Francis Report: Update and Response

Liz McInnes Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

Absolutely. I have visited George Eliot hospital, and observed a few beds in the A and E department. One of the most inspiring things about it is that it came out of special measures by developing a strong link with University Hospitals Birmingham NHS Foundation Trust—under the leadership of Dame Julie Moore—which enabled it to learn very quickly what changes were needed. The “buddying” of trusts in difficulty with high-performing trusts is one of the measures that have worked the best.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am pleased that the report mentions support for the right of NHS workers to speak up. When I was a Unite workplace rep in the NHS, I spent much of my time giving support and advice to workers who asked about blowing the whistle on malpractice. Does the Secretary of State recognise the vital advisory and supportive role provided by trade unions in the NHS, and will the Government cease their attacks on trade union facility time?

[Mr Hunt]

I agree that unions have an important role, but this should not have to be about unions. Regardless of whether a hospital has unions, people should be able to contact someone independent if they feel that their concerns about poor care are not being listened to, and that person should be enthusiastic about listening to what they say.

Improving Cancer Outcomes

Liz McInnes Excerpts

Thursday 5th February 2015 Commons Chamber

[Mr Baron]

That is a debate for another day. I accept that dramatic improvements could be made within the existing structures of the NHS, and I want to focus on that in this debate.

The Government have estimated that from 2011 to 2015 an additional 12,000 patients will survive for more than five years after diagnosis compared with the previous five-year period. That figure tells us nothing about how we are doing relative to our European counterparts, who will no doubt also have made improvements. Are those 12,000 lives just a continuation of a fairly stable and steady trend line that has been in evidence for the past 25 to 30 years, or a kick-up, as it were, above the trend line that suggests that we are catching up with our European neighbours? I would appreciate it if the Minister provided clarity on how the figure of 12,000 additional lives saved has been calculated and what action the Government are taking to ensure that we continue to strive towards matching the best outcomes in Europe.

I am conscious that a good number of other Members will speak in the debate, so, without being exhaustive, I will focus my remarks on four key areas: earlier diagnosis and survival rates; inequalities and older people; patient experience; and, last but certainly not least, the problem that some charities are having with data access.

Earlier diagnosis has long been an issue that the all-party group has campaigned on: we describe it as cancer’s magic key. All the statistics suggest that the NHS is as good as any other health care system at treating cancers once they are detected, but poor at detecting them in the first place. That suggests that we need to raise our game as regards earlier diagnosis. Most of these 5,000 or 10,000 lives are being lost at the one-year point, and the NHS is not catching up. We therefore need to drive forward initiatives at the coalface that encourage earlier diagnosis. It is almost a national disgrace that one in five cancers are first diagnosed at A and E when those patients are, on average, twice as likely to die within a year than those diagnosed via an urgent GP referral. That shows the importance of earlier diagnosis.

With this knowledge, we have spent the past two years working with the Government and NHS England to ensure that the right accountability levers are in place to encourage earlier diagnosis. We have been successful, together with the wider cancer community—because ultimately this is about teamwork—in getting one-year and five-year cancer survival rates into the NHS outcomes framework and one-year cancer survival rates into the commissioning outcomes indicator set. That is good news. We were also delighted when Simon Stevens agreed to our recommendations on including one-year survival rates in the delivery dashboard of the clinical commissioning group assurance framework from April this year.

I have used a lot of terminology, but there is a basic logic in putting the one-year figures up in lights and breaking them down by CCG. One of the best ways, if not the best way, of driving up one-year survival rates is to better introduce initiatives that encourage earlier diagnosis at the coalface. Those could be, for example, better awareness campaigns at a local level; encouraging better screening uptake figures, some of which are pretty poor; better diagnostics at primary care; better GP referral rates; or an A and E system which, when it detects these one-in-five cancers, instead of pushing patients back down the system, refers them up, potentially saving crucial time. All or any of those could be introduced by CCGs that are trying to get their one-year figures up. Putting the one-year figures up in lights will put pressure on those CCGs to raise their game on earlier diagnosis.

[Liz McInnes (Heywood and Middleton) (Lab)]

Does the hon. Gentleman agree that we need to look at the age range for cervical cancer screening? Only this morning, I heard of a 21-year-old who was found to be suffering from this disease, and who had begged the GP to give her a screening test but was unable to get it until it was too late. We also have a problem at the older end of the spectrum above the age of 64.

[Mr Baron]

Obviously, I cannot comment on the specific case, but I repeat that putting the one-year figures up in lights will put pressure—the best kind of pressure—on CCGs to look at all the initiatives at their command.

I do not think that the Department of Health or NHS England should be too prescriptive about this. We have CCG managements earning six-figure salaries who should, frankly, be able to make these sorts of decisions by introducing initiatives that best suit their populations. Where there is, say, a black and minority ethnic population, an elderly population, or a mining community population, initiatives have to be skewed accordingly, and that is what CCG managements should be doing. We have to leave an element of local initiative. One cannot just sign a cheque to the NHS for £120 billion and not expect accountability. By putting CCGs’ one-year figures up in lights, we can, over a period of time—there is no quick fix—monitor how they are doing. In the case that the hon. Lady mentioned, I would hope that the CCG would have a look at local initiatives that could perhaps change the situation for the better.

GP Services

Liz McInnes Excerpts

Thursday 5th February 2015 Commons Chamber

[John Howell]

If my hon. Friend will give me a chance, I will come to that very point, which is one that I discussed with GPs and patient groups.

There is also the expectation of what a GP can do. The number of visits per patient may be up, which is increasing demand, but the causes, according to GPs, are, first, the desire for an instant cure. People are not giving minor ailments time to heal themselves, but expect medicine on tap for everything. Thus going to a GP as soon as symptoms occur is part of the expectation. Secondly, people are motivated to see their GP by advertisements listing symptoms and encouraging people to go to a GP if they have them.

[Liz McInnes (Heywood and Middleton) (Lab)]

rose—

[Duncan Hames (Chippenham) (LD)]

rose—

[John Howell]

I give way to the hon. Member for Heywood and Middleton (Liz McInnes).

[Liz McInnes]

The hon. Gentleman talks about patient expectations, but in the Heywood, Middleton and Rochdale CCG, which serves my constituency, 16% of patients report that they are unable even to speak to somebody to get an appointment. I do not think it is an unreasonable expectation that patients should be able to contact somebody who can get them an appointment with a GP.

[John Howell]

I will give way to the hon. Member for Chippenham (Duncan Hames) and then respond to both interventions.

Human Fertilisation and Embryology

Liz McInnes Excerpts

Tuesday 3rd February 2015 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

As we have heard, mitochondrial DNA makes up a tiny proportion of our total DNA. Unlike nuclear DNA, it does not pass on any personal attributes; it is purely involved in the chemistry of energy production. That is why, when there is a defect in mitochondrial DNA, it tends to affect organs that require a high amount of energy, such as the heart, muscles, brain and liver. All of our mitochondria are inherited from the egg and, as we have heard, researchers have worked on techniques to replace faulty mitochondria using those from a healthy donor. To refer to that donor as a third parent, as some have, is something of a misnomer. There are 37 genes in mitochondrial DNA, which is less than 0.01% of our total DNA. Altering the mitochondria will not alter a child’s characteristics inherited from its biological parents, but it may provide a way to prevent a debilitating and sometimes fatal disease.

[Fiona Bruce]

I want to pick up on the point the hon. Lady makes about mitochondria not affecting characteristics. The Government’s own consultation document acknowledged that diverse characteristics are associated with mitochondria, including learning disabilities, neurological problems and dementia, and that every person’s symptoms are different. Is there not an insurmountable contradiction in saying that this is just like changing a battery if on the one hand one is saying that the aim is to prevent damage to those characteristics, but on the other hand one is saying that the techniques will not affect them at all?

[Liz McInnes]

I did not say it was just like changing a battery. In fact, I try to avoid using that terminology. The hon. Lady mentions learning disabilities, but as I just said, the organs affected the most by mitochondrial disorders are organs that require a large amount of energy, such as the brain, so that comes as no surprise to me.

Allegations have been made that the techniques are not safe.

[Jacob Rees-Mogg (North East Somerset) (Con)]

Will the hon. Lady give way?

[Liz McInnes]

No, I will not, because I need to make progress and let other people speak.

Last night, it was my privilege to attend the debate on the safety and ethics of this technique and to hear Professor Doug Turnbull, who leads the research team at Newcastle university, talk about the 15 years of work done by his team and the extensive safety checks that have taken place during those years. In the Chinese case to which my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) referred, the treatment was carried out by an American clinician on a single patient in China. The patient became pregnant with triplets, one of whom was aborted and the other two were born prematurely and died. Importantly, the clinician attributed the outcome entirely to multiple pregnancy and obstetric complications, not to the method of conception. I do not accept that that one case represents a proper clinical trial.

What we have to remember is that mitochondrial disease is a life-limiting debilitating disease, causing severe distress to parents and their affected children. We have here a technique with the ability to alleviate their suffering and to allow affected parents the chance to have a healthy child who is genetically related to them in all aspects apart from a tiny proportion of mitochondrial DNA. The spectre of designer babies can be dismissed. There is no possibility of using this technique to select certain characteristics. It will simply allow mitochondria to function normally and for the child to be free of mitochondrial disease.

[Fiona Bruce]

Will the hon. Lady give way?

[Liz McInnes]

I will not, no.

In safety, the UK has a robust regulatory framework. A vote in favour of the motion will not in itself open the way for mitochondrial donation to be used in clinics. It will simply enable the HFEA to consider each individual family’s request for treatment on a case-by-case basis, taking expert scientific and medical advice and licensing the procedure only if the evidence shows that that is appropriate.

I am lucky enough to have worked at the Royal Oldham hospital, where the first IVF baby, Louise Brown, was born. When IVF was first introduced, there was no certainty that it was completely safe. Only after the first babies were born using the technique could scientists be completely reassured that their detailed research had led to the birth of healthy babies, but to this day research continues on IVF, just as more research must be done on mitochondrial transfer. That is the nature of science: it is a continuous process; it does not stand still.

For families affected by mitochondrial disease, this research has given them new hope that they may at last have the chance to bear a healthy child of their own. Last night I heard from a woman who suffered from mitochondrial disease, which had also affected her mother. That young woman had taken a considered decision not to have her own children, for fear of passing on the condition. The opportunity to have this treatment presents her and many other women in that situation with new hope. The science is there to alleviate the suffering of affected families, and in my opinion it would be unethical to withhold this treatment. I urge the House to approve the regulations.

NHS (Government Spending)

Liz McInnes Excerpts

Wednesday 28th January 2015 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

I have the real-life experience of having worked for the NHS for 33 years, and I am not a doctor.

I have seen the NHS go through many changes, but I have never seen such industrial unrest and poor staff morale as have developed under this Government. This Government claim to have employed more doctors and more nurses, yet they are not talking about the cuts to other services and other staff, and the redundancies and the outsourcing of work to the private sector.

This Government like to claim that all is wonderful in today’s NHS, but those of us who work, or have worked, within it know that that is not the case. The NHS still operates to a large extent on the good will of the staff. This Government have been withholding a pay review body-recommended rise of just 1% to all NHS staff. Only now that an election is looming has the Secretary of State finally agreed to meet the trade unions, and now that meaningful negotiation appears to have finally commenced and the strike that was planned for tomorrow has been suspended the Government are claiming that as some kind of victory. There is no victory, and this Government need to remember that they have presided over a series of strikes and industrial unrest on their watch and only now that there is an election on the horizon do they see fit to address these issues.

I welcome this motion which proposes to invest £2.5 billion into our NHS. Staff have seen £3 billion being wasted on a costly reorganisation which nobody wanted, which was not necessary and which was in neither the Tory nor the Lib Dem manifestos. NHS departments such as the one I used to work in, pathology, have been making so-called efficiency savings for the last four and a half years, to the extent that if someone resigns from a post a business case has to be made for them to be replaced. In today’s NHS, decisions are being made not on clinical grounds, but on financial ones.

It is an absolute disgrace that this Government’s spending plans will return our public spending as a share of national income to levels last seen in the 1930s, before we had an NHS. The Tories assert that they will protect the NHS yet propose to cut spending on services to levels seen in countries where almost half the health service is privately funded.

The Government even deny that the NHS is being privatised on their watch, yet the evidence is of piecemeal privatisation of services. In my own area of the north-west, ambulance services have been privatised and are now run by Arriva transport, a bus company. This service is a source of constant complaints from my constituents, with patients being left to wait and being unable to get hospital for important medical tests. Medical staff tell me they struggle to get through Arriva’s complicated system of questions and answers—to which my hon. Friend the Member for Bishop Auckland (Helen Goodman), who is no longer present, has already referred—in order to secure patient transport.

[Andrew Gwynne (Denton and Reddish) (Lab)]

My hon. Friend is making a great case and is absolutely right about Arriva and its patient transport service in Manchester. Is she aware that many of the hospital trusts in Greater Manchester are now having to put in their own arrangements, which is costing the public purse even more, because of Arriva’s failure?

[Liz McInnes]

I thank my hon. Friend for his intervention, and yes I am aware of that shocking fact. This contract needs to be looked at as a matter of urgency. The private sector is not providing the service that was commissioned.

Medical staff have trouble getting the Arriva ambulance service to come out. If medical staff have difficulty getting through the question and answer system, imagine how patients must feel, and how they manage when they try to get patient transport from home to take them to hospital for urgent tests that need to be done in order to secure the treatment they need.

My constituents also complain to me about GP appointments. A lot of them are unable to get GP appointments within a week, and this is supported by the results of the GP patient survey. If this Government are allowed to carry on as they have been, more and more people will end up waiting a week or more to see a GP or even be unable to get to see one at all. Labour will guarantee a GP appointment within 48 hours, and on the same day for those who need it, funded by our time to care fund, as opposed to suggestions made from the Opposition Benches such as “People with chronic illnesses like diabetes and thyroid disorders should be charged for their drugs”, or “Patients should be issued with receipts for the costs of GP and A and E appointments.”

The NHS is not safe under this Government, and most NHS staff are aware of that. Only Labour can reverse the damage currently being done to our NHS.

National Health Service

Liz McInnes Excerpts

Wednesday 21st January 2015 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

The pressure that the NHS faces in my constituency under this Government is all too apparent. I have a constituent, Mr Stephen Corfield, who asked me to call on him last weekend. Stephen has been housebound for the past year with severe back, hip and neck pain that results in severely restricted mobility. He lives in his upstairs bedroom and is cared for by his wife. He has not been able to go downstairs for a year. Stephen is in dire need of X-rays to diagnose his condition, yet he cannot get to hospital because the privatised ambulance service in Greater Manchester, run by Arriva Transport, will not come out to take him. Arriva says that all Stephen has to do is to get to his front door, at which point its passenger transport system will do the rest. This completely overlooks the fact that Stephen is totally incapable of getting to his own front door. Is it any coincidence that Stephen’s problems are being exacerbated by the inaction of a privatised ambulance service? Stephen has to sit at home, his health deteriorating day by day, all for the want of an appropriate, decent response to his problems from that privatised service.

Other constituents have been to see me to complain about the withdrawal of the diabetic retinopathy screening service from Heywood. This has resulted in diabetics living in Heywood being asked to travel to Rochdale for an essential screening test. The test leaves them with impaired vision, and therefore unable to drive. They have to use public transport, and often have extreme difficulty in doing so. If ever there was an argument for keeping health services local, the diabetic retinopathy screening test is it. As a result of this cut to the service, diabetics in Heywood are not keeping their appointments because they do not feel confident that they will be able to return home safely after their test. The result of the cut is that patients are missing out on an essential test that helps them to maintain their eye health and keep them out of hospital. This is a false economy if ever there was one.

Sadly, those two examples are all too typical of the patient experience in today’s NHS. Services are being cut and privatised, with an inevitable reduction in quality of care for the patient, and this is all the result of the Health and Social Care Act 2012. The Act was introduced by a coalition Government with no mandate to do so; it was mentioned in neither the Tory nor the Lib Dem manifesto.

I should like to move on to talk about NHS staff. Not long ago, I was one of them. I worked as a health care scientist and I saw at first hand how demoralised NHS staff had become under this Government. NHS staff are not against change. We have spent our careers working with a background of constant change, but what has happened since 2010 has been unprecedented. Services have been cut and privatised, and staff have been made redundant or TUPE-transferred to private providers. I have seen hard-working colleagues burn out, and many people have taken early retirement if they can afford to do so. They were unable to take the pressure of working in today’s NHS.

In a spirit of consensus, I should like to suggest to the Secretary of State—were he here—that one easily achievable thing he could do would be to stop ignoring the recommendations of the pay review body that were made last year, and to pay all NHS staff the 1% pay rise they so richly deserve. I cannot understand why this Government have chosen to pick a fight with NHS staff over a 1% pay rise. They cannot possibly be proud of the fact that they have presided over strikes in the NHS. Any Government who can get the not-normally-militant Royal College of Midwives out on strike must surely admit they are doing something wrong.

NHS staff will strike again next week, simply because the Secretary of State refuses to meet the trade unions to discuss and negotiate the issues. The Secretary of State constantly heaps praise on hard-working NHS staff, yet he refuses to do this one simple thing. If he were to remunerate the staff in this way, it would improve morale, which would have a positive effect on patient care. The NHS is one of this country’s greatest achievements, yet under this Government we have witnessed a decline in the quality of care, growing health inequalities and stressed, demoralised staff. The Secretary of State is presiding over strike action in the NHS, yet the simple solution to the strikes lies in his own hands.

Contaminated Blood

Liz McInnes Excerpts

Thursday 15th January 2015 Commons Chamber

[Mr Geoffrey Robinson (Coventry North West) (Lab)]

Like other Members, it is appropriate that I should pay tribute to the right hon. Member for North East Bedfordshire (Alistair Burt) and the hon. Member for Colne Valley (Jason McCartney), who secured today’s debate, and, most of all, to my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), who has been responsible for getting the all-party group report out earlier this month. While we support and congratulate each other, we have to remember that the real victims in all this are those who have been infected and suffered this terrible disaster and tragedy, which has now been with us for more than 30 years. It is unique in one way, in that it is, alone in the health field, the fault of successive Governments. In no sense is this a party political debate, and the tone of today’s debate is a great credit to the Members who have taken part. It shows the growing awareness throughout the House and, I hope the civil service, too, of the seriousness of what took place all those years ago and the extent of our maladministration—let me put no finer point on it—in the handling of it since then.

The wide geographical spread of constituencies represented today is a testimony to the impact that this issue has had throughout the country. It has been pleasing to see two new Labour Members, my hon. Friends the Members for Wythenshawe and Sale East (Mike Kane) and for Heywood and Middleton (Liz McInnes), who have clearly taken on the role of successor MPs in the campaigning sense to their predecessors. My hon. Friend the Member for Wythenshawe and Sale East has already spoken to great effect, and he follows in the footsteps of Lord Morris and Paul Goggins, both of whom campaigned with us very effectively. Sadly, however, we have not really been successful yet. One point I wish to make to the new Members in the House is that they should not think we are starting all over again, because we are really at the end of this campaign now and they will, I hope, see the—I was going to say fruits, but there are none to reap here—thing brought to some sort of satisfactory conclusion, after all this time.

[Liz McInnes (Heywood and Middleton) (Lab)]

I thank my hon. Friend for his kind comments and I wish to pay tribute to the tireless work of the late Jim Dobbin on this campaign. Let me add that I have been contacted by two constituents who praised the work that Jim had done and asked me specifically to attend this debate. They do not want their names to be made public, but they wanted me to be here and to take in what was said, and I will be meeting my constituents afterwards.

[Mr Robinson]

I am grateful for that intervention. I was about to discuss Jim Dobbin, so my hon. Friend fortunately anticipates me. Jim was a good friend of mine for many years, and we had his memorial service yesterday, as she will know. He, alongside Peter Archer, Alf Morris and Paul Goggins, as well as others from the Government side of the House, was one of a series of outstanding campaigners that we have had on this issue. The fact that it is an all-party campaign enables us to get together to seek some resolution. This has been going on for an awfully long time and it has been very unsatisfactory, under all Governments. I must emphasise that all Governments are equally to blame, Labour and Tory Governments going back even to before Margaret Thatcher—I mention a name that will immediately resonate on both sides of the House.

As has been said, some of those who have been terribly affected have not wanted their names to be mentioned. Among those affected has been one of my constituents, Mr Joseph Peaty, whom I visited in his home only a few weeks ago. I believe he is here watching today’s debate and I would like to read to the House two brief extracts from his most recent letter to me. I am pleased to say that he is now the chairman of the Tainted Blood group, one of the campaigning groups that have been very effective on this matter. He wrote to me just reviewing the 30 years he has been infected. The House will be interested to know that he is now 49 years old and was first infected when he was 16. He has lived all his life in my Coventry constituency. He wrote to me recently—I got the letter only yesterday—to say the following:

“I miss being able to contribute to a productive career...Perhaps because of my age when I was first affected, my hopes and expectations, that were much like anyone else’s (education, home, partner, children, career, travel, ‘make a difference to the world’) were taken from me. I am now just a shadow of the potential I once held, struggling to exist let alone live a purposeful, fulfilling life, worrying what the next viral complication will be.”

In his case there is a shadow overhanging him, after all these tragedies, and after the terrible suffering, pain and treatments that have had to be gone through; he faces the prospect, having been infected by both Hepatitis C and HIV and undergone all the treatments, that he could now have to deal with some transmutation into CJD—mad cow disease. We just do not know. It is as bad as that.

The tone of Joseph Peaty’s letter is much better than these extracts perhaps reveal. There is nothing self-pitying about Joseph Peaty. He is in every sense a man of immense dignity and tremendous forbearance in the face of suffering that was inflicted on him by the very organisation that was meant to be treating his ill health. He writes:

“By supporting the haemophilia community in the pursuit of justice and financial recompense, I have learnt far more about the background to the introduction of pooled blood products than we were ever told prior to their administration. As a result I find the evidence overwhelming that the governments of the day knew of the infection risks, did not take adequate steps to mitigate onward transmission, failed to prevent non-consensual testing on patients, failed to inform patients of the risk, and put costs ahead of patient safety. The government were responsible for ensuring the safety of their citizens and failed disastrously in this primary duty.”

That is a terrible indictment, but it is true; it is factual, undeniable and incontestable in every respect. Joseph is referring to the entirety of his adult career since he was 16 years old. He lived in Coventry and that is the sum total of what he can point to in his life.

I do not wish to strike a discordant note when I mildly disagree with the right hon. Member for North East Bedfordshire—I congratulate him on securing the debate and on the way in which he introduced it—about the need for more reports. We do not need the Penrose report as we have already had the Archer report. All sorts of investigations have proved beyond doubt that this is the Government’s responsibility, that the extent of the tragedy is tremendous and that the provision we have made so far has been inadequate. That is the end of the story. What we now need is a resolution.

We are pleased that the Secretary of State attended the debate. Obviously, he is no longer in his place as he has other matters to which he needs to attend. I am also delighted to see my right hon. Friend the shadow Secretary of State in his place. We are all aware that the Prime Minister, in a moment of generosity, said that he would try to resolve this matter by the end of the year. I fear that he will not be able to do so—we know the pressures that Governments work under—and that is a great pity. The one useful thing that the coalition Government could do is to settle issues such as this. Indeed, when I raised the matter with the Deputy Prime Minister when he was deputising for the Prime Minister at Question Time, he said that he would take on the matter personally. I thought that we would at last have a more productive encounter between the two in the name of the sufferers in this tragedy. I hope that such a meeting can take place. If it cannot, the next Administration, whatever form they take—who knows what that will be—should take on the matter and settle it early. There will never be a good time. The only time is the earlier the better.

Five Year Forward View

Liz McInnes Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I congratulate my hon. Friend on finding every opportunity to promote integrated care. What the report says is that we need much more person-centred care. It welcomes the kind of models that we see in Tower Hamlets, where the new clinical commissioning groups, led by inspiring leaders such as Sam Everington, are carrying out social prescribing. GPs are actually prescribing social solutions to problems as well as medical ones. This report is a big stepping stone towards that type of integrated care.

[Liz McInnes (Heywood and Middleton) (Lab)]

In my constituency last year, 23,000 people were unable to see their GP within a week. What, if anything, will these plans do to address that crisis?

[Mr Hunt]

I welcome the hon. Lady to her place. This report says something with which this Government very strongly agree, which is that we need to reverse the shift that there has been over many decades of investment away from community care towards hospital care. It is really important that we focus on the role of GPs. We do not want to force all GPs to become employees of hospitals, but we would like to back them, so we have brought back personal responsibility for GPs for every single NHS patient as an important first step in that direction.