Sepsis (Preventable Deaths)

Jim Cunningham Excerpts

Tuesday 14th October 2014 Westminster Hall

[Sarah Newton (Truro and Falmouth) (Con)]

It is a great pleasure to serve under your chairmanship, Sir Edward, and it is a great honour to raise such an important issue with one of the Ministers with some responsibility for sepsis.

Before I outline the detail of my argument, I will share the scale of the challenge caused by sepsis. It is no exaggeration to say that sepsis is a hidden killer that claims more than 37,000 lives across the UK annually. Sepsis accounts for a third of the UK’s critical care expenditure, and it is the leading cause of death from infection here in the UK and across the world, but it can be stopped. An average constituency in the UK will have 140 cases of severe sepsis each year, resulting in more than 50 deaths. Simple interventions could cut those deaths by more than 50%. Timely interventions across the NHS could save 12,500 lives and £170 million each year with minimal budgetary requirements. Scotland and Wales have adopted the “sepsis six” and have better outcomes for patients than England.

So what is sepsis? Sepsis is a time-critical condition that can lead to organ damage, multi-organ failure, septic shock and, eventually, death. Sepsis is caused by the body’s immune response to a bacterial or fungal infection. It commonly originates in the lungs, bowels, skin, soft tissues or urinary tract. Rarer sources include the lining of the brain, liver or indwelling devices such as catheters. In a patient with sepsis, changes in circulation reduce the blood supply to major organs such as the kidneys, liver, lungs and brain, causing them to begin failing. Although most dangerous in those with impaired immune systems, sepsis can cause death in young and otherwise healthy people.

In my role as co-chair of the all-party group on sepsis, I have had the great pleasure of working with the UK Sepsis Trust, which is a registered charity comprising ex-patients and people bereaved by sepsis. In addition to raising awareness and providing support to members of the public affected by sepsis, the trust supports the actions and campaigns of its associated voluntary professional body, the UK Sepsis Group. Health professionals led by Dr Ron Daniels of the UK Sepsis Trust have identified simple, timely interventions and procedures, labelled the “sepsis six,” as a standard of care for sepsis patients when delivered within one hour. Early sepsis treatment is cost-effective, reducing hospital and expensive critical-care bed days for patients, and will save thousands of lives.

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

I am finding this information illuminating. I did not realise that 12,500 people a year are dying of sepsis. Will the hon. Lady indicate whether that figure is increasing or decreasing?

[Sarah Newton]

I thank the hon. Gentleman for his helpful intervention. The figures are, of course, estimates, but they are well founded estimates from clinical leads. As I will say later, the problem is that sepsis is poorly recorded, especially within acute trusts. We do not currently have a full picture of the number of people who are dying of sepsis. Often, the cause of death is registered as a result of sepsis, rather than from sepsis itself. Without the collection, mapping and use of accurate data, it is difficult to target interventions where they are most needed. The information I have been given is based on good, up-to-date evidence from clinical experts.

The hon. Gentleman is right to say that the scale of the challenge that we face is shocking. That is why I decided to work with the UK Sepsis Trust to set up the all-party group on sepsis in November 2013, following a successful reception for world sepsis day, and many parliamentarians on both sides of the House have been involved. At the same time, the Parliamentary and Health Service Ombudsman published her first report on the treatment of a particular condition. The ombudsman felt so strongly that we were not addressing sepsis in hospitals that she undertook research and published a report. That report, “Time to act. Severe sepsis: rapid diagnosis and treatment saves lives”, was truly groundbreaking, and it highlighted the number of preventable sepsis deaths and advocated swifter sepsis diagnosis and treatment across the NHS to reduce the numbers.

In June 2014, the all-party group launched a report, “The state of sepsis in the NHS”, which addressed the reliable collection of data on sepsis deaths in England and the wide variation in the adoption of the ombudsman’s recommendations across the country The report, however, noted progress, which we further discussed one month ago at our reception on world sepsis day. We noted that the National Institute for Health and Care Excellence will produce a bespoke clinical guideline on sepsis by 2016. NHS England is engaged and has launched a level 2 alert for sepsis, and it is discussing the possibility of a national commissioning lever. The Public Administration Committee recently held a one-off inquiry on sepsis, and it pushed the Government to act more holistically and make more rapid progress on implementing the ombudsman’s recommendations. Like me, the Committee was frustrated with the amount of time it has taken NICE to develop its guideline.

Some parts of the NHS have taken a pioneering approach to sepsis. I am proud to speak up for nurse Susan Bracefield, who has done excellent work in establishing an integrated sepsis pathway for children in the south-west, which I am sure will save lives through early detection and rapid treatment.

[Mr Cunningham]

It was remiss of me not to congratulate the hon. Lady on securing this debate. Is there any specific reason for the variation across the country? Can she identify what those reasons are?

[Sarah Newton]

I thank the hon. Gentleman for his kind words. I encourage him to visit the all-party group’s website, where he will find our report, which addresses each region of the NHS. I made a freedom of information request to every trust across the UK asking a series of questions about the identification, recording and treatment of sepsis in their area. The report shows stark regional variations in England. As in all matters, it is a question of leadership. Good leaders who identify and recognise that sepsis is a problem galvanise their colleagues into taking action. I have seen that in the south-west, particularly in the work led by Susan Bracefield on a paediatric pathway. Sadly, otherwise fit and healthy young children can quickly succumb to sepsis, with tragic consequences that none of us wants to see.

The all-party group’s report highlights the variations across the UK. Clearly more needs to be done, and this debate is about what more we can do about sepsis. It is important that we have education programmes for everyone involved in the health care environment. Sepsis is not only the responsibility of the acute trusts. We need early diagnosis by general practitioners, carers and ambulance staff. Everyone who comes into contact with people in the caring environment must be able rapidly to diagnose the early symptoms of sepsis and ensure that people get the appropriate treatment. That first hour is absolutely critical.

We need some sort of national commissioning lever to get things going. The commissioning for quality and innovation payment framework could be a good approach, and I am interested to hear what the Minister will say about that point. Public Health England also needs to develop a robust public awareness campaign. Terrific success has been achieved on stroke, through the work done to help people identify the early symptoms of stroke so they get to hospital or to their doctor quickly; health outcomes for stroke victims have improved in the UK. We should take a similar approach to sepsis, informing and educating the public about its symptoms, so that they seek medical help urgently.

Health Education England has a key role to play in disseminating education to health care professionals. Ron Daniels and the UK Sepsis Trust have done a huge amount of work with the royal colleges to consider training modules for people throughout the health service, and they need support to disseminate them widely. We also need a national registry of sepsis deaths and survivors to understand the longer-term impact. That will require resources, and exemplar sites will need to be developed and accredited to highlight best practice across the UK. Some parts of the country, such as Nottingham, are doing excellent work, and other parts of the NHS can learn from what their colleagues are implementing elsewhere in the country.

The Government could take a more joined-up approach to the issue. Three or four Ministers have some responsibility for sepsis in their portfolio. We need an approach that brings things together and a lead Minister to co-ordinate the work of their colleagues, and we need to sign up to the world sepsis declaration to reduce sepsis deaths by 2020. We need to make it a UK effort, but it is also a global effort; sepsis is a huge hidden killer around the world. Finally, we must consider how we can use commissioning within the NHS to drive forward the improvements that we all want.

Sepsis deaths can be reduced further. There are proven things that can be done, including implementing the sepsis six, that would have a huge effect on reducing avoidable deaths in the UK and would save the NHS considerable money. Sepsis is not only heart-breaking for families who have to watch otherwise healthy and fit young people, or people of any age, succumb rapidly to undiagnosed cases; it is traumatic for NHS staff who, due to a lack of education, sometimes feel powerless to give their patients the care they need or prevent those avoidable deaths.

We have made progress in the past 12 months. As one of the co-chairs of the all-party parliamentary group, I have been heartened by the extent to which the NHS has engaged with us on the issue. We must not lose that momentum. We must ensure that the issue continues to get the urgent attention that it needs.

Often, in debates on sepsis, we link in the issue of antibiotic resistance. Some very mixed messages can be sent out, particularly to people in general practice: they must prescribe fewer antibiotics to prevent antibiotic resistance, but they must prescribe antibiotics to prevent sepsis. However, I do not think that the issue is contradictory at all. As we deal with antibiotic resistance, we must understand that it and sepsis are intricately related. The two messages are actually aligned, as both campaigns encourage better and more appropriate antibiotic use.

I hope that in responding to this debate, the Minister will be able to address the specific challenges that I have set out and reassure me and all the parliamentarians with whom I am working that the issue remains of great importance to the Government and that the work of the ombudsman, the UK Sepsis Trust and parliamentarians through the all-party parliamentary group will be built on with great urgency in the months ahead.

Hospital Car Parking Charges

Jim Cunningham Excerpts

Monday 1st September 2014 Commons Chamber

[Jackie Doyle-Price]

Absolutely. It is always a good idea for public bodies to be more co-ordinated in how they approach such matters. No hospital acts in isolation, and car parking charges are often a function of how expensive local car parking is.

I welcome the recent announcement by the Department of Health to strengthen the guidelines given to NHS trusts on the implementation of car parking charges. They include the important provision that relatives of people who are seriously ill or in hospital for a long period should also be entitled to discounted or free parking. The guidelines are clear and welcome, but they do not go far enough. It is important that the House sends a clear message to the management of NHS trusts throughout the country that punitive car parking charges are wrong and will not be tolerated.

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

I congratulate the hon. Member for Harlow (Robert Halfon) on securing the debate; I assisted—if that is the right word—him in that. Does the hon. Lady agree that although car parking charges are far too high for a number of groups of people—my hon. Friend the Member for Coventry North West (Mr Robinson) and I have been campaigning for years in Coventry to get them reduced—it would take the muscle of the Secretary of State to help here, because not all car parking charges are based on PFI. There are hospitals that do not have a PFI, but those charges are built into their budgets.

[Jackie Doyle-Price]

The hon. Gentleman makes a good point. It is crucial for the Secretary of State to give clear and robust messages about what he expects from NHS trusts. This Secretary of State has probably done more in his period of office to put the patients at the heart of the NHS. We are talking about a rebalancing of the relationship between the patient and the provider. It is simply not appropriate for NHS trusts to decide their car parking charges without considering the impact that those will have on the welfare of patients.

Mitochondrial Replacement (Public Safety)

Jim Cunningham Excerpts

Monday 1st September 2014 Commons Chamber

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

Does my hon. Friend agree that it is probably necessary for the Government to bring proposals to the House for us to consider? There is not a lot of understanding about the disease outside the House and the public could be better informed, whichever way the decision goes.

[Mrs Glindon]

I agree. There is probably not enough understanding within the House, either.

The Minister had previously said:

“licensed fertility clinics are only required to report instances of OHSS to the authority that require a hospital admission with a severe grading, although in practice clinics often report moderate OHSS as well.”—[Official Report, 24 June 2014; Vol. 583, c. 157W.]

The figures that do exist indicate there has been a small recent increase both in the total number of recorded cases and in those cases categorised as “severe” rather than “moderate”. About 50,000 women go through IVF in the UK each year. The fact that we do not collect proper data on a potentially life-threatening condition that may affect a third of them, seems an astonishing oversight in the collection of official health statistics. Mandatory reporting of all cases is an essential first step in this process, but should only be the start of more effective and careful collection of statistics.

This issue has a particular pertinence at present because of proposed changes to the law on mitochondrial transfer and the Government’s stated intention to allow the creation of three-parent embryos. I am sure that many Members may be struggling to get to grips with the details of this procedure, but simply put both of the techniques used in mitochondrial transfer require a significant supply of donor eggs. Any such eggs will have to come from women who have been through controlled ovarian hyper-stimulation, with all the attendant risks.

Oral Answers to Questions

Jim Cunningham Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Speaker]

Mr George Mudie. Not here.

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

May I remind the Secretary of State that it takes seven years to train a doctor and most of the doctors he boasts about were trained under a Labour Government? What is he doing about the disparity between GPs surgeries and the service that they offer? Some months ago I made some visits in Coventry and I was amazed by the difference in the levels of service.

[Mr Jeremy Hunt]

It does take seven years to train a GP, but we also have to have an NHS that is able to pay for GPs when they are trained. That is why it was so important to take the difficult decision to reduce the amount of money that we spend on back-office and management costs. The hon. Gentleman is right to say that there is too much disparity in the services offered by different GPs. That is something that the chief inspector of general practice is thinking about, and he will publish his plans shortly.

Care Bill [Lords]

Jim Cunningham Excerpts

Tuesday 11th March 2014 Commons Chamber

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

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

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

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

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

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. With the hon. Gentleman facing that way I could not hear a word he had to say. I am sure it was a very short intervention that I would love to hear. Will he repeat the question?

[Mr Cunningham]

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

[Mrs Lewell-Buck]

I could not agree more with my hon. Friend.

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

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

Oral Answers to Questions

Jim Cunningham Excerpts

Tuesday 25th February 2014 Commons Chamber

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

What is the Minister doing to encourage local authorities to provide more places for care, particularly with the reduction in costs? Is he aware that local authorities are finding it difficult, because of Government cuts, to fund those places?

[Norman Lamb]

I am conscious that finances in local government are tight, but the better care fund, which I mentioned just now, has been widely welcomed. I was with a director of adult social care last Friday, who told me that his authority was planning to pool not just its share of the better care fund but the whole of its social care budget with the local health budget. That sort of radical, innovative thinking is exactly what we want and it will ensure that we protect services for vulnerable people.

Care Bill [Lords]

Jim Cunningham Excerpts

Monday 16th December 2013 Commons Chamber

[Andy Burnham]

One reason the Lewisham clause is so worrying is that simple collaboration between hospitals to solve financial problems is no longer an option to ease financial pressures. That is what it has got to do with the Care Bill. The Government are making a case for all hospitals standing or falling on their own, and in that context, the weakest can be picked off by the Secretary of State and closed without consultation. Given the financial pressures on many organisations, this special administration process is likely to be used on an increasing basis, putting more hospitals at risk. That should send a shiver though every community represented in the House today.

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

Does my right hon. Friend agree that the Government seem to have adopted a drip, drip, drip strategy to discredit the NHS? I can remember him proposing a national care service some months before we left office, but the Conservatives rejected it.

[Andy Burnham]

They did, and they put those posters up at the election to try to scare older people—I do not know how they thought that was appropriate, in the same way I do not know how their contributions today have been appropriate.

What my hon. Friend the Member for Coventry South (Mr Cunningham) says is exactly what is happening. People are not daft. They can see what is going on. They saw a Government legislate to place the market at the heart of the NHS in a way that means we now have the Competition Commission making decisions and forcing services out to open tender. We also have a Secretary of State who does not waste a day running down the NHS—“uncaring nurses”, “lazy GPs”, “coasting hospitals”; everything undermined, everything wrong—rather than celebrating good care. That is the agenda. They are softening the NHS up for more privatisation.

That will be the big choice come the next election. The Secretary of State can spin whatever lines he wants from that Dispatch Box, but that is the choice: a public, proud NHS under Labour, or a fragmented market under the Conservative party. I know which side of the debate I am on, and that is the choice we will put to people.

Hepatitis C (Haemophiliacs)

Jim Cunningham Excerpts

Tuesday 29th October 2013 Westminster Hall

[Paul Goggins (Wythenshawe and Sale East) (Lab)]

I am grateful to have the opportunity once again to draw the attention of the House and of Ministers to the injustice that still faces those who in the 1970s and 1980s became infected as a result of treatment with contaminated blood products.

Let me say at the outset that, although I seek in this debate to highlight the particular issues and concerns of those with haemophilia who were infected with hepatitis C, I recognise, of course, that the issues affect others beyond that group. Many haemophiliacs received other infections, HIV in particular, and some were dual-infected with HIV and hepatitis C. Others were multi-infected by the range of other viruses to which they were exposed. Some haemophiliacs were treated with blood taken from donors who later died from CJD. Others did not have haemophilia, but were none the less infected as a result of their NHS treatment. I am sure that some who contribute to the debate later will refer to the experience of those who have been affected in those other ways, and a number of points I will make will have a broader relevance to those people’s situations.

The reason that I selected financial support for people with haemophilia infected with hepatitis C as a topic for debate is simple: it reflects the specific concerns of three of my constituents with whom I have been campaigning on the issue for 16 years. They are Peter Mossman, Fred Bates and Eleanor Bates, who is Fred’s wife. I pay tribute to their determination and the single-minded way in which they have worked with other members of the haemophilia community in pursuit of justice and truth.

I am delighted that you, Mr Dobbin, will oversee our proceedings this morning, although given your keen interest in the topic, I suspect that a bit of you would like to participate.

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

I congratulate my right hon. Friend on securing the debate, which is one of many over the years. Does he, like me, think and hope that the Minister will give positive answers this morning, given the many debates in the past, so that the people affected can experience justice?

[Paul Goggins]

I am grateful to my hon. Friend for that intervention. He makes precisely the point I was moving on to. I welcome the new Minister, the hon. Member for Battersea (Jane Ellison), to the debate and to her new responsibilities. Whatever else she achieves in her time as a Minister—and I hope she achieves a great deal—nothing would be more important than bringing a measure of justice to those who have suffered from such injustice over so many years. Lord Winston described it as the worst treatment disaster in the history of the NHS.

I am delighted that we are joined this morning by so many hon. Members from both sides of the House—particularly the hon. Member for North East Bedfordshire (Alistair Burt), who raised the issue again with the Prime Minister in a clear and determined way a few days ago. I am also pleased that my right hon. Friend the Member for Leigh (Andy Burnham) is in attendance for the start of the debate. It is unusual for a Secretary of State, or shadow Secretary of State, to attend an Adjournment debate in Westminster Hall. His attendance is appreciated; he is keeping a promise made earlier this year. My constituents have asked me to thank him this morning for his willingness to listen—not only now in opposition, but when he was the Secretary of State.

Managing Risk in the NHS

Jim Cunningham Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

If the hon. Gentleman was listening, I said just a few seconds ago that the Secretary of State will not improve care for patients if he continually blames nurses and doctors. It is not one or the other, although Government Members seem to think they can attack the health unions for somehow being the enemy of patients. Ordinary people do not see it that way. They know that the staff are there for them day in, day out. We support the staff to help the patients. If staff are rewarded properly and have good working conditions, they will provide better care to patients. These are not opposites; the two go together, and the Conservative party would do well to remember that.

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

Some of us were here during the time of the previous Conservative Government, and I can remember that one of the hospitals in Coventry badly needed repair. After 1997, we got a new hospital. More importantly, one thing that Government Members always boast about is that they have increased the number of trainee doctors. It takes seven years to train a doctor. This Government are in their third year, so the credit goes to us.

[Andy Burnham]

As so often with the spin that we hear from Government Members, it is our achievements they are trying to claim credit for. I left behind the plans for the training of those doctors, but we do not hear much credit coming in this direction, do we? Government Members are happy to take the credit and then they try to cast off all the blame for everything else. My point is that criticism must be fair and made with care. We all have a duty to point out the failings of the NHS, in our own constituencies and nationally, and that is what I did when I did the Secretary of State’s job. However, we have to do that responsibly and fairly, especially for hospitals and those who manage them.

Hospitals are not the architects of all the problems we read about. For example, they are all struggling with the fallout of severe cuts to social care budgets, the appalling cost of which I recently revealed: a 66% increase over two years in the number of over-90s coming into A and E via blue-light ambulances. In human terms, more than 100,000 very frail and frightened people have been speeding through the streets of our communities in the back of ambulances. Hospitals have to absorb that extra pressure and also struggle with longer delays in getting people back home. We are in real danger of asking too much of our hospitals by allowing them to be the last resort for people who would be better supported elsewhere. Without a greater understanding of that situation in the current debate, and if the trend towards the vilification of NHS managers continues, who will take on the job of running our acute trusts? Good people will walk away and no one will want to do the job. Again, the NHS simply cannot afford that.

This crude blame game is an election strategy with two components: run down the NHS; and pin all the failings on the previous Government. The NHS cannot take 20 months of that until May 2015. It has been destabilised and demoralised already; if the Government are not careful, they will push it over the edge.

The Secretary of State needs to change course and find a way of bringing people back together, so the purpose of the debate is to put forward two constructive proposals to manage risk in the NHS—one for now, the other for the long term. First, I turn to the immediate proposal. It is clear that the best way to draw a line under recent events and unify people would be for the House to embrace today the analysis and main recommendations of the Francis report. The motion highlights the three most significant recommendations: benchmarks on safe staffing; a duty of candour on individual NHS staff; and the regulation of health care assistants. If all parties endorsed those proposals, it would send staff a message of support and recognition of the pressure that they are under, while the patients who have suffered poor care would receive the positive message that the parties are working together to prevent that from happening to others.

Given the tragic events that lie behind them, public inquiries should, when possible, produce consensus. It is extraordinary that, having commissioned a three-year public inquiry, the Government have slowly been distancing themselves from the Francis report’s analysis and conclusions ever since its publication. It is hard not to conclude that the report did not deliver what the Government wanted and that they have spent the past five months rewriting it. They have come up with their own recommendations on chief inspectors for hospitals, general practice and social care, yet dragged their feet on the actual recommendations. They have substituted the verdict of Francis on Ministers in the previous Government with that of the kangaroo court of Lynton Crosby. We do not oppose chief inspectors, but if the Government believe that ever-tougher central regulation will bring about the culture change locally that everyone agrees is necessary, they are mistaken. We need change that will have an immediate effect on the ground, and that will support staff and improve care for patients.

Health and Care Services

Jim Cunningham Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Grahame M. Morris]

That is an excellent point, and my hon. Friend the Member for Worsley and Eccles South mentioned evidence presented to the Health Committee that showed that £2.7 billion of expenditure or allocations has been removed from local government budgets and social care. That has had a huge impact on the service and resulted in changes to eligibility and thresholds, and charges for transport and other things.

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

I apologise to my hon. Friend for arriving a minute after the start of his speech. The hon. Member for Bradford East (Mr Ward) raised an interesting point about social care, particularly in relation to local authorities. Given the one-third cut, plus the 10% cut, in those budgets, I see a major problem for local authorities in buying care for elderly people. Indeed, it has been a major problem over the past two or three years.

[Grahame M. Morris]

That is an excellent point. I am sure that Members across the Chamber will have experience of that. On Friday gone, we had a crisis meeting of the county MPs and senior politicians in my local authority area of County Durham to determine how to cope with a further tranche of cuts. The situation is becoming serious. It is said that the allocations have been ring-fenced, but the local authorities’ discretionary spend is all being absorbed into social care and expenditure for children and the elderly, and there is very little room for manoeuvre.

--- Later in debate ---

[Mr Jim Cunningham]

Does my hon. Friend agree that, unless something realistic is done about the health service, we could find ourselves back in a pre-1997 situation, with a shortage of beds and with people sleeping on trolleys?

[Grahame M. Morris]

I am grateful to my hon. Friend for that intervention. There is certainly a crisis in emergency care. The causes of that are multi-faceted, and I certainly do not agree with the Secretary of State’s analysis that it is simply the result of the change in the GP contract in 2006. Some of his comments to that effect have caused great offence to the medical profession. We are in crisis in many respects, including in the area of recruitment. It has been pointed out in recent evidence to the Select Committee that the NHS is not recruiting enough people into emergency care, or enough GPs. We are storing up bigger problems for the future if we do not have the necessary cohorts of trainees going through medical school.

A new approach is needed if we are to meet today’s challenge of the rising demand for health care in an ageing society. We will certainly need more co-operation, not more competition. We will need to see the integration of health and social care services, not more fragmentation, and we will need more whole-person care. In many respects, the Government’s reforms will make that harder, with markets fragmenting services and an open-tendering free-for-all meaning more providers dealing with smaller elements of a person’s care, without the necessary overall co-ordination.

We know about joint budgets. We have seen the Government transfer resources from the NHS to social care. However, what we need is a single budget. I should like to see a national health and care service, a co-ordinated service that focuses on an individual’s physical, mental and social care needs from home to hospital. We need a new focus on prevention: people who are at risk of being admitted to hospital should be identified and supported in their homes. The Select Committee has been looking into the policies and interventions that have enabled that to be done in other countries. We need to end costly migrations from home to hospital, and from there to expensive care homes where, in many cases, the individual must bear a huge financial burden. That is good for neither the taxpayer nor the individual. The integration of services will allow significant savings to be made. Investment in early intervention will limit more costly hospital admissions, as well as helping people to lead healthier lives.

There is a real choice. While the coalition Government are pushing for a free market in health care, Labour is calling for the full integration of health and care services. While the coalition talks of choice, it is delivering fragmentation. In contrast, Labour supports co-operation between doctors, nurses, social workers and therapists, all working together with a single point of contact.

There are huge risks, and the first news stories about them are beginning to surface. If we do not deal with the present situation, the need for fees may arise, and we may end up with a two-tier system. Top-up payments for treatment may be required, especially as more private companies enter the market. We may even see the re-emergence of an insurance-based free-market private health care system. I believe that we should remain true to the founding principle of the NHS: that it should be a health service funded from general taxation and provided free at the point of use. Ministers may shake their heads, but they should remember their last promise, that there would be no more top-down reorganisations.

The NHS, whose 65th birthday we celebrate this weekend, is Labour’s greatest achievement. We created it, we protected it, and we saved it after years of Tory neglect and under-investment. We must continue to protect and transform our most cherished public service, so that we can meet the challenges that we face in the future.