Manufacturing

Iain Wright Excerpts

Thursday 24th November 2011 Commons Chamber

[Mr Iain Wright (Hartlepool) (Lab)]

I agree with the Minister that this has been a good and important debate. Manufacturing is not discussed in the House as much as it should be, which is perhaps a reflection of the perception of manufacturing more widely in the country. People could be forgiven for believing that Britain used to make things but does not any more. I therefore congratulate the hon. Members for Hexham (Guy Opperman), for Warwick and Leamington (Chris White) and for Burnley (Gordon Birtwistle), and my hon. Friend the Member for Huddersfield (Mr Sheerman), on securing this interesting and vital debate.

I agree with the Minister that the debate has been relatively consensual—the House should not worry; I will break that. The debate has been split not by party, but between optimists and pessimists. I am a bit of both. I am proud of the fact that our nation engineered the first industrial revolution. We became the workshop of the world. By the eve of the first world war, we produced one quarter of the world’s total manufacturing output.

To go back to my earlier comments, there seems to be a consensus out there, put forward by the media, that this country has somehow lost its grip on manufacturing and closed its factories one by one or sent them over to China. Today’s debate has made a good start in dismissing such myths, because we still make things. Indeed, as the Minister rightly points out, there is much to be optimistic about. Output from British manufacturing reached an all-time high, even adjusting for inflation, not in 1867 or 1907, but in 2007. In the decade 1997 to 2007, UK manufacturing achieved a 50% increase in labour productivity, which is the best rate of progress we have seen in our country’s history. Despite that perception out there, we remain the world’s seventh largest manufacturing nation. Our manufacturing is based predominantly on high value-added activity, including the production and manufacture of toilet rolls—in that high value-added activity, we are world leaders.

In high-technology manufacturing, the UK is second only to the US in the developed world. In some industrial sectors, our companies are some of the best anywhere on the planet, including in aerospace, which several hon. Members mentioned, and in automotives, oil and gas, chemicals, pharmaceuticals and bioscience.

As the hon. Member for Hexham will know, the north-east region has a world-class, efficient plant in Nissan, with all the supply chain opportunities that that provides. As the Minister rightly pointed out, today’s announcement that Toyota will build its new car plant in Burnaston is particularly pleasing, especially after the disappointments in that city for Bombardier, on which my hon. Friend the Member for Derby North (Chris Williamson) has been an absolute champion.

We in the north-east have always valued manufacturing. My constituency of Hartlepool has been particularly strong from the start of the industrial revolution in the 1840s and 1850s right through to the post-war era. We have huge potential now in some world-class sectors such as offshore wind, nuclear and biotechnology, but we need to grasp the opportunities. Global trends mean that British manufacturing should have considerable opportunity in the next few years. Rising incomes for households in many developing economies will create billions of extra customers to whom British firms can sell their goods—a point that was made by my hon. Friend. The need to manage global resources more efficiently and the move to a low-carbon economy will provide new markets for new and innovative products designed by ambitious firms in environments conducive to stable and certain R and D and capital investment. New technologies such as life sciences will revolutionise health care and the way in which drugs are developed, patented and brought to market. Despite the difficulties and issues that I have with the Minister about the science budget, I know that he is a champion of science, and Britain, with its strong science base, should be a leading global player in such fields.

Today’s debate has allowed the argument to be somewhat more sophisticated than is normally the case. We often see the argument in very blunt terms: we used to do manufacturing, but now we only do services, and we need to go back to making things. As my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) said, there has been a tendency in the structure of such debates to look in the rear-view mirror. In the past 60 years, this country has often chosen the stark model of economic sectors, selecting a service-based economy over manufacturing. That has meant that, despite our remaining a strong manufacturing nation, the sector constitutes only 11% of our economy, compared with 20% for Germany. As my hon. Friend the Member for Huddersfield said correctly, we have lurched too far away from manufacturing over the last 30 to 40 years. Manufacturing should constitute a much bigger share of our economy, but it should not be an either/or situation; nor should it be at the expense of our service sector. There should not be an artificial distinction, because services growth boosts manufacturing, and vice versa.

I can think of no finer example than Rolls-Royce, whose Derby plant I visited last month, as did the hon. Member for Erewash (Jessica Lee). The company is synonymous with British excellence—indeed global excellence—in engineering and manufacturing, but as we found out on our visit, it now derives half of its revenues from services, in providing long-term customer service contracts. The long-term revenues to be derived from such services are reinvested in manufacturing capability.

[Mr Sheerman]

I just want to correct a possible misapprehension. The members of the all-party manufacturing group are not rear-view mirror people: we actually believe that our manufacturing sector is superb in many aspects. It is just that we want to grow it and invest in it, as well as to encourage more entrepreneurs to lead it. That is the purpose of this debate. We are not negative: we are positive, and I congratulate my hon. Friend on choosing a product made by Britain, and I hope that every hon. Member will join the Made by Britain campaign.

[Mr Wright]

I absolutely agree, and my hon. Friend and I share the view of my right hon. Friend the Member for Wolverhampton South East that we should be bold and ambitious about manufacturing. We do not hark back to the past, but we want to engender that spirit of enterprise, innovation and ambition to ensure that we are the best engineering nation anywhere on the planet, that people can go into a career in manufacturing engineering secure in the knowledge that it is rewarding and produces products that we can sell to the rest of the world, and that Britain leads the world in that area.

[Guy Opperman]

May I take the shadow Minister back to the future? Does he agree that the idea of local banks, as outlined by several hon. Members, and an industry bank such as KfW, should be supported by Opposition Members?

[Mr Wright]

I listened closely to what the hon. Gentleman said in his excellent contribution, and in a moment I will mention the problems that companies—especially manufacturing companies—have in accessing funds that would allow them to grow, especially in export markets. I have a particular suggestion to put to the Minister on whether the Government are trying to do anything about that.

I hope that I have mentioned the huge potential and the enormous scope for us to be a leading player in manufacturing and engineering in the 21st century. None of that is inevitable, of course, and nor will it happen by chance. In the era of the most intense global competition imaginable and with economies such as China—known for its low-cost manufacturing—anxious to move up the value-added chain, Britain needs to put in place the best possible policy framework to ensure that our ambitions are realised. In the words of Richard Lambert, the former director-general of the CBI, the Government, particularly the Department designed to champion British growth, enterprise and industry, need to provide

“a vision of the kind of economy we want to have in ten years time and what it’s going to take to get from here to there”.

Instead, however, a leading global manufacturer has stated flatly:

“The government is not giving us a reason why we should be in the UK in 10 to 15 years’ time.”

The Government are not doing all that they can to allow British manufacturing to fulfil its potential. Worse than that, decisions taken by Ministers in the Department for Business, Innovation and Skills in the past 18 months have ensured that British manufacturing has taken a backward step. Our economy has grown by just 0.5% in the past year compared with 1.5% in the US and 2.3% in Germany. Export activity is stalling, and both output and sentiment are at their lowest levels since the height of the recession two years ago.

That situation is confirmed by today’s publication of the CBI’s industrial trend survey, the briefing on which reported:

“UK manufacturers reported a weakening in order books in November, with export orders in particular deteriorating significantly… As a result, firms expect a fall in production over the coming quarter”.

Not all of this is the Government’s fault, but an awful lot of it is—far more than BIS Ministers will acknowledge. BIS, charged with being the Department for growth, is weak and out on a limb in Whitehall. Whether trying to secure a stimulus for the economy—we will see what happens on Tuesday with the autumn statement—or support for the UK train manufacturing industry, the solar panel industry, Sheffield Forgemasters or long-term investment in oil and gas, the Secretary of State always plays the game but always loses. Worse than that, though, he always loses by putting the ball in his own net. The CBI’s director-general, John Cridland, described the appalling decision, which the House debated yesterday, on feed-in tariffs and the threat to the solar panel industry as

“the latest in a string of government own goals”.

[Richard Harrington (Watford) (Con)]

I agreed with much of what the hon. Gentleman said until he claimed that the Government should take much of the blame over the past few months. I must return his mind to the fact that more than 1 million manufacturing jobs were lost under the tutelage of the previous Government. I would like to hear his comments on that.

--- Later in debate ---

[Mr Wright]

I do not know whether the hon. Gentleman has been following my comments but, over a 40 or 50-year period, we have lurched too far away from manufacturing to the service sector. In the past 10 or 15 years, though, productivity in manufacturing has risen faster than ever in this country. My right hon. Friend the Member for Wolverhampton South East touched on these matters. Given the rise of China and other players, globalisation and the fact that we were the first country to industrialise, it was almost inevitable that there would be a relative decline. However, our manufacturing industry has declined too far, too fast, and we need to do something about that on a cross-party basis. Nevertheless, there has been great cause for optimism over the past 10 to 15 years.

[Mr Sheerman]

This has been a refreshingly all-party discussion but I want to come back to feed-in tariffs. The industry in green technology and green innovation is growing dynamically and people in my constituency in the business know that the feed-in tariff had to be modified, but for God’s sake why not give them six months to adjust, rather than allowing companies to go out of business and lose all that growth?

[Mr Wright]

My hon. Friend is correct, and to conclude this part of my speech, I shall quote the director-general of the CBI with specific regard to that decision on feed-in tariffs, which was taken without notice to the industry. In keeping with our football metaphor, the director-general said:

“Moving the goalposts doesn’t just destroy projects. It creates a mood of uncertainty that puts off investors. They wonder what’s coming next…Industry trust and confidence in the government has evaporated. This bodes poorly for investment in future initiatives…A new industrial policy needs to recognise the real-term costs of bad decisions and should set out a clear path that investors understand and can believe in.”

We certainly agree with that, as the country has not got the clear strategic direction we need from this Department. We sometimes get warm words; we often get welcome, albeit ad hoc, announcements. Industry, however, is uncertain of the strategic direction in which the Government and this Parliament want to take the country in manufacturing.

[Mark Hendrick (Preston) (Lab/Co-op)]

Coming back to the point about job losses, many manufacturing jobs were lost under the previous Government over the 13-year period, but some of them have moved, as the Minister said, to the far east and elsewhere. Many of these jobs were not particularly high-skilled, and modern technology and manufacturing has moved on. The problem was that those jobs were not replaced quickly enough by more modern, hi-tech skilled jobs. That is the challenge the Government must face for the future.

[Mr Wright]

I heartily agree with my hon. Friend. My questions for BIS Ministers relate to having an active industrial policy. Where is the assessment of the sectors in which Britain has unique competitive advantages and of where we can sell our unique products to the rest of the world rather than lamely following the rest of the pack? Where are the clear milestones along the way that would allow investment and business decisions to be taken with some degree of certainty and stability?

A recurring theme of today’s debate has been the role of research and development and associated capital allowances. Again, I want this country to be the best place for any investor in manufacturing to invest in research and development, but R and D tax credits, the industry tells me, are not working. What can we do on capital allowances and R and D spend? When can we expect some clear vision from the Government about the road map that is needed as part of an effective and active industrial policy? We have had welcome announcements about funding for technology and innovation centres—I think the Minister mentioned them in his remarks—but the ad hoc decision is a diluted version of what was set up and planned under the Labour Government, with businesses now unclear about how they fit into the bigger picture. The Department promised us its manufacturing framework document over a year ago, but it has still not been published. Where is it?

Another common theme has been the concern—expressed by the hon. Members for Hexham and for Burnley (Gordon Birtwistle)—about the inability of manufacturers to secure access to finance for growth. The Secretary of State’s initiatives have not worked. Project Merlin has not secured its aims and the regional growth fund is not delivering on the ground. In the space of 55 seconds—I timed it—in yesterday’s debate, the Secretary of State went from claiming that as a result of the RGF,

“factories have been built and the jobs are being created”—[Official Report, 23 November 2011; Vol. 536, c. 333.]

to acknowledging, in response to the Chair of the Select Committee on Business, Innovation and Skills, that he could not provide a figure on the number of jobs created by that fund at all. Will the Government look again at this crucial issue of access to funding?

Many companies are sitting on a pile of cash on their balance sheets, largely because they have little confidence in economic prospects, but is anything being done by this Minister and the Department to free up some of that cash to provide much needed finance to manufacturers? I hope that the Minister will intervene to provide a degree of clarity on that; otherwise, I am happy to wait for the Chancellor’s autumn statement on Tuesday.

Several hon. Members mentioned the huge opportunity for export markets. We have been behind the curve in emerging markets for some time. The CBI and Ernst and Young have just published a report, which demonstrated that UK businesses tend to rely on the US and continental Europe for their main export markets. The report quotes the chairman of a Mexican automotive parts manufacturer, stating:

“Overall I think the UK and its companies should pick the right battles and the right countries, and focus on specific sectors within those markets. There’s a lot of goodwill out there that’s not been exploited.”

Will the Minister respond to that and set out what has been done—he touched on it in his opening remarks—to strengthen our export capability? Time and again, firms say that they cannot exploit their potential by gaining access to export finance, that the range of such finance is limited and that things such as the export credit guarantee do not specifically address business needs. How can the Government address that?

Industry states that the supply chain to UK manufacturing needs to be improved. That is crucial in ensuring that British manufacturing is competitive in global markets throughout the world. The Secretary of State acknowledges that. In his speech to the Policy Exchange last month, he talked about how

“Government can support UK supply chains across a number of sectors critical for future growth.”

Since then, however, we have had no information or detail, or even an announcement as to when we might be given any. Industry is crying out for that as a means of boosting its competitiveness, so it would be helpful if the Minister could provide further detail.

[Mr Bailey]

Will my hon. Friend give way?

[Mr Wright]

Yes. I would very much like to hear from the Chair of the Business, Innovation and Skills Committee, as he has great expertise in this area.

[Mr Bailey]

Given the potential to expand the supply chain in the west midlands through the Jaguar Land Rover development and the possible repatriation of the supply chain for many of the Japanese manufacturers because of the problems in Japan, does my hon. Friend agree that the Government must come up with measures to bridge the capital funding gap, so that small businesses can exploit these opportunities?

[Mr Wright]

I entirely agree. One of the central themes of my remarks is that we have a huge opportunity, and that in the long term we can thrive as a leading manufacturing nation, but first we must overcome some very serious short-term difficulties involving finance and both domestic and international demand. Despite the warm words and fine rhetoric from the Government, I am not convinced that we are addressing the issues that industry wants us to address.

Manufacturing can play a leading part in Britain’s 21st-century economy, but in order to succeed in the modern era we need an active industrial strategy of partnership, where the join between industry and Government is not visible. Instead, we have a Department and a Government who lurch from one ad hoc announcement to another, via a series of wrong industrial policies. We need something better and more ambitious, so that we can tap into this country’s enormous potential and ambition in manufacturing, including in innovation. I want Britain to be the best place anywhere in the world in which to carry out manufacturing, but in order to secure that for the long term we need Government to act now.

Accident and Emergency Services

Iain Wright Excerpts

Tuesday 14th September 2010 Westminster Hall

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to serve under your chairmanship for the first time, Ms Clark. I congratulate the hon. Member for Southport (Dr Pugh) on securing the debate, on what I think we all agree is an incredibly important topic. The Minister will be pleased to hear that I do not want to detain the House for too long, but I do want to question him on the provision of accident and emergency services in Hartlepool.

The Minister will no doubt recall that just before the summer recess we had an important debate on the provision of hospital services in the north-east, and I obviously focused on the University hospital of Hartlepool. I was pleased to hear the Minister say that, regarding the future of Hartlepool hospital,

“there are currently no plans to close it”.—[Official Report, 27 July 2010; Vol. 514, c. 232WH.]

That statement was very welcome, but less than 24 hours after the Minister had uttered it the local press leaked the information that the University hospital of Hartlepool accident and emergency services, in their current guise, would close. The manner in which that was communicated was not conducive to providing any reassurance to my constituents about the future of health services. This was all part of the proposed changes, which had their origins in the Momentum programme, with which the Minister will be familiar, with some provision being transferred to the new minor injuries unit—the One Life centre in the heart of town. That is very welcome, because more people in Hartlepool will be treated for a wider range of ailments closer to home, and it brings into play the notion of more community-based health services, which is encouraging because Hartlepool needs and deserves first-class community-based provision. However, as part of the proposals, some provision, particularly for the more serious type of case seen in accident and emergency, would be transferred about 13 miles away to the University hospital of North Tees.

As I listened to the hon. Member for Southport it struck me that the model of health care in his area—a two-site trust, in Southport and Ormskirk—is very similar to my situation in the North Tees and Hartlepool NHS Foundation Trust. Moving more serious cases to North Tees is very unwelcome as it is detrimental to my constituents. As I have previously mentioned to the Minister, I know that there is a balance, and often a conflict, between providing state-of-the-art specialist medical care in a centralised setting and ensuring that all communities have access to services. The hon. Member for Southport mentioned that in his opening remarks. For many of my constituents, North Tees is not easy to get to. It might appear to be only about 13 miles away, but it is a lot further away in many people’s perception, particular that of people who do not have access to a car. Car ownership in my constituency is below the national average. I therefore suggest that there would be a disproportionate reliance upon ambulance services. Is that appropriate? Is that what the Department wants? I am interested in hearing the Minister’s thoughts about the relationship between accident and emergency and ambulance services.

I understand that the North East Ambulance Service had not been informed in advance in July of the proposed change to A and E. The change would impose greater pressure on that service at a time when we need to be thinking about how we put pressure on public services, and I cannot suggest that the change would help to secure safe and effective access to accident and emergency services. I am also concerned that the proposed move will accelerate the closure of the hospital in Hartlepool, despite what the Minister said in July.

I, like the hon. Member for Southport, am no medical expert, but it seems to me, as I think it struck him, that accident and emergency services are the centrepiece of a modern district general hospital. Related and interconnected services such as emergency care, surgery, resuscitation units and cardiac response teams, link up to ensure that specialist teams work closely together, both figuratively and literally, to provide the highest-quality service for the patient. In many cases, depending on the nature of the complaint, a patient presenting at A and E will result in the use of more specialist and complex medical teams that complement what might have been done in A and E. Again, that is welcome.

As to what is proposed at the University hospital of Hartlepool, the potential loss of A and E would mean that more specialist teams and complex medical interventions would move away from Hartlepool. That would be at a time when there remains considerable confusion and uncertainty about the future of hospital services, as we outlined in the debate in July. As the Minister is no doubt aware—I imagine he will recall it well—a decision was made early in the Government’s life to cancel the funding for the proposed new hospital to serve the communities of Hartlepool, Sedgefield, Easington and Stockton. Whereas, before, the Momentum programme culminated in the opening of a new publicly-funded hospital in the borough of Hartlepool, the Government’s recent decision on funding means, as I said in the July debate, that there is a big risk of services migrating away from Hartlepool and failing to return—without the prospect of a new hospital.

As the hon. Member for Southport said, you cannot get much bigger and more symbolic than accident and emergency, in the matter of reassuring a community about health services. I hope that the Minister will provide more information. Does he share my fear that the loss of an accident and emergency service will put a question mark against the long-term viability of a modern district general hospital? I should in particular be interested in any guidance that his Department provides about the relationship between accident and emergency and related services in a modern hospital.

As I mentioned, all that I have described is taking place against a backdrop of uncertainty and confusion about the future of health services in Hartlepool, because of the Government’s decision. I am concerned in particular about the confusion that the movement of accident and emergency will produce. I welcome, and would reiterate, the comments of the hon. Member for Southport about what happens if there is an accident.

At the moment there is relative simplicity and understanding. Someone who has an accident can feel reassured that they can present themselves at Hartlepool hospital’s A and E. However, although I welcome the introduction of the new One Life centre, I think that adds confusion to the mix. If, say, a child has an accident and bumps their head—which has happened to one of my children—or if, as has also happened, someone drops a lead bar on their head or gets pins and needles in their left arm, what happens then? Where should a Hartlepool constituent go? Should it be to the One Life Centre, the University hospital of Hartlepool or the University hospital of North Tees? As I asked before, what happens when those people do not have a car? Should we rely on the ambulance service? Should we rely on NHS Direct to give the first pointer about where to go? I suspect there is considerable confusion about the future of NHS Direct. In my part of the world, the north-east of England, there is a new provision—the 111 number that is part of the County Durham and Darlington NHS Trust. However, that is not particularly close to my constituency. What will happen—when will that be rolled out?

In all that is happening there is considerable local disruption and national uncertainty. I am concerned that the new service will not bed in properly and effectively until people are fully reassured that they know where to take their loved ones in the event of an accident. I was taken by the point that the hon. Member for Southport made about schoolchildren. Where would a teacher go if an accident happened at a school in Hartlepool this morning? I am not convinced that the acute trust in Hartlepool has sufficiently clear and robust communication plans to enable it to provide reassurance. Can the Minister do anything else to assist?

I pay tribute to Councillor Stephen Akers-Belcher, who chairs Hartlepool borough council’s health scrutiny forum, which, in the summer, challenged and questioned the trust management on the issue in question. I am pleased that as a result of that intervention both minor and major injuries will continue to be seen by medical staff at the University hospital of Hartlepool. The scrutiny forum will closely evaluate how the proposed changes to A and E are managed. That is a good example of councillors holding the local NHS to account, which relates to the point that the hon. Member for Southport raised about the democratic deficit.

The fact remains that there is considerable confusion and uncertainty about the provision of health services and A and E in Hartlepool. While that persists it is not a good idea to move accident and emergency services away from Hartlepool. I should welcome the Minister’s comments, and hope he will ensure that despite the confusion and uncertainty he will provide my constituents with the best possible access to accident and emergency services.

--- Later in debate ---

[Mr Burns]

Sorry, the shadow Minister. I was trying to make the hon. Lady relive old glory days.

[Mr Iain Wright]

Happy days.

[Mr Burns]

Obviously they were not happy for the country, or the hon. Lady would not be a shadow Minister now. But there we are; that is life. I pay tribute to the many members of NHS staff in the constituency of the hon. Member for Southport for all the hard work that they do to provide dedicated, committed health care to his constituents and those of other hon. Members in the neighbourhood who are served by the facilities there.

This Government were elected on a platform of reform of the national health service. Our White Paper, to which the shadow Minister alluded, sets out our plans. More than any other Government in the history of the NHS, we will devolve real power to patients, GP commissioners and all clinicians working on the front line. As the NHS becomes increasingly locally led, it will become locally accountable to local authorities and health watch groups. As the White Paper unfolds and reforms are implemented, subject to current consultations, I hope that that commitment will give some reassurance to all those hon. Members who mentioned democratic accountability. Local authorities and health and well-being committees will have a significant role, in terms of democratic accountability, in a way that primary care trusts and strategic health authorities did not.

Hospital Services (North-East)

Iain Wright Excerpts

Tuesday 27th July 2010 Westminster Hall

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to speak under your chairmanship, Mr Sheridan. The debate is about hospital services in the north-east, but I shall focus on services in North Tees and Hartlepool, so I welcome the fact that I can see here my hon. Friends the Members for Stockton North (Alex Cunningham), for Easington (Grahame M. Morris) and for Sedgefield (Phil Wilson), as well as the hon. Member for Stockton South (James Wharton). I am also pleased to see a good north-eastern Member in the form of my hon. Friend the Member for Wansbeck (Ian Lavery). As I said, I shall focus on North Tees and Hartlepool, but I think that the hon. Member for Hexham (Guy Opperman) will wish to catch your eye, Mr Sheridan, and widen the debate so that it has a more regional perspective. I thank him for writing me a note, asking to participate in the debate.

I welcome the opportunity to discuss hospital services in North Tees and Hartlepool again. We had an important but too short debate on 5 July, initiated by my hon. Friend the Member for Stockton North, in which many hon. Members hoped to contribute so that they could express their concern about, and seek clarification on, the Conservative-Liberal Government’s decision to cancel the £464-million new hospital that was to serve the populations of Hartlepool, Stockton, Easington and Sedgefield. I am indebted to Mr Speaker, who, after discussing the matter with me, granted this longer debate so that we could discuss more thoroughly the vital issue of health care and hospital services in my area. We also had a meeting with the Minister in the week following that debate.

The decision by the new Government—one of their first decisions on coming to office—to withdraw the £500-million investment from our area throws the vital issue of health care and hospital services back into complete confusion and mayhem. My constituents and those of my hon. Friend the Member for Stockton North, as well as those of my hon. Friends the Members for Sedgefield and for Easington, are worth much more than that and deserve much better.

It is especially important that there should be excellent health care in Hartlepool and the surrounding areas because the people whom I represent experience some of the worst health inequalities in the country. Much of that is due to our legacy as a former heavy manufacturing town, with industrial diseases and injuries. Much of it is due to the deindustrialisation of the 1980s and ’90s, and the failures of Government at that time to put in place an alternative economic model. Economic inactivity and health inequality go hand in hand, and we have in the past 30 years suffered from high levels of deprivation. Much of the health inequality has to do with poor and inadequate investment in primary health care in Hartlepool in the last half-century. For example, we have had a much lower ratio of GPs per head of population than we should have had for much of the time that we have had an NHS. As a result, we have had to rely on hospitals, whereas other areas may have had suitably high levels of GPs and primary health facilities.

Frankly, much of the inequality has to do with people’s lifestyles. One third of the population of Hartlepool smoke, as opposed to 24% across England. Some wards in Hartlepool have smoking rates of 40% to 50%. The rate for smoking in pregnancy is way above the national average. The proportion of women who breastfeed their baby in Hartlepool is half what it is across the country. Hartlepool is above the national average for the proportion of people who binge-drink, although I would like to point out that it is below the average for the Teesside area as a whole. Rates of early death from heart disease, strokes and cancer are significantly worse in Hartlepool than the national average, as is life expectancy. Although the gap in life expectancy between Hartlepool and the rest of the country has narrowed in the past decade, it remains the case that a man in Stranton ward has a life expectancy some 11 years shorter than that of a similar man in a more affluent area.

All that history—the lifestyles and the poor health outcomes—means that it is vital that we have the best possible health service for my constituents. Although progress has been made, it will take more sustained help and support, and reconfiguration of services, to narrow the gap still further. We have seen more investment in Hartlepool health in the past 10 years—actually, we have seen more investment in primary health facilities in the past five years than in the previous half-century—but the people of Hartlepool still feel battered and bruised when it comes to the future of hospital services.

Since the 1990s, there has been huge uncertainty about what shape the health services will take, and where they will be located. There has been review after review after review—the Tees services review, the Darzi review, the report from the independent reconfiguration panel—and now there is the decision to scrap the hospital at Wynyard. In that time, other areas have seen a reconfiguration of hospital services; in our neighbouring area south of the Tees, one of the best hospitals in Europe—the James Cook University hospital—has been built. Those of us north of the Tees deserve something similar.

While the uncertainty has continued for my area, the hard-working staff in our local NHS have not been provided with the clear vision and leadership needed. That has compromised their ability to provide world-class health care for our area. The uncertainty has led to a loss of morale and subsequent difficulties in recruitment and retention. The trade union Unison is to be commended in my area for proudly standing up for the people who work in hospitals, but the Government’s decision, together with other reforms that they propose, is placing strain on local services and threatening jobs. We need certainty and continuing investment, and the Government, in one of their first acts in office, have provided neither.

It is fair to say that many people in my area might consider the Government’s decision to scrap the proposed new hospital to be appropriate—indeed, welcome—and might think that with a hospital not being built in Wynyard, the University hospital of Hartlepool will stay open, and that services will migrate back to it. It surely defies common sense, as I have been told by some constituents, that a town such as Hartlepool, with a population of 90,000, cannot have a fully functioning district general hospital, with all the modern services that hospitals should provide. It is argued that the decision to scrap the proposed new hospital at Wynyard presents an opportunity to provide that, and will mean that the University hospital of Hartlepool will have a secure future.

That is an understandable stance, based on affection for the great service that Hartlepool hospital has provided down the years. The big events of life have occurred in the hospital for many thousands of Hartlepudlians, including me. I am thinking of the births of my four children, the death of my nana and the saving of my son Benjamin’s life twice—first when he contracted meningitis at the age of eight, and then at the age of 12, when he suffered a stroke. The dedication of people working in that hospital is second to none, and my family are very much testimony to that.

However, I fear that we will not see the return of hospital services to Hartlepool, and that we will have the worst of all possible worlds—hospital services will move away from Hartlepool and become more inaccessible to the people whom I serve, and we will not have a world-class facility in the borough of Hartlepool to replace them.

I fully accept and embrace the changes in health services. I welcome the technological advances that mean that whereas previously certain medical procedures required extensive stays in district general hospitals, those procedures can now be done safely and more cheaply in a local setting. Just a few years ago, high-quality internet use, for example, could be provided only by bulky and costly desktop computers; now, people can have internet access in the palm of their hand. In the same way, such advances are pushing more and more medical and surgical procedures into the community, into GPs’ surgeries and even into people’s homes. I welcome that.

We are certainly seeing that trend in Hartlepool. The Momentum programme is reconfiguring more and more services that were once the preserve of the hospital, putting them into the local clinic, closer to people. I met a man in Hartlepool recently who had had his toes amputated. Just a few years ago, that would have required an operation in a hospital and a lengthy stay there for recovery and recuperation. The man I met had had the procedure carried out in the operating theatre of his GP clinic in the Headland surgery, and he was home in a matter of hours. We shall see much more of that.

The newly opened One Life Hartlepool centre, built as part of the Momentum programme, is equipped to carry out minor skeletal surgery and will do orthodontic work that was previously the preserve of hospitals. GP surgeries increasingly take blood samples on-site rather than requiring the patient to attend hospital. Again, that is welcome.

However, we also have to admit that increases in medical specialisation, coupled with a wider and more miraculous range of things that can now be achieved through science and surgery, mean that many surgical procedures are now reserved for doctors and nurses with very specialised skills, as opposed to those in general medicine and surgery.

In preparing for this debate, I have been in contact with the Royal College of Surgeons of England, and I am grateful for its help. As part of its best clinical practice, for acute general hospitals that provide the full range of facilities, specialist staff and expertise for elective and emergency medical and surgical care, the college recommends a preferred catchment population size of between 450,000 and 500,000 people. However, the college estimates that hospitals of that size account for fewer than 10% of acute hospitals in England, and states that there is unlikely to be a significant shift to that size of hospital in the short to medium term. As it is, the majority of acute hospitals have, and are likely to continue to have, catchment populations of about 300,000. That is significantly more than the population of my constituency.

It is essential that MPs and all representatives listen to the professional advice of eminent surgeons. I do not intend to play fast and loose with patient safety and clinical excellence. As a politician, I realise that I do not know better than doctors, and I want the best possible health care for my constituents. I will fight to the last to achieve the best possible services for Hartlepool. They have to be safe and medically advisable, but if something is seen to be clinically essential by surgeons, it is right that my hon. Friends and I should listen. It is also right that Ministers should listen to eminent surgical and clinical advice, and I suggest that the cancellation of the proposed new hospital means that they did not. I hope that the Minister will do so today.

I believe that Lord Darzi’s proposals of 2005, under which Hartlepool hospital was to become a centre of excellence for women’s and children’s services, and the University hospital of North Tees was to become a centre of excellence for emergency surgery, were workable and feasible. Alas, it was not to be, as other parts of Teesside felt that they could not live with that. Although I thought that the subsequent independent reconfiguration panel review was unnecessary, I respect its decision, the quality of its evidence and its professionalism. I cannot argue with the overpowering weight of clinical advice on the matter.

In the IRP report, paragraph 4.8.5, entitled “Clinical views—the need for change”, stated:

“There was a common view across all staff that no change is not an option. Staff are keen to work with the Trust management and to embrace clinically-driven change”—

“clinically-driven change” is a hugely important phrase—

"that secures the best outcome for patients, staff and the Trust…There was widespread support for a new modern hospital, north of the Tees, concentrating on providing high quality hospital services that cannot be more appropriately provided in local communities”.

The IRP also stated:

“This is not simply a matter of recruiting additional staff. Specialist skills can only be acquired and maintained with sufficient ‘throughput’ of cases. Since safety standards can only be expected to rise in the future, the current model of service provision is unsustainable.”

In the concluding remarks in the report, the chair of the IRP—a GP and the chair of an acute NHS trust in Nottingham—stated in his personal recollections that:

“The clinicians were virtually unanimous in their desire to work on one site. This was not based on their personal convenience but on clinical evidence and a belief that a real and sustainable improvement in patient care would take place.”

I want the best possible services for Hartlepool. The ideal situation if I lived in utopia would be a hospital in the very centre of Hartlepool that provided the widest possible range of specialisms. In the real world, however, I realise that the desire to see a hospital serving the people of Hartlepool, Stockton, Easington and Sedgefield was driven by clinicians, based on clinical evidence and fuelled by a belief that patient outcomes would improve and health inequalities diminish as a result.

To be fair, I think that the present Government recognise that, too. In a recent answer to my written parliamentary question on whether he would implement the recommendations of the Darzi review, the Minister replied:

“The recommendations of the Darzi review of acute health services north of the River Tees were superseded by the advice provided by the Independent Reconfiguration Panel to the then Secretary of State for Health in December 2006. This advice formed the basis of the ‘Momentum: Pathways to Healthcare programme’ which was developed by the local national health service to provide a new health care system for the people of Stockton, Hartlepool, Easington and Sedgefield.”—[Official Report, 28 June 2010; Vol. 512, c. 407W.]

From that response, it seems that the Minister accepts that clinical pressures were driving and pushing this matter.

In that context, will the Minister confirm that the proposed new hospital entirely meets the criteria set out in a letter of 20 May from the NHS chief executive to Monitor—criteria that are about ensuring that all service changes are led by clinicians and patients, not driven from the top down? Taking that point further, will the Minister explain how the Secretary of State reconciles his policy of clinical-led decisions with the pledge made during the general election campaign that Hartlepool hospital would not close if a Conservative Government were elected and a Tory MP returned for the seat of Hartlepool? What clinical evidence was there to back that pledge? Is that not an example of top-down meddling by politicians, regardless of clinical evidence? Is it now Government policy for the configuration of health services to be contingent on voting behaviour, rather than clinical decisions?

Will the Minister provide further clarity about his written answer to me, to which I referred a moment ago, on whether Darzi should be implemented? If he believes that Hartlepool hospital should remain open, will he provide additional support and resources to ensure that it can remain open, and that services will return to it? However, this is not just about money; it is about the way in which services are provided and how they are linked.

Since the Adjournment debate of 5 July, and our subsequent meeting with the Minister, the NHS White Paper has been published. It rightly pledges to put patients at the heart of services and decisions regarding services. I welcome that. The phrase used in the White Paper is

“nothing about me without me”.

The White Paper also asks for an enhanced local voice; again, that is welcome. However, I would be interested to hear the Minister’s view on what should happen if there is a stark difference between what the professionals want and what the public want—if surgeons and clinical teams say that specialism requires a concentration of services on a central site, but local communities say, as they often do, that they like the status quo and that change is unwelcome? How does the Minister envisage such tension being resolved, given that such views are often polar opposites?

The Minister may say that the independent NHS board will be important when it comes to resolving tensions or contradictions, and that its decisions will be based on clinical views and free from political interference. That would be welcome, but does that mean that the NHS commissioning board will have responsibility for resource allocation? The White Paper certainly suggests so, saying that the board will

“allocate and account for NHS resources.”

In that context, I think that “resources” means revenue resources, but does it also mean capital resources? What would happen if the NHS commissioning board recommended that, for hospital services north of the Tees, it was clinically essential that the recommendations of the independent reconfiguration panel were implemented? Would the board’s decisions overrule ministerial priorities?

The Minister may respond along the lines that the independent NHS board will take decisions out of the hands of politicians, but the White Paper contradicts that. It states on page 33:

“The Secretary of State will have a statutory role as arbiter of last resort in disputes that arise between NHS commissioners and local authorities, for example in relation to major service changes.”

In other words, the reconfiguration of hospital services, which can cause bitterness and fear in many communities, as it has in mine, can still be decided by the Secretary of State. That does not take politics out of changes to hospital services at all.

I ask the Minister to address a number of other points. Does he accept that the manner in which the project was assessed within Whitehall—in both the Department of Health and the Treasury—under the Labour Government was entirely in accordance with appropriate procedures? Does he accept that the project was appraised by officials in an entirely appropriate and rigorous manner, and that that was not done a couple of weeks before the general election, but had been planned and prepared for several years? Hartlepool borough council has written to the Secretary of State on the matter. The letter was signed by the chairman of the council and the leaders of the Labour, Conservative and Liberal Democrat groups; they have yet to receive a response, so I would be grateful if the Minister could expand on what he said in the earlier debate.

Will the Minister publish the revised criteria and assessment considerations on which the project failed, so that we can see what is to be done to address the matter? Why are Hartlepool and North Tees rejected, when Liverpool and Epsom are not?

[The Minister of State, Department of Health (Mr Simon Burns)]

I might be able to help the hon. Gentleman on that point, so that he need not get confused. As he is a diligent Member, I need only remind him that in our debate on 5 July—in column 150 in Hansard—I went into great detail in answering that question. I am afraid that the situation has not changed since then. That was the accurate answer then, and it is the accurate answer today.

[Mr Wright]

I thank the Minister for that clarification. Some of my hon. Friends might probe him a bit further on that point, because we are unclear about a number of aspects. Let me return to the point about the appropriate and rigorous procedure that took place in Whitehall. My recollection might be incorrect, so the Minister may have to provide further clarification. Will he confirm whether a letter of direction, which would be needed if the permanent secretary was unhappy with the decision taken by the Secretary of State, was needed for the proposed new hospital? The decision has left Hartlepool and the surrounding communities high and dry. There will be no new world-class hospital, the plans for which were based on clinical decisions, and no money to upgrade existing facilities. I fear that we will soon have one hospital serving the people of my constituency, and that hospital will be in North Tees. That is completely unsuitable for the task, and for the people of Hartlepool, who will find it appallingly hard to travel to.

We have no clear direction from the Government on the future of hospital services; there is only a vague sense of having been told, “You are on your own; you can do what you like.” That is part of a worrying pattern emerging in the north-east. First, there was the future jobs fund, then the working neighbourhoods fund, then the decision on the hospital, and then the scrapping of Building Schools for the Future. The people of Hartlepool and the surrounding areas are worth more than that and deserve better. I hope that the Minister will acknowledge that this afternoon and clarify how we will provide help, support and additional resources to improve hospital services in North Tees and Hartlepool.

--- Later in debate ---

[Phil Wilson]

That is absolutely right. I heard John Hall speak last Friday, and he also has a lot to say about the abolition of the RDA.

[Mr Iain Wright]

My hon. Friend is making a convincing economic case for the hospital. Does he agree that the £464 million in investment that was to be provided could also provide about 550 apprenticeship opportunities in the construction industry and elsewhere? The Government say that they want private sector-led growth and recovery, and I agree with that approach, but scrapping the hospital and cancelling Building Schools for the Future will mean that private sector construction industry jobs are not maintained. Is that not a devastating blow for the north-east?

[Phil Wilson]

That is absolutely right. Over the past 13 years, the number of apprenticeships in the region has gone up astronomically. In 1997, in my constituency, there were fewer than 30 apprenticeships, but there are more than 700 today. Obviously, anything that curtails the growth of apprenticeships in the future should be frowned on.

As far as other jobs are concerned, the hospital would be a catalyst for inward investment and private sector investment. Wynyard Park Ltd worked closely with the hospital, local universities and further education colleges because it realised that high-value medical and other research jobs would come to the area. The company estimated that 12,500 jobs would be created on top of the 3,000 jobs that the hospital would create. There would be 12,500 private sector jobs in the area on the back of the hospital development—just think of the Government’s income tax and national insurance take and all the other benefits that they would pick up on the basis of that growth in the local economy. Public sector investment would kick-start growth in the private sector.

The hospital would also have become an anchor tenant—a tenant that attracted a lot of other investment to Wynyard. In addition, it would have brought greater investment in infrastructure: the roads and transport networks would have improved, which would have brought more businesses to the park. This is not just about the hospital, as great as that would be. My family and I have used the North Tees and Hartlepool hospitals, and they are great hospitals, but it is time to replace them and to have a new hospital. The credible case put by the new hospital’s designers was that the development would be not only a hospital, but a catalyst for growth in the private sector economy in the south Durham and Tees valley area. That case has been completely ignored.

I really get annoyed when people try to say that the project was worked out on the back of a fag packet a few weeks before the general election. I have been attending meetings on the issue since I was elected in 2007, and meetings were going on before then. We need the development to happen.

The Government’s proposals prove what the Prime Minister said during the election campaign when he pointed out that the north-east would feel the brunt of the cuts. He was right to say that we rely too much on public sector jobs, so the Government should give us the opportunity to change that, but that opportunity was taken away from us when the hospital programme was cancelled.

--- Later in debate ---

[Diana R. Johnson]

I am grateful to the Minister for correcting what he said earlier, when he talked about the figure of £11,000. We understand that the figure is £11 million. I suggest that in the great scheme of things, if the difference in cost between maintaining and repairing two hospitals and building a state-of-the-art new one is £11 million, Labour Members might think that it is £11 million that should be spent.

[Mr Iain Wright]

I just want to make two points. First, I am sure that it was an oversight, but I point out that my hon. Friend the Member for Gateshead (Ian Mearns) is here. In his short time in the House he has been a fantastic representative of that fair area. On the point about net present values and appraisals of the hospital, my hon. Friend may know more than I do about it, but—whatever the talk of £11,000 or £11 million—are the wider savings to the taxpayer from better health outcomes and from ensuring that people do not rely on hospitals for protracted periods also part of the appraisal system? Are they taken into account, or is it a matter of the narrow costs of maintaining existing or new sites?

[Diana R. Johnson]

I apologise to my hon. Friend the Member for Gateshead for not mentioning him; I know that he takes a particular interest in the issue.

I hope that the Minister will explain the rationale for the decision that was made about the hospital, and whether the cost-benefit analysis included the savings that would come about from a healthier population with better access to health services. I am sure that he will explain it. My hon. Friend the Member for Easington also mentioned health inequalities. It is important to ensure that patients and communities have access to high-quality in-patient facilities when they need them.

My hon. Friend the Member for Sedgefield argued compellingly on business grounds that the hospital could help lead the regeneration of the area. He described the hospital as an anchor tenant that could attract up to 12,500 private sector jobs, a telling point for an area of the country that wants to attract private sector business and stand on its own two feet. He made a compelling case. My hon. Friend also said how good the care that he and his family had received from the local NHS was.

--- Later in debate ---

[Mr Burns]

I admire the hon. Gentleman for his persistence. If he could have a little patience, I shall talk about the points made by my hon. Friend the Member for Hexham, and will then come on to the hospital that has so dominated the debate.

My hon. Friend mentioned Northumbria Healthcare NHS Foundation Trust and its proposal to build a £75-million emergency care hospital in Cramlington. I am advised that planning permission is currently being sought for the proposed site and that further development work is under way. I hope that that goes some way to answering the point that he raised. I will make sure that I write to him during the next week or so on the other points that he mentioned to explain all the outstanding issues.

I shall now turn to the review of the hospital in North Tees and Hartlepool. The hon. Member for Hartlepool specifically raised the Government’s decision to cancel North Tees and Hartlepool NHS Foundation Trust’s proposal for a new hospital building. As I stated in the House in our last debate on this matter on 5 July, the original proposal for a publicly funded capital scheme received Treasury approval in March this year, in the run-up to the general election. In view of the shocking state of the public finances and the desperate need to reduce the £155 billion deficit, which I need not remind Labour Members was left to us by their Government, the Treasury and other Departments reviewed every significant spending decision made under the previous Government between 1 January 2010 and the general election on 6 May.

[Mr Iain Wright]

I appreciate the Minister’s explanation and analysis, but if the Conservative-Liberal coalition Government are concerned about the state of the public finances and want to help drive down the debt quicker, why was there not a moratorium on all capital spend in the NHS, similar to that which the Secretary of State for Education put in place with regard to Building Schools for the Future?

[Mr Burns]

Because, as I will again explain—this is similar to what I said on 5 July—there were a range of criteria determined and, as the hon. Gentleman is aware, we took the decision on the hospital on the grounds of affordability and the foundation trust status of the hospital. If he will bear with me, I will explain that again, so that even if he does not accept the decision, he will, I hope, come to understand the reasoning behind it.

On 17 June, the Chief Secretary to the Treasury, my right hon. Friend the Member for Inverness, Nairn, Badenoch and Strathspey (Danny Alexander), announced to the House the decisions made following the Government’s review of spending commitments. The review cancelled 12 projects, including the proposed new hospital at North Tees and Hartlepool.

The aim of granting foundation trust status is to give bodies, such as the trust in the area represented by the hon. Member for Hartlepool, greater financial independence. As well as being able to keep any internally generated resources, foundation trusts also have greater freedom to borrow from either the public or the private sector. As the proposals required an allocation of public dividend capital from the Department of Health of more than £400 million, they were not consistent with that financial independence. Treasury and Department of Health Ministers, including me, decided that, overall, those factors—affordability within the changed economic climate and the hospital’s foundation trust status—weighed against the £458-million scheme for North Tees and Hartlepool more than they did against the other three schemes at Liverpool, Epsom and St Helier, and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew support for the scheme.

Following our previous debate, I was pleased to meet, on 8 July, Paul Garvin—the chair and non-executive director of North Tees and Hartlepool NHS Foundation Trust—together with the hon. Member for Hartlepool and many of his hon. Friends now present. At that meeting, we discussed the possibility of the trust putting forward a new proposal under the private finance initiative. As I have said repeatedly, I cannot in any way give any guarantees that such a scheme would, or would not, be approved. Like any proposal, it would have to be considered on its merits and in the light of the economic climate at the time it was put forward for consideration and possible approval.

However, the advice I would offer the foundation trust is the same advice I would offer any organisation putting forward such a proposal. Any scheme must reflect the changed realities of the national health service, as set out in the White Paper. It would clearly have to demonstrate that it passed the four tests for reconfigurations set out by my right hon. Friend the Secretary of State. That is, it has to have the support of GP commissioners; arrangements for public and patient engagement, including with local authorities, must be strengthened; there must be clear clinical evidence underpinning any proposal; and it must develop and support patient choice.

The economic and policy circumstances have changed since the original proposals were put forward. It would be advisable for the foundation trust to make sure that any revised proposals reflect those changes, and can demonstrate that they have the full support of GPs, the public and the local authority. Any new proposal must be realistic, affordable and provide value for money.

--- Later in debate ---

[Mr Burns]

I will now answer some of the Opposition Members’ questions. The hon. Member for Hartlepool asked whether there was an optimal population size for a hospital. I have consulted my officials, who tell me that they are unaware of whether there is an official optimal population size for hospitals, so I will look into the matter and write to him with a satisfactory answer as soon as possible, giving him any information we have.

I have already explained, including on 5 and 8 July, the decision that governed the withdrawal of approval for the hospital. On the hon. Gentleman’s question about the future of Hartlepool hospital, there are currently no plans to close it, and that will remain the case unless the strategic health authority and the PCT propose closure. There are no such proposals at present, as far as I am aware.

[Mr Iain Wright]

I thank the Minister for that clarity. Given the proposals to abolish SHAs and PCTs, what will happen after that?

North Tees and Hartlepool NHS Foundation Trust

Iain Wright Excerpts

Monday 5th July 2010 Commons Chamber

[Mr Iain Wright (Hartlepool) (Lab)]

I congratulate my hon. Friend on securing this debate, which is very important to a large number of hon. Members. Will he confirm that the whole driver for this reconfiguration has been a clinically led approach—led by eminent doctors and surgeons—and that the decision made by the Chief Secretary takes us back to square one, with no plan B?

[Alex Cunningham]

I certainly agree with that. I know that it is the view of clinicians and other health professionals that it will be impossible to sustain two hospitals with the full range of services and facilities needed to serve our communities. Indeed, patients in our areas have to access different services at the two different sites, which are 14 miles apart.

The new hospital was to be a vital element of wider health care reform in our region and would have delivered clinically sustainable hospital services in the single hospital while delivering a much wider range of services in the community much closer to people’s homes, including three new integrated care centres in Billingham, Hartlepool and Stockton. There is no doubt that there has been some controversy about the plan to build one “super hospital” to replace the two outdated ones, as well as unease among some in the community about the location chosen. I firmly believe, however, that the plan would have provided improved services for local people and that it is ultimately the right plan for the NHS trust to pursue.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

I begin by congratulating the hon. Member for Stockton North (Alex Cunningham) on securing the debate on the future of the North Tees and Hartlepool NHS Foundation Trust and its hospitals. I join him, with the greatest pleasure, in congratulating clinicians, GPs, ancillary workers and all those who work so hard on Teesside, in the north-east and in the rest of the country to provide a first-class quality health care service for the people of this nation.

The decision to cancel the North Tees and Hartlepool NHS Foundation Trust proposal has to be seen within the context of the wider economic climate. This year’s budget deficit of £155 billion—inherited, I gently remind Opposition Members, from the previous Government—illustrates the scale of the economic challenge facing this Government. As part of this Government’s determination to face that challenge head on, the Treasury and other Departments have reviewed every significant spending decision made between 1 January and the general election on 6 May. As the proposed new hospital scheme at the foundation trust received the previous Government’s approval only in March, the North Tees decision formed part of that review.

In these tough economic times, it is essential that all major hospital building schemes be affordable. On 17 June, as the hon. Member for Stockton North rightly said, my right hon. Friend the Chief Secretary to the Treasury announced to this House the decisions of the Government’s review of spending commitments. The review cancelled 12 projects throughout Government and considered four major NHS capital investment schemes with a total capital value of more than £1.2 billion.

The size and funding of the schemes were considered in relation to the nature of the organisations concerned. The aim of granting foundation trust status is to give such bodies greater financial independence. As well as being able to keep any internally generated resources, foundation trusts have greater freedom to borrow from either the public or the private sectors, and, by requiring an allocation of public dividend capital from the Department of Health of more than £400 million, the proposals were not consistent with that financial independence.

[Mr Iain Wright]

What local clinical advice did the Minister and his ministerial team take prior to the decision to scrap the new hospital?

[Mr Burns]

If the hon. Gentleman waits, as I develop my argument I shall continue to explain the reasons for cancelling the scheme within the public spending review.

Treasury and Department of Health Ministers, myself included, decided that, overall, these factors—affordability within the changed economic climate and the foundation trust status—weighed more against the scheme for North Tees and Hartlepool than against the other three schemes for the Royal Liverpool and Broadgreen University Hospitals NHS Trust, Epsom and St Helier University Hospitals NHS Trust and the Royal National Orthopaedic hospital. For those reasons, the Government withdrew their support for the scheme.

If I may, I shall just answer one question that was mentioned in an intervention on the hon. Member for Stockton North. The question was, “Why North Tees and Hartlepool and not the three other schemes?” After looking into the situation, we found that, for example, the Royal Liverpool university hospital building is not compliant with fire safety regulations, and that its mechanical and engineering services are more than 30 years old and at increasing risk of failure. Some 94% of St Helier hospital’s buildings are more than 50 years old, and the 2007-08 data show that the total maintenance backlog for the Royal National Orthopaedic hospital is £53.8 million; for Epsom and St Helier it is £23.8 million; for the Royal Liverpool it is £16.3 million; and for North Tees and Hartlepool it is £3.5 million.

Supporting Carers

Iain Wright Excerpts

Thursday 1st July 2010 Westminster Hall

[Mr Iain Wright (Hartlepool) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Benton. I remember with affection the long hours we spent together on the Housing and Regeneration Bill. I know that you will keep us in order to the best of your ability. I welcome the Minister to his new role and I wish him all the best in making sure that there is a real champion for carers in Government.

I shall concentrate on some of the issues for carers in my constituency. I know that many hon. Members will disagree with this, but I am fortunate to represent Hartlepool, as it is the best place in the country. Hartlepool is a strong, close-knit community, and a sense of community and family remains an enduring part of the Hartlepool character. Despite the knocks and disappointments that we have had over the years, and the social and economic challenges we have faced, that selfless sense of wanting to help one’s neighbour down the road, or to assist one’s partner, parents or grandparents as they get older, runs strongly through the Hartlepool character.

It might often be derided in sophisticated, metropolitan circles, but in Hartlepool it is not unusual for three or four generations of the same family to live on the same street or in the same estate, all providing help and support to each other. That could be a grandmother caring for her grandchildren so that the parents can work, or a son or daughter caring for older relatives. That sense of caring is very strong in Hartlepool, where people do it almost without thinking and where it is seen simply as part of being a member of a family, or as part of the “in sickness and in health” vow.

The hon. Member for Kingswood (Chris Skidmore) referred to the silent army of carers—an apt phrase—in his excellent and thoughtful contribution, and he is absolutely right. The strong sense of community is obviously demonstrated by the high quality of carers in my constituency. In a town that has a high-quality third sector, a local charity, Hartlepool Carers, stands tall with its great blend of professionalism and informality. In the past 12 months, Hartlepool Carers has provided help to more than 1,200 people. Led by Tracy Jeffries, chaired by Ruby Marshall, and with 11 paid members of staff and more than 100 volunteers, the charity provides long-term support to 560 adult carers and 125 young carers. It is estimated that the charity saves taxpayers about £150 million every year by reducing pressure on NHS resources and keeping those being cared for out of care homes and the formal care system.

The hon. Gentleman mentioned the overall national bill for the work done by carers. If we were to send such a bill to the Exchequer, it would be for more than £87 billion, more than four fifths of the NHS budget, which puts into perspective the invaluable contribution carers make. Carers provide not only an invaluable and personal service for their loved ones or neighbours, but a huge and often unrecognised contribution to the national finances. We owe them a huge debt of gratitude.

I think that we all agree that, as a country, we should be doing much more to assist carers. As the hon. Gentleman and my hon. Friend the Member for Stretford and Urmston (Kate Green) have said, carers often feel isolated and unsupported. Caring for someone can be physically demanding, and if a loved one has dementia or some form of degenerative disease such as Alzheimer’s, that can be psychologically distressing. As the hon. Gentleman rightly pointed out, that can affect a carer’s own health. They might feel a failure, or they might need a stiff upper lip to keep going.

In Hartlepool, many carers have given up employment because of their caring responsibilities. Not going out to work can be not only isolating, but result in real financial hardship. That is why the events that charities such as Hartlepool Carers provide are so vital for carers’ well-being. They provide drop-in services so that carers can take a break and have a good cup of tea and a chat. In addition, the charity provides volunteer services, which offer carers access to low-level, but vital, support services such as gardening, dog walking and collecting prescriptions. That extra help and support might not sound like much to us, but it is absolutely vital in providing a degree of respite.

I have several questions for the Minister, and my main line of questioning follows the comments on finance made by my hon. Friend the Member for Stretford and Urmston. Frankly, I was worried by some of the comments the Minister made in what was, I thought, a decent and civilised speech, as he might have been lining us up for further cuts to the care sector. Rather than cuts, I would like to see some of the £87 billion that has been saved given back to carers. What can the Government do to encourage carers to receive what they are entitled to? Carers in Hartlepool, in keeping with the Hartlepool character to which I have referred, are far too modest and reticent to request all that they are entitled to, but it is right and proper that we should do our utmost to ensure that that happens.

I genuinely do not want to make narrow, partisan points on the matter—the remarks I am about to make do not apply to the Minister—but I am concerned that the rhetoric from the new Ministers in the Department for Work and Pensions somehow suggests that all benefit claimants are not to be believed or that they are somehow scroungers. Given the enormous contribution carers make to society and the savings to the public finances that have already been outlined in the debate, what steps will the Government take to ensure that carers are able to come forward and receive what they are entitled to with confidence? In an era of tight public finances, what will the Minister do to ensure that some of those savings are handed back to carers?

In a similar vein, some of the low-level support services that Hartlepool Carers provides, which really enhance a carer’s quality of life, are very much dependent on finances from local government. There is a strong partnership between Hartlepool borough council, Hartlepool Voluntary Development Agency and Hartlepool Carers, but the local authority is expected to find £1.7 million of savings from its area base grant this year and is bracing itself for cuts of about 30% from its total budget over the next couple of years, so tensions will naturally arise between local government and the voluntary sector. What reassurance can the Minister give to carers in my constituency that those vital services will be safeguarded?

That brings me to a particular concern about young carers. Those young people have their whole lives ahead of them and should be able to fulfil their potential, but because a family member might be ill and require support, they often sacrifice their education, their free time, their friends and their future, all because they love their family and want to help. Young carers in my constituency are ably helped by Karen Gibson of Hartlepool Carers, but I would like the Government to do so much more for them. When I was a Minister in the Department for Children, Schools and Families, I looked into the life chances of young carers, which was absolutely heartbreaking. Young carers tend to underperform in educational attainment, which in turn limits their job prospects. The Government should be giving them as much help and support as possible in order to break that artificial barrier.

Again, I do not want to make narrow party political points, but I am concerned that the Government are cutting specific programmes that could be used to help young carers, such as the future jobs fund, the working neighbourhoods fund and, in Hartlepool, a quarter of the education element of the area-based grant, which was helping young carers fulfil their potential. When I had some responsibility in government for apprenticeships, I tried to prioritise young carers for places. What work will be done across the new Government to ensure that more help will be given, particularly to young carers, to help with training places and apprenticeships that will allow them to fulfil their potential so that their love for their family is not a barrier to a successful future?

My final point relates to foster carers. This week I received an e-mail from a constituent, Dawn Robinson, who demonstrates her commitment to the local community not only by being joint secretary of the Burn Valley North Residents Association, a great residents’ association where I enjoyed a fantastic pie and pea supper on Saturday night—I urge hon. Members to come along and sample the next one—but by being a foster carer and a carer to her husband. Dawn has expressed concern about the lack of flexibility for young people in foster care, as support tends to end abruptly when they reach the age of 18. She has been looking after a young person for about three and a half years, and he is fast approaching 18. She writes:

“He is autistic, diabetic and epileptic. Over the years he has grown in self confidence but still needs help regarding taking insulin etc. and constantly needs someone with him. He now goes to college and for the first time has started to make friends. His teacher at his review said he didn’t want his home life to affect his education and moving him on would be the worst thing to happen to him.”

When he is 18, he will have to leave Dawn’s home, and a carer and a warden-run placement will have to be found, which will obviously put additional pressure on hard-pressed resources. It would be reasonable to have the flexibility to allow Dawn to continue the current situation for several years beyond the age of 18, so will the Minister ensure that greater personalisation? He mentioned direct payments and personalisation in his opening comments, so what extra flexibility can be put into the system to ensure that the artificial break point at age 18, when the young person becomes an adult, does not hinder their progress?

The positive role that carers play across the country, especially in Hartlepool, is absolutely invaluable, as other hon. Members have said, and I hope that the Minister will recognise that in his closing remarks, as he did in his opening comments. I also hope that he will ensure that the appreciation of the role that carers play, which has been evident throughout the debate, is demonstrated by giving hard-working carers something back.

--- Later in debate ---

[Tony Baldry (Banbury) (Con)]

I am grateful to you, Mr Benton, for giving me the opportunity to contribute to the debate. With Baroness Pitkeathley in another place, I co-chair the all-party group on carers. We succeeded the hon. Member for Aberavon (Dr Francis), who during the last Parliament carried out that task alone and so brilliantly that it took two of us to succeed him. I pay tribute to his work—I am sure that he will continue to be a contributing member of the group—and many of those who have contributed to the debate have joined the all-party group because we want to be a strong collective voice in the House for carers.

The Minister is in a privileged position because the hon. Gentleman, the Minister and I were made parliamentary champions for carers during carers week earlier this year. It is rare to move from being a parliamentary champion to being a ministerial champion for carers within a few days. We will see how my hon. Friend delivers in his new and challenging task on behalf of carers. It is rare in Whitehall for a Minister to walk into a Department understanding part of the brief that he has been asked to cover.

[Mr Iain Wright]

That is dangerous.

[Tony Baldry]

The hon. Gentleman may say that, but I think that it provides a phenomenal opportunity for my hon. Friend to stride out and seize the agenda. I will try to keep my comments short. During carers week, I made a long speech which, for hon. Members and others who are new to Hansard and who may wish to read it, is on my website at tonybaldry.co.uk/campaigns/carers. We are all in the new technological world, and I do not want anyone to believe that only the new intake is up to date with the internet. Some of us who have been around for a bit can keep up with the new global technology.

I want to make various points to my hon. Friend the Minister. I am glad that we frequently have debates on carers, largely as a consequence of carers week and the previous Prime Minister’s intervention. Last year, we had a topical debate, and I am glad that we are having a full afternoon’s debate in Westminster Hall. One of the first issues is identifying carers. Many carers do not recognise themselves as carers, so they are not recognised in the system as carers. It would help them enormously if social services and the health service recognised and encouraged people to recognise themselves as carers. We would then have a much more accurate picture of the number of carers in the community.

GPs may have thought—I defer to my hon. Friend the Member for Totnes (Dr Wollaston) on this—that it would not be beneficial to identify carers because they could do little for them. The ability to recommend respite care for carers may have prompted GPs to ask themselves, “Is this person a carer; is there something I can do to help them and to support them through respite care?”

We are about to move to GP commissioning for services. I will try to ensure on my patch that I identify which partner in every GP practice in my constituency has the lead responsibility for carers. One objective of organisations such as the Princess Royal Trust for Carers and Carers UK is for them and us collectively to encourage GPs to engage with carers and to recognise and note those GP practices that are particularly helpful in supporting carers. With the best will in the world, the picture is patchy. Some practices work hard to support carers, but others, which may not be insensitive, have not taken such support fully on board in their list of priorities.

We must all recognise that the number of carers will inevitably increase with an ageing population. There is something else, which I fully appreciated only recently during carers week. At a reception in the Jubilee Room, I listened and talked to a number of carers who were looking after relatives with Parkinson’s disease. My mother was a theatre sister during the blitz in Coventry, and people either survived or died. People from earlier generations went into hospital for one acute incident from which they either recovered or died. Generally, the Greco-Roman medicine of western Europe works on the basis that people are given drugs or medicine and they get better.

The truth, however, is that an increasing number of people in our society have to care for people whom they love very much, but who are progressively getting worse and know that they will never get better. There are people who have Parkinson’s disease, dementia or Alzheimer’s disease, and in addition to the financial and other challenges that carers face, the psychological drain of knowing that, however much someone is loved and cared for, they simply are not going to get better but will progressively get worse must be enormous.

The number of people who have to care for people with age-related dementia and Alzheimer’s is increasing. When I was first elected nearly 30 years ago, each Christmas I would go round every nursing home in my constituency. Most of the residents were frail widows in their 70s who were perfectly spritely and intellectually sound. I have now given up going around nursing homes on my patch at Christmas, because almost everyone is suffering from some form of age-related dementia and they have absolutely no idea who I am at all. There is that standard joke where an MP goes in and says to a resident, “Do you know who I am?”, and they say, “No dear, but if you go and ask matron she may be able to help you.”

The pressure on staff is enormous, and if someone is old and frail, their chances of getting into a residential care home are increasingly less, so people have to be looked after at home by carers. Furthermore, the number of people who have early, pre-senile dementia and are waiting for places to get into a nursing home is increasing, and those people have to be looked after by carers. Therefore, the number of carers in our communities will increase substantially over time, and we must ensure that any carers strategy takes account of that.

We must ensure that new policy initiatives, such as GP commissioning, help carers and do not work against them. There are also other initiatives. For example, local authorities are, quite rightly, being enjoined to ensure that they get value for money in all services, including carer services.

In Oxfordshire, as in the constituencies of other hon. Members I am sure, carer services are going to be tendered. However, in Oxfordshire, we already have three good carers centres that are manned—or womaned—by volunteers. There is the Princess Royal Trust for Carers and other carers centres that have grown up over a period of time. The North and West Carers Centre in Banbury won the Queen’s award for unsung volunteers. Those people are not going to go away; they are committed to supporting carers.

However, there is a risk of an inevitable momentum, and that the county council social services department might feel that it has an obligation under some EU or Government directive to put services out to tender. It might feel obliged to contract out carers services to some completely different provider in some other part of the country. That does not seem to go with the grain of what I understand when I hear colleagues from all sides of the coalition talk about the big society. If the big society—as opposed to the big state—means something, it means building on the work of those volunteers and on the community spirit within one’s own community. It means building on civic pride and local roots, not undermining those things. I hope that ministerial colleagues in the Department of Health and other Departments will understand that although we should ensure that every Department gets value for money, that should not undermine the volunteers who have the competencies that are needed.

That brings me on to how we train carers, and I make this point simply so that my hon. Friend the Minister can respond to it should he wish. There has been some concern about the Department’s contract with Caring with Confidence, which is an organisation that has trained carers at carers centres. The Department has felt it appropriate to cancel that contract, possibly because it felt that sufficient carers were not being trained. However, there is an issue about how one ensures that carers and people who, often late in life, find themselves as carers can acquire the skills and competencies that will help them.

I make my final point so that we can have some clarity on this issue, either now or at some stage in the future when the carers strategy is published. Hon. Members from all parties have drawn attention to the carer’s allowance. At present, the only assistance that a working carer receives is the carer’s allowance, but those who are retired—many carers are above retirement age—get no further recognition in the system because Treasury rules state that people cannot claim two benefits. That is not new; it is a long-standing rule. If someone draws a state retirement pension, they can draw only that and cannot get anything more for being a carer.

During the previous Parliament, a couple of Select Committee reports were published on this subject, and that work should not be lost. The new Government must respond to those reports, and either make it clear that they cannot afford any further financial support for carers, or give some indication that they may be willing to consider recalibrating the benefit and financial system in support of carers.

In 2008, the Work and Pensions Committee recommended an overhaul of the benefits system. A report entitled, “Valuing and supporting carers”, which was the fourth report of the 2007-08 Session, recommended a new two-tier support system with a carer support allowance paid at the same rate as jobseeker’s allowance and a caring cost payment that would be available to all carers in intensive caring roles, similar to child benefit and set at between £25 and £50. That element would be available to some carers who were unable to claim the first element, including those carers in receipt of a state pension. The Committee also recommended that the Department for Work and Pensions commission an urgent examination into introducing a taper to the carer’s allowance earnings limit and lifting the 21-hour study rule.

Like so many Select Committee reports in the last Parliament, that report got lost in a review—I do not wish to criticise; it is just a fact, a process. The then Government said that they were introducing the carers strategy and would take the report on board and think about it, but I cannot recall anything coming out at the other end on what they thought about the Committee’s recommendations.

Last year, the Public Accounts Committee published a report on “Supporting Carers to Care”, which criticised the confusing and complex processes and poor communication involved in the support that carers received from the Department for Work and Pensions, including benefits and employment support—that point was made tellingly in a good contribution by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard). The Committee found that one fifth of carers who received benefits struggled with the application process, which is not surprising if no one helps them to fill in the forms. It found that the complexity of the system discouraged applications, and that Jobcentre Plus advisers were not given enough incentive to help carers to find part-time work. I am not sure that we ever had a response from the last Government to the Public Accounts Committee’s report.

It would be helpful if, early in the life of the present Government, we had an indication of how Ministers collectively see the opportunities for supporting carers financially. Of course, everyone recognises that that is set against a background of very difficult financial constraints and circumstances. That is a given. It should not be necessary, every time that one makes a speech now, to explain that we are the country with the largest amount of debt in the world, due to circumstances. However, it would be helpful, with a view to taking forward policy on carers, if we had an understanding of how the Government see the ability to give carers further support. I am referring to support that is valuable not only in financial terms, but because it makes carers feel that they are being recognised by the wider community for the work that they do and the role that they play.

My hon. Friend the Member for Totnes rightly raised the issue of young carers and my hon. Friend the Member for Blackpool North and Cleveleys raised the issue of young carers being bullied. I am always at a loss to understand why, in the 21st century, schools, the education system and all the people involved are not capable of being more supportive of young carers. That goes back to the point about identifying carers. Young carers deserve to be identified just as much as any other carer. One would hope that the education system and schools were capable of recognising young carers, that social services, GPs and others would try to ensure that schools knew who the young carers were and that schools would give young carers support. Often, they deserve double the support for the tasks that they are undertaking.

Many hon. Members, at different times in their lives as constituency MPs, come across families that include young carers and find out that the stress is incredible because they are often asked to take on adult responsibilities. Another difficulty is that the parent for whom they have taken on responsibility is sometimes able to look after themselves and be a parent, and sometimes is unable to look after themselves and is being cared for. For a child, having to cope with a parent who sometimes acts as a parent and an adult and sometimes is not capable of looking after themselves must be incredibly difficult, because they never know when they go home whether their mother will be poorly, drunk or whatever and whether they will be the carer or the child.

Schools and the system therefore need to give young carers particular support. I do not understand why every year when carers week comes round, we continue, a bit like groundhog day, to have the same debate about young carers. This area does not require huge amounts of extra money; it just requires the system and the community—society—to work out how we give younger carers greater support.

It is clear from the debate and I can tell the Minister that it is clear simply from the number of hon. Members who have joined the all-party carers group—I am sure that many more Members of both Houses have not yet got around to joining it but are equally interested—that there is considerable interest in and support for carers in Parliament. Those Members will be anxious and keen, in the course of the Parliament, to see what further work we can do in support of carers. Particularly for Government Members, if what my right hon. Friends in the coalition Government are saying about the big society and about engaging the community is to have any meaning at all, a very good test of that will be how we deliver enhanced and better lives for those who are caring in our society.

--- Later in debate ---

[Mr Burstow]

The hon. Gentleman has been a Member for some time, so he will know that there are regulatory systems in place that would deal with local authorities that were performing in the way that he describes. I am not aware that the authority’s activity has been reported in such a way. However, I stand by the offer that I have made, and I will be happy to receive further representations about the impact of tendering arrangements.

I want to pick up on the references that were made to the operating framework because the hon. Member for Worsley and Eccles South was right to point out that, in the operating framework that the Government issued just last week, we identified a requirement in the local priorities for the publication of dementia strategies. We think that that is an important signal. It was a signal to local PCTs that we wanted them to be more public facing and accountable to their local communities, and that they should account for why they have chosen not to spend money on dementia strategies. The signal was not specifically about dementia, but that we expected more of that sort of transparency in general. People should not need freedom of information requests to get information from PCTs about how public money is being spent, and I hope that that message will be understood by our local organisations that deliver such services.

The hon. Lady also talked about ring-fencing more broadly. The Government are determined to ensure that there is as much flexibility as possible for local authorities to make choices about how they prioritise their resources to deliver what is necessary to meet the needs of their local communities. We have made it clear that because we see the social care transformation grant as such a priority for investment in changes to services, so that they are genuinely personalised in the future, the budget for the final year in which it is available to local authorities will continue to be ring-fenced. We wanted to send the signal that we considered that grant to be important, and we want to ensure that local authorities deliver that grant during the course of this year.

The hon. Lady made a number of very useful points about good practice and the way in which GPs, schools and others play a part in delivering early identification of carers, whether those carers are young, old or otherwise. That should certainly inform the thinking of any Government when it comes to delivering a good carers strategy.

The hallmark of this important debate has been the great consensus about what needs to be done and the value that Members from all parties place on carers. I shall now try to address some of the other points that have been made.

The hon. Member for Stretford and Urmston (Kate Green) talked about financial issues and benefit changes, and such concerns were echoed by others. The carers cross-government programme board, which is charged with providing cohesion around the carers strategy, will look at those issues and hold cross-government discussions about them to ensure that the way in which we go about simplifying the benefit system actually delivers the right results at the end of the day.

The hon. Lady also expressed concern about the impact of public service cuts, which was also referred to by several hon. Members. Again, it is important to remember that some of the measures that are already in place were not initiated by this Government. Nevertheless, we have to be mindful about the impact of any budget decisions that we make through the spending review process. That will certainly be at the forefront of Ministers’ thinking in the coming weeks and months as we consider all the options that will have to be considered as part of the review.

The hon. Lady also talked about the difficulties faced by carers coming back into the workplace—the cliff edge, as she described it. The coalition Government’s programme sets out very clearly a desire to improve this country’s tax system significantly so that we raise the amount at which someone starts to pay income tax to £10,000. We believe that as we move towards implementing that change, we will begin to smooth out some of that cliff edge and start to have a significant impact on easing people’s return to work.

The hon. Member for Kingswood (Chris Skidmore) made a very good speech in which he set out a number of the challenges that we face. In particular, he rightly discussed the current complexity in the benefit system and the way in which it can be an obstacle to take-up of benefits.

The hon. Member for Hartlepool (Mr Wright) made a very good speech. He set out a range of issues relating to young carers in particular, but he also raised other points. He made a very important point about the Hartlepool carers centre, which he mentioned a lot in his speech, and it clearly provides an important service in his area. He also cited the £150 million a year that it saves taxpayers by reducing pressures on NHS resources. We need to ensure that such examples of social enterprises playing a part in easing pressure on public services and helping carers are considered. Such mutual operations can really make a difference.

The hon. Gentleman, like several hon. Members, talked about the role of GPs. He also made some comments about benefits. I refer him to what I have said about how we intend to move forward on benefits.

The hon. Gentleman also asked specifically about young carers. The key point I would make is that the Department of Health is piloting personal health budgets. In my written ministerial statement on Monday, I announced how we intend to evaluate those schemes. The schemes should give us yet another way of smoothing and removing some of the cliff edge that we have heard about by providing access to resources for care and health in a way that allows people to exercise real control over them and therefore much more control over their lives. That is particularly important for managing and smoothing the transition from childhood into adulthood, and we all want to ensure that that transition is made smoother.

The hon. Member for Chatham and Aylesford (Tracey Crouch) spoke about the key issue of the identification of carers. She said that only 5% of carers in her area had been identified by the local carers centre. A large number of people are hidden at the moment and do not necessarily identify themselves as carers. The identification of carers is a key challenge as part of the process of refreshing the carers strategy.

We have heard about the importance of flexible support for carers. Again, that is why personalisation will remain an absolutely central part of how the Government take forward the development of services. Such services should be tailored to fit around people’s lives, rather than requiring people constantly to navigate around them, often for the convenience of the service provider rather than the convenience of the person or family themselves. We want to accelerate towards achieving that vital aim, and we also need increased use of more user-led organisations that are much closer to the circumstances of the family, meaning that they can play an important part in advocacy, brokerage and helping families to navigate around the system.

I think that I have already addressed the main point made by the hon. Member for Hammersmith, who clearly put on record a number of powerful testimonies from his constituents about the value that they place on the centre to which he referred. However, as I have said, I will not attempt to micro-manage the decisions of local government colleagues of any particular party persuasion, as it is for them to account to their electorate for the way in which they spend public money.

The hon. Member for Totnes (Dr Wollaston) discussed young carers and talked about the devastating impact that alcohol can have on people’s lives. She offered advice about some of the ways in which the Government might tackle that issue, such as a pricing policy, and cited advice that the NICE has given. I can tell her that we will be publishing a White Paper on public health later this year setting out the Government’s approach on such challenging issues. I hope that my right hon. Friend the Secretary of State for Health will say more about that White Paper in the not-too-distant future.

The hon. Lady also talked about safeguarding, and we have announced a review of the vetting and barring system. I am one of the Health Ministers with responsibility for safeguarding, so I will receive the recommendations from that review. We need to ensure that the system is proportionate to the risk and that it delivers the appropriate safeguards, but it must not be so bureaucratic and difficult that it actually becomes a barrier to people participating as volunteers, so that is one of the tests that we will apply to the system.

The hon. Member for Liverpool, Wavertree (Luciana Berger) talked about the USDAW campaign, as well as the importance that she attaches to the role of carers in her constituency, some of whom she has already visited. She also discussed the plight of working carers, their interaction with the benefits system and the need for an examination of tapering as a way in which people could retain an element of carer’s allowance. All I can say at this stage is that the Government are committed to reviewing the system with a view to simplifying it.

The hon. Lady also asked how we could ensure that there is greater awareness of the right to seek flexible working. Again, that is not just a challenge for the Department of Health. We will need a cross-government approach on the issue involving my colleagues in the Department for Business, Innovation and Skills and the Department for Work and Pensions. Together, we have a part to play in ensuring that people are genuinely aware of that right.

The hon. Member for Blackpool North and Cleveleys (Paul Maynard) spoke very effectively. I was in the House when he made his maiden speech and it was one of the most impressive that I have heard. I know that his speech was excellent compared with mine 13 years ago.

[Mr Wright]

Hear, hear.

[Mr Burstow]

I wish that I had not put it that way, but there we go. That is the trouble with putting things on record.

We heard about the National Audit Office report on Jobcentre Plus, and it is important that the Government pay close attention to the work of the NAO. I was a member of the Public Accounts Committee during the last Parliament, and when the NAO identifies opportunities to obtain value for money and get more out of existing resources, it is important that we take them. If the report is not already required reading for DWP Ministers and officials, it should be.

The hon. Member for Blackpool North and Cleveleys also discussed the care to share forum that was set up to consider respite. We see peer support as a powerful part of what the big society is all about. It enables people to step up and support each other, rather than seeing local authority services as the solution to everything. The right to respite has been discussed a lot in this debate. It is often not the case that a carer wants a week off; a matter of hours can make a huge difference. When I was visiting some services in Newham recently, I met the people who run a telecare project and several carers who had benefited from it. It was clear that what was important to them was the knowledge that the person for whom they cared was safe so they could have a cup of coffee with a friend, a chat and a bit of real life, as that refreshed them. We need more such opportunities for many others.

The hon. Member for Llanelli (Nia Griffith) discussed how we can ensure that carers can both stay in work and return to work. She also mentioned Alzheimer’s and dementia, and research into those diseases. I am sure that she will know that, in the coalition programme for government, we indicated a clear commitment to prioritise dementia research. I am the Minister who chairs the board with responsibility for considering the issue, and we will be making announcements about how we will take it forward in due course.

The hon. Member for Banbury said some kind things, as a result of which I now feel immense pressure—thank you very much! He also made a good point about carers week that I read in this way: carers week is not an annual event; it is every week. We need to find ways to make that not just a platitude but a reality for carers throughout our country. He spoke a lot about the role of GPs as commissioners and the difference that they can make. They are one of the universal services and they see many carers. We must ensure that all GPs understand that when someone comes to see them because of a sickness or disability, the person with them is often the carer, who needs to be identified and offered the signposting and support that will make a difference for them.

The hon. Member for Banbury mentioned the caring with confidence programme, as did several other hon. Members. I purposely included it in my opening remarks because I wanted to be up front about what I had decided to do. My view, having considered the evidence about the programme, was not that the training materials were not excellent—they are well regarded by the carers who have been through the programme—but simply that we were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly. Now the money will be reinvested into delivering more training—including GP training, which has been mentioned—and more support for carers. We will make further announcements in due course.

Health Funding

Iain Wright Excerpts

Tuesday 22nd June 2010 Westminster Hall

[Andrew George]

I am grateful to my hon. Friend. She rightly highlights that many factors, including life expectancy, rurality and age profile, need to be taken into account, and we must get the balance right. The history of the changes to the allocation formula—not something I would recommend as bedtime reading—shows that all the factors have been conjured with and balanced over time. It is difficult to arrive at a formula satisfactory to all people.

I want to emphasise the fact that we need to identify and make the allocation formula clear. We need to be able to show that it takes into account the health inequalities across the country and, above all, does not further impoverish the most deprived areas. I represent the poorest region in the UK, yet its poverty was used as a reason not to give it additional funds. Its poverty acted against its best interests, which would have been additional funds, as I explained in my description of how the market-forces factor operated and the impact that it had in some areas.

It is difficult to assess what impact the Budget will have on the future of the PCT allocation formula so soon after the statement, which was made in the Commons today. The NHS Confederation recently estimated that the announcements made by the coalition Government indicate a real-terms reduction of between £8 billion and £10 billon in funding to the NHS in the three years from 2011. According to the King’s Fund, a rise in VAT will lead to an additional cost of £100 million per annum to the NHS budget overall.

My hon. Friend the Minister will no doubt ask where we will find the money to provide additional resources for deserving areas such as Cornwall and the Isles of Scilly, Bassetlaw, and South Staffordshire, and the other places that receive allocations that are further below their target than those anywhere else.

[Mr Iain Wright (Hartlepool) (Lab)]

Will the hon. Gentleman give way?

[Andrew George]

I will happily give way, because I asked myself a difficult question and I had better sit down.

[Mr Wright]

I am grateful to the hon. Gentleman for securing the debate and for giving way. He has been an extremely tenacious campaigner on health inequalities and housing, a subject on which I used to speak for the Government in a previous life. What are the hon. Gentleman’s views on the relationship between resource allocation and capital spend? It is an important subject to bear in mind when trying to iron out health inequalities. He mentioned the Chancellor of the Exchequer’s Budget statement, which said: “Well judged capital spending by Government can help provide the new infrastructure our economy needs to compete in the modern world.” If we put that in the context of reducing health inequalities, is it not important to have good capital spend in health? Does the hon. Gentleman share my disappointment at the £463-million cancellation of a new hospital for North Tees and Hartlepool?

[Andrew George]

I thought that the hon. Gentleman would use a local matter as a sting in the tail in his intervention. Let me commend his work on housing, which deserves a great deal of credit. With regard to capital spend, I was never terribly enamoured of the previous Government’s enthusiasm for the private finance initiative projects that were put in place across the country; they did not represent value for money. Having said that, I acknowledge that some difficult decisions need to be taken. I am sure that the hon. Gentleman’s point about his hospital will be heard by Ministers, and that he will be as tenacious in mounting a campaign to ensure that the right decision is taken as I have been on the issue of health funding, and on other issues.

As far as the health allocation formula is concerned, Hartlepool’s funding was 4.3% below its target, so the hon. Gentleman may wish to join the campaign to ensure that the areas furthest from their target achieve their target as quickly as possible. The PCT and the health community in that area may well be able to address their need for capital investment by ensuring that their revenue and allocations are increased by means of our campaign.

The difficult question that the Minister will be asking himself is where will the additional resources be found if areas such as Lambeth, Richmond, Westminster and Kensington and Chelsea are not to have the rug pulled from under them. Part of the answer lies in looking at how the last Government spent their money. There was an obsession with centralised, top-down and quite expensive projects, such as the alternative providers of medical services—or polyclinics, as some people have called them—and the independent treatment centres built across the country, which have never given value for money. A lot of money has also been committed to the NHS information technology programme. I urge the Minister to look at that, and at other such areas, to find the funding, and to give that funding to the PCTs. The PCTs can then decide how best to use their resources, rather than having decisions made for them in Richmond House.

Many issues in Cornwall need a great deal of further investment and support, including ambulance response times. Of course, given our geography, we do not expect to have the quickest ambulance response times in the country, but we would like resources to be put in place to ensure that the ambulance service can at least begin to address some of the deficiencies in the service at present. The NHS dentistry service in Cornwall is one of the most threadbare in the country. Given how difficult it is to see an NHS dentist in most of my constituency, and in many other parts of Cornwall, there would be massive benefits to improving the service there. Other such areas include: cancer screening and prevention; better support for the rehabilitation of stroke patients; improving the functionality of mental health services by ensuring greater availability of therapists and a greater ability to meet demands for treatment; improvements in psychological therapy support for armed forces veterans—provision is clearly insufficient in Cornwall, as in other areas—greater support for dementia; expanding physiotherapy; and improving and investing in the midwifery services in Cornwall, which are overstretched.

In closing, I want to ask the Minister a few questions that hit the bull’s eye of the issue. Bearing in mind that the NHS budget will be protected, how soon will the Government ensure that the funding shortfall in the most underfunded areas of the country is removed? I mentioned the 13 PCTs that are 6.2% below their target; do the Government see those targets as genuine targets to hit, or just as something for the Department to take note of? What is the Government’s policy on the pace of change in the most underfunded areas, and what will be the pace of change in future?

I know that a number of other hon. Members wish to contribute to this debate, so I will resume my seat now. I look forward to the Minister’s response.

--- Later in debate ---

[Mr Iain Wright (Hartlepool) (Lab)]

I want to reiterate what I said earlier in an intervention and congratulate the hon. Member for St Ives (Andrew George) on securing what I think is a very important debate; it is important not only in the south-west but across the country.

I also want to congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on what I think might be her maiden speech, although I am not entirely certain that it was. [Laughter.] I imagine that she will be as tenacious as the hon. Member for St Ives, her close parliamentary neighbour, in ensuring that she stands up for the interests of her constituents.

I want to make two or three key points about health funding issues that are affecting my constituents. The first point relates to something that the hon. Member for St Ives said; he has obviously done his homework and knows his brief incredibly well in this area. As he said, despite great improvements in recent years Hartlepool primary care trust is still some distance from its funding target. It is about 4.3% below its funding target, which is about £7.7 million. In the last two years, 5.5% more funding was provided year on year, but we still have some considerable way to go. I just want to press the Minister on the question asked by the hon. Gentleman—how far and how fast can we move to get to the funding target for deprived areas such as Hartlepool?

The second issue that I want to mention is access to health care and funding for health-care-related transport. The hon. Member for Truro and Falmouth made a telling point about how important it is that people should have access to transport in rural areas, to enable them to access health services. I certainly have that situation, to some extent, in my constituency. Hartlepool is a very urbanised constituency—one of the most urbanised in the country. However, we have outlying villages, such as Dalton Piercy, Elwick and Greatham, which I am thinking about in particular. In the last 12 months or so, Greatham’s nurse-led clinic has been closed, largely on clinical grounds rather than because of cost-cutting exercises. Nevertheless, I think that finance has still had a role to play. I have tabled a number of parliamentary questions about the provision of nurse-led clinics in rural areas and the Government, in their written responses, have said that they are very much committed to those clinics. But I want to know from the Minister what extra assistance will be given to residents of Greatham and other rural areas, which can really help communities to have access to health care—both preventive health care and care related to reactive clinical outcomes.

The third issue that I want to mention is the appalling health inequalities that we still have in Hartlepool, despite the improvements that we have made in recent years. A person is more likely to die earlier if they live in Hartlepool than if they live anywhere else in the country, with the possible exception of Easington, which is next door to Hartlepool. In certain parts of my constituency, particularly Stranton ward, the difference between the local life expectancy for men and the national life expectancy for men is 11 years; a man living in one of those parts of my constituency will die more than a decade earlier than if he lived in other parts of the country. That issue needs to be addressed, not only through funding but through reconfiguration of services so that they are really patient-led.

That brings me to my final point, which is my most relevant point at the moment. It is about the announcement made by the Chief Secretary to the Treasury on the Floor of the House last Thursday about the cancellation of the £464 million new hospital for North Tees and Hartlepool. That hospital was something like a decade in planning; it was not thought up in the last two months before a general election campaign. There has been an awful lot of pain with regard to reconfiguration of health services in Hartlepool. The issue dominated the by-election that I won to come to this House. It has been extremely painful for the community to get to this position, but with one swift swish of a pen we are back to square one, with no real vision about where we go to for hospital services north of the Tees in my area. With the co-operation of neighbouring primary care trusts, we are embarking on what is known as the momentum programme, whereby we are pushing services closer to the community. That has an impact on health funding allocation. What reassurance can the Minister give that we will receive additional services and additional resources, so that the momentum programme can go further and faster in pushing health care into the community?

Also, with regard to the cancellation of that hospital and with regard to the idea that we do not have a plan B—there is nothing in place—can the Minister provide me with a degree of reassurance that support will be able to maintain the existing North Tees and Hartlepool hospitals? Is that the way that his Department is suggesting that we are going? If so, that would be at odds with the clinical recommendations from the independent reconfiguration planning of a number of years ago. It was recommended that we should have a new world-class hospital, which could serve the communities of Hartlepool, Easington, Stockton and Sedgefield.

I hope that the Minister will agree to meet me and my neighbouring MPs, so that we can discuss these issues and ensure that the health inequalities and the uncertainty that has been created by the announcement last Thursday can be addressed; so that the concerns of my constituents and those of people in neighbouring constituencies can be addressed; and so that we can really begin to address health inequalities in the north-east.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate my colleague, the hon. Member for St Ives (Andrew George), on securing this debate on NHS funding allocations. I also congratulate the shadow Minister, the hon. Member for Kingston upon Hull North (Diana R. Johnson), on her appointment to the Health Front Bench. In Government she was a Minister with other responsibilities, and a Whip, and I assure her that she will find serving as a shadow Health Minister tremendously rewarding, because of the important role of such matters in our lives and those of our constituents. I also congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on her almost but not quite maiden speech.

I pay tribute to the NHS in Cornwall, which provides an excellent level of care to the constituents of my hon. Friend and those of my honourable colleague; he has long campaigned on how best to distribute resources and has argued that PCTs should be moved to their target allocations. Before I respond in detail to his points, perhaps I might set out the general principles of the system of funding allocation; that may help the hon. Member for Kingston upon Hull North.

The Government believe in an NHS that is free to all, irrespective of need or ability to pay; in which professionals are freed from the shackles of centralised targets and empowered to take responsibility for their patients; where better access to services is matched by improved quality and greater efficiency; and which provides value for money and health outcomes that are second to none. That is our vision for the national health service, and the coalition’s programme for government sets out how we will achieve it.

First, the Government will increase spending on the NHS in real terms for each year of this Parliament, as the shadow Minister acknowledged. It is a commitment that reflects a deeper belief: that the NHS must be protected and properly resourced to continue its vital work. We must focus our resources where they are needed most. That means stopping the flow of resources from the front line to the back office, giving front-line staff the responsibility and resources to improve outcomes for patients, and entrusting local professionals—and local people—with the means to improve local health. By committing to cut the costs of health bureaucracy by a third, we will release resources that can be reinvested in front-line services; by giving GPs the power to commission services based on need, we will push decisions about health care provision close to patients; and by giving local communities more responsibility for public health, we will create a more flexible national health system—one that is responsive to local demand for health services, and is able to react to changing health needs and to direct funds towards emerging priorities.

Secondly, we will establish an independent NHS board to allocate resources and provide commissioning guidelines. The board will ensure access to health services that are designed around the needs of the patient, not the needs of the bureaucracy. It will set standards based on clinical evidence, not political micro-management. The aim is to achieve the best outcomes for patients, instead of simply ticking boxes and meeting targets.

[Mr Iain Wright]

I congratulate the Minister on securing his post. I know that he is passionate about health, and I wish him all the best as a Minister in the Department of Health. He mentioned the establishment of an independent NHS board whose focus will be on clinical standards as opposed to political micro-management. Bearing in mind health services north of the Tees, a clinically led, independent reconfiguration panel recommended that a new hospital should be built. Is that not something that the Government should be doing?

[Mr Burns]

I have to congratulate the hon. Gentleman. I remember that as a Minister he was extremely helpful, within the confines and straitjacket of his remit. He was tenacious both in that job and this afternoon, and is using his skills to try to tease out an answer beyond the one that was given to him in my letter to him last Thursday explaining why that capital project was cancelled as part of the public spending review. However, to be helpful, and if he would like it, I will repeat basically what the letter said. Facts are facts, and I am afraid that the situation has not changed since I wrote to him.

When this Government came into power in May, we were faced with the largest deficit and debt that any Government had ever inherited from an outgoing Government. The debt is a financial problem that must be addressed urgently. Therefore, the incoming Government announced a review of spending commitments that were made by the previous Government after 1 January 2010—that is, in the run-up to the general election. As a result of the review, which has been carried out over the past seven weeks or so, an announcement was made on 17 June in which the coalition Government announced the go-ahead of four major hospital programmes, ranging from the Pennines to Liverpool and to St Helier in south-west London. Unfortunately, the North Tees and Hartlepool project did not get permission to go ahead. I am afraid that that is the answer. It is because of the economic situation and debt in which we find ourselves.

[Mr Wright]

The Minister is gracious in giving way a second time. On that basis, and given what the Prime Minister said about NHS funding increasing in real terms despite the financial problems that we find ourselves in, capital spends will be provided elsewhere in the country, but seemingly not in my constituency. Are my constituents’ health outcomes not to be thought of because of financial considerations?

[Mr Burns]

The hon. Gentleman knows the answer to that question. That is not why the hospital was not given the go-ahead last week. I can appreciate his frustration. As a constituency MP myself, I too would be frustrated, but the hon. Gentleman, who is a generous man, must not try to reinterpret the decision for other reasons. Sadly, the decision was taken simply because of the urgent need of this Government to take decisions to start curbing the ballooning debt problem, which needs to be addressed. That is the reason, I am afraid. It has nothing to do with our commitment to reducing health inequalities and spending more money on providing health care and services for people throughout the country.

I hope that the hon. Gentleman is satisfied with that. If he is not, and if it would be of any help to him, I would be more than happy to meet with him and, if he wants to bring them along, his colleagues from the Hartlepool area and the surrounding constituencies. They can discuss the matter with me—my door is always open. I would be more than happy to do that, if we can arrange a meeting, and if he thinks that it would be helpful.

Let me return to Cornwall and the general position on health funding allocations. I was saying, before discussing Hartlepool again, that we will establish an independent NHS board.