National Health Service (Amended Duties and Powers) Bill

Valerie Vaz Excerpts

Friday 21st November 2014 Commons Chamber

[John Healey]

My hon. Friend has been a strong champion of the NHS and followed this issue from day one of this Parliament. To answer directly his question of what could be more succinct and clear, I suspect that when we hear from the new Member for UKIP, the hon. Member for Rochester and Strood (Mark Reckless) or his colleague, the hon. Member for Clacton (Douglas Carswell)—given some of the things that they have argued should be the basis of the NHS in future—they will make the vision of the right hon. Member for South West Surrey look positively UKIP-lite.

This Bill is essential because it starts to correct the three fundamental flaws, brought about by the reorganisation legislation, that are now driving the NHS. We could call them the three Cs—cost, complexity and competition.

On cost, the scale of the reorganisation was simply huge. As the chief executive of the NHS said at the time, it was

“beyond anything that anybody from the public or private sector has witnessed”.

The cost of the waste has been huge. We reckoned beforehand that it was about £2 billion; we now reckon £3 billion. What is clear is that getting on for £1 billion has been paid out in redundancies, much of which was to staff who were paid off and then re-hired by our NHS.

[Valerie Vaz (Walsall South) (Lab)]

Could my right hon. Friend say what steps were taken to publish the risk assessment during the passage of the Health and Social Care Bill?

[John Healey]

I did not want to open up all the old arguments that we fought in 2010-11, though it was extraordinary to see the extreme lengths to which the Government went—seen before only on matters of military information—to stop the disclosure of the risk register about the potential impact and likely consequences of their policy. My hon. Friend was a great supporter of mine in trying to use the Freedom of Information Act to allow the public and this House to see the terms of what the Government knew could happen to the NHS if they passed the legislation.

My second C is complexity. NHS services are now so much harder to plan and so much harder to hold to account because of the changes the Government have made. We saw new national quangos responsible for tens of billions of pounds of spending of public money in each and every one of our local areas in England. The commissioning role, which was previously undertaken by one body, the primary care trust, is now fragmented with at least five different bodies trying to do the same job.

On the third C, competition, the Secretary of State has his foot lightly on the accelerator of privatisation for now, but let us make no mistake, if the Tories win the next election, he will press it hard down to the floor immediately afterwards. Even though they are soft-pedalling on the privatisation that their Act put in place, we have seen in the 18 months since it came into force 131 contracts won by companies such as Care UK, Virgin Care and BUPA. According to the NHS Support Federation, that is already valued at £2.6 billion. At that win rate, the contracts already currently advertised will mean another £6.6 billion in the private sector—getting on for 10% of our NHS run by private companies in private hands.

--- Later in debate ---

[Barbara Keeley]

I thank the hon. Gentleman for that comment, but the point is that Macmillan Cancer Support is using money fundraised by the public in ways that I do not think the public would approve of. That was the key thing we explored. It is not at all clear, if we look at the Macmillan website, how it is using approaching £1 million of the public’s money, donated on that basis.

[Valerie Vaz]

My hon. Friend mentions conflicts of interest. Is she aware that one of the companies bidding for the privatisation of cancer services is UnitedHealth Group, which was advised by the chief executive of NHS England?

[Barbara Keeley]

Indeed. Now that the shortlist for bidding has been announced for end-of-life care, we find that five of the shortlisted bidders are private companies, with only two NHS trusts on the list. For cancer care, there are three private companies and two NHS trusts. Given the seemingly headlong drive for change we found in those commissioning this large and risky contract, a great number of questions were left unanswered. For instance, despite the key role that GPs play in end-of-life care for patients choosing to die at home, the prime provider of end-of-life care will not have control over the actions of the GPs involved in that care unless a specific contract is drawn up and GPs are paid for extra tasks.

The contracts for cancer and end-of-life care are to be placed in early summer 2015, and I invite anybody with an interest in this to review the evidence and, in particular, the unanswered questions in the session the Health Committee held on 14 October. I have yet to find assurances in the evidence I have heard that the profit motive of private providers can be squared with the objective of improving cancer care and end-of-life care for patients.

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 21st October 2014 Commons Chamber

[Jane Ellison]

My hon. Friend is right to highlight this important issue. As he knows, the Department is negotiating with the manufacturer to purchase the vaccine at a cost-effective price, and he will understand that we need to ensure that NHS funds are used as effectively as possible. We are keen to see a positive conclusion to the negotiations as soon as possible so that plans for the Men B immunisation programme can be finalised.

[Valerie Vaz (Walsall South) (Lab)]

Will the Secretary of State explain why NHS England has entered into a contract with a company based in Kent to provide GP services, when my constituents have just seen a string of locum GPs at a higher cost to the NHS?

[Mr Jeremy Hunt]

Wherever we can avoid it, we do not want to use locum GPs or nurses or agency doctors, because they are much more expensive—our spend on that is far too high—but sometimes when there are issues of patient safety we need a quick solution. That is what has happened in response to the Francis report: as well as recruiting 5,000 additional nurses on a permanent basis, we are using extra agency nurses. However, we hope to bring those numbers down.

NHS Investigations (Jimmy Savile)

Valerie Vaz Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

No, I am not. That is why earlier this week we asked Sir Robert Francis to do a follow-up review to his public inquiry to determine what else needs to be done to create a culture of openness and transparency in the NHS. We have come a very long way as a society in terms of our understanding, but there is more work to be done. It is also very important, as I said in my statement—I know everyone would agree with this—that we do not undermine the brilliant work done by volunteers in hospitals and that we do not create a kind of bureaucratic morass that makes it impossible for that really important work to be done. However, I know we can do better than we are at the moment and important lessons need to be learned.

[Valerie Vaz (Walsall South) (Lab)]

The Secretary of State has been very gracious in his apology given that he was not Secretary of State at the time. Might I make one further practical suggestion? Will he speak to the Prime Minister about perhaps appointing a Minister to co-ordinate all these reports across the public institutions?

[Mr Hunt]

I reassure the hon. Lady that that responsibility lies with the Home Secretary, and the Home Office has a cross-governmental committee that will bring together all the lessons from all the reports. My first priority is to ensure that we are doing everything we can to make NHS patients safe, but there are much broader lessons to be learned. That is being led by the Home Office.

Health

Valerie Vaz Excerpts

Monday 9th June 2014 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is a pleasure to follow my hon. Friend the Member for West Ham (Lyn Brown). I am pleased to speak in this debate, and let me clarify if I stray slightly off topic that it is a tradition that one can be wide-ranging in one’s comments, but I will return to the NHS.

In my view the British people do not deserve the Gracious Speech as delivered. The first sentence contains a contradiction. It states that the Government

“will continue to deliver on its long-term plan to build a stronger economy and a fairer society.”

What is the evidence so far? So far there has been a tax cut to 40% for those earning more than £150,000, while at the same time some are struggling to pay the extra rent for the bedroom tax or a spare room. Those are among the most vulnerable people in society.

Added to that is a continued assault on the public sector, and as we start the new Session, there are still unanswered questions about the Royal Mail privatisation. There are plans to privatise the Land Registry, for which there is no case to answer, in addition to other cuts in the public sector. The Land Registry, the possibility of the east coast railway, the Forensic Science Service, the scientists at Kew Gardens—all that is the Government interfering with services that are profitable, safe and should be left alone to carry on with their expertise for future generations. Even the chief inspector of Ofsted has said that he will end its contracts with third-party services and employ school inspectors directly, because he thinks it is too important. So are all those other services and so is the legal system, but that does not seem to bother this Government. This is a giant jumble sale of the public sector.

The Gracious Speech contains a statement about selling off-high value Government land—land and assets that belong to the British people will be gone for ever. Members may remember the selling off of cemeteries for 3p by the former leader of Westminster council. The Government do not need to sell off high-value Government land for housing because that can be done by building on land where there is already planning permission. People in this country can use their creativity to find new ways to design new homes and build them, such as the programme developed by Walter Segal where people on the housing waiting list in Lewisham were taught how to build their own homes. That gave them expertise and empowered them, and the houses were sustainable.

My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) is right when she says that the Gracious Speech will allow fracking under people’s homes whether they want it or not. There is no definitive evidence that fracking works. Some 75% of the chemicals used in fracking are toxic and 25% are carcinogenic. There are concerns about its effects on the environment and on public health.

As many Members have pointed out, it is no coincidence that the Gracious Speech is silent on the NHS. Instead, the Secretary of State wants to punish the very people who have borne the brunt of the reorganisation that, by conservative estimates, amounts to £3 billion. He says they cannot have a 1% pay rise. He is withdrawing funding from front-line services, such as GPs’ minimum practice income guarantee, which affects surgeries in places such as Tower Hamlets and some rural practices, and which will be withdrawn from Wales a year later. The Secretary of State cannot blame the Welsh Assembly Government for that.

There is a lack of doctors in A and E because they are going abroad. Where is the long-term plan to end that crisis? Where is the Secretary of State’s response, other than leaving it up to NHS England? The lack of accountability, which was pointed out by my right hon. Friend the Member for Leigh (Andy Burnham), has been exposed since the implementation of the Health and Social Care Act 2012. Nothing has been done. Instead, we get announcements about community hospitals without consultation with local people about which hospitals are needed and where they should be placed. The Government want to use public money in their own way, but they do not want to be accountable for it.

There is a provision, as other Members have pointed out, for redundancies to be capped. The revolving door and merry-go-round of people being made redundant and then rehired as consultants has been exposed time after time by Her Majesty’s Opposition. That public money could be used for my constituent Grace Ryder, aged 9, who was recently diagnosed with type 1 diabetes. She wanted to draw attention to this and raise money for charity, so on Saturday she helped to organise a fair at Delves Baptist community church. This courageous girl has to wear a cannula in her stomach for the delivery of insulin. There is an alternative—a pod that has no tubes—but it is not available on the NHS and the family cannot afford the £90 per week that it costs. Instead of these vast redundancy payments, money should be spent on the courageous Grace Ryder and other children to help them lead as normal a life as possible. I would ask the Secretary of State, if he only bothered to listen, whether he is as courageous as Grace Ryder. Can he make this insulin pump available on the NHS?

To promote a fair, just and more equal society we need to tilt the balance back to the British people. The Government should look again at the scaling back of the Equality and Human Rights Commission and the equalities agenda. The organisation was there to help and to provide evidence for some of the myths that abound that may explain why some communities are not tolerant of each other. Her Majesty’s Opposition will repeal the Health And Social Care Act, which has caused chaos, insecurity and inequality in the NHS and repeal section 75, which forces competition, not collaboration, wasting millions of pounds on legal advice. We will also build affordable homes like those built under the vision of Walter Segal, which became a reality in Lewisham. Equality, opportunity, justice and tolerance should be the foundations of the Gracious Speech and our society.

Tobacco Products (Standardised Packaging)

Valerie Vaz Excerpts

Thursday 3rd April 2014 Commons Chamber

[Mr Speaker]

Order. I do not wish to be unkind to the House, but so far it is not obvious to me that we have had questions; we have had what might be described as lengthy volleys of words, which are not quite the same thing. If we can have short questions and short answers, we might have a reasonable chance of making effective progress towards subsequent business. Let us be led in that important mission by Valerie Vaz.

[Valerie Vaz (Walsall South) (Lab)]

I obviously welcome the Minister’s statement, but given the evidence from Sir Cyril, from Australia and Canada and from the Health Committee, will she update the House on a possible time frame? “Before 2015” is too vague.

[Jane Ellison]

As I said, I want to publish the draft regulations alongside the short final consultation to look at any final points people want to make about the wider aspects of the policy. It is important that we do that to move forward in a way that is robust and sensible and that shows that we have considered everything in the round. I want to do that this month; then, if we decide to proceed, we will move to give the House a final decision before the summer recess. There is no reason why the legislation could not be brought before the House before the end of this Parliament.

NHS

Valerie Vaz Excerpts

Wednesday 5th February 2014 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

I am grateful to the hon. Member for Strangford (Jim Shannon) for being so concise in his remarks. It is always a pleasure to follow him.

This debate takes place against a background of confusion and contradiction in the NHS. I hope that we will not end up with a national health disservice. We read all the documents and hear all the announcements about efficiency savings, but we still have not heard the lesson that people and patients should be at the heart of the NHS.

Many of the policy makers in the health service who appeared before the Health Committee warned us that there was not much detail in the lead-up to the Health and Social Care Act 2012. There was no pre-legislative scrutiny and then there was a pause. Not for the first time, the Government rushed to get legislation through without proper scrutiny and without an electoral mandate.

That played into the hands of the people who think that this Government and this country are up for sale to the highest bidder, and that there is no commitment to the people of this country. The Shard is an example. I understand that a number of its floors have been allocated to a private hospital. That is somewhere where pearly kings and queens cannot afford to live—they cannot even afford to go up to see the view.

I am pleased to see a number of my colleagues on the Health Committee in the Chamber. We hear a lot of first-hand evidence. At a time when there are concerns about A and E, the Government seem to be intent on fiddling about with name changes. The NHS Commissioning Board is now known as NHS England. The integration transformation fund is now known as the better care fund. Interestingly, the Chancellor announced in the spending review in July that the £3.8 billion that has been allocated to the integration transformation fund—aka the better care fund—will only be available in 2015-16. However, the problem needs to be addressed now.

That £3.8 billion is not extra money, but money that has been underspent in the NHS over the past few years. The underspend was £2.2 billion in 2013 and £1.4 billion in the previous year. When I asked the Secretary of State on 26 November last year why the underspend was not used for the NHS, he said that I should ask that question of Labour Ministers. I do not know whether he meant that I should do so in 2015. As I pointed out in an aside, which was not picked up by the Official Reporters, I am not a time traveller like Dr Who and was only elected in 2010. The rules of the House say that I should have had a proper response, rather than a dismissive one.

Another issue is that people have been fired and then rehired. One in five of the 19,000 staff who have been given redundancy payments has returned to the NHS. That is more money that has been wasted and that should have been spent on patients. Primary care trusts were disbanded and then re-formed with a different name. Urgent care boards were set up—their name was then changed to working groups—to ensure that there was a forum to replace the PCTs. All of that has strained resources and made staff suffer, without any increase in pay. There is job creation. However, it is not in front-line services, but in the appointment of a chief inspector, which was not suggested by the Francis report, and of assistant chief inspectors. There may well be assistant assistant chief inspectors as well.

The Select Committee heard evidence that the pay policy was significant in enabling the NHS to fill the gap, and NHS England said that, so far, around 25% of efficiency gains had come from pay. Ask A and E doctors who are struggling with working unsocial hours while locums without continuity in patient care are paid more, and they will say, “We need more staff; it is more money wasted on locums and agencies.” Perhaps Ministers should think about golden handcuffs for A and E staff, or the equivalent of an A and E special allowance to recognise the work of those doctors and staff in A and E. That might go some way towards ensuring that we keep them in their place and provide a safe service while doctors are trained. The College of Emergency Medicine has made repeated calls for such measures, and the emergency medicine taskforce made recommendations in 2011, yet we are still waiting for action.

Many Members will know from their own hospitals that patients are suffering from delayed discharge. I have seen that first hand at Manor hospital after the closure of the accident and emergency department at Stafford hospital, where perhaps the relationship with local government is not at the same stage as it is with the local authority in Walsall, for example, and it takes longer to discharge patients. We are still waiting for the £4 million that is needed because we have had to take the strain of the closure at Stafford hospital.

When giving evidence, Sir Bruce Keogh, the NHS medical director, acknowledged that 20% to 25% of people in hospital should have been discharged. The Secretary of State said that himself, having spoken to chief executives of hospitals with approximately two wards full of people who could be discharged. Our House of Commons Library says there have been £1.8 billion of cuts in social care, but apparently, the boffins at NHS England have not “dissected out” why people are in hospital when they do not need to be there. They are working on it now—that serious work on delayed discharges has apparently only just started, despite there being a problem for some time.

The urgent and emergency care review suggested that there should be emergency centres and major emergency centres. Sir Bruce said that NHS England was still listening to that proposal, but in a contradictory view, the Committee was told in the same evidence session that the clinical commissioning groups and other working groups are organising their networks to ensure that that is the outcome. Worse still, it was admitted that they have no intention of stopping any reconfigurations during that review.

[Barbara Keeley]

Will my hon. Friend give way?

[Valerie Vaz]

I am sorry; I have no time. The Secretary of State wants to reconfigure but he does not want a national debate. He gives himself extra powers if he does not like what the courts and local people say. We need that debate. We need to tell people the truth based not on ideology but on fact, because it impacts on the type of medical work undertaken, and on how we train the next generation of doctors, nurses and health care professionals and what specialties there will be.

The Nuffield Trust gave evidence to the Select Committee and said that people have made the easy savings and now they are running out. People’s memories are long. They have paid their taxes and expect the state to look after them when they need it; not to have to show their credit card as soon as they walk into an emergency centre, or a major emergency centre—whatever it will be called. People do not want prime NHS property in the centre of a city to be sold off so that they have to travel further to get to hospitals.

Chaos, confusion, contradiction, and finally, from the Secretary of State an admission. In evidence last December he said that hospitals want to employ another 4,000 nurses compared with a year ago—an admission that 4,000 nurses have gone missing on his watch. The shadow Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), made it clear that he does not want a further top-down reorganisation, and he started the conversation about whole-person care in the 21st century in a speech in January last year. Finally, Margaret Mead the anthropologist said:

“Never doubt that a small group of committed citizens can change the world…indeed, it’s the only thing that ever has”

We have in the staff, patients and people of this country a group of citizens who want to save their NHS.

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 14th January 2014 Commons Chamber

[Jane Ellison]

Obviously, health is a devolved matter, but research goes across the United Kingdom. In 2012-13, we spent £2.3 million on research into this disease through the National Institute for Health Research. The hon. Gentleman may be aware that during the passage of the Mesothelioma Bill, which has recently passed through this House, ministerial colleagues agreed to write to the Association of British Insurers. The Department of Health is seeking to set up meetings with the ABI and the British Lung Foundation to explore how insurers can individually sponsor specific mesothelioma research.

[Valerie Vaz (Walsall South) (Lab)]

4. How much has been spent on medical locums in accident and emergency departments in each year since 2009-10.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Staff employment is a matter for NHS trusts and we do not collect that data centrally. We recognise the challenge in recruiting and retaining A and E doctors, who can take up to six years to train. However, growth in the medical work force has kept pace with the increase in attendances since 2010.

[Valerie Vaz]

I am sure the Minister will agree that it is a grotesque situation where a trainee doctor working as a locum is paid as much as a fully qualified doctor. That is the result of not listening to legitimate concerns during the passage of the Health and Social Care Act 2012, so will the Minister not blame women in the work force or overpaid doctors but do something quickly to stop this drain on public money?

[Dr Poulter]

I hope the hon. Lady will be pleased to hear that under the current Government we have reduced locum costs to the NHS by about £400 million. That is, of course, good medical practice: it is good for patients to receive better continuity of care from permanent doctors. In A and E, specifically, we have seen the work force grow by more than 350 since 2010.

Mid Staffordshire NHS Foundation Trust

Valerie Vaz Excerpts

Tuesday 7th January 2014 Westminster Hall

[Jeremy Lefroy]

I agree. I welcome my hon. Friend’s huge support, both for Stafford and Cannock, throughout this process.

[Valerie Vaz (Walsall South) (Lab)]

I congratulate the hon. Gentleman on securing this debate. I know how hard he has worked and I echo the tribute of the hon. Member for Cannock Chase (Mr Burley).

The impact on the Manor hospital in Walsall has been immense, as the hon. Gentleman said. We have already had to open 70 beds, as well as attempting to open two wards. The hospital desperately needs £40 million. I have raised this matter frequently with the Minister. I should be grateful if the hon. Gentleman took that on board in his summing up and if the Minister looked at the Manor hospital—he has visited it, although I was not there when he did—to ensure that it gets the funds that it desperately needs, having taken the impact of the closure of accident and emergency at Stafford hospital.

[Jeremy Lefroy]

I am grateful. I place on the record my thanks to all the staff at all the hospitals—Stafford, Cannock, Wolverhampton, Walsall and Stoke—for all they have done through this difficult time.

Let me turn to the detail of the services, which comprises the bulk of the trust special administrators’ report. We have come a long way from 11 months ago. Then, the contingency planning team recommended removing A and E and all acute services from Stafford, as well as elective surgery from Stafford and/or Cannock. We now have proposals that retain elective surgery at Cannock and, indeed, foresee increased activity there. At Stafford, we retain 14/7 A and E, together with acute medicine, elective and some less serious non-elective surgery, day-case surgery and a large out-patient department.

As a result of the consultation, the administrators proposed a midwife-led unit for maternity, when their original proposals removed all childbirth from Stafford. The estimate is that some 90% to 91% of all current patient attendances would remain at Stafford and Cannock.

Accident and Emergency

Valerie Vaz Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andrew George (St Ives) (LD)]

My expectations for this debate were low, having previously endured shouting matches between the former Labour Secretary of State, the right hon. Member for Leigh (Andy Burnham), and the current Secretary of State, with the usual antics of carefully selected and spun statistics thrown at each other. Those expectations were not disappointed. This issue is not helped by being dragged into the gutter of partisan politics. The fact is that the A and E crisis—if there is indeed an A and E crisis—has existed and has been endemic in the NHS before and after 2010. This is largely the result of A and E being seen as an issue that somehow needs to be treated separately and not part of an integrated NHS. Before 2010, there were ambulances queuing outside the A and E in my constituency and in the Royal Cornwall Hospitals Trust in Truro. The problem exists. From time to time, there will be those kinds of pressures, which are created by a whole set of things that are not entirely the fault of a failing A and E service.

One aspect of unscheduled care in Cornwall that I raised with the former Secretary of State is the out-of-hours GP service. The previous Labour Government were perfectly happy to see that service put out to tender and privatised, and we saw a fragmented unscheduled care service. I reported the Serco out-of-hours GP service to the CQC, because it was simply putting profit before patients by manipulating statistics to make the outcomes appear better than they were. It was announced last week that Serco will be handing that contract back early. I hope that that will result in an integration of unscheduled out-of-hours care, as that is the kind of thing we need to do. This is not an issue that should be subject to party political point scoring, because that completely misses the target.

[Valerie Vaz (Walsall South) (Lab)]

The hon. Gentleman sat on the Select Committee with me. He must surely accept that there was a top-down reorganisation that nobody wanted and that cost the NHS £3 billion.

[Andrew George]

Yes, and the previous Labour Government were involved in multiple top-down reorganisations of the NHS. The hon. Lady knows that I opposed that top-down reorganisation; I voted against the Health and Social Care Bill.

We could just bemoan the things that are going wrong, but I want, in two minutes, at least to lay on the table my prescription for what needs to be put right. The two themes have to be integration and prevention. My intervention on my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) spelled out the theme of integration. Unscheduled care includes not only A and E, but minor injuries units, urgent care services, the 111 service, the ambulance service, the out-of-hours GP service, GP surgeries themselves, and, indeed, GP walk-in centres, which the previous Government created. Significant confusion is created about where the general public are supposed to take themselves if they have an urgent need for medical attention. We really need to find ways to integrate those unscheduled services in a way that does not result in the fragmentation that bedevils the service at present.

On prevention, often in acute hospitals planned work cannot go ahead because patients cannot be discharged from hospital and other patients cannot be admitted because there are insufficient beds. The health service is not integrated, because there are insufficient community beds and the primary care service is struggling and stretched to the limit, unable to provide the kind of care for people in their homes and community hospitals that would avoid them ending up in hospital as emergency cases. Those are the two themes: further integration of the service, which is not helped by the Health and Social Care Act 2012, and significant investment in preventive care and primary care.

Oral Answers to Questions

Valerie Vaz Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

I am delighted to do that. As these are the last Health questions before Christmas, all of us would want to pay tribute to the voluntary organisations that do an extraordinary job of making sure that vulnerable older people do not get lonely over the Christmas period. It is heroic what they do—when we are with our families, they are looking after other people—and we should salute them all.

[Valerie Vaz (Walsall South) (Lab)]

22. One way to ease the pressure on the NHS is by not handing the £2.2 billion underspend back to the Treasury. Will the Secretary of State consider using it for the NHS?

[Mr Hunt]

I wish the hon. Lady had been as diligent in asking that question of Labour Ministers, who also handed back underspends to the Treasury when they were in power.