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Health and Social Care

Volume 464: debated on Wednesday 10 October 2007

After a decade of unprecedented investment in the NHS, we see the results in more staff, 1 million more operations each year, 100 new hospitals, reduced waiting times and lower mortality rates, particularly for cancer and cardiovascular diseases. Having expanded capacity in the service, we can now focus even more closely on raising quality. Last week, Lord Darzi published his interim report setting out a vision for world-class health and health care in England, developed and owned by patients, staff and the public. Yesterday’s comprehensive spending review settlement enables us to take the measures necessary to begin to implement that vision.

It is a good settlement for the NHS: locking in current record levels of spending and adding real-terms increases—year on year—so that total health spending will rise from just over £90 billion in 2007-08 to £110 billion in 2010-11. That represents a real-terms increase of 4 per cent. a year on planned spend, compared with an historic average of 3.1 per cent. In 18 years under the Tories, real-terms growth was 3 per cent. In the five years up to 1997, it was 2.6 per cent. In 14 years under Labour up to 2010-11, real-terms growth will average 5.6 per cent. That extra funding is essential if we are to meet the challenges of an ageing society, the opportunities of new technology and the demands of rising public expectations of what a health service in the 21st century should deliver. I am proud that it is a Labour Government that have delivered, and will continue to deliver, these necessary increases in funding.

Lord Darzi’s interim report drew out four overarching themes for the NHS over the next 10 years: fairness, personalisation, innovation and safety. First, an NHS which is fair: no single institution has made a greater contribution to social equity in this country than the NHS, yet 60 years on, whilst the health of all income groups has improved dramatically, stubborn health inequalities remain. We will begin to address one important element of this problem with a new £250 million access fund that will deliver at least 100 new GP practices in the 25 per cent. of primary care trusts with the poorest provision. These practices will bring the most modern health care models direct to the nation’s most deprived areas. They will offer an innovative range of services, will be open for longer, and will have a specific remit to prevent ill health rather than simply treat it. That is crucial when lifestyle choices are responsible for as much as half of the gap in health outcomes.

Secondly, we want an NHS that is personalised. That means that GP practices should fit around people’s lifestyles, not the other way around. We have set a clear aim that, working with new and existing GP practices, we will ensure that at least a half of all surgeries are open either at weekends or after work. We will also explore all the options for making it easier to see a GP nearer to the workplace for those who commute.

The new access fund will also establish at least 150 new GP-run health centres in easily accessible locations, open seven days a week from 8 am to 8 pm. These will offer bookable appointments, walk-in services and, in some cases, access to physiotherapy, diagnostics and social care services. There will be at least one in each PCT area.

More than a third of GP time is spent dealing with mental health problems, from which one in six people suffer at any one time. Mental illness accounts for 40 per cent. of those on incapacity benefit. Prescription medication provides a successful treatment for many, but we know that psychological therapies work equally well, and often prove to be more effective in the long term. The time has come to do much more to help those with depression and anxiety.

I can announce today—which is, of course, world mental health day—that we will build a groundbreaking psychological therapy service in England. Backed by new investment rising to £170 million by 2010-11, the service will be capable of treating 900,000 additional patients suffering from depression and anxiety over the next three years. Around half are likely to be completely cured, with many fewer people with mental health problems having to depend on sick pay and benefits.

Thirdly, we want an NHS that is innovative. British scientists have been responsible for discovering some of the most important medical breakthroughs in history. In this modern age of rapid medical scientific and technological advance, we must ensure that the NHS remains at the cutting edge of developments in products, processes and procedures.

We will establish a new health innovation council to drive a more innovative NHS, identifying and removing barriers to change. The council will bring together all the splendid work that is going on, from discovery through development to adoption, and ensure that ideas can pass efficiently from the labs to patients without any compromise to patient safety. In addition, we will set up a new £100 million fund for innovation jointly funded with the Wellcome Trust.

We will also expand the single fund for health research to £1.7 billion. In the 18th century, Edward Jenner discovered the smallpox vaccine. In the 19th century, British scientists developed anaesthetics and antiseptics. In the 20th century, Alexander Fleming discovered antibiotics. In the 21st century, we want British scientists to combine to lead in the fight against global killers such as cancer and HIV/AIDS.

Fourthly, we want an NHS that is safe. Health care-acquired infections are a growing problem around the world. Hospital cleanliness should be the last concern of patients and the first duty of everyone in the health service. We have announced that all hospitals will be deep cleaned at least once a year. Isolation wards will be extended wherever possible, and we will empower and encourage matrons and nurses to use their expertise to fight infection on the front line.

The Health and Social Care Bill contained in our draft legislative programme will provide the new health and adult social regulator with tougher powers, backed by fines, to inspect, investigate and intervene in those hospitals that fail to meet hygiene and infection control standards. As Lord Darzi recommended and the CSR provides for, we will invest £130 million to introduce MRSA screening for all admissions, elective and emergency, over the next three years. We will also put a further £140 million into reducing clostridium difficile infection rates.

To develop an NHS that is clinically led and locally driven we need more local accountability. I have already said that there will be no top-down structural reorganisation of strategic health authorities and primary care trusts for the foreseeable future. Although we must ensure minimum standards, we will not impose a swathe of new targets. We know that future improvements will come from more local ownership, fewer top-down targets and concentration on better health outcomes.

As Lord Darzi has said, any change to NHS services must clear a high clinical bar, based on full engagement with patients and the public. Ensuring that the health service is clinically led will be pivotal to ensuring that the service moves from good to great—world class in all aspects instead of just some. How we match local ownership with greater local accountability will be one of the principal aspects of Lord Darzi’s continuing work.

The historical problem for the health service has been under-investment. The challenge today is to ensure that we maximise the potential of this unprecedented level of increased investment. The public want more money to be spent on the NHS, but they also require it to be spent well. Measuring productivity when quality of care is paramount is not an easy task, as Wanless highlighted recently. The better care, better value indicators, published yesterday, showed that £363 million of productivity improvements were achieved last year. Those first-step savings came from reducing the length of stay and from increasing prescriptions of low-cost generic statins for patients with high cholesterol. Those gains are modest but they point to the potential of what can be achieved without compromising patient care.

We must now look to build on these achievements, systematically and sensibly. Over the course of this spending round, the NHS will deliver average value for money gains of 3 per cent. every year, releasing more than £8 billion a year by 2010-11 to spend on front-line care. There are some obvious areas that can contribute in that difficult task. Improving community-based services so that people with long-term conditions can receive greater support in the community could bring savings of about £500 million a year. Intervening with preventive action, such as regular health check-ups, when someone is at risk of illness could reduce the costs of chronic lifestyle diseases such as diabetes, heart disease or lung cancer. Spreading new technologies and best practice across the health service could lead to savings of £1.5 billion a year. Improving procurement could save £1 billion a year, and by introducing MRSA screening for all admissions we can reduce the risk of huge costs occurring later.

In the face of unprecedented demographic change, it is clear that our social care system needs to respond. The Chancellor has announced that we will develop a Green Paper exploring options for reform, with the aim of increasing dignity and reducing dependency for those who rely on our social care systems. The social care settlement is divided into two parts: local government grant and direct funding from my Department for social care. The local government support grant will increase by £2.6 billion by 2010-11 and direct funding from the Department of Health for adult social care, which covers, for example, carers, mental health and the social care work force, will increase by an average of 2.3 per cent. a year in real terms, worth £190 million.

That funding will enable social services to do more to give service users and their carers greater choice and control over the way in which their needs are met. In particular, the investment will enable further expansion of care tailored to the individual; it will go into prevention and improving people’s quality of life. It will enable more individuals to live independent lives in their own home. But as the Wanless report on social care identified, we need a radical rethink about how we fund that crucial element for everyone in need, not just the elderly, in the future. The Green Paper will begin that important process.

Those are our concrete plans for future investment in the NHS, which our party created and then rescued from Tory decline. The Opposition promise to spend £2 billion on a tax cut for a wealthy elite, whereas we will spend that money on delivering a better health system for all our people. They have a black hole to fill and a dilemma to fix: either they break their promise on inheritance tax or they break their commitment to match our investment in the NHS.

Lord Darzi and his team of 1,500 clinicians will finalise the NHS next stage review in time for the 60th anniversary of the NHS. This is an exciting time for everyone involved in health care, but as the comprehensive spending review demonstrated, it is patients and the public who will continue to benefit from a national health service that is rising to the challenges of the 21st century. I commend the statement to the House.

I am grateful to the Secretary of State for the opportunity to see the statement in advance. I am sure that the House will be grateful for the opportunity to debate the announcements on health spending that were made yesterday, and indeed Lord Darzi’s interim report, which was mysteriously brought forward to be part of what we have just heard from the Secretary of State—a cobbled-together, pre-election series of announcements, which add up to no vision at all for the future of the national health service.

Where was the reference to patient choice in what the Secretary of State had to say? Where was the reference to a voice for patients, a voice that the Government have persistently taken away from them? Where is the freedom for doctors, nurses and NHS professionals, so that they can deliver the care that they want for their patients, free from top-down targets? Where are the separate public health investment and the dedicated resources for delivering on public health measures, which have failed under the Government in the past decade? Where was the reference to an NHS that is open to new providers, bringing in new investment and new capacity? In contrast, over the past year the Government have cut the national health service’s prospective building budgets.

The Secretary of State talked about Derek Wanless. Let me remind him that last month Derek Wanless reviewed the report that he gave to the Prime Minister. He said,

“what is equally clear from this review is that we are not on course to deliver the sustainable and world class health care system, and ultimately the healthier nation, that we all desire.”

And why? Because none of the three requirements that Wanless set out five years ago—the need to improve productivity, technology and public health—has been met. There was nothing about improving public health in what the Secretary of State had to say. There was nothing about technology or the review, which is absolutely necessary, of the NHS IT programme.

On productivity, we all know, as do people working in the national health service, that what really matters is not just the resources that they receive, but the ability to deliver improving and effective care as a result of them. However, in reality, under this Government there has been bureaucracy, over-regulation, distorting top-down targets and declining productivity. The Office for National Statistics made it clear that there has been a 1.3 per cent. a year reduction in productivity in health care. Just last month, it said that there was a 2.1 per cent. a year reduction in productivity in social care.

The Secretary of State reiterated the numbers from yesterday’s comprehensive spending review statement, but as always with this Government, and in particular with this Prime Minister, one has to look at the small print. The Secretary of State says that there is a 4 per cent. real-terms increase, but in reality, in the Budget in March this year, the then Chancellor of the Exchequer took £2 billion out of the national health service’s planned capital budgets. Yesterday, the Chancellor of the Exchequer said that he would put that £2 billion back in by 2011, but of course, as he had reduced the denominator, he made the percentage increase look larger than it would otherwise have done. If the £2 billion that had been taken out in March was still in planned Department of Health spending, the real-terms increase to 2011 would have been just 3.2 per cent. That is less than half the rate of increase of recent years and, indeed, well below the 4.4 per cent. minimum real-terms increase that Derek Wanless recommended to the then Chancellor five years ago.

The NHS needs certainty. Given that the Government have failed on reform and that the NHS needs a new Conservative Government as soon as possible who will deliver that reform, I make it clear to the House that a Conservative Government will match the Government’s proposed health spending through to 2011. But we will spend the money better. We will not be a Government who cut 8,000 beds as a consequence of financial deficits when patients are contracting hospital-acquired infections because of excessive bed occupancy. We will not be a Government who permit a situation where 14,000 junior doctors apply for training posts and do not attract them in the first round. We will not have a situation where trained nurses, physiotherapists and midwives who are needed in the NHS cannot find jobs. We will be a Government who deliver better productivity.

The Secretary of State said that 1 million more operations were taking place. If the productivity gains before 1997 had continued since then, there would be 2 million more operations taking place in the NHS rather than 1 million, and waiting lists would be a thing of the past.

What have we heard from the Secretary of State? He has given us re-announcements—I have the details here, should hon. Members wish to see them. In January 2006, the previous Secretary of State said that the Government were going to remedy the failures of their own general practitioner contract and secure more GPs in deprived areas. Two years ago, we were told that that would be done with immediate effect—that did not happen. In January 2006, we were told that there would be extended opening hours for GPs, but that has not happened and the Government are re-announcing the measure now.

The Secretary of State said that there will now be money for screening for admissions to hospital. Does he not know that such a provision is already in the published code of practice, which was debated in this House, but it just has not been implemented? He is now borrowing our policies. In our manifesto for the last general election, we made it clear that we would provide additional resources for the rapid screening of patients for hospital-acquired infections. It has taken two and a half years for the Government even to catch up with our policies.

The Government’s latest announcements contain a U-turn in respect of individual budgets that embrace both health care and social care. We have recommended that. If the Secretary of State were to think back to January 2006 and the White Paper, he would recall that when I challenged his predecessor to do precisely that, she and the Government said that they would not do so. They have now had to do a U-turn and accept Conservative policies.

On social care, the Government have failed time and again. The Secretary of State talks about a partnership model, but the King’s Fund report made it clear that Kent county council, a Conservative local authority, had undertaken a pilot project on a partnership model and wanted to do further analysis. What did the report say? It stated:

“In the end, Kent County Council found there was no appetite from either the Department of Health or the Treasury to fund further modelling on how such a scheme could be implemented, each department wanting the other to sponsor the work.”

The Government cannot join up the work of Departments—in fact, there is not even a joined-up approach inside the Department of Health.

Today’s social care announcements are for a 1 per cent. real-terms increase in social care budgets in local authorities, the effect of which will be to create additional charges for adult social services in local authorities across the country and to force an increase in council taxes. Those will be the consequences, but what we need are individual budgets and the greater efficiency that will come from them.

I welcome the Secretary of State’s comments about support for talking therapies and mental health services. Professor Layard and my colleagues have been asking for just that. Is the Secretary of State confident that the thousands of additional counsellors and therapists needed to make that happen will be available? Does he see this as reflecting the pilot in Newham, which has an integrated model with other agencies, or is it closer to the one in Doncaster?

What we have heard today contains no vision, but it does contain re-announcements of things that the Government have said before and policies stolen from the Conservative party. The Government are flagrantly unwilling to apologise for the cuts and closures that are happening in the NHS across the country because of their failed management. We have a Secretary of State who has no ideas of his own, a Government who have no chance of delivering change and a Labour party that has no hope at an election now or in the future.

That was very disappointing. The hon. Gentleman has been on the Front Bench since 2003, but nothing in his contribution takes us any further forward on health policies.

Let me deal with the first point, because it shows how pathetic the Opposition are getting. We have heard criticisms, the first of which was that we brought the Darzi report forward—another was that the Prime Minister opened a hospital twice. On the first point, I must point out to the hon. Gentleman that on 4 July I said in this House that Darzi’s interim report would be presented in three months—it was presented on 4 October, which was exactly three months later—and that it would come before the comprehensive spending review.

On the hospital, I must admit that I was rather crushed when I visited that splendid new facility in Basildon, of which we should all be proud, where some £60 million has been invested in cardiothoracic surgery. It was so exciting that I asked whether I could open it. I was told by the people running it, “No, we have asked the Prime Minister or the Queen to do it.” That put me in my place. Indeed, they wrote in early July to ask the Prime Minister to open it in October. Unless the Conservative party has been so long out of government that they have forgotten that many buildings open and then are officially opened some time afterwards, it is a strange

The hon. Gentleman asks me to say something of substance. Well, I could mention the new community hospital being built in Beverley, which he curiously never mentions in any debate on health.

The hon. Member for South Cambridgeshire (Mr. Lansley) also said that we have somehow abandoned choice and abandoned new providers. The Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw), has been talking all morning to the independent sector about precisely the announcement that I have made about introducing these new, state-of-the-art facilities, which will be open from 8 am to 8 pm, seven days a week, into 150 PCTs around the country. We are talking to the independent sector all the time. I have made it clear in the House that we will judge the use of the independent sector on whether it can add to capacity, whether it provides value for money and whether it can improve the service.

The hon. Member for South Cambridgeshire also mentioned Wanless. I shall make it clear what his report said:

“The funding increase has helped to deliver some clear and notable improvements–more staff and equipment; improved infrastructure; significantly reduced waiting times and better access to care; and improved care in coronary heart disease, cancer, stroke and mental health.”

Wanless also says that

“the direction of health care policy now being pursued by the government”


“correct to address the key challenges identified in the 2002 review.”

For good measure, he said:

“The NHS is now in better shape than in 2002 to deliver improved quality and increased productivity”.

I will swap Wanless quotes all day.

The hon. Gentleman also raised an important point of substance on productivity, which I mentioned in my statement. I said how difficult this issue was and that we have made modest gains over the past year. As he well knows, the difficulty is that people can examine two calculations. One can show that productivity has declined by 7 per cent. since 2002 and the other can show that it has increased by 8 per cent. The problem is how one defines quality of care when examining productivity. GPs now spend four minutes more with each patient than they did in the early ’90s. The onus must be on spending more time and personalising care. The National Audit Office and others have found it almost impossible to define how one puts quality into productivity considerations. That is the dilemma. It is not that NHS staff are not working hard and doing their best: it is about how we reflect that in the statistics.

The hon. Gentleman also talks about the 4 per cent. real-terms increase. This is an amazing continuation of record investment in the NHS. It is a 4 per cent. increase on forecast spend in this year. He promises to match it, and he also suggests that the Conservatives will go further on social care. That will just add to their black hole problem. Incidentally, the most recent document that I have read on their policies in this area contained just one sentence on social care.

We are saying that the 2006 Wanless report was a very important contribution. We need to move forward on it now, because Wanless made some important points, not least of which concerned the need for a partnership to cope with social care. He was examining how we provide proper social care in 2026.

Our self-regard increases all the time as the Opposition nick our policies, but let us get this straight. They have now signed up to the NHS funded by the taxpayer. The patient passport, which was their policy, has gone. They have signed up to the idea of the NHS 60 years after we created it, having opposed it bitterly when it was introduced. They have signed up to the 10 core principles of the NHS plan, which we introduced in 2000 and they opposed. They have just come round to signing up to the spending commitments that we agreed in 2004. Accusing us of nicking their policies is rather rich coming from a party that has decided at last that it cares about the NHS. The public will see through that.

I welcome my right hon. Friend’s statement and its implications, particularly the £250 million access fund to open up another 100 GP practices in areas where there are great health inequalities. That is not rocket science, yet for 60 years areas of the country have had high ill-health indices and high levels of health inequalities, but have not had the high levels of activity in the national health service that there should have been. Patient-GP ratios are a simple measure showing where we should be working. In some areas those ratios are far too high. I welcome the Government’s revolutionary initiative. To say that it is not new is nonsense—it is new, and it is welcomed by those who represent areas such as mine.

Order. The right hon. Member for Rother Valley (Mr. Barron) did not ask a question. So far there have not been many questions. Perhaps we can have questions from now on.

One thing that cannot be denied is the enormous contribution that my right hon. Friend has made over a number of years. He will remember the Black report, which was commissioned under a Thatcher Government to look at health inequalities. It was published on a bank holiday Monday, 260 copies were produced and it disappeared without trace. The Conservatives did nothing about health inequalities, apart from worsen the situation.

My right hon. Friend is right. The Opposition say that there is nothing of substance in the statement. However, we have announced £170 million to be spent on psychological therapy services, £270 million on health care-acquired infections, £250 million on access, part of which is for the crucial 25 per cent. of PCTs with the least provision, and £100 million on innovation. That is not bad for a seven-minute statement.

I thank the Secretary of State for early sight of the statement. In his response to the hon. Member for South Cambridgeshire (Mr. Lansley), he referred to the fact that he had delivered the interim report exactly three months after he had promised to do so, which was before the summer recess. That must be the first time ever that a Government report has been published on time. I congratulate the right hon. Gentleman on his impeccable timing.

I start by acknowledging the good things in the report. We warmly welcome the extra investment in psychological therapies, which is long overdue. There are many people languishing on incapacity benefit who could be helped back to work but who are not getting the help that they need. I also welcome the announcement on screening for hospital-acquired infections—a necessary change. I hope the Secretary of State agrees that there should be a zero tolerance of low hygiene standards, following the Dutch example, which nails down the standards expected in hospitals.

I welcome the greater flexibility in accessing GPs and the focus on securing more access to GPs in the most deprived communities. The fact that people in those communities have poorer access to primary care is wholly unacceptable. If the proposal starts to address that, it is a good thing. The statement refers to local accountability. For a long time the Government have used the rhetoric of local accountability, but what does it mean? Will there be any substance to the assertion that it is important to listen to local communities and that they should have a say, rather than just staff having a say, important as that is? Innovation and spreading best practice are clearly good things. Is it right, though, to set up another quango to deliver them? Is that necessarily the best way of achieving the aim? How will it sit alongside the National Institute for Health and Clinical Excellence, which already does work in this area?

The statement gives little attention to care for elderly people—[Interruption.] The Secretary of State laughs, but this is an important issue. Is not Niall Dickson of the King’s Fund right that the failure to support frail and vulnerable older people is one of the unrecognised scandals of our time? Although I welcome the tentative step towards some sort of resolution, is not the issue far more urgent than the Government acknowledge? The royal commission in 1999 recommended free personal care. The Liberal Democrats forced such a provision through in Scotland, and we want people in the rest of the UK to benefit in the way that people in Scotland already do. [Interruption.] The Tories scoff, but it is a question of priorities. They prefer to give tax cuts of £300,000 to millionaires. We think that people who lose everything when a loved one develops dementia are a greater priority. Does the Secretary of State acknowledge that the Joseph Rowntree Foundation found that in Scotland there is more care as a result of the introduction of free personal care, more innovation in services and public support for the policy in Scotland some years after it was introduced? Is not the truth that the funding of social care—care for the elderly—continues to lag scandalously behind other funding?

The pre-Budget report highlights the fact that there is a 4 per cent. increase in NHS funding, which is absolutely necessary, but just a 1 per cent. increase for social care provided by local authorities. What is the justification for care for the elderly having such a low priority in the overall funding settlement? In the Department’s budget for social care initiatives, why do we have to wait until 2010-11 before the bulk of the extra funding comes through, with very little extra funding next year or the year after? Is not the reality that social care continues to be cut and that yesterday’s statement will do nothing to change that?

Is it right that there should have been a 25 per cent. drop in households receiving domiciliary care in the past 10 years? The criteria tightened massively so that only the most urgent cases receive support, and charges were massively increased for people needing care in their own home. Is that not unacceptable treatment of elderly people? Why will we have to wait an interminable length of time before any reforms come in? Will the review include respite care? When I spoke to carers last week, they made it clear that their top priority was gaining access to respite care, which is unavailable to many people in many parts of the country.

What is the timing of the review? When will concrete proposals be introduced and will the review be given priority? Is there any real hope of reform, given that public finances are much tighter? Why, when yesterday’s statement perpetuated the funding crisis for elderly care, should we have any confidence that the Government are genuinely committed to badly needed reform?

I thank the hon. Gentleman for congratulating us on probably the only report delivered on time. We should proceed on that basis in future.

On the question of how we develop the psychotherapy proposals, we are running trials, and we will extend the pilots to inform the way in which we introduce the measures. The aim is to provide a groundbreaking network right across the country, which will be set up during the comprehensive spending review period.

In a balanced contribution, the hon. Gentleman’s other positive point—I will address his criticisms in a moment—concerned the introduction of pre-screening across the health service. In the Netherlands, the incidence of MRSA was reduced to 1 per cent. over a long period, and one of the biggest factors was the introduction of pre-screening everywhere. As the hon. Member for South Cambridgeshire mentioned, many hospitals pre-screen for elective surgery, but the introduction of pre-screening for emergency care requires isolation facilities. Reducing the length of the testing process, which is between 24 and 48 hours, is important. New technologies will allow us to do that and open up a new war against MRSA.

The hon. Gentleman made an important point about local accountability. If politicians are removed from the process of reconfiguration, it will be clinically led. I have removed myself, so if a case is passed to me, I will pass it to the independent reconfiguration panel, which is clinically led. If that is to become a permanent arrangement, which is what Lord Darzi is considering, we need proper local accountability in the system. The hon. Gentleman is right that we should listen to local communities, and that will be a big part of Lord Darzi’s final piece of work heading towards the report next year.

On innovation, a quango will not be involved. I understand the point about the other initiatives and NICE, but the organisations involved have welcomed the setting up of the innovation council, because, as I said in my statement, a lot is happening on development. There is no overarching view, which is what the innovation council will bring. The Wellcome Trust is enthusiastic, and I think that the scheme has achieved widespread buy-in. I assure the hon. Gentleman that there is no danger of duplication.

The hon. Gentleman made a long contribution, and I am trying to respond to the issues he raised. In his criticisms, he stated that we should go down the Scottish route and provide free care for the elderly, but that is not what the Wanless report states. The hon. Gentleman is sitting close to the hon. Member for Romsey (Sandra Gidley), who is a Front-Bench health spokesperson and who said in the House that she regretted the fact that her party’s manifesto had misled people to believe that care could be free. There is a disagreement not only between the hon. Gentleman and Wanless, but between the hon. Gentleman and the person who is two seats away from him.

It is not only unaffordable. In Scotland, the cap on payments is £214 a week, and the average cost of health care is £217 more than that. The majority of people in Scotland pay for health care for the elderly, which is why Wanless examined an affordable and sustainable solution.

I have detained the House far too long. The hon. Gentleman has raised some important points, which we will debate at length at some stage. However, he should have welcomed the whole statement rather than some of it.

May I tell my right hon. Friend how much I welcome the visionary decision to put £170 million of new money into psychological services? Mental health trusts in Derby city and Derbyshire serve patients who in some cases have waited two years to access those services. Where will we get the clinicians, psychiatrists and therapists? Furtherthermore, there are serious organisational deficiencies around the country in how services are provided, not least in Derbyshire.

My hon. Friend is right about the urgent need to introduce such services. We made that manifesto commitment in 2005 and examined some pilots. We must secure the resources and tackle the organisational problems that my hon. Friend rightly raised. We do not intend to wait for the end of the three-year period, and we will immediately start to recruit extra staff and set up centres across the country to allow us to deal with the 900,000 people who are just offered drugs, when many of them would find therapy far more effective.

During the recess, I became involved in the case of an elderly, retired farmer living in a rural area who was terminally ill—he was on both morphine and oxygen. I was incensed that the local PCT would not provide continuing health care—free care at home—for my terminally ill constituent. Social services found it extremely difficult to provide any form of care at home, and the family had to carry an unfair burden. Must not the Government and the national health service address such cases? That man, who was dying, deserved free care so that he could die with dignity.

If the hon. Gentleman writes to me about that case, I will look into it. We issued new guidance on 1 October, because, as he rightly pointed out, the issue is important. This is a dreadful American phrase, but the NHS was not particularly good at “end-of-life issues”—indeed, there was an element of postcode lottery. The hospices were set up to counter the fact that the NHS was not concentrating on that issue as much as it should have done, but the situation is changing. One of Lord Darzi’s clinical review groups is considering that issue, and Lord Darzi will report on it next year. The guidance that we issued on 1 October was meant to address some of the points raised by the hon. Gentleman. The case that he described may have occurred in the recess before 1 October, but I want to look into it, because I agree that it is unacceptable.

May I tell my right hon. Friend how much I welcome the statement and everything that it does to tackle health inequalities, particularly in areas such as Stoke-on-Trent? Last week, I visited North Staffordshire Carers Association, and I am sure that it will welcome the extra £190 million that will be available nationally. The real issue, which Opposition Members have raised, concerns social care and the Green Paper. Will my right hon. Friend hold urgent talks with the Alzheimer’s Society on how we can ensure that the radical rethink will enable all the people who need extra social care to be treated with dignity?

My hon. Friend is right to raise that important issue. In the spring, we will publish our new deal for carers. I recently attended a reception in Bournemouth, where all the charity organisations and voluntary groups were enormously excited about the level of consultation on the new strategy. We have a new approach to dementia, which we need to tackle more intensively. Along with many other mental health problems, it is an important issue, but it has not been at the top of the agenda—in some cases, it was not even considered important, although it is the single biggest cause of ill health in this country.

Will the Secretary of State accept that more deaths result from preventable venous thrombosis in hospitalised patients than from MRSA? Does he support measures to make risk assessment mandatory, which would result in wider prevention?

Lord Darzi is considering that specific issue. Indeed, I believe that he recently spoke to the hon. Gentleman.

If Lord Darzi has not done so, he will be in touch soon, because he wants to talk to all the members of the Health Committee. We have an enormous amount in common on that issue—whether we can proceed as quickly as the hon. Gentleman would like is another thing—and I think that that conversation should take place.

It is great news that the Government are investing much more in psychological therapies, which is surely an example of spending to save. However, if we are not going the full hog and adopting the recommendations of the royal commission, why are we waiting to implement the reforms on social care recommended by Wanless? I know that that would cost money, but yesterday the Government found money to help the winners in the lottery of life—those who will not develop dementia or other conditions that require long-term care and who have assets in excess of £350,000. Does my right hon. Friend agree that a Labour Government should give priority to the losers in the lottery of life who develop such conditions, end up having to sell their homes and have no inheritance tax for the Government to take?

Wanless was considering a vision for social care in 2026. His report came out in 2006. We need to appraise it, and achieve close integration between Government Departments before we can begin the debate with a Green Paper. That does not mean that nothing will happen on social care between now and the publication of the Green Paper—and the debate on it. For a start, there has been a 39 per cent. real-terms increase in the money invested in social care since 1997. Secondly, a concentration on individual budgets and individualisation is being led by authorities around the country. Recently, I was in Barnsley, where terrific things are being done. The settlement will allow us to move that forward.

The situation is much like that relating to pensions a few years ago. We need cross-party consensus, because we are looking towards 2026. It does not have to be done this way, but we need a Turner report on social care that can cross boundaries that have never been crossed before. The NHS has never provided social care free of charge; it did not do so under Nye Bevan, and it does not do so now.

Will the Secretary of State reflect on the false economy of removing fundamental services across health and social care and on its consequences? This week, a report from Age Concern about the consequences of the removal of chiropody services on the frail elderly was published. If people cannot cut their own toenails—a pretty basic thing—and have no one to do it for them, they may fall over trying to do it themselves, which can be life threatening. They become less mobile. I hope that the Secretary of State will take account of that sort of thing, at that very basic level, as he seeks to improve services.

As always, the hon. Lady makes a sensible and pertinent point. Incidentally, Help the Aged has welcomed our commitment to a Green Paper and is part of the consensus on the need to discuss Wanless seriously, as grown-up politicians, and find agreement. The very point that she raised is why the issue is so important, because we now find in some areas that only those in need of the most desperate care are provided with help. People with serious needs, such as the elderly person mentioned by the hon. Lady, find that their services have been cut, and we need to address that. As Wanless pointed out, the cost of doing so effectively for everyone—given an ageing population, demographic change and all the other things that we know about—would take up the whole pot of public money. We will have to find a solution that is different from the one found in Scotland.

I welcome my right hon. Friend’s comments about spreading new technologies and best practice, and I urge him to ignore the sniping of the hon. Member for South Cambridgeshire (Mr. Lansley) about the connecting for health programme. I used the recess as an opportunity to see the photo electron and x-ray—PAX—digital programme at Ipswich hospital, which is absolutely fantastic. It delivers improved diagnostic imaging, which elicited unrequested congratulations from members of staff on the quality of the investment that the Labour Government have made in the PAX programme and on the benefits to them and their patients, as well as the savings—

Order. The hon. Gentleman and other hon. Members should be putting questions. The hon. Gentleman can write to the Secretary of State and tell him what he did during the recess.

The question was about whether I agreed that lots of good things were happening in new technology in the NHS, and I am happy to say yes.

Why was there an important omission from the statement? Will the Secretary of State confirm that the GPs in all the new medical centres that he proudly announced will be free to prescribe what they consider the most appropriate and best medication for patients with conditions such as Alzheimer’s and age-related macular degeneration? There should be not only social equity but health equity between some of the most vulnerable and elderly people in England and their counterparts in Scotland and Wales.

Well, I can happily say that I am not prepared to go back to those days. One of the world-class features of our NHS system that people around the world try to imitate is NICE. For the first time we have a system under which it is compulsory for all parts of the NHS to offer a drug, provided that it has been approved by NICE, which was a huge step forward. We could not go back to the days when it was up to a GP to decide such things, without a proper clinical examination.

I welcome the announcement of additional funding for social care and a radical rethink in social care. However, as well as being radical, will the rethink be careful? Vulnerable adults and frail elderly people are already anxious about the services that they receive. They need reassurance that they will continue to receive support. They also need reassurance that their voices will be heard in any development of new services.

My hon. Friend is right. As I mentioned earlier, tackling the Green Paper does not mean that everything goes on hold. That additional funding is another real-terms increase on top of the 39 per cent. real-terms increase in social care. It is a combination of the funding from the Department of Health and from the Department for Communities and Local Government that goes to local government. That funding will result in far greater independence for the vulnerable people whom my hon. Friend mentioned.

May I tease out the limits—if there are any—to what the Secretary of State described in his statement as the matching of local ownership and greater local accountability in Lord Darzi’s work? I am thinking especially of the integration of all health care with social care. Would the Secretary of State be prepared, for example, to consider local authorities taking on entirely decision making and budgetary control from PCTs?

“Steady as we go”, is the answer to that question. I am not yet able to say that we are getting to that position. However, in many local authority areas somebody from local government is on the PCT, so there is far greater integration. I do not know whether that is the final solution to the issue. I accept that I do not have the solution; I just know that Darzi’s work is important to ensure local accountability. Otherwise if we remove politicians at national level and there is no increased accountability further down the system there will be a gaping hole. That is where the accountability needs to be. We need to talk the issues through, and I am sure that the hon. Gentleman will make an important contribution to that debate.

Does the Secretary of State agree that the £250 million access fund, which will deliver 100 new GP practices, and the establishment of 150 new GP-run health centres, are nothing but good news for areas such as County Durham and for my constituents in Sedgefield? Will he meet me to see how best to implement those changes in Sedgefield, where health centre provision has been an issue?

Following the recent by-election, I know the constituency of Sedgefield. Those provisions will specifically help areas such as Sedgefield and others such as my constituency in Hull which have been under-doctored and have been for many years.

For GP practices in the 25 per cent. of areas that are most poorly provided for, the statement unleashes 900 staff—doctors, nurses, health professionals, health visitors and community nurses—into the most deprived areas in our country, giving the very best services to areas that previously had the worst. I will happily talk to my hon. Friend about how that is being implemented in his constituency.

Does the Secretary of State recognise that although the title of his statement is “Health and Social Care”, only 12 words in it were about the major providers of social care in this country—local authorities? Does he recognise that they are spending billions over their standard spending assessment on social services, withdrawing preventive work, intervening only in life-threatening cases, pushing up charges and piling pressure on the council tax? Would it not have been better to share the proceeds of growth more evenly between the national health service and social services?

Lots of the money that we provide through the NHS will provide greater resources. I am not a representative of the Department for Communities and Local Government, but we will have an opportunity to talk about that issue.

The right hon. Gentleman is absolutely right about local authorities, which, incidentally, will have ring fencing removed as part of the settlement to give them greater freedom to spend money on priorities. That could well mean spending much more on social care. The problem that he identifies is how we keep that contribution sustainable, as the hon. Member for Tiverton and Honiton (Angela Browning) said, so that an increasing elderly population receive better care services than they do at the moment. [Interruption.] It is a question not just of putting in better resources, but of dealing with the whole organisation and, as the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis) says from a sedentary position, of the better use of existing resources. That can be done and some local authorities are doing it brilliantly. We need to spread that best practice more widely.


Microgeneration and Local Energy

Dr. Alan Whitehead, supported by John Austin, Lorely Burt, Colin Challen, Mr. David Chaytor, Mr. David Drew, Dr. Ian Gibson, Julia Goldsworthy, Chris Huhne, Alan Simpson, David Taylor and Mr. Mike Weir, presented a Bill to make further provision in relation to microgeneration; to promote local energy provision and energy efficiency; and for connected purposes.: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed. [Bill 155].

Fixed Term Parliaments

David Howarth, supported by Mr. David Heath, Simon Hughes, Chris Huhne, Danny Alexander, Lynne Featherstone, Paul Rowen, Mr. Paul Burstow, Mr. Nick Clegg and Norman Baker, presented a Bill to fix the date of the next general election and all subsequent general elections; to forbid the dissolution of Parliament otherwise than in accordance with this Act; to allow the House of Commons to change the day of the week on which a general election is held; and for connected purposes.: And the same was read the First time; and ordered to be read a Second time on Friday 19 October, and to be printed. [Bill 157].