Where is he?
I welcome the success regime, details of which were published by Monitor yesterday. The purpose of the success regime is to improve health and care services for patients in local health and care systems that are struggling with financial or quality problems. It will build on the improvements made through the special measures regime, recognising that some of the underlying reasons may result from intrinsic structural problems in the local health economy. This will therefore make sure issues are addressed in the region, not just in one organisation.
The regime is designed to make improvements in some of the most challenged health and care economies. The first sites to enter the regime—North Cumbria, Essex and North East and West Devon—are facing some of the most significant challenges in England. They have been selected based on data such as quality metrics, financial performance and other qualitative information.
Unlike under previous interventions, this success regime will look at the whole health and care economy: providers, such as hospital trusts, service commissioners, clinical commissioning groups and local authorities will be central to the discussions. It will be supported by three national NHS bodies, whereas existing interventions tend to be delivered by individual organisations and to concentrate on one part of a health economy—for example, the commissioning assurance framework led by NHS England that concentrates solely on commissioners, or special measures led by NHS England, the Trust Development Authority or Monitor, which focuses on providers.
Together, Monitor, TDA and NHS England, with local commissioners, patients, their representatives such as Healthwatch England and health and wellbeing boards will aim to address systemic issues. The national bodies will provide support all the way through to implementation, with a focus on supporting and developing local leadership through the process.
As we have just heard, this announcement has far-reaching implications for people in Essex, Cumbria and Devon. It was being finalised on Tuesday, when the House was engaged in a full day’s debate on the national health service, yet there was not one single mention of it during the debate. What are we to make of that, and why was the Secretary of State not here to make this announcement to the House? Why does he think that it is always more important to make announcements in television studios or to outside conferences than to Members of Parliament in the House of Commons? That is not acceptable. People in Cumbria, Essex and Devon will be worried about what the Minister has just said, and what it means for health services in their areas.
First things first. Can the Minister confirm that services in those areas are safe and sustainable? Are there enough staff, and will work be undertaken immediately to deal with staff shortages? Are plans being drawn up to close A and E departments, or other services, as part of this process? Could it mean mergers between organisations, and job losses?
We welcome action that means taking a broader view of challenged health economies—indeed, my hon. Friend the Member for Copeland (Mr Reed) has long called for such action—but what will the new regime mean for local NHS bodies? Will it be possible for NHS England to overrule them? The House will recall the last occasion on which the Secretary of State tried to take sweeping powers to close health services over the heads of local people in south London. It did not end well; indeed, it ended with his being defeated in the High Court. Can the Minister assure us that patients will be consulted before any changes go ahead?
Is not the fact that NHS is taking drastic powers over whole swathes of the NHS in three counties a sign of the failure of the Government’s plans for local commissioning, and evidence of five years of failure of Tory health policies? Is it not evidence that care failures are more likely, not less likely, on the Tories’ watch?
This is no way to run a health service, and no way to treat Parliament. The Minister, along with the Secretary of State, is trying to shift the blame for things that have gone wrong in the NHS on their watch—for problems that are of their making. We will not let the Secretary of State do that. He should have been here to do Members who are affected by this announcement the courtesy of giving them answers, and I ask his junior Minister to relay that to him directly after the debate.
The shadow Secretary of State has spoken at length—in his answer to his urgent question—about NHS bodies. He has spoken about local commissioners, about NHS England and about the Department of Health, but Members will have noted that there was one group of people about whom he did not speak, and that was patients. It is extraordinary that, once again, he has come here to speak, again and again, about structures—about the NHS and its bodies, about jobs, about providers and about deliverers—but not about the people who are being failed at local level, namely patients in Essex, west and north-east Devon and north Cumbria.
Let me deal with the right hon. Gentleman’s points in detail. First, he made accusations about television studios. I think it is a bit of a cheek to make such claims—and I should tell the House that the Secretary of State will very shortly be addressing the NHS Confederation.
The urgent question was submitted this morning.
Coming from a shadow Secretary of State who is, one might suspect, using urgent questions and the subject of the NHS not to address issues relating to the quality of care, but for his own political reasons—as he always has—this was a shameless attack. It reflected rather badly on the right hon. Gentleman himself, rather than reflecting on the cause that he should seek to pursue: the better care of patients, which lies at the heart of what NHS England is attempting to do. If he had read what Simon Stevens said when he announced the plans yesterday to the NHS Confederation, he would have noted that they are being drawn up, co-ordinated and, in part, led by local commissioners rather than—as was the case before—by monolithic centralised bodies headed by bureaucrats. This process is being led, locally, by clinicians, who are being supported and helped by NHS England and professional regulators.
The right hon. Gentleman asked about staff shortages. I am surprised that he mentions that, given that he was in part the author of the staff shortages that hobbled the NHS at the end of the previous Administration and that led in part to the problems at Mid Staffordshire that we have been seeking to address. Only this Government, in their previous incarnation, promised to correct that situation, in part through our pledges on GP numbers over the next five years.
The right hon. Gentleman asked about plans for accident and emergency departments and about job losses. I would say to him that it is different this time. These plans are being drawn up by local commissioners, who are now beginning the process of working out how to improve their local health economy. This is not a plan that will be devised centrally in Whitehall, imposed on local areas and announced as a done deal for local people. I know that that is what the right hon. Gentleman is used to, but in this instance it is a genuine conversation between local patients and local commissioners with the aim of improving their local health economies, and it will be supported by national bodies.
The right hon. Gentleman asked about south London and about consultation. I was a candidate in a constituency that had a solution imposed on it, during his tenure as Minister for Health, without any decent consultation. That proposal was eventually thrown out. The previous Government never consulted local people properly when he was in control, but we have changed that. These local plans will involve local people, patient bodies and health and wellbeing boards from the outset.
The shadow Secretary of State asked about the powers of NHS England, about localisation and about the co-ordination of local services. I ask him once again to go back and read Simon Stevens’s speech. He will see how things have changed. This is not about decisions being made by politicians in Whitehall. I dare say that the right hon. Gentleman does not know the solution to the problems in the local health economies in Devon, Essex and Cumbria—
I am so glad that the shadow Minister is such an augur of knowledge. I will tell him who knows the solution: it is the patients and the local clinicians. They will provide the answers and make the changes. We want patient care to be improved for local people to provide excellence in the local NHS—excellence delivered and excellence for patients—and we were supported at the general election in that mission to create a world-class NHS.
Order. I understand that there is a high-spirited atmosphere in the Chamber and a great deal of interest in this subject, but I remind Members that brief questions and brief answers should be on the subject of the urgent question—namely, the success regime. It is with that matter that we are dealing this morning.
I welcome the additional support for struggling health economies, even if it is a classic example of NHS newspeak to call it a success regime. Will the Minister reassure the House that, in looking at a wider approach to health economies, he will also look at the funding formulae for health and for social care, which do not adequately take into consideration the impact of age or rurality?
I thank my hon. Friend for her typically gracious welcome for the proposals. She understands why this matter requires a whole-system approach at local level. I can confirm that the NHS will be studying every single aspect of the local health economy and all that that entails.
Is it not disgraceful that in the health debate on the Gracious Speech two days ago the Secretary of State had nothing to say about the financial crisis affecting the NHS and refused to answer my questions about his plans for Devon, and that this announcement was made to the media yesterday with no details of how it is going to affect patient care or the quality of services in my area? The Minister is very keen on quoting Simon Stevens, but Mr Stevens told BBC Radio Devon this morning that this chaos was a direct result of the fragmentation following this Government’s reorganisation of the health service. When is the Minister going to admit that that reorganisation was a disaster, and when are the Government going to get a grip on the spiralling financial crisis in our NHS?
I heard the right hon. Gentleman’s comments during the debate on the Queen’s Speech, and I know that he has taken a keen and detailed interest in the problems in his local health economy. I know also that he has been very careful and keen to include local commissioners and those who understand what is happening on the ground. That is why I had hoped he would be pleased about the introduction of the success regime, which will build on the financial consultations and discussions that have been going on, will involve local commissioners and, importantly, will provide the back-up of national regulators and NHS England. I did not hear the comments of Simon Stevens on local radio but I did read his speech, in which he made the opposite point to the one that the right hon. Gentleman suggested. The reforms that were brought in, far from being as the right hon. Gentleman characterised them, have saved £1.5 billion in this year, in addition to the £5 billion previously—money that is being invested in care in his constituency.
I am grateful to the Minister for the statement. How will my constituents in mid-Essex and the local health economy in mid-Essex see the results of what is going to be done under this regime? Can he assure me that it will examine the funding formula for health care per head of the population in mid-Essex, which has historically been skewed away from mid-Essex towards other parts of the country?
My right hon. Friend will be aware of the hospitals in Essex that have been placed in special measures. He will also be aware that focusing on one or several particular institutions is not sufficient to sort out the problems in the wider local health economy. That is why the success regime is being brought in—to try and deal with those systemic issues. Once the success regime has been concluded, I hope that his constituents will rapidly see an improvement in the service that they receive and that they deserve, wherever they are in the county.
On his second point about funding per head, he will know that NHS England has already started to look at that and, in some instances, address it. I have the same problem in my constituency in Suffolk, and it needs sorting out in the medium term across the country.
The Minister talks about consulting commissioning groups locally, but why is he not willing to listen to groups of doctors across the country who talk about the point I made on Tuesday—fragmentation? We need integration. Local authorities are having their budget taken away, which means cuts to social care. Social care companies are one thread away from bankruptcy. We need to fund both sides of that, yet we are running round looking at structure. We need to move and look at outcomes. I have heard the Minister talk about “Five Year Forward View”. In Scotland we are already doing that as part of 2020 Vision: look at the patients, as the Minister says.
I take this opportunity to congratulate the hon. Lady on her entry into the House and on her maiden speech, which I enjoyed listening to in the Queen’s Speech debate. In England we are addressing the issues surrounding social care and its integration with the health service. That is why we have introduced the £5 billion better care fund. Under the success regime, far from looking at structure, we are trying to see how we can better link up services. That is why local councils will be a key partner at the table in the discussions.
I welcome the announcement, which I see as an opportunity to review the whole health economy in north Cumbria. It is a chance to review the strengths and weaknesses of health care and patient care in and around Carlisle and north Cumbria. However, will the Minister confirm that this will not hinder other developments, such as the acquisition of the Cumberland infirmary by Northumbria NHS Trust?
It is such a pleasure to see my hon. Friend return to the House. I know that he has been a tireless campaigner for the people of Carlisle. The success regime, as I said in answer to previous questions, will look at every single part of the local health economy, and every single partner in those discussions will be locally based or national regulators and NHS England.
I am desperately concerned about the state of our health services in west and north Cumbria, as are many of my constituents. Many people told me during the election that they want their services delivered as close to where they live—as close to home—as is possible. That is challenging in west Cumbria. I hope that the success regime recognises that, and that we stop talking and consulting and actually have action to deliver the services where people live. That is challenging because of recruitment, and those issues need to be taken into account. I would like the Minister’s assurance that that will be part of the success regime, because without it there will be no success.
I welcome the hon. Lady to her seat. She is right in much of what she says, and the entire purpose of the success regime is to take action, rather than just to keep on publishing PowerPoint presentations. We will be addressing every single part of the failures in her local health economies, and that may well include recruitment.
If a major feature of the success regime is ensuring that there is adequate care in the community, so that people who no longer need to be in acute beds can be released safely and comfortably and to the assurance of their relatives and family, is that not something to be welcomed?
I thank my right hon. Friend for that, and he has got to the nub of the point in a way that the shadow Secretary of State did not. This is about patient care and the excellence we expect from it. That is precisely why I agree with him that success regimes will be successful only if we ensure that we are improving patient care, and that might well include improving access to care at a local level.
The hon. Lady should not be confused because the success regime is indeed dealing with local failure and we intend to turn it into a success. That is the point of what we are doing. We have made these decisions where the NHS has assessed areas as having quality and financial problems. We intend to address them rather than just talk about them, which is why I am so glad that this will be locally led, finding local solutions to local problems.
This intervention affects every one of my constituents, and if it improves their patient care of course I welcome it. The Minister has done extremely well from the Dispatch Box in one of his earliest outings, but can he tell us the timescale of this intervention and how we will measure whether or not it has been a success?
I thank my hon. Friend for his kind comments. He should be aware that success regimes will begin imminently, but we have no set timescale for them yet, because that will be determined by the plan drawn up in the initial stages by local commissioners. Again, that goes to the root of what we are trying to do; this is going to be a plan led by local clinicians, commissioners and providers, in order to provide a local solution.
There are real concerns in the north-west generally about deficits and problems with patient care and safety if those deficits continue. Let me ask the Minister a specific question on the issue before us today: who will have the final say in these areas? Will it be commissioners or will it be NHS England? If it is the commissioners, will they be able to call for more funding, and will the Government meet that?
The hon. Gentleman should know that the success regime will be co-ordinated by local commissioners, supported by NHS England, the TDA and Monitor. They will come together with a plan, which will then be implemented. The only way these success regimes will work is if they are owned by everyone who makes decisions locally. [Interruption.]
I welcome this announcement. As my hon. Friend will know, Basildon hospital has been making good progress in improving patient care, but that has been at a cost. This regime will allow it not to have to choose between balancing the books and providing a safe environment. Can he confirm that patients and the public will be involved at every stage of this process, so that they can suggest any changes that may be necessary to achieve the success we are after?
They will not just be involved; they will be central to the discussions. The jeers and taunts from Opposition Front Benchers give the game away: they expect a decision to be made centrally—that is what they want. That is the only way they think. Conservative Members believe that local people should be central to that decision and that we should fix the whole local health economy, as opposed to trying to deal with individual trusts as they encounter problems.
Will the Minister explain how the problem of chief executives who are not performing properly will be dealt with under this regime? Let me give him an example. Under the coalition Government’s watch the chief executive at Hull, who was disastrous, was moved to Harlow where he is now earning £170,000 a year. He had the help of the TDA in that move and left a disastrous situation in Hull.
I was not aware of that situation and would very much like to talk to the hon. Lady about it afterwards. If the facts she states are true, that is indeed wrong. The whole point of the success regime is to get away from the idea of being able to change one chief executive or commissioner in one provider in a challenged health economy while expecting to see a change to the whole system. We are trying to correct the system so that local care for local people is improved.
If this intervention improves healthcare for my constituents, I will welcome it very much. However, will my hon. Friend clarify the impact on Derriford hospital in my constituency and whether the intervention will put any new management into our hospital?
I thank my hon. Friend for his question and welcome him to this place. To repeat the answer I have given several times so far—[Interruption.] Those on the Opposition Front Bench say that I do not know, but I must explain to them once again that this is not about a Minister sitting in Whitehall making a decision having never visited an area. That is what the right hon. Member for Leigh (Andy Burnham) did when he tried to destroy local services in my constituency and other places in Suffolk. This is different. It is about trying to fix problems in these challenged local health economies, which in some places have been present not for months or years but for decades. We are trying to ensure that the decisions are corrected and made by the local commissioners and clinicians.
Ministers will be aware of the plight of the Barts Health NHS Trust, which is in special measures. Part of its problem is the weight of the interest on its private finance initiative, a new Labour policy that I did not support. It is having to pay that back at £500,000 a month. Surely a success regime for Barts and other hospitals burdened with PFI debt would be a serious attempt to renegotiate those PFI agreements.
I am so glad that the hon. Lady welcomes the success regime and the potential it might have. I spoke to one of her colleagues the other day about the troubled hospitals that she mentioned and I was about to invite her in to have a discussion about them, as we must try to find out what the core issues are with Barts Health NHS Trust. She raises an interesting point about PFI, however. One reason we are struggling in some cases, and why we have struggled over the past five years to provide the funding within the NHS that it requires, is the enormous NHS PFI debt that was loaded on to it by the previous Government and that has cost it billions of pounds over the past 10 years.
I thank my hon. Friend for his very thoughtful comments and replies. Does he recognise that one of the problems for the Devon clinical commissioning group is that it covers a large rural community and also Plymouth, the largest conurbation west of Bristol? We need to find a way in which this can all work to ensure that the city of Plymouth gets looked after and that levels of deprivation and so on are considered.
My hon. Friend makes the point better than I did. How do we sort these problems out using the local knowledge that he has just demonstrated rather than having a Minister in Whitehall with a map thinking that he or she can make the decision themselves? The success regime seeks to harness that local knowledge and the local solutions.
It is simply not acceptable that an announcement of this magnitude should have been made without first being debated in this House. As I understand it, the success regime applies to a number of areas of the country but not to London. My local hospital, King’s College hospital, has a deficit well in excess of £40 million. It is nigh on impossible in parts of the constituency to see a GP when people need to. We have a crisis in the NHS across the country. What is the comprehensive plan to address that? We need that rather than a piecemeal intervention in only parts of the country.
I welcome the hon. Lady to her place. She will not know that there was an Adjournment debate at the end of the last Parliament on precisely this issue. I invite her to seek such a debate if she wishes to discuss local issues with me or other Ministers. The success regime has been devised by Simon Stevens and NHS England. It will be clinically led, fulfilling our desire to see the NHS led by doctors, not Whitehall bureaucrats.
I welcome the announcement. Colchester general hospital is in special measures. One of the biggest issues facing our hospital is the recruitment of nursing staff. Will my hon. Friend give an assurance that county-wide recruitment will be included as part of the success regime?
Having listened to the Minister’s answers, it seems to me that patients have every right to be worried about whether care is safe in the NHS. Does he not realise that, unless the Government reverse the cuts in social care, the problems in patient care will not be resolved anywhere in the NHS—not just in the areas covered by the so-called success regimes?
May I gently remind the hon. Gentleman that this Government and their predecessor changed the culture of trying to suppress bad news, whether on care or money, and instead tried to understand what was best for patients, even when that meant facing up to difficult decisions? That is precisely what NHS England is doing with the success regime, and that is why we are addressing seriously challenged local health economies, rather than pretending that there is not a problem, which I am afraid was the attitude of the Labour Front-Bench spokesman when he was in power.
Order. I must say that it is a pleasure to welcome back to the House the right hon. and learned Member for Rushcliffe (Mr Clarke), who when he celebrates 45 years in the House this month will I think be approaching the mid-point of his parliamentary career.
At this crucial mid-point, thank you very much, Mr Speaker, for that unusual way of calling me.
Does my hon. Friend the Minister recall that the whole purpose of introducing the purchaser-provider divide many years ago, which was developed by the Labour party and is now known as local commissioning, was to concentrate on patient care, patient outcomes and local priorities? Will he therefore, with this welcome announcement, continue to stick by NHS England, allow it to do that, and resist the blandishments of the shadow Health Secretary, who seems to pine for the days of centralised bureaucracy and is still feebly trying to weaponise the NHS for party political purposes?
It gives me particular pleasure to respond to my right hon. and learned Friend. He was an exceptional Secretary of State for Health because he understood the centrality of local decisions by patients and their doctors and commissioners. I confirm that we will continue to allow local commissioners to make the decisions, rather than try to wrest power back from them to Whitehall, which is precisely what the shadow Secretary of State did when he was Secretary of State.
I welcome the hon. Lady to her place. I only hope that she does not have the same contempt for her constituents that her predecessor seems to have expressed. It is interesting how it all comes out afterwards. I repeat to the hon. Lady that the decisions will be made locally by local people and local commissioners in response to local problems, and where they arise we will seek to address them.
I have heard that trusts in my constituency were potential candidates for this regime. Will the Minister please make it clear that, unlike some previous oversight regimes, this regime will enable local health care organisations to work together to solve their problems and will involve not just scrutiny but more support?
I thank my hon. Friend for her question. I am delighted to see her in her place. She has experience and expertise in this area. She will know that elsewhere in the country, before 2010, local commissioners, doctors and providers often came up with good solutions, but then strategic health authorities would come in with a completely different answer and override all of them. That is what we are seeking to avoid.
The Minister is right that patients are key to this, but so are the people who deliver hands-on services. He has mentioned the role of clinicians a number of times, but what about the voice of care workers, nurses and other people on the front line? Will they be listened to, and will their representative bodies, such as trade unions and colleges, be listened to, or will they be completely and utterly ignored, as was the case with the Health and Social Care Bill?
The early stages of these exchanges would have been better had the Opposition asked how the Government will respond to the deficiencies shown in the Care Quality Commission report. I recommend that all Members read the article in The Guardian today by Diane Taylor and Denis Campbell, which sets out the problems that this is tackling. Will my hon. Friend ensure that those areas where there are no major problems, such as Coastal West Sussex, are given support and not overlooked, and that resources are not taken away from them, because they are as under-resourced as others?
This is not about moving resources around the country. I must say that I differ with my hon. Friend on his views about the CQC. It was a complete basket case when the Government came to power in 2010, but it has since been turned around and is now providing exceptional inspection regimes, which is changing the whole nature of safety and quality in the NHS. I hope that it will continue to improve.
The Minister says that there are systemic issues in Devon, Cumbria and Essex. Did the National Audit Office confirm that, and did he know that before the election? Why did he not reveal his hand then to say that he would intervene in one or more of those areas, or is he simply playing politics with patients’ lives?
The hon. Gentleman should know that there have been issues in those areas not just for months and years, but sometimes for decades. We have sought in the first instance to deal with problems with providers, which is why in two of the areas we have hospitals in special measures, or formerly in special measures. We are now seeking to fix the problems in the wider local health economy, led by local people. We are getting on with that, rather than just talking about it, which is what happened before.
I do not at this stage anticipate—I have received no indication from NHS England—that the success regime will be extended in any way. I repeat that this is a particular intervention by local people, in co-ordination with NHS bodies, to fix local NHS problems. It they arise elsewhere in the country, I am sure that local people will want to look at them too.
I welcome the hon. Lady to her place. We are now repeating discussions we had in the previous Parliament, because I am afraid that the Labour party still does not understand that these decisions are not being directed from Whitehall. I know that is uncomfortable for them, because what they want to do is pull a lever and hope that something happens at the other end, but that does not work. The only way to get success is by having local clinicians, supported by national bodies, providing the solutions that local people deserve.
In North Northamptonshire we had a problem with the A&E at Kettering hospital. Local commissioners and three hon. Members—my hon. Friends the Members for Kettering (Mr Hollobone) and for Corby (Tom Pursglove) and I—all worked together to produce a plan, which the Minister has taken up. That is a precursor to the success regime, and it shows that local commissioners, local hospitals and MPs can solve problems by working together. Will the Minister continue to look on that favourably?
The care of my hon. Friend’s constituents, including Mrs Bone, is always a prime consideration. He has shown what Opposition Front Benchers should understand, which is that working across parties, as he did in his part of the world, can bring about co-ordination and success. I only wish that those on the Opposition Front Bench, on what should be a clean slate, would do the same.
Is the success regime a 21st-century way of improving the NHS? If so, may I ask the Minister always to seek to improve the NHS, which has to be constantly moving and improving for the sake of every patient? Will he, like the Secretary of State, visit Teddington memorial hospital in my constituency, where a local initiative has vastly improved our out-of-hours service?
I welcome my hon. Friend to her seat. I hope to make a whole series of visits soon and I will certainly talk to her about her hospital. She will have noted that the very first speech given by my right hon. Friend the Prime Minister was about the NHS. That reaffirms our commitment to the NHS. We were the only major party to commit to the NHS’s own plan for success over the next five years. That is why the Conservative party, to be frank, is the only one that can now be called the party of the NHS—[Interruption.]
It must have been a great pleasure for my hon. Friend to have taken personal possession of the 2015 Act, which he helped steer through Parliament and piloted himself. It is a significant contribution to the cause of patient safety, which lies at the heart of the Government’s vision for the NHS.
I thank my hon. Friend for his kind comments. The success regime is locally based but must take into account the developing national opinion on the integration of health and social care. However, those can be properly integrated only on the basis of local considerations; this is not something that we can design from the centre, as some would wish.
I thank the Minister for confirming that the Health and Social Care (Safety and Quality) Act 2015 will be at the forefront of the minds of those implementing these plans. The 2015 Act was passed by the House in the very last days of the last Parliament. Does not the fact that the Opposition have asked this urgent question today show that they have already forgotten the central tenet of the Act: that patient care and safety will be at the forefront of everything that the Government do?
I repeat to my hon. Friend the observation that I made earlier: it is interesting that in his opening contribution, the right hon. Member for Leigh did not make a single statement about patients and their centrality to what we are trying to do. The NHS has devised its own plan for its own success over the next five years, and the safety and care of patients lie at the heart of it. Only one party is supporting that plan, and that is why the Conservatives are the only party backing the NHS.
I congratulate my hon. Friend on his response to the urgent question and the new Government on acting so swiftly. Having listened to the exchanges across the Floor of the House today, I think it would be particularly sensible and grown up for Her Majesty’s Government, first, to admit that there are geographical parts of our NHS that are not working as well as they might and, secondly, to seek local holistic solutions to put them right as soon as possible.
Thank you for calling me, Mr Speaker; my knee is giving way.
Would my hon. Friend like to come to Morecambe bay to see an excellent initiative run by Dr Alex Gaw called Better Care Together which is a pointer for the success regime? I should also say that, according to Labour, the NHS is always in crisis—but it never says what from, unless it is hospital closures that do not exist.