It is a great pleasure to open today’s debate on health and education.
A few weeks ago, my right hon. Friend the Secretary of State for Education and Skills and I visited the Sure Start children’s centre in Church street, Westminster. We met Jo White and some of her outstanding team of health visitors, child care workers and therapists working in this inner-city estate in a community that is so ably represented by my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck). In 1997, there were no Sure Start children’s centres; today, there are 1,000, and by the end of 2010, 3,500 will be transforming children’s lives. Opportunity and security in action is the central theme of this Queen’s Speech—the 10th consecutive Labour Queen’s Speech.
I thank all the dedicated staff who work in our education and health services. We can see the improvements in our own constituencies and in communities all around the country. There is now a nursery place for every three and four-year-old whose parents want it; nine years ago, there were very few. Child care places have doubled, literacy and numeracy standards are up, the number of failing schools is down, and more young people are getting good GCSEs than ever before.
The NHS is treating more patients faster and better than ever before. In the past 12 months alone, cancer treatment has been transformed. A year ago, for most cancers, one person in three of those urgently by referred by their GP with suspected cancer had to wait more than two months for tests, diagnosis, out-patient appointments and the start of treatment. Today, almost 95 out of 100 such people are diagnosed and start their treatment within 62 days. That has happened because of the outstanding work of NHS staff—300,000 more NHS staff than there were in 1997. It has happened because we set a target—a target that the Conservatives have said they would abolish. It has happened because a Labour Government have been willing to invest—with, by 2008, education budgets doubled and health investment trebled—and because, in health as in education, we have matched investment with improvement and reform.
That may be the case for cancer services, but is the right hon. Lady aware that since the changes to primary care trusts cuts have been made in some NHS-provided services such as acupuncture and homeopathy? Does she recognise that her Department has provided no framework for delivery, nor any guidance of any kind? Will she be kind enough to allow me to come to her with a small delegation to discuss these issues?
I will of course ensure that the hon. Gentleman and his colleagues are seen by me or by one of my ministerial colleagues. His area has more funding than ever before, and the local NHS, in consultation with local people, needs to decide how best to spend that money. We have asked the National Institute for Health and Clinical Excellence, as it considers treatments for a different range of conditions, to take into account the contribution that acupuncture, homeopathy or other complementary therapies can make.
The right hon. Lady and I share the same general hospitals in Leicester. Two days ago, I spoke to a man in his 30s in Leicestershire—our own county—who has an embarrassing and painful problem. Eighteen months ago, he was told by his GP that he had to have a circumcision and was referred. On Tuesday, he went for his pre-op medical. How can that be described as speedy treatment in Leicestershire?
I am not aware of the circumstances behind that case, but I am sure that the hon. Gentleman has taken it up with the University Hospitals of Leicester trust. I am sure, too, that he would wish to recognise that when his party was in government, people waited more than 18 months for the operation after they had been put on the operation list, whereas now the maximum is just six months. There have been real improvements that he and his party are not willing to acknowledge.
The extra investment in the local health economy in Stockport has meant that my constituents are waiting only weeks for operations for which they used to wait years. It does not become the Conservatives to fail to acknowledge the huge investment in health. Does my right hon. Friend agree that PCTs must be able to invest in community services and public health initiatives, as investment in those areas can often prevent hospital admissions?
My hon. Friend is right on both points. Medical technology now enables hospitals to work in completely different ways—day case surgery is an example of that. It is also possible to move many treatments and out-patient appointments into the community, which means that we need fewer beds and sometimes fewer staff in some of the acute hospitals, and that we can provide better and much more convenient care to patients close to their homes.
Before the Secretary of State gets too carried away discussing waiting list comparisons with her hon. Friends, I should remind her of what I was told in reply to a parliamentary question on 8 November when I asked what percentage of patients on in-patient waiting lists were seen within six months in each year, going back to 1990. In 1997-98, 85 per cent. of patients were treated within six months. In 2004-05—the last year for which data were available—the figure was 87 per cent. Perhaps the right hon. Lady would like to comment on that.
I am not sure what point the hon. Gentleman is trying to make. The latest figures—hospital by hospital and area by area—as he knows, show that whereas thousands of people used to wait more than 18 months, then more than 12 months and then more than six months for their operations, almost nobody now waits more than six months for an operation. I readily acknowledge that much more remains to be done. There are new challenges to face and people’s expectations are rising. People want public services to give them more personal services. Education and health services should be built on the needs of different individuals instead of people having to fit around the needs of the system.
Let me make a little more progress.
We have been discussing waiting lists. We have cut the waiting time for elective operations, hip replacements and so on from more than 18 months under the Conservatives to a maximum of six months and, for most people, far less. By the end of 2008, we will have cut waiting times from 18 months—[Interruption.]
Thank you, Mr. Speaker. By the end of 2008, we will have cut waiting times from 18 months for an operation to a maximum of 18 weeks—far less for most people—from GP referral to the operating theatre, including all the tests and the out-patient appointments in between. Of course, that means more change and that is not easy. For most patients and most operations, it will mean the end of waiting lists as we have known them. What an achievement that will be for the 60th anniversary of the national health service.
Will my right hon. Friend help me to resolve an impasse in Staffordshire? The health authority has told the ambulance trust to stop the magnificent community first responders administering 13 drugs, procedures and medicines when they are first on the scene of serious injuries and illnesses. All Staffordshire Members have asked by what authority the responders cannot administer the drugs. I have personally written to the health authority, the Department and the regulatory authority, and that seems to have thrown them all into confusion. May we have a definitive reason why the community first responders cannot administer those important procedures?
My hon. Friend refers to the work of community first responders, who do a wonderful job in Staffordshire and many other parts of the country in helping to save the lives of thousands of people. However, the drugs to which he refers include controlled drugs. A question has arisen in Staffordshire about whether the community first responders have the legal authority to administer the drugs. The appropriate authorities are examining the matter and a decision will be made as quickly as possible to ensure that community first responders administer drugs in an emergency in full accordance with the laws that are designed to protect patient safety.
Is the Secretary of State aware of discussions between Telford and Wrekin borough council, the Shropshire County primary care trust, the Telford and Wrekin primary care trust and the Royal Shrewsbury and Telford hospitals NHS trust about the £20 million debt in respect of maternity, paediatric and neonatal services? If she is aware of them, will she tell the House whether the borough council’s saying that it will help out with that debt will mean a sharp rise in council tax for the people of Telford and Wrekin, and, indeed, in Shropshire generally? Is it not time that the Government recognised that people pay their national taxes and deserve good services for it? They do not expect to suffer from yet another hike in next year’s council tax increases.
I am somewhat flabbergasted by the hon. Gentleman’s point. I am certainly aware of the overspending that has been going on in the NHS in his area—overspending that needs to be brought under control by making the local NHS more efficient and effective, giving patients better care with more effective use of resources so that they do not take money from other NHS services in other parts of the country. I am not aware of the proposal made by the hon. Gentleman’s local council, but it appears to be a constructive proposal aimed at helping to protect services in the short term. The hon. Gentleman seems to be against that; no doubt he has told his constituents so, but I am sure that this issue should be resolved locally.
I am grateful, as my remarks apply to what the Secretary of State has just said. Is she not in danger of falsely raising public expectations by using the language of taking waiting out of the NHS? Even by her own terms, it will be more than two years before she believes that she can deliver an 18-week wait. Is it not misleading to raise expectations more than two years in advance and to get that vocabulary, as new Labour always does, in currency now? Do not her own figures this week show that more than 40,000 people are waiting more than a year just for diagnosis? Are we not an awfully long way from the period when the Secretary of State should start using those phrases?
The hon. Gentleman is absolutely right about the number of people who are still waiting too long for diagnostic tests. Last year, we introduced choice in respect of where people can go for CT scans or MRI scans, for example, if the NHS could not treat them within six months. That has already helped to bring down the waiting times for diagnostics, but what I want to know from the hon. Gentleman is whether he supports us in trying to get rid of the excessive waiting times. We promised in the manifesto on which we were elected last year to move from an 18-month wait for an operation to just 18 weeks from GP referral to the operation. That means making further changes and improvements to the NHS to ensure that people do not have those unacceptable waits for diagnostic tests.
My right hon. Friend is right to draw attention to the significant achievements in the health service over the past 10 years, but does she acknowledge that one destabilising and demoralising factor for many who work in the NHS has been the constant stream of centrally imposed initiatives and demands for the redrawing of boundaries? Can she promise a period of calm in the period ahead, as it is still a source of great disturbance, even among the best-run health authorities, in which I include my own?
In terms of the changes to primary care trusts and strategic health authorities over the past year, I most certainly can promise my hon. Friend such a period of calm. Indeed, I would like to take the opportunity to pay tribute to the leadership of SHAs and PCTs, who are doing a superb job in leading the NHS and securing those further improvements.
For far too long, mental health services were neglected. We have changed that. Less than 10 per cent. of the NHS budget used to be spent on mental health, but now it takes a much bigger share of a far bigger budget. There has been an increase of almost £1 billion in the past five years alone. Again, we are talking about investment matched by reform. In almost every part of the country, when I meet mental health staff and the users of their services, I hear about a transformation in the way in which those services work. Fewer people are cared for in acute hospital wards and far more people are looked after in the community. Painfully vulnerable people and their families are benefiting, with suicide rates at their lowest since records began in Victorian times.
I wonder whether the Secretary of State will qualify those figures about the share of spending in the NHS going on mental health. My understanding is that spending on mental health in 1997 accounted for around 14 per cent. of the NHS budget; now it accounts for around 11.5 per cent. and has been growing more slowly than the rest of the NHS. That sends out a bad signal and points to the fact that mental health services remain a second class citizen in the NHS.
I do not recognise either the hon. Gentleman’s figures or his characterisation of the services. Although I would be the first to say that there is a great deal more that we need to do to improve and expand mental health services, I wish that he would acknowledge the quite outstanding work of staff in mental health services and the transformation that they have made.
No I shall not, I should like to make some progress.
The mental health Bill that was announced in the Queen’s Speech, and which is introduced in another place today, will help the NHS to build on those achievements. Hon. Members are only too aware of the problem of those mental health patients who are treated in hospital and whose condition improves with care and medication, but who leave hospital and then fail to keep up their treatment. In a small minority of cases, involving some of the most seriously ill people, that can lead to terrible and tragic results.
Notwithstanding the importance of funding and the transformation or otherwise of services, there is another critical aspect to mental health that needs to be addressed—reducing the stigma and the fear of mental illness and mental health patients. What more can be done to help to break down the barriers of fear and the stigma associated with mental health?
I know that the hon. Gentleman feels strongly about such issues and his point is important. That is why we have already put in place a campaign to try to reduce the stigma that affects people with mental health problems and in particular to change the attitudes of employers. We are working with a number of business organisations on that very issue.
The mental health Bill will provide for supervised community treatment for certain patients after they have been detained in hospital, ensuring that they comply with treatment and enabling action to be taken to prevent relapse. The Bill will also strengthen human rights protection and introduce new safeguards for people who lack the capacity to make a decision for themselves and who are deprived of their liberty, but are not subject to mental health legislation.
We shall also publish in this Session a draft Bill to establish a single regulatory authority for tissue and embryos, and to ensure that our law on human fertilisation and embryology—which is already one of the best in the world and is widely acknowledged as such—continues to provide the right ethical framework as medical technology develops.
On providing mental health care in the community so that people in crisis do not have to be admitted to mental health institutions, my right hon. Friend will be aware that I drew her attention to the recommendations that the Sainsbury review made to the Milton Keynes General PCT on reforming its mental health services. The PCT has implemented some of those recommendations, but not enough to be able to provide a 24-hour crisis service. Will my right hon. Friend reiterate to the PCT the benefits, in both service and efficiency, of providing that crisis service, so that people receive treatment and do not have to be admitted, which is less satisfactory and more expensive?
My hon. Friend makes an important point and I am sure that her local PCT will take note of that.
My final point about health and the Queen’s Speech is that because public engagement in local NHS decisions is so important, we shall seek an early legislative opportunity in this Session to build on the work of patient and public involvement forums, with the creation of new stronger local involvement networks.
The Secretary of State will recall that, before the 1990 embryology legislation was introduced, the then Government made it clear that at all stages it would be subjected to a free vote. I know that many hon. Members were disappointed that this Government chose to whip the regulations relating to donor anonymity for sperm and eggs, rather than leave it to a free vote. Will she give a commitment today that the legislation on embryology will, like the previous legislation, be subject to a free vote?
I have not had an opportunity yet to discuss that with my colleagues. I had better not anticipate those discussions. For this Session, it is a draft Bill, but the hon. Gentleman makes an important point about the need for free votes in this House on such matters.
The dramatic changes that are taking place in medical science and technology are only part of the far larger changes that are creating a knowledge-driven global economy. When the 3.4 million unskilled jobs we have in Britain today will shrink to about 0.5 million by 2020, and when China and India are producing 4 million graduates every year, we must do far more to ensure that every man and woman in our country has the skills and the confidence to earn a living and to lead a fulfilling life.
No, I have been generous in giving way and I am going to make some more progress.
It is extraordinary that, in yesterday's debate, the Conservative and Liberal Democrat leaders scarcely mentioned the economy and the importance of education. As we announced in the Queen’s Speech, we are introducing a Bill to reform the further education sector, which already does so much to help people to learn—often, people who had few opportunities in their earlier lives. It will streamline and modernise the Learning and Skills Council, ensuring that it works even more closely with employers, learners and regional development agencies. It will develop foundation degrees and create the powers that are needed to improve further education provision where that is not yet good enough. I am sure we will have lively debates on those important Bills.
Before I finish, I want to say a little more about investment in public services. The Conservative party likes to complain—it has done so again today—about NHS funding and particularly about the funding formula, but what is its alternative?
No, I am going to make some more progress. As I said, I have been generous in giving way.
In our debate a few weeks ago, I quoted from the Tories' campaign handbook, which complained on page 18 that “parts of Bedfordshire” were getting less money than “parts of Manchester”. My hon. Friends will remember that I accused Conservative Members of wanting to take money from poorer, sicker communities to give to healthier, wealthier neighbourhoods. I fear that I may have been unfair to the Conservatives. I may have misrepresented their policy, because it turns out now that they want
“the most NHS resources to be given to those areas where the disease burden is highest.”
That is on page 24.
That sounds fair enough, does it not? We should all be able to agree on that. Well, I have investigated what would happen if NHS funding were based solely on the “burden of disease” and took no account of past funding levels, the existing provision of services or even of the age of the population in a particular area. What I found surprised me—and it may surprise Conservative Members as well.
The hon. Member for South Cambridgeshire’s local NHS, thanks to the record investment that we are making—investment, of course, that he voted against—now receives over £1,000 for every man, woman and child in his constituency. But what puzzles me about his position is that, under his proposals, based on the “burden of disease”, his constituents in the city of Cambridge would actually lose £205 each of NHS funding, a cut of 20 per cent. and a total loss to the local NHS of nearly £24 million. Has he told his constituents yet what he is proposing? I think they ought to know.
I wonder whether the hon. Gentleman has told his constituents that, under his proposals, my constituency, which is already funded at £1,300 a head, having greater health needs than South Cambridgeshire, would gain another £305 per person, a total gain in Leicester of £43 million. I am very grateful to him for that generous offer, but I wonder whether he has explained to his Front-Bench colleagues that, under his proposal, every one of them would see NHS funding in their own constituency cut and every one of my ministerial colleagues would see funding in our constituencies rise. I hate to disappoint my hon. Friends but, tempting though it is, we will not adopt the hon. Gentleman’s policy for the simple reason that we believe in fairness for everybody. We believe in more money for the health service everywhere, but with the biggest growth for places with the greatest needs. We can do that—growth of 8 per cent. this year and next year everywhere, but even faster growth in the places that need it most—only because NHS funding is growing faster than ever before. It is time that the Conservatives stopped complaining about funding, especially as they voted against the national insurance contributions that made the funding possible in the first place.
As we learned in yesterday’s debate, the truth is that the Conservative party is in a complete mess on policy. The Opposition cannot decide whether they want more money for Bedfordshire and less for north Manchester, which is what they tell the people of Bedfordshire, or less money in Bedfordshire and more in Manchester, which is what their policy would actually mean.
That muddle is no accident; it is the direct result of a Tory party that does not know what it believes in, and of a Tory leader who thinks that nobody will notice if he says one thing to one audience and something completely different to another. He is trying to pretend that he would give the NHS more money, when he and his party colleagues voted against the increased funding, and when his party’s economic policy would mean that there is less money, not more, for public services. He is trying to pretend that he supports NHS staff, when his shadow Chancellor has said that he would rip up the agreement that we have reached with staff on public service pensions.
Anybody who listened to yesterday’s speech by the right hon. Member for Witney (Mr. Cameron) could reach only one conclusion: he is a lightweight—quite pretty, I grant, but a lightweight all the same. He does not begin to understand the scale of the challenges we face, and he cannot, and will not, make the difficult decisions that it is necessary to make in order to rise to those challenges.
I look forward to a lively debate today, and I commend the Queen’s Speech to the House.
I am grateful for this opportunity to open for my party the day of the debate on the Address that is about education and health. We chose those subjects because education and health, and the improvement of our public services, are our party’s priorities. In the Queen’s Speech of May 2005, it was stated that education was the Government’s main priority, but it disappeared in the briefing, and it has completely disappeared this year; it is off the radar screen. Health is the number one priority for us; the Leader of the Opposition has made that absolutely clear. What price security, if we cannot be sure that our NHS is there for us and our families when we are ill and in need? What price hope, if we do not have the hope of high standards in education that people can rely upon?
Those are our priorities, but they are not expressed in this Queen’s Speech. In this Gracious Speech, written by this Government, education has disappeared off the radar screen, and so have expressions of priority for health. That is very curious. We have heard time and again—in business questions, as well as in interventions on the Secretary of State today—that people working in the national health service are worried about the loss of services, about their jobs, about the loss of confidence and morale across the service, and about where they are going and what the future holds for them. There was nothing in the Queen’s Speech about any of that.
There was also nothing in the speech about the fact that, since the last Queen’s Speech in May 2005, gross deficits of £1.3 billion have been announced for the previous financial year in the NHS, and just last week the Department of Health was forced to admit that the gross national health service deficits in the current financial year are now predicted to be £1.2 billion—and, worryingly, the Department has admitted that the number of NHS organisations in deficit is approaching the same number as were in deficit last year. Is there any indication in the Gracious Speech that the Government propose to respond to that, and to the concerns to which it gives rise? No, there is not.
My hon. Friend has touched on the subject of deficits, but is he aware that the new Norfolk and Norwich primary care trust is starting off with a staggering debt of £50 million? We have already heard that the Queen Elizabeth hospital, in my constituency, will not carry out any non-urgent operations during next February and March. Surely the Government should allow the new PCTs to start without these staggering deficits.
I thank my hon. Friend for giving way. I am sad that the Secretary of State did not give way to me, as a past Chairman of the Health Committee, because I wanted to ask a very relevant question. Are not many of the deficits due directly to Government policy on payment by results? If hospitals are being much more active in dealing with patients and cases, and the Government and PCTs have underestimated the amount of activity that hospitals can carry out, is it not up to the Government to respond by saying to hospitals, “You can’t carry out the number of operations that you currently do, because we can’t afford it”? It is not the fault of hospitals, doctors or nurses; they are responding to Government policy.
My hon. Friend makes a very interesting point. In itself, payment by results is not a problem; indeed, it is necessary. When we were in government, we made it clear that we wanted a system in which the money follows the patient. If a hospital does the work, it should be paid for it, but in any rational system one would combine the implementation of payment by results in the hospital sector with a process of demand management in primary care. Of course, when we were in government we implemented hospital sector reforms that incentivised activity, while at the same time introducing GP fundholding, which provided effective demand management in the primary care sector. The evidence on deficits that was given to the Select Committee makes it clear that many NHS managers have experienced centrally imposed change, costs and upheaval, which has destroyed any ability that they might otherwise have had to conduct their business planning.
During the early part of this year the Department of Health incompetently got the tariff wrong, and it had to be completely changed. One chief executive complained to the Select Committee that changes to the purchasing parity adjustment completely tore up the business planning. Those are precisely the matters that Ministers are responsible for. It is no good their pointing the finger—as the Secretary of State is always doing—at NHS managers, saying that they are responsible for the deficits; the Government are responsible for them. By having a debate on this subject today, we saved the Secretary of State from having to meet the Select Committee this morning—she will have to do so next Tuesday—and offer it an explanation. The Committee said in a previous report that PCT reorganisation would be a costly distraction in the NHS—a claim that she rubbished at the time. However, last week the Department of Health produced a document stating that one main reason for the deficit is the additional cost of PCT reorganisation.
Does the hon. Gentleman stand by his claim that 20,000 people currently working in the NHS are going to lose their jobs, and in particular, that 1,200 people currently in work at the Nottingham University Hospitals NHS Trust are to lose their jobs? No redundancies have been made in Nottinghamshire; it is the hon. Gentleman who is causing worries about job losses.
The hon. Gentleman is misrepresenting what I have said—and, indeed, what NHS employers and the Royal College of Nursing have said. We have all been entirely consistent. We have been talking about up to 20,000 jobs being lost in the hospital sector alone this year, not across the whole of the NHS. The hon. Gentleman cites Nottingham. Well, I visited the Queen’s Medical Centre in late May, just after the announcements were made, and the figure that I gave is precisely the one that I was told about: 1,200 potential job losses. At the time, at the end of May—[Interruption.] Yes, I have always made it perfectly clear that the figure is up to 20,000 jobs. If the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), is disputing it, I should point out that in a briefing for a debate that took place in the latter part of last month, NHS employers made it clear that it is now their view—as it is that of the Royal College of Nursing—that that is a perfectly straightforward estimate of the number of jobs that will be lost in the NHS.
At the time, it was anticipated that 1,200 jobs would be lost in Nottingham University Hospitals NHS Trust, and it was believed that 600 of those might be lost by way of redundancy. Those figures will have changed because, as the hon. Member for Sherwood (Paddy Tipping) and others have rightly said to Ministers, the trust was being asked to make changes and financial cuts to a wholly impractical time scale that did not match its business plan. It has been given more time, but many other NHS organisations in other places are not being given the time or opportunity that it has rightly been given.
If I understand the hon. Gentleman correctly, he is now saying that the figures in his party’s campaign document are wrong. Will he and the right hon. Member for Witney (Mr. Cameron) stop repeatedly quoting the 20,000 figure in this House? Will he withdraw those figures and make it absolutely plain that they are inaccurate?
No, I will not withdraw them, because they accurately reflect what has been said inside the NHS. They accurately reflect what NHS employers say are the potential job losses in the NHS this year, and they are precisely the figures that Beverley Malone and others at the Royal College of Nursing say reflect their view.
I find it absolutely intolerable that Ministers are parading the fact that they can make nurses compulsorily redundant. Some 135 nurses are to be made redundant, and for Ministers, that is a cause for self-congratulation. They say, “Oh, only 1,000 people are being made compulsorily redundant.” It has always been true that up to 20,000 jobs will be lost. Some of those will be compulsory redundancies and others will be voluntary, and many more will be lost by not filling vacancies. The consequences of that are being felt, in that 50 per cent. of nurses coming out of college cannot find jobs, and physiotherapists cannot find jobs, either. It is outrageous that Ministers are trying to misrepresent what is going on in the NHS. That is why NHS staff look to us, to the Royal College of Nursing and to their representatives—including Unison and other trade unions—who came here to meet my right hon. Friend the Member for Witney and me. They made their points, and they may have met the Minister as well, but if they did he clearly was not listening.
In reply to my hon. Friend the Member for The Wrekin (Mark Pritchard), the Secretary of State said that Shropshire health authorities had been overspending, which has led to a £34 million deficit at the Royal Shrewsbury. But surely the people who are making such decisions are spending the money on vital services and staff salaries, so it is not overspending, but spending on what is required for the people of Shropshire.
I understand the point that my hon. Friend makes. It is this Government’s past failure to make appropriate decisions that has put hospitals such as the Royal Shrewsbury and the Princess Royal, in Telford, in their current situation. They should have been given much greater support at an earlier stage to help with redesigning.
My hon. Friend will appreciate that Havering PCT is efficient and well run, but that its budget has been top-sliced to subsidise other, less well-managed PCTs in London. Does he agree with me that that is demotivating, and that there is no incentive for PCTs to balance their budgets if they know that they will have to subsidise others?
I understand the point that my hon. Friend makes. London PCTs top-sliced not just once but twice, in order to deal with a ballooning deficit. Indeed, the London-wide NHS is forecasting a bigger deficit. A well-run PCT is, unfortunately, the exception rather than the rule. Ministers appear not to take responsibility for that, but it was they who established PCTs. Just last month, the Healthcare Commission told us its view of PCTs’ financial resource management record. Apparently, 80 per cent. of financial resources go through the hands of PCTs. What about the effectiveness of PCTs? How many PCTs did the commission regard as “excellent” in their use of financial resources? None—not one out of 303. How many were regarded as weak, with immediate action needed to remedy failures? The answer is 124. That is outrageous, and a condemnation of the Government’s failure in financial control—a failure that begins in the Department of Health and goes all the way down to PCTs.
I want to be clear about whether the hon. Gentleman is for or against using top-slicing to support struggling PCTs. The hon. Member for Upminster (Angela Watkinson) obviously does not want top-slicing, because her PCT would be okay without it. If the hon. Gentleman agrees with her, is he saying that struggling PCTs should not have the money that they would otherwise get?
I have always made it clear that indiscriminate top-slicing is highly undesirable. The Government are returning to an indiscriminate form of brokerage. In the past, the NHS bank system was meant to be transparent. Indeed, the Audit Commission has said that we need a much more transparent NHS banking function, although there was no mention of that in the Queen’s Speech. The job of PCTs is to spend the money that they are allocated as effectively as they can, for the benefit of their populations, not to generate artificial surpluses to be allocated across the country.
That is a tough message. Some PCTs and hospitals have plunged into deficit over the past two years and will have to balance their books over a period, but there is no managed system to allow that to happen. Instead, we have a system of indiscriminate top-slicing that is meant to try to offset the deficits, and that is not good enough.
The Queen’s Speech of 18 months ago said:
“My Government will continue to reform the National Health Service in a way that maintains its founding principles.”
Yesterday, it said:
“My Government will carry through the modernisation of healthcare based on the founding principles of the National Health Service.”
If it seemed that we had heard it all before, it was because we had. Of course the NHS must remain true to its founding principles, but it also needs investment with reform. The Government talked about that, but they never achieved it. The Conservative Government of the early 1990s introduced reform and, for a while, we had investment with reform. However, I admit that the investment was not sufficiently sustained through the 1990s to maintain progress—[Interruption.] Well, it might be useful to do some honest talking in the House for a change, and I shall talk about some honest figures in a while.
No one disputes that under Labour a great deal of extra money has been made available to the NHS, but there has been a complete lack of consistency and coherence in reform. Instead, we have had the sort of organisational upheavals that I discussed with my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton).
This Queen’s Speech should have delivered a future framework for the NHS that would have allowed us to see the direction of travel routinely talked about in the Department of Health. That framework needs to be independent; it should help people working in the NHS to understand how the future will be for them, and give them the freedoms at every level of the organisation necessary to allow them to focus on patients.
However, Ministers at the Department of Health are like rabbits caught in the headlights of NHS deficits. They appear incapable of delivering even on their own reform promises. In her first flush of enthusiasm, the Secretary of State asked Lord Currie of Marylebone and a regulatory review panel to advise what the regulatory framework should look like. He produced a report before Christmas last year, but she has neglected to publish it. She said that there would be a document in the spring, but spring came and went and nothing happened, and now the Department is promising a White Paper—at some point. We will arrive in 2008 and NHS staff will still have no idea what the future will look like. They will look to a Conservative Government to deliver that future.
Does my hon. Friend agree that it was extraordinary that the Secretary of State did not refer to reorganisation? Maternity, paediatric and accident and emergency services across the country are being downgraded. Last year we had Currie; this year, we have Carruthers, but the Secretary of State did not mention him or say what he was meant to be doing. People confronted with downgraded services remain in the dark about what the right hon. Lady and her Department intend.
My hon. Friend makes a good point. The Secretary of State is not talking about such matters because she has no credibility. We in this House and people across the country know that Ministers have been poring over so-called “heat maps” to identify where the media pressure on them will come from, and where the political advantage lies with NHS reorganisation. The Department’s credibility has diminished to the point where the NHS chief executive has to write to Members of Parliament to restore some faith in the Government’s policy.
We need more than just letters from the NHS chief executive. Service reorganisations around the country have to be justified on straightforward, clinical service grounds. The specialisation of services must be balanced with the access available to them, and NHS staff must understand the arguments involved. Moreover, consultation with the public must be real and genuinely taken into account. At present, that consultation is driven by the Department of Health on financial grounds, or is held as a result of staffing pressures stemming from the working time directive. Two and a half years ago, Ministers said that the directive would not impact on services, but it has done. They failed to amend it, and they failed again at last month’s European Council. A change in the working time directive would make a big difference to NHS staff.
The hon. Gentleman should admit that the previous Conservative Government negotiated the working time directive. They did it so badly that its wording, and the judgments that have flowed from it, mean that the NHS faces severe costs and challenges. Whenever a local NHS proposes a reorganisation on clinical grounds—the recent decision to reorganise maternity services in Calderdale and Huddersfield is an example—the hon. Gentleman goes out on the streets to oppose it. Will he start supporting those decisions instead?
First, it would make a difference if we knew what the clinical arguments were. At present, financial and staffing issues are meshed together with clinical service issues. It is not a coincidence that Ministers and the NHS chief executive say that 60 accident and emergency departments and maternity units across the country must be downgraded, just at the moment when they have deficits worth £1.3 billion. That is cause and effect: if the service redesign were based on clinical reasons, such changes would be happening locally and on a planned basis, not as a result of financial crisis.
The Secretary of State mentioned the working time directive. Two and half years ago, the Government never suggested that the previous Conservative Government had failed in the negotiations on the directive. We had an opt-out on the social chapter, and the new deal for junior doctors meant that their hours were being reduced anyway. The working time directive was not going to interfere with that, as Ministers made clear. Indeed, in mid-2004, the present Secretary of State for Work and Pensions—then a Minister of State at the Department of Health—said that no adverse service consequences would arise from the directive’s implementation. The Government said that they would renegotiate the directive to remove any adverse effects, but they did not do so. They have continued to fail in that respect, so we need to hear no more nonsense from the right hon. Lady about that.
It is time to get some facts on the record. Of course there have been improvements over the past nine years. When I said at a recent Prime Minister’s Question Time that the NHS had improved over the past decade, the Prime Minister seemed to think that that was an admission on my part. Crikey, it is precisely because of the hard work done by NHS staff that things have improved, but they know—
No. Staff in the NHS know that that improvement has been in spite of the Government, not because of them. It has come about in spite of nine organisational upheavals in nine years, and in spite of bureaucracy that eats up all the extra money. The Secretary of State talks about the extra staff in the NHS, but she does not admit that, although there are 25 per cent. more nurses, there are also 54 per cent. more administrators and 75 per cent. more managers and senior managers. The rate of increase in the number of administrators is double that in the number of nurses, and the number of managers is rising at three times the nurses’ rate.
We do not argue that the NHS is not improving, nor that the staff are not delivering those improvements. What we say is that the rate of improvement is far lower than it ought to be, given that two and a half times as much money is being put in and that the Government have had nine years of opportunity to get things right. What about major hospital projects? Even with the private finance initiative, there have been only five additional major new hospital projects a year since 1997—the same rate as before.
The Prime Minister talks about cancer death rates as though the Labour Government were personally responsible for saving people from the threat of cancer. Let us look at the figures. In the seven years up to 1997, the rate of improvement in mortality for people with cancer aged under 75 fell by 19.6 points per 100,000 of the population; in the seven years since 1997, the rate fell by 17.3 points per 100,000. The rate of improvement in cancer mortality for the under-75s was higher before 1997. The comparable figures for coronary heart disease show that the reduction before 1997 was 42.7 and that since then it has been 44.3. Those are long-term trends, not just in the UK but in other countries. They are not the result of Government investment; even less are they the result of Government targets.
I have already mentioned waiting times. I have another statistic, derived from the answer to a question to the Department of Health in July about average waiting times: in 1997, according to hospital episode statistics, the average waiting time was 11.8 weeks, but in 2005 it was 12 weeks. That does not say much for the improvements under the Government.
In Wales—[Interruption.] The Minister of State, the hon. Member for Leigh, says that he is not responsible for Wales, but as this is a debate about the whole of the United Kingdom, he might have liked to bring along somebody who is responsible, because one in 10 people in Wales are waiting for an operation; 20,000 more people are waiting for operations in Scotland than in 1997.
The Government may say that 400,000 fewer people are on waiting lists than in 1997, but that is not because there has been a big increase in NHS capacity and more patients can be treated. The change is almost entirely explained by a reduction of 400,000 a year in the number of decisions to admit people for in-patient treatment. People are being kept as out-patients rather than being admitted to hospital.
No, I apologise to my hon. Friend, but I must make some progress.
Productivity is at the heart of the issue. If public services are not improved through greater efficiency, the service cannot be delivered for patients. That relates to the structure of reform. In the run-up to 1997, we were reducing the average length of stay by 9 per cent. a year. The Secretary of State is always telling people in the NHS that they must reduce length of stay, because that is a means of delivering efficiency, yet since 1997 the time has been going down at the rate of 3.25 per cent. a year—about a third of the rate before 1997. If the productivity achieved in the run-up to 1997 had been maintained since then, 1.4 million more operations would have been carried out in the NHS this year. Waiting lists could indeed have been a thing of the past if the Government had remotely delivered on the productivity that we achieved before 1997 and allied to it the investment that they have been making in the health service. That will be our job in the future.
Where is the legislation that we thought would be included in the Queen’s Speech? The Secretary of State talks about looking for an early legislative opportunity to reform patient and public engagement, but first she will have to convince people that the Government have any idea about what they are doing on that subject. They abolished community health councils, and they are planning to abolish the Commission for Patient and Public Involvement in Health, and patients forums. There is little understanding or support for the new local involvement networks that the Government propose. However, as we are already discovering, there is far more support for a more independent structure of the kind that we are talking about—an independent health watch.
Where is the review of regulation? Where is the legislation for the proposed extension of direct payments in social care, especially to those who lack capacity? Where is the commitment to public health that ought to have been in the Queen’s Speech? Such a commitment is not just a matter of legislation, although there is a case for its review; it is needed to deal with rising health inequalities, to combat the fact that in his annual report in July the chief medical officer had to say that far from achieving the fully engaged scenario that was at the heart of his hopes for the NHS, we are now in the worst-case scenario. There are rising public health problems due to obesity, drug and alcohol abuse and sexually transmitted infections.
We need legislation. At business questions, I heard the discussion about whether we have too much or too little legislation. The point is that we should have good legislation. We need a piece of legislation whose purpose is to deliver NHS independence. The national health service needs greater freedoms—not a free-for-all, “Here’s £90 billion and do what you like”—but an NHS board responsible for commissioning, free from the day-to-day controls and political top-down targets imposed by Ministers. We need the independent structure of patient and public engagement that I mentioned, and an independent health care regulator, based on Monitor and the Healthcare Commission, which will be responsible for tariff setting and the fair allocation of resources.
I heard the nonsense from the Secretary of State about the impact of a more equitable system for the allocation of resources—[Interruption.] It is nonsense, because all she has done is to calculate figures on the basis of premature mortality, not on the basis of morbidity data, which might give very different outcomes—[Interruption.] I am not trying to predict the outcome; we need an independent structure to set up the system. The Secretary of State obviously has not been listening to the evidence given to the Select Committee on Health by academics, which makes it clear that the extent to which Ministers have tampered with the formula is driving it towards social deprivation indices as a principal determinant of resource allocation, in the fond hope that spending more money on NHS services in a location is the best determinant of future health. It is not.
The best determinant for future health is a public health structure for those resources. We have always talked about that, but the Secretary of State does not distinguish between, on the one hand, money for the public health service, which needs to be allocated on the basis of health inequalities and future need, and, on the other hand, the genuine burden of disease in an area. Such a distinction would ensure the availability both of equitable access to services through the NHS and of resources for public health support and intervention. That distinction needs to be made, but at present that is not happening.
No, I should finish—[Hon. Members: “No, keep going”.] There is always a lot more to say, but I had better stop saying it.
There are commitments to legislation in the Queen’s Speech. I asked the Secretary of State about embryology. There are two important points about the proposals. The first is to recognise that the legislation has been successful since 1990, so the Government would be well advised to take note of how the Conservative Government made it clear at the outset—at the White Paper stage—that the measure would be based on consensus. There should be a free vote, and the Government should not try to drive through the legislation on whipped votes.
Secondly, abortion and the reform of abortion legislation should not be part of the debate on the human tissues and embryos Bill. Those issues should be tackled separately. I hope that Ministers will take account of the recommendation made by the Select Committee on Science and Technology that the Government should give time to private Members’ legislation—the conventional route—to allow discussion of those issues entirely separately from the legislation on embryology and tissues. If the two are brought together, there could be serious complications.
I ask Members to look back to a debate earlier this year, when we made it clear that we have to tackle the stigma of mental health, and that mental health services should have a priority in the NHS that they have not been accorded. As always, the Government had good intentions at the outset but they have not delivered. It would have been a good idea if the Government had listened to the Ginevra Richardson expert committee in 1998. They produced a Green Paper, a White Paper, draft Bills in 2002 and 2004, a commitment to legislation in the last Queen’s Speech and then in March the Minister had to announce that they would not proceed with the Bill. It all collapsed, so we have a commitment to legislation in this Queen’s Speech—the Groundhog day speech.
We need the Government to bring us—preferably to this House, as I have told the Minister—a Bill that genuinely reflects the fact that mental illness is indeed an illness; it should not be treated as part of the criminal justice system. The role of legislation is to secure effective therapy. The proposed measures need an evidence basis, and the example of the Scottish legislation in 2003 should be looked at carefully and positively. We need to ensure that the stigma attached to mental illness is minimised, so we need to ensure that compulsion is used as a last resort, not a first option, and that there is no attempt to incorporate the requirements of the criminal justice system into what should properly be health legislation. That is the test that we shall apply to this legislation, and frankly, so far the Government have not matched up to those requirements in the legislation that they have drafted.
We have heard a Queen’s Speech that says nothing new on health—a Queen's Speech which, frankly, just repeated last year’s. We know why. It is because, in the absence of any understanding of where they are going, the Government are paralysed. A Government who are divided are paralysed. The Prime Minister says that he is in favour of choice. The Chancellor of the Exchequer says that he is against choice. The Chancellor of the Exchequer gets up and says that he wants the NHS to be more independent. The Prime Minister gets up and says that he does not want the NHS to be more independent. They are paralysed. The Secretary of State and Ministers in the Department of Health have no influence over this matter at all; their mismanagement of their legislation in the previous Session means that they have no slots, other than for a mental health Bill, in this Queen’s Speech. They spend their time sitting down with the Labour party chairman, trying to work out how to wrest some modest political advantage out of the financial mismanagement and the chaos that they are creating in the NHS.
This Queen's Speech has done nothing for the NHS. Improvement in the public services will not stem from this Government. The improvement of public services will be the priority of the next Conservative Government, and I look for that day as soon as possible.
I know of a number of local examples, from just the past few weeks, of the modernisation of health services under this Government, and of steps to raise educational standards as highlighted in the Queen's Speech. For example, for the past year I have been following the progress of my local newsagent as he struggled to get healthy enough to give a kidney to his sister, who is on dialysis every day. He is now proudly showing off his scars—or rather the lack of them, because amazingly he had a kidney transplant at Nottingham hospital by keyhole surgery. If that is not modernisation, I do not know what is.
I have a friend who is undergoing breast reconstruction after a mastectomy, which she got astonishingly quickly after a scan and a diagnosis of breast cancer.
On Monday I saw a new science, art and technology block going up at Mill Hill school at Ripley in my constituency, where the school buildings were scandalously neglected under the Tories. I was also giving out Skills for Life awards to local people, as part of a project that is developing new training rooms at a local resource centre for people with disabilities. It is part of a partnership between my union, Unison, and Derbyshire county council, involving those union learning reps that the Conservatives so bitterly opposed in spite of their apparent commitment to education.
So I know of many local good examples, but I want to indulge myself today by focusing on health and education in an international context. Specifically, in view of the Government's commitment in the Queen's Speech to continue their focus on Africa, I want to give some examples from the Democratic Republic of the Congo. As a member of the all-party group on the great lakes region and genocide protection, I have been an international election observer there in recent weeks, for the first election in more than 40 years. I was hosted by Christian Aid. The election is widely regarded as the most important in Africa since Nelson Mandela's election as President of South Africa. As I am away on Select Committee business next week and cannot speak in the foreign affairs debate, I cannot miss this opportunity, the day after the provisional presidential election results were announced in the Congo, to speak about the situation.
There is huge tension in the country, including in the capital, Kinshasa, where some have died as a result of the tension between presidential candidates. That election is key to the future of Africa. It holds enormous potential for the future stability and development of Africa, but comes with enormous dangers of reigniting instability and conflict. Undoubtedly, the foreign affairs debate next week will be dominated by Iraq, Afghanistan and the middle east, but in debate on a Queen's Speech that focuses on security, and on countering terrorism and its roots, let us remember that civil war in the Congo cost 4 million lives and involved six neighbouring African countries, whose rebel troops traipsed over Congo, partly lured by its mineral resources. Let us remember that the current largest United Nations peacekeeping force in the world is in the Congo. Therefore, I may be indulging myself, but I could not let this opportunity go by without ensuring that we talk about this matter.
Let me return briefly to the themes of the day: health and education. I have been delighted by the work of the Chancellor and the International Development Secretary in launching the international finance facility for immunisation. Every day, 29,000 children die of diseases that are preventable by vaccination, yet immunisation of a child costs just £20. Now the international finance facility is developing a programme to front-load the mass inoculation of children against the five key illnesses, which has fantastic potential to improve the health of children around the world. I remind people of our debate about MMR. It is critical to achieve herd immunity by getting that vaccination done on a mass basis, as we did in eliminating smallpox. That can make a phenomenal difference to the health of the world's children.
I am delighted by the Government's decision to commit ourselves to universal primary education and to take a new initiative on that—with 19 countries committed to building their capacity to provide it. On my recent visits during the elections in the Congo, I saw for myself just how essential those programmes are, and what an important part they will play if we are serious about doing something about the education and health problems around the world.
Just a few weeks ago I was in a hospital in Kindu in eastern Congo, surrounded by children and families stricken by those five diseases, which are completely and utterly preventable. I saw children with malaria, which we are going to tackle after addressing the five initial illnesses. I saw a child with meningitis. I thought it a miracle that that child reached the hospital, given that there are only 300 miles of paved road in a country two thirds the size of western Europe. That child was able to get there only because we had that hospital, which could not have existed without the support of Medical Emergency Relief International—Merlin—and the Department for International Development. The election officials told me that it was a lifeline for their area. They could not have provided such facilities themselves.
For every 1,000 live births in the Congo, 205 children die before they reach the age of five. If we can do something about that, we can really feel proud of ourselves. In my constituency, I am very engaged in all our local problems concerning education and health, but thinking about what is faced in other countries such as the Congo has not half made me come back down to earth and put our problems in perspective and be proud of our achievements.
When I was with Christian Aid in the Congo, we went up the road calling on about 10 polling stations between Kindu and Kalima. We were greeted by a group of Swahili women, singing and dancing. Their children cannot go to school because it is too far for them to walk. There are few roads. It is impossible for them to get to school until they are about 10. They have been dispersed even further than the distance that we went to meet them. We had to go by motorbikes off a long trail to get to see them. They had been dispersed because of the violence of the then Mai-Mai rebels. They had been burned out of their homes. There was mass rape, and the sexual violence in that country has been appalling. The Mai-Mai are not there now, but people have been dispersed. Of perhaps 40 women, only five had been to school. When we asked whether children died under the age of five, they said, “Oh yes; her child died two days ago.” We did not have the heart to ask of what.
I was curious about the project that we were visiting. DFID paid Christian Aid to run a micro-financing project, lending women the money to buy two goats. I asked the people from Christian Aid to ask in Swahili why people did not lose their goats, because the goats and the pigs were wandering all over the place. I learned something: apparently goats have a homing instinct, like that of cats. They wander around but go home at the end of the day. The women were given goats, which will reproduce and provide them with some capital. That is a great project that we are involved with.
Once I knew the distances that people travel, the impossibility of those children going to school and the difficulties that they have, I realised how difficult it is for us to get the programmes that we are committed to in that country up and running. We gave a lift to one woman who was heavily pregnant; we must have taken her 30 km. The people who walked to the polling stations covered long distances. How can children get an education? There are all the street children who have been chucked out of their houses because of allegations of sorcery and witchcraft, because of a lack of finance, or because they have been abducted to be child soldiers.
I am excited by the immunisation programme and by what we are talking about in relation to primary education. However, just as with problems in this country, it will work only if there is good governance. One of my reasons for raising the matter today is that I want to make sure that we focus on it. We can be proud of what we have done. We are the largest European bilateral donor to the Congo. With the international community, we have put a great deal into the elections. We have given a lot of help with civic education and development, but we have to keep on the ball in trying to assist people as they experience the difficult situation that they are in at the moment, after the elections, and as they go forward into the future.
A number of the themes in the Queen’s Speech—education, health, security, dealing with terrorism and climate change, which I will come on to—are international. They are not themes that can be considered only in relation to this country. The Congo is a country that should be able to feed itself—if we did not dump our food on it. It is a country that can provide electricity for the whole of Africa and that has huge resources in diamonds, gold, and coltan, which is used for mobile phones. It has massive resources to be able to do things, which is precisely why it has been plundered and pillaged by the Belgian colonisers, by Mobutu, the dictator, and by the rebel armies that have plagued it.
Why have the neighbouring countries got involved? They have had an incentive to try to get some of the mining contracts through the international mining companies. It will be hugely difficult to put that right, but we must consider the potential for stability in Africa if we can get stability in that country. Of the neighbouring countries, half a dozen have civil wars and internal conflicts, and their troops have bases in the Congo, or have had. The potential for stability if we can get that country moving is incredible.
It is important to mention the matter today because the important provisional results of the election were announced yesterday. Joseph Kabila got 58 per cent. of the votes and Jean-Pierre Bemba got 42 per cent. Members of the all-party group have met representatives of both the candidates. The results are being contested. There is a danger of continuing violence: 29 people died in violence in Kinshasa after the first round and several people died at the weekend. Those results have to be upheld by the supreme court. It is important that we keep trying to apply pressure for peace and for them to accept those results. Because of the way in which the results have gone, the losing candidate will have fantastic power and influence in the country. Within a large part of it, he will have a great deal of support through the provincial and parliamentary elections. He will be able to have great influence in that context.
I was in one part of the country where Kabila was the clear favourite and in another part, last time, where Bemba was the clear favourite. I was astonished that in that massive country—there are 55 million people in a country nearly the size of Europe, with 300 miles of paved road—the elections were run as well as they were. They were more transparent than some other elections that I have heard of recently. Every ballot paper was held up for people to see. The forms were allowed to be copied and given to the witnesses of the political parties, so they can be checked. Any complaints about things going wrong in the election have to be followed through to make sure that people have confidence in the outcome. However, I hope that the presidential contenders do not go back to conflicts, arguments and deaths. We cannot afford that.
We can be proud of our country’s contribution and what we have done to try to assist, but we have to keep a forward-looking perspective. We have to carry on putting effort and work into making sure that the Congo gets through this period and starts to tackle some of the fundamental problems. I and others will seek an Adjournment debate when the results of the election have been confirmed. The issues that we want to raise and that we want to keep our Ministers’ continuing attention on include security sector reform. We clearly need a single body to co-ordinate security sector reform. There are problems. If people in the army do not get paid, it is hardly surprising that they pillage, rape and live off the countryside. If the country has not got one co-ordinated security force, if each of the contenders has his own forces, and if there are still the remnants of rebel armies, it is not surprising that there is a problem with peace and stability.
We also have to look at the issue of natural resources, which have been hugely exploited. Reports have shown that the contracts have been given out in a way that has not been fair and reasonable. That will have to be tackled, but it will be difficult because there are too many interests involved. That needs to be taken on board. It is estimated that the resources are worth perhaps $300 billion over the next 25 years.
The UN panel of experts described a multi-billion dollar theft of the country’s natural resources and implicated a number of western-based—including UK-based—companies and individuals as having had an involvement in that awful scandal. However, no one has been brought to justice as a result of that process. Has not the international system failed in that context? The Department of Trade and Industry—the responsible Department in this country—failed to carry out any investigation into the UK-based individuals and companies that have been implicated in that process. Is that not something that we ought to be rather ashamed of?
I absolutely agree. The all-party group has taken up the issue of company transparency and has been working with some of the companies in relation to that. There has been an International Development Committee report quite recently on that subject. There has also been a parliamentary report of the old Parliament in the Congo. One difficulty is all the vested interests of those who have been involved in giving out the contracts. The potential wealth is there, and as that wealth increases again and people start getting things out of the mines again, one of the dangers will relate to where that money will go. If it is available and goes in the wrong direction, and not into dealing with education and health, will we have less influence?
The education and health system went backwards under Mobutu. Our driver showed us the school he had attended. He had managed to get to the point where he was going to go to university and then Mobutu closed the university down. Now, the children cannot even get to school. Unless we find a way of using those resources—I agree that that means putting pressure on the companies, making sure that we take the issue on board, and keeping international pressure on the new Government to take it on board seriously—we are not going to make progress.
In relation to the intervention from the hon. Member for North Norfolk (Norman Lamb) and what the hon. Lady was saying about the use of resources in the Congo, which I happen to know rather well, will the all-party group take a particular interest in the evolving role of China in mopping up resources throughout Africa, with no attention at all being paid to good government or humans rights? That is an emerging issue that the all party-group should look at.
That is interesting. I assume that we will get some reports back from the recent events involving China and Africa, looking at precisely that. I am a member of the Trade and Industry Committee and we have been interested in the role of emerging countries. I suspect that we will do more work on China. I agree with the hon. Gentleman.
The issue of governance and democracy is critical, looking to the future. It may be quite hard, given some of their histories, to know how the leading presidential contenders will react to what has happened with the election and to their future responsibilities, but with provincial and national elections there is the potential to get local people to start to realise that they can put pressure on and demand things. That is important. I am pleased that the Department for International Development is putting work into education about parliamentary procedures and how to work at a parliamentary level, and also that we have done a lot of work with civil society. It is important that we work with those local organisations so that they can stimulate developments locally.
I must pay tribute to Christian Aid. I was pleased that I went with its representatives on my two visits, rather than just being with the ambassador and people from the Foreign Office, because I saw far more than I would have otherwise. Christian Aid has played a good role in local civil society by trying to educate people about the elections. That process needs to continue.
In view of the Queen’s Speech, the other issue I should mention is forestation. One of the polling stations that we visited was in a tropical rainforest clearing, where we were told that 513 out of 517 potential voters had voted in the first ballot. I am envious of those turnout figures, although I am not sure what lessons we could learn. We could try to make our elections more interesting; special material was provided for everyone to wear for the Congolese elections and the returning officers were kitted out in election robes, so perhaps we should add a bit more entertainment and life to our elections, as that might encourage more people to participate.
The Queen’s Speech highlights the importance of a climate change Bill. Preserving the Congolese rainforest is thus important. There are not many roads in the country, so it is not easy for the logging companies to get to such areas. As soon as there are more roads, that will become easier. It is essential that we put pressure on people and give support to stop deforestation, given its potential effect on the world’s climate.
We need to pursue a number of issues. I started by discussing health and education, but these things are all tied in together. It is a scandal that there are children in that country with illnesses that we should be able to prevent and that they cannot go to school. Providing what is needed should be possible, given that country’s resources; it certainly should be possible with our assistance. The situation requires us to keep our eye on the ball.
We spend our time being obsessed about Iraq, Afghanistan and the middle east, which is understandable because they are all crucial aspects of foreign affairs, but we should remember the 4 million people who died and the fact that, in effect, an African world war has taken place. There is potential for stability in Africa. It is the one continent that has been going backwards, which is why we reasserted such a commitment to it in the Queen’s Speech. We must thus ensure that we take on board these good governance issues.
I hope that the contenders in the presidential election do not allow the situation to descend into further conflict, but take the opportunity offered to ensure that any potential flaws in the election are examined seriously and that the result is seen to be fair, and then start to work to put their country right. We must not forget the work that we are doing there. We have put a huge amount of effort into the elections and into trying to make the candidates and the country run them in a way that works. We must maintain our commitment.
I am concerned that the EUFOR troops—the European troops that back up the UN forces—have reasserted that they will leave that country. I do not think that many people are aware that the UN peacekeeping force there is the largest in the world. We must keep up the work that we are doing so that the children there get the education and health resources that they need and the Congo’s resources are used to put it on a good footing. That will assist us in getting stability in Africa. I urge our Ministers and our Government to continue to do what they have been doing well up to now. They must not let the issue slip off the agenda. It must be kept at the forefront of our minds, along with all the other difficult foreign and home affairs.
It is a pleasure to follow the hon. Member for Amber Valley (Judy Mallaber), who made a thought-provoking, well-informed and, in some senses, sobering contribution about her recent experiences in the Democratic Republic of the Congo. She reminds us of the global context of our debate and I am sure that the House is grateful for her comments.
I am sure that hon. Members will forgive me if I focus principally on domestic matters, particularly those in the sphere of health. I am still trying to work out from my notes whether the Secretary of State said that the Leader of the Opposition was “pretty lightweight” or “pretty and lightweight”; I suspect that it was the latter, which is a noteworthy way of kicking off the debate. I am not sure, but that might say something about the state of NHS opticians.
There is one sentence in the Queen’s Speech that will probably strike fear into the hearts of the 1.3 million people who work in the national health service, despite the fact that it has not really received any attention. It gives us the promise of—guess what—more reform. The sentence reads:
“My Government will continue its investment in”—
we support that—
“and reforms of, the public services”.
Yet again, we have the promise of another year of reforms. Lord Warner, the Government’s Health Minister in another place, was initially given the title of Minister for delivery. It seemed reasonable for a Minister to be responsible for delivery in the national health service. However, Lord Warner’s title has now changed to Minister for reform, because, obviously, reform is an end in itself. I have remarked to him that if I were the Minister for reform, I might wake up every morning thinking, “What can I reform today?” He seemed to nod at that suggestion and implied that he did such a thing.
I suggest that the Department should have a Minister for leaving things alone for a bit. As the hon. Member for Sunderland, South (Mr. Mullin) said, the NHS has suffered seriously due to permanent revolution. People sometimes say, “All the money has gone in, so why haven’t we seen more output?” I would be the first to welcome the progress that has been made and I appreciate the work that has gone into achieving it, but why has not more been done? Part of the reason why is that too many people in the NHS have had to take their eye off the ball to deal with constant reform.
For example, my hon. Friend the Member for Somerton and Frome (Mr. Heath), who was in the Chamber at the start of the debate, has asked me whether the new primary care trusts are up and running. When I assured him that they were, he pointed out that his PCT had not a permanent chief executive, but an acting one, because the new chief executive was still working for the previous body that was in the process of being abolished. A body that is presumably trying to sort out deficits in its region and to get the Government’s health reform agenda in place does not even have a chief executive, despite the fact that it has been created due to yet another reform to a body that was created only a few years ago. Such constant turmoil and reform is undermining the effective spending of the money that has been invested.
What would be the value of a period of stability? We could—I will use a dirty word here—evaluate the reform that has already gone on, instead of fiddling and tinkering with it, changing it and reforming the reform. When one makes a change, is it not worth determining whether that has worked before changing it again?
I welcome the fact that the Secretary of State nods her head. However, primary care trusts were created and then merged. I have seen the abolition of bodies that had not even been created when I first became a Member of Parliament, which was less than 10 years ago. The equivalent of county-level health authorities have been disaggregated and then re-aggregated. Such constant fiddling and meddling leads to waste.
We need stability so that we are able not just to evaluate, but to plan effectively. The hon. Member for South Cambridgeshire (Mr. Lansley) said that too many PCTs were not effectively able to manage their budgets. Part of the reason why is that their budgets are constantly changing. We have already heard that London’s PCTs have been top-sliced—to use the jargon—not once, but twice.
My PCT is one such body that has been top-sliced several times. I went to the opening of a new community hospital just six months ago, but proposals are now on the table to downgrade that hospital to a nursing home so that the PCT can make the severe cost savings that it must achieve in a short space of time.
My hon. Friend cites a pertinent example. If one puts something in place, but is then faced with a stricture saying that a specific financial target must be met at short notice, one makes the cut that enables one to meet that target most quickly, rather than making the best cut, the most rational long-term decision, or even the cut that delivers the best service improvements or avoids damaging services. Such instability in services damages the morale of people in the NHS. Many of us will have met NHS employees during the recent mass lobby of Parliament. They gave me the clear message that the Government are doing damage to the goodwill and morale of people working in the NHS, who are its greatest resource. If we undermine their goodwill and willingness to go the extra mile—there is often no financial or professional reward for doing so, given that innovation is regularly stifled—we damage the NHS. Such regular top-slicing cannot go on. We cannot have a situation in which people’s budgets are radically altered halfway through the year; that is no way to manage a health service.
I accept that the national health service will never stand still. No one is suggesting that we set it in aspic. We need a long-term direction of travel, but what should be its key features? We have heard one suggestion from the hon. Member for South Cambridgeshire: that we should have an independent NHS and that is what the Queen’s Speech should have introduced. However, I think that that is the wrong answer to the right question. Yes, there is worry about over-centralisation, meddling and constant tinkering—I fully agree with the hon. Gentleman on that—but his conclusion that we should have an NHS board to carry out commissioning independently confuses me, because at the same time he says that he would make sure that drugs such as the bone cancer drug Velcade were available. If his independent board declined to commission such treatments, what would he, as Secretary of State, do?
To be precise, I have not said that I would make such drugs available if I were Secretary of State. What I have said is that NICE or an NHS board responsible for commissioning should examine whether it can negotiate on the price of the treatment—in the case of Velcade, with Johnson & Johnson. That seems to me to be a perfectly reasonable way to proceed. The response of Ministers is to say that if the drug company wants to ask about that, fair enough. My point is that NICE takes the price of a drug as given, and it has no power to negotiate.
I cannot let the hon. Gentleman get away with that. Even with the best will in the world, with the best negotiators getting the best prices, there will be always be drugs on which NICE or a national NHS board says no. Then, his constituents and mine will raise a political clamour to get the drug prescribed anyway, because a lot of people want it. Is he saying that, in his vision of the NHS, politicians would have no power to overrule the independent board?
The hon. Gentleman nods. What he is saying is that if we—the electorate—vote Conservative, we will get an NHS whose activities we will not be able to determine. I understand his argument that the board would set broad strategy, but he also said that, whatever the price negotiated, the commissioning board, like NICE, would decide whether the NHS provides certain drugs. Either there is a political override in that respect, or there is not. Which is it?
The answer is that one has to give responsibility for appraisal of drugs to an independent body and one has to accept its judgments. I am not saying that one should override NICE. Ministers and the hon. Gentleman know that, on Alzheimer’s drugs, there is a tough call. Ministers set the legislative framework. Within that framework, Alzheimer’s drugs and drugs such as Velcade raise similar issues, such as what benefits to take into account. However, we should also consider whether the independent body in question should have to take the drug price as a given. In my view, it should not. It is a matter of setting the legislative framework: once that has been done and an independent body has been set up to undertake appraisal, one should not then simply give Ministers the ability to override its decisions.
I am not sure that I understand the hon. Gentleman’s argument. He has given people the impression that he would ensure that people could get drugs such as Velcade. Now he is saying that we will try to ensure that we ask the right question and get the best price, and he is right about both those things. However, even if we ask the right question and get the best price, a line will have to be drawn somewhere; on some things, the answer will be no. In essence, he is saying, “Vote for me, and I can’t guarantee to deliver anything, because the decision won’t be mine—it will be for an independent board to make.” In certain respects, that is the opposite of the direction in which I think the NHS should go.
People think, not that there is too much accountability, but that there is not enough accountability. That is the heart of the difference between my party and the Conservatives. Both the hon. Gentleman and I go around the country talking to local health campaigners and the recurring message that we hear everywhere is that they are not being listened to.
The hon. Gentleman is developing an interesting argument. Does he, like me, find it interesting that the Opposition talk about independence in the NHS when NICE—the body that we ask to take the most complex decisions on behalf of the Government and society on how to use taxpayer’s money most efficiently—is the best example today of exactly that. The shadow Secretary of State for Health said on television that he would ensure that Velcade was prescribed. Either one accepts the independent model of NICE, or one does not; one cannot face both ways and pick off certain treatments and technologies. Does the hon. Gentleman agree?
I do. The record will show that when an early-day motion is tabled that states “This House disagrees with NICE and we should ensure that drug X is prescribed,” I do not sign it. I do not believe that, having set up NICE, we should overrule it simply because sometimes it says no, although I have written to NICE in relation to Alzheimer’s drugs and others to probe whether the correct questions have been asked and the proper procedures followed. In Health questions recently I asked the Minister of State to examine the reasons why health services in other European countries reach different conclusions. That is an important and legitimate question. In the cut and thrust of monthly questions, he did not really answer it, but I hope that he will come back to me on it.
I do not want to dwell too long on the Conservative’s hypothetical policy, but what is the alternative? The alternative has to be real local accountability. The Government will cite foundation trusts—the brave new world of accountability in the NHS. The previous Secretary of State for Health but several, the right hon. Member for Darlington (Mr. Milburn), said:
“NHS foundation trusts will usher in a new era of public ownership.”
He said that they were about
“relocating ownership out of the hands of a state bureaucracy”—
he sounds like Jim Hacker—
“and into the hands of the local community… They will be owned and controlled locally not nationally.”
The reality is anything but that.
When the hon. Member for Amber Valley was talking about slightly dubious elections, I wondered whether she was thinking of foundation trust board elections, which we have been examining. If that is the governance structure of the future health service—we must remember that every trust will be a foundation trust—I have grave concerns about the existence of proper local democratic accountability in the health service. Let me give a few examples.
In February 2006, the snappily named Basildon and Thurrock University Hospitals NHS Foundation Trust held elections for 13 governors: nine were elected unopposed, as were four staff governors. Rather than getting people engaged in the cut and thrust of vibrant democracy in which competing views on local health services are aired, the trust could barely get enough people to stand, so it held more elections. A few months later, in April, the trust issued 4,000 voting papers of which 1,000 were returned—1,000, from a population of 310,000. I calculate that one third of 1 per cent. of the people of Basildon chose the governors of their local trust, yet that is what the Government mean by local democratic accountability. I know that local government turnouts are not great, but when we get to one third of 1 per cent., we have problems.
Were that the only such example, we might say, “Well, that’s only Basildon,” but it is not. In Gloucestershire in April 2005, 18 of the 20 positions were filled unopposed. In Homerton in September 2006—only a couple of months ago—half of the eight positions were filled unopposed. In August, there was no competition for seven of 10 posts at the Liverpool Women's Hospital NHS Foundation Trust. At the Royal Berkshire NHS Foundation Trust, eight positions were uncontested. In the 2006 elections to the Rotherham NHS Foundation Trust, 12 of the 14 posts were uncontested. The story is the same elsewhere. That is the revolution of democratic accountability in the national health service—the way in which every hospital will be run.
When people are elected, what do they do? They are not being elected to the board; they are being elected as governors, but the governors are not the people who make the decisions. The board makes the decisions. I have come across trusts that are saying that now they have local people elected as governors, they do not need local authority representatives on the board. The end result might be less local democratic accountability, rather than more. The national health service’s direction of travel should be toward real local democratic accountability, not sham accountability, which is what we find in too many foundation trusts.
Local democratic accountability is different from patient and public involvement. I was slightly confused when the Secretary of State intimated that the Department was seeking legislative time to legislate on patient and public involvement. Do I infer from that that she has not been successful in getting that time? I would be grateful for clarification. From the fact that such a measure was not mentioned in the Queen’s Speech, may I infer that she failed to get legislative time? Does she hope to get it, but is not sure of doing so?
It is indicative of the importance that the Government attach to patient and public involvement that they abolished first the community health councils, and then the newly created patient and public involvement forums—a putative new scheme, but the Government cannot even find time for the legislation that might put it in place. There has been a complete failure of local democratic accountability, and a failure to find parliamentary time for patient and public involvement, and the reason is that the Government think that they know best. They have decided what they want done with the health service, but the public have an inconvenient way of saying something different. That is the problem, and that is why we need greater democratic accountability.
Another area in which we would like to change the direction of travel is health and social care; we want those two services to work together much more closely. The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), who has responsibility for social care, today made a statement headed “Dignity in Care”, which says that there is to be extra money for care homes next year, which is obviously welcome. The money will “further the dignity agenda”, and there will be “dignity tests” and “champions of dignity”. Who could be against any of that? However, the reality is that, in social services departments across the land, people’s serious home-care needs are not being met, because local authorities are up against it and have to restrict the availability of social care. The Secretary of State, in her “It’s nothing to do with me, guv,” mode, would say, “Well, that’s down to councils.” Does she accept any responsibility for the fact that growing numbers of elderly and frail people cannot get the care that they need? That is clearly happening, and the restriction is getting tighter.
Does my hon. Friend agree that part of the problem is that, in an effort to make cost savings, many primary care trusts are shunting their debts on to councils? They are renegotiating the partnership arrangements between health and social care, and are telling councils, “Well, we can’t meet our budgets, so you can have my debt.”
My hon. Friend is absolutely right, and that is another reason why budget pooling, and greater co-ordination between health and social care, would mean that money was not shunted from one pot to another, and people were not shunted from one part of the system to another. Instead, the system would be seen as an integrated whole, and the service would be delivered in the way that was best for the individual, not in a way that enabled one organisation to balance its books at the expense of another, as that is not the way to run services. That has to be the direction of travel.
Two pieces of health legislation were mentioned in the Queen’s Speech. One was the draft legislation on embryology. I assume that the Secretary of State for Education and Skills will respond to the debate, and it is only fair to forewarn him that I have a question for him about sperm donation. I do not know whether that is a specialist subject of his, but there is a serious issue to discuss. The legislation on the anonymity of sperm donors is causing real problems. I visited—in a professional capacity—the infertility services department at one of my local hospitals, and constituents have come to see me about the issue.
Although I fully understand the thinking behind removing anonymity, it has had serious, practical results. The supply of donated sperm has fallen substantially, because now that they can be named, donors realise that, as each donation can serve 10 families, each of which can have two children, one donation of sperm can generate a maximum of 20 children and, in principle, all 20 could turn up on the donor’s doorstep in 18 years’ time and say, “Hello, dad.” It is hardly surprising that in those circumstances, the supply of donated sperm has fallen.
A further problem resulting from the loss of donor anonymity is that we do not know whether the child born was created by the donated sperm. If the mother continued to have other partners, perhaps including a spouse or regular partner, we could not always be sure that the donor was the father. It is not yet clear how the Government will ensure—
Well, DNA has been mentioned, but such tests are not carried out. What reassurances does a donor have that the people who turn up on the doorstep in 18 years’ time and say, “Hello, dad” are actually his children? What will be the consequences? The theory behind getting rid of anonymity is that children have a right to know who their parents are, but the reality is that people are buying sperm off the internet, or are going abroad to get donated sperm, and in those circumstances they have no idea who the donors are.
I understand that there is a good flow of trade from Bristol International airport to Barcelona, where there are clinics with good, English-speaking nurses, and where there is a ready supply of sperm. In other words, to get around the problems in this country, people simply go abroad. Generally—but not in that particular case—there are issues about the quality of donated sperm, too. I have repeatedly written on the subject to the Minister of State, Department of Health, the hon. Member for Don Valley (Caroline Flint), who has responsibility for public health, but she simply tells me that there is no problem, and that there should just be more effort made on recruitment. There is a serious problem, and I hope that the Government will take it seriously and will think again about the consequences of legislation that was well-meaning, but that is causing practical problems.
I want to make a final remark about the provisions in the Queen’s Speech for a mental health Bill. We have already heard about the history of an earlier mental health Bill, and how it went through various consultation phases and drafts, and was trashed by a Joint Committee of both Houses. The proposed mental health Bill is classic new Labour, because the Government neglect prevention and then legislate in an authoritarian way. Across the country, mental health services are being cut back, because they are always the easiest thing to cut. Everywhere I go, when hospitals and local primary care services are struggling, I hear of mental health services being cut.
On one level, we are struggling to provide support for people with mental health problems—day centres are closing, and services and access are being reduced—yet we are to have a Bill that really ought to be brought forward by the Home Office, because it is essentially criminal justice legislation. It does not offer real entitlement to treatment. It is all about detaining people, and it is almost a response to tabloid scare stories. When there are isolated problems, the Government’s reaction is to legislate. Unless the Bill looks very different to the draft forms that we have seen, my colleagues in the other place and I will have great difficulty supporting it.
The Queen’s Speech had relatively little legislation on health, but that legislation gives us serious cause for concern. We do not need masses of reform; we need a period of stability. The health service needs to know its long-term direction of travel. That direction of travel should not be about the independence of public scrutiny, but real, local, democratic accountability in the NHS. It should be about integrated services that serve the whole person, and those services should have that person at their centre, and not the financial crisis in the NHS.
I am pleased to contribute to this debate on the Queen’s Speech, which continues much of the work that the Government have already begun, and which addresses critical problems that we must face, such as climate change, organised crime and the security of our people. A number of my remarks will be about security, because despite our economic successes, we all know that there is a feeling of insecurity in society. One of the great paradoxes of our time is that although prosperity has risen, and although many people have more material goods than was imaginable just a couple of generations ago, they still feel under threat. That threat may be real, as the terrorist threat is, or it may be a matter of perception. Those kids at the end of the street may be up to no good, but they may just be hanging around with their mates.
The difficulty for us politicians is that it is often hard to get people to believe in the real threats, such as the terrorist threat that everyone in the House knows exists. Sometimes people may sincerely feel, even in a safe and secure community, that they are not safe in their own homes. Much of the legislation in the Queen’s Speech aims to deal with external threats, such as organised crime, antisocial behaviour and so on, but I want to consider some of the other reasons why people may feel insecure, and how we can deal with them. Although that insecurity often manifests itself expressly in a fear of crime, the roots of people’s insecurity go much deeper. They relate to the profound changes that society has undergone.
The world that my parents knew has vanished, and even the world in which I grew up has gone. It was a world where we knew our neighbours, and we often went to school with people we had known since we were born. We might even work with them later, or at least live close to them. When I was growing up, my family did not consist of just my parents and me; my grandparents, aunties and cousins all lived around us. My family, like many others, is scattered around the country, and the sense of security that derived from having one’s extended family nearby has gone. People often have to work irregular hours to cope with the demands of a 24/7 society. Having grown up in a household where my father worked shifts, however, I know that some people have always had to put up with that.
People no longer start a job and expect to do it until they retire—they will change jobs several times. Many communities have altered beyond recognition. That has given us a much wider outlook on the world and enriched our lives, but it has challenged us to learn to live together. It is no use politicians lamenting those changes—they have taken place, and we have to cope with them. The question for us is how we build a society that is sufficiently secure in its beliefs and confident of its values to be able to cope with change and regard it as an opportunity, not a threat. An insecure society, like people who feel insecure, cannot cope with change. Security has an economic foundation, and the Government have achieved a great deal in that regard. In 1997, families in some parts of my constituency were suffering from third-generation unemployment. Children were growing up not knowing what it was like for someone in the family to go out to work. Now, however, the number of people in employment is greater than the proportion in Beveridge’s definition of full employment, and we expect another 12,000 jobs to be generated once the biggest industrial development in the region comes on stream. However, people not only need to believe that they are doing well now to feel secure but that they will continue to do so in future. Many people who are in work grew up in a period of recession, and they worry about what will happen to their jobs in future. Some people who are in work suffer as a result of low skills and, certainly in my area, low-paid employment.
The challenge for us is to assure people that if they lose their job and they have to change work in future they can reskill or improve their skills to move on, so I am glad that the Gracious Speech makes provision for a further education Bill. The Government are the first in a long time to take further education seriously, but may I point out to the Secretary of State for Education and Skills that many of our efforts, for understandable reasons, have been directed at young people? We must think about adults, too, because over the next 20 years, the economy will need an estimated 2 million more workers, only a quarter of whom will be school leavers. The needs of the economy and the individual for security and upskilling must mesh if we are to achieve a greater emphasis on adult skills.
The Government have done a great deal in that regard, as there are 670,000 more people in FE than there were in 1997. The employer training pilots have given 18,000 people an opportunity to raise their skill levels, but we must do more. We must concentrate on people who are hard to reach and do not have many skills. In doing so, we should learn from what has been successful. Adult and community education are extremely good in bringing back into the system people who have had bad educational experiences in the past; so, too, is the trade union learning reps scheme, which is one of the Government’s great unsung successes. We must learn from that success, and pay attention to a sector that enables people to learn things that may not be directly relevant to their employment. The question for us is how we build on that engagement with the education system so that they can move on. We must remember, however, that without that system, those people would never go through the door of a college. We must work with them where they are.
Another problem is to upskill our existing work force. I hope that the Government will look carefully at the pilots in the north-west and the midlands to allow people to achieve level 3 skills in work. As the number of unskilled jobs declines, we will require the work force to have a much higher level of skill, so people’s future economic security will depend on such skills. Economic security is not an end in itself—it is a means to an end. Unless we enable people to use that economic security to build good lives for themselves in decent, stable communities, we will fail. As politicians, we face two problems. First, how do we reconcile the needs of the community with growing individualism in society? Secondly, on a related point, how do we build and promote a system of values by which we can all abide?
Politicians are very good at talking about individuals. We all fight election campaigns on the platform, “What we can do for you and what will happen to you in future”. Life, however, is more complicated. The rise of individualism has many benefits, because it allows people to live as they wish and to defy convention, but we need to find a language to talk about the meshing of the individual and the community. Our lives do not proceed along parallel lines—it is not a question of me and everyone else—as our paths cross or merge for a time. Unless I as an individual or anyone else live in a secure community, my life will not be as secure, safe and prosperous as it could be. It used to be easy to explain such things when there were many big institutions, but those institutions have declined, so we must find a new language to talk to people about the things that we need to do for the benefit of all.
The Government have made several efforts in that direction, but I want to touch on a few issues that need to be addressed if people are to feel secure. First, in the inner cities and areas such as mine where house prices are much higher than in surrounding areas, it is difficult for young people to get a foot on the housing ladder. There is not enough rented accommodation, and the available housing is often of poor quality. I admit that we are schizophrenic about that—we all want our children to have access to good, affordable housing, but we do not want it to be built near us. We must address that problem, because many families fear that their children will not be able to do as well as they did, and they will not get their foot on the ladder because of housing problems. I commend the Government on encouraging more forms of home ownership and on their investment to bring housing up to a decent standard. However, those new forms of home ownership must be spread more widely if we are to tackle the problem.
We must look carefully at the provision of affordable housing. Quite simply, developers often wriggle out of their obligation to provide affordable housing on developments, but they should not be allowed to do so. We must consider, too, the development of housing tenure, as it has split communities. I grew up on a council estate with mixed communities, but that is no longer the case in many areas, where social housing has become the preserve of the old and the poor. That is a recipe for problems further down the line. We need many more mixed developments of houses for sale and for rent, whether through social landlords, housing associations, private developers or, dare I tell Ministers, local authorities.
A local government Bill was announced in the Queen’s Speech, but it is not simply by changing the structure of local authorities that we will reinvigorate local government. What matters is what they are able to do. When I grew up, the local authority built housing for sale, as well as for rent, and built it where I lived. There is no reason why local authorities should not do that in future.
Indeed. We must stop weighting the system against action by local authorities. If there is to be real local democracy, we must accept that sometimes people make decisions that we may not want. With regard to housing, in many cases people want to stay with the local authority rather than transfer to other registered social landlords or arm’s length organisations.
Another issue that we need to face is the environment in which many people live. We talk a lot about the environment in general terms, but what people see is what is outside their front door every day. Although the Government have done a great deal through the single regeneration budget, there are still areas, particularly in authorities like mine, where not enough effort has been put into improving the general environment in which people live. Authorities like mine, which include very prosperous areas and very deprived areas, do not come high on the scale of deprivation when they are measured overall. We need to get much more realistic and much cleverer about how we target funding for these matters.
Environmental problems—litter, graffiti and vandalism—need to be improved quickly, because they take an area downhill. Although the Government have done much to enact legislation to allow such problems to be sorted out, it is often not enforced locally. That is what we need to focus on—not just on environmental factors, but on antisocial behaviour in general.
I fully support the Government’s agenda on antisocial behaviour. I support it because I am sick of decent, hard-working people having their lives made a misery by a minority around them. I am sick of seeing people in my surgery who cannot get action on it. I am sick of passing legislation in the House which is not being used. I have seen examples of people who have waited two years to get anything done about their antisocial neighbours. I have seen people who have filled in nuisance neighbour diaries, which have been lost. I have seen people who had monitoring equipment installed, which failed.
When I addressed a conference organised by Golden Gates Housing the other week, those were the issues that I raised. I urge the Government not merely to get tough on antisocial behaviour, but to get tough on those who refuse to act on antisocial behaviour. My constituents are fed up with people having tea and biccies and discussing the respect agenda. What they want is the people who make their lives a misery to be removed from their estates. They would like their lives back. So let us send in the respect squad if we must, but let us penalise local authorities or registered social landlords which do not act, because my constituents cannot wait any longer for them to act.
As well as dealing with the negatives in our society, we need to encourage the positives. We need to be clear about the values that we stand for. That does not mean resorting to nostalgia or bringing back jingoism. There are values clearly rooted in our history which we all ought to abide by—respect for the rule of law and for democracy, fairness and tolerance. In some parts of the country, though not, perhaps, all, there is a built-in respect for the value of learning.
Many politicians have made a mistake in the past by believing that those values were somehow the preserve of the few. They are entrenched in the sort of community that I come from. When Lancashire and Cheshire women in the mills fought for the vote, for instance, and—a story that has long been forgotten—when the cotton workers welcomed Gandhi, what were they doing but expressing their belief in the values of fairness and democracy? When the Welsh miners, who are my ancestors on my father’s side, put aside pennies from their meagre wages to fund libraries, what were they doing but expressing a belief in the value of learning? Those are the values that we must pass on to our young people. We do it in the home, but we must also be clear about doing it through education.
The Government have made huge advances in education, but if I have one comment to make, it is this: we should not talk about education only in economic terms. Of course, a good education system must equip people to earn their own living. If it does not do that, it has failed, but it has to do much more than that. It must equip our young people to behave, to learn, to live in a society that encapsulates respect for those values. There are things that money cannot buy, such as respect for other people, a commitment to the service of others, the ability to discuss the great issues of the day, the ability to use leisure.
The hon. Lady is making a wonderful speech, to which I, like other hon. Members, am listening with great interest. Why does she think we have lost the value of education in too many communities over the past 40 years? What does she see as the fundamental cause of that?
There are numerous causes. There are huge changes in our society, for example. There are the values which we as adults pass on to young people. If young people do not understand the value of learning, we are to blame. We are the adults, and we must ask why, for instance, some of our young people see as the only use of leisure going shopping or getting so drunk that one falls down in the street—not the majority, by any means, but some of them do.
Why, in an information age, have we neglected to teach our young people sufficiently how to sort good information from bad, and how to deal with the huge amount of information that comes over the internet so that they can discuss the issues? I do not want for one moment to stigmatise all young people. That is wrong, but those are issues that we must face. I hope we will return to them in future debates in the House.
The passing on of those values is a job that our schools must undertake, and they must ensure that we engage our young people actively in their communities. We have a great opportunity to do that now through the Government’s youth strategy and through their plans for extended schools. Citizenship should be active, but it cannot be fact-free or value-free. The Select Committee on Education and Skills is undertaking an inquiry into citizenship education. I do not want to pre-empt that inquiry, but it is clear from the evidence that we have received and from the Ofsted reports that the subject is sometimes very badly taught.
We need some joined-up government. If we are talking about building strong communities, we must start with our young people. In the light of that, it is folly to cut the number of training places available to people wishing to teach citizenship education in the future. I hope my right hon. Friend the Secretary of State for Education and Skills will consider that carefully.
To build good communities, we must start with young people. We must get them engaged and active and we should recognise that most young people are decent, hard-working youngsters. Very often, we speak about the bad in young people. The majority of young people are not like that at all. We need to say so and nurture the good, positive qualities in our youngsters. That is our job as adults, and if we fail in it, we will be failing for the future. I hope those young people will grow up to be active citizens engaged in their communities, as I hope many more adults now will be. But the one thing that is necessary in order to be engaged in the community is time, and that too we must consider. We need time for our families and to volunteer to be a parish councillor or whatever. The Government have done wonders in family legislation, with improvements to maternity leave, the introduction of paternity and adoption leave, and the right in some circumstances to request flexible working, but in future we will have to look at our long hours culture. Longer hours do not necessarily mean greater efficiency. In future, if we want a society that combines work and leisure, we will have to learn to work smart as well as hard.
We talk much about empowering communities, but we must be clear about what that means. If involvement in the community is restricted to only a few who have the leisure for it, we are not really empowering communities at all. In addition, we must be clear about the lines of accountability that we want to introduce; otherwise, we will simply be setting up more and more quangos. We must remember that democratic accountability has to be a part of any community involvement.
I do not want to suggest that everything is negative; there are great signs in our society of good, with people engaged actively in their communities, and we need to celebrate that. There are people who do good work every day. There are people who carry out charity work without making any fuss about it. We should be rewarding and honouring those people far more than we do. There are young people who engage in their communities now, who work hard but who are also volunteers in various groups and societies. Despite the problems that we have had, there are some great signs that the various communities of different origins in this country are now meshing together.
I end on a hopeful note, and I hope that those to whom I am about to refer will not mind my doing so. In the summer I went to my godson’s wedding. Despite being born in this country, he rejoices in a very Irish name. His wife is a Hindu, again born and bred in this country. I watched the families and the young people at that wedding, of different ethnic origins and backgrounds, people in saris and western dress, and they meshed together wonderfully. It was a great occasion. That shows that our young people in particular are moving on from some of the problems that we have seen in the past. They do not care about people’s ethnic origin or religious beliefs; they work and live together in many areas in a way that offers a great sign of hope for our society. We need to ensure that we build strong communities that encourage that wherever people live and which prepare us for the future. If we get that right, we will be able to do it.
I remind the House of my interests recorded in the Register of Members’ Interests.
I congratulate the hon. Member for Warrington, North (Helen Jones) on one of the most interesting and eloquent speeches that I have heard in a Queen’s Speech debate. I almost wholly share her analysis of the issues that face us, and some of the solutions. I hope that what she has said has been taken full account of by those on the Government Front Bench. On one particular issue she must be right—the House has neglected the issue of continuing and further education in recent years. We spend a lot of time in both Houses discussing higher education but we have neglected further and continuing education, and I hope that we can put that right when the new legislation comes before us. I hope that I will be able, with her, to contribute to that. It was a very good speech indeed, which I could not possibly match, and I hope that those of my and her colleagues who are not here will read it with profit.
There is always something to welcome in the Queen’s Speech, and I certainly welcome two particular measures, limited though they are. The first is the measure to deal with long-term pensions. I obviously welcome the legislation to start implementing the recommendations of the Turner commission, but it is limited in two respects. First, from what I understand, the Government do not intend to deal with the central issue of equity to put existing as well as new members of public pension schemes on to a more equal footing with those in the private sector. As I understand the drift of the Government’s proposals, those who remain in the private sector will have to work longer and harder well on into their 60s, not least to restore the damage done by the Chancellor’s attack on pension funds, while those in the public sector schemes will still be able to claim their fully indexed rights so much earlier. That cannot be right, and if we are to have long-term pensions reform, we will need to return to the issue of equity between the public and the private sides.
Secondly on pensions, I hope that the legislation will also give us the opportunity to see what we can do to put the longer-term pensions issue on to a more permanent basis. I am struck how in the United States the future of pensions policy is not a partisan matter. There is widespread agreement between the parties in the United States, and it is not an election issue or a major party-political issue. The Turner commission suggested that it might be given some kind of permanence, and that it might become some kind of standing commission. The Governor of the Bank of England has asked us to reflect on how the new successful arrangements for monetary policy might be replicated in other areas of public policy, and long-term pensions policy might well be one of those. It might well be better if we were able to turn to some more independent figure, other than the Secretary of State of either party—perhaps the Government Actuary relabelled as the public actuary, perhaps the pension regulator. I do not know how it might be structured, but when we are considering pensions overall, we need some more independent source of advice. The Government Actuary’s Department advises on the various public sector schemes, but that advice is not always published, so does not contribute to the public debate in the way that I would like to see.
Secondly there is the Bill to legislate for the independence of statistics. That is welcome, though it has been a long time in coming. The Government first promised to introduce an independent national statistical service in their 1997 manifesto. The Green Paper was published back in 1998. It was entitled “Statistics: A Matter of Trust”. It might better have been entitled “Statistics: A Matter of Time”, because we have had to wait some eight years for the legislation. However, it is welcome, and I will not go into great detail on it, not least because I spoke on this subject at a conference with the Financial Secretary yesterday because I had the honour to be in the Chair for the Treasury Sub-Committee report into independence for statistics, one of the main recommendations of which was that the Government were right to say that the key must be to improve public confidence. But the way to do that is to make the statistics as independent as possible.
I was a little disappointed with the wording in the Queen’s Speech. It says:
“Legislation will be introduced to create an independent board”—
that is good—
“to enhance confidence”—
that is good, but then come the words—
“in Government statistics.”
The statistics are not just the Government’s statistics; they are our statistics. They are national statistics. Statistics are a public good, not simply for the Government, not simply for users, but also for the public, who, through official statistics, should be better able to measure the performance of those whom they have deputed to govern over them. Those statistics belong to all of us, and that is why it is so important that the new board is properly independent and does establish statistics as a public good. Those are two Bills that I certainly welcome.
I come now to three specific issues, which are touched on in the Queen’s Speech, but which I think need more attention: public service reform, competitiveness and localism. I begin with public service reform. As many of my hon. Friends have said, so much money has been spent and so many new bodies have been created, yet with so little result. In the national health service, trusts are still not free to set their own pay. Through the power of the royal colleges on the one hand, and the power of the trade unions on the other, we still have national rates, terms and conditions and working practices that do not enable the best trusts to vary, differentiate and experiment with different ways of working in the delivery of health care. Community hospitals are back in vogue and, properly, supported by the Government in a welcome White Paper, but that is not properly thought through.
Local primary care trusts that want to establish community hospitals find that they first have to sort out how the new trust that has just come into existence wants to take account of the overall pattern of community hospitals in the wider area, as well as having to compete for attention with the “fit for purpose” exercise that is examining almost everything else. Furthermore, the growing inflexibility of the private finance initiative means that acute hospitals are in danger not only from the purchasing and commissioning power of PCTs, which can change from year to year, but from the costs of longer leases whereby rental payments have to be paid for 25, 30 or 35 years to come.
As the hon. Member for Northavon (Steve Webb) rightly reminded us, we have an increasingly demoralised NHS work force—people who were, rightly, encouraged by the Government to train for and to join the NHS. We have all had in our constituencies cases of physiotherapists, midwives and health visitors who cannot find the post that they were originally promised and are denied the jobs for which they trained. Trusts are under such financial pressure that they are tempted to cut out what may be too cheaply labelled as the softer end of the NHS—vital services such as physiotherapy, health visiting and so on, which are important in early identification and early warning as regards health and need.
I am pleased that the Secretary of State for Education and Skills is still with us. Perhaps he is still wrestling with the policy on the anonymity of sperm donation and the challenge that has been thrown at him, but if he is going to stand for the deputy leadership and deputy premiership of his party he will have to learn to multi-task and to get his head round these various topics. I will not pursue that analogy. To their credit, the Government have delivered more capital spending on education, with gleaming new buildings that are very welcome, if, as my friends sometimes tell me, rather expensive in terms of pounds per square foot and the engineering and design and so on, compared with other buildings in the public sector.
We have the new buildings, yes, but head teachers and governors are still stuck with the same working practices and terms and conditions that were laid down 20 or 30 years ago. I fully accept that teachers’ working hours were laid down by a Conservative Government 20 years ago and that the Secretary of State has had to live with the consequences in terms of primary legislation. However, this Government have been in power for nearly 10 years. No other business or service organisation outside the public sector still has to work on the basis of working practices laid down 20 years ago. I do not understand why heads cannot be free to set their own pay for staff and to change hours and duties where necessary.
The question of competitiveness was ignored in the Queen’s Speech, which makes no reference to the need for a more competitive economy. It refers to a stable economy, but that is not quite the same thing. A stable economy is a necessary condition of our future prosperity, but not a sufficient condition. We need to be more competitive. I am worried that we are slipping down the various competitiveness league tables. Of course, Front-Benchers can bandy about league tables from different sources to prove whether we are fourth, fifth or 11th, and whether our position has worsened. Nevertheless, I want to share with the House the results of an exercise that I ask the Library to do every three or four years—to measure gross domestic product per head, on a purchasing power parity basis to eliminate the differences in market exchange rates, between the United Kingdom, the 24 other European Union countries, the G7 countries, and all 50 of the states of the United States of America.
Hon. Members may be somewhat surprised to learn of the results. Five EU countries are wealthier than us per head. Much more interesting, however, is the comparison of GDP per head when the UK is ranked with each of the 50 states of the US, which shows that we would come 44th. Only Mississippi, West Virginia, Arkansas, Montana and Oklahoma are poorer than the UK in those terms, while states such as New Mexico, Utah and Arizona are wealthier. That is an extremely alarming position to be in.
There is no simple answer to reversing that trend, but this Government have certainly made things worse by increasing the burdens of taxation and of regulation. At first, the Prime Minister wanted to place us at the heart of Europe, but then he signed the social chapter. The Government are bending every sinew in Brussels to get out of the impact of the working time directive, which will not only hit businesses and make us less competitive but, as the Government know full well, hit our public services, not least the NHS. It will affect the social and caring services and doctors on split hospital sites such as serve my constituency and result in huge extra costs for the NHS.
Irrespective of what has been happening in Brussels, the Government have piled on the regulation here at home. The Pensions Act 2004, well intentioned though it was in dealing with the particular problem of the collapse of certain schemes, has added immeasurably to the burden of regulation on British business. I suspect, as I warned at the time, that that makes it increasingly difficult for weaker companies to be taken over by stronger companies and rescued as they were previously. The Companies Act 2006, which we passed a couple of weeks ago—our very own Sarbanes-Oxley Act—has piled on the bureaucratic burden in terms of lists of suppliers, compliance, business reviews and all the rest of it with which company directors will now have to cope.
The Government talk a good game on localism, and they have bandied around various phrases in recent years. For a while, we had “earned autonomy”, but it then turned out that almost no school had applied for it. In the great trust schools revolution, only 50 or so schools out of 24,000 have so far expressed any interest in trust status. That is not a great number. There are only 50 foundation trusts so far—fewer than 20 per cent. of the total of NHS trusts. We do not hear quite so much about “earned autonomy” nowadays, perhaps because of the failure of various trusts and schools to apply for it. The Treasury has a different phrase—the “constrained discretion model”. I take the phrase from the book, “Microeconomic Reform in Britain: Delivering Opportunities for All”, by the Economic Secretary and his colleagues. On the ground it does not feel like a constrained discretion model because, as the hon. Member for Warrington, North (Helen Jones) reminded us, interference in planning, policing, health policy and housing occurs again and again.
I shall give two simple examples. When my former local police commander, who has recently retired, was already battling in west Kent with targets that the chief constable of Kent and the Home Office had set for him, the Government office for the south-east suddenly set him a new target. He received a letter telling him that he was underperforming on tackling bicycle thefts. That edict on behalf of central Government was delivered through Guildford to a local police commander who was trying to police his patch.
This week my district council, which had presented its planning policy—as it had to do—for reference to the Government office for the south-east, received a letter commenting on it. Some of the detail might be of interest to hon. Members. The letter was from the senior planning officer and the title on the letterhead was, revealingly, “Surrey, Kent, East and West Sussex Planning”. That gives some idea of the power of the new Government regional offices. The officer is in charge of Surrey, Kent, East Sussex and West Sussex planning, and he writes a letter to interfere with Sevenoaks district council.
The letter states:
“On the information before us, our view is that there is no apparent or convincing case to introduce the policy approach outlined in the SPD;”—
the planning document—
“that your Council should instead have regard to the emerging PPS3 (and the Barker 1 response) and that, as it is a high demand area…it should consider applications for housing favourably where they meet the criteria”.
It goes further. As well as objecting to the Sevenoaks document, it continues:
“In view of the serious reservations which we have expressed about this SPD, we would strongly urge you to abandon any further work on the document.”
It then threatens my district council:
“You should be aware that, should a planning appeal be made on this issue, this letter may be brought to the attention of the Inspector.”
The council had set out a strategy to build more affordable houses in an area that is 90 per cent. green belt, and was on track to deliver the 3,000 or so houses—a target originally set for the 20-year planning period. It was playing its part by proposing several hundred houses each year to comply with the target. Yet an elected council is suddenly told that it must allow any sort of housing because there is high demand, even if it is in the green belt. That is not what I understand by localism.
As this is the Prime Minister’s last Queen’s Speech as Prime Minister, I want to say a word or two about him. He and I became Members of Parliament in the same year and we represented the same council area. I believed that he was interested in effecting radical change. Although he did not agree with the objectives and delivery of the Conservative Government and did not always vote with us when we fought to extend opportunity, widen ownership and encourage social mobility, in 1997 I had hopes that he might show us other ways of achieving that agenda. Three times he had the majority to do that, and he had a successful economy in which to introduce the necessary reforms. However, 10 years later, it all appears to have been frittered away. Of 25,000 schools, 50 are interested in trust status. Of 250 NHS trusts, only 50 so far have foundation status. That is a pitifully poor return for 10 years of absolute power, billions in public spending and Bill after Bill. For a truly radical Government, we must await the election of the Government of my right hon. Friend the Member for Witney (Mr. Cameron).
I am delighted to follow the hon. Member for Sevenoaks (Mr. Fallon), who made a thoughtful speech, especially on localism. I pay tribute to my hon. Friend the Member for Warrington, North (Helen Jones)—she is popping out of the Chamber briefly—who made an excellent speech with which I fully concurred.
I am grateful for the opportunity to speak in the debate. It has not been long since other hon. Members and I had the opportunity to hold a thorough debate on the NHS. Nevertheless, I welcome the chance to contribute during the Queen’s Speech debate.
The major reforms that are now occurring in our constituencies are having substantial—in my view, positive—effects on care, and I welcome that and the fact that the important issues that affect health care in the years to come will continue to be debated in the House.
The NHS is both a huge institution employing around 1.3 million people, and a vast array of local institutions in every corner of the United Kingdom. It is important to take opportunities such as the one afforded by the debate to highlight local perspectives on the changes. After all, our constituents experience the NHS through local services. It is also important to ensure that our local experiences are expressed in a wider context. I do not, for instance, think that it is acceptable to complain about service rationalisation in areas that have been allowed to overspend their budgets for many years while simultaneously opposing and criticising the increased investment that the Government have championed.
We hear many conflicting arguments from the Opposition. Conservative Members claim that, if ever back in government, they would introduce an independent NHS body to distribute funds; share the proceeds of economic growth between spending and tax cuts; and ensure that wealthy areas that traditionally overspend have all the resources that they desire. Those are obviously conflicting aims. It will always be impossible to create financial discipline in the NHS if we do not ask primary care trusts to keep to their budgets, just as it will be impossible to retain current service levels if public expenditure is cut by £17 billion, as the Conservative party’s policy commission recommends.
Whether a formula is used to allocate funds or vast sums are spent on a new independent body to do the job, it will always be important for the constituent parts of the NHS to operate within their means. Our aim should surely be to provide the NHS with generous funding so that it continues to offer a world-class service to its patients, free at the point of use, while ensuring that NHS bodies spend their budgets sensibly, in a way that provides the best health care for the most people, and without compromising the resources available for other areas of the country.
The Government must deliver fairer funding in the future by moving PCTs towards their proper share of NHS resources. It is vital that the NHS is brought back into balance to achieve a fairer funding settlement for our constituents. In the past, overspending organisations had no incentive to improve because they knew that they would be bailed out by underspending parts of the NHS. That is unfair. When we examine the matter carefully, it becomes clear that the overspenders are mostly in areas with fewer health problems, while the underspenders are mainly in the north of England and the midlands—generally areas with far greater health needs.
If local service rationalisation and reform is necessary to stop overspending in wealthy areas, that must be done. Large organisations with major budget problems will understandably take some time to do that, and the Government have promised support to help them succeed, but they must get back into balance as fast as possible. It is simply wrong to expect the PCTs and the acute trusts that serve my constituents to continue to postpone improvements in care for their patients for the sake of those that continually overspend.
Although much has been done, health inequalities in this country remain significant, with residents of the poorest urban areas having the lowest life expectancies. New efforts must be made to tackle those inequalities. My constituency of Denton and Reddish has higher obesity rates, more smoking-related deaths and, consequently, lower life expectancies than the English average. It is my job to ensure that the most vulnerable people in Denton and Reddish get the support that they need and it is unfair to continue to ask the Tameside and Glossop primary care trust, Stockport PCT and my constituents to fund overspends in areas where people can expect to live significantly longer.
The money that the Government continue to invest has delivered vast improvements in health care. Stepping Hill and Tameside general hospitals, which serve my constituents, have received good and excellent ratings by the Healthcare Commission in respect of quality of service and use of resources. Those hospitals were two of only 10 health care organisations in the north-west to acquire that positive seal of approval. I want us to ensure that more hospitals in the north-west of England have the same opportunity to reach that level of care for their patients. In particular, I want to ensure that the Tameside general hospital tackles those areas where it still needs to improve its performance. My hon. Friends the Members for Ashton-under-Lyne (David Heyes) and for Stalybridge and Hyde (James Purnell) and I recently raised those problems with Ministers. There are certainly issues that Tameside general hospital needs to resolve.
Society is changing and hospitals and clinics will have to spend their allocated budgets in a way that addresses the needs of the patients whom they treat, just as Stepping Hill and Tameside hospitals do. Since coming to power, the Government have increased the number of people working in the NHS by 300,000, but increasing staff numbers and keeping large district hospitals open should not be seen as the end goal. Yes, in many cases, keeping staff numbers high and large successful hospitals open are the best ways to achieve NHS aims, but they should not be seen as ends in themselves. The Government must ensure that the best structures are in place to provide health care to all who need it.
If NHS money is best spent caring for people in their own homes, rather than in hospital beds, that is what should be done. If money is better spent on small specialist units, rather than on large general hospitals, that is also what should be done. Similarly, if money is better spent on new services at general hospitals, as with the new, improved accident and emergency department at the Tameside that is part of the £80 million private finance initiative at the hospital, or the newly rebuilt Stepping Hill hospital, that is what should be done.
The Government are putting unprecedented levels of funding into the NHS. Investment has doubled since 1997 and it will have trebled by 2008 to more than £90 billion. That will bring it up to the European average for health care spending, but such an unprecedented level of taxpayers’ money has not been injected into the NHS to keep it standing still. It has not been invested to retain services for their own sake. It has been invested so that if more efficient ways of providing health care exist, the NHS can afford to pay for them.
If we value the way in which the NHS is structured today or was structured 60 years ago more than we value its core values, we will let our patients and constituents down. The NHS is not a museum for outdated methods, but an institution that must be continually reformed as new demands are placed on it. To ensure that the NHS continues to deliver high-quality care, it must respond to changes in patient needs and developments in medical technologies.
By 2025, the number of British people above the age of 85 will be up by two thirds, with the average 85-year-old costing the NHS five times more than the average 16 to 44-year-old. With an ageing population such as ours, more resources will have to be directed to helping people in their own homes, rather than admitting them to hospitals for long stays. With new technologies to support care at home, it will simply become more efficient to treat patients in that manner.
GPs in Denton and Reddish are increasingly providing minor surgery. Community matrons are working in Tameside and Stockport to help people better manage their long-term health conditions such as asthma, heart disease and diabetes. That will improve people’s health and avoid unnecessary hospital admissions. When people do have to be admitted to Stepping Hill or Tameside general hospital, more procedures are being carried out as day cases. Also, better drugs and rehabilitation mean that the number of days that my constituents have to spend in hospital will continue to decrease.
Committed, highly trained staff have been integral to the success of both Stepping Hill and Tameside general hospital, just as they are integral to the overall success of the NHS. As I mentioned earlier, there are now about 300,000 extra staff working in the NHS than there were in 1997, including 85,000 more nurses and 32,000 extra doctors. In the north-west of England alone, there has been an increase of nearly 49,000 staff. The extra money put into the NHS has allowed the Government to invest more than £1 billion in improving pay and working conditions across the NHS.
The minimum hourly pay for all staff is now up by 35 per cent. in real terms since 1997. The starting pay for newly qualified nurses is now £19,166, up from £12,385. Qualified nurses now earn on average £30,890, up from £20,760, and nurse consultants can earn up to £60,000. Front-line midwives can now earn up to £31,000, up from about £19,000 in 1997. In addition, all staff get a minimum of 35 days holiday, which is up from 30 days. The Government have also improved access to flexible working and affordable childcare.
When we debated the issue in October, some Opposition Members called current NHS productivity into question. Indeed, the shadow Health Secretary did so today. Conservative Members deplored the fact that new investment money had gone on substantial pay increases for front-line staff and argued that those pay increases had not been matched by increased activity. I would argue that, given the indefensibly low wages that NHS staff received before 1997, it was the Labour Government’s duty to increase rates of pay. NHS staff deserve the pay increases that they have received since 1997, and it is right to take pride in the numbers of new NHS staff and the fair wages that they now receive.
Productivity per pound is simply not a useful indicator when assessing NHS wages. In view of wage rates in 1997, it can only be concluded that many nurses were committed to working for their communities in spite of their salaries rather than for them. It may be considered good management by some to get nursing care for the cheapest possible price, but my hon. Friends find that simply unethical.
I said what needed to be said about pay in the NHS. Investment has been put into salaries and I recall Conservative Members bemoaning the fact on their Opposition-day debate in the previous Session. I have to say that, at the end of the day, NHS staff are doing a brilliant job and we should not forget that.
It is the responsibility of politicians to ensure that NHS staff continue to be treated fairly and paid well, but it is also our responsibility—
I thank the hon. Gentleman for being so generous. At this present moment there is a meeting at West Hertfordshire NHS Hospitals Trust to decide to close Hemel Hempstead hospital—the trust has already put that out in the public domain—and 750 doctors, nurses and technicians as well as porters and other unskilled staff are to be made redundant. That is a fact; it is not something we have made up. What is the point of going on about the money that they are going to get when they are to be made redundant this afternoon?
I am very sorry to hear about that case in the hon. Gentleman’s constituency. I do not know the bigger picture of the reconfiguration of health care in his region, but I do know that in the south-east or south-central areas there are very few compulsory redundancies in comparison with the numbers claimed in the Conservative party’s press releases. That is a fact also, even if the hon. Gentleman does not like it.
A small number of jobs have been lost, but nowhere near as many as the number suggested by the figures that the shadow Health Secretary quoted. Strategic health authorities have reported 903 compulsory redundancies between April and September this year, but eight out of every 10 of those redundancies will have been among non-clinical staff. In the north-west, there were only four compulsory redundancies among clinical staff during that period. Change can be difficult, but when society changes, in both age and expectation, that change is vital.
The NHS continues to improve for patients and staff. It is important not to see every job loss as a sign of failure. No hon. Member likes to see redundancies, but the number of jobs that have been lost in the NHS is small when compared with the increase in overall manpower since 1997. The hard work and dedication of NHS staff, backed by Labour’s investment and reform, are transforming patient care year on year. Let us be clear: without the staff, none of what has been achieved by the NHS would have been possible.
Her Majesty’s Gracious Speech declared that a new mental health Bill would be introduced in this Session. That was a Labour party manifesto commitment and I very much welcome the news. New legislation will do much substantially to bolster the Government’s commitment to patients’ rights and public safety. The mental health Bill will address concerns about public safety and keep pace with the growth of community-based treatments. Increased supervised treatment in the community will ensure that treatment regimes are kept to and will help prevent deterioration in patients’ health. I very much welcome the Bill. If the community is the best place to treat an individual’s mental illness, it is vital both to ensure that the patient receives the care that they require and to build confidence among the public that the individual will be properly supervised.
The Bill is in addition to the massive improvements that have affected my constituency, along with the whole country. New reforms will ensure that improvements on the same scale continue in the future. Virtually no one waits more than six months for an operation now, with the average wait for an operation being only 7.6 weeks. Patients can now expect a maximum 13-week wait for an out-patient appointment, with the average wait being only eight weeks. More than 99 per cent. of people with suspected cancer are seen by a specialist within two weeks of being referred urgently by their GP. Nearly 99 per cent. of people with cancer are treated within 31 days of diagnosis and more than 91 per cent. of people are treated within 62 days of being urgently referred by their GP. Some 19 out of 20 patients are seen, treated and discharged from accident and emergency within four hours. More lives are being saved. Deaths from the big killers, such as cancer and coronary heart disease, are now falling ahead of target.
Reform will bring even more improvement to NHS care. The Government are working towards their goal of 18 weeks between GP referral and operation. Choice will be a major driver to deliver that radical improvement. My constituents want more choice about when and where they receive treatments. They want more care in their local communities and at home. The choices that they will make will demonstrate that our collective public services can meet their personal needs and aspirations.
Choice and reform are integral to improvement, whether we are discussing the hard-working single parent who wants to be treated in a fast and efficient way in a treatment centre near their work, rather than at home, or diabetes patients who want to access their medical records online in order to take them to a different GP, as the patients of Haughton Green medical centre in my constituency now can. Choice and freedom will lead to improvement. If we give patients the medical services that they want, rather than the ones that Whitehall thinks that they want, money will be saved, fewer appointments will be missed and my busy and hard-working constituents will receive the treatments that they need, when and where it is convenient for them.
Our goal must be to deliver the best possible care for patients and the best possible value for money for taxpayers. The values of the NHS must remain the same. It is those values that will ensure that future generations can receive free health care at the point of use, just as their relatives received it 60 years ago. It is those values that must be protected. It is through careful reform that they will be protected by this Labour Government.
I am delighted that a day of the debate on the Queen’s Speech has been allocated to health and education. Both are close to the hearts of all our constituents, and both suffer from considerable problems, as well as enjoy successes.
As the hon. Member for Denton and Reddish (Andrew Gwynne) said towards the end of his speech, we share a common philosophy and principle about the health service. We share a strong belief that the health service should be free at the point of use for all those who are entitled to use it, with the exception of those aspects of the health service that—dating back to the days of Hugh Gaitskell, Nye Bevan, Harold Wilson and John Freeman—have traditionally not been 100 per cent. free, such as prescriptions.
I was interested to hear the Government give a commitment in the Queen’s Speech to introduce legislation to provide a better framework for those suffering from mental illness. The recent history of attempts to introduce legislation to update, modernise and make more relevant the Mental Health Act 1983—which was the last major piece of legislation governing the way in which we treat and look after people suffering from mental illness—has been long and chequered. The proposals have received pre-legislative scrutiny and there has been a draft Bill, which has aroused a considerable amount of controversy in certain quarters. The Government have considered the legislation and Opposition parties of all complexions have voiced their concerns and support where appropriate.
I am delighted that the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) is in her place. However, I do not wish to devote my speech to the ins and outs of the Bill, which is published today, except to say that the overriding desire must be to help to provide the finest treatment possible to those suffering from mental illness, rather than getting the balance wrong and looking at the issue too much in the context of the criminal justice system. However, I accept that there are aspects of mental health care and treatment that will inevitably involve the criminal justice system. We must not lose sight of that.
The theme on which I want to concentrate initially is in some ways a by-product of the legislation, but to me it is just as important: the way in which society regards those people who are unfortunate enough to suffer from mental illness, and the stigma and fear in society associated with those medical conditions. It was Enoch Powell, back in 1963, who introduced the concept of care in the community, rather than having people locked up in long-stay hospitals, out of mind and out of sight, where their conditions, quality of life and environment were horrendous. The basic ethos of the policy since then has been to integrate people into the community, where they can receive their treatment and live as reasonable and normal a life as everyone else. That is absolutely the right philosophy and guidance to adopt in a civilised society.
There must of course be safeguards, as the Minister would be one of the first to accept. I, too, was a Minister for mental health many years ago and that duty was uppermost in our minds then. There are still flaws in the system, and they need to be addressed, but that does not mean that we must abandon and compromise the basic principle of care and decide that just because an individual suffers from mental illness, they must be isolated and treated differently from those suffering from appendicitis, flu or cancer. There must be equality, and there must also be protection for those individuals who are a threat to other citizens, but that is a different issue. We must ensure that we have in place a system that can recognise and identify those people who are safe and who should be treated in the community and those people who are a threat to themselves or others and who need a more secure form of residence and treatment. That requirement is not an overriding problem that invalidates the concept of appropriate mental health care.
If we accept that basic premise of a civilised society, we must consider how to change the public’s perception. The public’s attitude towards people with mental illness is radically different from their attitude to other acute illnesses. If one suffers, sadly, from cancer or one has flu, there is tremendous sympathy, concern and interest among family and friends—we have all have come across that throughout our lives—but if one suffers from mental illness, however mild, there is fear and a stigma attached, and that starts with the patients themselves. They are fearful of telling people—sometimes, even members of their own families—about their illness because they are frightened of the reaction and the raw prejudice to which they may be exposed. Beyond one’s family and friends, members of the public in general may be frightened. They always assume the worst, because they do not understand the complexities and conditions of mental illness.
Sufferers become the butt of jokes, prejudice and may be shunned and subject to associated ill treatment. Although that has gone on for generations, significant attempts have been made not only by the voluntary and charity sector, which does a fantastic job in providing help, support and practical assistance to the sufferers of mental illnesses, but by Governments to minimise such negative reaction. In the 1990s, my own Government started the process to try to reduce the stigma of mental illness and to break down the barriers. To their credit, this Government have done so, too. It would be stupid to suggest that, on 1 May 1997, all the good work that was being done before then stopped and that this Government have done nothing. It would be equally stupid to claim that everything that this Government have done in that respect from 1 May 1997 has been wonderful and that the previous Government did nothing. We may have started too late—society may have started the process too late—but we made that start in the 1990s, and to their credit, this Government have carried on with that and built upon it.
We now see genuine attempts by the Government and in communities, through the mental health and community health trusts and the charitable and voluntary sectors and organisations, to work to break down the stigma, the fear and the prejudice; but by definition, that is a very time-consuming and slow process. Of course the Bill will concentrate on the nuts and bolts of mental health legislation—the treatments and all the other associated issues—but I ask the Minister not to forget to carry on the work against fear, stigma and prejudice.
I have been listening very carefully to the hon. Gentleman, who obviously brings to the debate his experience as a previous Mental Health Minister. I absolutely agree with him about stigma and discrimination. That is why I feel that one of the very important parts of the mental health Bill relates to the ability to undertake supervised treatment in the community. I am sure that, too often, he met the carers of people with mental health problems who felt that the stigma and discrimination was increased because, under the previous legislation, people always had to be detained in hospital. When people were no longer in hospital receiving treatment, they would deteriorate and carers had no ability to help them in the recovery process. That is why supervised community treatment is an important part of tackling stigma and discrimination, but there is also—
Order. The right hon. Lady has made a sufficiently long intervention.
Order. There are ways around the powers of a Deputy Speaker.
I agree with the hon. Gentleman about the stigma and discrimination, but an important part of reducing people’s fear about those who have serious mental health problems is to give an assurance that robust legislation is in place to ensure that, if people need treatment, they can get it. If the public are reassured about that, a lot of the stigma and discrimination will disappear.
I thank the Minister for that intervention, and she is absolutely right. It was quite evident to me 10 years ago that there were some glaring errors and problems with the Mental Health Act 1983 and with the state’s impotence, sometimes even when all the relevant authorities, such as the police, social workers, the health service and the voluntary sector, were concerned about an individual. Although everyone was convinced it was only a matter of time before that person committed a crime because of their mental state, nothing could be done because they had not yet done anything wrong.
I have considerable sympathy for the Minister and the Government in trying to wrestle with that problem and in coming up with a solution that both protects the public and is positive and helpful to the well-being of the individual involved. I do not want to come up with an opinion about what exactly should be done, because I am not qualified to do so. I will leave that to the Minister and to my Front-Bench colleagues when the relevant time comes. I am certainly not going to step into a quagmire now and talk on the hoof, because I understand that these are very difficult, complex issues. As the Minister rightly says, one way to try to break down the barriers is to establish or restore public confidence. The House must sort out how to do that during the legislative process, while balancing both sides of the argument and protecting the individual.
Does my hon. Friend agree that the problem goes much wider? Bad examples of stigma occur in the workplace. The Queen’s Speech also includes the Welfare Reform Bill, which is an attempt to reform incapacity benefit. One of the obstacles that people with mental illness particularly face in getting back into the workplace is discrimination and stigma among employers as well.
My hon. Friend picks up an extremely important point that is a crucial part of the equation. In fairness to the Secretary of State for Health, who is no longer present, I was heartened by her response to my intervention on the issue. According to her, such work is going on, rightly so, and I hope that it will be not only successful but applied throughout the work force and to all employers, as well as in the rest of society. That will be a crucial step forward. I will stop there on the issue of mental health, because I hope that there is a common ground on both sides of the House about tackling the problem.
I should like to raise another issue, which will probably not bring such happiness to the Minister, about the other part of the Queen’s Speech that relates to the national health service. It is, by and large, the catch-all phrase that the Government
“will carry through the modernisation of healthcare based on the founding principles of the National Health Service.”
As I said at the beginning of my speech, I wholeheartedly subscribe, as I have throughout my life, to the founding principles of the health service and I wish and am confident that, regardless of whether it is a Labour Government or a Conservative Government, those principles will be maintained, but what worries me is this inexorable drive towards modernisation.
I am not talking about modernisation where one embraces new and better drugs, more effective treatments and more effective equipment to treat people—obviously, we all subscribe to that. What I worry about is the constant and inexorable desire of politicians to make changes to the system the whole time, so that we now have a national health service that is basically in a constant state of flux. Again, to be fair, it did not start on 1 May 1997. We, too, as a Government made changes. All Governments, regardless of their political colours, seem to have this desire to tinker, to change everything in the NHS the whole time and to reorganise. I think that the time has come to say enough is enough. It is time for us to allow the changes in the structures to bed down and to allow people to get on with working in the health service, delivering the finest possible health care for our constituents, not wasting money on one reorganisation after another.
Funnily enough, I visited my national health service GP yesterday for a minor treatment. Knowing that it was the day of the Queen's Speech, he was talking to me about what he thought the Government would introduce in the next Session of Parliament. We got on to the health service. The one plea he made to me was, “Can we please be left alone to get on with doing our job and treating patients, without constantly having reorganisation after reorganisation and change after change, micro-managed from Richmond house?” I think there is considerable sympathy for and merit in that case. We must let the staff get on. A considerable amount of money has been wasted by the constant changes, which are not wanted by local communities.
The beauty of the PCTs when they first came in was that they were going to be local organisations based on local areas, with local people running them to determine local priorities for health care. I wholeheartedly accept that principle. When the legislation was going through Parliament, I wholeheartedly supported that concept, as a shadow health Minister, and wished the Government well. I thought, as I think in their heart of hearts the Government did at the time, that the size of the PCTs was too small and that that was never going to be a viable size. As I understand it—the Minister can correct me if I am wrong and I do not mean this in a derogatory way—the Government understood that prior to the last general election, but were not going to allow any true mergers until after that election.
We did see a type of merger, for example, in my own PCT, where we had the same chief executive as the Braintree and Halstead PCT next door, which was a form of merger in that it halved the salary bill for chief executives. However, it was inevitable that, once the election was over, PCTs were going to merge into more viable, realistically sized PCTs. We have probably reached that stage now. Certainly in Essex we have, where fortunately the Minister's Department listened to the lobbying of Members of Parliament and others and the number of PCTs went down from 13 to five, rather than the two that the health community proposed in Essex. That number is probably the right one to be able to be viable, to perform well and to meet the local needs of the community, which will identify with those PCTs.
Again, ambulance services in the east of England have been merged. The Essex ambulance service has been merged with those in the surrounding counties to form the East of England ambulance service. I do not think that that is a particularly clever idea. Earlier this year, the Home Office backed away from doing it with the police, which I welcomed. It is a mistake and a pity that the ambulance services were merged into one very large east of England regional service, but time will tell. The jury is out and we will have to wait and see.
The hon. Member for Denton and Reddish seems to think that everything is 100 per cent. wonderful in the health service and that there are no problems. Either he does not fully understand what is going on in his constituency, in mine and in my hon. Friends’ constituencies, or some over-enthusiastic researcher in the equivalent of Central Office for the Labour party wrote the speech and he just read it out. Listening to some of it, I thought that it seemed to be totally divorced from reality. The only thing I can say to cheer him up is that I hope that the Whip on the Government Bench was listening carefully because such on-message loyalty to the regime can only help the hon. Gentleman at a future reshuffle.
Sadly, the wonderful impression that the hon. Gentleman gave is not the experience in Essex and West Chelmsford. We have suffered a double whammy. We have a fine nursing school at the local university, which trains nurses—the health service has been crying out for nurses for a number of years. We have invested in them both financially and in time and in training. They are now trained, have experience and are all ready to put something back into the health service, but a significant proportion of them cannot get any jobs in local hospitals; my local hospital announced six weeks ago that it is losing 245 jobs. We have invested in skills and in training people for an essential vocation—nursing—yet, ironically, they have the frustration of not being able to go into the health service to practise their skills, look after patients and earn a living. That is a callous waste and I am disappointed.
Because of the deficits both of the Chelmsford PCT and the Mid Essex Hospital Services NHS Trust, three intermediate care wards have been closed. I think that the Minister was in post when they were created. The Government, to their credit, provided funding to set up the wards, which were to relieve the problems of delayed discharges at Broomfield hospital and St. John’s hospital, so that we did not have beds being wasted by people remaining in them whose medical condition did not warrant that. The three intermediate care wards were established. We saw a significant drop in the problems of delayed discharges at the acute hospital and the wards were extremely good, but because of the £13 million deficit at Chelmsford PCT, now all three wards have closed, solely as a money-saving exercise, not because there was no clinical or medical need to keep them open. That is a waste. A good initiative by the Government has been stopped because of financial realities.
We will spend the next year of this Session discussing the further modernisation of the health service and the provision of the finest, highest-quality health care for our constituents. I ask the Government and Ministers to reflect and not to decide, as all politicians do, that they have to do something about a given problem, as doing something usually means reorganising or changing. It is not always necessary to change. Sometimes, it is better just to sit still and let the existing system bed down, so that it can deliver the services to the highest quality that we could hope for.
It is a pleasure to follow the hon. Member for West Chelmsford (Mr. Burns) in this debate. We engaged in many stimulating discussions when we were colleagues on the Health Committee. As usual, he was trenchant this afternoon; but more unusually, I found myself agreeing with much of what he said, at least in the earlier part of his remarks when he was speaking from his experience as a Minister with responsibility for mental health.
Let me first say that I welcome the central thrust of yesterday’s legislative package, which is to tackle the big issues of today—the changing nature of crime, the causes and effects of climate change and the need for pension reform. Each of those issues is of great concern to my constituents, and I look forward to helping to progress the new legislation through this House, and—possibly more important, and as has been remarked on more than one occasion today—to ensuring that it is put into effect once it is enacted.
I wish however mainly to confine my brief remarks to the mental health Bill. It is interesting—and perhaps a little regrettable—that the mental health Bill has been introduced in an atmosphere that emphasises the need for security. It might have been better to have reassured the many people—some estimate the figure to be as high as one in four of the population—who at some time in their lives will suffer from a mental illness. Incidentally, the great majority of them pose no threat to anyone—save, on occasion, to themselves. It would have been better to have reassured such people that the outdated laws—they date back to 1983—will be replaced by modern legislation that will uphold the human rights of patients, provide easy access to care for people with mental illnesses and allow the use of compulsory treatment only as a last resort. The words used by Her Majesty yesterday reflect that:
“A Bill will be introduced to provide a better framework for treating people with mental disorders.”
I hope that that will be the main focus of the Bill as it passes through both Houses of Parliament.
I spent much of the parliamentary Session of 2004-05 as a member of the Joint Committee on the then draft Mental Health Bill. That was an interesting and rewarding experience. We took a great deal of evidence, deliberated long and hard, and eventually produced a fairly lengthy, but well targeted, report. It was well received by most of those best placed to understand the issues. But unfortunately, not long after it was published, the Government thanked us for our work and told us that they had decided that they would not proceed with a draft Bill in that form.
In our report, we recognised that the current legislation was clearly out of date, and that its replacement’s
“primary purpose…must be to improve services and safeguards for patients and to reduce the stigma of mental disorder”.
Naturally, my colleagues in this House and the other place were disappointed that there was to be further delay in replacing the outdated legislation. So the new proposals for a mental health Bill that were put forward yesterday are most welcome, and it is pleasing that some of them clearly reflect a number of the points highlighted in our report: in particular, the increase in availability and appropriateness of treatment, which the Minister has emphasised; the emphasis on patients’ human rights; the introduction of limited supervised treatment in the community, but only after a period of treatment and assessment in hospital; the attempt to agree a single definition of mental disorder; and expanding the skill base of professionals who are responsible for the treatment of patients treated without consent. All that has been recognised.
Our report also made some other important recommendations which have not so far been addressed in the information provided about the proposed Bill. They include conditions to ensure that legislation cannot be used inappropriately. There is also no mention of the recommendation that the threshold of risk for harm to others should be raised, or that compulsion should be used only where a treatment is available which would be of therapeutic benefit to the patient.
A number of other questions will be asked of the new Bill. Where a person’s decision-making is unimpaired, will they be allowed to refuse treatment, as recommended in the report? Could there be separate criteria, or different legislation, for dangerous people with severe personality disorder, also as recommended in the report? Will the Bill introduce new national training standards and monitoring, as recommended in the report?
Our report also expressed serious concern in respect of the resources needed to implement the proposals in the previous draft Bill, particularly in relation to adequate staffing and funding for mental health tribunals. Some of the evidence we took clearly demonstrated that, even under current legislation, there are frequently difficulties in this area. If there is to be expansion in the role of tribunals—and even if there is not—it is essential that this matter be addressed.
There have been great improvements in mental health services over the past nine years. There has been record spending on the service, and there are thousands more nurses, psychiatrists and clinical psychologists, as well as new early intervention services for young people, new outreach teams improving access to mental health services, and crisis teams providing care in patients’ homes. Against this background of improving services, it is crucial that we have updated legislation, not only to address concerns about public safety, but to keep pace with the growth of modern community-based patient services and to be compatible with the European convention on human rights, as well as to provide properly for the Bournewood judgment, which will have a big influence.
Before I finish, I wish to refer to sperm donation, which was mentioned by my constituency neighbour, the hon. Member for Northavon (Steve Webb). I suspect that we have been briefed by the same consultant at the same hospital in the Bristol area. Something of a crisis seems to have developed since the recent legislation outlawing anonymity. There are now apparently only two centres operating fully in terms of sperm donation for the whole of the United Kingdom, as opposed to certainly more than a dozen, and probably almost 20, before the new legislation began to take effect. That must be addressed, and I trust that the Minister will make sure that that message is relayed back to headquarters.
This is an exciting time to be in the House for Conservative Members, and we should look at the Queen’s Speech in that context. We are ahead in the polls—by 10 per cent. Our new leader has a positive rating of 42 per cent. as against the Chancellor’s 38 per cent. It is clear that we will win the next general election. As the sun sets gently over the Labour Benches, it will not be long before, when we see Labour Members for marginal seats rising to speak, we shall raise our order papers and say goodbye. Some of us, such as my hon. Friend the Member for Ribble Valley (Mr. Evans), have seen it happen before—the swings and roundabouts of politics.
Here we are considering yet another Queen’s Speech, and I have to say that it looks overloaded and tired to me, but in a spirit of generosity I shall start by thanking the absent Secretary of State for agreeing to meet me and a small delegation—perhaps with the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton)—to discuss the pressing problems associated with integrated health care. That issue could have been included in this Queen’s Speech, but it most certainly was not.
It is perhaps no surprise that I will confine most of my remarks to integrated health care, but, if I may, I shall turn first to a local issue. Colleagues in all parts of the House have commented on the primary care trust crisis and the problems arising from reorganisation; indeed, my hon. Friend the Member for West Chelmsford (Mr. Burns) made some valuable points in that respect. The number of primary care trusts in Leicestershire is being reduced, which is affecting Hinckley, in my constituency. The proposed improvements to the new community hospital on the old Sunnyside hospital site were put on hold for re-evaluation. Why? In my view, it was because the hospital is on the fringe of the area. We see the same thing with policing. In cases where the organisation in question is large, it is the police stations—or hospitals—on the perimeter that tend to suffer first. More generally, the health service is having massive problems with procurement, which takes far too long, and there has been a very poor review of contracts, but I will leave that issue to my hon. Friends on the Front Bench, who will doubtless want to comment on it.
In turning to the importance of integrated health care in the health service, I want to point out to the Minister that since the 1987 Parliament, which is when I first entered the House, there has been a gradual and relentless movement toward improved integration of alternative and complementary medicine into the health service. During that Parliament, we introduced as a private Bill—I did not do so myself, but I sat on the Committee that considered it—the legislation regulating osteopaths, who were seen as being outside the health service. In the 1992 Parliament, chiropractors came forward with a Bill, which was passed successfully. As a result, osteopathy and chiropractic, which used to be seen as out on the wings of medicine in Britain, are increasingly part of its structure and fabric.
I pay tribute to the Government for looking very seriously at the regulation of acupuncture and herbal medicine—an issue on which Professor Pitillo, the late Lord Chan and others did a lot of sterling work. We will see better regulation of acupuncture and herbal remedies very soon, within the framework of law. That demonstrates the inevitable surge toward integration.
Those colleagues who recently saw on television the head of a patient in a Chinese hospital being removed for brain surgery using just acupuncture will surely need no further evidence. If one can take off the top of the skull and perform a complex operation using just acupuncture and no anaesthetic—
I am grateful to the hon. Gentleman. You said that we should be brief, Madam Deputy Speaker, which is perhaps why I took out “the top”. I did of course mean to say the top of the head. However, many hospitals are adopting that practice.
The Government claim to have a new modernisation agenda, which is supposed to offer all sorts of new commissioning possibilities. One obvious area for consideration is integrated health care. Such an approach would fit in with the Government’s stated intention of increased patient choice and more innovation. This is surely a great opportunity for the Government to look carefully and seriously at existing therapies, of which there are 60,000 practitioners. There are a lot of conditions that doctors find very difficult to treat. For example, back pain: 91 per cent. of doctors surveyed said that musculo-skeletal problems were among the most difficult to treat. After that, 45 per cent. of doctors listed depression, 36 per cent. eczema and 32 per cent. chronic pain. All those problems can be treated by complementary therapists, of whom there are 60,000 in this country. They can alleviate the symptoms of chronic conditions and achieve improvements in patients’ quality of life.
When she looks at integrated health care, the Minister should also bear it in mind that complementary medicines are very cheap. Compared with the cost of drugs and other services offered by the NHS, they offer very good value. The parliamentary integrated health care group met last night, and Committee Room 8 was full. One of the homeopathic doctors present said that his prescriptions often cost only 16p each. Osteopaths and chiropractors use only their hands, and acupuncturists use sterilised needles, with no big drugs bill attached. Healers just use their energy, so there are terrific cost savings to be made.
I agree with much of what my hon. Friend is saying about complementary medicines. I was treated with acupuncture for a problem that I had when I was younger, and I believe that it helped. However, does he agree that the problem is that most people have to pay for such treatments, as they are not offered on the NHS? That can be quite expensive, especially for poorer families.
I am grateful to my hon. Friend for bringing that to the House’s attention. Such treatments are available on the NHS in some parts of the country, and later in my speech I shall describe the success achieved by a practice in Nottingham that offers a free service to people largely from ethnic communities. However, cost is an issue, which is why we need a wider roll-out of such treatments—I hope that the House will forgive the jargon—in the NHS.
People want these services. In any high street chemist, one can find ranges of herbal medicines and food supplements, as well as homeopathic medicines with 6C or 30C potencies. People can use such preparations to treat themselves safely. There may be as many as 20 remedies for colds, and all sorts of treatments for stomach upsets. That keeps people out of GPs’ surgeries, and improves patient throughput overall.
Patient demand for such treatments is increasing: 75 per cent. of people support NHS access to complementary and alternative medicines, and 6 million people use them. When I trawl the House on these matters by means of early-day motions, I find that perhaps one colleague in every three or four will say something like, “My daughter had a terrible problem with spots. We tried steroids and all sorts of strange things but nothing would fix it until we found a practitioner of Chinese medicine.” People are always amazed at the results that can be achieved.
With homeopathy, for instance, a remedy might be so diluted—perhaps one part in 200—that it almost cannot be analysed. In theory, it should be weak, but in fact it gains power from being diluted. I have used homeopathy many times over the years, but I have never been trained in it. Even so, I once looked at the relevant research and prescribed—if I may use the term without insulting the hon. Member for Wyre Forest—a certain remedy for a child who had grommets inserted to deal with glue ear. The treatment was successful after one application, and the problem never recurred.
There is growing evidence that people want complementary services, and that those services are effective. I shall produce one or two relevant statistics, but not too many—unlike the Chancellor, who in his speeches uses so many figures that no one can understand him. That is one of the reasons why, at the next election, my right hon. Friend the Leader of the Opposition is going to trounce the Chancellor, if that is who he has to stand against. My right hon. Friend always speaks gently and persuasively, and manages to say so much with so few words.
There is no need to call me to order, Madam Deputy Speaker, as I shall not go down that track—although I suppose that it is in order, given that this is the Queen’s Speech debate! I can say what I like about the Chancellor—in which case, let me say that I loathe his delivery. His is one of the most tiresome and repetitive styles ever witnessed in the House, and it compares unfavourably with that of the former Conservative Chancellor Lord Howe. His speeches were built around three or four main points, and we listened with care and interest.
With this Chancellor, one does not know whether one is at the beginning, middle or end of an argument. I shall give way to anyone who wants to intervene.
There are great new opportunities to integrate complementary and alternative medicine through the so-called modernisation agenda of the NHS, especially in the context of patient choice and innovation. The situation is good in some parts but disastrous in others. Some practices are thriving and succeeding, with huge demand, but other older, well established alternative medical organisations, such as the Tunbridge Wells hospital, are under threat of closure. Indeed, a senior doctor from the Royal London Homeopathic hospital told me yesterday that he thought all homeopathic hospitals were under severe threat.
Why are complementary services and hospitals threatened with cuts? First, they are often the easiest to cut; they are soft services on the edge of the primary care trust vision. Secondly, when financial advisers are sent in they do not really understand the provision of complementary services; and thirdly, there is sometimes hostility from general practitioners.
What needs to be done? The Government need to do two things, which should perhaps have been included in the Queen’s Speech. I shall be raising them when I visit the Minister, so she will be well briefed in advance. First, the Government need a proper CAM delivery framework, which does not exist at present. The development of such a framework was intimated in the 2003 White Paper, “Building on the Best: Choice, Responsiveness and Equity in the NHS”—I do not think that title was a joke. Secondly, there is a need for guidance from the centre, which is completely lacking. When I talk to people in the field in Leicestershire, they tell me that they receive nothing from the centre, which is amazing because Richmond house is like the Berlin bunker in some respects. Missives, orders and directives are sent out and counters are moved around on the board; regulation of even the tiniest surgery comes directly from Richmond house—Josef Stalin would have been happy with the way it is run. However, it is a great sadness that there is no central guidance for PCTs about how innovative service re-design could involve CAM, as suggested in the latest White Paper, “Our Health, Our Care, Our Say”, published in February 2006. The Minister can see that there is work to be done.
I want to give some brief examples of what a good complementary and alternative medical practice can do. I have chosen the Impact integrated medicine partnership, a Nottingham-based social enterprise, which provides free acupuncture, chiropractic and homeopathy to patients with long-term conditions in a primary care setting. There is practice-based evidence of effectiveness in treating mental health conditions, musculo-skeletal disorders, back pain, chronic pain and gynaecological and menstrual disorders. As I have already noted, three of those—musculo-skeletal disorders, back pain and chronic pain—are conditions that doctors find difficult to treat and where they perceive a 91 per cent. effectiveness gap.
I shall not do a Chancellor; I shall use only a few statistics, but I must cite two or three to show the effect on primary care. On completion of treatment at Impact, 87 per cent. of patients reported that they either stopped or reduced their medication on completion of treatment, which represents a saving of both doctors’ time and NHS medicine bills. Three quarters of patients reported that they visited their GP less often and some patients no longer required secondary care. The Nottingham case is particularly interesting because 48 per cent. of the patients—nearly half—are from black and minority ethnic communities, in an area where they comprise about 30 per cent. of the population overall. Furthermore, 40 per cent. of the patients are men, which is very unusual because usually one gets a much higher proportion of women, which tends to indicate that there is a very high acceptance of the way this practice is treating patients. Furthermore, a third of the patients consider themselves to have a disability. So that service in Nottingham provides a free service to the ethnic minorities—to those who are most disadvantaged—and it is also treating others. That is a very interesting role model for the Minister to consider; I can provide her with the details if she wishes.
I shall discuss two other issues. One is the general problem facing the homeopathic hospital community, and I should like to give a couple of illustrations of cost comparisons. There are in the United Kingdom five homeopathic hospitals. They are Royal London, which has just been refurbished, Glasgow, which is brand new—I went to the opening two years ago—Bristol, Tunbridge Wells and Liverpool. All are threatened. Tunbridge Wells came within three weeks of closure in September but it is still going. Those hospitals have a total budget of £6 million per annum. The total NHS budget is £742 billion per year. So the homeopathic hospitals’ budget is just under 1 per cent. of the total. I will say straight away to the Minister that I think they are incredibly good value for that small sum of money.
Surveys have been done to see whether the treatments are effective. The Bristol homeopathic hospital did an outcomes study, not just of a percentage of its patients, but of the lot. It surveyed 6,544 consecutive follow-up patients, and the outcomes scores were as follows. They had all taken homeopathic medicine, and they were asked whether it worked. Seventy-one per cent.—three quarters—said that they had improved, half said that they were better or much better, and homeopathy was associated with positive health changes to a substantial proportion of a large number of patients with a wide range of chronic diseases. In other words, cutting out the jargon, the hospital was treating lots of different people for lots of different things—lots of serious problems.
In the press recently there has been much rubbishing of homeopathy generally. There have been some front pages in the newspapers claiming that it does not work. But I have looked into this carefully. Up to the end of 2005 there have been 119 randomised, peer-reviewed clinical trials—randomised, controlled trials of homeopathy, using placebo or active comparators. Of those, half showed that homeopathy had a positive outcome, only 3 per cent. were negative and just under 50 per cent.—48 per cent.—were inconclusive. So that shows a very positive outcome indeed.
Finally, I want to highlight some cost comparisons. I am indebted to the Royal London homeopathic hospital for this information. I want to focus on two medical problems: irritable bowel syndrome and intractable nerve back pain. With irritable bowel syndrome, using conventional therapy—referral to gastroenterologist/endoscopy/colonoscopy/radiology —would cost approximately £5,000 to £15,000 per patient. If a patient is treated at the out-patient department of the Royal London homeopathic hospital—that is one new treatment plus two to three follow-ups and investigations—the total cost is approximately £500 to £1,000 a patient. So that is a fraction of the other figure, with the same outcome. That itself, I say to the Minister, needs investigating,
I have already said that intractable low back pain is the most difficult problem for doctors to treat; 91 per cent. of those doctors surveyed said that it was the most difficult issue for them. For conventional therapy—that is, referral to orthopaedic/ rheumatology/pain relief/ongoing drugs costs including MRI and CAT scans—the total cost is between £5,000 and £10,000 per patient. However, at Royal London homeopathic, for one new out-patient appointment plus two to three follow-ups, investigations and treatments, the total cost is £500 to £1,500 per patient. We are talking about phenomenal reductions in costs. If only the Government were able to see a way of linking in those therapists, or boosting the hospitals that we already have—perhaps I should not be saying this. Perhaps we should save this information for the incoming Conservative Government. Why am I tipping this Government off when they will be out of office soon? [Interruption.] My colleagues are not pleased with me for tipping off the Minister.
The Minister has a great opportunity. In a spirit of comradeship—is that not the Labour party terminology?—I say to her, please look at this area. We will come and talk to her. What I am talking about works. Give it a chance. It will save the Government a lot of money, and it will make a lot of people happy and save their lives.
It is a pleasure to follow the hon. Member for Bosworth (David Tredinnick) and I can reassure him that in the cancer units that I know, acupuncture, aromatherapy and reflexology are routinely used. However, I have to take issue with him about irritable bowel syndrome. The manoeuvres that he mentioned—colonoscopy and sigmoidoscopy—are not part of the treatment. They are necessary in the diagnostic work-up, before one can begin to treat irritable bowel syndrome, because it is a diagnosis of exclusion.
I welcome the comments from the hon. Member for Bristol, North-West (Dr. Naysmith), who is an expert on the draft Mental Health Bill, having served through many sittings of the Committee. I shall study his comments and talk to him before deciding my reaction. I welcome the contribution of the hon. Member for Warrington, North (Helen Jones) and particularly her tribute to the good qualities of our young people, which I echo. I also welcome the fact that the Government have included in the programme educational reform that will continue to raise standards in schools. The educational reform taking place on my patch is proving extraordinarily difficult and there are tremendous problems to overcome.
Before I talk about the modernisation of health care, I must join the argument about job losses and staff reductions. Like my eminent predecessor, A. P. Herbert, I sometimes see myself as a referee between the warring factions on either side. What we need in the case of job losses, or staff reductions—whatever we call them—is the truth. The Conservative Front-Bench health spokesman, the hon. Member for South Cambridgeshire (Mr. Lansley), began to try to unravel the patterns. We have to separate compulsory redundancies, voluntary redundancies, retirements when people are not replaced, promotions when people are not replaced, the vacancy freeze, and natural turnover. My acute trust has a natural turnover of approximately 10 per cent., which is 450 jobs. If those are not replaced, that means 450 fewer people doing the work. We need a list of the 300,000 new posts, which the Government cite and which I do not dispute, broken down into clinical staff and administrative staff—we need the detail—and they should then be matched with all the categories that are being reduced because of the various sorts of staff reduction.
I want to talk about two aspects of the modernisation of health care in particular: the National Institute for Health and Clinical Excellence and hospital reconfigurations. NICE has been much maligned recently, particularly because it appears to be stopping extraordinarily useful drugs getting to patients, and appears to be impeding innovation. It is partly responsible for the UK’s slow uptake of new drugs, which is not half a bad thing when one considers the speed with which Vioxx was taken up, and the problems that that caused.
I strongly support NICE, but several criticisms of it can be made. Does it do everything right? Does it get the selection of expert advisers right? The technology appraisal committees are all generalist in nature, so they must depend on expert advisers; the system must be absolutely right. Is the NICE process as fast as it should be? Is the method of selecting the therapies that it examines appropriate? Somehow we must allow it to approve more drugs for use, which means lowering the cost-benefit ratio so that drugs to combat diseases such as Alzheimer’s become affordable.
There is a great deal of discussion about drugs for wet age-related macular degeneration. I believe that they will cost about £6,000 a course, per patient. The chief executive of my primary care trust tells me that this will cause such a crisis in the NHS that it could well lead to a major rethink of the role of NICE and the way in which it works.
What would the hon. Gentleman say to taxpaying constituents of mine who suffer from Alzheimer’s or breast cancer and are told that they cannot receive the appropriate drugs, while the Government make a value judgment that convicted drug dealers and drug abusers in prisons can have drugs because of the Human Rights Act 1998? Does he think that a strange set of priorities for any Government to pursue?
I agree with the hon. Gentleman. It is odd that NICE’s equivalent organisation in Scotland seems to get its answers out much more quickly. That situation needs to be addressed.
I return to the impact of affording the treatment for wet age-related macular degeneration. My PCT’s chief executive tells me that providing such treatment would cost Worcestershire alone £1.5 million a year, which, taken across the country as a whole, would mean a figure of about £150 million.
The answer is not to weaken NICE. I am sure that many hon. Members will have seen the dramatic headline in The Guardian a few days ago, “Open up NHS to our drug firms, White House demands”. We should not be swayed by that sort of pressure. There are ways in which NICE could have a lower cost-effectiveness ratio and thus be able to recommend much more in the way of treatment. This all comes down to the terrible phrase that we are not allowed to use, “health care rationing”. It is better to use the euphemism “resource management” in health care. We could free up money to be used for more in the way of drugs.
Many PCTs negotiate commissioning policies with clinicians and patient representatives. In a way, they are rationing, or allocating priority to, their limited resources already in subjects such as aesthetic surgery, and, in the case of my PCT, in respect of radiofrequency ablation for liver cancer, vacuum-assisted wound closure therapy and so on. Such resource management initiatives should be nationwide, and subject to public debate. Should we be paying under the NHS for tattoo removal, for treatment for male pattern frontal baldness, or for anti-smoking pills?
The Government have made a start by producing an invaluable document, “NHS Better Care, Better Value Indicators”, which goes through a range of procedures comparing the efficiency levels of primary care trusts and acute trusts. It measures things such as reducing length of stay, eliminating operations of doubtful value, increasing day case rates, variations in emergency admissions, and so on. If all trusts could be lifted to the standards of the best performers a lot of money could be saved.
Most dramatic and easiest to understand is section 3.1 of the document, which every MP should read. It is about the use of statins. I guess that many hon. Members are already on statins, and most of us will be at some point in our life, because their effect is dramatic. The Department of Health has studied the rate of low-cost statin prescribing. The first two statins are now off patent and cost a fraction of the others. The introduction to the section states:
“The volume of statin prescribing has increased several fold during recent years and there are large cost differentials between the different statin drugs. By ensuring that clinicians initiate patients on one of the lower cost drugs, PCTs can keep statin prescribing costs down.”
In 2005-06, statins cost about £500 million. The survey is of all PCTs and measures the percentage of low-cost statins they prescribe. The rate in the best PCTs is 84 per cent. At this point I have to praise my local PCT, which is second best, with a rate of 82.7 per cent. The worst is Rochdale PCT, where the rate is 19.2 per cent. The difference between the best and the worst is huge.
I looked up the statistics for the constituencies of Health Ministers. If the Doncaster PCTs increased their rate of low-cost statin prescribing to 69 per cent., which is the figure achieved by the top 25 per cent. of PCTs, Doncaster could save £967,000. If the Leicester PCTs did the same, £917,000 could be saved. Bury PCT ranks 298th out of 303 PCTs in the survey; it could save £1.2 million. Ashton, Leigh and Wigan PCT is 291st on the list; it could save more than £2 million simply by raising itself into the top quartile. Whole parts of the country, such as Lancashire and the surrounding area, are not doing especially well.
Given that the hon. Gentleman has done so much analysis, does he agree with many Conservative Members that in terms of investment, the Government appear to be doing more for the Labour heartlands than for Conservative and Liberal Democrat constituencies?
On primary care trusts that seem to spend extravagantly when they could cut costs, does the hon. Gentleman think that that has anything to do with the situation in places such as Leicester, where, as the Secretary of State has admitted, £1,300 a year is spent per person? In my constituency we get only £960 per head, even though we do very well on prescribing.
No, I do not think that that is the case. I praise the Department of Health for producing the document. It has only just come out, so we will see whether it has any effect. I would like hon. Members to look at section 3.1 of the paper and see how their PCT is doing, not because we can influence what doctors prescribe, but so that we can ask PCTs why they are not saving £2 million or £500,000 or whatever, when they can do so by simply increasing the proportion of low-cost statins to 69 per cent., as the top 25 per cent. of PCTs have done. That will not interfere with medical freedom, because it will give doctors the scope to prescribe some of the proprietary brands, if they feel that they have to. That is one way in which more money could be made available for the drugs that we really need. I hope that the Government will widen the initiative. I would love them to consider Viagra, for example. It costs about £5 per tablet to the NHS, and there are strict guidelines on when it can be used under the NHS, but it would be awfully useful to look at the figures across PCTs and see whether the same sort of discrepancy occurs with that drug.
Turning to NHS reconfigurations, it is essential to differentiate between acute hospital reconfigurations and community hospital reconfigurations. We need the truth about which constituencies hospitals are in. I have a list of 39 acute hospitals for which a merger or reconfiguration is under discussion. There are 39 MPs involved, 18 of them Labour, 16 Conservative and five Liberal Democrat, so there is only a very slight bias. I have not analysed the figures for community hospitals, but if one thinks of the sort of constituencies that have community hospitals, there is bound to be a preponderance of Conservative and Liberal Democrat-held seats, rather than Government-held seats, represented, so the accusations of political bias are probably rather overplayed.
I think that the same applies, although I must admit that I have not looked at the figures in detail. Many of the midwife-led birth centres will be in community hospitals, and so are probably more likely to be in Conservative or Liberal Democrat constituencies, but I have not looked into the matter in detail.
To return to hospital reconfigurations, we have to accept that some changes must occur. Given the European working time directive, changes in medical practice and health service deficits, not all acute hospitals can keep all services, particularly when they are close to other acute hospitals. In the past fortnight, I have been lucky enough to have a meeting with the Health Secretary and the chief executive of the NHS, because I regard myself as one of the few people who know absolutely how not to undertake a hospital reconfiguration. I told them that the sort of thing that happened in my area—the loss of all acute in-patient services, and the total loss of accident and emergency services and any practical emergency facilities—would never be acceptable. I told them that people want fairness; they want the pain of reconfiguration to be borne equally. They understand the need to travel to treat rare and complex conditions, but they wish common emergencies to be treated closer to home.
Since we were drastically downgraded, there have been lesser downgradings, which I have mentioned. The changes at Hexham and Bishop Auckland are much more likely to be acceptable. At my meeting with the chief executive of the NHS I learned something amazing about a tiny hospital in Yorkshire. When he was chief executive of the Doncaster Royal Infirmary NHS trust he oversaw the merger of the tiny Montagu hospital at Mexborough with Doncaster royal infirmary, but he made sure that the Montagu retained medical admissions. In 2000, however, we were told that it was quite impossible for our hospital to do so. The tiny Montagu hospital has 115 beds, including 56 for medical admissions and 16 for rehabilitation, three physicians and five senior house officers—so it is possible to offer such services. The chief executive of the NHS says that many hospitals must be altered, but he oversaw a merger that did not rob a tiny hospital of everything, and kept various services that we all want. Indeed, far more was kept than was kept at Kidderminster. The bulk of emergencies are medical emergencies, so if a hospital accepts such admissions it sees most people who would otherwise go to a full accident and emergency centre. Reconfigurations and mergers can be managed so that they work and are more acceptable than those that took place in my patch.
The Gracious Speech states:
“My Government will carry through the modernisation of healthcare based on the founding principles of the National Health Service.”
The Government’s view of those founding principles is distinctly different from other people’s. They certainly think that the NHS will remain a national health service provided that patients receive free treatment. Many people in the NHS want to go much further, as they believe that unity of providers, rather than competition, is what Bevan wanted. A personal view was expressed in the British Medical Journal on 23 September by Ian Greener, who is not a doctor but a senior lecturer at the centre for public policy and management at Manchester business school. Nearly 60 years after Bevan, he said:
“we find ourselves with a government committed to changing Bevan’s NHS to a form its founder would surely struggle to recognise.”
“These reforms seem more radical than commentators in this journal dared imagine…If we add in the vagaries resulting from the PFI process, then we have a reform agenda that seems to sweep away Bevan’s NHS across the board, blurring the boundary between public and private not only in financing the service but also in the provision of care”.
I appeal to the Government to protect the National Institute for Health and Clinical Excellence, to look at criticisms that have been made, to expand resource management to make more money available, to carry out reconfigurations and mergers sympathetically, and to slow down reform. I shall check Hansard carefully, as I am sure that the Secretary of State responded to an intervention from a Labour Member by saying that the Government expected a period of calm in the NHS. I take that to mean that she thinks that the pace of reformation and change in the NHS should slow down. I certainly hope so.
I am pleased that the Minister of State, Department of Health, the right hon. Member for Doncaster, Central (Ms Winterton) has returned to the Chamber because, unusually for me, I am about to praise her. I congratulate her on the mental health Bill that is to be introduced, on which my colleague on the Labour Back Benches, the hon. Member for Bristol, North-West (Dr. Naysmith), worked so hard on the Health Committee and the Regulatory Reform Committee on which he serves. He is truly an expert in the field. I hope that much of the work that has been done on previous Committees is incorporated into the Bill that will come before the House.
One aspect of mental health provision is particularly important. It is right that we do not have the sort of Victorian institutions that I grew up around. The Runwell hospital in Essex, which was close to my home and where many of my friends used to work, was an appalling institution where people were sent for reasons that had nothing to do with mental health. It was right and proper that care in the community was introduced.
However, I have raised with the Minister previously my grave concern that at times people need help which cannot be delivered in their homes or in the community by their local GPs and other experts. Very often, people want to admit themselves to a ward, not only to get the help that they need, but so that their carers can get the help that they might need at times. Sadly, some of those wards are under threat as a result of the deficits in some mental health trusts—not least St. Julian’s ward in St. Albans in south-west Hertfordshire.
So many of the patients and carers to whom I have spoken need such wards as a safety net. The wards need not be full every day or every weekend, but they should exist as a facility so that when care in the community cannot quite cope with individual cases, patients can be admitted to a ward. In the vast majority of cases, those are self-admissions. There is a great deal of fear out there that we pushed too hard down the avenue of care in the community, believing that everything could be done outside a ward—often outside a secure ward.
There is also fear—ill-founded in many cases—that people who go into a ward are a danger to the public. Very often, they are admitted because they are a danger to themselves, and they know it. That is a difficult mental health issue, as I know the Minister recognises. Although I praise the work that has been done and look forward to the Bill, the contraction in secure wards must not go too far, or we will have even more problems in the community. I am pleased to see the Minister nodding, indicating that that will be looked at.
Before I go on to speak about the circumstances in my constituency, I shall deal with another aspect of health that worries me greatly: health in the armed forces. I have the honour of participating in the armed forces parliamentary scheme, and I also had the honour of serving in the Army when I was much, much younger. I recently visited the Army recruiting centre down on Salisbury plain. A matter of grave concern is the shortfall of about 7,500 servicemen, especially in the infantry and the Royal Artillery. Furthermore, almost 10,000 servicemen and women are sick and unable to be deployed on operational duties. That is a huge figure for a standing Army of fewer than 100,000. Together, those numbers mean that about 17,500 servicemen and women are unavailable for operational duties.
If the contraction of medical services in the armed forces continues, that will place an increasing burden on the health service. I asked the senior generals in charge: who was signing off the soldiers—who was responsible? Was it the medical officers in the armed forces?
Any Government of any political persuasion should look after their armed forces, who have given so much to the country. It is extremely worrying that such reports are still coming through.
I asked the generals whether so many people were unavailable for operational duties mainly because of injuries resulting from conflict, and the answer was no. In most cases, sickness notes are signed by civilian doctors—GPs—who do not necessarily understand the ethos of the armed forces quite as well as they should. Many of the ladies and gentlemen who serve in the armed forces may not be operationally available to serve in Iraq, Afghanistan, Sierra Leone or elsewhere around the world, but they may be able to do a desk job or something while they are recovering from their injuries.
I was most grateful to General Viggers when he said that many servicemen who have had amputations as a result of injuries sustained in Afghanistan and Iraq would not automatically be discharged from the armed forces, as would have been the case when I served in the Army, when those with a serious injury would have been thrown out on to the dustcart. These days, common sense prevails and people’s skills are used.
My understanding from what the Prime Minister has said in the House previously is that he will consider giving the armed forces only a dedicated wing of the hospital in Selly Oak, whereas on the continent many countries have a specific hospital in their capital city that is purely for their armed forces and their relatives, who, in the event of the deaths of their partners obviously need that special care as well. Does my hon. Friend agree that our country, which has the best armed forces in the world, should also have a dedicated hospital for our armed forces?
As a former soldier, I could not agree more. I am due to visit Selly Oak hospital in the near future; it does some fantastic work. Selly Oak is working hard, but the ethos in the armed forces is completely different from that in a civilian establishment.
I ask the Minister to look carefully at health care for our armed forces, which in most cases these days because of the closure of military hospitals is provided by civilian GPs and surgeons. It is important to look after our servicemen and women when they are in desperate need. Will the Minister also look into why so many of our armed forces are sick or unavailable for operational duties? Ten per cent. of the standing Army seems a huge amount; a figure that we probably would not accept on the civilian side.
As my hon. Friend has made such a compelling case, would he use this opportunity to invite the Government to make time in their agenda to debate more fully the issues that he has raised on medical services for the armed forces, because I do not think that the House has said or done enough about that?
I could not agree more. We have defence and armed forces debates every year, but this is a specific area that needs help. Servicemen and women would like to hear the House debate matters that are of such importance to them and, most importantly, to their loved ones. Sadly, today, we have seen four of our brave servicemen and women brought back from Iraq after the terrible, tragic deaths on Remembrance day just outside Basra.
The Minister will not be surprised that I come now to the reconfiguration, cuts, closure, sackings, or however one wishes to describe what is going on at this moment at a board meeting of West Hertfordshire Hospitals NHS Trust, which is deciding what to do about local medical provision in south-west Hertfordshire. For some months now a consultation has been under way. Earlier the Secretary of State went on and on about local involvement, democracy or consultation in the way in which the health service is provided within our communities. I was fascinated to hear how she wants more and more people to be involved. I have the honour of representing a constituency that could not be more involved in the future of its general hospital. It has been campaigning for 30 years to try to keep it open, under successive Governments. I freely admit that there were pressures in the ’90s to close Hemel Hempstead hospital, but a decision was made long before 1997 that that general hospital—with full A and E and maternity services, and built for the community as a new town—must stay open because of the services that it provides to 250,000 to 300,000 people.
Investment from the previous Conservative Government—nearly £70 million—was made and massive rebuilding took place. New buildings opened and everybody seemed happy. Then, in 1997, this Government came to power. Within weeks, they closed the consultant-led maternity unit at Hemel Hempstead hospital and moved it to Watford. Since then, there have been continual closures at the hospital—
That is because they have heard it all before. They are not listening to my constituents either. During the ongoing consultation process, we have written to the Secretary of State on many occasions. She has been sent tens of thousands of letters asking her to visit Hemel to explain why she wants to close the local general hospital. Hon. Members may be interested to know that she turned up a couple of weeks ago. She did not go anywhere near the hospital, of course; she went to the local social services department. There was a small demonstration outside comprising ladies with pushchairs, people in wheelchairs, elderly people on walking sticks—oh, and a Member of Parliament, namely myself. The Secretary of State did not come past to look at their banners and try to understand the local community’s concerns. Instead, the police were called and three patrol cars arrived, at huge expense to my constituents. At the same time, she was hopping over a back fence to try to get through the back door and run away from my constituents and the local media. That is the kind of listening process that she has been undertaking in my constituency.
How do the hon. Gentleman’s demands for intervention from the Secretary of State fit with his Front Benchers’ policy of operational independence for the national health service? Has he explained to his constituents that their policy is that the Secretary of State should not interfere at a national level in the local decision-making process?
My hon. Friend makes a good point. When we return to power at the next election, we will empower local authorities and local people to ensure that that sort of thing does not happen. At present, sadly, the Secretary of State is in charge of the future of my local health service. The Minister keeps nodding and wittering from a sedentary position—if he would listen for a while he might learn something about what goes on in local democracy.
For months, letters have gone to the Secretary of State asking her to intervene. She has the power to appoint the chairman and the chief executive of the trust and to remove them if she is not happy. The Government have been complicit throughout with the proposals to close the vast majority of the hospital. Nevertheless, there was a consultation process, because that has to take place under the legislation. The results of that consultation were announced a few hours ago in Watford at the meeting of the board of West Hertfordshire Hospitals trust. Eighty-five per cent. of respondents said, “Leave Hemel Hempstead hospital alone—we do not want it to close.” Yet the chief executive of the trust stood up and said that he wanted to go ahead with the proposed closures.
Such closures and amalgamations are devastating for a local community. I agree with the hon. Member for Wyre Forest (Dr. Taylor), my colleague on the Health Committee, who talked about keeping local services local. We hear a lot about choice in the health service these days, but there is no choice if one has nowhere to go. Under the proposals that are being nodded through by the board, the chief executive will order the removal of all acute services from Hemel Hempstead hospital to Watford general hospital. By the way, I should add that Watford is one of the few places left in Hertfordshire with a Labour MP. Elective surgery will go to St. Albans. All the services of a full general hospital, which was built for the new town that was its community—not all constituencies represented by Conservative Members of Parliament are rural; mine is a new town with some serious social and economic problems on the estates—will go. If we are lucky, we may be left with an out-patient and diagnostic department.
Hon. Members may be interested to know that the trust has already been in discussion with developers, and that an informal meeting took place with the local authority—representatives of which had to attend, whether they wanted to do so or not—about redevelopment and building houses on the hospital site. When the Secretary of State goes on and on about local engagement and involvement, it is frankly a sham. The decisions are based purely on financial deficits.
At a public meeting, when I asked the medical director of the trust whether he would close the hospital and cut all the services if it were not for the deficit problem that he had been told to sort out, he replied that the cuts were based not on clinical need but on financial problems. He will probably get the sack for admitting that, but at least he was honest, which is a damned sight more than Government Front Benchers’ comments on the state of the health service today.
I shall sit down in order to let many of my colleagues talk about the health service and its importance to them. However, I emphasise that decisions are being made today that affect my constituents’ future. I think that we shall be among the first to be hit by the cuts. It appears that, by Easter, there will be no hospital in Hemel Hempstead. That is a disgrace.
Well, it is the Department for education at least—[Interruption.] All right; fair enough—I am slightly out of date.
I shall not cover aspects of health and education that other hon. Members have mentioned but raise some other, novel issues. Several sensitive matters affect the relationship between the authorities and individuals. Let me make a declaration of interest of sorts: I chair an umbrella co-ordinating group that deals with reform in public family law, which is called Justice for Families. I have no financial interest in it or any declarable interest that qualifies for an entry in the Register of Members’ Interests, but I am concerned about children and families.
The Government’s Green Paper on looked-after children demonstrates the difficulty for children who are taken into care. That was reinforced by the recent National Consumer Council report, which showed that children in foster care are moved too frequently. For example, a recently born baby about whom I heard has been with five carers in his first 12 weeks of life.
In essence, the report shows that, on average, being taken into care is not a positive step for children. We must therefore be certain that it is the right thing to do. One of the difficulties in obtaining information about the child protection system is the secrecy of social services. It is claimed that that secrecy exists to protect the child, but it is clear that it is maintained mainly to protect any professionals involved from allegations of misconduct. The intentions of the majority of the people involved are clearly good and many hard-working people care a lot about their clients, but a much smaller number cause great problems. However, the system as a whole is at fault and Ministers need to consider what should be done.
The system’s faults were demonstrated by the current General Medical Council hearing about David Southall, in which the GMC has tried to keep things secret against the express will of the parents. I have, however, published at their request the names of four of the families, who are Janet and Lawrence Alexander, Sharon and Hannah Bozier, Janet Davies, and Davina and Ben McLean.
The case of 15-year-old Heidi Frost in Essex is a good example of the secrecy of the family courts protecting social services, not the child. She is not allowed to answer her friends’ questions about what happened. Social workers and paediatricians were shown to be in the wrong, but she is not allowed to tell people. As a result, she does not have a doctor. She believes that her experiences would be useful for any other children who were falsely accused. The system works against the interests of the children concerned, who remain its victims. There is an element of hypocrisy in adoption, with local authorities actively advertising children for adoption and providing their details, while their birth families are not allowed to talk about things.
It is good that the Government are reviewing secrecy in the family courts. The recent cases of Clayton v. Clayton and the judgment of Justice Mumby in respect of Nicola and Mark Webster have opened up more than a chink in the armour surrounding the family courts. It may be that people like Heidi can now speak out, but the law is not clear, and checking it costs tens of thousands of pounds.
Professionals have avoided scrutiny through secrecy and continually made errors that would have been picked up had matters been considered in public. It is very clear that too many children are taken into care and there are a number of reasons for it. There is the simple failure of the system where the system gets the facts wrong. In the case of the Williams family in Newport, which was recently in the news, a local paediatrician diagnosed “chronic sexual abuse” and split up a family for more than two years, when a more properly handled diagnosis at a later stage found no signs of sexual abuse. In that case, international evidence showed
“that the UK took a wrong turn after the Cleveland Enquiry and has been overtaken by other western nations”.
That evidence also showed that there was
“a tendency in the UK for paediatricians to over-diagnose”
Another worrying case is that of the Webster family in Norfolk. A radiologist diagnosed child abuse based on metaphyseal fractures and the children were taken away from the family. Metaphyseal fractures sound very worrying to a lay person, but they are not the same as a broken limb. Indeed, metaphyseal fractures can be caused by being born or by various bone diseases. It is clearly wrong to claim child abuse merely because of the presence of metaphyseal fractures. The good news is that the Royal College of Paediatrics and Child Health and the College of Radiologists are looking into the matter of non-accidental injury. However, we also need to look into the conflict of interests caused by the way in which payment is received for reports. If people get paid only for diagnosing child abuse, more child abuse will be diagnosed.
Those two cases came about from the actions of almost certainly well motivated physicians. The prosecution of Marianne Williams in Wiltshire—the salt poisoning case—was, however, a very different and more worrying case. It resulted in the person who was responsible for the care of her son—she was an alternative suspect for causing the child’s death—driving the prosecution case.
There are also cases such as that of Ben Hollisey McLean, in which the threat of child protection proceedings was used to force him into dangerous medical research. I have evidence of the threat of child protection proceedings being used to silence parents. Indeed, parents have been forced to admit that they harmed their children—when they did not—simply to keep them. When parents are caught in the Catch-22 world of social services it is one of the most pernicious and invidious aspects of the system, and it provides a reason why it is difficult to get clear understanding from the research.
Roy Meadow, who followed in the tradition of Matthew Hopkins, and David Southall, who shared that ancestry and that of Joseph Mengele combined, should have to account for the misery that they caused. Even if their motivations were good, the consequences will hang over many people’s lives for decades. The witch hunts, where mothers are alleged to have killed their children and are then required to prove their innocence against unfounded medical opinion, need to stop now. That does not require a change to the law, but it does require a change to procedure.
Apart from where the system basically gets things factually wrong, there are issues when the system gets the facts right but takes the wrong action. I know of a woman in Birmingham with epilepsy, whose children are continually taken off her at birth. I think that she has now had five. She has expressed the desire to continue to have babies until social services allow her to keep one because they run out of money. We really need to look at such cases and see why she cannot be supported to keep at least one child.
We also need to look at how issues of domestic violence are handled. It is wrong for a mother who is a victim of domestic violence to find that social services try to remove her children from her without trying alternative approaches. I am aware of a case in Sunderland and a second in Devon where that is happening at the moment. The underlying issue is fear of missing a child at risk, which means that people tend to play safe and treat a normal situation as one where a child is at risk. In cases like that of Victoria Climbié, abuse is obvious and should not haunt the system, driving people to treat normal situations as abusive. Common sense is needed to bring balance back into the system. One key point about the Climbié inquiry was that it showed how social workers were busy chasing up the chimera of a few Munchausen’s syndrome by proxy cases and did not have the time to focus on a serious case of abuse, which was ignored.
We clearly need to separate out the child protection function from the supportive function of social services—under “Every Child Matters” it is being reorganised slightly anyway—and link child protection to the police rather than the local authority. The police are generally much better at handling such issues. Families are complicated things. Human relationships based mainly on affection rather than contractual arrangements may not seem a reliable system from a legalistic perspective. The evidence, however, is that on average they provide far more security for children than being formally looked after.
The words used in the system cause me some concern as well. I have seen reports in which the phrase “looked-after children” becomes the noun “LAC” with a plural of “LACs”. I have heard of the phrase “trans-racial adoptable commodity”, which means a mixed-race child whom social services think they can easily get adopted. Such phrases demonstrate dehumanising attitudes.
The system’s attitude is that parents do not matter. Case conferences are held at times and places that are inconvenient for parents, who are not given copies of the papers before the meeting, while other professionals are bullied into agreeing with social services as the lead agency. The system ends up careering towards disaster and its attitude is wrong.
Contested adoptions are another area with hazard. Currently, a secret case heard on the balance of probabilities and frequently based on flawed evidence, and in which parents are required to prove their innocence, results in the destruction of a family. That stores up problems for the future, as the case of Yvonne Coulter and her daughter Tammy shows. We must not forget the impact on the adopting family, who believe what they are told, only to find that the errors of the system cause breakdown during adolescence, which is a difficult time for many families. The process for contested adoptions must be changed. A life sentence should require cases to be held in public with a jury, and the evidence to prove them beyond reasonable doubt.
The current General Medical Council hearing over the allegations against David Southall shows how the system tends to maltreat families. It is not clear that the GMC wants to enforce the rules. I am particularly worried that it is not considering the decades of dangerous research on babies that David Southall has managed. The GMC tried to dismiss even the milder allegations currently being considered, and has tried to gag the parents and forced legal and medical advisors on them whom they do not want. The prosecution in that case is acting on behalf of the GMC, not on behalf of the victims of that doctor.
In the meantime, thousands of secret medical files—estimated to be more than 2,000—are being held by the University hospital of North Staffordshire. Many of the parents of the babies who were choked, given carbon monoxide and had their breathing damaged in other ways did not give consent to the experiments. The parents should be told if there are secret files on their children.
Given the regulatory system’s failure to deal with such research, it is worrying that the Department of Health is proposing a further deregulation of research. On a side note, I was contacted by a doctor who was concerned about medical ethics and who believed that those changes could lead to more situations such as that which arose at a hospital in Norwich, where a drug experiment went badly wrong.
The system in the UK has gone wrong in so many ways. It has not served children well. The biggest reason for that is the lack of independent scrutiny. Many changes are needed and many are missing from the Queen’s Speech, but the most important is to bring in independent scrutiny.
I never thought that I would say this, but it is a pity to see so few Labour Members of Parliament in the House. Across the vast expanse of green in front of me, I can count three and a half Labour MPs, which is about 0.5 per cent. of the total composition of the House. It is a pity that so few Labour MPs have come for this debate on the vital topics of health and education, and that so many of them have chosen to take a long weekend, rather than coming to debate Parliament’s legislative agenda for the year ahead. It is a pity that more Labour MPs are not here, because if they had come, they would have heard the excellent speech of their colleague, the hon. Member for Warrington, North (Helen Jones). She gave a thoughtful speech from which hon. Members in all parts of the House could learn a lot.
I listened to the Queen’s Speech with great interest and was delighted to hear that the Government plan a programme of educational reform. Indeed, there is much that needs to be changed. I was pleased to hear that the Government plan to reform further education. Again, there is much in need of reform. There is probably the need for a new Bill on further education, preferably one that gives further education institutions real autonomy to run their own affairs.
I should like further education institutions to have the power to carry on running their own affairs and would welcome the idea of them awarding their own degrees. We need to ensure that they have even more independence from Government interference and the target-setters in Whitehall, regardless of which political party holds office. However, we need to ensure that any Bill does not swap higher education institutions’ independence from Whitehall for dependence on remote and unaccountable quangos.
The learning and skills councils are not fit to oversee our further education institutions. Self-government for further education institutions does not mean government by learning and skills councils. Further educations institutions need to be made accountable not to Whitehall or learning and skills councils, but to those who use them.
I also fear that we will see a creeping agenda of regionalisation in the way learning and skills councils are organised. That will not make for more local accountability, but for corporate bogus accountability. If we put our further education institutions at the beck and call of unaccountable regional quangos, further education institutions will look back fondly to the days of Whitehall control. We need to set them free.
In the Gracious Speech, the Government talk about the need to raise educational standards for all children, but I was disappointed not to see anything relating specifically to children with special educational needs. I have worked on the Select Committee on Education and Skills with Members on both sides of the House, including the hon. Member for Warrington, North. It recently produced a report that was highly critical of the existing policy on special needs education. In my constituency, Leas school in Clacton was shut as a result of the enforced inclusion policy. That closure meant that a lot of pupils who might otherwise have chosen to be in a special school were forced into mainstream schools. That policy, which has caused much hardship to parents in my constituency and to those in Clacton, is also causing hardship to children with special educational needs and their parents up and down the country. The work that we have done has helped to achieve a new consensus among parents, charities and the voluntary sector that the policy of enforced inclusion has gone too far. In the Westminster Hall debate we had on the subject the other day, pretty much everyone, apart from the Minister, agreed about that. Yet confusion remains about what is the Government’s policy. Is there still a policy of enforced inclusion? Are the guidelines and the statutory guidance, as the Select Committee found, still pushing local education authorities towards a policy of inclusion? There is a need for clarity. The Queen's Speech is a missed opportunity to introduce legislation to clarify where the balance lies between inclusion and mainstream.
The Queen's Speech shows, particularly on education but in other areas too, a general unresponsiveness on the part of the Government. I remember the somewhat heady days a few months ago when the Government announced a White Paper on education reform to set schools free. I supported the Prime Minister when he said that, every time he tried reform, he wished he had gone further. This Queen's Speech shows that, true to form, lightweight or heavyweight, he is still pulling his punches; he is not going far enough.
Why was the Queen's Speech so unresponsive? I would like to make a broader observation about the way it is drafted and about the way this Parliament sets the legislative agenda. Clearly, the Queen's Speech is not written by the Queen, yet I suspect that elected MPs made no substantive input to it. At best it is the work of half a dozen Ministers—but work conducted at the direction of remote Whitehall officials, rather than at elected MPs.
The Queen's Speech is not drafted by Her Majesty, nor was much of its authorship down to democratically elected Members of this Chamber. Much of the work is done by remote and unaccountable civil servants, technocrats and remote quangocrats. That is why it contains the perennial calls for things such as identity cards, and the perennial demands for new powers for this or that quango.
This Queen’s Speech is a Sir Humphrey’s wish list. It outlines measures to be rubber-stamped by this supine House for the convenience of the quango state that really determines policy. Listening to the speech, I wondered how much longer we can continue to have our country's legislative agenda set by a tiny unaccountable Whitehall elite. How much longer should a tiny elite have a monopoly in setting our country's legislative agenda? I would like to see a Queen's Speech drafted not by the heads of various quangos, civil servants or technocrats, but with the direct input of the people. I believe that we need a right of popular initiative so that everyone in Britain can have a voice in the Queen’s Speech. [Interruption.] The Minister laughs, but there is a good case for direct democracy, and he might wish to listen to the voice of the people.
As a mere Back Bencher, like most Members, I had zero-impact on the drafting of the Queen’s Speech—as did most Ministers, I suspect—and therefore zero-impact in deciding this Parliament’s legislative agenda. As a Member of Parliament, my best hope is to put my name in for the private Member’s Bill lottery. If I were lucky enough to win it, I would introduce a Bill that allows for proper Queen’s Speeches in the future: speeches that contain measures drafted by popular initiative and that reflect a system of government that is made of the people, by the people and for the people.
My hon. Friend the Member for Harwich (Mr. Carswell) referred to this Chamber as being supine, and I agree: apparently, there is a lack of Labour Members who want to scrutinise what their own Government are doing, and it is a great regret that so few of them are present.
I must start by expressing my anger at the Minister of State with responsibility for delivery and quality at the Department of Health, who is no longer in the Chamber. He scoffed and laughed at my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State for Health, when he started to talk about Welsh patients. The Minister simply shouted across the Chamber that that was not his responsibility, but I have to inform the House that it is his responsibility. He is responsible for Welsh patients because almost all patients in mid-Wales come across the border to use the Royal Shrewsbury hospital, which is an English hospital. In fact, my hospital loses almost £3 million every year because the Welsh Assembly pays a far lower rate for its patients than English authorities do. Therefore, the Minister should be ashamed of himself.
I decided to speak in the health debate because I recently carried out a survey of all of my constituents. One copy of that survey went out to every household, and we have so far received 8,000 replies. Apart from showing a very large swing from Labour to the Conservative party, and an even greater swing from the Liberal Democrats to me, they show that the top priority is the Royal Shrewsbury hospital. My constituents are extremely concerned about its £34 million of debt.
The Secretary of State has said to me and the chief executive in private meetings, “Well, of course it is your problem, isn’t it, because you have been overspending?” How on earth can a hospital such as the Royal Shrewsbury be blamed for overspending? Its managers are not spending that money on luxuries or on sending themselves on Caribbean cruises. They are spending the money on medicine and the other vital things that the hospital needs to provide for the people of Shropshire. One example of that is Herceptin; there has been a huge increase in demand for it, so there needs to be more funding. But the Government simply are not providing enough funding for hospitals.
I shall now turn to maternity services, which I feel very passionately about because my first child was born just three weeks ago: a beautiful little baby girl. Mercifully, she looks like her mother; she is the spitting image of her mother—she is beautiful. Her name is Alexis.
I wish to describe the level of service that we received at the Royal Shrewsbury hospital when we were waiting for little Alexis to be born. The midwives were superb; they were extremely hard-working, professional and comforting, and I am deeply indebted to them. They were also, however, extremely busy. The labour ward was full throughout the entire time that we were there. Many midwives came up to me late at night and said in hushed whispers, “We’re going to have maternity beds cut. You can see how busy we are, Mr. Kawczynski, and that all the beds are occupied. We must tell you that four beds will be cut in November. Another four will be cut in December, and in January eight will be cut.”
So between now and January, 16 of the Royal Shrewsbury hospital’s maternity beds will be cut. That is an absolute disgrace. That so many maternity beds can be cut in this socialist utopia in which we apparently live fills me with absolute horror. What upsets me is that—as is always the case with the NHS—these people come to talk to me in hushed whispers because they are absolutely petrified of losing their jobs. They do not want to go public because they work in a regime of fear, and they worry that, if they rock the boat, they could lose their jobs.
The maternity beds are being cut because outside consultants, who want to reduce the £34 million-worth of debt, have identified that in Shropshire, on average, a woman stays in hospital for 2.6 days after giving birth. The figure for the United Kingdom as a whole is 1.6 days, so they have latched on to the fact that women in Shropshire stay in hospital for longer than is normal, compared with the rest of the country. That is why they want to cut beds—to get the women out quicker. However, that is totally wrong, because the help that the mother—and the father—get after the birth and while at hospital is absolutely invaluable and very necessary. They are taught how to bathe, feed and generally look after the baby; indeed, the help that they receive from the midwives is tremendous. Simply trying to get women out of hospital as quickly as possible will lead to far greater problems further down the line.
Of course, it is much easier for us, because my parents-in-law have moved very close to us—on a temporary basis, I hasten to add. My mother-in-law is renting a house just two miles away, until Christmas, in order to help with the baby, and I am very grateful to her.
Well, we have the advantage of having my parents-in-law to help look after the baby. But there are a lot of teenage mothers in other parts of Shropshire, particularly in Telford, who do not have such family support. They are very young and inexperienced, do not know how to look after a baby and have nobody to help them. Throwing them out of our hospitals just to make way is wrong. I do not normally get emotional, but that is very wrong, and I want to put it on the record.
The deficit is so bad that my nurses have been told this week that they will have to pay £90 a year to park their cars in the Royal Shrewsbury hospital car park. How on earth are those nurses, who earn so little money anyway, going to afford that? Nevertheless, they are going to be forced to cough up £90 just to park their car. It is an absolute scandal. In fact, many of my constituents have written to me asking me to try to stop car-parking charges at the Royal Shrewsbury hospital. Every time that they visit an elderly relative, for example, they have to pay. Indeed, I myself nearly got a parking fine. The tickets run out at midnight, so those whose wives are giving birth late at night are expected to leave them while giving birth, and to run down to the car park to buy a new ticket. It is absolute madness.
There has been little discussion so far about dentistry. There is a terrible shortage of NHS dentists, and I am disappointed that there is nothing in the Queen’s Speech about what the Government intend to do to improve NHS dentistry and to increase the availability of this vital service.
The other day at my surgery I met a very senior local dentist who has set up an NHS dental practice in Shrewsbury. He told me that buying all the equipment and so on cost £650,000, and that he had taken out a bank loan. Interestingly, although NHS dentistry is said to be national, the grant from Government was worth only £50,000.
The chief executive of our hospital, Mr. Tom Taylor, has a very difficult job. He is an honourable and hard-working man whom I admire, but he is trying to ensure that Shropshire retains two accident and emergency departments—one in my hospital and the other in Telford’s Princess Royal hospital. He is fighting the Government tooth and nail because they want only one such department in Shropshire which, despite its size, has a population of only 500,000. In these difficult financial times, the Government think that that means that we do not deserve or need two accident and emergency departments.
Closing one of our departments would be a travesty for the county. Will the Minister give me an assurance that Shropshire will continue to have two accident and emergency departments, and that neither of the existing facilities will be closed in the foreseeable future?
The Government do not take into account the rurality of the county. For example, Coventry hospital serves an area of 17 square miles, whereas my hospital serves 172,000 square miles. It is huge area, stretching all the way from Aberystwyth to the Staffordshire border, but the Government take no account of that when providing funding.
The Royal Shrewsbury hospital is also engaged in a huge battle over cancer services. We are going through a public consultation process that might mean that we lose our urology services. The Government want to shut down Shropshire’s cancer services and make people go to regional centres such as those at Stoke and Wolverhampton. They want such centres to be situated in areas with populations of more than 2 million people, but that must be wrong. People who live in one of Shropshire’s small rural villages—such as Ploxgreen, Snailbeach or, in the south of the county, Cardington—find that it takes them at least three hours to drive to Stoke. We should bring services closer to people, not move them further away.
My local newspaper is the Shrewsbury Chronicle. Today, it highlights a problem centred around the local bed bureau, an agency that for 30 years has liaised with GPs around the county to arrange relevant treatments and provide transport for the people involved. The PCT has decided to scrap the bureau and replace it with two GPs, who will sit in a little room trying to suggest to the county’s doctors alternatives to hospitalisation for patients.
That has inflamed the local GPs. They are the experts: they know whether their patients need to be hospitalised, and they are furious. To circumvent the process, they are sending their patients to my hospital’s accident and emergency department. The A and E department at the Royal Shrewsbury hospital is brimful because patients are being sent there who should be going to other, more appropriate, departments.
My last point, which strikes a personal note, is not a criticism of the Government—although, my goodness, there is certainly a lot to criticise them about. Recently, I injured myself rather badly while I was chopping down some trees on my farm. A tree fell on my foot and skewered it—going straight through it. I am extremely grateful to the doctor who, with pin-point precision, managed to remove pine needles and other things from my foot, but I needed to use crutches for some time afterwards. Indeed, I was amazed that my hospital managed to find crutches that were big enough for me. When I no longer needed the crutches and asked someone at the hospital about returning them, I was met with surprise. They were extremely grateful that I wanted to return them, but said that most people hang on to their crutches, or pass them to someone else, or even sell them at car boot sales. The Government have a responsibility to ensure that people are made to return such equipment, because the cost to the NHS is staggering.
I finish my speech by welcoming my neighbour, the hon. Member for Telford (David Wright), who has just come into the Chamber. He and I are fighting strenuously to preserve good hospital services in Shropshire.
I notice that we have just under an hour for four speakers, so my speech will take less than 15 minutes.
We have had a good debate. I am delighted that the hon. Member for Warrington, North (Helen Jones) has returned to the Chamber. Her speech was one of the best I have heard in this place, so much so that I should like her to speak at one of my supper clubs. Most of my constituents would find much to enjoy in her speech and much to think about.
I want to talk about health, where it is not all roses in the garden. On Wednesday, I was joined by a number of colleagues from Hertfordshire for a rather bleak meeting with Anne Walker, the new chief executive of Hertfordshire’s two PCTs. Normally, there is a bit of jollity and levity at such meetings, but Hertfordshire’s health economy is facing a grim time over the next few years as the chief executive tries to bring it back into balance. I am sure that in Anne Walker we have a capable chief executive, but it will be a difficult few years for my constituents, regardless of whom they support—whether they voted for me or for the Labour candidate, Jamie Bolden.
Our experience carries a warning for all politicians. Broxbourne and Hertfordshire have been the victim of enthusiastic electioneering. In February 2005, Chase Farm hospital, which although not in Hertfordshire serves many of my constituents, received a visit from the then Secretary of State for Health, now the Home Secretary. We were told that there were great plans to renew Chase Farm, with new services and buildings and a thorough overhaul of that rather tired Victorian hospital.
Unfortunately, after the general election, the situation seems to have changed and Chase Farm hospital has a very thin future ahead. Local people are fighting a valiant campaign to ensure that services, such as A & E, remain at the hospital, but I fear that we may lose that service and the hospital will be run down until it is no longer viable to keep it open.
There was also some enthusiastic electioneering in Welwyn Hatfield in the run-up to the last general election. Hatfield was promised a brand new, shiny hospital straight out of the wrapper, costing about £500 million. Of course, we looked forward to that new hospital because we felt that it was much needed in Hertfordshire. As the site also happened to be in the constituency of a then Labour Health Minister we thought that the two might be linked, but we put such thoughts behind us as uncharitable. However, after the general election there was a new Member for Welwyn Hatfield and we have been told that the hospital will not happen. First, we thought the project would be downgraded to a smaller hospital, but last week we discovered that there will be no hospital at all on the site.
The proposals for the Hatfield private finance initiative project were all locked into “Investing in Your Health”, which was part of the plan to run down and close facilities at Hemel Hempstead hospital. The sad news is that not only is Hatfield not going ahead, but while I was actually speaking in the House this afternoon, the board of West Hertfordshire Hospitals NHS Trust announced the closure of all acute and all elective surgery at Hemel Hempstead hospital, against the wishes of 85 per cent. of the consultees. It is shameful.
I thank my hon. Friend for that intervention. It is a great sadness because he has fought tirelessly over the past year and a half to keep the hospital open. He has run an energetic campaign, as was shown by the fact that he presented a very large petition and that 85 per cent. of his constituents have asked that that hospital remain open. It is a sad day indeed.
So Hertfordshire and my constituency have been victims of over-enthusiastic electioneering. We are now left with the Lister hospital and Watford. We were led to believe that if the hospital in Hatfield did not go ahead, which is the case, Watford general would receive some additional investment. We thought that that would be more than £300 million.
We thought that it would be £350 million, but we now hear that it could be well below £300 million. That decision was taken without consultation or any warning. It was just announced at a meeting. That is giving us all cause for great concern. The Lister hospital has fantastic staff and they do an excellent job within the resources that they have, but the Lister hospital too is looking tired. There are problems with the infrastructure and structure there, so investment is needed.
This type of electioneering, whether it is done by the Labour party or even the Conservative party, does bring politicians into disrepute. We really must not promise, for short-term political gain, things that we cannot deliver or have no intention of delivering.
That brings me to the funding of the NHS. Only recently a gentleman in his early 50s, a police officer, came to my surgery. He has secondary bowel cancer. He, his wife and his family are desperate to get him a treatment made by the pharmaceutical company Merk, to help stem the spread of that cancer and perhaps give him a future. That drug is not provided on the NHS; one has to get it privately and it costs between £20,000 and £25,000. There are more of these drugs in the pipeline. I hope that the House will agree that this is a serious point: I am concerned that no matter how much goodwill there is in this Chamber for the future funding of the NHS, the NHS within its current structure and current confines will not be able to find the resources to provide those drugs. It is incumbent on the great brains on the Labour side of the House and the great, huge brains on the Opposition side of the House to provide this country with an NHS that can meet the demands of an increasingly sophisticated user group. And perhaps, in doing that, we need to have more cross-party discussions on the best way of providing these health services to all our constituents, regardless of which constituencies we represent.
I have been speaking for seven minutes, which means that I am going to give hon. Members another six minutes of this, which will come as a grave disappointment to many but is of great delight to me.
I am concerned, but also interested, to hear that there is to be a mental health Bill. I am interested to hear that because mental health is of huge importance to me and my constituents. We have an excellent mental health trust within Hertfordshire, which has seen its resources diminished over the past year. It had to make a £6 million saving last year and it will have to make a similar saving next year. I do understand that within the area of mental health there is an argument for reducing the number of hospital beds and transferring services into the community to destigmatise mental illness, but I am concerned that in our county, St. Julian’s ward in St. Albans is being closed while at the same time we are reducing services in the community; so we are getting a lose/lose situation as opposed to a lose/win situation. I hope that the mental health Bill will reaffirm the Government’s commitment to providing first class mental health services, because there is some concern in Broxbourne that they are being run down and that they will not be able to meet people’s expectation.
On the issue of mental health, like many Members, I have seen some tragic cases that I find very moving, particularly in the area of schizophrenia. There are families who are at their wits’ end when a loved one—a child, a mother, a father, a son or a daughter—is suffering from that disease. When I look at my children, I think, if they are going to get an illness, please God do not let it be schizophrenia, because for many it is a life sentence. It is an illness that never leaves and, at best, can be controlled. For that reason, I hope that we can work collectively, as politicians, to destigmatise that awful illness.
I missed some of the speech from my hon. Friend the Member for West Chelmsford (Mr. Burns), but in the 10 minutes that I caught he made some powerful points. Although, of course, we have an obligation to protect the public, the last thing that we want to do is lock up people with an illness, with no hope of getting out, meaning that they lose all hope of having a future. That would be a huge sadness to me and I could not countenance ever supporting it.
I have taken a particular interest in this area. Is my hon. Friend aware that many who suffer from schizophrenia benefit hugely from the therapy of a mental hospital? That is because of the serenity, the quietness, the tranquillity and the security of a hospital that specialises in the treatment of schizophrenia. It is a critical disease. We do not want to throw the baby out with the bathwater and close all those wonderful hospitals that do such an excellent job.
My hon. Friend makes an excellent point. I am totally opposed to the institutionalisation of people with an illness, but there again, those hospitals provide specialist and loving support. There are nurses, doctors and other staff dedicated to getting sufferers of schizophrenia on the road to recovery.
Does the hon. Gentleman agree that we need flexible living settings for people who have mental health problems? We need a range a providers and partners—for example, housing associations and health bodies—to work with us to get those. We need flexible settings so that some people can go back into a hospital environment for a limited time, when they need to, and then out into independent living when they are able to cope with that.
I take the hon. Gentleman’s point. In my constituency, there is an excellent charity called Working Together, which provides facilities to help people reintegrate into the community. If someone has had a serious episode of schizophrenia, they cannot just go back to living on their own, but they may not want to be in a hospital. The charity provides an intermediate service: for example, sheltered accommodation in a flat, where, if things get on top of someone, they can get the support that they require to ensure that they do not relapse.
I hope that there is consensus across the House that, when dealing with the illness of schizophrenia we will put the sufferer foremost in our mind. With that, I shall conclude. I have plenty more to say, but I am sure that we will have a wide-ranging debate on the Second Reading of the mental health Bill, which I believe is being published today. I am sure that many Members will want to be in the Chamber at that time to show their support for people with mental health suffering. When we talk about mental health in our constituencies or at functions that we attend, people come up to us quietly to say, “Thank you so much for speaking about mental health. It means so much to us because we get so little support and we feel that there is so little support out there for our family and the people who are suffering within our family.”
It is a great pleasure to take part in the debate on the Queen’s Speech. I am grateful that the Secretary of State for Education and Skills is in his place, because I am going to say something nice about him. I wish him well in his leadership, or deputy leadership, bid. I lose track of what is going on, because there are so many candidates going for so many positions, but I wish him well, none the less. I congratulate him on his rapid U-turn over proposals that faith schools should take in 25 per cent. non-faith pupils. He listened to what my constituents and no doubt many others were saying. Certainly in the case of Ribble Valley, those schools are not broken, so there is nothing to fix. I am grateful that he listened carefully to what pupils, MPs and parents had to say on that issue.
I am sad to say that I was not in the Chamber for the speech from the hon. Member for Warrington, North (Helen Jones), but many Members have spoken about how good it was. It must have been good for her to get a supper invitation from my hon. Friend the Member for Broxbourne (Mr. Walker)—even I have not had such an invitation yet. I am always one for a free supper, so it was clearly a good speech. I, too, look forward to seeing the contents of the mental health Bill; this is a Cinderella illness for too many people.
As my hon. Friend knows, there were three large mental institutions in my constituency, but there is now only one medium-sized one. Although the old Victorian institutions were clearly not fit for purpose for the 21st century, care in the community, as it is called, does not fit everybody either. We need to be more flexible about our provision for people with mental illnesses.
I agree with my hon. Friend the Member for Bosworth (David Tredinnick) that the Queen’s Speech was overloaded. There is a lot in it. I wonder why the Prime Minister felt it necessary to pack the Queen’s Speech so full of legislation when he will stand down at some stage next year and it will be for someone else to consider what sort of programme there should be. We do not know how much of the Queen’s Speech will be taken forward—[Interruption.]
Order. I am sorry to interrupt the hon. Gentleman, but far too many sedentary exchanges are going on. They are disturbing the person who is trying to address the House. I hope that the hon. Gentleman will be given a fairer hearing.
Thank you very much, Mr. Deputy Speaker. I always get a bit unnerved when I am heckled, but even more so when that comes from my own side.
Let us consider education in the round. One provision in the Queen’s Speech is on help with off-peak travel being given to pensioners and disabled people. I welcome that because there are problems to be addressed, but youngsters, especially in rural areas such as Ribble Valley, have faced a huge hike in their bus fares to go from where they live to school. If such journeys are free, that is fine, but not everyone lives within the designated three-mile distance. Such fare hikes, which are particularly felt by rural parents, force people to re-examine how they get their youngsters to school. Many parents are being forced to transport their children themselves. If people have more than one child, the increases are huge.
The Government stressed the importance of “education, education, education”, but it should be considered in the round. That includes getting youngsters from where they live to school. I hope that the legislation will be such that it will assist young people to get from home to school.
Earlier in the year, the right hon. Member for Neath (Mr. Hain), as part of his bid for the deputy leadership, said that he was going to attack all the remaining grammar schools in this country. That is doubtless populist, and red meat for Labour Members, but it is not good—it is certainly not welcomed by my constituents. Ribble Valley contains Clitheroe royal grammar school, which is a fine school. I hope that the Secretary of State for Education and Skills includes it on one of his visits to the north-west, along with some of our other good schools that are not grammar schools. It is all about diversity of choice. The last thing that the pupils of that fine school and their parents want is for it to be under attack for party political reasons.
It might well be. I suspect that a lot of red meat will be thrown towards the Labour Benches over the coming months. We must look to see what is good in education and preserve and improve it. The last thing that we would want to do with the fine grammar schools that we have in this country is to junk them. What has happened in Northern Ireland is a complete disgrace, and I hope that the Secretary of State for Education and Skills will give us an assurance that grammar schools will be preserved.
I shall move on to the health service. I am chairman of the Commonwealth Parliamentary Association’s virtual HIV working group. As I am sure Ministers know, in the past 10 years, the incidence of HIV/AIDS has increased dramatically throughout the world, especially in Commonwealth countries, and in the United Kingdom within the past few years the incidences of HIV infection and AIDS have quadrupled. That has to be a cause of concern.
The Secretary of State for Health told us that we were to have a £50 million advertising campaign on sexually transmitted diseases, but then nothing happened until just this week, when a £4 million television and radio campaign, which I believe has already started, was announced. That is chickenfeed compared with the £50 million that was to be spent. When sexually transmitted diseases are spreading as they are in this country, surely the right thing to do is to ensure that we have a good advertising campaign. Prevention is better than cure. I hope that the Government will carefully consider that. I understand that the £4 million campaign is hard hitting, which is the right approach if we are to get the message across, but let us consider how to make that message more effective. When the Government promise that they will spend £50 million—and get a headline for doing so—but then do nothing and only belatedly spend £4 million, that is not good enough.
My hon. Friend makes an interesting point. Is that not another example of the Government simply latching on to one high-profile area? The Government have touted the very slim fall in teenage pregnancies that was achieved after a lot of money was spent on tackling that problem, but the incidence of STDs has rocketed, with 100,000 cases of chlamydia for example. We are simply trading one problem for another that might be even worse.
I agree. It is a false economy: it will cost far more if STDs continue to spread at the present rate while we try to hide that increase behind other statistics and pretend to ourselves that the situation is not so bad. It clearly is bad and worsening, and we need to tackle it through a proper and effective campaign.
We have heard today about the skills of workers in the NHS. We value the work of the nurses, doctors and ancillary staff in the NHS—my goodness me, it costs a lot of money to train them and we should value them. However, in the last Session we were all visited by a number of physiotherapists who came to lobby Parliament, and I am sure that some of us have since received messages from them about their campaign. This year, 2,900 people will train as physiotherapists, but 93 per cent. of them will not get a job. That is clearly ridiculous when we have made a massive investment of millions of pounds in their training.
Will any Member present tell me that we do not need more physiotherapists in the national health service? It is clear that we do. If we train people as physiotherapists, we must use them. It is another false economy to train physiotherapists but not to give them jobs. If we fail to do that, those fully trained people will look abroad for work. That cannot be right.
That is correct. They are dedicated people who want to work in the health service—they want to give care to people. People who are in need of physiotherapy live in constant pain—[Interruption.] My hon. Friend the Member for Hemel Hempstead (Mike Penning) points to himself; no doubt he has received valuable care from physiotherapists. To raise the expectations of young people who are trained at great cost, only tell them at the end of their training that there is no job for them, is wrong, especially when they know that there is a job to be done. That must be agonising and incredibly frustrating for them.
I sympathise with the hon. Gentleman’s argument, but is he aware that we are approaching the point at which PCTs do not have enough money to bid for university places for future health workers? We are facing boom followed by bust, which will have a serious long-term impact.
The hon. Lady is absolutely right. We all know what happens during the bust phase. It is another example of false economy, as agency nurses will be brought in at a much greater cost, so the Government are not saving any money. We know why primary care trusts are acting in the way that they do: it is because they have amassed huge debts and are looking for front-line services to cut, but clearly that is not right. We are talking about the national health service, and we want to make sure that there is proper provision in all parts of it.
Dentistry was mentioned earlier, and one of my constituents, Pearl Miller, wrote to me to ask why she cannot find an NHS dentist. She has been told that she will have to wait many months while the NHS finds one, because the reality is that there are none. The Government have been in power for almost 10 years, and in that time they should have ensured that sufficient numbers of dentists were trained, so that dentistry could remain part of the national health service. In effect, it has been privatised through the back door, by stealth. If only the Government would come to grips with that. I hope that when they talk about modernising the national health service, they will look fully at every aspect of it, including physiotherapists and dentistry, because that is important.
The hon. Member for Wyre Forest (Dr. Taylor) mentioned drugs and the National Institute for Health and Clinical Excellence. He was hugely generous to that body in many ways—far fairer than I will be. We all have constituents whose primary care trusts have turned down their request for drugs, because those drugs have not been passed by NICE. The truth is that trusts could offer drugs that have not been passed by NICE, but many of them, because they want to save money, hide behind NICE’s decision as a way of explaining why they are not giving those drugs. I have at least two constituents who need Velcade but who have been told that they cannot have it. That drug is made available in Scotland via the Barnett formula, and it is subsidised by English taxpayers, yet English patients cannot obtain it. Something is therefore wrong. If drugs that are clinically proven are made available in Scotland and Wales, why are they not made available to our constituents? I thought that we had a national health service, so I ask the Minister whether we can have it back. We want a service in which drugs are made available throughout the United Kingdom, once they are proven to be effective.
The situation is the same for Alzheimer’s drugs. Why cannot people suffering from Alzheimer’s obtain drugs with a relatively small cost of £2.50—that is less than a pack of 10 cigarettes—which are proven to be effective in slowing down the onslaught of Alzheimer’s? What about the effect on sufferers’ families, as the drugs are available for a relatively small amount of money, but their loved ones cannot obtain them? That is appalling, especially when we juxtapose it with the news this week that the Government have come to a settlement with some prisoners who were forced to go cold turkey because they could not obtain access to drugs in prison. At the same time, people who are ill through no fault of their own cannot obtain access to drugs on the national health service because of cost, which is quite scandalous. I hope that that topsy-turvy, Alice in Wonderland situation can be corrected, so that drugs are given to people who desperately need them.
I shall conclude on the subject of primary care trusts, which has been mentioned time and again. There have been alterations in Ribble Valley, too. It is important to listen, and my hon. Friend the Member for Hemel Hempstead talked about the public saying, “This is the sort of health service that we want. We are paying for it; this is how we would like to be treated.” The same thing happened in a town in my constituency, Longbridge, which was taken out of one primary care trust and put into another. It is completely insane for some bureaucrat to decide to do that on the basis of a geographical nicety, or for the sake of tidiness, without listening to all the doctors and patients who said that they wished to remain where they were, and to be treated in the Preston area, as opposed to east Lancashire. I know that the Minister is going to look into the issue again, to see whether any changes can be made so that the people of Longbridge can once again be covered by the primary care trust for the Preston area, and I hope that that can be done. It is not easy, particularly given the nature of the bus services in rural areas, to travel from Longbridge to parts of Burnley, Accrington or Blackburn, where my constituents may have to go to obtain part of their treatment. As I say, the move may have made sense from the point of view of bureaucratic tidiness, but it is a crying shame that people who live in a town should be told that they cannot receive their treatment there, and must go somewhere else.
Finally, we should pay tribute to all the nurses, doctors and ancillary staff, and to our teachers and their ancillary staff. They are the investment in both of those wonderful services that we have in the United Kingdom. My hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) mentioned car parking charges. Imagine what would happen if we tried to charge teachers for parking in our schools. It is nonsense. None of us would tolerate it, so why do we tolerate our nurses and doctors having to pay car parking charges when they go to work in hospitals? It is an outrage and ought to be corrected.