Healthcare: East Midlands

Ruth George Excerpts

Tuesday 30th April 2019 Westminster Hall

[Karen Lee (Lincoln) (Lab)]

I beg to move,

That this House has considered provision of local healthcare in the East Midlands.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am glad to have secured this crucial debate, which gives me and my east midlands colleagues a great opportunity to highlight the healthcare crisis in our constituencies, our region and across the country. I must stress in everything I say that I do not blame the hard-working and dedicated staff for any of it; the fault lies fairly and squarely with Government cuts. Our constituents deserve better than the past decade of under- funding, which has created a postcode lottery in local healthcare. It has had particularly detrimental implications for my constituency of Lincoln: local healthcare centres have been forced to shut, more general practitioners’ services are at risk of closure in the coming months, and local hospitals are in need of considerable funding and support.

Our healthcare infrastructure in the surrounding region of Lincolnshire has also been put under considerable pressure over the past nine years. In July last year, the chief inspector of hospitals recommended that United Lincolnshire Hospitals NHS Trust, which has a deficit estimated at £80 million, should remain in special measures. The latest figures show that the trust missed its A&E waiting time target by 32% and has not met the national standard since September 2014.

The east midlands reflects the national picture of a health service in crisis. The Government have spent nine years running down the NHS by imposing the biggest funding squeeze in its history, with massive cuts to public health services. Social care has been slashed by £7 billion since 2010. Our NHS is short of 100,000 staff, including 41,000 nurses and nearly 10,000 doctors. That has had a detrimental knock-on effect on performance: waiting lists are at 4.3 million, more than 500,000 patients are waiting more than 18 weeks for treatment, and 2.5 million people are waiting for more than four hours in A&E. That is a crisis.

It is clear that the underfunding, privatisation and inadequate staffing of our health service has had a devastating effect on healthcare provision in Lincoln and the east midlands. Government decisions have had terrible consequences for people who need care in the areas that I and many of my colleagues represent. That is typified by the recent announcement that the highly relied-on Skellingthorpe surgery may close.

For those who do not know it, Skellingthorpe is a beautiful village in my constituency. Its doctors surgery provides healthcare to more than 8,000 patients, many of whom are local residents. The national patient survey found that 81.9% of the surgery’s patients felt that their overall experience was good or very good. The Glebe Practice, which runs the surgery, is in the process of proposing its closure to the clinical commissioning group, and the practice’s patients are centralised in its Saxilby surgery. I acknowledge that there are pressures on the service—there could not fail to be, given the Government’s cuts—and that the practice is struggling to recruit clinicians, so centralising its service in Saxilby allows it to maintain quality in one surgery. However, centralising the service restricts my constituents’ access to care. They have told me that it is already very difficult to book a timely GP appointment there.

As many other hon. Members will know from their own constituencies, rural areas are often inaccessible because of limited transport links. If the Glebe Practice’s plan to transfer patients to its Saxilby practice is agreed to, it will mean patients having to travel on public transport—remember, not everybody can drive or has a car—or walk for 90 minutes from the Skellingthorpe surgery. Even the closest surgery is about a 40-minute walk away. Imagine elderly people having to walk for 40 minutes!

This is a shocking downgrade of my Skellingthorpe constituents’ access to care. The proposed alternatives do not offer an acceptable journey length to patients who are in need of health services. Many patients may struggle with mobility issues because of age or illness, while others may not be able to afford to travel other than by public transport.

[Ruth George (High Peak) (Lab)]

My hon. Friend is making an excellent speech that sets out the challenges to healthcare in rural areas such as Lincolnshire. Just this week, the wound service in one of our local clinics in High Peak has shut. Elderly patients with open wounds are having to travel for four hours each way, on three buses, to access the clinic that they are supposed to go to. Does my hon. Friend agree that that is absolutely unacceptable?

[Karen Lee]

Yes, I do. I hope that everybody in this Chamber would agree that that is really unacceptable.

Rather than reducing access to one-to-one healthcare, we should be outlining how we can help groups such as the Glebe Practice by implementing effective national programmes that incentivise recruitment in rural areas. There is a major workforce crisis: as a report co-authored by the Nuffield Trust, the King’s Fund and the Health Foundation has found, the NHS could be short of 7,000 GPs within five years. Rural areas will be the first to be hit. As access to GP services in the east midlands is reduced, I urge the Minister to take action to address the staffing crisis.

Before the surgery closes, Lincolnshire West CCG intends to hold a public consultation—but the people of Lincoln have been there before, very recently. Lincoln’s walk-in centre on Monks Road closed last year after an allegedly meaningful public consultation, 94% of respondents to which were opposed to the closure. Protests were held outside Lincoln County Hospital and along the high street. Both Conservative-led Lincolnshire County Council and Labour-controlled City of Lincoln Council formally objected to the closure, as did I, but not a bit of notice was taken—the centre was still closed. The justification was similar to the one being given now for the Skellingthorpe closure: we were told that there would be sufficient alternative provision to ensure the same level of care. After researching that claim, we found that no substitution would come anywhere near the accessibility of the walk-in centre, so I am afraid that my constituents’ faith in any local consultation is pretty limited.

Appointment-only slots will not meet the needs of my constituents who rely on short-notice, timely access to care. Inevitably, they will only add to the pressure on the overworked A&E department at Lincoln County Hospital and East Midlands ambulance service.

I am very concerned that a trend is emerging: the implementation of cuts to healthcare services, in direct opposition to local people’s wishes and needs. It is deeply worrying that CCGs are not listening to residents’ concerns before closing local health services. I completely acknowledge that there have been sustained budgetary pressures on the healthcare system over the past nine years, and that it is the CCGs that are expected to deliver large-scale cuts, but in a transparent health governance system we cannot allow cuts to be rubber-stamped against such clear local opposition.

I ask the Minister to consider these cases and contact me to provide substantial reasoning to explain why another closure in my constituency is considered acceptable. The information that I and my constituents have been afforded has led us to the opinion that neither the walk-in centre nor the Skellingthorpe surgery should have been considered for closure. I am sorry, Minister, but passing the buck to the CCG is not good enough for my constituents.

It is not just local GP practices and health centres that have been put under debilitating pressure over the past decade. In my constituency, Lincoln County Hospital serves the city of Lincoln and the north Lincolnshire area. Due to funding and staffing pressures, the latest Care Quality Commission inspection has found that Lincoln County Hospital is below the national standard and requires improvement. It is important to stress that, as is the case in hospitals throughout the UK, this substandard performance is in no way the fault of the dedicated and hard-working staff. I speak from experience: when I was a nurse there, we often used to stay up to an hour late. In theory we got our time back, but in practice we did not.

The staff give a lot—it is not their fault. I worked as a nurse at Lincoln County Hospital for 14 years and I know how much energy and care all the staff, from porters to doctors, put into their challenging work. That is supported by the CQC report, which concluded that the hospital requires improvement in four out of five areas: safety, effectiveness, responsiveness and management. The only area rated as good was the caring nature of the hospital. As the report states repeatedly:

“Patients were treated with compassion, dignity and respect.”

I pay credit to the hard-working staff for that, but they are being let down by a Government who have consistently neglected our health services. I have been through their cuts myself.

The inspection found that nurse staffing numbers were often insufficient to keep people protected from avoidable harm and that the hospital relied heavily on agency and locum staff. I know that at first hand: my friends who are still nurses there tell me that that is true even now. Most worrying was the fact that adequate levels of nurses were observed on only four of the 28 days that the CQC reviewed. It is hardly surprising that there are such drastic staffing shortages. Since 2010, there has been a 19% real-terms fall in weekly earnings for full-time nurses. Nursing degree applications have dropped by one third since the Government scrapped nursing bursaries, without which I would not have been able to train. I go on and on about the nursing bursary, and I will not stop. We need to bring it back; we will not have enough nurses until we do.

The Health Foundation has also found that the number of nurses quitting because of a poor work-life balance almost tripled between 2011 and 2018. Our NHS staff should be celebrated and supported. Their kindness and commitment should not be taken advantage of by a Government who strip away the security of their profession. Lincoln County Hospital demonstrates the devastating way in which avoidable staffing shortages affect vulnerable patients in our communities.

The CQC report also found that patients could not always access care and treatment in a timely way. Waiting times were worse than the England average and did not meet the national standard. Some 60% of ambulance handovers were delayed by 30 minutes or more, and 47% of patients in A&E waited longer than the recommended 15 minutes to be triaged. I went out with an ambulance crew about a year ago, and I saw that at first hand.

That shows how hard-working, committed NHS staff in Lincoln are being put under intolerable pressure by decisions made in Whitehall. That is not unique to Lincoln. In July last year, England’s chief inspector of hospitals recommended that United Hospitals Lincolnshire NHS Trust should remain in special measures after visits to Lincoln County Hospital, Pilgrim Hospital, County Hospital Louth and Grantham and District Hospital. Pilgrim Hospital in Boston, which serves my constituents, is a particularly worrying case. It received an overall rating of “inadequate” in this year’s CQC inspection. The report found that there was no allocated corridor nurse. Corridor nurse—really? Should people be in corridors on trolleys? One nurse was caring for up to 21 patients at one time. When I was a nurse, the average was about six or eight. On a bad day, if someone did not come in, it could be 10 or 12, but 21—really?

It is clear that at the local, regional and national level, healthcare provision is not working. Vulnerable people who need care in Lincoln, the east midlands and across the UK have a right to access the health provision that they need. That requires a properly funded and staffed NHS service, from local GPs to county hospitals. Although I welcome the Government’s planned funding increase for the NHS, most health experts agree that it is barely enough to keep the NHS afloat, let alone reverse nine years of severe funding cuts. Areas such as Lincoln and the east midlands need and deserve much more than a plan that will barely keep afloat a system operating on a shoestring budget.

As someone whose job used to be to provide local healthcare, I am lifted by the fact that everyone can access healthcare as a human right in this country, but that universal right is threatened by policies that do not enable an effective health service in which everyone can access care based on their need, not on the austere policy decisions of the Government of the day.

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[Ruth George (High Peak) (Lab)]

It is a pleasure to speak in this debate about the issues that specifically affect the east midlands. I thank my hon. Friend the Member for Lincoln (Karen Lee) for bringing the debate to Westminster Hall and the hon. Member for Bosworth (David Tredinnick) for expounding on some of the local and national issues in his area.

High Peak in Derbyshire is on the very north-west tip of the east midlands, which brings its own pressures to a very rural area on the edge of two other regions that provide most of our acute healthcare: Greater Manchester and Sheffield in the Yorkshire region. We are highly dependent on other regions for our acute healthcare. People can find it difficult to access our local healthcare services. It is important that they are able to access the best possible healthcare locally, to prevent their problems from becoming more serious and so that they do not have to travel much longer distances to access acute care.

When I was first elected, I had an indoctrination of fire on healthcare matters. A consultation by our North Derbyshire CCG had been ongoing for two years. It was called “Better Care Closer to Home”, so its aspirations sounded marvellous: people would receive the care they sought closer to home or in their own home, rather than having to travel anywhere. In practice, it meant an announcement in July 2017, just after I was elected, that our local gold-standard dementia ward, the Spencer ward at the historic Cavendish Hospital, was to close.

The ward had 10 beds and took the most seriously ill patients with dementia, whose families were no longer coping with them at home. Often, they had got to the stage of being violent and abusive, fighting against the illness and against the people trying to care for them. It is a tragic illness and I have seen members of my own family go down with it, and at that stage families need all the support they can get.

The Spencer ward would take those patients whom no one else could cope with and, within six weeks and with no drugs whatever, manage them and their families into getting them home again. The staff claimed it was the shepherd’s pie that did it, but it was down to years of skill, expertise and kindness. The patients could be cared for at home, which everyone had thought was impossible, instead of having to go into specialist dementia care housing with high-level nursing care, which often costs six-figure sums for each patient. The ward closed in February last year, and it was an absolute tragedy for the patients and their families—even more so for the patients now coming through with dementia.

We were told that the 25 skilled staff would be transferred to a dementia rapid response team, a group who would be able to visit patients in their own homes, giving support to the families and enabling continued care at home. In practice, however, I am afraid that has not happened. The response team is located 20 miles from some of the areas in my constituency that most need it, and only one of the 25 skilled Spencer ward staff members went to work in that team. Others were left with no jobs in the health service; they went into retail and their skills were lost. That was a tragedy not just for patients but for staff and our whole community, because once those skills are lost, once those jobs have gone and people have left the NHS, it is almost impossible—without years of training and dedication—to put that service back together again.

That is why I am so committed to fighting for services in High Peak that are being let go because of years of cuts to our CCGs, which have to make very short-term decisions based on balancing the books by the year end. NHS England does not let them look at any longer-term measures or decisions that could put the investment into the preventive health measures talked about by the hon. Member for Bosworth. That cannot be the case.

In 2016-17, the formula was changed for the CCGs. Our CCG went into deficit and then special measures under NHS England. The chief executive said that he and his board were prepared to make £12 million of cuts in north Derbyshire, but NHS England said that that was not good enough. It insisted on £16 million of cuts within six months, so the chief executive left. In the year just gone, 2018-19, the cuts have come on. With a deficit of £95 million for all the Derbyshire CCGs, which are looking to band together to achieve some efficiencies of scale, they had to make £51 million of cuts. We are constantly being told about the NHS 10-year plan and the £20 billion of funding coming into the NHS. I do not know where that is going, but our CCG will not see it. The Minister may smile, but I do not find it funny that over the next four years Derbyshire, the area I represent, will experience £270 million in cuts to health services, which are already stretched almost to breaking point.

Like my hon. Friend the Member for Lincoln, I went out with the East Midlands ambulance service. I saw how stretched it was, having to travel vast distances and out of area, sometimes leaving little or even no cover, with patients perhaps having to wait five hours after a stroke, or being lost because of the cuts. The ambulance service has experienced five years of cuts, year on year.

Last year we had a Westminster Hall debate about the East Midlands ambulance service, which was attended by many of the Members present. I was delighted that another £20 million was invested in the service, but there is an issue with recruitment—once the skilled paramedics have left the service, recruiting them back again is very difficult. Meeting the targets for that extra £20 million will be extremely difficult for the service, through no fault of its own.

The issues in our local area put pressure on acute service providers as well. The hospitals in Macclesfield and Stepping Hill, which serve the north Derbyshire end of my constituency, have staffing problems and can shut their doors to High Peak patients because they are out of area—we are not in their region. The Macclesfield cardiology, gastroenterology and general surgery departments were shut to my local patients. Just before Breast Cancer Awareness Month in October, Stepping Hill shut breast services to patients from north Derbyshire, who therefore faced having to travel 30 miles for the follow-up to a mammogram. That is a huge distance for people in rural areas to travel; often, there is no transport available for them, so they are reliant on lifts. Yes, there is community transport, but that has been cut, too.

Our voluntary services have been cut because the clinical commissioning groups have to make their cuts by the end of the year, and one area they can cut is grants to external organisations. The voluntary sector has had cuts to social care, befriending services and community transport. As the hon. Member for Bosworth has said, a sustainable health service needs such services in order to provide preventive care and to enable communities to come together and support each other, particularly the most vulnerable. That needs a framework, but voluntary sector services are being cut time and again, as I said in a debate in September. Some £300 million of cuts have been made to voluntary sector services in Derbyshire.

Health service cuts are being made alongside those to social care. Derbyshire County Council has made huge cuts to services, resulting in care workers’ shifts changing from a two-shift to a three-shift system. It wanted more efficiencies and was struggling to fill some shifts, but working early, late and night shifts is almost impossible for anyone with caring responsibilities, which most social care workers have. I am sure my hon. Friend the Member for Lincoln, who worked in nursing, will sympathise with that and will know the destructive effect on people’s lives. It is one thing to do that for a nurse’s salary, which is a professional salary, but it is very different to ask people to do that for the minimum wage—it was a living wage under the Labour-led Derbyshire County Council, but now it is less than the national living wage. Asking people to work a three-shift system for that sort of money is simply not worth it, so they have left in droves.

Our care home fees have been frozen while at the same time the minimum wage, pension costs and business rates are all increasing. The care homes are not prepared to take any elderly residents with any sort of additional needs. There are no nursing homes whatsoever in the High Peak area, so we have to go out of area. It is an increasingly difficult situation for families, who struggle to visit patients and keep family ties going. It is heartbreaking that, at the end of a long life, residents are taken out of their area, away from the people they know and love and their communities.

That is the impact on rural areas of years of cuts to health and social care and to the young people’s services provided by the county council. Both older and younger people are being squeezed. A couple of weeks ago I held a debate in the main Chamber on young people’s mental health, because of the low-level support being given. Derbyshire CCGs have cut the contract for counselling services with the third sector and there is no longer a service in place. The number of school nurses, who support young people through difficult times in their lives, when they have anxiety and are distressed, has been halved. There is an 18-month wait for access to child and adolescent mental health services. I hear from young people and their families who are desperate. Often, parents feel they have to stay with their child 24 hours a day, seven days a week, because they are so scared of the harm that the child may do themselves and the risk of suicide that the hon. Member for Bosworth mentioned.

Why are we letting it get to this stage? Why are we letting our young people suffer in silence? Why are we sending our older people away from their families? It comes down to the failure to look holistically at our health and care services in the long term. NHS England still has Derbyshire CCGs in special measures. They have been told to meet a target of between £50 million and £70 million of cuts over each of the next four years. They have to identify those cuts behind closed doors. There is a lack of scrutiny, as my hon. Friend the Member for Lincoln has said.

Often, so much of the impact is on patients and GPs, who have to pick up the pieces. The strain on GPs is almost intolerable. Buxton has only about half the GPs we need. There are shortages in other areas, too. At my surgery, patients have to phone two weeks in advance to even try to get an appointment with a GP. If they do not phone early enough, they cannot get an appointment in those two weeks and they have to try the next day. That leads to an increase in people going to A&E and an increase in admissions to acute care and costs to the NHS as a whole. That is not a cost-saving process.

Budgets that do not look at the whole picture, to try to help primary care and to support people’s conditions, are leading to an increase in the need for acute care. Because of the lack of social care, once people are in a hospital bed it is hard for them to get out of it. The number of beds at Fenton ward in Cavendish Hospital—the one rehabilitation ward left in my constituency—has just been reduced from 18 to 10. That was going to happen in October but I managed to persuade the hospital that it might need some rehab beds over winter. It kept them open but it is now down to 10 beds. There is a waiting list of six or seven patients, who are stuck in hospital, taking up hospital beds because the rehab beds have been cut. That is a false economy.

I hope the Minister will look at how the system has an impact on the health professionals who are trying to deliver a service, and most of all on the patients who are suffering under it. Yes, there is price for rationalisation in any service, but we also have to look at the long term. As the laudable aims of the NHS 10-year plan set out, we need to work with our communities, support our professionals and help our patients to care for themselves. Unless this financial system changes, that NHS plan will be simply hot air.

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[The Minister for Health (Stephen Hammond)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. As you know, I have met the chief executive of the team from Kettering, I have visited Kettering and I have responded to you on the Floor of the House about Kettering. Kettering and its requirements for the A&E are therefore not far from the forefront of my mind.

I congratulate the hon. Member for Lincoln (Karen Lee) on securing the debate and I thank all hon. Members for their contributions. I intend to spend some time going through a number of the areas raised this morning. I am bound to say that the long-term plan, which a number of Members welcomed, is a substantial step forward, and the funding commitment—the biggest ever in peacetime—is a key to ensuring that that can be delivered. The number 100,000 has been trotted out, but clearly that does not represent posts unfilled, nor does it take any account of the actions that the Government are undertaking. More than that, the simple fact is that, compared with eight years ago, there are 14,700—over 15%—more doctors, 10,300 more nurses, midwives and health visitors and, in addition, over 15,900 more nurses on our wards.

I also point out that of those vacancies that several hon. Members mentioned, well over 80% are being filled by a combination of bank and agency nurses. Of course no one wants that situation to persist, but there has been a consistent decline in the number of agency staff, and since the transfer from the bursary to the loan system, much has been done working with nurses to ensure that courses are filled. We are seeing more applications than previously: this time around UCAS reported over 4,000 more applicants. Last year, my predecessor announced a fund to provide an increased package for postgraduate nursing students starting courses in 2018-19 in terms of employment in learning disability, mental health and district nursing roles, which are the key vacancies that need to be filled.

I will try to answer a couple of specific points raised by the hon. Member for Lincoln. She rightly voiced concerns about the closure of Skellingthorpe health centre in her constituency. As she pointed out, were there to be a closure, the CCG would be required to conduct a proper consultation. I spoke to the CCG yesterday and I understand that as yet—she may wish to correct me—there has been no formal request for closure. Equally, the CCG tells me—I hope this is right—that it will meet the hon. Lady later in May to discuss this matter, and that, were there to be a request, it would immediately inform her and offer her a meeting with it and the lead GP at Skellingthorpe to see what action could be undertaken. The CCG has also confirmed —she will understand this—that it appreciates that this is a rural community, and that there are additional challenges for local residents, so it is working not only with Skellingthorpe to understand the challenges and how they may be met, but to ensure that the rural network of GPs might work together.

The hon. Lady rightly expressed concern about CQC inspections, and I will go on to speak about those if I have time. She mentioned the recent inspection that took place on 25 February at Pilgrim Hospital, with a report published on 3 April. Although “requires improvement” remains the rating, there were marked improvements in certain areas, including in the standard of care, numbers of staff and nursing provision for children, and a real improvement in the triage time. She will appreciate that the trust is receiving substantial support from NHS England, including to help the hospital get out of special measures.

My hon. Friend the Member for Bosworth (David Tredinnick), chair of the all-party parliamentary group for integrated healthcare, spoke passionately about the health and wellbeing partnership. He is absolutely right, and the Government support the integration of healthcare services and recognise the good work being done by that partnership in Hinckley and Bosworth. The Secretary of State enjoyed his visit to Hinckley, and was particularly pleased to get a real impression on the ground of the improvement in services that will come from the £8 million investment. My hon. Friend reminded me of his Christmas present to me, and I was pleased to read some—although not all—of his report over the Christmas period. You will not be surprised to hear, Mr Hollobone, that I was also intrigued to hear his comments about India. I sometimes think that the “Ministry of Calm” in India could benefit many people in this place.

The hon. Member for High Peak (Ruth George) spoke about “Better Care Closer to Home”. That reminded me of when I was a councillor 18 years ago and a different Government wanted to do to local services in my area the things that she described. The issue was only resolved some years later, in 2015, when a new medical centre was built. She rightly mentioned the East Midlands ambulance service and—most importantly —its paramedics. I visited that service earlier this year, and spoke not only to the management but to the medics who deliver those services. There are clearly challenges regarding location, and not all the standards have been met. It is also true, however, that there are 67 new ambulances—an increase of 27—and response times have improved, which is to be welcomed. I recognise the problems with CAMHS that the hon. Lady raised. That is clearly an issue nationally as well as in the east midlands, and it is right for the long-term plan to recognise that. The commitment to mental health diagnosis and treatment times is a significant change from the previous situation.

[Ruth George]

Mental health services were allocated £1.2 billion, but that money was not ring-fenced. That is the problem that CAMHS has had with the cuts. Will the Minister commit that any additional funding for mental health services will be ring-fenced, so that it goes where it is needed?

[Stephen Hammond]

There is a commitment to treatment and the funding that backs it in the long-term plan, and that money is dedicated to that commitment. That is pretty clear.

[Ruth George]

indicated dissent.

[Stephen Hammond]

The hon. Lady is asking me to use the word “ring-fenced”, but if I say that the money is there and allocated for that matter, then it is specifically ring-fenced for it.

My hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) gave us a valuable insight into the NHS, given her experience as a consultant. She is right to say that we must tackle a number of workforce issues, and morale is undoubtedly key to that. I was pleased to see that set out in the initial workforce plan; and Baroness Harding, chair of NHS Improvement, has been asked to consider a stream of work about making the NHS the best employer. That work will consider a number of issues about retention and the culture and morale of staff. I look forward to the publication of that report, and I hope my hon. Friend will join me in welcoming the new ideas it contains.

My hon. Friend was right to mention the pensions of a number of GPs and other NHS staff. She will not be surprised to hear that I am continuing to persuade Treasury colleagues to accept the Department’s proposed solution for that issue, and I hope we can make progress and make an announcement on that soon, which will be reassuring to many. I encourage my hon. Friend to write to me about the dispensing service she mentioned, and I will consider what issues we can take up. Finally, she was right to talk about the orthopaedic services at Grantham. “Getting It Right First Time”—GIRFT—is led nationally by Professor Tim Briggs, who was lead clinician at the Royal National Orthopaedic Hospital. That is making a huge difference, not only to the concentration, specialisation and number of operations being undertaken, but—equally importantly—the great improvement in safety and reduction in infections is leading to hugely better care for patients.

The hon. Member for Washington and Sunderland West (Mrs Hodgson) mentioned A&E performance, and she is right to say that it fails to meet the target. However, she is wrong to say that this year has seen the worst performance ever, as there has been an improvement on last year. Over the past months, United Lincolnshire Hospitals NHS Trust has seen a huge increase in attendances compared with the previous year. That reflects the wider NHS, where demand is up by 6%, yet more than 4,700 patients per day are treated within the four-hour waiting limit. The hon. Lady mentioned Public Health England and Health Education England, but funding for those bodies was designed to be dealt with in the comprehensive spending review that will take place in the autumn. It was never intended to be tackled inside the long-term plan and spending commitment.

The hon. Lady mentioned money, but this is a transitional year for funding. The funding provided is enough to work on the deficit, and given the analysis being done, the Government’s commitments, and the work on efficiency in the health service, it is surprising that Labour Members who recognise the benefits of much of the long-term plan are not prepared to welcome the financial settlement that backs it up and will deliver it.

Briefly, let me mention another east midlands MP, my hon. Friend the Member for Erewash (Maggie Throup). She was not able to speak today as she is my Parliamentary Private Secretary, but she has done great work in pointing out the benefits of Ilkestone Community Hospital, which I intend to visit in the near future. May I just say that—