House of Commons
Tuesday 29 June 2010
The House met at half-past Two o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
Late detection of cancer is one of several reasons why our cancer survival rates are below the European average. That is why we will focus on improving those outcomes and achieving better awareness of the signs and symptoms of cancer. These aims will be part of our future cancer strategy.
Over half the men who receive a testing kit under the national bowel cancer screening programme throw it away. What action is the Secretary of State taking to improve the take-up of screening, particularly by men, and what provision has he made within the NHS budget for the extra costs of increased take-up?
I am grateful to the hon. Lady for that question, and I have had the privilege of twice visiting the national bowel cancer screening programme at St Cross hospital in Rugby—it looks after people in parts of the midlands and the north-west—and indeed, I have visited the Preston royal infirmary, which deals with bowel cancer screening follow-up. As I said in my first reply, one of the things we aim to do is to increase awareness of the signs and symptoms of cancer. It is unfortunate that, as a recent study established, only 30% of the public had real awareness of what the symptoms of cancer would be, beyond a lump or a swelling. We have very high rates of bowel cancer, so it will be part of our future cancer strategy to increase awareness of those symptoms and to encourage men in particular to follow up on them.
The recent inquiry of the all-party parliamentary cancer group into cancer and equalities heard expert evidence to suggest that if people can survive the first year of cancer, their chances of surviving for five years are almost identical to the chances in the rest of Europe. Does the Secretary of State therefore believe that a one-year survival indicator is a good idea both for encouraging early diagnosis and for matching the survival rates of the best in Europe?
My hon. Friend makes an extremely good point. When we set out proposals for an outcomes framework, I hope that he and others will respond, because that is one of the ways in which we can best identify how late detection of cancer is leading to very poor levels of survival to one year. I hope that we can think about that as one of the quality indicators that we shall establish.
I welcome the Secretary of State to his new position and wish him well in his role. I understand that he is keeping the two-week target for seeing a cancer specialist, but abandoning the work that the Labour Government did on the one-week target for access to diagnostic testing. Professor Mike Richards stated in the annual cancer reform strategy that improving GP access to diagnostic tests is essential to the drive for early diagnosis of cancer. Can the Secretary of State spell out some of his current thinking on what the alternative would be if we no longer have the one-week target?
Let me make it clear to the hon. Lady and the House that only 40% of those diagnosed with cancer had actually gone through the two-week wait. Establishing a better awareness of symptoms and earlier presentation across the board is, as we have been discussing, important to achieve. I am afraid that the hon. Lady is wrong: I have not said that we are abandoning any of the cancer waiting-time targets at the moment, but that we have to be clear about what generally constitutes quality. For example, seeing a cancer specialist without having had prior diagnosis is often pointless, whereas getting early diagnosis is often a serious indicator of quality.
Targets focused the NHS on bringing down waiting times, but also put process above clinical judgment and patient choice. Changing the way in which we manage waiting times will empower both patients and clinicians. NHS targets have dictated clinical priorities and harmed patient care. Focusing on long waits has meant less progress on reducing average waits than could otherwise have been achieved.
I noticed that in his answer the Minister did not say that any assessments had taken place. How many representations has he received from clinicians, people working in the NHS and the public demanding the removal of the 18-week target, for instance? Targeting is about making people better and getting them seen more quickly, so is not the real reason for dropping targets the fact that the Minister wants to undermine the NHS again?
I am sorry, but the hon. Gentleman, for whom I have considerable respect, is just plain wrong. There have been a number of representations over the last seven weeks or so. In addition, as my right hon. Friend the Secretary of State and his shadow team went round the country over the past five years, they were constantly told by GPs and clinicians from hospital to hospital that politically motivated targets were distorting clinical decisions and patient care.
Does my hon. Friend agree that by far the most important way of improving the service delivered by the NHS is to focus on the three key indicators of clinical outcomes, patient experience and value for money? Can he assure the House that the Government will pursue those, particularly against the background of increasingly scarce resources, in order to deliver the objective we all have: a better-quality NHS?
I am extremely grateful to my right hon. Friend, who is absolutely right, and I can give him the categorical assurances he is seeking, but I would also like to add one more: we need information to empower patients, because if patients are going to be at the heart of the NHS they must have the information to take the decisions that are important to their health care.
We do, Mr Speaker, very much; we want to see him squirm.
First, let me say that we welcome the Minister back to the Department of Health; he was a Minister in the Department 13 years ago. As I have said before, we trust that he finds the NHS in much better condition than when he left office. Last week we had an independent verdict on those 13 years. The independent and respected Commonwealth Fund said that the NHS was one of the best health care systems in the world, and, indeed, that it was top on efficiency: a ringing endorsement of Labour’s stewardship of the national health service. That verdict reflects the huge progress on waiting times that has been made over those 13 years. So does not the abolition of the 18-week target, which the Minister announced last week, put all that progress at risk? Will he today give us a straight answer to this question: can he guarantee that waiting times will not rise, and that patients will still be treated within 18 weeks?
I thank the right hon. Gentleman for the kind comments at the beginning of his remarks; things went downhill thereafter, but that is politics.
The right hon. Gentleman needs to understand that patients have to come first in a national health service, and the trouble with the approach he took was that he wanted politicians and bureaucrats to micro-manage it from the top down, rather than having a bottom-up system that listened to local people. One of the key aims is to ensure that people get the finest and best treatment possible, and I am afraid that his approach—a straitjacket of targets in certain areas—did not work then, and will not work now.
I shall take that as a no, because the Minister did not answer the question; he could not give that guarantee. He says that we must put people and patients first, yet at a stroke he has taken power away from patients and handed it back to the system, turning the clock back to the bad old days of the Tory NHS. Let me quote some comments by Jill Watts, chair of the NHS Partners Network, which represents private providers. In the Financial Times on 18 May, she is reported as saying the following about the loss of targets:
“Waiting times will go up and if people want a procedure they have a choice: they can wait or they can look to pay”.
Is that not always the Tory choice on the NHS: wait or pay?
The right hon. Gentleman is not right. We have not taken that attitude; we never have taken that attitude. We want to have a system whereby the health service is not in a straitjacket of targets that disrupt and distort clinical decisions. We want to empower clinicians and GPs to take decisions about who should be treated when according to their clinical judgment.
NHS Dentists (Chesterfield)
I assure the hon. Gentleman that the Government have committed to improving access to NHS dentistry, and the introduction of the new dental contract, focusing on achieving good dental health and increasing access to NHS dentistry, will be vital.
I thank the hon. Lady for her response. The Stubbing Road medical centre is a brand-new building in Chesterfield providing doctor services to people who are among the most deprived in Derbyshire. One floor there was also meant to provide dental services, but in the last week we have been told that that might not—indeed, that it will not—go ahead, although the primary care trust is paying the rent on the building and its new suite. Can the hon. Lady assure the people in the Rother ward who have been waiting so long for those services that the guarantee that everyone in Chesterfield will have access to an NHS dentist by March 2011 will remain in place?
I cannot comment on the specific circumstances, but I would be happy to meet the hon. Gentleman if he would like. I must point out to him, however, that the number of people now seeing an NHS dentist remains lower than when the previous Government introduced the new contract in 2006. He mentions children, but there is no doubt that the inequalities in the oral health of children are scandalous.
Thank you, Mr Speaker. Given my declared interest, it was too great a temptation not to contribute.
Does my hon. Friend not agree that for dentists, the biggest disincentive to providing an NHS service in Chesterfield—and, in fact, in the rest of England too—is the contract that she just mentioned, with its targets, its “units of dental activity”, its clawbacks and so on? Will she ensure that any new system that she introduces enables and encourages dentists to offer a choice between national health and private dentistry, thus encouraging those who have opted out to opt back in again?
4. What steps he plans to take to implement the Government’s proposals to end the target culture in the NHS. (4462)
On Monday 21 June I published a revision to the NHS operating framework in which I removed the central management of three process targets that had no clinical justification. We will carry on focusing on quality and outcomes, getting rid of top-down process targets.
My hon. Friend is absolutely right. I was here just a few weeks ago, announcing a public inquiry into the events at Stafford general hospital. Of course, in that hospital the adherence to ticking the box on the four-hour target was one of the things that contributed to the most appalling care of patients. We have to focus on delivering proper care for patients—the right treatment at the right time in the right place—and delivering the best outcomes for them. We will focus on that—on quality—not on top-down process targets.
Is it really true that the coalition Government are going to scrap the right for people to see their GP within 48 hours? If so, will the Secretary of State publicise that, so people know that the right has been reduced? If it is true, is he not just axing public service quality under the pretence of dealing with so-called bureaucracy?
It is astonishing—the Labour Government spent money trying to achieve the GP access target, and the hon. Gentleman might at least have recognised that the latest data, published two or three weeks ago, show that public satisfaction with access to their GPs, and the things that the Labour Government had been paying for, had actually gone down. A consequence of the 48-hour access target was that patients were unable to access their GPs more than 48 hours in advance. Is it not reasonable to expect GPs to be able to manage their own services in order to deliver better patient experience and outcomes across the board? I think we can reasonably expect that.
It has been reported today that historically speaking, as a result of targets, an obstetrician in a hospital could herself have a caesarean section but then have to refuse one to a patient, because of the pressures that targets put on the local NHS trust. Can the Secretary of State give us an assurance that any woman in the NHS who needs a caesarean section will have one, and that no targets will be imposed?
My hon. Friend is referring to World Health Organisation targets, which have not in themselves been applied within the NHS, and it certainly would not be my intention to impose such targets. I agree with the implication of her question, which is that a woman who needs a caesarean section should have access to one. I am also well aware that when a woman does not require a caesarean section we should seek, through a process of discussion and providing information, to avoid that wherever possible. Birth should be considered a normal event, rather than being subject to excessive medicalisation.
It is for primary care trusts and local authority social services departments to make decisions on commissioning, having assessed the evidence and needs in their areas, and taking account of standards and best practice.
Is the Minister aware of the excellent scheme in Wales that allows people with low vision to refer themselves to a high street optician or consulting ophthalmologist, and thus to have almost immediate access to the aids and support that they need? More than 87% of people are seen within two weeks under that scheme, whereas some areas in England have an 18-month waiting list, so will he examine the scheme to see whether it can be introduced in England?
I am grateful for that question. Obviously, the devolved Administrations are responsible for health care in their own areas, so we have an opportunity to learn lessons from each other. This Government will examine the evaluation of the scheme that the Welsh Administration are undertaking to see whether it provides any lessons for our system.
Will the Minister say whether the money provided by the primary care trust is ring-fenced? Will he ensure that the time-sensitive nature of such conditions, especially wet and dry macular degeneration, will be taken into account across all the English PCTs?
We need to achieve that not by ring-fencing budgets but by making sure that clinicians can deliver clinically evidence-based practice so that those with age-related macular degeneration receive the treatments that they need. Ring-fencing is not the way to go; we need to ensure that local commissioners have access to the right evidence, are empowered by patients and listen to clinicians, in order to deliver the right services.
I thank the hon. Lady for her question—to which the answer is that we recognise the crucial importance of high-quality surgery in improving outcomes for cancer patients. Since 2003, cancer-related surgical training programmes have been developed when new technologies and procedures have proved that patients would benefit from their introduction. Through the national cancer action team we are supporting training in laparoscopic surgical procedures for colorectal cancer, and we will be introducing surgical training for lower rectal cancer.
As procedures for cancer surgery, including robotic surgery, are getting more and more complex, does my hon. Friend feel that there is a case for an earlier selection of specialism for surgeons, to ensure that the NHS maintains its reputation for clinical expertise and to influence positively cancer survival rates in the United Kingdom?
As I said in my original answer, we recognise the crucial importance of high-quality surgery. The hon. Lady has made the important point that we must equip our surgeons with the right skills to carry out highly complex and specialist procedures. That means that we must deliver specialised training for that purpose to our existing work force.
Does the hon. Gentleman recognise that the 18% fall in the breast cancer rate between 1998 and 2008 was due not only to the expertise of cancer surgeons but to the target culture to which he is so opposed? What would he say to the 3,500 women who, because of those targets, did not die in 2008?
I imagine that that would be an answer the previous Government should be giving, and they should be sorry. [Hon. Members: “What?”] The reality is that this Government are clear that we are sticking with the targets in relation to cancer, but we are also clear that we need to raise awareness of the signs and symptoms of cancer, and ensure that people present themselves at an earlier stage and get access to the appropriate diagnosis, so that they get the right treatment.
I thank the hon. Lady for her question. May I correct the hon. Member for Bolsover (Mr Skinner), who suggested from a sedentary position that one of us might be getting the sack, by saying that I doubt it, because it is the previous Government who have just got the sack? In answer to the hon. Lady’s question, I say that there is no doubt that anything that the Government do must have a strong evidence base. It is for individuals to take responsibility for their health, and that includes healthy eating. However, the Government can help people make better choices—for example, by providing information, advice and so on.
I am little disappointed in that answer. Maternal nutrition before and during pregnancy is essential to the birth of a healthy baby. The Joseph Rowntree Foundation has shown that a healthy diet costs a minimum of £43 a week. A young woman on jobseeker’s allowance receives only £51.85 a week, so can the Minister explain what she will do to ensure that young women on such low incomes can choose a healthy diet?
I am sorry that the hon. Lady was disappointed. Clearly, she does not feel that the Government should take a strong evidence-based approach to public health. I should point out to her that although life expectancy has increased, the gap between the rich and the poor has widened. If we look at the difference between spearhead areas and the country as a whole, we can see that the gap went up by 7% for men and 14% for women. We are determined to reverse that.
Will the Minister join me in condemning the vote in the European Parliament not to back the traffic light system of food labelling, which is the clearest way of communicating nutritional messages? That followed a lot of lobbying by companies such as PepsiCo, Tesco and Kellogg’s. What will she do in terms of speaking to European colleagues to get that important scheme back on the agenda?
Again, the hon. Gentleman raises the point that anything we do must have a strong evidence base. We are considering a number of schemes at the moment. What is important is that people have the information on the pack of food that they buy, so that they can make good choices about what they eat.
Last week’s Budget scrapped the health in pregnancy grant, which helps all pregnant women to eat healthily in the final 12 weeks of their pregnancy. The previous week, the Government scrapped the free school meals pilot for 500,000 children, thrusting 50,000 children back under the poverty line. They have also scrapped free swimming for under-16s and pensioners just as the long summer holidays begin. Is that not the most extraordinary start for a Government who promised to rename the Department of Health the “Department of Public Health”? With so many broken promises in their first seven weeks, how can we trust a word that they say about public health?
The hon. Lady and I have exchanged niceties in a slightly calmer atmosphere in another setting. I find it staggering that Opposition Members cannot understand that what matters is not what we spend but how effective that spending is. They simply cannot understand it. In fact, Labour has said that it would cut the NHS, whereas we have said that we will not. The sick must not pay for Labour’s debt crisis. We did not get us into this mess, but I would point out to the hon. Lady that everything that we do must be based on evidence. It is not what you spend, but what you spend it on, that matters.
Community Hospital (Eltham)
The Department of Health is in contact with strategic health authorities regarding ongoing community hospital programme funding. This includes contact with the London SHA for Eltham and Mottingham community hospital and other schemes in the region.
I am grateful for that answer, as far as it went—but there is a great deal of expectation in the community in Eltham that that project will be delivered. It has been in the pipeline for quite some time and will provide 40 respite beds, diagnostics such as blood tests and X-rays and, I hope, dialysis at a local level, as well as a GP-led walk-in urgent care centre. May I urge the Minister to revisit the project, and when I ask a future question, to come back with a better answer?
I am a bit perplexed by the hon. Gentleman’s comments, because I have answered the specific narrow question that he asked—but let me try to cheer him up, if I can. We understand that he has been a redoubtable campaigner for the hospital, and we support the principle of community hospitals. The Department, as the hon. Gentleman knows, allocated £4.58 million to help the community hospital in Eltham and has already given about £1.9 million to NHS Greenwich, the primary care trust, for it. I hope that the hon. Gentleman will not have to come back to me with another question, because I trust that I am now going to cheer him up: I can announce today that the balance of the money will be paid and made available during the current financial year.
I congratulate my hon. Friend on that announcement, which will bring considerable pleasure to people in south-east London. He is well aware that proposals are being made within our area of south-east London to reorganise health provision, which are causing considerable concern. Will he ensure that vital services are maintained in our area for patients?
I am grateful to my hon. Friend. As he rightly says, I am aware of the situation. As he will be aware, we believe that local people, local clinicians and local GPs should have an input into any reconfiguration of health care provision. As my right hon. Friend the Secretary of State said when he announced the changes to the criteria, there will be an assessment of whether they apply to the reconfiguration to which my hon. Friend refers. Once that has been done and decisions have been reached, we will be able to move forward in the proper way.
Alcohol Health Warnings
A public consultation on options for improving health information on the labels of alcoholic drinks closed on 31 May. The responses to that exercise are now being analysed, and we will set out our plans for next steps through announcements in the coming months.
I welcome all those on the Government Front Bench to their new posts. The tobacco health warning regime introduced by the previous Government has produced excellent results in improving the health of our citizens. Does the Minister believe that a parallel scheme for alcohol would achieve similar progress and benefits?
I thank the hon. Gentleman for his warm words of welcome. It is important to note that sometimes such warnings are not transferrable between products. As he rightly says, there have been a number of initiatives on smoking that have, without doubt, had an impact on the number of people who smoke and the number who have given up. Whether those are transferrable to alcohol we do not yet know, but we will be looking at all the evidence available.
The Minister will be aware of a recent Alcohol Concern report that points out that a minimum alcohol price of 50p a unit would cost a moderate drinker only about 23p a week, but would reduce alcohol-related illness significantly, and would save the NHS millions. What discussions has she had with colleagues in other Departments about such a minimum price?
We have had a number of conversations about all aspects of alcohol policy, and what to do about the 7% of hospital admissions that are due to alcohol and the £2.7 billion cost—some estimates put it much higher, at about £5 billion—to the NHS. Without doubt, we have to change the public’s relationship with alcohol. We are committed to a ban on selling below-cost alcohol, which is important—but it is also important not to disfranchise responsible drinkers, as plenty of people enjoy alcohol responsibly. What we have to do is stop irresponsible drinking and protect people’s health.
I thank the Minister for that answer. She will recognise the problems that binge drinking causes our health service, our police and our local communities. I am delighted that she has recognised that there has been an agreement to ban the sale of alcohol at below cost price, but will she assure us that the Government are taking this issue seriously, and that we will hear an early announcement?
The hon. Gentleman is right; this is a cross-departmental issue. This is not just about health; it is important for local government as well. We need a multi-faceted approach. As I have said, we will look at all the evidence to see what works, and to make those changes not only in law and order, as he pointed out, but in people’s health.
There are cross-references between the labelling on alcohol and on other products, and the evidence clearly shows that with food labelling, the public find colour-coded, front-of-pack labelling far easier to understand. What has the Minister learned from that, and will her Department, with other Departments, seek an opt-out for retailers that want to continue, voluntarily, with front-of-pack colour-coding on their products?
NHS Decision Making
I have stopped top-down reconfigurations where the NHS has not listened to local people. Our coalition agreement is clear that we will give patients more control over their own health care, and give patients and the public a stronger voice in the design of local health and care services.
NHS managers have justified cuts in community hospitals in Walton, Cobham, Molesey and other parts of the country on efficiency grounds, but in 2009, because of targets, almost 1 million patients were discharged and then readmitted within 30 days, at a cost of £1.6 billion. What plans has the Secretary of State to strengthen local democratic control over community hospitals and the vital services that they provide?
My hon. Friend has raised an important issue. Let me make two points. First, we need to strengthen not only the local public and patient voice but the voices of GPs who are involved in commissioning, so that they can act on behalf of their patient population in commissioning the services, and design of services, that they need. Secondly, as I have made clear in the revision of the operating framework, we must look at results. When someone goes into hospital for treatment, we must consider not just their treatment in the hospital, but their subsequent rehabilitation and re-ablement. I believe that that will allow greater use of intermediate care beds in the way that my hon. Friend has described.
I thank the Secretary of State for agreeing to meet me—together with representatives of my local primary care trusts, local mums and midwives—to discuss maternity services in Salford. In the light of his new criteria for reconfigurations, will he confirm that he is prepared to reconsider the decision to close Salford’s maternity services, and to recognise the views of thousands of people throughout Salford and Eccles, including me, who opposed it at the time?
The right hon. Lady knows that we will meet to discuss the issue. However, as I said when I was in Greater Manchester, it is not for me to reconsider the application of the new criteria from 21 May. That is for local people to reconsider. It is for GPs, the public, local authorities and, indeed, PCTs in Salford and district to start thinking about what they consider to be viable and successful future services for mothers-to-be.
In helping local people to become more involved in NHS decision making, will my right hon. Friend agree to consider my Ambulance Response Times (Local Reporting) Bill, which received its Second Reading during the last Parliament? The Bill requires all ambulance trusts to publish local as well as regional response times and patient outcomes so that—as is already the case in Crewe and Nantwich—they have access to those details and can deliver better response times, with the help of local initiatives such as Community First Responders.
From April 2011, the accident and emergency four-hour waiting time standard will be replaced by a set of clinical quality standards, developed with clinicians, which will support quality care without the damaging distortion of the four-hour tick-box target. On the basis of clinical advice, I have immediately reduced the threshold for meeting the four-hour standard from 98% to 95%.
I am sure that the Secretary of State will want to join me in congratulating the staff at Wythenshawe hospital in my constituency. Last year 85,000 patients were seen in the accident and emergency department, 98% of them within four hours. Can the Secretary of State explain to my constituents why he has decided that this year 4,500 of those patients will not need to be seen within that time?
As I told the right hon. Gentleman, I made that decision on the basis of clinical advice. It was clear that the 98% standard was distorting clinical care for patients. There is no benefit for patients if, for the purpose of meeting a four-hour target, they are discharged inappropriately, transferred to wards when they have not been thoroughly looked after in the accident and emergency department, or indeed put in an observation ward for 48 hours, which is under the scrutiny of the accident and emergency department but ticks the box. None of that helps patients. I will focus on what is actually in the best interests of patients, and delivers the right outcomes for them.
Evidence of the impact on public health of plain packaging of tobacco needs to be developed further, because no jurisdiction globally has yet introduced it. However, Australia will do so from 2012. We will monitor developments there with considerable interest.
Smoking costs the NHS £2.7 billion a year, six times the cost of a new hospital for north Tees and Hartlepool. In the north-east, approximately 10,000 children between the ages of 11 and 15 are smoking. We want all of them, not just half of them, to lead a fulfilled life. Will the Minister ensure that the assessment of plain packaging is expedited, so that we can be given an answer as soon as possible?
The hon. Gentleman is right to raise the impact that smoking still has on the health of children in particular—I believe that 200,000 take up smoking each year. We still have 80,000 smoking-related deaths in this country. It is important to watch what happens in Australia and see where the evidence points for the future.
We are committed to addressing the health care needs of people with autism and are fully supportive of “Fulfilling and rewarding lives: the strategy for adults with autism in England”. Consultation on statutory guidance for health and social care bodies to support the strategy will begin shortly.
May I thank the Minister for that reply? We have all been inspired by the parents of children with autism. One thing that they depend on perhaps more than anything is respite care. That provision has improved in the past few years, but with the pressure on budgets, will the Minister do all he can to ensure that respite care does not become an easy target for cuts, given the importance of the service to parents of children with autism?
I am very grateful to the hon. Gentleman for that question. He is right; carers are a valuable and valued resource. They make an incredible difference to the quality of life of the people for whom they care. The Government are determined, as we have outlined in the coalition programme for government, to develop respite services further and make them available through direct payments for those people.
Given the success of central Government in persuading child and adolescent mental health services to take the needs of those with learning difficulties more seriously, will the Minister commit to doing the same for those with autism, given that only 11% of CAMHS have specialist provision? Will he make a commitment to do the same thing for those with autism, please?
May I congratulate the Minister on his new role. As my hon. Friend the Member for Gedling (Vernon Coaker) mentioned, carers of people with autism rely on respite care. However, carers organisations are reporting that cuts to local authority funding are already leading to cuts in funding for charities and other providers of support care. How do the Government plan to deliver the promised increase in access to respite care through improved community support provision, when that is already starting to fall away?
The hon. Lady makes an important point, but perhaps she will be a little cautious with her question, not least because the previous Government made a lot of promises to carers in respect of the amounts of money that were to be invested, only for carers to find that on the ground the money was not delivering changes in services. So this Government are determined to ensure that we not only make promises but deliver on them. That is the commitment that this Government have made.
At the Warrington and Halton Hospitals NHS Foundation Trust, in the 12 months up to April 2010, 93.2% of patients admitted to hospital for treatment and 97.8% of patients whose treatment did not require admission to hospital waited 18 weeks or less from referral.
May I reassure the hon. Lady that in my lexicon no one “deserves” to wait longer. What I want, and my right hon. and hon. Friends want, is a first-class health service that makes decisions based on clinical reasoning and gives treatment swiftly and relevantly to those who need it. My right hon. Friend the Secretary of State has made some changes to some of the targets to ensure that clinicians and clinical decisions dominate, not political decisions by politicians and bureaucrats.
The coalition agreement sets out our plans to establish an independent commission, which will consider how we ensure responsible and sustainable funding for long-term care. Further details on the commission will be announced shortly.
Since 7 May, the Department has received about 120 representations from hon. Members, noble Lords and members of the public on a range of issues concerning the National Institute for Health and Clinical Excellence, including its remit.
May I urge the Secretary of State to get NICE to go back to what most people think it is for, which is monitoring the cost-effectiveness and clinical effectiveness of drugs? Many people do not think that it does a particularly good job on that, anyway, but it is currently indulging in empire building, with its ridiculous drivel in recent weeks about smoking breath tests for pregnant women, compulsory sex education for five-year-olds and subsidies for food companies to make healthier food. Surely it ought to go back to what it should be doing, and do it better, rather than empire building, as it is doing.
My responsibility is to lead the NHS in delivering improving health outcomes in England; to lead a public health service that improves the nation’s health and reduces health inequalities; and to lead the reform of adult social care that supports and protects vulnerable people.
When the new Secretary of State intervened to stop the reorganisation of health services in London, he said that there would be no forced closures. Can he give me an unambiguous and categorical assurance that he will not allow the closure of the accident and emergency department, the children’s surgery or the maternity services at King George hospital in Ilford? Yes or no?
The hon. Gentleman’s question seems rather churlish, given that he wanted to stop the top-down configuration that NHS London imposed so that people in his area—GPs, the local authority, local people and patients—could have an opportunity themselves to decide how services might best be designed for local people. That is the pledge that I have made. Those criteria will enable that process to be led locally, rather than imposed and forced on people.
T4. St Catherine’s hospice is used by many of my constituents, and they will be pleased to be able to go ahead with the hospice’s planned improvements, which will be funded through the capital grants programme. Does the Secretary of State agree, however, that the excellent work of such hospices goes far beyond the hospice building? What will his Department do to ensure that hospices play a greater role in providing services to the local community? (4487)
I am very grateful to my hon. Friend, who will know that I entirely understand and applaud the work of St Catherine’s hospice, because we have visited it together. She makes a very important point, because those whom I know in the hospice movement want to think not just about the service that they provide in their buildings, but about an holistic service for patients’ families and for those who require palliative care. I might just say that on Saturday I made it clear that up to £30 million will be available in this financial year to support children’s hospices, specifically, in extending their work so that they can provide a service in the community for children with life-limiting illnesses.
The right hon. Gentleman will remember our exchanges at the election hustings, where there was a real difference between us: we said that we would protect the NHS budget in real terms, and I stand by that commitment; the right hon. Gentleman said that he would increase the NHS budget. After last week’s Budget, however, we now know the price of that commitment: 25% cuts to social care will mean vulnerable people either left without the support that they need or facing higher charges to pay for care, and huge pressure on carers. It means also that the NHS itself stops working, because it cannot discharge people from hospital when there is no support in the community. That unbalanced approach to public spending is dangerous and will decimate services on which the NHS depends. Is it not time to drop a pledge that had more to do with votes and nothing to do with people’s lives?
So there we have it, Secretary of State. [Hon. Members: “Secretary of State?”] I meant “Mr Speaker”—you are far more elevated than a Secretary of State, Mr Speaker.
The shadow Secretary of State’s belief is that the NHS budget should be cut. I fail to see how that could help social care. We are going to look much more positively at how we can join up the work of the NHS and social care. What my colleagues and I have announced on 30-day support for patients leaving hospital, including rehabilitation and re-ablement, will do precisely that, relieving some of the pressures on social care by seeing the NHS as a more holistic service for patients.
T5. Does the Secretary of State accept the conclusions of the Science and Technology Committee’s report “Evidence Check 2: Homeopathy”? Earlier, the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) gave a commitment to an evidence-based approach and today the British Medical Association passed a motion about homeopathy. Given the financial constraints in which we all share, can the Secretary of State defend spending millions of pounds of NHS money on methods that simply do not work? (4488)
I thank the hon. Gentleman for his question. He obviously knows how much is spent on homeopathic treatments, although no one else seems to know exactly. The decisions should be taken by doctors locally, and the effectiveness, safety and efficacy of a treatment should be taken into account. The estimate is that 0.001% of the drugs bill is currently spent on such treatments. At present, we are looking at the Science and Technology Committee’s report. We hope to respond to it before the summer recess.
T2. My right hon. Friend the shadow Secretary of State referred to the Commonwealth Fund report, which said that Britain’s NHS was the most efficient. Does that not make it clear that after 13 years of a Labour Government, the NHS is not just so much better for patients, but efficient? To say that it is not is an insult to the people who have worked so hard to make it great. (4485)
I have looked at the reports of the Commonwealth Fund for a number of years; it regards the NHS as efficient because it spends relatively little in comparison with other health economies. In this country, we need to recognise that the NHS does not spend very much in comparison with other countries but it could spend it more efficiently. There has been declining productivity for 10 years. [Interruption.] The shadow Secretary of State needs to recognise that NHS management costs went up by 63% while nursing costs went up by just 27%. My colleagues and I are committed to halving NHS management costs and to reducing the costs of the NHS, through efficiency, by £20 billion. Every penny of that will be reinvested in meeting the rising demand for the NHS and the improvements in quality that we require.
I am very grateful to the hon. Gentleman for that question. It is up to local communities and local health providers to identify what they believe are the local needs of their communities and then go through the procedures, measures and mechanisms to seek to achieve what they want—in this case, that could be a new A and E. It is not for Ministers to promise such provision; there are proper procedures, from the local area upwards, for achieving such aims.
One of the concerns of a great many of us recently has been the availability of cancer care drugs. [Interruption.] Right across—right across, Mr Speaker, the whole United Kingdom, and Northern Ireland in particular, a great many people have not been able to access cancer care drugs and have had to endure sickness and illness without them. Can the Secretary of State assure the House today that cancer care drugs will be made available and that those who are ill and suffering from cancer can rest easy?
We have been very clear that it is a scandal that we have some of the finest cancer research anywhere in the world and some of the best cancer medicines have been developed in this country, yet in the past in this country NHS patients have often been the last to have access to those drugs. That is why at the election we made it clear that we will introduce from April next year a cancer drugs fund, the purpose of which will be to ensure that patients get access through the NHS to the cancer medicines that they need, on clinical recommendation and advice, and that they are not unduly delayed in getting that access.
T9. I am sure that the Secretary of State will remember visiting my constituency earlier in the year and listening to constituents’ concerns about the withdrawal of spinal injections on the NHS. Given that the PCT’s decision is set to become another example of the postcode lottery in the health service, will his Department consider the ongoing debate about spinal injections in York and support the attempts of my constituents as they seek to shape local health services around their specific needs? (4492)
I am a bit confused as to where to look. [Interruption.] Right, I will look forward.
My right hon. Friend the Secretary of State well remembers his visit in April to meet the York and District pain management support group. He made it plain at the time that it should be for GPs and their patients to decide what treatment should be given, as opposed to a decision by the PCT to veto spinal injections for all sufferers of long-term chronic back pain. We will, in due course, set out our proposals to put more power in the hands of patients and GPs.
T3. Does the Minister agree that it is crucial for patients to have information if we are to make a reality of choice within the NHS? In that respect, does he agree that if we are to give people a real choice as regards the choose and book system that GPs operate, there is a need to ensure that patients have the information about the success rates of different hospitals, and different surgeons, as regards operations? (4486)
I agree with the hon. Gentleman—it is just that that did not happen under a Labour Government in the way that it should have done. For example, the national quality registers in Sweden have 69 areas of clinical practice for which such comparative data are published. I have made it clear that one of our priorities is that we focus on outcomes and on giving patients real empowerment. To do that, information for patients on outcomes will be absolutely critical.
T10. I have here a letter from my local PCT indicating that the clinical review of the safety of a proposed children’s walk-in centre in Southport is to be conducted by Dr Sheila Shribman and the Minister’s Department. Will the Minister arrange to meet me and relevant officials to ensure that the Department is properly aware of the background to this vital access issue and that we have a clinical network suitable for patients, as well as for practitioners? (4493)
I thank the hon. Gentleman for that question, of which he gave our office prior warning. It is important that decisions made locally focus on outcomes for people, that they are about choice, that they have support from local clinicians and commissioners, and that they are based on sound clinical evidence. I would be happy to meet him to discuss this further.
T6. Every year in the north-east, 300 children are born with congenital heart disease. These very sick children receive expert treatment locally in the world-class cardiothoracic unit at Newcastle’s Freeman hospital. Can the Minister assure my constituents, who value this vital local service, that the findings of Sir Ian Kennedy’s review of children’s heart surgery centres will be implemented without financial constraint? (4489)
I should tell the hon. Lady that it is premature to make any commitment about the review, because we now need to have proper engagement with local people, patients and those who are responsible to focus on how we can make absolutely certain that the outcomes that we achieve for children requiring cardiac surgery are as good as we can possibly make them.
I am extremely grateful to my hon. Friend for raising an issue that I know is of concern to many people. Although I cannot make promises about the outcome of any review, he has my assurance that we will be looking into this, and that we take on board the concerns that have been expressed over a number of years.
The Secretary of State has halted the reconfiguration of services in south-east London, which was clinically led, the subject of detailed public consultation and approved by the reconfiguration panel. The outcome is to leave my PCT and hospital trust acutely troubled about their ability to deliver the improved health services that were promised under “A picture of health” and to meet their financial targets. What does that say about the Government’s commitment to evidence-based policy making?
What we have done in London is to give those who would be most affected by decisions to reconfigure services the opportunity, where decisions have not already been made, to have a local say. That includes patients, the public and GP commissioners. The delay, in so far as there is any delay, need not be great if those proposals are fully subscribed to by local people and by their GPs as commissioners.
Would my right hon. Friend accept that there is widespread anecdotal evidence of the effectiveness of homeopathic medicines? There are 500 doctors in this country who use them, and nobody is obliged to have them if they do not want them. Will he therefore heavily discount the illiberal views of our hon. Friend the Member for Cambridge (Dr Huppert)?
May I thank my hon. Friend for his question and pay tribute to him for his continued and persistent lobbying on this subject? I gather that he has been elected a member of the Select Committee on Health, so I welcome him to that position and I am sure that we will meet again at some point.
What is important is that decisions about treatment are made by clinicians, and they will base their decisions on the safety, efficacy, efficiency and outcomes that a particular treatment will provide.
The North Tees and Hartlepool NHS Foundation Trust believes that its strategy for one hospital to replace the North Tees and Hartlepool university hospitals is the right strategy, despite the project being dropped by the Government. Does the Minister accept that the trust’s strategy to provide a new hospital and health facilities closer to communities to meet their health needs is correct, that the trust should be encouraged to press ahead with alternative funding models that could still deliver the new hospital, and that its members and the public at large can expect Government support to realise that strategy?
What I would look for is for the foundation trust to meet the criteria that I published on 21 May in relation to any reconfiguration of services that it proposes for its area. As a foundation trust, I would also expect that, having secured the freedoms associated with that status, it should not ask the Department of Health to meet the whole capital cost of whatever it proposes.
I will now announce the results of the election of members of the Backbench Business Committee. No ballot was required for the election of the following: Mr Peter Bone, Philip Davies, Jane Ellison, John Hemming and Mr Philip Hollobone.
In the ballot today, the votes cast for the candidates were as follows: Mr David Anderson, 99; Katy Clark, 57; and Alison Seabeck, 92. Mr David Anderson and Alison Seabeck are elected. I congratulate all those elected.
Points of Order
On a point of order, Mr Speaker. This morning we lost an hour and a half of valuable debating time in Westminster Hall on the issue of apprenticeships, when the hon. Member for Gloucester (Richard Graham), whom I informed that I would raise this point of order, did not turn up at the appointed time. Incidentally, the Minister for apprenticeships, the hon. Member for South Holland and The Deepings (Mr Hayes), was not present at the appointed time either, and the debate fell. To lose one Member might be considered unfortunate; to lose two seems like carelessness.
Is there anything that you can do, Mr Speaker, to reinstate the valuable time for that debate so that hon. Members such as myself who took time to prepare a speech can have the opportunity to deliver it to the House and have it recorded in Hansard? Could you also have a word with the Independent Parliamentary Standards Authority to see whether it will allow Conservative Members to claim for alarm clocks?
I am grateful to the hon. Gentleman for his point of order and for giving me advance notice of it. I understand that Members are disappointed to have missed the opportunity to debate the national apprenticeship scheme. I have received a letter of profuse apology from the hon. Member for Gloucester (Richard Graham), which I appreciate and I think the House will appreciate.
The smooth conduct of business requires keeping to set times for the start of debates, and it is important that all Members grasp that at the outset and keep it in the forefront of their minds. It is perhaps an object lesson for all of us early on in the new Parliament. I note the request that the hon. Member for Cardiff West (Kevin Brennan) made for the matters in question to be aired on another occasion. I cannot commit at this point, but I hope that there will be another chance for those important matters to be debated in the House.
As the hon. Member for Gloucester is in the Chamber, I think we would be pleased to hear from him.
I am extremely grateful to the hon. Gentleman. I think that quite enough has been said. [Interruption.] Order. Members are getting ahead of me—or they think they are—but I know what I was thinking and they do not. They will now see what I was thinking, which is that it would be helpful for the House to hear from the hon. Member for South Holland and The Deepings (Mr Hayes), who is in his place. I know that he will be happy to comment.
That was literally irresistible. Of course, I should have been in my place as well. I arrived as the sitting was suspended by the relevant member of the Panel of Chairs. I apologised to him then, and I have also dropped a note to you, Mr Speaker, as you know.
On a point of order, Mr Speaker. I note that the particular bird has flown, but is it in order for a Member on the Front Bench to berate, scoff, scold and hiss at the Chair when a Member is trying to ask a question? Do you recognise that it is disrespectful to the House and the Chair, and, importantly, it also impedes a Member from asking a question and getting a sensible answer from the occupants of the Front Bench? Will the Speaker make it clear that his order covers not only Back Benchers but Front Benchers?
The hon. Gentleman is absolutely right about the last point. The writ of the Chair applies to all Members, irrespective of whether they sit on the Back or the Front Benches. On his particular point, I must say that nothing was recorded. I was focused at all times on the questions being asked, those seeking to ask them and Ministers answering them. However, respect for the Chair is important, and respect by one Member for another’s right to be heard without interruption is extremely important. I hope that it will not be necessary in the course of the new Parliament and the new politics for that point to have to be made again from the Chair. I am grateful to the hon. Gentleman for highlighting an important matter.
On a point of order, Mr Speaker. Last week in the Budget statement, the Chancellor said:
“Today there are some families receiving £104,000 a year in housing benefit. The cost of that single award is equivalent to the total income tax and national insurance paid by 16 working people on median incomes. It is clear that the system of housing benefit is in dire need of reform.”—[Official Report, 22 June 2010; Vol. 512, c. 174.]
In order to drill down into that—I promise I will get to the point of order in a second—I asked, with my hon. Friend the Member for Edinburgh North and Leith (Mark Lazarowicz), a parliamentary question of the Department for Work and Pensions. I had a reply today, which said:
“The information requested is not available.”
Has the Chancellor sought to rescind his statement about the £104,000 housing benefit? It has become common currency in the debate about reforming housing benefit, yet the Department tells me, as a Back Bencher, that the information is not available.
I thank the right hon. Lady for her point of order. I think that she is continuing a debate with some force, eloquence and insistence. She is an experienced Member and a distinguished former Minister, and the opportunity exists for her to table follow-up questions. I have a hunch that it will not be long before she avails herself of it.
Further to that point of order, Mr. Speaker.
My right hon. Friend the Member for Stirling (Mrs McGuire) referred to the question on that subject that was tabled in my name. In fact, I have tabled a written question today asking the Chancellor to give the evidential basis for the statement that he made in the Budget last week. Could you urge him to give a speedy answer to that question, in order to reassure the House that his assertions in the Budget speech were based on fact?
I do not think that it would be right for the hon. Gentleman to seek to draw me into these interesting exchanges. He has tabled a question, and an answer might be forthcoming. I note his reference to the importance of evidence, and I simply note in passing that we would be establishing a new precedent in the House if we were to regard it as mandatory for a Minister to provide evidence for the arguments that he or she was making.
On a point of order, Mr Speaker. Have you or your office been notified as to whether the Secretary of State for Culture, Olympics, Media and Sport will be coming to the House to apologise for the distress that his unacceptable comments about the Hillsborough disaster have caused to the families of the 96 who died, and to people right across the political and football divide?
I am grateful to the hon. Gentleman for his point of order, and I understand the very strong feelings—including those of constituents—that will have motivated him to raise it. In response, I would say that the remarks complained of—which I am neither justifying nor condemning—were not made in the House, and that my clear understanding is that the Secretary of State has apologised for them. He has made a public apology, and the question of whether he seeks to make an apology or any other comment on the matter in the House is a matter for him. I am grateful to the hon. Member for Liverpool, Walton (Steve Rotheram) for raising the matter, and I hope that he feels that I have given him at least an informative response.
On an earlier point of order, Mr Speaker. In the previous Parliament, the Procedure Select Committee decided to establish a process whereby hon. Members could approach the Committee if they were unhappy with the nature of the answers that they received to written questions. I understand that, in this Parliament, we will continue to offer such an opportunity for people to put their complaints to the Committee, once it has been created.
On a point of order, Mr Speaker. I understand that important announcements have been made today on the abolition of the regional development agencies and the setting up of new local government structures to replace them. May I implore you, sir, to use your good offices to press Ministers to make statements of that nature in the House first, so that they can be properly debated?
[2nd Allotted Day]
Local Government Financing
Force of habit, Mr Speaker.
I beg to move,
That this House regrets the decision of the Government to introduce £1.165 billion of cuts to local government funding in England in the current financial year; regrets the Liberal Democrat members of the Government supporting cuts they opposed during the general election campaign; notes the promise in the Coalition Agreement to “ensure that fairness is at the heart of those decisions so that all those most in need are protected”; regrets that this programme of cuts fails to meet this test of fairness, as they fall disproportionately on the hardest-pressed communities; notes with concern the principle set out by the Parliamentary Under-Secretary of State on 10 June that “those in greatest need ultimately bear the burden of paying off the debt”; condemns the failure of the Secretary of State to tell the House or local authorities where £504 million of cuts to funding will fall; further regrets the failure to consult local government on the allocation of the cuts; further notes with regret that the Government’s further decisions on the Future Jobs Fund, housing and support for neighbourhood policing will weaken the ability of local councils to shape and deliver services in their areas; regrets the failure to make any progress on implementing the previous administration’s commitment to Total Place, enabling local authorities to deliver real efficiency savings and contribute to reducing the deficit while protecting frontline services; and resolves that decisions affecting local government spending should be based on the principles of fairness, protection of frontline services and promotion of growth.
I was interested to hear the earlier exchanges about Ministers not turning up for debates. May I say how disappointed I am that the Secretary of State for Communities and Local Government has not bothered to turn up for this one? In 10 years as a Minister, I always respected the strong convention in the House that if a shadow Secretary of State chose to lead an Opposition day debate, the Secretary of State would respond. I am very disappointed that, on the first Opposition day debate on a Communities and Local Government topic, the Secretary of State could not be bothered to be here. The truth is, of course, that he is too scared to be here. He is too scared to explain the series of blunders that he has already made over these cuts. He is so scared of defending what he is doing that he prefers to treat the House with disdain. So we shall have to make do with the Minister for Housing, the right hon. Member for Welwyn Hatfield (Grant Shapps) instead.
I remember when my right hon. Friend the Member for Wentworth and Dearne (John Healey) and I insisted that building firms who took public money to build social housing should train apprentices. When they did so, the current Minister described it as ludicrous and counter-productive. We have all seen the minutes of his meeting with the Prime Minister’s adviser on local government, the leader of Hammersmith and Fulham council, at which it was agreed that it was a priority to raise rents in the social sector to equalise those between social housing and the private sector. So we know where he is coming from—he has got form.
I have something of an interest in what goes on in Hammersmith. I heard the Minister for Housing say from a sedentary position that he was not at that meeting. Perhaps he would like to clarify that, because my understanding is that he was not at the main part of the meeting, discussing the demolition of council estates and the ending of social tenancies—although he has learned the lesson and is now proposing to do just that—but he did get there for drinks and canapés at the end.
While reflecting on the past, would the right hon. Gentleman like to apologise for the unprecedented situation that occurred when he was Secretary of State and his own permanent secretary disavowed the key policy of unitary status for various areas? The permanent secretary had so little faith in that policy that he went public with his view that it was a waste of public money.
I am sure we all wish the former permanent secretary at my Department well in his new position as permanent secretary to the Scottish Government. I took the right decision on Norwich and Exeter, and I was right to back the desire of those cities to run their own affairs. It was a decision that I reached after many months of careful consideration, along with my right hon. Friend the Member for Wentworth and Dearne. I have to say that it was all too typical of this Government that, within two days of the new Government being formed, the Secretary of State—who talks about localism—decided to quash the aspirations of those councils to run their own affairs, in a timescale that meant that he could not possibly even have read the evidence that had been submitted by so many councils. I will return to the attitude of the Secretary of State in due course.
On 10 June, the Secretary of State announced £1.165 billion of cuts in local government spending in England in the current financial year. Because those cuts were so big, the Secretary of State should have come here to defend them. They were part of the £6 billion of cuts proposed by the Tories during the election. We opposed them as too early and too damaging to economic recovery. The Liberal Democrats also opposed them. As the right hon. Member for Eastleigh (Chris Huhne)—now a Liberal Democrat Cabinet member—said during the election campaign:
“If we took Tory advice and cut spending and raised taxes precipitately, growth would stop. Unemployment and benefit spending would rise further. Tax revenue would stall.”
But now he has taken Tory advice, and he will be held to account for what happens.
Now the Lib Dems support these cuts, and their credibility as a progressive alternative to the Tories is shot to pieces. These are cuts that no local council had any chance to prepare for, coming as they do well into the financial year. As the Tory leader of West Berkshire council told us,
“This is unprecedented. We have never faced cuts in the middle of the year.”
As the Tory leader of Telford said,
“this is money that we had planned to spend this year and will now have to be cut.”
My right hon. Friend is right to be furious that the Secretary of State is not attending the debate. The Secretary of State seems to see himself as some sort of Conservative John Prescott. Does my right hon. Friend share my feeling that that fine gentleman would have been proud to stick up for his Department instead of letting it take the majority of the cuts, and would have come here to defend his decision rather than skulking off to the scene of former crimes?
My hon. Friend makes a good point. Despite some apparent superficial similarities between the two gentlemen, one thing is clear: John Prescott never ran away from a debate or argument, unlike the Secretary of State—[Interruption.] I did not say he never ran away from a fight; I just said he never ran away from an argument.
The truth is that the cuts were not only made too fast, but made without consultation. There was no discussion with local councils about whether or how they could be made. The Local Government Association initially put out a press release welcoming the fact that it had been promised consultation, but ended up sending a desperate letter two weeks later saying, “Will you please tell us what’s going on?” The cuts came ahead of the Budget, which sets out cuts of 25%, 30% or 35% to local council services.
Does my right hon. Friend agree that the basis of the cuts is simply party political prejudice, which is why they were done so quickly? Otherwise, how could deprived Salford have twice the rate of cuts of affluent Trafford?
My hon. Friend makes two important points, both of which I will deal with, about the unfairness of the cuts and the real agenda l behind them. Of course the deficit needs to be tackled, and we set out our plans to reduce it by more than half over four years. That was a tough enough target, but the cuts now laid out go much further than we would have gone; they go much faster than we would have gone; and are being done in ways that we would not have chosen.
Does my right hon. Friend share my concern that the cuts will be felt disproportionately in heartland areas that have suffered a great decline in manufacturing, such as Stoke-on-Trent? I am particularly concerned about their impact on the Supporting People programme and the money providing care for people in the community. How can we plan for that?
This is an important debate. The way in which the Secretary of State is handling these first cuts warns us all of what lies ahead and the unnecessary damage that will be done to the local services on which the people we represent rely. When he made his cuts, he had choices to make about how to make them—to make them fairly, or not to make them fairly. So let us remember the promises that the right-wing coalition made:
“We are all in this together. I am not going to balance the budget on the backs of the poor”,
said the then shadow Chancellor, now the Chancellor of the Exchequer.
“Our core aim is to hard-wire fairness back into national life”,
said the Deputy Prime Minister during the election campaign. The right-wing coalition document states that
“we will ensure that fairness is at the heart of those decisions so that all those most in need are protected.”
So what did the Secretary of State do?
Let us take two boroughs next door to each other in the same conurbation. One is 15th in the deprivation index; the other 178th. One has 27,000 people on housing benefit; the other has 13,000. One has 11,000 unemployed people; the other has 8,000. One has an average weekly income £40 below the other. One is poor; the other comfortable. So what does “We are all in it together” mean? Which one gets the bigger cut under the right-wing coalition? The poor one, of course! Salford loses twice as much as Trafford. And that is not an isolated example. According to the Secretary of State’s own figures, Newham, the sixth most deprived borough in the country, loses £4.6 million, while Richmond, the 309th most deprived borough, loses less than £1 million. In the Prime Minister’s district council, there will be no cut. His county of Oxfordshire, which has a deprivation index of 10.85, gets a cut of 0.7%.
If we look at the Deputy Prime Minister’s area, we see that Sheffield has a deprivation index of 27.8 and a 1% cut—perhaps the real price of coalition. As for the councils losing the highest proportion of the their income, they are in places that have been left behind—the Lancashire mill towns like Burnley, the ex-coalfield areas like Ashfield and the struggling seaside towns like Hastings. Among the metropolitan boroughs, it is the poorest that lose most. Why? Because it is what these Tories and Liberal Democrats believe in. As the Under-Secretary of State for Communities and Local Government, the hon. Member for Bromley and Chislehurst (Robert Neill)—who I see is not here to answer this debate either—said at oral questions with refreshing honesty:
“Those in greatest need ultimately bear the burden of paying off the debt”.—[Official Report, 10 June 2010; Vol. 511, c. 450.]
The poor will pay most, and that is what this right-wing coalition is all about.
The right hon. Gentleman cannot honestly defend the previous funding regime that saw authorities such as mine in East Riding receive hundreds of pounds less per pupil than those in neighbouring Hull. Is he suggesting that he wants to have cuts dished out to authorities that are already disproportionately doing badly out of the funding, which would mean deprived pupils in my area doing even worse than deprived pupils in neighbouring authorities?
There is the true voice of the Tory shires. The truth is that the local government funding formula—widely debated, widely discussed, widely consulted on—does give a weighting towards those areas with the highest social need and the highest deprivation, because the challenge of delivering services in those areas and of bringing about the equality of outcomes that we should all seek is greatest there. I do defend that. I do defend programmes like the working neighbourhoods fund, which has been targeted by this coalition Government, and through which money has of course been spent in areas of higher worklessness. It is because of that that those areas saw more people coming off incapacity benefit as local authorities used that money to help get people off benefit and into work—something we hear so much cant about from Government Members. So I say to the hon. Gentleman, yes, I do defend that approach.
Is my right hon. Friend aware that during the opening of yesterday’s debate on the Budget, in an exchange about cutting benefit to the long-term unemployed who are seeking work, the Secretary of State for Work and Pensions referred to pensioners living in houses that were too big for them and that they were unable to look after. Does that not give away what is really behind these benefit changes—that the pensioners and the poorest in our communities are going to pay the price?
Does my right hon. Friend agree that another area where the coalition’s words are just not matched by its actions is in the talk about big societies and strengthening civic society? The reality of the cuts in Birmingham is a slashing of grants to those very voluntary organisations that our city relies on to provide the services that supplement those of the local authority and statutory agencies, which ordinary people need.
I have some sympathy with my hon. Friend, as I have been involved at a local level in working the voluntary sector’s Shopmobility scheme, which the local Conservative council wanted to cut. Here was an organisation that had only a small amount of public money but engaged huge numbers of volunteers, enabling thousands of people to get around the town centre. It is funny, is it not, that that should be the Tories’ first target, despite all the talk about the big society?
I shall give way again in a few moments, but I want to make a little progress.
What is quite clear is that all this is not an accident; it reflects the values of the coalition. I have talked so far about the Secretary of State’s figures. When he published the written ministerial statement, he said with great flourish that no council would lose more than 2% of its budget this year. That is bad enough; it is not trivial. It feels about 30% worse than that, however, if we take into account the cuts implemented from today. By the time most councils have been able to put cuts into practice, it is going to feel like twice that level of cut.
The truth is far worse, because the Secretary of State consciously withheld the true situation from the House. In the figures that were published, over £500 million of the £1.16 billion of cuts was not allocated to local authorities, so no one could tell what the impact would be: it was kept secret—kept under wraps, kept from this House. A few days before, the centralising, dictatorial Secretary of State had instructed local authorities, under threat of punishment by law if they refused, to publish details of every item of spending over £500. As his hapless Minister told the House, no one had even bothered to work out what that would cost local taxpayers; it was just another diktat from behind the big man’s desk. Yet the same Secretary of State who can tell councils what to do down to the last £500 could not manage to tell this House or local councils where he was cutting £500 million. It is ridiculous.
Does my right hon. Friend agree that the current cuts in local government belie any notion of fairness or progressiveness? The London borough of Tower Hamlets is the third most deprived borough in the country yet it faces one of the largest cuts: £9 million, of which £1 million is from the working neighbourhoods fund. That is in addition to a likely £55 million of cuts over the next three years. We should compare that with the figure of £1.3 million for the London borough of Richmond upon Thames, which includes the seat of the Secretary of State for Business, Innovation and Skills, the right hon. Member for Twickenham (Vince Cable). How is it possible that the poorest have to suffer so much compared with one of the richest boroughs in the country?
My hon. Friend makes a very good point, and also underlines the point I am about to make, because on the original figures published by the Secretary of State, the Tower Hamlets cut was nowhere near as big as that. Earlier, I used the example of Newham, for which his table gives the figure of £4.6 million, which was the biggest cut in London. Now that the dust has settled, however, we find that Tower Hamlets is up there as well, with a figure of about £9 million, and Hackney loses £8.6 million—but as my hon. Friend said, “Don’t worry, because Richmond is still doing all right.”
I rise to say a few words in the interests of fairness, because the right hon. Gentleman obviously thinks that, apart from eating babies, there is very little the coalition does not do. Can he tell us which of the £40 billion of unallocated cuts the Labour party was likely to implement were going to fall on local government? That would be a transparent, open, rational and reasonable thing to do.
The hon. Gentleman needs to explain something to his constituents: why he is supporting a cut that goes tens of billions of pounds deeper than the plans we set out. That is what is causing the pain. During the election campaign, he opposed the cuts I am talking about. He and his party colleagues said that these £6 billion of cuts would damage the economy. He is the one with questions to answer for his constituents, such as how he managed to run an election campaign against a VAT increase and these cuts, yet here he is standing up in the House defending the cuts—and no doubt in due course defending the VAT increase as well.
I thank the right hon. Gentleman for giving way. Why does he treat Members as if they are fools? If he wants the truth, it is that his Labour Government’s funding formula was based on petty party politics and had absolutely nothing to do with the needs of individuals. If we want to use examples, the schoolchildren in my constituency of Bromsgrove get £900 less per annum than those in neighbouring Birmingham. The reason for that is very simple: over the past 13 years areas where there are Labour voters got far more money, and the truth is that what we are doing is, in this terrible economic climate, restoring some fairness in the system.
I think the whole House should take full note of that intervention, because the statement of principle we have just heard from the hon. Gentleman flies in the face of the commitment made during the general election by the then shadow Chancellor, now Chancellor, who said:
“We are all in this together. I am not going to balance the budget on the backs of the poor.”
We have now heard the authentic voice of the Conservative party, however. Irrespective of any economic challenges faced by this country, the Conservatives would have wanted to hammer the poor, and that is what they intend to do. It will not come as any surprise to Labour Members to know that that is what the Tories stand for. What the Liberal Democrats are doing supporting it, I have no idea.
Does my right hon. Friend not agree that the interventions he has just taken from the hon. Members for Brigg and Goole (Andrew Percy) and for Bromsgrove (Sajid Javid) both demonstrate that the coalition is intent on redistributing grant away from the poorest boroughs and the poorest education services and towards the better-off? Does that not completely give the lie to the idea that the so-called pupil premium will put more money back into the very boroughs and authorities that those Members have just attacked?
My right hon. Friend, as always, is absolutely right.
I must say that this debate is turning out to be rather more useful than I expected. Just a small scratch on the surface of the Government’s supporters tells us what they really believe, stand for and intend to do. As a number of Members have said, this has got nothing to do with the economic crisis or the deficit; they just think that our spending more money in the areas of greatest need was the wrong thing to do. Let us agree that that is the difference between the Government and the Opposition.
I wonder whether my right hon. Friend is experiencing, as I am, a slightly spooky feeling of déjà vu. If we think about political gerrymandering, we all remember the days when Westminster and Wandsworth were able to levy zero council tax because of the fix that had been done on the allocation and distribution of grant. What we are seeing from Government Members is history replaying itself. We are seeing not a new, centrist, Cameron-friendly Tory party but the same old right-wing Tories, determined to balance the books on the backs of the poor.
My right hon. Friend is right. She too has done the job that I did until the election, and she knows that there are many people in local government who are not of our party, but who have a genuine commitment to the communities they serve and by whom they were elected. Among the people who have been kicked in the teeth by these budget cuts are the locally elected representatives of this Government. The Tory leader of Blackpool council said:
“We are one of the most deprived areas in the land and we shouldn’t be singled out like this.”
He had better not go to the East Riding or Bromsgrove, because he will get a different message. He continued:
“I understand that some of the leafy lanes of Surrey and places have got away with it; well that can’t be right.”
The Lib Dem leader of Burnley council said:
“we are a deprived borough but once again we are suffering. I am disappointed and sick of us being kicked by budget cuts in Burnley.”
I am grateful to my right hon. Friend, who is making a very good case. Is he as surprised as I am that members of Liberal Democrat-controlled Stockport council, who were extremely vocal in the run-up to the election about the fact that their grant settlement was not enough, have not uttered a single word of protest at the cuts now being forced on them?
If I may, I will just complete the point I was making by giving one last example.
We were told that there would be a 2% limit on cuts; however, Corby council faces a cut of 15% in one year, because the figures did not include the housing and planning delivery grant. Corby council did the right thing: it gave planning permission for houses and economic development—and now it has had to pay for that with a 15% cut. I now give way to the hon. Member for Croydon Central.
I am very grateful to the right hon. Gentleman for giving way. He is trying to make the point that the previous Government allocated money on the basis of need. Does he recognise that the result of the introduction in 2006-07 of the fourth block into the funding formula, according to the London Councils report, has been a shift in local authority funding
“from a relative needs basis towards a per capita basis, causing an arbitrary redistribution in funding between high-need and low-need authorities”?
That is the result of the policies his Government introduced, and he did nothing to correct those decisions.
Does my right hon. Friend agree that we should not be too surprised at what this Tory Government are doing to shift the balance towards the wealthier areas of Britain, because every pit in Bolsover was shut by the previous Tory Government, throwing thousands of people on to the dole and creating deprivation that hitherto had not existed? Now the Tories are doing it again, but there is a difference because this time they are doing it under the cloak of so-called “respectability”, using those tinpot Liberals to cover for them. The Liberals will undoubtedly have to pay for it at the end.
My hon. Friend is absolutely right about that. One of the things that we need to recognise is that, sadly, in large areas of the country, particularly in my own area of the south, as well as in the south-east and the eastern region, local government has for too long been divided between the Tweedledum of the Tory party and the Tweedledee of the Liberal Democrats. The Liberal Democrats have often got away with claiming that they were a progressive alternative to the Tories, but that will no longer be allowed to stand. Somebody has to speak up for the people of the areas suffering cuts, and it will be the Labour party.
There are perhaps two arguments here. One argument is about whether the cuts should be made now or later, and the other is about how they should be allocated. My personal view is that we must ensure that we fund local authorities on a needs basis—there is no question about that. The basic questions in this debate are about whether or not cuts should be made earlier and whether the quantum should be the size it is. If we do not do this, the interest rates will be higher. If we follow the Labour party’s advice, we will actually have greater cuts because we will have to pay a higher interest rate on a higher level of debt. That is the fundamental truth of this argument, so the right hon. Gentleman is arguing for greater cuts in the long term.
No, I am not going to give way, because it was not worth it last time. The hon. Gentleman spent an election campaign saying that the cuts should not be made now, but he has spent every week since the election saying that they should be. That is ridiculous and he cannot expect to be taken seriously.
When I was in my office, after a meeting, I heard the right hon. Gentleman take the name of Corby in vain. May I point out to him that the cuts allocated to Corby borough council are merely 1.1%, which puts it in the lower half of councils receiving cuts? Is the shadow Minister aware that Pat Fawcett, the Labour leader of Corby borough council, complained bitterly at the funding settlement that Corby received when his Government were in power?
I should make some progress, because I have further important points to make to the House—unfortunately, the Secretary of State is not here to defend his case. When he made his announcement, he tried to sweeten the pill by promising local councils greater freedom in spending what was left of their money; he said that £1.7 billion would be taken outside the local government ring fence. That was fair enough, because that is the same direction of travel that the Labour Government had set and I am not going to argue with it, but what has happened since? This Government have now been forced to admit that it was all a mistake and that the figure was not £1.7 billion after all, but £1.2 billion, so we have another disappearing half a billion pounds. How could that be? The truth is that the Secretary of State and his Ministers are not on top of their brief, and they do not understand how local government finance works or where the money goes.
All that would be bad enough, but that is not all. What is being revealed bit by bit is this Government’s limited vision of local democratic government. The country faces a major challenge as we and the world recover from a global recession, and effective, democratically accountable local government must be part of the solution, not part of the problem, but it is now clear that this right-wing coalition does not understand how important local government must be.
It is not just about the unfair cuts, the impact on front-line services and the impact on growth. It is quite clear that there is no decision too small for the Secretary of State to intervene in. We wanted local councils to be able to decide whether planning powers should be used to control the spread of houses in multiple occupation and to let them decide what was best for local people, but now the Secretary of State is tearing up those rules. Who is going to decide what is best for local people? He is. We wanted local councils to have a say in the big planning decisions that affected more than one district. Who will decide now? The Secretary of State. He wants to set the council tax in every council, how often the bins are collected and how often councils can communicate with the public. He imposes cuts from the centre and will not talk to local councils about how to do it—no wonder he will not turn up to speak in the House. Remember the power of general competence? Remember the Prime Minister, when he was Leader of the Opposition, saying that councils would be free to do whatever they like as long as it was legal? That did not last long under this Secretary of State. He needs to learn that there is a lot more to localism than sitting behind a desk in Whitehall giving orders to local councils.
Councils need to be leaders, shaping and delivering services in their area. Under Labour, councils were better financed—we reduced ring-fencing and targets and believed that local councils were often best placed to decide what was best for local people. Labour local councils had the lowest council taxes and Tory councils had the biggest increases. We trusted councils to deliver the things that local people wanted. That is why local councils were the right vehicle to deliver the 18 million free swimming sessions for pensioners and kids that will now be scrapped. The views of the Tory leader of Derby council will be shared by many. As he said:
“The withdrawal of funding for the free swimming scheme is very disappointing because we consider this to be a resounding success in Derby.”
It was our belief in local government that made us see why local councils should take the lead on council and social housing and in supporting the Kickstart schemes, all of which are now on hold or scrapped. That is why local councils were the right people to lead in tackling worklessness, and why so many local councils, including Tory councils such as Kent and Hampshire, were big bidders for and big users of the future jobs fund. They could see that it was right to offer real jobs to young people in their communities. Now, up to 80,000 jobs for young people will be lost.
We trusted local councils—Tory, Lib Dem and Labour. Yes, sometimes they let us down. I remember when the Tory-Lib Dem coalition in Birmingham failed to spend its working neighbourhoods fund money; perhaps we should have realised that that was the shape of things to come. However, many other councils repaid that trust many times over.
It was right that local councils led on Building Schools for the Future. There are now 750 schools in 90 local authorities whose schemes are on hold and in doubt.
My right hon. Friend has set out in an extremely worrying way the effect of this right-wing Tory-Liberal Democrat coalition and of its cuts. Does he acknowledge that the coalition has not in any way flagged up the potential savings before going straight into the cuts programme? The Total Place project was one through which Tory councils in London and elsewhere said that they could make significant savings of tens of millions of pounds, yet there has been no mention of it from the Government. Will my right hon. Friend comment on that?
My hon. Friend is absolutely right, and I shall move straight to that point. It is very clear that the right-wing coalition is handling these cuts in a way that is creating much deeper damage than is needed. My hon. Friend should not be in any doubt: cuts would have had to be made under our deficit reduction programme. They would not have been as big or as fast, but difficult decisions would have had to be made none the less. There are big efficiency savings to be made, many of which were set out in the report that we published before the election, written by Sir Richard Leese, leader of Manchester city council, and Sir Steve Bullock, mayor of Lewisham. They set out very clearly the savings that could be made from sharing services, sharing staffing and reducing layers of management, but those changes need to be properly planned and implemented consistently over several years, always putting citizens first. The Government’s approach of badly planned, short-term, unfair cuts and arbitrary suspension of key investment makes efficient savings impossible and ensures that the cuts will fall on front-line services and their users, not on the back office.
In government, we recognised—this was the point that my hon. Friend the Member for Plymouth, Moor View (Alison Seabeck) made—that the only way to make the best use of local public service spending was to look at it as a whole. We need to look at all the money spent on children, older people, offenders and drug and alcohol problems as a whole. Rather than worrying at the outset whether it is police money, health money, school money or council money, we need to look just at how best to use it.
We know that the most expensive children—the ones who are disruptive at school—are often those whose families are of most concern to social services. They cause the most nuisance to local people and the police and they probably have the highest need of adolescent mental health services. So we worked with local government and the Local Government Association to show that we could produce better services much more efficiently if we brought together all the money that is spent on that group. Our Total Place pilot showed that when we do that, we get a better service at lower cost.
The LGA says that government as a whole could save £20 billion over five years. I am cautious about the details behind that figure, but it is significant. That is what councils think they could offer to cut the deficit while protecting front-line services. That should be taken seriously.