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Westminster Hall

Volume 465: debated on Tuesday 23 October 2007

Westminster Hall

Tuesday 23 October 2007

[Mr. Bill Olner in the Chair]

Social Care Services

Motion made, and Question proposed, That the sitting be now adjourned.—[Siobhain McDonagh.]

Before I call the hon. Member for Romsey (Sandra Gidley), I should say that a few Members have indicated their wish to speak, and I should like to bring in everyone if I can, so I ask those who participate to make their remarks clear and succinct.

I welcome the opportunity to discuss this important subject. I was moved to apply to debate the issue following the comprehensive spending review, but this is not a new issue—the hon. Member for Wyre Forest (Dr. Taylor) told me that he has been trying to secure a debate on it for some months.

A welcome 4 per cent. increase for health was announced in the CSR, which builds on the welcome investment of previous years. However, unfortunately, the settlement for local government, which is responsible for providing social care, was less rosy. The Secretary of State for Health provided further details in a recent statement to the House. He told us that the social care settlement is divided in two—the local government grant and direct Department of Health funding targeted at social care. The local government support grant will increase by £2.6 billion by 2010-11, but the Local Government Association estimated that it will cost an additional £2.682 billion simply to provide care for the increasing numbers of older people in the next three years. It also raised concerns that the additional funding could be taken up entirely by social care, despite the fact that many other services funded by the general grant are subject to financial pressures.

Direct funding from the Department will increase by an average of 2.3 per cent. a year to fund carers and the social care work force, but that funding is based on the idea that the situation will stand still. The LGA believes that the increases will not enable local authorities to meet the budget pressures that they anticipate for 2009. One south-east council claimed that, as a result of demographic and other pressures, expenditure will need to rise by 4.6 per cent. in real terms if services are not to be cut. That is a much greater increase than the CSR settlement allows for, however we might dress it up.

Many organisations have reacted angrily. Help the Aged claimed that there is not enough money in the Chancellor’s provisions to take account of the growing needs of an ageing population. It also said that the settlement grant increase will be less than 1 per cent. in future years, and that that is below the growth rate of the vulnerable population and the likely rate of inflation in the cost of providing care.

I am delighted that we are debating this matter, but will the hon. Lady make it clear, and put on the record, whether the Liberal Democrats would be committed to spending more money on social care than is spent at the moment and where she would expect any increase to come from?

It is mischievous of the Minister to attempt to deflect the point. I am raising a serious point about the relative balance of money between health and social care. [Interruption.] If the Minister listened to my whole speech, he would hear some suggestions towards the end.

Age Concern has said that the increase in investment will

“allow the current system to creak on in the short term”.

It is interesting that both France and Germany spend more than double the amount spent by the Government on care for older people. The relatively lowly settlement has come against a background of significant pressures on social care. The Wanless social care review identified considerable funding shortfalls in the current system if it is to meet people’s needs and forecast increasing needs in social care in the next 10 years, which will come as no surprise to anybody.

There have been significant pressures on social care services. The minimum wage, for example, caused cost pressures a few years ago, although I do not begrudge care workers the minimum wage; in fact, it is scandalous that some are paid so little for their valuable work. However, there is an increasing demand for more expensive, intensive care services, and the age of the population is increasing and more people are living longer. As a result, councils are left with some tough choices.

The biggest inequity surrounds the phenomenon of eligibility criteria. People might say that health care provision is a postcode lottery, but the biggest lottery in Britain is the postcode lottery for social care provision. Simply put, access to care depends on where a person lives, their income and their local authority’s charging policy and eligibility criteria.

People’s needs might be broadly categorised as critical, substantial, moderate or low. Local authorities must now ration care provision by raising the eligibility criteria. Despite the rising numbers of older people, the number of households that receive domiciliary care services has fallen by more than a quarter in the past 10 years. The LGA predicted that, by 2009, not a single local authority in the country will provide care for those with moderate needs. Many councils have already tightened their criteria and now meet only critical needs.

Services are also means-tested, and there have been steep increases in charges for people who access them. A Counsel and Care survey backed that up. It is almost impossible for older people to access support in the community if their needs are not severe. Two thirds of local authorities fund only substantial or critical needs, and Counsel and Care believes that the number of councils that restrict services in such a way will increase.

In 2007-08, 15 per cent. of local authorities further raised their thresholds and not a single authority has extended its criteria to become more flexible. Only 16 per cent. of local authorities continue to offer support services for older people with moderate needs, compared with a third as recently as 2006. Yet more worryingly, 12 per cent. of local councils provide support only for older people with the most acute critical needs. Liberal Democrat research corroborates those statistics. We found that almost one in five councils has increased provision in higher-level categories since 2003.

Low-level social care is a thing of the past—the number of households that receive low-level care has decreased dramatically. As a consequence of the fact that care is delivered to fewer households, the proportion of households that receive only one weekly visit of two or fewer hours has dramatically decreased from 42 per cent. in 1992 to 17 per cent. in 2002—the latest year for which we could find figures. The funding of low-level care needs might be a cost-cutting measure in the short term, but it could store up problems for the future—it might benefit the state if a person is happy to stay at home.

Supposedly, the thrust of Government policy has been to treat people in their homes, which, for many, is a welcome approach. However, people often get to the stage at which they need help with some practical matters if only to keep on top of things. If a person does not feel that they are on top of the upkeep of their garden, for instance, and that they cannot manage as well as they might, they might become depressed and their mental health might suffer.

As the older person is not coping, there is a risk that they will become institutionalised at an earlier stage. Research has backed that up; it is not some wild theory that I keep expounding. Age Concern and Help the Aged have done quite a lot of research to examine the impact of withdrawing the type of service that I have described, and it has shown that continued independence can increase an individual’s life expectancy and reduces the number of days spent in an acute setting or a care home.

Pressures have been even more acute over the past year, as NHS financial pressures have had a knock-on effect on social services. Even though the Government have tried to tighten up the continuing care criteria, there are still far too many cases in which there is an unseemly tug of funding between the health and the social care services. There is a feeling in many county councils that they had to take an unfair share of the burden last year and were funding services that should have been paid for by the health service.

In Hampshire, we faced particularly acute pressures. I have talked to officers in the social care services at the county council, who said, “Somebody had to pick up the bill for these people. We couldn’t go on arguing, but we feel that we ended up bailing out the health service and spending money that we didn’t really have.”

How is all this working in practice throughout the country? In Hampshire, there was at one stage a proposal to restrict the eligibility criteria to critical and substantial needs. Understandably, that caused an outcry, and the council thought again about whether there was another way of doing it. It was portrayed in some ways as though things were then fine and those needs were being funded; but in practice, many people who had had a care package for some time suddenly found that they were reviewed. A stream of people came to my constituency surgery. They had had packages that fitted their lifestyle and seemed to help, but for no reason that they could understand, part of that package was withdrawn. I do not know whether other Hampshire MPs had similar experiences, but those people all came forward at once, and it seemed to be part of an overall picture. The good news was that everyone still seemed to get something, but clearly it was hard for those who had to take a cut in services and share the pain.

I shall cite a few examples of other parts of the country where similar things have happened. In Stockport, it has been estimated that, by 2020, 27 per cent. of the population will be over 85 and a further 21 per cent. will be over 65. Stockport has estimated that it provides some sort of support for one in four of the over-65s and for half the over-85s, so more rapid growth in the number of over-85s will have a disproportionate effect on the budget. Stockport also cited an increased demand for funding by people with learning disabilities and estimated the inflation uplift for the private sector to be 5 per cent. Again, the settlement will not cover that.

People in Bristol highlighted the fact that this is not just about elderly care. One of their huge pressures came from adults with learning difficulties transferring from school. Transitions were not being fully funded, which meant that an extra £500,000 had to be spent on top of other financial pressures. Bristol also raised the issue of supporting people. That was one of the Government’s better ideas. It has been rather depressing and demoralising to see the funding for supporting people cut in recent years, so that people find it much more difficult to access support services. In Bristol, the budget has been cut by £3 million in two years—it is now £27 million—and the belief is that it will be further cut to £19 million.

In the royal borough of Windsor and Maidenhead, referrals for social care increased by 20 per cent. in 2005-06. Not only did that put extreme strain on the system, but the nightmare was exacerbated by the closure of 54 beds in local hospitals. We just cannot separate health and social care as we go into the future, because increasingly any changes in health services are having a significant impact on social care.

Somerset highlighted the problems with the number of people with learning disability increasing. It estimated that the rate of increase was about 35 people a year. That may not sound very much, but it equates to an extra £1 million a year having to be found.

This is not just about adult services; there are problems in children’s social care, too. There is an increase in the number of children with complex needs, set against the overall context of a falling population of children and young people. Nationally, the prevalence of severe and complex disabilities among children aged five to 14 is projected to increase from 0.4 per cent. in 2001 to 0.76 per cent. by 2011. We are talking about children with very complex needs requiring very expensive and detailed care packages.

Wherever we look in the country, councils are highlighting a picture of overspend, health pressures and increasing financial pressures. The overspend is not occurring because councils are out of control; they have never had a better grasp on where the money is going and what the future demands will be.

I want briefly to mention failings in the way in which local authorities fund care homes. Local authorities are supposed to pay the going rate for care, but the going rate in many areas is significantly lower than the actual price of virtually all the care homes in the area. That is particularly so in my part of the country. Relatives are therefore routinely expected to make a top-up payment to fund the difference between what the local authority will pay and the actual rate. We have the perverse situation locally in which Southampton and Hampshire pay different amounts for care homes and nursing homes, so people in adjacent rooms in a home may be funded differently. That makes a mockery of the system.

In other cases, people did not need a top-up when they entered the home, but because local authorities have not increased fees in line with inflation, the homes often have no choice but to start charging a top-up. That is an increasing phenomenon and there is a perverse consequence of that underfunding. There is growing evidence that it is having a knock-on effect on those who fully fund their own care home place, as they are often charged a higher rate than people with equivalent needs who are funded by the local authority. Clearly, by any measure of fairness, that does not meet the criteria, and it desperately needs to be addressed.

Another aspect of the pressures is that carer support is being cut. Many carers say that they could cope much better and for longer if only they had a break occasionally, but respite care is often one of the first services to be axed.

A number of things clearly need to be done if we are to live in a fairer society. I contend that most councillors, whatever their political colour, want to do their best for the elderly and vulnerable people whom they represent, but that cannot be at the expense of other vital council services. We need to consider a number of issues in the longer term, set against the background of the ageing population and the increase in the number of people with complex needs. It might be helpful if the Minister, when he sums up the debate, says whether the Green Paper will address some of these issues.

The postcode lottery of eligibility criteria needs seriously to be examined. There needs to be a fully comprehensive assessment, taking into account the ageing population, the increasing numbers of adults and children with problems and the impact of housing build in an area. Often, local government settlements are on a per year percentage increase basis, and in the south of England, where we face acute pressures for housing build in the future, funding is very often not increased accordingly. That definitely needs to be considered.

The assessments should focus on the individual, not just whatever happens to be available as a care solution. Greater clarification is needed of what the NHS will pay for. I accept that the Government have made efforts in that direction, but the continuing care criteria are still far too open to individual interpretation.

We must address cross-subsidy in care homes and set a fair independent rate. The time has come for a serious look at how better to join up health and social care, so that people do not fall through the gaps but get what they need and deserve after a lifetime of paying into the system.

Order. Four Members have risen to take part in the debate. I advise again that I intend the winding-up speeches to start at about 10.25, so if Members can discipline themselves to fit into that timetable, I should appreciate it.

I congratulate the hon. Member for Romsey (Sandra Gidley) on securing this important debate. It strikes me that some of us were in this room last week debating health inequalities throughout the country, so we are clearly on a roll. Health inequalities and care inequalities are clearly foremost in our constituents’ minds, and they should therefore be foremost in MPs’ minds.

I rise not only to say well done to the Government—I do not mean that sycophantically—for their progress, but to carry out my responsibility to highlight issues about how the settlement has been allocated. We are approaching a three-year settlement, and I shall place on record for the attention of the Minister and the Government some of the issues for cities such as Salford, which is in my constituency.

“We are facing unprecedented demographic change in this country, in common with other western societies. For the first time, this year there are more people aged 65 and over than 18 and under. We are also facing a steadily rising number of people with long-term conditions. The effects of obesity, smoking, alcohol and drug misuse, diabetes and conditions such as strokes and dementia all have an impact on individuals and families that increases their likelihood of requiring adult social care.

One of the biggest growing sectors of the population is those over 80. We know that it is older people who are the biggest users of adult social care, and particularly those aged over 70. Once people are in their 80s, the incidence of dementia steadily increases, with one in five people suffering from some form. We also know that, due to medical advances, more children and adults are surviving with multiple disabilities, requiring high levels of social care services throughout their lives. As more and more of us come into contact with social care services as users, carers or friends, relatives or neighbours, we now expect much higher-quality, flexible and individual personalised services.”

Those are not my words but the words of Anne Williams, president of the Association of Directors of Adult Social Services, in an address to the local government national children and adult services conference at Bournemouth last week. Although they are not my words, I identify with them, and I am sure that hon. Members present agree with them, too.

In her day job, Anne Williams is the excellent strategic director of community health and social care in Salford. Anne and Councillor Maureen Lea, the lead member for adult services, have assured me that relations with respective Departments are increasingly good and that partnership work with them is better than it has ever been, which is welcome. That is all the more welcome, because in Salford we start from such a low base. It is of concern that Salford is ranked 12th in the 2004 multiple index of deprivation. We are a paradox: Salford city council has been identified as one of the most improved councils in the UK, but at the same time it is struggling with the Government to build and increase care services from a low base.

Some people would call this subject boring, because we must refer to statistics, but it is important that we consider how the detail affects our constituents, so I make no apology for doing so. I shall address the issue of an ageing population. The Minister is, of course, responsible for all the areas of care, but I shall concentrate mainly on adult care today. I am sure that other hon. Members will cover the other areas.

Salford’s population is predicted to increase, and with it both the number of older people and their proportion within the population will also increase. The population is projected to increase from 215,000 in 2008 to 218,300 in 2025, and all my comments relate to those dates. During that period, the number of people who are 65-plus will increase from 33,200, or 15.44 per cent. of the population, to 37,400, or 17.13 per cent. The number of over-85s will increase from 4,300, or 2 per cent., to 5,500, or 2.52 per cent. Some may not think those figures important, but the figures represent a staggering increase of nearly 30 per cent. in our 85-plus population. The picture is similar for older middle-aged people.

The Minister has one of the most important briefs in Government. I have said that the matter is serious, but it is good to see that he has a sense of humour, notwithstanding that his comment from a sedentary position was based on fact.

The picture is similar for older middle-aged people, the percentage of whom within the population is projected to increase by 11.5 per cent. by 2025. The statistics might be dry, but they have clear implications for health and social care provision, as most needs increase with age, such as the need for sensory equipment, home care, residential care and so on. One in four people over 80 are estimated to have dementia. An ageing population will mean a shift in the type of provision needed and in the staff skills needed to deliver such care. Conversely, the number and proportion of younger adults in Salford is decreasing, which has implications for the availability of potential carers. We must pay particular attention to that. Some characteristics of an older population must be addressed.

Order. Will the hon. Gentleman please bring his comments to a conclusion in order to allow others to speak?

Mr. Olner, the statistical approach is dry, but I assure you that it is important to recognise that the change in nature of our population and its needs is happening so fast and will have such an impact that the nub of the matter must be addressed.

I welcome the announcement by my right hon. Friend the Secretary of State for Health that we will receive an extra £2.6 billion. That is welcome, but we should accept that the current settlement system is unfair and that it works against those councils with residents in most need. We in Salford wish to build on the enhanced relationship with Departments and on the excellent progress made by the city council, but we need a fairer funding system.

I accept that the Minister is sincere in his passion to do better in his brief for residents across the United Kingdom, but I hope that he recognises that the system is not yet right. I hope that the forthcoming three-year funding settlement recognises that councils such as Salford wish to deliver the services needed by families in the area in a fair way. We need to ensure that the words “social justice” mean something. I know that the Minister wishes to do that, and I hope that he and the Secretary of State will ensure that the funding system is made fairer during the three-year settlement.

It is a pleasure to follow the hon. Member for Eccles (Ian Stewart), who spoke movingly about the challenges that confront his constituents. His constituency could not be more different from mine; his is an inner-city seat in the north and I have a rural seat in the south. However, the fact that we both face the same problems makes the case that the Minister needs to answer even more powerful.

I congratulate my parliamentary neighbour, the hon. Member for Romsey (Sandra Gidley), on securing this timely debate, as it is in the shadow of comprehensive spending review 2007. For some reason, the CSR will not be debated in the House—instead, we have rather more fragmented debates in Westminster Hall—but it sets the parameter for social services expenditure over the next three years.

More than half of those hon. Members who are here took part in a similar debate earlier this year in the context of residential care. Everyone who spoke in that debate made the point that social services were under extreme pressure. The right hon. Member for Oxford, East (Mr. Smith) said of this “complex and crucial” area of care that it was

“under enormous pressure because of demand and constraints on resources even as they are increasing.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 316WH.]

My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) spoke about the problems in residential care, and my hon. Friend the Member for Eddisbury (Mr. O'Brien) spoke about the absence of a long-term strategy for funding care, a subject to which he may want to return.

In that debate, I asked for a step increase in funding for social services to eliminate its historical underfunding and a realistic baseline to be provided from which we could move forward. In his reply, the Minister—I welcome him again this morning—gently rebuked us for not noticing in the last pre-Budget report that

“the Treasury identified social care as one of the great challenges facing this country and one that we have an obligation to address.”

He went on to reassure us that

“We are arguing forcefully—I shall not reveal the details in this debate—with the Treasury about the importance of a good settlement for social care under the comprehensive spending review.”

He then said:

“We need a new deal to reflect a new settlement in the demographic realities of the 21st century.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 332-32WH.]

He was right. This morning, we have an opportunity to assess the Minister’s performance, as set out in CSR2007, against those statements.

The average real-terms increase in public spending over the next three years in the comprehensive spending review is 2.1 per cent. Against that benchmark, who are the winners and who are the losers? The biggest loser is local government, at 1 per cent., narrowly below the Home Office at 1.1 per cent. No way is that a good settlement. No way is that the new deal that the Minister held out earlier this year.

The third biggest winner, after the Department for International Development and the Cabinet Office, which are both small Departments, was NHS England. That disparity in treatment under the Government between health and social services underlines my point. Although the NHS has had a 90 per cent. increase in funding since 1997, if schools are exempted—they are now directly funded by the Government—local government has received only 14 per cent., and the largest service provided by local government is social services.

I understand the political imperatives. Ministers have direct responsibility for the NHS, whereas social services fall to local councillors. How tempting it must be for Ministers to pre-empt for themselves the lion’s share of the CSR for the services for which they are accountable and let councillors take the rap for social services. It is understandable, but it is wrong. The extra 1 per cent. for the NHS, announced with a flourish by the Chancellor a fortnight ago, should, if one believes in joined-up government, have gone to the under-funded social service authorities rather than the NHS.

Does the right hon. Gentleman not accept that his comments, pointed as they are, would be more pertinent if we were starting from now? All the statistics that I and others have cited have been built up over the past 30 years. It is important to recognise that.

I am grateful to the hon. Gentleman, who may have made a valid point. He might like to consider what happened from 1992 to 1997, and see whether there was a disparity then in the treatment of the two. I hope, in return, that he will extend the gentle criticism that I have made of his Administration, that there has been a disparity—in my view, an indefensible disparity—since 1997. Even the 4 per cent. comprehensive spending review increase for the NHS is aimed much more at hospitals than at assisting the NHS to move resources into the community. Had it been the other way around, one could have had a greater partnership with the county councils, who know the communities and have good links with them.

The Government have allowed adult services a growth of 1 per cent., but they expect councillors to increase direct payments, to invest in prevention so that people can remain independent, and to phase out the use of NHS accommodation for people with learning disabilities and to help them live independently in the community. Adult social services are struggling to cope with their current responsibilities. It seems a Herculean task to respond genuinely to the challenges that the Government have laid before them with such resources.

The Minister must know what is going to happen. As the hon. Member for Romsey said, eligibility thresholds will have to be raised, care will be rationed for the most vulnerable, preventive work will be cut back, and charges will be increased or introduced—and the council tax will take the strain. If the Minister believes that health and social services are key partners in the welfare state, he will know that they need to be given roughly comparable resources. If one needs help, one is not interested in whether it comes from social services or health; one simply wants the services to which one is entitled. Policy for the past 20 years has focused on breaking down the barriers between the two—promoting joint commissioning, joint assessment, and the rest. If they are to be key partners, they must be more equal. They both need to bring something to the table.

I shall pass over the demographic clock that is ticking in Hampshire, as it is in Eccles and elsewhere—the needs of young adults with learning disabilities coming up from children’s services demanding and expecting large care packages, and parents with offspring with a learning disability who themselves are ageing.

Consultation is about to begin on the Green Paper. It will, of course, be important, as it will offer a potential overhaul of the funding of social care. However, it will not help during the next three years of the spending review. No additional resources have been added to help with the demographic pressure and the other pressures that are on adult services nationally. My county council will get less grant than others, because it is a floor authority; it will have to make economies in other services and raise the council tax to make up the difference.

I leave the Minister with a final question. Is that it? Will there be, at some point during this Parliament, an opportunity to revisit the three-year settlement announced for social services, so that we can get them a squarer deal?

I, too, congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. It is highly significant that we have heard from right hon. and hon. Members from the north and the south; we are now bang in the middle—the midlands.

I regard such debates as an opportunity to pass on advice to Ministers. I may not have a major party to make firm plans, but I like to think that what I say is taken seriously and that it remains in their brains for the future. My interest in the subject was kindled by a meeting with the chief executive of Worcestershire county council not all that long ago, when he made the stark statement that funding social care was the major problem now facing county councils. He went on to provide some of the figures purely for Worcestershire for people who are supported to live at home. The figures from 2002-03 to 2005-06 for learning difficulties, mental health, physical disability and older people have increased by 17 per cent. In 2005-06, 12 young people were moving to adult care; in 2006-07 there were 39 and in 2007-08 there are 43.

Other hon. Members mentioned an increase in the population over 65—in my county, a 14 per cent. increase over the next five years—and talked about the reasons for that, such as increasing longevity, the complexity of problems that it brings, including an increase in disability and dementia, and the fact that young people with serious illnesses can be kept alive longer.

Hon. Members who have been around for some time, like me, will remember that NHS hospitals 20 and 30 years ago were full of long-stay beds. Quite rightly, with innovative geriatricians, long-stay beds have been cut back dramatically, but shutting those beds has passed the problem from health to social care. The Select Committee on Health report on NHS continuing care, in the parliamentary Session of 2004-05, drew attention to that in one of its recommendations when it said:

“long term care responsibilities of the NHS have reduced substantially, and people who in the past would have been cared for in NHS long stay wards are now…accommodated in nursing homes”,

which meant that there had been a shunting of the work without the funds.

Other hon. Members referred to the inequitable investment between health and social care. Although one welcomes tremendously the increase in health funding, that makes it more difficult for social services, because an increased throughput in the NHS is likely to increase the work load on social services as well.

Economies that my county council are putting in place hit older people in particular. Staffing is reduced, and the terrible vacancy factor effectively reduces staff. Things like meals on wheels and rapid response teams are being attacked. One specific example of that is the cessation of in-house benefits advice, which is being passed to citizens advice bureaux. The local authority is ceasing to pay the CAB for specialist mental health advice. That matter was brought to my attention in one of my surgeries by a mental health advice worker who pleaded on the part of one of her cases. She was speaking about an illiterate elderly gentleman looking after a schizophrenic wife at home. He could not understand the benefits and finances that he was allowed and was only managing because of the advice from this dedicated worker who will now be removed. The CAB will be lumbered with all this extra work.

I want to say a word on the Health Committee report on NHS continuing care. It contains a lot of clear recommendations, and I am delighted that one of those is that there should be clarity about NHS continuing care and NHS-funded nursing care. The national framework certainly addresses that, but, sadly, there has been no change as far as we can see in the Government’s thinking about the unification of health and social care. One comment in the summary of the Health Committee report said:

“The artificial barriers between health and social care lie at the heart of the problems surrounding access to continuing care funding. It will be impossible to resolve these problems without first establishing a fully integrated health and social care system.”

At that time, the Government kicked that firmly into touch and responded as follows:

“The divide between health and social care provision, and the basis on which it is provided, has stood since 1948. To dismantle this would be a fundamental and costly change to the structure of the welfare state, which would go well beyond the scope of this inquiry.”

The Government seem to be pretty good at reorganising the health service and I would like to think that this matter will be mentioned in the Green Paper because it would make a huge difference.

We must continue to look for economies. I was delighted when the Secretary of State for Health remarked in one statement that the NHS better care, better value indicators were already producing some economies. The Disability Rights Commission feels that direct payments would be more efficient and better. With the health and social care regulator coming together, links forming across health and social care, and public health doctors being shared between health and social care, surely there is a move towards combining these things.

Finally, if one were to address health care rationing, which lots of people would like us to do, many people would think that cradle-to-grave care is one thing that should be funded, if we can make the economies on some of the unnecessary things by cutting them out with rationing.

It is a pleasure to discuss the funding of social care, which we did as recently as January. Many hon. Members who are in the Chamber today spoke then, as my right hon. Friend the Member for North-West Hampshire (Sir George Young) said. He put his finger on the central point, which is ensuring that the Government deliver on social care in the way that the Minister promised he would in January. It is worth repeating his words then, because I hope that he will address the matter. He said that he would be

“arguing forcefully”


“the importance of a good settlement for social care under the comprehensive spending review.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 331WH.]

The question today, which has come from hon. Members from all parties, is whether a comprehensive spending review settlement that sees increases in social care spending that are actually a full 50 per cent. below the average across all government spending, as my right hon. Friend pointed out, and a full 3 per cent. less than the real increase in health care, in any way constitutes a decent and proper settlement for social care, given the pressures itemised by so many hon. Members today and on previous occasions. That is the nub of the issue, which I hope the Minister will address. I do not believe that that is a decent settlement.

My right hon. Friend made a persuasive argument as to why Ministers would separate social care, which is not their direct responsibility, from health care, which is, leading to a grossly disproportionate settlement on each despite the pressures on social care spending.

If the Minister would like to intervene, I would be happy to give way. He is normally quick to do so.

I have two important things to say to the hon. Gentleman. First, for 18 years, was there not a separation of the amount of money that was announced for the NHS, vis-à-vis social care? Secondly, is his party committed to spending more money on social care than this Government have over the next three years, and, if it is, where is that money coming from?

The Minister has one admirable quality, in many areas, and that is consistency. The Conservative party has not run the country for the past 10 years. With respect to the hon. Member for Eccles (Ian Stewart), who mentioned the fact that the basic system was set decades ago, this comprehensive spending review offered the opportunity, with the increase in spending by the Government, to set priorities between social care and health. What have the Government decided to do? This Minister, who promised in this Chamber in January that he would fight for a fair settlement for social care, has delivered a woefully inadequate settlement for social care, which is compounding the situation, where there have been increases in the thresholds for access to care.

Another key question to which I hope that the Minister will return is his assessment of the raising of the thresholds of access to social care. In the east riding, the fear and the feeling is that we will move to a stage where the only people who receive support from adult social care will be those in care homes and those at the most severe end of the critical band. That is the position that we are looking forward to, and it is the direct human result of the failure of the Minister to honour the promise that he made in this Chamber to get a fair deal for social care. If he does not accept the analysis of my right hon. Friend of why that failure has occurred, we need him to explain why it has happened, and not to make party political points about the past and the separation. They might have been in separate strands, but I believe it is fair to say that such a discrepancy between health and social care at a time of such need has not been seen before.

I shall do so in a moment.

That has been in the context of how the Government have moved forward the policy agenda, in a way that has had broad support across the House, towards merging health and social care. They have taken forward the agenda, and I am happy to congratulate them on doing so, if the Minister is so desperate to have partisan point scoring and credit given. With the support of the Opposition, they have moved forward an agenda of integrating health and social care for exactly the reasons mentioned by my right hon. Friend: people should be able to access services in a seamless way that does not differentiate artificially because of departmental boundaries. We have supported that move and it is in that context that we have the discrepancy in funding between social care and health, and that becomes hard to justify, although we look forward to hearing from the Minister.

It is a bit rich of the hon. Gentleman to accuse others of party political point scoring. He just gave a tour de force in party politics and diminishes the argument for me. Does he not accept that we can acknowledge points in time during the process that have led to the situation in which we find ourselves, which most of us would like to see changed? The single biggest effect in my city of Salford was when a Conservative Government transferred care from the health service into the community. They did not set the structure up right, and we are now addressing that.

The hon. Gentleman has had more than his share. He does not seem to have understood—or will not acknowledge—that the comprehensive spending review offers the opportunity to make a shift, or at least to ensure that social care gets the funding that it needs within an integrated health and social care system. That has failed to be done. That is not the fault of a Conservative Government that was last in power 10 years ago, or some other Government four decades ago. The opportunity was there for this Minister to deliver on his promise made in this Chamber earlier this year to get a fair funding settlement for social care. This Minister, this Chancellor of the Exchequer and this Prime Minister have failed to deliver on that, although the opportunity was there.

East Riding of Yorkshire council has been recognised as the top local authority in the country for its stewarding of financial resources. It has demonstrated its commitment to investing in adult social care services with a 6.6 per cent. increase in the adult services budget for 2007-08, significantly higher than most other council services. It has done so because of its commitment—a commitment that I wish that we could see from the Minister—to ensuring decent social care services.

Despite that increase, what is the situation in social care in our area? Because of the increase in the over-85 population in the east riding, which is an increase of more than 400 per annum over a six-year period, the council has had to conduct a review and has decided to remove provision for those with moderate needs. It has also had to put substantial needs into two bands and only those in the upper band will now receive social care services. That was before the comprehensive spending review and its woeful result for social care.

I hope that the Minister will answer my questions and accept that the settlement will lead to a year-on-year cut in adult social care services with an impact not only on the elderly but on those with learning disabilities to boot.

I want to start by congratulating my hon. Friend the Member for Romsey (Sandra Gidley) on securing this important debate, which could scarcely have come at a more pertinent time. We have had an excellent and interesting debate, which has shown that these issues apply up and down the country and in very different areas.

“The current social care system is in crisis and needs wholesale reform”.

Those are not my words, but a summary of the situation by Age Concern. We are all aware that we have an increasing number of older people in the population of this country, and yet a decreasing number of people are receiving social care. That is a decreasing number of people receiving care at home, which has fallen by a quarter over the past 10 years, and a decreasing number of care beds in care homes.

We have seen the recent comprehensive spending review, and my hon. Friend, and other hon. Members, powerfully—

Let me make this initial point—hold your horses, and I will let you have a go.

The comprehensive spending review clearly has not delivered enough funds to this important area. Various hon. Members have made it absolutely clear that although the 4 per cent. increase in NHS funding is very welcome, the 1 per cent. increase in social care funding is simply inadequate. The reality is that the vast bulk of the settlement over the subsequent three years is loaded into the third year, but we have a crisis now.

The reality of social care in this country is that services are often of insufficient quality. According to the Commission for Social Care Inspection, only 79 per cent. of homes for older people and 72 per cent. of domiciliary care services meet national minimum standards. Compliance with some critical standards is even lower, as only 65 per cent. of homes for older people meet standards for recruiting staff and 54 per cent. meet standards for safe working practices.

My hon. Friend the Member for Romsey discussed the concern over recent years of local authorities’ rationing care, a point that was also mentioned by the hon. Member for Eccles (Ian Stewart), and the worrying fact that the Local Government Association has admitted that by 2009 not a single local authority will provide social care any longer for those with moderate needs. If we consider those moderate needs—that is a euphemistic phrase—they are the sort of needs that every one of us, individually, would believe should be met for our older people. NHS continuing care does not reach a large majority of those who fulfil the eligibility criteria. Three out of five people, according to Age Concern’s estimates, could miss out on care. We have heard powerful evidence about the postcode lottery, which clearly applies more in social care than in the NHS, which is where the media regularly raise it.

We have heard of the problems with the way in which care homes are funded by local authorities, with the issues of block buying and top-ups, where relatives have to find the difference between what the local authority will pay and the cost of care charged by the home. We have also heard the scandal of people who fund their own care entirely, paying a higher rate than those afforded by the local authority. We cannot allow that to continue.

During the course of the hon. Gentleman’s contribution, will he clarify the Liberal Democrats’ policy on paying for social care?

I shall be delighted to, and I shall come on to it when I finish my synopsis of care in this country.

The personal expenses allowance is £20.45 per week, which is supposed to cover toiletries, personal items and clothes. Can anyone here seriously say that that is enough?

That £20.45 limit has been mentioned by a number of organisations. However, is my hon. Friend aware that residents of homes increasingly have to pay for extra services? Sometimes they are charged for things such as physiotherapy and expected to meet the expense using that money.

My hon. Friend has made a valuable and important point.

I do not think that carers have been mentioned today. They do such an important job and save a huge amount of taxpayers’ money, but, in many areas of the country, they do not have the right or even the option of respite care. I hope that the Minister will touch on that. Although most of this discussion concerns older people, my hon. Friend mentioned children with complex needs. It is important that we bear in mind the needs of all those with disabilities who require care.

The Minister will have his chance to contribute later. If he wants to intervene, he may, but I would prefer it if he did not chunter throughout my speech.

In presenting these issues, why does the hon. Gentleman not say, during the course of his narrative, that the Government have just announced unprecedented investment in support and respite care for disabled children and their families over the next three years? Why has he missed that out of his speech?

I asked the Minister to clarify what the Government are doing for carers. He has done that and, therefore, does not need to do so in his speech. However, if he wants to make more interventions, I suggest that he does so on the basis of what I am talking about.

On the 2006 Wanless review, the fear is that, once again, the Government are ignoring the advice that they sought, and that this will be Wanless-light, although we accept that the Government have not published their proposals yet—it is important that they say when they will do so. We fear also that the percentage that individuals will be expected to contribute will be considerably less than that proposed by Wanless, which is a real concern.

The other big issue that has been touched on today is the divide between health and social care, and just about every hon. Member has mentioned that today. We must seek to end this rather artificial structural divide. It is difficult to understand why someone who needs care gets it free in a hospital, but not in a care home, and we must address that. However, administratively, I am sure that we would all recognise that the divide causes inefficiencies and, sometimes, contradictions in what clearly are common-sense objectives shared by the two sectors.

Will the Minister comment on the situation in Northern Ireland, where those two sectors are combined? Also, there are examples of good practice, of which he will be aware, in Herefordshire and, most excitingly, in north-east Lincolnshire, where the new care trust system has been developed. We will watch those developments with interest. We need leadership from the Government, which does not necessarily mean a one-size-fits-all approach. Different local authorities need the ability to introduce different ways of integrating social and health care, and I am sure that we all agree that that is something that we should move towards.

The Minister asked me about the Liberal Democrats’ position on funding. Do the Liberal Democrats believe that the Government have older people’s care as a high enough priority? No! Do we believe that the Government’s current spending plans are sufficient to deal with the crisis? No! Do I believe that the Government are letting down older people in this country? Yes!

The Liberal Democrats will make older people a higher priority and invest more money than the Government.

I would follow the hon. Gentleman’s argument better if he did not just criticise, but said specifically where the money would come from, and on what basis it would be allocated.

We will do that when we publish our manifesto and our policy at the next election. Our policy at the last election was the right one for this Parliament, which has been shown to be the case. Our policy at the next election will be the right one as well, and it would deliver better care for older people than the current Government policy. Will the Minister lay out a clear timetable for the progress of reform, and tell us when we will see the Green Paper and when we can hope for the reforms to be implemented? This crisis needs to be addressed now, and I am afraid that that is not happening.

Will the Minister address concerns expressed by many leading organisations that the funding announced in the comprehensive spending review is weighted in the third year, when it is quite possible that he will no longer be a Minister and when we might not even have this Government? This seems to be a very slow and tardy response to what everyone agrees—including him, I am sure—is an immediate problem that needs swift and decisive reform.

Order. That is a comprehensive list of questions to the Minister, which he will answer, if he has the time.

I am pleased that the hon. Member for Romsey (Sandra Gidley) has secured this debate and congratulate her on doing so. The debate is a little unusual, however, given that she is the Liberal Democrats’ spokesperson for this policy area—at least she was the last time that I checked—and certainly it is a rule within the official Opposition, as opposed to the opposition of her smaller party, not to seek to secure debates on our own subjects. But I shall leave that for the Liberal Democrats.

I am sure that Members on both sides of the House will support me when I say that the contribution of the Liberal Democrats in this debate, as in so many serious debates, avoids any rational approach to policy and costings and treats members of the public as though they have no memories. Let us consider what happened when the Liberal Democrats did something in this policy area in Scotland. Members will be aware of the long waiting lists and the funding shortfall that ran into tens of millions of pounds, caused by the Liberal Democrats, with the support of the then coalition Labour party.

No. The hon. Gentleman has only just had his chance.

In her speech, the hon. Member for Romsey studiously avoided that matter. I am referring, of course, to the fact that, on 31 October 2006, in this Chamber, during an intervention that I invited her to make, she, the Liberal Democrat’s health spokesperson—

I am not surprised the hon. Lady finds it boring, because we keep on reminding her of this.

One must ensure that this is on the record, the veracity of which is attested to by the fact that I could not use this word were it not inscribed for all time on the pages of Hansard. In that debate, the hon. Lady admitted that she had said that her party’s policy of free personal care was “dishonest”. Furthermore, she admitted that dishonesty is the modus operandi of the Liberal Democrat manifesto writers. It is amazing that she said that. I hope, therefore, that the Minister will not spend too much time addressing the dishonest policy of the Liberal Democrats.

I rest my case.

I hope that the Minister will now give a substantive response to the public’s concerns about the future funding of personal care and, in particular, answer for his Department’s and, arguably, his personal portfolio’s abysmal showing in the comprehensive spending review. The rate of increased funding to the NHS has been reduced by the Government. I note the reduction in the above-inflation funding increase, from 7.5 per cent. for 2004-05 to less than 4 per cent. for the coming three years. We shall wait and see whether the financial control reasserted in the NHS, which continues to run a deficit of £911 million, is anything more than cosmetic.

Furthermore, what the Chancellor advertised as a 4 per cent., above-inflation funding rise amounts to no more than 3.2 per cent. when the Prime Minister’s £2 billion cut to the NHS capital fund is taken into account. The Chancellor sought vainly to dismiss the Conservative party’s prediction of an estimated 3.5 per cent above-inflation rate. It turns out that that really was a conservative estimation of the Government’s cuts.

Financial pressure on the NHS is relevant to the debate. Throughout the sorry saga of the NHS deficit, local authority services have often borne the brunt of PCT cutbacks. In June this year, for instance, London councils alone identified extra pressures amounting to £22 million owing to front-line NHS cuts.

I shall turn to the direct social care aspects of the comprehensive spending review. The Government made three points, each of which I shall address. They were an increase in overall local authority funding, an increase in direct funding for social care and a Green Paper on long-term care funding. It is disingenuous of the Government to pray in aid the small increase in overall local authority funding—a trick that enables them to announce it many times over in each area of local authority spending. Further, Sir Simon Milton of the Local Government Association called it

“the worst settlement for local government in a decade”.

That point was powerfully demonstrated by my right hon. Friend the Member for North-West Hampshire (Sir George Young). A mere 1 per cent. increase is inadequate to meet the social services demand pressures, and it exacerbates the inequity between health and social care funding.

The Minister will no doubt tell us once again that direct funding from the Department of Health for social care for older people and support services for carers will increase by £190 million to £1.5 billion by 2010. It should be pointed out that that means an extra £32 million for 2008-09, an extra £88 million for 2009-10 and an extra £190 million for 2010-11, with no promises about what will happen thereafter. Will the funding be ring-fenced for services to older people and carers? Are the increases real or nominal? And, as my right hon. Friend said, is that it?

In the Department’s press release, it said that the money would support personalised budgets, the provision of advocacy and information services and an increased focus on preventive services to support people to live independently and to help 3,000 people with learning disabilities to leave NHS accommodation and live independently. I was particularly intrigued by the first and last claims. On the first, it was my understanding that personalised budgets cost less, rather than more, to administer. On the last claim, will the Minister tell us, first, why it was not completed by April 2004—the target that was set in the White Paper, “Valuing People: A New Strategy for Learning Disability for the 21st Century”? Secondly, is the money distinct from the £175 million of funding that he announced on 9 August to take 1,600 people with learning disabilities out of campus accommodation? It is particularly important to note that the increase in funding in no way approaches the sums needed to deliver an effective and affordable solution to stop people selling their homes to fund their long-term care.

Tony Blair said in his 1997 conference speech:

“I don’t want them”—

our children—

“brought up in a country where the only way pensioners can get long-term care is by selling their home.”

Not only have the Labour Government failed to solve that issue, but they have failed ever to address it substantively. Does the Minister agree that the 2005 Labour party manifesto, which promised to

“continue to provide healthcare free in long-term care establishments”,

is another Labour broken promise and that it deserves from him similar opprobrium to that which the hon. Member for Romsey gave her party’s manifesto claims? In doing so, the Minister must also acknowledge that our fully costed limited liability model at the previous election would have delivered a solution to the problem, that we were the only party ever to put forward a real policy on long-term care funding and that, perhaps, he could learn from us. It is a trend, and something for which he would no doubt gain great popularity with his own Prime Minister, because he seems to enjoy taking whatever policies he hears us put forward.

It would be helpful if the Minister considered what has happened in Kent, which has a Conservative-run county council. The Government’s latest announcement contained a welcome U-turn on individual budgets, embracing health care and social care. Although it was clearly accepted that the Government have failed on social care in the past, the Secretary of State talked about a partnership model. The King’s Fund report, however, made it clear that Kent county council had undertaken a pilot project on the partnership model and that it wanted to do further analysis. However, the report said:

“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 recent social care announcements are for a 1 per cent. real terms increase in social care budgets in local authorities, the effects of which will be additional charges for adult social services in local authorities throughout the country and a forced increase in council tax. We need individual budgets and the greater efficiency that comes from them. Importantly, the Government should not dismiss the experience of Kent county council’s pilot quite as off-handedly as they have done.

Will the Minister also explain his sad and—I dare say for him—bitter failure to secure anything substantive from the Treasury? He has spent the past 18 months giving the impression to parliamentarians, to stakeholder organisations—we have all spoken to them—and to the public that he will deliver a

“new settlement in social care”.

He said as much in January, as my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) said in his very powerful speech. On 21 February, the Minister also told us:

“We continue to negotiate with the Treasury to secure a fair and reasonable settlement as part of the comprehensive spending review.”—[Official Report, Westminster Hall, 21 February 2007; Vol. 457, c. 98WH.]

On 6 March, he wrote:

“We will assess proposals for the future provision of long-term care services as part of the long term vision of the comprehensive spending review 2007.”—[Official Report, 6 March 2007; Vol. 457, c. 1940W.]

And on 17 January, he said:

“We are arguing forcefully—I shall not reveal the details in this debate—with the Treasury about the importance of a good settlement for social care under the comprehensive spending review.”—[Official Report, Westminster Hall, 17 January 2007; Vol. 455, c. 331WH.]

Further, will the Minister explain to the House what happened to the findings of the review of social care funding, which his predecessor, now the Minister for Borders and Immigration, announced on 30 March 2006? It was a transparent attempt to fend off the Wanless review, and in announcing it, the then Minister said:

“The Department of Health will conduct a review of social care, starting from first principles on how social care is funded. We believe this is a once in a decade chance to undertake a fundamental review of social care costs.... This work will inform the Department’s plans for social care funding, which will be submitted to the Treasury as part of the comprehensive public services spending review in 2007.”

If it really was a

“once in a decade chance”,

where are its findings and why do we now need a Green Paper, as the Minister has had to announce, which will not have any impact until 2011—well after even this bottling Prime Minister will have been forced to the polls and these Ministers and this Government will be long gone? How long is the long grass into which they have kicked that vital issue?

Without the Minister’s usual rant or statement that he will take no lessons from the Conservatives—after all, the Prime Minister has led the way and announced new policies that are all the result of lessons taken from the Conservatives—will the Minister tell us exactly why he has failed to deliver that which he has promised to the House and to the public?

I congratulate the hon. Member for Romsey (Sandra Gidley) on securing the debate. It is rather bizarre that as a Front-Bench spokesperson she has secured a debate as a Back Bencher, and that there is a replacement Front Bencher, but do not ask me to explain the Liberal Democrats.

I also congratulate my hon. Friend the Member for Eccles (Ian Stewart) on the way in which he began his contribution. He is right that there is a major demographic change, not only because people are living longer, but because they are developing long-term conditions such as strokes and dementia. He was also right that disabled people now have long and full lives, which is a sign of progress in our society. He also raised the issue of people’s rising expectations of care; they do not want, for example, institutionalised care, but care at home.

For the record, I shall discuss the investment that has been made, because we must ensure that we are clear about the context. Over the past 10 years, overall local government funding has increased by £28.4 billion or 39 per cent. in real terms. The Department of Health allocates a number of specific grants to the 150 local authorities with adult social service responsibilities in England, totalling more than £1 billion, and there is £68 million of capital grants for 2007-08.

The Department has also allocated £60 million for the partnerships for older people projects, £80 million for preventive technology and £60 million for extra care housing in 2006-07 and 2007-08. Since 1999, we have invested just over £1 billion to support carers’ services. As a result, there have been major advances in the care that people receive. Under the comprehensive spending review announcement, local government will receive an average real-terms increase of 1 per cent. per year, which will be worth £2.6 billion a year by 2010-11. In addition, there will be an average increase of 2.3 per cent. in real terms per year for direct departmental funding of social care. There will be an additional £2.6 billion by 2010-11 for local government, and almost £200 million additional money for social care provided through the Department.

I shall not.

I wish to make it clear that the settlement for the Department of Health, at 2.3 per cent., is higher than the average public sector growth of 2.1 per cent. That reflects genuine pressures in the system, and we need to continue to transform the service. The 2.3 per cent. real-terms settlement is in addition to the 1 per cent. settlement for local government, which is about meeting demographic pressures.

I agree with those, including the hon. Members for Romsey and for Wyre Forest (Dr. Taylor), who said that we need a more integrated approach between the NHS at a local level, local government, the voluntary sector and the private sector to create a more integrated health and well-being system in every community. We have made a number of advances towards achieving that, but we still have a long way to go. I point out to the hon. Lady that, in the next three years, the Government will invest unprecedented amounts of money in supporting disabled children and their families for respite care, key workers and transition planning. That has been warmly welcomed by the every disabled child matters coalition.

My hon. Friend raised a number of issues about inequalities in funding and so on. He also talked about the progress that his local authority has made, and I wish to pay tribute to Anne Williams and Maureen Lea for the leadership that they have provided in Salford, and to Anne Williams for the leadership that she is now providing nationally on adult social care.

On the partisan contributions made by Opposition Members, let us be clear that the Liberal Democrats currently do not have a policy on the subject, but they still say in their local leaflets that their policy is free personal care. The hon. Lady said on the record that that was a dishonest promise in their manifesto at the last election. It is completely duplicitous politics. Conservative Members talked of their policy on the funding of social care in their previous manifesto, but it is not their current policy. So the Conservative party does not have a policy on the matter either. Neither of the two Opposition parties is offering to spend more on social care than the Government are committed to spending in the next three years, and neither is committed to a Green Paper on the fundamental long-term reform of social care. That is yet another example of the Government facing up to one of the great challenges that this country faces in future health and well-being issues, which, as my hon. Friend said, is right at the heart of a socially just society.

I shall not; I am coming to the hon. Gentleman’s points now.

The right hon. Member for North-West Hampshire (Sir George Young) contributes extremely well to making the case for social care, which of course I welcome, but he and the hon. Members for Beverley and Holderness (Mr. Stuart) and for Eddisbury (Mr. O'Brien) asked, “Is this it?” Let us be clear: we have a Green Paper committing us to tackling long-term reform; we have a local government settlement of 1 per cent. in real terms; and we have a high real-terms increase in resources through the money that the Department of Health will make available to local government to reform social care in the next three years. We shall announce the details soon, and hon. Members will have answers to all their questions about what improved services that funding will buy.

In addition to all that, the Prime Minister will announce next spring a new deal for carers, building on the record levels of money that this Government have invested in supporting carers in the past 10 years. On 1 October, the Government issued new continuing care guidance to ensure that primary care trusts do not shunt the costs of continuing care on to local authorities. For the first time, we have national guidance. As I have said, the Government are putting record resources into supporting disabled children and their families.

Hon. Members do not like to hear these messages, but they are going to hear them.

I also wish to mention the appropriate use of resources in the system. There is a local authority—I shall not name it, as I do not wish to embarrass it—that is spending £300,000 on setting up a television station, while it has increased the fees for home care by £300,000. Let us be clear: some decisions being made at a local level about what matters to people need serious scrutiny in relation to local authority prioritisation.

We must all ask why social workers are now spending their whole time as assessors and box tickers rather than doing social work with people. That is not required by any legislation that this Government have passed; it is a result of the community care legislation introduced in the 1990s. When did we ever say that just because people were self-funders, they should be left on their own to navigate the care system by choosing nursing homes or home care? We never said that.

It was this Government who introduced the deferred payment scheme, which means that no elderly person going into care has to sell their home. It is shameful that the Conservative party frightens elderly people by suggesting that old people have to sell their homes when they go into care. This Government changed that and introduced free nursing care, after 18 years when people had to pay for it.

Order. It is obvious that the Minister is not going to give way, so I would appreciate it if there were no further interventions.

I want all-party consensus on the long-term funding of social care. That is the responsibility of grown-up politicians. We need a new system that redefines what the Government will fund through tax and what individuals are expected to pay. It must be fair and affordable. The current system is not right to meet the demographic challenges that my hon. Friend the Member for Eccles identified, but free care for all is not realistic either. Any politician who says that it is is misleading people. If we unpick the details in Scotland, we see that the system is not really free. Waiting times for services are rocketing, which proves that it is not sustainable, as the Scottish local authorities are saying. We are not wedded to any particular model at this stage. We genuinely want to open the debate to the public, and we want all parties to participate.

The hon. Lady asked what issues we need to examine. In trying to find a new system, we need to consider together what should be available to everybody, wherever they live, and what should be left to local discretion; which elements of the service should be for all, irrespective of their means, and which should be means tested, and what level of assets should trigger full or partial self-funding. Those are the big issues that we must face up to if we are to find consensus on a new settlement on long-term funding. There are no easy solutions or quick-fix wins, and there is nothing that would leave everybody happy and provide a system that is both fair and affordable.

In the new year, we shall announce the process for significant citizens juries and consultation in different parts of the country. We want all political parties to join in the debate and make a contribution, and then we shall produce a Green Paper. We will announce the time scale for that in January. It will identify for the people of this country the scale of the demographic challenge and the range of choices available for meeting it. We will then be clear about the choices that we face and the principles that should underpin them.

This Government are the first to prevent elderly people from having to sell their homes. We introduced free nursing care, and we are facing up to one of the great challenges that face the country. Despite the scale of the tight funding settlement across government, when the details are announced it will be demonstrated that the settlement for social care, to support personal budgets and a shift to prevention, will mean that we can make significant progress on the quality of services for elderly and disabled people and their families in the next three years. We will deal with the long term and put in resources in the short term, and there will begin to be significant reform of services in every local authority, so that carers and older and disabled people have the quality of support and care that they deserve in a civilised society.

UK Aid (Sudan)

I very much welcome the opportunity to debate this important subject. On 10 October, I asked the Prime Minister this question:

“Given the still extremely serious situation in Darfur, will my right hon. Friend explain what steps his Government took during the recess to support Security Council resolution 1769, as well as the wider peace agreement in Sudan, in order to ensure that humanitarian aid is delivered in desperate circumstances, and that this carnage is discontinued?”

He replied:

“The combination of peace talks beginning in the next few days, and the possibility of an end to hostilities, gives us hope that this outrage—which has meant that 2 million people have been displaced, 4 million are in famine and a quarter of a million have died—can soon be brought to an end.”—[Official Report, 10 October 2007; Vol. 464, c. 294-95.]

There followed a debate in Westminster Hall on 16 October, which was led by my hon. Friend the Member for Stroud (Mr. Drew), whom I am delighted to see here today. That debate highlighted the Foreign and Commonwealth Office perspective on Sudan, underlined by the fact that my hon. Friend the Minister for Europe replied. Today, I invite a wider debate specifically on aid and want to draw attention once more to the immense humanitarian problems that still exist in that unhappy region. It is right to seek to update the excellent debate on Darfur that we had on 5 June on the Floor of the House, but I wish to widen the debate to include the whole of Sudan.

A report received as recently as last week shows that the humanitarian crisis in Sudan is getting worse, with aid agencies suggesting that targeted attacks on their workers are at their highest since the conflict began. On 9 October, the African Union Mission in Sudan published a bulletin stating that, on 29 September, an AU peacekeeping camp was burned down, killing 10 African soldiers for peace. For reasons that I gave to the House on 5 June, aid agencies working in the region now understandably refuse to be quoted by name for fear of having their cover blown.

In a country of 35 million people, nearly 4 million in the Darfur region alone currently rely on aid. The activities there have been described as the world’s largest humanitarian response. Nearly one in seven Sudanese people are in need of aid; that is equivalent to the population of Wales. Two million of those people are displaced and living in refugee camps, often in appalling conditions, and half a million cannot be reached by aid agencies. Two years of bad rainy seasons, particularly in the east of Sudan on the coast of the Red sea, have put even more strain on the fragile infrastructure of the country, with more humanitarian efforts having to take place in that region.

Implementation of the comprehensive peace agreement between north and South Sudan has been slow. Southern Sudan is potentially achieving four of its 20 millennium development goals, compared with 13 out of 20 in the north. Enrolment in primary schools in the north is about 60 per cent. compared with 20 per cent. in the south. Sudan is facing horrendous problems, and it is profoundly unacceptable that, when the international community seeks to offer assistance, its efforts are blatantly undermined by—there is no point in mincing words—the Government of Sudan. It is plainly outrageous that, while non-governmental organisations and aid agencies struggle to assist in refugee camps, they do so under conditions of aerial bombardment initiated by the Bashir regime.

There has been no absence of outright condemnation; nor should there be when men, woman and children are fleeing their homes, women are being raped as they gather firewood and emaciated children appear on our television screens. The case for international outrage is surely justified. Comparisons with Rwanda have been made. I do not for a moment seek to excuse what took place there, and I welcome the reconciliation, but that terrible scenario extended over 100 days, whereas the awful carnage in Sudan has gone on before our very eyes for something like five years.

What is to be done? A consensus seems to have emerged in the House that our humanitarian efforts should be matched by a diplomatic approach. I commend the efforts of my colleagues in the Department for International Development, especially the former Secretary of State, my right hon. Friend the Secretary of State for Environment, Food and Rural Affairs, and the current Secretary of State for International Development and his team. I particularly welcome my good friend the new Minister, who will respond to the debate. DFID is the second-largest bilateral donor to Sudan, having given more than £250 million in humanitarian assistance since April 2004.

It seems to me that the House believes in taking a two-pronged approach by stepping up humanitarian delivery and pursuing urgently the diplomatic route. However, I concede that that is far from easy. President Bashir seems to concede when the international community makes concerted efforts to put pressure on him, but carries on as before as soon as our back is turned. The only way to force real change, given the unacceptable intransigence of the brutal regime, is to exert pressure continually on every relevant issue. Parliament is the right forum for doing that in Britain. Without that pressure, the Sudanese Government will throw up obstructions at every opportunity. They will impose needless red tape, undermine NGOs, delay United Nations and African Union peacekeeping efforts and carry out aerial attacks on their own people. The truth is that the shame of the regime knows no bounds.

Many people have placed their hopes in the peace talks due to take place in Libya at the end of this month, but the considerable concerns about progress must be expressed. For example, those very hopes must have taken a severe blow when the Justice and Equality Movement, one of the main political players in Sudan, announced last week that it would not attend the conference because of the planned absence of other key parties. A spokesman for the group said that he would stay away unless the rival Sudan Liberation Army united its warring factions. Indeed, in the run-up to the talks, infighting between the warring factions in Sudan has led to the creation of many splinter groups. It almost seems that no one is sure who should or should not be at the table in Libya.

Will the Government continue to give their full support to the fine work of Ban Ki-moon, who is attempting to get negotiations off the ground? On that point, I received a letter from the United Nations High Commissioner for Refugees this morning, virtually on my way to the debate. Its immediacy is extremely striking. It is able to give a far clearer picture, devastating as it is, of what is happening. I ask for the patience of my colleagues as I share some of the letter with them.

On UNHCR operations in Sudan, the letter states:

“Sudan epitomises the complexity and intricacy of refugee crises in today’s world. Whilst repatriation is ongoing to South Sudan, violence in the Darfur region in the west of the country continues to force people from their homes, the Eastern part of the country continues to receive asylum seekers from Eritrea, Somalia and Ethiopia, and up to 2,000 Palestinians may soon be resettled from Iraq to Sudan.

The UN Refugee Agency has a network of 16 offices across Sudan, managing the return operation to South Sudan, supporting tens of thousands of refugees in one of the world’s most protracted refugee situations in eastern Sudan, as well as providing protection and assistance to some of Darfur’s two million internally displaced persons in the west of the country.

UNHCR has welcomed the UK Government’s funding of 1.2 million GBP for its 2007 operation in Darfur and Chad. However, further support from the international community is urgently required as two of UNHCR’s largest operations within Sudan—repatriation in the South, and protection and assistance to internally displaced persons in Darfur—both face funding shortfalls.”

Elsewhere, the letter deals with UNHCR operations in Darfur. It states:

“UNHCR opened offices in…West Darfur, in 2004. In April this year, UNHCR responded to a request by the United Nations Humanitarian Coordinator and agreed with the Sudanese Government to ‘scale up’ its activities in west Darfur, which are expected to include south and eventually north Darfur.

However, the general security situation in Darfur continues to be unstable, with recent reports of vehicle hijackings, temporary abductions and even killings of aid workers. The deteriorating security environment prevents UNHCR from accessing some displaced persons (the agency’s current reach is about half of Darfur’s two million displaced) as well as placing civilians at great risk.”

A poignant paragraph—again, I appreciate the forbearance of my colleagues—states:

“The plight of Darfur’s internally displaced is extremely precarious, with the recruitment of displaced children”—

displaced children—

“into armed groups a serious protection issue. UNHCR has continued to search for innovative ways of addressing this problem, including programmes to keep youths productively engaged and the separation of armed elements from refugees.”

Given the title of this debate, I should like to refer finally to what the letter said about funding shortfalls. It states:

“Unless funding is received soon, a shortfall of US$7.1 million in its 2007 Darfur budget of US$19.7 million may force the UN Refugee Agency to scale down protection and humanitarian aid operations in the conflict-ridden region. UNHCR is appealing to donors for immediate contributions. UNHCR is concerned that the lack of funding will soon have a direct impact on our operation to protect and assist some of the more than 2 million internally displaced persons…and thousands of Chadian refugees in Darfur, whose numbers continue to rise.

Similarly, UNHCR is facing a critical shortfall of US$11.1 million for its refugee return and reintegration operations budget in South Sudan for this year.”

I am grateful to my colleagues for their forbearance while I quoted from an extremely important letter. I believe that it shows the importance of the focus that we are giving to these matters today, and I am glad that the Minister is indicating that he agrees.

The UN and the African Union have committed a force of 26,000 troops for the task of peacekeeping in the region. That is an admirable and much-needed step forward in the process of getting aid into the region. However, although the force is due to reach its full complement of troops by December, it appears that diplomatic impediments have been placed in the way. As a result, there is now no clear timetable for having personnel in place to safeguard the aid agencies and their work, and, therefore, to help the 500,000 or so people who are unable to receive aid.

Another issue of enormous concern has recently come to my attention. A group called the Aegis Trust, to which the hon. Member for Buckingham (John Bercow) referred in the June debate in the Chamber of the House, has written to several hon. Members. That international genocide prevention organisation has highlighted cases of Sudanese people seeking asylum in this country who could be sent back to Sudan because the capital, Khartoum, is considered safe, even though it is plainly obvious that they would be in considerable personal danger.

The matter has been before the courts and is due to be considered in another place, but the other side of the coin is truly intriguing. Sudan’s head of intelligence, Salah Abdullah, is seen by many as the architect of what they consider to be Sudan’s genocide. He recently hosted an intelligence conference, which representatives from the United States, France and the UK attended. Indeed, Mr. Abdullah was recently invited to this country to receive medical treatment, and it was revealed by The Guardian that he later met unnamed officials. That was at a time when aid workers were putting their lives on the line and working with inadequate resources, including insufficient medication to meet the needs of the most vulnerable of the world’s oppressed people. More than 10,000 people, mainly young, attended the charity concert for Darfur at the weekend. What would they have thought if they had known that their contribution had been so deeply undermined? The House is entitled to an explanation.

Let me be frank as we survey the carnage that clearly exists in Sudan. It did not come about by accident, and those responsible should be held to account. For example, the House knows that arrest warrants were recently issued by the International Criminal Court. Former Sudanese interior Minister, Ahmad Harun, and Janjaweed militia leader, Ali Kushayb, are wanted for war crimes and crimes against humanity in the region. Khartoum has refused to co-operate with the ICC and has said that it will not hand over Kushayb or Harun, who—would you believe it?—is now Sudan’s Minister for Humanitarian Affairs. The ICC’s prosecutor, Luis Moreno-Ocampo, has expressed his worry that Harun in his new position will not help the people whom he displaced.

Before the Minister prepares to respond to the debate, may I make a few points for his consideration? Many people are asking where we are with the proposed no-fly zone over parts of Sudan, and perhaps he would enlighten us. What are the Government’s thoughts about the problems in neighbouring countries, such as the Central African Republic and Chad, which have had to deal with 235,000 refugees since the conflict escalated? What response have the Government made to the Sudan-UK investment organisation, particularly its letters to the Governments of India, Malaysia and Japan, which have close economic ties with the Sudanese Government? Those letters ask those states to make their economic relations with Sudan dependent on its full commitment to peace and security for the people of that country. What is the Government’s view of the effectiveness of the European Union’s response?

As in so many other regions of the developing world, we know that wealth-sharing is an increasing imperative in moving people towards genuine development, so I invite the Minister to take this opportunity to outline the steps that DFID is encouraging in this important matter.

In conclusion, I want to underline the importance of crucial diplomatic initiatives. Of course, a positive approach involves France, the United States and the UK speaking with one voice on this crucial issue, but there is another window of opportunity with the Olympic games in Beijing. In many ways, China could be the key to a permanent solution, especially with its desire to be seen in a positive light as the games approach. I was greatly encouraged during the debate in June, when I made that point to the then Secretary of State for International Affairs, who said that

“at the Addis meeting last November…we reached the point where the Chinese representative said to the Government of Sudan, ‘I think you really ought to accept what is being offered here.’ The Sudanese Foreign Minister looked around the room and realised nobody else was supporting him.”

The then Secretary of State continued:

“That collective determination of the international community helped to get that agreement.”—[Official Report, 5 June 2007; Vol. 461, c. 227.]

Unless the Sudanese Government change track, they are destined to be isolated and alone. The international community might have been found wanting in the past, but the future can be so different. Challenges and opportunities exist, and we should not flinch from our duty when the opportunity for peace and progress comes.

It is a pleasure to follow my good and right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), and to have a second bite of the cherry, having had a debate last week with the Foreign Office.

I welcome the Minister, and the good news is that I do not intend to go over the same ground. I am sure that you would rule me out of order, Mr. Olner, if I did, because this is a different debate. However, I want to emphasise a couple of points that I made last week and to examine the funding situation. It is good to see the hon. Member for North-East Milton Keynes (Mr. Lancaster) here today. He accompanied me and the hon. Member for Richmond Park (Susan Kramer) to Sudan a couple of months ago when we saw the situation for real, and I want to make a further contribution as a result of that.

We are having this debate against a difficult background. I referred last week to the decision of the Sudan People’s Liberation Movement to withdraw from the Government of national unity for a period. Various attempts at mediation are being made, but while the situation in Darfur is dire, the wider ramifications for Sudan of losing the comprehensive peace agreement must be understood in their full context, because they are deeply worrying. I hope that at the very least the Minister will tell us what efforts we are making to ensure that the comprehensive peace agreement is maintained, and that every attempt is being made to persuade the SPLM to return to the Government of national unity. That is an interesting concept, but it remains the only show in town, and there is no possibility of solving the Darfur situation unless we can keep the north-south dialogue on track. Given that the Darfur peace agreement is entirely reliant on the comprehensive peace agreement, we must understand how important this time is in the history of Sudan.

I make no apology for looking at the multilateral arrangements for funding, but as chair of the all-party group on Sudan I have nothing but praise for the way in which the Government have engaged with Sudan, and that includes current Ministers and their predecessors. When we took on the issue, we knew that we were in it for the long run and that it would be a rocky road. It has certainly proved to be so, but there is no evidence that the Government have reneged on their commitment and they have been asked to take on more responsibility, which they have done so willingly, knowing that the situation is difficult.

To put the funding situation into context, I shall give some of the background. When the original arrangement to proceed to the comprehensive peace agreement was put in place at the Oslo conference, some £5 billion was pledged. There is a downside to the international community’s commitment, and the hon. Member for North-East Milton Keynes will remember that Riek Machar, vice president of southern Sudan’s Government, put it to us fair and square that the international community had failed to deliver its Oslo commitment.

Again, it is pleasing that the British Government have kept to their commitment, but many other countries have yet to deliver the money that they promised. The international community has made a commitment, and if we are going to point the finger at Khartoum and Juba and argue that it is right for them to pursue peace, it is only fair that we keep our side of the agreement. However, we have failed to do so, which is lamentable, given that that will bring pressure to bear on the comprehensive peace agreement.

On the wider issue, it is fair to say that Sudan has been something of an experiment—almost a laboratory experiment—in the provision of funding, but no one knows whether that experiment will work. Part of the problem is that the situation is quite complicated in terms of what has been put in place and how it works or—dare I say it—does not work on the ground. There are three main funds—the multi-donor trust fund, the basic services fund and the common humanitarian fund. I will quickly go through what I think each of them does, although there is some questioning of them on the ground in the south, and I am sure that there will be some questioning when we get some peace in Darfur whether the right structures are in place and whether they have worked.

Seventy per cent. of the funding that goes into the south comes from the multi-donor trust fund. The fund largely concentrates on capacity building and focuses on larger projects; indeed, there is a de minimis level below which it does not become involved. Sadly, Vice-President Riek Machar strongly felt that the ratio of funding from the oil revenues that the Government of southern Sudan are beginning to receive and from the international community was two to one. He felt that that was the wrong way round and that there should be much greater commitment from Governments internationally.

One problem, as I said last week, is that 60 per cent. of the moneys from oil revenues go towards military expenditure, which is not helpful. Of course, we can define such expenditure in the widest sense to include policing, as well as soldiers. What is more, a lot of people have been under arms, and something must be done with them—we cannot pretend that it is not important to find ways to occupy them. However, spending oil revenues on such things is not a good start. Of course, the security situation in the south is difficult, as it is in other parts of Sudan, but spending 60 per cent. of revenues on military expenditure does not leave an awful lot for health, education and basic support. Like me, the hon. Member for North-East Milton Keynes will have been quite shocked by what he saw and by the insufficient level of provision on the ground. There are huge question marks about what is being done to improve the quality of people’s lives. If it does not improve, people will simply question the comprehensive peace agreement, and the danger is that they will return to conflict.

The basic services fund simply cannot cope with the demand for basic requirements, such as new schools and health centres. Indeed, we saw a health centre, which was very primitive and lacked medicines. Furthermore, most people simply have no access to such centres. Given that people cannot receive basic health care, there is a huge question mark about whether they see their quality of life improving.

As one would suspect, the common humanitarian fund tries to do the absolute basics and to keep people alive by offering some protection and help. Very limited funds have gone into it. Some $279 million was requested for the work plan, but only 61 per cent. has so far been provided. Again, money has been promised, but nothing has been delivered by Governments, let alone on the ground.

As I suggested, such problems add up to a significant threat to the peace process. Those who have returned home with some expectation that things will be better have been sadly disillusioned. That cannot be acceptable to the Government in the south and certainly not, as my right hon. Friend the Member for Coatbridge, Chryston and Bellshill has said, to the Government in the north, whether that is the Government of national unity or the National Congress party, which effectively runs the north. That cannot be acceptable to the British Government, let alone to the wider community, and we must do something about it.

My recommendation is simply that we must ensure that the different funds work more efficiently and that they move money to where it is needed—to the people themselves. It is all well and good to ask for additional funding, and it is true that we need it, but the reality is that we need to put in place the funding that was promised. The message from the south, however, is that that has not happened.

Let me move quickly on to Darfur. Again, an awful lot of resources are going into the region, but they are not enough, and a lot more will have to go in as we gear up for the introduction of the force of 26,000 soldiers, who will need support. In the defence debate last week, I challenged the Secretary of State to say exactly what the Government are doing to provide logistical support. Understandably, he was somewhat careful—I will not say less than frank—in what he said. My right hon. Friend the Member for Coatbridge, Chryston and Bellshill must be aware that it will not be easy when that force goes in. The recent outrage at Haskanita made it clear what it is like in parts of Darfur and highlighted the bravery of the forces there—they are currently from AMIS, but will soon be from the United Nations African Union mission in Darfur. Given the level of anarchy in some places in the north, west and south of Darfur, those forces will be fighting all manner of different groups, which will make things difficult. At the same time, however, we must try to get the funds in to make people’s lives better. Humanitarian support is vital.

While the bravery of the troops should, of course, be mentioned, as my right hon. Friend has said, the NGOs are working against an amazingly difficult background, and they deserve a lot of praise. There are always arguments whether the money should go directly to the governmental agencies in the region, both donors and recipients, or through NGOs, and that tension is always there. In reality, however, it does not matter, as long as the funds, the resources and the support reach people. Sadly, there are too many examples of when that does not happen, and that is largely because of the security situation, which is very difficult and which is not getting better, as my right hon. Friend has rightly said.

I ask the Minister to look at the funding mechanisms in the north and south under the comprehensive peace agreement to see whether they should be improved. How do we learn from the mistakes that have been made in the north-south relationship, so that proper funding can begin to improve the humanitarian situation when Darfur moves, I hope, to some form of ceasefire and when some attempt is made to impose a peace settlement?

As in last week’s debate, I finish with a plea not to forget the east. Sadly, it is always left out of the situation. Our group did not get the chance to see it, because we were, as always, strapped for time. The problem in the east is that many promises have been made. People forget that the area around Kassala and Port Sudan is the poorest part of Sudan. It would not take much of a leap of the imagination to see how the rebel groups that have argued forcefully that they have lost out because of what has happened between the north and south could launch their own conflict. At the moment, they remain at peace, but they have Somalia and Eritrea as neighbours—hardly the most stable parts of the world. Issues about the funding mechanism arise in that context, as do issues about ensuring that Khartoum for once does what it has said that it will do and puts resources into the east to prevent a conflict, rather than trying to overcome a conflict once it has arisen. On that sombre note, I shall sit down, and I shall be pleased to hear what the Front-Bench spokesmen have to say.

Sudan is cursed by some of the worst afflictions to which states can fall victim. There is not one problem, but a mixture. Everything that could go wrong has gone wrong there. I congratulate the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) on securing this important debate. With the continuing problems in Iraq and Afghanistan, the focus of the media has drifted away from Sudan, but the House cannot afford to let events elsewhere, however serious, push into the margins the humanitarian disaster that continues to deteriorate day after day in that country.

Before looking at UK aid to Sudan and what could or should be done by the UK Government and taxpayers to help those who are suffering, it is worth taking a minute to consider what the problems are, so as to understand how better to deal with them. To say that the situation is the worst humanitarian crisis on the planet is no exaggeration. What has caused the problem? Religious and ethnic tensions have existed between many tribes and communities, going back well into the past. Even before Gordon of Khartoum was there in the 1870s and 1880s, there was conflict in Darfur, a region that today is a byword for everything for which UK aid is urgently needed: poverty, malnutrition, lack of water and basic sanitation, and a desperate need for health care. Aid is needed to help to deal with infant mortality and to assist refugees within and outside its borders.

“Displaced people” is a phrase that we often hear to describe those who have lost everything but who remain in their own country. It does not sound too bad, but there are few things that could be worse, for those displaced people are often hungry, homeless, malnourished and suffering from a variety of illnesses that leave many too weak to survive. The scale of the problem is well documented. The chairman of the all-party group on Sudan, the hon. Member for Stroud (Mr. Drew), has been very eloquent in detailing the problems.

Climate change is one of the problems from which Sudan suffers that give rise to its need for a huge amount of aid. With the change in global weather patterns, farmers’ and pastoralists’ traditional land use is also changing, and in some areas it has developed into a battle for survival. We have heard about oil revenues. With the discovery and exploitation of oil, in what is for many a desperately poor country, there is money to fuel conflicts but not enough to feed the hungry. Corruption, as I have said before, and poor governance, are at the heart of the problem in Sudan. I am in no doubt that the Sudanese Government, who should be part of the solution, are in fact a major part of the problem. Arms are another problem. There are simply too many weapons available to too many people. Knowing that an automatic machine gun is required to protect their herd of animals makes potential killers of many farmers. There is also evidence of a flow of second-hand arms from neighbouring countries. Those are some of the factors that our aid, and the people in the front line, are struggling to cope with.

In a debate on UK aid and the Sudan, it is crucial at the outset to pay tribute to the dedication of aid workers and those with the task of delivering our aid on the ground. They risk their lives daily and some have already paid the ultimate price. The international community owes them a great debt. At a sitting of the Select Committee on International Development some time ago, during evidence from Save the Children, the execution of two of its workers was graphically described. More recently, others who have gone to help have also lost their lives. I want also to pay tribute to the work of the former Secretary of State for International Development, the current Secretary of State for Environment, Food and Rural Affairs. He worked hard and was often to be heard responding to debates such as this in this Chamber.

Since its independence in 1956, Sudan has known only 11 years of peace. Given that peace is a basic necessity for development and infrastructure building, the scale of the challenge for the people of Sudan and Darfur is considerable. Development will never succeed without good governance and peace. As hon. Members outlined, Sudan is one of the poorest countries in the world, with its per capita income languishing at the bottom of international tables. When the most recent millennium development goals report for Sudan was published in 2005, it painted a grim picture of South Sudan’s progress towards the MDGs. Decades of marginalisation, conflict and insecurity, and lack of access to basic social services, have undermined livelihoods, increased levels of poverty, reduced opportunities and led to high rates of malnutrition. Two years on, in spite of many false dawns, all of those problems remain.

My hon. Friends and I strongly support the work of DFID in Sudan and Darfur. Sudan has rightly been a focus for the Department and its efforts. No one could fault the Government on their commitment to Sudan. Huge amounts of money are flowing into the country, including the south, as well as Darfur. However, unless tangible benefits are forthcoming, frustration will grow. Increasingly, there are questions about how much of the money is making its way through to the ground and to the refugees who need it most.

As to the comprehensive peace agreement, to talk about aid delivery in Sudan we must first talk about the conditions affecting peace there. Along with other hon. Members who are here, I was among those who welcomed the signing of the comprehensive peace agreement as a major breakthrough. However, despite all our hopes, less than two years on implementation is lagging. We are concerned that the international community has disengaged to a degree from getting it back on track. Any progress in Sudan will be hamstrung from the start if we cannot get the CPA to work. The Government rightly stress benchmarks and compliance as the key to sustainable peace in Darfur. They now need to do the same for South Sudan. Benchmarks are in place, but international bodies and Governments are not putting enough pressure on the parties concerned to ensure that they are met.

Transparency in the handling of oil revenues is also a vital component of the CPA. There are currently too many unanswered questions about exactly where much of the oil revenue is going. I am afraid that too little of it is apparently being pushed into basic service provision. I would appreciate the Minister’s thoughts on the lack of transparency and on his Department’s assessment of the scale of the problem with oil revenues.

Although the Government of Sudan need to do more to meet their commitments to the CPA, they are not the only ones: $5 billion was pledged at the 2005 donor conference, and yet only about $150m has been channelled through the Government or to implementing agencies. That is frankly not good enough, and I look forward to hearing from the Minister what the UK Government are doing to put pressure on other countries to live up to their promises. As the hon. Member for Stroud said, Sudan has become something of a laboratory for funding mechanisms. We must look at whether those are working. Donors have set up a number of pooled funding mechanisms, including the multi-donor trust fund, the basic services fund and the common humanitarian fund. However, none has to date adequately dealt with the immediate humanitarian and short-term recovery funding that is needed in South Sudan.

Hon. Members will be aware that 70 per cent. of donor funding to the south is channelled through the MDTF, which is administered by the World Bank. However, the MDTF was not designed to meet immediate recovery needs, and I know from speaking to NGO representatives that in their experience the fund has been far from perfect, with recipients experiencing severe delays, confusion and frustration. Similarly, channelling funding through South Sudan’s Ministries has also been very slow. I have real concerns that the Government of South Sudan simply do not have the capacity to channel so much centrally driven funding through the MDTF.

The DFID-instigated basic services fund was designed to plug a time-limited gap until the MDTF money was paid. However, two and a half years down the line, the BSF is the only major fund that NGOs, which are the main services providers in most cases, can tap into effectively. I commend DFID for setting up the BSF and for committing £17 million to it but, simply, it is not enough to cover the dearth of basic services in South Sudan. What plans are in place for funding NGOs in future?

The common humanitarian fund, which was set up to address humanitarian relief throughout Sudan, is overstretched. The fund is administered by the United Nations Development Programme, and UN agencies and NGOs tap into it for both humanitarian and early development purposes, but their requests overwhelm it—only two thirds of requests currently receive funding. Funding shortfalls and delays carry a considerable cost for intended beneficiaries, and such costs outweigh any efficiency savings gained from pooling resources. Clearly, there are problems with the current approach. What assessment has the Department made about where we go from here? We must recognise that a significant increase in funding is likely to be necessary in the future to provide basic services as long as the MDTF continues to struggle.

Sudan is a prime example of a country in which conflict has destroyed the education system and rid children of a chance to go to school. There has been a severe shortage of aid funding and teachers since the conflict began. For many, learning takes place under trees or in thatched huts. When I was in Sudan, I witnessed first hand massive classes taking place outdoors under the burning midday sun. There was no running water for the children, and they had hardly any learning materials at their disposal. The result is that fewer finish primary school, especially girls. I commend the work of Save the Children for highlighting that injustice. For Sudan to progress, education provision must be adequately funded, in particular in South Sudan, which must avoid producing a generation of illiterate youths. Although enrolment has increased in recent years, three quarters of children have no access to education. In that regard, marginalisation of girls and young women has serious implications because it reduces women’s opportunities to participate in all levels of government and civil society. I would appreciate it if the Minister would comment on that. Is he aware of how much the South Sudan Government spend on education compared with defence? Right hon. and hon. Gentlemen will, like me, have seen reports that defence spending has reached a high percentage of GDP, and education spending might be suffering in comparison.

On health, one child in four dies before the age of five, and the lifetime risk of a woman dying in pregnancy or childbirth is one in nine. That is an outcome not only of poverty and insecurity, but of inadequate health services. There is currently only one doctor for every 100,000 people, primary care facilities lack drugs and equipment, and there is virtually no obstetric emergency care. Those problems are compounded by the fact that fewer than one third of the population have access to safe drinking water, and by the prevailing poor hygiene and sanitation practices.

I have seen the great work that Médecins sans Frontières does on the front line. I shall not forget hearing about what young nurses deal with on a daily basis in both the south of Sudan and in the Darfur refugee camps. A significant amount of aid has gone to support them and they do a magnificent job—many of us are stunned and impressed by their work.

The right hon. Member for Coatbridge, Chryston and Bellshill mentioned that some bigwigs fly to use UK hospitals. Does the Minister know what is going on and will he say what the Government’s policy is on that?

Order. I hope that the hon. Gentleman will bring his remarks to a conclusion soon, because I want to give the Opposition spokesman and the Minister plenty of time to reply to this important debate.

Thank you, Mr. Olner. I shall conclude my remarks shortly.

Aid workers in Sudan’s Darfur region come under increasingly savage attack, but I shall not say more on that because hon. Members on both sides of the House are well aware of it.

The debate is entitled “UK Aid (Sudan)”. The aid comes from a number of sources, but it is mainly paid by the UK taxpayer through DFID. The people of the UK, including my constituents and people throughout Scotland, are generous, but there is another aid budget—that of the Scottish Government. Their aid budget has doubled since the May elections, and it would not be proper to exclude it from the debate. If the Minister is in discussions with the Scottish Government, will he ensure that their aid and that provided through DFID works together to maximise its impact? The Scottish Government have raised a number of issues. They would like to spend aid money within the UK, but they have never mentioned Sudan. They have mentioned the doubling of their aid budget, but to my knowledge they have not mentioned aid to Sudan.

Most debates on Sudan in recent years have centred on the problems of Darfur, so it has been good to look at the wider issue of aid to Sudan, because many areas are at risk, as there will be in future. I am optimistic by nature, but one of the few places to defeat my optimism is Sudan. There is one simple reason for that: the Sudanese Government. Most other countries that struggle to cope with disaster—I exclude Zimbabwe—have a Government who work towards a solution. That is not the case in Sudan. Until something changes, I fear that no matter how much aid is poured into the country, the problems will persist. There is no alternative but to continue to work for change at all levels, but that will take time. Unfortunately, time is the one thing that many of those who most need help to survive do not have.

May I say what a pleasure it is to serve under your chairmanship, Mr. Olner? Some six years after the event, I have just about come to terms with your election victory in 2001, even if I remain convinced that there were 7,500 or so Conservatives who, had they voted, would have made things rather different.

I congratulate the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) on securing this important debate. His reputation in the field proceeds him and, in a wide-ranging speech, he demonstrated his commitment to and knowledge of the issue. It is a pleasure to follow my friend the hon. Member for Stroud (Mr. Drew), with whom I enjoyed enormously a trip to Sudan this year. He is widely recognised as the House expert on Sudan and demonstrated his knowledge on our trip. I am sure that he will join me in offering thanks to Chris Milner, who works in his office, for the wonderful job he did to organise our trip. I am also pleased to follow the hon. Member for Edinburgh, West (John Barrett), who covered much of the ground that I wish to cover, as is often the case in such debates. He outlined eloquently some of the key problems in Sudan.

As the hon. Member for Stroud mentioned, I returned from a trip to Sudan with the all-party group recently. Although I did not have time to travel to every region of the country—I went mostly to the capital and to South Sudan—I saw a fractured society, a creaking political structure and unchecked militias. The international community is giving its all in an effort to resolve the various internal crises; but ultimately, it is struggling to make much progress.

I wish to mention briefly two key issues: DFID’s involvement in Sudan and, time permitting, some of the different geographical crises and their impact on aid delivery. I commend the Minister and the Department’s continuing commitment to Sudan. I shall certainly not criticise DFID for the monetary aid that it gives to Sudan. As was mentioned, the figures suggest that, since April 2004, DFID has given more than £250 million in humanitarian assistance to Sudan, of which £145 million was directed to the Darfur region. Sudan is the third largest recipient of bilateral aid from the UK, which is the second largest donor after the United States.

The budget for 2007-08 is £110 million, £67 million of which will fund humanitarian work and £40 million of which will in turn be channelled through the UN-administered common humanitarian fund. The remaining £27 million will be used to support NGO programmes, mostly in Darfur. With that in mind, I ask the Minister to outline the priorities for the common humanitarian fund and the measures in place to ensure that the UK taxpayer is receiving value for money. Can he also offer a breakdown of which NGO projects are being funded and where?

Although we can see that the input of financial support is considerable, my concern is exactly how we are measuring the success of that support. If I were to be critical, I would argue that the Department, rather like the Government as a whole, continues to judge its success on inputs rather than outputs. Unfortunately, when we begin to look at the outputs, we see that the picture is slightly less rosy.

At macro level, we could take progress towards achieving the millennium development goals, for example. The United Nations Development Programme’s Sudan millennium development goals interim unified report concluded that achievement of the 10 millennium goals, broken down into their 20 subsections, was unlikely in 12 of the 20 sections and only potentially achievable in the eight others. Only the MDGs on the under-five mortality rate, the maternal mortality ratio and the proportion of population with access to an improved water source were assessed as probably being achievable. Those statistics paint a grim picture, but it is a picture for the country as a whole. In areas such as Darfur, South Kordofan, Abyei and Gereida, the situation is, unfortunately, much worse.

The report suggests that, although education enrolment is increasing, 75 per cent. of children still have no access to education—worst off are girls—and the problem has become so bad that southern Sudan is in danger of producing a generation of illiterate citizens. That obviously has huge implications for Sudan’s future development.

Health standards are also very low. One in four children dies before the age of five. One in nine women giving birth in Sudan dies in labour. Hospitals are badly under-stocked with drugs, and a number of sources suggest that there are only enough doctors for a ratio of one doctor per 100,000 people—assuming, of course, that they can get to the doctor in the first place.

Shortly before the hon. Member for Stroud and I met the Vice-President of the Government of South Sudan, we travelled a short distance out of Juba to one of the villages where many of the recently returned former internally displaced persons from the north were staying. Accompanied by some immaculately dressed, armed and fed soldiers—that is hardly surprising, as some 40 per cent. of the budget from the oil revenue for the Government of South Sudan is spent on defence—we talked to villagers who were almost at their wits’ end because, despite being little more than three miles from the capital, the village lacked any basic infrastructure, whether a kindergarten, junior school or even the most basic medical clinic. I recall causing our excellent ambassador some concern less than an hour later by asking the Vice-President why his Government were spending so much on defence and so little on the most basic facilities for his people.

In 2005, the comprehensive peace agreement created two multi-donor trust funds: one to provide financial aid to the Government of national unity in Khartoum for war-affected areas in the north and for the three transitional zones of Abyei, Blue Nile and South Kordofan; and one for the Government of South Sudan. The amount of money currently committed to the two funds is estimated at $508 million. Of the £47 million originally committed by the UK, £30 million has been committed to date, with a further £17 million due in 2007-08. Regrettably, however, during the trip the common view from those whom we met appeared to be that the MDTFs are failing.

It appears that not only did the international community force unrealistic start-up programmes on the two MDTFs, but their inability to support quick impact aid delivery went unrecognised. To be fair, the MDTFs were not designed to meet immediate recovery needs. Instead, the funds focus on Government capacity building and centrally decided programmes, with an over-reliance on outside consultants. Having met representatives of several NGOs, we heard how their experiences of the MDTFs had been very negative, with recipients experiencing severe delays, confusion and frustration.

In the light of those problems, the UN has suggested that the MDTFs implement a new quick delivery strategy. Although the Government of national unity were supportive in the north, the Government of South Sudan appear less supportive, and recent events seem to have underlined that fact.

If development is to progress in Sudan, the big international players, the UN and, most importantly, the African Union need to put pressure on the Government of South Sudan as soon as possible. With that in mind, can the Minister confirm whether all the budgeted £47 million will be given to the two funds by the end of the financial year? Will he explain what progress has been made in setting up a quick delivery mechanism to address the slow delivery problem? Will he also outline some of the outputs that have been delivered by the MDTFs to date? Is he confident that they represent value for money?

I realise that I am asking a lot of questions, but I hope that they do not come as a surprise to the Minister. Finally, can he confirm when the donor-commissioned review of the MDTFs is due to report and why the Sudan consortium meeting scheduled for this month has been delayed at least until January and possibly even March?

The hon. Member for Stroud suggested that Sudan has become something of a laboratory for experimentation in funding mechanisms. I have to agree. Donors have set up a number of pooled funding mechanisms. In addition to the multi-donor trust funds and the common humanitarian fund, which have been discussed, is the basic services fund. As has been said, however, even now, we are simply failing to address the immediate funding crisis. That was repeated to us again and again during our visit, perhaps most noticeably by the head of the UN mission in southern Sudan. What plans has the Minister to give a greater percentage of UK aid to the basic services fund to help to plug that gap?

It is clear that funding shortfalls and delays carry a very considerable cost for the intended beneficiaries, outweighing any efficiency savings gained from pooling resources. The lack of a clear peace dividend in terms of high-impact additional funding represents a serious threat to the comprehensive peace agreement.

While we were in Juba, in the south, we also visited the new joint donor team that was first set up back in May 2006. That joint project involves the UK, the Netherlands, Norway, Denmark, Sweden and Canada. It is commendable in that, through working together in that innovative way of joint funding and joint policy making, the delivery of aid should be more effective. However, the same problems seem to exist where the multinational nature of the team seems simply to add to an already slow delivery time. Can the Minister confirm whether it remains DFID’s intention ultimately to deliver all expenditure, except humanitarian aid in the south, through the joint donor team? Will he also outline what outputs the joint donor team has delivered since its creation in May 2006?

Time is marching on, so I intend to deal briefly with just one area, which is Abyei. The Abyei oilfield is estimated to be raising $529 million in 2007. Boundary disputes continue, although it is hardly a surprise, given the oil interests, that both the north and the south claim the region as their own. DFID and other key international players have an opportunity to bring both sides back to the negotiating table and use the region as a springboard for greater success across the whole country.

Since Dr Garang’s untimely death, trust between the National Congress party and the Government of South Sudan has ebbed away. When we visited southern politicians who were part of the Government of national unity, they certainly said the right things, but the events of the past two weeks have shown that there was really a lack of trust. However, if a demilitarised zone can be created, it could set a precedent for the rest of the country. Of the four possible methods of resolving the deadlock drawn up by the joint NCP and Government of South Sudan group, only political mediation has been attempted so far. The Government of South Sudan have shown a willingness to involve international mediation. However, the NCP continues to rule out that option. Perhaps most seriously, the recommendations made by the boundary commission have still to be recognised, and with that stumbling block still in place, progress probably remains a pipe dream.

Will the Minister outline what actions the Government have taken to hold talks with our Chinese counterparts, whose considerable influence could be used to bring about peace in the Abyei region? Also, what does the Minister propose to kick-start the talks about the boundary commission report?

I congratulate my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) on securing this important debate. He is someone who uniquely commands respect in the House for his work on international development, and it is a privilege to respond to his debate.

My right hon. Friend’s eloquent and powerful description of the reality of life in Sudan was, frankly, depressing, but it is important that we are depressed. That depression should act as a catalyst for us to do even more, but we will all recognise that while we are depressed here, we are not living that reality—the people of Sudan are. I know that right hon. and hon. Members are clear about the fact that the cruel, prolonged and unnecessary suffering of the people of Sudan must come to a swift end. Their impatience for peace is shared by people on these shores and beyond.

Sudan faces significant development challenges. The war between north and south Sudan left more than 6 million people displaced. Large swathes of the population endured some of the worst development indicators possible, and the recent conflict in Darfur has added to that suffering. Current projections suggest that Sudan will not meet any of the millennium development goals by 2015. Each year, 100,000 children die from preventable diseases. The UK has more than 25,000 qualified midwives; we are told that southern Sudan has only eight. It should not be a surprise that Sudan has perhaps the worst maternal mortality rate in the world, at 2,000 deaths for every 100,000 deliveries.

The UK is responding to those challenges. As has been mentioned, we are the second largest donor to Sudan. In 2005, we pledged £317 million in aid over three years. To date, we have spent £290 million and stand to exceed our pledge. This year alone, we have committed £110 million, £67 million of which will go to humanitarian assistance.

My right hon. Friend the Member for Coatbridge, Chryston and Bellshill was kind enough to share with us a letter from the United Nations High Commissioner for Human Rights about funding shortfalls. We are pleased that the UK’s role and commitment has been acknowledged. Our response is that we cannot meet the needs of the people of Sudan alone. As the hon. Member for Edinburgh, West (John Barrett) has said, other donors must meet their commitments and play their parts, if we are to have the impact so desperately required now and for many years in Sudan.

Work in Sudan is becoming increasingly complex. The comprehensive peace agreement in 2005 ended decades of civil war between the north and the south. It is the essential foundation for long-term peace and stability for all parts of Sudan. We remain fundamentally committed to supporting its implementation.

My right hon. Friend spoke about the bombings and condemned them. I know that he is aware that the UK sponsored the UN resolution in March 2005 referring Darfur to the International Criminal Court. Two arrest warrants for atrocities in Darfur have been issued so far. I concur with his comments and those of my hon. Friend the Member for Stroud (Mr. Drew) and other hon. Members that the announcement on 11 October by the Sudan People’s Liberation Movement to suspend its participation in the Government of national unity underlines the agreement’s fragility. Political leaders in the north and the south need to muster the political will and demonstrate the leadership necessary to resolve the more sensitive issues at the heart of the agreement—border demarcation, elections and Abyei. The current political deadlock has the potential to derail the relative peace that is, at the moment, mercifully allowing recovery and development work to continue in the south. We must do all we can to restore faith in the agreement and demonstrate to the people of Sudan the tangible benefits that peace will bring.

The UK provided £60 million in development assistance last year to support CPA implementation. We have also put £47 million into the multi-donor trust fund over three years, to be split evenly between the north and the south—a vital contribution to funding the introduction of a new currency for Sudan required by the CPA. Through a DFID programme, we have also provided £17 million for basic services such as primary schools, boreholes, latrines and health services, which are having a major impact on people’s lives.

We will provide support to help ensure that the 2009 elections are a success, as they are crucial, and will continue to support the transformation of the Sudan People’s Liberation Army into a disciplined professional army operating under democratic civil control with respect for human rights. My hon. Friend the Member for Stroud focused on that issue. The Government believe that it is crucial to consider it, as well as the disproportionate sums of money that seem to be targeted at the military, including many former military operatives who are still being paid salaries.

We are also working with partners to reinvigorate the assessment and evaluation commission, which oversees CPA implementation, and to ensure that the CPA remains high on the international agenda and is not forgotten. I think that we all accept that it is crucial to get close to the kind of situation that we want. The CPA is the bedrock of stability for the whole of Sudan, and it is indivisible from the peace process in Darfur.

The humanitarian situation there remains a major source of concern. Since the start of the conflict, many thousands have been killed and wounded, and more than 2 million people are internally displaced in camps throughout the region, while more than 4 million depend on international aid for their basic needs. Malnutrition levels exceed emergency thresholds in many parts of Darfur. We have spent £145 million on humanitarian funding to Darfur since the start of that tragic crisis in 2003. The majority of this year’s aid, some £40 million, is being channelled through the common humanitarian fund, a pioneering multi-donor mechanism allowing the UN humanitarian co-ordinator to allocate resources where the need is greatest.

My hon. Friend the Member for Stroud mentioned the need for efficient and effective funding mechanisms that would have an impact on the ground, and we are very conscious of that. The multi-donor trust fund is being reviewed, and we rely on the Governments of Sudan and southern Sudan to take part in that process. They have asked the World Bank for more time to prepare, but we hope that the review will take place in early 2008, so we can be more confident that the systems in place are delivering the maximum possible.

My hon. Friend also mentioned the 2:1 ratio. The ratio has been proposed to ensure that the Sudanese Government make a long-term commitment to poverty reduction. The UK will continue to fulfil its obligation to help alleviate the suffering, but sustainable peace and security in Darfur will be achieved only through a political process involving all parties to the conflict.

The Prime Minister is leading international efforts to build a consensus on Darfur. On 20 July, he and President Sarkozy announced a joint initiative for Darfur. It focused on four areas—rapid deployment of an effective peacekeeping force; movement towards political negotiations; preparing for economic recovery to show the people of Darfur that there are dividends of peace; and regional stability.

My right hon. Friend the Member for Coatbridge, Chryston and Bellshill and the hon. Members for Edinburgh, West and for North-East Milton Keynes (Mr. Lancaster) have discussed China’s role. We are certainly encouraging China and India to play a more prominent and positive role. Hon. Members should be aware that, like us, China has urged and pressed the SPLM and President Bashir to end the political crisis and fully to implement the CPA.

My hon. Friend the Member for Stroud has mentioned east Sudan. The peace agreement there was announced on 14 October last year, although we accept that progress has been slower than we would have liked. Unfortunately, that is a common theme in Sudan, but we are sure that the multi-donor trust is playing an important role. I assure my hon. Friend that the embassy in Khartoum monitors progress regularly. It is appropriate now to pay tribute to our British personnel, who do a magnificent job under what must be extremely challenging circumstances. I have not had the opportunity to go to Sudan to see them in action, but most hon. Members here today have, and I know that they would wish to join me in paying tribute. It is always useful to remind ourselves of their efforts.

Recently, we have seen progress. UN Security Council resolution 1769, which was sponsored by the United Kingdom with unanimous agreement, mandates a hybrid African Union and UN peacekeeping force. My right hon. Friend the Member for Coatbridge, Chryston and Bellshill spoke of a no-fly zone. That is obviously a possibility, but our initial focus and priority must clearly be to ensure that the hybrid force is up and in action. We hope and pray that it will create the secure environment that is so desperately needed for us to deliver vital humanitarian assistance to the people of Darfur. In September, the UN Secretary-General announced that peace talks would be held in Libya later this month, which is an encouraging sign.

Despite those positive developments, we are all aware that problems remain. The violence has increased, including a heinous attack on AMIS peacekeepers in Haskanita and fighting around the town of Muhajiria. That has added to an already challenging humanitarian situation, with a quarter of a million people being displaced this year alone.

My right hon. Friend referred to the Central African Republic. We support the deployment of an interim European Union force for the Central African Republic and for Chad, and we have given some £6.5 million of humanitarian assistance for Darfurian refugees in Chad.

Since the start of the year, more than 100 humanitarian aid vehicles have been hijacked and five aid workers have been killed. That seriously undermines the ability of humanitarian agencies to deliver vital aid to those in desperate need. I pay tribute to the brave efforts of those humanitarian workers who continue to provide essential assistance to the people of Darfur. Their tireless contributions in the most dangerous of circumstances deserve not only recognition but praise. The hon. Member for Edinburgh, West, too, rightly gave praise to those brave front-line workers.

We call on all sides to commit themselves to an immediate cessation of hostilities, so that humanitarian workers can do their job and so that the peacekeeping forces can be rapidly deployed. They must engage fully in the political talks being led by the African Union and the United Nations.

The hon. Member for North-East Milton Keynes asked about the multi-donor trust fund. As I said earlier, £47 million has been given, and we remain committed to meeting the target that we set ourselves. We all want to see the quick delivery mechanism; although we support efforts to make the MDTF more flexible, there is a trade off between fiduciary standards and speed of delivery. Looking forward to the next Sudan consortium meeting early in 2008, we hope to address some of the issues correctly raised by the hon. Gentleman. He also spoke about the common humanitarian fund and channelling funds to meet the most urgent of needs is an absolute priority.

A breakdown of projects cannot be given today, but disbursal by non-governmental organisations is rising. NGOs received 26 per cent. of the fund in 2007, compared with just 12 per cent. in 2006. As for results, in 2007 the common humanitarian fund supported the return and reintegration of some 180,000 people displaced by the civil war.

The hon. Member for Edinburgh, West mentioned the Government of Scotland. I am not aware of any approaches having been made by them, but my right hon. Friend the Secretary of State for International Development is a former Secretary of State for Scotland. I am sure that he would want to maximise the impact of the work that we do in Sudan by working with all nations of the United Kingdom.

I am grateful to the Minister for giving way. He is making an absolutely excellent speech, and has a firm grasp of all the issues raised today. Will he join with me in saying that we should continue working with our colleagues in the European Union, particularly with France? We believe that they have much to offer. I thank the Minister again for his excellent contribution.

It is right that we work with all nations and parties, including the EU, which has an important role to play. Again, I commend my right hon. Friend for his efforts on these and wider issues. I now need to get on the home straight, as only 90 seconds remain.

As the Prime Minister made clear, if the situation improves we are prepared to act in support. As part of the joint initiative for Darfur and as an incentive for the peace process, the UK will ensure that when political progress is made it will be matched by economic support. However, if the Government of Sudan and the rebels do not meet their commitments, I make it clear that we will pursue further, targeted sanctions.

On Sunday night, I attended the Muslim “Live 8” concert for peace in Darfur, which was organised by Islamic Relief. About 10,000 people gathered in Wembley arena, which demonstrated the strength and depth of support here for the people of Darfur, and I congratulate the organisers on that timely initiative.

None of us should forget the people of Darfur, and we accept that we have an obligation to end their suffering. The CPA must be implemented, because only then will we have a chance to bring lasting peace to Darfur and the whole of Sudan. With the help of our international partners, we will work with the people of Sudan, letting them know that they are not alone. Our challenge is to deliver their dream—a Sudan where there is peace, prosperity and justice for all. We will meet that challenge.

Maidstone and Tunbridge Wells NHS Trust

I am glad to have the opportunity to follow the oral statement made by the Secretary of State for Health last week. Indeed, he was forced to make it, following the urgent question by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), whom I am glad to see in his place.

Like other Members of Parliament representing the area covered by the Maidstone and Tunbridge Wells NHS Trust, I have received a number of letters from constituents whose relatives and nearest and dearest have been afflicted by hospital infections. As appalling and grim as these letters were to read—obviously, I took appropriate action on them—they did not prepare me and, I suspect, many others for the magnitude and severity of the criticism that came from the Healthcare Commission.

This is a scandal in which some 90 people have died directly, or most probably, because of Clostridium difficile. It is also a scandal because the treatment of individual patients in some cases can only be described as absolutely abominable. I should like to take this opportunity to put on the record this quote from the Healthcare Commission’s report:

“They told us that when patients rang the call bell because they were in pain or needed to go to the toilet, it was not always answered, or not in time. A particularly distressing practice reported to us was of nurses telling patients on some occasions to “go in the bed,” presumably because this was less time-consuming than helping a patient to the bathroom. Some patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of pressure sores. Families claimed that tablets or nutritional supplements were not given on time, if at all, or doses of medication were missed. Wards, bathrooms and commodes were not clean and patients had to share equipment such as zimmer frames which were not cleaned between use.

I cannot think of a more disgraceful account of a part of the NHS than what has come out in this report revealing grossly inadequate management. I shall give just one example:

“Policies for the control of infection were on the trust’s intranet, but they were nearly all out of date and not all staff could gain access to the intranet.”

And there are some pretty strong criticisms of doctors:

“Areas of concern included infrequent reviews of patients by doctors, the lack of systematic monitoring of whether the patients were recovering from C. difficile, and the failure, in many cases, to change antibiotic treatment for C. difficile when a patient had failed to respond to the initially prescribed therapy.”

Now, of course, we have a Kent police investigation into possible criminal offences.

Against this outrageous, appalling background, there have been just two resignations: the immediate, totally warranted, resignation of the chief executive and the further resignation—somewhat belatedly and reluctantly, I felt—of the chairman of the board of the trust. I must put it to the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), and to the Secretary of State: is it right that, following such an appalling scandal, there should have been only two resignations from this trust?

That brings me to the Government’s policy on severance payments for those who have fallen down on their job in the NHS. In my view, the former chief executive of the Maidstone and Tunbridge Wells NHS Trust should not be receiving one single penny in severance payments. Yet here we have the ludicrous position of the trust board having taken legal advice—I have a copy of the strictly private and confidential letter sent by the former chairman to the Secretary of State for Health confirming that—on the basis of which it is on one hand offering a very substantial sum to the outgoing chief executive while, on the other hand, the Secretary of State is desperately seeking to intervene to prevent the payment being made, which is wholly unacceptable.

I put it to the Minister that, surely, it is high time that the Government issued clear guidance to boards of NHS trusts about some of the basic terms of contract that they should be offering to the top management. A key element of those basic terms of contract should say, “If you succeed, you do well—you get recompensed financially, accordingly—but if you fall down on the job, do not expect to be bailed out with a significant sum at the taxpayer’s expense. Failure means no financial pay-out.” That should be the key watchword for the Government. I do not understand why such a policy has not been conveyed throughout the NHS.

So where do we go from here? We need to start right at the top of the Maidstone and Tunbridge Wells NHS Trust. We have in place a new chief executive. Obviously, I wish him well in respect of an immense challenge facing him. I hope that he will hit it off distinctly better with the staff of the trust and, indeed, with patients than his predecessor did and I hope that he achieves infinitely greater success. However, I have to say that the chief executive’s first public utterances in his new role were not wholly comforting. They were as follows:

“My name is Glenn Douglas and I was appointed as acting Chief Executive on Monday. My normal job is as Chief Executive of Ashford and St. Peter’s Hospitals NHS Trust in Surrey.”

So here we have an acting part-time chief executive put into the Maidstone and Tunbridge Wells NHS Trust, which has suffered an appalling calamity for patients and now needs to be put on the road to recovery.

What is the position on the board? Two of my constituents who are consultants in the trust rang me yesterday. I asked them the same question: “Who is now the chairman of the board?” They gave me the same answer, saying: “We have no information as to who is now the chairman of the board.” One of those consultants added, “The trust is rudderless.” The Secretary of State must get in and grip this situation. We cannot have this trust left with a part-time chief executive and no chairman in its present plight. Will the Secretary of State look urgently, today, at the need for a full-time, razor-sharp chief executive and a truly effective chairman?

I now turn to the relationship between beds and infection control. I thought that what used to be called—and apparently still is called—hot-bedding went out with the Factory Acts in Victorian times. Well, I was wrong. Hot-bedding is still alive and well, although that is not a very appropriate term to use in reference to the Maidstone and Tunbridge Wells NHS Trust. It is still very much in use.

I noted the interesting comments in The Sunday Telegraph last Sunday about the relationship between hot-bedding and infection. The article said:

“Experts say that ‘hot-bedding’, with beds filled again soon after they have been vacated, does not leave enough time to clean them properly, while a lack of spare beds makes it hard to isolate infected patients.”

It went on to refer to an important report that is being produced by Professor Barry McCormick, the Department of Health’s chief economist. That report apparently shows that

“when a hospital’s bed occupancy rate passes 90 per cent., the risk of MRSA rises by 42 per cent.”

The article goes on:

“Prof McCormick’s final report is also expected to show that C. difficile spreads most quickly when hospitals are crowded.”

Rather worryingly, the article went on to report that the Government do not seem to be keen that the report should see the light of day.

However, 90 per cent. is the danger threshold. What do we have in the Healthcare Commission’s report on the Maidstone and Tunbridge Wells NHS Trust? It states:

“The trust’s bed occupancy rates were consistently over 90 per cent. in the medical wards at both Maidstone Hospital and Kent and Sussex Hospital”

with all the consequent dangers of infection. The particular scandal in our area—I have to put it that strongly—that I want to draw to the Minister’s attention is that on the one hand the acute trust, the Maidstone and Tunbridge Wells NHS Trust, is hot-bedding, while on the other hand, in the same area, the West Kent primary care trust had half the beds in its four community hospitals shut down in the whole of last year, which was one of the most absurd and short-sighted false economies in the NHS that could possibly be made.

Happily, West Kent PCT has finally woken up to the idiocy of shutting down the beds in its community hospitals. It is at least reopening the beds in three out of the four. The one where the beds are not being reopened at the moment is Tonbridge Cottage hospital in my constituency. Half the beds remain shut. I have received no respectable medical justification for keeping those beds in Tonbridge Cottage hospital shut. I wish through the Minister to urge the Secretary of State to issue a direction to the chairman and chief executive of the West Kent PCT to reopen the beds in Tonbridge Cottage hospital forthwith. That trust, at the moment, in my view, is failing in its duty of care to patients. There is no good reason for keeping those beds closed. They should be opened immediately.

I now want to turn to debt and its relationship to infection. I looked closely at and listened to what the Secretary of State for Health said last week, and he gave an extraordinary answer to my hon. Friend the Member for St. Albans (Anne Main). He said that there was “no correlation” between debt and C. difficile. Eradicating C. difficile costs money—it has to be funded. The Secretary of State himself, at the end of his statement, drew attention to the fact that he was spending an extra £50 million on dealing with C. difficile.

I bring to the Minister’s attention the extraordinary situation that we have with debt in the Maidstone and Tunbridge Wells NHS Trust. The trust is a victim of what the Government choose to call the resource accounting and budgeting, or RAB, system. The idiocy and unfairness of the system for the Maidstone and Tunbridge Wells NHS Trust is that having paid off a historical debt of £17 million, under RAB it is required to pay off that same amount a second time over. It is intolerable that the trust should be put in that position, which is directly detrimental to patients.

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and my hon. Friends the Members for Tunbridge Wells (Greg Clark) and for Sevenoaks (Mr. Fallon) and I wrote not once, not twice but three times to the previous Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), urging her to remove the debt burden from the trust. I urge the Minister and the Secretary of State to wipe out the totally unjustifiable debt that the trust is having to make economies to try to pay off a second time.

Reconfiguration was also raised in the exchange with the Secretary of State last week. I thought that he gave a very strange answer to my hon. Friend the Member for Faversham and Mid-Kent (Hugh Robertson). He said that as far as the Maidstone reconfiguration proposal was concerned:

“If it is referred to me, I will refer it to the independent reconfiguration panel, which is clinician-led, so that there is a clinical argument for any change.”—[Official Report, 15 October 2007; Vol. 464, c. 569-70.]

I appreciate that the Secretary of State has not been long in his job, but reconfiguration for Maidstone has already been referred to him and he, in turn, has referred it to the independent reconfiguration panel, which is due to report to him on 30 November. The matter is before the Secretary of State, who will have to take a decision on it in a few weeks’ time. I ask the Minister whether it makes sense, given the C. difficile scandal, for reconfiguration to be approved now to transfer services from Maidstone hospital to the antiquated buildings in the Kent and Sussex hospital and the Pembury hospital. Surely consideration should be given to delaying that reconfiguration until the new hospital is built.

My right hon. Friend is making a powerful speech, as ever. Will he confirm our understanding that the new hospital is absolutely imperative, if we are to have a long-term solution to these problems? Does he welcome the Secretary of State’s assurance that no expenditure on infection control will stand in the way of that? Does he share my concern that the Treasury holds the purse strings and will ultimately approve the new hospital? Will he join me in urging the Minister to urge her right hon. Friend the Chancellor to approve the hospital without delay whatever the final year balance of the new hospital?

My hon. Friend has correctly anticipated my concluding remarks. I have been somewhat critical of the answers given by the Secretary of State for Health last week, but I should like to finish by saying that I wholly agreed with the Secretary of State’s reply to my hon. Friend, when he put that question to him last week. The Secretary of State gave a clear assurance that he was committed to the new hospital and that the case for the new hospital was made even stronger by the appalling experiences that we have suffered from the C. difficile outbreak.

My constituents, and those of my hon. Friend, of my right hon. Friend the Member for Maidstone and The Weald and of my hon. Friend the Member for Sevenoaks, have suffered grievously through the delay in the arrival of the new hospital. They have had to endure mixed-sex wards, antiquated buildings, antiquated layouts, and now that terrible infection. I urge the Secretary of State to approve our new Pembury hospital and to approve it forthwith.

I congratulate the right hon. Member for Tonbridge and Malling (Sir John Stanley) on securing this important debate. I appreciate the comments that he and other hon. Members have made, and, in particular, the seriousness of the tone with which they have been expressed. Other Members from the area who are not in the Chamber today have also made their voices clear to me and to the Secretary of State.

I want to take the opportunity to offer my sincere condolences to all who have been affected by the tragic deaths that have occurred at the trust. Of course, that is not sufficient for grieving relatives and families. I have always acknowledged that since the announcement of the report, which is as serious as it gets. It showed a lack of management across the spectrum, from the wards to the board. There is no excuse for that at any level—from professional clinical staff, nurses, medical and biochemistry staff, to cleaners and managers. We have failed people across the health service spectrum. I have acknowledged that on previous occasions, and can do so again today, although it gives me no pleasure to say that to the right hon. Gentleman.

The report found that the trust board was unaware of the high infection rates, and did not spend enough time considering infection control. The report makes recommendations for action by the trust, including a review of the trust board’s leadership, prioritising of infection control at board level, risk management, clinical guidance, staffing levels and training. The right hon. Gentleman referred to a report by Professor McCormick, which will be updated and published, I believe, at the end of this year. We note that and look forward to his report back.

On other leadership matters in the trust, I accept totally the right hon. Gentleman’s comments about with whom the buck should stop. I personally think that that goes across the clinical field, and I know that a leadership review is taking place, which will report back shortly.

It is now nearly two weeks since the report was published, but still people are employed by the trust who were directly criticised in it, including non-executives, with the exception of the chairman, who approved, we are told, the pay-off to the former chief executive. That seems to be an unconscionable delay. Under section 66 of the National Health Service Act 2006, the Secretary of State has the power to serve an intervention order to remove individuals. Will he make use of those powers?

The Secretary of State has made it very clear that he is taking legal advice. Sadly, that is not going as fast as people in the Department, and certainly Ministers would like. However, the Secretary of State is taking advice and meeting regularly with the strategic health authority and chief executives to address all of the other concerns that the right hon. Member for Tonbridge and Malling rightly raised in his contribution.

We cannot take this matter more seriously, because the most serious errors have taken place in Maidstone and Tunbridge Wells NHS Trust. I assure Members that the Secretary of State is working very closely, on a daily basis, with everybody, in order to bring these very sorry events to a conclusion, and to move on in the most positive way possible.

Many measures have been put into place in Maidstone to improve systems for monitoring all infections, which of course have to be in place in all trust and primary care trusts. In particular, I take note of the right hon. Gentleman’s comments about community trusts and community beds. I assure him that I shall go back to the Department and check up on that. I would be very happy to discuss my findings with him.

We have reviewed nurse staffing levels and are recruiting to enlarge nurse staffing numbers on wards. As a former nurse, it is beyond my comprehension how such a level of infection could take place in 2007. I accept that they are operating in very poor conditions, and I accept the point about the speed of the reconfiguration, and emphasised it to the Secretary of State, who is working very hard to address it.

We have extended cleaning in all clinical areas. Of course, we have relaunched the “Clean Your Hands” campaign. I am aghast that we have to do that, but we do, across the board, from the most senior medical consultants down to the most junior members of staff.

I, too, am a former nurse, and I remember the smell of cleanliness in hospitals. Is the Minister aware that, in 1982, 170,520 ancillary staff worked in NHS hospitals in England, but, by 1995, that number had fallen to 66,760? At the same time, there was a corresponding increase in MRSA and other infections that have been highlighted. Does she agree that it is time that we got back to the domestic levels of cleanliness in hospitals that we had in 1982, prior to compulsory competitive tendering?

I agree. Of course, given that we both worked in hospitals back then, we know how important domestic staff are to the well-being of patients and of the contribution that they make to the team. If they are designated to be in one ward or clinical area, they take pride, and always have done, in their work, and feel as responsible for the cleanliness and infection rates of their hospitals as any member of the professional team.

I agree with the right hon. Member for Maidstone and The Weald (Miss Widdecombe), whom I met this morning, and who said, in her own way, that an air of carbolic is required in our hospitals once again. However, we must look at individual practice in the case before us, which we have said was unacceptable. Now we have to look to the future and help to restore community confidence in the Maidstone and Tunbridge Wells area, and I know that hon. Members will work with us to help with that.

Targets have been mentioned, but the Healthcare Commission pointed out that targets in themselves did not create this problem, because other organisations meet targets while keeping patient safety as paramount at all times. Complaints must be taken seriously. In this instance, for those of us concerned with health care professionals, one complaint would have been one too many. We also need to look to how we manage C. difficile infection in the future. It has always been an infection in its own right, and the medical care of patients and the appropriate use of antibiotics is paramount, as well as the cleaning. We must take a team approach to this difficult infection. In many areas of microbiology, other countries are now looking to us to see how we can assist them.

We must not forget the hard work and dedication of our NHS staff who feel the anger and shame of what has taken place in Maidstone and Tunbridge Wells. We all understand that the public expect to be cared for in clean hospitals, which is why the Prime Minister announced the big spring or autumn clean—whenever it takes place— but that is just one thing. It is not sufficient, but it will start to give the public the confidence that they always had in the cleanliness of our hospitals. The way in which clinical matters are managed and run needs to be looked at again.

I could, of course, go back a few years when it was unheard of to have such a busy stream of people in and out of wards and clinical areas, and to see our hospitals used by so many people in so many different ways at the most inappropriate times. I have asked the chief nursing officer to look at that. Pilot projects taking place in parts of our hospitals are showing huge signs of saying, “We will have rules and all the clinical staff will obey them.” However, in this case, that is not enough. Senior people across the board will be, and have been, called to account. The Secretary of State and I want to work with a new chairman and chief executive, and to get round the table with all the hon. Members concerned to look at how best to do that.

My door is open to all hon. Members in order to get this right and to see how best to work with constituents so that we can restore confidence in the NHS, in which we still have great pride. That is a serious issue. We can balance books and meet targets, which have helped patients, but we also need future targets to reduce infection rates and to adhere to a very strict code of practice. The chief executive, David Nicholson, has sent out a very strong message to all NHS managers saying that an atmosphere of being unable to report situations and of complaints not being taken seriously will not be acceptable at any level. All members of staff must feel that they operate in an open and safe environment, and patients and communities must always feel that about our beloved NHS.

Senior Care Workers

The quality of the life of a nation is judged by how it treats people who are most dependent upon the care of others. In this country, the care of our elderly should be not only one of our most important concerns, but one that we constantly monitor and assume to be fundamental to the quality of their lives.

Some months ago, I was approached in my constituency by a series of Filipino care workers who, to be frank, I did not know existed in my constituency. They gave me the names of and information about three care homes, owned by Southern Cross Healthcare, which I did not realise existed. They told me that they, who had been working for periods of between four and six years in this country, almost all of them with children in local schools, mortgages and stable homes, had suddenly been confronted with a case that they had never expected.

The new Border and Immigration Agency had decided, without, as far as I can see, any consultation with Parliament, that the rules for care workers needed to be changed. The work permit applications for senior care workers were altered in such a way that people who had been working sensibly and quietly at difficult jobs were told that their work permits would not be renewed. I am glad that my hon. Friend the Minister is replying to the debate; but frankly, in the past three months, I have been appalled by the way in which his Department—the Department for the Home Office, or whatever it happens to be called presently—has batted me about from one area to another with the highly spurious argument that not one Department is responsible for that set-up.

The Home Office Border and Immigration Agency, however, directly changed the rules of the game. In other words, when those workers entered the United Kingdom, not only were they accepted as capable of acting as senior care workers, but no one ever questioned their status.

The situation that my hon. Friend describes is very much like that in North-West Leicestershire and elsewhere in care homes in Coalville and in Castle Donington, where Filipino carers have worked for several years. Its worst aspects are tardiness and uncertainty, because the Border and Immigration Agency and the Home Office are not replying to letters. I wrote to the Minister, whom I greatly respect, on 4 July—not a single reply yet. I raised the matter in the Chamber on 9 July with the Home Secretary. I hope that that speeds things up and that we receive replies, so that we can remove the uncertainty hanging over many hundreds of people who perform a vital role for the very elderly in our society.

I hope to set out exactly that set of circumstances, because the whole episode has been a stain on the responsibility and reputation of the United Kingdom.

Many of the Filipino care workers were told that they must apply through their existing management, who initially said that it was the Government’s responsibility and that the workers were not allowed to apply for an extension. Then, when we obtained information from the Government, the management said that a certain rate of pay—£7 an hour for people of their status—had been imposed and that it had been made very clear that, unless the workers were paid that rate, they could not be employed.

Is the Home Office now in charge of wage negotiations for people employed in private care homes? If it is, I understand why the Department of Health sent me a letter that said:

“Matters relating to pay and conditions of employment of staff employed by independent care home operators are for negotiation for employers and employees and/or their representatives, taking account of relevant employment legislation…the Department of Health extends only as far as the regulations and national minimum standards governing the quality and safety of care”.

If that is true, how have we found ourselves in that situation? In reality, large numbers of private health care workers, working in many instances for American chains, have been told that they cannot apply for an extension of care. Owing to the fact that those women—they are largely women—are Filipino and Indian, very law-abiding and extremely worried about whether they will be able to remain if they do not have legal status, they have in some instances been driven out of the country at very short notice, and they are in others terrified that, in some way, they will contravene the rules.

I congratulate my hon. Friend on securing the debate. She mentions that the Filipino workers are law-abiding. Does she agree that, of all the immigrant groups, they are probably the most industrious, well-motivated, law-abiding and socially integrated in our society? Does she agree also that the Minister should show some compassion when dealing with that group and that they should be allowed to work out their current permits? Their precipitous removal would be at great personal cost to the individuals, their families and the hundreds of thousands of elderly people who need that top-quality care.

I strongly agree with every word that my hon. Friend says. Let us enumerate the qualities of those women: they are English-speaking; they are enormously warm in their approach; and they do difficult jobs in care homes dealing with the elderly—in some cases for the minimum rates of pay. They are doing jobs that Britons do not want to do—jobs that will not be filled successfully by people who are non-English-speaking. However, that appears to be the burden of the argument: get rid of people who are without the European institutions and countries, and replace them with people from eastern Europe. If that is true, it has been done in the most astonishingly incompetent, insensitive and appallingly thought-out manner.

I wrote to the Prime Minister saying that I was being bounced from one Department to another without any clear statement about the circumstances. I shall quote a letter from a marvellous man called David Edgar, who has been doing his best to protect those workers, simply because he was so concerned about what was happening in the care homes about which he knew. He said:

“There is…abundant evidence that…many small care home companies who are desperate to employ experienced and qualified Senior Care Workers who…speak excellent English…are quite happy to pay the imposed hourly rate however their nightmare is the constant moving goalposts of the Home Office, the rules are now so complicated and conflicting that care home managers do not know how to apply for Work Permits, Visas and…at a cost of £190 for each Work Permit…are very reluctant”

even to try.

Those are the responsible companies. The irresponsible ones have simply told people that they will not apply for extensions, and they are leaving large gaps. In subsequent evidence, Mr. Edgar says that he believes that many of those women are “now being blackmailed” into doing much harder work to fill the gaps and that, in some instances, they are being told that, if they create any difficulties about their terms and conditions, the Home Office will be told that they are not to remain because the company will not apply for any extended permits.

I apologise, but only yesterday did it occur to me that I could not be the only Member who was dealing with the situation. As we can see from the number of my colleagues who are gathered in the Chamber for a half-hour debate, that is true. Some 24 Members e-mailed me with specific details. Some of them had as many cases as me—I have more than 20 in my constituency—and some Members have up to 50. Some of the cases involve the most appalling stories. In one case, six care workers had their work permits refused, even though they had been here for four years.

My hon. Friend the Member for North-West Leicestershire (David Taylor) and many others have given me detailed case histories that not only chime with what I have discovered but make it clear that the problem continues. My hon. Friend the Member for Eccles (Ian Stewart) has approached Ministers and been given the same sort of reply as me and has also been told by a care home:

“The handling of this matter by the Home Office has been shambolic…No one at the Home Office gives a damn about the effect these guidelines have had on staff welfare. This is nothing more than an effort to increase the deportation figures”.

I do not have to agree with every word of that to say that Members of Parliament are extraordinarily concerned about what has been happening to those people.

If the Minister gets to his feet and says, “Of course, this is not a matter for me; it is for the Borders and Immigration Agency”, I can say to him only that there is a lamentable failure in management care in the Government, considering that two major Departments seem totally incapable of deciding what they want to do. If there was wide consultation on the change in the rules, with whom did it take place? When was it brought before Parliament and why were we not aware of it before it happened?

Once Members of Parliament started to raise the matter, the Home Office mildly backed off by saying that there should be a degree of flexibility in how cases are handled. However, as far as I can see, there has been no plain statement of the status of the women in question, even though it is known not only that they are desperately needed in the care homes where they worked, but that their absence is putting enormous strain on the existing health care staff and the quality of life of the people living in those homes.

Since a Department of Health Minister is responding to the debate today, I want to know what the Department intends to do. Why is it not possible for the Home Office to grant those women an amnesty for a minimum of three months after the expiry of their work, if it can clearly be proved that they have been working here, in some cases for up to six years, so that they can apply for other jobs? Let them apply for other jobs in the health service or the care homes sector. There is absolutely no reason why that should not be so.

Filipino nursing qualifications are extraordinarily good. It is all very well for the Department of Health to say, “Well, of course they can get themselves accredited and apply.” Those women have no support system, do not know what they have to do to get themselves accredited in a foreign land and face the considerable pressure of wondering whether they will be thrown out of the country in a short time. It is clear, since none of us seem to have accurate figures of the number people involved, that more and more people’s work permits will soon expire and their cases come to light. Their Members of Parliament will ask for clear protection for people from whom we have clearly benefited, yet seem prepared to abandon without a thought to their situations.

I shall not take the Minister through everything that has happened to senior care workers, but I shall say that David Edgar, who has been fighting this battle almost single-handed, dealt with another Southern Cross home, not in my constituency. He made a request to the Home Office in July, and the carers in question were ordered to leave the UK on 27 July. The Minister was served with a letter before action, and legal action is taking place. However, in August, Southern Cross—the very people who were saying to their workers, “Well, I’m awfully sorry, but as far as we are concerned, once your work permit ends, you are on your own”—signed up to a skills pledge. Like me, David Edgar then went to every relevant Department. There was a change on 13 August, when new work permit criteria were introduced.

A parliamentary Committee condemned the poor treatment, abuse and neglect that elderly residents receive in many care homes, at the same time that even more difficulty was being caused. David Edgar then made formal complaints on behalf of various care workers about the way in which they had been cheated out of money. He was received not only with little evidence that the police intended to investigate but with scant courtesy. Since the beginning of the episode, there has been an appalling set of circumstances that does nobody any credit.

I wish to ask the Minister a number of things. Has his opposite number in the Home Office said that he is prepared to assist those women if they can genuinely show that they have been here for a certain length of time and have the skills to find jobs in the health care sector? If not, is the Home Office prepared to make specific undertakings on how those workers can be assisted in the interim period to deal with the circumstances in which they find themselves?

The Minister will forgive me—I am allowed an elderly moment. I did not realise that he was indeed in the Home Office. I am surrounded by Ministries whose names I cannot pronounce and whose acronyms seem to produce such sounds as “Brrrrrr.” He will forgive me for not realising that he has moved on.

Although I am allowed senior moments, I, too, will need care at a certain time in my life. I shall want it to come from people who are nice, warm and caring and have proper training. The group of women affected exemplify those standards and the best in care work. Many of them are now terrified—I use that word advisedly. I have had people wandering into my surgery, as I am sure other Members have, saying cheerfully to me, “Oh yes, I was refused the right to remain here”—10 years ago, in one instance. Yet these women come to me weeks before their work permits expire and say, “We are so frightened. What are we going to do? We will have to leave our homes and take our children out of school. We will have to deal with it.”

If a mistake has been made, which I believe it has—24 Members of Parliament are not making up the problems that they have told me about—the Home Office should simply say so. It should bring in interim arrangements and make them clear and public. It should stop running away from what it obviously perceives as a suggestion that it is giving special care to those who come from outside the European Community, and it should ensure that it does not impose such things as hourly rates and then tell me that the matters for negotiation are for those in the health care service. It is a case of one or the other: the Government might decide on home care rates—fine, I do not have a problem with their setting minimum rates—but they should make up their mind. When they do, they must remember that the people affected are not toys or counters; we are playing with people’s lives. So far, we have not done a very good job.

I endorse everything that my hon. Friend has said. There have been such cases in my constituency, and we cannot get people to fill the jobs created. The ladies at Stocks Hall nursing home do a fantastic job. They are caring, diligent and everything that one would want. The residents want them and so do the directors, but they cannot afford to pay them £7.02 an hour. I ask the Minister whether it can really be fair to allow those individuals to come to England, take up employment, settle in the community and then face deportation after two years. They are efficient staff members and really needed.

The Minister knows the case. Let us hear his explanation or, better still, his excuses and decisions about what he is going to do to assist such people urgently. This is an urgent problem.

Let me start by congratulating my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) on securing the debate. As she has said, I used to be the Minister with responsibility for social care, and in my time at the Department of Health, the issue of the work force in social care detained me more than most.

This afternoon, I shall sketch out the chronology of events that has brought us to this stage and the transitional arrangements that I put into place, which are benefiting nearly 80 per cent. of people in this category. Before I expand on those points, I apologise to my hon. Friends—we are all hon. Friends this afternoon—if there have been delays to the replies that they have received. Such tardiness has sometimes been due to my concern to ensure that the policy was right before we got back in touch with people, because it has been changed substantially. I take personal responsibility for the policy, because I have spent a considerable amount of time on it in the past few months, not only with officials, but with hon. Friends and other hon. Members.

That brings me to my second introductory point: if colleagues have particular cases that they want to bring to my attention, I am always happy to meet them to discuss in detail how I can help. My hon. Friend the Member for Weaver Vale (Mr. Hall) is not present, but he has been particularly vocal in arguing this case to me, so I wanted to put his name on the record.

To give a brief chronology, the changes in this area began in October 2006, when new age discrimination legislation was introduced. Against that backdrop, care home operators continued to advertise senior care worker jobs in local job centres, as they are required to do to pass the resident labour market test. In those adverts, they specified that the post of senior care worker required a national vocational qualification level 3 and three years’ experience in a job at that level. That is important, because the work permit system has operated on two important principles since 2000—this is not a recent innovation; it has been around for seven years. The first principle is that people coming in under the work permit scheme have to be skilled. Only two parts of the immigration system operate low-skilled schemes: the seasonal agricultural workers scheme, which will soon be given over to residents of Bulgaria and Romania, and the food processing scheme. Between them, those schemes have about 20,000 places.

The second principle, with which I am sure all Labour Members will agree, is that people must be paid the going rate to do the job. My hon. Friend is right that the Home Office does not conjure its guidance out of the air. It simply reflects what Skills for Care and other sector skills councils tell us is the going rate for a particular post. Another problem then arose: Jobcentre Plus pointed out to us that employers could not justify advertising those posts as requiring an NVQ level 3 and three years’ experience because the role being performed did not require such skills. Age discrimination legislation says that a job requirement cannot stipulate skills that cannot be justified and cannot be potentially discriminatory. Research was then undertaken within the sector to see whether the senior care worker post did, in fact, meet the skills criteria. Let us not forget that the reason why the post existed was that the care industry said that the job required that level of skill. However, evidence then emerged that there was no such requirement, and our research confirmed that, which placed us in a difficult position.

Obviously, the Home Office cannot operate a policy under which we give work permits against our own guidance—the relevant guidance being that people need to have a certain level of skill to do the job. The result was that 100 per cent. of the people who applied for extensions were being refused. I was not prepared to countenance that, so I asked my Department to work with the Department of Health to see how we could introduce new guidance that would allow the post of senior care worker to be retained and waive the skill requirement that we insisted on before, on the condition that employers stepped up to pay the going rate for that job. My hon. Friend is right that it is not for me or a Health Minister to determine that pay rate; we have been advised by Skills for Care that it is the going rate for that job. Some hon. Members have said to me that that is a national raise. Of course, social care is a different business, and there are different rates of pay in different parts of the country.

The Minister has four minutes left in which to tell us what he is going to do now. I accept that his Department got itself into a mess. The legal advice that it received was unhelpful, and it is my experience that one can get different legal advice if one wishes. The reality is that the women whom we are discussing, who have enormous abilities, are being thrown out of the country and are not being replaced, and that the ones who are left are being overworked. What is he going to do about it?

Let me come to that point directly. The Home Office has to translate Government policy into the immigration rules, and that is sometimes difficult, but I do it to the best of my ability. I have put transitional guidance in place, and the figures show that 79 per cent. of the people who apply for extensions to their leave are being given further leave to remain. That is partly driven by employers accepting their responsibility to pay individuals the going rate for the job. My hon. Friend is right that those workers are hard-working, well integrated and doing something with a level of tenderness, expertise and care that is, in my experience, second to none. It is not unreasonable for businesses in the social care sector—I name Southern Cross in particular—to pay £7.02 an hour for that job.

I hear what the Minister has said. We should tackle the employers that treat their employees shoddily, not the employees themselves.

My hon. Friend is absolutely right. That will take some fundamental changes to the way in which the immigration system is run. One of the founding principles of the points system that will be introduced at the beginning of next year is that employers will need a licence to sponsor people into the country, so that we will have a means of quality control.

My hon. Friend asks, from a sedentary position, about people—her constituents, I think—who are here now. I have made it my policy not to discuss individual cases in the Chamber.

There are 20 of them. What is the Minister going to do about the 20 that I have and the 50 that my hon. Friend the Member for North-West Leicestershire (David Taylor) has? We need an undertaking now.

I ask my hon. Friend whether we can meet privately to discuss her constituents’ cases and see whether there is something specific that we can do. As a general principle, the transitional guidance means that 80 per cent. of people in that category are getting their leave extended. For those who are not, I challenge the employers to pay the going rate for the job.

Westmorland General Hospital

I am extremely grateful for the opportunity to engage the Minister on the matter of the acute service review at Westmorland general hospital. In spring 2006, the local Morecambe Bay hospitals NHS trust began a process of consultation on proposed changes to acute services provision at the hospital in Kendal. The consultation process formally began in the summer and concluded at the beginning of September last year.

The trust presented the public with four options, all of which constituted closure of or a severe cut to the coronary care unit and other acute services at the hospital. The public outcry against the proposals was enormous: more than 27,000 people signed the petition against the planned closures, a record-breaking 7,000 formal responses to the trust’s consultation were received, and 6,000 people marched through Kendal in abysmal weather last September to protest against the proposals.

The outcome was that on 13 September 2006 the hospitals trust chose option three, which entailed the closure of the heart and stroke unit and other acute services at Westmorland general. It seemed clear to thousands of us that although we had been consulted, we had not been listened to.

The acute service review has been marked not only by a staggeringly dangerous final decision that will, undoubtedly, cost lives, but by a catalogue of maladministration, procedural flaws, management failures and broken promises, which, frankly, have brought the management of the NHS in south Cumbria into disrepute. The Minister will have done her research, no doubt. My great concern, if I can be entirely honest with her, is that the principal source of that research will have been the trusts themselves. I suggest that she take information from such sources with a pinch of salt, given that at the centre of my concern and that of just about every one of my constituents is a range of faulty decisions taken chiefly by the hospitals trust after a faulty process.

As I speak, preparations are being made for a judicial review of the consultation process. In addition, the Healthcare Commission is undertaking an unprecedented independent review of the process that led to the decision to cut acute services at Westmorland general hospital. However, it should not fall to private citizens—NHS patients and their relatives—to have to undertake the risks associated with legal and other actions when we have a democratically elected Government, and, in particular, the Department of Health, which has the power to be their champion, to exact justice and to ensure that fair decisions are made.

The hospitals trust, alongside the now defunct Morecambe Bay primary care trust, presented four options, all of which constituted a reduction in service. At the time, I made a formal request for the inclusion of further options including the status quo and an option to enhance services. My request was refused by the then hospitals trust chief executive, who stated that status quo was not possible and could not therefore be an option.

The trusts used a formula to assess the four options, but, incidentally, had no financial costings. Option 3 came out on top and triggered the movement towards closure of the heart and stroke units and all other acute medical services at the hospital. At a meeting of the joint health service overview and scrutiny committee in October 2006, however, the then acting chief executive of the hospitals trust demonstrated that the status quo option, which the trusts had refused to offer in the consultation, would have scored more highly across all the trusts’ criteria than three of the four options that were presented in the review.

That graphic admission, if it were the only evidence, would be evidence that would render the consultation process flawed and unsafe. We were presented with incomplete options. Indeed, it appears that the selection of options was fixed and based on internal prejudices rather than fact. The evidence suggests that a decision had, in effect, already been taken.

There was no justifiable reason to exclude the status quo as an option in the consultation. Indeed, there was no justifiable reason to exclude an enhancement of acute services at Westmorland general. An enhancement such as the provision of a CT scanner would have been completely in line with the Government’s stated policy of delivering NHS services closer to home. There was no justifiable reason for those options to be excluded. However, there was a strong unjustifiable reason—the decision to downgrade had already been taken. Before a single consultation response had been received, before the options were even presented, the trusts knew what they would conclude.

Only last month, thanks to a medical consultant, whom I will not name at this point, we secured further evidence that the decision to close acute services had been taken before the consultation had even begun. I paraphrase only slightly what the consultant told witnesses at a public meeting at Kendal town hall: “The consultants had argued for 10 years with our administration that acute medical services should be transferred from Westmorland general to Lancaster. The administration had resisted, but we saw our opportunity when the financial crisis occurred. We recognise that the consultation process was defective and we argued for accurate costs to be included, but the final decision was the one we wanted. That is all that matters.”

Of course, the Minister may think that the consultants must be right, even though there is clear evidence of prejudice and maladministration. After all, they are the experts, are they not? However, the consultant in question was not a cardiologist, and a huge body of local clinicians fully object to the trust’s conclusions. The consultant did, however, confirm the suspicions of many of us, when he clarified that the matter had been a done deal all along.

Let me explain that the trust presented its case for closure chiefly on two grounds. First, the financial imperative: the hospitals trust had a projected deficit of more than £12 million and had to make savings. Although that was the case at the time of the board’s decision in September 2006, it is not the case now. Since that time, the trust has improved its financial standing, in part thanks to the Government’s correct decision to overturn the old accounting rules so that trusts were not forced, in effect, to pay back their deficits twice over. That accounting change alone improved the trust’s financial position by £6.3 million, and it completely destroyed its financial case for the closure of acute medical services at Kendal.

The second part of the trust’s case for closure was ostensibly clinical. In a nutshell, the Royal College of Physicians produced guidance notes in 2002 which included a recommendation that consultants in acute medical care should not straddle more than one hospital. To follow that guidance to the letter would mean closing acute medical services at either Lancaster or Kendal. However, the guidance is just that—guidance. It is not an edict. Indeed, in answer to my written question last year, the then Secretary of State for Health, the right hon. Member for Leicester, West (Ms Hewitt), confirmed that it was only one of a range of considerations to be weighed up when trusts were deciding how best to allocate acute medical resources.

The principal alternative consideration to the guidance is the sheer distances involved in south Cumbria, which includes massive tracts of the Yorkshire dales and the Lake district. The Minister will know all about the golden hour in which patients must get to hospital to be stabilised in the event of a heart attack, for example. As things stand, more than half of my constituency is already an hour or more from hospital, yet the trust seeks to close Kendal and make dangerously ill patients travel a further 30 or 40 minutes to Lancaster or Barrow.

All acute medical crises have better outcomes the sooner they are treated by a full medical team of a doctor and specialist nurses situated in a fully equipped resuscitation room. Kendal has an excellent record of managing the initial stages of heart attacks and other life-threatening acute cardiac emergencies. I invite the Minister to review the statistics, which show clearly that timings at Kendal for patients getting vital treatment after the patient reaches the hospital door are significantly and consistently better than those for either Lancaster or Barrow. Outcomes are also excellent.

To counter the compelling clinical evidence against the preferred option of closure, the trust management presented the board at the crucial meeting on 13 September last year with new evidence secured at the last minute. It stated that no patient in the trust area would be more than 42 minutes away from the coronary care unit at Lancaster. The board accepted the figure, and the decision was taken to close acute medical services.

I can inform the Minister that she might make it from the north of my constituency to Lancaster in 42 minutes, if the Department were to provide her with her own jet pack. However, if she had access to an ambulance only, like the rest of us, the average journey time from, for example, Chapel Stile near Ambleside to Lancaster would be in the region of 75 minutes or more. On top of that, ambulance response times in south Lakeland are often in excess of 30 minutes. Having decided to close acute medical services, partly on the basis of that laughably faulty evidence, the trust sheepishly admitted a week later that it had been wrong and that the evidence presented to the board consisted of draft figures. The severely embarrassed board hurriedly agreed to change the figures, but carried on regardless with the plans to close acute medical services. I am no lawyer, but I know that any verdict based on faulty evidence is unsafe. At that point, the trust should have gone back to the drawing board, but it seems that it had already made up its mind, so why let a few faulty facts get in the way?

Sadly, the Morecambe Bay primary care trust voted to support the hospital trust and to back the closures, but providence prevailed. Owing to NHS reorganisation a fortnight later, the Morecambe Bay PCT was wound up at the end of September 2006. At the beginning of October, the new Cumbria PCT reacted with horror to the position that it had inherited and refused to endorse its predecessor’s decision. Eventually, the PCT organised a group of GPs who used the strength of public opinion to win some concessions, including the retention of 50 GP-managed beds, but the trust continued to press on with the proposed closure of 70 per cent. of acute medical services at Westmorland general and, particularly, the loss of the coronary care and stroke units.

The Cumbria PCT caved in on the other 70 per cent., having been promised by the hospital trust that the closures would not begin until April 2008, and on the understanding that no movement towards enacting the acute service review would take place until Lancaster and Barrow hospitals had been upgraded to take on the additional capacity and until the ambulance service had been significantly enhanced.

The upgrade to the ambulance service to cope with the significant increase in journey distances would constitute a guarantee of at least one and normally two paramedics per ambulance, a 12-lead electrocardiogram on each vehicle, full telemetry and telephone contact on each vehicle—incidentally, something that just will not work in south Cumbria because of the terrain—and one additional ambulance serving the south lakeland area. At the moment, there has been no enhancement at Lancaster or Barrow hospitals and no upgrade of the ambulance service. Indeed, senior ambulance service managers stated candidly and publicly that they cannot, for example, guarantee even one paramedic on every ambulance.

The hospital trust’s promise to wait not only until April 2008, but until all those measures are in place before moving towards closure was broken earlier this month. A report was leaked to me on 2 October showing that the hospital trust was beginning implementation of the acute service review that very week, with the closure of ward 11. I protested against that, and the PCT, to its credit, refused to support the document. Ward 11 was then re-opened, but not fully. It took a further week of pressure to ensure that the trust did more than just re-open it in name and re-opened it fully in practice. That latest demonstration of bad faith rightly led to a humiliating climbdown by the trust.

While all that was going on, nurses, doctors and other staff continued to provide outstanding service. Despite being undermined and working under a cloud of job insecurity in the knowledge that trust bosses have dealt with them and their patients unjustly, local NHS workers have not let us down. They deserve our praise and enduring gratitude, and I want to take the opportunity to register my thanks to them in this place. However, hospital staff deserve more than gratitude, and I am asking the Minister to give Westmorland general hospital staff and the whole south lakeland community what they deserve. I am simply asking the Minister to undertake a full review of the facts, with a view to instructing the local NHS trusts to go back to the drawing board, and to instruct the Cumbria PCT to lead new consultation in which all options are fully considered and due process is observed.

A decision to close life-saving services that was clearly prejudged and chosen from a deliberately inadequate list of options, based on laughably inaccurate information about ambulance journey times, that failed to gain the confidence of the PCT and that has been pushed by a trust that has lost the confidence of the community that it serves stands to bring the NHS into disrepute. Only last month, 4,000 of us formed a human shield around the hospital to demonstrate our support for medical emergency services there and our opposition to the closure of those services. Eighteen months from the start of the consultation process, the acute wards at Westmorland are still open. We, the community, take some credit for that. We will not accept a decision that is both wrong and wrongly arrived at, and which is unsafe in both the legal and medical senses of the word.

I congratulate the hon. Member for Westmorland and Lonsdale (Tim Farron) on securing this debate. I am aware of his keen interest in the future of health services at Morecambe Bay, particularly in the future of Westmorland general hospital. I also pay tribute to all the NHS staff in Cumbria and Lancashire who have made such an enormous contribution to improve the local NHS.

As is the case throughout England, Cumbria PCT has received major increases in resources to improve the health service for its local population. During the two years 2006-07 and 2007-08, Cumbria PCT will receive an increased allocation of £108.4 million. In the hon. Gentleman’s area of the North West strategic health authority, the extra funding received since 1997 has provided 1,153 more consultants, 544 more GPs and more than 11,000 more nurses. All those professionals make a huge contribution to health care in the hon. Gentleman’s constituency.

Waiting times have greatly reduced as a result. In the north-west, the number of people waiting more than 26 weeks for in-patient treatment has fallen to 10, and only 16 are waiting more than 13 weeks for an out-patient appointment, compared with more than 61,000 in 1998. All staff should be congratulated on that major achievement, which is real progress. However, we recognise that, alongside record investment, reform is needed to deliver a national health service that provides health care fit for the 21st century.

As part of those reforms, many NHS organisations are considering with their local stakeholders changes to the way in which they organise their services. I am sure that the hon. Gentleman will agree that hospital and community services must adapt if we are to continue to meet patients’ needs and to improve access. I am also sure that he will agree that it is right that those changes should be driven locally and in conjunction with patients, clinicians and other stakeholders.

In 2006, the university hospital of Morecambe Bay trust and the then Morecambe Bay primary care trust identified strong clinical and financial reasons why the pattern of acute medical services needed to be reviewed and undertook a review and consultation. The review’s aim was to improve the management of patient flows—the patient journey—operational management and bed usage. On the clinical front, the overriding consideration is, and always has been, patient safety. Consultant physicians at Westmorland general hospital had raised concerns about the admission of acute medical patients to the hospital and their management on several occasions. In addition, the Royal College of Physicians issued guidance on the minimum resources, both human and capital, required.

The review’s report was considered by the overview and scrutiny committee of elected local councillors, who recognised the need to move forward, but raised concerns and recommended some modifications. To accommodate those concerns, the Morecambe Bay NHS Trust and the newly formed Cumbria PCT initiated a planning process that focused on clinicians and clinical issues from primary and secondary care perspectives. The aim was to establish a new consensus across the clinical spectrum and to reflect the perspectives that had been articulated during both the consultation and the subsequent engagement with public and patient groups, which was not easy.

As a result of that work, a new clinical model for acute medical services emerged, which was more responsive to the needs of local residents and significantly supported a more integrated general approach by the PCT to the health systems throughout the county. Proposals relating to the Westmorland general hospital were consulted on between June and September 2006, and the preferred option has since been subject to further work. Westmorland hospital has since fallen under the remit of Cumbria PCT. The proposals relating to the hospital will now be taken forward as part of the Cumbria-wide whole system review. The consultation on the review commenced on 27 September and will run for three months. It does not cover the services provided at Westmorland general hospital, and the proposals that were previously considered will not be revisited. Proposals for the reconfiguration of services are a matter for the NHS locally, working in conjunction with clinicians, patients and other stakeholders, and they are built on a sound clinical case for change.

Until such time as the Cumbria-wide review is completed, it would be inappropriate for me to comment further on the details of the consultation, as I am sure that the hon. Gentleman realises. However, under the current proposals, I understand that Westmorland general hospital will become a diagnostic, treatment, care and rehabilitation centre, designed to offer quality services to meet the needs of the local community. The proposed redesign and development of the unscheduled care facilities at the hospital will therefore be in line with the developing Cumbria-wide strategic plan for delivering urgent care services.

The shared clinical vision for the future is that acute medical care will build on the expertise of clinicians from primary and secondary care. The development of the vision for Westmorland general hospital sets the future of services in the broader context of care and rehabilitation for patients at home, in the community and in hospital—an important aspect of aftercare rehabilitation. That vision is very much in line with the White Paper “Our health, our care, our say”, which signalled a shift towards a greater concentration of specialist services for those who need them, while more care would be provided closer to people’s homes to deal with cases where treatments no longer required a hospital visit. All aspects of health care change regularly, as they should, and that important point is very significant to today’s chronic management of care.

In future, some patients may no longer be admitted directly to Westmorland general hospital. Such patients are those whose diagnosis is such that they would be deemed to be at risk if they were not admitted straight to a more specialist acute hospital, so it is absolutely right that they should be transferred to neighbouring sites. For example, someone who has a stroke needs to be in hospital, given a brain scan and seen by a specialist within three hours to determine whether they can be given the clot-busting drug that can make the difference between permanent disability and walking out of hospital again. Not everyone can have thrombylosis, but we need to act quickly to find those who can. The required scanning facilities are not available at Westmorland general hospital, but once the patient is medically stable, it would be possible to return them there for the remainder of their care and, most importantly, their rehabilitation. That is progress, and we should acknowledge and cheer it.

I am pleased to say that the delivery of a new emergency floor at the Royal Lancaster infirmary, comprising an acute assessment unit, an in-patient, short-stay medical/surgical ward and a coronary care unit, is well advanced, and it is planned to open those facilities in December. Providing care and rehabilitation at Westmorland general hospital for patients who currently receive their acute specialist care in Lancaster, or who will receive it there in the future, will have a positive impact on patients’ lengths of stay in the Royal Lancaster infirmary.

My fears have been realised, in that the trusts with a case to defend are the source of the Minister’s information. In no way do I demur from her earlier comment about the importance of the health service specialising and modernising, but does she agree that we need to take a balanced view of what is most relevant in every case? To put it bluntly, there is no point in having all bells and whistles at Lancaster if someone is dead on arrival. If someone has an hour-and-a-half journey from the point where they have their emergency to the point where they arrive at hospital, that will, to say the least, be counter-productive. Given that the planned closure of the heart unit will take place in April 2008, unless someone intervenes to prevent it, will the Minister at least agree to force the PCT to review the consultation, so that any decision that is made—whether to close or otherwise—can be deemed medically and legally safe?

The hon. Gentleman’s point would be valid if the facts that he gave earlier about the ambulance service were correct, but the upgrades have taken place. I will happily meet him to share the information that I have received about the upgrades to ambulances and the ambulance service itself.

Yes. It is important to put that on record.

The PCT and North West Ambulance Service NHS Trust are working together to produce better services for the south lakeland population. There will be investment in a range of service provision, including manpower, vehicles and equipment. It is accepted that additional training and a lead-in time will be needed to ensure that staff are trained. I hope that that meets the hon. Gentleman’s concerns.

When we talk about reorganisation and improvement, we are talking about providing better, safer services. The desire is to achieve better outcomes for patients, including increases in safety and quality of care, and that is ultimately what is driving the change. If change is clinically led through consultation, with all the experts working together, difficult as that may be, the desired outcome is better patient care. We have to go along with such discussions, and we have a duty to see them put into practice to ensure patient safety and patient care.

I am reassured to know that no services will change until clinicians are satisfied that it is safe to proceed and that no services at Westmorland general hospital will close until local NHS organisations are satisfied that ambulance service provision is the same as the current service or better. It has also been agreed that the overview and scrutiny committee will be kept informed by means of regular six-monthly reports and prior notification of specific service changes that will take place.

The trust believes that it has a robust and sustainable plan for the future of Westmorland general hospital and the community that it serves. It continues to work to deliver improved services to communities in Cumbria. It is the duty of all of us to ensure that we do not raise patients’ and families’ anxieties to a level that is not justified, when people are working to such safe clinical ends.

To sum up, reconfiguration is about modernising treatment and improving facilities to improve patient outcomes, to develop accessible services closer to home and, most importantly, to save lives. I remind the hon. Gentleman that proposals for the reconfiguration of services are a matter for the NHS locally, working at all times in conjunction with clinicians, patients and other stakeholders, and that such proposals are built on a sound clinical case for change. I therefore encourage him to continue to engage with his local NHS on the way forward for services in Westmorland. I feel confident that Nye Bevan today would say to us what he said almost 60 years ago:

“the service must always be changing, growing and improving—it must always appear inadequate.”

We must always do more to achieve that goal, and we will do so.

Question put and agreed to.

Adjourned accordingly at two minutes to Two o’clock.