I beg to move, as an amendment to the Address, at the end of the Question to add:
‘but regret the absence of measures in the Gracious Speech to empower professionals responsible for the delivery of health and education services and of measures which would make those services more accountable to patients and parents; deplore the absence of measures to improve public health and reduce health inequalities; regret the lack of a reformed legislative structure for the National Health Service which would reduce central targets and devolve decision-making closer to patients and enable health services to respond to the need for high quality and accessible care; further regret the lack of measures to deal with school discipline, raise standards in literacy, numeracy, science and languages, address under-performance in the primary sector, tackle disadvantage at its roots and provide effective support in the earliest years; and further regret the absence of measures which would deliver the real improvements needed in these and related public services.’.
Last Tuesday, I sat here and listened to the Prime Minister’s speech, but I waited in vain for him to talk about health or the national health service. Back in July he described the national health service as his priority, but in November that turns out to have come to nothing: an empty vessel—from hero to zero. I suppose that we should not have been surprised, given that last year, as Chancellor of the Exchequer, he completely ignored in his Budget speech the financial crisis that was afflicting the national health service. At the same time, he said that education was his passion. So it may be, but the passion must be for high standards in education, not just for high spending. In last week’s speech, he did not even commend doctors, nurses, social care workers or teachers—all those in our public services on whom we depend—so let me start by doing so.
Public services are vital to our well-being and to our quality of life. We value and support the NHS and its staff, teachers and support staff in schools and colleges, and social workers and care workers. We know that while we can make promises here, it is they who deliver. However, we cannot expect the delivery that we want when morale and motivation in public services is not high. Earlier this year, a hospital doctor carried out a substantial survey. Two thirds of the doctors who took part said that morale had fallen in the past year, while 54 per cent. said that morale in their hospital was poor or terrible. I am afraid that we need higher morale right across our public services. I therefore make no apology for repeating that one of our central intentions as a party must be to re-empower professionals working in public services so that they can deliver the service that they wish to deliver, whether to parents or to patients.
In the Gracious Speech, Her Majesty, on behalf of the Government, announced that there would be an education and skills Bill. There is something of a theme to this Gracious Speech. For all that the Prime Minister might like it to be thought that there is a change in this Government, in fact there is no change. When I listened to the speech, I thought, “Surely I’ve heard these intentions before”—and so I had. In July 1999 the Government published a document called “Bridging the Gap”—I am sure that the Secretary of State for Children, Schools and Families recalls it—in which Tony Blair said:
“staying at school or in training until 18 is no longer a luxury. It is becoming a necessity.”
Indeed, but that was in 1999. The trouble, as with all these things, is how well the Government have delivered on their intentions.
Eight years on from the intentions expressed then, the number of those not in education, employment or training has risen from 160,000 to 220,000. Connexions, which we were promised in 1999 would be one of the solutions, has come and is about to go. The Learning and Skills Council has gone through an endless succession of reorganisations without ever delivering on its intentions. However, there has not been a recognition of the fact that, as stated in “Bridging the Gap”, non-participation beyond 16 is strongly linked to the relative achievement of young people prior to 16. That is the central issue. That is why what the Government are saying feels like such a failure on their part. Extending the education leaving age is an insufficient response to earlier and continuing failings in educational achievement, particularly among those in low-income households.
Participation depends on motivation, the relevance of the education offered and the reward that young people expect from it. Young people have to think it worth while; there have to be results. If they fail to see results from a decade of schooling, why should they respond positively to more compulsory education and training? My hon. Friend the Member for Surrey Heath (Michael Gove) will explain this in more detail later, but we must tackle the roots of disadvantage, and ensure that young people in schools, including those from the poorest households, have a platform for their participation in learning through life, and see that they can secure their future position through the acquisition of standards, including basic standards in literacy and numeracy, in a disciplined environment.
Is the hon. Gentleman disputing the facts that have been produced by Stockton borough council stating that in low-income areas, the improvement in English and maths has been between 30 and 47 per cent. during the past five years? That is an incredible improvement in primary schools, which should be celebrated. Is the hon. Gentleman really disputing that that is taking place?
I am sure that my hon. Friend the Member for Surrey Heath will be able to elaborate on that later. All I do know is that the Government’s acknowledged statistics show that they have not met their targets for key stage 2, and we have seen some of the standards in basic literacy and numeracy pretty much flatlining in recent years.
There was nothing in the Prime Minister’s speech, or in the Gracious Speech, on the subject of public health. The Secretary of State for Health said that his priority was to tackle health inequalities, so where was that in the Gracious Speech? Where was it in the Prime Minister’s speech? It was not there at all. Just as we want to tackle inequalities in educational outcomes, we have to tackle them in health outcomes, too, because they have been widening. The Secretary of State must know, because it was in Lord Darzi’s framework for action in London—the right hon. Gentleman has of course subcontracted responsibility for policy in the Department of Health to Lord Darzi, so perhaps he does not bother to read his documents—that the spend per head on public health in primary care trusts in London is inversely related to the relative deprivation of those trusts. Frankly, that is a scandal.
The Government have been distributing ever larger amounts of money in the direction of primary care trusts that have statistics of relative deprivation, and yet what do we find in London? They spend less on tackling that problem. Why do they do that? It is not a wilful desire on their part to ignore their responsibilities. It is because, of course, in the national health service everything is focused, through the target culture, on the delivery of a small number of Government targets. Too little is focused on the necessity of understanding that we must prevent disease and improve health outcomes. That is one of the reasons why my party has made it clear during previous Queen’s Speech debates, and in our own proposals, that we should have separate funding to tackle specific public health needs.
I urge the Government and the Secretary of State, if they are serious about tackling health inequalities, to amend the structure of public health care. In the health and social care Bill, they will do a little to reform public health legislation on the control of infectious diseases, but they could do so much more to ensure that we have a strong public health infrastructure that can use dedicated resources to back up local authorities in the NHS, which are tackling those issues through local area agreements. The Secretary of State came to the Dispatch Box only a couple of weeks ago and described obesity as akin to climate change. He probably does not seriously believe that—try telling it to people in sub-Saharan African or Bangladesh. It is, however, an important issue. His response seemed to be that there should be a national debate—but that debate did not even get as far as the Queen’s Speech.
During the Gracious Speech we were promised a children and young persons Bill. Again, I am afraid that we have been here before. For a very long time, the Government have not taken those responsibilities seriously. I was a member of the Select Committee on Health, with David Hinchliffe, in 1997-98, and we produced a report on the care of looked-after children. Why has it taken so many years to address this issue? We have waited 10 years to see legislation to avoid circumstances in which lots of young people are looked after at a considerable distance from where they live and where their friends and families may be. The gap between looked-after children’s educational achievement and that of other children has widened. It is still true that 30 per cent. of looked-after children still do not have full access to immunisation programmes. The duties of local authorities to young people and the responsibility that we take on when children are looked after must be clear.
We Conservatives understand that none of that will be possible without not only clear duties but the staff to make to it happen. That is why my hon. Friends established our commission on social workers. Lady Butler-Sloss and Lord Laming were the patrons and brought together a team without party affiliation to make it clear how we can support social workers who work with children, value their profession and help them in the process of delivering better services.
Clearly, if there had been a plethora of NHS legislation, the hon. Gentleman would have criticised the Government for taking panic measures and for thinking that legislation was the answer to everything. In fact, many of the issues that he talked about are being addressed through means other than legislation, not least investment. Is he trying to suggest that there were halcyon days in the health service prior to 1997? Does he not recall that at that time a quarter of a million people had waited more than six months for their operations? Now, virtually no one waits that long. Does he expect people to believe that what he has to offer is any different from what the Tories offered before?
I am not pretending that before 1997 the national health service did not have problems. Equally, however, if the hon. Gentleman thinks that the public think that reducing waiting times to the exclusion of their safety, through the clear increase in infection rates, is an advantage, he is absolutely wrong. In the same way—[Interruption.] Labour Members should do as we have done, and understand from experience what will make the best policy for the future. I see no evidence from those on the Government Front Bench that they are learning at all.
The hon. Member for High Peak (Tom Levitt) is still peddling the idea that the pursuit of waiting time targets has been an unalloyed good. It has not. During the course of questions, the Secretary of State has seemed to dispute that fact, but the report on Maidstone and Tunbridge Wells NHS Trust states:
“Many staff told us about the consequences of targets, in particular the target that no patient should be in A&E for more than four hours. Some staff told us senior managers had given the A&E target much greater priority than the control of infection, including at the time of the outbreaks…One senior manager said that because of the other pressures and ‘over-heating’ in the trust, the A&E target was delivered at the price of chaos elsewhere in the system.”
I emphasise the “price of chaos”. We have had a report like that on Maidstone and Tunbridge Wells and another on Stoke Mandeville, and across the NHS people have made it clear that it was also targets—the waiting time target in particular—that led the NHS into the financial disaster that was 2004 to 2006.
No, I will not give way again. If, in the change that has occurred since 1997, the Government had understood better what they were setting out to do, they would have learned at an early stage that moving from central top-down targets to a culture of continuous improvement and performance measurement and management inside the national health service was the point. The Secretary of State gets up and says, “Sir Ian Kennedy is in favour of targets.” Well, no one in their right mind does not have the idea that a service should have performance measurement and management, but the idea that it should be done through a single set of targets dictated from the centre in a one-size-fits-all fashion is completely absurd.
The Government are now moving to the point where they want to run the whole health service on the basis of the 18-week referral to treatment target. What they do not tell anybody is that the 18-week referral to treatment target actually applies to only 30 per cent. of hospital activity, let alone whether it has any impact on people living at home with chronic conditions or on primary care services.
The hon. Member for High Peak asked what we would have said if there had been a series of health service Acts. But there has been a series of health service Acts— I am afraid that this is a constant theme of this Queen’s Speech. There was the Commission for Health Improvement, established in the 1999 legislation, which we were told would be the answer to the problem of standards in the national health service. Then the 2003 legislation abolished the Commission for Health Improvement and created the Commission for Healthcare Audit and Inspection, which we were told would solve all the difficulties with standards and problems such as infection control. Then we had the Health Act 2006, when the Government said, “Ah, well, the Healthcare Commission’s trying to do this thing, but it must have the code of practice”, but no, it turned out that that was not good enough, either.
I was here two years ago arguing that the code of practice needed to be strengthened, but that was not done; and then suddenly, in 2007, we are told, “Oh no, the Commission for Healthcare Audit and Inspection’s now going to be abolished and a new care and quality commission created in its place.” So in eight years we shall have gone through three inspectorates, all with exactly the same intentions.
Before my hon. Friend allows the hon. Member for High Peak to get away with his comment, does he agree that before 1997 people in my constituency could at least get a national health service dentist? Those over the age of 80 were not sent back from the hospital several times in order to get the waiting list time started again, people could access a proper health service, because local hospitals such as the Bartlet hospital had not been closed, and, although I have some of the oldest constituents in the country, we did not receive one of the lowest payments per head. The Government have given a second-rate health service to areas such as mine that they do not think are worth supporting.
Another thing that people did not find before 1997 was their local hospital’s maternity services disappearing and being transferred 15 miles up the road, as has happened in Welwyn, which I visited on Saturday. People in Banbury, where I also visited, did not find their maternity services being transferred to the John Radcliffe hospital 10 years ago. Likewise with A and E services. Right across London, people might well wonder what kind of NHS they have when, after 10 years and three times the amount of money, they cannot visit their local hospital safely, because although it advertises that it has an A and E department, it does not have the necessary back-up to make it one.
Lord Darzi, who is on—[Interruption.] The Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo), mentions Tomlinson from a sedentary position—I have a quotation from when she opposed the Tomlinson report—yet she and her colleagues propose a reconfiguration in London that seems to be based on the proposition that A and E departments will be available in local hospitals that have high dependency level 2 care, not intensive care. However, the Academy of Medical Royal Colleges has said in terms that for an A and E service to be provided, it is essential that it should be backed up by level 3 intensive care. And these Ministers have the temerity to come to the House and tell us that the reconfigurations are locally determined and based on clinical criteria. They are not; they are being dictated by the Government.
The latest evidence came out only last week, in the Health Service Journal, that the Government are proposing to try to fix the NHS tariff, so that they can force specialist services into centralised, larger hospitals by undermining the viability of specialists in district general hospitals.
I am grateful to my hon. Friend. I have not forgotten about that—far from it. Indeed, the Government’s central argument for their promised health and social care Bill is that it will strengthen infection control, but the code of practice should have been stronger and it should have been enforced. Indeed, we were here legislating for that more than 18 months ago and arguing about what needed to be done even before that. The Secretary of State can talk about the importance of screening now, but we were arguing that screening before admission was necessary four years ago. The chief medical officer said, in “Winning Ways” in December 2003, that screening before admission was a necessary part of the process of infection control, but Ministers did not implement that proposal. They talk about accountability, but there is no accountability on the part of Ministers for their failure to deliver infection control.
Years ago, the National Audit Office demonstrated that there were insufficient isolation facilities in the NHS. Now, Ministers talk about isolation but cannot provide it. We have known for years that bed occupancy rates are too high. For nearly two years, the Department of Health has been in possession of a report quantifying the increases in MRSA as a result of bed occupancy rates rising to above 90 per cent., but what have Ministers done? They actually reduced the number of beds in the NHS by 6,000 in the last year for which figures were available, so that we are now way below the figure that obtained in 2000, when the NHS plan—which, according to Ministers, is the basis on which they are working—said that there was to be an increase of 2,100 in the number of general and acute beds.
The health and social care Bill will simply bring together the Healthcare Commission, the Commission for Social Care Inspection—CSCI—and the Mental Health Act Commission. In principle, that is fine. Indeed, Opposition colleagues argued for that arrangement way back in 2003 when those bodies were first established. In implementing it now, however, it is important that we do not lose sight of the role of CSCI in respect of social care, which must be protected. It is also important not to lose sight of the responsibility of the Mental Health Act Commission, which must be carried into the new body in order to follow up on the Mental Health Act 2007, which we passed earlier this year.
Where in the Government’s legislative programme is the wider regulatory review that was always promised? Frankly, we have done the work over the past two years to determine what is needed to give the NHS a sustainable, long-term structure that will give professionals in the service greater autonomy while ensuring that that devolved power is subject to enhanced accountability. We have put those measures into a Bill, which we have published ourselves and which we will introduce in this Session. It sets out for the first time a constitution for the national health service which will incorporate the principles of the NHS, devolve responsibility through the NHS board closer to patients, make services increasingly accountable to patients through patient choice, empower providers to come into the system by creating an independent regulator in Monitor to work right across the health care sector, ensure genuine competition in health care matters, give the national institute its own statutory responsibilities for the first time, and for the first time create a national patient voice. A review undertaken by the Department of Health in late 2005 said that it was necessary to create that voice, but Ministers have signally failed to do so.
Let me make exactly the same offer to the Secretary of State now that I have already made to him privately. In the past, we supported the Government when they were doing the right thing on education and schools, giving greater freedom, through legislation, to those running schools. If the Secretary of State will work with us now, we will use our legislation to give far greater freedom and accountability to patients through the national health service, but the Government will have to be prepared to get away from their ideological fixations and to get into thinking about how this can be achieved more effectively.
We hear the Government’s promises time and again, but those promises seem to turn to nothing in their hands. We see one incompetent failure after another. We have just been listening to a further failure of the Home Office. Unfortunately, we know from the capability reviews that the Department of Health is second only to the Home Office in that regard, thanks to its failings in supporting the national health service. We need that incompetence to end, but I am afraid that that will happen only when we have an election.
Let us look at what we have ahead of us. The Government’s handling of the training scheme for junior doctors was described by the Royal College of Physicians as the worst event to impact on the medical profession for decades. We are not out of the woods. [Interruption.] Ministers think that it is funny, but they are responsible, and it has left a demoralised generation of junior doctors, thousands of whom cannot pursue their training.
Thousands of junior doctors are thinking about next year, and when the Secretary of State speaks, he can tell us what he is going to do. The consequence of thousands of junior doctors not having run-through training posts, in addition to those coming out of the foundation programme, and of the Department of Health losing its court case last week, which means that it will not be able to discriminate against those on the highly skilled migrant programme who are already here, is that the Department believes that there will be a 3:1 competition ratio for applications for training posts in the coming year. By any measure, the impact on junior doctors looking for training posts in the coming year will be worse than it was in the year just gone. What is the Secretary of State going to do about that?
The disasters in the DOH have led to a loss of confidence. Government Members like to talk about how much has been spent in the national health service over the past year, but consider the DOH’s evidence to the doctors and dentists pay review body, which states the real-terms increase in 2006-07 in NHS expenditure: on revenue, the increase was 2.8 per cent. in real terms, which is lower than the long-run average and lower than the average under the last Conservative Government. That is simply a consequence of gross financial mismanagement in the preceding two years, which led directly to the reduction in provision in the national health service last year. When the Prime Minister gets up and says, “Look what a big increase there has been this year in comparison with last,” it is in part because last year’s expenditure was artificially depressed by the impact of previous deficits.
The Government have wasted money time and again, and we cannot be sure that they have finished. The capital building programme went £4 billion over cost; the Paddington health basin scheme was abandoned after £15 million had been spent; and necessary changes to St. Mary’s Paddington simply did not happen. The NHS IT scheme is more than two years off, but the Minister came to the House and told us that that was fine because we do not have to pay most of the bills. If I were a director of a public company and said to the board of directors, “The IT and computerisation scheme that is integral to the improvement of services in our company is not going to be delivered, but that is okay because we are not going to pay the bills just yet,” I would be shot or sacked. The NHS was promised the delivery of benefits, be it electronic patient records or the electronic transfer of prescriptions, but once again there has been a failure.
I love the Department’s evidence this month to the doctors and dentists pay review body, which includes this epic understatement:
“We intended GPs to have benefited from the new contract but we expected more in return”.
The Department did not get it, and that is true of GP contracts and its management across the NHS. This Government’s epitaph will be: “We intended to get more from our taxes, and we expected to get more in return.” They did not get it. [Laughter.] I was never a copywriter; I do policy and management, and it would be better if more Ministers did, too.
The Government say that they want to respond to rising aspirations. Ten years ago, they raised expectations, but they did not deliver, which is also true today. They have tested to destruction the idea that the Government can spend and legislate their way out of trouble. What is needed is a vision of patients who are empowered to demand high standards through choice and competition to secure the service that they have the right to expect. We need empowered professionals in public services who can provide the education, health care and other care that is their professional purpose and passion—if there is passion in all this, then it involves the people who work in our public services and what they want to be able to achieve. We want empowered families and communities who take control of their local services and take responsibility for bringing up young people, including young people’s education and health.
The Conservative party has indeed set out such a vision—not least at our party conference—and we have presented the policies to back it up. We have even done the necessary work to put the framework in place. What we want is more autonomy for professionals delivering our public services; professionals more responsive to the people they serve and more accountable for the outcomes they achieve; and services more focused on high standards. We will meet the aspirations of the electorate after the next election. I commend the amendment to the House.
Last week’s Queen’s Speech set out our programme to respond to the rising aspirations of the British people and to build a Britain in which everyone can rise as fast as their talents and hard work will take them. In the areas of health and education—the twin subjects of today’s debate—we will legislate to make the NHS more focused around the needs of individual patients, as we back British science. We will help all children—including the most vulnerable in our society—to get the best possible start in life and we will extend educational opportunity to all young people in order to ensure that they get the qualifications and skills that they need to succeed. My right hon. Friend the Secretary of State for Health will now legislate to bring the regulation of assisted reproduction and embryo research up to date and he will ensure the safety and quality of health services by introducing a new integrated regulator, the care quality commission, with new enforcement powers. A health pregnancy grant will also be introduced for every expectant mother.
As my right hon. Friend the Secretary of State has said, we have made real progress since 1997 through unprecedented NHS investment and reform. We have had 1 million more operations each year, built 100 new hospitals and reduced mortality rates, particularly for cancer and heart disease. But we still face new challenges—to take advantage of new technologies, to tackle rising obesity, particularly among children and young people, and to meet the rightly rising expectations of patients about what a 21st century health service should provide.
I do not accept that there is such an epidemic, but it is important to do all we can to ensure that young people get the advice and support they need both in schools and outside them. My right hon. Friend the Health Secretary will respond to that later, as I am sure he will to those issues raised by the hon. Member for South Cambridgeshire (Mr. Lansley) that he understood.
I am happy to answer that question. There are no deficiencies in the academies programme that led to any review. As the hon. Gentleman will know, the Prime Minister’s delivery unit conducts regular reviews across all Government programmes. In my September meeting with that unit, I asked it to look at the academies programme to ensure that it was delivering our objectives. It has delivered a faster rise in standards in academies where the catchment areas and pupil intakes have more free school meal pupils than the average school. Because of the scale of the resources that we are spending on this programme, it is right to ensure that we deliver value for money. That is what the review will do. I made it clear yesterday, as I did in my July statement, that we are taking forward, indeed accelerating, the academies programme. That is what we will do; I make no apology at all for looking into it in detail.
Is the Secretary of State really telling us that he asked the Downing street Policy Unit to look into the programme without having any concerns at all about it and without believing that it has any deficiencies? If he expects us to believe that, it would seem to be a quite extraordinary waste of time.
The delivery unit looks across all Government spending, Department by Department. I have a six-monthly meeting with the delivery unit and I asked it to look into all aspects of my programmes. If it can make proposals to help us strengthen the academies programme even further, that is all well and good. In July, I announced reforms, including the abolition of the £2 million entry fee to get more universities into the academies programme. We are taking forward and accelerating that programme, as I said yesterday in topical questions. The continual charge that we are slowing down or trying to undermine the academies programme is quite wrong—I said that yesterday and say it again today.
Last Friday, my right hon. Friend the Secretary of State for Innovation, Universities and Skills published the Sale of Students Loans Bill. This week, my right hon. Friend the Minister for Children, Young People and Families will publish the children and young persons Bill to improve the life chances and provide greater stability, more support and a bigger voice for all children in care. In this debate, I want to set out more details of our education and skills Bill, which I will introduce with my right hon. Friend the Secretary of State for Innovation, Universities and Skills. That Bill will deliver world-class skills for all and raise the education leaving age to 17 by 2013 and to 18 by 2015.
Let me pay tribute to my right hon. Friend the Secretary of State for Health for his work and leadership on this issue in his previous job. He published the Green Paper on children in care and highlighted the fact that while the achievement of children in care has risen in the past 10 years, they are still five times less likely to get five or more good GCSEs than the average, and are nine times more likely to be excluded from school. That was not all that I inherited from him: he also published a Green Paper on raising the education leaving age. He set out how, despite rising participation rates, UK staying-on rates at 16 still lag behind those of international competitors, and how a young person’s background is still a key factor in whether they progress into post-16 education and training.
That is why the Queen’s Speech introduces the biggest reform in educational participation for more than 50 years. Let me tell the hon. Member for South Cambridgeshire that it was not introduced first in 1999; in fact, the first proposal in the House to raise the education participation age to 18 was in the Fisher Act of 1918. That Act introduced compulsory education to 14, but it also contained a provision to raise the education leaving age to 18, which was dropped in the years after the first world war because of the Geddes axe.
What was visionary 90 years ago, however, is essential today, both economically and morally. As the Leitch report demonstrated, the demand for higher-level skills is increasing, and the supply of jobs for lower-skilled workers is decreasing. Other countries are making fast progress in developing their own skilled work force, and we need to do more to avoid lagging behind.
Can I take the Secretary of State back not to 1918 but to 1997, when the Labour party pledged that fair funding would mean equal funding per pupil, regardless of local education authority? Perhaps it might be better to live up to that pledge, rather than moving forward to his great vision. Currently, Leicestershire languishes at the bottom of the education funding league. Apparently, across the Braunstone lane, my constituency boundary, a child will get £600 more in 2010 than a child in Leicestershire. How can that be fair, especially given that pledge that I suspect he was involved in, in view of the job he was doing in 1997?
Leicestershire, over the next three years, will have a 13.4 per cent. increase in spending, which makes it 34th out of 149. Rather than having a go at me for my pronunciation, the hon. Gentleman should congratulate me on delivering for Leicestershire in education funding. If he is still confused, I will explain it to him later.
Those who leave school early without good skills and qualifications are less likely to get a good job or gain further qualifications. Because those young people who leave education and training come disproportionately from poor families, raising the education participation age is also about social justice.
My right hon. Friend is stating clearly one of the central points of the Government’s case, which is that we need more skills and more vocational qualifications in the work force. Does he agree that, at a time when that ambition is being lauded across the sector, it is extraordinary that Opposition spokesmen should appear to be doing their utmost to undermine the focus on vocational skills by what they are saying?
I would not be so pessimistic. I was disappointed to discover that Opposition Members oppose the reforms in the Queen’s Speech on raising the education-leaving age to 18 and the proposals for diplomas, but it is not too late. Later in my speech, I will urge them to change their minds and consider backing those reforms.
In Britain today we need all young people to be in education or training until 18. That is why our Bill will establish new rights for young people to take up opportunities for education and training, and the support they need to take up those opportunities. It will also establish new responsibilities for young people, and a new partnership between schools and colleges, and between local government and employers, so that every young person will be in education or training until 18 from 2015. It is my aim to build a consensus in the country in the next few years on that proposal, even if we cannot manage that in this House.
There are also serious and proper concerns about the legislation. There will be extensive opportunity for debate over the coming months as the Bill moves through each stage, but I wish to address three of those concerns now. First, let me make it clear from the very beginning that this is not a Bill to force young people to stay on at school or college full time until they are 18. I have heard many people refer to our plans as raising the school-leaving age, but we are not raising the school-leaving age; we are raising the education and training-leaving age.
Not all young people will want to continue in school or college, so our proposal is for young people to continue their education and training in the way that makes best sense for them. That could mean full-time education at school or college; work-based learning, through an apprenticeship; or one day a week in part-time education or training, if they are employed, self-employed or volunteering for more than 20 hours. That means that we will expand the number of apprenticeships in the next few years. We have already doubled the number since 1997, and we will increase that number further by 90,000, to 240,000 a year by 2013.
My right hon. Friend the Secretary of State for Innovation, Universities and Skills and I have agreed that we will legislate in the Bill to ensure that there is the proper statutory basis for apprenticeships for 16 to 19-year-olds. That will set the framework for an entitlement by 2013 to an apprenticeship place for every young person who wants to continue their learning on a work-based route and meets the entry requirements.
With our Bill, all individuals will have a legal right to train to their first level 2 qualification. Up to the age of 25, young people will have the same legal right to train for their first level 3 qualification. But because my right hon. Friend and I recognise that it is not only young people who need to achieve their full potential, and because 70 per cent. of those who will make up the 2020 work force will be beyond the age of compulsory education, our Bill will also ensure that all adults have the right to access proper free provision for basic literacy, numeracy and first full level 2 courses. That will enable all low-skilled and unemployed adults to improve their skills and secure sustainable employment.
If a young person is in full-time education or college, it is normally 16 hours a week. If a young person is working more than 20 hours—at a job, self-employed or volunteering—over the course of the year they will have to do the equivalent of one day a week, although that would not have to be one day every week. The hon. Gentleman can work out what that would mean and we can discuss the detail when we consider the Bill.
Before we leave the question of 14 to 19-year-olds and the welcome increase in the participation rate, will my right hon. Friend tell us whether he has given any thought to the transport implications of this greatly increased number of young people moving from school to college and to the workplace? Does he think that there is a powerful argument for reviewing the concessionary fare arrangements for young people, and has he discussed that with our right hon. Friend the Secretary of State for Transport? If not, will he do so?
The Minister for Schools and Learners, who is travelling to Canada, texted me at 5 am Canadian time to make sure that I raised this very point. Members will understand that he is an MP for a Dorset constituency and that travelling issues in rural areas are very close to his heart. That is why he and I have discussed the issue with our transport colleagues to see what can be done. These are early days in the process, but the issue is certainly on our radar.
What my right hon. Friend said to dispel the myth that we will keep children in school until they are 18 is very welcome and he knows that I had a private Member’s Bill along similar lines to the Government’s proposals. I think it was Leitch who said that we were aiming for 500,000 apprenticeships, but will my right hon. Friend nail down whether apprenticeships will always be linked to a qualification?
It is important that apprenticeships lead to a qualification. I was talking about apprenticeships for 16 to 18 year-olds in England by 2013. Clearly, we can attempt to go further than that as we go up the age range over more years and for the whole UK. It is our determination to match the Leitch ambitions, but there is clearly a lot of work to be done over the next few years.
Although we want to make sure that young people can combine education and training with work, it is also our view that no young person should be left out on the basis that education and training are not for them or that it is too hard to meet their needs. That is why the Bill is about both rights and responsibilities. Under our proposals, young people will receive advice and guidance. They will achieve enhanced educational support in the form of education maintenance allowances and they will have a wide range of opportunities to take up opportunities in school, college, apprenticeship work with training or on a place on a pre-apprenticeship course or an entry-to-employment programme.
If young people fail to take up these opportunities, however, there will from 2013 be a system of enforcement. It will be very much a last resort and, as now for young people aged under 16, it will be at the discretion of the local authority, but it is necessary. I make no apologies for saying again that it is necessary to strike the right balance between new rights and new responsibilities. Some will need extra help, but that does not mean that they should be exempt. We will apply the same approach for 17 and 18-year-old mums as we do for school-age mothers now. Of course, they are allowed time off from learning before and after giving birth; of course, local authorities exercise care and discretion in relation to enforcement; and, of course, teenage mothers will need the extra support for child care that we currently provide through programmes such as Care to Learn. However, they should not be excluded from the opportunities and nor should people with special educational needs or people in custody. They will also receive education and training up to the age of 18. When we say that everyone will participate, that is what we mean.
What the right hon. Gentleman says about opportunities for people in custody is of the greatest importance. Given that something like more than 60 per cent. of the 12,000 people in our young offenders institutions suffer from speech, language and communication problems that prevent them from accessing education and training courses, will he agree that it is absolutely essential if his Department is in the lead to take steps to ensure that those people’s problems are identified, that they are referred to provision and that that provision is provided sooner rather than later if they are to have any chance of striking out on a constructive path in the rest of their lives?
I commend the hon. Gentleman for his work on this subject. In fact, I am pleased that he is carrying out a review and reporting to both me and my right hon. Friend the Secretary of State for Health on these very issues. The hon. Gentleman has always shown a willingness to expand the terms of reference of that review and is clearly trying to do so again today. I am sure that we will be accommodating.
Tomorrow I will speak about youth justice issues at the Youth Justice Board’s annual conference. In particular, I will talk about what more we need to do to improve the standard of education and training for young people in custody. I am happy to say to the hon. Gentleman that I will refer to the particular needs of those young people.
Does the Secretary of State accept that no fair-minded person can possibly disagree with the objectives and vision that he is outlining? However, will he accept from someone who has represented an area for 25 years that over that time we have had real problems when trying to engage a number of young people—some as young as 12—in secondary education? We need to rethink what we might be able to offer them in a way that might not yet be contained in the Bill.
I agree that we need to think hard. However, I do not think that those young people should settle for second best, or be excluded from opportunities. If I were proposing to implement the new obligation from tomorrow, I would share my right hon. Friend’s concerns. However, we are talking about legislating for a group of young people who are nine and 10-year-olds today and will be 16 and 17 when the Bill comes into effect. We should be working between now and then to ensure that we offer a better set of options for those young people so that they are not permanently excluded from education, employment or training. That is our ambition and we have six years to deliver it. If we work together, we can ensure that we end the problem.
Of course, in the mid-1980s, the level of young people not in education, employment or training was much higher—youth unemployment was at a record high. It has come down since then, but not by enough. Some 25,000 young people in our society are long-term NEET. We should reduce that number to zero over the next six years, and I hope that the Bill will provide us, as a society, with the compulsion to achieve that. I only wish that I had the support of Opposition Members.
The Bill is warmly welcomed on the Tees. We have serious problems attracting sufficient skilled individuals to the chemical process industry. There is a problem that many youngsters see the chemical process and engineering industries as dirty and unglamorous, so we really have a job to do—the employers are prepared to do that with the Government. Will my right hon. Friend engage with employers to ensure that young people are shown the seriously exciting opportunities that both those industries offer them?
My hon. Friend is absolutely right. We have six years between now and 2013 to make the progress required so that the legislation works. That involves raising our sights and building a culture of enterprise and learning for all, not just some. It means putting in place plans for the curriculum and new qualifications that will not only engage all 16 to 18-year-olds in learning, but get them ready for work. That could be achieved through our apprenticeship programme, but it will also be delivered through our new diplomas, which, I am pleased to say, are winning support from leading universities and employers alike. The diplomas will offer a combination of academic and practical skills that will be fit for purpose for young people, whether they want to go into work at 16 with training or an apprenticeship, go into work at 18, or go to university. With my hon. Friend’s support and that of local employers, I hope that we will be able to achieve that between now and 2013 so that we have a programme that will be really exciting for all young people when the obligation comes in.
I welcome the legislation regarding staying on until 18, but the Government have addressed only partially the problem of the gap in education funding for 16 to 18-year-olds. There is much less per capita funding for those in further education colleges than for those in sixth forms in schools. There is an even bigger funding gap for 16 to 18-year-olds in the secure estate who are trying to get an education, a large proportion of whom are illiterate, as well as having speech and language difficulties, as the hon. Member for Buckingham (John Bercow) said. What assurance can my right hon. Friend give me that those gaps will be closed and that education funding for 16 to 18-year olds in the secure estate and FE colleges will be increased to the per capita level for 16 to 18-year olds in schools?
As my hon. Friend knows, we are integrating for 14 to 19-year-olds. We are involving employers in our diploma programme and in education and training in schools and colleges. We have brought the funding of 16-to-19 education into my Department and local authorities precisely to allow that integration to work more effectively. My right hon. Friend the Secretary of State for Innovation, Universities and Skills and I are working on that; we shall set out our proposals in due course. I cannot promise to close that gap quickly, but I can say that it is our long-term ambition to do so. The provision of fair funding is an important part of the preparations for 2013.
The Secretary of State is being very generous in taking interventions. May I urge him to go further than the measures on social inclusion and wider participation, which I support? One of the big challenges in the next few years will be to increase the number of young people who are prepared to learn the individual science subjects and mathematics. Some 40 per cent. of our manufacturing industry depends on physics, yet maths, physics and chemistry are declining in our schools. What will the new Bill do to meet that challenge?
Had the hon. Gentleman been present at Education questions yesterday, he would have heard my hon. Friend the Minister for Schools and Learners lauding the fact that we have had such a large increase in the number of physics teachers seeking qualification. [Interruption.] Or praising it; it depends which word one wants to use. I hope that our science diploma will help us to provide the integration of single subjects up to the age of 18, which the hon. Gentleman wants.
No. I said that I would not take any more interventions.
Through the reforms in the Bill and our work on the curriculum, NEETs, advice and guidance, education maintenance allowances and apprenticeships to drive a culture of greater learning, I believe that we can achieve our objective of having every young person in education or training by 2013. I am pleased to tell the House that we are winning widespread support for our plans—[Laughter.] But not from the Tories. In response to this summer’s Green Paper, the Confederation of British Industry said that
“the government's proposal for raising the age for compulsory participation in education or training to 18 is a necessary step”.
Last week, the British Chambers of Commerce said:
“Combining new specialised Diplomas and an expansion in the number of apprenticeships with a rise in the compulsory participation age to 18 is a move that we welcome.”
We will work closely with business in the coming months to ensure we get the detailed implementation right.
However, rather than support our plans to get every young person into education or training until the age of 18 and to extend educational opportunity for all, the hon. Member for Surrey Heath (Michael Gove) has announced that he will oppose our plans—indeed, he dismissed them as “a stunt”. He has also said that he will not support our plans for new diplomas for 14 to 19-year-olds.
I had hoped that the hon. Gentleman might be in favour of our reforms to end the old damaging divide between academic and vocational qualifications and to offer alongside A-levels—I have postponed the planned 2008 A-level review until 2013—new diploma qualifications, which I believe could emerge as the qualification of choice for all young people. However, when I announced the next stage of our new diploma qualifications a few weeks ago—three new diplomas in science, humanities and modern languages, developed with the support of the CBI and many leading employers such as Cisco Systems, Toyota and Microsoft and of leading universities such as Cambridge, Leeds and Exeter—the hon. Gentleman opposed the new diplomas. He said:
“Diplomas were supposed to be about improving vocational education not undermining academic excellence.”
He went further and called the three new diplomas “mush” and “fantasy qualifications”.
Why is the hon. Gentleman against reform? Why is he on the wrong side of this debate? After all, there was a time, not so long ago, when we thought we might have won the Opposition's support—a time when his party might have claimed to back these historic reforms, when it looked like they were arguing for opening up opportunity and not for closing it down. Just two years ago, the Conservatives claimed that they were backing these qualifications—in fact, they urged us to go further and implement what they called the central recommendation of Tomlinson. I do not know whether the hon. Member for Surrey Heath recalls that. He might want to check with the hon. Member for Tatton (Mr. Osborne). I have a transcript from BBC Radio 4. Just two years ago, the shadow Chancellor said that
“an over-arching diploma which brings together academic and vocational training into one single diploma which we support, the Conservative Party supports, and I think would help end this historic gap and this deeply damaging gap between academic qualifications and vocational training.”
In two years, there has been quite a U-turn. Two years ago, the hon. Member for Tatton said that his party backed reform, and a new general diploma—the very reform that we have announced we will deliver. Two years on, the hon. Member for Surrey Heath opposes that reform, and boasts that he will continue with a clear divide between academic and vocational qualifications. That two-tier approach to education has held Britain back for decades. Why does he now oppose the reforms that, two years ago, the shadow Chancellor not only advocated but criticised us for not implementing? [Interruption.] My guess is that he learned—
Opposition Members do not want to hear what the shadow Chancellor said two years ago. They do not want to hear the details of the U-turn. They do not want to hear what it was like when the Conservative party appeared to be advocating education for all, and not just a few. Why has the hon. Member for Surrey Heath changed course? My guess is that he learned the right lesson of what happened to his predecessor, the hon. Member for Havant (Mr. Willetts), who came out against grammar schools and in favour of opportunity for all, not just for some, with the seeming support of the Tory party leadership—a bold move for his party. At the time, it seemed to signal the possibility of consensus on education for all. He is not here to tell us about that; he has decided not to come. Forty-eight hours later, the Leader of the Opposition changed his mind, and the hon. Member for Havant was outflanked from the right and sacked in 48 days. I can see why the hon. Member for Surrey Heath is determined not to be similarly undermined, but he has revealed the truth about the supposedly new Conservative party. The fact is that the Conservatives are reverting to type under the hon. Gentleman’s leadership—
On education. It is the Conservatives’ deeply held belief, which the hon. Gentleman now tells us he shares, that excellence can only be for the few, and not for the many. [Interruption.] That is why the Opposition oppose our education reforms. They oppose our plans—
Of course I will not, but I will read the hon. Gentleman what he said:
“Diplomas were supposed to be about improving vocational education not undermining academic excellence.
We support the reform of vocational learning but these new exams are designed to subvert GCSEs and A levels.”
He said that we have to keep A-levels, and make diplomas only vocational, if we are to have excellence, and that is not true.
Thank you, Madam Deputy Speaker. The Government clearly are not interested in excellence for everyone. We Opposition Members believe that A-levels and GCSEs—academic excellence—should be spread as widely as possible. That was the view of the Prime Minister, Tony Blair, whom you spent all your time trying to subvert—[Interruption.] Whom the Secretary of State spent all his time trying to subvert. If the Secretary of State cannot justify his allegation, I am afraid that he will have to withdraw it, or once again his credibility will be undermined.
The hon. Gentleman made allegations about what I supposedly did, or did not, do. He regularly appears on “Newsnight” to review fiction, but he has no facts to back his assertion. The fact is, two years ago, the hon. Member for Tatton said that the Conservatives would support an overarching diploma to end “the damaging gap” between academic and vocational qualifications. Two years on, the hon. Member for Surrey Heath opposes our three new diplomas, because he says that they would be “fantasy qualifications” that would undermine excellence. I reject that entirely. We can have excellence for all, not just a few, through a comprehensive suite of diplomas. The idea that diplomas should be only for some—only for vocational learning—is not true. That is why—and I stand by this—we stand for excellence for all. We reject—
No, I will not give way. [Interruption.] Well, I am happy to do so, but if the hon. Gentleman is going make the same accusation, I will make the same reply. In opposing diplomas, in coming out against our three new diplomas, and in saying that the very fact of introducing them would undermine excellence, he made it clear that in his view a comprehensive system of diplomas delivering excellence for all is not consistent with the excellence he supports. That is why he advocated a two-tier system. I can provide more details. [Interruption.] No, the fact is that we want more than 50 per cent. of young people to go to university, but the Conservatives oppose that, because they do not believe that excellence can be for all—they think that it is only for the few. They oppose our diplomas—a U-turn on what the hon. Member for Tatton said—because they do not believe that excellence is for all. We propose the biggest educational reform in 50 years, to provide excellent education or training for every young person until 18, but the Conservatives oppose it, because they do not believe that excellence in education and training until 18 can be delivered. They oppose our legislation.
On a point of order, Madam Deputy Speaker. The Secretary of State made an allegation, which he has not substantiated. He said that he would give way, but he has not done so. Is there anything that you can do, Madam Deputy Speaker, to ask him either to substantiate the allegation or to withdraw it?
It is very clear, Madam Deputy Speaker: the Conservatives stand for two tiers of educational opportunity. Education for all until 18 with the Government; education for some with the Opposition. We support a comprehensive system of diplomas, which was rejected by the Opposition, who would make vocational education available only to some people. I stand by what I said: we stand for educational excellence for all. They advocate two-tier education and excellence only for some. That is the dividing line on education. They may not like the fact that it is there, but it is. [Interruption.]
Order. I have listened—or at least, attempted to listen, given the numerous conversations on both Front Benches—very carefully to what has been said. It is clear that this is a question for debate. I hope that the opportunity will arise for Members to put their point of view on the record later.
The hon. Member for Surrey Heath is upset, because I read out a very clear statement by the shadow Chancellor two years ago that the Conservatives would support excellence for all through an
“over-arching diploma which brings together academic and vocational training into one single diploma…and…end this deeply damaging gap between academic qualifications and vocational training.”
I am now implementing that proposal, but the hon. Member for Surrey Heath rejects it. I stand by what I said. He will perpetuate the damaging gap between academic and vocational training, and he will perpetuate a two-tier system of education. Excellence for some, not excellence for all—that is the dividing line.
May I give the Secretary of State some advice? When in a hole, stop digging. He asserted that we believe in education for a few, but nowhere could he substantiate that assertion. He used a phrase that he could not substantiate but, worse than that, he said that we did not believe in increasing the number of people going to university. We argued at our party conference that we should increase it beyond 50 per cent. to match other high-performing countries, so there were two misrepresentations in the course of one speech. There is a legitimate debate to be had about how we achieve those goals—compulsion or incentives—and I am happy to join it. I am deeply disappointed, however, that the Secretary of State has chosen to go in for misrepresentation and distortion, which reflects badly on his office and on the strength of his case.
I am happy to have a discussion with the hon. Gentleman about false allegations. This morning, he claimed on the news wires that I was slowing down the academies programme when, in fact, I have accelerated it. He claimed that I am going backwards on reform when, in fact, I am going faster on reform with academies. He said that I wanted to exclude them from education policy, but I want to bring them into the mainstream. He made those allegations. I did not seek to give him advice; I just sought to have a debate with him. He is upset, because he did not like to be told that, two years ago, his party stood for educational opportunity for all, and he does not support that.
It is very simple: he can refute that allegation, and support excellence for all. I never said that he was not in favour of excellence; I said that he was in favour of excellence for a few, and the evidence is, first, his opposition to our three new diplomas, which he says will undermine academic excellence, and, secondly, his opposition to our Bill to raise the education leaving age to 18. It is very easy: if he wants to set the record straight and show that he is in favour of excellence for all, and not just a few, it is not too late. He can change his mind and show that the Conservatives are not stuck in the past. He can show that he does not stand for the few and not the many, and that he stands for educational opportunity for all. My advice to him is: be a moderniser, and back our reforms. That is what he ought to do. I hope that, as he chose not to open the debate, and as he has a bit more time to think—
On a point of order, Madam Deputy Speaker. May I ask through the Chair that the Secretary of State withdraw the assertion that my hon. Friend the Member for Surrey Heath (Michael Gove) chose not to open the debate. The Opposition’s intention was always that I should open the debate with the Secretary of State for Health, until we were notified yesterday of a change in plan. There was no change on our part at all.
I have never attended a debate where the Opposition have tried so many parliamentary techniques to try to avoid the big issue. We stand for educational opportunity for all, but they stand for opportunity for a few. We propose new diplomas; they oppose them. We propose legislation to raise the education leaving age to 18 for all young people, but they oppose that as well. The fact is—[Interruption.]
It is for the Opposition to decide whether they want separate debates on health and on education, and they have chosen not to do so. Last year, the debate was opened by a health spokesman, so when I conferred with my right hon. Friend the Secretary of State for Health, we assumed that this year the opening speeches would be on education. We discussed that last Wednesday, and we found out only yesterday that the Conservatives were not continuing with an opening speech on education.
I can assure you, Madam Deputy Speaker, that the Speaker’s Office and the Government were informed that we would open today’s debate with a speech on health and close with one on education. For the Secretary of State to say anything else shows that he is not in contact with the people who make those decisions, and is unaware of what is going on in government.
I conferred with my right hon. Friend the Secretary of State for Health and on the basis of his knowledge of precedent both as Secretary of State for Health and as a former Secretary of State for Education and Skills, we proceeded as we thought best. I am happy to open or close debates in the House. Whether I had made the opening or the closing speech would have made no difference—
The reason there are so many points of order and interventions is that Opposition Members are trying to conceal a fundamental fact—that on education policy and raising the education leaving age to 18, they are against reform, they are acting against the reviews of business, and they are acting against educational opportunity for all and not just some. It is the Government who are taking the long-term view and delivering educational opportunity for all and not just some. It is the Government who are preparing all our young people for the demands of the modern world. It is Labour, not the Opposition, that has the vision, and I commend the Gracious Speech to the House. [Interruption.]
I suspect that I am not alone in having lost the will to live after that performance. I suspect that, on reflection, the Government might decide that the Secretary of State for Health should have started the debate.
The beginning of the debate has been rather disjointed, with the shadow Secretary of State for Health being followed by the Secretary of State for Children, Schools and Families, and now we are back to the subject of health. It might have been helpful if the Government Whips had informed the Liberal Democrats of the shenanigans that went on yesterday. No one on our side was informed of the change. It seems that the Government Whips themselves did not know.
In last year’s Queen’s Speech, the Government committed to investment in and reform of public services
“to help the most vulnerable members of society”.
That passion appears to have been ditched this year. This year’s commitment is
“to providing a healthcare system organised around the needs of the patient.”
That goes to the core of determining the future of our health service and making sure that it is fit for the 21st century.
The key question is who decides the needs of the patient. The Labour Government’s approach so far has been for Whitehall to determine the needs of the patient. My view, and my passion, is that patients should be empowered to make decisions about their health care, not just about which hospital to be treated in, but about all aspects of their treatment.
I was fascinated to see the Conservative amendment. It refers to empowerment, but is that empowerment of patients? No, it is empowerment of professionals. Clearly, it is important for professionals to be empowered to do their jobs without national targets distorting and interfering with their clinical judgment, but surely the key issue is ensuring that patients are empowered to make decisions about their own health care. That is not just an aspiration. It is a necessity to empower the patient, particularly to self-care.
When Wanless first advised Government on future investment in the health service, he made the point that unless patients were empowered—enabled—to look after their own health, the health service would end up bankrupt. Too often in today’s health service, patients are treated as passive citizens. They get what they are given. It is not just about investment. It is about ensuring that the patient is treated as the most important element of the equation.
There are three areas where I expect even the Government would admit a failure to meet their own standards of ensuring that services are organised around the needs of the patient. I shall deal first with health inequalities, which mean that people in disadvantaged communities are getting poorer health outcomes, and often poorer access to services. The Department of Health’s departmental report this year contained a section dealing with health inequalities, which had an optimistic title, “Progress on health inequalities”. It set a target of 10 per cent. reduction by 2010, but the conclusion in the Department’s own report was that the long-term trend is of widening inequalities. That is still continuing.
Let us look at the facts in modern Britain. Accident of birth determines one’s chances of survival as a child. People from the poorest communities are three times more likely to die in childhood than those from the wealthy suburbs. There is a gap of 10 years in life expectancy between men in Manchester and men in Kensington and Chelsea. If that is narrowed down to individual wards in cities, the inequalities are even greater. In Sheffield, there is a 14-year gap between the poorest wards in that city and the wealthiest suburbs.
I find that unacceptable—as, I suspect, do many Labour Members. Surely it is unacceptable—[Interruption.] The hon. Member for North Durham (Mr. Jones) laughs, but I regard this as an important issue. After 10 years of a Labour Government, it is a disgrace for health inequalities to have widened.
In a recent report the NHS Confederation examined the causes of inequalities and highlighted, for example, the number of people who are not accessing health care. The report refers to the British Lung Foundation. There are 2 million people in Britain with chronic obstructive pulmonary disease who are not diagnosed. Lung disease is preventable and treatable, if only those people were getting access to treatment. According to Diabetes UK, there are 750,000 people with undiagnosed diabetes. If only they could be diagnosed and treated, their quality of life would be dramatically improved.
On the big public health challenge, obesity, the Foresight report recently warned of
“continued polarisation of the population, into the junk food eating, less-educated poor and functional food eating, better-informed higher classes”.
We should all be concerned about that. The report draws attention to the importance of improving educational attainment in those deprived communities in order to address the problem.
Derek Wanless was brought in by the Government to advise them on the future of the health service. His conclusion about the Government’s record on public health is that it is impossible to track trends in public health spending because it is not monitored, so we do not know what is happening. He goes on to say:
“It is…indicative of the relatively low priority given to public health that, while non-public health medical staff…have increased by nearly 60 per cent since 1997, the number of public health consultants and registrars has”
fallen. We have massive challenges on public health, yet we now employ fewer specialists than when Labour came to office. That is also a disgrace. Wanless says in his conclusion:
“tackling recent financial difficulties in the NHS by raiding public health budgets”—
anyone on the Health Committee will know that it gathered evidence of that—
“has not been in the long-term interests of the public health of the nation.”
That is the legacy of the financial mess in the NHS over which the Government have presided.
When times and finances are difficult, the most vulnerable usually end up suffering, and that has happened in respect of the cuts in public health budgets. [Interruption.] Yes, there have absolutely been cuts; in many areas of the country, public health budgets have been cut—and the Health Committee, with its Labour Chairman, has confirmed that view.
What do the Government say they are doing about health inequalities? Lord Darzi has proposed that there should be 100 new GP practices in deprived communities, and on the same page discusses 150 new GP-led health centres; I do not know whether that makes 250 in total. That would make a difference. However, the NHS Confederation has already highlighted the fact that in the current GP contract there are disincentives against practices working in deprived communities. The confederation has put forward suggestions that could change those disincentives now, and I hope that the Government will listen.
I agree, and I know that that was in the NHS plan. Commitments to make all sorts of changes are of absolutely no value unless action follows.
In the current GP contract, there is the minimum practice income guarantee, which pays sums based on historic funding levels for GP practices. The NHS Confederation concludes that the way in which that works disadvantages practices in deprived communities. Why was the contract negotiated in a way that had that result?
I am sure that the hon. Gentleman is aware that the NHS Confederation actually negotiated the GP contract. If it was so upset about those issues during the negotiations, it should have driven a better deal. The hon. Gentleman is concerned that the confederation is worried now—but it negotiated the contract.
I do not care what the GPs think about the situation or whether it is of concern to them—[Interruption.] Listen to the answer. I am concerned about whether sufficient numbers of GPs are working in deprived communities. The statistics show that there are fewer GPs per 100,000 of population in poor communities, in which there are greater health problems, than there are in the wealthier suburbs. That is a fact, and it is unacceptable. It is ludicrous that the GP contract should provide disincentives for GPs to work in deprived communities.
I shall not give way now, although I shall in a moment. Let me finish my point about the GP contract. The quality and outcomes framework—the method of incentivising GPs through further payments—also works to the disadvantage of practices working in deprived communities. The NHS Confederation confirmed that under QOF, rates of achievement in deprived communities are lower than those of wealthier suburbs, so practices in the former end up getting paid less.
Under QOF, GPs get paid more working in a wealthy suburb than if they work in a deprived community. Remarkably, QOF remunerates at a lower rate practices with a higher disease prevalence. The NHS Confederation gives an example of that. The hon. Member for Dartford (Dr. Stoate) looks bemused, but he should read the confederation’s report on health inequalities.
I am not bemused about that, but about the fact that the hon. Gentleman is talking about the NHS Confederation, which is the body designed to negotiate such issues with the British Medical Association. If it has such issues, it should involve itself in the QOF talks, which are carried out each year to ensure that the GP contract is modernised.
I have one further point. The hon. Gentleman talked about deprived communities, and I entirely agree with him, but Lord Darzi has proposed 100 new GP practices and 150 new GP-led health centres for deprived areas. That is precisely to meet the problems that the hon. Gentleman has raised.
I have no idea whether the NHS Confederation is culpable, but ultimately the Government are in charge. The confederation now says to the Government that they ought to change the GP contract to remove the disincentives to practices working in deprived communities. What is the hon. Gentleman saying? Should we ignore the confederation? That is a ludicrous proposition.
The hon. Gentleman is being generous in giving way. The NHS Confederation should be negotiating; if it does not like the GP contract, it should renegotiate it. I assure the hon. Gentleman that GPs would be happy to look at the GP contract again to improve on some of the issues that he has raised.
No, I shall not give way. The hon. Member for Dartford seems to abdicate completely from the Government’s responsibility to ensure that the GP contract removes disincentives for practices working in deprived communities. He seems unable to understand that point.
The NHS Confederation says that at the extremes, a practice working in an area of high disease prevalence could end up receiving £13 per patient under QOF, whereas a practice in a leafy suburb could get £26,600 per patient. That is a perverse and outrageous outcome—[Interruption.] The hon. Gentleman should read the report. It is remarkable that the Government should have been prepared to preside over a system that so disadvantages practices working in deprived communities.
I want to move on to the next area where the Government have completely failed to ensure that health services are provided on the basis of the patient’s need. I refer to mental health. The Secretary of State’s announcement of £170 million to develop therapy services is certainly welcome. However, I suspect that if the Government were to measure mental health services against the test set by the Queen’s Speech—that services should be based
“around the needs of the patient”—
they would accept that the service had been found severely wanting. Mental health has again been one of the main casualties of cuts when primary care trusts have faced heavy deficits in the past two years.
A psychologist with whom I recently spoke in Sheffield said that some of the most vulnerable people, with severe and complex needs, had been on her waiting list for more than two years. She said that cognitive behaviour therapies, which will be provided under the Layard reforms, would not be sufficient for many of those patients. Given that some have to wait more than two years for access to therapies, and that in many parts of the country there is no access at all to talking therapies, the service is not based around the needs of the patient—that rather bland commitment that the Government made in the Queen’s Speech.
Mental health patients should have an entitlement to treatment within a defined period. We should also tackle the wholly unacceptable state of many mental health wards around the country. The condition of many of those wards would not be accepted in any other acute hospital, yet they are there behind closed doors in many of our mental health hospitals. There needs to be a revolution in mental health. It is a disgrace that after 10 years of this Government, and so much investment going into the health service, that has not yet happened.
I will not give way at the moment.
It is also a disgrace that people with mental health problems are discriminated against in terms of their physical health. People with mental health problems have a life expectancy of 10 years less than the rest of the population because they do not get equal access to health services for their physical health needs. That is unacceptable.
The third area that I want to deal with in assessing Government performance against the tests set out in the Queen’s Speech is care of older people. The spending review contained a 4 per cent. real-terms increase for the health service and a 1 per cent. real-terms increase in social care funding. Why the distinction? What possible explanation or justification could there be for it? The hon. Member for Dartford is nodding; I am glad that he is acknowledging that. Our big challenge is an ageing population. We know what is going on in social care. In the vast majority of local authorities, the criteria for accessing domiciliary care have been cut right back so that only the most urgent crisis cases are getting access to such care. Fees have rocketed. Over the past 10 years, there has been a 25 per cent. reduction in the number of households accessing domiciliary care from local authorities, at a time when the number of older people is significantly increasing. Again, that is unacceptable.
It is extraordinary that 10 years into a Labour Government and nine years after the royal commission report, we get to a point where the Government are announcing a process that will lead to a consultation that will lead to a Green Paper, which might in due course lead to the possibility of reform of a grossly unfair system. The means-testing system for the funding of care for older people is scandalous. Niall Dickson of the King’s Fund described the way in which old people are treated as one of the unrecognised scandals of our time. The brutal truth is that many older people, particularly those on lower incomes, do not get access to the support that they need in their own home, and often the quality of care in care homes is not good enough. There is a chasm between the bland assertions in the Queen’s Speech and the reality of what we see on the ground. This Queen’s Speech, quite apart from those in previous years, should have included a commitment to legislate to ensure that older people get the funding support that they need for care at home or in care homes.
Absolutely. One gets from local authorities the clear impression that they have a crisis in the funding of services for older people.
Let me turn to the Conservative position. The Conservatives say that the NHS is their No. 1 priority—that is what we heard at their conference—but they offer a tax cut of nearly £300,000 for estates worth over £1 million, yet would do nothing at all for people who lose everything as a result of getting dementia or Alzheimer’s and end up having to sell their home because they cannot afford to pay for care. Their priority is to give tax cuts to millionaires and their families; our priority is to help those who miss out on means-tested benefits but have worked hard all their lives to gather together a small nest egg only to see everything go because of a pernicious system of means-testing.
That brings me to the rest of the Conservatives’ vision for the future of the health service; it will not take me too long. On the radio this morning, the Conservative leader talked about the Conservative party being the party of localism. I nearly choked on my muesli—being a good Liberal Democrat—because that is a contradiction in terms. The Conservative plan is for a national quango with no local democratic accountability. Having read through their paper—it was rather turgid, but I got through it—I asked myself, “What would happen under the Conservative paradigm when a hospital is threatened with closure?” The answer is that an unelected national quango would make the ultimate decision about whether to close a hospital in, say, Sidcup. That is their localism—it is utterly meaningless—and once people realised that their hospital was to be closed by an unelected quango in London, they would lose any enthusiasm that they might have had for it.
I want to say a few words about professionals working in the health service. One is often left with the impression that they do such good work despite what happens in Whitehall rather than because of any direction from there. In the past week, I have been overwhelmed by watching the work of a consultant professor at University College hospital in London who is developing pioneering photodynamic therapy to cure people of cancer without the need for an operation. I talked to a consultant who is developing a cure for multiple sclerosis. When one hears from these people about the remarkable work that they are doing, one is left humbled by the quality of people within the health service. That is just the specialists, but it goes the whole way through the system, from the lowliest cleaner to the most specialist consultant. The dedication and quality of care is immense.
However, as the Secretary of State wonderfully declared recently, those working in the NHS are “not happy bunnies”. That is because they are utterly sick of the endless incompetence, contradictory reform and reorganisation from Whitehall. The psychologist from Sheffield who I mentioned earlier told me that morale in her section is being undermined because she and her colleagues face a change of employer. They are going to carry on doing exactly the same job, but once again their employer will change. I talked to health visitor in Sedgefield who was on her fifth employer and had been doing exactly the same job since 1987. There are ludicrous changes and reorganisations from the centre, as we saw with the junior hospital doctors debacle.
Then there are payments to administrators. In Health questions, the Secretary of State was very honest in response to a question about what is happening with pay-offs to administrators who leave the health service. I want to refer to the case of a guy called Peter Reading, who was chief executive of a hospital trust in Leicester. He was earning £180,000 a year. There was a pathway project to build new hospitals in Leicester, which collapsed. This guy was widely respected, but it appears that he was forced out of his job with no notice, probably by the strategic health authority. He got a £700,000 pay-off. The new temporary chief executive will earn £100,000 in three months—that is, on my reckoning, £400,000 a year. What is going on in Labour’s health service? This is ridiculous, is it not? How can one possibly justify such pay-offs to people who are often in their early 50s and doing very good work but for one reason or another, following a decision by the powers above—usually the SHA doing the Secretary of State’s bidding in the region—have to go, so there is another change and another enormous pay-off?
I end by referring briefly to the Bills in the Queen’s Speech. The health and social care Bill will be welcomed by the Liberal Democrats. It is positive and will break the regulatory divide between health and social care, which is a good thing. while bringing in mental health care as well. I am struck by the fact that the organisational divide between health and social care will remain in place. That divide is damaging patient care, and we must integrate those services much better than we do at the moment. The new service must be properly and adequately resourced, and we have to ensure that mental health is prioritised—it must not be allowed to sink as part of a larger service—and that it has real powers to drive up health and social care standards. The regulation of human embryology was also a welcome inclusion in the Bill. That will be the subject of joyous debate because it involves many controversial issues, many of which are conscience issues that will divide the House on the basis of a free vote.
We will support the Conservatives’ amendment, but on the basis that our vision of a reformed legislative structure for the NHS is very different from what the Conservatives have in mind. Our vision is of local democratic accountability and local control, which this Government have so far failed to provide, and which is certainly not on offer from the Conservative party.
I would like to concentrate my remarks on the education and skills Bill, and in particular the fulfilment of the historic commitment to education and training for all young people up to the age of 18. I have three general points. First, the commitment to the educational and skills needs of everyone in this age range is greatly to be welcomed, as the TUC, CBI, the British Chambers of Commerce and many others have already said. However, we have to think through its implementation carefully—and I believe that we are. We all know that the process will not work if it just conscripts uninterested or hostile 16 and 17-year-olds into occasional attendance at schools or colleges that they do not want to be in, where a minority would have the opportunity to sabotage other people’s education as well as their own.
Secondly, the reform will work only if it is enabling and engages those who so far have not done well at school and do not like it. It must give, and be seen to give, a range of good opportunities. As the Secretary of State said, it must not be seen as mandatory school attendance up to 18. As it applies most of all to those who might not otherwise have chosen to stay on at school, it must be good at guiding them towards options that they feel really offer them something, and at persuading them that they have the chance to make something of themselves.
Thirdly, that process must be part and parcel of raising aspirations and standards, as we are seeking to do throughout mandatory education, not simply as an add-on or an alternative. If the problem is that there are too many 16-year-olds without basic numeracy, literacy or social skills for employment, the best solution is still to have a more effective focus in getting the basics right in the early years, not simply adding another year or two of remedial education.
The hon. Gentleman says that that is absolutely right. The difference is that I see the investment and attention that we are giving to the early years as a platform for opportunity for all 16 to 18-year-olds, whereas Opposition Members would deny them that. We must make sure that the goal of achieving five A to C grades at GCSE does not detract from efforts to ensure that those who do not achieve at that grade come away with a basic qualification in literacy, numeracy and communication that employers recognise and that young people can be confident will meet basic requirements for some of the jobs on offer. We have to pay closer attention to that matter.
The right hon. Gentleman repeated the mantra, which no doubt might have some political resonance and use, but does he accept that Members in my party are not committed to excellence only for the few? All of us, throughout this House, want an education system that helps everybody, and indeed, that helps most of all the vulnerable and those with least, who are failed by the system. That is common throughout the House, and parroting the weak remarks of the Secretary of State does not do the right hon. Gentleman any justice.
I am sorry, but as the hon. Gentleman knows, time is very limited and I have to press on.
Meeting the goal of providing appropriate education and training for 16 to 18-year-olds not presently in education and training will, as we know, be a huge challenge. It puts a big responsibility on all providers and employers, as well as the Government, to make sure that we get it right. It is crucial that the 14-to-19 partnerships to plan delivery of entitlement to diplomas work well. I must commend the guidance the Government have put out on the gateway to diplomas, which is commendable.
I stress the importance of young people getting accurate advice about the opportunities available to them. The issue of which courses and qualifications actually enable them to do a job is important. For example, at the moment, someone completing a hairdressing course at a college of further education would get a licence to practise, whereas someone doing a hairdressing course at school will not. Once over 18, such a school leaver would have to pay to complete the vocational course, which clearly disadvantages those from poorer backgrounds. It is very important that young people and their parents know where they stand on that sort of choice.
Advice on education, skills and careers needs to be independent. We need to make sure that the advice suits the interests of the young person, rather than those of the organisation through which it is provided. We also need to make more and better use of providers with a track record of working successfully with young people at risk of exclusion from the education system. I have seen at first hand the good work done in a range of secondary schools in my own constituency by Skill Force, which provides project-based personal development and basic skills courses. Teachers have told me that Skill Force instructors have been able to re-engage pupils with whom they were struggling. From talking with some of the young people concerned and reading their own self-evaluation in their workbooks, it is clear that they appreciated and benefited from the approach, which is based on breaking down longer-term goals into discrete projects, so that the young person can see, almost day to day, the progress that they are making.
Skill Force was able to expand its activities to cover some 200 secondary schools through central funding from the Ministry of Defence and the Department for Children, Schools and Families, as well as funds raised externally. They have accepted the phasing out of central funding in favour of payments from schools themselves, but have asked if that could be done more gradually. I and my hon. Friend the Member for Stockton, South (Ms Taylor) have been to see the Secretary of State about that, and I was pleased to learn yesterday that he was able to provide Skill Force with some additional transitional funding, which is welcome. However, that raises the more general issue of the mechanism for funding plurality of provision within the system, especially where schools are both purchasers and providers.
Would my right hon. Friend stress, before he leaves the matter of Skill Force, what many in the teaching profession have said? When such projects are established in their schools, they are able to teach for the first time, and they find a serious improvement in the relationship that they have with students. Secondly, the youngsters end up with significantly improved examination results. It is a win-win.
It certainly is, and my hon. Friend is quite right. Not only do young people benefit from the Skill Force approach, but it subsequently enables them to re-engage with mainstream education and their teachers.
My point is that there is a lot to be said for shifting the responsibility for such funding across to local education authorities so that they can mobilise resources to engage young people who might otherwise drift out of the system. Making the LEA the broker in such a way would also help the involvement of external providers by cutting down to a more manageable level the number of separate relationships they have to establish and maintain. It would also better align provision with consequences in so far as the LEAs would ultimately have to pick up the pieces when young people drop out.
Many of the additional young people whom we will expect to stay in education and training will be attracted by courses at colleges of further education because of college links with employers and expertise in vocational courses. It is important that the role of colleges is fully recognised. The point about funding was mentioned earlier. Of 16 and 17-year-olds presently in full-time education and training, 38 per cent. are at maintained schools, 9 per cent. are at independent schools, 14 per cent. are in sixth form colleges and 39 per cent. are at further education and other tertiary colleges. If resources are to follow the student rather than the other way round, it is important that further progress is made to eliminate the funding gap between schools and colleges, which will still be around 12 per cent. per student next year, and to tackle disparities, such as the fact that colleges are not funded for each additional student they take on whereas schools are.
Let us do all we can to ensure that employers large and small play their full part through apprenticeships and effective training. The TUC, in its submission on the Queen’s Speech, makes a powerful case for apprenticeship targets to be included in sector skills agreements. I hope that that is something that the Government will consider favourably.
For many young people in the age range who are not presently in education and training, employment with accredited qualifications will be a more attractive way forward than staying in the classroom, but some will need a lot of help and support to make it a reality. Let us make sure that they get it. This is one of those epoch-making reforms which, done well, will strengthen opportunity, social cohesion and competitiveness. Whatever the Opposition Front-Bench team say now, I do not believe that they would reverse the change if they got the chance. They ought to join us now in making it a success.
I am pleased that the Secretary of State for Health is speaking second, even if it is a result of the Government not understanding what the other parties were arranging for the debate. It gives me a chance to address him, as he will be winding up the debate, and ask him some fundamental questions about health. I want to invite him to try to reassure me that his commitment to reform and improving the health service remains unabated and that we are likely to see some more practical progress in the near future.
It has become a truism to say that the Queen’s Speech revealed no signs of that vision for which the Prime Minister apparently delayed going to the country for an election. I waited to see whether it gave any signs of the now old and discredited Blair Government being abandoned and new policies being produced by the “new Government”, led by this Prime Minister. It gave us few clues. The only change of policy that I noticed in this area is that we are now to give every expectant mother £150 to buy vegetables and fruit, which does not seem to me to go to the heart of the health care of the nation. There are more substantial issues, in particular how far the health service will be further reformed and whether the Government are committed to going in the direction of reform on which there was a wide measure of agreement.
I regret that the Secretary of State for Children, Schools and Families wound up his contribution with a quarter of an hour of knockabout nonsense in his description of our education policy. In health, that is scarcely possible because everybody knows that for the past few years, in principle, there has been a remarkable degree of connection between the Government and the Opposition, despite all the controversy that health reform caused in the past. Both sides are committed to a free national health service paid for out of taxpayers’ money and so on. We have always agreed that a combination of more resources and reform at the same time are required if the vision of the health service is to succeed. We are agreed on the purchaser-provider division, and that choice and competition are the way to drive up standards in the health service. At least that was the position of the Blair Government: money would follow the patient, with payment by results, and the services being purchased with taxpayers’ money would come from a wider range of providers, including voluntary and private sector providers as well as state-owned ones.
When I listened to most of the previous Secretaries of State for Health under the Blair Government, after the first one, I always found that when they spoke in principle, they made speeches that I could have made. The principles that I have just described were those of the third-term Thatcher Government, of the Major Government and of the Blair Government after about 1999. What went wrong was the competence in delivery, about which I frequently complained. I agree with my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) that the whole thing was buried by an over-centralised approach, a plethora of constant initiatives, an over-concentration on nationally determined targets and so on, and constant structural upheaval. As the hon. Member for North Norfolk (Norman Lamb) rightly said, that upheaval means that many people working for the NHS have found that they are working for the umpteenth employer in the past few years and have had to reapply several times for their own job when it has been readvertised by some new organisation.
Are the “new Government” as committed to reform as their predecessor?
The Prime Minister has constantly let it be understood that he was far less committed than Tony Blair to all this reform of the health service. He regarded it as what we used to describe as the internal market, and thought that there was a limit to what the market could achieve. The Queen’s Speech gives no clue about that. The Secretary of State is comparatively new, because we keep changing Secretaries of State for Health. His predecessor found herself, near the end, in a constant mist. She made little progress in reform and spent her entire time firefighting incident after incident and presiding over debacles such as the junior doctors appointments farce.
Is the Secretary of State now committed to reform? He nodded and said yes earlier. He will have to reassure me that he does not mean just trying to keep out of trouble with his foot taken off the accelerator and a touch on the brake. The NHS will require more. In my opinion, the NHS has never needed reform to be implemented effectively more than it does at the moment.
The background is a great financial crisis. I shall not go into the cause of the present crisis, but it finally came to a head with those ridiculous pay settlements and new contracts, which laid down levels of provision for payments that the NHS could not afford. That has produced a fantastic mess, with deficits all over the place. My NHS trust is allegedly “borrowing” almost £10 million, which it will have to repay with interest next year to get itself out of deficit. Primary care trusts with surpluses find that they are “lending” money to the NHS trust to get it out of trouble, so that those that are run well and have surpluses they thought they could use to redesign their services do not have the money at the moment. The growth in funding in the NHS will slow down. The days when everything was buried with money and a 7 per cent. real-terms increase each year could smooth out a lot of the problems are over, and so the need for properly implemented reform has never been greater. I do not quite see where we are going.
I want to concentrate on the key and most difficult issue in reform towards the model that the Queen’s Speech defined as a patient-led service. That is the euphemism for reform in the direction that I have described. The most difficult thing on the way is the purchasing, or so-called commissioning, of services. Patients should have a choice, and I agree with the Liberal spokesman on that. Actually, Liberal Democrats are wrong to dismiss the professionals. None of us has clinical expertise. The patient exercises choice with the advice of his family doctor, usually a GP, who should be in a position to satisfy that choice. I have no idea where we are getting to on commissioning. No subject in the service has surrounded me in more of a mist of incomprehensibility. When I was Secretary of State, I laid down the plans for GP fundholding, to which we were committed. By the time the new Government came to office, half of all GPs in the country were in fundholding practices. The system was becoming popular and the Government made a big mistake by scrapping it. There is no point in going back over that; but then they changed their mind, did not abolish the purchaser-provider divide and revived the scheme under the name of practice-based budgeting, which we are now meant to have.
The Government corrected some of the errors that we made. I approve of the national tariff. I will not argue too much about whether practice-based budgeting is exactly the same thing as GP fundholding, but it is the same principle. We are to back to purchasing and commissioning. Most GPs share my hope that they will be given much more control over how taxpayers’ money is used for their patients and much more ability to redesign their local services and improve them in directions that they can see are desirable.
I do. The best general practices in this country are among the best features of the NHS. I would argue that there is a wide variation in quality, but the best family doctors are in the best position to have a big influence on the development of the service and are greatly trusted by their patients. The best of the younger ones are mad keen to get on with things. I am always pleasantly surprised by the entrepreneurial spirit and the desire to improve things that one finds among the best GPs. That is why 96 per cent. have signed up to the idea of GP practice-based budgeting.
Indicative budgets have been agreed and put in place by all the PCTs in the country. That sounds marvellous, but what I and, so far as I can gather, many in the field have difficulty understanding is how far that means anything so far and how far it will be allowed to make any difference in practice. The PCTs retain all the commissioning powers. The new PCTs are therefore to be the only purchasers. Unfortunately, they have just been set up, as a result of a massive reorganisation, so most of them are just beginning to grope their way towards doing anything. The original idea in 2005 was that the GPs would do the commissioning themselves. The PCTs have now been put in charge, but they are now in the middle of a monster upheaval. They were originally set up to be purchasers and not to be providers, but the Government backed down on that, so they are a mixture of purchasers and providers. The PCTs are also extremely reluctant to give up their new commissioning powers to GPs. Meanwhile, GPs have their own budgets, but find that they have remarkably limited discretion over them.
Is there not a particular difficulty when an organisation involved in the commissioning process has responsibility but lacks power? The example that I have in mind is when a local education authority is charged with procuring speech and language therapy services but does not have the power to secure them because the therapists are principally employed by the cash-strapped primary care trust. Is that not a problem?
It is entirely a problem. The moment a keen, go-ahead GP consortium—I have one in my constituency, although it is not the one that has complained to me particularly—wishes to make changes in its budget and use any savings to develop the service, it first needs the consent of the PCT. It is extremely difficult to secure the consent of the PCT. Most are not geared up to agree and many do not have the necessary skills. The result, as surveys in the Health Service Journal and so on show, is a high level of frustration, with GPs having signed up to the new approach but large numbers thinking that it has so far not made a significant difference to the standard of service in their areas.
I should therefore like to ask whether the bland reference in the Queen’s Speech to a patient-led service will lead to more progress in that area. At one time it was thought that the private sector would bring in expertise. The Secretary of State played that down in a speech that he made in February. He has now announced that there are private sector providers that will be able to give advice to PCTs, but only a small number of PCTs seem prepared to take that advice. I wait to see whether the Secretary of State will be any clearer about the way out of the present confusion, because he has to make the system work if he is not to find himself presiding over a service that is in an even worse crisis than on the day he took over.
I am pleased to say that this is my first speech as the new Chairman of the Select Committee on Children, Schools and Families, although I understand that the Department has already been given a different name and is known within as the Department for curtains and soft furnishings. The acronym works, but it makes it rather confusing to remember what the new Department is called.
On a serious note, we had the first meeting of our Committee yesterday, at which deep concern was expressed, which it was felt should be raised at the earliest opportunity, that two Front-Bench spokespersons from the official Opposition had been appointed to the two new Select Committees that replaced the Select Committees on Education and Skills and on Science and Technology. This is the first time that that has happened in the Select Committee system—
I bring the matter to the House because concern has been expressed on an all-party basis that what has happened seems to run against the whole notion of scrutiny of the Executive. I make the point because all the members present at the first meeting of our Committee asked me to raise it, not only here but in the Liaison Committee.
The Queen’s Speech always gives us the opportunity to run across all the issues in it and all the ones that we wish were in it. Wearing a slightly different hat, I would have loved to go into detail about the Climate Change Bill, the planning reform Bill and the way in which the Government will, wisely we hope, provide proper management for a reduction in carbon dioxide. I would have touched on a wide range of issues if I did not have only 10 minutes, but I shall concentrate on education, not health.
I want to talk about raising aspirations, which comes right at the beginning of the Queen’s Speech and is an important theme. Any hon. Member who is the Chairman of anything to do with education in the House will have seen the range of things suggested for legislation, such as education and training until the age of 18. I introduced a private Member’s Bill in the previous Session, earlier this year, that proposed a similar provision, to ensure that children in this country are children until they are 18, as I have always passionately believed they are. If we are to have a children Act with outcomes for children, they should not stop at the age of 16, but apply right through to 18. My private Member’s Bill tried to push that. Do we allow children in the 21st century to leave school at 16 with no qualifications and go into work with no training? I am glad that my private Member’s Bill has been superseded by the Government’s commitment to a proper system for young people.
My right hon. Friend the Member for Oxford, East (Mr. Smith) was absolutely right in what he said about that. We have time to ensure that what we supply for young people between 16 and 18 is the right thing for them. For too long, the right thing has been for the academic high-fliers to do their GCSEs or A-levels and go to university. The system has also not been bad for people who stay on and decide to get a job with qualifications at 16 or 18. But, for a large number of young people in our country, there has been very little, post-16.
I celebrate the fact that we now have this Bill. We have time to get this right—in relation to expansion, for example. My right hon. Friend who is now the Secretary of State for Health will remember when we used to discuss these matters in relation to Sandy Leitch’s proposal to expand the number of apprenticeships to 500,000. That is an important element of these proposals. If we are going to get this right, we shall need to provide a whole range of genuine alternatives for young people of very different kinds. Some of those might involve opportunities to work in the community. I would like to see them linked to apprenticeships and qualifications. For too long, apprenticeships in our country were time-served, not qualification-served. Not many people know that someone could finish their apprenticeship and still not have a proper qualification.
I urge the Opposition parties not to rush to judgment on this issue. Let us all try to get this legislation right. Please do not undersell it or misrepresent it. It is not about forcing children to stay on at school until they are 18. The Bill will provide a whole range of different opportunities through work, training, apprenticeships and the new diplomas. I remember Howard Newby telling the Committee that the British had a genius for turning diversity into hierarchy, but I hope that we can avoid that. We must create a genuine choice for young people at 16, 18 and beyond, and establish a viable alternative for all their talents.
The proposals for 18-plus are wonderful, as is the fact that we are going to reform apprenticeships. However, we also have a Bill on services for vulnerable children, and is it not about time that we did? That Bill is absolutely necessary. We have a shameful record on the way in which we treat the children who used to be said to be in care, but who are now described as being looked after. They are the very children who deserve the best help, the greatest care and the most investment; there are about 60,000 in our country at the moment. Historically, however, they have been shamefully treated, often by local authority departments. Instead of taking care of them responsibly, they deputed the job to institutions and to people who were poorly trained, poorly supervised and poorly paid. What is the result? Statistics have been given by other hon. Members, but one that was left out is that only 1 per cent. of that cohort goes on to higher education. That is shameful.
I see no political advantage in being ideological: I do not care who delivers the appropriate level of care to looked-after children. It could be the private sector or the voluntary sector. I favour the third sector as the supplier of much of that provision, or perhaps a reformed local government department.
I acknowledge the iniquity that the hon. Gentleman describes. The Secretary of State focused on a theme of the pursuit of excellence—I say this as a fact, not a criticism—very much in the context of post-16 because of the legislative programme, but should not we start at pre-school level? The hon. Gentleman knows that the I Can Early Talk programme has received a warm reception in 227 children’s centres across the country. Would it not be a good plan to roll out that programme—or a comparable competitor—across the country, so that no child of two, three or four years old is denied the help that he or she needs?
The hon. Gentleman knows that I agree with much of what he says on these matters. His suggestion has a lot to recommend it.
Another good thing in the Queen’s Speech is the commitment to the work-life balance. We underestimate the importance of that for people of the modern generation, who have much more stress. In most families, both parents work, and there are many more single-parent families than there used to be. These factors can place great stress on the work-life balance.
I want to finish on a subject that stems from the whole notion of raising expectations. I am not making a narrow political point here, but something that we have failed in recently, and not just over the past 10 years, is social mobility. According to the fine work of the Sutton Trust, and to most of the research that I have seen from the London School of Economics, social mobility has slowed down.
All of us should be concerned to get something out of the policies in the Queen’s Speech, but I detect certain missing parts. Probably the most important speech on education this year was made by the hon. Member for Havant (Mr. Willetts), which was rigorous in its intellectual capacity. It looked at the impact of selection on our schools, and at the damage that it does. He ended up by saying that selection
“entrenches advantage, it does not spread it”.
Labour has been too weak on this issue.
My hon. Friend mentioned the LSE. Does he believe that Oxford and Cambridge are traditionally as fair as other universities? They still dominate the university system. Does he not agree that they go for the rich and the powerful within their enclaves?
I certainly agree with some of that, and I have an ongoing dialogue with the vice-chancellors concerned. It goes further than that, however. Children are badly served by selection, whether in Kent or elsewhere. Some get into the grammar schools, and that is fine, but I have been to a secondary modern in Maidstone where 100 per cent. of the kids are on free school meals and 65 per cent. have special educational needs. That is not the way to run the education service for our children.
The important thing about the very good article by the hon. Member for Havant is the rigorous logic by which he concludes that the selection and the grammar schools that we already have should be abolished. That is the fact of the matter. I have taken quite a long time to join my hon. Friend the Member for Bury, North (Mr. Chaytor) in this campaign, but I now think that it is right. The days of selection have gone. Indeed, I will make myself even more unpopular—I am not saying this in a partisan spirit—by pointing out the real damage that is done by people opting out of sending their children to their community’s schools, their society’s schools, and sending them instead to schools in the independent sector. That undermines what we understand to be a good education, which should be based on the education of all the children in our community together. Getting the balance right between the poor, the more able, the less able, those with special educational needs and looked-after children is what we should be about. That is the mission before the House over this next year.
Order. I hope that hon. Members do not need reminding, but it might help if I point out that, as we are debating an amendment to the Queen’s Speech, their remarks must be confined to the broad terms of the amendment and not stray into other areas, as they could on the earlier days of the Queen’s Speech debate.
Thank you, Mr. Deputy Speaker. I will of course obey your stricture, much as I would otherwise have been tempted to comment on matters that need further attention in the Queen’s Speech, such as the encouragement of the move to nuclear power as part of our overall energy diversity. I will, however, refrain from going down that route.
I want to focus today on the Government’s education policies and, particularly, on the subject of science, which is mentioned in the amendment. Let me start by saying that some of the behaviour of the Secretary of State for Children, Schools and Families during the debate would not have gone down very well with schools. Indeed, he might have been faced with exclusion, even if he did not break any of the rules of debate in this House.
There is no disagreement between the Conservatives and the Government on the need to encourage more participation. There is no desire to make a distinction between those who can succeed in academic life and those who struggle, and who would—as the right hon. Member for Oxford, East (Mr. Smith) wisely pointed out—perhaps be better off following an alternative career path, and therefore an alternative educational path. Furthermore, Conservative Members understand that there are real issues around trying to keep the attention of children, whatever they are studying. The other day, I discussed some of those issues with a police inspector in my constituency. The police are trying to work with schools to keep children in school and to improve children’s behaviour, without which no effort by the Government or anyone else will make a significant difference to those who find it difficult to maintain attention.
In the past 18 months, I have been preparing a submission to the shadow Cabinet on education and science. I have considered existing apprenticeship and training schemes and visited Network Rail’s impressive training scheme in Gosport, which takes youngsters when they are 15 to 16-years-old. The first year of that course is residential, and it will train our future engineers for the railway system, which is commendable. In many cases, those children did not want to stay on at school, but they will obtain a structured education within that engineering apprenticeship.
We must reach out and find more options. I do not believe that the Government are attempting to extend the school leaving age to 18, and I share their idea that we should try to find diverse ways of encouraging youngsters to engage in something that will ultimately benefit them and society, and I am sure that my hon. Friends do, too. However, there is an issue: my concern is that in that desire to be inclusive, we are misunderstanding the concept of “excellence”. Of course, everybody should be excellent, but we should not set the barrier for excellence at the point at which everybody can be excellent. I hope that the Secretary of State for Health will take that point on board in answering the debate. It is, of course, easy to malign someone such as me for saying that we must ensure that we keep striving to improve the top level of attainment in this country, but I am not saying that we should forget those who cannot attain it. As I have a short amount of time to speak, however, I want to concentrate on my real concerns.
I shall start with a controversial point. In his opening remarks, the Secretary of State for Children, Schools and Families said that Conservative Members are against a 50 per cent. target for university education. I want to rephrase that point: we would like 50 per cent. of young people to be able to go to university—we would like to see more and do not see why the target should be 50 per cent.—but the issue is what we mean by “university”. If only 25 per cent. or fewer of those young people get a decent A-level, it is almost certain that the others will not be able to aspire to getting into our best universities. There are all sorts of ways in which we can try to help them—I will not repeat the speech made by the right hon. Member for Oxford, East—but we cannot ignore the fact that we have a problem. Meanwhile, global competition is expanding, and our best youngsters are being induced to go not only to American universities, but to Australian universities, which is not good for the United Kingdom.
There has been some criticism of our best universities for not widening their intake—in many cases, they have strived to do so, and many of them have schemes to work with schools that they have identified locally—but we must recognise that we need to improve the standards of entrance, even from today. There has been a decline not in the intelligence of 18-year-olds, but in the standard that they are asked to reach. In mathematics, for example, some of our top universities have to spend at least two terms, and possibly even the first year, bringing students up to the standard that used to be achieved by students when they entered university, and that example involves top-grade entry. That means that we have a problem in making sure that our best children are stretched.
There is a bigger issue. As I said in an earlier intervention, if one considers the number of youngsters who are taking chemistry, physics and maths—in the past year, there has been some debate about the figure for maths, which may well be due to a blip—the situation is extremely worrying. Unless we change that, we will not encourage this country’s youngsters, who will subsequently become employees, to obtain the necessary skills. Many of our companies already say that they are extremely concerned by that point.
Chemistry and physics are old world subjects, and there is so much contact now between different sciences—for example, environmental sciences comprises chemistry, physics, biology and so on. Is the hon. Gentleman not a bit behind what is happening in the real world?
With great respect to the hon. Gentleman—I almost addressed him as my hon. Friend, because we have worked together so much on science subjects—I do not agree with him. One must have a grounding in the subject first, before one becomes multidisciplinary. It is perfectly reasonable for universities to offer the subject of forensic science as a more appealing name for chemistry, but actually chemistry lies at the bottom of the subject. Unless one has done chemistry at A-level, it is very difficult to study any multidisciplinary subject at university that requires that core knowledge. The number of students taking such core subjects is declining, which is worrying.
Will the Secretary of State for Health pass on to his colleague the Secretary of State for Children, Schools and Families that it is a particular worry that more and more schools are adopting a leaving-certificate approach to A-levels in which general science will do? General science might be interesting, and it might be a tick in the league table, but it does not get students into the best universities to study science.
I support the hon. Gentleman’s point about the importance of the so-called hard sciences of physics and chemistry. Employers in forensic science want graduates with degrees in chemistry and do not look so well on graduates with degrees in forensic science or, for that matter, forensic science and music, which is offered at some universities.
Putting forensic science with music sounds interesting. I entirely agree with the hon. Gentleman.
The core of the problem is the qualifications of teachers. Some 26 per cent. of state 11-to-16 schools have no physics specialists, and 12 per cent. of them have no chemistry specialists. I urge the Government to address that point. As well as trying to embrace more and more people in our education system and finding ways to keep their attention and improve their skills, we need to work out how to stimulate young people to take sciences and how to keep their attention as they go through the system.
I want to mention another big issue, which is often not understood. Many science departments in universities have closed in recent years, partly because the funding council does not fully fund the cost of the disproportionately expensive courses. However, there is another factor: if university vice-chancellors and bursars see that the cohort of 15 and 16-year-olds taking GCSE physics and chemistry in a particular year is small, they know that not many children will apply to do those subjects at university when they reach the age of 18. If the number of applicants is smaller, the departments will be smaller, and if the departments are smaller, the research grants will be smaller, because such grants relate to departmental size. The effect is that a university knows when it looks at the number of 15 to 16-year-olds taking GCSEs what size the research budget will be, and they are worried.
We must address that network of issues, and I urge the Government to do much more. I have published my submission to the shadow Cabinet, and as we are not having a general election, I urge the Labour Government to read my report, which is available in the Library and on all good websites. We must take corrective action now. We must improve teacher retention in sciences. We have to do more to stimulate use of the available science learning centres—partly funded by the Government and partly by the Wellcome Trust. That means changing the structure to allow supply teachers to go in when teachers go off to be trained. A whole series of interconnections have to be addressed; if not, we will not make a rapid change, however aspirational we are. We have to change the career structure that by and large sees careers teachers saying to children, “Well, that might well be a difficult subject, so don’t try it”. We need to downgrade the weighting of non-core subjects in school league tables to provide an incentive.
I urge the Government not to engage in banter between the Front Benches, as such banter is irrelevant. Let us stimulate ourselves to stimulate children to do better at whatever they want to do. Let us also remember that part of the overall ambition is to be excellent on a global basis and face up to some of the real challenges that the country will encounter over the next decade.
Let me say at the outset, Mr. Deputy Speaker, that I am speaking in favour of the Loyal Address and against the Opposition amendment. It is a pleasure to participate in today’s debate. I do not intend to detain the House for long, but I want to make a few points about education. I pay tribute to my right hon. Friend the Member for Oxford, East (Mr. Smith), who made an excellent speech on the same matter that I want to raise—increasing the school leaving age to 18.
In my Barnsley constituency, we have made great progress in education over the last few years. We have had two record years of educational achievement. Unfortunately, just as we have achieved better results, the national average has improved, so a gap still remains between our own achievement and the national average—but we still strive towards it. The building schools for the future programme provides one important advantage for us in the near future, as most of our primary schools, and every secondary school in the constituency, are to be rebuilt—thanks to the resources invested by this Government.
I welcome the Government’s proposals to increase the school leaving age to 18, but I do want to raise one or two issues about it, particularly in respect of the NEETs—an awful acronym, which means young people not in education, employment or training. If someone were to mention NEETs in Barnsley, by the way, people would think they meant the opposite of days—such are the nuances of our language; if one is really unlucky, it could be a question of NEETs, afters and days, on a three-shift system! Our NEETs figure has been quite high over the years, but I am pleased to report that it currently stands at only 8 per cent.—the lowest ever. That has been achieved by a steering group—a partnership between the schools, the local further education college and employers—by setting up customised college courses and by requiring schools to take some responsibility for their school leavers.
My worry is that by extending the school leaving age to 18, we would inadvertently increase the number of children in my area who just disappear from the system, and do indeed drop out of education, employment and training. A significant number of young people in my constituency are happy to attend college after 16, but only until the age of 17. The local college has tailored courses to address that age group by providing a foundation course. The college, and indeed certain employers, look on it as a foundation course for these young people, before they look for or enter employment. The college is happy with that particular outcome: it views it as an achievement to have kept young people in FE until 17 and to have prepared them for the world of work. The college’s worry is that extending the leaving age to 18 might deter young people from staying on the extra year, resulting in a drift away from provision.
The hon. Gentleman makes an excellent point about NEETs. Is he aware that the Government have spent a cumulative total of £1.6 billion on education maintenance allowance, but that the number of 16 to 18-year-olds not in education, training or employment has actually risen by more than 30 per cent. between 1997 and 2005? Does he really think that that is money well spent?
Yes. That is an aspect that I am about to deal with. My constituency has the highest number of people in receipt of the education maintenance allowance, and that has gone a long way towards improving staying-on rates after the age of 16, so I am a big fan of EMA.
As I was saying, there is a fear that increasing the staying-on age to 18 could increase the number of young people in my constituency who completely drop out of education. The question has to be asked whether the resources would be better spent earlier in the pupil’s lifetime, or whether we should increase the resources spent earlier in an individual pupil’s school year in order to prevent the drop-out rate.
I was pleased to see the Government talk about one-to-one literacy classes and the idea of secondary school pupils having a tutor of studies. Experience in my constituency suggests that we need to address problems as they occur in primary and secondary schools rather than allow children to leave school at 16, drift away and be lost from the system. I recall talking with employers a few years ago and finding that they wanted to take children at 16 and provide them with training within the job that they offered—but they did not want to have to teach the kids how to read and write. They wanted children to leave school with the basics, so that they could take on the training aspects.
Let me say a few words about further education funding issues resulting from the Government’s moves in that regard. I am particularly interested in the relationship between the post-16 agenda and the 14-to-19 agenda. My question is about the future of the learning and skills councils. Are they still to provide post-16 funding? Is money going to local authorities intended to provide for the 14-to-19 agenda, and if so, will that detract from the money available to our FE colleges? My hon. Friend the Member for Wolverhampton, South-West (Rob Marris), who is no longer in his place, referred earlier to the funding gap between schools and colleges. It would be quite wrong to maintain or increase the gap, or just to allow it to continue. The colleges are worried that local authorities will take some of their funding for the provision of the 14-to-19 agenda.
Another question to the Government—I understand that my right hon. Friend the Secretary of State for Health cannot respond to it, but I hope that someone else will pick it up and answer it—is about the relationship between the vocational and the 14-to-19 agenda. We heard the Secretary of State for Children, Schools and Families talk about diplomas, but will there be any opportunity to mix and match between the two? Can the academic cross over to the vocational and vice versa, or are we to have a dividing line between diplomas?
As for the capital funding of Barnsley college, it, like many others, has undertaken a rebuilding programme at the behest of the LSC, which has required it to borrow large amounts of money. Next year the college is embarking on loans of some £10 million. Because of the LSC’s delays in agreeing that funding, the rebuilding programme has been held up and almost jeopardised. The college had to agree a rebuilding programme in phases, the first of which was to allow a decanting of the buildings to be refurbished. That first phase almost fell through because of the delays, jeopardising the other phases in the programme. What is the future of the LSC, which has brought about those loans, not only at Barnsley college but at others? Colleges are worried that they might be left holding large mortgages or loans in an uncertain future, given the divisions of funding between the 14 to 19 set-up and the colleges.
I repeat that Barnsley has one of the highest take-up rates for the education maintenance allowance, which has been a huge success. It has improved post-16 staying-on rates in my constituency, and I hope that it will continue to do so.
Finally, I have a concern about the Sale of Student Loans Bill. Will the Government ensure that students repaying student loans are not placed in any worse situation than at present through the sale of that student debt?
The Human Fertilisation and Embryology Bill, under which amendments could be made to the 1990 abortion legislation, will soon come before the House. I want to consider some of the information to which MPs can look to inform their vote on such a serious issue.
As many MPs will know, more than 200,000 abortions take place in the UK each year—the highest number in any country in Europe, apart from Ukraine. A large percentage of women, particularly younger ones, are now multi-aborting, so we have concrete evidence that abortion is being used as a form of contraception. Everybody agrees that 200,000 abortions a year is too many. It was never intended that so many should take place. We would all like to see that number reduced—we would be strange people if we did not—on a yearly basis.
Many people cite the British Medical Association, which ruled this year that it would like the requirement for two doctors’ signatures to be replaced with a requirement for one doctor’s signature. I want to describe how that ruling took place. A motion was passed at the BMA conference. Three motions were put to the floor. At a BMA conference, motion one is always heard and voted on, sometimes motion two will squeak though, and motion three is very rarely heard. The three motions put to the BMA for a vote on that day were all pro-abortion; none was pro-life. Let me tell the House that I am not a pro-lifer; I believe that abortion is absolutely necessary in today’s society, and I do not want abortion driven under ground. Nor am I a pro-choicer; I suppose that I am pro-choice in terms of abortion to a certain stage, but I am pro the foetus, and very much balanced on the issue.
Members of the House and the Government describe the BMA’s position as being that only one doctor’s signature should be required. That is not the case, because the following week more than 1,000 doctors who are members of the BMA put a petition online to say that that was not their position, and that the conference was given only pro-choice motions on which to vote. So Members should not look to that BMA ruling to inform their opinion.
Members might therefore look to the Royal College of Obstetricians and Gynaecologists instead. The Government paid the RCOG to establish a guideline committee to inform Government policy and provide the framework within which the abortion industry operates. Who is on that committee? Every person on it is pro-abortion and pro-choice. For example, the all-party pro-choice group is represented on that committee, but not the all-party pro-life group. Nearly every person on the Committee has a vested financial interest in the abortion industry; they are either paid to carry out abortions, or run clinics that carry out abortions.
Let us take the example of Dr. Kate Guthrie, who is on that committee. She advocates via that committee the assertion that abortion is fine up to 24 weeks. She does not support a change in the upper limit. On the “Dispatches” programme, she said that personally, she would not perform an abortion at over 16 weeks, because the foetus is too much like a baby. She is, however, a pro-choicer who sits on a committee and says that the upper limit should remain at 24 weeks.
The committee has no pro-lifers, or anyone with a balanced view. I do not believe that the RCOG main board realises what has happened, but the guideline committee has been completely hijacked by pro-choice activists and those who have a vested financial interest in the abortion industry. Members should not therefore look to the BMA or the RCOG guideline committee, because they will not get a balanced view from either of them.
Members might want to look at the report produced by the Science and Technology Committee, on which I served. They might think that it had a balanced view, as it was an all-party Committee. Let me tell them what happened on that Committee. The Committee recommended that there was no scientific reason to reduce the upper limit from 24 weeks, because, it said, there is no evidence that babies can live below 24 weeks. It also says that a foetus cannot feel pain.
That is absolutely true: the response was that it does not matter whether a foetus can feel pain, because a foetus can be anaesthetised before it is aborted.
The issue of abortion is not only scientific but ethical and moral, and we all have our own consciences to deal with. It is now also a matter of public opinion, because there is now a huge movement by the general public towards wanting to see a reduction from the upper limit—72 per cent. in the most recent poll, and 69 per cent. in the Communicate Research poll. Marie Stopes has just done a poll, and 62 per cent. of GPs want to see the upper limit reduced.
I am digressing slightly, and I want to return to the Committee’s report. It says that there is no reason to show that babies can live below 24 weeks’ gestation, and that foetuses cannot feel pain. First, no research post-2003 regarding foetal pain was considered by the Committee; it considered only research pre-2003. Why was that? Research pre-2003 says that foetuses cannot feel pain until 24 weeks. Research post-2003 tells a different story; it says that a foetus probably can feel pain, down to 16 weeks. Anyone who has been pregnant or who has seen a scan of a baby having its position changed will understand this. If one scans a baby at 18 or 20 weeks and attempts to change its position, one can see on 4D scanning that the baby suffers discomfort and does not like it. In fact, 4D scanning has shown us what a baby looks like in the womb, and how it behaves. There is no hard evidence that, for example, if we see a baby crying in such a scan, it is really crying, but we are looking at a small human being.
The hon. Lady says that the Human Fertilisation and Embryology Bill is important, but there is nothing in it that necessitates a digressional discussion about abortion. That is an important issue, but we will have other opportunities to discuss it. The Bill is about so many other issues, and we would not want to be deflected from them by talk about abortion. We need to talk about the real issues, including fathers, the sex of children, and IVF and the other assisted reproductive techniques, and whether they need to be regulated. The hon. Lady is trying to deflect us from those real issues.
All those issues are important and will be debated, but the Clerks have taken a ruling that amendments to the Abortion Act 1967 can be tabled. I will table such amendments, as will many other hon. Members, so the discussion is valid.
Post-2003, the research shows that foetuses feel pain as early as 16 weeks. So hon. Members should think again before letting the Science and Technology Committee report inform their position. The report recommends—and hon. Members have said that they will table amendments to this effect—that only one doctor’s signature should be required. One of the reasons why two doctors’ signatures were thought necessary when the issue came before the House in 1990 was that abortion is not a tonsillectomy or an appendectomy but the ending of a life, and that is a grave and serious consideration. Therefore, it was felt that two doctors’ signatures should be required, to reflect the gravity of the procedure. However, the report suggests that the requirement should be reduced to one signature.
Amendments may also be tabled to provide that nurses should be allowed to perform surgical and medical terminations—abortions—rather than doctors. That recommendation was made by the Royal College of Nursing, which did not consult its grass-roots membership on the issue. I am a former member of the RCN and I would have objected strongly to that. The BMA does not support that proposal, because its members have an interest in the abortion industry.
Making access to abortion easier should not be a priority. We do not want to see the numbers go up. What is it that we would be asking nurses to do? My American intern, Stephanie, telephoned a British Pregnancy Advisory Service clinic and said that she was 18 weeks pregnant and a student alone in the UK. She said that she had been to see a GP who had told her that she was 17 weeks pregnant and she needed a termination, and asked what she could do. She said that she did not want to have an anaesthetic or go into hospital. The clinic said, “No problem. Come along to the clinic, we will give you medication and you can go home and abort there.” They told a student, who they thought would be on her own, with a pregnancy of 17 weeks gestation to go home and experience pain like she would never have known before, to bleed in a way that she would never have imagined possible, and then to abort her own baby and dispose of it. At that stage of gestation, the baby would be entirely recognisable. That is what is taking place today in the UK—and the amendments that I have described would make abortion even more easily accessible.
The BPAS, and the other providers carrying out abortions on behalf of the Government, do so for around £700 a time. There are some 200,000 abortions a year, and some people have a very serious interest in ensuring that we do not restrict the number of terminations, and even that they increase. I call that almost an abuse of women’s rights. When a woman goes to a doctor to request an abortion, she is in crisis. Every woman who presents at a GP’s surgery requesting an abortion should be counselled and told what the alternatives are. She has a right to know her options and the consequences of abortion, but that does not happen. I want amendments tabled to the Bill that would give a woman the right to know what abortion entails and what she would go through.
I hope that hon. Members, when they seek to inform themselves about abortion, will not go to the Science and Technology Committee report, the RCOG committee or the BMA, because too many people in those organisations have too great a financial vested interest in the industry.
I welcome the Government’s commitment in the Gracious Speech to ensuring that all young people have the opportunity to continue their education up to the age of 18. That has been referred to, somewhat carelessly, as “raising the school-leaving age to 18”, but as my right hon. Friend the Member for Oxford, East (Mr. Smith) so eloquently explained, it should not be seen in that way. That conjures up a negative image of young people reluctantly sitting at their desks and trying hard to do anything but listen to the teacher. That is a very mistaken image as the Bill is about ensuring that all young people have as wide a possible range of choices in combining opportunities for employment with continued training, through schemes such as apprenticeships, or to continue in full-time education on courses that provide them with up-to-date skills.
Since 1997, we have increased the number of apprenticeships from 75,000 to 250,000 in 2007. I very much welcome the Government’s commitment to make more apprenticeships available to young people and adults. Time and again, constituents tell me how much they or people they know have benefited from an apprenticeship. An apprenticeship offers young people the opportunity to develop their skills in context and to work with people who have years of experience and can offer the best form of education—immediate, one-to-one feedback on what the apprentice is doing and suggestions on how to improve. It is often only when a young person is trying to do something in the workplace that they realise what skills and knowledge are necessary to make real progress. It is then that they are ready to go back to college one day a week to increase their knowledge and skills, and gain accreditation.
We need to start earlier. Some good work has already been done in providing an alternative style of education from 14 onwards for pupils who are clearly not benefiting from the current conventional curriculum. While GSCE results improve year on year and we must ensure that we do not close off opportunities for pupils, there are those who could benefit from much greater contact with the world of work from 14 and the development of skills that they perceive as relevant.
We have made huge strides forward in raising achievement in schools, improving GCSE results, increasing the number of pupils staying on in school until they are 18 and increasing the numbers in higher education. No one would have dreamt 30 years ago that nearly 50 per cent. of the age group would go on to higher education. In addition, large numbers of young people are successfully taking a range of courses up to the age of 18. However, we continue to have a small number of young people who, for whatever reason, drop out of the system and become so-called NEETs—not in education, employment or training.
The figures for NEETs are often exaggerated by counting individuals who are in transition from one activity to another. Nevertheless, we must ensure that we identify those who are genuine NEETs and re-engage them, so that they do not end up drifting aimlessly into deprivation and possibly being vulnerable to exploitation by criminal elements. That is why the Government proposals to improve tracking systems are vital. We have already seen improvements in tracking systems that mean that we have reduced the number of young people whose activity is not known from 13 per cent. in 2003 to 4.9 per cent. in 2006, but even 4 per cent. of our young people is too many. That is why I support our proposals to improve tracking systems and ensure that every young person has a choice of provision that enables them to progress and acquire the skills that they need for life and work.
A trial is being held of an extension of the education maintenance allowance, with more courses eligible. The planned rolling out of the EMA to a wider range of courses will undoubtedly help more young people stay on in education and training.
As we extend the apprenticeship scheme, we need to look carefully at the uptake of apprenticeships in different sectors by young men and women. I pay tribute to the work done by the YWCA’s “More than one rung” campaign in highlighting that issue. Far too often, the uptake of apprenticeships is starkly polarised by gender. Although the increase in mechanisation and the use of technology means that there is much less dependence in many sectors on physical strength than in the past, we still see very few young women taking up apprenticeships in areas such as the electrical and automotive industries, construction and engineering. When I say “very few”, I mean very, very few. They make up a mere 1 to 2 per cent. of the apprentices in these areas.
Why should that matter? It means that young women often miss out on opportunities that may lead to much better-paid jobs than those in the areas into which many young women are pigeonholed. The choice of training routes and apprenticeships has a significant impact on future earning capacity and the choices that young women make at present contribute significantly to the disparity in pay between men and women. We need to build into the legislation a duty on local authorities and key personnel to make sure that young women are genuinely encouraged to consider the full range of opportunities.
That we get this right also matters from the point of the view of the economy and our skills shortages. We could make much better use of women’s potential to fill some of the gaps in our skills. Increased skills are vital to our economy; they are vital to the survival of individual companies and to all our citizens to enable them to adapt to the changing opportunities that they will encounter in the course of their working lives. Here I pay tribute to a company in my constituency, Schaeffler—it is commonly known to us as INA Bearings—which has upskilled its work force, making itself far more competitive. It is now in a position to take on apprentices again, and I very much welcome that.
I welcome the Government proposal that will guarantee that all young people up to the age of 18 continue to develop their knowledge and their skills.
It is a great privilege and pleasure to take part in this Queen’s Speech debate—I am not sure whether I am using the right terminology—on health and education, which are the twin pillars of public services in this country and make such a contribution to our society. They have something in common in terms of the pattern that has been in place since the Government came to power. In both cases, the Government have put in vast amounts of increased expenditure. In cash terms, I think that they have doubled expenditure on education and trebled the expenditure on health. However, productivity has fallen and the hopes of Ministers and not least the rest of the country and those who pay taxes have not truly been delivered.
We have not yet had a Secretary of State for Health or for Education in this Government who has been prepared to be as entirely honest with the House as they may be with others behind closed doors. Who could be more frustrated than the Ministers of this Government who have put in so many resources and seen so little in return? That is not to say to the Secretary of State for Health that there have not been improvements; of course, there have. There have been improvements in every decade since the second world war. That is certainly so of health and I hope also of education, but the improvements have been too little for the money spent.
If we consider issues such as social mobility and the aspirations of many Labour Members and Conservative Members—although Labour Members are often too grudging to accept that we share similar aspirations—it appears that, at a time of record levels of spending, we could have seen a real change in the opportunities for those with the least in this country and that we could have tackled the sustained levels of disadvantage that for too long have been a feature of this country. In many countries of western Europe and, indeed, across the world, those problems have been tackled more effectively than they appear to have been here. The Government deserve congratulation on being prepared to will the means and to will the funding, but they have not been able to deliver the policy framework that would have delivered the change that we all hope for. Social mobility has not improved.
I wish to touch on a comment made by the right hon. Member for Oxford, East (Mr. Smith) who, as I said in an intervention, was parroting the remarks of the Secretary of State for Children, Schools and Families that Conservative Members are somehow interested only in the few and not the many. I hope that any fair-minded member of the Labour party would accept that that is absolutely untrue. Because the issue is about willing the means as well as the ends, Labour Members must accept that the legislation going through the House over the past 10 years, when coupled with the funding, have not been enough to tackle disadvantage—be that health inequalities or inequalities of outcome in education. For Conservatives Members to take a differing view and to challenge the Government’s record and new legislative programme is not a sign that we are uninterested in the outcomes that we all devoutly wish for. We challenge them because of a profound disagreement about how the outcomes could be delivered.
That neatly brings me to the subject of the diplomas over which there was a rather angry exchange because the Secretary of State for Children, Schools and Families entirely misrepresented, I think deliberately—
I am grateful again, Mr. Deputy Speaker. I apologise for forcing you to come to your feet again. The word that I could use on behalf of my hon. Friend the Member for Surrey Heath (Michael Gove) is that he feels “traduced” by what the Secretary of State for Children, Schools and Families said. The position of Conservative Members is not that there should be excellence only for the few, but that we must not have a policy framework that destroys the opportunity for academic excellence in the name of creating vocational excellence. We wish to see differentiated paths for people to take, and we do not consider that the academic route is somehow superior to the vocational route. We need excellence in both and we need to support that.
A policy for diplomas that undermines the academic standard bearers of excellence—namely the A-levels—is not one that we can support. That is not because we are not committed to providing opportunity for people, but precisely for the opposite reasons. We know that those with most in this country will find a way round even the most foolish of Government policies to ensure that their children prosper. We want a system that allows those with least and with the least support to prosper. The Government’s proposal for diplomas will fail to do that.
It ill behoves me in a debate about education not to ask the Government to look at the funding for local education authorities. The East Riding of Yorkshire is the fourth lowest-funded education authority in the country. It is a large geographical area, with high transport costs and pockets of deprivation. Therefore, it has a real need for a fairer funding system. My understanding from the Government is that there would be a fairer funding system. Because of the deprivation in the Hull constituency of the Secretary of State for Health, it would necessarily receive more money than the East Riding. However, having factored that in, we would not expect the gap between the two to widen over time. I hope that we can find a way of bridging the gap and ensuring that we have greater fairness in the system.
As I have mentioned, inequalities in health care outcomes have not been removed. Hull is a classic place to see the failure of Government policy in that respect. I hope that getting rid of health inequalities will be a high priority for this Secretary of State, not just in the rhetoric but in the delivery of policy and in outcomes.
In the context of spending on health, the Secretary of State will no doubt rehearse some numbers, and I suppose that Members of the House necessarily tend to be a little selective in the figures that they use. However, the following numbers from Reform throw a harsh light on the performance of our health service given the money spent on it. The five-year survival rate for leukaemia in England is 28 per cent. compared with 39 per cent. in Germany. The survival rate for prostate cancer, of which my father unfortunately died a couple of years ago, is 44.3 per cent. in England, but it is 67 per cent. in Germany. The difference is significant. For breast cancer, the rate is 66 per cent. in England, but more than 80 per cent. in France and Sweden.
From Reform. Estimates from a Government report suggest that 10,000 lives are lost each year because of the failure of the NHS to deliver the European average on outcomes for cancer care. Of course, that must be coupled with last year’s 6,500 deaths from hospital-acquired infections. At a time of such record spending, those deaths are not something of which the Secretary of State or any Labour Member can be proud.
Does my hon. Friend agree that after 15 years of economic growth and 10 years of this Government, it is a badge of shame for the Government that they have managed to embed welfare dependency, given that 5.4 million people in this country are economically inactive and we are in a position of having to recruit people from across Europe and the rest of the world to do jobs that should be done by many of those 5.4 million people?
My hon. Friend makes an excellent point. One must couple that scandal with the waste of resources and the wasted hopes and opportunities of many clinically trained individuals in this country who have found that there are no jobs for them because of the fiasco in the training system. I hope that this Secretary of State—I have far more confidence in him than his predecessor—will be able to make a positive difference to that situation.
Like my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), I hope that the Secretary of State will take the opportunity at the beginning of this Session to restate the Government’s commitment to reform in the NHS, rather than ducking down for safety. I am sure that the Secretary of State has read the Wanless update, so he will know that there is no safe place to be found by avoiding reform. If we do not tackle the failure to increase productivity and to improve health outcomes in this country, the NHS will be overwhelmed. If it is not transformed, it will be unlikely that political support can be sustained for the financial inputs that will be required.
The hon. Member for Norwich, North (Dr. Gibson) might be interested in the fact that the Wanless update said:
“What is equally clear from this review is that we are not on course to deliver the sustainable and world class health care system, and ultimately the healthier nation, that we all desire.”
Wanless wrote a report in 2002 as a main Government adviser, but he had to be asked by an outside body to look at the issue again.
The Secretary of State knows that I take a great interest in community hospitals in not only my constituency, but throughout the country. He has asked me twice in the House—with several months between each time—to recognise that a new hospital is being built in Beverley. He is clearly not being briefed properly by someone because I have news for him: no new hospital is being built in Beverley. It is at the bid stage and we are waiting for an early announcement. I met the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), yesterday and I am pleased to hear that we will have an answer on the next round of funding soon. I am hopeful that the Secretary of State’s view of what is happening will be the case in the future.
Order. Before I call the next speaker, may I say to the House that I will allow the next speaker 10 minutes under the rule that applies at the moment? However, to ensure maximum possible participation in the debate, after the next speaker has completed his remarks, a revised time limit on Back-Bench speeches of seven minutes will apply.
I will try to speak for only seven minutes as well, Mr. Deputy Speaker.
I do not usually seek to catch your eye during an education debate, Mr. Deputy Speaker, which has perhaps endeared me in the past to colleagues who are in the Chamber today, even if that will not be the case this evening. However, I strongly support a proposal in the Queen’s Speech that I believe is one of the most radical measures brought forward by the Government since 1997. I think that the extension of the participation age to 18 will be warmly welcomed in my constituency.
My constituents say to me, “Why can’t these youngsters get a job?” It is sometimes difficult to find the answer to that. The economy has been buoyant—unemployment in my constituency is much less than half what it was in 1997—and many extra jobs have been created, so people wonder why youngsters are not getting jobs. The situation has crept up on us. It is perhaps in only the past year or two that many of us have become aware of the phenomenon, although we were focused on the issue by the statistics on immigration that were being thrown about between Front Benchers two weeks ago.
I firmly believe that people have the basic human right to move about. People have the basic human right to try to get the best employment that they can, wherever they can, although I recognise that there must be some regulation. A lot of these youngsters have not been able to find employment because employers in my Newcastle constituency who are looking for new labour find it far easier to take on someone from an east European country or, in some parts of the economy, an irregular worker—one who is illegal and works in the black market. People want to get the best labour for their business.
Of course, employers should be prevented from using the irregular market, but in the regular market it is absolutely legal for an employer to take on a young Polish person. Such a person might be full of ambition and with a lot of previous training. That person might be taking a job that initially requires a skill level that is lower than the skills that they hold. They might also be disciplined, used to work, and with a work ethic. An employer in Newcastle will say that employing such a person will be an easier option. Although I am someone who believes firmly in people’s right to migrate and to move around—I will defend that to the end, and nothing boils my blood more than people who try to make racist advantage out of immigration—that creates a problem for a lot of youngsters in my constituency.
When the economy was buoyant in the 1970s, employers had no option but to try to get people to aid their production processes, so they had to take on those they could get locally. It was not easy to tap into other groups of people, so employers would put in place the training that they thought was necessary to get the show on the road. However, that is no longer the case because there are other options. Although the economy in Newcastle is buoyant and more jobs have been created, we still have a problem with getting the indigenous—I do not like that word, but I cannot think of a better one—labour supply into the labour market. If we do not achieve that, a lot of tension will be created in our communities because some ambitious young people will say, “Why are we not getting a job when they are?” The answer will be that those young people will not have the necessary skills.
A number of young people come from families in which no one has worked for generations and there is no work ethic. They are co-existing in society because, in a sense, their welfare benefits are being financed by the growth of the economy that is partly created by the migrant community, so the situation thus has a beneficial aspect for them. As we raise the participation level, we need to drag those youngsters into the labour market so that we give them an opportunity.
I am not quite sure about the legislative status of some of the proposals, but I am told that the Government have a scheme—I think that my hon. Friend the Member for Barnsley, Central (Mr. Illsley) referred to this—whereby youngsters from poor families can get a bit of extra tuition in basic arithmetic and English at school. I know that my right hon. Friend the Secretary of State for Health, who is sitting on the Front Bench, was a strong supporter of that scheme in a previous life, and I hope that the whole House recognises that that radical proposal is an excellent idea. We all know that if middle-class parents have a little bit of extra cash and think that it can help their kids, they will get a bit of extra private tuition. Poorer families do not have that option, which is why the proposal is radical.
When I visited my local Tyne and Wear fire brigade last Friday, I saw that it had a scheme whereby it offered a course for youngsters—young girls in this case—who found discipline and school difficult and had no ambition. This Pheonix project brings youngsters into the fire station, and they do all the things that firefighters do for a week or so. I was extremely impressed. I said to the girls, “The bosses are telling me that this is a great scheme run by Tyne and Wear. They say that you came here last Monday with no intention of co-operating, and now—by Friday—you want to be firefighters when you leave school. Is that true?” All of them said that they enjoyed the scheme and it improved their motivation, and about five of the seven said that they wanted to be firefighters. That is the sort of innovative scheme that should be taken up by the Department as it works on proposals to increase participation.
I should have liked to say more, but I shall stick to my seven minutes. I shall certainly vote against the Opposition amendment, which does not give the Government due credit for a radical scheme which I believe can benefit many people in my constituency who would otherwise lose out badly.
I am pleased to be able to speak in this debate on health and education because I wish to raise specific issues relating to access to health services that are clearly pertinent to the proposed children and young persons Bill.
The first issue is the provision of therapeutic services for all abused children, including children in care. I have tabled amendments to a series of Bills to achieve that provision, starting with the Bill that became the Sexual Offences Act 2003—sadly, unsuccessfully in all cases. I believe that such provision must be made for looked-after children if we are to make a real difference. As an ambassador for the National Society for the Prevention of Cruelty to Children, I agree with the call for comprehensive post-abuse therapeutic provision for children in care, children in custody, children in refuges and children exhibiting sexually harmful behaviour.
Child abuse remains an unacceptably large problem in the UK. A study undertaken by the NSPCC in 2000 showed that 16 per cent. of children had experienced some form of sexual abuse, which may well have been by a parent or other relative. Other forms of abuse—physical and emotional, or neglect—can also have a traumatic impact on children. In 2006, the Department for Education and Skills said that of 60,000 children in care, 63 per cent. were in care because they had experienced some form of abuse or neglect. Of course, in reality the problems are likely to be much more widespread, because of unreported instances or reporting taking place many years after the abuse occurred.
The long-term consequences of child sexual abuse include anxiety and depression, anger and guilt, difficulties functioning at school, poor self-image, and difficulties with personal relationships and parenting. Adults being treated for mental health problems often identify childhood abuse as an influence. Research shows that 25 to 40 per cent. of all alleged sexual abuse involves young perpetrators. The majority of those children and young people have been or are being sexually, physically or emotionally abused themselves. Therapy at an early stage could therefore help to reduce the scale of the problems over time by breaking the cycle.
Therapy can transform children’s lives, but provision is inadequate and patchy across the country. Resources to provide a comprehensive service will be a problem, but I want at least a commitment to a strategy to make such services fully available in time. Camila Batmanghelidjh, the founder of Kids Company, has recently pointed out that the amount of money spent on locking up young people, and the generation of more crime with consequent high reoffending rates, could be reduced dramatically if comprehensive therapeutic services were more widely available. The average cost per child of therapeutic counselling is £5,000; the cost of holding a young offender in custody for a year is £30,000 to £40,000. Surely it makes sense to invest in preventive action such as therapy.
A related issue is funding for residential family therapy and family assessments. In an Adjournment debate earlier this year, my hon. Friend the Member for Richmond Park (Susan Kramer) raised the case of the Cassel residential treatment centre, which is the only NHS residential hospital for families in the UK. Its services comprise psychotherapy for the parent and child, as well as specialist nursing input. Families are referred when concerns are raised about a child’s welfare. Most referrals arise from a child being the subject of care proceedings, which are, in turn, legally enforced by section 38(6) of the Children Act 1989.
After a 2005 legal case involving Kent county council, which centred on a dispute over whether the council had a legal obligation to fund the treatment of a child at the centre, there are concerns that there is a legal requirement only to fund assessments rather than treatment. It now appears that instead of an attempt being made to treat the family and enable them to overcome problems and become successful, children are simply being removed from the home and put into foster care or adopted. Surely it would be cost-effective to provide preventive services to support families. We must do our best.
I commend the hon. Lady for highlighting the lack of residential therapeutic places. Is not the same true of drug and alcohol treatment services, where the provision of residential care is minimal, especially for adolescents? There is only one such statutory service in the whole country—Middlegate Lodge—and family services depend wholly on the voluntary sector, which does a fine job but gets limited support from the Government.
The hon. Gentleman makes some very relevant points, and if time permitted I would pursue that line of debate.
It is important we get clarification of the judgment in the case involving Kent county council from the Department of Health as soon as possible. It would be wrong to allow family assessments to end.
Children’s services have been further affected by a more recent change affecting access to legal aid. Part contributions from the legal aid budget can no longer be put toward residential assessments for families. It has been argued that the new arrangement will ensure that the limited legal aid budget is spent on the legal aid needs of priority clients, rather than diverted into therapeutic services that should be paid for by other public bodies. Where is the joined-up working and thinking? I can see the legal aid argument, but surely money must be provided for residential assessments for families. It has to be cost-effective in the long run to keep a family together, where that is possible and practical.
The forthcoming children and young persons Bill must require joined-up working of services and a culture of “Every Child Matters” and its five outcomes to be embedded within all professions and workers involved with vulnerable young people. Preventive action that should be taken automatically now will save money and heartbreak in the long run.
A constituency case is pertinent to this debate. Living in my constituency are the parents of a young man who has been in prison for 15 years; there is no indication of when he might be released. When he was 14, he committed a minor sexual offence and was, I think, just given a caution. His parents tried to access treatment for him, but he received none. He went on, at the age of 19, to commit an extremely serious offence, which is why he is now in prison with such a sentence hanging over him. I recently visited the local youth offending team and, without any prompting from me, the team identified one of its current problems, which is that when young people are given a caution for sexual offences, the team finds it extremely difficult to get those young people into programmes to tackle their sexual offending. Before my eyes, history was repeating itself.
We need joined-up thinking. The new Department for Children, Schools and Families covers not only schools and children, but young people’s health issues and youth justice. All those areas must be brought together when considering the need for therapeutic treatment.
I shall speak against the amendment. Earlier, the shadow Secretary of State referred to statistics that have been artificially depressed. I cannot speak for the statistics, but I feel pretty depressed after listening to an hour and a half of Opposition Front Benchers’ interminable whingeing about the state of the national health service. Their criticisms bear no relation to my experience of the NHS over the past few years, or that of my family and the vast majority of my constituents. It was significant that the Opposition’s criticism was that the Government had not closed health inequalities and improved the quality of health care quickly enough, but there was not a single proposal from either of the main Opposition parties that would have increased the pace of change, and that is extremely significant.
I welcome the references in the Queen’s Speech to new legislation on health and education. On health, I want briefly to reinforce the point that I raised at Health questions this afternoon, and I hope that my right hon. Friend the Secretary of State for Health will take it on board. He will know the complications of the reorganisation of maternity services in Greater Manchester, and the crucial importance of careful implementation of the new arrangements. I hope that he, his junior Ministers and officials in his Department will work carefully and closely with NHS North West to ensure that the new arrangements are put in place at no jeopardy to the 2,500 women who give birth at my local hospital each year.
On education, it is indisputable that for the overwhelming majority of young people in our schools, colleges and universities, the range and quality of experience has increased year on year over the past 10 years, but I want to draw attention to one or two particular points. The most remarkable commitment in the Government’s education policy is the commitment essentially to rebuild the whole secondary school estate through the building schools for the future programme over 10 to 15 years. However, I am concerned about some of the underlying assumptions. I am particularly concerned about the assumptions made—or not made, as the case may be—about the number of children entering our secondary schools in the next few years.
I am afraid that I will not, because I do not think it is fair to my colleagues.
I tabled a question at the end of the previous Session, asking the Department to list the estimated number of year 7 pupils in full-time education in the next 10 years, and I was astonished to discover that the answer was not available; there are figures only for the next three years. There is general agreement among local authorities that the reality of the demographics will hit secondary schools in the next decade. I find it astonishing that the Department for Children, Schools and Families does not have readily available figures, or is not prepared to release them. I urge the Secretary of State to look again at the issue, because it relates to my next point about the growth of the academies programme.
I support the principle of academies, although their earlier design left something to be desired. I am delighted that the new Secretary of State has made important changes, abolishing the requirement to provide £2 million of private sponsorship and encouraging universities to get more involved in academies. All things being equal, if a school in my constituency wished to be an academy, I would give it my support. However, there is one issue that the Government need to consider carefully: their encouragement, if not their requirement, for all new academies to have their own sixth form. I link that to my point about demographics and falling rolls, because if we go ahead with a massive expansion of the academies programme, and we do not have reasonably reliable information about the number of pupils entering secondary school in the next 10 years, we will build a whole set of new academies—I think that the figure is 400—each with its own sixth form, few of which will be able to attract the right number of pupils for a viable sixth form. By the middle of the next decade, we will find that we are starting a programme of closure and rationalisation of sixth forms, and possibly even of academies. I ask the Government to consider that point carefully.
On the question of 14-to-19 diplomas, I do not understand why the issue is polarised between those who want the diploma to be the prime vehicle, and those who want the A-level and the GCSE as the prime vehicles. Sir Mike Tomlinson’s original report was clear in its recommendation that A-levels and GCSEs be self-contained qualifications within the diploma. That is absolutely the right way forward, and as the Government have now announced new diplomas in arts, languages and sciences, I urge them to ensure that individual A-level and GCSE subjects can be fully integrated in those new diplomas. I am sure that that would meet some of the Opposition’s concerns.
Finally, I reinforce the point made by my Friend the Member for Huddersfield (Mr. Sheerman) on academic selection. I agree with him entirely that although our Ministers have made important speeches this year, the most important speech of the year was made by the former shadow Secretary of State for Education and Skills, the hon. Member for Havant (Mr. Willetts), to the CBI on 16 May. Let me put what he said on the record:
“We must break free from the belief that academic selection is any longer the way to transform the life chances of bright poor kids. This is a widespread belief but we just have to recognise that there is overwhelming evidence that such academic selection entrenches advantage, it does not spread it.”
We know that all Members of this House are increasingly concerned about social mobility; I believe that social mobility is related to admissions policies in secondary schools. The hon. Member for Havant believes that, and I think that the Government do, too. The issue is a major priority for all three parties. We really cannot put the matter off any longer; we have to take decisions about the future of academic selection.
I am pleased to take part in this debate. I say that with some caution, because I know that some of my hon. Friends on the Conservative Benches wonder why, now that education and health matters are devolved to Northern Ireland, I wish to take part in a debate on education and health in this Chamber. It is a great pity that some of my hon. Friends take the view that there should be two tiers of membership in this House, and that on some issues people who have been elected should be excluded from debates or from votes. As a Unionist, I believe that as a citizen of the United Kingdom who has been elected to the Parliament of the United Kingdom, I have the right to take part in these debates, and I am happy to take part today.
No one could quibble with the objectives set out by the Secretary of State for Children, Schools and Families—increasing skills in the economy, increasing employability, and turning the least academically able section of our population away from a life on benefits. However, I have concerns about the method, and the vehicle, that is to be used.
My first concern is about raising the age for full-time education. I notice that we are moving from talking about the school leaving age, and instead talk about the age for full-time education. Nevertheless, as the Secretary of State made clear in an intervention, there will be an element of compulsory attendance at an educational establishment. Whether that is on a full-time basis, for 16 hours a week, or—for those who are in employment—one day a week over the year, there will be an element of compulsion. As someone who spent all his life teaching before coming to the House, and having taught in a grammar school for a long time, may I tell those Members who rubbished academic selection and grammar schools that social mobility in Northern Ireland is far ahead of social mobility in this part of the United Kingdom? More people from working-class backgrounds go into higher education than elsewhere. We have already passed the 50 per cent. figure, which is partly due to the fact that we retained the grammar school system.
I had the opportunity to teach in further education, and one of my early memories is of teaching people who were compelled to go to a further education college one day a week. I had the joy of teaching first-year plumbers on a Friday morning for a couple of hours. Many of them were happy to learn their trade and acquire plumbing skills, but it was a nightmare for them to return to the educational setting—it was a nightmare for those of us who had to teach them, too—which created all kinds of problems. The Secretary of State must not underestimate the fact that even if it is only on a part-time basis, compulsory educational attendance will cause problems for teachers, and will have a detrimental impact.
The Secretary of State described four main building blocks for trying to attract young people who are not in full-time education including, first, new qualifications. Looking at the range of qualifications, from NVQs and GNVQs to GCSEs, vocational GCSEs, A-levels, basic numeracy and literacy, one can see that there is no shortage either of qualifications or of variety, so that is not what is preventing young people from participating in education. I am not sure that new diplomas will make things any different for those hard-to-attract young people. Allowances are an extension of the Government’s proposals, but the education maintenance allowance is already available, probably to the very people whom the Government seek to attract to full-time training and education. I do not think that there is anything new that will change the situation.
The same is true of the proposals on educational guidance. Most further education colleges, the careers service and jobcentres already provide a full range of guidance to youngsters, yet there is still a hard core of people who are not attracted to education. The final building block are the new apprenticeships, but we already offer a range of opportunities, whether through involvement in community-based schemes, industry-based schemes or training, so young people are doing hard work. The Government have tried to play down the compulsory element, but I am not sure that the proposals will increase the attractiveness of training for that hard-to-reach group of young people, which is why I support the amendment. If we are to raise expectation, there is no point trying to do so once people are totally turned off education, because they do not even have the skills to read or write. They are turned off by the indiscipline in schools, so if resources are to be directed at them, that should be done before the lights are switched off, rather than trying to raise their expectations once they have left school without qualifications. That is the emphasis of the amendment—its sentiments were shared by a number of Government Members, who warned that we must reach those young people at an early stage—and that is why I have taken part in the debate, and am happy to take part in the vote.
I am pleased to talk about education and health in our debate on the Gracious Speech. It seems to me—and, I am sure, to many other hon. Members—that it is a major step forward to ensure that we do all that we can to educate children about health. The Government have responded well to the challenges that we face in those areas. At the brand new Cardinal Hume Catholic school in Gateshead in my constituency, it is a joy to see teachers and pupils excited about their new learning environment and the facilities that are on offer to them. Oxclose school in Washington has been fully refurbished using money made available through the building schools for the future programme, and it is a lesson to all of us that we do not always have to knock something down and start again to make it better.
I want to talk about two issues that can be clearly linked across health and education. The Government rightly note the need to tackle obesity, promote skills and change lifestyles. My constituency suffers from health inequalities, which must be reversed. Obesity rates, smoking rates, cancer rates and deaths from heart disease are all higher than average. Despite that, I remind hon. Members that it remains one of the most scenic and friendly places in which one could hope to live.
To help reverse these health inequalities, I know how important it is that we go further still in delivering good quality school food. We hear tales of mums passing pizzas through the school gates, chip shops making record lunchtime profits, and some children causing a mess and a nuisance out on the streets. The solution that I propose is straightforward and simple: free, universal, locally sourced, hot school lunches, given to all pupils under the age of 16, coupled with a policy whereby pupils are not allowed off the school site at lunchtime—a lunchtime lock-in, so to speak.
If the scheme is to work properly, packed lunches should be discouraged. A large number of parents send their children to school with a packed lunch, but unfortunately most lunch boxes are far from healthy. What parent would go to the hassle and cost of providing a packed lunch, healthy or otherwise, if they could have a free, healthy, hot school meal for their child? Sourcing food locally would not only cut food miles, but play a role in supporting the local economy. In addition, universal free school meals would remove any stigma that is often attached to claiming free school meals, usually because children would rather be with their friends having a packed lunch or out at the chippie.
Some 250,000 children who are entitled to free school meals do not get them because they do not claim them. In my constituency hundreds of children lose out every day, despite the best efforts of my local councils to increase take-up. A universal free school meals policy has been working in Sweden, Finland and Honduras, delivering significant results. Closer to home, there are pilots in Scotland and north Tyneside. These pilots are possible in England because of the Education and Inspections Act 2006, which removed any statutory obligation on schools to charge for meals, so let us make the most of that change. Surely that is why it was made.
That would, of course, have a cost implication, but the long-term benefits of boosting educational attainment, fighting child poverty and tackling health inequalities must begin to outweigh the cost. Estimates of the cost vary, and I have heard a figure of £2 billion. However, the House of Commons Library, which is highly respected and a credible source, has put the cost between £900 million and £1.1 billion. That includes the cost of providing more meals and restructuring current catering contracts, but savings would be made through economies of scale. That sum is not peanuts, but it is still only about 0.2 per cent. of Government spending. It is worth noting that the cost of obesity is conservatively estimated to be about £3.5 billion a year, and we know the old adage about a stitch in time. I am sure that that provides us with some food for thought, and I hope the Minister digests it well.
The second issue that I wish to raise in the time allowed is closely related to education. I urge Ministers to train a dyslexia specialist in every school, who in turn will train all teachers to recognise the signs of dyslexia. I also propose that during their training all teachers are taught a compulsory special educational needs module, rather than SEN as an optional extra, as at present. As a parent with a severely dyslexic son, I know only too well the pressure and frustration faced by many other parents in the same situation. My son was eventually statemented, and with that comes not only the recognition that he needs extra help, but the extra funding to pay for it. We can give all dyslexic children across the country—even those without statements—the help that they need and save money at the same time.
Dyslexia affects one in 10 people. That means there are around 1 million dyslexic children in our schools. They need extra help and support. All our brains work in different ways and we need to ensure that pupils with special educational needs are given special teaching, with teachers who are qualified and able to meet their needs. It has taken 10 years of government and we have come an awful long way. We could not have done it without listening to people and stakeholders. We must listen to the parents of dyslexic children.
A recent survey of such parents carried out by the charity Xtraordinary People and the British Dyslexia Association says that nine out of 10 parents think the support that their children are receiving is ineffective, and seven out of 10 believe their children are being given support by staff who have no specialist training in dyslexia. I welcome the one-on-one tuition that is being given to children who are falling behind in school, but for dyslexic pupils what makes the biggest difference is the opportunity to spend time with a specially trained teacher.
I shall give one quick example. Ben, a 12-year-old dyslexic pupil, had spent six years being helped by a learning support assistant, at a cost of £27,000, and he had shown little, if any, improvement. I know this example to be true because it is exactly the same as my son Joseph’s. After only 20 hours working with a dyslexia specialist, Ben’s reading and spelling age rose by two years—all that at a cost of only £600.
I am proud to say that the Government are delivering nearly £1 billion in funding for personalised learning, but we must ensure that it is spent wisely and not wasted. I hope that the Minister will give sincere consideration to the points that I have made.
Quality of care and safety are at the heart of the Health and Social Care Bill, and I shall spend my precious few minutes talking about quality of care. I am not whingeing or scoring political points; I shall just give the House some examples of the truly awful quality of care that is brought to my notice. I shall then consider some of the measures in the Bill to address the problem.
My first example involves a patient known to have terminal cancer. After treatment at a local cancer centre, with which he was very satisfied, he had to be admitted to another hospital for the investigation of an unexplained fever. The admission process took a long time. Staff were busy and there was no sympathy for his family. Eventually, he was admitted, but no information was given to him or his family. When they went to visit him the next day, he said, “Get me out of here; they do not know what they are doing.” The family were told that no doctor was available to talk to them, although at times doctors and nurses were laughing and joking at the nurses’ station.
On one occasion, the patient’s family were told that he was not in the ward where he in fact was, and they feared that he might have died. When they found him, he was obviously dehydrated and had not been washed. He said, pitifully, “I don’t feel safe in this hospital. They are leaving me to die.” Eventually, the family saw a junior doctor who knew nothing about the patient, so they took the patient home.
I have to declare an interest in respect of my second example. My wife’s elderly aunt—a fit 90-year-old, except for her bad case of cancer—has completed her radiotherapy. She had a check-up on 9 October; she was supposed to have had a scan. Her journey was wasted, as the scan had not been done. It was done on 6 November. Today, she went for the result, only to be told that it was not available as it had to be reviewed at a weekly meeting, which had not been held. How is that patient-centred care—care organised around the patient? It is not; it is care for the convenience of the staff.
I have received letters from people appalled by their treatment in hospital. They mention delays in responding to calls, alarms being ignored, wet beds not being changed, staff sitting around talking and joking, and days without fluids—“If you can’t eat, you don’t get anything.”
I am speaking out about that sort of thing on the basis of local complaints, but it is a national issue. Compulsory reading for everybody—Department of Health Ministers, Members, administrators, NHS staff—is an article in the British Medical Journal this week. It is a personal view, written by a psychiatrist and headed, “So, you want to know what’s wrong with the NHS?” It is about the care of the psychiatrist’s mother during the course of her schizophrenia, which merged into Alzheimer’s disease. He paints a vivid picture of uncaring, incompetent senior health care staff, the difficulty of complaining, the lack of continuity of care and the migration of an elderly woman across five wards in 14 days. I shall give two quotes:
“Those who cannot do their jobs, who cannot elicit histories or examine the sick, are curiously diligent when it comes to applying the rules under which complaints can be made against them.”
Here is the other:
“It doesn’t matter what you do because the “carers” do not care. It does not matter what you say, because they do not listen.”
I thank the hon. Gentleman for that point; it allows me to say that these are not anecdotes but actual occasions of which I am personally aware.
How does the Bill propose to tackle what are, I hope, pockets of appalling care? We are to have a single inspectorate—the care quality commission—instead of the three existing bodies. Is that an economising move? Will it have enough resources? The timing seems pretty poor. The Healthcare Commission is just getting to grips with having annual health checks instead of star ratings and surely needs time to refine that process. Is self-certification of compliance with standards a reliable system? The bodies are to be merged in March 2009—what will be the effect in the meantime? The Healthcare Commission has picked up 19 weak hospitals on quality of care, and it needs time to follow that up.
I am worried by the reform of the complaints process, particularly the loss of the second stage. The Healthcare Commission seems to be escaping from that process because it is insufficiently resourced to cope with the huge number of complaints that it receives. I do not understand why the Department of Health paper, “The future regulation of health and adult social care in England”, states:
“We do not believe the investigation of complaints from individual patients or users of services sits easily with the functions of a regulatory body.”
Why ever not? One of the best ways of assessing what is happening with an organisation’s performance is to examine complaints and the responses to them. When we lose referral to the Healthcare Commission, we lose the automatic inclusion of an independent opinion, which is absolutely necessary in clinical cases.
There is a stress on the use of PALS—patient advice and liaison services. Those are not independent and have been widespread casualties of the financial deficits and actions taken to balance the books. I would like to know whether most trusts are like mine, which, when I last inquired, had precisely one PALS officer for three hospitals. The Independent Complaints Advocacy Service is extremely helpful, but we still depend on the trust that is being complained about calling in independent advisers of its own choosing. The paper, “Making experiences count: a new approach to responding to complaints”, mentions the use of independent mediators and specialist advocates, including:
“People independent of the service provider, the commissioning organisation and even the locality, who could be called on to conduct an investigation where complaints cannot be resolved satisfactorily and/or there are complex issues involved.”
An independent review is absolutely crucial before the case has to go to the ombudsman.
My main concern is whether a merged inspectorate can really cope with the vital issues of improving quality of care in failing hospitals. Is the complaints process being watered down to the disadvantage of the complainant?
I thank and pay tribute to my hon. Friend the Member for Gateshead, East and Washington, West (Mrs. Hodgson) for raising the issue of free school meals. We saw an excellent system operating in Sweden, and I too urge the Government to take note of what is being delivered there and to think about setting up pilots here.
I congratulate the Government on setting up the Department for Innovation, Universities and Skills—evidence, if it were needed, of their looking to the future needs of the economy and putting our universities at the centre of the agenda, not only to foster innovation but to deliver skills that are needed for the future. I strongly support the measures in the Gracious Speech to support skills development, and I suppose that I am therefore speaking against the amendment.
It is vital that we continue to upskill our population so that we can compete in the global economy, not at the bottom end of the market but at the top. The importance of concentrating on higher-level skills is demonstrated by even a quick glance at future skills requirements. As our Prime Minister has pointed out, we have 6 million unskilled workers today, but by 2020 we shall need only half a million such workers. The rising demand for skilled employees is the reason why we have to ensure that our young people leave school with skills and qualifications, and why we have to upskill our work force.
In passing, I applaud the Government for their bold step of wishing to guarantee training or education for every young person up to the age of 18. It is important that we do not allow the Opposition, or sloppy journalism, to package the change as simply raising to 18 the age below which staying on school is compulsory. The policy is one of providing training, which will be made available in a range of settings to meet the needs and aspirations of the young person concerned. Of course, we have to pay attention to the quality of that training and ensure that it is implemented properly in a way that does not further alienate the young person. Lord Leitch set the agenda and outlined the rationale for improving skills to meet the needs of the individual as well as those of the economy. He showed that better skills lead to better-paid jobs and improved social mobility. It is therefore important that we consider the development of individuals and communities as well.
I say to the hon. Member for East Antrim (Sammy Wilson) that the Government are not ducking the huge cultural change that needs to take place to ensure that education and qualifications are valued in all sections of our society. We know that that is a difficult task, and the Government are leading the discussions that say that there is no quick fix to the problem. It requires long-term investment and gradual change, including working with parents, young people, the wider community and employers to instil respect for education in all sectors of our society. Some of the measures being introduced, such as diplomas, apprenticeships and work-based training, will help to do that.
Despite the huge challenges that undoubtedly exist, the Government have set their sights high. There is a commitment to become a world leader in skills by 2020, benchmarked against the upper quartile of the Organisation for Economic Co-operation and Development, which will mean 95 per cent. of adults achieving functional literacy and numeracy, and a shift in the balance of intermediate skills from level 2 to level 3. It will also mean, as many other hon. Members have said, boosting the number of apprenticeships to 500,000.
In many constituencies such as mine, where there has been a tradition of heavy industry, the increased emphasis on apprenticeships and vocational-based subjects is very much welcome, as is the opportunity to move from an apprenticeship to an advanced apprenticeship, and then on to degree level. Such progression routes are extremely important if we are to deliver world-class training. “Train to gain” and learner accounts will, we hope, encourage employers and adult learners to improve their skills as well. The commission for employment and skills is also to be welcomed, not least because it will advise on necessary skills and give employers an important voice.
Clearly, further education has an important role to play, but we must also look at what our higher education institutions are doing. There are some who think that universities should not be dragged into the murky world of skills for employment and should concentrate on education for its own sake. In reality they can, and do, do both. That will be increasingly important as we move towards the 50 per cent. target. It is important that we use our universities to develop in as many young people as possible the ideas, creativity and innovation needed if we are to compete successfully in a global market. Science is essential, but high-level skills in a range of sectors, including creative industries, art and design, are also important.
The Government are raising their expectations of universities but they are also continuing to improve investment in them. The DIUS budget following the comprehensive spending review will rise 2.2 per cent. above inflation. I am stressing that point because the increased investment in universities is not always recognised by people who work within the sector, and sometimes not by those outside it. Additional money has certainly been given to universities so that they can reach out to the wider community and support knowledge transfer, so that constituencies such as mine can be ahead of the game in developing a knowledge-based economy for the future.
I commend the amendment, and in particular the reference to
“the absence of measures to improve public health”.
In his response to the Gracious Speech, the Prime Minister made only passing reference to public health and even less to concerns about drugs. He referred to those in the context of law and order, but we all know that they are an issue in health and education, and therefore appropriate for debate today. They are also relevant to alcohol and the concerns about the lack of appropriate measures to tackle the level of alcohol misuse. The Alcohol Health Alliance has properly raised concerns about the number of children admitted to hospital every day.
The concern about alcohol is that it is the poor relation when it comes to treatment, but the concern about drugs is that the Government have woefully failed. Public money has poured in, with more than £100 million primarily focused on getting people into treatment. What is that treatment? Primarily, 85,000 people per year—maybe more—are prescribed methadone, but only 350 or so addicts move to recovery. Treatment is not only about medication or the cul-de-sac of prescription drugs, whose use has been described as a medically managed half-life. Surely we could do so much more, and encourage people into residential treatment rather than, as the Government term it, “exit from treatment”.
Residential rehabilitation is an exit from dependence that the Government should take seriously. Rather than having a drug strategy that is about harm reduction and ticking a box to say, “You’re managed, you’re safe, you’re okay,” we should be more optimistic. We should do so much better and give people the option of rehabilitation to realise their full potential. We should deal with the human lives that are not just defined by a tick-box, and which should be released from the slavery of addiction to alcohol and drugs. More needs to be done.
I want to address most of my remarks, however, to something that is in the Queen’s Speech: the Human Fertilisation and Embryology Bill. I was pleased to be a member of the Joint Committee on the draft Human Tissue and Embryos Bill, although it had insufficient time for scrutiny and a limited remit. The Government have pinned their colours to the embryonic research mast through their pledge that the new Bill will
“reform the regulation of human embryology and ensure that Britain remains at the forefront of medical research.”
The key question is whether the Government’s desire is to be at the forefront of medical research or embryonic research. A primary concern is the proposal to permit research into inter-species embryos. Although the presumption in the Bill is the Warnock position, which permits research on human embryos and therefore their destruction, it is important to record the acute concern about the extension and expansion of such research. In its leader on 26 April, The Times rightly stated:
“Unfashionable as it may be to say so, destroying an embryo extinguishes the possibility of a life.”
To balance that, I would say that the science editor of The Times was not right in the evidence that he gave to our Committee. He said that
“there is… indifference and perhaps a lack of really strongly held views”
on the subject of inter-species embryos.
We should not underestimate the level of concern among the public. Let me make it clear that the destruction of an embryo after it has been subjected to experimentation and used to create a fusion of human and animal cells matters deeply. The ethical implications, as I am sure we are aware, are immense, not least because that involves tampering with the fundamental essence of human life. Its implications will have an impact beyond these shores, with the scientific world watching, as it did with the Human Fertilisation and Embryology Act 1990, to see how high we will jump or—in my view—how far we will sink.
In many places, the Bill will permit things that are banned in countries such as France, Germany, the Netherlands, Belgium and Canada. It is not surprising that the UK lags behind when it comes to ethical principles. The chief medical officer, Sir Liam Donaldson, gave evidence to the Committee and said:
“We have had, generally, in this country a deficit in medical ethics”.
In the absence of a clear moral compass, it is inevitable that research seems to cross more ethical boundaries in the name of progress, and wanting to be at the forefront of it. At the very least, the moderate recommendation of the Joint Committee for a bioethical Committee of both Houses should be followed up.
The aim of the Human Fertilisation and Embryology Bill is, we presume, to promote useful research, but the evidence supporting the potential for useful research using embryos or, where there is a shortage of those, inter-species embryos, is limited. Evidence from scientists suggests that there is no chance of embryonic research delivering positive therapeutic outcomes for a long time. The goalposts have been widened since the wild hopes in 1990. It is important that we should pursue alternatives that are not fraught with the ethical controversies surrounding inter-species embryos. Umbilical cord blood is one possibility, as is using adult stem cells, which have already provided more than 70 treatments. I have a ten-minute Bill about how to put in place greater provision for retaining cord blood, so that we can research that possibility further. Why are we speculating in an ethically precarious future? Surely we should be investing in ethical research. Surely we should have a Bill that is at the forefront not just of research, but of ethical research.
The Bill goes further than that, however. It deals with the wider issue of fatherhood and seeks to define the legal parentage of children in a new way. Although there is an increasing cross-party recognition of the importance of the role of fatherhood in social and emotional well-being, the concern with the Bill is that parenthood will move from a biological relationship to a legal responsibility. As a fellow member of the Committee, Baroness Deech, said on 8 November, the concern is that fatherhood is being downplayed in fertility treatment, with men being reduced to nothing more than a “genetic contributor”.
The Government’s stance on judicial policy is contradictory, on the one hand encouraging fathers to be part of the birth certificate process, but on the other seeking to remove the need to take account of the father when considering fertility treatment. Doing so has an important symbolic value. We should not sanction fatherlessness; indeed, we should not go further, as the Bill seeks to do, and sanction state deception. In the words of a donor-conceived person:
“I was angry at the idea that where donor conception is concerned, everyone focuses on the ‘parents’, the adults who can make choices about their own lives. The recipient gets sympathy for wanting to have a child…It’s hypocritical of parents and medical professionals to assume that biological roots won’t matter to the ‘products’”.
We should challenge that and say that they are not “products”—regardless of whether they are children or unborn children.
I am grateful for the opportunity to speak in this important debate. I will confine my remarks to the proposed education and skills Bill and the health and social care Bill. In the context of social mobility, I should also like to put on record my total support for the Crossrail project that the Government announced in October, with a financial package of £16 billion in place.
In the spirit of the theme of the Gracious Speech about supporting all children and young people, not just some, in their efforts to gain the necessary education and skills, I warmly welcome the education and skills Bill, which will raise the minimum age at which young people can leave education and training to 18. Combined with new specialist diplomas and an expansion in the number of apprenticeships, that will provide an improved participation rate beyond the age of 16, which is vital for my constituents individually and for business and society, as well as for the long-term sustainability of the UK economy in the ferociously competitive world economy.
The renewed commitment to reducing the number of young people not in education, employment or training will be of great benefit to some of my constituents. It must be achieved by paying close attention to the supply side and by delivering a range of vocational options in which young people will voluntarily seek to engage. The compulsory element is important, but really engaging the young people most alienated from the education and training system will require an effort to produce imaginative solutions. For that reason, I also welcome the draft apprenticeship reform Bill as a vehicle for producing those solutions.
In conclusion, I should like to make a few comments about the Government’s commitment to a health care system organised around the needs of the patient. I congratulate Ealing hospital in my constituency on recently gaining foundation trust status. I had a very productive meeting only this morning with the chair and chief executive of the hospital, at which we discussed how the new foundation status would help to make the hospital more flexible and responsive to local people and local health needs.
I also ask the Department of Health to look for ways to increase the numbers of primary health care centres in my constituency, in which groups of GPs can work together to provide a much more responsive and flexible service to my constituents than single GP practices working alone.
From my previous professional experience as a day care centre manager for adults with learning disabilities, I welcome the proposed health and social care Bill, which will create a new integrated regulator for health and adult social care—the care quality commission—bringing together the existing health and social care regulators into one regulatory body. With the current trends towards joint working between health and social care, it makes complete sense to unite the regulatory bodies into one.
The Bill will also introduce a new single set of registration requirements for all health and social care services, but this will need to be done very carefully, as the requirements could end up being too generalised to be meaningful, given the broad range of services that they will have to cover. For example, regulations that currently guarantee care home residents the right to meet visitors in a communal space or to bring in their own furniture could not be reflected in regulations covering acute medical settings. Increasing the quality of health and social care for individual patients must be the absolute priority of the Government, and this Bill will help to bring that about.
As a newly elected Member listening to my first Queen’s Speech debate on these Benches, I welcome the Government’s legislative programme, which I believe shows real vision in meeting the rising aspirations of the people of the United Kingdom. I commend it to the House, and oppose the Opposition amendment.
The Prime Minister’s first hundred days can be summed up with a modified form of an old wedding proverb: something old, little new, plenty borrowed, lots of blue. Lumping health and education into one day’s debate after two ministerial statements is also something of a marriage of convenience for a Government who have failed to deliver on 10 years of empty promises on health care and education. However, it is less convenient for my constituents, most of whom regard the delivery of good health care and good education as the two most important ways in which Government policy affects their lives. I suspect that my constituents would be happier if there were fewer Bills in the Gracious Speech and more emphasis on the delivery of the services that matter to them.
As ever, the Government are long on rhetoric and short on progress when it comes to the delivery of proper local health care. The Prime Minister now seems to have cast himself as Hercules cleaning out the NHS stables—or, more simply, as a cross between Flash Gordon and Mr. Muscle. But, as my right hon. Friend the Member for Witney (Mr. Cameron) exposed last week, his deep clean commitment has more than a whiff of spin about it.
A further deep clean is now desperately needed: a deep clean of the Government’s target culture and centralised control of health care. The Gracious Speech contained a commitment on behalf of the Government to
“providing a healthcare system organised around the needs of the patient.”
Yet the new health and social care Bill will introduce a new integrated regulator, more targets and more interference with front-line professionals—all, perversely, in the interests of boosting public confidence in a failing system.
The sickness in the health service is borne out by my constituents’ experience of obtaining adequate local health care. Before the 2005 election, they were promised a community hospital, but progress on that has since evaporated as surely as the Labour majority did in Braintree. I have repeatedly raised the fate of that project in Parliament, and I will continue to do so. The primary care trust’s latest position is that a full business case for the Braintree community hospital scheme will not be ready until March next year.
Those delays have already had real consequences for patient care locally. This afternoon, I hosted an event to celebrate the 25th anniversary of the Farleigh hospice, which provides support for my constituents and others across mid-Essex. Last year, Farleigh cared for 2,663 people, but its year has closed with the news that the day hospice must vacate its premises on the site of the former St. Michael’s hospital in Braintree by the beginning of next year, because the future of the site and of the community hospital that was supposed to be built there is still uncertain. I do not see the Government’s commitment to local health care anywhere in the vicious circle that has trapped Braintree’s community hospital project since 2005. We have a Government whose unprecedented investment has been matched only by its unconscionable waste. Will the Secretary of State for Health now demonstrate a true commitment
“to providing a healthcare system organised around the needs of the patient”—[Official Report, House of Lords, 6 November 2007; Vol. 696, c. 1.]
by committing to build a community hospital in Braintree?
Unfortunately, the pace of change on education has left a lot to be desired. Some £1 billion has been invested in cutting truancy, but truancy rates have risen again recently with a hardcore of more than 200,000 children still regularly playing truant. The Government have failed to get to grips with keeping children in school until they are 16, but they now propose to keep children there until they are 18. I agree with the principle that improving skills among young people is both an economic and moral imperative. However, to think that greater participation can be achieved by the simple expedient of higher targets is at best naive, while to believe that either bribery or compulsion are the means to attain those targets is simply cynical.
I also want to sound a brief note of caution about one of the core principles of the Leitch review of skills. Lord Leitch’s exhortation was to
“focus on economically valuable skills. Skill developments must provide real returns for individuals, employers and society.”
That is right as far as it goes, but it has its origins in the Thomas Gradgrind school of thought, being “eminently practical” but lacking in essential humanity. We must remember the moral imperative as well as the economic imperative.
By way of simple example, I recently met my constituent, Mrs. Gina Fost, who is one of many people who are struggling to afford the cost of lip-reading and signing classes as a result of central Government meddling. Providers of adult community learning courses must follow guidance from the Learning and Skills Council. Residents in Braintree and Witham have seen their fees for lip-reading classes increase in the space of three or four years from nothing to £94 and finally this year to £186. The reason for those jumps is that the LSC does not view signing and lip-reading as “basic skills” worthy of full fee remission under the skills for life programme. Consequently, pensioners must pay 37.5 per cent. of the cost of the course themselves. To my way of thinking, however, there is no more important basic skill than the ability to communicate with others. The education and skills Bill will supposedly place new duties on the LSC to support free tuition for literacy and numeracy. If so, it ought to support free tuition for lip-reading and other basic skills, too.
We need to reduce complexity in the funding system, not reinforce it. We need to move from a target-led approach to a demand-led approach to skills. In the drive for skills, we need to remember that support for some skills is governed more by a moral than an economic imperative. One of the Government’s besetting sins in the past 10 years has been the unholy alliance between profligate legislation, prodigal spending and parsimonious delivery. This year’s Gracious Speech is nothing different, which is why I shall vote against it and support our amendment.
I rise to speak in favour of the Loyal Address and against the Opposition amendment.
I want to examine the education and skills Bill, mention some of the great things that have happened in my constituency as a result of our policies so far and consider what the Bill’s introduction will mean. Although the headlines in the days after the Gracious Speech seemed to focus on the school leaving age, now that the dust has settled, we can see that this is not an arbitrary measure and it is not just about raising the school leaving age. Extending the path of young people to remain in education until 18 is surely something to value. Perhaps we should view it as extending the right to education and training up to 18.
Those who have been involved in education and training know that in order to succeed in work, it is a matter of common sense to remain in education or training—providing that it is of high quality—until at least 18. That is equally important to the nation if we are to compete at global level. The most important issue, however, is that there should be a variety of good-quality options available: work-based learning and college, school or employment training, especially high-quality apprenticeship.
The key to the Bill’s success is aspiration. I truly believe that all young people should aspire either to apprenticeship or higher education. It falls to us to ensure that their path to achieving all they can is assured. Throughout all the depressing times as a teacher during the Thatcher years—believe me, there were many, including lack of resources, exercise books and pens and having to rein in classes of 37 eight and nine-year-olds—nothing was more depressing than the pupil without hope or without aspiration. I will always remember that as a probationary teacher, one of my first lessons in key skills was how to fill in a UB40.
Of course, much has changed, especially over the last 10 years and unemployment in my constituency is now at its lowest level for 10 years. It is now 3 per cent.—down 29 per cent. in 1997. Youth unemployment has been virtually eradicated. The number of 15-year-olds getting five or more GCSEs at A* to C grade is up 12 per cent. since 1998.
Our sixth form college, King Edward VI, ably led by John Glazier, has an A-level pass rate of 99.6 per cent. and 90 per cent of its students progressed to higher education last year. The college is looking to the future and is helping to shape the three new academic diplomas recently announced by my right hon. Friend the Secretary of State for Children, Schools and Families. The college has ambitious expansion plans, assisting the aim of having all 16 to 19-year-olds in education.
Just down the road at Stourbridge college, the staff ensure that no learner leaves without a level 2 qualification; and a ground-breaking programme of learner progression ensures significant progress. The college also has ambitious plans to expand, to add to local regeneration, to raise aspirations and to improve tomorrow’s opportunities and sustainable jobs. Again with dynamic leadership—this time from Lynette Cutting—the college works with more than 500 employers every year. It manages the black country construction employers taskforce and leads a regional team to gain a construction consortium of £3.6 million. Last year, it delivered 40 per cent. above the original contract allocation and it was first in terms of recruitment and achievement.
I am sure that Stourbridge college would welcome a visit from my right hon. Friend the Secretary of State for Innovation, Universities and Skills to see the outstanding progress being made there, especially as the college is planning to deliver 100 per cent. above its original “train to gain” offer and establish a new arm of “Stourbridge Training” to enable the college to be responsive to employer needs. That is just what we need in the black country. As you can see, Mr. Deputy Speaker, Stourbridge is a “can do” town with two “can do” colleges, of which all of us in the local community are rightly proud. They are already delivering on the education and skills agenda and aspiring to do much more.
The black country as a region has suffered from a decline in traditional industries and manufacturing and there is a need to upskill our work force, broaden our horizons and look increasingly outwards rather than inwards. Advantage West Midlands, the Black Country Consortium and the learning and skills council are all working on that agenda, but development and aspiration also need to be encouraged and supported by local councils and by joined-up thinking across their departments.
What is the use of encouraging young people to stay on in education and training or encouraging over-19s to upskill and train to attain functional literacy or numeracy when their local council is closing libraries where they can research, study and learn, youth services are being cut, leisure centres and swimming pools are being closed and top performing schools closed down for no better reason than to have the lowest council tax rate in the region?
For all the good that the Government’s education investment is doing in Stourbridge, short-sighted, short-term, penny-pinching local council policies can and will undermine our progress locally. That is why it is vital for Ministers to keep a close eye on the efforts and performance of councils such as Dudley—not just in respect of education policy, which is soon to benefit from £25 million black country learning challenge money, but across the services as a whole that are necessary to back up progress in the education and skills agenda.
The black country as a whole, and Stourbridge in particular, has a proud history, and aspires to a prosperous and proud future. I am confident that the proposed legislation will be invaluable in that quest.
We have had an excellent debate today—it was lively and vigorous, not least thanks to the Secretary of State. I thank all those who participated. Their individual commitment to improving our public services was clear and in many cases moving.
The right hon. Member for Oxford, East (Mr. Smith) stressed that any policy to secure greater educational participation must be rooted in getting the basics right in the early years. We wholeheartedly agree with that. My right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), in his characteristically brilliant style, pointed out that this Government have retreated from reform on health as well as on education. The hon. Member for Huddersfield (Mr. Sheerman) spoke with passion on education. Although we may differ, I appreciated his palpable commitment, which I share, to greater social mobility.
My hon. Friend the Member for Esher and Walton (Mr. Taylor), in a typically tightly argued speech, reminded the House that the Conservative party is in favour of increasing university participation. The hon. Member for Barnsley, Central (Mr. Illsley) underlined his reputation as an exemplary constituency MP. My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries), a former nurse, spoke affectingly and with a formidable grasp of detail on the question of the protection of unborn life.
The hon. Member for Llanelli (Nia Griffith) made important points about ensuring appropriate consideration for the position of women in extending opportunity. My hon. Friend the Member for Beverley and Holderness (Mr. Stuart) made a persuasive and cogent case for further reform in the NHS, reinforcing his reputation as a great campaigner for better health outcomes. The hon. Member for Newcastle upon Tyne, North (Mr. Henderson) spoke with characteristic fluency about the effects of globalisation on his constituency.
The hon. Member for Mid-Dorset and North Poole (Annette Brooke) made a speech that reflected her long-standing commitment to children’s issues. The hon. Member for Bury, North (Mr. Chaytor) made a thoughtful speech with interesting ideas about how to extend academic excellence, which I enjoyed. The hon. Member for East Antrim (Sammy Wilson) spoke with all the authority of a former teacher, and we all benefited from his shrewd Ulster wisdom. The hon. Member for Gateshead, East and Washington, West (Mrs. Hodgson) spoke persuasively on the need for improved school nutrition.
The hon. Member for Wyre Forest (Dr. Taylor) spoke with formidable authority about real weaknesses in contemporary patient care. The hon. Member for City of Durham (Dr. Blackman-Woods) underlined the importance of extending educational participation if we are to compete better internationally. My hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) spoke with great moral force about the Human Fertilisation and Embryology Bill. Whatever our personal positions, we all benefited from his thoughtful arguments. The hon. Member for Ealing, Southall (Mr. Sharma) consolidated his growing reputation as an assiduous constituency Member. My hon. Friend the Member for Braintree (Mr. Newmark) assailed the Government’s record with brio and élan, and the hon. Member for Stourbridge (Lynda Waltho) spoke with charm and fluency in support of the Government line.
The nature of the Chamber, and of political life, can exaggerate division. While good men and women will always disagree, it is appropriate to acknowledge that public services have been strengthened and are supported by all parties in the House. The Liberal Governments of the first decade of the previous century laid the foundation for universal welfare provision and Labour Governments introduced the national health service and the Open university, while Conservative politicians made a reality of universal education, presided over the biggest increase in affordable house building in our history and laid the foundations for greater individual choice within the state system. It is important that we acknowledge that collective, cross-party commitment to better public services.
That is why I was so disappointed by the rather partisan approach favoured today by the Secretary of State for Children, Schools and Families. I should not have been surprised, however, because long before he took up his post he made clear what he wanted to do with the job. In an interview with the New Statesman, he explained how he wished to reject the consensus that used to exist between Mr. Blair and the Conservatives and
“get back to clear dividing lines”
with the Conservatives over policy, preferring division over consensus and putting political positioning before real reform. We had more of the same today.
The Secretary of State made no substantive arguments. Instead, he built his speech around a flimsy, pre-fabricated soundbite. He asserted that the Conservatives supported “excellence for the few”. When challenged three times to provide evidence for that quote, he could not. When challenged on the facts, he fell back on assertion. When asked to justify his position, he resorted to caricature and bluster: Brownism in action.
As I watched the Secretary of State struggle at the Dispatch Box, however, I could see a nervous tic—a quivering palm, betraying the shaky ground that he was on. We saw another quivering palm last week from the Prime Minister. It is becoming a characteristic of this Government: when they are challenged on the facts, we can see how nervous they are. Under this Government, a handshake from the Prime Minister has taken on a whole new meaning. Instead of the smack of firm government or the great clunking fist, we have the great quaking wrist.
Under the great quaking wrist, and his mini-me, a much more profound dividing line has opened up than the one between Labour and Tory. It is a division between those serious about reform and those stuck in a bureaucratic mindset. While those on both Opposition Front Benches are united in our desire to see greater freedom for professionals, more pluralism and wider choice, on the Labour Benches there is a fundamental split.
The dividing line is increasingly drawn around the Secretary of State. We know that throughout his time at the Treasury he was an enemy of reform. It is no good him furrowing his brow and shaking his head: we have the witness statements here. We do not need 56 days to get the evidence in order, because the suspect is bang to rights. An eyewitness account of a meeting between the Secretary of State and the then Prime Minister reveals:
“The meeting started to go wrong when Ed Balls began to be astonishingly rude to the Prime Minister.”
Those challenging the Prime Minister were said to be irretrievably on the side of darkness and anti-reform. By the end, the Prime Minister was made to feel
“like an abused and bullied wife.”
There is also the testimony from the hon. Member for Norwich, North (Dr. Gibson) when interviewed by the BBC about his rebellions against Blair over education. The hon. Gentleman revealed that he had the support of the Secretary of State who egged him on, saying that
“you’ve been on the TV and radio a lot recently on the issue. Keep going. Excellent”.
Another quote reveals that
“following a lunch with Balls, the Mail on Sunday carried a provocative article entitled, ‘Blair’s away with the fairies…and the men in the white coats are coming’”.
If that is support for the Blair reform agenda, I would hate to see what opposition looked like.
The truth is that the Secretary of State was the Kim Philby of the Blair Government—outwardly part of the establishment, but secretly working for the Stalinists. [Laughter.] I am glad hon. Members laughed at that one.
By rejecting the reform agenda, the Secretary of State has left us with a remarkably thin agenda. There are no measures in the Queen’s speech to deal with the scandal of illiteracy, with more than 40 per cent. of children leaving primary school not having met the basic standard in reading, writing and arithmetic. There are no measures in the Queen’s Speech to deal with the tragedy of innumeracy, with less than half of children getting five good GCSEs, including maths and English.
There are no measures in the Queen’s Speech to reverse the tragic educational waste that begins in our primary schools and sees the gap between the most privileged and the least fortunate widen as they go through school. There are no new ideas. There is no passion for improvement and no liberating vision. There is just one Bill, with one aim—political positioning. Let us be clear what the purpose of the Bill is. It is not there to address the significant problem that we have with educational under-attainment. Nor is it principally about providing improved vocational education for those who currently opt out of learning too early. It is about politics, pure and simple. Because the numbers not in employment, education or training have risen, not fallen, under this Government, they want to get that embarrassing statistic down by legislating that record of failure out of existence.
One cannot stop a problem just by passing a law against it. One cannot end unemployment or inflation with legislation. Labour tried that in the 1970s, when it thought that it could pass a law to fix prices. It was trying to eradicate the symptoms, rather than tackle the problem at root. The root problem here runs deeper than the Government admit.
One wise old figure argued this week:
“Unless we start the process much earlier, whatever we do, whether we threaten, whether we provide carrots, whether we extend the EMA, we won’t achieve unless way back when they’re at primary school and through their early teens we’re engaging with these young people”.
Wise words from the right hon. Member for Sheffield, Brightside (Mr. Blunkett), the best Education Secretary this Government have had. He also said:
“I am against the idea of suggesting that deeply damaged men and women could somehow be fined and it would make them go into education and training. I think it’s cloud cuckoo-land.”
There is a dividing line for the Secretary of State—between those on the Labour Benches who know what they are talking about and those in office today.
That is not the final dividing line that is worth recording tonight. When we talk about skills, employment and specifically about those not in education, employment or training, there is one particular policy, even more than the one for the school leaving age, that is associated with the Prime Minister and his colleagues. It is his favourite phrase—the one that he has used here at the Dispatch Box, at the Trades Union Congress and at the Labour party conference. That phrase is “British jobs for British workers” and it has certainly attracted attention. The Chairman of the Home Affairs Committee has called it “employment apartheid” and the hon. Member for Hackney, North and Stoke Newington (Ms Abbott) called it a British National party slogan. The two most senior black and minority ethnic Labour Members have rejected the Prime Minister’s shallow pandering to populism. There is a new dividing line within Labour—between a principled defence of equality and a sly wink to prejudice.
Unless I am wrong, I do not think that a single BME Labour Member has used that phrase, and I do not blame them. It sullies Labour and it erects a new dividing line in our society. When our schools are increasingly multi-ethnic, our hospitals depend more and more on workers from abroad and our society as a whole knows how dangerous loose language on this issue can be, how can the Prime Minister have allowed himself to become a prisoner of the BNP’s rhetoric? It is a tragedy.
We have a choice tonight between an Opposition committed to change, optimism and hope and a Government who prefer the politics of division and calculation, a choice between an Opposition who believe in spreading choice, opportunity and excellence more widely or a Government exhausted, rudderless and addicted to control. That is why I hope as many hon. Members as possible from whichever party who believe in principle will support us and our amendment tonight.
This has been a rambunctious debate and, in view of some of the misunderstandings at its beginning and for the avoidance of doubt, I should put it on the record and make it clear to the House that the Opposition indicated last Wednesday the order in which their Front-Bench spokesmen would speak. We then made it clear what our order would be and I am sorry if there was any misunderstanding particularly between those on the two Front Benches. Having made that clear—[Interruption.] I wish I had not bothered now. [Hon. Members: “Try again.”] I think I will pass on that.
The two Front-Bench spokesmen for the Conservatives, the hon. Members for South Cambridgeshire (Mr. Lansley) and for Surrey Heath (Michael Gove), are both pleasant and affable people and they are reasonably bright, but something comes over them when they get behind that Dispatch Box. I remember when I was a kid seeing an old Walt Disney film in which a very timid husband says goodbye to his wife, walks out downtrodden, gets into his car, closes the door, switches on the ignition and suddenly horns come out of his head. His character changes completely. Something like that comes over the hon. Members for South Cambridgeshire and for Surrey Heath. They get this preening self-regard. In Scotland, they say that if they were chocolate, they would lick themselves. That is great in whatever debating society they come from, but I do not think it really does justice to the debate that we have had in the House on the Queen’s Speech.
We have been debating the two most important issues for the public in terms of the services that are provided in this country. We have Bills on health and social care, a human fertilisation and embryology Bill, Bills on education and skills and on children and young persons, and the sale of student loans Bill. Admirable justice was done to them in the long debate and in the important contributions that I shall come to in a moment.
I say to the hon. Member for South Cambridgeshire that the right hon. and learned Member for Rushcliffe (Mr. Clarke), who has just taken his seat, pointed out that the policy differences between us on health—and I believe in the health Bills that will come before Parliament—are very slim if, indeed, they exist at all. It was remarkable that when the Conservative party’s policy arrived on my desk with a dull thud—the dull was more than the thud—it was a thoughtful exposition on how we could move forward. I think that the hon. Member for South Cambridgeshire will agree that I am doing him justice when I say that the thing about the Conservatives’ health policy on which to remark is that it explicitly endorses the broad shape of the Government’s reform programme.
The policy agrees with the 10 reform principles set out in the NHS plan. The patient passport policy has disappeared and there is now a policy of commitment to the NHS. There are commitments to practice-based commissioning, payment by results, local involvement networks—they are an important development for patient and public involvement—foundation trusts, primary care trusts, local area agreements, patient choice, strategic health authorities and the National Institute for Health and Clinical Excellence. That is a remarkable indication of how the Government have moved the centre ground to the left and the Conservative party is trying to occupy that ground.
Let me give the hon. Gentleman a word of advice about his policy. It is completely wrong—the hon. Member for North Norfolk (Norman Lamb) also pointed this out—to suggest that we should introduce the monolithic, top-down, unaccountable organisation that the Conservatives are putting forward. For a start, that would mean structural reform. The Conservatives say that they want structural stability, but they also propose the biggest structural reform that the NHS would have ever seen.
If the hon. Gentleman will not take my word for that, he should listen to the NHS Confederation, which is clear in its views on the Conservatives’ proposal. It says:
“the problems of the NHS are not just about political interference. And it would be odd for politicians not to take an interest in an organisation spending almost £100 billion of tax payers’ money”.
It also says:
“Autonomy and independence are more to do with the nature of relationships in the system than the structures. If the relationships are not clearly defined, then no amount of structural change will protect frontline organisations.”
There is no difference between us on the need to ensure that we have a clinically led, locally driven NHS. However, the Conservatives’ policy solution is badly thought out and would fail.