Cities and Local Government Devolution [Lords] Bill
Natascha Engel Excerpts(9 years, 1 month ago)
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The Parliamentary Under-Secretary of State for Communities and Local Government (James Wharton)
I beg to move amendment 29, in page 1, line 14, leave out “under section 2”
This amendment would be consequential on leaving out clause 2.
The Second Deputy Chairman of Ways and Means (Natascha Engel)
With this it will be convenient to discuss the following:
Clauses 1 and 2 stand part.
New clause 1—Competences of local government—
‘(1) The Secretary of State must, after consultation with representatives from local government, publish a list of competences of local government.
(2) After the list has been published, the Secretary of State may not publish any amended list of competences of local government without first obtaining approval of the revised list consent from—
(a) the House of Commons, with two-thirds of its membership voting in favour of the amended list, and
(b) the Local Government Association.”
This new clause would define the independence of local government, and entrench it beyond easy repeal.
New clause 13—Double Devolution statements—
‘(1) A Minister of the Crown who has introduced a Bill in either House of Parliament having the effect of devolving functions or powers of the United Kingdom Parliament or the Secretary of State to a combined authority must, before the second reading of the Bill, make a double devolution statement on the arrangements for further devolving those functions or powers to the most appropriate local level except where those powers can more effectively be exercised by central government or by a combined authority.
(2) The statement must be in writing and be published in such a manner as the Minister making it considers appropriate.”
The intention of this new clause is to make clear what double devolution to smaller councils and neighbourhoods will occur in the wake of big city deals being agreed by combined authorities when giving powers to cities and/or combined authorities.
New clause 18—Independent Review, Support and Governance—
‘(1) It shall be the duty of the Secretary of State to lay before each House of Parliament each year a report about devolution within England and Wales pursuant to the provisions of this Act (an “annual report”).
(2) An annual report shall be laid before each House of Parliament as soon as practicable after 31 March each year.
(3) The Secretary of State may by order make provision for an Independent Commission or Advisory Board to undertake a review, challenge and advisory role in relation to:’
(a) reviewing orders and procedure arising from the Secretary of State’s decisions; and
(b) requests for orders received from combined or single local authorities.”
This new clause would ensure the Secretary of State has the necessary power to create an Independent Commission or Advisory Board to scrutinise the work of the Secretary of State relating to devolution, Annual Devolution Report and handle requests from local government about the decisions made by the Secretary of State.
New clause 22—Devolution in London—
‘(1) Within six months of the passing of this Act, the Secretary of State must publish a report on a greater devolution of powers in London, including on whether to make provision for the Secretary of State to—
(a) transfer a public authority function to a joint committee of London councils, and
(b) establish a joint board between London boroughs and the Mayor of London to support further devolution in London, and
(c) devolve responsibility on fiscal powers, including but not limited to, setting and revaluating local tax rates, banding and discounts.”
This new clause makes it a requirement for the Secretary of State to report on further devolution options for London, including fiscal devolution (e.g. council tax revaluation, etc) which has been called for by the Greater London Assembly and the Mayor of London.
New clause 23—Fair funding settlement: report—
Within six months of the passing of this Act, the Secretary of State must publish a report on the impact on the functions of combined authorities of the fairness of the distribution of funding from central government to local authorities, particularly with regard to levels of deprivation.”
This new clause would require a report linking the impact of devolution with the level of funding.
New clause 25—Public authority functions—
Within one month of the passing of this Act, the Secretary of State must publish a list of public authority functions which may be the subject of a transfer of functions under the provision of this Act.”
This new clause would require the Government to be more specific about the functions which it intends to developed to mayors, combined authorities and other local authorities.
Government amendment 4.
Amendment 51, in clause 3, page 2, line 19, at end insert—
‘(2A) An order under subsection (1) may not be made unless the proposition that the combined authority have a mayor is approved by a referendum of the electorate in that combined authority.”
The intention of this amendment is that elected mayors will be introduced only if that proposal has been endorsed, in a referendum, by 50% of the population.
Amendment 43, in page 2, line 31, leave out subsection (8) and insert—
‘(8) An order under this section providing for there to be a mayor for the area of a combined authority may be revoked or amended by making a further order under this section; this does not prevent the making of an order under section 107 abolishing the authority (together with the office of mayor) or providing for a constituent part of the combined authority to leave the combined authority and to resume its existence as a separate local authority.
(8A) An order under this section providing for a constituent part of the combined authority to leave the combined authority and to resume its existence as a separate local authority must make fair provision for a reasonable and proportionate division of resources between the former combined authority and the seceding local authority.”
The intention of this amendment is that a constituent part of a combined authority can leave a combined authority without the combined authority being dissolved, with provision for “fair terms” for the leaving part (i.e. their resource is calculated on a per capita basis, or similar.)
Amendment 46, in page 2, line 38, at end insert—
‘(10) This section does not apply to the County of Somerset, as defined by the Lieutenancies Act 1997.”
Amendment 39, in page 3, line 2, at end insert—
‘(1A) For an area of a Combined Authority where for any part of that area there exists both a County Council and District Council, no order may be made under section 107A unless either the Secretary of State or the existing combined authority has carried out a consultation with local government electors on replacing the existing County Council and District Councils with one or more unitary authorities.”
Amendment 44, in page 3, line 14, at end insert—
‘(4A) A constituent council may withdraw consent after the creation of a combined authority and a mayor for that authority.
(4B) Where one or more constituent councils have withdrawn their consent under subsection (4A), the Secretary of State must make an order either:
(a) abolishing the combined authority and the office of mayor, or
(b) reconstituting the combined authority without the non-consenting council or councils concerned”.
The intention of this amendment is that a constituent council may withdraw its consent to the creation of a combined authority, in which case the Secretary of State must either abolish the authority and mayor or re-constitute the authority without any non-consenting council.
Amendment 53, in page 3, line 27, at end insert—
‘(2A) The Secretary of State may make an order under section 107A in relation to a combined authority‘s area if a proposal for other appropriate governance and accountability structures for the authority’s area has been made to the Secretary of State by the constituent authorities.
(2B) The Secretary of State may set out accountability and governance tests in respect of other appropriate governance structures.
(2C) Orders may allow for a mayor or other appropriate governance structure to enter into collaborative working arrangements with more than one combined authority, or local partnership board covering for example rural areas.”
This amendment would allow for a mayor to work with more than one Combined Authority, or partnership board covering, for example, rural areas.
Clause 3 stand part.
Government amendments 18 to 22.
That schedule 1 be the First schedule to the Bill.
Amendment 57, in clause 4, page 3, line 33, at end insert—
‘(1A) Where the mayor for the area of a combined authority appoints a deputy, regard to gender balance must be given”
This amendment is intended to make sure that gender balance is taken into account in mayor/deputy teams
Clause 4 stand part.
New clause 21—Consultation with local community—
The Secretary of State must make an order to determine the consultation processes which will be used with the local community.”
This amendment is intended to ensure that mayors are provided only where the local resident population has been properly consulted.
Amendment 56, in clause 6, page 6, line 24, at end insert
“which is not restricted to a specific governance structure”
This amendment will allow a council to choose any form of governance and would be defined as a local authority according to the 1992 Local Government Finance Act.
Amendment 42, in clause 8, page 10, line 12, at end insert—
‘(2) The Secretary of State must lay before each House of Parliament at least once in each calendar year a report on the exercise by the Secretary of State of powers which have been devolved to the mayor of a combined authority.”
The intention of this amendment is that the Government should publish every year publish a report that shows that it has not exercised a power that has been devolved to a combined authority mayor.
Amendment 59, in clause 11, page 11, line 27, at end insert—
‘(1) Within 12 months of the passing of this Act, the Secretary of State must publish a report on the performance of the Localism Act 2011 and a review of the general power of competence provision.”
This amendment requires a review of the Localism Act and local authority innovation.
Government amendments 27 and 28.
James Wharton
As well as amendment 29, I will speak to Government amendments 4, 18 to 22, 27 and 28, and to the stand parts for clause 1, clause 2, clause 3, schedule 1, and clause 4. I will also comment, if time and the mood of the Committee permits, on new clauses 1, 13, 18, 22, 23 and 25, amendments 51, 43, 46, 39, 44, 53 and 57, and new clauses 21, 56, 42 and 59, which have been placed in the same group.
The range of interest that has been shown in this Bill speaks for itself. On Second Reading 76 colleagues made contributions, and there was a great deal of consensus. This Bill is of a consensual nature, and while there are issues that we will be discussing in Committee, it is important to put that on record. My intention and that of the Government today is to reflect on the debate that is now to take place and take that into account going forward. We hope this debate can continue in this consensual tone and that it will characterise the passage of this Bill.
Clauses 1 and 2 were inserted into the Bill in the other place. We have considered carefully the arguments in support of the clauses. We share the views of those who supported the clauses about the importance of the Government’s accountability to Parliament for the devolutionary measures and deals they pursue.
Clause 1 places a statutory duty on the Secretary of State to provide annual reports to Parliament setting out information about devolution deals. We recognise that the effect of this clause will be to bring together in an annual report to Parliament details about the whole range of devolutionary activity. While some, if not most, of this information will have been made available to Parliament in the ordinary course of business, we accept that there can be value in such a comprehensive annual report, enhancing transparency and accountability. The Government therefore accept that clause 1 should stand part of the Bill.
Amendments that hon. Members have now tabled seek in various ways to extend the reporting requirements. We are not persuaded that these are needed to ensure the transparency and accountability that we all wish to see, but I will listen carefully to the debate and we will consider further expanding the reporting requirements on devolution in due course subject to the arguments hon. Members put forward.
The hon. Member for Nottingham North (Mr Allen)—whom I may refer to occasionally throughout today’s discussion—has tabled new clause 18, which would require the Secretary of State annually to lay before Parliament a devolution report and enable the Secretary of State to establish an independent body to provide advice on devolution of powers. I think the reporting requirement he has in mind is already covered by clause 1, and while we accept the importance of reports, I do not believe a case can be made to establish some new independent body to provide advice. I fear that any such step would simply lead to additional costly bureaucracy.
The hon. Gentleman has also tabled new clause 13, which would require the publication of a report about how powers devolved to combined authorities are being further devolved. I know he takes great interest in that issue, in line with the devolution agenda more broadly, and wants that taken forward. The Government attach importance to such further devolution. In the Localism Act 2011 we have recognised the importance of neighbourhoods and of neighbourhood planning, and of communities being able to take ownership and management of community assets or take on the provision of local services. This is an important element of devolution and I can see the case for any comprehensive report about devolution covering these matters.
Amendment 42 was tabled by my hon. Friends the Members for Altrincham and Sale West (Mr Brady), for Hazel Grove (William Wragg) and for Bury North (Mr Nuttall). It would require the Government to publish an annual report about powers that have been devolved to a combined authority mayor. This again is an important matter and there is a case for information about this to be included in any comprehensive annual report on devolution. The Government recognise that and want to find the right solution for the concerns hon. Members have.
The shadow Secretary of State and the hon. Members for Heywood and Middleton (Liz McInnes), for Croydon North (Mr Reed), for Dewsbury (Paula Sherriff), for Easington (Grahame M. Morris) and for Stretford and Urmston (Kate Green) have tabled new clause 22 which would make it a requirement for the Secretary of State to report on further devolution options for London, including fiscal devolution which has been called for by the Greater London Authority and the Mayor of London. As we made clear in the other place, we are open to discussing with London plans for the devolution of wider powers. Indeed, the Mayor and London Councils have already sent in formal devolution proposals and the Government are engaged in discussions regarding these. We are committed to taking forward these discussions and I doubt whether there is a need for some further reporting requirement therefore to be included in this Bill.
Post Office Horizon System
Natascha Engel Excerpts(9 years, 4 months ago)
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Gerald Jones (Merthyr Tydfil and Rhymney) (Lab)
Concerns about the Horizon system are clearly of long standing. In the few weeks that I have been here I have heard from at least three constituents who have long-standing concerns about the Horizon system, and there are huge problems that are historic. I understand from one constituent that an injunction has been taken out against her for the sale of a property—
Madam Deputy Speaker (Natascha Engel)
Order. That intervention has been slightly too long.
Andrew Bridgen
I am not surprised to hear that from the hon. Gentleman. The management style of the senior management at the Post Office is Dickensian, and they have an almost feudal relationship with their sub-postmasters. This is now a national scandal. The Post Office has demonstrated that it is incapable of putting its own house in order, so it falls to this House and to this Government to do so for it. I therefore respectfully ask the Minister for a full judicial review into the Post Office Horizon system and the way in which the Post Office contracts with is sub-postmasters and sub-postmistresses.
A&E Services
Natascha Engel Excerpts(9 years, 5 months ago)
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Madam Deputy Speaker (Natascha Engel)
Order. Before I call the Minister, I am putting a six-minute time limit on Back Benchers—that does not apply to Front Benchers. Six minutes is already a little over-generous, so may I make a plea for few interventions, so that we can get in as many Back-Bench speakers as possible? With that in mind, I call Ben Gummer.
Barbara Keeley
On a point of order, Madam Deputy Speaker. I really wonder whether this is within scope. Is it at all orderly to be debating which Minister is answering or proposing a debate? This happens quite a bit in this House—for example, the Chancellor did not come last week. It is just not orderly to be starting off the debate in this way.
Madam Deputy Speaker (Natascha Engel)
I thank the hon. Lady for that point of order. I think the point has been made. Perhaps we can move on with the debate.
Ben Gummer
It is a matter of importance, Madam Deputy Speaker, because in this episode of “Health Handbags”, we have been given an insight into the crisis within the Labour party and Labour Members’ inability to understand what the priorities are for the NHS and for the country.
If the NHS and A&E services are of such importance to the Labour party, one would expect the shadow Secretary of State—
Madam Deputy Speaker (Natascha Engel)
Order. If the Minister could sit down for a moment, I will take the point of order, which I imagine is very similar to the previous one. It would be nice if we could move the debate on, as there are several maiden speeches waiting to be taken. It is an important subject and I would like to move on, rather than get bogged down in this. I will take the point of order, and then I hope we will move on.
Robert Flello
I am grateful, Madam Deputy Speaker. For the benefit of new Members on both sides of the House, I think it would be helpful if you spent a moment clarifying when it is in order to challenge the Chair’s ruling on something and when it is not.
Madam Deputy Speaker (Natascha Engel)
Thank you very much. It is the person in the Chair’s decision whether something is within scope or not. I did not take the Minister’s response to my decision as a challenge to the Chair; I merely wanted to point out that it would be nice to get on with the debate and to allow other hon. Members to speak, especially new Members who wish to make their maiden speech. If the Minister could move on, we would all be very grateful.
Ben Gummer
With pleasure, Madam Deputy Speaker.
In the absence of the shadow Secretary of State, I shall channel him, which is something I enjoy doing. I like the right hon. Member for Leigh (Andy Burnham); he is a man who often—sometimes; a few times—speaks some sense. Just before the last election, he said that after the election,
“we need to come together, and then allow the NHS to get on with the job of building 21st-century services”.
What I do not understand about the motion that he and other Opposition Members have put before the House is that, far from coming together and trying to build consensus on the future of the NHS, what they are seeking to do—once again—is reproduce the golden oldies of criticism that they put before the country before the last election, and that were so roundly rejected.
That comment was about after the election. What I do not understand is what the shadow Secretary of State felt was the purpose of leading a campaign so politicising the NHS before the election. I, like so many others, had a leaflet through my letterbox saying that there were 24 hours to save the NHS—
Madam Deputy Speaker (Natascha Engel)
Order. We are straying into the general election, which has passed, and away from what is on the Order Paper, which is a debate on A&E services. If the Minister could stay on that subject, I would be enormously grateful.
Ben Gummer
With pleasure, Madam Deputy Speaker. The point is that we were warned that there were 24 hours to save the NHS, yet it is still there, and the A&E crisis, which is named at the top—
Madam Deputy Speaker (Natascha Engel)
Order. If the Minister could resume his seat, we are beginning to stray into the realms of challenging the Chair’s decision. We do not have much time and I do not want to take any more points of order on this one subject, so if he could stick to the subject on the Order Paper and let us move on, I would be very grateful to him.
Ben Gummer
I apologise, Madam Deputy Speaker.
The motion is about A&E services, and I would like to talk about the progress that the NHS has made in the past five years. Far from the picture painted today by the hon. Member for Copeland (Mr Reed) and Members who intervened during his speech, the NHS is treating more people than ever before, it is treating more people in A&E than ever before and it is treating more people at a higher rate of satisfaction than ever before, and the result of that is that patient outcomes—something we did not hear much about from the shadow Minister—have improved. We are treating more people to a higher standard.
Helen Hayes (Dulwich and West Norwood) (Lab)
I want to raise a point of substance that affects my constituents. There are young people in my constituency who would love to train as nurses and work in the NHS, but by cutting the number of training places in London by 25%, the Government have made that much harder. At the same time, when I last spoke to the recently retired chief executive of King’s College Hospital NHS Foundation Trust, he told me that he was recruiting nurses in the Philippines, because there are not enough nurses—
Madam Deputy Speaker (Natascha Engel)
Order. When the Chair is on her feet, Members sit. I have said before that interventions need to be very short and kept to a minimum. That was too long.
Ben Gummer
The shadow Secretary of State cut the number of training places for nurses; it was increased under the last Government and is now at a record level.
We were on the subject of performance, which is at the heart of the motion. The shadow Minister can speak warm words about the workforce, but he failed to congratulate them on their exceptional performance under unprecedented pressures. At no point in his speech did he acknowledge the real increase in pressure on A&E services in the NHS. Some 3,000 additional patients a day are being seen, treated and discharged in accordance with the 95% target; that is being delivered by NHS staff across the service. He fails to point out the places where we have seen remarkable successes. He fails to give the example of Barking, Havering and Redbridge University Hospitals NHS Trust, which saw a 16% improvement in A&E performance times in the last year. That is front-line staff delivering better outcomes as a result of changes made by the Secretary of State over the past five years.
Dawn Butler
The time that people have had to wait for four hours has gone up—
Madam Deputy Speaker (Natascha Engel)
Order. Interventions should be kept to a minimum. The hon. Member for Central Ayrshire (Dr Whitford) is not on a time limit, but please be aware that many Members are coming in to speak. Thank you.
Dr Whitford
Absolutely, we have seen the performance drop across the UK. The Minister quoted a report showing that England was performing better than Scotland. I would be interested in seeing that one—where it is comparing like for like with core A&E services—because those are not the figures I have seen. However, we all face the same challenge. We are dealing with older patients, who are more complex. The figures from Scotland last winter showed that we did not have a huge increase in numbers, but far more of those patients had to be admitted. Nothing else could be done, and we will face that situation more and more in future. The problem is that we are losing the staff to deal with that, and we are talking about A&E, but in the vast majority of cases, they key issue does not lie with A&E. There are two simple things: the number of patients coming in, which relates to out-of-hours GP access, and patients getting back out, which is described by the Royal College of Emergency Medicine as exit block.
It is important to remember that the four hours does not involve someone sitting on a chair, waiting for four hours. People are often given that impression—that they turn up in A&E and sit there, and no one will touch them for four hours. However, they will be triaged, see a clinician, have a history taken and have investigations. They may well get sewn up or be given something, and they will go home. Those patients are moving through. Our problem is the patients who have to come in, and it results in a whole cascade of issues, such as people stuck on trolleys getting the start of a bedsore, or families made miserable, or staff very depressed at trying to look after people in a corridor. It also results in people ending up boarded to any ward—any port in a storm—so that people are not in the correct ward and not getting the correct treatment from the correct team. We know that that, bizarrely, results in longer patient stays, which exacerbates the problem.
What we need to do—as we have done in Scotland, where we set up the unscheduled care action plan—is to work with all stakeholders. That involves looking at how patients flow through. It is not about people being obsessed with measuring the target and counting it, but about people opening the gates in front of the patient. The data on how long patients wait should be automatically available to staff from their system; it should not require an extra body to generate that data.
If we have the data weekly, which means we are getting them timeously, we can see one week from the other and ought to be able to see the patterns. The problem with monthly data for something that is identified as a currently acute issue is that, by the time they are collated, verified and out, staff may not remember quite what made that a bad week, whereas with weekly data, they can see whether they are getting a response to their actions.
I support keeping weekly measurements, but I do not support them being used as a tool—and certainly not for beating one another across the Benches here. I can tell hon. Members that staff in the NHS feel that they are beaten over the head with these targets, so it is not about having a target, but about how it is used. In the paper released by the Royal College of Emergency Medicine here yesterday, one of its myths was that the four-hour target is a distraction. It pointed out that it allowed a focus.
To try and tackle the problem in Scotland, we have ensured that the majority of our A&Es have a co-located out-of-hours service. I mentioned before that achieving 8 till 8 in every GP practice is so far in the future that it cannot be reckoned on as a solution to this problem. We are unable to fill the GP vacancies we have now. Telling them that they will be working from 8 till 8 on Saturday and Sunday is not overwhelmingly attractive.
The pilots that have been done have started to report in the last fortnight, and they have reported a very poor uptake. When people want to deal with an out-of-hours problem, they come to A&E. Rather than trying to change the whole population, we could have a system in which people are easily diverted once they get there: “If you have this, please step next door to our primary care service.” We need to look at those solutions, and some are working quite well.
The other issue is health and social care. To get patients out at the end of their journey, they need to be able to get into care. We need to remember that, although extra money may be given to health and social care through the health side, if we are cutting local authority budgets at the same time, we end up cutting the legs from under the NHS.
Marie Rimmer (St Helens South and Whiston) (Lab)
A 25% reduction in the number of GPs and practice nurses has been forecast over the next five years. I have the statistics to prove that. People talk about the cost of agency staff and locums in hospitals, which is out of all proportion. There are also massive increases in costs—
Madam Deputy Speaker (Natascha Engel)
Order. It is essential that we keep interventions to the absolute minimum.
Dr Whitford
The problem with moving patients into hospitals is being exacerbated by the reduction in in-patient facilities. Every new hospital seems to have fewer beds than the old hospital it replaces. The Scottish Government finally accepted the view of clinical staff that that could not go on. We now treat people in a different way. People used to get a hernia done and lie there for a week. My breast cancer patients used to come in and stay for 10 days. That has changed, which is great for those patients, but there is an inexorable rise in the number of older patients who have complex needs. The problem is not that we are living longer. I get quite upset at the phrase, “the catastrophe of living longer”. I suggest that Members think about what the alternative is. At medical school, I was definitely given the impression that people living longer was the point.
People are surviving their first major illness and, actually, their second major illness. They may present with breast cancer in their mid-70s to someone like me and have four co-morbidities. Such patients do not get in and out quickly for elective surgery, and they do not get out quickly when something major goes wrong, such as pneumonia or a chest infection. We therefore need to stop the downward trajectory in the number of beds, because we will not get the flow of patients if we go on cutting beds.
For me, the key things that we need are the co-location of GPs; an out-of-hours service for out-of-hours issues that are better dealt with in primary care; and enough beds in the right places. Finally, we need to smooth the way of our patients to get back to their homes. In Scotland, we have free personal care that allows us to keep more people at home and stop them going into hospital and to get more people back out of hospital.
I commend the “Five Year Forward View”. Much of it is taken from something that was written in Scotland several years ago called “2020 Vision”, which was about integrating health and social care.
GP Services
Natascha Engel Excerpts(9 years, 9 months ago)
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Natascha Engel (North East Derbyshire) (Lab)
It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow) who, in his previous role as Minister responsible in this area, gained a wealth of knowledge of primary care, mental health and social care, something I want to pick up on in terms of GP services.
I do not want to repeat everything that has been said before, but without a doubt GP services are facing a real crisis. Everybody has mentioned how many people use their GPs. Most people have a GP. Over 90% of all contacts made in the NHS are made through GP services. GPs and GP practices are the absolute bedrock on which the NHS is founded, so we must get this right. At the moment something is going very, very wrong.
I want to put this in context. The hon. Member for Clacton (Douglas Carswell) said earlier that this was about patients, not doctors. Unless we get right the framework in which the doctors are working, it is the patients who suffer. We also need to understand that, over the last 20 years, the number of GP consultations has risen by 25%. There are many more appointments, without the system having changed that much to accommodate that. The average person now sees a GP six times a year, which is double what it was a decade ago, but the word “average” hides something. I represent a constituency with quite high levels of deprivation, but there are a couple of perfectly well-to-do areas where the GP services are not in crisis and are absolutely fine. The problems are in those areas of greatest deprivation. Arguably those are the areas that most need GP services to be running as well as they can. It is also where GPs are under such a lot of strain; some are retiring early and others are not going into GP practice in the first place. I want to emphasise that if a person is deprived, they will use their GP services as much more of a lifeline than others who go to see their GP.
My hon. Friend the Member for Walthamstow (Stella Creasy) spoke passionately on behalf of her constituents. We found in one of our practices where services were starting to crumble that problems compounded each other. Once things start to go wrong, there is a terrible domino effect. A high number of patients are signed up to my practice and one of the partners retired. That one retirement caused the GP practice to go into crisis. We can all sometimes make the situation worse by highlighting an individual practice, in order to try to help as much as possible, and saying that it is in crisis. That means that GPs will not then apply to work there, when actually the issue is not about that one practice; it is one piece of an entire jigsaw. Patients then leave that practice and sign up at a neighbouring practice, causing that practice to go into crisis. We need to look at this not from the perspective of North East Derbyshire or Walthamstow, but as a national problem.
Mr Jamie Reed (Copeland) (Lab)
Does my hon. Friend share my concern that unless we as a country address these problems quickly, holistically and in a detailed way, we run the risk of creating a two-tier NHS service, in which those who, as she rightly points out, most need care are less able to access it?
Natascha Engel
Absolutely. I am deeply concerned about that, and about where the pots of money are that people are accessing. I will come to that in a moment. One thing I hear a lot locally is, “The problem is that we are all living longer.” Of course it is not a problem that we are living longer; it is fantastic, but we need to change the way we look after people as they get older. The problem is not just dementia, cancer or heart disease; diabetes, as we have heard, is an absolute killer. We need to invest much earlier to make sure that people can manage their illnesses or, hopefully, avoid them altogether. GPs have a fundamental role in that.
What I really wanted to talk about was the interconnection locally. We have had enormous cuts to the budgets of local authorities. Derbyshire county council, which is responsible for social care, has had its budget slashed to a point where it is difficult to provide the levels of care that were provided before. I have a sheltered housing facility called Mallard Court, where 50 people are living independently because they have a warden service. That warden service and the care line allow people to live active, social and healthy lives with a minimum level of support. Cuts to local authority funding mean that that social care can no longer be provided. We are looking at finding other ways to provide it, but taking that warden away means that those people will, in a matter of weeks or months, go into crisis, whereas now they are living independent lives. In looking at GP services, we need to look at that issue as well, as it is the local GP practices who will feel all the pressure of those 50 individuals.
That goes back to my point about pots of money and the ring-fencing of them. We can have social services, GP services and acute care in different places, which sucks up all the money in the NHS. Unless we start to look at all of this, as my hon. Friend the Member for Copeland (Mr Reed) said, as one big picture, the solutions will not be found.
Younger generations are much more demanding, and people have access to the internet. It is good that people are more demanding. That gives a rocket boost to the NHS by making people develop and keeping them on their toes, but we really need to make sure that people are realistic in their demands. The group of practice managers that I meet regularly—they have joined us here today—would say that it is a question of people being realistic in the demands they make on GP services. As MPs, we need to promote that.
I want to talk about normal GP practices. Most of my practices have multiple members. At the moment, there is immense stress and strain on GPs who are partners and own the building that the practice is in. Those employed just as GPs in the practices do not have the same pressure, financial uncertainty and risk that a partner does.
What often happens is that partners retire young and sell their shares in the ownership of the practice. People are not taking on that risk, but are instead working, often in the same practice, as locums. As locums, they can earn around £100 an hour, and that is before they start charging for additional things on top. Rather than having all that stress and strain, and never really having the time to take a step back and look at the bigger picture of where the GP practice is going, partners are standing down and working as a locum, doing the work that they want to do and getting highly paid for it; that is, so far as I can see, a no-brainer.
Tim Loughton
The hon. Lady makes a very good point. I, too, mentioned locums. Are not the pressures on and requirements of partnered GPs deterring many people? That is why it is easier for Worthing hospital to recruit doctors; it is looking to take on directly salaried GPs to place in the A and E department to relieve pressures there.
Natascha Engel
Absolutely, and we ought to look at the issue of ownership of GP practices quite quickly; perhaps more imaginative ways can be found of ensuring that NHS England and those in the areas finding things most difficult can take on ownership of individual practices and GP services. We need to consider all these different issues. The Royal College of General Practitioners has said that there is a shortage of 10,000 GPs, and we need to get on top of that urgently. We need to make it more attractive for GPs to go into practice. As the hon. Member for Clacton said, it is patients who suffer when there are not enough GPs in the service.
I have worked closely with Steve Lloyd, a GP who is chair of the Hardwick clinical commissioning group, which covers the southern part of my constituency. He took me through all the facts and figures, but the big point he made at the end was, “Cherish it or lose it.” I want to end on that note.
Oral Answers to Questions
Natascha Engel Excerpts(11 years, 10 months ago)
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Mr Hunt
The biggest safeguard is the fact that the Government have made it one of our key priorities to improve mortality rates for cancer to the best in Europe. That means we are putting in a huge amount; for example, we are investing £450 million in early diagnosis. There are many other measures, which shows how seriously we take it.
Natascha Engel (North East Derbyshire) (Lab)
My 92-year-old constituent, Ron Lewin, was referred for minor oral surgery. He was eventually written to by the specialist, who said that waiting lists were very long and that assessment appointments were available in 18 weeks, but that they did offer an independent service if he wished to be seen earlier. Independent obviously means paying to jump the queue. Is that how the Government propose to cut waiting lists?
Dr Poulter
It is a decision for front-line medical professionals to outline when treatment should or should not be given. Treatment must always be given on the basis of clinical need, so I am sure the hon. Lady will be feeding that message back to local commissioners. There is an opportunity for people to appeal against decisions when they are not made on the basis of clinical need, as that is clearly not the right thing and not in the interests of patients.
Business of the House
Natascha Engel Excerpts(12 years, 2 months ago)
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Mr Lansley
I completely understand how strongly my hon. Friend feels about that, and I think many Members of the House feel the same. I hope she sees that there is an opportunity for her on the 18th of this month to raise that issue at Justice questions. I am sure that Ministers will feel as strongly as she does on this.
Natascha Engel (North East Derbyshire) (Lab)
Before I welcome the new Leader of the House to his new role, I too would like to put on record my thanks to his predecessor, the right hon. Member for North West Hampshire (Sir George Young). Without his help and good advice, the Backbench Business Committee would not be what it is today, and the Back Benches are a more interesting and more powerful place as a result of his time in office.
I am sure that the Backbench Business Committee will continue to enjoy a good and strong working relationship with the Office of the Leader of the House, and I look forward to working closely with him. May I take this opportunity to say to the House that the closing date for submitting subjects for the mini-recess Adjournment debate on the final Tuesday is Wednesday 12 September?
Mr Lansley
I am grateful for the hon. Lady’s kind words. I was pleased that in my first announcements on the business of the House I was able to include not only the pre-recess Adjournment debate but a day for the Backbench Business Committee which is not a Thursday. I want to follow what my predecessor achieved in improving the opportunities for debates for Back-Bench Members and in bringing a sense to this House of being a forum for the nation on issues of importance. I hope that we will continue to do that.
Oral Answers to Questions
Natascha Engel Excerpts(13 years ago)
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Natascha Engel (North East Derbyshire) (Lab)
8. What arrangements he has put in place to involve dental practitioners in the commissioning of dental services.
The Minister of State, Department of Health (Paul Burstow)
Responsibility for the commissioning of all dental services across primary, salaried and secondary care will sit with the NHS Commissioning Board. The vision for commissioning dental services sees dental local professional networks developing and delivering local service plans and quality improvement strategies across all dental services and providing clinical leadership and expertise at local level. This will enable dentists, working with commissioners and other local stakeholders, to ensure that all dental services are integrated and work together in the most efficient way.
Natascha Engel
I thank the Minister for that answer, but I still do not see why GPs are good enough to commission services locally, but dentists are not. Can he explain exactly how dentists are to be involved, in the same way as GPs are, in commissioning services locally?
Paul Burstow
I refer the hon. Lady to the answer that I just gave. The vision for commissioning dental services sees dental local professional networks developing and delivering local services and local quality improvement strategies. Beyond that, it involves local health and wellbeing boards working together closely, involving local clinicians through the networks that I referred to earlier. The answer is that local dental clinicians will be fully involved in the ways that I have just described.
Breast Cancer Screening (Young Women)
Natascha Engel Excerpts(13 years, 12 months ago)
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Pat Glass
I am aware of the “Predict” computer system, which is an incredibly useful tool in the hands of clinicians, but I do not think it should be generally available for people to use in their own homes to calculate, using their symptoms, how long they have to live. I think they would find that very worrying. However, it would be incredibly useful for their doctor.
Of the women who died last year from breast cancer, 1,300 were under 50 years old. We know that women with a mother, sister or daughter who have been diagnosed with breast cancer have almost double the risk of being diagnosed themselves. We know that the risk increases with the number of first-degree relatives diagnosed, but even so, eight out of nine breast cancers occur in women with no family history of cancer whatsoever.
Natascha Engel (North East Derbyshire) (Lab)
A woman in Derbyshire, Wendy Watson, runs the national hereditary breast cancer helpline. What is my hon. Friend’s view on getting national funding for that helpline, which is a lifeline for many women suffering from hereditary breast cancer?
Pat Glass
I am aware of Wendy and the fantastic work she does; I also know that she is struggling to secure funding. Perhaps the Minister might look at that as a result of today’s debate. I thank my hon. Friend for making that point.
We know that obesity presents a risk, as do hormone replacement therapy and the use of oral contraceptives. In the binge capital of Europe, we are now told that as little as one alcoholic drink per day increases the risk of breast cancer by about 12%.
Paul Burstow
I am grateful for those points, and I am coming to them, which is why I was smiling—it was not because of the subject, which is very serious.
Let me talk briefly about partial age extensions, which is another issue worth airing. The last cancer reform strategy committed the Government to extending the NHS breast screening programme to women between the ages of 47 and 73. Beyond 73 years of age, patients would still be able to self-refer. That extension will ensure that all women are invited for screening before their 50th birthday. The June revision to the NHS operating framework confirmed that the extension will begin this year—in 2010-11. By the end of March next year, we expect 60% of screening programmes to be screening that wider age group, and we obviously want to go as far and as fast as we can.
Our updated cancer reform strategy will focus on outcomes and on improving cancer survival rates. Although the one-year and five-year survival rates have improved in recent years, we still lag behind other European nations. If we could match the five-year survival rates of the best countries in Europe, we could save up to 10,000 lives every year in England. As has been said, therefore, early diagnosis is essential. In September, I announced funding for a new £9 million campaign to get people to recognise and, importantly, to act earlier on the signs and symptoms of cancer. We are talking not so much about a campaign as a series of 59 local campaigns, which will focus on the three big killers: breast cancer, bowel cancer and lung cancer. The campaigns will raise public awareness of symptoms and encourage people to talk to their GP at the earliest possible opportunity. We will target those populations that the hon. Member for Easington talked about, which are often harder to reach.
Our approach will also encourage GPs and others in primary care to act appropriately. The tragedy of these cancers is that they are preventable. As has been said, lifestyle—eating too much, drinking too much and not getting enough exercise—plays a big part. That is why the coalition is determined that public health will become a far more important part of overall public policy and practice nationally and locally. We will make sure that we treat and prevent cancer in that context. That is why we will, as I said, publish a White Paper later today to set out how we will provide the right leadership and the strategy to improve people’s lifestyles and to reduce their risk of getting cancer in the first place.
Natascha Engel
Will the Minister briefly outline his opinion regarding national funding for the hereditary breast cancer helpline? It is a national service and it needs national funding, but the Department of Health has said that it is more appropriate to fund it locally. This incredibly important service provides information and advice and helps women up and down the country. What does the Minister think needs to be done about it?
Paul Burstow
I am grateful to the hon. Lady, and I certainly pay tribute to the work that the helpline does, but it is important to stress that NHS organisations and commissions are responsible for such funding, so it is perfectly possible for them to collaborate to make the resources available.
The hon. Lady rightly refers to inherited cancers. It is perhaps important to stress that about 5% of women will contract breast cancer simply because it runs in the family. National Institute for Health and Clinical Excellence guidance published in 2004 recommends that women with a moderate or higher risk of familial breast cancer should receive annual screening. However, across the NHS, delivery is patchy, and we have heard examples of that patchiness in the debate. Women deserve better than that; they deserve a consistent service wherever they happen to live. For that reason, the NHS breast screening programme will soon take responsibility for ensuring that familial screening is regularly and routinely carried out.
In conclusion, I very much respect the points that the hon. Member for North West Durham has made, the passion with which she delivered them and the commitment that she clearly has to improving our ability to detect these cancers early and prevent them. We must do everything we can to improve survival rates and to improve the quality of life for those living with cancer. We will do that by focusing resources on what works and where the evidence demonstrates the risks are outweighed by the benefits. In this instance, the evidence at the moment is clear: extending annual breast cancer screening to all women over the age of 35 would not improve their chances of surviving the disease. However, it would mean that we would need to ensure that we did not place women in a situation where they felt unnecessary anxiety as a result of false positives. We will always act on best evidence, which is why I make the undertaking to take away the evidence that the hon. Lady referred to. At this time the evidence does not lead us to conclude that there is a case for change. But we will keep it under review.
I thank the hon. Lady for raising these matters today. The Government are determined to achieve the best possible outcomes for people with cancer through our public health strategy and our cancer strategy. We are committed to ensuring that the resources are there to avoid the postcode lottery that some hon. Members described, an inheritance that we are determined to deal with.
Oral Answers to Questions
Natascha Engel Excerpts(14 years ago)
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Paul Burstow
I am grateful to the hon. Gentleman for his question, because I chair the ministerial group that is considering how we can improve and increase the supply of research. It is examining a number of matters, including how we can ensure that there is an increase in the volume of research, how we can engage the public—he is absolutely right about that—and how we can translate research into practice quickly. Next year we will set out more detailed proposals and publish the details of all the research programmes that are under way.
Natascha Engel (North East Derbyshire) (Lab)
13. What plans he has for future public funding for the hereditary breast cancer helpline.
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I congratulate Wendy Watson on starting the helpline in 1996. I also congratulate the hon. Lady and my right hon. Friend the Member for Derbyshire Dales (Mr McLoughlin) on the support that they have given it. I know that it has experienced difficulties in gaining funding from primary care trusts, with only 36 of the 152 PCTs providing it, but the cancer networks are working on an interim solution to fund the helpline through the transition period prior to the NHS commissioning board and GP commissioning coming online.
Natascha Engel
I thank the Minister, but what I am most concerned about is the fact that Wendy Watson is running the helpline on a shoestring from her home in Derbyshire. She is getting small grants from PCTs, but once PCTs are abolished, where will the money come from? Can the Minister commit to funding the national helpline, which is the only one of its kind, directly from the Department of Health?
Anne Milton
I point out to the hon. Lady that with the new commissioning consortiums, those decisions will be made at a much more local level. Only 36 of 152 PCTs are currently contributing to the helpline, which is nonsense when one considers that they are being asked for only £422 each. It is right that such decisions should be made locally, particularly in view of the sort of emotional support that the helpline can give.