Health and Care Services

Debate between Steve McCabe and Richard Fuller

Wednesday 3rd July 2013 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I recognise that there is almost no prospect of a return to the 4% annual rises in the health economy that we had got used to, and the right hon. Member for Charnwood (Mr Dorrell) explained the impact on income tax of such a move. The Institute for Fiscal Studies reported that to return to that would require a budget freeze on every other Government Department for the foreseeable future, even allowing for significant growth in our economy. We have to recognise that the NHS will have to make do, therefore.

The NHS is currently halfway through finding efficiency savings of more than £16 billion up to 2016. The savings are coming primarily from pay restraint, administrative cuts and reductions in centrally determined payments. In the long run, pay restraint may lead to a shortage of essential staff and, of course, poor pay and conditions is a factor in the poor-quality social and residential care we already see. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out, social services directors say that reductions in payments to care providers are leading to a fall in the quality of the care they are able to commission, and that often leads to a cycle of admissions to hospital.

Although it is politically convenient to scapegoat administrators, even the Minister must recognise that there is a limit to efficiency savings in administration. In these circumstances, the decision to waste so much on a top-down reorganisation now looks a little stupid.

[Richard Fuller]

The hon. Gentleman has raised the issue of low pay in certain sectors. He will know from the evidence of the Select Committee report that 16 of the 42 trusts stated that pay amounts to at least 50% of the total cost pressures. Does he think there is a case throughout the NHS for looking at managing down the pay of the more highly paid, so that those on the bottom can get higher increases?

[Steve McCabe]

There is some merit in looking at that, but when the people at the top end are scarce, we must be careful not to lose them to other countries. That is a challenge.

Today’s announcement about charging foreign nationals was strange in the sense that it seems to undercut existing private providers such as BUPA. I am not quite clear how that will save money. I fear it is the kind of posturing that may well end up costing us money, rather than saving money.

Like others, I welcome the Chancellor’s decision to allocate £3.8 billion to the joint NHS social care budget, but I would like to know an awful lot more about how it will be allocated and spent. In particular, I would like to know how the Minister hopes to measure its impact on medical services such as accident and emergency and hospital beds.

I would like us to have a statement on the proposed pathfinder integrated care pilots, because many of us are curious to know where that is going. It seems to me that there is not an awful lot of point in proclaiming the virtues of pooled budgets unless we know exactly what the Secretary of State thinks he is going to achieve. We have an idea from the Health Committee about where it thinks that might go, and the shadow Secretary of State has sketched a vision, but so far we have had an announcement from the Chancellor about making money available yet we do not have any idea what the Secretary of State hopes to achieve through that measure.

I would like to make one suggestion to the Minister: he should take a look at the home from hospital care service, which I understand operates in several parts of the country, and which was inspired by the work of Geraldine Amos almost 40 years ago now. In Birmingham, that service helps people move from hospital back into their own home and community and, of course, frees up hospital beds. It is quite a limited service in Birmingham at present, as it is currently financed by a grant from Birmingham city council, and I am not sure how much longer that will last, given the pressure on local authority budgets. That is, however, one example of how quite a small amount of money can be used to make quite a big impact in getting people back and settled at home, and trying to stop repeat admissions and bed-blocking. The recent NHS Confederation survey of chairs and chief executives revealed that 50% of respondents believed that the financial pressures have affected waiting times and access in the past 12 months and that 70% believe that waiting times and access will be affected by the continuing financial pressures in the next 12 months. So it is slightly strange that we have heard so little from the Government about how they plan to redesign services so that they are able to unlock more sustainable efficiencies for the future.

Given the answers I have received to some written parliamentary questions, my impression is that far from having a vision for the NHS, Ministers are seeking to evade responsibility for it. I have lost count of the number of written answers I have received advising me to contact this body or that body when I have asked the Minister for basic information and figures. We need a bit more clarity about the Government vision, and local communities and their representatives, including local and national politicians, should be properly engaged in that vision. That is one area where we could all be in it together; we could all be party to some kind of change programme, which would help us to redesign the services and to plan an NHS that will have to operate with fewer resources in future.

My recent experience of trying to obtain straight answers on the future of the NHS walk-in centre at Katie road in my constituency does not fill me with any optimism. Why on earth should clinical commissioning groups be allowed to keep private and secret a report on the future of walk-in centres, given that the report was not even commissioned by them? Why should the local Members of Parliament not be given access to that report? Why on earth set up a body such as HealthWatch if it does not get automatic access to it?

I would really like to know a bit more about that Government vision, and I would be particularly interested to know what they want to do to manage some of the growing pressures to which hon. Members have referred. I would like to know the Government’s policy with regard to the greater prevalence of long-term conditions such as diabetes and dementia. Like the hon. Member for Southport (John Pugh), I think it is hard to see the impact of health and wellbeing boards in that area, not because they are not bringing the right mix of people together, but because their chairmen are currently engaged in a line-by-line review of budgets designed to exclude everything that is not a statutory obligation. It is difficult to see how such bodies will be the ones with vision about long-term conditions when that is the level at which they are currently operating.

The Secretary of State should give a clear commitment to tackling the problem of conflicting incentives in the NHS. Acute trusts are paid for their activity through the tariff, while primary care and community care is paid through block contracts which actually serve as a disincentive to activity. I welcome the news that Monitor and NHS England are to examine this problem, but we need some response to it fairly quickly.

In conclusion, I recognise that we are discussing the estimates made possible by the economic circumstances of the country, but it remains the responsibility of the Secretary of State to provide vision and leadership for the NHS, even in such difficult times.

Budget Resolutions and Economic Situation

Debate between Steve McCabe and Richard Fuller

Thursday 21st March 2013 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

This is a Government whose central argument rests on the spurious claim that the economic crisis was national and all Labour’s fault up until 2010, and magically internationalised only after they came to power. With every passing day, the extent of that basic deception and the false conclusions drawn from it are exposed. We were told the pain would be worth it because the Chancellor would have the debt and the deficit under control by 2015. Now it will be 2017-18 and, according to PricewaterhouseCoopers, the current debt overshoot is likely to be £8 billion higher than predicted just three months ago.

This was the tomorrow budget for a tomorrow that never comes—almost anything of any value is put off until 2015 or beyond. With a Chancellor whose forecasts have proved worthless so far, just what kind of certainty does that provide? The Government’s claim is that the deficit is down by a third but the OBR’s figures show that it is down by less than a quarter, and there is no prospect of further cuts in the deficit in the next two years.

[Richard Fuller]

Does the hon. Gentleman think that the answer is to borrow more money?

[Steve McCabe]

The answer can be to borrow some money for investment, but not to squander it on rising unemployment and wasteful expenditure, which is what the Chancellor is doing. All the pain will simply be to stand still. The OBR has also pointed out that the public debt in 2015, rather than being the £37 billion the Chancellor originally promised, will actually be a staggering £108.4 billion. Just when are this lot going to learn that they have lost all right to lecture anybody about debt?

I welcome the cut in the duty on beer, although the VAT rise added 5p to a pint of beer, and the likely benefit of the measure will be offset by the loss of jobs and sales in the whisky industry, so it is not quite the achievement that some people might think. I am also pleased that the Chancellor has offered some certainty by scrapping, rather than postponing for the umpteenth time, the planned rise in petrol. The £3 billion lift in capital spending is welcome, but we need it now, not in 2015. His own fiscal rules allow him to borrow to invest: why does he not do so?

We can all welcome the cut in national insurance for small employers as probably the one genuinely growth-stimulating measure in the Budget. Perhaps that is not surprising, as it was our idea.

The Chancellor has once again promised a cut in corporation tax in 2015. Just like the now-forgotten triple A rating, stimulating inward investment by cuts to corporation tax is a Government mantra. It is not working, however. Foreign direct investment inflows to the UK fell between 2010 and 2011, and are now about a third of what they were before the crash. Meanwhile our total investment rate is 15% of GDP—the lowest in the G7—and our current account deficit is now at its highest since the 1980s. We are stifling opportunities for investment.

Legitimate foreign students are worth approximately £8 billion a year to the British economy, and that is being lost in pursuit of the Home Secretary’s immigration target. Simultaneously, she is letting in 30,000 people a year on temporary student visas that require no entry qualifications, no evidence of income and no guarantee of qualification. As usual, it is the wrong target at the wrong time. Similarly, the lack of Chinese tourists means that the very people we need to attract and to encourage to trade with us are now four times more likely to take their spending to France.

As usual, this was a Budget of missed opportunities. Where is the plan for a properly capitalised British investment bank of the kind operated by every other G7 country? There is nothing in the Budget about a target to decarbonise by 2030, but that is exactly the message that would provide certainty for the renewables supply chain and create jobs. Only one in 10 wind farm components are directly sourced in the UK. Why is it that the Chancellor is unable to see what everybody else can see?

The Chancellor called this a budget for an aspiration nation; it sounds more like alienation to me. He is presiding over what Professor Arnold Blumberg calls a zombie economy where rising inflation and no growth eats away at savings, strangles enterprise and innovation, and deprives small businesses of the capital and opportunities they need to grow. We have yet to see who the real beneficiaries of the abolition of stamp duty on share trading will be, but we know who it will not be. This is an alienation budget because the vast majority of our people are into their third year of pay cuts and falling livings standards, and the only ones doing okay are the millionaires in line for a tax cut. There is alienation as it emerges that the mortgage assistance scheme is actually a second home subsidy at the very time when the bedroom tax threatens to throw others out on to the street.

I invite the Chancellor to try listening to real people, like I do. Of those I surveyed in Selly Oak, 50% said that creating jobs and the conditions for jobs should be his top priority, 39% were worried about the rise in domestic gas and electricity prices, and 29% cannot make ends meet and will be forced into debt by his policies. The people of Selly Oak are a good barometer and they know what needs to be done. When will this Chancellor start to listen to real people and do the things that the country desperately needs?