mr Gareth Thomas]

My hon. Friend’s point about poorer areas and the full devolution of business rates is apposite. Is the Chancellor’s suggestion to axe completely the revenue support grant for local authorities—that was in the same speech as plans for the full devolution of business rates—likely to have a dramatic impact on increasing inequality of income between areas? Will my hon. Friend’s Committee be considering that?

[Mr Betts]

We will certainly want to consider that issue. From reading what has been said, and the written statement that was presented to the House on the first day back after the recess, there does not seem to be a commitment simply to leave the amount of business rates collected in an area with that local authority. Instead there was a move to allow the full retention of the growth of business rates, and then a decision about what to do with the rest. I think that is the position, but Ministers will have to explain it further in due course. I am sure that the Committee will want to explore that.

The Minister and I have slightly different views about whether elected mayors should be a requirement for full devolution, but the Minister won the vote and that measure is back in the Bill. I am still concerned to have a level playing field, however, and I am surprised about one element in the Bill that Ministers have not sought to explain. Amendment 60 would delete from clause 5(1)(7) words that would devolve to a mayor who is exercising powers independently, any powers that are

“similar to any power exercisable by the mayoral combined authority…but the power conferred on the mayor may not include a power to borrow money.”

When a combined authority is set up, it can have the power to borrow money. In the Sheffield city region, the combined authority has to borrow money for the functions of economic development, skills and matters devolved to it. The mayor will effectively become the transport authority and exercise transport functions. In exercising those functions, however, the mayor will not be able to borrow money. Somebody else will have to do that if, for example, a new tram system is going to be developed. The mayor will have to go to somebody else and say, “Will you borrow money for me?”

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[Scott Mann (North Cornwall) (Con)]

It is my view that there are no problems with the Bill. I championed it last week because I believed the Government were right to give more powers to councils, which can better address the issues in their areas. Cornwall does not have an elected mayor, but it does have a rather unique sense of identity and a desire to get its traditional low-wage economy functioning as a high-wage, high-skill one and to secure the lifestyle benefits that brings.

As many Members are aware, the Bill was preceded by the Cornwall deal, which, as a Cornwall MP and local councillor, I was proud to see signed off by the separate bodies and the Minister. Devolution for Cornwall recognises the needs of its people. The Government are saying to the people of Cornwall, “If you want more power, you can have it.” It is no secret that Cornwall has been a very deprived area. This is not just recognised nationally; it is also recognised on the continent. Cornwall has received European funding to improve this situation, but the last round created only 3,500 jobs out of the 10,000 planned. This is in a county of only 500,000 people. Those 10,000 jobs would have been of huge benefit to us, but the funding was not properly utilised. Cornwall has now been granted intermediate body status and so gets to take control of such money. That is the best way to make businesses grow. Let us give business the opportunities to invest.

As a rural area, Cornwall struggles with the reliability and frequency of transport links. In my constituency, there are no main line railways—there is not one passing anywhere near the constituency—so I know how important bus links are to communities. I am glad, therefore, that bus links were part of the deal. Not everyone has a car or driving licence, so it is buses that help them to commute to and from work. The Cornwall deal now gives us greater control over those bus links, and with the introduction of smart ticketing, like that in London, we can move Cornwall into the 21st century.

Cornwall and local health organisations plan to introduce a business plan for the integration of health and social care, meaning that Cornwall will have a greater say over how healthcare is provided to our elderly, sick and vulnerable constituents. With the empowerment of local government, however, comes great responsibility, and my constituents want to hold local government to account. This deal makes that possible. It gives the power to local people to hold their politicians and boards accountable. I feel proud to be MP for an area that has seen these devolved powers. It is a historic deal for Cornwall, and I hope that many of my right hon. and hon. Friends will feel the same way when the same powers are devolved to their areas.

[Mr Gareth Thomas]

I rise to make the case for new clauses 10 and 11, which stand in my name, but first, I should preface my comments by supporting the remarks of my hon. Friend the Member for Nottingham North (Mr Allen) about a constitutional settlement. That is an entirely sensible way forward. I do not know whether he has considered the distinctiveness of London as part of that settlement, but I think that any such convention should recognise its difference, the scale of the challenges facing it and the significant contribution it makes to the wealth of the UK as a whole.

I read new clause 22, debated in the previous group, with interest, and I commend my hon. Friend the Member for Croydon North (Mr Reed), whom I understand was its genesis. I hesitate to commend him more fully, in case it damages his career, but I am encouraged that the Labour Front-Bench team recognise the need to argue quickly for more devolution to London. I hope to persuade him and the Committee that my new clauses contain the substance of what needs to be devolved to London.

The substance of new clause 11, referred to by my hon. Friend the Member for Sheffield South East (Mr Betts), secured cross-party support in London as a result of the London Finance Commission, which Tony Travers chaired and which was established by the Mayor of London, the hon. Member for Uxbridge and South Ruislip (Boris Johnson). That commission recommended that the full sweep of property taxes—not just business rates, but council tax, stamp duty, capital gains, property development tax and the annual tax on enveloped dwellings—should be devolved to London.

High property prices in London mean that the capital contributes a disproportionate amount to the Treasury through property taxes. Last year alone, some £3 billion was paid in stamp duty in London—40% of the total, more than was paid in Scotland, Wales and Northern Ireland put together.

It is right that much of the wealth generated in London is redistributed around the UK. There should be continuing equalisation measures, as my hon. Friend the Member for North Durham (Mr Jones) rightly said, perhaps through the revenue support grant or other means. There should also be a corresponding reduction in grant income to London to ensure that devolution of property taxes is fiscally neutral to the Treasury.

My point, however, is that London needs to control more of the wealth that we create to solve the challenges that our city faces. We have the most severe housing crisis of any part of the UK, the highest cost of living, and the starkest levels of inequality. Our transport infrastructure is under huge pressure, and we have stubbornly high levels of child poverty and deprivation. I say that not in any way to dispute the fact that other parts of the UK face significant challenges as well, but merely to underline the argument that London needs to be able to control more of the levers to shape our responses to these challenges.

I thus support the instinct to retain 100% of business rates, but it is the full devolution of all property taxes that is needed to help us in London to tackle our challenges, with a pound-for-pound reduction in London’s revenue support grant as the quid pro quo going forward. There is widespread support among the business community for the devolution of property taxes because that community recognises that it is key to developing the necessary infrastructure to promote economic growth.

I use as my example the 40 years it has taken to start work on Crossrail. Given the pressures that London’s rapidly growing population is creating for further investment in infrastructure, it is vital for big infrastructure decisions to be brought to resolution more quickly and for the control of property and taxation to be exercised at London-wide levels, which would increase the Mayor’s ability—and, indeed, that of local councils—to put the financing together for the infrastructure schemes necessary for the future. Greater control over property taxes would ease the borrowing constraints on London’s local councils so that they could invest in vital infrastructure such as affordable housing.

As the London Finance Commission set out, London currently controls only 7% of the taxes that are paid here, compared with more than 50% in New York. Property taxes are set locally in Paris, Berlin, Madrid and Tokyo. Such control would not only enable London to plan infrastructure projects better, but allow greater scope to ensure that the property taxes that are levied suit London’s property and land markets. For example, the introduction of a hotel occupancy tax, as successfully levied in New York, could raise up to £50 million a year for London. Even if the Minister is not minded to support my new clause 11 at this juncture, he might give some indication of being tempted to develop a feeling of courage in taking on the Treasury and advocate further devolution of more property taxes to London.

New clause 10 devolves responsibility for housing law to the Mayor and Assembly. That matches arrangements for Scotland and Wales and would allow Londoners themselves to decide whether to extend the right to buy and whether or not to cut rents. It is the scale of the housing crisis that provides the overarching rationale for this new clause. We have seen a huge drop in owner-occupation in London. An average home in London costs nine times the average wage of a police officer, 21 times the average wage of a chef and 35 times the wage of a Foreign Office cleaner. Rents have rocketed, and are not expected to bottom out any time soon. Homelessness has also increased rapidly: there has been a 50% increase in my own borough over the past five years. Meanwhile, Ministers—and I say this with all due respect to the Minister who is present—sit on their hands doing very little about a crisis which, given that we are building fewer than half the homes a year that London needs, is likely to become more rather than less acute unless radical steps are taken.

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[James Wharton]

The hon. Gentleman is articulate and persuasive, but he will not tempt me to elaborate further.

New clause 11, tabled by the hon. Member for Harrow West, provides for the devolution to London of the receipts from taxes on property. I know the Mayor’s ambitions for London and we have announced the local retention of business rates, but devolving taxes such as stamp duty to London could create a distortive effect. There would be a significant increase in administration costs for both the Greater London Authority and businesses that purchase properties both in and outside London. I have heard what the hon. Gentleman has said, and I will consider his comments further, but I do not want to give him the false expectation that they are likely to be reflected in the Bill or to make a commitment that I cannot fulfil at this time. He has, however, made his case very effectively.

[Mr Gareth Thomas]

I am grateful to the Minister for his smooth words. I gently suggest that his argument against the further devolution of property taxes as distortionary does not fit with his argument for devolving business rates, which will arguably be just as distortionary, as my hon. Friend the Member for North Durham (Mr Jones) said. There seems to be a slight lack of consistency in the Minister’s position, which may be because of what the Treasury has bequeathed him. I encourage him to go back to the Treasury and press it further before Report.

[James Wharton]

I hear the hon. Gentleman’s comments. The announcement that we will devolve business rates was made in the way it was exactly because we wanted to ensure that we talked to local government about how it should be done to make sure it works properly and effectively and meets our policy desires. To devolve certain taxes to just one area is a different proposition. He clearly supports it and argues for it effectively, but it does not have a place in this Bill at this time.

Amendment 1, which was tabled by the hon. Member for Nottingham North, clarifies that the persons who may be invited to attend an overview scrutiny committee meeting may include

“representatives of parish, neighbourhood, community and other councils in the area of the combined authority”.

I understand the hon. Gentleman’s intention and commend him for pursuing openness in the process, but the Bill already allows people to attend. To define them in a list risks the provision being narrowly interpreted, rather than broadly interpreted, which is what we want.

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 25th November 2014 Commons Chamber

[Dr Poulter]

Of course. As my hon. Friend is aware, every local health area—every clinical commissioning group—is receiving an increase in the funding available to it year on year. I would be happy to meet him to discuss the matter further, if that would be helpful.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

As the Minister knows, North West London Hospitals is one of the NHS trusts that is in deficit. It has seen the accident and emergency departments at two nearby hospitals close, and its hospital board estimates that an additional 123 beds are necessary. Will the Minister meet me to discuss the problems of its historical deficit and the need for additional funding to make sure that those 123 medical beds are provided?

[Dr Poulter]

I can reassure the hon. Gentleman that, in the words of the medical directors of all the hospitals affected, there is a very high level of clinical support for the programme across north-west London, and the changes will save many lives each year and significantly improve the services that are available to local patients. I hope that is reassuring to the hon. Gentleman and to local patients.

Oral Answers to Questions

Gareth Thomas Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right that PFI deals signed by the previous Government have crippled the finances of many hospital trusts, meaning that many of them are unable to invest as much in front-line patient care as they would like. It is important that the Government support the mitigation of PFI deals, when possible, and we have a group that is doing exactly that and supporting local commissioners to deal with the worst excesses of the previous Government’s mismanagement of the NHS finances.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

3. How many patients waited longer than four hours in A and E departments in 2013-14.

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

Of the 21.7 million attendances at all A and E departments in England in 2013-14, 939,000 were not seen and treated within four hours, meaning that 95.7%—0.7% above the national target—were. I am pleased to inform the House that hospitals will have an extra 260 A and E doctors this winter, bringing emergency medics in the NHS to a record high.

[Mr Thomas]

The reason for the big rise in A and E admissions in my area is the weekday closure of the hugely popular Alexandra Avenue polyclinic. Will the Secretary of State look again at Harrow’s NHS funding formula to determine whether that popular service could be reopened?

[Mr Hunt]

I am happy to look at the point that the hon. Gentleman raises. I have visited the Northwick Park A and E department, where the clinicians on the front line are working incredibly hard. As he knows, the funding formula is decided independently—at arm’s length from politicians—but we have ensured that everyone gets a real-terms rise.

NHS Funding (Ageing)

Gareth Thomas Excerpts

Tuesday 25th March 2014 Westminster Hall

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Sir Edward, and to follow the hon. Member for Suffolk Coastal (Dr Coffey). I apologise to the House and in particular to the Front-Bench spokesmen for the fact that, because of a long-standing commitment, I shall have to read their responses to the debate in Hansard.

I want to raise a concern similar to the one raised by the hon. Member for Suffolk Coastal, about the funding formula, although there are constituency differences. Many health professionals in my constituency are concerned that Harrow does not receive an appropriate share of NHS funding and that that is already affecting elderly people there, and may affect many others. The context is that both the key hospital serving my constituency, Northwick Park hospital, and its parent trust, the North West London hospitals NHS trust, have been in a challenging financial position for many years.

In 2010-11, the trust made a tiny operating surplus; in 2011-12, it had an operating deficit of some £7.5 million; and in 2012-13, the operating deficit had increased to £20.5 million, approximately. Figures in papers submitted to the NHS Trust Development Authority’s recent board meeting suggest that the trust is again heading for a sizeable deficit this financial year, of about £20 million. Although final 2013-14 accounts are clearly not yet available for Harrow’s clinical commissioning group, the prediction, from NHS England information, is for an end-of-year deficit of £10.4 million. Indeed, Harrow clinical commissioning group is one of only four in London where there is significant concern about financial performance.

By setting out that information, I do not mean to criticise the trust management, the clinical commissioning group or their staffs. I have been treated at Northwick Park hospital several times, and I think the staff and management do a first-class job. I know the chair and many of those who serve on the board of the Harrow clinical commissioning group, and they, too, do a first-class job in extremely difficult circumstances. Those circumstances are made difficult by the amount of funding that Harrow receives from the NHS.

To humanise the consequences of those statistics on the financial situation that Northwick Park hospital and Harrow clinical commissioning group face, I should make it clear that there are increasing concerns about cancelled operations and longer waiting times in the A and E department at Northwick Park. Given the cuts to local government funding, there are fears that Harrow council’s social care budgets, which are already hard hit, will be cut further by an estimated £70 million over the next three years. The concern is that the NHS in Harrow will come under even greater pressure to meet the needs of elderly people in our area because of an inevitable lack of access to social care.

Additionally, the popular Alexandra Avenue polyclinic, which was open from 8 am to 8 pm for 365 days a year and provided an excellent walk-in service, has for some time been closed to patients without an appointment for all but a short period on Saturdays and Sundays. Again, the service was heavily used by elderly people, as well as by many others in my constituency. The closure of large parts of the Alexandra Avenue polyclinic’s service is particularly galling because health professionals in Harrow accept that the polyclinic was making a difference by helping to improve health care opportunities and access to health care for elderly people and many others in my constituency. That is the context of my participation in this debate, and I am concerned about whether the funding formula properly reflects the needs of the NHS and my constituents.

The hon. Member for Suffolk Coastal set out some of the funding formula issues, and I will present them in a slightly different way; that is perhaps a reflection not only of our different political parties but of the different nature of the seats we represent. The Minister and the shadow Minister, my hon. Friend the Member for Copeland (Mr Reed), will be far more aware of the debate on changes to the funding formula than I am. Like the hon. Member for Suffolk Coastal, I understand that a weighted capitation formula based on population, the local cost of providing health services, the level of health care need and health inequality is used to determine allocations to each clinical commissioning group. I also understand, as she set out, that the Advisory Committee on Resource Allocation was charged with developing a revised funding formula based on the standardised mortality ratio for those aged under 75—the so-called fair shares formula.

After substantial consultation—the hon. Lady made this point—the board of NHS England decided not to adopt the fair shares formula, and clinical commissioning group allocations were initially uprated based on their estimated share of previous primary care trust allocations. In December 2013, the board of NHS England decided on CCG funding allocations for 2014-15 and 2015-16. I understand that, again, the board decided to reject proposals for a faster move towards CCG allocation targets. I do not intend to make a party political speech, but I gently insert the point that perhaps the board might have felt differently if it had had access to the £3 billion that has been spent on reorganising the NHS, about which Opposition Members are somewhat sceptical.

The hon. Lady alluded to distances from target figures for 2014-15 and 2015-16. The figures indicate that Harrow’s allocation was almost 10% away from the target for 2014-15 and almost 9% away from the target for 2015-16. The total estimated funding shortfall for Harrow is some £23.4 million over the next two financial years. That information was provided to me by statisticians from the House of Commons Library based on estimates using the closing target allocations per head and our estimated CCG population.

I recognise that, as the Minister will presumably point out, the figure is not completely settled and that there may be movement given how far Harrow clinical commissioning group is from receiving its target allocation, but I hope that I can persuade the Minister today to scrutinise the Harrow figures. I hope he will ask his officials to talk to Harrow clinical commissioning group to see whether there is more information that might justify a further funding increase for the NHS in Harrow, to close the funding gap that has been identified.

A little like the hon. Member for Suffolk Coastal, I have tried not to be party political in this debate, although she will understand that I think I have managed it better than she did. In that spirit, I hope the Minister will take seriously my concerns about the NHS in Harrow and will ensure that his officials talk to those who do an excellent job working for Harrow clinical commissioning group.

[Sir Edward Leigh (in the Chair)]

When the Minister replies, I have no doubt that he will refer to Harrow’s ageing population.

Accident and Emergency

Gareth Thomas Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

Last week, the NHS missed its A and E target—the hon. Lady’s A and E target—which is a lowered target. If she is going to maintain that complacency through the winter, I suggest that it might well backfire on her.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

My right hon. Friend’s description of rising waiting times in A and E and ambulances queuing outside A and E will be recognisable to my constituents who use Northwick Park hospital. What is his view of the Government’s proposed new funding formula, which, I hear, might mean that £20 million will be cut from Harrow’s NHS budget?

[Andy Burnham]

Since the change of Government, the previous Secretary of State and this one have talked about a formula based predominantly on need, not deprivation. The worrying thing about that is that it means that we have a formula based on the use of NHS services as opposed to the need to improve health. NHS England has been debating that issue this week and I hope that it has taken heed of what has been said in this House, because to do this to the NHS alongside the local government cuts mentioned by my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) will be catastrophic for the communities in this country with the greatest need.

Accident and Emergency Waiting Times

Gareth Thomas Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

I remember debating that with the hon. Gentleman when I was the Secretary of State. Those problems rightly needed to be addressed, and the particular issue he raises today should be investigated. I hope, however, that he will also understand the problem that I am describing to the House. If we go down the path of fragmenting services—if we take a successful national service such as NHS Direct, for example, which was trusted by the public, and then break it up into a patchwork of fragmented, some privatised, services—this sort of chaos will be the result.

A report has emerged this afternoon, showing that the viability of NHS Direct is in serious question. The headline states, “Leaked report casts doubt over NHS Direct’s ‘overall viability’ in the wake of NHS 111 failings”. This is a warning that NHS Direct may well go down altogether. What an indictment that would be of this Government’s mismanagement.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

rose—

[Andy Burnham]

I shall give way one last time before concluding.

[Mr Thomas]

Are the closures and restricted opening hours of many walk-in centres not having an impact on the increasing A and E crisis? Alexandra Avenue polyclinic, which serves my constituents, now restricts its opening hours to weekends.

[Andy Burnham]

I entirely agree, and I shall say more about that issue shortly.

Let me return to the subject of the 111 service. Will the Secretary of State review the contracts with the aim of negotiating changes so that more calls can be handled by nurses? The use of the computer algorithm should be reviewed as a matter of urgency, and the full roll-out of 111 should be delayed until the problems have been solved.

There are more general questions to be asked about the scale and pace of NHS privatisation. NHS Direct offers an illustration of what happens when services are broken up. Those who attended last week’s summit heard that in some areas there had been a huge increase in the provision of 999 ambulances by private companies. It was said that on a single day in Yorkshire, 50% of 999 calls had been responded to by private operators. I think that the public would be surprised to know that. It shows that there is no part of our NHS that cannot be put up for sale by this Government.

Is the Secretary of State satisfied that those private crews are appropriately trained and have the right equipment? Is there not a danger that because contractors are operating in isolation from the rest of the system, they will all too often simply transport people to A and E? Does the Secretary of State envisage any limits to private 999 services? Given that the issue raises fundamental questions about emergency services, should there not be a debate about it before this goes any further?

Fourthly—I come now to the point raised by my hon. Friend the Member for Harrow West (Mr Thomas)—there is good evidence to show that NHS walk-in centres have diverted pressure from A and E units. In 2010-11, there were about 2.5 million visits to such centres from people who might otherwise have gone to A and E. Analysis by the House of Commons Library shows that 26 of them closed in the last year alone, and that the number is down by a quarter. The Government have let that happen, but at least Monitor has intervened and set up a review of the loss of walk-in centres. Will the Secretary of State halt all further closures while the review is taking place?

That brings me to my fifth and final point, which concerns A and E closures and downgrades. At least 25 A and E units—one in 10—are under threat or have recently closed. The trouble with these plans is that they were drawn up in a different context, when A and E was not under the pressure that it is under today. Let me say this to the Secretary of State: if a clinical case can be made in support of closures—if there is evidence that lives can be saved—the Opposition will not oppose the plans. However, we cannot accept the pushing through of proposals that have not taken enough account of the latest evidence, and cannot show that extra pressure can be safely absorbed by neighbouring units. That is important, because the public will rightly ask this simple question: how can it make sense to close A and Es in the middle of an A and E crisis? To reassure people, will the Secretary of State personally review all the ongoing A and E closure or downgrade proposals on a case-by-case basis, in the light of the very latest evidence of pressure in the local health economy?

--- Later in debate ---

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I am grateful for the opportunity to follow the hon. Member for Bracknell (Dr Lee). Given the views he articulated, I hope he will come and canvass for my opponent at the next general election; we would be very happy to have him there. I say that in the context of the situation in the North West London Hospitals NHS Trust, which in 2010-11 was well within the waiting times targets for A and E. Just 2.9% of patients waited more than four hours, but by 2011-12, that figure had risen to some 10.8% at the end of the year, while for the whole of the last financial year the figure is 12.2%—the second worst set of statistics in London, surpassed only by the Barking, Havering and Redbridge University Hospitals NHS Trust, where almost 16% of patients had to wait over four hours.

[Stephen Pound]

I am grateful to my hon. Friend and neighbour for giving way. In view of what he has just said, does he think that the best possible prescription is that currently recommended by the Government whereby the existing A and E departments at Ealing, Park Royal, Hammersmith and Charing Cross all close? Does he think that will improve waiting times in A and E departments?

[Mr Thomas]

My hon. Friend, as ever, is ahead of me. He makes the perfectly reasonable point that if the Northwick Park and Central Middlesex A and E departments are not achieving the 95% target now, how can our constituents have any more confidence about reaching that target should the Central Middlesex and Ealing hospitals close?

[Barry Gardiner (Brent North) (Lab)]

As my hon. Friend knows, Northwick Park is just in my constituency and we share that border. Does he agree that whatever the future configuration of hospitals in north-west London, it is absolutely essential that the A and E unit at Northwick Park is expanded to cope and that that should happen before any reconfiguration?

[Mr Thomas]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I remind the House that there are nine speakers still to be called, and that the winding-up speeches will begin at 6.40 pm. That means that some Members who have been sitting in the Chamber will not be able to contribute. I therefore ask Members to be sparing with interventions, and to make them only when they are absolutely crucial. I also remind them that interventions must be short, and must relate to the point that the speaker was making at the time rather than be an extra debating point.

[Mr Thomas]

I share the view of my neighbour and hon. Friend the Member for Brent North (Barry Gardiner). We need that expansion to go ahead, and to go ahead soon.

In an intervention during the speech of my right hon. Friend the Member for Leigh (Andy Burnham), I raised the plight of many of my constituents who formerly used Alexandra Avenue polyclinic, an extremely popular walk-in centre which used to be open from 8 am until 8 pm, 365 days a year, to people who were genuinely concerned about their health and did not feel that they could wait to see their GPs. It was opened by Ara Darzi some five years ago. Amazingly, its opening was opposed by my political opponents in Harrow, but it quickly came to be greatly appreciated by, in particular, people living in the south Harrow and Rayners Lane area. Those people have noted with considerable regret that, after the last general election, the primary care trust decided to restrict the opening hours of their walk-in centre, but not those of the walk-in centre in Pinner, in the constituency of my other neighbour, the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd).

As a result of the cuts that the primary care trust decided to make, the walk-in service now operates only between 9 am and 3pm on Saturdays and Sundays. The fact that it remains open at all is entirely due to the scale and strength of feeling about the loss of what was an excellent service, and the campaign that we were able to run in order to save it. Perhaps some of the £3 billion that the Prime Minister spent on what was—as others have already pointed out—a completely unnecessary reorganisation of the NHS could have been invested in keeping Alexandra Avenue polyclinic open, and some of the pressure that my constituents are imposing on Northwick Park hospital’s accident and emergency unit could have been alleviated.

Staff at the excellent Pinner ambulance station in Rayners Lane do an extremely good job, generally spending all their shifts out on the road. It is clear that they, like the rest of the staff of the London Ambulance Service, are under extremely heavy pressure. On occasion, ambulances have been used as temporary reception or holding areas at Northwick Park when patients cannot be admitted to A and E as they arrive because of the pressure on that department.

There is also concern about the district nursing service in Harrow. My personal experience of that service has been mixed. An elderly relative and, more important, that person’s carer have found it difficult to gain access to it by telephone when problems have developed. It has been slow to respond, and has demonstrated poor co-ordination with other parts of the local health care system. Again, funding was cut by the primary care trust.

The new clinical commissioning group has given notice to the local trust which runs the service that it may outsource the contract, but I am not convinced that that is the answer. Investment in staff—trained staff—and, crucially, investment in management time by the local trust seems to be the immediate requirement if the problems in the service are to be sorted out. Meanwhile, to those who are aware—as many of my constituents are—that the district nursing service is far from brilliant, it is hardly surprising that family members should want to delay the discharge of elderly patients from Northwick Park.

It is telling that the number of cancelled operations is rising fast at Northwick Park. So far, it has risen by some 13%. That is a further symptom of the crisis in the national health service, as evidenced by others—

[Madam Deputy Speaker]

Order. The hon. Gentleman’s time is up.

Mental Health

Gareth Thomas Excerpts

Thursday 16th May 2013 Commons Chamber

[Paul Burstow]

I certainly would. The fact that a large number of hon. Members are present, hoping to contribute to the debate, that the Backbench Business Committee advocated the debate, and that the Government have given the time suggests there is cross-party consensus that mental health has for far too long been hidden in the shadows and not awarded sufficient priority. The cost to our society of mental ill health across England, Scotland and Wales amounts to over £116 billion a year, but that does not adequately capture the human cost—the misery—that arises from it. Given that the burden of mental ill health is about 23% of the burden of all disease in our country, it is surprising that for so many years it has not been tackled with the necessary vigour. So I agree absolutely with the hon. Lady.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Does the right hon. Gentleman accept that, in addition to the need for continued investment in the so-called medical facilities and services that are part of treating mental health, there is a need for continued investment in the so-called talking therapies, and the opportunity to invest and grow the social services’ response to mental health services as well?

[Paul Burstow]

I am grateful to the hon. Gentleman for that question. He is absolutely right that access to talking therapies—begun as a result of Lord Layard’s initiatives before the general election, which the coalition Government continued to support and which is being rolled out—is very important in enabling people to recover socially, get back into work and get on with their life. At the best performance rates, as many as half the people that go through talking therapy services recover, and that can make a huge difference to them, their families and the figures I was talking about earlier. I shall return to the subject of talking therapies in a moment.

Last year I took part in the debate from a slightly different position—I spoke from the Dispatch Box. I was able to report some important progress. We had a new mental health strategy. We had the continued roll-out of talking therapies, which the hon. Member for Harrow West (Mr Thomas) just asked about. Groundbreaking work was being done to reinvent child and adolescent mental health services from the inside out, to offer access to talking therapies for children and young people. We had the flowering of a new movement to establish social recovery as a goal for mental health, with the establishment of recovery colleges channelling the lived experience of mental illness into practical learning and skills, and resilience to enable people to get on with their lives.

There was the good news that the Government had backed financially the task of Time to Change, the charity sponsored by Rethink and Mind, really motoring to tackle issues of social stigma in our country. Reports since then show that the first phase of that programme has materially altered public views about mental health in this country, but the programme needs to be sustained.

--- Later in debate ---

[Paul Burstow]

Yes, and that issue, which I know is of concern to Members on both sides of the House through their constituency casework, for example, was raised in last year’s debate. Although some steps have been taken to try to improve those processes, they still do not seem to me to capture fully the important differences in dealing with mental health and, as a result, can exacerbate mental health problems. There is more to do in that area and I look forward to the Minister picking up on that issue. Given that the Cabinet committee that had co-ordinating responsibility for the mental health strategy, which is a cross-government strategy, is no longer in place, I wonder how tackling those sorts of issues will be co-ordinated in future.

It is worth noting that there are a considerable number of working-age people with a history of schizophrenia, for example, who are able and—I stress this point—willing to work. Indeed, Rethink’s schizophrenia commission identified employment rates in that group as being about 8%, with a range of 5% to 15% across the country, compared with the obviously much higher rates for the general population. Individual placement and support schemes, which are some of the most effective forms of employment support for people using mental health services, really can achieve remarkable transformations in people’s ability to take up employment. I hope that the Minister can say something on how such issues are being addressed with DWP colleagues, because that is where a cross-government strategy really should be making a difference, rather than simply addressing direct NHS provision.

[Mr Thomas]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will give way one last time, but then I really must conclude.

[Mr Thomas]

I am grateful to the right hon. Gentleman for giving way a second time. Will he underline the importance of mental health trusts such as Central and North West London NHS Foundation Trust, which serves my constituents, working with the local voluntary sector such as the Mind groups in Harrow and Brent? Will he therefore encourage his Front-Bench colleague to look with particular interest at the letter I am about to write to him, raising the concerns of Mind in Harrow and in Brent about the trust’s failure to work properly with the services it is providing?

[Paul Burstow]

I note that the Minister paid close attention to that intervention and I am sure the hon. Gentleman will enjoy the exchange of correspondence on the matter.

I want to discuss the health care aspects of parity of esteem. Curiously, not all general hospitals have 24/7 access to a mental health liaison service offering immediate support, yet we know that when that works well it can make a big difference to the quality of care, help to reduce the length of stay in hospital, especially for older people, and generate savings four times greater than the cost of running the service. There are good examples of where this has been done, particularly in Birmingham, and it is odd, given such obviously compelling evidence, that it has not yet been taken up more widely.