Oral Answers to Questions

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Monday 24th April 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Secretary of State.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

The Minister’s proposal to essentially collapse the work capability assessment into the PIP assessment means that up to 1 million people who have fluctuating health conditions, or who may be recovering from treatment, could lose out on up to £350 a month. That is causing considerable distress, and it will not actually get anyone back to work now. Why does he not adopt instead the policy that we have put forward, which is supported by the Centre for Social Justice: to change the work capability assessment rules and offer an “into work guarantee” for those with no work requirements? Is he content to leave 700,000 sick and disabled people who want to work blocked from journeying into work?

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Secretary of State.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

The Minister has just said that the DWP did not assess the reasons for which people are using food banks. Perhaps she will go back to her private office after this and ask her officials to look into whether people are using them because the Government cut universal credit by £20 a week, and cut it in real terms last year. Perhaps she could ask her officials whether it is because the DWP is taking deductions from universal credit payments every week. Perhaps she could ask the DWP if it is because earnings are worth less than they were in 2007. Perhaps she could ask the DWP whether it is because the Government have raised the taxes on working people. Perhaps she could ask the DWP whether it is because the Government crashed the economy and sent mortgages and rents through the roof. Perhaps she could ask the DWP whether more people are using food banks because that is the price of 13 years of economic failure.

Covid-19 Update

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Monday 12th July 2021 Commons Chamber

[Jonathan Ashworth]

rose—

[Madam Deputy Speaker]

Is it further to that point of order?

[Jonathan Ashworth]

It is indeed further to that point of order, Madam Deputy Speaker. I rise to reinforce the point raised by the hon. Member for Christchurch (Sir Christopher Chope) and the right hon. Member for Forest of Dean (Mr Harper). What the House is being asked to decide tomorrow is whether to proceed with compulsory vaccination for a certain section of the healthcare workforce. We have not had compulsory vaccination in this country since the 19th century, when it was tried and abandoned. This is an incredibly serious intervention. Is there a procedure by which the House can delay coming to a decision tomorrow until the assessment is published?

[Madam Deputy Speaker]

I do not believe there is such a procedure, as the matters on the Order Paper are a matter for the Government. I note that the Lord President of the Council has just come into the Chamber, so he will undoubtedly hear the end of this matter, although he did not hear the beginning of it and so I would not dream of asking him to comment. If the hon. Gentleman is suggesting that a delay should be put in place, I am sure he will be able to make reference to that when he has the opportunity to do so tomorrow.

A Plan for the NHS and Social Care

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Wednesday 19th May 2021 Commons Chamber

[Jonathan Ashworth]

I want to make a bit of progress. If the hon. Gentleman wanted more beds in the NHS and greater diagnostic capacity, he would have been arguing for capital investment in the NHS, which we did not get in the Budget and we did not get in the Queen’s Speech.

That brings me to diagnostic capacity—I have just given the hon. Gentleman his local diagnostic figures. [Interruption.] This is not about new hospitals; this is about diagnostic capacity. The Secretary of State knows that we still have some of the lowest numbers of computerised tomography scanners and magnetic resonance imaging scanners per capita in the OECD. We still have only average amounts of RTE radiotherapy machines. We need investment in this technology, which we are not getting in sufficient amounts. That is why, in the past year or so, we have seen 4.6 million fewer diagnostic tests for cancer. Some 46,000 fewer people are starting cancer treatment. We should not have to choose between covid care and cancer care, but, for too many, that has been the reality of the past year, and it means that 4,500 additional avoidable cancer deaths are expected in the next 12 months. It means that progress in survival rates for colorectal cancer, breast cancer and lung cancer is expected to be undone. The proportion of cancers diagnosed while still highly curable has dropped from 44% to 41%.

The long-term plan, on which the Secretary of State fought the election, promised rapid action on cardiovascular disease. Experts now predict the highest cardiovascular mortality in a decade, and they predict 12,000 additional heart attacks and strokes over the next five years. The Queen’s Speech needed to include proposals to expand access to the appropriate cardiovascular healthcare facilities, but it also needed to include real interventions to tackle smoking and alcohol rates, and to reduce salt intake. Yes, there is a commitment to a tobacco control plan, but will there be a reversal of the 17% cuts to smoking cessation services? Given that 7,400 people died last year from alcohol abuse—a record number—will the Secretary of State reverse the cuts to drug and alcohol addiction services, with budgets being cut by 15% over the past three years?

We have been promised action, again, on banning junk food advertising, but when? I have heard the Secretary of State—and, to be fair, his predecessor—make that promise at the Dispatch Box many, many times, but when will we have the ban? When will he reverse the cuts to public health weight-management services?

Narrowing health inequalities should be at the heart of every Government policy, but there can be no levelling up while life expectancy advances stall for the poorest in society. Levelling up and tackling inequalities apply to mental health outcomes as well. More people suffer from depression in the poorest areas of the country than the richest. We know that the mental health problems are prevalent among certain minority ethnic communities —black men, in particular, are more likely to be detained under the Mental Health Act 1983, more likely to be subjected to seclusion or restraint, and less likely to access psychological therapies. We therefore welcome the commitment to reform the Mental Health Act, as we welcomed it last year, and I look forward to working constructively with the Secretary of State on reforming the Act. I would like to put on record my thanks to Sir Simon Wessely for his pioneering work on this front. Simon is a committed Chelsea fan, so I dare say that he will be more responsive to my felicitations this morning than he might have been on Saturday evening.

We face a crisis in mental health now, and we need action now. Two hundred and thirty five thousand fewer people have been referred for psychological therapies; eating disorder referrals for children have doubled; and the pandemic—again, because of infection control measures —has meant a reduction of almost 11% in beds occupied, which is equivalent to 1,700 fewer patients over the past three months compared with a year earlier. When will the Government implement their promise of significant increases in staff and resources for mental health, to ensure that mental healthcare is genuinely given parity of esteem with acute services?

That brings me to staffing more generally. Given that we are short of 200,000 staff across the health and social care sector, why was there nothing new in the Queen’s Speech to recruit more doctors, nurses and social care staff? Why was there no plan to give our NHS staff the pay rise that they deserve? NHS staff, including nurses who have cared for those with covid on wards, and district nurses who, in the first wave, cared for those who were discharged from hospital earlier than planned so that they could stay at home safely, have gone above and beyond, yet they feel that the 1% pay rise, which could well turn out to be a real-terms cut because of inflation, is a kick in the teeth. Is it any wonder that nurses are leaving the profession, including the nurse who cared for the Prime Minister, blasting Ministers for treating NHS workers with a total lack of respect? It is simply not fair. Our NHS staff deserve better.

The gaping hole in the Queen’s Speech is the plan for social care. Two years ago, the Prime Minister stood on the steps of Downing Street and said he had a plan to fix social care. He said:

“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”

It was not a plan to be developed, or work in progress; no, this was a plan that was already done—oven-ready, you might say, Madam Deputy Speaker. But two years on, where is it? Has the Health Secretary seen it? What do we need to do to see it—perhaps we could pay for some cushions in the Downing Street flat? The Government promised us cross-party talks. They now brief that cross-party talks have taken place, but when—did they forget to send the Zoom link?

However, there is a consensus on social care, isn’t there? Care workers should be paid the living wage and proper sick pay. There should be a cap on costs, as this House legislated for. When the Institute for Public Policy Research, social care and older people’s charities and a House of Lords Committee, which, at the time, consisted of true-blue Thatcherites such as the noble Lords Lamont and Forsyth, have all called for reform of free personal care, why is the Secretary of State not engaging in that debate with us? To be frank, though, lack of cross-party talks is not an excuse for not getting on with reform. A Prime Minister with an 80-seat majority should be able to show some leadership and get on and fix social care.

If the Health Secretary wants to talk social care reform, I am free this afternoon. He knows where I am. I am happy to sit down with him at any time and discuss it. I think we would have very constructive conversations on this one, because it is true to say, as Members have detected, that we have developed something of a bond these past 12 months. The Health Secretary has been so friendly to me across the Dispatch Box that I am half expecting to win a lucrative PPE contract by the end of the day.

Because we have this new friendship, I have, as we say on the Labour Benches, some comradely advice for the Health Secretary. I know he is bringing forward a Bill to neuter the independence of the NHS chief executive and bring powers back to the Secretary of State. I have been around a long time and I remember when Tory MPs used to complain that the NHS needed independence, but we will leave that to one side. I just suggest that he ought to be careful what he wishes for, because I have been reading the Evening Standard, where Mr Tom Newton Dunn reveals not only that Simon Stevens, whom the Secretary of State is trying to neuter, was best man at the Prime Minister’s wedding, but that the Prime Minister is said to be about to appoint Simon Stevens—I beg your pardon, Lord Simon Stevens—to, yes, you guessed it, the newly empowered post of Secretary of State for Health and Social Care. It brings a whole new meaning to the phrase, “the best man for the job”, doesn’t it? But this is a Secretary of State who set up Test and Trace, who was responsible for PPE procurement and who failed to protect care homes. Dominic Cummings said the Department under his leadership was a “smoking ruin”—and now he wants more control.

The Queen’s Speech was remarkably unspecific in its description of the contents of the coming health and social care Bill, so perhaps the Secretary of State can reassure us today. Can he commit to ensuring that neither the NHS nor the partnership force to be set up in each integrated care system will permit the inclusion of private sector participants? Will he rule that out? Can he guarantee that as statutory bodies ICSs will meet in public, publish board papers and be subject to the Freedom of Information Act 2000? What guarantees can he give this House that the establishment of integrated care systems will not lead to more private corporations taking over GP practices, as has happened recently with Centene, or services currently delivered by NHS providers? I hope he can give us those very simple reassurances today.

With nearly 5 million people on the waiting lists and rising, ever-lengthening queues in our constituencies waiting for hip replacements and cataract removals, cancer survival rates worsening, mental healthcare in crisis, social care reform kicked into the long grass, and a costly, morale-sapping reorganisation on the way, we needed a fully resourced 10-year rescue plan for our NHS. I commend our amendment to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. At the beginning of this debate, I fear it was not quite clear which other amendments had been selected by Mr Speaker. I have now had an opportunity to look at my notes on my Order Paper. For the sake of clarity, let me tell the House that Mr Speaker has not selected amendment (e) in the name of Mr Bryant, as I predicted earlier. He has selected amendment (g) in the name of the hon. Member for Walthamstow (Stella Creasy), the right hon. Member for Haltemprice and Howden (Mr Davis) and others. He has also selected amendment (i) in the name of the leader of the Scottish National party.

I remind hon. Members that, although their contributions should address the terms of these amendments, it is in order for them also to refer to other matters relevant to the Gracious Speech.

Health Inequalities

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Wednesday 4th March 2020 Commons Chamber

[Zarah Sultana]

I thank my hon. Friend for giving way. Health inequalities between regions are stark, but there are also huge disparities across short distances. In my constituency, the life expectancy of men in St Michael’s is 13 years shorter than it is of men just 2.5 miles away in Stoneleigh, just south of Coventry. Does he agree that to reduce those shocking health differences, the Government need to tackle underlying economic inequality and systemic poverty, and reverse 10 years of Tory cuts?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Lady’s intervention might not have seemed very long to her, and I appreciate that she is new to the House, but it was very long. I thank the hon. Member for Leicester South (Jonathan Ashworth) for what he said before he took that intervention. It would be much appreciated if the Front-Bench spokespeople took only a few interventions. This is a debate—we can have some interventions—but if Members who intend to intervene and then leave take up all the time at the beginning of the debate, those who sit here all afternoon will not get to speak at the end. We are talking about unfairness here, and that is unfair. The hon. Gentleman has been most courteous, and I know that the Minister has also been courteous in saying that she intends to take only a few interventions.

[Jonathan Ashworth]

I am grateful, Madam Deputy Speaker, but the point made by my hon. Friend the Member for Coventry South (Zarah Sultana) was an excellent one. She is right: this variance in life expectancy and these widening health inequalities are surely intolerable, and we have been sent here by our constituents to do something about it.

Taking your guidance, Madam Deputy Speaker, I will try not to take any further interventions, because I am aware that Members want to make maiden speeches. I am sure that Members who have been in the House a bit longer will testify that I am usually very generous in taking interventions. I hope Members will understand.

I dare say that the Minister will pray in aid the Office for National Statistics data that came out last night, but that is just a single data point. The ONS data also shows that regional inequalities in health have widened since 2010 and confirms that life expectancy for women in the most deprived decile outside London and the north-west has fallen. The rate of increase in life expectancy slowed markedly after 2010, which just happens to coincide with the swingeing cuts to public services and working-age benefits that the Tory Government imposed upon our society.

When life expectancy stops improving, inequalities widen and health deteriorates. That is why Sir Michael Marmot found that time spent in poor health is increasing for men and women in the most deprived areas of England. He found that there is a north-south gap opening up, with some of the largest decreases seen in the most deprived 10% of neighbourhoods in the north-east. He found that the mortality rate among those aged 45 to 49 is increasing. So-called deaths of despair—the combined effect of increasing death rates from suicide, drug abuse and alcohol-related illness—are a phenomenon we have seen for many years in the United States, and they are now making their morbid presence felt here. Perhaps most shamefully of all, the most deprived 10% of children are now twice as likely to die as the most advantaged 10% of children, with children in more deprived areas more likely to face a serious illness during childhood and to have a long-term disability. Surely this stands as a devastating and shameful verdict on 10 years of Tory austerity and cuts. Of course, we have always had health inequalities since the NHS was created 70-odd years ago, but the point is that the Government should be trying to narrow them, not widen them, because as Professor Marmot says,

“if health has stopped improving it is a sign that society has stopped improving.”

Perhaps some will quibble with Marmot’s findings, but they coincide with what others have found. For example, the all-party group on longevity found a few weeks ago that men and women in our poorest areas are diagnosed with significant long-term conditions when they are, on average, only 49 and 47 years old respectively. The Institute for Fiscal Studies’ Deaton review has also warned about deaths of despair, pointing out that rates of long-standing illness and disability among people aged 25 to 54 have been increasing since 2013. The Royal College of Paediatrics and Child Health has today warned of stalling infant mortality rates and how a generation of children is being failed.

I am afraid that this does not suggest that the Government are “moving heaven and earth”, in the words of the Secretary of State, to tackle widening health inequalities, and it does not fill us with much confidence that the Secretary of State is on target to meet his goal of five years’ longer healthy life expectancy by 2035. Will the Minister update us on how we are getting on in meeting that target?

I hope that the Minister, who has responsibility for public health, will also give us some reassurance about the Government’s plans to mitigate the health inequality implications of the covid-19 outbreak. May I press her to explain exactly what the Prime Minister meant at Question Time earlier? Is the Prime Minister saying that statutory sick pay will kick in from day one? If so, we welcome that, but because of low pay, the earnings threshold, precarious work, the gig economy and zero-hours contracts, about 2 million people are not eligible for statuary sick pay. The Prime Minister seemed to suggest at Question Time that such people would be eligible for universal credit, but the Government’s own guidance—I checked the website just before the debate—makes the position crystal clear. The Government’s website says:

“It usually takes around 5 weeks to get your first payment”

in respect of universal credit. The public health implications of that should be blindingly obvious: some of the lowest-paid workers who need to self-isolate will be forced to make a choice between their health and financial hardship. Surely it would be far simpler and smoother just to guarantee statutory sick pay for everyone from day one.

There are also practical problems with sick notes. People are being asked to self-isolate for a fortnight, but as the Secretary of State himself said yesterday, self-certification lasts for only seven days. Will this now be extended from one week to two weeks? I put it to the Minister, as I put it to the Secretary of State yesterday, that we will co-operate and help the Government with emergency legislation to ensure that statutory sick pay for all from day one is on the statue book as quickly as possible. Will Ministers take up our offer?

I dare say that the Minister will want to remind us of the funding settlement for the NHS for the next four years, but she will not be able to remind us of the public health funding settlement for local authorities for the next month because Ministers have not told local authorities what their public health allocations are for the next financial year, which starts next month. It is not good enough to say that the grant overall will increase. These are services that prevent ill health and promote health and wellbeing, as she knows, and those services have been left teetering after years of real-terms cuts of about £1 billion. Smoking cessation services have been cut, obesity services have been cut and drug and alcohol services have been cut, while health visitor numbers are falling, school nurse numbers are falling and mandated health visits are abandoned, yet directors of public health are expected to plan for the next 12 months when they have not even been given their local public health allocations. When will they be published? We are expecting directors of public health to put in place plans to deal with the covid-19 outbreak, and they do not even know their budget lines. That is clearly irresponsible and unsustainable.

It is not just about health funding, however, because that does not tell the full story, as the Secretary of State, in fairness to him, has recognised. He has said before that

“only around a quarter of what leads to longer, healthier lives is…what happens in hospitals.”

We need the Government to focus on the wider social determinants of ill health, too: the childhood experiences we are all exposed to; the neighbourhoods we grow up in; the schools we are nurtured in; the conditions of the work that we do, especially in today’s gig economy; the food we eat; the quality of air we breathe; and the support we rely on in our older years.

Whether it is air pollution, the toxic stress of precarious work or how the benefits system operates, it is those in poverty whose health suffers as a result. Just last week, a longitudinal study in The Lancet found that universal credit is exacerbating mental health issues among claimants, causing tens of thousands to experience depression and mental distress. The Government cannot deny the links between poverty and ill health, because poverty, as Sir Michael Marmot says, “has a grip” on our nation. Some 14 million adults live below the poverty line. We have record food bank usage. More than 4,000 of our fellow citizens sleep rough on our streets, a huge increase since 2010, and over 700 die on our streets.

The poverty a child experiences harms their health at that time and through the rest of their life. Child poverty impairs cognitive development and creates an environment in which mental health and emotional disorders fester. Children in poverty are more likely to be obese, less likely to be up to date with immunisations, and more likely to be admitted to hospital, yet under this Government, the number of children living in poverty has already risen to 4 million, and we have reports of children scavenging in bins. We have 120,000 children pushed from pillar to post in temporary accommodation—a huge increase under the Tories. The working-age benefit cuts that are set to come in will push child poverty levels to the highest since records began in 1961—higher than even in the Thatcher years. That is not levelling up; that is condemning future generations to ill health and shorter lives.

But poverty need not be inevitable and life expectancy does not have to stall. This House should not let health inequality leave an indelible stain on our society. There is a better way, and I commend our motion to the House.

NHS Funding Bill

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Siobhain McDonagh]

Is my hon. Friend aware that there is also a tendency for capital funding in new schemes to go to those areas that are far more wealthy than those with the greatest health inequalities? Let me give my own experience of Epsom and Saint Helier Trust, where the local NHS is consulting on moving all acute services to Belmont.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. The hon. Lady will have her chance to speak for quite some time later in the debate, and I think that the hon. Gentleman is just concluding his speech.

[Jonathan Ashworth]

My hon. Friend’s point is absolutely right, and she is right to raise it.

The point is this: those most in need of health services now experience the poorest quality of care. It is an absolute disgrace. This political stunt of an underfunding Bill will not deliver the scale of improvements that our constituents deserve. We will not divide the House tonight, but instead seek to amend the Bill. Let us be clear: the Government should have brought forward a fully funded financial settlement for our NHS and social care. The ever lengthening queues of the sick and elderly in our constituencies deserve so much better.

The National Health Service

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Wednesday 23rd October 2019 Commons Chamber

[Jonathan Ashworth]

Let me deal with this point first.

The people of Leicester can see what is happening. Although the Secretary of State is putting money into Leicester Royal Infirmary, Leicester General Hospital in the constituency next door loses maternity services, loses the hydrotherapy pool, loses renal services, loses—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Remember that we were all going to try to be polite. The hon. Gentleman is talking about hospitals that people care about, and we must listen to him.

[Jonathan Ashworth]

It loses elective orthopaedics, loses urology, loses brain injury and neurological services, loses gynaecology, and loses podiatry.

--- Later in debate ---

[Jonathan Ashworth]

Absolutely.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Let me say before the hon. Gentleman answers the intervention, that he has been very generous in taking interventions, and that is good for the debate, but I am sure he will bear in mind that he has been at the Dispatch Box for nearly half an hour, and I just say to him gently that that is all right with me, but he will incur the wrath of those who are waiting to speak later in the debate when they only get three minutes.

[Jonathan Ashworth]

Thank you for your guidance, Madam Deputy Speaker. You are absolutely right. I will not take any more interventions and I will move to wrap up.

My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) is absolutely right that the compulsory competitive tendering provisions of that Act have forced through the privatisation of £9 billion-worth of contracts. Everything that was promised in the Act, from delivering on health inequalities to delivering more integrated care, has not come to fruition, which is why everybody understands that it needs to be repealed.

But there is another reason why the Act needs to be repealed: while it is on the statute book, it runs the risk of the NHS being sold off in a Trump trade deal. Under the World Trade Organisation, public services can only be excluded from trade deals where there is no competition with private providers or where they are not run for profit, but the enforced competitive tendering of contracts through the Lansley Act means private health providers already operate in competition with public NHS providers, and the so-called standstill ratchet clauses and the inter-state dispute mechanisms would mean a Trump trade deal would lock in the privatisation of our NHS ushered in by the Health and Social Care Act.

Integrated Care Regulations

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Monday 18th March 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move,

That an humble Address be presented to Her Majesty, praying that the Amendments Relating to the Provision of Integrated Care Regulations 2019 (S.I. 2019, No. 248), dated 13 February 2019, a copy of which was laid before this House on 13 February, be annulled.

I am grateful that we have found time to debate this prayer motion in my name and the name of my right hon. Friend the Leader of the Opposition. For the Government to have attempted to make these changes without proper scrutiny is a huge discourtesy to the House. These changes are fundamental, with potentially far-reaching implications for the NHS, and they have aroused concern—[Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. It is not fair to the hon. Gentleman that people who have voted are now having conversations here. I would be grateful if people who wanted to talk about other things left the Chamber.

[Jonathan Ashworth]

The changes in the regulations have aroused considerable concern in the country, and proper parliamentary time should have been made available for a proper debate on them; they should not have been made through secondary legislation.

The Opposition oppose the regulations and will seek to test the House’s opinion on them. We oppose the changes not because we are against integration. We have long called for greater integration of services to offer seamless care to patients, because the demands on the NHS are of a different nature from those of 71 years ago, when a Labour Government created the NHS with a tripartite structure. In those days, life expectancy was so much shorter, and infectious disease was the overwhelming medical challenge. In 2019, we are worlds away from the days when 30,000 hospital beds were set aside for the treatment of tuberculosis, or when wards were filled with row after row of iron lungs to treat those suffering from polio. Today, we are all living longer, with a variety of complex conditions, from diabetes to cardiovascular disease and chronic obstructive pulmonary disease—conditions that increase the risk of a poorer quality of life and mean a greater risk of premature death. Indeed, around 14.2 million people in England—nearly a quarter of all adults—have two or more conditions. More than half of hospital admissions and out-patient visits, and three quarters of primary care prescriptions, are for people living with two or more conditions.

The issue is not just ageing and frailty; poverty takes its toll. People in the most deprived areas of England can expect to have two or more health conditions at 61 years—10 years earlier than people in the least deprived areas. Health inequalities are widening, while advances in life expectancy are stalling. An ageing population, the increase in long-term conditions, and the increasing number of people with multiple health conditions means that we need to integrate services. Sometimes in these debates, when we talk of long-term conditions, we suggest that we are talking about a homo- geneous group, but it is quite the opposite. We could be talking of a 61-year-old man with renal failure and high blood pressure, or a 101-year-old woman with profound deafness and blindness. The way that such conditions affect quality of life, and the extent to which they are amenable to medical intervention, is likely to vary.

If health services are not better co-ordinated and not integrated, there is a greater risk to patient care through the poor co-ordination of medical care and increased time spent managing illness. The need to manage multiple medications may lead to poorer medication adherence, adverse drug events, and the aggravation of one condition by the symptoms or treatment of another. It can also mean damaging self-management regimes in which there are competing priorities, and a bewildering landscape for patients, who are often of an advanced age, with cognitive impairment and limited health literacy, so we support integration.

I have seen integration working on the ground. Just last week, I was in Bolton, where I visited the Winifred Kettle centre to see the model of integrated multi-agency work bring together mental health professionals, pharmacy, physio, occupational therapy and social workers. In Bury, I heard about how the local council’s chief executive doubles up as the chief executive of the clinical commissioning group. In Luton and Dunstable I saw with my own eyes that the hospital trust has various social care workers in its discharge unit, helping to avoid the indignity of huge numbers of elderly patients being trapped in hospital, ready for discharge but delayed for days on end, as happens too often. In Wolverhampton, a fascinating example is being developed: the hospital trust is taking on and employing GPs directly. In Wolverhampton, they call it vertical integration, although some might wish to go as far as to suggest that it is the nationalisation of general practice, something that not even Nye Bevan was able to achieve.

A Labour Government would move away from a competitive landscape of autonomous providers to one of area-based care delivered through integration, collaboration, partnership and planning. We will restore a universal, publicly provided and administered national health service. Locally, we envisage something akin to health and care boards, with a duty to provide health not only for those on a CCG list but for all residents. Nationally, the Secretary of State’s duty to provide care will be reinstated. We are consulting on these matters with patients, staff and wider stakeholders.

Points of Order

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Monday 22nd October 2018 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I thank the hon. Gentleman for his point of order. As ever, he knows, and the House knows, that that is not a matter on which the Chair can rule or take immediate action, but I can well understand from his description of what has happened why he wants to bring the matter to the attention of the House, and by raising this point of order, he has very effectively done so. I hope that the relevant Minister will note what he has said, but if he does not get the response that he hopes to get in the proper way, I am sure that he will raise this matter again with the Chair through one of the orderly ways in which such matters can be raised.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

On a point of order, Madam Deputy Speaker. I hesitate to raise yet another point of order on the ongoing clinical waste fiasco, especially as Mr Speaker has very generously granted me two urgent questions about it in recent weeks. However, it seems that every time the Minister for Health comes to the House, his statement unravels within days. Last week, he was specifically asked whether it was true that unqualified drivers were driving hazardous waste from Yorkshire to Slough. He did not answer and he said he was not aware of what was happening in Slough. Now we learn, yet again from the Health Service Journal, that Department for Transport officials had in fact granted a special licence for this waste to be transported in this particular way, even though it is in breach of the normal safety regulations. Indeed, just last week another licence was granted—this was before the Minister came to the House—to Mitie to allow it to take waste to Slough, and yet another licence was granted to allow it to take waste to Littlehampton in west Sussex.

The Minister did not say any of this in his statement last week, so could you advise me, Madam Deputy Speaker, of an appropriate way to express my disappointment and get it on the record? Could you also let me know whether you think that Ministers in the Department of Health and Social Care are as clueless as those making decisions in the Department for Transport?

[Madam Deputy Speaker]

I thank the hon. Gentleman for his point of order. On this second point, no, I could not let him know whether I think that Ministers are useless or perfect in the way in which they undertake their duties. That is a straight answer from me: no, I could not let him know that.

On the hon. Gentleman’s very important point, he will know, as the House knows, that of course the Chair is not responsible in any way for what a Minister says at the Dispatch Box; that is up to the Minister. I assume that the Minister has said what he has said in good faith, but the hon. Gentleman has an argument with that. He has asked me how he can put his concerns on the record, and again I will give him a straight answer: he has just done so most effectively. I am sure he will get a response from the Minister, and if not, I am sure he will be able to use one of the proper forms of bringing a question of an urgent nature to this House.

We now come to the presentation of a Bill by Mr Frank Field. The notice of presentation has been withdrawn.

Offensive Weapons Bill

Bill to be considered tomorrow.

NHS Winter Crisis

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Wednesday 10th January 2018 Commons Chamber

[Jonathan Ashworth]

On a point of order, Madam Deputy Speaker. Can you confirm that the effect of the Government refusing to defend their position in the Lobby this afternoon is that the motion that stands in the name of the Leader of the Opposition has been endorsed by the whole House and that we should therefore expect the Secretary of State to come to the House before the end of the month to make an oral statement to explain to our constituents when their cancelled operations will be rescheduled?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

What I can confirm to the hon. Gentleman is that the House has just voted to carry the motion that was before us. The motion therefore stands. As to what the Secretary of State will say or do over the next few weeks, I am sure that he will be back at the Dispatch Box in the near future as he is a most assiduous attender of this Chamber, but we all appreciate that he has other work to do, and we look forward to seeing him doing that.

Palestine and Israel

Debate between Jonathan Ashworth and Baroness Laing of Elderslie

Monday 13th October 2014 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

On a point of order, Madam Deputy Speaker, there are many Members who are keen to speak in this debate and—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. That is not a point of order. [Interruption.] It is not a point of order. The House is well aware that many Members wish to speak. The Minister and the Opposition Front-Bench spokesman are well aware. I notice that the Minister is keeping his remarks much shorter than Ministers normally do and I am sure he will conclude soon. We will not waste time on more points of order that are not points of order.