Glenfield Hospital Children’s Heart Surgery Unit

Liz Kendall Excerpts

Wednesday 19th October 2016 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

I beg to move,

That this House has considered the future of Glenfield Hospital’s Children’s Heart Surgery Unit.

It is a pleasure to serve under your chairmanship, Mrs Gillan. The future of Glenfield’s children’s heart surgery unit is a hugely important issue not only for my constituents and patients in the east midlands but for people across the country—Glenfield currently serves patients from 296 parliamentary constituencies. The Minister will know that 34,000 people have signed an online petition to save the unit, and I understand that many thousands more have signed the paper petition. That shows the strength of local feeling.

Like the hospital, I support NHS England’s desire to achieve the highest possible standards for children’s heart surgery across the country. NHS England’s standards rightly state that it must be able to

“reserve the right not to commission services from a provider that is so significantly at variance from the standards as to cause safety/quality concerns. Such a decision would only be taken following a risk assessment of the costs and benefits of both closure and non-closure.”

However, there is no evidence that Glenfield is at significant variance from the standards—in fact, quite the opposite. According to independent assessments, Glenfield has among the best clinical outcomes in the country, including for mortality rates and readmission rates, which are significantly lower than those in other centres. Clinicians at Glenfield rightly say that it makes no sense to close a centre that is already achieving precisely the good clinical outcomes NHS England wants.

[Sir Edward Garnier (Harborough) (Con)]

I congratulate the hon. Lady on achieving this debate, which continues the public debate we have been having in the county and the city in respect of the hospital. Does she agree that the hospital and its children’s heart unit not only has a regional and national reputation of the highest order but is a world centre of excellence, and for it to be closed or for any of its services to be decreased would be little short of wanton destruction? I urge her to urge the Minister to take that message firmly back to his Department.

[Liz Kendall]

I completely agree with the right hon. and learned Gentleman. I am sure that not only the 57 patients from his constituency who are currently receiving treatment but the thousands of patients who receive ongoing care, including for extracorporeal membrane oxygenation, which I will come back to, rightly value the high standards at Glenfield. It would be a huge and terrible mistake to close the centre.

In a recent letter to the hospital, NHS England raised concerns that more complex cases are being referred to Birmingham from Glenfield. I take issue with that. I would like the Minister to confirm that, in fact, only four such cases have been referred to Birmingham in the past three years, and that it is a professional obligation to seek second opinions when that is in the best interests of patients. That is enshrined in General Medical Council good practice guidelines and was recommended by the paediatric and congenital services review group in its recommendations in 2003. Few complex cases are referred but, when they are, it is in the best interests of patients. That should not be used as a reason to close the unit.

A second part of the standards that NHS England has set out is ensuring that sustainable numbers of children have surgery in each unit every year. The aim is to have 375 operations per year over the next three years, with 500 a year in the longer run. I want to make this clear: the hospital has told me and NHS England that it is on track for 375 cases this year and that, if it does not quite achieve that, it will not be by significant numbers. It therefore rightly asks: “Why put a centre on track to reach those standards at risk by this proposal?”

On the longer term goal of achieving 500 cases a year, there is an important question. More than 500 children in the east midlands need congenital heart surgery every year but do not all go to Glenfield. NHS England claims that that is due to patient choice. Some patients in Peterborough or Northampton will choose to go to places such as Great Ormond Street, but the claim that all patients in Northampton choose to go to Great Ormond Street while all patients from Peterborough choose to go to Leicester suggests the goals are more about historic referral patterns than about genuine patient choice.

[Gloria De Piero (Ashfield) (Lab)]

I thank my hon. Friend for securing the debate and for all the campaigning she is doing on this important issue. I could raise many constituency cases, but I will raise just one. Scarlett from Kirkby was minutes from dying by the time she arrived at Glenfield. Her mum, Zoë, told me that she would not have made it any further than Glenfield. Keeping Glenfield open is a matter of life and death for so many children.

[Liz Kendall]

I thank my hon. Friend for raising that point. She is absolutely right. Many patients and their families have told me that they simply would not be alive if they had had to travel much further. If the proposal goes ahead, the east midlands will be the only region in the country without a children’s heart surgery unit. It does not have to be this way, because if we properly manage the number of referrals across the east midlands, there will be enough for Glenfield and other surgery units to keep going. It is a balance between getting the right numbers and having quick access to a centre.

[Robert Jenrick (Newark) (Con)]

I thank the hon. Lady for initiating the debate. May I reiterate the point made by the hon. Member for Ashfield (Gloria De Piero)? My constituents who have contacted me about the hospital live a long way from Leicester—some of them live virtually on the South Yorkshire border, many miles away—and have used the hospital not just for routine surgery but for emergencies. They already have to drive 60 miles to get to Leicester, but if they had to go to Birmingham or Great Ormond Street, it would put lives at risk.

[Liz Kendall]

I share the hon. Gentleman’s concerns. We have to be aware that it is not just about the essential, vital emergency care and surgery when it is a matter of life or death and whether children can reach a centre in time. It is also about ongoing care and support. It is not just that they have one or two operations when they are little; they need care and support right through into adult life.

We must remember that children are part of families, and families have obligations. They have other children they need to get to school and they have work commitments. To throw that up in the air when they have those arrangements and their children need ongoing care and support is denying those patients choice.

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend is doing an excellent job in presenting the case. My young constituent, Jack Phillips, will be celebrating his first birthday later this month thanks to life-saving open heart surgery at Glenfield. His dad, Christopher, wrote to me:

“At such a devastating time having the support of our family who were able to visit from Nottingham regularly while we were in Leicester was vital to us.”

Is that not one of the issues about a centre being within easy reach of other parts of the east midlands?

[Liz Kendall]

My hon. Friend is absolutely right. We have to think about people’s needs in the round—the need for high-quality surgery; ongoing care and support; and, critically, help for those families for whom this is a terrible, frightening and ongoing experience. Making the east midlands the only place without a heart surgery unit does not make sense.

It does not have to be this way. In its own standards, NHS England says:

“Networks will need to establish systems to ensure that referrals…between centres are managed in such a way as to ensure that each clinician is able to achieve their numbers”.

Its own standards say that people need to work together so that everyone can achieve the best. However, at the moment NHS England is not developing the work. I am a long-standing champion of patient choice, but the current proposals deny choice to patients from across the country who use Glenfield children’s heart surgery unit on an ongoing basis.

[Edward Argar (Charnwood) (Con)]

I pay tribute to the hon. Lady for securing this important debate. The Glenfield children’s heart unit is vital not only to my constituents but, as she said, to people across the east midlands and beyond. She has alluded to the significant progress that the hospital has made in just the past year in driving up the number of referrals and operations. That significant progress gives me confidence that it is on track to meet its target. Will she join me in urging the Minister to press NHS England to pause, look at the excellent clinical outcomes and the progress on increasing referral numbers, and think again, to keep this hugely important children’s heart unit open?

[Liz Kendall]

The hon. Gentleman makes an extremely important point. The clinicians at the unit and the hospital bosses have striven continually to improve patient care. They are not complacent for a second. They bust a gut to keep making improvements. Those improvements will, I am sure, be recognised and acknowledged by the 58 patients in the hon. Gentleman’s constituency who are receiving continuing care at Glenfield. He is right to say that NHS England needs to look in detail at the improvements that have been and are being made. When NHS England came to the centre in September—I was more than a little disappointed that it had not made a visit before it launched its proposals to close the unit—it found that some of its perceptions were wrong.

One important standard for improving care is co-locating—bringing together, in other words—the different children’s services, which includes not just surgery but other heart support, paediatric intensive care and wider services available to children. NHS England initially marked Glenfield down for not having plans to co-locate services. I am afraid that that was completely and utterly wrong. On coming to the centre it discovered that there are indeed such plans. I would like the Minister to confirm that University Hospitals of Leicester trust has plans to complete the co-location of all the services before April 2019, and has secured all the capital budget necessary to build its new children’s services hospital. To put all that at risk when the hospital is trying to improve services would be a big mistake.

Finally, I want to discuss the impact on other services in Leicester and the region of closing the children’s heart surgery unit. It is extremely important. As I said earlier, NHS England has itself said that it would not put forward proposals to close the unit unless it had done a risk assessment of the costs and benefits, including the knock-on effect on other services. It has not yet done that. I am concerned about two services in particular. Glenfield has a world-leading extracorporeal membrane oxygenation service. Essentially, if someone has a weak heart and needs surgery on it, ECMO enables oxygen to be pumped back into the blood during the operation. Glenfield’s is only the second ECMO service in the world to treat more than 2,000 patients. It conducts 50% of the entire ECMO activity in the UK. It also has the country’s only national patient transport service enabling people who need ECMO to be transferred swiftly from anywhere in the country to Glenfield. The huge benefits of that service were seen during recent flu crises.

[Lilian Greenwood]

I thank my hon. Friend for being so generous in giving way again. My constituent, Alice Parker, was born at Queen’s Medical Centre 17 years ago. Her condition was so grave that her mum, Vicki, was told to expect the worst, but thanks to the expertise of staff at Glenfield who provide ECMO, Alice is now studying for her A-levels at Bilborough College and hoping to go to university to study biochemistry. Vicki describes the centre as “a true national treasure”, but actually, as my hon. Friend has said, it is an international treasure and it is vital that we do not lose the service.

[Liz Kendall]

That is right, and in fact Glenfield’s ECMO training is currently being provided not only to people from three other UK centres, but to people from seven other countries. NHS England seems to think that that work can be picked up and transferred somewhere, quickly and immediately, without loss of quality. In fact, as I know from speaking to many clinicians and nurses, that is not as easy as NHS England says.

[Amanda Solloway (Derby North) (Con)]

I thank the hon. Lady for bringing this important debate. Given that Glenfield’s outcomes are among the best in the country, and having listened to accounts of the expertise it offers, I wonder whether she will, with me, encourage the NHS to rethink its decision to close it.

[Liz Kendall]

Absolutely. It would be a big mistake and it does not have to be this way. The unit is improving its care. It already has some of the best outcomes in the country. If we manage the referral patterns, we can ensure that Glenfield and other units continue to improve their care and support. I am sure that the 41 patients from the hon. Lady’s constituency who are currently being treated at Glenfield will appreciate her speaking out.

UHL is one of five tier 1 providers of acute specialised services in the midlands and the east region. Our amazing paediatric intensive care unit is part of a network of centres covering 17 million people. Any significant change in the number of children with complex heart problems being moved away from UHL will have a serious impact on the PICU and destabilise the network. That is not my view—I am not a clinician—but what the clinicians in the hospital tell me, yet so far NHS England has failed to publish any risk assessment of those knock-on effects on Glenfield’s ECMO or paediatric intensive care. The continuing uncertainty about the unit is terrible for the clinicians who are working there and trying to improve care. The threat of closure may be one of the reasons why it is not receiving as many referrals as it normally would, but it is also deeply destabilising for the families whose children need ongoing care and support.

[Sir Edward Garnier]

I am grateful to the hon. Lady for letting me intervene on her twice. I concur with the point she made: the situation makes it very difficult to attract clinicians, nursing staff and technicians to such a hospital. We need the expertise but, if there is a state of confusion or uncertainty, things become more difficult. I know that my hon. Friend the Member for South Leicestershire (Alberto Costa) wanted to make that point—he has many constituents who work in or use the hospital—but unfortunately, owing to parliamentary business, he was unable to be here at 11 o’clock.

[Liz Kendall]

I know the hon. Member for South Leicestershire (Alberto Costa) would have spoken up on behalf of the 94 patients in his constituency who are receiving ongoing care and support.

It is a miracle that Glenfield is providing such incredible standards of care when it has been under the cloud of uncertainty for so many years. It makes no sense to close a unit whose clinical outcomes are already among the best in the country. It makes no sense to deny choice to hundreds of patients who are treated or want to be treated at Glenfield, and their families, when, if services worked together to achieve the number of referrals that we need, our unit and others could benefit and improve. It makes no sense to leave the east midlands as the only region in the country without a children’s heart surgery unit, or to put at risk a world-leading ECMO unit and a vital, high-quality paediatric intensive care unit that supports millions of patients across the midlands and the eastern region.

The Government must think again. They must look in detail at the current evidence from the hospital about its outcomes; they must listen to the views of patients; and they must balance all of those issues—high-quality surgery, ongoing care and support, the knock-on effect on other services and whether other units in the country would be able to treat all those extra patients before they have made huge improvements, which will take time. It does not make sense. It does not have to be this way. We can work together to save the unit and improve care for everybody.

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a great pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Leicester West (Liz Kendall) on securing the debate and on speaking with such evident passion and knowledge on the subject. I think she has impressed us all with her grasp of the issues. I also congratulate all other hon. Members, from both sides of the House, who managed to secure an intervention during her speech. They made their points clear, with some personal testimony from constituents who have used these facilities, and also made clear how important it is to the region of the whole, in their eyes, that the facility continues.

The future of congenital heart disease services at Glenfield hospital is an important subject, not just regionally but as part of the national plan to ensure that we have world-class heart facilities for infants and children in this country. It is a matter that has been around for some time, and I understand the point the hon. Lady and others made about how unsettling the uncertainty around the future of services is for the dedicated staff who work in those units. It is appropriate that we try to bring these discussions to a head in an orderly, thoughtful and timely way, so that that is not prolonged.

It is worth emphasising that NHS England’s review is about ensuring that CHD services are delivered with high quality and that they are consistent and sustainable for the future. The common standards, which have been agreed by clinicians, other experts and patients, are the driving force to make sure every patient benefits from the same excellent care. It is worth reminding hon. Members present that the proposals for changes to adult and children’s congenital heart services at Glenfield and the other centres across the country are at present just that: proposals. They are not final decisions. NHS England will be consulting on the proposals in the coming months, so it is not appropriate for me to respond in detail to all the concerns raised here today.

The hon. Member for Leicester West asked some specific questions, some of which I will be able to address but most of which, I regret to say, I will not. Those will be drawn out when we come to the consultation, so that the points she made about the current performance of the hospital can be brought to attention through the consultation process.

[Liz Kendall]

I am soon to meet the Minister at the Department of Health. If he is not able to answer the specific questions I have raised, perhaps he can come back to me on those issues at that meeting next month.

[Mr Dunne]

The hon. Lady has put her points on the record. I will be able to respond to some next month, but some will be part of the consultation, which we anticipate will get under way in the new year.

I am trying to put this in context, particularly in relation to the amount of time that we have been considering how to create excellent centres of congenital heart surgery for children across the country, which has been the subject of concern for more than 20 years. Clinical experts and national parent groups have repeatedly called for change, and there has long been an overwhelming feeling that change is needed. Added to that is the fact that children’s heart surgery has become ever more complex and technically demanding. Surgeons now operate on babies who may be only hours old, which demands a highly-skilled and technical team of doctors and nurses who maintain those skills through regular practice. That is why standards are being progressively raised for each surgeon over time, as the hon. Lady referred to.

As I am sure everyone involved in the Glenfield debate is aware, the process of consultation began quite a long time ago. A Safe and Sustainable review was launched in 2008 by the Department of Health under the previous Labour Administration—of which the hon. Lady was a member—to start addressing these issues. The decisions that came out of that review were challenged in court, via referral to the Secretary of State and subsequently to the independent reconfiguration panel. As a result of those challenges, the Safe and Sustainable review was halted. Responsibility for reviewing children’s CHD services was then handed to NHS England, which decided that its new review of those services would also encompass services for adults.

NHS England’s review team consulted extensively with patients and their families, clinicians and other experts before publishing the new standards for CHD services, which only came into effect in April this year. Hospital trusts providing CHD services were then asked to assess themselves against those standards and report back on their plans to meet the standards within the set timeframes. In July this year, following those assessments and further verification with providers, NHS England announced its proposals for change.

In the case of Glenfield, NHS England is minded to work with University Hospitals of Leicester to safely transfer CHD surgical and interventional cardiology services from there to appropriate alternative hospitals. The rationale for that is that NHS England is currently of the view that Glenfield does not meet the standards to be a centre for surgery and interventional cardiology, and is unlikely to do so in the future. The hon. Lady eloquently expressed her belief, presumably based on conversations with the hospitals and with clinicians, that they are on track to meet those standards. That will be important evidence to make available to the consultation, and I am sure that she and other hon. and right hon. Members will do so over the months of the consultation. NHS England’s assessment is based on information provided by the trust itself about surgical numbers, surgeons and their expertise, and which specialist services are located together. It has not come from the centre; it has come from the trust itself.

There is no plan to close Glenfield as a provider of CHD services, other than in relation to surgery. NHS England is instead proposing to continue to commission specialist medical services that make up much of the pre and post-surgical care required by people with congenital heart disease. Closing the medical services for CHD at the hospital is not mentioned under any of the proposals. That has understandably prompted much concern, including about the impact that such a transfer might have on issues such as children’s extracorporeal membrane oxygenation—ECMO—services and paediatric intensive care services, as the hon. Member for Leicester West identified. As I understand it, when the review was undertaken in 2008, Glenfield was not only the first hospital in the country providing ECMO services but was the leading hospital. There were not many others. Today there are five centres offering ECMO services, so Glenfield is not in quite as strong a position as it was a few years ago.

The hon. Lady referred to the petition on Glenfield and the many hundreds of thousands of people who have signed it, which demonstrates the strength of public support for maintaining the service. It shows how passionately people feel about these issues and their strong desire to defend their local services. At this stage I reiterate to those people that no final decisions have been made. We need to wait and see what comes from the next stage of the process, and I am sure the petitioners will make their views known during that. I appreciate that hon. Members may be frustrated that I cannot answer all their questions at this stage. The hon. Member for Leicester West has referred to the meeting we will have in the coming weeks. I look forward to that and to attempting to answer some of her questions.

I remind hon. Members that this is not about cutting costs—that allegation has not been made by anyone during the debate, which I appreciate. It is about trying to improve the standard of service for some of the most sick infants and children in the country, and to ensure that we have a robust, sustainable pattern of expertise in a slightly smaller number of hospitals. Precisely where we get to in deciding which hospitals should provide those services in future will come through the consultation that will take place. The intent is for a formal, three-month public consultation that will conclude in the spring, with decisions being made next summer. I am sure all hon. and right hon. Members present will participate in that debate and I look forward to hearing their contributions.

Question put and agreed to.

Land Registry

Liz Kendall Excerpts

Thursday 30th June 2016 Commons Chamber

[Mr Lammy]

If the House will forgive me, I will make some progress, because so many Members want to speak.

The recording of land and property ownership is integral to the functioning of our economy and has been carried out with integrity and impartiality by the Land Registry since 1862. Indeed, the Land Registry’s reputation as wholly independent from the influence and pressures of the market is crucial to its work. The current consultation exercise tries to preserve that necessary independence by attempting to create an artificial distinction between “Land Register ownership” and a new company which “delivers Land Registry services”. That is totally meaningless in practice. While the Government claim they will retain “ownership” of the land register, a private company would be free to grant title and make changes to the register as transactions occur. The consultation document talks of putting

“the right protections in place”

to ensure that the Land Registry would continue to deliver an impartial service to customers. However, there is absolutely no detail about what those protections and safeguards might be. In the words of John Manthorpe, former Chief Land Registrar,

“at the heart of this is the nonsense that a private company should have the power to decide the legal land and property title rights for others”.

The Department for Business, Innovation and Skills is yet to publish the responses to the latest consultation, but I have taken the time to read through the responses to the January 2014 consultation. I quote Clifford Chance, the law firm, certainly no stranger to the profit motive or enemy of the private sector, which said that privatisation would create:

“An inherent conflict between a private sector company, whose main purpose is to maximise shareholders’ profits, and the need of consumers for a low cost, high quality and risk free service”.

[Liz Kendall (Leicester West) (Lab)]

Does my right hon. Friend agree that although the Government say that they will retain ownership of the land register, that is completely meaningless while millions of changes are progressively made to it by the private company? Is that not the key issue? In the words of John Manthorpe, the former Chief Land Registrar whom my right hon. Friend has quoted, the proposal does not stand up to “any reasoned scrutiny”.

[Mr Lammy]

I am very grateful to my hon. Friend, who is absolutely right. Most registrars in the country are opposed to this act.

--- Later in debate ---

[Alan Johnson (Kingston upon Hull West and Hessle) (Lab)]

I congratulate my right hon. Friend the Member for Tottenham (Mr Lammy) on securing this debate. It is also a pleasure to follow the hon. Member for Carlisle (John Stevenson), who has demonstrated its cross-party nature. I shall not keep the House for long as my right hon. Friend has done such a good job and covered practically every point.

The Land Registry office in Hull represents our only success in securing Government business in many years by bringing that business out of London. It came to Hull in the 1980s specifically because the Government of the time wanted to bring good, decent, well-paid jobs to an area that had been devastated by the collapse of the fishing industry. Incidentally, the collapse of that industry had nothing to do with the EU; it was the outcome of the cod wars with Iceland, for which Iceland gained retribution earlier this week on the football field.

The Hull office has taken its share of the overall two-thirds reduction in staffing that has taken place in an attempt to make the Land Registry more efficient. During my 20 years as an MP, I can almost plot my time in that role by the number of inquiries, examinations and investigations into the Land Registry. They come up about every two to three years. My right hon. Friend mentioned the wonderfully named quinquennial review of 2001, when I was a junior Minister at the old Department of Trade and Industry. Quinquennial reviews took place across Whitehall and I was responsible for the quinquennial review of the Patent Office in Cardiff. One of my bright young civil servants—obviously hugely qualified—asked me why quinquennial reviews only took place every five years, so I explained it to him. That review, as my right hon. Friend said, concluded by saying that

“privatisation should be firmly rejected”

and that it would

“be an act of considerable folly”.

Three quinquenniums later, we are being asked to commit this act of considerable folly by a Government whose motivation seems to be not to improve the service, but to raise a quick buck—and a fairly insubstantial buck in the scheme of things.

[Liz Kendall]

My right hon. Friend mentioned the quinquennial review, one of the most important findings of which was that the registry’s core functions—maintaining the land register, providing services to customers and operating its guarantees and indemnities scheme—hang together

“like the particles in an atom”

and that it would be “a great mistake” to contract out or split any of those core functions and threaten the whole enterprise. Does he believe that that argument remains true today?

[Alan Johnson]

I do indeed. The quinquennial review, like all quinquennial reviews, had to be carried out by a neutral Minister from a different Department and the procedure was quite rigorous. That conclusion has been said in different words in practically every other examination.

Since the quinquennial review, the Land Registry has been subjected to an accelerated transformation programme, a feasibility study, a proposal for public bodies reform and, a little over two years ago, a plan to make it a service delivery company which was supported by just 5% of those consulted. Never has an organisation been scrutinised so often to such little purpose.

In the meantime, the Land Registry has got on with its crucial work with unimpeachable integrity, registering 87% of the land mass of England and Wales, paying large dollops of cash to the Exchequer—over £119 million last year—building up its digital capability and achieving customer satisfaction ratings close to 100%. It was 95% last year and everyone was reaching for the Kleenex because it had gone down from 98%. That is an extraordinary level of customer satisfaction.

NHS and Social Care Commission

Liz Kendall Excerpts

Thursday 28th January 2016 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to follow the hon. Member for Totnes (Dr Wollaston), who is always open to discussion and debate, and who speaks with great experience. I am sure I speak for many hon. Members in saying that we are all the better for it.

I support today’s motion not because I think we can somehow take the politics out of the NHS and social care. Services that are used by millions of people, employ more than 3 million staff and cost more than £130 billion of taxpayers’ money every single year will always be the subject of political debate and, in my view, rightly so. I support the motion because the NHS and social care face huge challenges—they are bigger now than they were at any point in our history. We must no longer ignore or downplay those challenges and expect services, staff and the families who need care to try to struggle through.

I agree with the right hon. Member for North Norfolk (Norman Lamb) that we need a new settlement for health and social care in England, and an independent commission involving the public, staff and experts could play an important role in helping us to achieve that goal. Cross-party support for such a commission is vital. As the former shadow Minister for care and older people, I know that it is extremely difficult for Front-Bench politicians, whether in opposition or in government, to be open about what it will take to ensure that our care services are fit for the future, how much that will cost, where the money will come from and, as importantly, what changes are needed to ensure that our care services are truly fit for the future. Front Benchers’ comments are likely to be leapt upon, twisted and exaggerated and end up as screaming headlines, but in the end it is not the politicians who suffer, but the patients, users, families and staff.

Many important reviews and commissions, and Green and White Papers, from both the Opposition and the Government, have addressed the issue in recent years. In particular, I give credit to the commission on the future of health and social care in England, set up by the King’s Fund and chaired by Dame Kate Barker, from which many of my comments today are drawn. However, all those initiatives have failed to achieve genuine cross-party involvement and agreement. The commission proposed in today’s motion could help to create the political space and buy-in that we desperately need to agree a long-term settlement for the NHS and social care, whichever party or parties are in power.

The need for such a commission is urgent. As the Barker commission said, given the budget settlement that the NHS has had since 2010, staff have performed remarkably, but the NHS is now struggling to meet many of its waiting time targets: the target for diagnostic services has not been met for 18 months; the 62-day cancer waiting time target has not been met for more than a year; and A&E waits are back to the levels of the early 2000s. NHS finances are also under acute pressure, with a projected year-end deficit already of more than £2 billion.

The situation in social care is even worse. Some 400,000 fewer people are receiving publicly funded social care than received it in 2010, even though our population is ageing. Many of those who still get care are getting less support than they were. More than 1 million people who have difficulties in the very basics of daily living, such as getting up, washed and dressed and going to the toilet, now receive no formal or informal help at all. Last year, the Care Quality Commission found that one in five nursing homes do not have enough staff on duty to ensure good-quality care. The latest survey from LaingBuisson shows that, for the first time since it started collecting figures, more older people’s care beds closed than opened. Five of the largest care home providers predict significant provider failure within the next 12 to 24 months. Three of the larger home care providers have already withdrawn, or signalled their intention to withdraw, from providing publicly funded care.

Those problems are not going away. The NHS “Five Year Forward View” sets out how the NHS hopes to close a gap in health spending that is estimated to reach £30 billion a year by 2020. That will require efficiency savings of £22 billion, and at least an additional £8 billion a year of real additional funding, which the Government have committed to provide, but no health service in the world has achieved efficiency savings of 5% in one year, let alone for five years in a row. As Simon Stevens, the chief executive of the NHS, has repeatedly stressed, the very broad calculations in the forward view depend on social care receiving a decent level of funding, given that cuts to social care inevitably increase pressure on the NHS.

I do not believe that there is a decent funding settlement for social care. The Dilnot reforms, which have been postponed to the end of the Parliament, were not intended to address current underfunding, but to cap the costs of care to individuals. The better care fund, which is welcome, and the new 2% precept on council tax for social care, will not fill the gap either. Indeed, even with the precept, it will be harder for areas with the greatest need for publicly funded social care to cover their costs, because they raise the lowest amount from council tax.

Our population is ageing and demand for care will increase, so the question we face is not whether the money will be spent, but where the costs will fall. Will they fall on collective provision through public expenditure, or on those individuals and families who are unlucky enough to need care and support?

There is no shortage of proposed solutions to that problem. The Barker commission has called for changes to the national insurance system to help increase funding, including removing the complete exemption from employee national insurance contributions for those past state pension age, and raising to 3% the additional rate for those above the upper earnings limit. The commission also proposes restricting winter fuel payments to the least affluent pensioners, so that at least some of the extra costs of care are met by those above state pension age who have the means to contribute. In his recent interview in The Guardian, Simon Stevens called on the Government to consider the housing assets, benefits and other support received by older people to achieve

“more flexibility between current disconnected funding streams for older people, so that at times of need everyone is guaranteed high quality social care”.

I believe we must face up to the vital question of intergenerational fairness. The vast majority of older people have worked hard all their lives in paid employment and bringing up their families. They need and deserve support, and they do not want to end up having to sell the family home to pay for care if they need it, but I know from my own family as well as from my constituency that older people also worry about their children and grandchildren, and how on earth they will be able to afford to pay the bills or go to college or university, let alone have the chance to own their own homes. In my view, we simply cannot ask the working age population to shoulder all the extra costs required to properly fund the NHS and social care in future. I believe many older people would agree.

An independent commission with proper cross-party support that genuinely involves and engages with the public—after all, they are the ones who ultimately fund the NHS and social care—could finally help us to make progress on finding lasting solutions to these inevitably difficult and controversial questions. As the Barker commission says, the challenges we face are clear: more people in need are receiving no support at all; fewer people are receiving publicly funded social care; care home providers are closing in the face of rising demand; companies that provide care in people’s own homes are leaving the publicly funded market; individuals and families who are unlucky enough to need high levels of care continue to face enormous bills; and staff shortages are leading to a rise in neglect as good people are unable to deliver good care, piling further pressure on the NHS, which in turn is likely to lead to declining standards of patient care. That is not a future that anyone would wish for their parents, themselves or their children, but it is the future that is upon us. It is time for politicians on both sides of the House to act.

--- Later in debate ---

[Alistair Burt]

If I may say so, Simon Stevens said, “Look, it needs £8 billion.” It also needs £22 billion in efficiencies. We have met the challenge and put in even more than £8 billion—by 2020 it will be £10 billion. I understand the pressures in the system and fully appreciate the right hon. Gentleman’s remarks. The King’s Fund stated in its 2015 report:

“‘Business as usual’ is not sustainable. But that does not mean the NHS is fundamentally unsustainable.”

Simon Stevens recently said:

“The NHS has a huge job of work to do ensuring an already lean health service is as efficient as it can be—which, in my assessment, people are entirely up for.”

He recently told the Health Committee, “In headline terms, £22 billion is a big number, but when you think about the practical examples and do the economic analysis, we have some pretty big opportunities in front of us.” We know that the challenge is there; nobody denies that. However, NHS England put its assessment of what it needs to the political parties at the last election. We met that challenge and were elected.

We have spoken about a process, and I will return to that in a moment. What NHS England produced was developed by it, along with Public Health England, Monitor, Health Education England, the Care Quality Commission and the NHS Trust Development Authority. The Government back the plan, but we need a strong economy to be able to do that, as a number of colleagues have said. Without trespassing too much into other areas, that is the meat of political debate in this country. The public are not just asked to make a judgment on the delivery of one particular service, however precious it is. It is about whether they think that those who are promoting their view of a particular service have the economic background to deliver it. That question was also comprehensively answered at the general election. We now have responsibility for carrying that forward. People believed that we could put the money into it, and we have done so.

[Liz Kendall]

The Minister says that he believes that the Government have met the challenge, so does he think, with regard to funding the NHS and social care, that it is job done?

[Alistair Burt]

I said that we have met the challenge that was put before us, which was to support what NHS England said it needed. We have done that through the financial commitment we have made. We looked very hard in the spending review to see what social care would need, and the Chancellor came up with the £2 billion social care precept, plus the £1.5 billion from other resources, so that is £3.5 billion extra by the end of 2020. We have put in place the financing that we believe will allow the delivery of health and social care over the next few years. But—and it is a big but, which I will refer to later—it is not just about the resources; it is also about how they are spent. Most colleagues have spoken about variability and how best practice is not always available elsewhere. We have to ensure that best practice comes in, and that is not just about resources; it is also about how things are done.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

I am very happy to look into that. The general direction of travel my hon. Friend is talking about is right. We need to empower patients. We need patients to become expert patients, so that they take responsibility for their own healthcare. That means giving them much more information to help them to make the right decisions.

[Liz Kendall (Leicester West) (Lab)]

The Secretary of State is trying to avoid the question asked by my hon. Friend the Member for Wirral West (Margaret Greenwood). It was a key recommendation of the Francis review into Mid Staffs that safe staffing guidelines should be drawn up independently from Government and NHS managers to make sure people are confident that they are based on what is best for patients, not budgets. Why has he gone against Francis? What was wrong with what NICE was doing? He has published no new criteria for NHS England and no process or timetable for action. Will he now commit to doing that, so that patients, staff and Members of this House can be confident that this is not just a cover for cuts?

[Mr Hunt]

We will not take any lessons from the Labour party about what needs to be learned from Mid Staffs. Labour Members should be ashamed of the state of hospital care they left behind. There are 8,000 more nurses in our hospitals as a result of the changes that this Government have made. They should welcome that, not criticise it.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

This is one of the main reasons why the Chancellor allocated £1 billion to modernise primary care facilities in the autumn statement. We recognise that many GP premises are simply not fit for purpose. If we are going to transform out-of-hospital care, we need to find ways to help GPs move to better premises, to link up with other GP practices, and that will be a major priority for this Parliament.

[Liz Kendall (Leicester West) (Lab)]

The 2010 Conservative manifesto promised every patient seven-day GP access from 8 am to 8 pm, but access has got worse and almost half of all patients now say they cannot see a GP in the evenings or at weekends. Five years on, the Conservatives made the exact same promise. Can the Secretary of State tell us why he has failed?

[Mr Hunt]

I welcome the hon. Lady back to her place, although I know she hopes it will be for only a brief time, and say to her that we have not failed. We made very good progress delivering seven-day access to GP surgeries for nearly 10 million people during the last Parliament, and we have committed to extending that to everyone during this Parliament. I think the hon. Lady said that what is right is what works, and what works is having a strong economy so we can put funding into the NHS that will mean more GPs.

Health and Social Care

Liz Kendall Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

As my hon. Friend the Member for Heywood and Middleton (Liz McInnes) has just said, it is a real privilege to speak in today’s debate and to follow so many passionate and thoughtful speeches, particularly from new Members. On this side of the House, my hon. Friends the Members for Bristol West (Thangam Debbonaire), for York Central (Rachael Maskell), for Brentford and Isleworth (Ruth Cadbury) and for Coventry North East (Colleen Fletcher) talked about the great talent and resources in their constituencies, but also about the inequalities in income, wealth, housing and health that hold too many of their constituents back. My hon. Friend the Member for Brent Central (Dawn Butler) and my right hon. Friend the Member for Enfield North (Joan Ryan) spoke about the closures of vital local services, which have caused—and will continue to cause—real concern in their constituencies, just as they are doing in many other parts of the country.

My hon. Friend the Member for Neath (Christina Rees) asked us to look through a window into her constituency, and she painted a picture as good as any Turner. But she and my hon. Friend the Member for Edmonton (Kate Osamor) also rightly reminded us of the struggles that their constituents face and the urgent need to regenerate and redevelop their areas to boost education, jobs and local services.

My hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), who is the first home carer to enter this House, warned us about the insecurities facing careworkers and those who depend on care. She also reminded us of the power of the Government to change people’s lives, which is something that we on the Opposition Benches firmly believe in. My hon. Friend the Member for Merthyr Tydfil and Rhymney (Gerald Jones) talked about the benefits to his constituency from European funding and the need for a yes vote in the referendum, which is something that I wholeheartedly support.

In the Queen’s Speech five years ago, the former Member for South Cambridgeshire, the then Health Secretary, promised “sustainable, stable reforms” that would deliver excellence and greater efficiency in the NHS. That was the rhetoric, but the reality was so very different. In place of stability, the Government forced through the biggest reorganisation in the history of the NHS. They said that it would cut red tape, but instead we have seen bureaucracy boom. We now have NHS England, the Care Quality Commission, Monitor, the Trust Development Authority, Healthwatch England, Public Health England, Health Education England, the National Quality Board, the NHS Commissioning Assembly and strategic clinical networks, and that is just at the national level. Then there are four NHS England regional offices, 25 local area teams, 12 clinical senates and commissioning support units. That is on top of 221 clinical commissioning groups and 153 health and wellbeing boards. Are we confused? We should be. Should we care? We must. [Interruption.] The Minister asks why I am going on about this again. I will tell her. As my right hon. Friend the Member for Exeter (Mr Bradshaw) said, the lack of clear leadership and accountability in the NHS, which is a direct result of this Government’s reorganisation, is fundamental to why the NHS cannot make the changes that patients need or get a grip on its finances.

[Mrs Main]

The hon. Lady listed an awful lot of bodies. Obviously, she thinks that there are far too many or that it is too confusing. Will she tell me which ones she would like to scrap?

[Liz Kendall]

Why is the hon. Lady not talking to her Ministers about the problems created in the NHS? Why do the Conservatives never talk about their reorganisation? I will tell you why: it is because they know it has been a mistake. Far from putting power into the hands of clinicians, let alone patients, it has put power into the hands of bureaucrats.

This Government’s addiction to broken promises goes on. Five years ago, patients were promised that they would be able to see a GP from 8 am to 8 pm, seven days a week. That may sound familiar—well, it should. The Prime Minister has had to make the same promise again in the latest Tory manifesto. It is no wonder that he has had to do that, because, under his watch, it has got harder to see a GP. Two million more patients now say that their surgery is not open at a convenient time, and a quarter say that they cannot get an appointment in a week, if at all, let alone on the same day.

The list of broken promises goes on. The Prime Minister said that, under his leadership, we would never go back to the days when patients waited for hours on trolleys in A&E, or months for vital operations. Yet the number of patients kept on trolleys for more than four hours has quadrupled, and the waiting lists are at a seven-year high. Why is that? It is because the Government wasted three years on reforming backroom structures rather than front-line services. They slashed the very social care and community services that should help to keep elderly people at home, piling further pressure on our hospitals instead.

The Government want us to forget their mistakes. But Labour Members will not let them run away from their record. We will hold them to account for their failures every week, every month, every year. I am talking about their failure on NHS finances and the deficits that have soared to more than £800 million and are set to get worse. Those deficits are predicted to be £2 billion by the end of this year.

[Mr Jackson]

rose—

[Liz Kendall]

What will the hon. Gentleman do about that?

[Mr Jackson]

On the subject of mistakes, apologies and looking back at the past, would the hon. Lady—in her role as a candidate in the Labour leadership election as much as anything else—like to apologise for paying GPs 27% more for doing less work in 2004 through the GPs’ contract, which curtailed out-of-hours services so drastically?

[Liz Kendall]

I will never apologise for Labour’s record on the NHS, for the investment and reforms that saw waiting lists at an all-time low and patient satisfaction at an all-time high, for rebuilding our hospitals and our public health and primary care or for tackling health inequalities. That is more than can be said for the record of Conservative Members. We will hold them to account for their failure on A&E as hospitals miss the four-hour target for the 97th week in a row, and we will hold them to account for their failure on cancer care. The cancer treatment target has now been missed for more than a whole year, and 21,000 cancer patients have waited more than 62 days to start their treatment. Anyone who has a relative or friend with cancer waiting to start treatment knows how desperate that can be, and it is not going to get better anytime soon.

The day before Parliament was dissolved for the election, NHS England snuck out a report saying that the cancer target will not be met again until at least March of next year. Would the Minister like to confirm that? If she will not confirm that, will she tell me how many patients will wait longer as a result so that Members can tell their constituents? Does she think that it is acceptable, and what is she going to do about it? I would be happy to give way to the Minister if she would like to respond. No? Well, that is typical of Conservative Members, who create the problems but refuse to admit to them and do not have a plan to deal with the result.

Five years ago, Government Members made important promises to patients and the public on the NHS. They promised stability, but their reorganisation created chaos. They promised to maintain Labour’s historic low waits for treatment, but waits have risen year on year on year. They promised seven-day access to a GP, but it is getting harder to get an appointment, and they promised to make the NHS more efficient, but they have wasted billions of pounds on their reorganisation, on agency staff, management consultants and soaring delayed discharges because elderly people cannot get the services they need at home. They come to this House today and repeat their promises and claims, but NHS staff do not trust them, patients will not believe them and we will not allow them to get away with five more years of letting patients down.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I echo the words of the shadow care Minister, the hon. Member for Leicester West (Liz Kendall): this has been a very good and passionate debate. We have heard a great deal of expertise and many excellent maiden speeches, to which I shall turn in a few moments. Of course, we have also been treated to rounds three and four of the Labour leadership hustings, which shone through very clearly. Oh, to be a fly on the wall at the shadow Health team meetings. The hon. Member for Denton and Reddish (Andrew Gwynne) and the hon. Member for Liverpool, Wavertree (Luciana Berger) have already declared for the right hon. Member for Leigh (Andy Burnham), but I think that the hon. Member for Copeland (Mr Reed) is keeping his powder dry at the moment. He is not in the Chamber at the moment; perhaps he is away considering his views. He has had a chance to listen to all the prospective leaders now. He is a one-man jury in “Labour’s Got Talent”, and we want to hear from him. We need to hear what he has to say.

The shadow Minister was rightly generous in her tribute to the new hon. Members who have made their maiden speeches today. It was particularly noticeable how many of them brought relevant health experience to this House. That will greatly enhance our debates over the coming years.

Let me mention in turn the Members from the SNP and from my own party.

The hon. Member for Lanark and Hamilton East (Angela Crawley) spoke powerfully on inequalities. The hon. Member for Glasgow East (Natalie McGarry) spoke of the powerful reputation of the City of Glasgow and her role as a spokesperson for disability. I warmly welcome the SNP spokesman for health, the hon. Member for Central Ayrshire (Dr Whitford), a very beautiful part of this United Kingdom. I was particularly interested to hear about her experience as a breast cancer specialist; I am sure that will greatly enhance our debates on an issue that we have many debates about, and to which I have responded many times.

On my side of the Chamber, my hon. Friend the Member for Eastbourne (Caroline Ansell) spoke about her health campaigning. I was sorry to have missed her speech. I was also sorry to miss the speech by my hon. Friend the Member for Eastleigh (Mims Davies), but I am at least in time to wish her a happy 40th birthday for today. My hon. Friend the Member for Vale of Clwyd (James Davies) spoke about his experience, and that of his constituents, of the Welsh NHS, and I would echo his hopes of improving the health services of people on both sides of the border. My hon. Friend the Member for Faversham and Mid Kent (Helen Whately) spoke about her experience of more than a decade of working in the NHS and highlighted the importance of the way we conduct our debates on health matters, and the need to rise above party political lines. Today’s debate has for the most part been an example of how that can be done, but we still have some work to do. I shall return to that.

My hon. Friend the Member for Colchester (Will Quince) spoke about the challenges facing his local hospital and the investment being put into it. I was very struck by hearing my hon. Friend the Member for North West Hampshire (Kit Malthouse) speak of the need to safeguard and champion the interests of children. My hon. Friend the Member for Telford (Lucy Allan) demonstrated the positive effects that the Government’s long-term economic plan has had on her constituency and focused on the health needs of Telford and her determination to be a powerful voice for her constituents. My hon. Friend the Member for Cheltenham (Alex Chalk) spoke very warmly of his constituency; having heard his speech, I am confident that we can expect great things from him.

Many speeches focused on health. Many speeches brought out what people could contribute in this Chamber on health matters. A variety of other issues were raised and I shall try to cover them, but it might not be possible to get through them all.

It is clear since the election that the public have resoundingly rejected the politics of fear that so often characterises statements on the NHS from the Labour party. [Interruption.] Well, at least it is clear to us that they did that, but, as the hon. Member for Leicester West may reflect when she looks back on the debate, it seems that it is far from clear to many of her colleagues that that tone was rejected by the electorate. The former Leader of the Opposition said he would turn the NHS into a weapon and—thankfully for us and unfortunately for him—that weapon backfired, but a number of Opposition Members do not seem to have taken that message on board. Yes, the NHS faces big challenges. Conservative Members have always been absolutely clear and honest about that—we have said it time and again—but we have dedicated staff working on it, and they are stepping up to those challenges and working tirelessly for their patients.

[Liz Kendall]

As we are speaking of one of the major challenges facing the NHS, will the Minister tell us whether the NHS England business plan published on Friday 27 March said that the NHS would not meet the cancer target until March 2016?

[Jane Ellison]

That is another example of trying to weaponise the NHS. [Hon. Members: “Answer.”] There were 700,000 more cancer patients treated in the last Parliament. Figures show that 12,000 more people are surviving cancer at the end of the last Parliament than were at the beginning. There were millions more diagnostic tests, for cancer and a range of other issues, so there is a great record here. We acknowledge—

--- Later in debate ---

[Jane Ellison]

The hon. Gentleman says it is bluster. Is it bluster to talk about the £1 billion invested in the cancer drugs fund?

[Liz Kendall]

rose—

[Jane Ellison]

No, I am sorry, I will not give way. As they have demonstrated today, the hon. Lady and many of her colleagues sought to weaponise the NHS in the last Parliament and they are seeking to do so again.

In return for NHS staff stepping up and working so tirelessly for their patients, the Conservatives have committed the money that the NHS says it needs. Two elections running, the Labour party failed to commit the money that the NHS says it needs. Until the Opposition do that and explain how they can deliver the strong economy that is needed to do it, they have no right to speak about this. It is only possible to deliver that if we have a strong economy and a long-term economic plan. Listening to the NHS, not running it down—that will continue to be our approach in this Parliament.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 24th February 2015 Commons Chamber

[Mr Hunt]

I congratulate my hon. Friend on his understanding of the importance of transparency. He will welcome the fact that we are now saving 1,000 more lives a month as a result of focusing on the five-year survival rates. But that transparency must apply to CCGs as well, and discussions are ongoing with NHS England as to the best way to do that for lots of things, including cancer.

[Liz Kendall (Leicester West) (Lab)]

Last week, we learned that the 62-day target for cancer treatment has been missed for a full 12 months:

“This isn’t just about missed targets–consecutive breaches mean thousands of patients are being failed. These targets exist to ensure swift diagnosis of cancer and access to treatment, which is vital if we’re serious about having the best survival rates in the world.”

Those are not my words; they are an exact quote from Cancer Research UK. Which bit of it does the Secretary of State disagree with?

[Mr Hunt]

I do not disagree with it, but I will tell the hon. Lady why we are missing that one target. Incidentally, we are hitting the seven other targets. We are treating and diagnosing so many more people, with 560,000 more diagnoses every year. That means that in this Parliament we are treating 700,000 more people than were treated in Labour’s last Parliament, saving 1,000 more lives a month. If the hon. Lady looks at some of the other things that Cancer Research UK says, she will see that it welcomes that strongly.

NHS (Government Spending)

Liz Kendall Excerpts

Wednesday 28th January 2015 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to close the debate. There have been some passionate speeches from Members on both sides of the House who are really standing up for care for their constituents. My hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) talked about the excellent joined-up care provided by the Whittington hospital, which I was privileged to visit, and the excellent work of Islington council, which is still funding social care for people with moderate needs and ensuring that all its home care staff are paid the London living wage, including for travel time.

My hon. Friend the Member for Bishop Auckland (Helen Goodman) talked about the terrible problems with long ambulance service waits, and my hon. Friend the Member for Heywood and Middleton (Liz McInnes) talked about the difficulties with the Arriva patient transport service, a problem I have in my constituency, where there have been some appalling lapses in the quality of care.

My hon. Friend the Member for Barrow and Furness (John Woodcock) talked about the huge financial problems facing his trust, and made a powerful case for its uniqueness in terms of its geographical position and transport links, such that it needs to be looked at seriously in future. My hon. Friend the Member for Kingston upon Hull North (Diana Johnson) expressed concern about financial irregularities in her trust, which I hope we can get to the bottom of. My hon. Friend the Member for Easington (Grahame M. Morris) did not get much time to speak, but I agree with him that the NHS, perhaps more than football or cricket, is what makes us proud to be British.

Our NHS faces huge challenges: our ageing population; the increase in people living with long-term conditions; drugs and medical technologies advancing at incredible speed; and public expectations changing rapidly too. Meeting these demands, when the NHS faces the tightest financial settlement of its life, requires a Government who are laser focused on ensuring that all our services get the best results for patients and offer the best value for taxpayers’ money.

In practice, we know that this means that some services must be provided in specialist centres, so that patients get expert treatment 24/7. Others must be shifted out of hospital into the community and towards prevention, to help people stay living at home. All services—physical, mental and social, across hospitals and in the community—must be properly joined up and personalised, so that people have the right care, at the right time, in the right place. We also need bold action on public health to prevent long-term illnesses such as diabetes, obesity and heart disease from developing in the first place and to ensure that the NHS is sustainable in future.

In the light of those huge challenges, what did the Government do when they took office in 2010? They focused not on reforming front-line care, but on forcing through the biggest backroom reorganisation in the history of the NHS, wasting three years and £3 billion of taxpayers’ money. Ministers promised that they would cut bureaucracy, but instead they created 440 new organisations—not just NHS England, 221 clinical commissioning groups and 152 health and wellbeing boards, but four regional NHS England teams, 27 local area teams, 19 specialist commissioning units, Public Health England and Health Education England, and that is obviously alongside Monitor and the Care Quality Commission. It is a system so confusing that no one knows who is responsible or accountable for leading the changes that patients want and taxpayers need to ensure that the NHS is fit for the future.

Ministers promised that their reorganisation would save money, but £1.4 billion has been spent on redundancy payments alone, and more than 4,000 people who were made redundant have since been re-hired elsewhere in the system. They promised to cut the costs of management consultancy—indeed, the right hon. Member for South Cambridgeshire (Mr Lansley) specifically promised that those costs would be reduced by 46% by 2014. Instead, these costs have soared as hospitals and CCGs spend good money after bad to try to make sense of the new system. Last month, the British Medical Journal revealed that NHS spending on management consultancy has not been cut by 46%; it has increased by 100% to £640 million. That is enough to run three medium-sized hospitals or employ 20,000 extra nurses.

But the Government’s disastrous reorganisation does not even stop there. It is still going on. Primary care is being reorganised again because NHS England has finally realised that it cannot commission effective local GP services at a national level—just as Labour warned. Specialist commissioning is under review because NHS England has lost grip of the budget and realised that patients need specialist services that are joined up with local care—just as Labour warned. Support for GPs in their commissioning role is being reorganised too, with commissioning support units forced to merge and then—get this!—bid to be on a list of approved organisations, including private companies, that are allowed to sell their services back to the NHS. It is a Kafkaesque nightmare of incompetence and chaos written by the Conservatives and signed by the Liberal Democrats.

As if all this was not bad enough, Ministers have made the pressures on the NHS even worse by cutting the services that help to keep people out of hospital and living at home. They shut one in four walk-in centres, scrapped the 48-hour GP waiting target, and removed Labour’s incentives for evening and weekend surgery appointments, so more people are forced to turn to A and E. They slashed social care budgets by £3.5 billion, so fewer older and disabled people get vital help to stay living at home. They cut over 2,000 district and community nurses, who help elderly people get back home from hospital and prevent people with long-term illnesses from ending up there in the first place.

What is the result? More sick, elderly people in A and E, and more patients stuck in hospital, often for weeks or months at a time, when they could be cared for back at home. Over the past 12 months, delayed discharges from hospitals have cost the NHS £280 million. This could have paid for 6,500 nurses or a year of decent home care for 40,000 people. Where on earth is the sense in that? More patients are stuck in hospital, more people are forced to wait longer for treatment, and more planned operations are being cancelled. Patients are in distress, families are struggling, and staff are under intolerable pressure.

Patients, staff and taxpayers cannot afford another 99 days of this Government, let alone another five years. They need Labour’s long-term plan for investment and reform, with an extra £2.5 billion a year, on top of this Government’s plans, to get the doctors, nurses, midwives and home care workers we need. We will join up physical, mental and social care services from home to hospital, with one team and one point of contact, to get families the support they need. We will introduce a year of care budget to create a powerful incentive for better home and community services, to keep people out of hospital, and to tackle the scandal of 15-minute home care visits. We will give more power and control to patients, with new rights to swifter cancer tests, better GP access, talking therapies and care at home. We will end the zero-hours contracts that exploit social care workers, so that elderly people finally know who is coming through their front door every morning and staff can properly plan their lives.

At the next election there will be a real choice on the NHS. It will be a choice between care going backwards, services fragmented and money wasted under the Conservatives, or Labour’s plans to fully integrate services to get the best results for patients and the best value for taxpayers’ money. It will be a choice between the Conservatives, whose Prime Minister has broken his promise to protect the NHS and thrown the system into chaos, or Labour, who will make the real investment and reforms the NHS needs to meet the challenges of the future. It will be a choice between the Conservatives’ unfunded plans to cut taxes for the wealthiest and make even deeper cuts to social care, or Labour’s fully funded proposals and 10-year plan to ensure that the NHS is sustainable for the future. I commend the motion to the House.

National Health Service

Liz Kendall Excerpts

Wednesday 21st January 2015 Commons Chamber

[Chloe Smith]

My hon. Friend makes a wise point.

Tomorrow, I am visiting a walk-in centre and the hospital that serves my constituents. When I am there, I shall be explaining, as I have several times in the House recently, my support for the NHS in Norwich and across Britain, my thanks for what the staff are doing and my understanding of what the patients, my constituents, need from the NHS.

I want to make three points in the debate. My first point is that, as many hon. Members have said this afternoon, the NHS is under unprecedented demand. It does it no disservice to acknowledge that and bring it into the debate. I for one welcome the decisions that allow for increased numbers of doctors and nurses in urgent care—that is true in the Norfolk and Norwich University Hospitals Trust; for an increased number of operations to be carried out each year—that is true everywhere in the country; and for increased hours at GP surgeries. I recently learned to my pleasure that Norwich doctors will apply for the next round of the access fund. They have not done that before and it is very welcome. The Government have made the fund available and it could be of great benefit to patients in my area.

I am also grateful to the Government for the decisions made early—earlier than ever before—that have allowed for winter pressures to be dealt with. Again, that directly benefits the area of Norfolk that contains the Norfolk and Norwich hospital. I am particularly pleased that the use of that funding will be planned jointly with local authorities through the system resilience group. That is incredibly important. I will turn to that kind of joined-up working in my final remarks.

Let me make a point about the motion. We have heard wise contributions from Back Benchers on both sides of the Chamber. For example, my hon. Friend the Member for Stafford (Jeremy Lefroy) rightly asked us not to use the name of his area as a shorthand. He is right that we ought to look much deeper. As a further example, the hon. Member for Wirral South (Alison McGovern) rightly spoke eloquently about mental health. Unfortunately she is not in the Chamber, but I am sure she will be back before the winding-up speeches. I intervened on her to ask why the motion does not refer in its own right to mental health; it is a great shame that it does not. The motion is 10 lines of overblown and fly-blown rhetoric. It asks for an NHS that is “fit for the future”, but makes no mention of mental health being equal to physical health, which I believe strongly. Mental health and physical health should be equal in word and deed, and in budgets. Indeed, I have been discussing that with the Minister recently through parliamentary questions.

The truth is that the motion is rather sad and inadequate. It betrays even the usual standards of political football that are played on Opposition days. The right hon. Member for Leigh (Andy Burnham) said in his opening speech that it is time for honesty. To that end, we would like to know whether his party leader believes in “weaponising” the NHS. To that end, we would like an end to the shabby leaflets on the NHS that go around the country.

I would have liked mental health, which is an important topic, to replace the waste of words in the motion. The motion is a pathetic reuse of the tired and crumbling money-making policy—the mansion tax—that not even all Opposition Members agree with.

[Liz Kendall (Leicester West) (Lab)]

Will the hon. Lady give way?

[Chloe Smith]

Perhaps the hon. Lady will explain whether the mansion tax will be spent once or 20 times over, like Labour’s bonus tax.

[Liz Kendall]

Why is the NHS as a whole not one of the hon. Lady’s Government’s five priorities?

[Chloe Smith]

The hon. Lady will have heard the Secretary of State speak eloquently on the topic of the Government’s priorities. The point I was about to make is that economic competence allows us to run an NHS securely and strongly for the future. It is the Conservative party and this Government who are demonstrating such economic competence, thus allowing the NHS to be a priority for the future.

My final point is much more important than this political to-ing and fro-ing. My hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) made a sensible point about the good that can come from local commissioning and joined-up working. I would add a third point, to make a kind of trinity. The third important thing we all want to see in our local health services is the making of decisions in good time. For example, the walk-in centre in Norwich has recently had to move. As I mentioned, I will be there tomorrow discussing this further with staff and patients. There was no need for the decision to relocate to be made at the last minute. It is a source of great frustration to patients locally that the decision was not confronted earlier on. It was there in black and white in the centre’s rental lease contract, so it was not too hard to spot.

Patients look to health officials—both locally and, where it applies, nationally—to make sensible decisions on time, and for those decisions to be made locally, wherever possible, and in a joined-up way, as my hon. Friend the Member for Blackpool North and Cleveleys rightly said. I would like the walk-in centre to look to its future by assessing its relationship with accident and emergency, GPs, physical health, mental health and all types of provider, including the voluntary sector, which has not been mentioned in the debate so far. I would particularly like decisions about the walk-in centre to be made in good time. There can be no forgiving decisions taken right up to the wire, which fail to deal with the real world as it stands in terms of rental contracts and, most importantly, fail to serve patients best.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to speak in this debate, which has seen some passionate and thoughtful contributions about the NHS. Many hon. Members spoke about the pressures on their local ambulance services and A and E departments, including the hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Barrow and Furness (John Woodcock), for Penistone and Stocksbridge (Angela Smith), for Heywood and Middleton (Liz McInnes), for Hammersmith (Mr Slaughter) and for Bolton South East (Yasmin Qureshi). The hon. Member for Stafford (Jeremy Lefroy) and my hon. Friends the Members for Jarrow (Mr Hepburn) and for Wirral South (Alison McGovern) spoke about the closure of walk-in centres, and difficulties in getting a GP appointment, which are piling pressure on their local hospitals.

My right hon. Friends the Members for Holborn and St Pancras (Frank Dobson) and for Rother Valley (Kevin Barron) described the terrible impact that this Government’s cuts to social care are having on elderly and disabled people, piling further pressure on the NHS, as Age UK’s excellent report showed yet again today. My hon. Friends the Members for York Central (Sir Hugh Bayley) and for Kingston upon Hull West and Hessle (Alan Johnson) spoke about the problems with child and adolescent mental health services, which have seen their constituents, like mine, sent thousands of miles away from family and friends to get treatment, which is terrible for them, terrible for their families and costs the taxpayer far more.

We have heard time and again during the debate how many of the long, hard fought-for gains achieved under the previous Government are being squandered before our eyes. When we left office, 98% of patients were seen within four hours in hospital A and E departments. Now that is down to 84%, with 180,000 patients having waited for more than four hours in the last month alone. In 2010, 80% of people could get a GP appointment within 48 hours; now one in four waits a week or more or cannot get an appointment at all.

The maximum 18-week wait for treatment has been missed for the last six months. Cancelled operations and delayed discharges from hospital have reached record highs in recent months. The vital cancer waiting target has been missed for the last nine months, meaning that 15,000 people have had to wait more than 62 days to start their cancer treatment. Anyone who has had a family member or friend wait for that treatment to start knows just how frightening that can be.

Ministers repeatedly claim that these problems are nothing to do with them and are simply the result of people living longer. But when our population is ageing, when more people are living with long-term chronic conditions and when the NHS faces the tightest financial settlement of its life, we should not cut the very services that help keep people out of hospital and living at home, which is better for them and better for the taxpayer. We should not remove the very incentives that improved GP access and close a quarter of walk-in centres, so that more people end up in A and E.

We should not slash social care budgets by £3.5 billion, so that half a million fewer of the most vulnerable older and disabled people cannot get help to get up, washed, dressed and fed. Forty per cent. fewer people get home adaptations such as grab rails, which prevent falls, and 220,000 fewer people get meals on wheels. We should not cut 2,000 district and community nurses, who are essential to helping elderly people get back home from hospital, and prevent people with long-term conditions ending up in hospital in the first place. We should not cut training places, so that hospitals are now spending £2.5 billion on more expensive agency staff and hospitals such as mine in Leicester have had to recruit 260 nurses from Spain and Portugal.

Moreover, as my hon. Friend the Member for Dudley North (Ian Austin) and my right hon. Friend the Member for Tottenham (Mr Lammy) so powerfully explained, we should not force through the biggest back-room reorganisation in the history of the NHS, wasting £3 billion, distracting the entire system, making thousands of people redundant only to re-employ them elsewhere in the system, and creating even more layers of bureaucracy, so that no one knows who is responsible or accountable for leading the changes that patients need on the ground.

In case the House needs reminding, I should say that the Government have created not only NHS England, alongside Monitor, the Care Quality Commission and the Trust Development Authority, but regional NHS England teams, local area teams and commissioning support units, as well as clinical commissioning groups and health and wellbeing boards. No wonder there is so little leadership in the system.

Labour Members make no apology for holding this Government to account for their record. After all, their Prime Minister promised people that his top priority in government could be summed up in three letters: NHS. I would hate to see what happened in a service he is not so bothered about.

Labour Members know that people want hope—the hope that there is a proper plan to get the NHS back on track. That is exactly what Labour will deliver. We have set out our plans for immediate action to ease the strain on A and Es by making sure that there are enough GPs in emergency departments and enough clinicians on NHS 111; stopping walk-in centres from closing; getting nurses to return to practice; and making sure that councils, the NHS and voluntary organisations identify the older people who are most at risk of going into hospital so that they get the right support to stay at home.

We have also set out a long-term plan for investment and reform so that our care services are fit for the future. We will provide an extra £2.5 billion on top of this Government’s plans to get the GPs, nurses and home care workers we need to transform services in the community and at home.

[Mr Stewart Jackson (Peterborough) (Con)]

Despite the £40 million structural deficit and a dodgy PFI deal that the right hon. Member for Leigh (Andy Burnham) shackled my local hospital to, in the past four years we have increased the number of nurses by 14% and the number of doctors by 9%. On the subject of apologies, would the hon. Lady like to apologise for her party’s dodgy £63 billion encumbrance of PFI off-balance-sheet deals that have been forced on my constituents and others?

[Mr Speaker]

There is no breach of order; that is a matter of taste and judgment for individual Members.

[Liz Kendall]

I make no apology for my party’s record on the NHS. When we came into government, people were dying on waiting lists for operations. People could not get to see their GPs, and mental health services had suffered. I would have thought that the hon. Gentleman would be pro reforms that help to keep his elderly constituents at home and oppose the cuts to social care that make that so much more difficult.

We have set out our plans to bring together physical, mental and social care across primary and secondary services in a single service to deliver truly personalised care and support, shift the focus to prevention, and get the best value for taxpayers’ money. We are going to help family carers get the health checks and breaks they need to stop them from reaching crisis point, and give them one point of contact with care services so that they do not have to battle all the different services.

We have a radical programme to improve public health, which is the biggest long-term challenge we face, by helping people to do more to help themselves: setting limits on sugar, salt and fat in food marketed to children; improving food labelling to tackle the impending obesity crisis; and taking tough action on tobacco, which this Government have abjectly failed to do. We have a bold national ambition to transform physical activity in our schools, communities and workplaces. That is what we need to put the NHS on a sustainable track in future by making sure that the health of our population improves.

People want a serious Government who face up to the problems in the NHS, not deny they exist or try to sweep them under the carpet. They want a Government who will deliver the real investment and real reforms we need to make sure that our care services are fit for the future. They want competence, not chaos, and a long-term plan that puts the NHS on the real road to a strong recovery. That is what Labour will deliver. I commend this motion to the House.

--- Later in debate ---

[Norman Lamb]

No. I need to make progress, and I have very little time.

In a Guardian debate yesterday, in which I took part, Peter Carter, the respected chief executive of the Royal College of Nursing, spoke of the need for political consensus

“so that we stop this ridiculous points-scoring”,

which

“frankly is destructive and does nothing to enhance the quality of the debate.”

Let us take his plea on board. I have argued for a non-partisan review of NHS and care budgets this year —whoever is in power—which would engage the public. We should all commit to that.

Labour claims that it will increase funding, but its proposed way of doing so appears to be unravelling before our eyes. Lord Mandelson has described the mansion tax as “sort of crude” and “sort of short-termist”. In the debate, the hon. Member for Hackney North and Stoke Newington (Ms Abbott) cast doubt on how much the policy would raise.

Before I address the main issues, I want to pick up the remarks made by the right hon. Member for Kingston upon Hull West and Hessle, who raised important issues about mental health. He talked about the case of his constituent, Beth. It is intolerable that she has been shunted around the country. I have met the right hon. Gentleman, and I am happy to engage with him again. It is unacceptable for this to continue to happen. That is why there is an urgent need for children’s mental health services to be reformed, and our taskforce will soon report on the essential changes that are necessary.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

I do not have time.

I am pleased that the right hon. Member for Kingston upon Hull West and Hessle endorsed the case for access and waiting times standards in mental health, which I think will have the same transformative effect as they had in cancer care when his party was in government. As my hon. Friend the Member for Norwich North (Chloe Smith) said, why is mental health not in the motion? It certainly ought to be.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

Let me make this point.

I acknowledge that several Members, including the hon. Members for Penistone and Stocksbridge (Angela Smith) and for Barrow and Furness (John Woodcock), raised distressing cases. I offer my personal sympathies to everyone who has been let down by the system. Such cases should motivate us all to strive to do everything that we can to improve how our NHS operates and to address the areas where it falls short.

The Opposition claim that the move from NHS Direct to NHS 111 has increased the demand faced by accident and emergency departments. There is no evidence to support that claim. Only 8% of calls result in a recommendation to go to A and E, and 30% of callers say that they would have gone to A and E if NHS 111 had not been available.

An accusation has been made about the impact of local authority cuts on social care. I remind the Labour party that the Government were faced with a £160 billion black hole in the public finances and had to act to sort that out. There is still no proposal from the Labour party to increase the funding for social care. The claims that it makes are hollow, without the money to go with them.

Let us look at one of the key indicators: delayed discharges from hospital. From August 2010 to November 2014, delayed days attributable solely to social care decreased from 38,324 to 37,000. The position is not as simple as some people suggest. Social care is performing incredibly well under difficult circumstances. In Cambridgeshire, there is the brilliant development of a service for older people to address their needs in innovative ways.

It has been claimed that the closure of walk-in centres has led to the current pressures on A and E. Again, we need to look at the evidence. A report by Monitor found that the reasons why local commissioners decided to close walk-in centres included that they were replacing them with urgent care centres co-located with A and E departments or other models of integrating primary care staff in A and E departments. The situation is not as simple as is suggested by the claim that walk-in centres have been closed and A and E has been left to pick up the burden.

The Opposition have said that the ambulance service is failing. In fact, ambulance services nationally are delivering nearly 2,000 more emergency journeys every day than in 2010. Ambulances respond to the majority of life-threatening cases in less than eight minutes. The Government have provided an additional £50 million to support ambulance services through this winter. It is right to take clinical advice to ensure that target response times are clinically based to avoid the unintended consequences of ambulance crews being driven crazy in the pursuit of targets, when it is patient safety that should be prioritised.

I come to the solution. In the short term, the Government have made an additional £700 million available to the NHS to cope with the pressures this winter. The right hon. Member for Tottenham (Mr Lammy) did at least acknowledge that. In the longer term, we need to focus on stopping the crises from occurring in the first place. We need a much greater focus on prevention, better integration of health and social care, and the implementation of Simon Stevens’s forward view.

I thank NHS staff for the amazing work that they do, often under great pressure, and the tremendous commitment that they make. We owe it to them and to the public to ensure that our NHS is protected and enhanced. Most people who use urgent and emergency care services receive effective, timely treatment. That is as it should be. Patients and their families should get the right advice and should get a response when they need it. We set the toughest standards in the world, and rightly so. We all know that those standards are under pressure across the UK, so let us be open and honest about that.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 13th January 2015 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

Ministers have been repeatedly warned about the impact that their social care cuts are having on elderly people and that that is a key cause of pressures on A and E. Today it has been revealed that public health officials have issued an alert about a statistically significant and “sustained” decline in life expectancy in parts of the north-west. They say it is extremely unusual and that

“central government driven reductions in adult social care budgets”

are a possible cause. Will the Minister confirm that alert, say whether life expectancy is declining elsewhere, guarantee that Public Health England will urgently investigate the matter and promise that its findings will be published in full?

[Norman Lamb]

Although there was a fall in life expectancy for those aged 85 in 2012, preliminary analysis shows that there was no further drop in 2013. Incidentally, let me pay tribute to the people who work in social care. The system has performed remarkably well. Statistics on delayed discharges due to social care show that the number of delayed days is almost exactly the same this year as it was in 2010—a remarkable performance.