NHS (Government Spending)

John Bercow Excerpts

Wednesday 28th January 2015 Commons Chamber

[Charlie Elphicke]

rose—

[Mr Speaker]

Order. Members shouting, and then expecting to intervene, do not display great wisdom. The hon. Gentleman can probably do better, and he should certainly try to do so, within the limits of his capacity.

[Chris Leslie]

I am very grateful, Mr Speaker.

In urgent questions, there is obviously a time limit on our ability to read out quotes from NHS England documents, but there is no such time limit in an Opposition day debate, so let us take the opportunity to spell something out clearly for the record. The Secretary of State is here now. I apologise for not noticing him as he came into the Chamber, but he is here now, and that is good, because I can hold this document up and show it to him—it says “NHS England” on the front. He is nodding; he has accepted that point. I turn to page 21, where in paragraph 7.2.3, under the heading—[Interruption.] Government Members want to shout me down. If the Under-Secretary of State, the hon. Member for Battersea (Jane Ellison), is patient I will read out the full quote from the NHS England document. It refers to principles for considering escalation and the responses to be had. Paragraph 7.2.3, under the heading “Politics”, says:

“(a) Is there increasing involvement of senior command and control tiers, political involvement or excessive media coverage?

(b) Is there a requirement to bolster or assure public confidence?

(c) Is there a risk of reputational damage?”

I do not understand why an NHS document contains those exact words. The Secretary of State can probably read them from there, across the Table—he is nodding again. Yet only a few minutes ago he denied that NHS England had such a document. What am I holding up—a mythical piece of paper? We can now at least establish that NHS England has been issuing documents suggesting that reputational damage and politics need to be taken into account when preventing major incidents. We have now at least had the opportunity to read into the record, as Hansard will reflect, the full text of that NHS England document.

This is the set of situations and circumstances that the NHS faces: pressures on A and E departments, pressures on cancer treatment, and pressures on the major incidents as we have seen. Why are things in such a fragile and critical state? The Government took £3 billion out of elderly social care and wasted it on a £3 billion reorganisation of the NHS that nobody voted for and nobody wanted. They are cutting corners and rushing the care that is needed to help the frail elderly to stay out of hospital. What greater example of a false economy could there be?

National Health Service

John Bercow Excerpts

Wednesday 21st January 2015 Commons Chamber

[Yasmin Qureshi (Bolton South East) (Lab)]

I wish to start by thanking NHS staff. I agree with the Secretary of State that they should be recognised for all their work, so I ask him to consider giving them the 1% pay rise that has been recommended by an independent body. That would be a real way of recognising all their hard work.

I wish to talk about the Royal Bolton hospital in my constituency; it is the third largest accident and emergency department in the north-west. Last year, it saw 114,510 people. A and E admissions numbered 26,267 and in 2013-14, elective operations stood at 14,865 and non-elective at 1,407. The staff—porters, cleaners, care assistants and clinical staff—do an excellent job in a very difficult situation. My hospital needs more resources.

As I attend regular meetings with the chief executive officer and the chair of the Royal Bolton hospital, I also often visit the A and E department to see the situation at first hand. Recently, the hospital declared a major incident when it could not take in 76 patients. By cancelling non-emergency elective operations, it managed to free 40 beds. However, as a consequence of cancelling those operations, it lost £600,000.

As the hospital will now no longer be able to meet the target of the clinical commissioning group, it will end up getting penalised as well. To meet that target, the hospital may have to resort to using private companies, which may cost it even more. Whichever way we look at it, the hospital stands to lose quite a lot of money. Over the past two years, it has had to make £40 million of cost savings, and it will have to carry on cutting in light of the demands that it is facing.

The main reason for the long waits in A and E was that many people could not get GP appointments or go to walk-in centres, so they had to go to A and E as a first port of call rather than as a last one. Secondly, many elderly and frail people could not be discharged, which then led to bed blocking. There were 94,046 acute delayed days last November, which then created even bigger blockages. The hospital is caught bang in the middle of the problem—there are problems at the start, before people go to hospital, and there are problems at the end, because people are not being transferred or discharged. That situation must change. One reason for the delays in transfers and discharges is the cut in the budget for social services and adult care. More than 300,000 people no longer receive state funding for social care.

In 2009-2010, the Labour Government spent 8.2% of GDP on the NHS, whereas in 2013-14, the figure was 7.9%. It is quite clear, therefore, that less money is going into the sector. It has been recognised in this Chamber that, with more people living longer and with growing health needs, that money has to go up. To say that nothing further can be done with regards to putting more finance into hospitals is completely wrong.

In Bolton, the local authority, the hospital and the clinical commissioning group are trying to work together. When I recently visited my local A and E, 17 cubicles were in full use and two people were on trolleys. The situation is not good enough, because Bolton is an incredibly large area, serving about 300,000 people. People from Wigan and other surrounding areas also use the hospital.

Another problem is the shortage of GPs and the fact that walk-in centres have been closed down. We know that we need at least another 400 GPs and more walk-in centres. If we had an increase in those areas, the problem would not be so acute. Finally, not enough nurses are being trained, which will lead to a big shortage. That is another tsunami waiting to happen.

[Mr Speaker]

I am immensely grateful to the hon. Lady.

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[Ian Austin]

On a point of order, Mr Speaker. Is it in order for someone who has not been in the debate at all this afternoon to stand up and make these sorts of points during the wind-ups?

[Mr Speaker]

There is no breach of order; that is a matter of taste and judgment for individual Members.

[Liz Kendall]

I make no apology for my party’s record on the NHS. When we came into government, people were dying on waiting lists for operations. People could not get to see their GPs, and mental health services had suffered. I would have thought that the hon. Gentleman would be pro reforms that help to keep his elderly constituents at home and oppose the cuts to social care that make that so much more difficult.

We have set out our plans to bring together physical, mental and social care across primary and secondary services in a single service to deliver truly personalised care and support, shift the focus to prevention, and get the best value for taxpayers’ money. We are going to help family carers get the health checks and breaks they need to stop them from reaching crisis point, and give them one point of contact with care services so that they do not have to battle all the different services.

We have a radical programme to improve public health, which is the biggest long-term challenge we face, by helping people to do more to help themselves: setting limits on sugar, salt and fat in food marketed to children; improving food labelling to tackle the impending obesity crisis; and taking tough action on tobacco, which this Government have abjectly failed to do. We have a bold national ambition to transform physical activity in our schools, communities and workplaces. That is what we need to put the NHS on a sustainable track in future by making sure that the health of our population improves.

People want a serious Government who face up to the problems in the NHS, not deny they exist or try to sweep them under the carpet. They want a Government who will deliver the real investment and real reforms we need to make sure that our care services are fit for the future. They want competence, not chaos, and a long-term plan that puts the NHS on the real road to a strong recovery. That is what Labour will deliver. I commend this motion to the House.

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[Norman Lamb]

That is absolute rubbish. Indeed, one of the right hon. Gentleman’s predecessors, the right hon. Member for Hull West and somewhere—

[Mr Speaker]

The right hon. Member for Kingston upon Hull West and Hessle, rather than “somewhere”.

[Norman Lamb]

I apologise, Mr Speaker. The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) spoke very candidly about the role of the private sector under the previous Labour Government, which the shadow Secretary of State constantly seeks to deny.

Contaminated Blood

John Bercow Excerpts

Thursday 15th January 2015 Commons Chamber

[Several hon. Members]

rose—

[Mr Speaker]

Order. In order to try to accommodate everyone who wishes to contribute to this important debate, I have thought it necessary to impose, with immediate effect, a seven-minute limit on Back-Bench speeches. Such limit may have to be reviewed, probably downwards, in the course of the debate.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 13th January 2015 Commons Chamber

[Dr Poulter]

I hope the hon. Gentleman will be reassured to hear that, according to the latest GP survey, 87% of patients in Southport and Formby clinical commissioning group were able to get an appointment or to see somebody they wanted to see at an appropriate and convenient time. It is important to note that Labour’s 48-hour target did not work. From 2007 to 2010, the percentage of patients who were able to get an appointment within the 48-hour target actually fell.

[Mr Speaker]

Order. Let me explain to the Minister, which I have done several times, that we have a lot of business to get through. We need answers to questions and no more than that.

[Mrs Cheryl Gillan (Chesham and Amersham) (Con)]

Last month, I contacted one of my excellent GPs in Chesham concerning the waiting time for one of my constituents. In his response, he reminded me that Buckinghamshire patients receive less funding per head than almost anywhere in the country. What can be done to address that inequality, so that my constituents can benefit from the same level of funding for services and treatment enjoyed by other parts of the country?

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[David Tredinnick (Bosworth) (Con)]

Is my right hon. Friend aware that there is clear evidence that homeopathy is effective in treating autism, especially when doctors have not found a solution? Now that the Society of Homeopaths is regulated by the Professional Standards Authority, will he make more use of homeopathy in the health service generally, and in this particular instance?

[Mr Speaker]

The hon. Gentleman’s question is quite a long way from the statutory guidance, but it can be given a brief reply.

[Norman Lamb]

I have to say that I was not aware of the information provided by the hon. Gentleman. I should be happy for him to send me more information, but I make the general point that it is always important for us to base our decisions and expenditure on evidence.

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I am sorry to disappoint colleagues. Including the main Order Paper questions, we have got through 78 inquiries today. Box office records have been broken. I leave it to Back Benchers and the ministerial and shadow ministerial teams to argue among themselves about who wishes to claim credit for that. We will have to leave it there for today. [Interruption.] The Secretary of State for Energy and Climate Change makes a very generous and loyal remark from a sedentary position that modesty prevents me from repeating.

A and E (Major Incidents)

John Bercow Excerpts

Wednesday 7th January 2015 Commons Chamber

[Several hon. Members]

rose—

[Mr Speaker]

Order. A very large number of hon. and right hon. Members are still seeking to catch my eye. As always, I am keen to accommodate as many as possible, but I simply point out to the House that there is a statement to follow by the Secretary of State for Northern Ireland and other business. I therefore appeal to the House to help me to help individual Members. That is to say, prolonged statements prior to questions are undesirable. Pithy and succinct questions are the order of the day, in which important exercise I think we can be led by an illustrious parliamentarian, Mr Philip Hollobone.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering general hospital is experiencing its busiest winter on record. The three hon. Members for north Northamptonshire, the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and myself for Kettering, are working together to attract extra investment into our A and E. When we go to see the Secretary of State’s colleague, the hospitals Minister, next week, will he encourage the Minister to receive us warmly and favourably?

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[Geraint Davies (Swansea West) (Lab/Co-op)]

The NHS is in financial crisis, with more money needed for A and E, yet we are spending £10 billion a year on diabetes because people are consuming twice the daily amount of sugar that they should be consuming—nine teaspoonfuls for men, which is equivalent to a can of Coke, or six for women, which is equivalent to a light yoghurt. Does the Secretary of State agree and will he support my Bill, which is published today, which requires manufacturers to express sugar content in teaspoonfuls on products to empower consumers to make rational choices in order to manage down overall obesity—

[Mr Speaker]

Order. [Interruption.] Order. These are extremely important matters, but their relevance to the question of A and E was not immediately obvious to me, added to which, unfortunately, the hon. Gentleman—

[Geraint Davies]

rose—

[Mr Speaker]

No. I am not debating with the hon. Gentleman; I am telling him. His inquiry suffered from one little disadvantage: it was too long.

[Mr Hunt]

I have spoken to the hon. Member for Swansea West (Geraint Davies) about his Bill. Part of the long-term solution is to give people better information about sugar consumption. We will certainly look at what the Bill proposes.

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I really am keen to accommodate remaining colleagues, because I understand the interest in this subject. May I appeal to colleagues to put single, short supplementary questions without preamble? Now, who might be a master of the genre—Mr Richard Graham?

[Richard Graham (Gloucester) (Con)]

Thank you, Mr Speaker—I will seize the moment.

Part of the long-term solution is attracting and retaining more nurses. Will my right hon. Friend encourage the National Health Executive to allow the university of Gloucestershire to run pre-registration training courses for nurses so that we can attract and retain more local nurses?

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[Clive Efford]

You idiot—it went to court!

[Mr Speaker]

Order. First of all, it is unseemly to squawk, and I think it would be accurate to say that what I heard was a squawk. I am not sure if there is a verb “to squawk”, but there was a squawking sound. What is worse, it was unparliamentary language, and I believe that the hon. Gentleman used a word that he will now wish to withdraw.

[Clive Efford]

I withdraw it unreservedly, Mr Speaker, but the public out there will draw their own conclusions.

[Mr Speaker]

I am grateful to the hon. Gentleman for his withdrawal and I note what he says.

[Mr Hunt]

The plans were to continue to have an A and E at Lewisham but to take some of the higher-risk patients to another hospital. Those are the plans that we originally had that have now been changed. What I will say to the hon. Gentleman, though, is that there were problems with South London Healthcare Trust for years and years. This Government dealt with them and sorted them out, and that means that his constituents are getting better care than they otherwise would have done.

A and E and Ambulance Services

John Bercow Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Simon Burns (Chelmsford) (Con)]

Will my right hon. Friend join me in congratulating the staff of Broomfield hospital in Chelmsford and the GP surgeries in mid-Essex on the fantastic job they are doing to look after patients in difficult circumstances because of the significant increase in the number of patients needing and accessing care? Furthermore, does he agree that it is rather demoralising for staff and sad that Labour seeks to turn the NHS into a party political football simply—

[Mr Speaker]

Order. The Secretary of State does not need to concern himself with Opposition policy, as I think the right hon. Member for Chelmsford (Mr Burns), on his good days, knows. The Secretary of State should focus on a brief statement of the Government’s policy, for which we will be grateful.

[Mr Hunt]

I can confirm that the Government’s policy is to root out poor care wherever we find it, not to cover it up and conceal it for party political purposes.

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[Paul Burstow (Sutton and Cheam) (LD)]

rose—

[Mr Speaker]

An absolutely delicious intellectual beauty parade. Mr Martin Horwood.

[Martin Horwood]

Mr Speaker, your festive generosity equals only that of Father Christmas.

Gloucestershire hospitals have been under severe pressure in recent days, but is not one complicating factor that, in Gloucestershire and elsewhere, every unplanned GP admission to hospital goes via the emergency department? Although such cases may be relatively urgent, they are not necessarily what most of us would understand as an accident or an emergency.

NHS (Five Year Forward View)

John Bercow Excerpts

Monday 1st December 2014 Commons Chamber

[Several hon. Members]

rose—

[Mr Speaker]

Order. For the avoidance of doubt—because there was some consternation about this matter—let me say that I am sure the Secretary of State is not making an allegation of any personal dishonesty on the part of any Member. It would simply not be legitimate to do so.

[Mr Hunt]

indicated assent.

[Mr Speaker]

The Secretary of State confirms that he is not making any allegation of personal dishonesty against any individual. Enough: we are grateful. We will leave it there for now.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the statement. The extra funds for the NHS constitute a clear endorsement of Simon Stevens’s excellent “Five Year Forward View”. I particularly welcome the announcement of multi-year budgets and investment in patients’ ability to control their own records. Will the Secretary of State confirm that the process of creating paperless NHS hospitals will move seamlessly from primary to secondary care, and will be controlled by patients themselves?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. I am keen to accommodate as many colleagues as possible on this extremely important set of issues, but may I appeal to colleagues to exercise a certain self-denying ordinance, whether they are speaking from the Back Bench or the Front Bench?

[Sarah Newton (Truro and Falmouth) (Con)]

I welcome today’s announcement of the national sepsis prevention campaign, which will make a such a difference to people in Cornwall and all around the UK. Will my right hon. Friend continue to work with the all-party group and the UK Sepsis Trust to implement the sepsis six, which it is estimated will save 12,500 lives and £2 billion for the NHS every year?

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[Mr Marcus Jones (Nuneaton) (Con)]

rose—

[Mr Speaker]

Wow—what a choice! I call Mr Andrew Stephenson.

[Andrew Stephenson]

Thank you, Mr Speaker; I am honoured.

I very much welcome the £2 billion of additional funding announced today. This morning, I was at Airedale hospital for the preview of its new £6.3 million A and E department, which will open to the public this Wednesday. Will the Secretary of State join me in paying tribute to all the hospital’s NHS staff and management, and its patients, who have been involved from the start of the process in making sure that the new A and E department, which is more than double the size of the old one, is now a reality?

Oral Answers to Questions

John Bercow Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

The best assurance I can give the hon. Gentleman is not what I have said, but what the EU Trade Commissioner, Karel De Gucht—I challenge colleagues in Hansard to spell that correctly without looking at my notes—has said. In an interview in September, he said:

“Public services are always exempted—”

from TTIP—

“there is no problem about exemption. The argument is abused in your country for political reasons but it has no grounds.”

[Mr Speaker]

Colleagues in Hansard may not even rely on the Secretary of State’s notes; they may have their own source material. They are very special people those reporters.

[David Morris (Morecambe and Lunesdale) (Con)]

I thank my right hon. Friend for that concise answer. I reiterate the message to the unions, which are sticking up billboards in my constituency, that Cameron and Hunt are not selling off the NHS.

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[Sarah Newton (Truro and Falmouth) (Con)]

T2. Public Health in Cornwall has estimated that 300 people in Cornwall might die from the cold this winter because they are living in cold homes. Last week the Government introduced the first proper fuel poverty strategy to eradicate that totally unacceptable situation by 2030. Will my right hon. Friend join me in praising the work being done in Cornwall by a partnership of over 30 organisations in the Winter Wellness programme to ensure that people stay warm and well this winter?

[Mr Speaker]

Order. On both sides of the House the questions have been too long. It is not fair on other Members who are waiting to contribute. Please cut it out.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I commend my hon. Friend, who, as many of us know, has worked enormously hard on a whole range of health issues in her constituency. In particular, I know that she has helped deliver the Winter Wellness programme with a number of local organisations. It is important to highlight what help and advice is available for people who need it most in order to stay warm. The Government’s cold weather plan has a series of cost-effective and simple measures that people can take to reduce the harm caused by cold weather.

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[Several hon. Members]

rose—

[Mr Speaker]

Order. The level of interest in Health questions today has broken box office records. I am sorry not to be able to accommodate remaining demand, but we must now move on.

Five Year Forward View

John Bercow Excerpts

Thursday 23rd October 2014 Commons Chamber

[David Morris (Morecambe and Lunesdale) (Con)]

May I invite my right hon. Friend to come to my local hospital and to my constituency to see what good works have been done in my area? A £25 million health centre has opened, we have a new walk-in centre that was opened by the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). May I ask my right hon. Friend’s views on the talk about top-down reorganisation? [Interruption.] We walked into a shambles of an NHS after 13 years of Labour government and a debacle of a CQC policy that we had to reconfigure. What are his thoughts—[Interruption.]

[Mr Speaker]

The hon. Gentleman has had a very full tilt. On the whole, it is a good idea to face the House, rather than the Government Front Bench. We are grateful.

[Mr Hunt]

Of course I would be delighted to visit my hon. Friend’s constituency. Morecambe Bay hospital is one of the hospitals whose problems we are looking at in a way that should have happened before but did not. We are turning round that hospital. We are determined to do it and we want his constituents to have absolute confidence in the quality of hospital care they receive.

[Mr Hunt]

That is why we continue to take the tough and difficult decisions—[Interruption] that keep this country on the right economic path and which are opposed at every turn by Labour. They told us that our economic plans would lead to a million jobs being lost—[Interruption.]

[Mr Speaker]

Order. The hon. Member for Kingston upon Hull East (Karl Turner) keeps calling out “Ah!” as though he is sitting in the dentist’s chair. It is quite unnecessary. He can exercise his vocal chords later.

[Mr Hunt]

Perhaps the simplest thing is to say to the hon. Member for Edinburgh East (Sheila Gilmore) that we inherited one of the poorest performing economies in Europe. We now have the fastest growing major economy in Europe and that is the best possible future for the NHS.

Oral Answers to Questions

John Bercow Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is right to talk about that intolerable pressure on hospitals on the England-Wales border. For every one English patient admitted for treatment in a Welsh hospital, five Welsh patients are admitted for treatment in an English hospital, which creates huge pressure for them. I have written to the Welsh Health Minister to say that the NHS is happy to treat more Welsh patients, but the trouble is that NHS Wales is not prepared to pay for it. That is why Welsh patients get a second-class health service. [Interruption.]

[Mr Speaker]

Order. The hon. Member for Caerphilly (Wayne David) is normally a very calm and reserved fellow—almost statesmanlike. This curious behaviour is quite out of character. He should take some sort of sedative. The hon. Member for Cardiff South and Penarth (Stephen Doughty) can probably advise him.

[Liz Kendall (Leicester West) (Lab)]

With hospitals set to be £1 billion in the red this year, the Secretary of State should be getting a grip of NHS finances. Instead, he is starting on yet another reorganisation. First, he put NHS England in charge of commissioning primary and specialist care. Now, NHS England wants to hand this back to clinical commissioning groups. Ministers have already wasted three years and £3 billion of taxpayers’ money. How much will this Secretary of State’s second reorganisation cost?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. Questions must be shorter. I say with the greatest courtesy to the hon. Member for Hereford and South Herefordshire (Jesse Norman) that to read out a prepared script and be too long is doubly bad, and it really is not excusable.

[Dr Poulter]

My hon. Friend is right to highlight the fact that the annual cost of PFI left by the previous Administration is £1.79 billion, which will rise to £2.7 billion. It is right that we do all we can to support hospitals to reduce the costs of PFI that have been inflicted upon them, and we will continue to do that and work with the Treasury to make sure that that specialist advice is available for the NHS to reduce the cost.

[Dr Poulter]

There is nothing wrong with PFI schemes in principle; the point is the way in which they were put together by the previous Government. In 2011, the right hon. Member for Leigh (Andy Burnham) said:

“We made mistakes. I’m not defending every pen stroke of the PFI deals we signed”.

Those PFI contracts have damaged local hospitals and damaged local health care provision—

[Mr Speaker]

Order. I just said to a Back Bencher that his question was too long. I have said to the Minister several times that his answers are not just too long, but far too long, and if they do not get shorter I will have to ask him to resume his seat—which frankly, for a Minister, is a bit feeble.

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[Jane Ellison]

All the issues that the hon. Gentleman outlines are extremely important. We, too, are very interested in the prevalence study on foetal alcohol syndrome. He may be aware that the World Health Organisation has just launched some work in that area, which will be of great interest to him. It would of course be a delight to visit the project.

[Mr Speaker]

These are splendidly succinct answers. Perhaps the Minister should issue her textbook to her colleagues. That would be extremely useful.

[Bill Esterson (Sefton Central) (Lab)]

The Canadian Government say that foetal alcohol spectrum disorder is the most important preventable cause of severe childhood brain damage. The Minister told me in Westminster Hall last week that the chief medical officer’s review of the evidence is continuing. Is not the truth, however, that the evidence has been available for years, and that the time has come for the review to be published and for there to be much greater protection for the thousands of children who are damaged each year by women drinking in pregnancy?

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[Several hon. Members]

rose—

[Mr Speaker]

Order. We have overrun, principally because of long questions and answers earlier, but I am keen to accommodate a couple more colleagues.

[Fiona Bruce (Congleton) (Con)]

Mitochondrial technique was last tried on humans in 2003 by John Zhang, resulting, I understand, in two still births and an abortion. Last week, one of the members of an expert panel of the Human Fertilisation and Embryology Authority said he had only just become aware of Zhang’s study. What action will Ministers take to ensure that this worrying study is properly examined before any steps are taken to bring this issue before the House?

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[Sir Nick Harvey (North Devon) (LD)]

rose—

[Mr Speaker]

Last but not least we shall hear from a Devon knight.

[Sir Nick Harvey]

Thank you, Mr Speaker.

Devon clinical commissioning group is embarking on a major programme of change next year, closing community hospital beds and replacing them with services at home. Do Ministers see that public and staff would have more confidence in the new services if they were being worked up first before getting rid of the existing services? Could the better care fund put money into the transition?