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Health and Social Care Budgets

Volume 623: debated on Tuesday 14 March 2017

I beg to move,

That this House has considered budgets for health and social care.

It is a pleasure, as ever, to serve under your chairmanship, Mr Bailey. I thank the Backbench Business Committee for granting this important debate about the funding of health and social care. I pay tribute to my fellow Committee Chairs—the hon. Member for Totnes (Dr Wollaston), Chair of the Select Committee on Health, and my hon. Friend the Member for Sheffield South East (Mr Betts), Chair of the Select Committee on Communities and Local Government—for their work, including with my Committee, to shine a light on the challenges of funding our health and social care system for the next generations. I also pay tribute to the Select Committee on Public Administration and Constitutional Affairs for its work in this area. The fact that four Select Committees, and three in particular, are focusing their attention on the issue demonstrates its importance to the nation and to the long-term health of our citizens.

The Public Accounts Committee’s view and concern, which is well documented in a dozen reports produced by us in this Parliament alone, is that there is a challenge with the funding settlement for the national health service. I will not repeat all the arguments that I made in the Chamber during the debate on the estimates the other week, but we are also in the grip of a crisis in social care. The NHS accounts are showing the strain again as we approach the year end.

Last year, as I am well documented as saying, the Comptroller and Auditor General put an extraordinary commentary on the Department of Health accounts, which were laid on the last day of Parliament’s sitting. Extraordinary measures were taken to get them into balance—again, I will not mention them all, but it was a difficult adjustment. The permanent secretary at the Department of Health has acknowledged that that was not good enough, and that such one-off measures should not be repeated. We are now hearing concerns that NHS trusts are delaying paying their suppliers in order to ensure that their budgets balance. We know that, once again, capital funds will be raided and converted into resource funding to keep the NHS on track.

My Committee has discovered that funding in every area of the NHS is facing increasing demand, including specialist services, diabetes and discharge from hospital, which we have considered. The increasing age of the population and advances in medicine mean greater demand on our national health service. When the Government tell us that they are putting more money into the NHS, we must treat that with caution: more money without consideration for the number of people using the service and those who will need it in future is not always enough. Not only is the money not meeting current need, but it will not meet the growing demand.

I will speak briefly, as I am aware that 15 or so Members are scheduled to speak in this debate. The Budget came up with some solutions, as the Chancellor sees them, for funding the NHS. Our concern is that, once again, piecemeal funding is being offered rather than long-term solutions. The Chancellor talked about putting £2 billion into social care, £1 billion of it in the next financial year, starting in April. However, the Local Government Association estimates that more than £1 billion every year is needed to fund the gap in social care. The 2% council tax, often vaunted as a great solution, is a challenge in some areas, particularly where the council tax base is low. My own local authority has increased council tax to cover it, which of course means that local taxpayers are helping fund the system.

I congratulate my hon. Friend on securing this important debate. Dementia Care, a charity based in my constituency, has deep concerns about the current and future funding plans for social care. Dementia Care believes, and I agree, that funding should be based on need, not on a local area’s ability to raise council tax, which clearly disadvantages people in areas such as Newcastle. I know that my hon. Friend shares this view, but I wanted to reiterate on the record that charities providing vital services up and down the country share her concerns.

I know that my hon. Friend the Member for Sheffield South East will discuss the funding of social care in more detail.

I, too, congratulate the hon. Lady. Does she agree that Ministers are engaged in wishful thinking? The ability to reduce the number of hospital beds relies on the availability of better and more social care, yet in Brighton our sustainability and transformation plan footprint means that we are being forced to find another £112 million in efficiencies specifically in social care. It just does not add up, and it is not sustainable.

One concern that our Committee has uncovered is the pressure to make 4% efficiency savings. That figure was used in the last Parliament, but has now been acknowledged to be too stiff a target. However, we are also seeing a move to 4% efficiency savings in STPs. That is challenging to achieve while going through transformation. One would expect the Public Accounts Committee to be no slouch in considering where efficiencies can be found, but even with efficiencies there is just not enough money in the system. It is being squeezed.

One welcome aspect of the Budget—I hope that the Minister can give us more detail—is that there will be a Green Paper later in the year on the future funding of social care; again, I know that my hon. Friend the Member for Sheffield South East will want to talk more about that. There are also other bits of money: £100 million to support 100 new on-site GP triage projects at accident and emergency departments in hospitals in time for next winter; £325 million in capital funding to support the implementation of sustainability and transformation plans that are ready to proceed; and a multi-year capital programme for health. That all sounds like a lot of money, but relative to the total NHS budget, it is a very small amount, and the concern is that it is not long-term and sustainable. That is what our Committee said. A long-term plan is necessary for funding the NHS.

After looking at this year’s accounts, we are concerned about the number of trusts in deficit; perhaps the Minister can update us on that. As of month 9 of this financial year, 74 of 238 trusts were in deficit, to the tune of £886 million total. Granted, that is less than the £2.5 billion last year, but it is still not a healthy situation. Raiding capital funds to pay for resource and other such measures is just not acceptable in the long term.

I commend the hon. Lady on working cross-party to find long-term solutions for the huge issues facing social care and the NHS. She highlighted the fact that capital money has been transferred to revenue. Does she agree that in places such as Huddersfield, in my area, that makes the prospect of looking for another disastrous private finance initiative deal to fund capital improvements more likely? The disastrous PFI at Halifax is now dictating disastrous changes at Huddersfield; services are being moved to fund that PFI deal.

The hon. Gentleman rightly highlights that the NHS is not new to challenges in dealing with capital projects. One of our concerns about taking out capital is that NHS buildings and equipment will deteriorate, costing more in the end. That is not good value for money, which is what my Committee considers. We should all be watching the situation. The consequences might not be apparent today, but they will become so as time goes on, and we as parliamentarians need to keep a close eye on what is happening in our local area. I am glad that the hon. Gentleman is doing so.

I will finish, as I am aware that an awful lot of Members want to speak. We must not forget that the situation has an impact on patients. For instance, the target for accident and emergency waiting times is 95%, but actual performance is just under 87%. Diagnostic waiting times have risen from 1% to 1.68%, and referral to treatment within 18 weeks has not reached its 92% target; it is just under 90%, at 89.41%. The number of people waiting more than 52 weeks for referral to treatment is 1,220. Those are just some of the figures demonstrating the impact of how NHS and social care finances are being managed and what is happening to patient outcomes.

I congratulate the hon. Lady on securing this much needed debate. Does she agree with me and other stakeholders that a comprehensive review is needed in which everybody—stakeholders, the Government and the Opposition—works together to find a way forward for a comprehensive funding solution?

The hon. Lady neatly brings me to my conclusion. That is what we need: a long-term, sustainable future for our national health service. The present situation will not last from Parliament to Parliament and from one governing party to another. We need to agree a way forward and have a national conversation. We did that with pensions. It was difficult, but we got there—I know that there are still issues, but we reached cross-party agreement. We cannot chop and change, and we cannot have Governments pretending that throwing a little bit of money at the problem in a Budget is a solution. We need a long-term, sustainable solution and a national conversation about what the NHS will deliver and what outcomes we want to achieve.

Order. Before I call the next speaker, I will just make it clear that I am trying to shoehorn a three-hour debate into one and a half hours. I need to call the Chairs of the relevant Select Committees, and I am looking for five minutes each from them. There will be a hard and fast three-minute time limit for subsequent Back-Bench contributions. If anyone wishes to intervene, they are perfectly free to do so, but I might take it into consideration when I consider the order of speakers.

It is a pleasure to follow the hon. Member for Hackney South and Shoreditch (Meg Hillier). I pay tribute to all the Select Committees and their members for the work that they done and to all those outside this House who made the compelling case that led to the announcements in the Budget. I say to the Minister that I unequivocally welcome those announcements, and I thank the Government for listening to the case that was made, not only about social care but about capital.

However, I would nuance some of that, because the point about social care is that we must not consider it “job done”. The £2 billion over the next three years is very welcome—it is also welcome that it has been profiled to address the back-loading of the previous settlement. However, I would like the Minister to say how we will ensure that it gets to the frontline and is distributed fairly according to need, and also that that reflects the different abilities of councils to raise their own money through the social care precept, because that is important for public confidence about how the money is spent.

I also welcome the announcements on capital—the £325 million for the sustainability and transformation plans that are ahead of time is very welcome. I look forward to the announcements in the autumn Budget about further money, although the Minister will know that £1.2 billion has been transferred to revenue from capital. That is an ongoing issue that is hampering the ability of areas to put effective plans in place. Will he touch on that and say how quickly he thinks we will get to a position where we do not see these capital-to-revenue transfers as being necessary?

Another welcome announcement was about the capital improvements available to accident and emergency departments, although I would caution that this is being linked to putting general practitioners alongside casualty departments through co-location. This is not only about funding; it is about having a general practice workforce that can fund these co-located departments alongside out-of-hours departments and providing routine surgeries on Sundays. I am afraid that we simply do not have the workforce to sustain that activity. I know that there is a commitment to increase the workforce in primary care, but that is alongside a significant retirement bulge in primary care. Something will have to give. As things stand, I simply do not feel that we have the workforce to do that work.

Finally on the Budget, there was a very welcome announcement of a review and a Green Paper in the autumn, which we all look forward to. However, I call on the Government to stop and take stock, because next year will be the 70th birthday of the NHS, and it will come at a time when it is under unprecedented financial pressure. Over the last Parliament we saw a 1.1% annual uplift, against the background of uplifts of around 3.8% traditionally since the late ’70s. This is a sustained financial squeeze, at the same time as an extraordinary demographic change and an increase in demand across the whole service. As welcome as the announcements were last week, I am afraid that they do not go far enough to address the scale of the generational challenge that we face. It is of course very welcome that more people are living longer, but that is happening alongside a shrinking base of our working population who are able to fund that demand.

We simply cannot carry on as we are. If the review focuses simply on social care, we will miss an extraordinary opportunity to address the issue in time for the 70th anniversary of the NHS. I would therefore ask the Minister to go back to colleagues and say, “Can we widen this Green Paper to take in health and social care, and can we try to do that on a consensual, cross-party basis?”, as has been said by many across the House. Notwithstanding the issues about that in the past, the scale of the challenge is so great that we owe it to all our constituents to put that aside and to take nothing off the table in considering the scale of the challenge and the solutions ahead.

We have an opportunity to explain that to the public, because whenever I address public meetings and I ask people whether they would be prepared to pay more to fund our health and social care adequately, I find that the response is almost unanimous. People are ready for this. They understand the pressures, and they value health and social care immensely. That would be my big ask of the Minister: think again, widen the review, make it consensual and explain it to the public. Let us get the consent and move forward.

It is a pleasure to follow the two Select Committee Chairs, my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) and the hon. Member for Totnes (Dr Wollaston); we have worked very closely on these issues. It is also a great pleasure to see so many other colleagues in the Chamber today. It is obvious that social care and health issues are now coming very high up the agenda, which is absolutely right.

I will refer to the report that the Communities and Local Government Committee has just produced, “Adult social care: a pre-Budget report”. In the next few weeks, we will produce a longer report about longer-term issues in social care. To begin in the here and now, the Committee welcomed the fact that the Government have allowed local authorities to increase the precept in the next two years and have encouraged local authorities to take up that offer, while still recognising that there are challenges around the fact that the precept raises very different amounts of money in different local authority areas. We asked for an immediate further injection of £1.5 billion, so it is welcome that the Chancellor announced an increase of £1 billion, even though £1.5 billion would have been more welcome—I think that is how the Committee will look at that.

Recognising that that would not be a permanent solution for this Parliament, however, we asked for the National Audit Office to be given the responsibility to look at what is required for the rest of this Parliament—the further two years of the spending rounds—to address the issues in social care. Those issues are very real, with an increase by a third in the number of people in their 80s or 90s over a 10-year period, with local authority spending on social care down by 7% since 2010 in real terms, with the increase in the minimum wage, with the Care Act 2014 and with all these other pressures.

Does my hon. Friend recognise that there are two groups of victims of the crisis in social care? They are not only those who depend on the services, but those who work in the sector and who face, for example, widespread non-compliance with national minimum wage legislation, which the Government are aware of but not acting on. Does he agree that needs to be recognised in a future settlement? We need a paradigm shift in how we view care work.

We will return to the proper training, long-term commitment and pay of staff in the care sector in our Committee’s further report, but we certainly had evidence to that effect.

We need another way of dealing with the funding gap for the rest of this Parliament. For the longer term, I very much welcome the announcement of the Green Paper, but I echo the comments of the two previous speakers. We need to get cross-party agreement on a sustainable, long-term settlement that will last not merely for the next Parliament, but for several Parliaments after that. There are major challenges. I agree that we should look at health and social care together, but there are fundamental differences in governance and accountability between the two systems, so how do we resolve that?

We should certainly look closely at what is happening in Manchester, to learn about the devolution deal there and how the two can work together within the same governance structure. Personally, I feel that losing the local accountability that the social care system currently has and simply centralising the whole system would be a mistake. That would take us in the wrong direction, so it is important to look at what is happening in Manchester. We have two very different funding systems. We have the health system, which is free at the point of use, but I do not think that anyone suggested in evidence that we could fund social care on exactly the same basis. We will have to consider something slightly different to fund social care, but how the two systems fit together will be a challenge.

If we are considering the future for social care funding, we should bear in mind that currently we have a mixture of funding. We have some central Government funding, local authority funding and the personal contributions that come through people paying for their care, particularly in residential homes, and what happens to their estate when they die. Will that mean a bit extra from those different elements—a bit more from central Government, local Government and personal contributions—so that the total whole grows? However, the Government have said that they will introduce the Dilnot proposals in the next Parliament—that is what the Minister said to us—which will cap and reduce the contributions that may come in from people’s private estates when they die, so does that mean more money from somewhere else?

I am sorry that the Chancellor did this, because everything should be on the table, but he ruled out a different way of taxing or receiving contributions from people’s personal estates when they die: taking a percentage of everyone’s estate. Currently, people contribute their estate if they end up with dementia and go into a care home, but if they have a heart attack, they tend to contribute nothing. Is that system fair? Is that a challenge we must look at? Even with Dilnot, the £72,000 limit would take most of the estate from a small house sold when someone in my constituency dies, but it would be only a fraction of the value of a property sold in the more expensive parts of London. Is that fair either? Do we simply scrap the whole thing and go on to a German system of social insurance?

The Communities and Local Government Committee went to Germany to have a look at its model. There are pros and cons to it, but we really need to put everything on the table and not rule out any possibilities. We need something that we can, in the end, reach cross-party agreement on, recognising that the social care system will probably be different in its funding from the health system. How they can fit together and be governed together will be absolutely crucial to the success of a long-term settlement, when we eventually reach one.

I shall be brief, Mr Bailey.

Our NHS is the envy of the world; our social care system, frankly, is not. Much has changed since the war years, and that has not yet been reflected or accepted. The health budget of £120 billion sounds a lot, but it is inadequate. It assumes that demand is falling; it is not, it is rising. Even NHS England has admitted that it is not enough. It is not sustainable—that is what the Public Accounts Committee report has set out. Trusts are still in deficit. Clinical commissioning groups have a very varied outcome, financially. The GP triaging offer is welcome, but it is a drop in a proverbial ocean.

The move to sustainability and transformation plans is absolutely right; the problem is that it is not properly funded and we are considering implementing models of care that are untried, untested and uncosted. That cannot be right. There is no transition funding and, although I welcome the capital funding for the project, £325 million is, I am afraid, not enough, Minister. Social care represents a third of local authority spending. We currently spend £14.4 billion. Unlike with the NHS, it is means-tested. Again, demand is going up but the funding is going down.

The funding to local government is inadequate. The 3% precept is helpful, but those of us in rural areas clearly have to pay more because we pay more council tax overall, compared with input from the state. The £2 billion is very welcome, but as my neighbour, my hon. Friend the Member for Totnes (Dr Wollaston), explained, it is a little bit but not enough and we need a proper review. We must also ensure that that money does not get stuck with our local authorities. That has happened before and I would not be happy with its happening again.

On the big picture, we do not really measure the system. We do not look at, or measure, need. We do not look at the people who do not even ask for help. Until we start measuring input, output and outcomes across the whole of health and social care, we will not solve the problem. The Green Paper is extremely welcome, and I agree with my hon. Friend the Member for Totnes that it must cover both health and social care. It would be better than a commission, but it must look at the whole system. It must look at the free/means-tested issue. It must look at integration, joint commissioning and a joint budget and accept some structural changes. We have had Sutherland, Wanless, Dilnot and Barker; the issue really is not that simple.

The Government must face up to the problem, but the public also must play their part. We have to accept change, and that is not easy. We must, as others have said, look at general tax, hypothecated tax, insurance, compulsory saving and much more, but the issue is not about just money, but models of care. While we are at it, Minister, please could we have some fair funding for rural areas? We have a disproportionate number of over-85s and rural sparsity that is not properly dealt with. Please Minister, can we have honest acceptance of the problem and the will to face up to it?

It is a pleasure to serve under your chairmanship, Mr Bailey, and also to serve on the Public Accounts Committee.

Whatever the right level of funding is, there must be agreement on what that is and, crucially, on what it can provide. In our Select Committee sittings over the past year, we have come to the conclusion that the promised programme cannot be delivered with the money available. Via the NHS mandate, which sets out each year what is expected, we know what the NHS is set to provide and what money is available. However, today is 14 March and we have not really had sight of what is mandated for next year.

The mandate is a requirement of the Health and Social Care Act 2012; it sets the direction for the NHS, helps to ensure accountability to Parliament and, crucially, sets objectives. We know from this year’s mandate that the indicative budget from April is £109,853,000 and the capital is £310 million, but it would be useful to hear from the Minister today when we can expect to see next year’s mandate.

The second crucial document in this debate is the NHS constitution, which we do not talk about enough. The constitution sets out the rights to which patients, the public and staff are entitled, including consultant-led care within 18 weeks of a referral from a GP and a specialist referral from a GP for urgent cases when it comes to suspected cancer. It sets out pledges and people’s responsibilities.

I agree that we need to involve the public much more in this debate. Waiting times will, I think, quickly start to increase. We have already seen today information from the King’s Fund on what is happening with hip operations. We will, invariably, go back to the days of the 1990s, with longer lists. Access to GPs and other professionals will continue to decrease and, largely, we will start to depend more on families and local care—not just for social care, but because of the consequences of not having well-accessed healthcare. Staff will become more demoralised and we know that morale is crucial for patient safety.

What I want to hear from the Government today, therefore, is how we are going to include the public in the trade-offs that are now necessary with the sustainability and transformation plans in local communities. How will that be done? Will Parliament start to debate the erosion of the NHS constitution and the rights that people have come to expect? Crucially, will the Minister say when—within the next two and a half weeks—we will see the mandate, so that we will know what funds are available and what they are set out to do?

Like many colleagues from across the House, I recognise that the issue of adult social care is not easy to fix. It will affect many of our constituents at some point in their lifetimes, and some of the barriers to care can be heart-breaking for families.

In May this year, I will stand down as a county councillor in Northamptonshire after eight years’ service; I was also leader of Northampton Borough Council for four years, so I have witnessed at first hand how the system works. Also, as a member of the Communities and Local Government Committee, I have been part of a four-month inquiry into adult social care. We published an interim report ahead of the Budget. I have also had discussions with professionals in the system, from the chief executive of Northampton general hospital down to care workers.

It is clear that the recently announced additional £2 billion of new money in social care is welcome. I recognise that it shows that the Government have listened to representations made by many Members of the House and the social care sector, and to the Select Committee recommendations. But no one on either side of the House is under any illusion that that will fix everything or, indeed, that money is the only issue. It is vital that we find a more sustainable way of paying for the increasing cost of social care over the long term, but we must also fix the systemic problems.

I welcome the Government’s statement that they will shortly set out proposals in a Green Paper. Although short-term action is vital, the social care sector faces medium and long-term funding, structural and other problems that need to be addressed, and it is important that we have a full review of the service for the long term. We must move the debate away from the idea that the entire sector can be saved with increased funding, because the issues go much deeper.

The idea of joined-up care must be exactly that. I have lost track of the number of cases I have worked on with families who are trying to resolve issues between the care provider and the local authority—in some cases, local authorities—and deal with the multiple pressures of finding solutions while dealing with the emotions and trauma of an ill relative, sometimes with many complex or difficult medical conditions.

The systemic problems in some cases can lead to financial pressures, which will only get greater as we have an ageing population, demographic growth and enhanced medical treatment. Often, too many organisations are involved: the poor family can get overwhelmed and unsure about which organisation is dealing with which part of the care package and who they should be chasing to make something happen.

The carers and staff involved are usually equally frustrated, and concerned for the patient and their family. The Green Paper needs to focus both on the structural barriers that prevent care packages from being put in place or patients from being discharged from hospital, and on a serious examination of how the different organisations involved work together. In my opinion, the review must take a wide-ranging look at whether the organisations currently involved are fit for purpose, whether the current splits between health and adult social care can be justified, and the possibilities for reform.

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate. I want to draw attention to the crisis in social care in Liverpool. The background is the severe cuts put on a city with a very low council tax base. Some 80% of Liverpool’s properties are in council bands A and B. Cuts to Government funding will reach 68% by 2020, resulting in a £90 million cut in funding for adult social care. The consequences up to now have been a reduction in social care packages from 14,000 to 9,000.

There are two aspects to social care: domiciliary care that enables people to live independently in their own homes, and social care that enables people to be discharged from hospital. Both are equally important. I certainly welcome the announcement of an additional £27 million for Liverpool over the next three years from the £2 billion additional allocation. That money is very important and has staved off an immediate crisis, but it will be eaten up by demographic changes.

For example, the increase in the number of people aged 65 and over will lead to an £8 million increase in cost next year. The increase in funding required to implement the living wage means that an additional £25 million is required by 2019-20. Welcome as that £27 million is, it will be eaten up by those increases. The situation is compounded by an error by the Department for Communities and Local Government in assessing how much funding could be raised from Liverpool’s council tax. I gather that that error has now been rectified, but it confused the situation.

What do we need? Additional funding now is welcome, but we need long-term consistent funding related to need and more integration between the national health service and social care. I recognise the problems that the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), identified, but a move towards integration is essential. Liverpool is innovative and is already trying to do that, but it needs funding and general support from the Government to enable it to work constructively with the NHS.

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate. I would like to touch on three different elements of adult social care: the short, medium and long-term aspects of funding. In the short term, the Government have allowed revenue raising of nearly £14 billion since 2010; most recently, there was the £2 billion in the Budget. That was very welcome and has had an immediate impact on my constituency. North Yorkshire will see an extra £18 million over three years. While I very much appreciate that response to the various different submissions that have been made, I think that most people, including the Chancellor, accept that it does not provide a long-term solution.

The medium-term solution would be to look at business rates retention, which is coming down the line for 2020. A lot more money will be coming into the system, with £12.5 billion to local authorities. What bang for their buck the Government want for that, we do not quite know. The reality is that more money will be coming in, but the point has been made that the current distribution of local authority funding is not fit for purpose. There is no correlation between the need in local authorities and the amount of funding that goes in. It is based on an old formula—regression—and we need it to be based on cost drivers, which are around such things as age and deprivation.

We often fight the battle here between rural authorities and metropolitan authorities, but the battle we should be fighting is about the fact that the lion’s share of funding goes to London authorities. If we add up all the different elements, including the revenue support grant, business rates and council tax, total spending power in London is on average 40% higher than any other authority. Often those London authorities have lower need, younger populations and wealthier populations. There is no correlation, and I think we all want to see a fair system. I have nothing against London—it is a fantastic place—but I want a fair deal for North Yorkshire.

The other issue with business rates retention is the quantum. Will it grow to meet the need as need grows? The need is growing exponentially, and we need a longer-term solution. We have hugely increasing demand, and there needs to be correlation between need and the money coming in. In business, we always used to say when we came to such problems, “Ideas are ten a penny. We need a proven solution that is sustainable and scalable.” On our Select Committee visit to Germany, we saw that sustainable, scalable solution, which was delivered with cross-party agreement. I absolutely agree with the calls for us to tackle the issue on a cross-party basis.

I think there is a consensus in Westminster Hall, informed by multiple Select Committee reports that have highlighted the crisis in our health and social care system. My clinical commissioning group is facing a £40 million deficit. My local hospital, which is one of the best run in the country, is facing a £20 million deficit. It is obvious that that simply is not sustainable.

As other colleagues have pointed out, accident and emergency figures are deteriorating, waiting times are lengthening and there are increasing difficulties in seeing a GP. In Devon, we face controversial plans to close community hospital beds and to close a number of community hospitals completely. That is not an accident; it is the result of seven years of the most stringent restraint on NHS investment in its history, combined with 40% cuts to social care when we have a growing elderly population and increasing demand. The issue was exacerbated by the disastrous Lansley reforms in the Health and Social Care Act 2012—the biggest structural upheaval in the NHS’s history— implemented at the same time as maximum spending restraint.

As well as that organisational upheaval, we face a workforce crisis in health and social care, as the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), pointed out. That has been exacerbated by the uncertainty over Brexit. Until recently, the Government have appeared pretty oblivious to all that. The £2 billion extra in the Budget was welcome, but it is a drop in the ocean compared with the amount of money that is needed.

I welcome the commitment in the Green Paper to look root and branch at a sustainable funding solution for health and social care. I worry, however, that a Green Paper is often a euphemism for kicking an issue into the green grass. I would like to see a policy announcement or a White Paper. As colleagues have pointed out, we have had much cross-party support. One proposal was scuppered in the run-up to the last general election. I worry that to grapple with the issue in the second half of a Parliament is not sensible timing. Governments need to get a grip on the issue at the beginning of a Parliament so that there is maximum time for cross-party working to get something in place. I am not optimistic that the Green Paper will come to a conclusion.

We also need to have an honest conversation with the British public about how we fund health and social care. I share Members’ regret that the Chancellor seems to have ruled out any sort of posthumous levy on people’s estates. We need to look at all options, including the excellent sugar tax that was recommended by our Select Committee. It is already having a dramatic effect in getting drinks manufacturers to reduce the sugar in their products and therefore improve public health.

Finally, we would like the Government to end the uncertainty over EU nationals working here in our health and social care system. They could do that today when the Prime Minister stands up in the House and gives her statement on article 50. That would give a huge boost to morale and end the uncertainty. People are already leaving, and the system is not able to recruit. That workforce crisis will do more damage in the short term than anything else.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate. It will not surprise colleagues to hear that I am unashamedly here to speak up for Devon, and North Devon in particular. We are part of the south-west, and it is significant, looking around the Chamber, to see so many Members from the south-west from all sides. It is because we are concerned that rural areas in the south-west are not getting our fair share in the distribution of available funds.

I join my hon. Friend the Member for Totnes (Dr Wollaston) in unequivocally welcoming the extra money that the Government have put into health and social care. The £10 billion extra for the NHS over this Parliament and the £2 billion for social care announced in the Budget are extremely welcome, as are the extra revenue-raising powers that have been given to local authorities for social care, and I thank the Minister and his team for those.

However, we need our fair share in areas such as Devon and the south-west. As has been mentioned by the right hon. Member for Exeter (Mr Bradshaw), we face a sustainability and transformation plan that is causing huge concern among my residents in North Devon and among those of other colleagues here from Devon constituencies. There are particular concerns about the future of some acute services at North Devon district hospital. I have said before and I will say again that any cuts to services at that hospital would be absolutely unacceptable. That is because of what I describe as the three Ds: distances, demographics and deprivation. I will not rehearse the arguments here; the Minister knows them well. He has been kind enough to hear me out on many occasions, as have the Secretary of State and many others. Those three factors in Devon and in North Devon in particular mean that we have to look at a fairer way of funding our health service so that we get the services we need. I repeat that any cuts to services at North Devon District Hospital would be absolutely unacceptable.

The holy grail of social care is the integration of the health and social care systems, which many colleagues have mentioned. I want to pay tribute to the Northern Devon Healthcare NHS Trust, which does better than most in working with its social care partners to ensure that packages of care are in place when people are able to move out of hospital. I welcome the hard work of all the people who work in the North Devon services to achieve that.

I will not. The Chair was clear about the time limits; I apologise to my hon. Friend.

I will end by saying we must remember the three Ds. Let us work together across parties to find a long-term solution for the fairer funding of health and social care.

The consensus in this room on the scale of the challenge that we face strikes me as remarkable. The £1 billion for social care this coming year is welcome, but against the £2 billion gap identified by the Health Foundation, the real risk is that this will result in more older people ending up unnecessarily in hospital because care fails at home, which puts more pressure on the NHS. In the following financial year, 2018-19, real-terms spending per head on the NHS will start to fall. That is a remarkable statistic. At a time when demand is rising rapidly, that makes no sense to anyone, wherever they are on the political spectrum. I want to touch on the human consequences of that.

Across the country families with children who have significant mental health problems routinely wait months for treatment. They suffer enormous anxiety. A man in my constituency was told he had a two-year wait for the adult ADHD clinic. Routinely across the country we are breaching the referral to treatment standard on cancer care. There is now an awful insidious trend whereby anyone who has money—we cannot blame people for this—is minded to opt out and fast-track treatment privately. Families faced with long delays do what they can for their loved ones, but do any of us really want to live in a country where timely access to treatment and potentially survival depend on whether we can pay? That is where we are heading.

No party has come up with a full solution to the crisis facing our NHS and care system. We have to be honest about that. Collectively, we are letting down the people of this country. It is remarkable how many speakers today have called for the Government to embrace a cross-party process. A load of MPs—senior MPs, Select Committee Chairs and former Ministers—have come together to call on the Prime Minister to establish an NHS and care convention to engage with the public in the mature discussion that we know we need to have but keep putting off. So I call on the Minister to support us within government, be audacious and recognise that this is a once-in-a-lifetime challenge. The Government will get credit for working with others to achieve the solution that this country badly needs.

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my friend from the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), on securing this debate, which is welcome. To start on a positive note, we are having this debate because the NHS has been a great success. Life expectancy in England is now approaching 81, which would have been unimaginable when the service first started. Treatments in today’s hospitals would have been seen only in “Star Trek” in the late 1980s. So, to be positive, the story is about how we deal with a challenge created by the greatest success.

I remember my time in local government. Other former councillors in the room may have seen the same graph showing that emptying bins and disposing of rubbish and social care would be the only thing left that councils would be able to afford to provide owing to the predicted rise in the cost of social care as demand increased. We have heard a lot today about the possibility of integrating services. I can certainly reflect on the challenges that my hon. Friend the Member for Northampton South (David Mackintosh) faced in terms of different budgets and different organisations.

In Torbay we have an integrated care organisation that is fairly successful in removing barriers. It has certainly helped contribute to one of the lowest levels, if not the lowest level, of delayed discharges over winter, yet now we are having to discuss how the risk-share agreement is structured, because the NHS organisations still need to comply with budgetary rules for them as individual organisations. It is not about the amount of money in the system overall; it is not about the spending of taxpayer pounds; it is about how that is divvied up in terms of a risk-share agreement. That is the exact opposite of what we want to see when we look at integrated care.

The issue is also the pace of some of the changes. Paignton Hospital will stop taking inpatients on 3 April after a consultation that many of us felt was a bit of a done deal and a waste of time. I was shut out of the first meeting because a small venue had been booked for a large meeting. There was a feeling that the measure was going to happen anyway. On top of that, we have 32 beds being closed at Torbay hospital in the same period. For me the issue is how the pace of change is being forced.

There is a long-term debate. We have touched on pensions and—let us be blunt—there was an element of cross-party agreement when the pension age for my generation was increased to 68. It can be tempting to talk about the amnesia of opposition. We need to discuss long-term solutions. The Budget was welcome, but it has to be seen as a short-term measure. We need a long-term schedule that will last for more than one Parliament and more than one Government.

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing today’s debate. There must be honesty in the room. The trajectory of the funding crisis started with the Health and Social Care Act 2012, which introduced a funding formula that has failed. It also put the wrong financial drivers into the system, which has pushed us into this crisis.

I need only look to my own clinical commissioning group, which is seeking £1,150 per patient in an area of ageing demographics and increasing social deprivation. From the primary care group to the primary care trust right through to the CCG, my area has been seriously underfunded, and it is now having to pay heavily when a CCG down the road is getting over 50% more per head. That does not suggest equality across our NHS. Our CCG is now being pushed into special measures and is having to make a £50 million saving because of a governmental failure instead of trying to meet the real needs of our community. Of course, we see that reflected across the country. In addition, the STP includes a £420 million cut, and that will really affect patient outcomes.

Of course we need to agree a way forward on funding for health and social care, but public health also has to be included, because we are seeing public health funding severely cut. Public health measures and prevention are the drivers of better healthcare in future. We have seen the end of the smoking cessation programme, NHS health checks, and the ability to drive better health for future generations. The local authority will see a further £250,000 cut in that budget over the next three years and a £400,000 cut to sexual health services.

Rationing is coming into the service. Just two weeks ago, the Minister and I debated the rationing of surgery. Putting the wrong, perverse financial drivers in yet again is going to escalate costs in the medium term. We need to examine the way CCGs and trusts are handling the current financial crisis to make sure that we are not just kicking the can down the road and therefore escalating costs as we move forward.

Ensuring that we have early diagnosis in the system is also important. We have heard about waiting times for diagnoses of mental health conditions and emotional and psychological difficulties. In York, I heard from a parent who had spent four to seven years waiting for a diagnosis; support did not come forward until the diagnosis had been made. We should really be looking at functional care and supporting the family as a whole—we know that not supporting the family brings an additional cost. In any review, we need to make sure that we focus on prevention and early intervention, and its financial impact, and put the right financial drivers in the system now.

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, on securing this debate. First, I would point out that a strong NHS requires a strong economy, and on that front the Budget brought good news.

In the short term, we need to think about how to deal with some of the problems we now face. To that extent, I very much welcome the £2 billion for social care, the £300 million to underpin sustainability and transformation plans and the £100 million for A&E. I also welcome the rumours of more medical school places, which, as my hon. Friend the Member for Totnes (Dr Wollaston), the Chairman of the Health Committee, said, are very important indeed.

We need to look at intergenerational fairness. Sadly, most healthcare cost is generated in our declining years. It is reasonable, after 2020, to look at instruments such as the triple lock to see whether those substantial sums of money should be handed to our national health service. Most elderly people I know would welcome such a thing.

We need to look fundamentally at what to do with healthcare funding going forward. It is very good to hear of the injection of money in the Budget, but it will not do in the long term, for reasons that have been explained. A Green Paper will not do either. Although that is welcome for social care, health care is much more complex.

A conversation with the public means looking fundamentally at what underpins our health service and trying to work out why outcomes in this country fall significantly short of those in countries such as Germany, which has been mentioned, France and Holland. That means examining Beveridge versus Bismarck, something in between or something completely different, which requires a commission or a convention—perhaps an Adair Turner-type commission. It needs to have that conversation with the public. On the NHS’s 70th birthday, that is appropriate, because we need to carry the public with us if what we are ultimately suggesting is quite substantial sums of money injected into healthcare to bring our healthcare outcomes to where they should be.

As an optimistic sort of person, I rather suspect that the reason why a Green Paper has not been suggested for healthcare—notwithstanding the “Five Year Forward View”, which is only halfway through its evolution—is that the Government are considering such a conversation as a proposition. I very much hope that the support I think the Prime Minister gave to the concept when a number of our colleagues met a short while ago is translated into concrete proposals in the near future, so that—on a cross-party basis—we can have the convention, commission or conversation that we need with the public to establish, in the NHS’s 70th year, a long-term funding arrangement for this national institution that we all hold so dear.

I congratulate the hon. Member for Hackney South and Shoreditch (Meg Hillier) on securing this debate and thank you, Mr Bailey, for making sure that we all get a chance to participate. As my party’s health spokesperson, this is an issue that I long considered in the run-up to the Budget, hoping and praying that there would be funding for drugs such as Orkambi for cystic fibrosis sufferers, money available for the training of additional GPs and more cancer drug funding. The list is exhaustive—we all have a long list of things—but I want to mention three issues in the short time that I have.

Together for Short Lives provided me with a briefing full of information for this debate. It is clear that local authority funding for children’s palliative care charities does not reflect the level of social care provided by such organisations. In the spring Budget, the Government announced a further £2 billion for adult social care funding over the next three years.

Given the vital role that these charities play in delivering children’s social care, including short breaks, what guidance will the Government give local authorities to make sure that they provide financial support to those organisations? Will the Government use the forthcoming Green Paper on social care funding to consider evidence and proposals for increasing funding for children’s social care? The care costs for children’s palliative care rose by 10% in the last year, due to an increase in the number of children with life-limiting and life-threatening conditions and the increasing complexity of their needs and the care that they require.

As a member of the all-party parliamentary group on blood cancer, I am aware of the inquiry into blood cancer care that is being launched on Wednesday. Blood cancer, as the Minister knows, is the fifth most common cancer in the UK and the third biggest cancer killer, yet awareness among the general public and policy audiences is very low. I trust that the Minister will look at that report. It is important that we consider reports, because we want the willingness to act on them. I respectfully ask the Minister to consider that.

My third point is about multiple sclerosis. Some 100,000 people in the UK have MS—4,500 of those in Northern Ireland. Great research has been done by Queen’s University Belfast to revolutionise life for people with MS. They are trying to find a way forward, looking at how the damaged brain repairs itself. The research is good stuff. I remind Members of the importance of ensuring that funding is available for research into diseases. I believe the Department must step up and make sure that that happens.

I know that there is not an unending supply of funding, but I believe that it is necessary that the money is used in the most productive way. I am subsequently asking that consideration be given to the issues that I and others have raised this morning. My mother often said, “Your health is your wealth,” and that is very much the truth. We must do all we can to protect the real wealth of this nation, and make sure that help is available to those who need it most at the time they need it.

I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing this important debate.

On 4 March, just over a week ago, a quarter of a million people marched through central London to call on the Government to stop the cuts and the privatisation of the national health service. I pay tribute to each and every one of those people who came to London to make that protest to the Government. When a quarter of a million people assemble directly outside this Parliament, the Government should think about what they are asking for. People value the NHS highly and are prepared to fight for it.

Many of the problems that we are facing in the health service have their roots in the Health and Social Care Act 2012. I hope that in any cross-party discussion, where we say that everything will be on the table, repeal of the 2012 Act will be on the table for consideration. One of the very many changes it introduced was the removal of the requirement to provide a comprehensive health service in England. As a result, we are seeing increasing rationing, and patients are suffering.

My hon. Friend the Member for York Central (Rachael Maskell) made an excellent speech in the Adjournment debate she recently secured on the rationing of surgery. As a former physiotherapist, she is very well-placed to make those points. Earlier this year, three clinical commissioning groups in the west midlands produced proposals to reduce the number of people qualifying for hip replacements by 12% and for knee replacements by 19%. Clearly, that has nothing to do with addressing patient need; it is all about balancing the books on the part of a Government with an austerity agenda that they are wedded to. Thousands of elderly people in our country are losing their sight, due to the rationing of cataract operations. That kind of rationing has a real and painful cost to many people in our society.

We are seeing the emergence of a postcode lottery. People are being told that we cannot afford a comprehensive service any more, but that needs to be challenged. Ministers will cite the ageing population and the costs of technology. Well, technology can reduce the costs of care; treating somebody sooner for a cataract operation— a relatively cheap operation—is a much more efficient way of using money than letting somebody become blind and hence terribly dependent on social care.

The coalition cut £4.6 billion from social care. The £2 billion over three years that the Government are providing is nowhere near enough. We want an injection of £2 billion now to stabilise the social care system. The public will not stand for it, and they will not forgive or forget a Tory Government who take the national health service off them. Ministers might think that they can erode it by trimming a little bit here and a little bit there—[Interruption.] But the public know what is going on. Those who have hospitals that are going to close understand what I am talking about. People will not stand for it: they will march again, and it will not be—[Interruption.]

Order. I ask Back Benchers in sedentary positions to allow the speaker to speak. She did not interrupt their contributions, and I wish they would offer the same courtesy to her.

When 250,000 people are so unhappy about what the Government are doing and we are seeing the closure of A&Es, hospitals and all sorts of services, and the rationing of services that people really need, the Government should listen, as should Conservative Members.

We now come to the Opposition spokespersons’ contributions. I wish the Minister to have a minimum of 10 minutes to respond to the debate, because many points have been made. I can allow the Opposition spokespersons 10 minutes each, but it would be helpful if they kept their speeches a little shorter so that Meg Hillier may respond to the Minister’s comments.

It is a pleasure to take part in this debate, Mr Bailey, once again with you in the Chair. I will keep my remarks brief to allow the required summing up to take place.

I pay tribute to the hon. Member for Hackney South and Shoreditch (Meg Hillier) for securing the debate, and I congratulate her on her speech. She highlighted the issues very well and was right to focus on the shift from capital to resource: £940 million this year, the third year in a row of such a shift in NHS England.

This has been another good debate on the subject. Only three weeks ago, I summed up for the Scottish National party in a social care debate. The right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) said in that debate—I agreed with him—that social care was the greatest domestic policy challenge facing the UK Government. Some revisions to what was said in that debate are required, however, as a result of the Chancellor’s Budget statement. It was welcome that he chose to spend £2 billion on health and social care in England, but it was a mistake for him to stagger it over three years. That is simply not enough.

We welcome the Barnett consequentials that go to the Scottish Government as a result of the social care enhancement—£99 million in 2017-18, £66 million in 2018-19 and £33 million in 2019-20. I am sure that those funds will be used by the Scottish Government to continue investing in the new health and social care joint boards which have been legislated for and recently established. The joint boards are local authorities and health boards working together to overcome the challenges of bed blocking, delayed discharge, domestic adaptations and care packages.

One of the most frustrating cases that we all deal with as MPs is delay to domestic adaptations, which is frustrating for the family, the recovery time and the flow through the healthcare system. I used to deal with dozens of those as an MP and previously as a parliamentary assistant. Thankfully, they are now becoming fewer and further apart. I am not saying that there are no challenges in Scotland—of course there are—but north of the border we are in a very different place from what we see in England.

Over the past two years, as we have started to integrate health and social care and invested record levels in our NHS in Scotland, Scotland’s core A&Es have been the best performing in the UK. On 5 February this year, in a report comparing UK health services, the BBC stated:

“Out of all the four nations, hospitals in Scotland seem to have fared the best...Much of the credit has been given to the way councils and the health service are working together.”

According to the most recent figures, the four-hour A&E waiting time target is being hit in 92% of cases in Scotland, 79% in England, 76% in Northern Ireland and 65% in Wales. Taken with other initiatives and investments, standard delayed discharge of more than two weeks has dropped by 43% in Scotland.

In the Scottish Government’s 2016-17 draft budget, we have allocated a further £250 million to health and social care partnerships to protect and grow social care services and to deliver our shared priorities, including paying the real living wage to adult care workers. In spite of the cuts to Scotland’s budget, the SNP has increased funding for adult social care. As a result, the average time received for home care is 11.3 hours a week, compared with 5.6 hours a week in 2000. Again, I am by no means saying that things are perfect in Scotland, but we faced up to the social care challenge long before it became the crisis we see south of the border. I hope that the UK Government can look to the Government up the road for inspiration as they face up to their own serious domestic policy challenges in England.

It is a pleasure to serve with you in the Chair, Mr Bailey. I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing the debate and the excellent way in which she opened it.

Last week, in the spring Budget statement, the Chancellor announced that the Government would provide £2 billion in funding for social care over the next three years. We have heard a variety of comments about that in the debate. It is welcome that Ministers have finally heard the warnings from the Opposition, a wide range of health and care leaders and the three Select Committees represented in the Chamber today about the fragile and underfunded state of social care, but the extra funding has to be seen against the cuts to local council budgets, leading to the loss of about £5 billion from adult social care budgets since 2010. Clearly, the announced funding is not enough.

The cuts have already had an impact on the lives of many people. Older, vulnerable and disabled people have had support that they relied on taken away. Others have been turned away by local authorities and left to rely on friends and family for help. Last week, in this Chamber, we debated social care in Liverpool, when we heard that the cuts there meant that care could be funded for only 9,000 people, not the 14,000 people who had previously received care packages, as my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) reminded us today. In one city alone, that is 5,000 care packages lost and, nationally, 400,000 fewer older people than in 2010 receive publicly funded care.

We should remember that, as Age UK tells us, 1.2 million older people have to live with unmet needs for care—older people who do not have help they need to feed themselves, wash or get dressed. Apart from coping with future demographic change, we have to look at that unacceptable level of unmet need, because that is part of the serious state of social care and it is having a knock-on effect on the NHS. As Mark Porter from the British Medical Association said:

“When social care is on its knees, patients suffer delayed transfers, and the personal and financial cost is vast.”

In January we saw a record high in the number of delayed discharges from the NHS. The King’s Fund recently described social care as

“little more than a threadbare safety net for the poorest and most needy older and disabled people”—

it is a threadbare safety net that many people are now falling through, with the NHS left to pick up the pieces.

Given the damage done over the past seven years and the crisis that the Government have caused in social care, the £1 billion announced in the Budget for this year is simply not enough. As we have heard in the debate, the King’s Fund, the Nuffield Trust and the Health Foundation warned the Government about a £1.9 billion funding gap in social care, which means that the Government are funding only half of what is needed now. As for comments outside this place, the Care and Support Alliance has said that the extra funding

“keeps the wolf from the door”,

but no more, while the Academy of Medical Royal Colleges said that

“we’ve now got to get real and recognise that short term measures of the kind we’ve seen today won’t help in the longer term.”

Is it not time to examine the true gap in social funding? Will the Minister acknowledge that £2 billion in funding is needed now, rather than spread over the next three years?

We also heard about the intention to produce a Green Paper on the long-term funding options for social care. The Chancellor said that those options do not include what he described as “Labour’s hated death tax”. As my hon. Friend the Member for Sheffield South East (Mr Betts), the Chair of the Communities and Local Government Committee, said, the Government should not reject options proposed in the past by other parties, and the Chancellor should not label one such option as a “death tax”, because to describe it in that pejorative way is not helpful in securing cross-party support for a sustainable solution to funding social care. That was done back in 2010 for political reasons, and it is being done now for political reasons. Inheritance tax is not called a “death tax”, although it is a tax levied after death. It has been known in the past as probate duty, estate duty and capital transfer tax. The Labour party has not played such political games with the Government’s highly unpopular increase in probate fees, which will affect people in the coming months.

I also challenge what Ministers have said about previous work on a sustainable and long-term funding option for social care. We need to deal with the issue now. In the Budget debate, the Financial Secretary to the Treasury denied that the Government might kick it into the long grass, instead talking about previous reviews. Let us be clear about that, however. In 2010, the Labour Government produced a White Paper called “Building the National Care Service”, a copy of which I have with me. Before that, in 2009, we had a Green Paper and the “Big Care Debate”, involving 68,000 people. Members are right that we need that big conversation with the public, but we have already had it once—we held it in 2009. We had firm plans to build a national care service. In seven years, this Government abandoned those proposals, established the Dilnot commission on the future funding of adult social care, adapted Dilnot’s proposals for their 2015 manifesto and then abandoned them. I call those seven wasted years. We appear to be back where we were in 2009.

As we have heard, it is clear that the demographic pressures in social care have a real impact on the NHS. In a typical hospital at any one time, two thirds of in-patients are over 65 and more than a quarter have a diagnosis of dementia. On top of rising demand, the Government have simultaneously sought to pass on what I see as unachievable savings. As we have heard, hospitals already have record deficits. NHS providers ended last year with a £2.5 billion deficit, although the Nuffield Trust suggests that the real underlying deficit was closer to £3.7 billion. The Public Accounts Committee identified that the NHS is resorting to

“repeated raids on investment funds in order to meet day-to-day spending”.

We have heard those issues covered in this debate.

The decision to provide just £100 million in the Budget for capital investment looks odd, given that the NHS had to resort to raiding £1.2 billion from capital funding this year just for day-to-day running costs and faces a £5 billion repairs backlog. It has become increasingly clear that a £22 billion savings target for the NHS is simply not realistic. The Public Accounts Committee said:

“we remain concerned about whether plans are really achievable”.

Not one independent expert I have seen believes that such savings can be achieved with services maintained at current levels, and I am worried that efficiency savings on that scale will increasingly affect the quality of care that patients receive. We know that the number of trolley waits rose by 58% last year and the four-hour target has not been met since July 2015, and we have now heard about the rationing of hip replacements.

Importantly, the King’s Fund told us this week that the financial pressures on mental health services have been

“a major factor driving large-scale changes to services, which may have had a detrimental impact on patient care”.

Its report states that patients who are able to access treatment get fewer contacts with adult secondary mental health services. That suggests that there is rationing of support in England. It is also clear that the shortage of specialist mental health beds is resulting in a significant increase in the number of patients being sent for treatment away from their home area. In the four months to January this year alone, more than 2,000 vulnerable people in England with serious conditions such as schizophrenia, psychosis and anorexia were sent for out-of-area treatment. Almost half those placements were more than 60 miles from the patient’s home, and one in five of those patients were admitted to a psychiatric intensive care unit.

The Public Accounts Committee said that

“the financial performance of NHS bodies has worsened considerably and this trend is not sustainable.”

In social care, mental health and the NHS, it is evident that the most vulnerable people in our society are bearing the brunt of financial pressures. We have heard a strong consensus in this debate that that has to change.

I congratulate you on chairing this substantial debate so efficiently, Mr Bailey. Some 31 colleagues were present—that is a very high turnout for Westminster Hall—of whom 18 spoke, including three distinguished Select Committee Chairs and two Opposition spokesmen. Certainly I have not attended such a significant debate in Westminster Hall, and it reflects our common interest in ensuring that the NHS and social care services in this country provide as high-quality a service to the public as possible.

Virtually all speakers welcomed the developments in last week’s Budget, and I welcome that broad consensus across the Chamber. Only one discordant note was struck—reference was made to a march in the streets of London led by the shadow Chancellor, the right hon. Member for Hayes and Harlington (John McDonnell). That march obviously demonstrated a degree of concern, but it happened before the Budget, which, as I shall touch on, responded to many of the concerns that have been raised.

We all recognise that the NHS faces a significant challenge, given the increasing demand for health services as a consequence of our ageing and growing population, new drugs and treatments, and safer staffing requirements, and that in turn is increasing the pressure on social care services. We know that finances are challenging for both areas, which is why we have ensured that spending on the NHS has increased as a proportion of total Government spending each year since 2010.

We backed the “Five Year Forward View” as part of the spending review in late 2015. That ensured that real-terms NHS funding will increase by £10 billion by 2020-21 compared with the year before the spending review. Some hon. Members said that they wanted to see a plan. We have supported the NHS’s own plan—the “Five Year Forward View”—and announced that we will publish a Green Paper this summer looking at how social care is funded in the long term, which hon. Members have welcomed, so it is churlish to deny that this Government are providing long-term strategic thinking about the way we fund both those services. I remind colleagues that the NHS budget was £98 billion in 2014-15 and will be £119.9 billion in 2020-21. That is a £21.8 billion increase in cash terms, which seems to get lost from time to time in these discussions.

We are almost at the end of the financial year. The NHS received a cash increase of more than £5 billion in 2016-17. That was front-loaded, as NHS chief executive Simon Stevens requested. For the year that starts on 1 April, there will be another significant increase in funding once the mandate is settled. The hon. Member for Bristol South (Karin Smyth), who is a member of the Public Accounts Committee, asked when we will see that document. It has to be published by the end of this month, and I assure her that it will be.

The measures announced last week, which many hon. Members referred to, have three features. I will not go into them in detail, because they have all been covered. Much of the focus has been on the additional £2 billion that we will provide for social care over the next three years, half of which will start to come in next month, when the new financial year begins.

Some hon. Members are aware of the numbers for their areas and some are not, and one colleague came up with a slightly incorrect figure. I will not go through every area, but I applaud the presence of Devon MPs in particular, given the manner in which they have massed themselves with colleagues from across the House. Devon will get a £30.3 million increase in its social care budget over the next three years and will receive half of that in the year that is about to start. My hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) referred to an £18 million increase for North Yorkshire. I can give him a bit of good news: it will actually be £19.6 million over the next three years. I am grateful to the Chair of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), for her support for the Budget measures. Hackney will receive £12.8 million, as she acknowledged. Like many colleagues, she sought a long-term funding settlement.

I am afraid I cannot take interventions, as we have very little time.

The spending review provided a settlement for the NHS. The Chancellor indicated that there will be a social care Green Paper this summer. Several colleagues called for a cross-party consensus. The Green Paper will provide an opportunity for debate and consultation, and such discussions should focus on that.

The second Budget measure was a £100 million increase in funding for A&E services, so that people who present at A&E who do not need intense or urgent care can be diverted to GPs or clinics run by nurse practitioners. That best practice has been proven to work in A&Es that have such a streaming service, so we are looking to provide facilities for basic capital spend to ensure that every A&E hospital across the country has streaming in place by next winter. I am pleased that that has been welcomed by hon. Members from across the House.

The third measure—this was touched on in the debate, albeit not in such detail—is the £325 million capital investment in the first set of sustainability and transformation plans. Those who make the strongest case for investment and can deliver better, more joined-up services, which can bring real improvements to patient care, will benefit from the funding. We look to that to be an exemplar for other areas whose plans are less well developed, to encourage them to develop a better, more integrated approach to patient care for the future, including closer working with local authorities for the provision of social care. That should encourage areas to bring forward more comprehensive plans for the next wave of STPs, which will be supported. As hon. Members have said, we look forward to explaining more about that at the time of the next Budget.

Something that has been missing from the debate is the 6.5 million carers in the UK— 17,000 of them are in Portsmouth—who save costs of £132 billion a year. Will the Minister recognise that in the Green Paper and, in particular, respite care for them?

In the sustainability and transformation plans there is the opportunity for commissioners of care and health services to look holistically at the demands of the residents in their area, which to a degree includes palliative care and respite care. As we move towards an STP, there is a greater opportunity for those things to be considered as well.

I agree with the hon. Member for Portsmouth South (Mrs Drummond). There is a real dearth now and respite care for carers has got lost. With £120 million, 40,000 carers could be helped with a respite care break. The Minister should look at that.

As I just said, the STPs provide an opportunity for areas to place greater focus on respite care if they consider that to be required.

I would like to touch on the adequacy of the social care funding package. The announcement means that in the next three years councils will have access to some £9.25 billion of more dedicated funding. That includes extra money going to local authorities through the combination of the improved better care fund and the social care precept, which, for those councils introducing it with effect from next month, will raise some £1 billion extra. The £1 billion provided in the Budget and the £1 billion from the precept amount to the £2 billion called for by external sources for the coming year. That funding will allow councils to expand the numbers of people they are able to support and, in turn, address issues at the interface with the NHS such as delayed discharges from hospital, which as we know cause problems with patient flow through the system.

Questions were raised about how the social care funding is to be allocated. I inform colleagues that 90% will be allocated using the improved better care fund formula to local authorities that have responsibility for adult social care. That distribution takes account of the ability to raise money through the council tax precept for social care and means that it is well targeted at areas of greater need and market fragility. However, in recognition of the social care pressures faced by all councils, 10% of the funding will be allocated using the relative needs formula.

The response to the measures from external audiences reflects comments made by hon. Members today: they have been broadly welcomed. Of course, several hon. Members said that it is not enough, but that is a traditional response to any increase in money—it is always easier to say that it is not enough. Hon. Members have generally recognised that the Government have listened to concerns about social funding. Those of us with responsibility for the health service recognise that there has been a particular problem in dealing with delayed discharges from hospital. Through closer working in the sustainability and transformation plans as they are rolled out across the country, with local authorities working more closely with health service providers, we think that the money will provide a lifeline to help to remove some of those pressures and to improve patient flow through our hospitals.

I would like to touch on the medium-term challenge and how in the coming months we can try to use the development of a social care Green Paper to address the longer-term concerns. The Government are committed to establishing a fair and more sustainable basis for funding adult social care in the light of the future demographic challenges that the country faces. We will therefore bring forward proposals to put the state-funded system on a more secure and sustainable long-term footing, setting out plans in a Green Paper. Some hon. Members asked when the Green Paper will be published. If I was in charge of Government timetabling, I would be in a better position to answer. They will not be surprised to hear that I cannot give a definitive answer, but, to use traditional parliamentary language, it would be fair to say that it is expected to be published in the summer.

Will the Minister clarify the Government’s position on the idea of a posthumous levy on estates? The Chancellor ruled that out, yet we read in the newspapers that the Prime Minister slapped him down over that. Are the Government ruling it out or not?

I will not pre-empt anything in the Green Paper, and it is not for me to give the right hon. Gentleman any comfort on discussions that might or might not have happened around the Budget.

We recognise that the NHS and social care face huge pressures and that there is more for us as a Government to do. However, we can be confident that we have plans in place both to cope with the pressures that we currently face—winter, A&E pressures and delayed discharges—and to sustain the system for the future. We have a long-term plan in place through the “Five Year Forward View” and the efficiency work being undertaken and rolled out progressively this year. We have given extra funding to both the NHS and social care to support those plans, and we have plans to bring forward a Green Paper on social care. I am pleased that that was broadly welcomed and recognised by hon. Members and distinguished parliamentarians in the debate, and I am grateful for that support.

I thank all hon. Members for their contributions to this thoughtful and reasoned debate. I do however need to challenge the Minister on his suggestion that there was strong support for the Budget measures. Let us not overplay it: there were “buts” in the speeches of nearly all hon. Members. Therefore, while those measures are a help, I think everyone agreed that they are not sufficient, because that is not long-term funding.

Let us be clear. We have had short-term funding though the better care fund, a recent announcement on money for GPs at A&E, the cash injection of £2 billion for social care front-loaded for the next financial year, and a precept increase of 2%. None of that is long-term sustainable funding. Let us also nail the issue of the £10 billion with which the NHS plan has been resourced. That has now been stretched by the Government over a six-year period, not five years—both my Committee and the Health Committee have highlighted that—while they continue to seek a 4% efficiency saving. It is not just the Select Committees saying that; the Comptroller and Auditor General said of the NHS accounts that there is not yet

“a coherent plan to close the gap between resources and patients’ needs.”

Ministers really need to get a grip on that.

Will the Minister write to the Select Committee Chairs, outlining in more detail not just the timescale for the Green Paper’s publication but the proposed plans for discussions around that and when it will be taken further forward? Will he also write to us about the Care Act, phase 2, which has come up in the debate, albeit not mentioned directly? The permanent secretary at the Department of Health could not give an answer to our Committee. He talked about it being postponed, possibly to 2020. It would be helpful if the Minister would write to say what is happening with that element of the Care Act.

There is a strong view that there is a need for a long-term solution, and the Budget measures are not yet that. Health and social care are interconnected, and hospitals are not a great place for older people to be in. We need to ensure that we have a long-term sustainable solution to keep people out of hospital, keep them well as long as possible and keep them independent. That requires long-term thinking, not the sticking-plaster measures that we keep seeing unveiled by all Governments at the time of elections, especially in the light of cuts.

Motion lapsed (Standing Order No.10(6)).