In challenging circumstances, the NHS is performing extremely well. Front-line staff are making heroic efforts to control costs as they cope with the pressures of an ageing population and when 1 million more people are using A and E every year than at the time of the last election.

The Opposition run down NHS performance, but the reality is a service delivering more than it ever did on their watch: 400,000 more operations every year than under Labour; the number of people waiting more than a year for an operation down from over 18,000 in May 2010, to just 665 at the end of February; MRSA infections halved; mixed-sex accommodation nearly abolished; dementia diagnosis rates going up; and more than 28,000 people receiving life-saving drugs from the cancer drugs fund that Labour refused to set up. As we debate health, care and support today, I take the opportunity to commend and thank all the dedicated professionals who work extraordinary hours, day in, day out, for their part in making this happen.

If we are to prepare for the future, however, we need to do more. In our generation, the number of over-85s will double, the number of people with dementia will pass the 1 million mark, and 3 million people will have not one, not two, but three chronic conditions to cope with, on top of the other pressures of old age. We must be there for each and every one of them—the founding values of the NHS would accept nothing less—and to do so we must be able to answer three big questions: how can we be certain that people receive compassionate care even when they are not able to speak for themselves; how can we deliver joined-up care to people who use the NHS and social care system on a regular basis; and how can we ensure that sustainable funding is in place for care and support?

The Secretary of State will be aware of widespread concern among the herbal medical community that there is no statutory regulation on that area in the Care Bill. Does he agree that if polymorbidity is to be dealt with we must have firm regulation, and that just licensing herbs, as the European Union wants, would destroy the industry?

My hon. Friend follows such matters extremely closely and I reassure him that the Government will update the House on that issue very soon.

The Care Bill will take a critical step forward in addressing each of the big questions that I raised, so let us consider how. First is compassionate care. Labour’s target culture led to warped priorities in our NHS and appalling human tragedy. No one disputes the value of targets, and the four-hour target played an important role in improving A and E departments. We do not, however, need targets at any cost, as we saw at Stoke Mandeville, Maidstone and Mid Staffs.

I agree with the Secretary of State about the value of the four-hour target. Is he disappointed, as I am, that that target has so often been missed in major A and E units over the past few months?

I am pleased that we hit our A and E target in the NHS last year, but disappointed that in Wales, which is controlled by the Labour party, the A and E target has been missed since 2009. Those on the Opposition Front Bench still refuse to condemn that.

Will the right hon. Gentleman give way?

I will make some progress.

Even worse, when signs of how the targets policy was going wrong became clear, Labour’s response was to ignore or cover up the findings.

Rubbish!

The right hon. Gentleman says “rubbish” from a sedentary position, but the Francis report—if he read it—mentioned 50 warning signs that were missed by his Government about Mid Staffs. He himself rejected 81 separate requests for a public inquiry into what happened. The Labour party created a lame duck Care Quality Commission, unable to speak out or force change, and an NHS where too often the system was more important than the individual.

At the outset, will the Secretary of State correct the record and remind the House that it was my decision, two months after being appointed Secretary of State in June 2009, to appoint Robert Francis to conduct an independent inquiry?

The right hon. Gentleman’s decision not to have a public inquiry that revealed extremely important information has meant that we are finally addressing the issue that his Government failed to address.

The Care Bill will include a vital element of our response to the Francis report, including regulatory clarity on who is responsible for identifying problems, driving up standards, and operating a single failure regime when urgent changes are not made.

My right hon. Friend will be aware that there have been teething problems with the 111 telephone service, which could be an essential tool to treat people in their own homes, certainly for palliative care. Will he provide stringent new guidelines to all providers to ensure that such teething problems are addressed and to enable the 111 service to operate as it should?

My hon. Friend makes an important point. Teething problems have led to unacceptable levels of service in some parts of the country, which we are in the process of sorting out. As we sort them out, we also need to look at the long-term causes of the problems of out-of-hours provision and the fact that the general practitioner contract of 2004 has led to a removal of GP responsibility for out-of-hours care, which means that there is much less public confidence than there needs to be in the whole picture. We need to sort that out, too.

Will the Secretary of State give way?

I will make some progress, then take more interventions.

The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.

Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.

We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.

The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.

I am grateful to the Secretary of State—out-of-hours is relevant to my point. He will be familiar with Newark. He closed the A and E department and the rate of deaths among local residents went up from 3.5% to 4.9%. Why does he therefore persist in saying that, if he downgrades Lewisham A and E, 100 lives will be saved across the south-east of London?

Because that is what the independent medical advice I have received has told me. The right hon. Lady should be very careful about the Newark statistics, because the increase in mortality rates, which is worrying and should not happen, happened before the A and E was downgraded. It is very important that we do not get the figures wrong.

Will the Secretary of State give way?

I am going to make some progress.

Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

I am grateful to the Secretary of State for giving way, but the trouble with him is that, often, there is a huge gap between the rhetoric he comes out with at the Dispatch Box and the reality on the ground. He says he is promoting integrated care, but what does he say about the pioneers of integrated care in Torbay, who are threatening to take legal action because of the requirement for compulsory competitive tendering of services? Under this Government, are not the beacons of integration being demolished by his free market?

It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

Will the Secretary of State give way?

I am going to make some progress.

The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.

Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.

In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.

I respectfully suggest that the Secretary of State should look at the situation north of the border, where reform to change who pays has worsened the situation because no extra funding was put into care; all that happened was that we shuffled around who actually paid. Will he look carefully at that situation so that it is not repeated? How much extra funding is he going to put into the system?

I agree with the hon. Lady that the amount of financial support is important. I gently say to her that her party wants to cut the NHS budget, which would make the situation vastly worse.

The Bill is a vital element of our plans to improve the lives of the frail and elderly and of people with long-term conditions and disabilities, but it is only one element. Other areas that do not require legislation will come together in a plan for vulnerable older people. The plan will consider all aspects of how we look after older people most in need of support from the NHS and social care system. It will look at how our hospitals are set up to support frail and elderly patients, particularly those with dementia, in emergencies. Of course, we must continue to give people with serious needs immediate access to highly specialised skill, but in many cases we could offer better alternatives outside hospital. That would improve clinical outcomes and reduce pressure on A and E departments.

Secondly, the plan will look at primary care—in particular, the role of GPs in supporting vulnerable older people. Active case management of vulnerable people is making a huge difference in some parts of the country and we will look at whether the primary care sector as a whole has the incentives, investment and skills to deliver that. We will also consider the provision of out-of-hours services and how to restore public confidence in them following the disastrous changes to the GP contract in 2004.

Thirdly, the plan will look at the barriers and incentives that prevent joint commissioning and stop people from getting joined-up care. In particular, it will consider the operation of financial incentives in the system, which can act as an unnecessary and counter-productive barrier. The Minister responsible for care, my hon. Friend the Member for North Norfolk (Norman Lamb), who is leading on integration, will announce further practical steps forward later this week.

I intend to announce the plan in the autumn, with implementation from April 2014. It will require a great deal of careful work, ask difficult questions and make tough decisions, but if it leads to more personal, more integrated and more compassionate care, it will stand alongside the Care Bill as an important step forward in reforming the care received by millions of people.

Does the Secretary of State agree that that can work only if social services budgets are increased? Where will the resources come from to deal with the problems we face, and will there be an increase in social services budgets to pay for the services we need?

There is currently a difficult environment for public finance, for which the hon. Gentleman’s party bears considerable responsibility. The Labour party has given up on the budget; it says it wants to cut the NHS budget. We say that these changes are possible without cutting the NHS budget and in dealing with the inefficiencies caused when care is not joined up. Taken together, the measures represent more progress in three years than the Labour party made in 13 years. They represent our determination to prepare the country for the consequences of an ageing population.

The right hon. Gentleman knows that the cap on costs of care is a little way off the Dilnot proposals. How many weeks—surely his Department has made some calculations—would that involve for a typical older person before they reach the £72,000 cap?

The point of a cap is not that we expect everyone to have to pay £72,000 towards their care. First, through pension plans and insurance policies people can make provision so that they never have to pay that £72,000. Secondly, as part of the package, we are increasing the threshold, below which the Government help, to £118,000—much higher than it is currently—so that it will be available to help, I think, around 40,000 more people than are currently helped because of the level of the means-testing threshold.

Will the right hon. Gentleman give way?

No, I am going to make some progress.

Finally, the values of the NHS—compassionate care and free at the point of need—are its greatest asset, but they open it up to risk of abuse from health tourists coming to this country to exploit that generosity.

Will the right hon. Gentleman give way?

I am going to make some progress.

Over the summer, we will consult on proposals to make the system fairer and ensure that people who should pay for NHS services do in fact do so. That will also help to ensure that our NHS remains sustainable at a time of tight public finance.

These proposals represent our commitment to ensuring a compassionate, fully integrated and sustainable system of health and social care built entirely around the needs of the patient. They represent a commitment to the NHS and social care system, which lies at the heart of our determination to make Britain the best country in the world to grow old in. [Interruption.]

Order. It is not altogether obvious whether the Secretary of State is giving way or has concluded his speech. [Interruption.] He has concluded his speech. It is usually helpful to have some indication of that.

Like you, Mr Speaker, I am tempted to say, “Is that it?” I suggest to the Secretary of State that he starts reading the weekend newspapers. He began with complacent statements about how everything is marvellous and it is all going so well, but it will not feel like that to staff working in A and E. The Secretary of State’s statement will just confirm to them that he is completely out of touch.

Every day brings new signs of an NHS in distress: more ambulance queues outside A and E; more patients left waiting for a call-back by a 111 service ill-equipped to deal with their needs; more older people seeing social care support withdrawn, or struggling to pay spiralling care charges and ending up in A and E; more patients waiting hours in A and E on trolleys in corridors; and more hospitals running way beyond safe occupancy levels. This is the fragile state of the NHS today: battered and bruised by a reorganisation that nobody wanted and nobody voted for; an entire health and care system on the brink, facing huge challenges that require urgent answers. However, we will not find them in this Queen’s Speech. There is no answer to the collapse of social care, and no answer to the understaffing of hospitals or the growing chaos in A and E. On the preventable deaths and health harm caused by smoking and alcohol, there is silence.

This Queen’s Speech is the product of a dysfunctional Government who have lost any ability they once had to face up to the big challenges the country faces. It cements the impression of a failed coalition project now preparing the ground for the next election rather than governing in the national interest. What else could explain the pathetic spectacle this weekend of Government Members, spooked by UKIP, falling over themselves to say that they will be voting against their own legislative programme? Has this place ever seen something so ridiculous?

Will Labour give us a referendum?

I thought the new compassionate Conservative party was meant to have stopped “banging on about Europe”—that was the phrase, was it not?—but now its Members are all dancing to UKIP’s tune and reading out what Mr Crosby gives them. It will not wash. The country can see that this is a shambles of a Government who look ridiculous to the country they purport to govern. When Britain needed leadership, it got the farce of this coalition. There is no need to send in the clowns; they are already here.

Does my right hon. Friend think, like me, that perhaps the Government feel more comfortable exposing their divisions on Europe than facing up to their record on the NHS, which, as many people across the health service recognise, is an absolute disgrace?

I shall come to that point directly, because the Queen’s Speech is a diversion from the real issues, an attempt to say, “Look over here at this other issue” and divert people’s attention from the chaos the Government have visited on the NHS.

On health and care, our objection is not to the modest measures the Government are proposing. We will of course wait to see the detail, but it sounds as though we will be able to give our support to many of them. Our objection to the Gracious Speech is not to what is in it, but to what is not in it and to the unpleasant political strategy that lies behind it. As a response to the developing crisis in our health and care system, it is inadequate. Worse, however, it tries to disguise that fact by pointing the finger at others. Forget compassionate Conservatism; this is straight back to the dog-whistle tactics—failed tactics, I might add—of the 2005 general election. This is the coded message the Government want the Queen’s Speech to send: “You see all those problems with accident and emergency departments? Well it’s all down to immigration. It’s nothing to do with us.” It is a Crosby-fied Queen’s Speech that is more about positioning and politics than a serious programme for government.

On a real issue that concerns people, there have been 1.1 million immigrants from eastern Europe since 2004, so I repeat the question very courteously put by my hon. Friend the Member for Rochford and Southend East (James Duddridge). The right hon. Gentleman talks about leadership, so will he show some and tell us whether the Labour party would grant the British people a referendum on Europe? Yes or no?

It is interesting, isn’t it? Here we are, in the middle of this Parliament, discussing the Queen’s Speech and health and social care, and what is the only issue Conservative Members can raise? Europe! We are talking about people waiting hours on end in A and E, about ambulances queuing outside, about a 111 service that does not ring anybody back, and about social care close to collapse, but they have nothing to say about those issues. Instead, they bang on about Europe. That is because they are preparing the ground for the 2015 election. The nasty party is back, scapegoating vulnerable people and stoking social division as a means of diverting attention from its own record, so get ready to hear how problems in the NHS are caused by health tourism and are nothing to do with the coalition’s toxic medicine of fragmentation, privatisation and budget cuts.

Is there not another side to the argument about immigration in relation to the NHS, which is that many of the people who keep the NHS functioning are from outside this country? One of the biggest problems facing accident and emergency departments around the country is that they cannot recruit enough consultants, yet the system that the Government have introduced on migration for those people is making it more difficult to recruit overseas. Would not a more enlightened attitude give us a more effective NHS?

As ever, my hon. Friend says it more eloquently than I can. The Government are playing politics rather than addressing the national interest. People will see that, but at least the Government have revealed their hand. We will work hard over the next two years to show who is really to blame and expose this Government’s failures on social care, the NHS and public health. Let me take each in turn.

At face value, the social care measures that the coalition is proposing sound like progress towards a fairer and simpler system. Indeed, the Care Bill builds on many of the recommendations of the Law Commission’s review of adult social care legislation, which was initiated by the last Government and included in the White Paper I published before the last election. National standards for eligibility could help to bring consistency to the care system, and stronger legal rights for carers are long overdue, as is improved access to information and advice. However, the question in the minds of many today, particularly councillors watching this debate, will be: how on earth will we be expected to pay for all that? That is when we realise again that there is a huge gap between the rhetoric we hear from the Dispatch Box and the reality on the ground across England. More than £1.3 billion has been cut from local council budgets for older people’s social care since this Government came to power.

Just last week, the Association of Directors of Adult Social Services said that Government cuts to care and councils would mean a further raid of £800 million from care budgets in the next year. The Care and Support Alliance has said that the system is in deep crisis and that without

“appropriate funding for the social care system…the aspirations set out in the Care Bill will not be reached.”

The Care Bill does nothing for people who face a desperate daily struggle to get the support they need right now, with many paying spiralling charges for their care. That is the effect of this Government’s drive to cut councils to the bone. They are foisting huge care charges on the most vulnerable people in our society. These are the coalition’s dementia taxes.

Does the right hon. Gentleman not understand that the people of this country would have more confidence in what he says at the Dispatch Box had he not said in the last general election campaign that it would be irresponsible to safeguard the NHS budget, which is what this Government undertook to do?

I will come directly to that quotation in a moment, because the hon. Gentleman will remember that at the last election he stood on a manifesto promising real-terms increases for the NHS. I hope that when he speaks later—or if he wants to get up right now—he will tell me whether they have been delivered.

I am grateful for the opportunity to acknowledge the great difference between England and Wales, where Labour is in power and where we are seeing real cuts in NHS spending.

Government Members are just embarrassing themselves. When they cannot answer a question, they try to raise another one or go on about Europe. It is just not good enough. The answer is—though the hon. Gentleman cannot admit it—that Andrew Dilnot said this Government had cut the NHS. It is there in black and white. That is what they have done, and they stood on a manifesto promising the opposite. I secured a budget to protect the NHS at the last election. I said that I could not give real-terms increases because that would be irresponsible; and as it turns out, nor can the hon. Gentleman. His party was writing cheques that it simply could not cash, and that is a fact.

The Care Bill does nothing for those hit by the coalition’s dementia taxes right now. Since this Government came to power, the average care user has paid £655 a year more for home care than when they came into office. Overall, that is around £6,800 a year. Dial-a-ride transport services have doubled in price over the same period, from an average of £1.92 to £4.12. Meals on wheels now cost an extra £235 a year, while people in Conservative areas pay more for each service on average than friends and family in Labour-controlled areas—on average, £15 a week or £780 a year more for home care. That is the record of this Government.

rose—

I will give way one last time.

The right hon. Gentleman has been speaking for more than 10 minutes and he has not once said what Labour would do. Will he come to what the Opposition propose we should do?

I assure the hon. Gentleman that I will come on to that, but I have a job to do in holding this shambles to account and that is exactly what I am doing.

Under this Government, people are paying more out of mum or dad’s bank account for care, which often does not come up to the standards that they want, because their council has been cut to the bone. What are they meant to make of a promised, far-off cap of £72,000, or £144,000 for a couple? The Government are giving a little with one hand, while with the other they are grabbing a fortune from people’s bank accounts.

Does my right hon. Friend acknowledge that this is not even a question of £72,000 or £144,000, because those caps will be metered at the level that the council would pay, and will take no account of top-ups or accommodation costs? I have seen examples that show that people might have to pay £250,000 before they get anywhere near the cap and any help from the state.

My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

indicated dissent.

That is what this Government are doing. A cap is ineffective without long-term funding for the future of social care, and the failure to face up to the crisis in adult social care budgets that Conservative councillors are talking about will leave people with the impression that this Health Secretary is fiddling while Rome burns. The social care system in England is close to collapse, and the reality behind the Government spin is that, under this Government, people’s savings are being washed away more quickly than ever before.

I want to turn now to our accident and emergency services. The crisis in social care is the predominant driver of what we are now seeing in our accident and emergency departments. If people’s services are withdrawn, or if they cannot afford to pay for them, they are more likely to struggle and fall ill at home and to end up in hospital. That is bad for them, and it costs the NHS more. Also, NHS staff are finding that people who are ready to leave hospital cannot be discharged because the necessary support cannot be put in place. Beds are not being freed up on the wards, and A and E therefore cannot admit people to the wards because there is no space. A and E then becomes full, which results in ambulances queuing up outside because they cannot hand over patients. The system is now backing up right through A and E.

indicated assent.

The Secretary of State is nodding; he should do something about it. This is happening on his watch. Across the country, hospitals are operating at levels way beyond safe bed occupancy—[Interruption.] He nods, but I am saying, “Do something. Don’t just nod!” We need action from the Secretary of State.

Let me return to the quote that I mentioned earlier. People love to say that I would have cut the NHS. For the record, I have never said that I would cut the NHS. At the last election, I promised real-terms protection for the NHS. The Conservatives promised real-terms increases, which have never been delivered. Let me read that quote in full:

“It is irresponsible to increase NHS spending if the effect is that it is damaging, in a serious way, the ability of other services to cope…that are intimately linked to the NHS. The health service needs functioning day care, and housing”

and meals on wheels.

That warning has now come true.

rose—

I will give way to the Secretary of State, but I ask him to address this point. He has paid for the so-called ring fence on the NHS by ransacking local government funding, and that makes no sense whatever.

If the right hon. Gentleman looks at the figures, he will see that real-terms spending on the NHS has gone up since Labour was in power. Given that he thinks it irresponsible to increase the NHS budget, does he agree that if he were to follow his own policy, he would now need to cut that budget from its current level? That is Labour policy.

I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.

Surely the Secretary of State has forgotten that he received a letter in December from Andrew Dilnot, the chair of the UK Statistics Authority, which said that

“we…conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10…In light of this, I should be grateful if the Department of Health could clarify the statements made.”

I am very grateful to my hon. Friend. He has now embarrassed the Secretary of State who, just a moment ago from the Dispatch Box, claimed the opposite. Similarly, the Work and Pensions Secretary was pulled up last week for doing exactly the same thing. They think they can stand there and say whatever they like, and they think they can get away with it, but they cannot, because people have seen through them. They have cut the NHS; they have broken the central promise on which this Government came to office. Now they are saying that the pressure on A and E has nothing to do with social care funding or NHS funding, but is all to do with the GP contract in 2004. That is what they have been saying on the radio for the last three weeks.

Let the Government answer this. In 2009—five years after the GP contract came into force—98% of people were seen within four hours at A and E departments across England. What we have seen recently is that, week after week, major A and E units are missing their lowered target. That is the reality right now, and the Secretary of State had better start facing up to it.

My right hon. Friend will have heard me refer to the situation in Newark, when intervening on the Secretary of State. Does my right hon. Friend agree that when a promise is made that closing or downgrading an A and E will save lives, that is what one logically expects to happen? The fact that the death rate subsequently went up is an indictment of what the Secretary of State has done. Does my right hon. Friend agree that when we cannot meet the four-hour target for A and E throughout the country, it is ludicrous to close existing, well-functioning A and E units?

I could not agree more with my right hon. Friend. All over the country, we hear that A and E is under intense pressure. Such is the importance of these services to every community that changes should be made only if there is a compelling clinical case to support them. If clinicians can demonstrate that more lives will be saved and disability will be reduced by changing A and E services, I think every Member should have a moral obligation to support them, but when the changes are financially driven—my right hon. Friend knows this better than anybody, as the Secretary of State has downgraded a successful A and E in Lewisham to deal with problems in another trust—that simply will not do. A and E units in west London, for example, are being closed one after another. That is not good enough, and neither is it good enough in Greater Manchester, where huge changes are planned. These changes must be clinically driven, not driven by finance, which is what we are seeing under this Government.

rose—

I will give way one last time, before making some progress.

I am grateful to my right hon. Friend, who is rightly concentrating on A and E units and social care. Does he agree with me that many hospitals around the country are facing a financial crisis, too, where the Government are refusing to fund anything other than consultancies? In my area, that has meant spending hundreds of thousands of pounds to tell us what we already knew—namely, that my hospital is underfunded.

That is what happens when a market is set up in the NHS, pitting one hospital against another in open competition. That is what is beginning to take hold in the NHS, where the Government waste money on consultants and all the other things that come from bidding for contracts. That is a direct effect of the legislation they pushed through. This reorganisation and the budget cuts I mentioned a few moments ago are providing a toxic mix. This is why for 32 weeks running, the NHS in England has missed the Government’s own lowered A and E target for major units. It really is time that the Health Secretary got a grip on the issue. We hear that last week he was trying to hatch a panic plan to deal with the A and E crisis. That is the reality of what was going on behind this threadbare Queen’s Speech: the Health Secretary was trying to cobble together a plan to deal with the A and E problems, weeks after we had first raised the issue in the House.

We hear of an e-mail leaked by an NHS finance officer which said:

“The SoS would like to announce tomorrow that £300m-400m is being invested to solve the A&E problem. We have spent most of the day trying to hold him off doing this.”

The Health Secretary seems to have forgotten that his powers to intervene were given away by his predecessor. He no longer has the power to mandate the NHS to do what he wants; the NHS can now “hold him off”. I am afraid that he looks weak. He has no response to what is happening to A and E departments. And where is the “£300 to £400 million” plan? It has not materialised. That is proof that when the Government surrendered their powers of control over the NHS, the Health Secretary surrendered his ability to do anything about the problems that we now face.

It is just as bad when it comes to staffing. We hear that nurses’ posts continue to be lost. Nearly 5,000 have been lost since the Government came to power, and according to the findings of a survey published yesterday, nurses fear that further tragedies could happen as a result of staff losses. That should set alarm bells ringing throughout the Department of Health. The Care Quality Commission has said that one in 10 hospitals in England does not have adequate staffing levels. The Health Secretary nods. I am glad that he accepts that, but, again, what is he going to do about it?

I welcome the fact that the Care Bill will contain measures relating to the Francis report, and I will work with the Health Secretary on that, but let us get to the crux of the issue of safe staffing levels, because that is the most urgent problem facing the NHS. The Health Secretary nods again. Let me make him an offer. If he introduces a benchmark—if he specifies minimum staff to patient ratios—we will support him, and the measure will go straight through the House. I shall wait for him to respond to that offer, and to ensure that the recommendations of the Francis report are properly implemented.

I give a cautious welcome to some of the Health Secretary’s measures to deal with health tourism, but let me issue two caveats. First, it is important not to overstate the nature of the problem, and secondly, it is essential for health practitioners not to be turned into immigration officers. In March, when asked how much health tourism was costing the NHS, the Health Secretary said:

“I don’t want to speculate… but… we have heard… it’s £200 million.”

On the same day, the Prime Minister’s spokesman said he believed that the figure was more like £20 million. Perhaps the Health Secretary could account for the difference—or did he just add a zero?

Would it not be helpful if the Health Secretary could tell us exactly how much he thinks is being lost and what it will cost to try to recover the money? At present the only figure that he has is the one on the invoices, rather than one relating to the money that is actually recovered.

We must wait to see what the Government produce, but we need to be sure that they are attacking the real problem rather than playing politics with an issue and creating the impression that all the A and E problems are caused by immigration. If that is their real intention, they will have no support from the Opposition.

Did my right hon. Friend have an opportunity to hear what the Conservative right hon. Member for Haltemprice and Howden (Mr Davis) said during the debate on the Queen’s Speech last week? It was very intelligent and nuanced. He said that it was necessary to ensure that not just life-threatening diseases but notifiable diseases and mental health conditions would not be covered by the proposed measures. The position is not quite as straightforward as some newspapers might like to suggest.

Nuance, care and caution are precisely what we need in this debate; we do not need press statements written by Lynton Crosby which then turn up in the House as Bills. We want responsible government, ensuring that the NHS is not abused. We will support the Government as long as that is their intention, but if they are doing something more sinister and playing politics with these issues, they will not have our support.

We have had no answers on the NHS. Let me finally turn to public health. There was not much on which I agreed with the last Health Secretary, but he had my strong support when he spoke about tackling smoking. He said that he wanted tobacco companies to have “no business” in this country, and that introducing standardised packaging was an essential next step to ensure that young smokers were not recruited by the tobacco industry. [Interruption.] The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), looks confused, but I think she advanced the same argument on the radio a couple of weeks ago, saying she was an advocate of standardised packaging. Then, we read in advance in our newspapers that the measure had been dropped—one of the “barnacles” on “the boat”, we were told, by the said Mr Crosby. This is the same Mr Crosby who has represented “big tobacco” since the 1980s, who masterminded the campaign against standardised packaging in Australia, and who was federal director of the Liberal party of Australia when it accepted millions of pounds in donations from the tobacco industry.

The Secretary of State said last week that a decision has not been made yet because the consultation has only just finished. It ended nine months ago. He can make a decision. I say to him again today, here is another positive offer from the Opposition: if he brings forward these proposals, they will have our full support and we will get them on the statute book.

My right hon. Friend may be interested to learn that the Prime Minister wrote to me about plain packaging before the Queen’s Speech was delivered to both Houses. He said in that letter that there were currently no proposals to introduce plain packaging.

The former Secretary of State said that it was full steam ahead and that is what they would do. This Secretary of State comes in and says nothing about the issue. Then, a right-wing Australian lobbyist arrives, and all of a sudden no one mentions it at all. Has the Secretary of State ever met Lynton Crosby and discussed this issue with him? I think we have a right to know. [Interruption.] He nods; I should be interested to know the substance—[Interruption.] He has not met him to discuss the issue. He looks very uncomfortable all of a sudden.

Just to put the right hon. Gentleman out of his misery, I have not discussed this matter on any occasion with Lynton Crosby.

We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.

I appreciate that the right hon. Gentleman has very clear convictions and a desire to tackle smoking as a public health issue. However, a third of cigarettes smoked in London are contraband. How would standardised packaging deal with that problem?

I agree that we need to do something about that, and we did bring forward measures in government, but standardised packaging is not plain packaging: it is about having designs on the pack that could be used to ensure there is no counterfeit tobacco. Surely some things are more important—the young smokers in the hon. Lady’s constituency and mine who are targeted by the tobacco industry. Surely we in this House can unite on issues such as this and take steps to improve the long-term health of the country. It seems to us that the Government have given up on the health of the nation.

I said I would set clearly out for the House what I would do had I been standing at the Government Dispatch Box today. For a start, I would have introduced a Bill to repeal the disastrous Health and Social Care Act 2012, which has placed our NHS on a fast track to fragmentation and privatisation. That Bill would have restored the powers and responsibilities that the Secretary of State’s predecessor gave away, and which he found out last week he no longer has. I would legislate for the full integration of health and social care as the only realistic answer to the challenges brought by the century of the ageing society.

People can see that increasingly it is the Opposition who have the courage and the answers to deal with the big challenges the country faces, not a failed coalition that is now playing out time. Its toxic medicine of cuts and reorganisation has laid the NHS low, and now it has no answers to the chaos it created. That is because the Secretary of State only discovered last week that his own reorganisation had stripped him of his powers to intervene, leaving him looking weak—in office, but not in power. Having done that, the Government’s answer is to try to scapegoat others for problems of their making. It will not work—we will remind people that it was a right-wing reorganisation that has left the NHS destabilised and demoralised. We will never tire of reminding the Prime Minister that the British people never gave him their permission to put the NHS up for sale, and we will restore the right values to the heart of our NHS—compassion before competition, integration over fragmentation, people before profits. The NHS and the country deserve better than a Government who are out of touch and out of ideas.

I am grateful for the opportunity to speak in the debate on the Address.

In nearly 30 years in the House, it has been my experience that Governments are always accused of having either too much or too little in their Queen’s Speeches. As my hon. Friend the Member for Banbury (Sir Tony Baldry) rightly said in his excellent contribution, however, they are works in progress. I congratulate the Government on bringing forward a measured and carefully thought-out programme, which has been welcomed by my constituents and which will make a positive contribution to the lives of many of our fellow citizens. The immigration measures, the national insurance contributions Bill and the deregulation Bill are particularly important to the work that the Government are doing—in my view far more successfully than they are being given credit for—in fixing the British economy, which is showing clear signs of real improvement.

I would like to report to the House that at the Burgess Hill Business Parks Association business exhibition on Friday there was a solid mood of determination to grow our local economy, as well as considerable satisfaction at the progress being made. The message that I take back from that admirable gathering is one that all our colleagues will find when they go to gatherings of that type: people want the Government to press on with getting rid of regulation and bringing in lower taxes—above all, they want to get on with growth. This Queen’s Speech presses on with a number of key reforms on welfare, on education and by the Home Secretary in her excellent work on immigration.

We were fortunate to have exceptionally good local election results in Mid Sussex, where the combination of a prudent and well-run West Sussex county council and an extraordinarily efficient and well-led district council have delivered with confidence the Government’s agenda, which is welcomed and well understood. What is clearly most important locally, however, is the state of the economy. For all of us, that must be at the very top of all our constituents’ concerns about the future of the country. Our constituents want the Chancellor and the Prime Minister to press on. If they do and the economy grows, much of the country’s serious anxieties will begin to disappear like the winter snow.

I am delighted that my right hon. Friend the Prime Minister is in Washington today with President Obama in our pursuit of the European Union-United States free trade agreement, which is clearly extremely important to our future, not only for our national trade and commerce in Europe and elsewhere, but as a mark of stability in world trade, which is vital to the ordinary conduct of economic and world trade growth. All of us here know that the opportunities in that regard are enormous.

Does my right hon. Friend agree that if we were to vote to leave the European Union, we would no longer benefit from that free trade agreement?

I do agree, but I will come to that point in a moment, if I may.

As co-chairman with the right hon. Member for Birkenhead (Mr Field) of the cross-party group on balanced migration, I warmly welcome the considerable progress that the Government have made on the difficult and sensitive matter of immigration. They have succeeded in driving down numbers and there is real progress, but there are no easy solutions. I welcome the carefully thought-out work of my right hon. Friend the Secretary of State for Health on those services. The cross-party group, and I think most of the House, knows that the most careful attention must now be paid to the question of access to benefits and the health service. Thus, the immigration Bill is an important step forward.

I know the Government do not underestimate the anger and frustration that many people feel about too many people arriving in Britain and accessing public services before they truly should. To that end, I will conclude by saying a few words about the European issue.

The House knows that I am a staunch but not uncritical pro-European. I acknowledge the profound frustration of dealing with Europe, and there are certainly the most serious problems with the European Union that we must fix. The Conservatives are committed to doing that. In many of these matters, we will find solid support across the continent from our European partners, and my right hon. Friend the Prime Minister will do that.

People need to understand that the Prime Minister has committed to the negotiation of a new settlement between Britain and the European Union. People questioned whether he would veto an EU treaty, but he has vetoed an EU treaty; people questioned his ability to get the EU budget cut, but he has succeeded in getting it cut; and people questioned his ability to get powers back from the EU, but the fact is that he got us out of the EU bail-out mechanism and saved this country hundreds of millions of pounds.

The Prime Minister has said that he is committed to negotiating a new settlement for Britain within the EU and I have every confidence that that is precisely what he will achieve. It will be then for the British people to judge that settlement in a referendum. There will be a referendum on our membership of the EU; the commitment on that is absolute. Some of my hon. Friends and indeed some of my right hon. Friends need to be a little cautious about trivialising what is involved. The decision on a referendum is hugely important for this country; it is probably the most important decision that it will have to take for generations. It is not to be lightly taken, or on the basis of prejudice or pub rhetoric.

Will my right hon. Friend give way?

No, I will not. No good is done to the public governance of this country by a constant chipping away at trust and at the Government’s integrity. If the Prime Minister says that something will happen, such is the momentous nature and importance of this decision that it will happen with orderly process and proper debate, and not with some hysterical, knee-jerk, publicity-seeking action.

I beg this House to remember that, with all the EU’s imperfections and all its problems, it gives our country free and fair access to the single largest integrated economic area in the world; a single market of 27 countries and 500 million people with a gross domestic product of $16 trillion. I could not possibly look my constituents in the eye and tell them I was prepared to risk that. I urge the House to support the Prime Minister and the Government in the orderly process that has already been announced, which will result in a referendum. I am confident that it will be a positive referendum for the United Kingdom.

I will not follow the right hon. Member for Mid Sussex (Nicholas Soames) in referring to Europe, other than to say I regret the possibility that European competition law will in future apply to the national health service, which will no doubt be exploited by major American health corporations.

I will talk exclusively about the current destruction of NHS Direct, a successful, safe and popular service, and its replacement by 111—I hesitate to call it a service— that has proved to be a shambles in many parts of the country. I must declare an interest—a sort of proprietorial one—because I was Health Secretary when we decided to set up NHS Direct in 1998. We set it up in a sensible way, and it worked from the start. We established three pilot schemes. The service was gradually rolled out across the country, learning all the time from the experiences of the earlier services that were already working. It worked well from the start, and there is no excuse for Ministers in this Government who have introduced the 111 service as a mess. They have been calling summits and announcing reviews ever since it started going wrong. That is pathetic, because they are not in the Department of summits and reviews; they are in the Department of Health.

Those Ministers were not even doing anything new. They had the opportunity to build on NHS Direct, which was a successful example. In 2002, it was described as a remarkably successful service by the Public Accounts Committee, then chaired by the hon. Member for Gainsborough (Mr Leigh), and of which the current Chancellor of the Exchequer was a very active member. Reports by the Comptroller and Auditor General and the PAC commended the service, saying it had met all its deadlines and properly addressed all the risks, and that it had a practical approach and had learned lessons as it went along. It was also commended for the fact that its computer procurement had been well managed and had been delivered to cost, and that there had been satisfactory consultation and it was clinically safe.

It was praised, too, for reducing demand on other parts of the NHS. The main reason it was reducing demand was because it was predominantly staffed by nurses, who had the professional confidence and judgment simply to offer reassurance to some who got in touch. In the current service, however, there are many call handlers, who do not have that professional knowledge and confidence, and are therefore referring people to GP services or A and E and are arranging ambulances.

I commend the views of the PAC back in 2002. It was far sighted, because it said:

“Departments should consider what wider lessons they could learn from the successful introduction of this significant and innovative service on time.”

The Chancellor’s Government have clearly decided to ignore that recommendation. The PAC also noted:

“Short lines of communication between the Project Team and those implementing the service at local level enabled lessons to be learnt quickly as the projects progressed.”

Clearly the current Government did not learn that lesson either.

The current Chancellor himself said in one of his contributions to the Committee:

“My concern is that the Permanent Secretary…is going to start saying, we are great, we have this giant switchboard for the NHS, and your service is going to lose the focus of its original function”.

That perfectly describes what has happened with the abolition of NHS Direct and its replacement by the 111 service.

The 111 service does not have short lines of communication—indeed, I doubt whether it has any at all. It has also taken on innumerable new functions, and has been expected to carry them out at less cost than NHS Direct was operating at. The only way it could reduce costs was by getting rid of nurses, because they are more expensive than call handlers. Indeed, GP representatives have told me the current service has reversed the situation: whereas there used to be more nurses than call handlers, there are now more call handlers than nurses, and in one area there are 15 call handlers and one nurse.

The computers keep going down, there are massive delays, and a lot of the call handlers are giving the wrong advice, much of which is expensive for the NHS. The Government cannot say that they were not warned about this because they were warned by Members, even Government Members, as long ago as March, not this year but last year.

In bidding to get one of these contracts, people assumed, in good faith or bad faith, that they could provide as good a service as NHS Direct at half the cost. It is now clear that they cannot. Other parts of the NHS are bailing them out to try to keep the 111 service going. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the question that arises is what the Secretary of State can do about it. The people running these services have bid for fixed-price contracts. If they now need to spend more, how is the money going to get to them so that they can do so? They are left with three alternatives: they can struggle on providing this very poor, unreliable service, they can go bust and there is no service, or the money is found from somewhere else in the NHS. However, under the crackpot system that the Government introduced when they changed the law, there is no machinery for putting extra money into these services so that they can do their job properly.

I want to concentrate my remarks on social care, because all too often in debates entitled “Health and Social Care” we tend to spend most of our time debating health, and yet our social care system is absolutely vital in regulating health care costs and delivering a better-quality health service. The Bill announced in the Queen’s Speech—it was indeed published on Friday—goes a long way towards laying some important foundations for a better social care system.

The Care Bill attempts to address a number of long-standing flaws in the system that have developed over the past 60 years through a series of piecemeal measures enacted by successive Governments. It is essential that in considering this over the next few months we make sure that we get it right, because legislation in the social care sphere comes to the House very infrequently. Our care and support system is of key importance because the rapid age shift that is taking place in our population is profoundly changing the nature of the demands on the system. It is important to note that this is not just about ageing; it is about the complex co-morbidities of long-term health conditions, both physical and mental, that are at the heart of the serious pressures on our whole system.

Our social care system has a number of features that need to change. It is too oriented around crisis and stutters into life when things have already gone wrong. It does not enable people to plan successfully for future care needs or, indeed, to prevent and postpone them. It does not provide adequate signposting, information, advice and advocacy for people to secure what they need from it, making it feel too much like a fight to get what is necessary. There is a lack of recognition of, and support for, family carers. Quality is variable around the country. We have heard announcements today about co-ordination of care and continuity, which is clearly a problem too. The costs of care are a lottery, and that needs to be addressed.

The Bill is taking all this forward. It focuses on early intervention and prevention, with a new responsibility for that to be up front in the way that local authorities plan their services. There are new duties on information and advice. I welcome the fact that the Government have agreed that the Bill should specifically refer to financial advice as being part of the legal obligations. There are new rights for adult carers—I will talk about young carers in a moment—with a lower threshold of eligibility for services. That is very welcome. A new rating system is being established to assist with quality of care and to help providers themselves to benchmark their performance.

I know that the right hon. Gentleman is very knowledgeable on this subject, but does he believe that councils have sufficient resources to consider new rights, given that we hear that care is collapsing all over the country and the Local Government Association says that if nothing else happens councils will be overwhelmed by the costs of care in less than 10 years?

I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.

The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.

I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill, which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.

The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

In a previous life I was a contracting officer for a local authority, and I contracted and commissioned care from the private sector. We always faced the same problem: the local authority tried to get more care for less money. That meant that contractors were paid less for their care workers, who were constantly not paid for travel time. How do we break this vicious cycle if we do not accept that we have to fund local authorities properly to make possible the provision of quality care?

I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

I agree that the quality of commissioning needs to be addressed as well as the quality of provision if we are to get better care for the people who need it.

I welcome that comment from the Minister and look forward to seeing more detail.

My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

Can I tempt my right hon. Friend to comment on his proposals on the use of universal benefits for wealthy pensioners? I know that he has produced a pamphlet.

I will try to do that in the one minute and 14 seconds left to me.

The ADASS survey paints a quite disturbing picture of the next two years. More providers will face financial difficulties and there will be increasing pressures on the NHS as social services shunt people into health care services.

The spending review that is under way is for just 12 months. It needs to fund the successful implementation of this legislation, and not least the introduction of the Dilnot proposals. More than 450,000 people will need assessments to get into the new system. The spending review also needs to sustain the transfers of money from the NHS to social care. Beyond that, the spade work needs to be done now to make the case for the critical interdependencies between social care and health that will sustain our social care system and make our health system deliverable and affordable.

The Queen’s Speech, with its specific commitment to this legislation, contains a landmark reform that will do a great deal to improve the quality of life of our constituents.

I am grateful to the 2,500 people from England, Scotland, Wales and Ireland who have written to me since last December, when I first raised the issue of compassion in nursing. The e-mails keep coming and I want to quote from some of them.

A man whose elderly mother was in hospital asked how many staff it takes to cut a fingernail:

“The hospital staff won’t cut my mother’s fingernails. They won’t clean them properly either. The excuse given to me is that this amounts to an ‘assault on patients.’”

My mother…has for the past several weeks been positive for a new superbug which is carried in faeces and would cause havoc if it got into the bloodstream…she’s in an isolation ward now. Barrier nursing, rubber gloves and pinnies for all staff and visitors. And still the nurses won’t do her fingernails, and they can’t or won’t see that filth under fingernails or wherever it is located, is intolerable in hospitals and needs to be eliminated—most especially in infection control units.”

The e-mail continued:

“I had a rant at the…staff for leaving the buzzer button and water out of reach of bedridden patients [i.e. people in beds near to my mother who were calling out to anyone for water]. My mother’s buzzer was also out of reach. I was then told these elderly patients might strangle themselves on a buzzer’s cable.

My mother tells me that if staff are dealing with a patient [e.g. bathroom visit] when the food trolley arrives then sometimes the patient may not get any meal. It is delivered, uneaten, and taken away. The idea the patient might still be in the land of the living and come back to their bed later and need some food seems not to bother them”.

A man whose father was on a ventilator wrote:

“There were no issues with the treatment he received, but the comment I received when going to say goodbye to him when the decision was taken by medics to switch off the machine is not one I will ever forget. After going to see him and saying goodbye, the nurse—whose Christian name and face I will always remember—said to me, ‘Can we crack on now?’”

A woman whose husband died of cancer at 53 after, she alleges, years of mistreatment and misdiagnosis wrote:

“When I complained to PALS—”

the patient advice and liaison service, which some hospitals have—

“my initial complaint was ignored. So I complained to the chief exec. I had several meetings with PALS and was told they would do an independent review. This took them two years and they denied any wrongdoing. No proper investigation took place. I then contacted a solicitor and had an expert review of the case. He said the treatment was nothing short of criminal…it has taken me four years of fighting for justice. They have now finally admitted liability for breach of care and duty and causing his death. But what happens to those responsible? Nothing. This was not one mistake, it was a catalogue of errors that went on for 3 years. They should be tried for manslaughter.”

A man whose wife suffered mistreatment wrote that

“she was regularly left to lie in her own faeces for half an hour or longer, and on more than one occasion for well over an hour. This led to a severe rash on her backside to the point that her bottom and the backs of both thighs were red and raw. The buzzer would be left hanging out of reach, either by accident or on purpose…at one point she was lucky enough to be able to reach her mobile phone as she rang me in tears during the middle of the night asking me to ring the high-dependency unit desk as she’d been desperate for a nurse…I had to bring her a fresh bottle of water every evening so that she could sleep with it in bed as the water on her tray was often pushed out of reach after her visitors had left for the night.

She was never weighed when in hospital despite multiple requests of both doctors and family. The staff allowed her muscles to atrophy to the point she could not even get herself out of bed…she was so badly undernourished, many family members doubted if she would ever come out of hospital.”

A woman writing about her mother’s mistreatment stated that

“nurses frequently chatted and laughed at the nurses’ station at night, showing a complete lack of consideration and respect for patients. Standards of cleanliness left much to be desired, and we were sometimes greeted by soiled dressings left lying around and on one occasion, splashes of blood which did not appear to be hers, left over the end of the bed. Generally there was poor liaison between the two hospitals and the GP, with outpatient consultant appointments being sent to my mother’s home address, when she was in hospital dying. We did not complain at the time as we were too distressed by my mother’s condition and after she had died unable to bear reliving her last months.”

A man wrote to plead that the right kind of person is selected and supported for a nursing job:

“I have seen nurses walk onto a ward chatting loudly about their social life, approach a patient and see to his needs while continuing their loud chat, apparently oblivious to the sad human bundle they were treating, as if it was a spare tyre that they were changing. I expect you have seen groups of nurses chatting at the nurses’ station and ignoring patients on their ward who are calling out for a nurse. Yes, we know, some of these will be demented or disorientated souls who do not need medical attention as such and are possibly a regular nuisance, but they are in the care of those nurses and should not be ignored.”

A woman, who after the experience of her last operation is dreading the next one, wrote:

“Upon being admitted I was placed in a storage area and left for hours in pain, and alone, and very frightened. A specialist came and took a cursory look and said I was to go home and come back the next day. I live alone and was very unwell to say the least. I became very upset and was treated like a naughty child. I then blacked out and upon waking I was in a bed with some very anxious nurses around me…I had blood poisoning. A nurse later stated that, ‘We have lost patients not as bad as you have been’. Later that night my abscess burst. I called a nurse who looked at the bed and then told me to sleep on a clean bit!”

One of the biggest problems is that of patients being starved. One account describes cleaners who

“put trays at the bottom of beds—unhygienic for a start—then come around half an hour later and lift the trays. Nobody checks to see if the patient has eaten it. It is fortunate if visitors or some of the better patients are around to help the more frail. I never saw any staff feed or help patients to sit up...I hope this is not common practice, but sadly I fear it is.”

I pay warm tribute to the right hon. Member for Cynon Valley (Ann Clwyd). That was an incredibly moving speech—we could have heard a pin drop in the House of Commons throughout those eight minutes—and a fantastic contribution to the debate.

I had intended to make a statesman-like speech, but sitting next to me is possibly one of the greatest statesmen, my right hon. Friend the Member for Mid Sussex (Nicholas Soames). I do not want to go out and bat on a losing sticky wicket; I would rather have a general thrash around the field of play. I admit to the right hon. Member for Leigh (Andy Burnham) that I am a Eurosceptic. When I came to the House of Commons, I fell into bad company, including my hon. Friend the Member for Aldershot (Sir Gerald Howarth). Indeed, when I arrived here, I was nursed at the bosom of my hon. Friend the Member for Stone (Mr Cash), so I am a Eurosceptic—[Interruption.] Anyway, I want to crack on.

In 2011, I attended a public meeting in my constituency. We were discussing the future of an urgent care centre. Five hundred of my constituents were there for a lively debate, which ended at about 8.30 pm. I had arranged at 9 pm to travel northwards in my constituency to Hoddesdon to meet 12 or 14 Polish people. As I left the room of what I would regard as fairly natural Conservatives and got in my car to drive up the A10, I thought, “Why on earth am I heading up the A10 to meet 12 or 14 Polish people?”

I was pleased I did. They waited in a circle to see me. We were in a recession at the time, but their eyes were gleaming and glittering. They said, “Mr Walker, this is the land of opportunity. It is fantastic. You don’t just get one job here; you can have two jobs. If you do those jobs really well and do what you are asked to do, you get promoted. This is a fantastic country.” It was so refreshing to see such enthusiasm in the room.

We should have had transitional measures in place when the Poles came over to this country. It was not good enough to say, “There might be 15,000 or 30,000,” when 500,000 ended up coming here. That was a grave error. However, to say that the Poles are somehow responsible for the country’s problems is a gross simplification and a fairly disgraceful statement to make. As I have said, I wish fewer had come here, because we should have had transitional arrangements. The infrastructure was not ready to welcome 500,000 people to this country, but I cannot fault them for a second for wanting to come here.

People say that people from eastern Europe want to come to this country to sponge off the NHS and our welfare system. The minority will, but the majority want to work hard and do the best for their families. There are rotten apples from European nations in this country, but there are quite a few rotten apples from this nation in foreign countries—hon. Members might have managed to see that a British fugitive was arrested by Spanish police yesterday on the Costa del Sol.

Immigration is not a uniformly good thing. It tends to work for the middle classes and the upper middle classes, whatever they are now. Basically, it works for people with money. Immigrants work very hard in our restaurants and cleaning our offices. However, immigration does not work so well if people are competing for scarce resources such as health, transport and education. I understand the concerns of people who now face additional pressures on scarce resources. We did not plan well. I do not want to sound overly partisan, but—dare I say—the previous Government did not plan well for the upsurge in immigration, which has created difficulties in our constituencies and a great deal of concern.

In my remaining three and a half minutes, I want to say a few more things about immigration. I am not a soft touch on that matter. I am extremely concerned about the continued underperformance of the UK Border Agency. About six years ago, I made the decision not to deal with immigration cases in my surgeries; I have enough problems from my own electorate to deal with, without having to take up UKBA’s case load as an unpaid officer.

Although our immigration system is improving, it still has a long way to go. It is simply not right that some people in this country should have to wait seven, eight or nine years for a decision on whether they can stay here. That is inhumane—it does not serve them or the taxpayer well. Unfortunately, those people are egged on by fairly ruthless and unpleasant lawyers, who keep lodging appeals and dragging out the process. However, it is we as politicians, of course, who provide the scope and room for those people to pursue those endless appeals processes. We must truncate the appeals process.

I congratulate my hon. Friend on his excellent speech. Does he agree that a system that does not work and leaves people in limbo is neither efficient nor compassionate?

I completely agree. Such a system is not efficient or compassionate and does not carry the confidence of the British people. More needs to be done to ensure that our immigration system carries the confidence of the British people, is fair and rewards immigrants who play by the rules. There has to be a premium for playing by the rules. We have to do something about the immigration system; we have to truncate the appeals process and to deal with people more quickly, including removing them more quickly once a decision has been reached.

I conclude with a few thoughts. I am a great fan of culture; I have travelled the world and immensely enjoyed other people’s cultures. However, I am also a great fan of our culture, which I think is pretty special—indeed, its promotion and protection are probably why most of us have chosen a vocation in politics. Our culture is often caricatured as being about the royal family and maypoles. Those are important—well, the royal family are; I am not so sure about maypoles—but what is our culture? Our culture, which we should promote ruthlessly, is freedom of speech, freedom of association, freedom of thought and expression, and the rights, protection and promotion of women and minorities. That is what being British is all about and what makes this country so attractive to so many people around the world.

I want to say something that I hope will not be misinterpreted. If people want to come here and make a positive contribution, that is fantastic. But people coming to this country should please value and respect everything that it offers them. It really is a great place. We can celebrate other people’s cultures, but we cannot have separate communities and societies in this country—that is not healthy for us or for those wanting to live here who eventually, I would like to think, integrate and become part of what is still a great place to live.

I am afraid I am running out of time, which probably comes as a great relief to most Members. I would just say that I am a world-expert moaner; if the Prime Minister even thinks about me, it is, “Oh my Lord! There goes Charles Walker moaning away again—the moaner-in-chief.” Actually, however, we are not in a bad place in the United Kingdom. Look at what is going on in Italy, Spain, Greece and Ireland. Things are pretty good here. I am sorry to say this to my Liberal Democrat hon. Friend, the Minister of State, Department of Health, but I am the first to whinge about the coalition. However, we are not actually in a bad place and in the final analysis, we should be grateful for what we have.

I welcome the fact that we have a Care Bill to debate. I pay tribute to the hard work of colleagues on the Joint Committee on the draft Care and Support Bill. I also welcome the fact that the Government have taken on board a number of the Committee’s recommendations. However, some have not been adopted. I want to speak about the areas where the Bill could be improved and strengthened: the identification of carers and, as the right hon. Member for Sutton and Cheam (Paul Burstow) mentioned, the clauses relating to young carers.

Does my hon. Friend agree with the National Young Carers Coalition, which has written to all Members pointing out that the Bill does not do enough for young carers and needs to be amended so that there is a greater responsibility for identifying young carers? Does she agree that the Government should have taken heed of her excellent private Member’s Bill and incorporated it into the draft Bill?

I am absolutely bound to agree with that point, and I will come on to it shortly.

As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.

The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.

When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.

I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

Last week, I had a telephone call from a young man who is caring for his father. His father has the same condition as my husband, and he contacted me because of the debate we had on dementia. He told me that he had phoned his social services department twice and the psychiatric nurse twice to ask for help and support. He did not know where to turn. Is this not increasingly the problem? There is just no money: no money to provide the assessments and no money to provide the care if those assessments are carried out.

I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.

The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?

I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

I represent a Lincolnshire seat. I wish to say a bit about opinion in Lincolnshire and relay it to the House, if Members are not already aware of it from the local election results.

Coincidentally, today is the feast day of St Earconwald, who was born in 693 in Lindsey, north Lincolnshire. Various miracles were attributed to him. For example, when he was elderly and in his wheelchair, the wheels fell off but it kept going. I am reminded of how the coalition still keeps going, despite its wheels occasionally falling off. I think we may come to a time before the end of this Parliament when, such is the divergence of opinion—perfectly honourably felt—between very honourable people such as the Minister on the Front Bench and me, that for the sake of the nation we may have to bring this coalition to an end and honestly put our separate programmes to the people.

When?

I have no idea when that will happen.

I said I wanted to talk about opinion in Lincolnshire. Despite all the Government’s success in their central aim of attempting to cut the deficit—we have cut it by a third—people there undoubtedly feel that their voice is not being heard. We have to listen to that voice. If I may be forgiven for being party political for a moment, I should point out that there is absolutely no enthusiasm for the Labour party, because people have not forgotten who created the borrowing mess we are in. We heard a lot about plain packaging from the right hon. Member for Leigh (Andy Burnham), who led for the Opposition today, but the whole Labour party is plain packaged. We have no idea, frankly, what it will do.

I cannot speak for all parts of the country, but I campaigned in the recent county elections in Lancashire and there was huge enthusiasm for the Labour party.

We will have to see what happens in various parts of the country.

It is said that this is a thin Queen’s Speech. As a Conservative, I do not object to a thin Queen’s Speech. I do not object to deleting unnecessary legislation either, whether on minimal alcohol pricing or plain packaging. I view all these as creatures of the nanny state, so it is good conservatism that we are not introducing them. However, if we are to have a Queen’s Speech that is, shall we say, somewhat light and has lots of room in it, that means there are various other things that we could do. One thing we do not need to do, I would have thought, is persevere with the Marriage (Same Sex Couples) Bill. I will not repeat all the arguments, but this is an area where many people in Lincolnshire feel that their opinions are being not represented.

If anybody wants to look at an excellent article on this subject, they should read Charles Moore’s in The Daily Telegraph on Saturday. There is a real problem. We are trying to deal with an economic crisis and the very first thing we will do after this Queen’s Speech debate—although it was not mentioned in it; as far as the Government are concerned, this is the Bill that dare not speak its name—is have two days on same-sex marriage. The Bill will then go to the House of Lords. There are enormous, complex issues at stake for the Church of England. I have no doubt that we are moving to a world in which the Church of England will be allowed to conduct only religious marriages, but will not be able to complete them. They will have to be completed by the state because of equality legislation. These are serious issues. The Government could easily mend fences with many of their supporters by putting the Bill out to further consultation.

If the coalition survives longer than the hon. Gentleman suggests, does he think that next time round it might be an idea for the Government to have a debate and then produce a Queen’s Speech, rather than producing a Queen’s Speech and then having a debate about what should not be in it?

That is an interesting argument. I have appended my name to the important amendment to the Queen’s Speech, and we should have a serious debate on the issue. This is not Conservative Members of Parliament obsessing about Europe; this is a real issue for people. It is no longer a dry as dust issue.

In Boston, a seat with a 12,000 Conservative majority, UKIP won nearly every council seat two weeks ago. Unlike my hon. Friend the Member for Stone (Mr Cash), the people there are not particularly worried about all the details of European legislation, but they are worried about immigration. I echo what my hon. Friend the Member for Broxbourne (Mr Walker) said in his very measured speech: people in Lincolnshire are not closet racists. They welcome Polish, Lithuanian and Latvian people, but they want their public services to be supported, when, on the coast of Lincolnshire, public services are overwhelmed. Since 2004, 1.1 million have arrived in this country from eastern Europe, and we have to address that issue.

Will my hon. Friend give way?

I am sorry; I have only a short time left.

Speaking personally as a comfortable, middle-class person living in the hinterland of the beautiful Lincolnshire wolds—where, incidentally, we held all the seats we were defending—and in a comfortable part of London, I have no angst about Poles. They are hard working, and I think that most of them will go back. Their religion is estimable, and I have no complaint whatever against them. But we should listen to the people who are worried about public services, and this is therefore a European issue.

I personally believe that we should listen to those people and that we should have a referendum. I would also say to my right hon. Friend the Member for Mid Sussex (Nicholas Soames) that I believe that the Prime Minister is absolutely a man of honour and a gentleman, and there is no doubt in my mind that if he is still Prime Minister in 2017 we will have that referendum. The trouble is that ordinary people—if I may use that expression—do not think like us. They do not think in terms of four-year Parliaments; they think about now. The question they ask is, “If this is such an important issue, why can’t we have a referendum in the next two years?”

There should at least be a mandate referendum that we can put to the British people, asking whether we should have a new relationship with Europe based on political co-operation and economic free trade. If we fail to listen to the people, we will create a sense of alienation and, despite all our success in driving through the Government’s central economic policies and tackling the deficit—the reason that the coalition was created and what we are really about—that would eat away at the support for the coalition. A sense of alienation is created when people are worried about their public services.

People are worried about other issues as well. In the middle of my constituency, the Government are erecting wind turbines more than 150 metres high—taller than the highest point in the Lincolnshire wolds—that are being paid for by ordinary people living in terraced houses in Gainsborough. They are paying £100 a year, and the money is going straight into the pockets of rich farmers, all in the name of dealing with global warming—if indeed there is global warming, if indeed carbon emissions are causing it and if indeed wind farms will make any difference. That all adds to people’s sense of alienation.

People also worry about the budget for international development. I am personally in favour of spending money on international development, but we have a commitment to spend 0.7% of our gross national product, for which there is no scientific basis. As we reduce the number of staff in the Department for International Development, we are loading more burdens on the remaining staff to hand out more money. That is simply not good economics. It is not a good way to run a Department.

I do not believe we should ring-fence the budget of any Department. We should spend wisely and carefully on the right things at the right time. Whether we are talking about same-sex marriage, about the EU referendum or about the DFID budget, we must recognise that people are feeling a sense of alienation, and that good, strong Conservative voters do not feel that their Government are representing them all the time. Let us also put the focus on the Labour party, but let us concentrate on the core issue of getting rid of the deficit. Let us make that the successful mission of this Parliament.

It is a pleasure to follow the hon. Member for Gainsborough (Mr Leigh) and to speak in the debate on the Gracious Speech to both Houses of Parliament.

I do not know about you, Madam Deputy Speaker, but I sense some confusion or dysfunction in the air—it started with the weather: first, we thought it was spring, and then found that it was not—which seems to have got down to the Government. Let me provide some examples. The Government want us to build more conservatories, but at the same time they are asking people to downsize to other properties. Over lunches, they are giving the benefit of the doubt to some companies minimising their tax bills, yet are not giving the benefit of the doubt to those who have to turn up to Atos assessments—even though they are in a wheelchair or have other long-term conditions. That is very dysfunctional.

Mr Qatada has been given £500,000 in legal aid, when he could have fought his appeal from abroad, but, with the cuts in legal aid, my constituent, Mrs Pressdee, cannot find a legal aid lawyer to help her from losing her home. What about the statement that Eton produces people who dominate Government because of their commitment to public service? I always thought there was a link between Eton and the Labour party, the Woodcraft Folk, the girl guides and the boy scouts, which are all committed to public service. Curiously, however, the number of public sector workers, who have a commitment to public service, has been decreasing over the last 13 quarters.

Let us deal with the commitment in the Gracious Speech to the reform of long-term care. This can be achieved only on the back of moving money from the health budget to social care, which the previous Secretary of State for Health had already started to do. This commitment in the Gracious Speech has been made against the backdrop of nurses and junior doctors saying they need more staff and that they are overstretched, but there is no commitment to staffing ratios.

About £10 million was spent on the Francis report, but its recommendations on the health service they have been practically discarded by this Government. Instead, the Secretary of State for Health is suggesting what can be described only as a vanity policy—he wants a chief inspector of hospitals. He was unable to tell me how much the chief inspector would earn, where the budget was coming from, whether this counted as committed spending, whether the Treasury knew about it, or whether it was to be taken out of the Care Quality Commission budget. This was not a recommendation that either Robert Francis or the Health Select Committee made. The Health Service Journal surveyed senior people in the hospital sector, 73% of whom said they did not believe hospital inspectors would be effective. This is a headline vanity policy.

The Francis report was not about sticks or the smack of firm government, but about a change in culture. Francis said that there should be one organisation undertaking the monitoring of organisations’ ability to deliver compliance of fundamental standards. At the moment, we have the CQC, Monitor and now the chief inspector who will apparently have the power to close hospitals. The Secretary of State made a comparison with Ofsted earlier, so let us remember Helen Mann, a head teacher who was so terrified of an Ofsted inspection downgrading her school from outstanding that she hanged herself. Is this what we want our public servants to do? In any case, it was not Ofsted, but the hard work of teachers and pupils that drove up standards. Here is the chaotic part: for a top-performing hospital, there will be lower regulation. How can that be fair? The Secretary of State was unable to tell the Select Committee how long these top-performing hospitals would be able to keep their top rating. That is a recipe for chaos. And what will be monitored? Again, the Secretary of State was unable to say. Will it be mortality rates, success in surgery or what?

I would like draw hon. Members’ attention to an article by Professor Nick Black in The Lancet in March 2012, in which he discusses the myth that grew up—that productivity in the NHS was falling—and warned of the dangers of using one set of indicators. That is exactly what happened at the Leeds hospital. The Secretary of State has conceded that the data were not verified when Sir Bruce Keogh made the decision to close children’s heart surgery, leaving parents and professionals confused and anxious. Whoever has the ear of the chief inspector and has their own data could therefore damage a hospital.

Let me deal now with the Gracious Speech’s reference to improving the water industry. Members may like to know that Thames Water, which is controlled by an Australian bank, now proposes to recycle sewage water for drinking, yet fails to mention investment in infrastructure or the leaking pipes that caused the shortage in the first place. All that was despite the fact that the company had made £552 million in profit by the end of March 2013. I ask the Government to look further into that.

This Gracious Speech should be based on justice, tolerance and the rule of law, yet all that is being undermined. The gracious people of this country, on whose behalf the Gracious Speech was made, deserve better.

My speech will be in two halves. I shall talk first about health care issues, as this is a health debate.

I welcome the Care Bill, particularly its commitment to social care. I feel that words such as “compassion” are sometimes missing from our discussions on health care. Before I say more, let me welcome publicly, for the first time, the right hon. Member for Cynon Valley (Ann Clwyd) to her position as head of a review body that will examine NHS complaints.

As many Members know, I was a nurse in a former life, and it was a profession that I absolutely loved. I was, I think, a committed nurse. I lived in a nursing home, and often worked for more hours than I was supposed to. I would go into the hospital on my days off to visit patients who had no relatives. I was not alone in that; most of the nurses in my nursing home behaved in the same manner. I pay tribute to a nurse who started work on the same day as me, on 5 November 1975: Helen Windsor, who contacted me recently. For all these years, she has been delivering the same committed care that she delivered in 1975.

I suppose many people will say that that was a long time ago, and it was, but I think that qualities such as compassion, kindness and caring are timeless. It does not matter when they were being delivered; they should be delivered in the same way today. Unfortunately, however, I—like many other Members—regularly receive complaints from constituents about the standard of nursing care. I mentioned Helen Windsor because I want to pay tribute to the nurses who deliver good care.

I recently visited a constituent in hospital, an 89-year-old man with no relatives. It was interesting that the right hon. Member for Cynon Valley mentioned nail clippings, because I had already written down that I intended to raise the subject. That constituent was agitated because his nails were serrated and were catching on the cardigan that he was wearing as he sat in his chair. When I asked the nurse whether she could cut his nails—he said that he had been asking for it to be done himself—she replied “No, I can’t. We are not allowed to do that.” So I took an emery board out of my handbag and filed his nails myself. I know that sometimes, as Members of Parliament, we feel that we are social workers, but I had never imagined that I would extend my role to the nail care and general hand hygiene of a constituent in hospital—but I did.

Unfortunately, on a number of occasions recently I have sat in a hospital and witnessed nursing care being delivered to my own daughter. Only a few weeks ago, when she was on a hospital trolley waiting to go into the operating theatre—distressed, anxious, upset—we witnessed nurses holding conversations over her head about intimate details of their love lives and their social lives, which, while she was in pain, my daughter had no interest in hearing. Not only was she subjected to those intimate details of their private lives; she was also subjected to a lack of care. She was completely ignored on that trolley. Yes, she was about to go into an operating theatre and be dealt with, but it is when patients are in that condition that they need nursing care most. They need to be reassured. They need to be calm. They need to know that everything is going to be OK. However, there was no interest in that.

The most appalling thing that happened was that, just before my daughter went into the operating theatre, one nurse told the other that she was going to the bathroom, and then gave exact details of what she was going to do there. I cannot think of a more polite way of putting it in the Chamber. It was a totally inappropriate conversation to be having outside the doors of an operating theatre.

A constituent who recently came to see me in my surgery told me that, when in hospital following a road traffic accident, she had noticed after a few days that her bottom sheet had not been changed and was bloodstained. Each day she wrote the date around the border of the bloodstains. When she left hospital 10 days later, she left that bottom sheet for the nurses to see, with the dates written in a pattern around the bloodstains. During those 10 days, no sheets had been changed. We used to change the sheets every day, and that was possibly excessive, but I think that, given that we are constantly trying to find ways in which to deal with, beat and get on top of hospital-acquired infections, bloodstained sheets indicate a lack of care.

I do not want to labour the point about complaints, because I know that a number of other people have already done so, and I feel that it is now the remit of the right hon. Member for Cynon Valley. Rather, I want to discuss immigration and its impact. We send £53 million per day to Europe, which limits our dealings with the rest of the world—in fact, the Prime Minister is trying to tackle that issue today. Labour will not commit to a referendum. Do Labour Members not see that that £53 million a day could be spent on dementia care, on Alzheimer’s care, on young carers? There are so many things we could do with that money.

People were asked one question when we went into the Common Market: do you want to go in, yes or no? They should be asked the same question to exit. If we can go to the electorate on behalf of the Liberal Democrats with a referendum on the alternative vote in a matter of months, why do we have to wait years to offer them a referendum on an issue as big as the European Union? Do we not realise what a self-serving, self-interested bunch we seem to people out there, when we can call an expensive national referendum on AV, yet obfuscate and delay on the question of European Union membership?

It is no good saying that people are not interested in this issue, because they are: it is the subject of almost every other question I am asked when I go out in my constituency. People now know exactly how much we are spending on the European Union, and they do not believe that leaving will cost us 3 million jobs. They would like a piece of the action in China, which reported growth of some 9.5% in the past year. They want some of the action taking place in the BRIC countries. That is where they want to trade—not in a sick and failing Europe that is getting sicker by the day.

I want to add my voice to those who have spoken out on this issue, and I would definitely join the two Cabinet Ministers in voting to be out. I would vote no tomorrow, and I know many of my constituents would. I completely support the measures in the health Bill in the Queen’s Speech, which will be well received by everybody, but I want to add my voice to the case for an in/out referendum. We must find a way to deliver that. We know that the Prime Minister means what he says; but if we can do it on AV, we have to do it on the EU: otherwise, people will not believe us.

I have to say to the hon. Member for Mid Bedfordshire (Nadine Dorries): welcome back to the Conservative party. I heard what she has been saying today from the Conservatives about 20 years ago. It led to their spending 13 years in opposition, and I hope it has the same result in a couple of years’ time. I look forward to that.

This debate seems to be more about what is not in the Queen’s Speech than what is, but immigration and access to the national health service are addressed, and the tone of this debate has been quite distasteful. We know that, from time to time, some of our constituents go to work in other European economic area countries; they pay their taxes and social insurance contributions there, and as a consequence they are allowed to obtain health care in those countries. Immigrants are not coming to this country to use our national health service, and they do not use it for free: they pay, as they should.

We need be very careful when we talk about people moving around Europe. Tens of thousands of our fellow citizens have gone to live in Spain, Portugal and France, not to work but to retire. If they return to this country en bloc, consider the impact on the health service, social care and care for the elderly. We need to have a rational debate on this issue.

In the last Parliament, I was privileged to serve on the Communities and Local Government Committee. We produced a report on community cohesion and integration under the right hon. Gentleman’s Government. It said that the pace of change, the resources and facilities were all wrong, and many of the communities we visited said that. He needs to show a little humility when talking about immigration and numbers, because his own Government condemned the situation in that report.

It was not a Government report but a Select Committee report, and I do not remember it, quite frankly.

Community cohesion is important and has been important in this country for centuries—not just since we joined the European economic area or the EU expanded to 27 countries, with people having the right to come and work here, as indeed we have the right to go out and work in other EEA countries. A lot of this debate is distasteful and is not the truth. In a recent by-election, a political party that is not represented here and I hope will not be was saying that, as of January next year, probably nearly half the population of Bulgaria will come and work in this country. That is nonsense, and neither Back Benchers nor Front Benchers should have a knee-jerk reaction to that type of debate. We should have sensible debates about what immigration does or does not do in this country.

Can the right hon. Gentleman provide evidence for his numbers? Can he tell us how he knows what the numbers will be? Can he quote from some extensive research that proves this?

I was quoting from the rhetoric put into the daily press during the Eastleigh by-election. I think the figure given was that about 3 million Bulgarians will be coming to this country—

How does the right hon. Gentleman know that that is not the figure?

If the hon. Lady will keep quiet, I can tell her that that was what was said, but there are fewer than 8 million Bulgarians living out there. Many Bulgarians have been living and working in this country for many years, because they met criteria outwith the criteria laid down when Bulgaria and Romania joined the EU. The whole debate is disgraceful, and we should get it into some perspective.

Will the right hon. Gentleman give way?

No, I have given way twice and I am not going to give way any more.

What is not in the Queen’s Speech? Public health has been mentioned by several people. I served on the Bill Committee for what became the Health and Social Care Act 2012. I will leave the reorganisation of the NHS for another day, but at the time the Bill was going through, the defence given by Ministers was, “What we will start doing is putting real measures down, and for the first time ever we will put in statute a responsibility to reduce health inequalities in this country.”

Two policies that most people involved in and concerned about public health thought would be in the Queen’s Speech are absent. One is the minimum pricing of alcohol, which was talked up by the Prime Minister over many months. There is evidence that it will stop some people drinking excessively. I served on the Health Committee in the previous Parliament, and just before the general election we published a report on alcohol. People ought to read it to see exactly what is happening. One of the worst statistics was on the people who are likely to die from alcohol-related diseases—certainly cirrhosis of the liver. Thirty years ago, they were people like me—men in their 60s—but now, men and women in their 20s are dying of that disease. This House has a responsibility to do something about that.

The other area that I wish to discuss briefly is the absence of legislation to bring in standardised packaging of cigarettes. That has also been talked up, not only by the Prime Minister but by others. The consultation on standardised packaging started on 16 April last year and ended on 20 August; now, nine months later, nothing is going to happen. I am deeply concerned, and I will tell Members why, although there can be no surprises about me and tobacco, because I have been on an anti-tobacco crusade in the House for nearly two decades. In my borough—I represent a third of it—there are still some 48,000 smokers, and although the number is declining, it is likely that more than 950 young people between the ages of 11 and 15 will take up smoking this year, and half of them will die a premature death. This year, more than 100,000 of our fellow citizens will die a premature death from using tobacco as instructed to by the tobacco companies. If half that many people were dying of anything else in this country, this House would be up in arms about such a massive number of deaths. In the past few months, what we have had is Ministers talking up the idea of legislation further to protect young children from starting smoking, but none of that has come about.

When the right hon. Gentleman chaired the Health Committee, it published the report that led to the banning of smoking in enclosed public places. That ban was only secured by a free vote in this House. Does he agree that, if we cannot get the Government to act, we need a free vote so that we can make the change in that way?

I shall be putting my name in the ballot for a private Member’s Bill in a few days. If I am successful as I was in 1993, the right hon. Gentleman will have a Bill on standardised packaging on which to vote.

The Government have ducked the issue. There has been some influence—many people say that Lynton Crosby, who has come along to advise the Government, has had that influence, but I will not make that accusation. I wrote to the Prime Minister last week to ask several questions about whether Lynton Crosby has been involved in giving any advice in political circles in this country. Lynton Crosby is advising the Conservative party about re-election, but I want to know whether he has been involved in this area, given his record both politically with the party that he ran, and with his company’s work with and the money it has taken from tobacco companies.

The right hon. Member for Sutton and Cheam (Paul Burstow) is quite right to say that in 2006, when this House took a decision on smoking in public places, Members of this House had a free vote. I was effectively the architect of that free vote, because I tabled an amendment signed by 10 members of the Health Committee and I negotiated a free vote with my own party, as one was being offered by the then Opposition. On that major public health measure, this House was trusted to take the decision itself. Yes, we were lobbied by our constituents. There is nothing wrong with that—after all, it is what we are here for, although we cannot represent them all, as some people seem to think we can. The House was trusted to make that decision and the then Government, to their credit—they should have been awarded that credit—allowed it to do so. Many people were against that, including the Prime Minister, who has said since that he thinks it is the best piece of legislation that ever went through this House.

I say to Ministers that, whether it is because of strings being pulled by people close to the tobacco lobby or because of anything else, we cannot tolerate their not taking further action against tobacco when it is killing 100,000 of our fellow citizens each year. It is about time that someone showed some courage, stood up for ordinary people and for good public health measures—not nonsense measures—and did something to stop the dreadful premature deaths in this country.

I must say at the outset that I am disappointed that no day has been set aside for us specifically to discuss defence and foreign affairs, because we face some pretty severe challenges around the world and, of course, our armed forces are undergoing major change. Such a debate would have provided me with a further opportunity to argue that we should not spend another £2.5 billion on overseas aid this year and that we should divert that money to our armed forces, which are very hard-pressed.

I understand my hon. Friend’s argument, but I disagree with it. I respectfully ask him: what is the right amount to spend on international aid?

It is a question of priorities. Our level of aid is such that the Prime Minister can say, with great justification, that Britain has given a lead in the world, but the figure of 0.7% is entirely arbitrary. I would submit that there is no natural level for the amount of aid to be given. I am not an opponent of overseas aid; I just believe that there should be other priorities at the moment.

I do not wish my speech to be a negative one, and it was written not by Mr Lynton Crosby but by myself. I welcome some aspects of the Gracious Speech. The first is the continuing priority to cut the budget deficit. It was pretty nauseating to listen to the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), and to hear him demand more money here, there and everywhere. He was part of a Government who destroyed the public finances of this country. That is why we have to make cuts. These cuts are Labour’s cuts across the country, because Labour destroyed the public finances by running up an impossible debt.

Secondly, I welcome the confirmation that we are going to pursue further reforms of the benefits system. It has been most encouraging to see how warmly the country has received our changes, particularly the £26,000 limit on families receiving benefits. The Philpott case was an eye-opener to many, highlighting that far too many people in this country are living a wholly immoral lifestyle on public finance, and we need to crack down on that.

Will the hon. Gentleman give way?

As the right hon. Gentleman would not give way to me, I am rather disinclined to give way to him.

Will the hon. Gentleman give way?

I will come back to the right hon. Gentleman in a minute.

Thirdly, I welcome the further attempts to bear down on regulation. We need to do much more to liberate businesses from regulation, but we are, of course, inhibited by Europe, on which I wish to say a few words later.

Fourthly, the reform of long-term care arrangements has not come before time. I recommend to my Front-Bench colleagues an excellent publication from March 1997 called “A New Partnership for Care in Old Age.” We had a tremendous scheme then, which unfortunately we were not able to implement because power passed to Labour, whose Government did nothing in the 13 years when they had stewardship of these matters. I also welcome the measures to tackle immigration, although I suspect they will have limited effect.

Finally on the good news front, I think the Prime Minister has done a fantastic job of promoting Britain’s interests overseas, particularly in developing overseas trade. We have seen some reflection of that in increased trade with non-EU countries, as against trade with the EU, which, as we all know, is in meltdown.

Two issues were not mentioned: gay marriage and Europe. My hon. Friend the Member for Gainsborough (Mr Leigh) set out why the same-sex marriages proposal is a complete diversion. We should not be doing this: the Government have no mandate for it, it is deeply divisive, particularly among many Conservative supporters, and I think we should drop it here and now.

Immigration is a big issue and it is relevant to this debate, as the Government are seeking to put in place changes to prevent people from benefiting from our taxpayers’ money by coming to this county simply to tap into our health care system. There have been encouraging signs. The observations made by the right hon. Member for Rother Valley (Mr Barron) show precisely what has been wrong in this country, in that anybody wishing to speak up on immigration has been told that their tone is wrong, or this is not the right time, or they are insensitive. His Front-Bench colleagues have now recognised that the kinds of policy he supports have been deeply damaging to his party. Labour supporters are as concerned about immigration as Conservative supporters and, I suspect, Liberal Democrat supporters.

My hon. Friend is making a powerful case. Does he agree that we should take the blandishments of the right hon. Member for Rother Valley (Mr Barron) in respect of Romania and Bulgaria with a pinch of salt, given that the Labour Government predicted that between 13,000 and 15,000 eastern European citizens would come to the UK, yet over 1.2 million have come here since 2004? Labour got the figures catastrophically wrong.

My hon. Friend is absolutely right. I was going to tell the right hon. Gentleman that some 1% of the Romanian population of working age, which is 150,000 people, have indicated that they wish to come to this country, as have 4% of the 4.9 million Bulgarians of working age, which is another 200,000 people. That is another 350,000 people. We cannot go on building houses and cities. As MigrationWatch has said, we will need eight cities the size of Birmingham if we are going to accommodate all the people who wish to come to this country.

I welcome the fact that the Opposition have at long last recognised that this is a serious issue. They have not a snowball’s chance in hell of being re-elected unless they are prepared to recognise the concerns of the British people. Under Labour’s stewardship, there was a deliberate act of policy: Andrew Neather, a speech writer at No. 10, said immigration was being positively encouraged by the Labour Government in order to

“rub the Right’s nose in diversity.”

They knowingly inflicted this on the country—it was not done by accident—and they left this Government with the most awful backlog of cases to deal with, which is unfair to those who ought to be allowed to stay in the UK and to those in our country whose lives are affected by the presence here of people who should have been deported.

The Select Committee report “Community Cohesion and Migration”, which Labour Members seem to have forgotten about, stressed that second and third-generation immigrants were as resentful as the native British population, because the necessary resources were never provided by the Government, who encouraged so much immigration so fast and without preparation.

My hon. Friend is absolutely right. Immigration is imposing burdens on our services, such as the health service and social services. I am seeing that in my own constituency. We now have some 10,000 Nepalese, mostly elderly, who have come to the United Kingdom as a result of the politicians’ caving in to the campaign run by an actress called Joanna Lumley. That has resulted in a fundamental change to the nature of Aldershot that has deeply upset my constituents, who are entitled to express a view without being told that they are racist. They do not like seeing their locality changed—[Interruption] I wish the right hon. Member for Rother Valley would shut up—because of something on which they were not asked for their opinion. When they do express an opinion, they are dismissed as being racist.

The projection that the United Kingdom’s population is likely to reach 70 million in the next 15 years means, as I said, that we will need to build eight large cities outside the capital during that time—in other words, one home every seven minutes, day and night, just to house new immigrants unless the Government are able to continue their progress in tackling immigration. The 2011 census revealed a mass exodus of white British from the city of London—a fall of 600,000 between 2001 and 2011. Almost half the population of Ealing and Hammersmith were born outside the United Kingdom. These are fundamental changes to the nature of our country. The people of Britain are entitled to express a view on the composition of their country. Last week there was a story in the Evening Standard about Harris Primary Academy Philip Lane in Haringey, where 59% of the 463 children are on free school meals, 79% have English as a second language, and Somali and Turkish are the most prevalent languages. What are we doing to our country? We have to take sterner action, and I recommend that to the Government.

Let me turn briefly to Europe, which the right hon. Member for Leigh dismissed as irrelevant and not a great issue that should be addressed, although he had no answer to the challenge by my hon. Friend the Member for Gainsborough. This issue is not going to go away, and it is of great concern to people in this country. Our European partners are determined to create a united states of Europe, which is not what the people of Britain want. The Prime Minister is entirely right to seek to renegotiate. He is also right to have a referendum. Like my right hon. Friend the Member for Mid Sussex (Nicholas Soames), I profoundly believe that he will deliver that referendum after the next election. The trouble is that people are uncertain about whether we are committed to that. The way to deliver it is a new Act of Parliament during this Parliament to determine that there will be a referendum during the next Parliament.

It is a pleasure to speak in this debate and to follow the hon. Member for Aldershot (Sir Gerald Howarth), although obviously I would not necessarily agree with all his comments.

I was not going to say anything about immigration, but sometimes we need to look to ourselves when we talk about that subject. I suspect that there is not one individual here who has not had at one point in their background an immigrant who came to the United Kingdom. Those who talk about the “native British” need to reflect on the fact that Britain has always had immigrants—from the Vikings to the Huguenots and from the Dutch to the Irish. My father told me that our family were descended from members of the Spanish armada who were shipwrecked off the north coast of Ireland when they were trying to avoid the English fleet. We need to reflect and have a rational debate about immigration, not the hysteria that there sometimes is in this House.

Will my right hon. Friend give way?

Very quickly, because I want to get on to the main substance of my speech.

Should we not get some of the figures clear in our heads? According to the Department of Health website, the actual cost to the NHS budget of the amount spent on foreign nationals is a mere 0.06%. This is not something that we cannot afford.

As I have said, I do not want to go down that track but, having been nursed in a UK hospital by non-indigenous British staff, I think we ought to be more balanced in our comments on immigration.

The main focus of this debate—health and social care—is a vital issue for many people; even if they do not think so at present, it certainly will be in the future. As we are all aware, the changing demography and advances in modern medicine and technology have thrown up challenges to our society in how to develop the capacity for social care and, indeed, how to pay for it. The issue is not unique to the United Kingdom; it is a challenge in many countries across the world. As has already been said, the Administrations in Wales and Scotland are developing their own policies in the realm of social care.

Although the legislation under discussion relates to England specifically, I want to discuss some general issues that cut across the debate in the whole of the UK. Like my colleagues on the Opposition Front Bench, I welcome some aspects of the Care Bill, which builds on the work undertaken by my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, when he was in government. I hope that the Bill will simplify the existing regulations, provide some confidence that lifetime assets will not be swept away by care costs, and—I stress that I hope that this will happen—eradicate the postcode lottery of care, introducing an element of consistency to the system. The Bill should also give stronger legal rights to carers—I echo the words of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)—who are often the forgotten players when we debate social care.

Having said that, there are still some major areas of concern and I want to concentrate on them. Frankly, they throw up challenges for everyone in this House, regardless of which political party we belong to. I am not convinced that the Government have thought through where young carers fit into the big picture painted by the new Bill. It is, of course, a welcome development that, for the first time, councils will have to meet the eligible needs of carers for support. I also welcome the aim for a family assessment, which in some areas should pick up the pressures on young carers.

Many organisations representing young carers, however, feel that many concerns have not been covered adequately. The well-being of young carers very much depends on the level of support that the person they care for—more often than not their parent—receives. If that support is not adequate, an unacceptable pressure remains on young people who should, to be frank, be doing other things. Council budgets are being stretched and care and support is being restricted in many instances to those who have critical or severe needs, so an unacceptable burden is still being placed on young carers who support family needs but who will not meet the new exacting standards.

I do not want to reiterate some of the points that other hon. Members have made about the need to move from the current random method of identifying young carers to a more systematic approach. I want to spend a few moments on the issue of working-age people who need support from our social services. Too often the debate on social care concentrates on older people, but it should not focus on them alone, because the reality is that about a third of people who rely on support are of working age and they are often forgotten. I am sure we will all agree that a younger person’s need for support from the care system is not necessarily the same as that of an older person. To that end, the all-party parliamentary groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler), as chair of the local government all-party parliamentary group, and Baroness Campbell of Surbiton and myself, as joint chairs of the disability all-pary paliamentary group, were delighted that 10 parliamentarians of all parties and from the Cross Benches in the Lords agreed to undertake an independent inquiry.

The report will be launched officially on Wednesday, so I will not pre-empt its findings. I hope that colleagues will take time out of their schedules to come along and hear what the disabled people, organisations and experts that appeared before the inquiry committee said. The evidence is powerful and I hope that people will read it. When we debate health and social care over the next few weeks, I hope that we will listen to the voices of the people who matter: the people on the receiving end of the system. What they say gives us food for thought and food for action.

It is well documented that more than a third of the people who receive social care are of working age. We must also recognise that most of the pressure and innovation will be at a local level. It is important that we encourage local organisations and local government to ensure that there is innovation in the system. As my right hon. Friend the Member for Leigh said in his opening remarks, there is a funding crisis in local government that no amount of innovation can mitigate. There is only so much innovation that any system can support without the recognition of financial instability. It is not just Labour councils that are saying that to the Government; councils of all political persuasions are trying to persuade the Government that they cannot continue to support the pressure that is being placed on their social services.

Finally, we have spoken a lot about the cap and the protection of assets. The Government have not been clear about what will happen to people who do not have the capacity to build up assets, and I am talking about working-age adults who are disabled who have not had that opportunity. The overwhelming majority of people with learning disabilities will not be affected by a cap because they do not have an asset base to protect.

I hope that there will be a robust, challenging and honest debate about the future of social care.

It is a pleasure to speak in the health and social care debate on the Queen’s Speech, which seems to have been rather wide-ranging.

I pay tribute to the Government for introducing the Care Bill. It shows that they have listened to the concerns of many people. I support the proposals for three main reasons. First, the Bill will put people in control of their care and give them greater choice. Secondly, it will simplify the system and processes to provide the freedom and flexibility that local authorities and social workers need to innovate and achieve better results. Thirdly, it will provide people with a better understanding of what is on offer, help them to plan for the future, and ensure that they know where to go for help when they need it.

The Care Bill is essential to the modernisation of adult care and support in England. One purpose of the Bill is to set out clearly what support people can expect from the Government and what action the Government will take to help them to plan, prepare and make informed choices about their care. I support the well-being principle as an underlying principle for care and the support for carers. However, I urge colleagues in the Department of Health to monitor the implementation of the Bill carefully to ensure that local authorities are completely clear about their responsibilities.

I have a constituent who suffers from an acquired brain injury. His parents sought assistance from the adult care services department of their local authority, Derby city council, and from the primary care trust. Both organisations say that it is the other’s responsibility. That is causing great distress and frustration to my constituent’s elderly parents who are caring for him and his six-year-old child. I have written to both parties, as well as to Ministers in the Department of Health, and so far both have repeatedly refused to take responsibility.

I have also written to Health Ministers about another constituency case. A constituent of mine is suffering from severe chronic pancreatitis and has been told he needs to undergo a pancreatectomy and an islet cell transplant. However, as the national specialised commissioning group has not issued confirmation of funding for an islet cell laboratory in my region, my constituent is left suffering in extreme pain unnecessarily. I would like to see movement on the two cases that I have raised with the Department of Health.

Over the past three years, I have also raised constituency casework concerning the cancer drugs fund, and I pay tribute to my right hon. Friend the Prime Minister who set up that initiative. Some 23,000 cancer patients in England have benefited from the additional £650 million provided by the Government to fund cancer drugs.

Like my hon. Friend, I welcome the cancer drugs fund, which I think is important. About 150 of my constituents will die from cancer this year—about 100,000 people a year. Currently, 15% of 15-year-olds are regular smokers. Does my hon. Friend feel, as I do, that we should have standardised plain packaging of cigarettes to discourage the take-up of smoking and the cancer that results from it?

I certainly do, and having watched my mother die from lung cancer, I passionately believe in anything that will stop people smoking. It is not a pretty sight, and I would do anything to stop young people in particular taking up the drug of smoking. That is important.

I am grateful to my hon. Friend for giving way. Our hon. Friend the Member for Thurrock (Jackie Doyle-Price) mentioned the risk from counterfeit tobacco, which is very serious indeed. There are two risks: first that the substance will be less pure than commercial tobacco; and secondly that the Treasury will lose a tremendous amount of money as the result of trafficking.

There is already counterfeit tobacco, so I do not see that it would make much difference. Those who are drawn to smoking do not go over and buy counterfeit goods; they start off in this country—often under age—by buying cigarettes over the counter. If we can stop that, I passionately believe we should do so, and I am disappointed that that measure was not in the Queen’s Speech.

The cancer drugs fund is a force for good, but in my constituency of Mid Derbyshire, which was covered by the east midlands cancer drugs fund, I have had constituents who were unable to access cancer drug treatment that was available from other CDFs. In one case, if my constituent had lived just 40 minutes down the road in Burton upon Trent in the west midlands, that CDF would have paid for her treatment. She paid more than £60,000 of her own money, but since I first raised the issue she has sadly died. The reforms introduced by the Government from 1 April this year and the establishment of the national CDF will end the unfair system of the postcode lottery. Under treatments now offered by the new NHS Commissioning Board, if my constituent were alive today, she would have access to that treatment.

Will the hon. Lady give way?

I am running short of time; I am sorry but I must make progress.

I urge my right hon. and hon. Friends on the Front Benches to look again at this matter because the Government have set up the CDF to ensure that people get access to the life-saving cancer treatment they need. I have constituents who need access to a form of radiotherapy called “SIR-Spheres”, which is used where bowel cancer has spread to the liver. That treatment is not now available anywhere in the NHS—people can pay for it, of course—although it was previously available in most CDF areas, although not the east midlands. Will the Minister look again at the issue and meet me and my constituents’ hospital consultant, Dr Jamie Mills, to see whether we can make progress?

I recently started working with the British Heart Foundation on sudden adult death syndrome after I was contacted by two constituents whose son, Sam, died suddenly as a result of cardiac arrest. He was 19 years old. SADS claims the lives of at least 12 young people such as Sam every week, but many of those fatalities are completely preventable. I knew a young man in his 20s who died in the middle of his round in a dressage competition. Like Sam, he was a very fit young man. All such young deaths are devastating for everyone concerned, family and friends alike.

The seconds and minutes after someone has a cardiac arrest are vital to ensuring their survival. Cardiopulmonary resuscitation should be used immediately until a defibrillator can be located. If those activities are used together, the potential for survival is immediately increased. In fact, here in the UK, we currently have only a 20% survival rate—that figure is for all cardiac arrests, not just cardiac arrests among young people—but in Seattle, where there is mandatory CPR education in secondary schools, the survival rate has increased to 54%. I am sorry that my hon. Friend the Under-Secretary of State for Skills in the Department for Education is no longer in the Chamber—he was here a few minutes ago. My suggestion is that, if we roll out a schools programme, we could increase survival rates, as more children are trained to undertake CPR and to follow-up with defibrillators.

I am deeply concerned about those figures. I should like to highlight the pressing need for the availability of life-saving equipment and skills in our schools. In the first instance, will the Department of Health work with local authorities through health and wellbeing boards to urge them to consider providing funding to install automated external defibrillators in all schools and other local authority facilities? AEDs are very simple to use, even for the untrained layperson. Detailed instructions on how they are to be deployed are delivered through a set of simple audio and visual commands. The machines are programmed to administer an electrical shock only if the patient’s condition requires it. In order to prevent mortality as a result of SADS, it is essential that those easy-to-use and relatively inexpensive devices are made available in schools.

Further to the availability of AEDs, it is also extremely important that, through citizenship lessons, children of school age are aware of, and able to administer, life-saving treatment such as CPR. Such a scheme would cost local authorities very little, and ultimately has the potential to save many lives every year. Organisations such as St John Ambulance would be able to go to schools to train students and teachers so that they are able to undertake such treatment.

In addition, I should like to point out to hon. Members that the British Heart Foundation provides grants to schools for defibrillators. Many schools are not aware of that. Perhaps MPs on both sides of the House could make schools in our constituencies aware of the grant. I look forward to working with the Department of Health on the issues that I have raised about the cancer drugs fund and on defibrillators.

It is a pleasure to follow the thoughtful speech of the hon. Member for Mid Derbyshire (Pauline Latham).

I congratulate the Government on their fine display of unity on the Queen’s Speech. In all my years in the Whips Office, I cannot recall seeing anything quite like it. In the early days of the Government, the ambition was simple: wipe out the deficit in a single Parliament, set debt on a downward path and restore health to the economy. Hon. Members were to judge success by how the credit ratings agencies maintained the triple A rating. Simple! The Government now claim that their ambition is to cut the deficit by a third, but almost everyone else believes it is more likely to be cut by only a quarter. That is our lot for the rest of the Parliament. Debt is rising, not falling, and triple A credit ratings are but a distant memory.

After the costs in administrative chaos caused by the top-down reorganisation of the health service, which the Prime Minister promised would not happen, the Government are turning their hand to social care. They are right to do so, at least in the sense that social care is a time bomb that desperately needs tackling. My most recent survey of constituents in Selly Oak shows that 73% of them consider care to be an issue of extreme importance, and only 42% think that the quality of care received by someone close to them is satisfactory.

People are struggling—people such as Mrs Hanslow, who cares for her 96-year-old father. She asks only for the odd break, and in the past she has arranged that by phoning a social worker. When she tried that this February, she discovered that the social worker had left. The office said that somebody would phone her back, but nobody did. She phoned again and was told that she needed to make a fresh application; apparently, files and arrangements leave with the social workers these days.

After several abortive attempts, Mrs Hanslow spoke to a nice lady called Wendy, who said that she would sort the situation out. Then a Mrs Collins rang saying that she was arranging for a social worker to come. But guess what? Mrs Hanslow waited in all day and no one came. Frustrated, she rang again and spoke to a Jackie, who could find no record of her application or complaint but said that someone would ring her back. No one rang, so Mrs Hanslow phoned again. This time, people at the office were not so nice. Mrs Hanslow was told that nothing had been reported because the social worker was out of the office.

What the hon. Gentleman is describing is the fault of the local authority, not the Government. The local authority is responsible for social workers, not the Government.

Bad practice is a problem everywhere, and everyone has to take responsibility for it—that is my point.

When Mrs Hanslow got upset and said she would have to cancel her break and lose her deposit, she was told, “That’s up to you.” She did not get her respite care. She is now under the care of the GP, and if she cannot carry on, we will need to find a bed for her dad. Perhaps he will become another bed blocker; there are so many in Birmingham that the brand new Queen Elizabeth hospital cannot cope and emergency wards in the old hospital, scheduled for closure, are reopening.

What about my constituent Margaret McGarry? She has cared for her elderly mother, who now has 9% kidney function and has had a dementia score of six, for about 10 years; if it was not for Ms McGarry’s love and care, her mum would probably be dead. In 2004, her mum received direct payments from Birmingham, which enabled Ms McGarry to hold down her job as well as look after her. The family then moved to Redbridge, but Redbridge decided that Ms McGarry’s mum was Birmingham’s responsibility. Ms McGarry pointed out that she was the carer and that her mum lived with her, but that was not the case as far as Redbridge was concerned. Eventually, the council offered the equivalent of six hours of support, as opposed to the 34 that Birmingham had provided.

Last year, after a hospital experience that almost killed her mum, the family moved back to Birmingham. Ms McGarry’s mum now needs almost constant care. That means another assessment, which takes weeks and weeks. As soon as they moved, Redbridge council terminated the payments. Birmingham’s assessment commenced in August. In November, it recommended fewer care hours than Redbridge and by December still had not paid a penny. As the old lady’s health deteriorates, so does the level of support.

I have had a letter from the man in charge assuring me that the case is complex. One of the complexities seems to be that Ms McGarry has exercised her rights and engaged a solicitor. Apparently, that is a very naughty thing to do if a person is caring for an elderly relative because Ms McGarry has now been advised that all direct payments are being stopped. That is the reality of social care in this country today, and it is against such nonsense that we are asked to have faith that the Government are going to give people more rights. We are asked to accept that £150 million and promises from the Secretary of State will fix the problem. It may have escaped the Government’s notice, but the most recent round of cuts took a further £800 million out of services for the elderly and disabled, on top of last year’s cuts. When will it dawn on the public relations boys in No. 10 that it is pointless pretending they are giving people more rights when they are cutting services to the bone?

Let us examine what the Government are actually doing. They say they are setting a cap at £75,000—£72,000 in the first instance—raising the savings limit to £123,000 and giving a guarantee that no one will have to sell their home. Of course, £75,000 covers only the costs of care, not what is called hotel costs, such as food and accommodation. The cap is not, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out, the amount the individual spends, but the amount a local authority can buy for £75,000. When we add the real costs of residential care, rather than the local authority rate, to the hotel charges, it is much more likely that an individual will spend at least double that amount before the cap kicks in.

The £123,000 savings threshold means that anyone who has capital, including an empty home, will have to pay all their care costs until the cap is reached. That only leaves the guarantee that no one will be forced to sell their home—except that since October 2001 no one has been forced to sell their home. The previous Government introduced the deferred payments scheme and, in 2009, advised local authorities that if they failed to recognise the scheme, the courts would almost certainly rule their actions illegal. No interest is charged on deferred payment arrangements while a person is in receipt of care, or for 56 days after their death. The Government intend to make the existing arrangements compulsory, but also apply interest charges from the moment the scheme is activated. While questions remain about who will qualify, it is estimated that most of the additional subsidy will go to the richest 40% of people in the care system. That is what is wrong with the Government. The Government are built on falsehoods: falsehoods about the unity and purpose of the coalition; denial about the real state of the economy; and policies that are more about UKIP than the UK. We need genuine reform. That is what a decent Government would put in the Queen’s Speech.

I would like to talk on two issues that, although not included in the Queen’s Speech, will come before the House in this Session, one of which needs to be addressed with some urgency.

In 2005, the European Court of Human Rights ruled that Britain’s automatic blanket ban on the right of prisoners to exercise their vote was incompatible with the convention on human rights, of which we are a signatory. Almost eight years on, the United Kingdom has still not acted on that ruling and time is running short. The Government must submit their response to the Council of Europe’s Committee of Ministers by 30 September. We have less than five months to prepare and present a formula that will be not only satisfactory to the Committee, but acceptable to Parliament and credible in the eyes of the British public.

I would like to state from the outset that I disagree with the ECHR ruling. I believe that the current ban on prisoner voting, which was ruled on and reinforced by successive Parliaments, is a proper and proportionate response following conviction and imprisonment, and I spoke and voted accordingly when the House last debated this matter. I repeat that to my mind the right to vote is not an intrinsic right, but a civic duty reserved for responsible citizens. However, we cannot talk of individual duty and responsibility in the eyes of the law while shirking our national obligations to uphold the international rule of law, one of the basic tenets of British foreign policy. Here is the troubling paradox: if, as the old maxim goes, no man is above the law, surely no country is either. I welcome the fact that this Government, unlike their predecessors, have recognised this responsibility, and I am pleased that the draft Bill on prisoner voting has been presented and that a Joint Committee will consider its options, but I am concerned that matters are progressing slowly against a swiftly approaching deadline and that we are not making a strong enough case for a pragmatic solution.

If the Government choose to maintain the status quo, we will stand in breach of the convention. If we ignore the judgment, we send the message that dissent is an acceptable state of play, and we would damage our reputation and lose the moral authority to demand compliance from those countries that persistently violate international law. Do we want our record on observing the rule of law compared with that of Russia, Ukraine, Turkey, Azerbaijan and Armenia? It would be neither right nor desirable, but a solution might be closer to home than we think.

Before the blanket ban came into force under the Representation of the People Act 1969, limited forms of prisoner voting were permissible and even practised. The Forfeiture Act 1870 disqualified convicted felons from voting, but only those serving a sentence exceeding 12 months. Felons serving less than 12 months could legally vote, and where it was practically and logistically possible, some indeed did. In the 1950 general election, for example, postal ballots were returned from prisoners in jails across the country.

There is more. When the Criminal Law Act 1967 abolished the distinction between felonies and misdemeanours, the concomitant disqualification on prisoner voting came temporarily to an end. In fact, all prisoners could vote. In effect, these prisoners had the right to vote, and it might surprise people that this was not an unintended consequence of the legislation, but a conscious decision based on a recommendation by a law review committee that the practice of prisoner disfranchisement should not continue.

That policy continued until a ban was introduced in 1969 under the Representation of the People Act, but the point is that the issue was not historically set in stone—not under the Forfeiture Act and not when the United Kingdom signed the convention in 1950—so past precedents should lead the way. To this end, the Government’s proposals on minimum thresholds are worthy of consideration, as they reflect an approach that was deemed compatible with UK law, public opinion and the convention, but we need to step up the dialogue.

How, then, do we move forward? I believe that the distinction between felonies and misdemeanours is obsolete, but the classification of crimes into indictable and summary offences, which distinguishes between grades of crime, mode of trial and punishment available, continues to apply. Like the old felonies, the most serious indictable crimes are tried before a Crown court, and I believe that this distinction could be used as a building block for a sentence-based solution that recognises the gravity of an offence committed. This is a route that we should consider, and the United Kingdom now has an advantage: the European Court recently reaffirmed its commitment to allowing the UK greater flexibility in how we apply the ruling, providing an opportunity to develop a policy that reconciles both principle with pragmatism and which allows our past to pave the way forward.

I think my hon. Friend has made a constructive contribution, but would he accept that what he is saying is totally at odds with what the people of this country believe? They do not want prisoners to have the vote and they do not see why European judges should be bossing them around and telling them otherwise.

I do not see why European judges should be bossing us around either, but if we stick to the principle that we should do nothing that we did not already do when we signed the convention back in 1950, then we have a pragmatic way forward to deal with the problem.

I said I wanted to deal with two issues. I want to say a few words to those of my colleagues who are often banging on about Europe. Let me remind them that divided parties do not give the electorate confidence and are generally not re-elected. If those colleagues genuinely want a referendum, they should rally behind the Prime Minister, who has a clear commitment to address the European Union’s institutional deficiencies and to get a better deal in Europe and then put that to the people of this country in a referendum. Carrying on in this mode is a sure-fire way to give Nigel Farage job security, for we will keep UKIP in business for ever if we undermine the Prime Minister and lose the next election. Perhaps some of my colleagues enjoy banging on about Europe and are not interested in the Prime Minister’s endeavours to find a solution, but they will have plenty to bang on about if we have another Labour Government. If they sincerely believe that what we want is a referendum on Europe, let me tell them that the only way we will achieve that is to return a Conservative Government. Therefore, I shall not support the amendment that has been tabled, although not yet selected; I shall definitely be supporting the Prime Minister.

I am pleased to follow the hon. Member for North Dorset (Mr Walter). He is right: we have heard a wide variety of views about Europe from the Government Benches in this afternoon’s debate. The most compelling case was the one set out in the first Back-Bench contribution, by the right hon. Member for Mid Sussex (Nicholas Soames). He made a compelling case for the UK to remain in the European Union. He was also right to make the point that what his constituents are really concerned about is the state of the economy.

That is the background to the Queen’s Speech. There is wide anxiety across the country because of our economic difficulties—rising unemployment and falling living standards. Their root is in the global financial crisis that has engulfed us and others, but they have been compounded by the failure of the Government’s economic policy to deliver what we were promised it would. We were told—I remember the Prime Minister telling us this three years ago—that the policy would deliver steady growth and falling unemployment. Instead, we have had no significant growth since, and unemployment has stayed high. It is rising at the moment and is forecast to become higher still later this year. We will get an update on Wednesday, but the key backdrop to the rather thin Queen’s Speech that we are debating over these few days is rising unemployment, falling living standards and the inability of the Government’s economic policy to deliver what we were told it would.

There is also a lot of anxiety about what is happening in the health service. That was clear from a survey of 1,700 nurses, the findings from which were published in the Sunday Mirror yesterday. Fifty-five per cent of them said things had got worse in the NHS since the election, compared with 6.5% who said they had got better. More than half the nurses surveyed said that morale in the national health service was either poor or at rock bottom. Rather startlingly, more than 40% said that there had not been enough staff to provide safe cover on their most recent shift. It is quite difficult to reconcile that description of what is happening in the health service—which tallies with some of the things we have heard in this debate about what is happening in hospitals—with the rather rosy picture that the Secretary of State presented to us at the beginning of the debate.

When this Government were elected, they criticised the health service targets that had been set under Labour, but there is no doubt that some of the targets delivered massive and very welcome improvements. In particular, the target for 98% of accident and emergency patients to be seen within four hours was very valuable. I was pleased to hear the Secretary of State affirm its value this afternoon. Before it was introduced, I regularly saw constituents who had experienced terribly long delays in accident and emergency. It was not unusual to hear from people who had been kept waiting all night, for example, but when the target was introduced the problem was resolved completely, and remarkably quickly.

After the election, this Government weakened the target from 98% to 95%. I am glad that there is still a target in place, but, as I said to the Secretary of State in an intervention earlier, there are growing signs that it is not being hit. The NHS in England has now missed the new, reduced target for major accident and emergency units for 32 weeks running. I hope, as he has reaffirmed the importance of the target today, the right hon. Gentleman will take steps to ensure that it can be delivered rather than be missed.

I want to mention two other parts of the Queen’s Speech. My first point is not a matter for the Ministers on the Front Bench today, although it is likely to be of some interest to them. The Mesothelioma Bill, announced last week, is the culmination of a process begun by the last Government, in which my noble Friend Lord Mackenzie played an important role. The plan was for the insurance industry collectively to compensate the victims of diseases caused by exposure to asbestos during their employment, often many years previously. Problems have arisen when the original employer’s insurance policy cannot be found.

The Bill is starting in the other place. I was struck by a report in The Independent on Sunday—not yesterday, but the week before—that the proposal had been so

“watered down after extensive lobbying from the insurance industry”

that it would help only a fraction of the victims, and that payments would be 30% lower than was standard. The report went on to say:

“Department for Work and Pensions minister Lord Freud met insurers 14 times about asbestos between October 2010 and September 2012. Over the same period, he met victims’ groups twice.”

It also stated that the scheme would apply only to people with mesothelioma and not to the similar number of people affected by other conditions caused by exposure to asbestos, and that one of the victims’ groups had described the Bill as an “insult”. As the Bill goes through the other place and then through this House, I hope that the Government will accept that many of us want to see a fair settlement for asbestos victims, rather than a scheme that simply minimises the costs to insurers. We know what a terrible disease mesothelioma is, but the other asbestos-related conditions are also very troubling.

I also want to comment on the commitment in the Queen’s Speech to ensure that

“it becomes typical for those leaving school to start a traineeship or an apprenticeship, or to go to university.”—[Official Report, 8 May 2013; Vol. 563, c. 3.]

I do not know what that means. I searched through the speech made by the Secretary of State for Business, Innovation and Skills on Friday without finding any illumination of that commitment. Indeed, when my hon. Friend the Member for Streatham (Mr Umunna) responded, he accurately described the proposal as “vague”. It is not at all clear what “typical” means in this context, for example.

I was in Germany with the shadow Secretary of State for Work and Pensions, my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne), last month. In the jobcentre in the town we were visiting, we were struck by the fact that young people were expected either to be on their way to university or to have an apprenticeship place arranged by the age of 15. For the 20% of youngsters who are not in that position, the jobcentre sorts it out for them. I hope that we can do something similar here.

On a point of order, Madam Deputy Speaker. I am sorry to interrupt the debate, but I need to raise a matter of extreme urgency. At the weekend, a constituent of mine, Augustine Umukoro, came to my surgery to consult me about his immigration situation. He handed me a letter and told me that he had had a meeting with representatives of the UK Border Agency, who said that in two weeks they might have to start removal proceedings, for which they would visit him and his family—his wife and their two children—in their home. I therefore dictated a letter to the Home Secretary today, asking her to look into the matter. Within the past hour, I have had a telephone call from Mr Umukoro to say that when he reported to the UK Border Agency office at Dallas Court in Salford, as he does every week, he and his children were taken into custody. His wife was not, as her whereabouts appeared to be unknown. He was taken down to Heathrow, and he is due to be removed from this country at 10 o’clock tonight without any warning and without the Border Agency having fulfilled any of its conditions.

I took the matter up with the office of the Minister for Immigration, the hon. Member for Forest of Dean (Mr Harper), half an hour ago. His principal private secretary told me that, as far as he knew, the Minister was content for the removal to go ahead. This is not a removal; it is a kidnapping. It is against every aspect of the rule of law in this country, and I am making it public because it is about time that acts such as these were stopped and because, in this particular case, Mr Umukoro should be allowed, through his Member of Parliament, to make representations.

As the right hon. Gentleman will know, that is not a point of order for the Chair. He is an experienced Member of Parliament, and he has placed this important issue on the record today, which I suspect was his intention. I am sure that he will continue to hold discussions with the relevant Minister right up to 10 o’clock tonight. This is not a matter for the Chamber or for the Chair but, as I have said, I know that he will wish to pursue it elsewhere.

The inclusion in the Queen’s Speech last week of a Care Bill in this new Session of Parliament is nothing short of a landmark occasion. Those of us who have been concerned with the reform of our social care system for decades know that those desperately needed reforms, which are well summarised in the Bill, have repeatedly been kicked into the long grass or filed under “Too difficult to do”. Finally, however, we are making progress.

I have been disappointed by the response to the Bill from Labour Members, who know as well as I do how welcome the proposals are, and what a step forward they will represent for the quality of life of many thousands of people in this country. It was a courageous decision by the Government to introduce the Bill at this time, given that public finances are under enormous pressure as we try to clear up the mess of the financial legacy bequeathed to us by the Labour Government, because the reforms will require additional public finances.

In the last Session of Parliament, excellent work was done by the group of Members of both Houses in undertaking pre-legislative scrutiny of the draft Bill. That was a good example of how people can bring the experience they have gained outside Parliament into their work as legislators. I am grateful for their consideration of my contribution and the subsequent inclusion in their report of my recommendations. The recommendations resulted from work undertaken with a number of Members across the political parties who worked with the charity Macmillan, looking at what could be done to improve the quality of care of people who want to stay at home at the end of their lives. Ensuring people have a genuine choice over where they die is of particular importance to me.

Last year, I chaired a round table event in Parliament, organised by Macmillan Cancer Support, which brought together carers, health and social care professionals and policy makers to discuss how to enable more people to be cared for at home until they die, if that is what they choose. The expert attendees were clear that access to basic social care support can make the difference between somebody dying at home surrounded by their families or dying in an expensive hospital ward. All too often, however, patients and families cannot access the support because of a lack of integration of health and social care systems or because they cannot afford to pay for it.

I believe that removing the social care means test for people on the end-of-life care register would lift a significant barrier to the integration of care, allowing many more people to access the support they need and to exercise choice, which could also save the considerable costs of people being in hospital. The Government’s commitment, made in the care and support White Paper, to assess free social care at the end of life through the palliative care funding review pilots represents very good progress. However, with the Care Bill likely to become an Act before the pilots finish in 2014-15, it is also crucial that the Bill allows for the delivery of free social care at the end of life. This would enable the Government to implement the policy without delay, once the pilots report.

I understand from the responses I have received to written questions that the Minister is undertaking a review of the pilots this year. I very much hope that clauses will be added to the Bill to enable free social care for those at the end of life. Such a step forward would be welcomed by professionals and families alike. It would make such a difference to families at such a difficult time of their lives.

Another specific aspect of the Bill I would like the Minister to consider—together with the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey), who has responsibility for disabilities—is social care for working-aged adults with disabilities. The debate about the future of our adult care system has very much focused on the elderly and their family and carers. I am as guilty as anyone else of focusing on the injustices in the current system for elderly people and the need for a fairer and better system, but the care system has another group of people who need support: adults who acquire a disability through an accident or an illness. They might not have been working long enough to have savings that they can spend on their care needs and they might have a degenerative condition that has prevented them from working full time. For them, reform of the current system is less to do with how they can protect their assets or how they can pay for care without selling their homes than with how they can get the help they so desperately need.

The definition of eligibility for care within the Bill is of greater importance than the means-tested threshold and the caps on personal expenditure. We must have a realistic threshold of eligibility, so that people can participate in society as a whole—in education, as volunteers or as employees.

As the Minister will be aware, some local authorities have, sadly, chosen not to spend the money provided by central Government on the adult social care budgets and have been increasing the eligibility criteria. The Dilnot commission highlighted this concerning trend, and I know that Ministers listened. I understand that the Department of Health is working on amendments to the fair access to care criteria currently used by local authorities. The amendments are reflected in the Bill, which includes new interim eligibility criteria. Concerns have been raised, however, that the interim criteria will not address the continuing shift of social care provision away from those with moderate needs. Research undertaken by the London School of Economics indicates that 105,000 people could lose eligibility if the Government move ahead as proposed.

Is the hon. Lady aware that in 2005, 50% of local authorities were setting the level at a substantial 84% for the move from “moderate” to “substantial” needs?

The hon. Gentleman makes a very good point, which illustrates the findings of the Dilnot commission.

I urge the Minister to consider this further and to ensure that the final interim criteria agreed upon, which will be in the Bill, recognise the very real care needs of those who fall into the moderate care category within the current fair access to care system. We found from the report we received on Friday on the Government’s consideration of what improvements might be put into the Bill that they have agreed to look at the eligibility criteria and to fund the proposals under the June comprehensive spending review. All that is very welcome. I hope that, once the criteria and the funding to support it have been agreed, the money passed over to local authorities will be ring-fenced for a period, perhaps up to three years. The Government have done that for public health, and doing it in this instance would enable the estimated 105,000 people who have moderate care needs to receive the funding and to continue with their working and volunteering lives, playing their full part in society.

I am sure that the Minister of State has been listening closely to the organisations that represent people with disabilities. I am also sure he supports the excellent vision and work of the Minister with responsibility for disabilities that aims to enable people living with disabilities to play as full a part in society as possible. I very much hope that, as this Bill passes through the House and is further scrutinised and consulted on, we will address the concerns of these groups of people who all too often fail to have their voices heard.

The Government have listened hard to the needs of elderly people and have produced a good way forward. These straightforward and common-sense improvements will make a hugely positive contribution to the lives of people at the end of life and those of working age who are living with disabilities. Those people are often living out of sight; we must show them that they are not living out of our minds.

I wish to speak on four matters in today’s debate on the Queen’s Speech. The first—heart-related issues—has already been mentioned by my right hon. Friend the Member for Rother Valley (Mr Barron) and by the hon. Member for Mid Derbyshire (Pauline Latham), who is no longer in her place. I am the chairman of the all-party parliamentary group on heart disease, which was set up 12 years ago. I give credit to the Government for consulting on minimum pricing of alcohol and on plain packaging for cigarettes and tobacco. Both those consultations have been good, engaging MPs from all parties and, indeed, the wider community, but the Government have lost a golden opportunity to put these measures in this year’s Queen’s Speech.

Over the past 10 or 12 years, we have had a fantastic record on heart disease, with deaths going down by 46%. We have taken some big and bold decisions: for example, the Labour Government passed a measure to ban smoking in public places; we also introduced statins, which are largely responsible for the 46% drop in heart-related deaths. We must keep up the momentum, however, and minimum pricing of alcohol and plain packaging of cigarettes could have helped us to do so.

Each year, about 11,000 10 to 15-year-old children in Wales take up smoking. The industry wants to catch those smokers young and keep them smoking until they are 55, 65 or until they die, in order to keep up profits. Those young people have been deliberately targeted. The hon. Member for Mid Derbyshire mentioned the use of defibrillators and the teaching of resuscitation skills in schools. If the Government made progress on those, it would help to keep up our excellent momentum on tackling heart disease in the UK.

Many Members have touched on immigration and some have connected it with the health service. There will not be one of us in this Chamber whose life has not been touched by an immigrant worker in the NHS. My doctor for 25 years, Dr Rao—sadly, now passed away—came from the Indian subcontinent, while the man who delivered my first-born child was an Egyptian consultant, and I am really grateful to both of them. If all the immigrants working in the national health service left tomorrow, our national health service would collapse. I pay tribute, too, to the Filipino workers in the care sector—lovely, family-orientated people, who have great respect and great compassion for the elderly. Immigration is an issue throughout the country and we need to reflect concern about it in Parliament. What we do not need to do is add to it. We certainly do not need to whip it up, as I feel some Members have done today.

I praise the hon. Member for Mid Derbyshire for what she said about cancer treatments. I pay tribute to the work of my constituent Mike Peters, a friend of mine, who has had cancer twice in his life and currently has a chronic leukaemia condition. Mike is spearheading an international campaign to increase the number of donors of matching blood cells for leukaemia treatment. He has set up two organisations, the Love Hope Strength Foundation and Delete Blood Cancer UK. He is a rock star who is a lead singer in The Alarm and Big Country, and he tries to recruit people when he sings in countries around the world. He has personally recruited 35,000 donors, mainly in America, through his concerts, and 500 people’s lives have been saved as a result.

Mike is holding an event in Room R in Portcullis House on Tuesday 4 June. Anyone—any Member of Parliament!—aged between 17 and 55 will be welcome to become a donor. All it takes is a mouth swab. The DNA is then kept on file, so that anyone in this or any other country who needs stem cells will be able to gain access to them. Let me again pay tribute to the work that Mike Peters has done.

I now want to say something about how mindfulness can help with problems related to health and social care. Members may ask “What is mindfulness?” Mindfulness is an integrative mind-body-based approach which helps people to change the way they think and feel about their experiences, especially stressful experiences. It involves paying attention to our thoughts and feelings so that we become more aware of them, less enmeshed in them, and better able to manage them. It uses breath as an anchor to slow down the mind and body and to help us to live in the present moment, rather than being chased by our past or worried by our future. It is the perfect way to combat stress—and the impact of stress on heart problems, cancer and mental health conditions is massive.

Members may think that that sounds a bit airy-fairy, but the National Institute for Health and Clinical Excellence has backed mindfulness as a better way of treating repeat-episode depression than drug therapy. It puts the individual in control. It is as cheap as drug therapy in the short term, and cheaper in the long term. It has no known side-effects, and, if taught early enough, it is preventive. Let me give the House some statistics. A total of 32.3% of people aged between 15 and 25 suffer from one or more psychological conditions. Every Member in the Chamber will know someone with such a condition, perhaps even a family member. In 1991, 9 million prescriptions for anti-depressants were issued; in 2011, 46 million were issued. That is a 500% increase in 20 years.

As my hon. Friend says, one of the problems on which we need to focus is depression among young people. Young people oppose the idea of taking anti-depressants. Will my hon. Friend say something about the importance of mindfulness in enabling them to build up their self-awareness, their self-confidence and their ability throughout their lives to handle possible recurring depression?

I know that the incidence of suicides among young people is a particular issue in my hon. Friend’s constituency, and mindfulness has a role to play in that context.

Many Members have mentioned compassion today. Mindfulness can help to give compassion to the individual and also to the health care worker. If compassion is lacking, mindfulness can enhance it. It can be used within the health care system, and has been taken up by doctors who are then in a better position to relate to their patients. Earlier this year there was a mindfulness session in the House of Commons for Members of this House and the House of Lords, and another will begin on 4 June.

Mindfulness can help in a personal capacity, but it can also assist the development of policy in prisons—85% of prisoners have mental health conditions—in education, in the armed forces, in the police and fire services, and in any area where there is trauma. It can play a big role throughout society and in all departments. I urge the Department of Health to recognise that, to act on NICE’s 2004 recommendations, and to ensure that the use of mindfulness for the treatment of repeat-episode depression is fully implemented. I also urge the Department to consider carefully its possible use in other parts of the national health service.

It is a pleasure to follow the hon. Member for Vale of Clwyd (Chris Ruane). I entirely agree with what he said about mindfulness and the need for NICE to ensure that it is available for the treatment of stress in particular. That is all the more important now that we have a Government who have put patient choice at the heart of the health service, a fact that will become more and more evident as health and wellbeing boards and Healthwatch start to make an impression through the Health and Social Care Act 2012.

Like the hon. Gentleman, I intend to focus exclusively on health issues. I shall concentrate not on what is in the Queen’s Speech but on what is missing from it, particularly the expected statutory regulation of herbal therapies. If we are to ensure that the range of treatments that people demand, including mindfulness, are safely regulated in the health service, we must tackle the issue of herbal medicine, which is a crucial tool in our cupboard.

At this point, I must declare an interest. I was involved in the legislation applying to the last two groups that were made subject to statutory regulation, the Osteopaths Act 1993 and the Chiropractors Act 1994, as a member of the Standing Committees that considered those Bills. Let me emphasise to Ministers how important it is to take that route. It makes practitioners focus on a disciplined structure and operate a robust complaints procedure, it makes it easier for doctors to refer, and it makes treatments more widely available.

When it comes to herbs, we need an interface with European legislation. We must deal with regulation 3(6) of the Human Medicines Regulations 2012, which grants “a person”, not a therapist, the right to practise. What worries me is that Ministers may regulate not therapists but specific herbs. There are thousands of them out there, and that cannot be satisfactory. We must give therapists the right to prescribe. In the case of traditional Chinese medicine, for example, most practitioners will prescribe three herbs to work in conjunction. As I have said in the House before, it works like the Whips Office: there is a chief, a deputy and a messenger. The messenger takes the chief and the deputy to cure the problem. My hon. Friend the Member for Rochford and Southend East (James Duddridge) laughs; of course, that does not always apply to Whips.

My greatest worry is this: I believe that the statutory regulation has been blocked by vested interests in the orthodox medical community who have said to the Secretary of State “We do not want this, because it will enhance the status of herbal therapists.” If that is true, it is selfish and stupid.

A sub-set of the problems lies in the fact that there are two types of herbal therapies. There is the phyto therapy provided by Hydes Herbal Clinic in Leicester, which I believe is in the constituency of the hon. Member for Leicester West (Liz Kendall), and there is traditional Chinese medicine, which involves the use of different types of herb. We need separate registers to make sure that these therapies are prescribed safely.

It is interesting to see the headlines that are appearing now. The hon. Member for Vale of Clwyd talked about doctors using mindfulness. One headline states, “GPs prefer herbal remedies to Prozac, says survey”, and one such cited remedy is St John’s wort, which in fact has side-effects if used with other, conventional, medicines. One reason why I want statutory legislation is to make sure that people who are taking herbal medicines can go to their doctors and say, “Yes, I am taking it, and doing so under the prescription of a statutorily regulated practitioner.”

I should say in passing that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has been dealing with this issue, has graciously offered me a meeting to discuss it further, and I look forward to taking him up on that.

Provision was made in the Health and Social Care Act 2012 for the Professional Standards Authority, which should regulate all complementary therapies other than those provided by individual practitioners, who are regulated under individual legislation. The Society of Homeopaths, which I have supported for years, should be regulated too. Here, we are completely out of line not just with Europe but with Asia and America. We have not used enough of such resources. It is patently absurd to say it is all placebo, given that in Europe 40,000 physicians practise homeopathy, in Asia, 250,000 physicians practise it, and it is practised in Brazil, Nigeria and America. It is not a placebo, because people are using it. One can fool some of the people all of the time and vice versa, but not all the people all of the time.

The other reason why those who oppose such therapies make some headway is they refer only to homeopaphy randomised control trials. Sixty-four of 156 have been positive, and only 11 negative. We should also consider meta-analyses and patient-reported outcomes. Where double-blind placebo-controlled trials are conducted, they are ignored.

Just a few centuries ago, scientists were saying that the sun went round the earth; now, we know that the earth goes round the sun. Science changes. Here, we should bear in mind what is known as the Semmelweis reflex. When a doctor in Germany discovered that child mortality rates could be reduced if doctors washed their hands, conventional practitioners pooh-poohed the idea, but eventually it became the norm. We have to be progressive, and so it is with some homeopathic remedies, which are so dilute that they cannot be seen through conventional analysis. However, the fact is that those very dilute substances work effectively. The future lies in a wider range of health provision across the health service.

I want to finish with an e-mail I received today:

“Dear David,

From browsing the web I hear you are cynically referred to as the honourable member for Holland and Barrett.”

Yes, a Labour Minister many years ago called me that. The e-mail continues:

“If those who jeer had survived a life debilitating illness like Parkinson’s for twenty years, I would have more time for them.

I have done this while trying to escape the unsolicited attentions of a family populated with several consultants and even more GPs… Alternative therapies like homeopathy, acupuncture, herbs and now helminths are the reason I am alive today.”

It is a pleasure to follow my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the hon. Member for Bosworth (David Tredinnick), who care passionately about health care in its widest and broadest sense.

This Gracious Speech is unprecedented. I cannot recall in all my years of working in this place, dating back to 1977, another instance of a Prime Minister saying it is okay for their party to vote against the Government’s programme. I cannot see the late Baroness Thatcher condoning such a move. This coalition Government are in meltdown, and the public must be wondering whether any of the proposals in the Queen’s Speech have the wholehearted support of their Members.

That said, there are measures in the health Bill that could and should be shaped and improved on a cross-party basis. It is therefore important that adequate time be allotted for the various debates and the Committee stage. The proposed programme is hardly onerous, so the guillotining of Bills should not be required—unless the Government decide that they dare not encourage full debate, and chicken out. We shall see.

Before moving on to the health-related elements of the Gracious Speech, I would like to mention the draft consumer rights Bill because it revisits the private Member’s Bill introduced by my father—Michael Ward, who was a Member of Parliament—which became the Unfair Contract Terms Act 1977. He was supported by the late David Tench in enacting what was groundbreaking consumer legislation. Lord Denning, the then Master of the Rolls, described it as

“the most important change in civil law”.

My father would, if he were alive, be very keen to ensure that the streamlining and simplification process in bringing together so much consumer legislation does not water down consumer rights.

There are a number of health-related proposals in the Queen’s Speech. In Plymouth—a mesothelioma hot spot because of the nature of its industrial base—people will welcome the further progress that has been made on speeding up the process through which insurance companies accept liability and pay compensation. However, for too many of my constituents progress has been tragically slow: they have not survived this awful disease long enough to benefit from the legislation. We have a moral duty to do everything we can to support the victims, and we need to ensure that the Bill, which has had a very slow gestation—it was discussed under the last Labour Government—does what it says on the tin and guarantees faster pay-outs. The failure to address other asbestos-related diseases is also giving rise to concern.

Those who are more fortunate are now, with support, living into grand old age, and we have to resolve the issue, which has dogged successive Governments, of providing care for our older citizens, as well as younger people with illness or disability. The care and support Bill should be welcomed as a step in the right direction, but I fear it will not be enough and, rather than having a full-blown national care service, we will end up with a piecemeal one. The level of the cap has been set too high—higher than Andrew Dilnot recommended—and without investment in local services the Bill will have serious consequences, as clearly set out in the opening speech by my right hon. Friend the Member for Leigh (Andy Burnham).

To deliver much of what will need to be delivered, local authorities will therefore be required to step up to the plate—the joined-up care that the Secretary of State talked about. Yet we know that many are having to dismantle the architecture upon which good care and support is offered—as we are seeing in Torbay, an exemplar—because of the deep cuts being made to their budgets. Can the Government please be clear about who will be running these care and support networks? If it is the private sector, how will they ensure that there is not a postcode lottery?

Oddly, earlier the Secretary of State was behaving like one of those nodding dogs we see in the backs of cars when it was pointed out that hospitals are under pressure and staffing levels are not all they should be. However, he has provided no real answers in this Queen’s Speech.

At long last, after almost four years, we have a Bill paving the way for a potentially dramatic change to the way defence procurement is carried out. There is consensus across the political divide that successive Administrations did not sufficiently reform defence procurement. Equipment programmes were overheated in respect of funding, and the Ministry of Defence was underpowered in the skills required to deliver increasingly complex programmes. There are too many questions that need to be asked for the time available, and today is not about defence, but we will need to come back to those questions. The themes, however, are the accountability of the proposed GoCo —Government-owned, contractor-operated organisation —and where the risk lies. For example, does it lie with the taxpayer or with the private company? Warning bells are already ringing around Westminster about the management of risk. We know from successive Public Accounts Committee and National Audit Office reports that the MOD struggles when it comes to assessing risk. We need to know whether the Ministry of Defence, like the Department of Health, is producing legislation that removes the Secretary of State’s power to intervene and take responsibility.

Finally, I come to the Bills that were not mentioned. My right hon. Friend the Leader of the Opposition emphasised the missing legislation in his response to the Loyal Address. The cold hand of the Prime Minister’s henchman, whose links to the tobacco industry as a lobbyist are well documented and who has accepted major donations to his campaign in Australia from British American Tobacco, is writ large on this Gracious Speech.

I agree that not having legislation to introduce standardised packaging for tobacco products is the wrong decision, but does the hon. Lady agree that it is appalling how the unions, too, have tried to stop this legislation?

People work in those industries, and, understandably, the unions representing them have to consider the membership’s point of view. Among the unions as a whole, there is a broad range of views, very much reflecting those in this place today.

Returning to my point, perhaps that is why No. 10 has U-turned, from a position where it was wrong for children to be attracted to smoking by glitzy designs on packets and there were statements that children should be protected from the start, to the obverse position, where we are not being allowed to have legislation that would have a beneficial impact on the future health of our population and on the NHS budget. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, we need to know who is pulling the strings in setting Government policy. The Government have bottled it; they are in thrall to their right wing. Young people in Plymouth, particular our Youth Parliament members and those in our youth cabinet, who wanted very much to see this change brought forward, will feel that they have been sold down the river. Many young people are asking what is in the Queen’s Speech for them; there is nothing to protect their future health and nothing to help them into work.

If the Government were serious about improving the health of the nation, we would have given these measures a fair wind. They would have had broad support from the Opposition, as would investment in other areas, such as housing that is affordable to rent, because good housing equates to good physical and mental health. Nothing has been said on those issues. The Queen’s Speech is a huge missed opportunity, and it is simply not good enough.

It is a real joy to follow the hon. Member for Plymouth, Moor View (Alison Seabeck), my next-door neighbour—you are being extremely skilful in your selection of speakers today, Mr Deputy Speaker. I very much enjoyed her contribution; she spoke in her usual trenchant and passionate style. I also enjoyed hearing about the work that her late father was involved in, and I can say with some confidence that he would be extremely proud of her and all that she has done in her time as a Member of Parliament.

I liked the Queen’s Speech, but it was a little long for my liking. I was looking forward to the Queen sitting on the throne and saying, “My Government have decided to introduce no new laws this year, but to concentrate on implementing and overseeing well the policies that we have already passed and the laws that we have already put in place.” As we all know, coming to the House and taking legislation through involves a huge time commitment for Ministers, and there is a huge case to be made for Ministers to focus on implementing well the things that we have already decided. We have been radical in the past three years in this Parliament, so let us make sure that the policies now work in practice on the ground—let us set our Ministers free to do that. Interestingly, the key areas our constituents are most concerned about—getting the deficit down, getting the economy moving and cracking down on immigration—do not require any legislation at all. They simply require us to do well the things we have already decided.

I welcome the Queen’s Speech and, despite having said what I just said, the increased attention on immigration, which is what our constituents want. The reaction of my constituents to some of the tough measures we have introduced so far on immigration and on welfare changes is, “It’s about time. We have been waiting for this for many years.” So I support the broad direction of travel of the Government, and I have full confidence in the Health Secretary.

I want to make two points in a brief contribution about health issues, the first of which is about the challenge of urgent care. Our parliamentary system has many strengths, but one weakness is that every Government Member is inclined to say that everything we are doing is wonderful, while the Opposition are inclined to say that everything we are doing is rubbish. We all know that the truth lies somewhere in between. I support and pay tribute to the fact that we continue to pump fresh money into the health system year after year. The shadow Health Secretary is convinced that we are not meeting our commitment to increase health spending above inflation every year—I think we are, but of course there is a debate to be had. I do know that there are pressure points in the health system that need to be tackled, and urgent care is one of them.

The hon. Gentleman’s association with the detail seemed to be loose there; Andrew Dilnot wrote to the Government to say that health spending was lower in real terms in 2010-11 than it was when Labour left government. It is important to point out that the promise the hon. Gentleman stood on was for real-terms increases in every year of this Parliament and that that has not been honoured.

That is Andrew Dilnot’s opinion, but it is not mine—that is the point I am seeking to make. [Interruption.] The right hon. Gentleman’s speech was riddled with references to spending—more spending on health and on local councils—but is he not aware that this year the deficit in this country will still be, even after three years of austerity, £110 billion? If he comes to the Dispatch Box to make speeches about extra spending for health and local councils, he is obliged to tell us where that money will come from. At the moment, I can see no signs of it whatever.

rose—

I will not take any further interventions, but let us not hear any further speeches calling for extra spending unless we know where the money is coming from.

As I was saying, before I was so rudely interrupted, there are pressure points in the health system, and urgent care is one of them. This is about not only accident and emergency departments, but GP and out-of-hours services, community nursing, social care, ambulance services and hospital beds—there is pressure on all those points.

The hon. Member for Plymouth, Moor View and I are fortunate to go to Derriford hospital in Plymouth for briefings. I have been going slightly longer than she has—21 years—and I can tell the House that in good times and in bad times Derriford hospital is under pressure. It has a running capacity of about 95%, which means that when there are spikes, as there have been this winter, it can be running at 103% capacity, which puts the hard-working staff under enormous pressure. Even when the Labour Government were spending money as though it were going out of fashion, I have never gone to Derriford hospital and had the staff tell me, “It’s fine. There are no pressure points. Everything is working in our health service. It’s all working well and waiting lists are coming down.” That has not happened once in 21 years.

Does my hon. Friend agree that perhaps one problem with the Queen’s Speech, and one of the issues with which neither Ministers nor shadow Ministers tend to grapple, is that there is a real problem in this country with demand? Unless and until we grapple with that, the national health service will always be under pressure.

I completely agree with my hon. and learned Friend, and I might come on to deal with that point in a moment.

The point I wanted to raise with Ministers is that the funding formula for emergency work needs to be reviewed. As I understand the system, the formula is based on the 2008-09 baseline, and any extra patients who come into an acute hospital over and above that baseline are paid at 30% of the tariff. It costs hospitals 100% to meet the needs of those people coming in, yet they are paid at 30%; the extra 70% is supposed to be spent by other health care agencies in providing alternative centres of treatment, which are intended to divert people away from acute hospitals. I am pretty well plugged into what is going on in my constituency, and I have not seen anything since 2008 that looks vaguely capable of diverting pressure away from Derriford hospital. The system of allocating 30% to the hospital and 70% elsewhere is simply not working. I ask our Ministers to look urgently at that formula and to find out why, if it is not working, we are still using it and to address that. I am not calling for extra money; I am calling for money to be diverted to the acute hospitals, because they are where the pressure points are. In my constituency, there have been no realistic options for treatment other than to go to Derriford hospital. So, such hospitals should be receiving not 30% but 100% of the tariff.

My hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) is absolutely right about demand growing exponentially. In 1979, if a man reached the age of 65, they could expect to live until they were 77. If a man reaches the age of 65 now, they can expect to live until they are 88, and of course that age is rising year on year, so the demand is going up.

One thing that we are noticing is that although the number of people admitted to the emergency department at Derriford hospital in the last 12 months has been stable, there is much higher acuteness—in other words, people are much sicker and therefore it requires a lot more effort to treat them. Please, nice Ministers on the Front Bench, may we have a look at that formula for the funding for people accessing acute hospitals on an emergency basis?

My final point, in the one minute of my time that remains, is that 20 years ago or so I made a speech in this House saying that the health service had lots of challenges, issues and problems, but that one of the things we did not need to touch was primary care as it was working fine. I cannot make that speech today. I will not hammer the Opposition again about the GP contract, but in the past few years constituents have been complaining to me in a way that they never did in the previous 15 years to say that accessing their GP is becoming extremely difficult. For someone—whether they are a mum with a young baby, or a senior citizen—to get a surgery appointment when they want it has become a serious issue in the past few years. Addressing that issue does not necessarily require legislation, but may I ask Ministers whether we can please put in place a system whereby GPs give the seven o’clock in the morning to seven o’clock at night, seven days a week service that this country so desperately deserves?

It is a delight to follow the hon. Member for South West Devon (Mr Streeter). I might not have agreed with everything he said, but he was right to point out that away from this place people’s concern is about economic growth. Sadly, the Queen’s Speech does not adequately address that concern.

Some of the less thoughtful contributions have demonstrated just how deeply divided this Government are—not between parties, but within the main party of government. The Prime Minister is unable to command the support of his own party. When he makes a decision, it is often the wrong one, putting party squabbles before national interest.

Just for one moment, let us imagine the scene in Washington today. The Prime Minister is there to seek the ear of the President on the EU-US trade deal, which is hugely important to this country and worth £10 billion a year. As the President received his pre-meeting briefing, I wonder what his advisers would have been saying: “Don’t waste time on this Prime Minister, Mr President. He has only two years left. He can’t even command the support of his own party. His Cabinet members are speaking out against him as they jostle for succession, and he has even told members of his own Government that they can vote against him on the Government’s programme. We will have to talk to the people who count in Government—ignore this one.” As Barack Obama raises his eyebrows in incredulity, British influence disappears out of the window because of the weakness of this Prime Minister.

That situation is also demonstrated in the Queen’s Speech, and as much by what is not included in it as by what is. When the Prime Minister makes a decision, too often he buckles under pressure from the wrong people, backing powerful vested interests against those of ordinary people. As a number of my colleagues and a number of Government Members have done, I want to highlight the absence of the promised legislation for standardised cigarette packaging, which sacrifices the health of our children in favour of the profits of the big tobacco companies.

Back in February, the Prime Minister talked clearly about introducing legislation for standardised packaging. The papers reported that

“Ministers are convinced that the ban is necessary to take the next step to reduce smoking in the UK.”

Those reports were confirmed by a senior Whitehall source, who said:

“We are going to follow what they have done in Australia.”

The source correctly went on to say:

“The evidence suggests it is going to deter young smokers. There is going to be legislation”.

That was what we were all expecting, although perhaps some of us were surprised that the Government had actually got it right on this issue and were putting people first—that was, until just a few days ago. I do not know whether they were under the influence of Lynton Crosby—bear it in mind that he earned considerable sums of money from the tobacco lobby, and that he failed to win the argument against standardised packaging in Australia before bringing his toxic approach to politics here—or perhaps they were just running frightened from the UK Independence party’s opposition to public health measures against smoking.

I note that the hon. Gentleman does not mention the intervention of the unions and their support for retaining the existing system of packaging. Would he like to condemn the position that the unions have taken on standardised packaging?

My understanding is that the majority of unions would support standardised packaging. I deeply regret the fact that the tobacco giants use some individual trade unionists as de facto lobbyists.

The Government surrendered to the tobacco giants. What message does that send to the country? This Government are prepared to see people die and, as the hon. Member for Mid Derbyshire (Pauline Latham) said, die horribly, and in their hundreds of thousands, to prop up the profits of the tobacco industry. There are no industries like the tobacco industry—the more cigarettes it sells, the more money it makes and the more people die.

Since science confirmed the link between smoking and lung cancer, the tobacco industry has opposed every single measure to reduce smoking. We all know that smoking is the largest preventable cause of cancer; it is responsible for four out of every 10 cancer deaths. According to Cancer Research UK, tobacco is responsible for 100,000 deaths in the UK every year. We have made huge strides with the measures that have already been taken against smoking, but as we have encouraged people to stop smoking, the tobacco giants have been building their market among young people. A report from Cancer Research UK in March showed that the number of children smoking had risen by 50,000 in just one year.

Let me demonstrate the absolutely vile morality—if I can combine those two words—of the tobacco industry. When it was discovered that nicotine was addictive, the industry increased the proportion of nicotine in cigarettes to make them more addictive. People like that should not be listened to; they should be shown the door.

I agree with my right hon. Friend: the tobacco industry should not be listened to. However, it finds no end of ways to seek to defeat the arguments of public health lobbies against smoking, and indeed to encourage the wider use of cigarettes.

Shockingly, in the last year for which figures are available about 207,000 children aged between 11 and 15 started smoking. The vile way—to use my right hon. Friend’s word—in which the tobacco giants operate means that that is a direct result of the industry’s marketing strategies, which are as sophisticated as they are cynical. Flavoured cigarettes have been introduced, and not only menthol, but chocolate and fruit flavours. Some cigarettes are targeted at young women. Even the Daily Mail pointed out, in condemning that move, that those cigarettes seek to

“make smoking look elegant, sexy and classy”.

Alternatively, as British American Tobacco’s Hinesh Patel said, almost acknowledging the company’s strategy:

“We’ve taken a creative approach to respond to the female under-30 demand for a smaller, slimmer, less masculine cigarette…a contemporary product in a new accessible size.”

In that context, packaging is crucial. A Saatchi & Saatchi marketeer said this of British American Tobacco’s Vogue package:

“The cigarettes look like something found behind a glitzy counter at Selfridges....trying to capitalise on a woman’s desire to feel beautiful to sell their cigarettes.”

The Government public health Minister, the hon. Member for Broxtowe (Anna Soubry), is not present, but she has made her views on this subject clear. In April, she said before a House of Lords Select Committee:

“We know that the package itself plays an important part in the process of young people and their decision to buy a packet and to smoke cigarettes.”

All the experts back standardised packaging, and until a few days ago we thought the Government did, too. The public back that as well, with 63% in favour and only 16% against, according to recent polling. This Government are getting it wrong again. They are showing again that they are out of touch with people and they are on the wrong side of the argument, and I urge them to think again.

I want to congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on her contribution, and I hope to add to her comments.

A quiet revolution is taking place. Slowly—although probably not very slowly—but surely, the life chances of thousands of vulnerable people are being changed. We in Bradford did a huge amount of survey work following the publication of the health and social care White Paper, the Bill and the progress report on funding reform, and we received a huge response with more than 500 direct responses from within the constituency. I want to pay tribute to Bradford council, which was very much involved, as well as the Bradford and District Age UK, the Bradford Alzheimer’s Society, Ideal Care Homes, Bradford disabled people’s forum, the Consortia of Ethnic Minority Organisations and also the area manager of Specialist Autism Services, who submitted a response last week.

The report was published after a Westminster Hall debate on this subject, and many of the Government’s proposals were generally welcomed. Some areas caused concern, however, including on hospital discharges, specialist housing, and waiting times for adaptations. Much of the concern is less about legislation and more about local delivery—about what is actually in place in the locality.

The backdrop to everything we are doing in all policy areas is the austerity programme and the deficit, and many local authorities are facing severe funding cuts as a consequence of the measures being taken. Their effects are being exacerbated by the increasing demand for social care. In my area, there will be an additional 5,000 over-65s in the next 10 years and a 38% increase in the number of over-85s. There will also be a large increase in those with learning disabilities. This will add an extra £10 million to local costs. A lot of complex cases are arising, and all of this must be seen against the backdrop of the cuts and changes.

The Government say that local authorities must decide on priorities. That is true, but it is also a bit dishonest. The national health service budget, for which the Government are seen as responsible, is protected, but the social care budget, which is predominantly picked up by local authorities, is under attack and being cut. If many of the preventive measures we are seeking to introduce enable people to go home sooner and have a better experience on their return from hospital, that will reduce the pressures on the NHS budget but increase the costs facing local authorities, as they will have to pick up the costs arising from those successful preventive measures. Things will be difficult for many local authorities, therefore.

The report we in Bradford produced following the publication of the Bill focused on residential care, and since then we have done a lot more work on another crucial, and topical, area: Bradford council has, through a consultation process, been addressing the fair access to care services—FACS—criteria, and I will focus on the criteria for the provision of social care. I mentioned discharge from hospital and adaptations, but the level at which the FACS criteria are set is crucial in determining the services many people will receive in their homes and the life chances and experience they will have.

The “critical” criteria include when “vital social support systems” and

“vital involvement in work, education or learning cannot or will not be sustained”.

A person’s care and support needs are deemed as “substantial” when

“many aspects of work, education or learning cannot or will not be sustained.”

We understand all that, but the bit I am not comfortable with is the description of anything lower than that as being “moderate.” That is a terminological inexactitude or misnomer. Listed under “moderate” are

“an inability to carry out several personal care or domestic routines and/or...several aspects of work, education or learning”.

I do not regard that as being “moderate.” The ability to do such things is often essential if people are to live a satisfactory life in their own homes and as part of their local community.

In plain and simple terms, and without trying to be funny, if someone cannot get their knickers or underpants on in the morning, they will not go to the day centre, however good it is, and if someone does not get the help to get the right tablets in the morning, they will not be going to the day centre in a minibus; they will go to hospital in an ambulance. We must not call this level of need “moderate.” For many people, it is essential if they are to have a full life in their community and in their home.

We must look less at what can be funded and more at what levels of need we need to fund. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) pointed out that much of the proposed legislation is about intervention and prevention, on the basis that prevention is better than cure, but the danger is that today’s moderate needs will become tomorrow’s substantial or critical needs if they are not met at the correct time. This is not about cutting our cloth or making do in times of austerity. It is about, foolishly, making short-term savings to the detriment of future taxpayers who will have to bear the costs of what should, and could, be regarded as avoidable needs.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) made a powerful case against the influence of the tobacco companies and their lobbying of this Government, and the utter ineffectiveness of the Prime Minister in standing up to them. I am also pleased to follow the hon. Member for Bradford East (Mr Ward), who made an impassioned plea on behalf of his constituents and others. He demonstrated the need for proper local authority funding to support care services, and I will address that later in my speech.

I think it is true to say that all independent commentators are noting that the Gracious Speech was very thin and did not rise to the many challenges facing this country, particularly the need for economic growth. I was therefore concerned to hear speech after speech in which Conservative Members talked only about Europe in a very obsessive way, without any recognition of the fact that constituencies such as mine that are desperately in need of economic growth rely on our relationship with Europe. Our region exports the most from this country, and a huge proportion of our exports are to European countries. We need those exports to grow, not to be damaged by the rhetoric on Europe that we hear day after day from the Government and Conservative Members.

I was also concerned when I listened to the Secretary of State for Health and heard how complacent he is about the state of the NHS. He showed no recognition at all of the anxiety of many of my constituents about what sort of health service we are going to end up with in a couple of months’ time and whether it will be able to meet their most basic needs. He showed no awareness at all of the challenges facing A and E departments right across the country, including my own in Durham. I am not criticising the staff, who struggle against the odds to provide the best care. This is happening because the Government are not looking at how to use the resources effectively and how to channel them towards under pressure A and E departments.

It would be extraordinary if we did not have a Bill on care in this Queen’s Speech given the clamour for it from carers, carers’ organisations, other agencies, cross-party commissions, and cross-party groups, and some of the work that Labour did when in government. The question remains, however: is the Bill up to the job of dealing with the problems facing our care system, which need to be addressed urgently because, as we all know, it is in danger of falling into crisis? The House of Commons Library has produced research showing that 10 million people in the UK are over 65 and that by 2030 the number is projected to rise to 15.5 million. Many of these additional older people will have care needs, putting increasing pressure on our care system. At the same time, more funds are being stripped from social care. The £500 million funding gap in our social care provision is still growing and, as Age UK has made clear, this is having a hugely detrimental impact on the care received by our elderly people. Age UK states that

“the widening funding gap has led to a reduction in service provision, increasing charges levied by councils for their services and less older people receiving the support they need.”

It further says:

“Every older person using local authority care services is now being charged £150 per year more in real terms in 2010-11 than in 2009-10, and £360 more than 2008-09”.

The situation is expected to get worse still. Due to the massive cuts faced by local government, by 2013-14 local authorities will have reduced their expenditure on adult social care by £2.7 billion—a massive 18% reduction when demand is increasing all the time. Clearly, this is not sustainable.

The Bill will do nothing to close the growing funding gap or to help the thousands of people who are already suffering with spiralling living costs and increases to home care costs. These people find themselves passed between care providers, often without any continuity of service. We will all have heard about such experiences in our constituency surgeries. Many people are ending up in hospital unnecessarily because they are not getting the care they need at home. Similarly, the Government’s earlier decision to ignore Dilnot and the experts who recommended a maximum cap of £35,000 and set it at £72,000 plus accommodation costs will not help many of my constituents, particularly those on lower or middle incomes.

Where the Bill might make some meaningful progress is with regard to improved rights and support for carers, but, as several hon. Members have said, there are huge gaps, particularly in identification of and support for young carers. That will need to be addressed as the Bill makes its way through the House. More needs to be done to support the various organisations that help carers. I work with a number of voluntary sector bodies in my local communities, and they are very worried that they will go out of business because they are not able to get enough resources to keep going.

Carers UK has set out some tests of this Bill. It says that it needs to be underpinned by appropriate funding, that it must promote the well-being and dignity of all our elderly residents, that it must ensure that independent advice is available to people and that there are appropriate advocacy services, that it should make sure that the criteria for people to get support are clear and transparent —it is no good just having assessments; they have to produce something in the form of appropriate levels of care—and that it must guarantee continuity of service and portability in whatever care support is given. I hope that as the Bill goes through the House it will be tested on those criteria.

I am pleased to follow the hon. Member for City of Durham (Roberta Blackman-Woods), who picked up the theme of the hon. Member for Bradford East (Mr Ward) in talking about social care, which I too should like to remark on.

Unlike others, I will not be tempted into the subjects of tobacco, Europe or gay marriage but will stick fundamentally to the title of this debate on health and social care. I have a few specific points to make about the impact on my constituency. In general, though, I am proud to be part of a Government who, despite the need to eliminate the huge budget deficit left to us, have protected spending on the NHS. That has been necessary, in large part, because of the demographic changes that are happening in the UK with a rapidly ageing population. We need to do more than just target health spending on the older population; we need to change the way we think about providing care for the elderly and what this means for our society. I think that that is what other hon. Members are working towards as regards the cross-over between social care and health care.

I warmly welcome the inclusion of the Care Bill in the Queen’s Speech and the Secretary of State’s comments about personal health care and social care plans for the elderly. We can all make criticisms in saying that more should have been done, but the fact is that this Government have actually done it. The previous Government kept promising to do something about the tragedy of people having to sell their homes to pay for care; this Government have set about doing it by introducing a Bill that will end that tragedy by introducing a cap on care costs. That is remarkable given the background of the deficit we face. The implications of that will be borne out when the electorate understand that finally a Government have committed to go this far.

I firmly believe that this is the right way forward. It has been clear for some time that we needed to create a long-term solution to allow people to plan with confidence for their future. Now other generations, too, can plan how they want to look after themselves in old age because they know that the cap is there and that there will be a higher means-testing threshold allowing them to put some money aside to address these issues. We have already heard in this debate arguments about the threshold, the cap, and the way forward. However, I hope that Labour Members will recognise that, as the right hon. Member for Leigh (Andy Burnham) and the hon. Member for Worsley and Eccles South (Barbara Keeley) indicated, we need to find a bipartisan way to deal with this fundamental demographic issue facing the population of this country and try to shift it out of the political arena.

Having talked about social care, I now want to address NHS funding more broadly. As I have said, I am proud that NHS spending has risen in real terms over the life of this Parliament, but the historic formula used to distribute NHS money around the country needs to be reassessed. Although it is correct to factor in depravation when deciding where funds are allocated, a bigger weighting needs to be given to the age of the local population. A recent Age UK briefing note stated that at any one time about 65% of hospital patients will be over the age of 65, while, according to national statistics, areas with the highest depravation are also likely to be those with the youngest population. At present, therefore, those parts of the country with the highest numbers of older people have to deliver highly specialised services and care without a funding formula to assist them in their work. Moreover, as a Member representing a semi-rural part of the country, I see at first hand the effect that geography also has on the delivery of services and the extra costs involved in delivering quality health care over a wide area.

Lancaster is part of the Morecambe Bay NHS Foundation Trust. It is a pleasant and wonderful geographical area, but it is enormous. It has three hospitals—in Lancaster, Barrow and Kendal. The distance between the hospital in Barrow, which offers some specialist services, and that in Lancaster, which offers others, is 50 miles by car, but the hills and dales mean that it sometimes takes one and a half to two hours to travel between the two. Nothing in the national formula acknowledges the problems faced by the trust. Specialist services need to be retained in as many of those hospitals as possible if journey times are to be kept to acceptable levels, which means that they will require proper funding to allow them to operate. I look forward to working with my hon. Friends the Members for Suffolk Coastal (Dr Coffey) and for Beverley and Holderness (Mr Stuart), as well as others, to try to tackle this unfair disparity with regard to some geographical areas.

I want to pinpoint how the problem affects us locally. The Royal Lancaster Infirmary has a vascular service unit and, despite the excellent clinical outcomes it has delivered for years, it has been suggested that it should close. That would leave a service gap between Carlisle in the north and Preston in the south of nearly 90 miles. It would leave patients from the more rural parts of my constituency, especially those from Barrow or south Cumbria, with lengthy journeys if they needed specialist treatment. Some areas are well outside the 90-minute transport target time, which is already an extension of the national target of 60 minutes.

That delay in journey time is a genuine issue for consideration when establishing where specialist services should be located, as has already been proven by the decision to retain a vascular service in Carlisle, where an exception was made to most of the scoring criteria because of the local geography and the time it would take to transport patients elsewhere. If exceptions are rightly being made in one part of the north-west, they should apply to other areas where substantial delay is likely to occur. As I have already said, under the current plans there is a huge geographical gap in service provision between Carlisle and Preston.

The closure proposal has been referred to the Secretary of State for a final decision and I sincerely hope that he and his Ministers will decide in favour of retaining the specialist provision at the RLI. That, however, is just one example. A more wide-ranging review is being undertaken of service provision across north Lancashire and there are concerns that our local A and E unit may be under threat as a result of geography not being taken into account.

The funding formula needs to change to take greater account of those parts of the country with an elderly population. It also needs better to reflect the difficulties of providing services in large geographical, sparsely populated areas. Without that and the accompanying reallocation of resources, hospitals in rural and semi-rural areas will struggle even more to provide the necessary services to their residents. I urge the Secretary of State to look into this as a matter of urgency.