Health Care (London)

Baroness Brown of Silvertown Excerpts

Wednesday 8th January 2014 Westminster Hall

[Lyn Brown (West Ham) (Lab)]

I will take the suggestion with the severity with which it was meant, Mrs Main. I congratulate my hon. Friend the hon. Member for Westminster North (Ms Buck) on securing this debate.

I want to reflect on some of what my hon. Friend said at the beginning of her speech and on the sentiments of a letter to The Guardian before Christmas from GPs, emergency doctors and nurses, midwives, physiotherapists, psychotherapists and NHS trusts. Their plea was for a page to be turned in the way we talk about the NHS. We need to talk about the failures in patient care, but we must also recognise that we have some extraordinary abilities in the NHS to reach and look after our communities as well as they do. Sadly, I have been close to the NHS in the past three years, and I have seen excellence and the pits. However, in general, the people who work in our hospitals do a fantastic job.

I wholeheartedly endorse the sentiments of that letter because I fear that the driver for the relentless daily trashing that the NHS receives comes from base political motivation—the softening up of public opinion so that marketisation and privatisation become acceptable. It will not be acceptable. It is not acceptable now and I do not believe it will ever be acceptable, so let us just stop it.

I am not the only one to mistrust the motivation and outcome of the coalition’s top-down, unwanted and wasteful reorganisation of the NHS. I did a survey of my constituents—I like to find out whether my impressions are the same as theirs—and 97% of those who responded said that the NHS would undoubtedly get worse under the new system. When they were asked about their main concern, 60% thought that the money intended for NHS staff and services would end up as profit for private companies. My constituents are very astute.

I want to turn to local circumstances before I am coughed at. In 2006-08, life expectancy for men in Newham was 75.8 years, lower than the London average of 78.2 years. In the same period, life expectancy for women was 2.3 years below the London average at 80.4 years. Even within my borough, there are variations that make the local situation much more complex and challenging. Life expectancy in some wards is 8.1 years shorter than in others. That is massive.

In primary care, the recommended ratio of GP provision is 1.8 GPs per 1,000 of population. In Newham, the ratio is appalling and equates to not much more than half that, at 0.56 of a GP per 1,000 of population. It is small wonder that in my survey, 35% of respondents reported that it is never easy to get a GP appointment, and just 10% said that it is always easy. Many practices—too many—are operated by single GPs, so it is no surprise that the patient experience in Newham is the worst in north-east London.

The primary care trust, before its abolition, had a clear plan for tackling that challenging situation and I enthusiastically endorsed and participated in it. Now, there are no mechanisms in place to root out poor practice and promote the best. I would like to hear from the Minister how she will ensure that Newham has the number of GPs to which we are entitled and that we have performance and outcomes that are the same as other areas of London.

Incidentally, I would be interested to hear whether other hon. Members here are experiencing the new phenomenon that we have in Newham: dial a diagnosis. When people contact their GP to arrange an appointment, they are initially offered a telephone conversation with the GP. Is that because GPs must bolster the failing 111 non-clinical service, which is now contributing to the difficulties of our A and E departments? Is it to save money, to sift out or deter patients or to ration GP time? Has there been a risk assessment of what that might entail, and does it contribute to the problems that my community is facing? Again, I would like to hear from the Minister about that.

Another statistic from Newham that should be good news is that the incidence rate for breast cancer is 104.6 per 100,000 of population, significantly lower than the UK average of 123.6. However, disturbingly and distressingly, the percentage of women alive five years after diagnosis—the five-year survival estimate—is, at 75%, also significantly lower than the UK average of 83.4%. The reason in part is the take-up rate of breast screening services, but there is anecdotal evidence of women who were part of Barts hospital’s preventative health services being encouraged to go away and become part of the general population, and to present sometime in the future. That encouragement not to continue to attend for breast screening gave a rosy picture of health needs.

The London Health Commission, under the chairmanship of Lord Darzi, has a remit that includes healthy lives and reducing health inequalities. I will be interested to hear what the Minister says in anticipation of the commission’s report, and what assurance she can give that the Government will act on health inequalities.

Let me refer to the Barts health care trust, which is the largest in the country and incorporates Barts, the Royal London, Whipps Cross and Newham general hospitals. Our patch is the growing part of London, with growth in population, complexity, the number of homes and, of course, opportunity. I was therefore grateful to hear the hon. Member for Cities of London and Westminster (Mark Field), who made a well balanced speech, talk about resources being sucked into the large university hospitals in the centre. Even though those of us on the far-flung borders of the east belong to the same trust as one of those hospitals, we experience the difficulties he talked about in relation to Romford.

Rumours abound at the moment that Newham general, as part of the Barts trust, is under threat of reconfiguration—a fascinating new word—to secure the viability of the trust as a whole. When I talked to the trust’s chief executive, he told me that the PFI represented only 10% of the trust’s entire budget and that, given that the budget was large, he did not see the PFI as having major consequences for the delivery of services.

However, there is an accusation that the trust is being a little disingenuous in its public statements that the A and E at Newham general will not be closed. Assurances have been sought that there will be no downgrading without full consultation, but those look weak in the face of a shortage of anaesthetists, for example, who are essential to support a viable emergency service.

Almost half of London trusts are struggling to achieve the 95% standard for patients waiting in A and E. Barts trust is just about achieving that target, but that is because Newham general performs well and helps the trust’s overall performance—a good example of how a local acute hospital catering for a place such as Newham can perform well, while larger hospitals struggle. Given that the future of Newham general’s A and E is under threat, the irony of the situation is not lost on me, and nor will it be lost on my constituents.

In that scenario, it is essential that we maintain Newham general as a fully functioning major acute hospital with a full range of services, including A and E and maternity. Given that we are seeing growth out to the east, it would be irresponsible and downright dangerous for us not to do that. It would also be a complete distraction from the absolute priority of putting in place improved, integrated care services in the community and in primary care.

Finally, I seek assurances from the Minister about the funding formula for CCGs being rolled out across England. In the London context, it is shifting resources from inner-London boroughs, with their younger populations, to boroughs further out, which have older populations.

Newham just happens to have the youngest population in the whole of Europe, apart from some tiny canton somewhere that is almost irrelevant. We will therefore lose substantial amounts, while London as a whole is losing 2.3% of its funding to other areas. I would like reassurance from the Minister that the funding formula will fully take account of deprivation, as the hon. Member for Cities of London and Westminster said, as well as of our population’s high mobility, with the health problems that brings with it, and diversity, with the specific demands that that puts on health care.

Accountability and Transparency in the NHS

Baroness Brown of Silvertown Excerpts

Thursday 14th March 2013 Commons Chamber

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. Before the hon. Lady responds—[Interruption.] I am sorry, but does the Opposition Whip have something to say?

[Lyn Brown (West Ham) (Lab)]

No.

[Mr Deputy Speaker]

Thank goodness for that.

We need short and concise interventions, because many Members wish to speak and I do not want to have to reduce the time limit further, but that is what will happen if we are not careful.

--- Later in debate ---

[Kate Hoey (Vauxhall) (Lab)]

It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell), who speaks with a breadth of experience and history in the national health service, and I congratulate the hon. Member for Bristol North West (Charlotte Leslie) on securing this long debate, providing an opportunity to all of us to say a few words.

I agree wholeheartedly with everything my hon. Friend the Member for West Lancashire (Rosie Cooper) said, particularly about what seems to me, too, to be a growing public body desire for secrecy. This is happening not in the national health service alone, but in many other bodies. Indeed, as my hon. Friend well knows, it is happening in this House. I am concerned about a number of issues—how staff are treated, getting rid of the telephone exchange and a whole number of other decisions taken up there somewhere. We, as Members who work here, have very little say.

It is important for us to remember the Nolan principles of public life to which every public body is meant to sign up—accountability, openness, honesty and leadership. I do not want to say much specifically about what happened in Mid Staffordshire, but it was appalling. As someone who has had a good and well-led hospital in my constituency for many years, I find it almost unbelievable that all that could have happened in the Mid Staffordshire hospital with so few people seeming to know what happened or to speak out about it. Then, when it was pointed out, no one listened. That provides a terrible warning about what can happen. We all think that we know what is happening in our constituencies, but we do not always, as this episode has shown.

Let me talk about my local hospital Guy’s and St Thomas’, King’s College hospital and SLAM—the South London and Maudsley hospital. What has been called the “King’s Health Partners” has sought to bring together the research work at King’s College medical school with others, and the body is now growing to be almost an entity in itself, making decisions, sending out publicity and getting further and further away from the foundation trust.

Looking back to when my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was Secretary of State for Health, some of the decisions he made in the Health Act 1999 were more about accountability than anything that has been done since by any Government. For example, he instructed NHS chairmen to hold their board meetings in public, while non-executive directors were required to live in the area served by the trust—a crucial step that fundamentally changed St Thomas’ hospital when we had a local chairman who knew the area, was involved in the hospital and cared about it. She spent all her time as chairman wandering around the hospital trying to find out about everything that was going on: she was accountable to everyone. That was crucial to the public, too, as they knew that they had people on the board who knew what was happening in the locality.

I believe that one of the first responsibilities of non-executive directors—they are not part of the management —is to visit the wards, to talk to patients, to collate local concerns and to talk to MPs, local councillors and the local authority. That was always happening. We had a very good system. There were concerns about the treatment of the elderly at one stage in one of the wards for elderly people at St Thomas’, but they got dealt with very quickly because we had a responsive chairman and a responsive board. A lot of that happened when my right hon. Friend the Member for Holborn and St Pancras was the Secretary of State. The Health Act 1999 also gave the chief executive officer absolute personal responsibility for clinical governance standards—another important reform—in addition to the responsibility to be the accountable officer.

Later we had foundation trusts, although I have to say that I did not vote for them. I have had a well-led foundation trust up to now, but I did not feel that this was the right way ahead for the national health service at the time. We have got them, however, and some foundation trusts saw fit to erode the principles as financial considerations took precedence over clinical standards on many board agendas. The foundation trusts still remain the chief executive officer’s responsibility.

One thing the King’s Health Partners are doing in the name of foundation trusts is steamrolling ahead to bring about a merger of Guy’s and St Thomas’ hospital, which is a huge trust, King’s College hospital, which is another huge trust, and the South London and Maudsley trust. It is believed that the merger will somehow lead to a “world-class”—I do not know how many times Members have heard the term—hospital.

I am furious and angry—as are, I think, all five of the MPs representing the area at how this merger has been handled. The lack of openness has been appalling and there has been no public board meetings or disclosure of information about the proposed changes. The proposals have been either badly put forward or not put forward at all. The board at St Guy’s and St Thomas’ has an occasional surreal meeting as a showcase for public involvement, but it never discusses the real issues. It opens meetings for the public only when it suits the board.

[Lyn Brown]

Does my hon. Friend agree that the plans for reorganisation of the trusts south of the river need to be put on hold?

[Kate Hoey]

That is precisely what the five Members of Parliament have asked for. Recently, on 28 February, we heard from the chairman of Guy’s and St Thomas’, who was previously a permanent secretary at the Department of Health. That takes me back to one of my earlier points about people moving around within the health service. It is always somebody who has been someone else in somebody else’s patch that gets a job with another NHS trust. This chairman wrote to say that the project is forging ahead with a full business case. William McKee, who brought together trusts in Northern Ireland, has been appointed and we are told that he is going to spend at least £5 million to bring about the business case to show why this will be such a wonderful idea. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and I have written back asking who is actively responsible, how the money from the different bodies is being allocated, what the precise budget will be and how it will be spent by whom. The whole accountability thing is there in a nutshell. Who is actually accountable? Does the Secretary of State have any say whatsoever? No. Apparently he is only interested if the move will clearly not be good for patients in clinical terms.

I know that the establishment of such a large trust will be totally against the interests of people. Trusts cannot operate on such a large scale. One chief nurse cannot be responsible for all those hospitals.

NHS Funding

Baroness Brown of Silvertown Excerpts

Wednesday 12th December 2012 Commons Chamber

[Mr Hunt]

I will make a little progress before giving way.

[Lyn Brown (West Ham) (Lab)]

rose—

[Mr Hunt]

I said that I would make a little progress, if that is all right.

I must confess to being both surprised and delighted at this afternoon’s motion, because I would have thought that the last thing the right hon. Member for Leigh (Andy Burnham) would want to do was remind the nation of his opposition to our increasing the NHS budget. The motion is about spending, but we can spend only what is in our budget. What did he say about budget and spend during his failed bid for the leadership of his own party? [Interruption.] I think that right hon. and hon. Members on the Opposition Benches should listen to what those on their Front Bench are saying. He said:

“It is irresponsible to increase NHS spending in real terms”.

So let me ask him to clarify this to the House: does he stand by his comment that it is irresponsible to increase NHS spending?

--- Later in debate ---

[Lyn Brown]

Will the right hon. Gentleman confirm just how many nurses’ jobs have been cut on this Government’s watch?

[Mr Hunt]

I will confirm for the hon. Lady that the nurse-to-bed ratio has gone up so that nurses are spending—[Interruption.] Perhaps the Opposition will want to hear about issues of care. The average bed is getting two hours of nursing care per week more than under Labour.

Let me give the right hon. Member for Leigh another chance to clarify Labour policy on health spending. In Wales, Labour has announced plans to cut the NHS budget by 8% in real terms despite an overall settlement protected by Barnett. Given that the motion condemns an alleged cut in NHS spending, will he, once and for all, condemn the choice that Labour made in Wales? If he does not want to do that, let me tell him what the British Medical Association says is happening in Wales. It talks of a “slash and burn” situation and “panic” on the wards. Would he want that to be repeated in England? If not, he should not sit idly by but have the courage to condemn the choice that Labour has made in Wales.

While we are on the subject of Wales, the right hon. Gentleman will know that NHS patients there are five times less likely to get certain cancer drugs than English NHS patients, but the Labour Welsh Health Minister has said it would be “irresponsible”—the same word that the right hon. Gentleman used—to introduce a cancer drugs fund in Wales. Does the right hon. Member for Leigh support what Labour is doing with regard to cancer drugs in Wales—yes or no?

Mental Health

Baroness Brown of Silvertown Excerpts

Thursday 14th June 2012 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

It is a pleasure to follow the thoughtful contribution of the hon. Member for Worthing West (Sir Peter Bottomley). I am very glad to be in the Chamber to speak alongside those who have made exceptional speeches today, including my hon. Friend the Member for North Durham (Mr Jones) and the hon. Member for Broxbourne (Mr Walker) to name just two.

I will highlight three things. The first is the key factors that are linked to mental well-being and the characteristics of my local borough of Newham. The second is what resources are available to my local health authorities and mental health services. The third is the need for those resources to be improved in the light of what we know works in improving mental health.

The need for a robust strategy to promote well-being is illustrated by the correlation between the determinants of mental ill health and some of the characteristics of the population of my borough. As my hon. Friend the Member for Vale of Clwyd (Chris Ruane), who is no longer in his place, attested so powerfully, one such determinant is age. The rates of mental illness vary across age ranges, but it is a sad fact that younger people are more likely than the elderly to experience mental ill health. A high proportion of mental health problems develop between the ages of 14 and 20. One in 10 children between the ages of five and 16 have a mental health problem, and such problems may well continue into adulthood.

The borough of Newham has one of the youngest populations in the country. The number of young people with mental health problems is therefore greater than elsewhere. Some 40% of the borough’s population is made up of people under the age of 25. As nearly 10% of people aged between five and 16 experience mental health problems, statistically we can expect 4,262 of the children and young people in Newham to experience such problems. That clearly has an impact on the needs of the population of Newham and on the type of service that it requires. It should be funded to cater for those needs.

We all know that there are other important determinants of the mental health of a community. One of those is deprivation. Common mental disorders such as depression, anxiety and obsessive compulsive disorder are more prevalent in deprived households. Again, Newham suffers from high levels of deprivation. It is ranked the third most deprived local authority in the country and 51.5% of its children live in poverty. The index of deprivation ranks the borough fourth in the country for the proportion of children aged between nought and 15 living in an income-deprived household. That is just one measure of deprivation, but I am sure hon. Members will agree that it is a worrying one.

In addition, the decline of owner-occupation and the increase in the private rented sector changes the very nature of local communities. Support networks that people rely on—their friends and family, and wider communities such as their Church and faith—are disintegrating as housing pressures force families to move home, leave their communities or remain in overcrowded, sometimes unhygienic and often poorly managed private rented housing, which is sadly a fast-growing sector of tenure in the London borough of Newham.

In my constituency, there is a high level of need for services that will enable the people of Newham to be self-sufficient and lead independent, successful lives. My concern is that the process used to allocate the resources needed to support those services is fundamentally flawed. It is skewed in a way that significantly disadvantages my community.

Since 2006, if not earlier, the population estimate for Newham has clearly been an underestimate by the Office for National Statistics. The under-count was estimated at about 60,000 people until, in November 2011, the ONS went some way towards recognising the historic underestimate by provisionally estimating the population at 272,000, an increase of 32,000. That significant increase of 13% is, by the way, the largest change in any London borough. However, the new figure still falls some 30,000 short of the population estimate made by an independently commissioned study. That is a shortfall in excess of 10%.

The real population of the borough stands at roughly 300,000. That is the figure that should drive resource allocation, because it relates to the real world and real need. However, the ONS mid-year estimates are used to determine how the national funding pot is allocated to local areas, even though they do not accurately reflect the true population of my area. Given the level of need in my constituency, to say that resources are not allocated on a level playing field is an understatement.

The effect of an inadequate allocation system is compounded by a reliance on historical spend to determine current needs. That means that my local primary care trust has consistently struggled to find resources to deal with persistent need. Figures in the House Library tell me that expenditure per head on mental health in Newham in 2010-11 was £208.93. That compares with £447.21 in Westminster and £331.81 in Kensington and Chelsea. I wish to hammer home the point that the spend for Newham is based on the ONS population estimate, so the real spend per head is even lower.

The shadow health and wellbeing board for the London borough of Newham has discussed the matter at length and agreed a robust strategy, with a clear focus on maintaining resilience within the community. It wants to support people by ensuring that they possess the skills and resources that will enable them to negotiate successfully the challenges that they experience.

Let us face it: we know from evidence what works. The health and wellbeing board has indicated that it wants to focus its activity on parenting skills and pre-school education to set up an early family environment that supports children’s emotional and behavioural development. It wants to support lifelong learning, with health promotion in schools and continuing education, as schools are a really important resource, particularly for children facing difficulties at home.

The board also wants to find a way of improving working lives in the borough, as one in six people in the work force are affected by mental health problems, and a way of supporting a good and healthy lifestyle by encouraging exercise and good diet. It wants to encourage the learning of new skills and the taking-up of creative pursuits—social participation that promotes mental well-being across the piece. The board is also supporting communities through environmental improvements. Environmental predictors of poor mental health include neighbourhood noise, overcrowding, fear of crime, poor housing and so on. Finding out what to do is frustrating, but it is also frustrating that resources are being rather unfairly allocated. Newham is poorly served in that regard.

I thank the Backbench Business Committee for creating this opportunity to discuss an issue that is often invisible, and on which there is not enough focus and debate. Poor mental health has an extraordinarily detrimental impact on huge numbers of people in our communities. We could and should be dealing with the problem in a plethora of holistic ways in our local communities.

Newham is severely under-resourced in the face of significant pressures on mental health provision. I am glad to see the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), in the Chamber. I know he has listened to me and, given that he is a former Whip, that he is a very honourable man. I shall write to him to push the case for greater funding for Newham as we continue to fight for the resources that my communities desperately need to access better life chances, which includes better mental health.

Health and Social Care Bill

Baroness Brown of Silvertown Excerpts

Tuesday 13th March 2012 Commons Chamber

[Jonathan Reynolds]

No, sit down and listen for once.

It is clear that the majority of non-biased, objective opinion is against the Bill proceeding. Never in the field of public policy have so many opposed so much and been listened to so little.

Should the Government not be asking themselves this: if the Health Secretary cannot convince the people who he wants to devolve power to, and if the Deputy Prime Minister cannot convince his own party members to support the Bill, maybe—just maybe—there is not that much going for it? The Health Secretary cannot even visit an NHS hospital, so low has his reputation sunk.

As has been said, the people who oppose the Bill, whether the royal colleges or Opposition Members, do not oppose all reform. Of course, NHS services will have to change over time, particularly in the provision of specialist services. The Labour Government introduced reforms, which used the private sector to the advantage of the NHS. The Bill does the opposite and uses the NHS for the benefit of the private sector. The problem is not reform, but these reforms. To say that anyone who opposes the Bill is against all reform is crass and simplistic.

Let us please put an end to the nonsense that the reforms are just an evolutionary approach following what has happened in the past. If that were the case, would there be an unprecedented groundswell of opinion against them? Once the Bill is passed, the primary care trusts and the strategic health authorities will be gone, and clinical commissioning consortia will be responsible for the whole NHS budget. Local authorities will take public health, and Monitor and the NHS Commissioning Board, not the Department of Health, will be responsible for the health system. That is a fundamental, top-down restructuring of the NHS, and no one wants it.

To justify that revolution, the Government started by rubbishing the success of the NHS. It began with the cancer survival rates and carried on from there, and every time the Government’s case has been knocked down. The King’s Fund, the respected health think-tank, in its review of NHS performance since 1997, clearly showed dramatic falls in waiting times; lower infant mortality; increased life expectancy across every social group; cancer deaths steadily declining; infection rates down, and in mental health services, access to specialist help, which is considered among the best in Europe. Again, I put it to the Government that they have no justification for the revolution that the Bill brings about.

The Government’s other justification has been that the NHS has too many managers, yet their reforms create a structure so confusing that, when an organogram of the new structure was published, it became a viral hit on the internet because it looked so ludicrous. What do the experts in the King’s Fund say about this? The myths section about the Bill on its website says:

“If anything, our analysis seems to suggest that the NHS, particularly given the complexity of health care, is under-rather than over-managed”.

[Lyn Brown (West Ham) (Lab)]

During the Bill’s passage, it has struck me just how vulnerable my constituents will be to doctors who are not as good as many of those who currently serve them well. One of our opportunities in Newham with a decent PCT was to deal with doctors who did not provide the right care. Is my hon. Friend , like me, concerned about the vulnerability of many of our constituents if the Bill is passed?

[Jonathan Reynolds]

I agree with my hon. Friend. If the Bill is passed, perhaps one of the biggest changes will be to the relationship between doctor and patient. Every time a patient is not referred for some sort of specialist treatment, they will wonder whether that is on clinical grounds or because their GP has one eye on the budget. Whatever the basis for those fears, GPs will be in a difficult position, and because NICE guidance will no longer be compulsory, the problem will be compounded when people compare their experience with that of others, using the internet or other means.

However, the most worrying aspect derives from the stories that we hear from parts of the country where individual GPs might have a financial interest in the services that they now commission. Such a relationship would not only destroy the trust at the heart of the system, but provide perverse incentives for how it might develop in future.

NHS (Private Sector)

Baroness Brown of Silvertown Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

The point that I am making is about how to manage the system, how to ensure proper regulation and how to ensure that NHS providers and the system work in the interests of NHS patients. If the right hon. Gentleman is arguing that there would be the same control managing the system through a series of fragmented commercial contracts, I would be interested to have that debate with him. Frankly, I do not believe that he is being serious, if that is his point.

[Lyn Brown (West Ham) (Lab)]

I have been contacted by constituents who access their cancer and cardiac care from Barts and from the London hospital. They fear that as a result of the Bill their health needs will be deprioritised in favour of private patients who can afford to pay. What would my right hon. Friend say to my constituents about their fears?

[Andy Burnham]

I wish I could allay the fears of those people, but when there is a proposal placed at the heart of the NHS for hospitals to devote half their facilities—their beds, their appointments—to private patients, how is it possible to give that guarantee to those patients, particularly when the Government are relaxing the waiting time standards that we did so much to establish in the NHS, with the two-week wait for cancer referrals and 18 weeks for elective operations, and a four-hour wait in A and E? How can we have that confidence when, effectively, the Government are taking those safeguards off the public and giving the green light for a massive expansion of private sector treatment in NHS hospitals?

National Health Service

Baroness Brown of Silvertown Excerpts

Wednesday 26th October 2011 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

I ask the House to reject the motion. I am sorry about the tone of much of what the right hon. Member for Leigh (Andy Burnham) said. This was his first opportunity to make a speech about the NHS and I thought that he might take the trouble to thank NHS staff for what they have achieved over the past year, rather than disparage and denigrate everything they have been doing. I also thought that he might take the opportunity to approach the issues facing the NHS from the standpoint of patients, rather than simply playing politics with the service, but he did not. Insulting me was the least of the problems in his speech. It seemed like the Burnham memorial speech—clearly no hard feelings about losing the election, then. Having spent 13 years in the House in opposition, I shall—at the risk of patronising him—give him a few words of advice: do not keep fighting the election that you lost. It is not the way to win any future election, and it will carry absolutely no credibility in the NHS.

Equally, the right hon. Gentleman will carry no credibility by wandering around telling people that he was not planning to cut the NHS budget, given that he made it absolutely clear in The Guardian last year that that was exactly what he intended to do and that he told us, in the run-up to the spending review, that it would be irresponsible to increase the NHS budget in real terms. I searched the Labour manifesto for any commitment to funding the NHS in real terms, but there is none. In March 2010, he might have said that he knew all these things, but he did not tell the public about any of it—[Interruption.] Well, it is here in his manifesto. The only reference to any kind of investment in the NHS is a plan to

“refocus capital investment on primary and community services”.

[Lyn Brown (West Ham) (Lab)]

Will the Secretary of State give way?

[Mr Lansley]

In a moment.

We know what that meant, because when we opened the books on arriving in the Department we saw that Labour was planning to slash by more than half the capital budget of the NHS. Every Member of Parliament who has a major hospital building programme in their constituency would have been affected by that. That might include my hon. Friend the Member for Harrow East (Bob Blackman), who has the Royal National Orthopaedic hospital in his constituency, or Members from Liverpool, who have the rebuild of the Royal Liverpool and Broadgreen hospitals and, all being well, the rebuilding of Alder Hey. That might also include the hon. Member for Copeland (Mr Reed). The last Labour Government, before the election, cut the capital budget, and his project—the West Cumberland hospital at Whitehaven—could have been at risk as a consequence of that. [Interruption.]

--- Later in debate ---

[Mr Lansley]

Thank you, Mr Deputy Speaker. I will now give way to the hon. Member for West Ham (Lyn Brown).

[Lyn Brown]

I am grateful to the Secretary of State for giving way. Will he now admit that this is the first time that the NHS budget has seen a real-terms fall since 1996, the last year of the Tory Government?

Health and Social Care (Re-committed) Bill

Baroness Brown of Silvertown Excerpts

Wednesday 7th September 2011 Commons Chamber

Another piece of misinformation that has been put about is the idea that the amendment would prevent or delay the abortion process. Again, that is incredibly untrue. Counselling would be delivered within 24 to 48 hours, and the abortion process would take seven to 14 days to arrange. This amendment, this offer of counselling, is not for women who have made up their mind and—fantastic for them—want to go straight to the abortion clinic; it is for women who may be in distress. The counselling would be delivered within 24 to 48 hours, so there would be no delay whatever to the abortion process. In fact, many women who accepted the offer of counselling and proceeded to an abortion would proceed empowered, because they would have had the opportunity to talk through their situation with someone totally impartial—

[Lyn Brown (West Ham) (Lab)]

rose—

[Kate Green (Stretford and Urmston) (Lab)]

rose—

--- Later in debate ---

[Nadine Dorries]

No, I have given way to the hon. Lady once. I will give way to the hon. Lady who also acts as a Whip.

[Lyn Brown]

I am listening with interest to the hon. Lady. How can she guarantee that the counselling that she proposes will not delay the abortion process?

[Nadine Dorries]

I have spoken to organisations that provide counselling and have 80,000 registered counsellors throughout the UK. [Hon. Members: “Who?”] The British Association for Counselling and Psychotherapy. I asked, “If somebody required counselling, was at a GP’s practice and a telephone call was made, how long would it take to get a counsellor to a particular woman?” The answer was that counselling could be delivered in the GP’s practice, at another venue or in the woman’s home, and that it could be anything from immediate to within 48 hours.

Registered counsellors, who have e-mailed me regularly since the amendment was tabled, say that they would love to work—counselling is a growing industry—and to have the opportunity to work with women in that situation. Unfortunately, however, counselling is available on the NHS only via the abortion provider or via the hospital.

--- Later in debate ---

[Lyn Brown (West Ham) (Lab)]

One of my biggest worries about the Bill is that it will stop me intervening in the health service to encourage outcomes for my constituents who come to me for help and advice. Does my hon. Friend agree that it will diminish my ability to represent them, rather than enable me to do so?

[Joan Walley]

My hon. Friend is right. Constituents go to Members of Parliament as a last resort to try to ensure fairness in how the system deals with everything. I have just had a high-profile case in my constituency relating to the postcode lottery, which my hon. Friend the Member for Pontypridd (Owen Smith) referred to.

Health and Social Care (Re-committed) Bill

Baroness Brown of Silvertown Excerpts

Tuesday 6th September 2011 Commons Chamber

[Lyn Brown (West Ham) (Lab)]

Bearing in mind the lack of popularity of the proposals among our constituents, is my right hon. Friend as worried as I and my constituents are about the £850 million that is being spent on redundancies and the projected £2 billion of primary care trusts’ budgets that is being held back from patient care to cover the risks and costs associated with the reorganisation?

[Frank Dobson]

I entirely agree. Nobody could possibly claim that redundancy payments constitute money being spent on improving services for our constituents. That is just money down the drain as far as patient care is concerned.

The fundamental problem behind the proposals is that the Government are, in effect, proposing a further major fragmentation of the national health service. In the past, up to the point at which the previous Tory Government introduced an internal market, the spending on administration in the NHS amounted to 4% of the total. That was largely because great big slugs of money were transferred round the system, and I am prepared to accept that there might be some disadvantages in that arrangement. Since then, however, under that Government and the Labour Government, the system has changed to one in which the money follows the patient. That has led to the creation of all sorts of exceptionally expensive systems to bring about individualised transactions, which has resulted in the cost of administering the national health service rising to 12% of the total—an increase of 8%. The NHS is spending about £100 billion a year at the moment, so an extra £8 billion that should have been spent on patient services is now being spent on the administration of the semi-fragmented system. What is now being proposed will involve yet further fragmentation, and I shall explain why I believe we will end up spending yet more money, but not on patients.

NHS Future Forum

Baroness Brown of Silvertown Excerpts

Tuesday 14th June 2011 Commons Chamber

[Mr Lansley]

Yes, I can give my right hon. Friend that assurance. He will know that in our response to the Future Forum we will strengthen the role of health and wellbeing boards, deliver more integrated care and ensure that the local health and wellbeing strategy is a central document in determining the shape of commissioning in the NHS, social care and public health. The powers, including those for service reconfiguration in an area, will be maintained so that they must continue to meet the four tests I set out last year. The public voice will therefore be at the forefront of the response to any changes in the local service.

[Lyn Brown (West Ham) (Lab)]

Given that the Secretary of State is about to waste £2 billion on this reorganisation—money that would be better spent on patient care—will he give us an assessment of how many A and E departments will close over the next two years?