Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

We recognise, absolutely, that bills for agency staff have become unsustainable, which is why we have taken deliberate action, including by introducing price caps on hourly rates last November, which has had a significant impact on reducing agency costs. In the year to date, agency costs are some £550 million less than they were last year.

[Jeremy Lefroy (Stafford) (Con)]

I welcome last week’s announcement about the increase in the number of medical school places. What plans does the Department have to ensure that there are sufficient clinical training places for those medical students?

[Mr Dunne]

I can reassure my hon. Friend that there is considerable excess demand from UK-based students to train to become a clinician in this country—only half of those who apply to train in medical school are accepted at present—so we are confident that there will be plenty of take-up for those extra places. With regard to clinical placements, we are in discussions with universities, colleges and teaching hospitals to ensure that there are adequate numbers of places.

NHS Sustainability and Transformation Plans

Jeremy Lefroy Excerpts

Wednesday 14th September 2016 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

First, I would like to place on record my thanks for the tremendous work of NHS staff throughout the country, in particular NHS staff in my constituency and the constituencies of other Members in Staffordshire, at the County hospital, the Royal Stoke hospital, GPs surgeries and so on. They have done a great job over the past five or six years when our health economy has been in the national spotlight.

Of course, we have had our own sustainability and transformation plan since 2012, with the trust special administration of the Mid Staffordshire NHS Foundation Trust. It was an extremely difficult and challenging time and I want to draw out two points from that. The first was eloquently made by the right hon. Member for North Norfolk (Norman Lamb)—the vital importance of consultation at every level. Do not leave people in the dark. There is nothing that my constituents like less than finding leaked reports and things that they are supposed to know about that they do not know about. Please keep as much in the public domain as possible. No doubt there will be plans that arouse anger and hostility, but it is better to deal with that properly and in public. That is what we discovered.

The second thing I want to say is: “Stick to what you agree.” What the trust special administrator for Mid Staffordshire came out with was not what we wanted. In fact, it was far short of what we wanted, although it was better than the minimum that was proposed at first, largely as a result of our local campaign. We have just had, as the hon. Member for Newcastle-under-Lyme (Paul Farrelly) mentioned, the temporary closure of our children’s emergency centre on safety grounds. That centre was specifically committed to in the trust special administrator’s proposals, and it only opened a year and two months ago. It must be brought back immediately, or as soon as possible—that means in the next few weeks—because it was a commitment. Commitments that come out of the STPs must be met.

The final point I want to make, following on from what others have said, is that we spend too little of our GDP on health. Even The Economist, as it made clear in an article last week, says that we need to spend a higher proportion of our GDP on the NHS. That means raising the money; in my view, we should do so through higher rates of national insurance in the long term. My hon. Friend the Member for Salisbury (John Glen) and I wrote an article about this a couple of years ago, in which we recommended a hypothecated tax. I believe that that is still an important way forward. As others have said, the STPs offer a good opportunity to go forward and make necessary changes, particularly around health and social care, but STPs that do not look beyond 2020 at the percentage of our GDP that we spend on health and social care will not succeed.

Carers

Jeremy Lefroy Excerpts

Thursday 9th June 2016 Commons Chamber

[Mims Davies]

I absolutely agree with my hon. Friend, and I am delighted to have secured this debate today to highlight these issues. I know that she works tirelessly in her community to support carers and the people who need them. I agree that there is a human cost and an economic cost to caring.

I thank the Backbench Business Committee for being so supportive in ensuring that this important topic gets time in the Chamber. I hope that this will be a wide-ranging debate. I am also grateful to the Government and to the Minister for Community and Social Care, who has been very supportive of my application to hold the debate this week, which is carers week.

We know the value of carers, but do we really understand what is involved? How do you become a carer? A loved one might get older or become disabled. A child might be born with challenges. Someone might experience an unexpected change in their health. There might be a car accident or an incident at work. An operation could go wrong. A mental health challenge could arise, resulting in the need for care. All of a sudden, you become someone who needs to be a carer. How do you manage it?

As my hon. Friend the Member for Cheadle (Mary Robinson) has suggested, long-term caring can have a financial and emotional effect on families. It can have an impact on relationships. You lose friends. You lose leisure time. You also lose your freedom. Relationships between husbands and wives change. You become a carer rather than a lover or a friend. The impact of the need for mum or dad or a child to come first means a big change for families. You can develop a fear of the phone. You could be at work, out shopping, doing the chores or walking the dog when you get a phone call to say that something has happened on your caring watch. It is worrying for you as a carer when the phone rings. You are mindful of what damage could be done while you are not there.

Carers week represents an important collaboration by Carers UK, Age UK, the Carers Trust, Independent Age, Macmillan Cancer Support, the Motor Neurone Disease Association and the MS Society. The focus this year is on building carer-friendly communities, and that is why I have tried in my opening remarks to remind people that someone in their lives is taking on the extra responsibility of being a carer. How many hidden carers do Members have in their constituency? Who do we know who is taking on that role? This debate gives us a chance to highlight the need to ensure that all our communities are aware of the work that unpaid carers do. Local GPs should understand the restraints a carer might face—I am aware that GPs themselves face many pressures—and employers should be spearheading flexible working and educating their own organisations to support carers.

[Jeremy Lefroy (Stafford) (Con)]

I congratulate my hon. Friend on securing this vital debate. Does she agree that some of the hidden carers are young people aged 12, 13 or 14? I have met some of them from Staffordshire and they do the most amazing work. They need our support.

[Mims Davies]

I absolutely agree with my hon. Friend. I shall go on to discuss the importance of young carers in a moment. More than 700,000 of the 6 million carers in this country are young carers who are taking on at a tender age all the burdens that I have described. This has an impact on their education and their opportunities. Our schools should show understanding and foster an environment in which young people can be carers. They should forge an appreciation of caring in our ageing society. Three in every four carers do not feel that their caring role is understood or valued by their community. It is incredible that we have so much more progress to make before we can live in a truly carer-friendly Britain. I believe that we are now at the start.

As I have said, more than 6 million people in England provide unpaid care, with 1.3 million providing more than 50 hours a week. In my constituency, there are more than 10,000 unpaid carers. We have an army of carers quietly working away looking after their loved ones across this country, and they do it for humane reasons. We do not do enough to support and recognise them. Locally, the loss of respite has been a great cause for concern. Respite offers carers freedom and time to regroup, and a lack of it can be a great concern. Alternatively, the wrong type of respite might be offered or it might be poorly managed. I have heard about such experiences in my constituency surgery feedback.

I thank the volunteers in my constituency who support our carers. The One Community brings together many groups to support each other, including the Age Concern centre, Dementia Friends, the Alzheimer’s group and all the people who help carers by driving their loved ones to hospital or to the GP.

I also want to say thank you to everyone in my constituency who runs a lunch club or a social club, all of which provide important opportunities for social contact.

A recent Carers UK report highlighted the fact that many carers are struggling. Most of us will have to care for someone at some point in our lives, and we want to be able to do that. Three in every five people become a carer at some point. Members of this House and of the other place, and our staff, are carers too.

In leading this debate, I should declare an interest. I was a carer, although I did not realise it. I was a hidden carer. We are nothing if we do not bring our own experiences to bear in our work in the House. I was a “sandwich carer”—that is, someone with small children and older, ill parents. We became so friendly with the local ambulance service that we were on first name terms, and I thank them all for the kindness they showed me and my family. My dad was affected by an incident at work and was cared for by my mother for more than 25 years. That had a massive financial impact on me as I grew up and on our family. And when dad was gone, guess what, mum needed looking after too, because when you are looking after someone you often forget to look after yourself. People can go downhill quite quickly in those circumstances.

I found myself muddling along looking after small children, going to GP surgeries and getting mum up to London, where we struggled on the escalators and on the tube to get to vital hospital appointments. I did not realise that that was an ongoing role for me. I gave up my job and threw myself into it. I remember the phone calls. One came when I was about to go on air at a radio station just before 6 o’clock in the morning. Dad was unresponsive. There had been a problem with his insulin. Luckily, mum was awake because she was going to care for my children, covering for me while I was at work. She was caring for me, I was caring for her, and we were all caring for dad. When the phone rang, I had to drop everything and get there. For me, that was a snapshot of what people are doing day in, day out, and year in, year out. There is no break. If someone is lucky to get one, that is great, but it is still your watch even when they are not with you—are they in the right place?

A particular story that comes to mind was when my dad developed glaucoma as a result of the diabetes that was brought on by the head injury. He was given respite, but at that point he had not told people that he was losing his sight. He was in a respite centre and got lost going to the loo in the middle of the night. He got in the wrong lift and was wandering around a strange place. He was over 70, frightened and concerned though he was meant to be in a safe place. That story meant that no further respite was taken, meaning no further breaks.

I want to move on from my experiences, but please remember that all of us will be doing this. There are people in the House who do it already. I hope that we can recognise and understand the issue.

Junior Doctors Contracts

Jeremy Lefroy Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

We are constantly monitoring what will happen with the new contract, and we want to make sure that we get it absolutely right. If the hon. Lady makes such a plea to me, she should also talk to the BMA and say that the way to make sure we implement this contract correctly is to sit down with the Government and talk about how to make it successful, rather than to refuse to talk to us, which is what is happening at Hull Royal infirmary and many other hospitals.

[Jeremy Lefroy (Stafford) (Con)]

I briefly attended a medical conference over the weekend, where doctors said they were hugely concerned about the impact on the vast majority of junior doctors who neither wish to strike nor believe that the contract is satisfactory, for the reason given by my hon. Friend the Member for St Albans (Mrs Main), when she was in the Chamber. They are being put in an impossible position. I really urge the BMA to withdraw the threat of strike action and the Secretary of State to make it quite clear that he will do whatever it takes in sitting down to resolve this issue for the sake of all our patients and their safety.

[Mr Hunt]

I am absolutely prepared to talk about anything that could be improved in the contract that will be introduced and, indeed, extra-contractual things such as the way in which rota gaps are filled and the training process. However, at the moment we do not have such a dialogue, and that has been the problem. The imposition of a new contract is the last thing in the world that we wanted as a Government. It followed 75 meetings—it was a totally exhaustive process—but in the end we found that our counterparty was not interested in sitting down to talk about this; it just wanted a political win. We had to make an absolutely invidious choice about doing the right thing to make patients safer. I wish we had not got to that point. We have got to it and we need to carry on, but the door is always open for further talks and discussions.

Junior Doctors: Industrial Action

Jeremy Lefroy Excerpts

Thursday 24th March 2016 Commons Chamber

[Ben Gummer]

Sir David Dalton wrote to the BMA with precisely that list. The BMA refused to reply to him. He made the judgment that there was no point in continuing negotiations because it was refusing to discuss, in any event, the remaining matters. The Government have to move ahead. We have been on this for three and a half years and it is better that we move ahead.

[Jeremy Lefroy (Stafford) (Con)]

It was with great sadness that I learned of the BMA’s decision, which is not in the interests of patients and not in the interests of its members. I urge it to withdraw the threat of action. At the same time, will the Minister consider pausing the imposition of the contract, so there can be meaningful discussions? Those discussions have to take place in the context of a withdrawal of strike action.

[Ben Gummer]

I say gently to my hon. Friend that meaningful discussions require both good faith and a will to talk from both sides. That is consistently the case on the Government side, but it has not been consistently the case for the junior doctors committee of the BMA. The fact is that this contract is better for patients, the patients he seeks to represent. It is better for doctors, the same doctors he seeks to represent. Therefore, any further delay would be bad for patients and bad for doctors. That is why we must move ahead with the implementation of this contract.

NHS: Learning from Mistakes

Jeremy Lefroy Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

My hon. Friend speaks very wisely. Let me say that one thing that has been a mistake of successive Governments is a short-termist approach to NHS managers. We ourselves have looked for a scapegoat when something has gone wrong—an A&E target missed or whatever—and not backed people making long-term transformations. That is something we need to think hard about.

[Jeremy Lefroy (Stafford) (Con)]

I thank the Secretary of State for his statement and for all the work he has done on this. I pay tribute to all those who have campaigned to bring patient safety to the fore, many from tragic experiences that they have had. What work is being done to ensure that medical schools and nursing schools have patient safety right there on the curriculum?

Mental Health Taskforce

Jeremy Lefroy Excerpts

Tuesday 23rd February 2016 Commons Chamber

[Alistair Burt]

The hon. Gentleman has a long-standing interest in these issues. He is absolutely right: in England, a pilot project with 27 schools is being run by the Department for Education to locate and identify a single point of contact in those schools on mental health issues for young people. Depending on the results, more projects can be rolled out. Early identification and support in school are absolutely essential, and that work is under way.

There are a number of different initiatives, sometimes inspired by people who have experienced personal tragedy in their own family. They realise that the tragedy that has befallen their young person might not have happened if their friends had been more aware of their circumstances, or if the school or college had been more aware. We look at all those different initiatives to see how best practice can be spread, but the hon. Gentleman is right to raise the issue.

[Jeremy Lefroy (Stafford) (Con)]

I congratulate the Minister and the Government on their commitment on this. He has just spoken about best practice. Last month in Stafford we held a round table on mental health. One of the issues that came up was that there were a lot of good local initiatives, both in the public and the non-governmental organisation sector, but sometimes they did not know about each other. Will he point us to best practice in the sector?

Oral Answers to Questions

Jeremy Lefroy Excerpts

Tuesday 9th February 2016 Commons Chamber

[Mr Hunt]

It is stretching things a bit to call that an austerity-driven problem when, next year, we are putting in the sixth biggest increase in funding for the NHS in its entire 70-year history. There are some severe problems at Barts, but we will tackle the deficit. We also need to ensure that we improve patient safety and patient care.

[Jeremy Lefroy (Stafford) (Con)]

The staff of the University Hospitals of North Midlands to whom my right hon. Friend entrusted the care of County Hospital in Stafford and the Royal Stoke University Hospital have done a great job both in improving the quality of care and in bringing down the deficit. Will he ensure that a long-term approach is taken to the finances of that trust so that we do not make rapid decisions that could result in difficult situations in the future?

[Mr Hunt]

As ever, my hon. Friend speaks very wisely. When we are reducing these deficits and costs, the trick is to take a strategic approach and not to make short-term sacrifices that harm patients. That is why, at the weekend, we announced a £4.2 billion IT investment programme, which will mean that doctors and nurses spend less time filling out forms and more time with their patients.

NHS Trusts: Finances

Jeremy Lefroy Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

I thank the hon. Lady, who asked some salient questions that I will address. She asked about the deficits across the system. It is true that there are some particularly challenged providers where the heaviest deficits fall, and they account for the larger part of the accumulated deficit, but it has been a very challenging time across the system, not only because of the demographic challenges facing the NHS that have got worse in every year of this and the previous Parliaments, but because of the effect of the excessive charges of agencies levied after the increase in staffing levels in the wake of Mid Staffs. To seek to address that area, which makes up the majority of the cost of the deficit, we have brought in the controls not only on agency spend—on locums—but on very high salaries and on consultancy spend. Taken together, that will make a significant difference to hospital trust finances.

The hon. Lady talked about public health. We accept that that is a very important part of achieving “Five Year Forward View”. That is why, over the course of this Parliament, we will invest £16 billion in public health across England, to ensure that we can achieve the kind of transformation that she wishes to see.

On GP recruitment, we intend to have 5,000 additional GPs by the end of this Parliament. I am glad to say that Health Education England is so far meeting its targets in filling those training places. I congratulate its chief executive, Professor Ian Cumming, on the work he has done in that regard.

The hon. Lady mentioned safe staffing and the NICE guidelines. During the process of NICE looking at safe staffing levels, it became clear, as the chief nurse identified, that we need to look more broadly at team staffing levels, not just at individual positions on wards. I think that the hon. Lady in particular will understand that. That is why the chief nurse and Dr Mike Durkin were commissioned together to look at and build on the advice of NICE. The safe staffing guidance, which will be released in the next few months, will show a broader and more complex understanding of staffing levels, which I know the hon. Lady will appreciate from her time on the wards.

I want to be clear that that staffing guidance will be signed off only once it has the approval of NICE, Professor Sir Mike Richards, the Care Quality Commission and Dr Mike Durkin, the head of safety and quality at NHS England. It will require their imprimatur.

[Jeremy Lefroy (Stafford) (Con)]

Our experience in Staffordshire is that it takes a medium to long-term plan to put things right. I pay tribute to the work of the staff at the Stafford County hospital and the Royal Stoke University hospital. Will the Minister assure me that any measures put in place, both in Staffordshire and across the country, will take a long-term view and not be driven by the need to cut costs within a financial year? A five-year plan, at the very least, is vital.

[Ben Gummer]

I could not agree more with my hon. Friend. It is important to take a long-term view. That is something that has bedevilled the NHS under all kinds of Administrations since its creation. For the first time, it has a five-year forward view, which means that it can begin to transform properly. The very best trusts in the country, such as that in Northumbria, previously run by Jim Mackey, have been able to do that. We want to bring that kind of excellence to hospitals across England, to ensure that they provide the sustainable staffing and quality levels that my hon. Friend is beginning to see at Mid Staffs after the long-term view taken by that hospital.

NHS and Social Care Commission

Jeremy Lefroy Excerpts

Thursday 28th January 2016 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

It is an honour to follow the right hon. Member for Don Valley (Caroline Flint), my hon. Friend the Member for Lewes (Maria Caulfield), the right hon. Member for Sheffield, Hallam (Mr Clegg) and other Members who have spoken. Excellent points have been made in every single contribution to the debate. One reason why I support the motion is that in my first contribution during this Parliament I said:

“Let us use the five years of this Parliament to set up a cross-party commission to look at health and social care for the next 20 to 30 years.”—[Official Report, 2 June 2015; Vol. 596, c. 524.]

I believed that then and I believe it now.

A substantial reason why I believe that comes from my experience representing Stafford since 2010 and my involvement in the community in the years before that. In the previous Parliament, there was a tremendous coming together of people from all parties in Stafford so that we could protect our health services and respond to the serious problems that we faced. We made proposals to the Government, as well as arguing with them and opposing some of their ideas, but we wanted to support our area’s health services. It was a privilege to be part of a process in which people from all the main political parties and none were putting aside their differences and working together. I know that a similar thing happened in other constituencies, but I was especially grateful that that happened in Stafford, given what we had been through.

Another reason why I strongly support a commission—or a commitment, or a way of bringing us together—is that there are incredibly important issues to decide. My hon. Friends the Members for South West Wiltshire (Dr Murrison) and for Bracknell (Dr Lee) made important points about the issue of specialism and generalism. There is a danger of going too far down the specialist route and thinking that everything must be in a specialty. According to the Royal College of Physicians, this country has something like 62 specialties, yet some of the royal colleges want to go even further. Indeed, I understand that there is a desire further to split up cardiology into interventional and non-interventional cardiology, although I hope that that is not the case.

By contrast, the RCP pointed out that in Norway there were just over 20 specialties—it is a more generalised system. Whereas I agree that specialties need to be concentrated in the way that my hon. Friends have suggested, we must not cast out general medicine. We must not cast out those who would like to work in a more general way in a more localised setting. For many people that can be a more satisfying route, seeing the broad range of health, rather than one increasingly narrow part of healthcare.

[Dr Murrison]

Does my hon. Friend agree that one solution might be to develop further the GPs with specialist interest model, which was started some years ago but, if we are honest, has never really found its place in our NHS?

[Jeremy Lefroy]

That is an excellent point. I declare an interest, being married to a GP. Many GPs are already doing that—many have specialist interests. Perhaps there could be a specialism of generalism, if that is not a contradiction in terms—the idea that it is possible for someone to say, “I want to practise my medical career in a smaller place where I do a wider variety of tasks, but I have the knowledge to recognise the limits of my competence and when to refer onwards.”

I welcome the motion and the commission, although I will suggest some boundaries to it. The points that have been made about not going over old ground and not making the commission’s remit so broad that it is of no earthly use are valid. The Barker report has done some tremendous work in that respect and I will come on to that. There are other reviews going on, which I am sure have not escaped Members’ notice. The maternity review under Baroness Cumberlege, to which I have made a submission, is extremely important.

Here again, we see the contrast. On the one hand, we want the best possible care for mothers, pregnant women and their children when they are born; on the other hand, women want to be as close to home as possible. In some cases, and with midwife-led units, which we have just got in Stafford to replace our consultant-led unit, that can work for a limited number of women, but probably only about 30% of women will be able to go into such units; 70% will have to go further afield. We need to think about whether that is the right model. In the UK the largest unit, I believe, is in Liverpool, with more than 8,000 births a year. In Germany the largest is the Humboldt in Berlin, with about 4,500 births a year. Is there something to learn from that model, from the French model, from the Dutch model? I am hoping that Baroness Cumberlege’s report will show us that and give us a clear path for maternity and newborn care in the NHS.

I welcome the Government’s commitment to fund the five-year plan. That was not an easy step to take, but it was extremely important. As far as I can see, funding has been increased even since the election, but as others have said, it is a very challenging plan. Nobody has ever managed to achieve £20 billion or £22 billion of savings and we are already seeing some potential problems with that. I was lobbied yesterday by community pharmacists, who are seeing potential cuts in the sums allocated, which may result in the closure of pharmacies in the future. Of course, reform is needed, but the Government need to look carefully at that area.

I welcome, too, the additional money for child and adolescent mental health services. I chaired a roundtable of mental health providers in my constituency a couple of weeks ago. The additional money, the first part of which is just coming through, was welcomed and should plug some of the gaps in that service, although there remains an awful lot to do, as the right hon. Member for Sheffield, Hallam so eloquently pointed out.

I shall focus on two areas—integration and financing. At present the two main acute hospitals serving my constituents, the Royal Stoke and the County hospital in Stafford, are full. As other Members have pointed out, this is at a time when we have not had a major flu epidemic or abnormal winter pressures. We have something like 170 beds at the Royal Stoke with patients who should really be out of hospital but cannot leave, and in the County hospital we have around 30 beds. Of course, that means it becomes more difficult for their A&E departments to meet their targets.

I must say that the people in those departments are doing a great job. I urge Members to watch the little online video recorded in the Royal Stoke by The Guardian and see just how hard they are working in a hospital that this time last year was going through a very difficult time. It shows exactly what we are talking about, with people working long shifts and putting patients first, as they are in the County hospital and, indeed, in hospitals up and down the country.

We clearly have a problem in getting people out of hospital. As Members have said, that was raised 10 years ago, but we have still not fixed it. That is a real reason for integration. It is something the commission needs to look at, not to reinvent the wheel, but to look at where things are working and say, “Let’s get this right across the country.”

I think that the supported housing review, which was discussed in yesterday’s Opposition day debate, is critical. If a lot of the funding for supported housing goes as a result of changes to housing benefit, we will see a greater problem, with more pressure on A&E departments and in-patient services.

I very much endorse what Members have said about community matrons and district nurses, who perform a vital role. Only this week my wife was talking about the work of the district nurses in Stoke-on-Trent and how valuable and appreciated it is. However, not many of them are available at any one time, particularly over the weekend, which means a lot of juggling to see when they can go out to see her patients. Members have talked a lot about integration, and they have far greater knowledge than I have. I will just make the point that the commission needs to look at best practice.

I want to spend some time focusing on financing. It is absolutely right that the commission should examine all the options, but I have to say that, having looked at this quite carefully over a number of years, I do not think that we have too many options. I tend to agree with the Barker commission on that. Its report states that there should be a ring-fenced budget for NHS and social care, and it rejects new NHS charges, at least on a broad scale, and private insurance options in favour of public funding.

I have come to that view because I do not think that there is any other way in which the volume of extra resources needed will be raised. At the moment—I stand to be corrected on this—we probably spend between 2% and 3% less of our GDP on health than France or Germany does, which could amount to an additional £35 billion to £45 billion a year that we need to raise and spend.

I have to say that the NHS is a very efficient system. Given that efficiency, just think what would be possible if we came up with that extra 2% to 3% of national income, as our neighbours in France and Germany do. I am not talking about the 18% that the US spends, which in my view is far too much. A huge amount is wasted in the US system, and it does not necessarily achieve the right outcomes, particularly for people who are uninsured—thankfully that is changing as a result of recent reforms—or in lower income groups.

That is where we will run into political problems, which is why it is so important to put it into a cross-party, non-party political commission. In our fiscal system we lump together many different things and call them public expenditure, but what is called public expenditure is, in fact, made up of very different categories of spending. There is spending on state functions, such as defence, policing and education, and then there is spending on individuals, of which the biggest categories are pensions, welfare and, of course, the national health service, yet we are coming to a situation in which we talk about it all as if it is tax. So often in politics tax is bad, yet a lot of this spending is good; the two things do not make sense. In countries such as Germany, the latter forms of expenditure—the more personal ones—are often provided more through income-based social insurance. In the UK we started with that system more than 100 years ago, with national insurance, but over the past 50 years we have allowed national insurance to become less relevant, except in relation to eligibility for the state pension and certain benefits.

[Maria Caulfield]

On finance, I know from talking to my local council leaders that because for the past few years there has been a cap on how much they can raise their council tax by, they have not been able to raise it in order to pay for social care. I speak to residents who say that they would be more than willing to pay more if it was ring-fenced for social care and meant that there were more home helps and more services available. I welcome the announcement in the spending review of the 2% ringfence for social care because the NHS has had to pick up the bill due to the inability to properly fund social care.

[Jeremy Lefroy]

My hon. Friend is absolutely right. In fact, last year Staffordshire County Council raised its council tax by 1.9% but ring-fenced that part for social care, so it was ahead of the game. I believe that it is looking at doing the same this year, possibly taking advantage of the Government’s welcome proposal.

[Dr Philippa Whitford]

My concern about the 2% precept is that wealthy areas will obviously get a lot more money than poor areas, and that will increase health inequalities. Would the hon. Gentleman consider, for example, combining tax and national insurance? National insurance has become an anomaly in that people pay it even when they earn very little and stop paying it when they retire, even if they are very wealthy, so should something more radical be looked at?

[Jeremy Lefroy]

I do propose something radical, but in completely the opposite direction, because I believe that national insurance is an incredibly good thing. I always listen to the hon. Lady with great respect, but let me argue the case for national insurance, and she may disagree with me by way of intervention or otherwise.

We have allowed national insurance to become less relevant, with the exception of the various eligibilities I mentioned. As a result, it has come to be viewed by Her Majesty’s Treasury as just another form of raising funds. There was a proposal for a consultation on merging income tax and national insurance. I would vehemently oppose that, because my perception is that our constituents still, understandably, see national insurance as something different from income tax in being their contribution to the NHS, pensions, and welfare. Indeed, about £60 billion a year of the national insurance money that is raised, although this is a bit of a fiscal fiction, still goes towards the NHS. That is far less than we spend on the NHS, but it is still there.

The notion that, as I contend, our constituents see national insurance differently from income tax was particularly evident when Gordon Brown raised national insurance in order to put additional money into the NHS. He rightly viewed that as the best way of raising additional money for the NHS because it was more acceptable than putting a couple of pence on income tax. The best way—I think the only way, but a commission would need to be very broad-minded in its views—to ensure that we can finance the NHS and social care properly in the long term is through progressive, income-based national insurance with a wider base, as Kate Barker said, whereby by it does not stop when people retire and does not stop at the upper national insurance limit, as it does at the moment at only 1% over it. Broadening the base of national insurance should make it possible to keep the percentage rate reasonable for all while paying for the services needed.

I welcome this motion and the proposal for cross-party work, whether through a commission or whatever, but I would plead that it be fairly focused. It should not cover ground on the details of healthcare that has been well covered elsewhere—probably better than we could cover it—but it should look at integration and, most important of all, future finance for the next 20 or 30 years.