A and E Departments

Stephen Pound Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

My hon. Friend speaks extremely wisely. We must do just that, particularly for the frail elderly, people with long-term complex conditions, because they are the people for whom an A and E department can be a bewildering place, especially if it knows nothing about them and cannot access their medical records. Prevention is far better than cure, and I agree that that is one way of doing it.

[Stephen Pound (Ealing North) (Lab)]

The Secretary of State advises us to visit A and E departments. Were he to visit the one in the excellent Ealing hospital in the constituency of my hon. Friend the Member for Ealing, Southall (Mr Sharma), he would see the grotesque, confusing and expensive sight of a spatchcocked urgent care centre next to an A and E department, one acting as a gateway for the other. It is confusing, divisive and expensive. Is he entirely comfortable with this concept?

[Mr Hunt]

The hon. Gentleman makes an important point. We have failed as an NHS to give the public confidence in there being anything between an A and E department and a GP surgery. Whether they are urgent care centres or other centres, the public do not have that confidence and do not understand their role. We need other things, besides those two extremes, and to do a better job of informing the public about how they work. That is part of the reason for reforming primary care.

Community Pharmacies

Stephen Pound Excerpts

Monday 15th April 2013 Commons Chamber

[Stephen Pound (Ealing and North) (Lab)]

: I am extremely grateful, Mr Speaker, for your generosity and for the way in which you slowed down through the gears. It is greatly appreciated. I am strangely gratified to see such a well attended House tonight, and delighted on behalf of both myself and the Minister that all our colleagues will be staying here rather than miss a word of this Adjournment debate.

There are many reasons why a humble, insignificant Back Bencher should raise an item on the Adjournment. One can seek the ventilation of an issue; one can seek the investigation of an issue. One can seek adumbration or agitation, and possibly even instigation. In my case, it is with some trepidation that I approach a subject that is originally to do with celebration, but that then moves into the dark world of prognostication and, in the case of the Minister, implication.

There has been a quiet but dramatic and extraordinary revolution in the world of the community pharmacist. The traditional model of the dispensing chemist is as outdated as the mediaeval apothecary. I urge all right hon. and hon. Members to visit the new world of the community pharmacist, which will exist in their constituencies as surely as it does in mine.

It would be invidious to mention individuals in the context of the miracle that is occurring in north-west London, but if I were so tempted, the names of Nilesh Morjaria of the Church pharmacy, of Mahendra Gokani of Mandeville road and of C.K. Nathwani of the Ravenor pharmacy would feature strongly, as would Usha and Dilip Shah of the Alpha pharmacy in Northolt. It was at a visit to that estimable emporium, kindly facilitated by the Royal Pharmaceutical Society in the person of the passionate Charles Willis, once an ornament of this House, that the full range of services now available from what we once called our “local chemist” became apparent.

The Minister will be well aware that the core role of the pharmacist—the dispensing of medicines—has grown from 556 million medicines in 2002 to 885 million medicines in 2011, an increase of 56%. I will return to the current figures. The patient or the customer will find the community pharmacist offering services such as home delivery of medicines and medicines use reviews, which ensure that patients gain optimal use from prescribed medicines—2.4 million people took advantage of such a review in the last year and the outcomes were staggering. Forty per cent. of asthma sufferers showed better asthma management and 55% of patients with chronic obstructive pulmonary disease demonstrated a reduction in symptoms following a medicines use review.

The consequential reduction in emergency visits to accident and emergency departments will bring a warm glow to the Minister’s heart and to the hearts of his Treasury colleagues, as will the new medicine service, which advises patients on the therapeutic use of newly prescribed medicines. Evidence already exists that shows that 31% of those who make use of this new medicines service adhere more fully to prescribed medicines, minimising waste and increasing their effectiveness.

Smoking cessation is one of the supreme achievements of the community pharmacists in my part of the world, and Usha and Dilip Shah have not only improved quality of life by their efforts, but actually saved lives, as theirs is one of the most successful smoking cessation services offered. As one who had his last gasper in February 2006, I can speak of the effectiveness of this service from a position of breathless authority.

There are more than 20 different services cited by the health and social care information centre, including the monitoring of anti-coagulant medicines, minor ailment schemes and supplementary prescribing services, but countless additional services are available, from flu vaccine provision to travel clinics. In the case of C.K. Nathwani, the Ravenor pharmacist, a mobility clinic supplies wheelchairs and dispenses walking frames and commodes, all in a friendly and familiar environment close to the patients’ homes and with no queuing up.

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

I recognise that the hon. Gentleman is saying that pharmacists do an incredibly good job, and I agree, but does he agree that we should seek to decriminalise any dispensing errors that pharmacists might make? They can go to prison for such errors, but GPs are merely struck off.

[Stephen Pound]

Not for the first time, the hon. Gentleman raises an extraordinarily interesting point. I will discuss later the issue of the level playing field for pharmacists. Far be it from me to suggest that he might wish to seek his own Adjournment debate on that subject as it is one of great significance, but I do not disagree with the points that he makes. I look to the Minister for a similar statement.

The Minister will conclude that I have certainly ventilated the approbation and celebration I referred to earlier, but all is not well—all is not sweetness and light in the well-lit and warm world of the community pharmacy. I hope that the Minister and I can agree that the community pharmacist is the third pillar of the NHS and, just as general practice and hospital care defined the early days of the NHS and were labelled as the two great pillars on which the new creation stood, the changing role of the community pharmacist can come to define a third pillar.

The cruel tyranny of time prevents me from fully detailing this proposition, but I refer the Minister and the House to the excellent 2013 UCL school of pharmacy lecture “From making medicines to optimising health”, given by the chief executive of the Pharmaceutical Services Negotiating Committee, Sue Sharpe. Dr Sharpe identifies the intentions of the 2008 White Paper “Pharmacy in England”, while rightly deducing that even in the short time since then the nature of the community pharmacist has changed over and over again. She should also be credited with allowing me to remind the House of the marvellous quote from Auden to which she refers in her lecture:

“Health is the state about which medicine has nothing to say”.

At one level, the picture is one of rosy growth and rude good health. Diversification in over the counter sales has increased the profitability of the pharmacist, and a new form of health care and preventive medicine has emerged almost without notice and certainly without fanfare. The NHS is so effusively documented at every level that I am sure I could find the evidence of my birth in the first week of the NHS in Hammersmith in July 1948, when I was one of the first of what Aneurin Bevan identified as “bundles for Britain’s future”—I like to think that he looked down on me swinging in my white-painted metal bassinet in Queen Charlotte’s hospital and identified me as a class warrior of the future, although I would sadly disappoint him in that area. The fact that I am still alive, however, is a credit to the NHS. In such a system, it is extraordinary that there is a real paucity of documentation relating to the range of services and extent of outcomes of community pharmacy. Hopefully, this will not remain uncorrected, but I freely admit to my concerns about the place of the community pharmacist in the new NHS structures. I very much hope that the Minister will allow me to share these concerns with him tonight, and also allow me to look in gentle supplication to him for some positive suggestions.

The Minister is all too well aware that the Health and Social Care Act 2012 empowers clinical commissioning groups, led by GPs, and health and wellbeing boards to play the key role in shaping local health care services. I contend that commissioning public services on a localised basis may lead to variations in availability, quality and outcomes. I realise that we have discussed this at length, and I do not want to rehash the arguments that wracked the House during the passage of the Health and Social Care Act 2012, but one way in which this apparent deficit could be addressed is through pharmacy representation. There is currently no pharmacy representation on health and wellbeing boards. Such representation could be a catalyst for constructive change in primary care. Even the pharmaceutical needs assessments drawn up by the health and wellbeing boards may lack any input from pharmacists.

The sheer complexity of the arrangements under which the new commissioning arrangements operate can be a barrier to the provision of services. I am indebted to Benjamin Wheatley of Boots for confirmation that individual contracts now require pharmacy contractors to invoice either local authorities or clinical commissioning groups via the NHS shared business services. I have to say that my head aches when I try to contemplate the mechanism whereby one invoices through all these various groups and all the choices concerned. I am all in favour of choice, but sometimes it is ridiculous. In cases such as this, we are actually preventing good people from doing good work. The effect of this additional work load can be catastrophic.

I do not often praise, without reservation, coalition Ministers, with the obvious exception of the hon. Gentleman who adorns the Dispatch Box this evening, but I pray in evidence the words of the noble Lord the Earl Howe, speaking at the pharmacy business awards dinner in 2011—what a night that was—when he said:

“The Government sees pharmacy as integral to every aspect of our plans to modernise the NHS.”

He went on to say:

“there is still some way to go before our reforms are in place. This transition period is an opportunity for pharmacy to make its presence felt.”

I profoundly hope that the transition period does not follow distant historical, if not to say Trotskyist, precedent and aspire to a state of permanent revolution. I sincerely hope that the Government can allow the community pharmacists to do what they do best.

At the present time the playing field is not level, but opportunities there are aplenty. One of the five domains in the NHS outcomes framework—I have to say, Mr Speaker, that the Minister is a good and decent and honourable man, and I have had the pleasure of his company and his acquaintance for many years. I cannot believe that he would ever talk about the “five domains of the NHS outcomes framework.” There are those around us who do and it is to them that we must give credit tonight, but let them come out with this peculiar, strangulated syntax. I hope that the Minister will reply in honest, Norfolk talk.

The NHS outcomes framework refers directly to the quality of life for people with long-term conditions, and this is an excellent opportunity for the community pharmacy, in addition to other qualified health care practitioners, to deliver a key aspect of the Government’s new health care system in England. The pharmacist, as is so obvious when one comes to think of it, may often be the first person to spot a development in a patient’s condition. An early identification can be therapeutically priceless. It is often the community pharmacist who notes that someone has not come in for their medication or, when they are delivering to their home, that the person does not open the door, is looking more tired and pale, or occasionally has something more dramatic such as a nosebleed. This early identification is absolutely priceless, and this is where the role of the community pharmacist has changed beyond almost all recognition. I am seriously worried that such best practice, as recommended by Earl Howe, is threatened by the impact of changing priorities as commissioners change.

The funding passed to CCGs and local authorities is already being used to commission services from community pharmacies, so that for every new service there is a very real possibility that an existing one will be ended. Local authorities will, quite rightly, look to address their own priorities. I referred earlier to the additional pharmacy-led services in England and the huge growth in recent years, but 2012 actually saw a decrease of 5%. It is reasonable to assume that the transition period between commissioners in 2013 and 2014 will see that decline continue. It must be recorded that any diversion from existing services will have an immediate effect on patients. If there is one thing we can all agree on, it is how the community pharmacist has earned the trust of patients and the patient community. It has been so remarkable and beneficial that it cannot be threatened. If there is one thing that patients in long-term care plans in particular are terrified of, it is a change in the structure that could affect their medication and the ability of a community pharmacist to provide for their needs.

The General Pharmaceutical Council is the regulator of pharmacists, and as such pharmacists are not required to register with Monitor or even the Care Quality Commission. This lack of a registration number actually inhibits many pharmacists from applying to provide services under the “any qualified provider” scheme. I do not know why, but they cannot register. I have tried myself to operate the system for registering online. If someone wishes to provide a service, they have to give their registration number, and if they are not entitled to be allocated a number, the whole process stops. I hope that this small but significant and far-reaching improvement is one that, yet again, can be laid at the Minister’s feet, with the gratitude of the people, and that we can be delighted by another Lamb amendment.

Allied with the codification of a requirement for community pharmacist representation within NHS England and the resuscitation of the roles previously identified in SHAs and PCTs, a new model of integrated health care could relieve pressure on general practice, provide local and accessible services, manage long-term conditions and deliver healthy living advice. In my part of the world, we have a huge number of singlehanded GP practices. They are typically elderly men—occasionally women, but usually men—operating in terraced houses. It is most unlikely that they can be sacked—I am not altogether sure they should be sacked—but they need a complementary service, because the singlehanded GP model is simply not appropriate to the dizzying variety of illnesses and conditions that apply particularly in the urban environment at this the beginning of the 21st century. I would like to see a synergy between community pharmacists and general practitioners working together to the benefit of all patients.

Above all, pharmacies can work with the new health bodies, GPs and other health care professions to support a modernised, caring health care system that delivers high standards of patient care. The Minister blanched earlier when I referred to him as a good and decent man. I meant that sincerely. I think that everyone in the House holds the Minister in the same esteem. He is a good and decent man, and I hope that he will consider some, if not all, of the points I have raised tonight and agree with me that a fair following wind from the Government would be greeted with delight and relief by our greatly valued community pharmacists and would go a long way towards ensuring a happy, hale and hearty nation and safeguarding our future.

I have received three messages from parliamentary colleagues inquiring whether this debate is a tribute to that distinguished former chemist, the late Baroness Thatcher. She achieved a great deal in the world of chemistry, and certainly as a woman she was an extraordinary achiever, but community pharmacists perform great miracles every day. Let us hope that the Minister is as convinced of their good will and good work as I am and that tonight he will put his shoulder to that wheel and advance the cause of integrated health care and the role of the community pharmacist.

National Health Service

Stephen Pound Excerpts

Monday 16th July 2012 Commons Chamber

[Stephen Pound (Ealing North) (Lab)]

Further to the previous question, the hon. Member for Ealing Central and Acton (Angie Bray) has said that this is all about finance, and she may well be right. However, bearing in mind the fact that Ealing hospital not only came in under budget but produced an operating surplus last year, what possible justification can there be for ripping this crucial and much-needed service from the heart of our community?

[Andy Burnham]

My hon. Friend makes his point powerfully. With some reconfigurations there is a clinical case supporting change, such as the changes I introduced in London before the last election to improve stroke services. We reduced the number of centres from 12 to eight. That was a difficult decision for many London Members at the time, but it was the right thing to do because lives are being saved. However, there is a world of difference between those changes and the crude, cost-driven reconfigurations in the NHS that those on the Government Benches said they would not allow.

I spent my weekend reading a very entertaining book entitled “Never Again? The story of the Health and Social Care Act 2012: A study in coalition government and policy making”. It is a very interesting book and offers a new, detailed account, by Nick Timmins, of the Government’s NHS reorganisation—or, as it says on the blurb, the inside story of a “car crash”. I particularly enjoyed the quotation from the Minister of State—I gather that he has not read it, but there he is, up in lights at the very beginning of the book. He made this comment about the then Bill, which the author thought worthy of special attention:

“You cannot encapsulate in one or two sentences the main thrust of this.”

He should know that better than anybody, as he toured more media studios than anybody, and used more sentences than anyone, in a vain attempt to sell the technocratic and dense plans that made sense to his boss and nobody else.

Hospital Services (West London)

Stephen Pound Excerpts

Wednesday 11th July 2012 Westminster Hall

[Mr Slaughter]

I am glad that the Minister is praising the standards of health care in Hammersmith. Saving the recent problems over referrals, we are all very proud of the standard of clinical care that people receive in our world-class hospitals under a world-class trust. The subject of the debate, which I hope that the Minister will address, is the fundamental changes being wrought on that and other trusts in north-west London, which will damage the standard of medical care and the health of my constituents. He has entirely missed the point.

The headline news from the consultation launched last week is the proposed closure of both A and E departments in my constituency, along with two of those closest by: Central Middlesex and Ealing. Clearly, that is a disaster for everyone living in the area, perhaps particularly for those in Shepherds Bush, White City and Old Oak, which include some of the poorest areas in London, with low car ownership, poor health outcomes and low life expectancy. The consequences for the two hospitals however are very different. Although neither will provide emergency care for my constituents, Hammersmith will remain a specialist hospital, but Charing Cross will be reduced to little more than an urgent care centre on an otherwise vacated site. Of the 500 beds, all but 30 will be closed or moved elsewhere. One of the largest and busiest hospitals in London will effectively become a clinic.

I want to move on to talk a little about the process of the review. I want to spend time on that, because it is the reason why there is so much disquiet and so much need for external intervention. Proposals for the closure of hospitals in Hammersmith have a chequered history. In my constituency office, I have a photograph of the former Health Minister, Ann Keen, standing on a chair with a megaphone outside Charing Cross hospital, when she was head of nursing there in the early 1990s and there was a massive community campaign against the then Conservative Government’s attempt to close the hospital. That campaign was successful, as I am sure this one will be. Over and between the past two elections there were, what I can only call scurrilous rumours that Charing Cross hospital would close either wholly or in part. That substantially muddied the waters, and was done, I think, purely for electoral advantage, in that there was no substance to those rumours at the time.

The rumours resurfaced last autumn in an article on the front page of The Independent, which speculated that either St Mary’s or Charing Cross or both would close. Following that, I, my hon. Friend the Member for Westminster North (Ms Buck) and, I am sure, others, sought assurances from Imperial College trust that that was not the case, and we were given those assurances. We are now told in the documentation, which I have brought with me today and was approved by the Joint Committee of Primary Care Trusts two weeks ago, that, over the past two years, when we were being assured that there would not be closures of the type now mooted, a very close consultation was going on and we all knew about it.

To take one page from the documents, it tells me that I received five pieces of correspondence from the trust in relation to the closures, and that at a meeting in March, which I did not attend, I was represented by my hon. Friend the Member for Westminster North. She is in the room and may contradict me: I did not know about that meeting and I certainly did not authorise her to represent me at that meeting.

Although I do not rule out some of the documents having been sent to me, they are junk e-mails—I do not use the term offensively; it is accurate. They are electronic newsletters that go straight into the very efficient House of Commons spam system. If we retrieve the e-mails and look at them, we can read things like, “There will be major improvements at Hammersmith and Charing Cross hospitals in the near future.” Even the document sent on the Thursday before the decision was taken, which was hidden in another newsletter from the chief executive of the trust, did not spell out the proposals.

When we walked into the decision-making meeting at Central hall Westminster two weeks ago, we were handed a bundle of 18 volumes of documentation to look at, which I believe had been available online for two days before that—very generous. We were expected to understand and respond then. That is not consultation. We are now told that a thorough process has been gone through, in which opinion formers have been consulted, and therefore we can proceed to the public consultation. We are presented with a fait accompli. The medical director of NHS North West London, Dr Spencer, when asked whether it was worth people lobbying and petitioning as part of the consultation process, said:

“No. People are currently wedded to mediocre services. If we don’t do this then people need to realise that our hospitals will go bankrupt. We have already seen this in south London.”

That does not sound to me like open and reasonable consultation. What is taking place is a pretence of consultation.

The options are no options at all. There is a preferred option, which I am sure will be adopted, and two others. All of them involve closing the A and E department at Hammersmith hospital, and two involve closing the A and E department at Charing Cross hospital. We will get the usual farrago of road shows, boards and helpful-looking people standing around with clipboards asking for our views. I am told that there is a five-page document that will be delivered, doubtless summarising the much larger consultation document, to all households in the area. However, if someone actually wants to take part in the consultation, they either have to go online—a lot of my constituents do not have access to the internet—or request a questionnaire.

NHS North West London could not provide me with a copy of the questionnaire or indeed a copy of the consultation document for the meeting that I had last Friday. I managed to print one off the internet and Sir Humphrey would have a field day with it. Buried at question 15, it says:

“How far do you support or oppose our recommendation that we should use our high quality hospital buildings with spare space as elective hospitals?”

At question 17, it says, and this is the closest that the questionnaire comes to asking a clear question in all its 50 pages:

“How far do you support or oppose the recommendation that there should be five major hospitals in North West London?”

At the meeting where it was decided that there would be consultation, I specifically asked, “Will there be questions that people will understand? Will there be questions such as, ‘Do you agree that Hammersmith hospital’s A and E should close?’, or, ‘Do you agree that the hyper-acute centre should move?’, or ‘Do you agree that the A and E at Charing Cross should close?’” There are no questions of that kind. As far as I can see, there is no question that relates to Charing Cross hospital’s A and E department at all. The only question that relates to Hammersmith hospital says:

“All the options above include the recommendation that Hammersmith Hospital should be a specialist hospital. There would continue to be a maternity unit at Hammersmith. How far do you support or oppose the recommendation that Hammersmith Hospital should be a specialist hospital with a maternity unit?”

My constituents are supposed to take from that the fact that they are losing their A and E service. As I have said already, they are living in some of the most deprived communities in the country and many of them have English as a second language. So I do not accept that this consultation is a valid process.

I want to finish before 10 am, because I know that a number of Members wish to speak. However, I will just make two or three other points. First, there is professional opinion to consider. It is increasingly clear that this proposal does not have the support of the local GPs. At a meeting of Ealing GPs a week or so ago to which my colleagues—my hon. Friends the Members for Ealing, Southall (Mr Sharma) and for Ealing North (Stephen Pound)—may wish to refer if they speak, there was universal opposition to the proposal from the 50 or so local GPs who were present. The only local GPs who did not oppose the process were those who are involved in it, and they abstained. I have written to Hammersmith GPs and they have expressed only questions, queries and doubts about the process in response to my inquiries.

[Stephen Pound (Ealing North) (Lab)]

Will my hon. Friend give way briefly on a point of information?

[Mr Slaughter]

Yes.

[Stephen Pound]

At that particular meeting of GPs, the voting figures, which I am sure hon. Members will want to know about, were 47 against and three for.

[Mr Slaughter]

I am grateful to my hon. Friend for that information. I had thought that the vote was 47 against, with three abstentions, but I always stand to be corrected by him.

The bodies that have supposedly devised these proposals are indeed the commissioning groups. As far as I can see, the only people supporting these proposals on a clinical level among the GP community are those who are heavily involved and who perhaps have a vested interest in relation to those commissioning groups, which of course will not take control until April next year.

It is absolutely true that, unlike some other hospital trusts, Imperial College Healthcare NHS Trust is at best acceding to this process and at worst actively supporting it. It is very clear why it is adopting that approach and why it would see the closure of two of its own A and E departments. The Imperial trust is in deep and dire financial trouble. It has a deficit of more than £100 million and the ability to close down significant services and, perhaps more importantly, to free up one of the most lucrative pieces of real estate in London—in other words, most of the Charing Cross hospital site—presumably for commercial disposal will, it believes, allow it to see its way out of its financial difficulties. Therefore, I am afraid that its opinion is coloured by that judgment.

Let me move on to discuss public opinion briefly. At 48 hours’ notice, I called a public meeting by e-mail and 250 people turned up. I also put a petition online and within a day 750 people had signed it. We have set up a consultative committee under the banner, “Save Hammersmith and Fulham hospitals”, which involves 40 concerned local residents. They have no particular political affiliation; they simply care about their local health services.

All that is but the germ of what I am sure will be the largest campaign of public opposition across west London that we have seen. There will be no safe parliamentary seats in west London if the Government pursue this course of action; there will be no limit on the opposition to the proposals, and there will be marches, petitions and protests until they are withdrawn.

I am hopeful that there will be a debate—at least a partial one—next Tuesday on the Floor of the House about children’s cardiac services, and therefore I will not spend as much time today discussing that issue as I had planned to. All I will say now is that the same body that has been involved in the proposals about my area—the Joint Committee of Primary Care Trusts—has taken the extraordinary step of recommending the closure of the children’s cardiac unit at the Royal Brompton hospital, despite knowing that there were no risks attendant on keeping it open. On the contrary, it is a world-class unit with world-class doctors and surgeons. Moreover, the JCPCT also took that step in the knowledge that a range of other world-class services at the Royal Brompton hospital—the respiratory service, the cystic fibrosis service and the neuromuscular services—are also at risk. The Royal Brompton hospital is not in my constituency, but it is used by my constituents and indeed I substantially used it myself when I was severely asthmatic in younger life. It is unthinkable that it should be put at risk by this decision to recommend the closure of services and I am glad to see that there is opposition to the review by the JCPCT from around the country.

Let me also mention the concerns that we in Hammersmith have about the Imperial trust and its use of data. I will quote from an article in last week’s Fulham and Hammersmith Chronicle, a local newspaper:

“An investigation has been launched to determine whether data recording blunders by Imperial College NHS Healthcare Trust could have cost lives. The panicked trust…realised there had been major errors in the way it handled recording files for patients referred for cancer tests earlier this year. People suspected of having cancer are required to be tested within two weeks of being referred by their GP. But Imperial found its records of this treatment path was flawed, with many incomplete, giving no indication of whether the patient was tested or not, and others duplicated.”

Furthermore, as was widely reported in the press last week, there were 25 deaths in that period in the local area that are still under investigation.

The issue of the Imperial trust’s record keeping and referrals was first raised by me in February. I know that there has been some limited improvement in clearing the backlog of cases, but it is simply not acceptable that a trust serving such a large proportion of west London’s population can continue to keep data in this condition.

That brings me to my final point, which is what I am seeking from the Minister. The Secretary of State for Health wrote to me last week and said that the consultation process

“is a matter for the local NHS.”

However, he acknowledged that

“there is an independent scrutiny and review process…which is overseen by local Health Overview and Scrutiny Committees (OSCs). OSCs have the power to refer proposals…which I am then able to pass…to the Independent Reconfiguration Panel for advice.”

I have no doubt that will happen at some stage, because there is such overwhelming opposition to these proposals from local authorities as well as from MPs and their constituents across west London. However, given the farce of this purported consultation and the way that this matter has been handled so far by NHS North West London, it would be better for the Government to act now and call off this consultation, review the proposals and engage genuinely with MPs, clinicians and local authorities in reaching a sensible set of conclusions and proposals. We are not luddites; we do not oppose change in the health service for the sake of it. But our NHS and our local hospitals are very special places. People who have used those hospitals—sometimes over generations—have a unique relationship with them. I am sure that is true. I know that the Minister is familiar with the area and has past associations with it, so he will know what I am talking about. I know that he will also be aware of my constituents’ special and particular problems in terms of complex health needs.

I ask the Government in what I hope is an open-handed spirit to look now at what is happening, not only in the Imperial trust but in NHS North West London, because this situation cannot be allowed to continue.

--- Later in debate ---

[Stephen Pound (Ealing North) (Lab)]

It is an honour and a pleasure to serve under you, Mr Gray. Like all other right hon. and hon. Members, I congratulate my hon. Friend the Member for Hammersmith (Mr Slaughter) on securing this debate. I assure him that although I was not present at the inauguration of the “Paupers’ Paradise” in Hammersmith, I was present at Queen Charlotte’s hospital on the same day that the national health service was born, having also been born on that day.

We have heard a great deal of extraordinary information that underlines the seriousness of the situation facing us. The hon. Member for Ealing Central and Acton (Angie Bray) put her finger on it: the root of the problem is finance. This is about money. It is not about clinical need, clinical determination or a reconfiguration of the health service. As many have said, there is no luddite tendency facing the health service. It has changed massively. I spent 10 years working at Middlesex hospital, which may or may not have been in the constituency of the hon. Member for Cities of London and Westminster (Mark Field), although he certainly knew that hospital. It closed because people realised that there was alternative provision at University college hospital.

The situation in north-west London has been dramatically illustrated by the range of geographical interests represented here. Although Ealing hospital is in the constituency of my hon. Friend the Member for Ealing, Southall (Mr Sharma), it is the hospital used by my constituents. Those who do not use Ealing tend to use Northwick Park hospital, which is in Brent, although it is used predominantly by people from Harrow. We have extraordinary crossover. If the toothpaste tube is squeezed in one place, the shape changes in another.

This is the message that I want to give the Minister, who is a decent man. I have known him for a long time, and in many ways I respect his instincts on this matter. We must recognise that London is different. The days of “predict and provide” may have changed and we may not consider it a fashionable option any more, but the reality is that we in west and north-west London face health problems. We face the resurgence of rickets, tuberculosis and illnesses that we thought did not exist any more. We have a massively mobile population, but above all a growing population. Every single school in my constituency is having to expand. Looking around, I see colleagues on both sides of the Chamber whose schools are having to expand. The population is increasing.

What possible clinical case can there be for reducing accident and emergency services, which at Ealing provide succour for nearly 100,000 people every year, as we heard from my hon. Friend the Member for Hayes and Harlington (John McDonnell)? Those people will wash up at West Middlesex university hospital and Hillingdon hospital, with appalling, dire consequences.

Can it be that we have changed so much in terms of clinical delivery that an ambulance service is a mobile operating theatre and that it does not matter how far an incident or accident is from the hospital, because the ambulance service is now so brilliant? That is very different from when a former Conservative Health Minister referred to ambulance staff as lorry drivers with first aid certificates. I cannot believe that moving people at speed, however efficient the vehicle, will help the problem. In many cases, it will make it worse. How many times have we seen people on the blues and twos hammering through our streets, which at the moment are crowded, congested and dangerous? It can only make matters worse.

I have less than a minute left to speak. I say to the Minister through you, Mr Gray, that the public are not persuaded that there is a clinical case. The Secretary of State has said that there are four criteria. There should be

“support from local clinical commissioners; strong public and patient engagement; clear evidence of the clinical benefit; and reflecting current and prospective patient choice.”

Ealing Hospital Save Our Services has been mentioned, and Colin Standfield, the organiser, is here in Westminster Hall today. I say to the Minister that there is no evidence at any level that anyone is committed to the proposals to cut the A and E department. We heard earlier from the hon. Member for Cities of London and Westminster that there might be political grief. The Minister and I have both sat in the House for a while, and we both remember an Independent Member who represented one hospital anti-closure campaign. Hospital closures are a massively toxic issue. That is not a threat; it is a reality.

People are not with the Government on this issue, they are not with a shadowy PCT and they are not at all confident that the process is anything other than the biggest, crudest, roughest and most brutal rubber stamp. That is the impression that we in west London have. I implore the Minister to put our minds at rest and tell us that the consultation is genuine, and that there is a prospect of something other than an evisceration, an amputation without anaesthetic and a destruction of what we in north-west London hold so dear.

--- Later in debate ---

[Andrew Gwynne]

Absolutely. I enjoyed my visit to Ealing hospital with Ken Livingstone in the run-up to the London elections, although I am not sure whether my support did Ken’s campaign much good.

[Stephen Pound]

We did win the Greater London assembly seat.

[Andrew Gwynne]

Yes, as my hon. Friend confirms, we did win the GLA seat.

Councillor Carlebach told the BBC in April:

“We have some serious concerns at closing that many A and Es in such a large region.”

The hon. Member for Cities of London and Westminster (Mark Field) has expressed similar concerns.

The scale of the problem is easily grasped when one considers that NHS North West London serves a population of 1.9 million people in eight boroughs: Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea and Westminster. Does the Minister agree with the remarks made by his colleague on Hammersmith and Fulham council?

The chief executive of NHS North West London, Anne Rainsberry, has been clear on what is driving the decisions. She told the BBC in February:

“The financial challenges in London are pretty much unprecedented.”

The local Joint Committee of Primary Care Trusts has said that there will be a £332 million gap to plug by 2014-15 if no changes are made.

My hon. Friend the Member for Hammersmith, and the Labour party, are not opposed to change. He said a few weeks ago that there was

“nothing wrong with economies of scale if you can join forces and do something cheaper that provides more resources,”

and I associate myself with those remarks. The chief executive of the King’s Fund agrees that

“London’s NHS is in urgent need of change,”

but, he goes on to say,

“the risk is no-one will be in the driving seat”.

My hon. Friend the Member for Westminster North (Ms Buck) also warned about the lack of leadership and the timing of the changes when she said:

“The question is how do we get there from here at a time of chaotic reorganisation in the health service, when planning is falling apart, when north-west London hospitals alone have to save over £120m between now and 2014.”

I am afraid that what we are seeing goes much further than, and is in direct contradiction to, the Prime Minister and Health Secretary’s general election promise to halt the closures of hospitals, A and E units and maternity departments. What happened between the general election and now that caused both those right hon. Gentlemen to change their position? Why does the Minister think that there is such widespread concern about the lack of leadership in the health service in London, at a time when the NHS is being put through an unnecessary upheaval?

It is obvious from what the Government have had to say to date that Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished PCTs for the forthcoming closures. We all know what happened between the general election and now: the unpopular and, frankly, unnecessary Health and Social Care Bill—the biggest threat to the NHS in its long history—was introduced. It was a disastrous decision on the part of the Government to spend £3 billion on an unnecessary top-down reorganisation that has led to the loss of financial grip on the NHS.

In the case of west London, we are seeing another broken promise on the part of the Prime Minister, who spent millions during the general election putting up posters throughout the country reassuring the British electorate that, under the Conservatives, there would be a moratorium on hospital and A and E closures.

Does the Minister think that the proposals in the “Shaping a healthier future” document will save money in the long term? If all the closures go ahead, would that not leave Imperial College Healthcare NHS Trust with just St Mary’s hospital as a single site, and pose huge financial and practical problems for the expansion of its services to cope with the extended case load?

The Opposition warned Ministers repeatedly during the Bill’s passage that it would lead to the break-up of the NHS, and the “Shaping a healthier future” proposals seem to be a missed opportunity to improve care by reducing duplication where it occurs and ensuring that hospitals work together for the benefit of patient care.

Health and Social Care Bill

Stephen Pound Excerpts

Tuesday 20th March 2012 Commons Chamber

[Grahame M. Morris]

I agree with my hon. Friend and am grateful for her intervention. Those points were exercised in a recent debate in Westminster Hall. The basic point that I seek to make—I will finish on this—is that in order to plan effective health interventions, we need an effective and reliable evidence base. I would like assurances from the Minister that the necessary funding will be in place to ensure that that is delivered as a consequence of that measure in the Bill.

[Stephen Pound (Ealing North) (Lab)]

May I trespass upon your good nature, Mr Speaker, to endeavour to speak on behalf of the House to praise my hon. Friend the Member for Easington (Grahame M. Morris), who is not well, but who has risen from his sick bed to join us today because this subject is of such importance?

Those of us who stood at the Bar in the other place listening to the debate—[Interruption.] Not that bar. Those of us who stood at the Bar of the other place listening to the debate on the Bill cannot help but to have been massively impressed by the breadth and depth of expertise that was displayed. We had past presidents of royal colleges and consultants, and people from every aspect of our glorious national health service, giving their expertise, passion and analysis.

I come from a slightly different perspective. I spent more than 10 years working in the national health service—this is specifically in relation to the issue of health and wellbeing boards, in case you are worried, Mr Speaker—before community health councils were established in 1974, when, frankly, the NHS was not run for patients, people or the local community, and when there was little or no consultation with democratically elected local authorities, let alone with special interest groups or people representing areas that were ill served by the NHS. Community health councils had not only statutory powers, but a budget. They enabled the voice of the people to be heard in wards, corridors and A and E departments throughout the national health service.

We have heard tonight an extraordinary, agonising attempt on the part of the junior section of the coalition to justify what had been for years their principled support of a public voice within the NHS. The Liberal Democrats say that they will scrutinise the measure having voted to destroy that for which they have stood for so long. It is like somebody setting fire to a house and saying that they will time how long the fire engine takes to get there—and then criticising it. It ill becomes Members to draw attention to the shortcomings of other Members, but one speaker reminded me of those people in Spain who, on Good Friday, flagellate themselves up and down mountains trying to display their agonies. All the time, the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) tries to show us that he is not enjoying this—he is in agony but that agony will not deter him, I fear, from voting against the amendments.

[Helen Jones (Warrington North) (Lab)]

I hate to disagree with my hon. Friend but is not the difference between the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) and the flagellants of Spain that they believe they have sins to expiate, whereas he believes that whatever position he adopts today, even if it is the opposite of yesterday’s, is entirely right and proper?

[Stephen Pound]

I yield to no one in my admiration for my hon. Friend and her knowledge of the slightly occult religious practices of south Spain—and possibly of parts of St Helens for all I know.

But we did not expect the Spanish inquisition. We expected a valid, proper, sensible voice to enable the people to engage with their national health service. The NHS must not be an isolated ivory tower dominated by the old consultant gods who used to run it. It must not be a matter of non-responsible bureaucrats in quangos sending letters of suggestion. The NHS must contain a proper mechanism for the people’s voice to be heard and, above all, for the involvement of the wider community. The NHS cannot be a stand-alone organisation; it has to be involved with local councils and local communities, but everything in the proposals for this mealy-mouthed, milquetoast healthwatch nonsense dilutes and destroys that.

All the proposal does is create a false illusion—a falsity; the suggestion that somehow the voice of the people will be heard through this mere sub-committee of the Care Quality Commission, a committee whose mighty weapons arrayed against the forces of reaction and conservatism consist of the ability to write a letter. Such a letter would have to be vast, powerful and extremely effective, and would have to do what no letter has ever done in the history of epistolatory warfare. It would somehow have to persuade people on this gentle nudge—I appreciate that there are those on the Government Benches much given to the modern, modish philosophy of the nudge, but there is nudging and there is fudging, and what we have heard tonight is a fudge-nudge.

Above all, however, there is a crucially significant and important point here.

[Jim Shannon]

Do the hon. Gentleman’s exhortations mean that the pen is not mightier than the sword?

[Stephen Pound]

I am not entirely sure, Mr Speaker, whether you would allow the debate to go down that line, but were anyone in Northern Ireland to suggest a model such as that being proposed tonight, they would get a very dusty answer—it might not be replied to with sword or pen alone, but it would certainly be responded to.

The NHS is not something that we choose to buy into or out of. It is something that we all subscribe to. For many people—I should think everyone in this Chamber except me—it is a part of their birthright. People have been born under the NHS, have lived with the NHS, have funded the NHS and have supported it, and their voices must be heard. What we have tonight does not represent a valid mechanism for people to engage with the NHS. That is the key point. It is simply not good enough to set up a sub-committee of a quango and imagine that it has any force. We must realise that, yes, people may have different political opinions and there might be different priorities, but we do not have differential rates of national insurance. We pay national insurance because it is our national health service, and we have a right to have our voices heard.

[Fiona O'Donnell]

Does my hon. Friend agree that part of the problem is that such a complex measure is before the House? The Government’s thinking was not developed in the early stages, and the Conservatives’ coalition partners have contributed nothing throughout our scrutiny in Committee. That is why, at this late stage, the Opposition are still left trying to amend and improve the Bill.

--- Later in debate ---

[Stephen Pound]

As ever, my hon. Friend makes an important point. In responding to it, I would like to ask the House to cast its mind back to the contribution of my right hon. Friend the Member for Wentworth and Dearne (John Healey). He rightly said that this is not an issue of party politics. The fact that we see party politics in its worst form—its most loathsome shape—forming before our very eyes, clouded in some foul, mephitic, stygian Hades, is to be deplored. We should all listen to my right hon. Friend and actually try to admit to ourselves that we do not know everything—that the people’s voice does deserve to be heard and that the national health service is just that: a national health service, for all people. Everybody has that right to have their voice heard.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that one of the deepest problems with this Bill is that the people’s voice has not been heard? These proposals were never put before the people in party manifestos. That is exactly why they feel so very angry.

[Stephen Pound]

I am grateful to my hon. Friend for her question. It is a great sadness and reflects ill on my personal life that I spend many a night browsing through Liberal Democrat and Conservative manifestos. I have searched; I have examined; I have deconstructed; I have applied the principles of Jacques Derrida to those manifestos. Have I found in there any smidgen, any suggestion, any hint or any implication that the NHS was to be fragmented, privatised and ultimately destroyed, and the connection between the people and the NHS to be ripped up, torn into shreds like the integrity of the Liberal Democrats, hurled from the window to flutter in the breeze of history, never, ever to be seen again? Had I found that, I would almost certainly have voted Labour—but as I did so anyway, that is neither here nor there. But the point that my hon. Friend makes is absolutely right. How can the people, who fund the NHS, who are born in the NHS, who live in the NHS and who will ultimately quit this mortal bourn in the NHS—when they depart this vale of tears, it will be with the comforting arm of the NHS about their shoulders—feel that they are best served by this organisation if their voice is not heard?

[Fiona O'Donnell]

If it is difficult for those people to imagine how they can rely on the NHS, surely they should take a lead from the Lib Dems at their spring conference and show Liberal Democrat Members that they need to listen to their members and vote with us this evening.

[Stephen Pound]

My hon. Friend tempts me down a partisan path. I hope she will forgive me if on this occasion I will not follow so closely behind her. All I will say is that Gateshead—that wonderful, glorious city—has been demeaned by the presence of those who spin endlessly before our eyes, desperately trying to justify their own appalling behaviour.

What we have this evening is a Bill that is inchoate in its extremities. There are so many different clauses. I challenge any individual to respond to a question on the total number of amendments that we have had to face before tonight. But above all, leaving aside all the numbers, the clauses, the subsections, there is at the heart of all this one basic irrefragable—

NHS Care of Older People

Stephen Pound Excerpts

Thursday 27th October 2011 Westminster Hall

[Julie Hilling (Bolton West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Brooke. I congratulate the hon. Member for Stourbridge (Margot James) on securing this important and timely debate. I beg your indulgence as I tell a personal story about my mum’s recent journey through the national health service. As many colleagues will know, my mum had a bad stroke in June this year, and we have had a bumpy ride over the past four months. I want to make it clear at the outset that the vast majority of care workers, nurses, doctors and other staff with whom we have come into contact have shown my mum a great deal of loving care, but she seems to have been let down by system failures.

Mum is 86, but before her stroke, she was still working, teaching three yoga classes a week, doing reflexology, driving her car and leading a totally full life. As hon. Members can imagine, it has been devastating not only for her but for all of us. After the stroke, she was first admitted to Luton and Dunstable hospital’s accident and emergency department. At about 4 in the morning, she was medically ready to be transferred to a ward and was taken up to the stroke ward. However, when we got there, we were told that there was no bed. We were not too fazed at that point—it was the middle of the night—so we accepted it, and she was transferred back to the emergency admissions ward. At the time, the medics were not sure that Mum would survive, so it was a difficult time for us.

By the following afternoon, we were getting agitated—[Interruption.] Excuse me, Mrs Brooke; you can tell how it made me feel. Anybody’s journey through the national health services in such circumstances is difficult, and ours has not been made better by what has happened to us. We were agitated by the following afternoon. Mum was still on the emergency ward, which was very busy and noisy. Eventually, we started the journey back to the stroke ward, to be greeted at the desk again with “Sorry, there’s no room.” At that point, I started to become six foot tall, thinking, “My mother is going to come into your ward.” Fortunately, a sister behind the desk treated us nicely, saying, “This woman will be admitted on to our ward.”

Some time later, concerned about her breathing, I called for a nurse. The nurse came in and said, “Well, you know she’s do not resuscitate, don’t you?” I said, “Yes, but I’m concerned about her breathing.” The nurse said, “Oh no, she’s fine. She’s actually in a deep sleep and things are good, but oh dear, I’ve not hung up the drip.” I spent the next half-hour holding up the drip so that Mum would get saline and holding Mum’s hand until the nurse eventually returned with the drip stand.

That is just the start of a chapter of system failure. It was a great frustration going to the desk and seeing all those people behind it, but being totally ignored. I did not know whether they were physiotherapists or doctors. When I said, “Mum needs the commode,” or “Please can you,” I was ignored. That was not just our experience but the experience of everybody on the ward.

[Stephen Pound (Ealing North) (Lab)]

Sorry, but I cannot believe I heard that. Can my hon. Friend confirm that the charge nurse said to the patient’s daughter that the patient was do not resuscitate? Please God, I heard that wrong.

National Health Service

Stephen Pound Excerpts

Wednesday 26th October 2011 Commons Chamber

[Stephen Pound (Ealing North) (Lab)]

I am grateful to the hon. Gentleman for giving way and I hope that my intervention allows him to cool his jets a little. One cannot make a case about this by arguing about minutiae. Will he accept that for many of us the reality of the NHS is what we see at Central Middlesex hospital, where somebody turns up on a Monday to be told that the accident and emergency department closed on the previous Friday and has now been rebranded without there having been any democratic input? If one has any complaints about that, however, one should not even bother trying to find a person to speak to. That is the reality. The NHS is over-commercialised and is losing touch with its roots.

[Chris Skidmore]

The hon. Gentleman will regret his comments. We have to pay back £65 billion on PFI deals that were originally signed for £11 billion—that ain’t minutiae. Many constituents are concerned about the waste that took place under the previous Government.

In 1997, there were 23,400 managers. That has gone up to 42,500. We are making a genuine attempt to tackle the problem. I could go on, but I will put the party politics aside.

--- Later in debate ---

[Stephen Pound (Ealing North) (Lab)]

There are few areas of our work in this House that may be described, honestly and without hysteria, as matters of life and death. The national health service is so utterly central to our existence, our future and the hopes of our country that it is no surprise that the emotions it engenders are as strong as those that have been witnessed on the Floor of the House this afternoon.

I have to tell the Secretary of State that he has a problem. He is a man of great charm, he is widely liked and he is popular, yet he has not sealed the deal on his disintegration, disaggregation and atomisation of the national health service. He has not been able to persuade the Royal College of General Practitioners, which tells us that three quarters of its members oppose it. He has not been able to persuade Professor Malcolm Grant, his own choice to run the commissioning board, who describes the plan as “completely unintelligible”. The Secretary of State wishes to persuade the nation that it is appropriate, at this time of all times, to spend about £3 billion on reorganisation—money that could be far better spent dealing with the dental abscess of the hon. Member for Southport (John Pugh) and all the other problems that face us.

The hon. Member for Truro and Falmouth (Sarah Newton) spoke for many in the House when she prayed for a depoliticisation of this issue. The reality is that the national health service was born amid the gun smoke of political opposition; it was born opposed entirely by one political party in this House and supported by another. Of the supporters—

[Mr Brine]

rose—

[Stephen Pound]

Hold on a moment, I am just having a rant.

Of the supporters, let us give credit—because there once was a time when we could give credit to a decent, humane, sensible, consistent bunch of men and women—to the Liberals of those days and to Beveridge for the work that he did. Above all, let us never forget the transcendent genius of a south Wales miner’s son who left school at the age of 14, Aneurin Bevan, who gave us our national—I emphasise “national”—health service.

[Mr Brine]

I apologise profusely for interrupting a rant that I was enjoying. While we are on the subject of opposition to the conception of the national health service, can we place on record the fact that the British Medical Association also opposed it?

[Stephen Pound]

May I thank the hon. Gentleman? I do not know how anyone persuaded him to bowl me that patsy ball that I can immediately crack to the boundary. He is absolutely right. Dr Hill, the radio doctor, opposed the national health service. Aneurin Bevan said that he had had to

“stuff their mouths with gold”.

Of course the producer interest opposed the beginning of the national health service because it was about the consumers—that was its major difference. Of course the vested interests opposed the creation of the national health service—that is no surprise. But that was then.

The national health service was born in compromise. I was born in July 1948, as was the NHS. For many years I was suspected to have been the first child ever born on the NHS, in Queen Charlotte’s hospital, but somebody in Salford beat me to it.

[Barbara Keeley]

Trafford.

[Stephen Pound]

Trafford. I beg your pardon. However, the year before I was born, my parents had a son who died at the age of seven months. The year before that, they had another son who died at the age of eight months. I was born on 5 July 1948, two days after the health service, and I have my five brothers and sisters alive to this day. It is that important.

When I worked as a porter for 10 years at the Middlesex hospital, where my sister and wife were nurses and one of my brothers was an ambulance driver—half the family seemed to be employed there—we realised the consequences of the pragmatic approach to the health service. We had a private patients wing where people like myself, paid by the national health service, did work for people who paid money to a difference source, and where doctors trained under the NHS got personal recompense. One of the single most important aspects of our lives has been political from day one.

Each of the Health Ministers will remember, as I do, that we have sat in the same House as an hon. Member who lost his seat over a hospital closure. Let us never forget Wyre Forest and Kidderminster hospital. It is almost impossible to be objective about this issue. When the Turnberg report was published, it proposed an entirely sensible reconfiguration of London’s acute general hospitals, but it was opposed by almost everyone because of parochial and local issues. When polyclinics were proposed under the previous Government—one of the most logical, sensible, rational and helpful ways of providing primary health care—they were violently opposed by the Conservative party.

The situation now is that there is no consensus. However, I have not often seen anything quite so consensual, positive and forward-looking as the reference in today’s motion to an offer made by the Leader of the Opposition and the shadow Health Secretary of

“cross-party talks on reforming NHS commissioning.”

What could be better for the country, and for the reputation of this House, than our recognising that the NHS is not a political football or an issue on which we can strike postures? Yes, there are ideological differences between us, and Opposition Members may wish to see a greater infusion of finance-led choice, more and more commercialisation and an end to the Whitley system, which has survived for so many years. They may wish to see local pay bargaining setting hospital against hospital, clinic against clinic and clinician against clinician, with a constant stream of industrial disputes as localised pay bargaining bursts out all over the place in some industrial conflagration that attracts even more attention. At the moment we have one of the lowest numbers of hospital managers anywhere in Europe, and we will inevitably have to spend more and more on a greater and greater number of managers to deal with all that localised bargaining.

[Debbie Abrahams]

Will my hon. Friend give way?

[Stephen Pound]

I will give way to my hon. Friend, who knows far more about the subject than I do.

[Debbie Abrahams]

I thank my hon. Friend, and I am greatly enjoying his speech. Does he agree that the opening up of competition under the Health and Social Care Bill as it stands will be a real threat to the NHS as we know it?

[Stephen Pound]

I am grateful to my hon. Friend, and may I place it on record that, as I am sure virtually everybody in the House would agree, she has brought enormous expertise in this area to the House, for which we are extremely grateful?

The NHS cannot be disaggregated. It has to be a national health service, not a notional health service, a postcode health service, a better-in-some-parts-than-others health service or a good-for-Kensington-bad-for-Kidderminster health service. It has to be for the nation, and why? Because Beveridge did not just produce a one-point proposal for the NHS. There were actually five evils that he wished to slay. It was an integrated proposal that addressed want, hunger, ambition and other issues.

The NHS is not just an agency to patch people up; it is part of providing a healthy, productive nation and increasing the good and the good life within this country. At so many levels, we have to look beyond the bottom line and beyond, as the hon. Member for Southport said, the bean-counting philosophy. The NHS should not be about the click of the abacus in some cobwebbed recess, or about constantly seeking whether things can be bought cheaper here or commissioned for a lower price there. It should not be about container-loads of cheap goods being shipped in from Shanghai because some GP commissioning group somewhere has discovered it can get a discount on Tubigrip. It should be about the recognition that the health of a nation is utterly crucial, basic and intrinsic to that nation’s hope and future. Without health, we have no future.

[Pat Glass (North West Durham) (Lab)]

I am sorry to break my hon. Friend’s flow, but is it not the underlying principle of this country that we take care of one another? That is the principle behind the NHS and what the NHS stands for.

[Stephen Pound]

It has been said—not by me, but by some—that the NHS has almost become the national religion. They say that as Christianity has faded, as it has in some places—not in my constituency, and certainly not in my home—the NHS has become more important. The NHS is the perfect example of what Galbraith called the “gift relationship”, when we look out for one another. We should not constantly look for the bottom line, but instead look to be our brothers’ keepers. That is the principle—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order.