Psychosis: Early Intervention

Roger Gale Excerpts

Wednesday 7th September 2016 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this very important debate. The House appreciates his engagement with this issue, given all his wisdom and experience as a former Health Minister, and his continuing work since the 2014 paper “Achieving Better Access to Mental Health Services by 2020”.

Every Member of Parliament, on both sides of the House, will have had the experience in their own advice sessions of people coming to see them who either are experiencing mental health problems or are a family member trying to get help for a child or partner with mental health problems. I think that every Member of Parliament will also have somebody struggling with mental health issues within their own family or among their wider acquaintanceship, but it remains the case that the stigma around mental health issues means there is more concealment, more shame and more delay in reaching out to the NHS for the treatment and support that people need. We know that mental health issues are on the rise. We know that there is a relationship between recession, unemployment and mental health issues and we can see it in our communities across the country.

I have to declare an interest because my mother was a mental health nurse until she retired. She worked in a mental hospital called Storthes Hall in West Yorkshire, and like a lot of mental health facilities it was a former workhouse. Despite the dedication of the nurses and doctors who worked there, this former workhouse on the edge of the Yorkshire moors exemplified, in a very physical way, the Cinderella nature of mental health services.

All parties in this House are committed to parity of esteem between mental health and physical health, but this important debate tests that reality. As we heard earlier, mental health is not just an issue for the individuals concerned; it can have a very sad and serious effect on their families. My hon. Friend the Member for Bristol East (Kerry McCarthy) touched on the issue of black and minority ethnic men and psychosis. This subject is not often discussed in this House, so I will be forgiven for saying a little about it. It has been an issue for many decades that black and minority ethnic people are disproportionately represented in our mental health system at every level. If someone goes on to the wards of the Maudsley in south London or of mental health hospitals across London, they will see that a disproportionate number of the beds are filled by people of black and minority ethnic origin. In some cases, nearly all the beds are filled by people of black and minority ethnic origin.

This subject has been examined and studied since the book “Aliens and Alienists: Ethnic Minorities and Psychiatry”, which is by Dr Lipsedge, I think, and goes back to the ’80s. First, the issue is disproportionate representation, but then it is what sort of access to treatment people from black and minority ethnic backgrounds get. The first problem is their presenting late, and one of the reasons why black and minority ethnic people present late is that they are so frightened of the mental health system. I have dealt time after time with mothers who are struggling with sons with very serious psychosis whom they cannot manage and feel physically threatened by. When I say to them that they need to approach the national health service, they are often very resistant because they are so frightened. They believe that if they let their sons go into the mental health system, they will just be pumped full of—

[Sir Roger Gale (in the Chair)]

Order. I am sorry to interrupt the hon. Lady. I understand that she wishes to address the Member who moved the motion, but she is off-microphone and it is making it difficult for the Hansard reporter. That is why, traditionally, Members address the Chair.

[Ms Abbott]

It is true of many communities, and in particular the black and minority ethnic community, as the statistics prove, that they are reluctant to take family members into the national health system. When they finally have to engage with the national health service, their symptoms are much worse and it is far harder to get positive outcomes. I tell the Minister that it is really important to look at this issue of black and minority ethnic people and the mental health system, because it is causing real misery and problems within the community. We are less likely to be offered talking therapies and more likely to be offered electroconvulsive therapy. Again, mental health facilities within the prison service, such as Rampton, have disproportionate levels of black and minority ethnic persons inside those institutions.

Junior Doctors Contracts

Roger Gale Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I absolutely agree with that, but I gently say to the right hon. Gentleman that if that was the case, he has my mobile phone number and he could have contacted me, and he did not need The Sunday Times to be the first place I saw his proposal. If the people involved were genuinely serious about brokering a deal, that was not the way to go about it. We all have a duty to do everything we can to avert tomorrow’s strike, but his proposal to change the Government’s plans into pilots would mean, as he knows perfectly well, that seven-day care would get kicked into the long grass and would probably not happen. That would be wrong. As he well knows, we have a responsibility to patients to deliver our manifesto promises, and that is what we are going to do.

[Sir Roger Gale (North Thanet) (Con)]

I wonder whether my right hon. Friend can refresh my memory. Is it not the case that under the new contract those who are going to strike tomorrow—it is by no means all junior doctors—putting patients’ lives at risk, will be earning more, rather than less, and for fewer hours, rather than more? Would he also remind me of any other public sector employee who gets time and a half for working on a Saturday morning?

[Mr Hunt]

My hon. Friend makes an important point. The deal on the table is fair for junior doctors; there is higher premium pay for people who work regular Saturdays than there is for nurses, paramedics, healthcare assistants in their own operating theatres, fire officers, police officers and pretty much anyone else in the public or private sector. Under the new contract we are bringing down premium rates for Saturday pay, but we are making sure we compensate that with a 13.5% increase in the basic pay—to my knowledge, that is not being offered anywhere else in the public sector. That will mean take-home pay goes up for 75% of junior doctors. It is a very fair deal. It is designed to make sure that they are not out of pocket as we make changes that are safer for patients, which is why we should be talking about these changes and not having these strikes.

Crohn’s and Colitis Treatment: England

Roger Gale Excerpts

Wednesday 24th February 2016 Westminster Hall

[Several hon. Members rose—]

[Sir Roger Gale (in the Chair)]

Order. I think four Members wish to speak. I will not put a formal time limit on speeches but request that Members confine their remarks to about six minutes. If we are sensible, everybody should get a chance to speak.

Primary Care: Tottenham

Roger Gale Excerpts

Wednesday 16th December 2015 Westminster Hall

[Alistair Burt]

I will ask exactly that. I do not doubt that it is doing that already. Clearly, the right hon. Gentleman needs to be reassured, and we shall do so.

[Sir Roger Gale (in the Chair)]

Order.

Motion lapsed (Standing Order No. 10(6)).

Junior Doctors’ Contracts

Roger Gale Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

My right hon. Friend is completely right, and I will come to some of those challenges later in my speech.

When the NHS is facing unprecedented challenges, it cannot be right to pick a fight with the very people who keep our hospitals running. I come here today to ask the Secretary of State to do three things: to show that he is willing to compromise by withdrawing the threat of contract imposition; to guarantee that no junior doctor will be paid less to do the same, or more, than they are currently doing; and to ensure financial penalties for any hospital that forces doctors to work excessive and exhausting hours.

[Sir Roger Gale (North Thanet) (Con)]

On that basis, given that the Secretary of State has indicated in terms that no junior doctor will be required to work more hours—rather, it is fewer hours—than at present and that they will not lose money, can the hon. Lady give me any reason why the doctors’ leader was able to say to me earlier in the week that he would not get round the negotiating table and talk?

[Heidi Alexander]

I am afraid that the Health Secretary has given absolutely no guarantee that no junior doctor will be paid less.

I have set out the three things that I wish the Secretary of State to do today. Anyone listening to this debate would say that they were all reasonable things to request. Anyone who wants to avoid industrial action would want the Secretary of State to step up and do the right thing.

G8 Summit on Dementia

Roger Gale Excerpts

Thursday 28th November 2013 Commons Chamber

[Tracey Crouch]

I agree entirely. This is something that blights many conditions, including cancer. We talk about cancer investment, but there is little or no research funding for some cancers. Mesothelioma is a classic example, about which there is a debate on Monday.

It is essential that research focuses on investment in infrastructure. Training and development for researchers is also crucial if we are to see swifter progress towards treatments and cures for dementia. However, it remains hard for an academic with a good idea to spin that off to a company, especially compared with the situation in America. The Government must do more to promote the commercialisation of research as these companies become a vital part of the ecosystem. Large companies and academia can then be partnered in the innovative collaborations that the Government seek.

Research on the provision of care is equally important. Four out of five people with dementia live at home. We want to keep it that way and to ensure that they can live there safely for as long as possible. Research comes in many different forms, including the identification of what works. We know that dementia costs the UK £23 billion, but arguably that money is not being spent properly or efficiently. Prevention is key. Avoiding unnecessary hospital admissions is vital to ensuring that funding is used effectively and, more importantly, makes a huge improvement in quality of life. Researching best practice in care is essential. An economic case developed by the Alzheimer’s Society estimated that if just 5% of admissions to residential care were delayed for one year as a result of dementia-friendly communities, there would be a net saving of £55 million a year across England, Wales and Northern Ireland.

There needs to be a change in the language we use when we talk about care. If we talk about weekly art lessons that are provided to help to improve cognitive function as therapy, rather than an activity, we could hope to see a change in attitude towards research and investment in this area. Many good ideas are having a positive impact in local communities. For example, Medway council, which covers part of my constituency, is promoting telecare as a means of supporting people with dementia, and there are lots of non-clinical treatments that could be further researched, such as the benefits of pets and petting animals for people with dementia, memory rooms and memory boxes. I have even heard of amazing innovative products such as wristbands that monitor someone’s usual actions so that they will detect if they have a fall. We need to consider all those things in the whole pod of research.

We should not forget to consider support for carers. Family carers of people with dementia save the economy £7 billion a year, but evidence shows that they struggle to do that, which can lead to avoidable crises in care, hospital admissions or early entry into care homes, all of which are very costly. The Dementia Action Alliance’s “Carers Call to Action” campaign, which I support, is calling for timely and tailored support for carers, whom I am sure we all agree are an important cog in the wheel of treating and providing for those with dementia.

On best practice, it is important that international collaboration includes the beneficial sharing of successes and failures. In utilising our resources, it is important that we do not duplicate unsuccessful investments and that we champion successful and effective progress. The summit should therefore ensure that all publicly funded dementia research data and results are made available, thereby allowing common factors in national research responses to be shared.

[Sir Roger Gale (North Thanet) (Con)]

Before my hon. Friend moves deeply into the main subject of the debate, which is the G8 summit, does she agree that we need much greater public understanding of, and support for, those who are caring for people with dementia and those with the condition, which can strike not just elderly people, but younger people? Some of us remember a former and much-loved Member of this House who, while still an MP, suffered from the disease. This is something that we have to ram home to people.

[Tracey Crouch]

I agree entirely with my hon. Friend. It is important to note that society has made much progress in the past 20 years and that dementia is not the taboo subject it perhaps used to be. We have changed how we think about it and now treat people with dementia much better, but we still need to get away from the idea of saying, “Nan’s gone a bit dotty.” We have to understand that something can be done about dementia and that proper care pathways exist to ensure that people can live well with it, and we have to support carers as best we can.

On the G8 summit, I turn to my final but no less important point: long-term strategies. The Prime Minister’s challenge on dementia for England has provided a welcome focus on the treatment and care of people living with dementia and the search for a cure, but there is a danger that the focus will be lost, especially as the initiative is not UK-wide but covers only England. Many countries have dementia strategies or brain bank initiatives, and the UK needs a new long-term strategy, because the current one is due to expire in 2014. I would be grateful if—not today but soon—the Minister could outline his plans to evaluate the national dementia strategy for England and tell the House when he will commit to a new strategy following the current strategy’s expiration next year. Notably, the US has a dementia strategy in place until 2025, which means that we could be left in the embarrassing situation of the UK Government leading the G8 in a discussion on dementia without a national long-term commitment comparable with that of many of their international partners.

In conclusion, it is fantastic that the UK Government, under the Prime Minister’s personal commitment, are using the G8 summit to champion a more collaborative approach to preventing, treating and curing dementia, but it is essential that the legacy of this summit goes further than the G8 and that the declaration and communiqué of the summit makes firm long-term commitments to the doubling of research funding, to sharing best practice, and to delivering an international ongoing collaboration on defeating this devastating disease, which affects so many people and their families.

Care of the Dying

Roger Gale Excerpts

Tuesday 17th January 2012 Westminster Hall

[Sir Roger Gale (in the Chair)]

Good morning, ladies and gentlemen. It will not have escaped your notice that a considerable number of hon. Members are present, and a significant number have indicated in writing that they wish to speak. Who gets called, other than in what order, is beyond my control. We have an hour and a half for this debate. The Front Benchers will traditionally want not less than 10 minutes each, so, if you do the math, as they say, it is up to you. If hon. Members confine their remarks to three minutes a head, we will get everybody in; that is, of course, other than the person who initiates the debate. If hon. Members take an inordinate amount of time, I have no power to curtail the length for which they speak, other than to say that they may not get called again in the near future. Please try to exercise some control, and we will endeavour to ensure that everybody gets heard. Those with less experience might like to pay attention to the fact that it is sometimes possible to make a point in an intervention, rather than in a formal speech.

--- Later in debate ---

[Several hon. Members]

rose—

[Sir Roger Gale (in the Chair)]

Order. Six hon. Members still wish to speak. I intend to call the Front Benchers from 10.40 am. Again, please do the sums.

--- Later in debate ---

[Anne Milton]

We want to end any mishmash. We want a consistently high quality of care for everybody. Everybody deserves a good life and that is why we came to this place. This debate has allowed us to debate, discuss and share the opportunities that exist for Parliament to allow people a good death too, with dignity, without pain, in the company of those we love and at peace in death with the lives that we have led.

[Sir Roger Gale (in the Chair)]

Order. Just before we move to the next debate and while I am awaiting the arrival of the Minister, who is not late, may I thank all hon. Members for the tone and the self-restraint that has been exercised this morning? As a result of that, we have managed to accommodate the views of 21 Back Benchers, in addition to those on the Front Bench. I regard that as exceptional. I hope that many people outside the Chamber will have heard the quality of the House of Commons at its absolute best. Thank you.

Childhood Obesity

Roger Gale Excerpts

Tuesday 3rd May 2011 Westminster Hall

[Justin Tomlinson]

I thank the hon. Lady for that useful contribution. She is right. A lot of what we are doing is putting in the building blocks for a long-term future to tackle health issues. Organisations, such as the sports forum, can talk to people of all ages and ask people to engage. Local authorities and sports groups have a role in that. One of the best things that I saw was Swindon borough council’s Challenge Swindon campaign, which brought together offices, pubs and sports groups and got them all involved in different sports. It aimed to get people to try something and then continue to do it.

We face a number of other challenges. The lack of volunteers is always a challenge, particularly in sport. A huge number of sports groups would like to be able to do something, but there are not sufficient parents with the time to be able to do that—a particular problem for organised sport.

Private finance initiative schools are another challenge: when I was a councillor, the majority of schools in my area were PFI schools. We had a high-density development and a wonderful piece of open space, but a fence and a set of high hire charges blocked children from utilising what was their school until 4 o’clock in the afternoon. Sports clubs came to me on a number of occasions saying that they simply could not afford to use the facilities, which could not be opened because there was not enough flexibility. It was a crying shame that they were left unused.

An issue that I have brought into other debates is the cost of insurance for transporting children. As we push things such as the school Olympics or outdoor active learning, insuring a teacher to take a minibus can cost more than £1,000. I have urged the Government to create a national insurance scheme for teachers and sports clubs using minibuses.

We must not forget the Olympics and the Olympics legacy, about which we had a debate in the main Chamber last week. It is all about the legacy. We will have an enjoyable Olympics, when we are bound to win some medals, but the key will be the lasting legacy. That is why I was so supportive of the principle of school sport partnerships. A big advert for a whole variety of sports that different children will have never thought of trying will be on the television, and the ones we do particularly well in will inspire children to go and re-create them. We must ensure that we do all that we can. Going back to the point about insurance, if we want the school Olympics to work, we need to be able to get children from one school to another in order to compete.

My slightly more radical proposal is to do with how leisure and youth services work in local authorities. In the old days, leisure was very much about competitive sport, with the traditional youth service organising youth activities. The two would never meet in the middle. Times have now changed massively.

I remember that on a Friday night the leisure centre would put on an ice-skating disco for the teenagers—again, not technically a sport, but 600 teenagers building up a head of steam and racing around chasing after the person they thought particularly attractive was a sporting activity. It was absolutely fantastic. Under my radical proposal, the youth service with its mobile buses would have been better off pitching up at that facility, to offer advice, advocacy and support to those who wanted it, and letting leisure be the attraction to bring people in. Likewise with the point made about the Pineapple dance studios and the street dance, often the biggest challenge is to get young girls active, but hundreds of children want to do dance and cheerleading.

Youth and leisure services should sit around the same table, pooling their funds and facilities—the leisure centres often have the better facilities—and working together. They would then be on hand. My hon. Friend mentioned the Get Set programme, and I have written to all the schools in my constituency, encouraging them to do as much as they can.

In conclusion, we need to learn three lessons. First, it is important to have balance in an active and healthy lifestyle. We can sometimes be a bit too zealous in saying, “You should not watch TV. You should not play computer games.” When I was growing up, as soon as the sun was shining, I was charging around outside. I would not have dreamed of watching TV or playing computer games. However, in the evening, that is what I did. That is a fine balance to have.

Secondly, we should allow people to make informed decisions through clear labelling and to do things for themselves. To do that, they need the skills, which is why I am such a fan of the cookery lessons.

Finally, everything should be fun. Children like fun things. Give them the open spaces—as I said, it does not matter if the open spaces are vertical, because children are creative and will come up with their own way of dealing with such things. However, let us at least give them the opportunity to have a better lifestyle.

Several hon. Members rose—

[Mr Roger Gale (in the Chair)]

Order. I expect the occupant of the Chair will wish to call the Front Benchers at five past 12, at the latest, and three hon. Members are waiting to speak. Hon. Members should bear that in mind when speaking.

Health (CSR)

Roger Gale Excerpts

Thursday 11th November 2010 Westminster Hall

[Ian Lavery]

The coalition agreement states quite clearly:

“We will stop the top-down re-organisations of the NHS that have got in the way of patient care. We are committed to reducing duplication and the resources spent on administration, and diverting these resources back to front-line care.”

Now we are seeing the largest ever reorganisation in the NHS. We are seeing the PCTs abolished and GP consortiums looking to take their place, which will inevitably create duplication and require more finance and more resources to be spent on administration. What does my right hon. Friend think about that?

[Mr Roger Gale (in the Chair)]

Order. As hon. Members know, I am the most tolerant of Chairmen, but I cannot help noticing that we are having a significant number of scripted interventions that are rather long. I am not entirely certain that they are in order, but what I am certain of is that the subject of the debate is the impact of the comprehensive spending review on the Department of Health. We appear to be embarking on a debate around the structuring of the health service. I think that, somewhere along the line, hon. Members might like to refer to the comprehensive spending review.

--- Later in debate ---

[Frank Dobson]

Does my hon. Friend accept that the 150 drugs that are most commonly prescribed in this country are half the price that they are in the United States, where the pharmaceutical industry, roughly speaking, determines the price of drugs? We can guarantee that prices will start to go up under the new system.

[Mr Roger Gale (in the Chair)]

Order. There is a very interesting debate to be had on those issues, but the hon. Member for Newport West (Paul Flynn) has been in the House a long time, and the right hon. Member for Holborn and St Pancras (Frank Dobson), who has just intervened, has been Secretary of State for Health and both are aware that, while the subject may be interesting, it is not to do with the comprehensive spending review, which is the title of the debate.

[Paul Flynn]

I want to address my remarks to the budget of the health service, and how it matches our priorities.

Perhaps I may move to a different subject. I should like to pursue what my right hon. Friend said. He is absolutely right that the lobbyists determine health policy in America, and will have an increasing effect on the comprehensive review, and on the demands on and priorities of the health service. However, I shall deal with another matter, which is not political in any way, because it involves decisions made by one Government, which were then approved by the pantomime horse of a Government we have now. It is about pandemics past and future. We have had a series of those, which have been costly for the health service. They go back to severe acute respiratory syndrome—a very severe and nasty illness, which killed more than half the people who caught it—through the threatened avian flu, which never lived up to its billing, to swine flu last year.

Swine flu in Britain cost the health service £1.2 billion on antivirals and vaccines. It also had other damaging effects, in that it scared the country greatly. People were frightened by the possibility of flu on the scale of the 1918 flu that killed between 25 million and 40 million people. It distorted all the priorities of the health service for a year. The health service gave attention to that rather than to the other things that it should have given attention to. It also involved the use of a vaccine that had not been trialled. The people who say it was not fully trialled are those who made it—GlaxoSmithKline and the other producers. That was a major event, and we might consider, knowing what we know now, how we got into that situation.

We were told by Liam Donaldson that it was likely that there would be between 3,000 and 750,000 deaths. He gave an average figure. We in the United Kingdom could expect 65,000 deaths, many of which would be among children. Rightly, that terrified the country and the media took it up. What was the source or basis for those figures, and the result? The result was that the number of people who died with swine flu was about 450. The number of people who died of swine flu was about 150. That compares with the 2,000 to 12,000 people—in one year it was 20,000—who die every year of seasonal flu. The swine flu outbreak was thus by any standards a minor event in Britain. Worldwide we were told to expect between 4 million and 7.5 million deaths. The total recorded was 18,000—a minute fraction of what had been expected.

In the context of the spending review, how do we prepare for another pandemic? What if we are given word by the World Health Organisation to prepare for another pandemic? Why did the WHO act as it did? It was for one reason—the definition of a pandemic changed between May and June last year. Scale 6 is the top pandemic; there is no six and a half, and no scale 7. The WHO told the press that there was a scale 6 pandemic; the press immediately went into hysteria mode and said that it was the same as the flu of 1918, and told us to prepare for tens of thousands of deaths. Until May 2009, the definition of a scale 6 pandemic was one that involved a tremendous number of deaths or serious illnesses. In June 2009 the definition was changed to take out that measure of severity and the point was made that it could involve mild flu. A pandemic would be a scale 6 pandemic depending on the geographical area in which the flu was detected. The alarming message came from Madame Chan, who was very much involved in the SARS outbreak in Hong Kong, and who expected something like SARS again. The world was expecting a flu epidemic, because we had one in 1957; there was a world flu epidemic in 1968, and another one in 1977. There was an expectation of a major flu epidemic, but we know the results now.

I want now to consider Tamiflu.

[Mr Roger Gale (in the Chair)]

Order. I am very sorry, but I must ask the hon. Gentleman to make at least a thinly veiled attempt to relate his remarks to the comprehensive spending review. We are not having a general debate about the health service.

[Paul Flynn]

As to the likely spending this year, if there is another threatened pandemic, how are we to fit it into the spending review, and future spending, since we are at present tied? Do we draw the lessons of what happened last year? If another epidemic comes along, will we react in the same panic-stricken way, or act as another country did? Perhaps we should consider the present spending review in the Polish Parliament. Ewa Kopacz, who has responsibility for health, was interviewed by GlaxoSmithKline, who told her, “We are not going to guarantee this vaccine, because we haven’t trialled it properly, and if there are any adverse reactions you, the Polish Government, will be responsible.” Ewa Kopacz said, “Well, if you don’t trust it, I don’t trust it.”

The Polish Government spent about 7 zlotys on the vaccine, compared with our £1.2 billion. The result was that they had half the number of deaths per million of population that we had. I want to point out that huge financial decisions were made in the swine flu pandemic, and we should have drawn the lesson from them, but we have not. We had a review, by one Department, which was a whitewash and was approved by the Government, and which said that the reaction was proportional. It was not proportional if we compare UK spending with the spending in Poland—which was virtually nothing—given the result that they had.

Tamiflu was approved by the Food and Drug Administration in America on the basis of its being a mass placebo medicine. In December 2009 the BMJ published an article alluding, in a reference along the lines of “Somebody stole my Tamiflu research paper” to the traditional excuse that students give for not doing homework. The authors had tried to find the research that said Tamiflu was some good, but it was not there. The BMJ could not find it. The FDA in America approved Tamiflu not because it found it was useful but because it had gone into the research and found that the drug was no better than a couple of aspirins. It had no perceived proved value; but the FDA approved it because it wanted to be able to prescribe something in the event of an epidemic. They wanted to show a man in a white coat, giving a pill. It would have an advantage as a placebo—but there is no advantage.

In spite of that, in this year’s spending review we shall almost certainly spend more money on Tamiflu and the vaccines that have not been properly trialled. I am not against vaccines, which are a huge and miraculous improvement in world health, and have saved thousands of millions of lives, but there are serious doubts about the fact that we spent our money last year, and might spend more next year, on a vaccine the side-effects of which are now becoming apparent in various countries—Japan, Finland and India.

I sense that you are going to call me to order, again, Mr Gale. My point is essentially how we order our finances in the spending review. With the changes in NICE, there will certainly be another increase in drug prices. The drug bill constantly increases, in real terms and as a proportion of the health budget. That has been going on for the past 20 years. It will happen again if we hand over power to the lobbyists and big pharmaceutical companies. We are seeing it now. It has been said that instead of a postcode lottery, we have a one-way escalator to higher prices. If we surrender further to hysteria about another world pandemic or to pressure from lobbyists to buy certain drugs to the detriment of other health services, the spending review will be inadequate. The Department will spend more money on drugs—some required, some totally unnecessary—and further impoverish the NHS, creating a decline in important life-saving services.

--- Later in debate ---

[Paul Flynn]

On a point of order, Mr Gale. There is a tradition in this place that Ministers making the winding-up speech reply to the debate. This Minister has been speaking for 14 minutes and has not mentioned a single point made in the debate.

[Mr Roger Gale (in the Chair)]

The hon. Gentleman has been in the House long enough to know that the Minister is responsible for his own speech and his own remarks.

[Mr Burns]

The hon. Member for Newport West (Paul Flynn) probably is not aware, because this is a new form of debate following the setting up of the Backbench Business Committee, that I am not winding up the debate, even if I am speaking last. I am making a speech on the Government’s position on the subject that we are debating, and I will certainly—on occasions, where appropriate—refer to and answer hon. Members’ questions, although I have to say to the hon. Gentleman that I probably will not answer any of his questions because he was not taking part in the same debate that is on shown on the annunciator. He was having a general roam-about on NICE and pharmaceuticals, rather than speaking on the spending review and health.

--- Later in debate ---

[Mr Burns]

I can say nothing further than what I said to the right hon. Member for Holborn and St Pancras, so I shall make progress. There is nothing further to say—I have answered the question. [Interruption.]

[Mr Roger Gale (in the Chair)]

Order. We cannot have such discussions going on across the Chamber. Either the Minister will give way or he will not.

[Mr Burns]

I will not give way because there is little more that I can add to what I have already said on the subject.

--- Later in debate ---

[Frank Dobson]

rose—

[Mr Roger Gale (in the Chair)]

Order. The Minister has made it plain that he is not giving way.

[Frank Dobson]

On a point of order, Mr Gale, the Minister might be inadvertently misleading those present here today, on the basis of information available to me.

[Mr Roger Gale (in the Chair)]

That is not a point of order for the Chair, Mr Dobson.

[Mr Burns]

All I can tell the right hon. Gentleman is the situation as it is known to me: no decisions have been made and discussions are continuing. In due course, decisions will be reached, but as of now none has been made and the discussions continue.

--- Later in debate ---

[Frank Dobson]

On a point of order, Mr Gale—as I understand it, the Department of Health has been briefing that it wants to take away only £4 million from Great Ormond Street.

[Mr Roger Gale (in the Chair)]

Order. That is not a point of order for the Chair. The right hon. Gentleman has been in the House long enough to know that.

[Mr Burns]

On the issue of social care, it is accepted by all parties that we need to be more efficient. There have been historic problems in the funding of social care and we found that, given the mounting pressures and the economic situation when we came to power, there was a serious problem that needed to be addressed so as to provide support in the forthcoming year and thereafter for some of the most frail and vulnerable members of society.

We believe, as I am sure the hon. Member for Halton does, that re-ablement services can restore someone’s independence. They have a crucial role to play, where appropriate. Around half of those who go through re-ablement require no immediate care package afterwards. The NHS is investing £70 million this year, £150 million in 2011-12 and £300 million a year for the rest of this Parliament in better re-ablement services. That will have a significant impact on improving the lives of many people.

Telecare, too, can help keep people safe and feeling more confident in their own homes, reducing their reliance on formal home care services. These are not isolated cases. There are similar remarkable stories across the country.

Re-ablement can make a real difference, provided that the authorities act seamlessly and quickly to ensure the equipment and anything else needed to assist someone to return home, avoiding a stay in a hospital, care home or any other non-domestic environment.

--- Later in debate ---

[Mr Burns]

I fully understand the issue that the hon. Lady raised about whether we merge the NHS part of social care in local government into the NHS, or vice versa. That has been an ongoing debate for many years. The hon. Lady may find it difficult to believe, but 13 years ago I was the Minister with responsibility for social care. The argument was raging then. I have no doubt that it will continue to rage for some time to come. I, too, have heard the worries that the money that comes through the RSG will not be spent on social care. From the discussions that the NHS has had with local authorities, I have been led to believe that that will not be such a problem. Given that there is a problem with social care and a need to provide support, there will be a determination and a positive attitude to ensure that the money is appropriately spent on what it is designed for and that it will, with the money from the NHS, make a significant difference to a very serious and sensitive problem that we, as a society, have to address.

In conclusion, the spending review is the necessary consequence of this Government’s facing up to the financial responsibilities and problems that we inherited when we came to power. If we are to secure a future of growth, prosperity and jobs and if we are to fulfil our commitment to increase funding for the NHS in real terms for every year of this Parliament, then we must place our public finances on a stable, sustainable footing.

We will not ask the sick, the disabled or the elderly to pay the price of the previous Government’s economic mismanagement. We are increasing the health budget in real terms and reforming the service, not only to make the most of every penny but to put power in the hands of those who know best how to improve services. I am talking not about the Ministers and civil servants in Whitehall but about the NHS staff and patients on the ground.

[Mr Roger Gale (in the Chair)]

Mr Morris has indicated that he wishes to make a few closing remarks with the consent of the Members present. I am perfectly prepared to facilitate that, but the hon. Gentleman must understand that these are closing remarks, and that he is not actually responding to the entire debate all over again.