House of Commons
Tuesday 19 December 2017
The House met at half-past Eleven o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
The Secretary of State was asked—
An impact assessment has been published as part of the Government’s public consultation, and it suggests that moving towards an opt-out system for organ donation, as part of a wider communication and logistical package, can be associated with higher donation rates. The Government have invited submissions of further evidence, which we will consider carefully before responding. We have already received in excess of 2,000 responses since the consultation started last week.
As someone with a long-standing passion to increase the number of organs available for donation, I am encouraged by the Minister’s response. Does she think that the shift from the current voluntary system to one where the state makes decisions based on presumed consent had an impact on the reduction in the number of live donors over the past three years?
I part with my hon. Friend on his point about the state taking control through presumed consent. We are talking about a register from which people could physically opt out, rather than opt in. The issues about end-of-life consent will continue to be the same, and the next of kin will be a full consultee. As for live donation, the issues are complex, but one reason why we are seeing a decline is that the waiting lists for receiving an organ are coming down, which is reducing the need for live donors. We should keep a watching brief on that.
Part of the evidence base relates to the fact that hundreds of people die each year because we do not have enough organ donors, so I thank the Minister for her work in bringing forward this consultation. What more can be done to widen public participation?
I thank the hon. Gentleman for his support and for his hard work in this space. Through him, I can perhaps thank the Daily Mirror for its public displays of education through the Max’s law campaign, but we all need to make an effort. There is no doubt that the public are hugely in favour of donation and want to be able to support it as best they can, but the matter has rather fallen from public consciousness. Everyone in the House has an opportunity to raise public awareness, get involved in the consultation and have a real debate, because we need to ensure that people are willing to donate their organs so that we can save more lives.
There are already 24 million people on the voluntary organ donation register, which is a significant proportion of Great Britain’s population. None the less, three people a day die because appropriate organs are not available for transplant, and it is vital to do something about that. Is my hon. Friend aware of a particular difficulty with members of black and minority ethnic populations being more reluctant to join the register than others? Is there a way to encourage them to take part in the voluntary scheme?
My hon. Friend highlights one of the biggest challenges we face. There is no doubt that the rate of organ donation is much lower among black and minority ethnic populations, and yet they are more likely to suffer from diseases that require a donated organ, so we are keen to work on that. Only this week, I met organisations connected with the black and Asian community to discuss how we can communicate, getting the right messages through the right messengers, to encourage people to join the register.
I fully support the organ donation opt-out, because it will increase the pool of organ donors. Will the Minister comment on whether the recent statistics from the Welsh Health Department show an increase in the provision of organs due to presumed consent? In other words, has it been a success so far?
I thank the hon. Gentleman for his support. The figures from Wales come at an early stage, but the system that we are looking to introduce has much in common with that in Spain. The issue is not so much about the register moving towards an opt-out system, but the wraparound care that goes with it, such as the specialist nurses who speak with relatives when they are going through the trauma of losing a loved one, and the public debate that raises awareness. Taken together, they are what will lead to more organs becoming available.
Group B Streptococcus
As the Secretary of State has set out, our ambition is for the NHS to be the safest place in the world to give birth. Information on prevention and the implications of a group B streptococcus infection is available on the NHS Choices website. Just today, the Royal College of Obstetricians and Gynaecologists published a new patient information leaflet that, from the new year, will be given to all pregnant women for the first time. Because it is Christmas, I have a copy here for the hon. Lady. [Interruption.] I see she has one, too.
I thank the Minister—he has anticipated my question. I reassert that, on average, two babies die each month from complications relating to group B strep. Awareness of the effects of that infection is incredibly low. Will the Minister meet me and Group B Strep Support to discuss how we can get this leaflet to mums-to-be at the earliest possible stage?
I know this is a subject about which the hon. Lady cares greatly. I would be very happy to meet her and to bring together the people I work with from Public Health England to see how we can make the best of this new leaflet and ensure it is the best and most important Christmas present.
I welcome the Government’s focus on reducing stillbirths, and I welcome the maternity safety strategy. I particularly welcome this focus on group B strep. Will the Minister outline how he is working locally with hospitals such as Southampton to make sure they are aware of this new focus?
I thank my parliamentary neighbour for that question. Public Health England is one of the most effective arm’s length bodies with which we work in government, and it will be working with commissioners and trusts across our country to make sure that this new information is out there with pregnant mums and the most at-risk groups. Members of Parliament have an important role to play with local commissioners and trusts, and I know my hon. Friend will play her part in that.
General practice remains under sustained pressure, which is why we remain committed to increasing the number of doctors working in general practice by 5,000, however challenging that might be.
Does my right hon. Friend not think it is unfortunate that, at a time when GP services are being sustained, local hospital services in some areas are being reduced? Does he share my concern that some NHS trust managers and clinical commissioning groups seem hellbent on removing valued local services from our smaller hospitals, such as at Driffield and at Bridlington in my constituency?
My right hon. Friend has talked to me extensively about this in private, and I fully understand his concerns. The Government are increasing funding to the NHS, which involves extra money going both to out-of-hospital services, such as general practice, and to hospital services. We expect all areas of the country to find sensible ways for those two sectors to work together.
I refer Members to my entry in the Register of Members’ Financial Interests.
Has the Secretary of State seen the recent report of the Royal College of General Practitioners, “Destination GP,” on how to inspire medical students to pursue a career in general practice? Will he consider the report’s recommendations to help to better support medical student placements in general practice?
I will absolutely consider the sensible recommendations of that report. People on both sides of the House, such as the hon. Gentleman, who were GPs before being elected do a fantastic job of flying the flag for general practice. We are making some progress. Some 3,157 medical school students have gone into general practice as a specialty—the most ever—but there is lots more work to do.
I very much welcome the additional funding this Government have put into the NHS, but constituents tell me that they can better manage chronic conditions and illnesses if they have consistent care from general practitioners, which is something they find difficult to access in some surgeries in my constituency because of problems with recruitment and retention. What is the Secretary of State doing with his team to make sure we can lessen that problem in future?
I totally agree with my right hon. Friend. One of the best things about the NHS is that people have a GP who knows them and their family. There is a lot of evidence that that is the best way to manage people with long-term conditions, as she rightly says. The truth is that, for a very long time, successive Governments have not invested as much as they should in general practice. We are trying to put that right, and part of that is flying the flag for what an exciting career general practice is. It is the one part of medicine where doctors have an ongoing relationship with patients and their families over their whole lives, which is very motivating.
The capacity and availability of at least one GP surgery in my constituency are both profoundly affected by the relationship with NHS Property Services—incomplete maintenance jobs and vastly increased rent are problems. Will the Secretary of State meet me and the practice manager of that GP surgery to discuss this?
I understand the concerns that the hon. Lady raises; they have been raised by a number of Members. There are historical issues on the levels of rent charged by NHS Property Services, which frankly are not fair given the variation in charges to different GP practices across the country. I will be happy to look carefully into the issues she raises.
The NHS has lost 1,300 full-time GP equivalents in the past two years and 200 GP partners during the same period. Given that 20% of the GP workforce is aged over 60, there is clearly a retirement time-bomb looming. What steps does the Secretary of State intend to take to address the growing workforce crisis in general practice? His efforts so far have failed and patients are waiting longer than ever for a surgery appointment.
I would respectfully say that the figures the hon. Lady has pointed out do not take account of locum doctors. None the less, there is a big problem and she is right to draw it to the attention of the House. What are we doing? I think there are two things. First, we need to encourage more medical school graduates to go into general practice as a specialty, and our objective is that half of all medical school graduates should choose general practice as their specialty. We are making good progress on that. [Interruption.] As she is saying to me, rightly, retention is also extremely important. That is why we are putting in place a number of programmes that will make it easier for GPs who want to work for a limited period of time to work flexibly, and potentially for people who have family responsibilities to work from home. We hope that those programmes will also make a difference.
NHS Funding Trends
We had productive discussions with the Chancellor of the Exchequer ahead of the Budget, which led to a £2.8 billion increase in NHS revenue funding and a £3.5 billion increase in NHS capital funding.
Given that NHS trusts in England are facing a cumulative budget shortfall of more than £1 billion and yet one in six patients who attend accident and emergency in England will still wait for more than four hours to be treated, what will the Secretary of State be telling health service managers to prioritise this winter? Have they to concentrate on cutting the deficit or cutting the waiting times?
I am slightly bemused to hear that question from the hon. Gentleman, given that over the past four years NHS funding in England has increased by 10%, whereas in Scotland it has increased by only 5%. Indeed, Scotland now has the longest waiting times on record for elective surgery. What are we saying to NHS managers? We are saying, “We understand how tough it is. You and your teams are doing a brilliant job, and we want to do everything we can to support you through what will be a challenging winter.”
As it is Christmas time, may I congratulate my right hon. Friend on securing the extra funding and making sure that it is spent effectively in his Department? Does he agree that one important thing to think about at this time of year is winter pressures? In an area such as mine, it is important that there should be some extra funding at the hospital at this time of year. Is he able to say anything about that today in respect of the Lister Hospital in Hertfordshire?
With patients in Exeter now waiting more than a year, in pain, for vital surgery—well beyond the 18-week maximum guaranteed in the NHS constitution—can the Secretary of State explain the contradictory statements of the Chancellor, who said at the time of the Budget that he expected significant “inroads” to be made into growing waiting time lists, and the NHS England board, which met the following week and said that NHS waiting time standards
“will not be fully funded and met next year”?
I have been waiting for the right hon. Gentleman to issue the press release welcoming the £1.4 million of extra funding that the Royal Devon and Exeter got in the Chancellor’s Budget, but for some extraordinary reason it has not been forthcoming. Let me tell him that, as many people have commented, the NHS got a lot more money than it was expecting in the winter announcement—
I very much welcome the £2 million winter allocation for the hospitals in my area. Funding is clearly important, but given the improvements in the hospitals in my area that are down to the leadership of the chief executives, the leadership team and the staff, does the Secretary of State agree that leadership is as important as funding?
My hon. Friend is absolutely right. Of course, both things matter, and hospitals do need the right level of funding, but one of the highlights of the year for me was visiting my hon. Friend’s local trust in Carlisle and seeing the total transformation in leadership there. It was one of the most troubled trusts in the NHS but, thanks to the incredible dedication of the doctors, nurses and everyone working in the trust, it has really turned things around.
The Scottish Government already pay nurses and care assistants the highest rate in the UK, have maintained the nursing bursary, and have now committed to a 3% pay rise for those earning £30,000 or less. Does the Secretary of State recognise that his failure similarly to value NHS staff in England is one reason why England’s nursing vacancy rate is more than double that of Scotland?
What I recognise is that life expectancy continues to rise in England but has ground to a halt in Scotland. One reason why is that the Scottish National party has consistently not taken the extra resources it could take and put them into the NHS, but has instead chosen other priorities.
At the previous Health questions, the Secretary of State said that funding from the Chancellor to remove the pay cap would be based on productivity improvements. Will he elaborate on what productivity improvements are expected and when NHS England staff will get the pay rise that they deserve?
We are having fruitful and productive discussions about productivity with the “Agenda for Change” unions, including the Royal College of Nursing. We are looking at all sorts of things, including how the increments system works. I am hopeful that we will have a win-win: a modern contract that is fit for the future for “Agenda for Change” staff and that also allows us to go beyond the 1% cap, as the Chancellor has authorised me to do.
Of course, this is not just about funding. The Secretary of State recently wrote to East Sussex Healthcare NHS Trust to recognise the fact that its A&E department was the most improved in the past six months. When I spoke to the chief executive, he said that the management focus on targets and delivery against them was the reason why that turnaround has occurred.
I met the chief executive in person last week and was able to congratulate him on several important changes that are happening. He will be pleased that we were able to find £1.9 million more for East Sussex in the Budget. My hon. Friend is absolutely right that it is not just about money. The difference between the Government and the Opposition is that they say it is all about money whereas we know that quality of leadership makes a critical difference in turning around our hospitals to make them the best in the world.
In the past few weeks, Simon Stevens, Sir Bob Kerslake, Sir Bruce Keogh, Jim Mackey, Chris Hopson and a number of other senior public servants have all told the Government that the NHS does not have the funding that it needs. It is patently obvious that, with most performance targets being missed, treatments being rationed and hard-working staff completely demoralised after seven years of pay restraint, funding levels are not sufficient. Arguing with celebrities on Twitter is not going to change that. Even though the Secretary of State has a new-found enthusiasm for 280-character statements, all I ask from him today is one word. Is the NHS getting the funding it says it needs—yes or no?
Order. We must observe the terms of debate. It is not for the Secretary of State to ask questions. He has been in the House long enough to know that. Please do not play games with the traditional and established procedures of the House, Secretary of State. You can do better than that.
Yes, I am delighted that the local hospital of the hon. Member for Ellesmere Port and Neston (Justin Madders) got £2.8 million in the Budget, but I am disappointed that he did not feel able to issue a press release to his local press. I have much enjoyed debating with the hon. Gentleman over the years, but the difference between me and him is that although we both want to find extra money for the NHS, he would do so by hiking corporation tax, which would destroy jobs, whereas Government Members want to get money into the NHS by creating jobs, which is what we are doing.
Councils in England will receive an additional £2 billion for social care over the next three years, as announced in March 2017. The Government have given councils access to up to £9.25 billion more dedicated funding for social care over the next three years as a result of measures introduced since 2015. This means that, overall, councils are able to increase spending on adult social care in real terms in each of the next three years.
Last week’s Health Survey for England revealed that older people in more deprived areas, such as my own constituency of Liverpool, Walton, are twice as likely to have unmet social care needs and our NHS is left picking up the pieces. When will this Government stop passing the buck and bring forward concrete plans on proper investment and reform to end the national scandal that is our care system?
The entitlement to care is completely enshrined in the Care Act 2014, so if needs are not being met, there is a statutory obligation that can be enforced. On the long-term solutions, obviously, we have put in additional money to sort out the short-term funding pressures, but we need to have a long-term and more sustainable deal with which to meet our obligations for social care, which is why we are bringing forward a Green Paper next year. I hope that the hon. Gentleman will participate in that debate.
I am grateful to the hon. Gentleman for raising this with me today, because I hope to reassure the House, and anxious people with loved ones in care with Four Seasons, that there is no immediate threat to continuity of care. I and my officials are keeping a very close eye on the situation, so that, with the Care Quality Commission, we ensure that there is a stable transition and that the commercial issues are dealt with in an appropriate way. That is leading to some very challenging conversations, but I can assure him that I and my officials are on it.
Given that health and social care are intrinsically linked, even more so now as sustainability and transformation plans are rolled out, does the Minister agree that now is the time to put health and social care under one roof in a combined department?
I have always thought that a silo culture was the enemy of good public policy, which means that integrating policy making across Government will tend to lead to better outcomes. I can assure my hon. Friend that I have regular conversations with the Department for Communities and Local Government and, as we approach the long-term funding pressures, we will be very much working in tandem.
The recent Health Survey showed not only that unmet needs were most concentrated among people who are the most deprived, as we have just heard, but that 2.3 million older people, aged 65 and over, now have unmet care needs—2.3 million. Neither the care Minister in her recent statement nor the Chancellor in his Budget said anything about closing the funding gap for social care. Given that the Green Paper is only scheduled for next summer, what is the Health Secretary doing about the crisis in funding social care and meeting staggering levels of unmet needs?
The hon. Lady will be aware that, immediately following these questions, we will be having a statement on funding from the Secretary of State for Communities and Local Government. I remind her again that we have made an additional £9.25 billion available for social care over three years, but she is right that the long-term sustainability will be addressed by reform, which is why we are bringing forward the Green Paper. As to the figures on unmet needs, I simply do not recognise them. The entitlement to care is enshrined in the Care Act, and those rights are protected.
NHS Funding (Autumn Budget)
The autumn Budget committed to backing the NHS, so that by 2019-20, it will have received an additional £2.8 billion of revenue funding for frontline services, including £337 million for winter allocated last Friday and £3.5 billion of new capital investment by 2022-23 to transform the estate.
My hon. Friend needs to be congratulated in this House on being a champion of the University Hospitals of Morecambe Bay NHS Foundation Trust. The trust has been through some difficulty, and he has stuck with it and supported it. I can confirm that the trust was allocated up to £2 million of funding last Friday; I congratulate it on that. I am sure that he would also join me in congratulating the trust on recently being awarded the title of the eighth most inclusive employer in the UK.
Does my hon. Friend share my delight at the £41 million capital allocation that was announced in the recent Budget? Does he agree that that huge sum will enable us not only to maintain the present excellent services at Southend hospital, but to enhance and develop them further for the benefit of all local residents?
My hon. Friend has worked tirelessly with his neighbouring colleagues in Essex to secure not only the £41 million to which he refers. In fact, that figure is a component of the £118 million capital allocation made to the Mid and South Essex Sustainability and Transformation Partnership area in the Budget. This will provide significant investment not only in his local hospital in Southend, as he as mentioned, but in Basildon and in Broomfield Hospital in Chelmsford. I am sure that he and his colleagues in Essex welcome that.
My local clinical commissioning group in north Derbyshire has been placed in special measures by NHS England. It has been forced to cut £16 million over just six months and to bring forward the closure of the Spencer ward in Buxton before any proper alternative is in place due to a lack of funding. Does the Minister not agree that the Budget funding is too little, too late?
The hon. Lady will be aware that the special measures regime was introduced to help trusts that are having difficulty in meeting quality performance standards to improve their quality. They receive support from NHS Improvement in order to do that. If she would like to write to me with the specific details of her trust’s situation, I would be happy to take up the case. But as far as I am concerned, her trust is on an improvement journey.
Given that about a quarter of the additional funding goes to patients with neurological conditions—from strokes to Parkinson’s —what steps is the Minister taking to reduce the often appalling delays between the onset of disease and access to occupational and physical therapy? Will he agree to meet a charity from my constituency of Twickenham called Integrated Neurological Services, which is saving lives and money by drastically reducing that timeline?
The right hon. Gentleman will be aware that centralising cardiac services in particular into acute cardiac hospitals is having a significant impact on improving access to treatment by reducing the time it takes to get diagnostic tests and initial treatment, and is therefore saving lives. Specialisation is working in London and in other parts of the country where it is being applied. I am sure that he would welcome the recent allocation to Kingston Hospital of up to £1.3 million to help with winter pressures.
The Minister visited Kettering General Hospital earlier this year and saw for himself that a record number of patients are being treated with increasingly world-class treatments. Will he confirm that the hospital will get £2.6 million to cope with winter pressures this year?
My hon. Friend never fails to highlight the success of Kettering General Hospital. I am delighted to confirm that £2.6 million will be available for that hospital this winter. We are working hard with the hospital management, through the special measures regime, to improve performance in that trust.
Bed occupancy rates across London last winter were running very near to 100%, including at Whipps Cross University Hospital in my constituency. With the much-vaunted extra funding, what will the bed occupancy rate have been by the end of this winter?
Bed occupancy rates are high at this time, not least following the recent cold snap, which has put additional pressure on hospital trusts. We have used some of the funding provided in the March Budget to increase the rates of delayed transfers of care to improve patient flow throughout all hospitals, and that has led to a slight reduction in bed occupancy in the run-up to winter.
Mental Health Workforce
In order to increase the number of mental health patients we treat by 1 million every year by 2020-21, we are increasing the number of mental health posts in the NHS by 21,000.
My hon. Friend is absolutely right, for the simple reason that prevention is better than cure, and about half of all mental health conditions become established before the age of 14. That is why it was so significant that, following the Budget, we announced the allocation of an extra £300 million through the mental health Green Paper, precisely to improve the service we offer students in schools.
The Secretary of State has, on numerous occasions, to both the media and this House, referred to an increase of 4,300 staff working in mental health trusts since 2010. In response to my written parliamentary question, he was unable to clarify whether this 4,300 figure includes the 1,478 people who were rebadged as mental health trust staff following a trust merger in Manchester last year. Nor would he confirm whether this figure includes the 858 people NHS Digital says were already working in the sector, who transferred from primary care trusts to mental health trusts when primary care trusts closed back in 2013. Would the Secretary of State offer the House some festive cheer and take this opportunity to set the record straight?
I am very happy to offer the hon. Lady festive cheer and to explain to her that, even if her suspicion is right—and I do not believe it is—there has still been a significant increase in the number of staff employed in mental health trusts. The other suspicion she has constantly raised in the media and in this House is that mental health funding is being cut. She will know that the best news of this year is that, last year, funding actually went up by £575 million.
Given that the NHS owns a great deal of land and buildings, and that mental health workers and other health workers face high accommodation costs, will the Secretary of State meet me so that I can explain how the benefits of the Self-build and Custom Housebuilding Act 2015 could be used as a powerful retention and recruitment tool for mental health workers?
I commend my hon. Friend for his work and thinking on this through the Public Accounts Committee, and he is absolutely right. I am more than happy to talk to him about this, but we actually have it as a priority to make sure that when NHS land is disposed of, NHS workers get the first opportunity to buy or rent the houses that are built.
There are still not enough staff trained in autism diagnosis across the NHS. Would the Secretary of State consider training a specialist in each community child and adolescent mental health service right across the country to ensure that there is no longer a postcode lottery?
I would always listen to the hon. Lady on those matters, because she has huge professional experience. I do not think we do well enough for families with autism, and we are looking at what we can do better, but I have a lot of sympathy for the case the hon. Lady is making.
Malnutrition: Hospital Admissions
Ensuring all our constituents—particularly the vulnerable and the elderly—are getting an adequate diet is critically important. That is why, for instance, we have given half a million pounds in funding to a special Age UK taskforce to reduce malnutrition among older people, and we will continue to train NHS staff so that early action can be taken.
A merry Christmas to you, Mr Speaker, and to the Ministers on the Front Bench—maybe they will answer my letter soon.
In the world’s sixth largest economy, it is damning that, under this Government, we have seen a 122% increase in the overall numbers admitted to hospital with malnutrition. It is clear that more action is needed to ensure that we eradicate malnutrition in our society. The Department for Work and Pensions and the Health Department must work together so that, rather than introducing measures such as universal credit eligibility criteria, which will see at least 1 million children lose free school meals, we commit as a country to tackling this issue head on. Will the Minister use his power and influence to ensure that this issue is addressed immediately and that we see an end to this failure to axe malnutrition in the 21st century?
Happy Christmas to St Helens as well. I agree that we need to work together. The Healthy Start programme, for which I am responsible, provides a nutritional safety net to hundreds of thousands of pregnant women and families with children under four. There is a slight increase in cases being reported in recent years. In part, that is due to much better diagnosis and detection. Some 1.1 million children get free school meals in England, and the Government are investing £26 million in breakfast clubs. Only last week, Kellogg’s was here with its breakfast club awards—an excellent innovation.
That being said, it is disgraceful that under this Government’s watch we have seen a 54% increase in children admitted to hospital with malnutrition. Instead of seeing malnutrition rising, we really should be eradicating it. As the festive period is upon us and it is the season for good will and giving, will the Minister give this House an assurance that he will seriously address this matter to ensure that no child in this country ever experiences malnutrition?
Of course we want no child in our country to experience malnutrition. I mentioned the Healthy Start scheme and the breakfast clubs. Healthy Start is an excellent programme run by Public Health England that encourages a healthy diet among hundreds of thousands of families with children under four. It is exactly that which is helping us to tackle this issue.
The recently announced life sciences sector deal draws significant investment into the sector from across the world, ensuring that the next wave of breakthrough treatments, innovative medical research and technologies—and highly skilled jobs, of course—are created right here in Great Britain.
In Scotland today there are over 600 life sciences organisations employing more than 30,000 people, making Scotland one of the largest life sciences clusters in Europe, so they too will welcome the announcement the Minister mentions. Will he give the House some more detail on the sector deal and industry investments that could give even more strength to this world-leading industry across the United Kingdom?
The sector’s commercial activity is very broadly spread across the whole of the UK—my hon. Friend’s concern. There are a number of strong emerging life sciences clusters. The deal highlights successes around the UK in Manchester, Leeds, Sheffield, Glasgow, south Wales, and the south-east, so it is a very broad spread.
Medical research charities play a key role in developing new medical treatments, yet the Charity Research Support Fund, which enables universities to unlock investment from the sector, has been frozen since 2010. Will the Minister heed the call from the Association of Medical Research Charities to enhance CRSF in real terms, in line with inflation and with charity investment?
I can come back to the hon. Gentleman in more detail on that. As part of the life sciences sector deal, there is just over £210 million of industrial strategy challenge funding for early diagnosis. This includes funding to build on the UK’s leadership in genomics, where we are very strong, and to establish programmes in digital diagnostics and artificial intelligence in healthcare.
Mental Health Workforce
Although we cannot meaningfully compare between 2010 and today, I can advise that the number of NHS staff working in mental health and learning disability trusts was 162,611 in July 2013 and 166,905 in July 2017—an increase of 4,334.
That did not actually answer my question. Earlier, my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) read out a long list of concerned professionals, so let me add one more—Professor Wendy Burn, the president of the Royal College of Psychiatry, who said after the Budget:
“There is a real and imminent danger that the promises made to improve mental health services for the millions of people who need them are about to be betrayed.”
Is she wrong? Is it not true that without proper funding for more staff, the Prime Minister’s pledge to transform mental health services will not be met?
As the hon. Gentleman knows, we have published a workforce strategy to deliver exactly on the commitments that the Prime Minister has made. I can report that we have had a significant increase in the workforce. For example, in IAPT—improving access to psychological therapies—the number is up by 2,728 since 2012, a 47% increase. The number of psychiatry consultants is up from 4,026 in 2010 to 4,292. The number of community psychiatry nurses is up from 15,500 in 2010 to 16,658 in August 2017. We are delivering the workforce to implement the Prime Minister’s commitments. The most important thing is that rather than trade numbers, we should look at outcomes for patients and improving patient care.
The hon. Lady raises exactly the point that we are trying to address through the Green Paper. We are committed to delivering on the four-week waiting time by 2020, which will make sure that we treat over 70,000 more children with mental health issues that need to be addressed. I will be quite honest: this is not where I want us to be, but that is exactly why the Government have made it a priority and we will deliver by 2020.
The Budget announced an extra £337 million to help NHS trusts to deal with the pressures of winter.
I am grateful to the Secretary of State for that answer, and I welcome the additional £2.6 million for Kettering General Hospital. As he knows, the Corby urgent care centre is a vital service that helps to relieve pressure on Kettering General’s A&E all year round. What role does he see such facilities playing in relieving pressures, particularly during the winter period?
I thank my hon. Friend for his campaigning, and I am delighted that the Budget allocated an extra £2.4 million to help Kettering General Hospital. He is absolutely right that urgent care centres play a vital role in keeping people away from busy A&E departments. We need to be better at signposting the public so that they know when to go to a GP surgery, when to go to an urgent care centre and when to go to a hospital.
One of the causes of pressure in my part of London is the continuing threat of impending closure to King George Hospital’s A&E. Will the Secretary of State today confirm that the consultation that is now being engaged in will result in the A&E at King George Hospital being saved?
I am afraid that the hon. Gentleman will have to wait until the result of that consultation is published. I visited the trust last week, although I went to the Romford end of it, and I think that it is making great strides in improving the quality of care. I congratulate all the staff at the trust on what they are achieving.
We remain committed to reducing the national suicide rate by 10% by 2020, and our record investment in mental health will ensure that we can achieve that ambition. Local suicide prevention plans now cover 98% of the country, and we updated the cross-government suicide prevention strategy in January to strengthen key areas for action, including by focusing on self-harm as an area in its own right.
My constituent Justin Bartholomew, a young man of just 25, recently committed suicide by hanging himself. His family are convinced that the high-energy drinks that he was taking—more than 15 cans a day—increased his anxiety and contributed to his suicide. As there is growing concern about the safety of such energy drinks, may I ask the Minister what assessment of that the Department is undertaking?
I thank my hon. Friend for sharing that very moving case. We have no evidence at this stage that those drinks cause such outcomes, but we know that all stimulants, whether alcohol or caffeine, have consequences that can affect people’s mental health. That is something that bears examination.
What discussions is the Minister having across the United Kingdom to ensure that best practice in dealing with suicide rates, and in particular the escalating rates in the regions of the UK, can be replicated across the United Kingdom as a whole?
I am always keen to learn from areas of the United Kingdom where things are going well. As the hon. Gentleman will be aware, our suicide prevention strategy is very much rooted in local prevention plans. Although 98% of the country is covered by those plans, we really want to do a proper audit of how good they are. That will enable us to share best practice across the nations.
Mental Health Services: Children and Young People
We have assessed children and young people’s mental health as part of our ongoing work to improve services, and the results of our assessments have led to £1.4 billion of extra funding to support locally led transformation plans. The recent Green Paper aims to improve the provision of services in schools, bolster links between schools and the NHS, and pilot a four-week waiting time target.
Many young people with mental ill health report that crisis care is not good enough. Of course, the pressures on them can get even worse over Christmas, so will the Government back the call by the charity YoungMinds to set up a crisis hotline for children and young people that would be available through the existing 111 service?
We are approaching Christmas, and the hon. Gentleman is quite right to highlight the fact that it can often be the moment of greatest crisis for people with mental health issues. I was with the Samaritans yesterday to commend it for all its work—it is obviously a good pathway to help—but, absolutely, we will speak with YoungMinds.
“Jesse Evans—Autism Adventures” highlights the daily challenges faced by families living with autism, who are supported by self-sustaining groups such as Autism around the Combe. Will the Minister explain how the recent announcement of a multimillion pound development at West Cumberland Hospital will help those families?
My hon. Friend highlights the great synergy between those health services that the Government can provide, on which people obviously rely, and self-help, which is very important, as well as the help that people can give each other when they share their experiences. I commend the work of Jesse Evans and his “Autism Adventures” blog, which is extremely positive and educational.
My clinical commissioning group delivers better-than-average waiting times for mental health talking therapies and follows up 99% of all vulnerable people within a week of their first appointment. It does all that and more on significantly less than the average budget nationally, so will my hon. Friend look at south-east Staffordshire as a case study for delivering a good service with value for money?
Next week, many NHS and social care staff will give up their family Christmas to keep NHS patients safe. I know that the whole House would like to thank them for their dedication and commitment over the festive period.
Is my right hon. Friend aware that, due to the difficulties in recruiting general practitioners, neither of the two GP surgeries in Maldon are taking on any new patients, despite the significant development taking place in the town? May I therefore welcome the 1,500 extra medical training places that the Government have funded, and ask for his support for some of those to go to the excellent Anglia Ruskin medical school in Chelmsford?
I have a great deal of sympathy with what my right hon. Friend says, and he is right that the recruitment and retention of GPs is a big issue. I have a constituency interest, in that I have a university that is also very keen to host more medical school places, so I am recusing myself from the decision. However, I wish all universities good luck, because this is a historic expansion of medical school places for the NHS.
May I join the Secretary of State in wishing all our NHS and social care staff a very merry Christmas, and in thanking them for their commitment this winter?
Virgin Care recently won a £100 million contract for children’s health services in Lancashire, but in the Secretary of State’s own backyard of Surrey, Virgin Care recently took legal action against the NHS, forcing it to settle out of court. This money should be going to patient care, not the coffers of Virgin Care, so why will he not step in and fix this scandal so that his Surrey constituents and the NHS do not lose out?
I, too, am very disappointed about the action taken by Virgin Care, but I gently point out to the hon. Gentleman that, contrary to the narrative that he and his colleagues put out, the reason why it took action was that the NHS stripped it of its contract and gave that back to the traditional NHS sector—hardly the mass privatisation that he is always talking about.
The Secretary of State’s Surrey constituents will have heard that he will not be taking action against Virgin Care.
Our research has revealed that there are vacancies for 100,000 staff across the NHS, and there is a “national crisis in workforce”—not my words, but those of the Royal Surrey County Hospital NHS Foundation Trust in the Secretary of State’s constituency. With bed occupancy at the Royal Surrey hitting a peak of 98.7% this winter already, and 94.5% across the NHS on average, can he tell us how he expects the NHS to cope this winter when it is understaffed, overstretched and underfunded?
If we decide that we want more nurses following Mid Staffs, that creates vacancies. If we want to transform mental health provision, that creates vacancies. That is why we announced a workforce plan, which I notice the Welsh Government have not had time to do yet. But I will finish by wishing the hon. Gentleman a merry Christmas. If he wants to take a bit longer off and stay away for January, we are happy to hold the fort.
My hon. Friend asks an important question. We have just commissioned Warwick University to investigate the links between breast density and breast cancer. If the findings suggest that there should be any changes to the national breast screening programme, the UK national screening committee will of course consider that, as it does with any new evidence that helps it to target screening appropriately and make women aware of any increased risk of breast cancer. I will be watching this like a hawk.
I can confirm that the health and wellbeing overview and scrutiny committee has submitted a request for a review by the Independent Reconfiguration Panel. I understand that officials have reverted to the committee to clarify the terms of the referral. Once that has come through to the Department, I am sure that the review will take place.
The truth is that we do not yet know enough about e-cigarettes. I welcome the Science and Technology Committee’s investigation into them. We have asked Public Health England to include messages about the relative safety of e-cigarettes in its Quit Smoking campaign next month, but it is for local organisations and businesses to implement their own policies on e-cigarette use in the workplace.
As the House knows, cancer is a huge priority for me and for the Government. Survival rates are at a record high, but we know there is much more work to do. Early diagnosis is key, and that is never more true than with oral cancers. We are supporting dentists to play a vital role in spotting mouth cancers early. I was discussing this very point just last week with the British Dental Association, which shares our passion on this issue.
We have not been very good at making it easy for people to work flexibility in the NHS. Contracts are too rigid and we are looking to change them. We recognise that for many nurses their commitment to the NHS runs very deep, but that they have to juggle that commitment with family responsibilities. We want to do better.
There are many very committed individuals working in health and social care services in Somerset, but one challenge is getting enough registered nurses into the system to allow them to integrate. What can the Minister do to help to get more registered nurses?
My hon. Friend will be aware that last week we published the workforce strategy. One major focus was on meeting the Secretary of State’s commitment to increase the number of registered nurses by 25% and to broaden the routes into nursing. There is a commitment to expand the nursing associate role, which is helping to provide opportunities, through an alternative route, for healthcare support workers to become registered nurses.
There is huge interest in this subject in the House. Over the past three years, there has been extensive work to communicate advice on the risks of valproate in pregnancy, through a huge number of channels, to help professionals and patients. It is evident from monitoring activities that providing health professionals with information, even when repeated constantly through multiple sources, is not changing prescribing behaviour sufficiently to minimise harm to children exposed to valproate in pregnancy. The expert working group of the Commission on Human Medicines is informing the UK position in European negotiations and advising on the national action required within the UK health system. [Interruption.] Sorry, Mr Speaker.
As my hon. Friend is aware, I visited all three hospitals in the trust. I am pleased to be able to announce to him today that the Department of Health has concluded its analysis of the outline business case for the £29 million allocated in July and that it has been approved.
On admissions to hospital for malnutrition, will the Minister tell me what has been happening at Wirral University Teaching Hospital? Admissions for malnutrition went up from 21 in 2009-10 to 707 in 2014-15. They went up again to 728 and this year currently stand at 586. That seems very, very high. Can anyone tell me what is going on? If not, will Ministers write to me to explain these huge figures?
I would like to thank the Minister for listening very sensitively to the victims of Paterson, the rogue surgeon, many of whom are constituents of mine. Does he agree that the evidence from the Hillsborough inquiry is that a bishop-led inquiry can indeed get justice and closure for victims? Will he join me in wishing the Bishop of Norwich great success in getting a good outcome from this inquiry?
I pay tribute to my right hon. Friend for her role in helping to support the victims, many of whom, as she said, are constituents of hers. We are pleased that Bishop James has agreed to take on this inquiry. Bishops provide the ability to empathise with victims and their families, which might not always be the case with judge-led inquiries. As she rightly points out, the Hillsborough inquiry was led by a bishop, but so too is the current Gosport inquiry, while the Morecombe Bay inquiry was led by Bill Kirkup, rather than a judge.
Those with erythropoietic protoporphyria cannot be exposed to sunlight or even some artificial light without extremely painful and violent skin reactions. Trials of the drug Scenesse have proved life-changing for constituents such as James Rawnsley, who, for the first time, can now take his kids to school and go on holiday. The decision to make it available on the NHS will be taken soon. Please will the Minister look at it?
The whole House will want to express its condolences to my hon. Friend on what is happening this afternoon. He, alongside many people on both sides of the House, including the shadow Health Secretary, has raised this issue, and we are looking closely at what more support we can give to children in one of the most vulnerable situations imaginable. I thank him for raising the issue.
The NHS patient declaration form for free dental care and prescriptions requires patients to determine the difference between contribution and income-related employment and support allowance. Getting it wrong attracts really hefty fines. Will the Minister ensure that patients first get the opportunity to make the right choice before fines are applied?
Yes, of course. The NHS Business Services Authority issues the penalty charge notices for incorrect claims for exemption from NHS dental care and prescription charges. We have recently increased the number of checks, however, because ultimately this is taxpayers’ money, and we need to ensure that it is spent properly and legally.
I warmly welcome the extra £1.1 million to help with winter pressures at Luton and Dunstable Hospital, and I can tell the ministerial team that the merger with Bedford Hospital is proceeding well, but it needs £150 million of capital. May I ask that favourable consideration be given to that in the allocation of the £3.5 billion announced in the Budget?
My hon. Friend will be aware that the Chancellor provided a package of £10 billion in the Budget last month to be invested in the NHS, of which £3.9 billion will come from the Treasury. All bids for capital are being assessed through the STP prism. The proposal that his area will be making will be assessed against others. As far as I am aware, no such proposal has yet been made to NHS England, but it will obviously be looked at in due course.
You may recall, Mr Speaker, that I raised earlier in the year the issue of a private mental health hospital in my constituency where a young woman had MRSA and was infecting staff and patients. Since then, there have been numerous inspections in relation to children having access to ligatures and medicines in order to overdose. Will the Secretary of State commit to a policy to ensure that no child or young person is placed in a mental health facility that is deemed unsafe?
I commend the hon. Lady for raising this issue, which she and I have met to discuss before. She is right to highlight the ongoing inspections and issues, and I have written to her to offer to discuss the matter with her again. It is absolutely unacceptable that anybody is placed in a facility that is deemed unsafe.
May I thank the ministerial team on behalf of my constituent Susan Bradley for finally laying the remedial order for single-parent surrogates, and can they assure me that they will do everything they can to get it through Parliament as quickly as possible?
An all-party parliamentary group has been established this week, I believe, to take this issue forward, and I look forward to speaking to that group, if invited, next month. The remedial order will follow due parliamentary process, which involves its being laid for 60 days and then, after an interval, for a further 60 days.
There have been 15,000 violent assaults on mental health workers in the west midlands over the last five years. What is the Government’s response to the Care Quality Commission’s opposition to routine searches of all mental health service users for weapons on admission or return to acute in-patient units?
I have a great deal of sympathy with what the hon. Gentleman has said. We are putting a lot of effort into patient safety and staff safety in mental health trusts, and we are discovering that there is a wide variation between practices. The hon. Gentleman has made an important point, and, if I may, I will write to him to inform him of our progress.
The patient transport service in northern Lincolnshire is contracted to Thames Ambulance Service Ltd, which is failing miserably to perform to an adequate standard. Will the Minister meet me, along with my hon. Friend the Member for Brigg and Goole (Andrew Percy) and other neighbouring Members, to discuss what influence the Department can bring to bear?
Order. I appreciate the commitment of colleagues. The session has overrun, but I feel that colleagues will go home for Christmas content only if they have asked their questions and they have been answered. I am extremely grateful to the Front-Bench teams on both sides of the House.
Is the Secretary of State aware that in the course of this hour there have been more questions about hospital closures than about almost anything else, covering East Yorkshire, Berwick on his own side, Warwickshire on our side, and High Peak in Derbyshire, including Bolsover and Bakewell Hospitals? There is a growing suspicion that what this Secretary of State is up to is leaving those hospitals and losing all the beds in them forever so that the private sector can move in and take the lot. That is what is going to happen.
I thank the hon. Gentleman for his Christmas cheer. Let me just say to him that if that were the Government’s intention, we would not have found an extra £2.8 billion for the NHS in the Budget, including £1.95 million for Chesterfield Hospital, which will benefit his own constituents.
Some 50% of young people do not use a condom with a new partner and one in 10 young adults never uses one, which means the chance of an unwanted pregnancy or, indeed, a sexually transmitted disease. Please will the Department do something to ensure that people are aware of the benefits of condoms?
Men may not be very good at wrapping at this time of year, but they need to get this one right. I welcome Public Health England’s “protect against STIs” campaign, which was launched last week and aims to reduce rates among 16 to 24-year-olds, and I encourage young people having fun this Christmas to do so sensibly.
There is an increasing trend for women to share breast milk over the internet with no recourse to the milk banking guidelines from the National Institute for Health and Care Excellence. Will the Minister meet me, and other members of the all-party parliamentary group on infant feeding and inequalities, to discuss the matter further and to ensure that breast milk can be used safely?
Local Government Finance Settlement
With permission, Mr Speaker, I would like to make a statement on funding for local authorities in England next year.
From 2015 to 2020, councils in England have access to over £200 billion to deliver the high-quality services their local communities need. They deserve no less; local government is on the frontline of the country’s democracy, with councillors and officers working at the heart of the communities that they serve. But to make the most of that local knowledge, councils need greater control of the money they raise: they need greater freedom to tackle challenges in their areas, and they need the certainty and stability that will allow them to plan ahead.
This Government are committed to delivering that, and today I am publishing a draft local government finance settlement that marks an important milestone in the journey to doing so. It comes in the third year of a four-year deal that was accepted by 97% of councils in return for publishing efficiency plans. We will continue to work with the sector to help councils to increase transparency and share best practice, supporting greater progress in delivering increased efficiency over the coming year. I expect this to have a tangible impact on the steps that councils take to promote efficiency from 2019-20.
Local government operates in a society that is constantly changing, and the system of financing local government needs to reflect that. The current formula of budget allocations has served local councils and communities well over the years, but to meet the challenges of the future we need an updated and more responsive distribution methodology that gives councils the confidence to face the challenges and opportunities of the future. So I am today publishing a formal consultation on a review of relative needs and resources. I aim to implement a new system based on its findings in 2020-21.
Alongside the new methodology, in 2020-21 we will also be implementing the latest phase of our business rates retention programme, a scheme that gives local councils the levers and incentives they need to grow their local economies. The aim is for local authorities to retain 75% of business rates from 2020-21. That will be done through incorporating existing grants into business rates retention, including the revenue support grant and the public health grant. Local authorities will be able to keep that same share of growth on their baseline levels from 2020-21, when the system is reset. So from 2020-21 business rates will be redistributed according to the outcome of the new needs assessment, subject to suitable transitional measures.
A number of 100% retention pilots have already been announced and they will continue. A further pilot will begin in London in 2018-19, and we had intended that a further five pilots would begin that same year. However, interest in the scheme was such that we will now be taking forward twice as many as planned. I am pleased to announce today that the new pilots will take place in Berkshire, Derbyshire, Devon, Gloucestershire, Kent and Medway, Leeds, Lincolnshire, Solent, Suffolk, and Surrey.
The first batch of pilots is taking place largely in urban authorities; the second wave will mainly cover counties. This ensures that councils right across the country will benefit, that the scheme can be tested in a wide range of environments, and that the benefits of growth are broadly comparable between London, existing pilots and new pilots. We received so many applications to take part that we will continue the pilot business rates retention programme in 2019-20, and further details will be published in due course.
Over the past year, my Ministers and officials have been listening to councils of all shapes and sizes, understanding their concerns and working together to develop ways of tackling them. The result of those conversations is reflected in this draft settlement. For example, rural councils have expressed concern about the fairness of the current system, with the rural services delivery grant due to be reduced next year. So today I can confirm that I will increase the rural services delivery grant by £15 million in 2018-19, meaning that the total figure will remain at £65 million for the remainder of the current four-year settlement.
We have also heard concerns about the proposed changes to the new homes bonus. To date, we have made almost £7 billion of new homes bonus payments to reward the building of 1.4 million homes. Over £946 million in new homes bonus payments will be allocated in 2018-19, rewarding local authorities for their work on fixing our broken housing market. I have consulted on proposals to link new homes bonus payments to the number of successful planning appeals, and considered raising the NHB baseline. Following conversations with the sector, I have been persuaded of the importance of continuity and certainty in this area. So today I can confirm that in the year ahead no new changes will be made to the way in which the new homes bonus works, and that the NHB baseline will be maintained at 0.4%.
As I set out in the housing White Paper, local authorities will be able to increase planning fees by 20% when they commit to investing the additional income in their planning services. This is a significant step towards addressing widespread concerns about under-resourcing in local planning authorities. Following discussions with the sector, I am also announcing a continuation of the capital receipts flexibility programme for a further three years. This scheme gives local authorities the continued freedom to use capital receipts from the sale of their own assets. This will help to fund the costs of transformation and release savings.
One particular issue causing concern for some councils is so-called negative revenue support grant. This is where changes in revenue support grant have led to a downward adjustment of some local authorities’ business rates top-up or tariff for 2019-20. I recognise the strength of feeling in local government on this issue, and I can confirm that my Department will be looking at fair and affordable options for dealing with negative RSG. We will formally consult on proposals in the spring, so that the findings will be in ahead of next year’s settlement.
Of course, anyone who has spoken to anyone in local government will be aware of concerns about funding for adult and children’s social care. That is why, over the past 12 months, we have put billions of pounds of extra funding into the sector, and why the Department for Education is spending more than £200 million on innovation and improvement in children’s social care. In the spring Budget, an additional £2 billion was announced for adult social care over the next three years. Along with the freedom to raise more money more quickly through the use of the social care precept that I announced this time last year, we have given councils access to £9.25 billion of dedicated funding for adult social care over the next three years. However, we also need to find a long-term solution to challenges that are not going away. That is why we have already announced that a Green Paper on future challenges within adult social care will be published in the summer of 2018.
Finally, I am conscious of calls for further flexibility in the setting of council tax. We all want to ease growing pressure on local government services, but I am sure that none of us wants to see hard-working taxpayers saddled with ever-higher bills. This settlement needs to strike a balance between those two aims, giving councils the ability to increase their core council tax requirement by an additional 1% without a local referendum, bringing the core principle in line with inflation. We have abolished Whitehall capping. Under the Localism Act 2011, local government can increase council tax as it wishes, but excessive rises need to be approved by local residents in a referendum. This provides an important check and balance against the excessive increases that were seen under the last Labour Government, when council taxes more than doubled.
This change, combined with the additional flexibility on the adult social care precept that I confirmed last year, gives local authorities the independence they need to help to relieve pressure on local services such as adults’ and children’s services, while recognising that many households face their own pressures. In addition, directly elected mayors will decide the required level of precept by agreement with their combined authorities. I am sure that voters will be watching closely, as I will, to ensure that that freedom is not abused.
I can also confirm that the Government intend to defer the setting of referendum principles for town and parish councils for three years. This is subject to the sector taking all available steps to mitigate the need for council tax increases, and the Government seeing clear evidence of restraint in the increases set by the sector as a whole. I have also agreed measures with the Home Secretary to make it easier for police and crime commissioners to meet local demand pressures by allowing a £12 council tax flexibility for police services, raising an additional £139 million next year.
This settlement recognises the need to keep spending under control while also tackling many of the issues that have been raised by local government over the past year. Two years of real-terms increases in resources being made available to local government will give local authorities the funding and freedom they need to make decisions in the best interests of the communities they serve. It is a settlement that offers councils the resources they need, the stability they have requested and the fairness they deserve, and I commend it to the House.
I thank the Secretary of State for giving me a copy of his statement. I have had the briefest possible time in which to adequately consider its contents, but it was nevertheless given to me in advance.
I pay tribute to councillors and officers across the country who are on the frontline of this Government’s austerity agenda yet continue to serve our communities as well as they can. Many of them will have been looking to today’s settlement for assurances that the Government understand the challenges facing local government. Councils have already experienced unprecedented funding cuts since 2010, and since the general election, they have been left in the dark about the Government’s sustainable long-term funding plans.
The Secretary of State says that he is listening to councils “of all shapes and sizes”, but why must he exacerbate the rural-urban split? He has listened to Surrey—that much is clear—but in doing so, he has ignored the needs of Stockton, Salford and Sheffield. Before the general election, we had been promised a full legislative package to fund local government beyond the revenue support grant. Now, however, we have been promised not legislation but a consultation. Councils are desperate for additional funding, and they might well appreciate some of the piecemeal solutions offered by the Secretary of State today, but we are still without a sustainable plan or a vision for how the sector will be funded in the future. The Secretary of State notes that the aim is for authorities to retain 75% of business rates by 2020, and I look forward to hearing more details of how that will function, recognising that not every area has the ability to raise the income locally.
Many will have looked to today’s announcements to offer solutions to the crisis in children’s services, after the Chancellor failed to mention them in his Budget. Demand for children’s services is placing unbearable pressures on local authorities. Central Government funding to support children and their families has been cut by 55% over the past seven years—a total cut of £1.7 billion —forcing less money to be invested in intervention to cover the cost of emergency care. The result of these cuts has been appallingly clear—[Interruption]—if the Secretary of State chooses to listen. Cuts to early years intervention have meant a record number of children—some 72,000 last year—being taken into care. The number of serious child protection cases has doubled in the last seven years, with 500 new cases launched every day. More than 170,000 children were subject to child protection plans last year, which is double the number seven years ago.
The Secretary of State recognises the crisis facing children services, but he just brushes it aside. I suggest that he listens to Lord Gary Porter, who warned recently that both adult social care and children’s services were “at the very top” of the Local Government Association’s “worry list”, saying:
“If we don’t look after our older and younger people, it’s bad for our residents, bad for our communities and bad for our services more widely.”
It was important that today’s statement provided much-needed certainty to our communities. Instead, it acts merely as a sticking plaster and pushes the problems down the road for another Secretary of State to fix.
Our key tests for today’s announcement are whether it addresses the cuts to everyday services and properly funds councils to deliver those services in future, whether it assists the funding crisis in children’s services, and whether it fully pays towards local government staff getting a decent wage. It is interesting that the council-tax-raising flexibilities will not even cover the pay rise, which will itself place further pressure on the cutting of services. On the day that Labour’s shadow Health team announced that 2.3 million older people have been left with unmet needs, which is up from 1.2 million, another test is whether the announcement ensures that our aged and vulnerable people are supported and protected. In addition, does it ensure fair funding in the truest sense of the word “fair”? Does it address the uncertainty around RSG, recognising that areas with greatest social and health inequality are also the least able to fill the funding gap by other means?
The statement fails on all those counts. While today’s announcement offers some additional support, it merely pays lip service to many of the problems facing our local councils. The Secretary of State has today presented himself as Santa, but the details of the announcement really show him to be the Grinch.
I thank the hon. Gentleman for his Christmas spirit. Time and again, he stands at the Dispatch Box and says just one thing: he wants more spending. He wants more spending on police, fire services, children’s services, adult social care, sprinklers, pay and pensions—spending, spending, spending. It is the only thing he knows. However, not once has he appeared at the Dispatch Box or anywhere else to tell the country how he intends to pay for all that spending. The truth is that it is the same old Labour, and Labour is all about higher spending, higher taxes, higher debt—all the same polices that will take our economy down to its knees and crash it. It is the only thing that Labour knows.
I want to remind the House about what happened the last time Labour was in office. We had the deepest recession in almost 100 years, which destroyed the lives of so many millions of people in this country. Unemployment was 500,000 higher when the Labour Government left office than when they first came into office, ensuring that they delivered on the one promise of every Labour Government: they will always leave unemployment higher than they found it. Under the 13 years of Labour Government, council tax bills went up by almost 110%, and their measures contributed to the deepest budget deficit of modern times. We will take no lectures at all from the hon. Gentleman.
I of course recognise the pressure on councils, and we have done something about that in the settlement by increasing real-terms spending power for the next two years while ensuring that we maintain a balance between the need for councils to provide services and taxpayers themselves. The hon. Gentleman mentioned negative RSG, but perhaps he was not listening carefully because I said that I will be consulting early in the new year on options to deal with that challenge, which will be welcomed by the sector even it if it is not welcomed by him. He referred to the business rates retention pilots, suggesting that there was some political dimension to how they were chosen. He said that Sheffield and Stockton did not get a pilot, but it would have helped if they had actually applied for one. Councils need to apply for something before they can get it. He then mentioned Salford, but perhaps he does not know that Salford is part of a business rates retention pilot as part of the Greater Manchester region, which received a pilot earlier this year. It would really help if the hon. Gentleman did his homework before he appears at the Dispatch Box and starts making things up.
As for social care, the hon. Gentleman does not recognise that we have acknowledged the pressures, particularly the short-term pressures, which was why the spring Budget allocated an additional £2 billion. Together with the extra flexibility through the precept, that will lead to a real-terms spending increase in each of the next three years.
Finally, the hon. Gentleman talked about his tests, which included seeing whether local authorities are properly and fairly funded. The one thing he should know is that, in order to fund any public services fairly, including those provided by our excellent local authorities, we need a successful economy, which Labour will never deliver.
Order. As per usual on a matter of this kind, there is extensive interest in participating in the exchanges on the statement, so I will just make two points. First, people who arrive late obviously should not stand or expect to be called. Secondly, because of the pressure on time and the fact that there is another statement to follow, there is a premium upon brevity, which must be exhibited—even by a lawyer. I call Robert Neill.
I welcome the Secretary of State’s statement. Will he confirm that it is particularly important for councils with a long history of efficient financing and a low cost base, such as the London Borough of Bromley, that the review of relative costs and needs ensures that financial efficiency is properly incentivised within the local government finance system?
My hon. Friend speaks with experience as a former Minister in this Department, and I thank him for his comment. I can confirm that. This is all about efficiency and ensuring that local authorities have the right incentives, which is why our business rates retention plan, for example, will help to deliver just that.
I thank the Secretary of State for advance sight of his statement. On the distribution methodology, I am glad to see quite a long lead-in time for that and a consultation in advance of something being done. Will he tell us more about how closely monitored the business rates retention scheme will be to ensure that there is no gap between business rates and the revenue support grant? If a big business goes to the wall, a gap could suddenly appear in a local authority’s budget, so how does he intend to cushion the loss of a high-tariff business rates company in a council area?
How does the Secretary of State intend for local authorities that have already disposed of a lot of their assets to gain capital receipts, which are clearly a declining resource for some local authorities? What advice would he give to councils that have essentially sold off everything they can?
The Communities and Local Government Committee, of which I was a member in the previous Parliament, published a fair and reasonable report on adult social care, but the Government unfortunately did not accept all its recommendations. When the Secretary of State brings the Green Paper to Parliament, will he look again at some of those recommendations? Will he provide some more detail on why summer 2018 has been chosen? It is quite far away, and this Government have broad definitions of what seasons are in this place. Is there really a need to wait for at least another six months?
The hon. Lady raises several points, but I will try to answer them all quickly. It is important that we take our time to get the fair funding review right, and I think she would agree with that. Part of the process involves ensuring that issues are properly consulted on, which is why we launched the 12-week consultation today. On capital flexibility, it is important to give local authorities more freedom to raise funds, including capital funds. If they want—it is their decision alone—to sell capital assets and to use that funding more efficiently for local people, that option should be open to them, so guaranteeing that flexibility for another three years is important.
On adult social care, I welcomed the Communities and Local Government Committee’s report. It made a number of recommendations, including one about more short-term support, which is why the funding that we provided in the Budget, for example, earlier this year is important. As for the Green Paper, it is very important that we take the time to get things right, consult widely, try to work across different parties and listen to people as well as care users. By taking that time, we can come up with a more sustainable long-term system.
My right hon. Friend has mentioned that 97% of councils are in the third year of a four-year settlement. Will he therefore confirm the position for the small group of councils that refused to publish an efficiency plan? Will they be rewarded for their failure, or will they be penalised in the funding they receive under this settlement?
The reward for accepting the four-year settlement is actually for the local people those local councils represent. The councils that did not accept the four-year settlement—it was around 10 councils, so it was a very small number—should reflect on what that means for local people, because local people want to see certainty on the delivery of services. Those councils should certainly take a close look at that.
I welcome some aspects of the statement, such as the increase in money from planning fees. On the flexibility on council tax increases, will the Secretary of State confirm the figures given to me by the Local Government Association that show that, even if the flexibility were fully used, it would raise just £250 million next year? That compares with the LGA’s estimate of the shortfall in funding for social care of more than £2 billion, even after the measures previously announced by the Government are taken into account. Will he also confirm that councils will raise very different amounts of money from such flexibility, depending on the size of their council tax base?
I always listen carefully to the hon. Gentleman, and I know he looks at these issues carefully. The extra flexibility on council tax means that the total core spending power this financial year of £44.3 billion will rise to £45.6 billion by 2019-20. That is an increase in real terms, so there will be real growth in core spending power in each of the next two years.
I welcome the Secretary of State’s confirmation of the continuation of the 100% business rates retention pilots in areas such as Greater Manchester. Does he agree that the success of business rates retention is key to continued growth in Greater Manchester and the success of the northern powerhouse?